Newbie with a BIG THANKS!!!!!!

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Goomer & Ronda

Goomer & Ronda

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Ok background. Goomer is a 4.5 yr old who I have had since birth. Also have his civie mother (Momma Kitten). DX 6-9-11. Started Lantus 6-13-11 at 1 unit 2x a day.Feed 4x day Wellness & Friskies lo-carb, also Prunia DM.(He is a grazer). After his first glucose curve being done at the vets, costing lots of $$$$, I got a Alpha Trek and do home curves. It paid for itself with the first curve. In the last 6 months we have got his numbers tight but they have not dropped. Vet kept upping his Lantus. As of earlier this week we were at 10 units 2x a day. Overwhelmed and feeling hopeless searched Facebook (FB) and was directed to this web site.Between FB and all the good info on this site I was armed a list of questions for my vet last Tuesday. We have ruled out akro and IAA. The vet is still running blood & urine cultures, but we found sores in the back of his mouth(food allergy). We are weening his off Prunia DM & his numbers have dropped. :-D How I know I only addressed doing home curves, but up until I found FB & YOU I did not realize I needed to do preshot tests or spot tests. Started doing these Tuesday and his Wednesday preshot number was 204. If I had just given his his 10 unit shot with no test..................... :cry: So I only gave him 5 units and we are ok. I emailed my vet and he was very pleased with the preshot tests and my judgement. He also dropped him to 7 units 2x a day. We are still waiting for some results of the culture, but hopefully by next week we will know what is going on and his dosing will be smaller. But the purpose of this was to THANK YOU for doing what you all do and putting out all this GOOD information.

Thank you all so much!!!!!

Goomer & Ronda
 
Welcome!

You're making great progress. You'll find it helpful to track his numbers, and can share them with us using Google Docs for feedback, if you put them in a spreadsheet. The instructions are here

Also, we have lots of information posted about Lantus (you may have found it already!) in the Lantus TR forum here. These cover how Lantus works, how to store it, what to do with low preshot numbers, and so on.

Info on how to recognize and manage hypoglycemia is here Print this out and put it on the fridge, so you have it if you need it.
 
BJM, Thank you for the info and the links. Yes I found the Lantus site and I am working on the spreadsheet of numbers. I am not to computer savy not to sure if I can figure out how to post it. :lol: Can't get the avatar to work. :lol: But I will work at it. Thanks again!

Goomer & Ronda
 
Welcome to Goomer & Ronda for sure! Isnt this place just wonderful! :thumbup

How did he do with the 5 units? sure still seems like a big dose..... just my thoughts.

I know when Bean was dx, the vet did not want me to home test, wanted me to feed higher carb script foods, and not to read or take advice from the internet...

HELLO, I did not fully listen to them because I found this forum! These folks had different advice that I followed. I was sooo scared to home test: afraid of needles, afraid of Bean hating me for poking, her not liking to do lap time unless it was on her terms... figured she would never allow home testing. Shooting was easy, do while eating...not really a problem...

The gentle encourgement from here, we did home test... we also increased the dose from 1 to 1.5 a coulple of times (never the 2 that the vet wanted). The first test we got, she was only 27 and only 2 hours after the shot! EEEEKS... Thank gosh for this forum! They helped me thru my first home test followed by our first hypo...omg, really???? I promised my girl to never ever shoot without a test first....SHE IS STILL WITH ME TODAY because of that decision.... and because of this place and the wonderful folks here: is now in remission! GO BEAN GO.

Bean has a spreadsheet that I really did not know how to use at first. After dropping in a few numbers, found that it was wonderful to keep up with all my information and could get rid of about 100 sticky notes ~LOL.

Keep up the good work, Goomer will thank you for sure.

Furry paw hugs coming you way from the Texas family
 
oh ronda! welcome to you and goomer!

i'm wondering how the vet ruled out iaa and acromegaly? there isn't a single way in a vet's office to do that. my cat has acromegaly and seriously, you wouldn't know it and without the test being sent to the one lab in north america that does the test you couldn't possibly know whether or not punkin had it. there is also a 3rd condition that can cause a need for high doses of insulin - it's called cushing's. it is characterized by thin skin that might tear and sores. i'm wondering about the mouth sore you mentioned.

i have to doubt that your vet knows much about feline diabetes or you wouldn't be here and wouldn't have had goomer on a dose of 10units. many vets don't, so it's not his/her fault, but let's see if we can unravel what's going on. we do feline diabetes 24/7 all year around and can give you a hand and help goomer.

