New to Lantus - How to shoot when still going down at PreShot test?

Kathy4Skipper

Kathy4Skipper

Member Since 2021
The vet changed Skipper to Insulin Glargine (generic form of Lantus) because I've never been able to get Skipper stabilized on ProZinc. I'm having a rough start with Glargine and not much luck finding a good dose because of late nadirs.

We started Glargine at 1u, and then the vet said to go to 2u. Knowing that Skipper is highly sensitive I just went to 1.5u, and he stayed in the beautiful greens most of the day. HOWEVER, he was 76 at PMPS and not likely to start going up for a while, so I fed, waited, and shot three hours later. (Aug 23) And we're all messed up again with numbers bouncing.

The Insulin Glargine is so long-lasting with Skipper that on most days, he's still going down at PMPS.

How do I know how to shoot when he's still going down at pre-shot?

Any advice on how to get him stabilized in the greens will be appreciated because he's starting to have medical issues being high all the time.

(Please Note: I'm not available to test at night.)

Thank you,
Kathy & Skipper
 
Kathy4Skipper said:
The vet changed Skipper to Insulin Glargine (generic form of Lantus) because I've never been able to get Skipper stabilized on ProZinc. I'm having a rough start with Glargine and not much luck finding a good dose because of late nadirs.

We started Glargine at 1u, and then the vet said to go to 2u. Knowing that Skipper is highly sensitive I just went to 1.5u, and he stayed in the beautiful greens most of the day. HOWEVER, he was 76 at PMPS and not likely to start going up for a while, so I fed, waited, and shot three hours later. (Aug 23) And we're all messed up again with numbers bouncing.

The Insulin Glargine is so long-lasting with Skipper that on most days, he's still going down at PMPS.

How do I know how to shoot when he's still going down at pre-shot?

Any advice on how to get him stabilized in the greens will be appreciated because he's starting to have medical issues being high all the time.

(Please Note: I'm not available to test at night.)

Thank you,
Kathy & Skipper
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I don't have much wisdom for you, other than to say welcome to the forum.

There are some very knowledgeable people here who can help you way more than I can.

One thing I have learned with Whiskey on Lantus though is that consistency is key. Same amount, similar shot times and similar feeding times.

If you look in the stickys on the forum, there are some posts which explain the protocols used here. I started out with her doing SLGS and moved to TR, which has done wonders for her.
 
Hello and welcome to the LLB forum. If you haven't already, take a read of the Sticky Notes at the top of the forum.

As Patricia suggested, the first thing I'd do is take a look at the Sticky Note on dosing methods, and pick one that works for you. We'll be better able to help you if we know which dosing method you want to follow, as the suggestions would differ between Tight Regulation and Start Low Go Slow. If you want to follow TR, it will require some more testing at night. Even on SLGS we suggest stepping up the PM testing. Getting at least a before bed test can really help us figure out what is happening at night, especially since many cats go lower at night. And we determine how to change the dose based on how low it's taking the cat. I know your signature says cannot test at night, but do you go to bed right after his PMPS? Even a +2 would help. You did see a 119 a couple days ago, so you know the dose is getting Skipper close to greens. If you do go to bed right away, is there any way of moving the shot time up a bit so you can get a second shot? If not, we'll work with whatever limits you have and figure something out.

Kathy4Skipper said:
How do I know how to shoot when he's still going down at pre-shot?
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There can be a few reasons a cat is trending down at preshot, some of which means it's perfectly OK to shoot then. First, it could be that the cat nadirs at or near preshot (my girl did that). It does mean you have to get used to shooting lower numbers - which you'll be able to do once you've had more experience and data with Skipper on glargine. Another reason cats can be trending lower is what we call the "Lantus double dip", that's where cats do almost a mini curve or dip down at the end of the cycle. Again, perfectly normal and OK to shoot. Yet another reason numbers could be lower is that the cat is breaking a bounce, which shows as numbers trending from higher numbers down to lower numbers the following preshot. 8/23 AM looked like that. The cycles after a bounce break can have a bit more downward momentum. It doesn't mean don't shoot, but post here for help. If you cannot monitor, it may be you have to skip that cycle. Depending on the circumstances, people here can give you different ideas how to handle lower preshots than you are used to.

