Not a Newbie, but First Post and Questions

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laurencuth

laurencuth

Member Since 2013
Hi all, My 10 year old cat, Marley, was diagnosed with diabetes about 6 months ago. We caught it early because as soon as the frequent urination / eating more / drinking more began, we suspected what was wrong (my husband is a physician). We took him to the vet, and sure enough his sugar was around 450. We started him on Lantus immediately, and he was doing a bit better on 4 units, but still not regulated. At the time, he was eating Iams, dry original chicken food. This was the only food that did not cause vomiting and diarrhea, so we were reluctant to switch. After researching the food issue, I realized that we had to find a canned food that he could tolerate. So, I slowly switched him to the Iams wet chicken food. We immediately saw improvement, and he was off of insulin for about 2 months after that. Then the symptoms started again, and I knew he wasn't regulated. So I put him back on Lantus, and I started looking at the food issue again. I realized that Iams canned food has too many carbs, and I switched him to Fancy Feast chicken. He was on Fancy Feast chicken for a few months when I was able to reduce and then discontinue to the Lantus. He was regulated for a few months, and then the symptoms began again. Now, on the Fancy Feast, he is up to 9 units of Lantus, and he is still not regulated. I have discovered him scavenging for food (I have two small toddlers who drop "carbs" from time to time,) and I've even caught him pulling a bowl of spaghetti off the table to try to eat it. So I am now trying to keep him away from the table at meal times, keep the kids from spilling cheerios, etc. I am feeding him 1.5 cans of Fancy Feast Classic Chicken twice a day, with 9 units of Lantus given each time he eats. Do you guys have any suggestions? My husband fears that his disease is just worsening, but I am hopeful we can get him regulated. Thoughts? Oh, and we home test with the Alphatrak 2. Thanks!
 
laurencuth said:
Hi all, My 10 year old cat, Marley, was diagnosed with diabetes about 6 months ago. We caught it early because as soon as the frequent urination / eating more / drinking more began, we suspected what was wrong (my husband is a physician). We took him to the vet, and sure enough his sugar was around 450. We started him on Lantus immediately, and he was doing a bit better on 4 units, but still not regulated. At the time, he was eating Iams, dry original chicken food. This was the only food that did not cause vomiting and diarrhea, so we were reluctant to switch. After researching the food issue, I realized that we had to find a canned food that he could tolerate. So, I slowly switched him to the Iams wet chicken food. We immediately saw improvement, and he was off of insulin for about 2 months after that. Then the symptoms started again, and I knew he wasn't regulated. So I put him back on Lantus, and I started looking at the food issue again. I realized that Iams canned food has too many carbs, and I switched him to Fancy Feast chicken. He was on Fancy Feast chicken for a few months when I was able to reduce and then discontinue to the Lantus. He was regulated for a few months, and then the symptoms began again. Now, on the Fancy Feast, he is up to 9 units of Lantus, and he is still not regulated. I have discovered him scavenging for food (I have two small toddlers who drop "carbs" from time to time,) and I've even caught him pulling a bowl of spaghetti off the table to try to eat it. So I am now trying to keep him away from the table at meal times, keep the kids from spilling cheerios, etc. I am feeding him 1.5 cans of Fancy Feast Classic Chicken twice a day, with 9 units of Lantus given each time he eats. Do you guys have any suggestions? My husband fears that his disease is just worsening, but I am hopefulA we can get him regulated. Thoughts? Oh, and we home test with the Alphatrak 2. Thanks!
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OK 9 units of Lantus twice a day and you have high numbers all across the cycles?
He may well be insulin resistant due to acromegaly.
I am glad you switched to all wet low carb food; I was going to say at the start of reading your post to drop the dose and remove ALL dry food, but you have already done that change... well done!

If you have set up a google spreadsheet already to record your BG testing, can you post the link?
If not, can you post the numbers you have from the AT meter?
Post the time of the shot, the dose & the BG at shot time, then post the time&BG for each test you took until the next shot.

Hunger. Diabetic cats before regulated are more hungry than non-diabetic cats. Acromegalic cats are not diabetic but have diabetes due to their condition and they often eat more plus gain weight.
Either way, you can feed more pate, but stay away from all dry and high carb foods.

