Newbies -- looking to regulate Max on Lantus

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tremblant

Member Since 2013
Hi, we are newbies to the board and just posted to the new members forum -- Wendy suggested we post here too (thanks, Wendy).

Max, our 13 yr. old grey-and-white short-hair cat was diagnosed with diabetes at the beginning of April and we are trying to regulate him. Max also has a history of uti's and bladder crystals. His weight has ranged from 13-22 lbs. since he was fully grown. His weight dropped from 19 lbs. to about 16 just prior to the diabetes diagnosis. Since he's been on insulin he has continued to lose weight at a lower rate and now weighs about 15.5 lbs. Prior to the diagnosis, he had dry food out at all times (different UTI formulas), a spoonful of Wysong wet mixed with water and an ounce or two of 2% milk each day. Since early April when Max was diagnosed with diabetes we switched him to two cans of Weruva and/or Wellness (and sometimes Purina DM) and stopped giving him dry food (though he prefers dry food). (Max hasn't needed treatment for bladder stones or UTIs in about 5-6 years now, but is a veteran of a bladder surgery to remove stones and two catheterizations to treat blockages.)

Max's ketone tests today show "small" amounts (15 mg-dl) of glucose in his urine. His bg readings generally range from mid-400s to mid-200s. His bg history is attached. (We test at home using a ReliOn Confirm meter.) Max has been getting 1.5 units of Lantus 2x a day for the past week (in a progression from 1 to 1.25 since early April). His bg test results don't seem to be improving even as his insulin dosage increases. We've uploaded/attached an Excel file with Max's bg history.

Would it make sense to up his dosage to 1.75 units?

Any advice the board may have would be most welcome! Thanks.
 

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Hello and welcome to you and Max to Lantus Land. I just wanted to say hi and wish you all the best with Max. I am unable to give you dosing advice so hopefully one of the experts will be by soon to give you some guidance. You are in the right place for great advice! :-D
 
Did your friend MK, post for you over the weekend? Here's the post I'm referring to.

We had suggested that you try to get some tests in the PM cycle. It's possible that Max is seeing some lower numbers and then bouncing into higher ranges. Without some PM tests, it's difficult to have the full picture of what's going on. I would not want to make a recommendation about dose without the bigger picture.
 
Welcome to LL! Sienne's advice is perfect - with those extra values, you'll get good dosing advice. Good luck!
 
Dear Sienne and Gaby,

Hi this is Mary and Wade with Max the cat. Thanks so much for your post. Yes, MK is our deeply valued friend, neighbor, and lover of cats who has spent so much of her precious time guiding us through this and to you! I am trying to learn how to use this website- Wade posted last night as he is the Excel-savy one....we are going to do a test tonite (May 1st)- late-- is one midpoint 6 hours after insulin good or shld I do more?

Okay, off to coax Max to eat more so I can do the insulin and get my 4 yr old ready for school!

Mary, Wade and Max
 
Welcome, Mary and Wade!

I am among the people here who's are "testaholics." The minimum number of tests we look for is 4 -- a pre-shot test to insure that it's safe to shoot and one additional test in each the AM and PM cycles. Getting a test at +6 may be helpful. However, getting tests at more random times will help to fill in the white spaces on the spreadsheet. It would be particularly helpful if, at some point, you could do a mini-curve (i.e., testing every 3 hours during a 12-hour cycle). This will help you to know when Lantus onset and nadir are. Not all cats have their nadir (lowest point in the cycle) at +6. My cat, for example, has an early nadir at around +3 or +4 and, nadirs can change. I'm also a big fan of a +2 or +3 test. If those numbers are substantially less than your pre-shot test, it very likely means you're going to see an active cycle and will need to test more.

We mentioned to MK that it would be helpful for us and I suspect in the long range, easier for you, if you could switch over and use a Google doc spreadsheet. This format will automatically update every time you add information and you can attach it to your signature so you don't have to upload a new file every time you want someone to look at Max's spreadsheet (SS). This is the information about the SS template and how to attach it to your signature. You're welcome to take a look at Gabby's SS.

As time permits, you may want to start reading the starred, sticky notes at the top of the board. They will help to orient you to Lantus and how this board works. Please let us know if you have questions. The people here are incredibly generous with their time and information. We're here to help.
 