you've done some tests. the significance of the test is understood by the timing of the numbers in relationship to the shot. for example, lantus has a curve to it. in a regulated cat, the test right before the shot is the highest, then the blood sugar will decrease until somewhere 4-7 hours after the shot, when it will begin to increase again until the next shot time 12 hours later. lots of things can throw that off, however.

so if you could tell us a little more, i'd specifically like to know what the blood sugar tests were and how long after the shot (even approximately) was given that that test reflects. in our lingo, we call it +hours. so i gave punkin his shot at 7am and will test him again at 10am, which we would call +3. people here are from all over the world, so that lets us understand each other's timing without having to figure out time zones. punkin was 292 at his morning preshot (amps) and i'm guessing will be around 250 at +3.

can you give us some numbers, please?
 
Julie, Got up about 5am to see if I could get the fecal sample the vet wants :roll: And saw your post. Took me all day to do it but figured out the spreadsheet and posted it. Take a look, I know there is not a lot of information but am a newbie. :oops: My vet seem to be very knowledgeable and knows how stressed and overwhelmed we both get. He seems to only tell me what he fells I can handle. That is one of reasons I am here. Not sure about the cushings, like I said they are running blood & urine cultures, hopefully will know something next week. And thanks everyone for the warm welcome. :-D


Goomer & Ronda
 
The spreadsheet is almost up. Go back to your signature. Highlight the whole URL again, then go up and press the URL button. (on the line with the Bold and italic buttons). That should work.
 
The URL is working in that it is all blue so the button worked. BUT it doesn't let us access the ss. On the google spreadsheet, did you go to File and choose Publish to the web and use that URL? It has the pub in the middle. (the one that is your original URL on your spreadsheet is your copy- we can't access or edit. It has the cc in the middle.) If you use the Publish to the Web feature, it lets us see it but we can't edit.
 
ya did great, ronda! we can "read" your data and hopefully be able to interpret what's going on.

so those are all tests that you did at home using your alpha-trak? great job!

individual tests tell some, but to get a better picture it is helpful to see tests over a the course of a few days. i see your note on the ss that you're working crazy hours right now. what i would LOVE to see is your preshot tests, plus one other test somewhere between +3 and +6 or +7 on each cycle for a couple of days. if you're gone during one of the cycles, like during the day, you could get one at night. what we're looking for is whether or not he's constantly pretty high or has some drops to lower numbers in there. sometimes cats getting too much insulin will drop low and then go sky high for a few days from it. then they may go lower and bounce back higher again. it can be a crazy cycle of higher numbers even if the dose is too high.

from his ss it looks like all of your insulin dose changes happened in increments of 1 unit, is that right? the recommended dose adjustments with lantus are .25 or .50 of a unit (one quarter or one half of one unit). every time a dose is changed it takes a while to settle in.

you've done a super job giving us some information to work with.

i'm a tiny bit confused on the ss comments about the dosing - are you giving shots at 5am and 5pm, and feeding at 5/11 am & pm? is that what it means?
 
Welcome to FDMB!

If you haven't had a chance to look at the information on the Lantus board, there is a great deal of information about how to use Lantus in the starred sticky notes. Below are the links to that information and a brief description of what each of the posts contains.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
I'd encourage you to take a look at the Tight Regulation Protocol sticky. You'll see that we utilize a method for dosing that's based on published research. It differs considerably from how your vet has been treating Goomer.

There is a great deal of information in those sticky notes. Please let us know if you have questions or how we can help.
 
Ok a little more background on us. There are 2 beans, a civie and of course my Sugar Baby in our house. My partner (the old man) helps, but very little. He has is own health issues. So basically I am Goomers sole care taker. Because of the hours I work (to pay for vet,meds,catfood & litter) :lol: I had to set up his shots at 11am & 11pm. All curves are done on Mondays, my day off, and 2 to 3 weeks apart if possible.
julie & punkin said:
i'm a tiny bit confused on the ss comments about the dosing - are you giving shots at 5am and 5pm, and feeding at 5/11 am & pm? is that what it means?
Click to expand...
So goomer day is as follows: 5am - feed, 11am amps- feed & shot, 5pm - feed(done by the old man) and 11pm pmps- feed & shot.
julie & punkin said:
i see your note on the ss that you're working crazy hours right now. what i would LOVE to see is your preshot tests, plus one other test somewhere between +3 and +6 or +7 on each cycle for a couple of days. if you're gone during one of the cycles, like during the day, you could get one at night.
Click to expand...
So yes I could do these in the pm. Will post when done. :smile:
julie & punkin said:
from his ss it looks like all of your insulin dose changes happened in increments of 1 unit, is that right? the recommended dose adjustments with lantus are .25 or .50 of a unit
Click to expand...
Use a Solar Lantus pen only increases by units.