Gayle

ETA: Cats with acromegaly have a pituitary tumor and if there is no excess growth hormone secretion, the cat does not need any insulin. If the tumor revs up again, the insulin is needed again. By the sounds of it, your cat going off and on insulin and now on a proper diet but up to 9u BID, it may be a good idea to have the tests done... just a blood draw at your vet and it's shipped off to MSU as it's the only place in N.America that test for acromegaly.
IAA Test
IGF-1 (Acro) Test
 
Welcome to FDMB.

That insulin dose is very high, so I've a few questions.
- How did you arrive at the starting dose? Vet?
- How did you make decisions to increase the dose?
- How much did you increase at a time?
- How much does your cat weigh?
- when do you test him?

By the way - Good for you for home testing! A lot of folks find that difficult.
 
Well, I am obviously not testing appropriately, because it sounds like I am supposed to be testing multiple times a day, and I was told by my vet to test every three or 4 days, unless he was lethargic / behaving differently. I did not start him on 9 units. We started at 2 and went up from there. With every food change, we have started back at 2 units. Acromegaly - what is the prognosis if he does have it?
 
It'll help if you would post your numbers on our online spreadsheet/chart. This lets folks review what is happening and provide ideas.
Spreadsheet instructions

AMPS = Morning pre-shot glucose
PMPS = Evening pre-shot glucose
+2 = 2 hours after shot
+4 = 4 hours after shot
Etc

We test before shots to make sure it is safe.
We test mid-cycle to see how well the insulin is working.
 
I can tell you that Marley was acting very lethargic / strange yesterday about 3 hours after eating and having 8 units. I tested, and his sugar was 550. My husband said to give him 5 units and test again in an hour. An hour later, his sugar was 330. We are out of test strips today, and more are being delivered tomorrow. He is acting "normal" today, though.
 
Cats with acromegaly can be treated for diabetes following the protocol for dose adjustments. Treating the acromegaly itself is possible, albeit expensive, if that is what he has.

There are some other high dose conditions such as Insulin Autoantibodies (IAA). Signs of that may or may not include progressively increasing insulin doses.

Specific blood tests are available for both acromegaly and IAA.

Lantus should be given every 12 hours. In the event of a high dose condition, supplemental, shorter acting insulin is sometimes given.
 
You may want to pick up a more economical meter; the AT is pretty expensive for strips.
I like the Bayer contour the best, but if you are in the US, you can use one of the Relion meters as they have the most economical strips and that's what costs you in the end.

There are 3 tests that are most important.
You want to test before every shot... humans would never give their diabetic child a shot without testing and most humans also test before their shots.
The third test would be just before you go to bed because some cats have been known to go lower overnite, so you may catch a lower than normal number and need to leave some higher carb food to bring the numbers up.

What has been told to many about the course of a shot's curve is the below very general guideline:
Example of a typical curve:
+0 - PreShot number.
+1 – Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 – Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

Now not all cats have a nadir at the mid point.... one of mine was around +5 and the other was closer to +10 or later. One curve looked like a valley; the other looked like a mountain.

It may be an idea to drop down to the 5u dose, test before the shot, and then every 2 hrs so you can see how that dose is working.

As for treating acromegaly, many just go with giving insulin if the SRT treatment is too expensive or not possible. Many acros do just fine on insulin and some DO go right off insulin on their own, depending on the tumor. My Oliver went off insulin in 10days and what was in Jan/2012. He's still off insulin but we still test to be sure he stays in good numbers.

Gayle
 
Ok doky so heres what you need to do

1. Set up a spreadsheet and test as BJ said - that will help you track trends and keep him safe. and help us advise you.

2. Revaluate dose - I am thinking your dose may be too high given he dropped 200 points in an hour on 5 units. So what weight is he (ideal weight) and we can calculate a starting dose.

3. edit your signature and put "using an alphatrak" in big and bold because its a more sensitive meter and we need to remember that if he drops below 80 at any point you reduce the dose. While you are editing your signature, add your and your cat name, insulin and dose, and food
ie Lauren? & Marley, Lantus 5IU, FF classics, Using an Alphatrak. plus the dates i.e. diagnosed date, remission dates, out of remission dates ie DX Jan 1st, OTJ Feb 2 - Apr 10, OTJ again Jun 6 - July 7, and so on.

