Newbie/Dose Advice; 3/30 Gus >600AMPS

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bev5477

bev5477

Member Since 2011
Hello, I am new to this board and have a 13 yr. old male, diagnosed 4 weeks ago. My vet told me that Gus is his 1st patient to be on Lantus. He started his dose at 1.5U and has been very hesitant to increase the dose significantly over this time. Gus is now at 3U/BID and consistently reads >600 throughout the day. He has been at this dose for 6 cycles. This website has been Gus's link to life because I have researched at great length the protocols, read the stickies, etc. Gus is on a very strick high protein, low carb, canned diet, eating a product listed on 'Binky's list'. I test him 4x/day, always with a nadir >600. I see that the protocol says to hold that dose for 3 days and increase by .5U, but getting the approval from my vet is difficult. I'd like to follow the protocol precisely in order to get Gus's numbers on the meter, at least. I have taken it upon myself to start ketone testing, something that the vet never mentioned. I learned of its importance on this site. How much approval from the vet do I need while following this protocol? I don't want to be rude or a pest but Gus needs to get on an effective dose, sooner than later. Any advice would be helpful.
 
Hi and Welcome! I wanted to bump you up so you can get more help. I'm not a dose advisor, but someone should be along soon. You've made a good start with researching and reading the protocols and checking for ketones. As far as your Vet, you can always give him/her a copy of the Protocol and kind of open up a conversation that way. Does it seem like your Vet wants to be in touch weekly or more often with you and Gus?
 
Hi, I wanted to stop through & welcome you & Gus. I agree that dosing needs to be more agressive because those #s are dangerously high, this forum is data driven & for those that will advise on dosing for Gus will want to see your am & pm preshot #s, along with your spotchecks that you are getting throughout the 24 hour period before a next step can be suggested. Have you had an opportunity to set up a spreadsheet?
If not, just click on the link & follow the instructions. I am thankful that your vet is cautious - versus starting too high & having an emergency on hands. As far as Vets input & FDMB input - it is nice to have a balance, however I follow what FDMB suggests & consider them to be experts & I trust their expertise.
You are doing a lot right, stick around.. ask questions & others will stop by & offer input.
 
hi and welcome - I agree with what Ann and Nicole have stated. Hopefully some of the dosing people will be along shortly to help you out.

Welcome aboard - you've found a great site - very caring and knowledgeable people here. You are off to a great start!
 
Unfortunately, our vets don't typically know enough about diabetes and specifically Lantus to be much help. The vet that I've been going to for 7 years told me to wait 6 months to begin treating Gracie to see if she got better(steroid induced). I told him no way, and asked for Lantus. He never used it before, so told me he'd have to research it first. After 3 days of waiting, I went to another vet. Unfortunately, that vet knew diabetes, but not Lantus. She prescribed it to me, and I've followed the guidance of this board and my own gut to treat Gracie.

With the guidance of this board, you'll learn to make good solid decisions. I think you're already there since you realize >600 numbers aren't right and your vet may not be the best guide.

Good luck!
 
Hi Bev (I'm assuming that's your name, please correct me if I'm wrong!) and welcome to LL!

I'm going to link your post from health here so others can look at it easily.

From your health post...
bev5477 said:
Hi, I'm new to this board and have a 13 yr. old male (Gus) cat who was diagnosed about 4 weeks ago. After extensive reading and studying about Lantus dosage, I'm afraid that Gus's dose is too low and being increased too slowly. My vet has acknowledged that Gus is his first patient to be on Lantus. He started him off at 1.5U when the protocol calls for 3U to start for a cat of his weight (13lbs).
Click to expand...

Actually, using the weight based formula, the starting dose for a cat of 13 lbs would be 1.48u...your vet's starting dose seems reasonable based on this. You need to convert the cat's weight to kg by dividing by 2.2, then multiply by 0.25u for the starting dose. That also assumes that 13 lb is Gus' ideal weight....is he overweight? Most people start out at a dose somewhere around 1u.

