Newbie and struggling - needing dosing help

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Anne & Zener GA

Anne & Zener GA

Member Since 2011
Hello,

I am new to the list so hope I am doing this right. My 11 year old cat Zener, who has cerebellar hypoplasia, was diagnosed with diabetes three months ago. We spent the first two months with Humulin N without good results and our vet switched us to Lantus almost 4 weeks ago. We are really struggling to get him regulated. He was on dry food and now is completely on wet food - Blue Buffalo and Fancy Feast. At present he is on 2.5 U in the morning and 1.5 at night but we have been adjusting his dose frequently. His lowest BG is now starting to be +12 to +14 and today's values are below. I am fearful to give the injection when his values are so low. If we skip a shot, his BG often is in the high 300s at the time of the next injection. I do not think we are on the right dose. I've been reading on the forum for a few weeks and would like some help.

Today, PSAM 388
+4 333
+8 228
+12 116
+13 92
+14 89

Thanks, Anne & Zener
 
Re: Newbie and struggling

hello and welcome to the group, anne!

Today, PSAM 388
+4 333
+8 228
+12 116
+13 92
+14 89

it looks like the action of the insulin may be peaking (nadir) late. it could mean one of two things. either zener is what we call a late nadir kitty or the dose is a little bit too high, but before we go there i'm wondering how you reached 2.5u in the AM and 1.5 in the PM. did you start somewhere like 1unit twice a day and then increase slowly in increments of 0.25u which is what we usually do here?

we've found shooting the same dose as close to every 12 hours as we can works out better than shooting different doses for AM and PM shots. here's the link to the protocol most of us follow when using lantus or levemir: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581#p13523.

you might want to try shooting a lesser dose so you'll feel comfortable shooting every 12 hours rather than skipping shots.
 
Thanks for the welcome Jill,

When Zener was switched to Lantus from Humulin N (he was 4 u BID and not regulated) he was started on 2u in AM and 2 in PM. BG values were staying high after 1 week.
Here is an example:
PSAM 469
+6 382
PSPM 373

After that my vet increased the dose to 3 units BID.
6/1/11
PSAM 251
+6 121
PSPM 306
+18 211

6/2/11
PSAM 222
+6 105
PSPM 114
+14 120
I did not give him an injection as I was advised not to do so if BG was less than 150, so no PM injection

Then we decreased to 2.5u BID for 5 days and BG went back up to 300-400. So, the vet increased to 3u in AM and 0.5 in PM, then 1.0 in PM and now at 1.5 in PM thinking he just needed a little to carry him through. All changes occurred after 3-5 days. Then values starting really fluctuating, for example:

6/17/11 3 u AM, 1.5 u PM
PSAM 352
+6 96
+8 81
+10 116
PSPM 217

6/19/11
PSAM 360
+6 170
PSPM 106
+13 155
again, skipped PM injection because BG was below 150

6/20/11
PSAM 410
+6 222
PSPM 331
+14 221
Gave PM injection

6/21/11
PSAM 120
Did not give injection, tested at
+1 102
+2 163
+6 440
PSPM 574

6/22/11 today
PSAM 388
+4 333
+8 228
PSPM 116
Did not give injection
+12.5 101
+13 92
+14 89
+15 131

And that is where we are now. After reading as much as I can absorb on this site without being too overwhelmed, I'm suspecting the changes in dose were made too quickly and we may have missed the correct dose. My vet has not used Lantus much with cats and also is wondering if his cerebellar hypoplasia has any effect, since it does limit his activity level.

Also, since starting on Lantus almost 4 weeks ago, I have successfully transitioned him to a wet food diet and I suspect that has had some effect as well. He also started feeling better almost immediately, even with BG values in the 300s. Also, his PU PD lessened almost right away, and drinking and urinating are back to where they were pre-diagnosis.

I agree completely that a lower dose equally distributed would be the best way to go and I am all for that, but now I am at a loss as what dose to use. My vet seems pretty baffled, so any help would be greatly appreciated.