Wendy
 
laurencuth said:
I can tell you that Marley was acting very lethargic / strange yesterday about 3 hours after eating and having 8 units.
I tested, and his sugar was 550.
My husband said to give him 5 units and test again in an hour. An hour later, his sugar was 330. ...
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So yesterday he had 13 units? In the evening?

It is very important to give Lantus at 12 hour intervals.
 
Also, very important when dropping dose and you don't know if it's needed lower or not, please be sure to test urine for ketones every day .... one of the ingredients for a very sick cat is not enough insulin, and ketones is your first warning sign.
Pick up a container of KETOSTIX to test the urine.

Gayle
 
BJM said:
Cats with acromegaly can be treated for diabetes following the protocol for dose adjustments. Treating the acromegaly itself is possible, albeit expensive, if that is what he has.

There are some other high dose conditions such as Insulin Autoantibodies (IAA). Signs of that include progressively increasing insulin doses.

Specific blood tests are available for both acromegaly and IAA.

Lantus should be given every 12 hours. In the event of a high dose condition, supplemental, shorter acting insulin is sometimes given.
Click to expand...

IAA is not a condition that has progressively increasing insulin doses; I have no idea what source there is for that statement because I have not seen it, and I am currently at a home where I am pet sitting an IAA cat and the dose is 2.25u. The condition is known for extreme DROPS and RISES in the BG numbers in very short times. That 200point drop could be an IAA type of example.
A great deal more testing is done with an IAA cat than an acro because you need to know your cat's "style" and when best to expect a possible drop.

Your normal insulin that is in the body all the time is your Lantus, the basal insulin.
Your fast acting insulin, R, the bolus insulin, is the type that is given to bring down higher numbers quickly so that your Lantus works better. Humans may use R to adjust their BG from a rise due to meals.

Gayle
 
From our forum on high dose cats
section on Cats with Insulin Auto Antibodies (IAA)

"“We have a couple of anecdotal reports of kitties who, by continuing to raise the insulin doses, were able to overwhelm the antibodies, eventually lower the insulin doses and gain control of the BG’s.”"

I knew I read it here.
 
If not treated correctly, possibly, but look at Sandy and Black Kitty.... BK was able to get off insulin, yes?
If you want to talk high dose, it's with acromegaly, and that cannot be forced to a lower dose... IAA can. You must test and be AGGRESSIVE, using R and forcing the cat into numbers lower than diabetics' aim. You need to push for 40s.... and if you do not treat it properly, you will have problems, but you will never reach the dose that acros reach.

If you are going to talk about signs that differentiate between IAA and acromegaly, the biggest difference is that IAA is totally unpredictable, but acromegaly is. IAA is all over the place; acromegaly just plods along, numbers not really budging, and the dose raised until the numbers do begin to respond.

Saying that IAA includes progressively increasing doses says nothing at all because ALL diabetic cats and insulin resistant cats need progressively increasing doses.... until they reach the dose they need.

Gayle
 
It looked like a possibility to me.
Insulin worked for a while (it might have overcome any antibodys OR the tumor stopped producing), then it didn't (antibodies may have returned OR tumor may have started producing again), then they had to do insulin again, at a higher dose.

Lab tests may confirm or rule out both IAA and acromegaly.

Here's what the Merck Veterinary Manuel online has to say about Feline Acromegaly
 
Thank you for all of the info. I will start a speadsheet and test as instructed over the next few days. I'll update my signature with the needed info as well! Thanks! I wish my vet had not sold me the Alphatrack 2 with the expensive strips! We will certainly look into a different meter after we use up the 100 strips just ordered.
 
I've added some info to my signature. I'm sorry, but I didn't document when his remissions occurred. I have a One Touch Ultra monitor that I am going to use for today / tomorrow until the new Alphatrak strips arrive. I checked him at 5:30 p.m., and he was at 258. This test is his PMPS. He has not had insulin or food since this a.m. He weighs 12 pounds. Where should I start his dose, and how does the One Touch compare in accuracy to the Alphatrak2?
 
You could return the alphatrak unopened maybe? The one touch I think should be fine. Most meters allow a 20% variance in numbers so I wouldn't get too hung up on meter differences.