We've kept Max at 1.5 units twice daily for another two days. His numbers seem to be stabilizing some and are generally improving (we're thinking this could have been related to the behavior of our 4-yr. old improving, because she can be a stressor for Max -- she loves Max but her tantrums don't seem to make him any happier than they make us). Any further thoughts on upping his dossage to 1.75, given the updated Excel sheet? Thank you! Mary and Wade
 

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Hi guys. I'm having on-going problems with opening the Excel file. When I open it, I'm only seeing data through 4/28. (I had problems when MK posted the file as well -- others didn't.) Is there any possibility of getting this into a Google spreadsheet. There are people here who can help you with this.
 
Hi Sienne and Gabby -- thanks again for your patience and advice. We created a google account and imported the data to a google spreadsheet which we then published to the web. We understand anyone should be able to see the spreadsheet using this URL:

https://docs.google.com/spreadsheet/ccc ... MWXc#gid=0

Please let us know if this is visible to you now. We did go ahead and up Max's dose to 1.75 tonight. If you think that's a mistake, please feel free to say so. We really appreciate your deep knowledge and understanding, not to mention that of the board, generally!

Kind regards,
Mary and Wade (and Max)
 
Thank you SO much. There are a couple of additional steps. Right now, you need to set the access permission so anyone with the link can open the SS. I just took a look at the spreadsheet instructions and I'm not sure if everything in the instructions is correct. For the time being, though, if you look at Max's SS, in the upper right corner under your name is a blue box called, "Share". There should be an option to select, "anyone with the link." You may need to copy and past the link in -- I'm not sure. Once you save those settings, anyone will be able to open Max's SS.
 
I just checked with Marje...

If you use "publish to the web" (not share with anyone with the link) it will take care of a separate issue.

Not changing the access is something lots of people do. No worries!
 
Now the link works!!

There are a couple of things I'd point out. The PMPS tonight is most likely a "bounce" from the blue numbers yesterday. What this means is that Max isn't used to spending time in lower numbers. When he does experience lower numbers, his liver and pancreas overreact. This entails the liver and pancreas dumping glucagon (a stored form of glucose) and counterregulatory hormones into Max's bloodstream. These cause the numbers to go back up. It can take up to 72 hours for a bounce to clear.

One of the unique features of Lantus is that dosing is based on the lowest point in the cycle, not on the pre-shot numbers. For this reason and the bounces, is why we've been encouraging you to get at least one test every night. When you see a high pre-test number, it's very tempting to want to increase the dose. This is where Lantus will teach you to be patient and wait to see where the numbers fall once the bounce clears.

At this point, since you raised the dose, it's going to be important to make sure you get tests in. I don't think that Max's numbers will drop overly low once the bounce works it's way out but you never know. Once he is more routinely in lower numbers, this concept will become more important.

One housekeeping detail... We start a new thread (aka "condo") every day that we post -- one condo per cat per day. If you look at the Board, you'll also see that we use a particular format for the subject line:
date cat's name AMPS-#, +time-#​
So for today, if you were to start a new condo, your subject line would read:
5/2 Max AMPS-375, +3-215, +8-218, PMPS-458​
Having the numbers in the subject line let's those of us who scan the Board to make sure no one's running into problems see what's going on quickly. It also means we don't have to open every condo to check on a kitty. If you post tomorrow, could you open a new thread/condo for Max?
 
Did you go to "File", "publish to the web" and copy the link there? The reason I'm wondering is because "ccc" is still in the link and it shouldn't be. When "ccc" is in your link, then every time someone opens the SS, it adds your SS to their google docs. If "pub" is in the link, it does not.

You might be able to just edit your signature block, take out the "ccc", replace with "pub" (without quotations), and submit. That might take care of it. The one thing important that "publish to the web" does for you is it allows you to make sure the box is checked that updates the SS every time you add something.

Let me know if I can help. You can always send me a PM.
 
Thanks, again for getting the SS set up.

What I'm seeing is that Max is bouncing off of those blue numbers today. This is very normal at the beginning of this process.
 
Thank you. Is it possible to put it in your signature block please so it is always there and you don't have to out it in a post every time?

Thanks again and I will post in today's condo if I have any suggestions about dose.
 
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