Also a favour to ask of you, after the last day of Prozinc and before starting Lantus, could you insert a blank line in the spreadsheet and put "start glargine" or something like that on there. It makes it easier for us to spot when that happened.
 
I'm open to following the TR. I need help getting comfortable shooting the low preshot that's trending downward. That's scary for me.

Skipper's numbers don't start to go down until later in the cycle. Testing at +2 hasn't seemed fruitful because of that. Getting tests at PM+10 through +12 may be possible. If I can get his shots back to 8am/8pm I can do a PM+2 to see if this is true for Glargine.

I had indicated when I started the Insulin Glargine in red "Start Glargine", but maybe you can't see the red text on the spreadsheet that's available to you? Can you see the red text? I was hoping red would show up. If red doesn't show, maybe I can do something else. I went ahead and added a blank line, as you suggested. Let me know. Thx
upload_2022-8-28_18-12-30.png
 

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Nice little 120 in there.:cool:

The Start Glagine in red didn't really jump out from the "ate dry food yesterday" comment. I was looking for something more in your face. A blank line with the comment in there might help. Red works as a colour, but maybe bold it too.

I only see one +2 test since he started glargine, and that was leading into a bounce. Hard to say when he onsets yet. It's typically in the +2-+3 time frame on glargine. Having said that, +2 didn't help me as my girl onset later. I'd try a few daytime +2's to see if that means anything for Skipper. Then you can decide if it's worth switching up your shot schedule.

As for low preshots, there is definitely a mind set change moving from Prozinc to Lantus/glargine. Data is your friend in helping you do that.
 
Wendy&Neko said:
Nice little 120 in there.:cool:
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Yeah, I was excited about the 120, so I ran into the other room to record it and apparently didn't latch the baby gate correctly, and Skipper ate some of his brother's Hill's i/d dry food. :banghead:

Noted and understand about the red text getting all mixed in there with my notes. I made it clearer now to see. Thanks for the feedback!

I'll start getting some daytime +3 tests.

So I can start wrapping my mind around shooting low numbers, if he's low and trending down, how do I know it's ok to shoot?
 
Hi Kathy I noticed on your signature and spreadsheet that you feed only FF Salmon Pate
Here is a post that one of our members said about feeding fish flavors only and other members have said the same thing

We recommend limiting fish flavors to once or twice a week due to several reasons. One is due to the heavy metal contamination found in a lot of fish these days, mercury being just one of them. Also, fish flavors are higher in phosphorus because a lot of bones end up ground up into cat food and bones are high in minerals. High phosphorus is harder on the kidneys. The last reason is because it can become "addictive" where the cat won't eat anything else. Fish isn't really supposed to be a normal part of any cat's diet. Few feline species include fish as a food source at all (although a few wild cats might snag a fish out of a river or pond now and then but more because it's something that's moving and triggers the hunting instinct than for actual food value)

Here is the food chart in case you haven't seen it and try and find another flavor Skipper might like
https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/
 
Thank you. The vet doesn't want me changing foods until he's stabilized.
What are the most popular foods that this group feeds? I've tried a bunch from the list, and it's daunting trying to find a food he will eat.
Thanks.
 
Kathy4Skipper said:
What are the guidelines to shoot when low and trending down? I don't see where this is explained.
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First, there is no hard and fast rules that fit all scenarios. The answer may differ if you are following Tight Regulation or Start Low Go Slow for dosing, how new you are, whether you have sufficient data that is close to your current situation. And finally, if the current scenario looks like the ones I described above for dropping numbers.
 
Wendy&Neko said:
First, there is no hard and fast rules that fit all scenarios. The answer may differ if you are following Tight Regulation or Start Low Go Slow for dosing, how new you are, whether you have sufficient data that is close to your current situation. And finally, if the current scenario looks like the ones I described above for dropping numbers.
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Ok, thank you. This will be a topic for another day since he ate some dry food tonight!
Thanks!
 