If his numbers are over 600 all the time, he could be significantly over dose. It may seem odd, but too much insulin looks a lot like too little because the cat's body releases stored sugar and hormones to boost BG levels to protect from hypoglycemia. I would NOT increase his dose at this time...we need more data to make dosing suggestions. Have you gotten any tests that were not over 600? It would be helpful to see as much data as possible from the different doses he has been on. Most of us use a spreadsheet to keep track of our tests, it makes it much easier for everyone. There are instructions on how to set one up and link it in your signature here You could also list your data in a post, the best way is to do it in the following format.

AMPS # dose amt.
+4 #
+6 #
PMPS # dose amt.
+3 #

AMPS is morning test before shot, PMPS is evening test before shot, the +2, +4, etc are the number of hours after shot was given..they are just examples of how to show when the tests were taken. Actual times (ex. 10:00AM) don't work very well, since we are all in different time zones.

It's great that you've been doing your research...changed his diet, are home testing and ketone testing....good job! Regarding vet input on following the protocol....it depends on the person and the vet, some people have great vets that are on board with the protocol and they make adjustments with the vet's approval, others are using their vet for health care but do the day to day management (dosing) with help from this site...and everywhere in between. I'm a believer in having your vet as a partner if at all possible. If your vet is willing to admit that he doesn't know much about Lantus but will still prescribe the insulin, I would take that as a good sign!

Edited to clarify
 
Welcome to Lantus Land.

You've gotten great information already. In addition to the modified version of the dosing protocol that's laid out in the stickies, I'd encourage you to take a look at the formal versions (they are also linked in the stickies). In particular the Tilly Protocol (Tight Regulation with Lantus or Levemir for Cats), does allow you to be more aggressive with dose if your cat is sitting in high numbers.
Tilly Protocol said:
Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose). From this point onward test for ketones once per week, or more often if the nadirs are still >=200 mg/dl.
Click to expand...

Also, what are you feeding Gus? Given that you've been doing a lot of reading, I'm hoping that you're feeding low carb, canned food. (If you stated this somewhere, I must have missed the info.)

Also, has your vet seen a copy of the Lantus dosing protocol? You might want to share this journal article with your vet. (They seem to respond far better to something out of a vet journal vs. something off the internet.)
 

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Thanks so much to all of you who gave advice about my poor guy. In answer to the questions asked: my vet would like a corespondance on a weekly basis. Yes, I'm appreciative that he's not too aggressive (but come on, now!). I feel as if I'm more or less on my own. Thank God I found this site. Don't get me wrong, I want to have my vet's input in Gus's recovery. He's wiling to listen & learn. Gus is not overweight. He was a very sturdy, large, and healthy male...16lbs. Very little fat. He lost 3 lbs. and that's what prompted the initial vet visit. That and increased lethargy. I'm familiar with the formula used to convert lbs to kg and find a dose. I feed Gus "Friskies" Tuna in Sauce or Tuna & Egg in Sauce. Very good protein/carb ratio. For snacks, he gets baked chicken breast or baked pork loin (I should eat as well!!). He eats his large meal at 6AM and 6Pm with dosages immediatley after. I fairly certain that we're not dealing with the Symogyi Effect here. We never achieved a level that was sustainable for more than 6 hours. I've studied the 'Tilly Protocol". That's my 'go to' referrence. I will attempt to create a spread sheet that will give more data and, in turn, more advice from the dosing experts. Thanks so much.
 
I apologize for my lack of computer skills. Here are the #s I have for Gus at 3U: AMPS #HI Dose of 3U
+4 HI
+6 HI
+12 HI Dose 3U
+6 HI

AMPS # HI Dose 3U
+4 HI
+6 438
+12 HI Dose 3 U
+6 HI

AMPS# HI Dose 3 U
+4 HI
+6 HI
+12 HI Dose 3U
+6 HI

AMPS# HI Dose 3U
+4 HI
+6 338
+12 HI Dose 3U
+6 HI

AMPS# HI Dose 3U
+4 HI
+6 460

These are the numbers for 3/26/11 thru 3/29/11 inclusive and half of 3/30/11. Is there any expert who can look at these numbers along with my previous post and give me some advice for the upcoming insulin dose and tomorrow? Thank you
 
Just one other bit of information will help with dosing decisions. How was Gus' dose worked up from 1.5u to 3.0u? Was this in 0.5u increments and how long were the doses held prior to an increase? If you were home testing, were the numbers pretty much like what you already noted (e.g., mostly above 300)?