Thank you everyone for the great advise!!!!
 
Purchase syringes to use in the pens - don't use the thing that comes with the pens.

Depending on the state, you may need a scrip from the vet - if so, ask the vet to write a scrip for U100 syringes - with 1/2 markings, short needles 30 or 31 gauge.

You fill find by inserting a syringe into your lantus that you will have control over dosing and be able to increase/decrease in 1/2 (0.50) doses and 1/4 (0.25) doses.
 
thanks for answering all the questions.

couple of things - what Hillary is referring to - take a look at the links that Sienne has given you. The one "New to the Group" shows how to use a pen with a syringe for finer dosing. Also, in the one about taking care of the Lantus, there is more information and a video on how to do that.

I'm going to give you the link to the post from when the people here discovered that punkin was on a much higher dose than we realized. i thought it was 3.0 units, but because i had the wrong syringes, it was actually 7.5units. a cat without some extenuating factors will get something under 5ish units. a 10unit dose is indicative of something - either a high dose condition or incorrect dosing that is overdosing your cat and causing a constant rebound as the cat's liver tries to keep the cat alive in the face of too much insulin.

Discovered Punkin was incorrectly dosed

I'm also going to ask Ella to come and talk to you. She had a similar situation with her cat.

Please take a look at the discussion on the link and see questions it brings up for you.

You have some options.
 
Hi Ronda & Goomer and welcome!

Julie asked me to look at your posts because the size of Goomer's dose looks very large and there is concern that your vet may be overdosing. My first diabetic kitty, Stu, was overdosed on Lantus by his vet. He had been switched to Lantus from PZI Vet when the latter was discontinued; PZI Vet was a U40 insulin and Stu had been on 5 units bid (2 units bid for almost 4 years and then, when we moved and had to find a new vet, very quickly raised to 5 units bid). Four years after diagnosis he still had all the symptoms of FD (drinking lots of water; peeing great quantities). I didn't know anything except what the vets told me, and I shot "blind" for those 4 years.

The vet did not make the conversion between 5 units of U40 and 5 units of U100 and prescribed 5 units of Lantus bid, which meant that Stu was getting much more insulin than previously. His numbers--always tested at the vet's, never at home-- kept going up (apparently overdoses can result in higher--not lower--numbers) and the vet kept raising him by whole units at a time. When we got to 7 units of Lantus bid, Stu's numbers tanked. It was at that point that I found this board and with the wonderful advice and help of everyone here took control of Stu's diabetes.

It seems to me that you do not have a problem with the U40 to U100 conversion because you have been using the Lantus Solostar pen with the needles that the manufacturer intends to be used with the insulin (don't forget that the pen is intended to be used by people, not cats!). These needles can only dispense doses in 1-unit amounts, however, so the first thing to do, as others have said, is to get U100 syringes to use with the pen. Once you have syringes you can treat the pen as if it were a vial (get syringes with 1/2-unit markings, because we often measure amounts smaller than a unit). I really like the Monoject 31 gauge syringes with 1/2-unit markings.
You can buy them at American Diabetes Wholesale (where, however, they are currently out of stock):
http://www.americandiabeteswholesal...t-ultra-comfort-insulin-syringes_2552_178.htm

or at Hock's: http://www.hocks.com/diabetic-suppl...16-inch-needle-1-2-unit-markings-100-box.html

Since it was apparent to me that Stu was on too high a dose, I attempted first to lower his dose in stages, but finally just went down to 1 unit bid and worked up according to the protocol. If you do this, be sure to test Goomer's urine frequently with Ketostix so as to avoid DKA (diabetic ketoacidosis), which can happen if a cat is not getting enough insulin.
The experienced people here will help you decide what to do. Mainly I just wanted to caution you not to make the same mistakes I made. You are home testing and you have a spreadsheet set up and you are reading and asking questions and that is GREAT. I hope that with the help of the folks here who are very knowledgeable about Lantus dosing you will be able to settle on a starting dose for Goomer that will allow you to make changes in dose safely and get his blood glucose numbers under good control.

Welcome again,

Ella & Rusty
 
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