New to the Relaxed Lantus group

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ajsandbe

ajsandbe

Member Since 2014
I have been active on the message boards since my dear Georgie has been diagnosed with diabetes about two and a half weeks ago. I cannot tell you how helpful this website has been. I have started testing Georgie's blood at least twice a day and have had to double his insulin unit from 2 units twice a day to 4 units twice a day (under my vets supervision). The testing is getting easier, with the help of vaseline! I have posted his google spreadsheet in my signature and am still getting used to all the numbers. His levels seem to fluctuate quite a bit which worries me a lot. Hopefully I am doing everything right. Is it a good idea to look at others spreadsheets or would that just be more confusing to me?
 
Firstly, welcome. You will find lots of support here.

Secondly.... wow, your vet, bless him/her, sounds like the vet I started with. The advise you are getting is faulty, and potentially lethal.

Lantus is a depot insulin, which means it builds up in the tissues, and has a carry over effect. The bigger the dose, the more substantial this effect is. At 4 units, the effect is huge, and grows exponentially daily.

Additionally, we dont increase doses based on pre-shot numbers. The nadir, or low point in the 12 hour cycle, is the deciding factor when considering an increase.

Fourthly, you must hold a dose for at least 3 days before you make a change.

The biggest thing I need to say here is that you do not have nearly enough data to make any increases and should certainly not be giving that much insulin "blind" which is in effect what you are doing.

The Rx DM cat food is still too high in carbs for a diabetic cat. Many of us feed either Fancy Feast or Friskies cat food, being sure to choose the pate varieties. These are generally less than 10% carbs, which is what we need to lower that glucose with diet.

How much does your cat weigh? that is what you base a starting dose of insulin on, and keep that dose for at least a week.

A cat's liver can and will panic when it goes into normal range when it has been high for a long while. This panic causes the release of glucose, which of course shows up in the BG tests. This is called bouncing, or rebound, and can make interpreting the data confusing.

Remember that insulin is a hormone, not a drug, and reacts over time. You cant just keep giving more and more until you get the results you want. And when your cat goes "low" (below 50 or so), it can be lethal. At the moment, you have no idea how low he has gone on the insulin given so far.

But the good news is that he is ok right now, and you are in the right place to get some great help.

So, tell us how much he weighs, and we will help you get started on the right dose to begin with. i will post links to more information for you in further posts.
 
Oh goodness. I am panicking! I am glad I read this right away. Thanks for your reply. Georgie weighs about 11 lbs. I was a bit concerned when my vet told me to up his insulin twice in a week although I think I gave him a reading that was three hours post shot. I even emailed my vet and asked if he was really sure, and he replied yes. I gave him 4 units this morning (before I read this) and will only give him 3 units tonight. 4 units sounds like a lot to me and all I want is the very best for my boy. The other thing that scared me was that really low 71 (called the nadir?) reading that came out of no where several hours after I upped his insulin from 3 to 4 units. How should I tell my vet that I am going against his advice? It. Ah, this forum is like a breath of fresh air. All the information is just what I have been looking for.

Will he be okay today with the 4 units I gave him this morning, I have to go to work for six hours and am wondering if I should have someone check on him.
 
Hi Abbey (?) and extra sweet Georgie!

Many of us have had the same type of experience with our vets so we understand. My vet isn't up to date on diabetes anything, we only use them for Lantus prescriptions and other medical stuff - we change doses and treat 'da sugarboyz' diabetes ourselves. There are insulins that can be dosed like your vet advised but not Lantus.

Quick question since he had you raise it by a whole unit - are you using regular syringes or the pen needles for the Lantus pen? If you're using the pen needles, let's get you switched over to regular insulin syringes. The pen needles aren't accurate enough altho' evidently sure are handy!

BIG HUGS! BREATHE! You CAN do this without your vet! You REALLY can! REALLY!
 
Thanks for the breathing part. I have only given him two 4 unit injections with a pen needle. I didn't know anything about getting a bigger needle (Yikes! . I don't think I want to keep doing this 4 unit injection thing. It seems to rash but I would appreciate your opinion. Im new to this whole thing.
 
ajsandbe said:
Thanks for the breathing part. I have only given him two 4 unit injections with a pen needle. I didn't know anything about getting a bigger needle (Yikes! How come my vet didn't mention that). I don't think I want to keep doing this 4 unit injection thing. It seems to rash but I would appreciate your opinion. I'm new to this whole thing.
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We don't use the pen needles as they are not accurate enough for dosing a small cat. Get some insulin syringes to help refine your dosing - U-100, 3/10 mL, 30 to 31 gauge , with half unit markings. In some states, you may need a prescription, so ask the pharmacist. Then you take the cap off, and treat the pen like a small vial, using the syringe to withdraw the insulin.