I know it's a lot of work, but if you can transfer your home testing data to the spreadsheet template that others linked it will make reading Gus' numbers a whole lot easier especially as you go forward.
 
bev5477 said:
I apologize for my lack of computer skills. Here are the #s I have for Gus at 3U
Click to expand...

Hi Bev,

What data do you have for Gus at 1.5u? Can you post those numbers as well? Did you raise his dose from 1.5u to 3u all at once on 3/26? And are you testing for ketones?
 
Gus's dosages were increased by .5U every 7 days after no change in #s. We went from 1.5 to 2.0 to 2,5 to 3U at a pace of 1 change per 7 days. Gus's numbers never hit the meter until we got 438 on 3/36/11. I will ask my daughter to set up a spred sheet for this site's use. The SS will be easier for everyone to use. (I'll learn....God knows, if you have to...you do). Thank you so far for all the help. I'm going to telephone the vet and chat with him a bit this afternoon!
 
Hi Bev: just wanted to welcome you and Gus to Lantus Land. You are in the right place to get excellent help from a very supportive "family" group. I think it is important to try and work cooperatively with your vet but I have found that most vets err on the side of extreme caution because most of their clients do not home test so the vet has a difficult time supporting tight regulation...and rightly so; in order to do that protocol, you must be able to test frequently. Let us know how we can help; questions are always welcome. You've gotten a lot of great info today and I send you kudos for all the reading and studying you have already done!
 
Bev:

Your daughter doesn't have to start from scratch with a spreadsheet. This is a link to the instructions and template we use (if you click on the links in pretty much everyone's signature, you'll see the spreadsheet. We all use the same one.)

If the lowest number you've gotten has been in the 300s, I'd increase Gus' dose to 3.5u. As you know from reading the Tilly Protocol, when nadirs are routinely over 300, you can increase the dose by 0.5u and increase every 2 - 3 days. This is an aggressive approach. You may need to test more just to make sure Gus' numbers are in a safe range, especially once you see a break in the numbers.

The only other thought I have is that it's possible that Gus is very carb sensitive. You might want to see if you can find a food that's lower in carbs than what you're feeding currently (I think the Friskies is 6 or 7% carb) and see if that has any effect on Gus' numbers.
 
All of you folks have been so wonderful incoming forward to help me (Gus). I spoke with the vet today and started throwing facts to him and he said,Where are you getting all your information? I gave him the website and he was very receptive to raising Gus to 3.5U for 3 days. He sounded very glad to hear that I was reaching out to other sources for info. He agreed to up the dose after 3 days. I think he feels more comfortable having me assume the responsibility for Gus's medication. (I won't share my opinion on that) So, on we go. I'll have my daughter fill in the spaces on the grid so that I can benefit from the dosage experts' opinions. In debt to all of you.
 
hi bev, i'm just into this for a couple of months myself, but one thing i'm wondering . . . have you tested the BG meter and strips on yourself? I just would want confirmation that the test strips and monitor are accurate & working, just for my own sake. Do it in the morning and then you'll know what your own BG is!

good job on all of the reading. i've had to read and read too. there's a lot of info to take in. you are doing an incredible job!

are you ever feeding Gus in the couple of hours before you test him? I know if my cat eats soon before testing it definitely raises his numbers. Most people here test the BG, then feed & give the insulin, all within a short time. The mid-cycle tests are done before any snacks, too.

about the vet - yay that he's open to learning! my vet doesn't know as much as i'd like him to, but i like him so much i'm ignoring a little bit of the conflicting info re: diabetes and for that, I'm relying on people here. Everyone here does cat diabetes 24/7 for months/years on end. i asked at the vet's yesterday and they said they have 1 other diabetic cat right now. I think they're the best veterinary practice in town & I trust my vet on other concerns, but just don't think he has the level of intensive expertise on feline diabetes that people here do. I also keep re-reading the protocol.