On your SS after the date on the left after 8-29 you have 8-21 :cat:
Can you put 2022 /2021 on the tap up top so members know you also have data for 2022 thanks :cat: we always start a new tap up top for 2022
Would you like me to tag a member to see if she can do this for you and take your 2022 results and transfer them over for you? I can contact her for you, it just makes it easier for us to get to 2022 to see your tests
 
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Thanks for all the food info. I went back and looked at my notes and see that I chose FF Savory Salmon Feast because it is descent on the phosphorous at 267, and the carbs are 1%. It doesn't address the heavy metals in fish, though. Skipper will only eat pate food so anything with chunks is out. To transition, I'll need a pate that's 1% carbs. It's going to take some digging!
 
Kathy4Skipper said:
Thanks for all the food info. I went back and looked at my notes and see that I chose FF Savory Salmon Feast because it is descent on the phosphorous at 267, and the carbs are 1%. It doesn't address the heavy metals in fish, though. Skipper will only eat pate food so anything with chunks is out. To transition, I'll need a pate that's 1% carbs. It's going to take some digging!
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Here is one pate from weruva if you're interested
https://weruva.com/product/family-food-3/
Carbs 0
Phosphorus is 197

You want the metabolizable energy profile percentage of carbs to be less than 10%, and the phosphorus which Weruva lists in Minerals to be less than 250 mg per 100 cals. So you have to look at two different places in the Weruva charts.
https://weruva.com


Click on here and look , you are looking at pouches not cans
https://weruva.com/nutrition-landing/pates-ni/
The pouches
Yoiu will see Family Food is 0 carbs
Phosphorus is 191


@Kathy4Skipper
 
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Hi Everybody,
Skipper has finally settled into a dose, and I'm scheduled to give him his shot in one hour... except he hasn't nadired (sp?) yet. Finally reached a green, and it's so late in the day. o_O

So, here I am to ask... What do you suggest that I do about his shot? I appreciate your feedback!

Thanks
Kathy
 
Diane Tyler's Mom said:
Hi Kathy I noticed on your signature and spreadsheet that you feed only FF Salmon Pate
Here is a post that one of our members said about feeding fish flavors only and other members have said the same thing

We recommend limiting fish flavors to once or twice a week due to several reasons. One is due to the heavy metal contamination found in a lot of fish these days, mercury being just one of them. Also, fish flavors are higher in phosphorus because a lot of bones end up ground up into cat food and bones are high in minerals. High phosphorus is harder on the kidneys. The last reason is because it can become "addictive" where the cat won't eat anything else. Fish isn't really supposed to be a normal part of any cat's diet. Few feline species include fish as a food source at all (although a few wild cats might snag a fish out of a river or pond now and then but more because it's something that's moving and triggers the hunting instinct than for actual food value)

Here is the food chart in case you haven't seen it and try and find another flavor Skipper might like
https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/
Click to expand...

Kathy4Skipper said:
Thanks for looking up the food. It's very expensive though. I have many mouths to feed and high vet bills since everybody is old. Do you know of something about half that price? Thx.
Click to expand...

Any fancy feast pate flavor will do like chicken or turkey or even beef if he has no IBD issues. I’m sorry to say none of these animals are truly part of a natural cat’s diet, but until someone comercializes cell-based mice and pigeon cat food, we’re stuck with those ;)
 
Ale & Minnie (GA) said:
Any fancy feast pate flavor will do like chicken or turkey or even beef if he has no IBD issues. I’m sorry to say none of these animals are truly part of a natural cat’s diet, but until someone comercializes cell-based mice and pigeon cat food, we’re stuck with those ;)
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lol. Does "cell-based mice" mean lab-grown mice meat? I'd go for that!
The phosphorus of the FF Chicken is 430, and I see that your recommendation is below 250. Skipper's kidney values are starting to elevate for the first time ever.
 
Kathy4Skipper said:
The phosphorus of the FF Chicken is 430, and I see that your recommendation is below 250.
Click to expand...
The chart shows that FF Savory Salmon Feast has a phosphorus level of 267. I'm wondering now if that number is incorrect? Do you know how to determine the phosphorus level? Thank you.
 
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