And just a note on the vet - they have to be generalists for a variety of species and cannot possibly know everything about all of them, much less stay up to date on all the newest stuff. She did get you a good insulin. What you can do is help the vet get up to date. For example, the Tight Regulation protocol for Lantus was based on a research study done by Dr Rand and the German Diabetes Katzen forum. There are sticky posts on it in that forum.
 
That 73 you got near the middle of the cycle on 3/7, while a nice looking number, was after at least 1, if not 3, doses of 4 units. The 371 after that is very probably due to compensatory hormones kicking in to protect your cat's life and releasing stored glucose to bring up the levels to safety.

Please consider stepping back to maybe 3 units if you're using the pen and 2.5 units if you can get syringes (preferred).

Always test before you give insulin; if below 200 mg/dL, wait without feeding for 30 minutes and re-test. If above 200, go ahead and shoot. Otherwise, post on FDMB and ask for feedback.

Tests between +5 to +7 show how low the glucose is going. For safety, that should stay above 50 mg/dL. If it goes below 50, you need to intervene to get the numbers up (see link for HYPO below).

In case you didn't get this already:

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

* * * * * * * * * * * * * * *​
Examples of using the chart:

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)
 
It's not a 'bigger' needle, it's just a 'regular' insulin needle. Look at the place where you screw/push on the pen needle - see that little round rubber seal? That's where you'll put the regular syringe and draw. I know, I know...it's a REAL needle but your cat's not big, we give doses in half and quarter units, the pens cannot do that. After your shopping trip to get your syringes, post again, we'll help you with it.

HUGS!
 
I will definitely get the needle that is most accurate. I will check his levels before his next shot tonight but I am pretty sure that I will lower his dose to 3 units. Is three units still to high? I will not be able to do half doses until I get the syringe so hopefully this will work out okay. I am so lucky to have read these replies because I would have kept giving him 4 units which could have had serious repercussions.
 
Its hard to tell because you haven't got tests around the nadir. It could be too how, just right, or not enough.
For added safety, drop to 2 units.
 
So it's key to test around the nadir? I will try to do that asap. Hopefully my work schedule will permit.
 
Absolutely key - you need to know how low the glucose is going.

Under 50 is too low and earns a 0.25 unit dose decrease.
Over 150 is too high and earns a 0.25 unit dose increase.

You might see if you could hire and train a pet sitter, vet tech, or college student to come and do some testing occasionally. This also builds up some folks who may help out in an emergency.

And some folks set an alarm to get up at night and test.

You want to get it as often as possible when trying to identify the best dose, then you can do it on days off.
 
The Relion syringes at Walmart are $12.58 for a box of 100, plus sales tax in some states. .3cc, 30 or 31 gauge, short (8 mm length needles), come with 1/2 unit markings. You should not need a vet's script for syringes in Iowa.
 
Please know that you can do this. It really is going to be okay. I agree, I would not give that cat any more than 2 units. I would even say to switch that cat food out to the low carb ones i suggested, and reduce to 1 unit and see how that goes. Diet can play a huge role in this. I know of what I speak, my cat was prescribed the same thing, and I saw a huge difference in numbers once I switched to Fancy Feast Turkey and Giblet pate. And then you need a week or so to let the dose settle in, during which time you can be learning to test more often.

At the very least, if it were my cat, I would test before EVERY shot, and at +5 or so (that is 5 hours after you shoot). Dont feed the cat before you do the preshot test, as you want real numbers, not numbers influenced by food. Likewise you want to hold off food before that mid cycle shot for the same reason. This also helps if you need to "steer" the kitty's numbers with food should you find them to be too low... a hungry kitty will eat for you, a stuffed one is rather hard to coax food into (but not impossible, as evidenced by my piglet non diabetic cat who will ALWAYS eat).

We are here for you, you are not alone.

Linda
 
I will definitely switch to friskies pate. I just got home and tested him right before his food and his level was at 23. THIS IS NOT OKAY!!! I believe the recommendation for 4 units was really unsafe. I am going to keep a close watch on Georgie tonight and hopefully everything will level out. Thanks for the encouragement. I am trying to do everything right and feel like I am failing miserably.
 