My vet also seems to have as his goal just maintaining punkin's BG between 100-200 so that he doesn't have organ damage and doesn't go hypo. Most people don't test at home, so if that's the client you're working with, i can see why that would be the vet's goal. my goal is to help my cat's pancreas heal and hopefully, get him off of insulin. i think the protocols followed here are his best bet for that.

and welcome! i'm looking forward to getting to know you!
 
I just want to voice a word (or several) of caution. Please do not be overly aggressive with dose if you can't test. I may have been premature with suggesting increasing Gus' dose without a spreadsheet (SS). Am I correctly reading the numbers and times you provided in that it looks like you are routinely getting tests at shot times and +6? (We refer to the test prior to shots at AMPS or PMPS -- AM/PM Pre-Shot). I want to make sure you are getting in at least one test during the PM cycle and from what I can tell, you are. Many cats experience lower numbers at night so those PM cycle tests can be important.
 
I would really like to see the other data you have, prior to the last few days. When did you start home testing? What meter are you using? How often are you testing for ketones, and what have the results been? Did the vet do any testing when you took Gus in? Does he have any other health issues, or history of steroid treatment?

Also, I'm a little puzzled...if your vet doesn't normally prescibe Lantus, why did he put Gus on it?

Sorry for all the questions...it helps to get as much info as possible in order to make sure we aren't missing something.
 
Yes, I test for ketones daily. Gus has tested negative over these 4 weks. I get an AMPS #, then feed him and when he's done, administer his insulin. I alternate injections sites, using his sides and not his scruff. I then get a +6 followed by a PMPS, dinner, and insulin. I always get +6 at night before bedtime. Following the advice given to me today at this site, I have started a curve and will continue to do so. It's a lot easier to understand what is happening when you can actually see the plotting of the BG. Gus's vet attended a seminar dedicated to managing feline diabetes and learned of the use of glargine there. Gus just happened to be the first patient to turn up with diabetes after that. The vet feels that Lantus is gentler and yields more remissions with proper administration. I try to keep him from eating any snack for 1 hour prior to taking a BG. I also perform a control test on each new vial of glucose test strips and store them correctly. The meter, control solution, and strips have all been tested in order to rule them out because they are all variables. I am 100% certain that I am giving the insulin correctly as I was a pediatric nurse for over 30 yrs. and have given sc shots to more rumps than I care to count. I feed Gus only canned food that is hi protein, low carb. Actually Fancy Feast and Friskies. I got the analysis of these foods from this site. I am impressed by the number of experts here who feel that Gus may be getting too large a dose. Using the curves that I'm getting, how can I tell if this is the Somogyi Effect or insufficient insulin? Thanks for all the help so far, you've all been great.
 
Hi, Bev,

Not an expert here, just wanted to say hi and welcome to Lantus Land. This is an amazing community of smart, informed, caring people. You're in the right place!

I also just wanted to add ... some of us (me) had vets who were WAY too confident when they really didn't understand what they were doing. (Read my profile if you want details.) A vet who has humility enough to know that he doesn't know everything about feline diabetes is much better than the other way around. Especially now that you're here!

You're doing great. I know Gus is going to make progress.
 
just stopping in to welcome you and Gus...

You'll like it here...vast amounts of experience and support...and folks are very willing to share it!

Celi & binks
 
well you go girl! you are set up and Gus is in good hands! i'm impressed and think you're going to hit the ground running and helping your boy.

glad to have you here.
 
Thanks for the welcoming words. Can anyone tell me how to determine if Gus is getting too little insulin as opposed to having a rebound, Somogyi effect? I'm open to the opinions I've received, but that is the real piece of expertise that I need right now. Thanks
 
Sorry, I forgot to answer a few of the questions that were asked. Gus does not have any underlying health issues that I'm aware of. His vet did a full blood panel which ruled out hyperthyroidism, kidney and/or liver issues. I've been home testing Gus since I received the glucometer, 3/4/11. Hope those answers can get me the answer that I need.
 