Thank you!

Anne
 
Thanks Ann & Tess!

I tried to access the spreadsheet using google as advised on the list but was not able to do so. I could get to the non-USA one but not the USA one. I am a mac user, so not sure if that has anything to do with it. I am very willing to use the spreadsheets. I posted some numbers. I keep and record these daily and have also done BG curves at home.
 
sorry. something went haywire with my computer and i had to reboot.

don't worry about the spreadsheet right now. there has been some trouble with google recently. however i did notice some new directions posted here which might help: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=17091&p=494632#p494406.

has zener ever had ketones or DKA (diabetic ketoacidosis)?

how much does he weigh? would you consider him overweight, underweight, or at his ideal weight?
 
Thanks Jill, I'll try the new instructions and see what happens in a few minutes.

He has never had keytones or DKA. In fact, his PU PD symptoms came on fairly quickly and I picked up on it almost right away and got him to the vet thinking it was his kidneys. He may have been high BG and not symptomatic for a while but once he because symptomatic, we started treatment. His initial BG values were in the 600s.

He was definitely overweight - just about 15 lbs. Had always been a dry food eater - wellness brand. Put him on the lower calorie version about 2 years ago and his weight had dropped some. He lost quite bit of weight in the first two months post diagnosis and dropped to 13 lbs. He has regained some and is now fairly stable at 13 lbs 8.5 oz - 13 lbs 10 oz. He was had problems with his back legs, already weak from cerebellar hypoplasia and now that has resolved. So, I would say he is at an ideal weight.
 
13.8 lbs = 6.3kg
6.3kg x 0.25u = 1.57 units

you were lucky to catch this early!

using the weight-based formula, 0.25u per kg of the cat's ideal weight, a starting dose is calculated out to 1.57 units. since there's no history of ketones, if he were mine i would try shooting 1.5u twice a day. if you post everyday we can keep an eye on his progress and fast track him up the dosing scale if necessary.

those are just my thoughts. what do you think?
 
Thanks Jill, my vet has not used the weight based dosing with him. I like this, it is very logical! Should I start in the AM with the 1.5 dose? I suspect his BG will be a tad high because we skipped the injection tonight. If I am unable to access the spreadsheet how would it be best for me to post his values daily? Thank you so very much!
 
yes, i would start with 1.5u in the morning. don't worry if the numbers are higher than you want to see. remember, lantus is a cumulative insulin. the skipped shot has emptied some of the "depot"... most here call it "the shed". it will take at least six cycles (3 days) to see what this dose can do.

insulin depot: http://petdiabetes.wikia.com/wiki/Insulin_depot


until you get a spreadsheet up you can use this format:


date
amps xxx (AM preshot number)
+3 xxx
+6 xxx
+9 xxx
pmps xxx (PM preshot number)
+3 xxx
+6 xxx
+9 xxx


the plus number denote how many hours the reading is taken after the shot. since we're all in different time zones... all over the world... we speak in +hours. :-D


post any questions or concerns you have. someone is most always around to help. if not, post on the Health forum.
hope to see you posting often. we'll want to keep an eye on his numbers just in case the dose is too low or too high. btw, if you get a preshot number lower than 150 - 180, please post for advice before shooting. someone will talk you through the best course of action until you collect more data.
 
You have been a tremendous help! I feel more relieved than I have since Zener's diagnosis! I will start with 1.5 u in the AM and check his BG as advised and post results. I will keep trying to get the spreadsheet up. And I will post for advice if BG is 150-180 before shooting. Is there anything special I need to put in the topic heading? Cheers!
 
if you glance down the list you'll see something like this:

date cat's name AMPS 213


as you collect data during the day you go back to the subject line and edit to add the new information. for instance, if you get a test at +3, you'd do this:

date cat's name AMPS 213; +3 234;

and so on.

don't worry about "getting it" right the first few days. you'll be a pro in no time at all! and if you don't do it right, someone will let you know. :lol:

every time you or someone else posts in your thread, the thread will be bumped to the top.
 