Welcome Abbey and Georgie. So glad you are with us. There is a lot of knowledge here and most have chimed in already. I hope you can keep Georgie safe. Then we work on figuring out a better dose. The fact that you are here and asking questions and heeding all the experienced advice is the best possible thing you can for your sugar. You are doing well. You may have to dole out a couple of meals to keep him steady and get out the hypo kit. 23 is too low. He may need a drop of honey or Karo syrup in a spoonful of food.
 
I read that post on HYPO and put it on my fridge. I put some pancake syrup on his food and he ate it up. He does not have symptoms of hypoglycemia but I am keeping a close eye on him. How long should I wait after he ate to test him?
 
You want to test again in half an hour and keep testing every 30 minutes until you have two rising numbers over 60.

Mel and The Fur Gang
 
Sytup wears off fast and Lantus lasts long Please keep monitoring in 30 minutes.
 
I've done three readings since and have gotten- 46, 154, and just now at 116. Will he be in the clear soon?
 
Its
Test
Feed 1-2 teaspoons high/medium carb
Wait 30 min.
Repeat.
You can switch to lower carb as the numbers start coming up.
Once nadir is past and there are 3 rising numbers with no high carb, you should be OK.
 
Perfect! Will do! Can you imagine what would have happened if I had blindly followed the vet's instructions- testing once a week and at 4 units. I don't even want to imagine!
 
ajsandbe said:
Perfect! Will do! Can you imagine what would have happened if I had blindly followed the vet's instructions- testing once a week and at 4 units. I don't even want to imagine!
Click to expand...

That is why I kinda jumped all over you this morning when I read your post. I am so glad you got the info you needed to deal with this today, but so sorry that it happened to you and your sweet kitty in the first place.

Where are we in the cycle? When is next shot due? (i dont think your spreadsheet is up to date?)
 
His shot was due this evening at 630pm but due to the low reading I didn't think I should give it. I think I have just updated the sheet.
 
Sorry, what time zone are you in, and what time do you usually shoot? Your spreadsheet indicates that you are at 11 hours after your PM shot time?
 
but to answer your question, I would advise you to skip tonight, once you have three tests that show the BG rising on each test, go to bed, get some sleep, and tomorrow do your test a half hour before shot time, post the number here and we will advise. Dont forget to change your clocks in the morning too, if the time change applies to you.

Linda
 
Cats that have gone that low and been given simple sugars or high carb food often have at the beginning of the next cycle a very high BG level, even into the 400s or 500s.

Do not let those high numbers cause you to want to give a high dose of insulin in the morning. Those are artificially high numbers cause by the carb load of the food and the liver dumping glucagon into the blood stream in its panic mode to save the cat from a hypo. In fact if it were my cat in this situation, I would be inclined to give no insulin on the morning cycle just the let Georgie's system "reboot" and clear his body from the counter-regulatory effects of carbs/glucagon. By his PM pre-shot test, he may even be in the low to mid 200s, allowing you a re-start of the insulin therapy at the level we normally recommend -- 1 unit BID.

All my best. ~Venita
 
ajsandbe said:
His level was 540 this morning!!! Oh boy. Was it because of the syrup?
Click to expand...

That and because compensatory hormones kicked in to help him survive. It takes as much as 3 days for that to settle down.
 
We really need you to use the spreadsheet the way we do, which means putting pre-shot glucose tests in the columns marked for pre-shots, etc. The numbers across the top are NOT times, they are number of hours since injection. Would you please adjust your entries to match the following?

Understanding the spreadsheet/grid:

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning or AM pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +5 column
and so on.

Halfway across the page is the column for PMPS (evening or PM pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
I was thinking about how I was using the spreadsheet completely wrong on my walk to work today. I will adjust it asap when I get home. I was putting his pre shot readings in the wrong section. Sorry for all the confusion.
 
Thanks. I figured it out when you said the pre-shot this morning and I found it under a different column.
 
Hello and welcome Abbey and Georgie! I've been out of town and am just catching up on the forum. What a day you had on Saturday. So glad that you found this forum and got the help you needed! I feel like finding all the info on this site and the forum have made all the difference in helping me turn things around for Max and keeping him safe and healthy. You are doing great with asking questions. That's how we all had to start to learn. It can be overwhelming at first, but, as you learn, it does get a lot easier. My cat Max started on Lantus in mid-December, so I'm still learning too. Before starting on Lantus, Max was in remission and before that he was on an insulin called PZI. Anyway, when he was first diagnosed, my vet recommended the MD dry food too. He was better on that food than the food I had been feeding him, but not as good as the low carb wet food. The diet change made a huge difference for Max and his #'s changed pretty quickly too, so when you do switch to the lc wet, like you mentioned, watch Georgie's #'s closely. And breathe!
 
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