Perhaps do the 5 units again. Get a test immediately before the shot and then anther before bed to see what the overnight plans are? However if he is under 200 preshot please let us know and don't shoot.

Wendy
 
Okay - I have a spreadsheet now. I realized that I tested him about an hour early tonight. So 258 was his +11. He has eaten and had his 5 units. I will test at +2, and see where he stands. I'm so thankful I found your site! Oh, and I've been using the Alphatrak for 8 months - no returning it now! :smile:
 
I'm very frustrated. I can't get the One Touch Ultra to work again - it's giving me error messages. I like the Alphatrak so much better! I stuck him about 6 times and wasted three strips with no luck. I've NEVER had trouble testing him before, even when we were first starting with the Alphatrak. I think it requires less blood? Anyway, I had to stop trying because he got very upset. I'll start over on the spreadsheet thing when my new Alphatrak strips come in.
 
First off, what is the error code the One Touch meter is giving you?

Online user manual One Touch Ultra Mini User manual. Error codes are on page 24-26.

The Alphatrak 2 requires a 0.3 microliter blood drop.
The One Touch Ultra Mini requires a 1.0 microliter blood drop. User manual, page nine, under number 4 shows the blood drop size.
 
Probably not enough blood. Try two pokes beside each other and holding the ear below the pokes to stem the blood, then collect it on your nail,

Wendy
 
I was able to get it on the first try this morning, and I updated his spreadsheet. Is everyone in agreement that we should start at 5 units and go up from there? Previously, we started at 2, slowly went up every week (of course I was only checking his sugar two or three times during the week, only once a day as per my vet), and then we arrived at 9 units because his numbers weren't dropping. So should I be doing my chart with the 9 units or the 5 units as suggested by someone yesterday?
 
I would start at 5 and we can go from there. Dont assume we will be going up ;) We will be holding this dose for three days unless we see him go under 50 ( would be a reduction). You will be needing to test for ketones regularly. Do you have urine ketone test strips?

Anyway for testing see if you can get these tests in - plus you will want to get some spot checks if he looks like he is dropping... we want to find out how low Marley is going as it is this low number we base dose changes on.

Tests:

- Always before you give every shot.
- Mid cycle - 5-7 hours after morning shot to see how low Marley is dropping
- Before bed - 2-3 hours after evening shot - to see what Marley's nighttime plans are.If this number is the same or lower than the preshot test you might want to set the alarm for another test mid night cycle as it usually means an active cycle.

Dont feed two hours before the shot/test as you dont want the preshot test number influenced by food.

Wendy
 
I am not currently testing for keytones, as my vet never mentioned it, but i will get the strips and start. I use the Breeze litter system, so collection should be fairly simple, right?
 
With the Breeze litter system, you've got a leg up on most folks. That makes it easy, especially if you only have one cat. :-D
 
Can you look at Marley's SS and tell me what you think? I had to switch monitors in the middle of everything, so that might throw things off. Should I keep him at 5?
 
I would hold the 5 unit for a couple of more days unless you get lower BG that suggest a decrease is in order. If you get similar BGs then I would increase to 5 1/2
 
The spreadsheet looks fine, but I would not hold the dose for 2 more days.
If your cat has an insulin resistance condition, you do NOT want to hold any dose longer than 6 shots.
If you are feeding proper low carb wet food and no dry food, based on the mid cycle yellows, I'd up the dose to 5.5u and hold it for 3 days/6 shots.
Continue with that pattern of dosing, upping by 0.5u every 3 days until you are seeing better numbers.

And you do NOT have to put the dose in your signature..... if you have the link to your ss in your signature, adding a line for your current dose is overkill and suits only the lazy people who can't be bothered to take the time and look at your ss.

And I would stick with the Relion meter because it's a good and economical meter to use, especially if you will be getting into a higher dose of insulin. The AT meter is just way too expensive for strips, and that money you save can be put toward insulin.

Gayle
 
He is on the proper food, and he has been on it since probably April. I bought some of the freeze dried chicken for him, so that is the only thing he is eating besides the FF classic chicken. He does occasionally eat something my kids drop on the floor - small crumbs, but still not good for him, and I am doing my best to avoid that. So switch him to 5.5u on his next shot? Is it likely that we have caused his insulin resistance by moving him up in whole units too slowly? We moved him up a whole unit about once a week.
 
