Newbie 7/24 Marley AMPS = 386, +3= 329, +5=266, +7=241

[laurencuth]

Hi all, I am new to the forum, but not new to the disease. My 10 year old cat, Marley, was diagnosed with diabetes about 8 months ago. We caught it early because as soon as the frequent urination / eating more / drinking more began, we suspected what was wrong (my husband is a physician). We took him to the vet, and sure enough his sugar was around 450. We started him on Lantus immediately, but my vet did not tell me anything about curves and frequent testing, so I was only testing and increasing his dose once per week as my vet instructed. He got up to 4u, but he was still not regulated. At the time, he was eating Iams, dry original chicken food. This was the only food that did not cause vomiting and diarrhea, so we were reluctant to switch. After researching the food issue, I realized that we had to find a canned food that he could tolerate. So, I slowly switched him to the Iams wet chicken food. We immediately saw improvement, and he was off of insulin for about 2 months after that. Then the symptoms started again, and I knew he wasn't regulated. So I put him back on Lantus, still only testing and raising the dose once per week per my vet. I started looking at the food issue again. I realized that Iams canned food has too many carbs, and I switched him to Fancy Feast chicken. He was on Fancy Feast chicken for a few months when I was able to reduce and then discontinue to the Lantus. He was regulated for a few months, and then the symptoms began again. Now, on the Fancy Feast, he was up to 9 units of Lantus, and he was still not regulated. I have discovered him scavenging for food (I have two small toddlers who drop "carbs" from time to time,) and I've even caught him pulling a bowl of spaghetti off the table to try to eat it. So I am now trying to keep him away from the table at meal times, keep the kids from spilling cheerios, etc. I was feeding him 1.5 cans of Fancy Feast Classic Chicken twice a day, with 9 units of Lantus given each time he ate. 5 days ago, I discovered this website, and after listening to people on the main forum, we dropped his dose back to 5u, and I started a spreadsheet and went from there. I've now upped him to 5.5u because I didn't have 1/2u syringes, but I now have the right syringes, so I can go back to 5.25 if needed. I have also started feeding him a small amount of the FF classic chicken after every test, so he is still getting three cans a day, but the third can is given to him after some of the bg checks. I bought freeze dried chicken for him to have as a treat after the other bg tests. His urine was negative for keytones today. The 5 ps you ask about are all fine - he is not urinating as much as he was a few days ago. Now people on the main forum have suggested that I join you all over here. Please look at Marley's SS and tell me if you think we are on the right track.

 

[Sienne and Gabby (GA)]

Hi, Lauren and welcome to Lantus Land!

I sounds like Marley has presented some challenges. What was the decision based on when your vet decided that Marley was in remission? What we often find is that what vets consider "normal" blood glucose (BG) for a diabetic cat is much higher than what we look for before considering a cat in remission. We look to get the cat into a range of 50 - 120. If numbers are higher and insulin is withheld, there's a good chance the remission won't hold.

I think there may be a couple of considerations. First, it sounds like Marley is a carboholic. Whatever you can do to discourage your toddlers from feeding the poor, starving kitty (who probably steals some of their food) would be great! Obviously, Marley is not convinced that he's an obligate carnivore and the kids won't do well on a purely protein diet! Anything that would prevent Marley from chowing down on Cheerios will help. At the very least, if you catch Marley hoovering up carbs, make a note on your spreadsheet.

The more challenging issue is that there's no way to know if Marley is getting too much insulin. It looks like his dose was raised in 1.0u increments. (Is that a correct assumption on my part?) As others have told you, we generally raise the dose in increments of 0.25u. If you were raising the dose in larger increments, there's no way to know if that was appropriate (i.e., if nadirs are over 300, it's fine to raise the dose by 0.5u). Unfortunately, if the dose hasn't been raised in a systematic way, it's very hard to tease apart if the resulting numbers are due to too much or too little insulin.

My inclination is to suggest you stick with your current dose. However, I want to ask some very experienced Lantus users to take a look, as well.

 

[laurencuth]

Yes - he was raised in full unit increments as per my vet - I didn't know any better. I do now! Thanks for your input!

Oh, and his numbers were under 200 and his symptons were gone, and his fur looked great, so we thought he was in remission. Maybe not!

 

[Wendy&Tiggy(GA)]

Nice to see you over here! Your first post is perfect! Tomorrow ( or when you post next) you will want to link back to this one. so that there is a chain of posts going all the way back and people can read back to see what happened.

Here is a link to your post on health. http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=100394

Also we suggest from time to time you pop into other peoples posts (we call them "condos" ) on here. Its good learning and by saying hi and giving support to others, not only are you paying it forward but people will be more likely to pop into your condo too!

Wendy

 

[laurencuth]

Does anyone think I need to start completely over - like back at 1u? Would that be dangerous for him? Or is there a more logical starting place based on his weight and length of disease? He weighs 12 pounds, and although he has lost some weight, I still consider him a little heavier than ideal. I will hold him at 5.5 and see what happens unless someone with more experience thinks otherwise. Thanks!

 

[KPassa]

Welcome to Lantus Land!

I'm not a "very experienced" user, but I don't see any reason to drop him back to 1u. You've held him at ~5u for the requisite six cycles and haven't caught him dropping too low and haven't had to skip any shots due to low numbers. Since you've skipped around between 5u, 5.25u, and 5.5u, it's hard to say which dose to stick with, but he's not (yet) showing to be bouncing from any lows that we can see. I'd probably stick with the 5.25u dose for now since that's in the middle. ;-)

Also, try and get a few more "before bed" tests every night if possible because he could very well be dropping too low at night and we're just not seeing it. (The last two nights makes me think this isn't very likely, but it's good to have the data just in case.)

 

[Sienne and Gabby (GA)]

Lauren:

I was contemplating the same question about re-starting dose. One of the most experienced members, Jill/Alex, felt that as long as you can monitor Marley closely for several days, we'll have better data and have a clearer sense of what Marley's numbers are telling us. So for now, stick with the 5.5u. You don't need to be doing daily curves. If you can get a couple of spot checks during both the AM and PM cycles, that would be great.