Welcome Anne!!

You couldn't have been in better hands last night. Jill is an exceptionally experienced caregiver.

Jill sent me a note asking me to stop by. She belatedly realized you are testing with an AlphaTrack meter. That particular meter is calibrated a little differently -- it's an animal blood based meter vs. a human glucometer like many of us use. The ranges for what are considered dose reductions and "safe to shoot" (at least for someone new) are a little higher due to the difference in calibration.
Jill & Alex said:
btw, if you get a preshot number lower than 150 - 180, please post for advice before shooting. someone will talk you through the best course of action until you collect more data.
Click to expand...
With the AT meter, you will want to use a range of 180 - 210. Basically, the AT shot range is 30 points higher than a human meter.

FWIW, you might want to consider switching over to a human meter. The AT is good. The problem that people here have run into is not only are the strips very expensive, if you are in a situation where you are running low on strips and your vet is closed, you're out of luck. At least make sure you have a meter with widely available strips as a back-up.
 
06/23/11 Zener AMPS 571; +3 475

Thanks for getting in touch with me and thanks to Jill for asking you to do so. I will make note of the different BG values for the meter that I have. I am able to buy strips a bit cheaper on the web at one of the diabetes sites, much cheaper than from my vet who suggested looking online. I'm blanking on where at the moment but can post if that would be helpful.

After skipping injection last night because BG was low, and we were probably on the wrong dose anyway, here was the first value. Gave Zener 1.5u after. He ate a little before, but not as interested as usual, perhaps because BG so high?

06/23/2011
AMPS 571
 
Welcome to lantus land--You have been given excellent advice and believe me, you will get better & better at it..You will get the hang of it very quickly-Ask questions, if you need help, put it in your subject line like you did today. Be Patient & consistant with the dosing & feeding.
We are all here for each other..Try the 1.50U dose twice a day, you will see good changes..
We were all like you in the beginning, scared,worried, and struggling, but when you see your kitty acting better,. feeling better, going back to old healthy behaviors, you will feel great!
Just do your best as you have a world of information here on FD--Again, Welcome!
 
Welcome, guys! You've been given great advice so far, so I just wanted to pop in and say hello! :)

I too started on the Alphatrak meter. I'm on a human meter now, but if you stay with the AT, I would suggest getting a backup meter from the store that has the closest 24 hr pharmacy to you. Many use the Relion Confirm from Walmart. That way, if you do ever get in a situation where you run out of strips, you have the backup and can just keep going... and you are only a quick trip from more strips if you need them. This happened to us over Christmas... visiting my parents on the farm in Iowa and Willie suddenly went very low for a couple days and my AT shipment hadn't arrived before we left like it was supposed to. We ran out of strips, but could just pick up testing with the Relion and it was a huge stress relief... knowing that I didn't have to go out, but that I could just run to Walmart once they opened (we of course ran out on Christmas Eve!!) if I felt I needed more strips.

Definitely check out ADW for AT strips if you haven't already... I found that their prices were the best of anybody's. Be sure to sign up for their email alerts as they often send out discount codes. Also, if you link through Mr. Rebates, you'll get 8% back on every purchase. That 8% really adds up!!

Sounds like you've got a solid dosing plan in place... as Jill mentioned, Lantus is a cumulative insulin, so you won't see the results of changes you make for up to 3 days. While it can be trying to the patience (We are the Sisterhood of the Traveling Patience Pants around here!! :lol: :lol: :lol: ), the dosing protocol does work.

I look forward to learning more about you and Zener!!
 
Hi Anne! I live in Flagstaff, too. Who is your vet?

I will tell you that I am totally ignorant about all this fancy Lantus stuff but if you need any other type of help, let me know!

Hugs,
Rebecca

P.S. PM me and I'll give you my phone #
 
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