Sienne is someone to ask about Somagyi. She has read up on it, and I believe I've read that SHE has read that it isn't clear at all that Somagyi is something for us to worry about. More likely, it's just rebound, a much more normal and understandable phenomenon.
 
bev5477 said:
Thanks for the welcoming words. Can anyone tell me how to determine if Gus is getting too little insulin as opposed to having a rebound, Somogyi effect? I'm open to the opinions I've received, but that is the real piece of expertise that I need right now. Thanks
Click to expand...

Hi Bev! Welcome to Lantus Land!

The only way to answer the question of too much vs. too little insulin is to test, test, test. Get that spreadsheet up and running and then work on filling in the blanks. I see some +4 and +6, but try to get other tests whenever you can. About to leave for work? Grab a test. Just got home from work? Grab a test. Getting ready for bed? Heading out to run errands? Happened to pop in at lunch time? Just grab tests whenever you get a chance. After we have some more blanks filled in then it will be easier to tell what is going on with the dose.

It would also be very helpful to see any old numbers from the previous doses. Do you have them written down somewhere that they can be added to the spreadsheet?

You're right, as it is right now you can't tell for sure whether the dose is too high or too low. The good news is that you can fix that problem by collecting more data. Then we can help you figure out how to bring those numbers down.

Hope this helps!
 
bev, when you look at a spread sheet that has a lot of testing numbers, trends begin to appear. you can look at punkin's in the bottom of my post, or anyone else's, and see that. the more numbers you have, the more you can see the cat's response to the insulin. kind of amazing, actually.

of course it takes a little time to gather those test results, but even in a few days the trends begin to emerge.
 
Good morning, Bev!! Just wanted to throw another hello and welcome into the hat!! :)

This group has been a lifesaver for us. I know the vet situation has been frustrating, but just want to echo from others that you'll soon see your vet's approach as a blessing. The vet who diagnosed Willie and put him on Lantus thought she could simply use her knowledge of other insulins and apply it to Lantus, and became belligerent and rude when I dared to contradict her. We were essentially kicked out of the practice for being non-compliant, and daring to follow the protocol here (nevermind the vet sent us to this site!!). Upon learning I had shot a low number (when I was around all day to test and monitor Willie), she pronouced that I had just killed my cat. Seriously!! While you feel lost right now, you will soon be very grateful that your vet is willing to empower you to do your own research and chart your own path. Plus, what he learns from you will no doubt benefit so many other furbabies to follow.

I would echo Sienne's suggestion regarding foods. When we started, Willie was RIDICULOUSLY carb sensitive, and the mere whiff of an 8% food would send his numbers soaring. There are many affordable options in the 0-3% carb range, and using those for the time being may help.

I know how daunting this all is right now. We were diagnosed almost 4 months ago, but I remember the stress and anxiety. You are already off to such a great start, and you will be amazed a few weeks from now by how routine this all seems. Will be keeping both fingers and paws crossed that Gus comes down to better numbers soon. You truly could not be among better company to help you improve Gus' health.

I look forward to learning more about you and Gus soon!!
 
Thanks again for all the encouragement. Have been working hard almost all day: working on spread sheet and plotting curves. These make all the difference, although we need more data and more days. Will post the spread sheet ASAP. Gus has had promising BGs yesterday and today. 'Promising' meaning he was <600 for most of the day.
 
I'm staying strong. Thanks for asking. I plotted Gus's curves from March 15-17 and saw a huge change in the appearance of the curve on 3/17. It had the spikes of big drops and fast increases. I'll have the info up on a SS later today. So, I believe that he's been getting too large of a dose for a while now. Quite a few folks here brought that possibility to my attention, and sure enough! Learn, learn, learn. Gus is fairly mopey today because of his PM dose yesterday. I've been feeding him more than usual just prior to the +6 drop in BG, trying to offset the hypo symptoms. He looks thin and tired and I'm just so sorry for him. Hopefully, he'll do better on a smaller dose.
 
Awww, hugs for poor Gus. And for you! Don't worry...once you find the right dose for him he'll start feeling so much better!

How much are you feeding him a day? If he's dropped three pounds you might want to increase his food for a bit, or pick up something low carb/high cal that will put a little meat on him. I found that EVO canned was excellent for weight gain with my other kitty.
 
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