Nomad's curve- could we be doing better?

[janelle and Nomad]

Nomad'' has been on. Lantus a year. Hiis current dose is 1.5 units twice a day. To be honest I have never been impressed with Lantus. I feel stuck with it because it seems to be my vet's only insulin. Since I had a whole day off I. Decided to do a glucose curve today. His 30 day average is 234. Today we started at 303 before insulin. +2h-183 +4.5-143 +6.5-159 +8.5-201 +10.5-280. At hour twelve we ended with 290 which is almost exactly where we started. I have not had the hemoglobin oxygen binding test done yet.

This sort of confirmed what I always suspected. Nomad. Metabolizes the lantus more rapidly than other cats. My vet seems to think numbers like this are OK. If Nomad were one of my human patients these numbers would be pretty lousy and he wouldn''t be regulated by any means. In human diabetics lantus and levemir are used as long acting base insulins and are usually paired with a short acting insullin . If the glucose number is higher than a certain level, then the shorter actiing insulin is given according to a sliding scale. I expected the same for Nomad.

When I use up this month's supply of Lantus. I plan to petition for a change. I think I can do better and Nomad deserves better than being just OK. I am interested in feedback from some other readers.

 

[Blue]

I have a couple questions ....

1. have you been giving the same dose, no changes, for the whole year? And if yes, how come? If no, do you have any record of the doses and the resulting BG numbers over the year or last while? Most people here find tracking the numbers on a google spreadsheet is helpful for the owners, as well as for others who can offer suggestions. You can look at the spreadsheets I am keeping for my cats, if you like.

If you want to aim for lower numbers, then why don't you try to increase the dose? The vet is NOT the boss of YOUR CAT.
Tight Regulation Protocol
LANTUS & LEVEMIR – INSULIN DEPOT –AKA- STORAGE SHED
Lantus&Levemir – Data Ready to Shoot Low Numbers

How I see it is this: if you are not putting enough gas in the car, you can't really complain that the car runs out of gas too soon and does not travel far enough. Maybe it's not the type of gas that's the problem, but rather the amount of gas.

2. If you want to try another insulin, what one did you want to try? I did switch from Lantus to Levemir, but for reasons relating to high doses and acromegaly. On occasion, I have used R to pull down some high numbers, but I really try to stay away from it unless absolutely necessary. Were you considering using a bolus insulin along with basal insulin you prefer?

3. Why don't you just tell your vet what insulin you want to use, say give me the rx or I will go elsewhere, to a vet who is able to adapt and be flexible. Unless you live in a very small place with only one vet, you should be able to locate a diff vet who is willing to work with you.

 

[janelle and Nomad]

Nomad has been on this dose for the last thirty days.Over the past year,he has been on various doses from one to three units twice a day.I decided to take a "middle ground" dose and stay with it to see what happens.I do plan on increasing the dose to 1.75 and doing another curve hopefully next weekend.I don't want to increase too fast because of possible rebound or going too low.In the past I changed meters three times because I thought some of the crazy numbers was from the meters malfunctioning. My data past the last thirty days is probably too messed up to be of any use.

 

[janelle and Nomad]

I guess I posted this in the wrong format and in the wrong forum. Please keep in mind that some people might not have access to a high tech graphics program or all of the data you are looking for. My laptop is out of commission thanks to one of my other cats and I am running off my blackberry now. It is hard to do things from a two inch screen. Please keep in mind that when someone is new to this forum it is easy to get overwhelmed by high tech graphs,' numbers and lin group lingo.

 

[chriscleo]

suggest increasing the dose.
even tho some cats take longer to respond to dose changes he's been on this dose a while now and your curve is telling you the numbers aren't going down enough.
the tilly protocol most of us follow has us raising by 0.25u every 3 days or so until an optimal range is reached (includes nadirs and preshot values). the instant we see too low of a nadir (40 or lower for most cats) we start reducing.
it works so well, really encourage you to try it. tho nomad's numbers are by no means terrible for a diabetic cat, he could stand to go lower.