Blue said:
And you do NOT have to put the dose in your signature..... if you have the link to your ss in your signature, adding a line for your current dose is overkill and suits only the lazy people who can't be bothered to take the time and look at your ss.

Gayle
Click to expand...
No lazy people here. SS was not setup until late in the evening of Saturday, July 20th.

Now that Marley has a spreadsheet (SS), you could remove the dose from your signature if you like. It was nice to see it there before you had a SS setup though.
 
Blue said:
And you do NOT have to put the dose in your signature..... if you have the link to your ss in your signature, adding a line for your current dose is overkill and suits only the lazy people who can't be bothered to take the time and look at your ss.
Click to expand...

Um... It isn't necessarily about laziness, OK?

If the particular device one is using doesn't access Google docs well (ex my @#$% cell phone), I appreciate seeing the dose or any specific tests in question in the post. I don't always have a PC handy to review posts.

Edited to clarify - If there is a particular question about dose or test, you might note them in a post; there's no need to mess with your signature. The signature is for those things which are pretty much constant.
 
laurencuth said:
He is on the proper food, and he has been on it since probably April. I bought some of the freeze dried chicken for him, so that is the only thing he is eating besides the FF classic chicken. He does occasionally eat something my kids drop on the floor - small crumbs, but still not good for him, and I am doing my best to avoid that. So switch him to 5.5u on his next shot? Is it likely that we have caused his insulin resistance by moving him up in whole units too slowly? We moved him up a whole unit about once a week.
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if you look at his ss, he's got a nice curve with some dip to yellow at mid point, so if you had passed your good dose, you'd see all high numbers pretty much, and as for the crumbs on the floor, YUM!
I would let the boy have some little treats, so long as they are not something harmful like onions.

Did anyone show you some general dosing guidelines?
"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.
Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.
A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.
Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.

if you get up to 10unit shots, your increases will be upped by 1unit each time.

Gayle

you do NOT need to put your dose in your signature.... if you want to keep changing it, go ahead but please refrain from making a new person futz around with fluff.
 
laurencuth said:
So switch him to 5.5u on his next shot? Is it likely that we have caused his insulin resistance by moving him up in whole units too slowly? We moved him up a whole unit about once a week.
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My recommendation is to maintain this same dose for at least one more cycle, possibly more. It may not be insulin resistance. You need the IAA blood test to confirm that.

Here is my logic. He did a nice 173 point drop yesterday morning. He isn't giving us high, flat curves. Yes, he has higher numbers than we like to see but not outrageously high.

I'd want to see if the insulin depot will drain more and then push him into higher numbers. If he were giving us high flat curves, we would recommend increasing the dose tonight. He isn't. If he starts throwing out 400's and 500's, we can bump his dose up. We are not at that point yet. With the high flat curves, we can even "fast track" the dose up after 4 cycles instead of the usual 6 cycles minimum.

Fast tracking is increasing the dose faster than the general guidelines in the TR Protocol calls for. It is used in special circumstances such as when the dose has been increased too rapidly and you lower it and then increase in smaller increments, 0.25U or 0.50 U.

We are fast tracking the dose up for another cat over in Lantus TR right now. She was in the 400's pretty consistently, flat curve. We have a different situation here. ECID.

Are you able to get any mid-cycle tests today for the AM cycle? Or are you at work?

If you have any more test data from the Alphatrak, entering some of that on the SS would be helpful to see some more history on how he responds to insulin. I'd suggest going back a week or two and entering data if you would be so kind.

No problem on the signature. When you have time.
 
Deb - the problem with the Alphatrak is that I was testing him so infrequently that I doubt it will tell us anything. I was only testing every 3 or 4 days and I was testing mid day. I can post it later if you want, but I didn't understand the need for a curve / multiple tests a day / frequent testing until I found this website 4 days ago. I so wish I had found you all immediately! I do not work, but I have two small very active children, and I am very often not home all day because I am out and about with them. I was able to test half and hour ago, so I just updated his SS. Thanks so much for all of the help! I can see that some of you disagree about how we should proceed. I will do some reading . . . . Should I move over to one of the Lantus threads? Or is it okay to post here still?
 
laurencuth said:
Deb - the problem with the Alphatrak is that I was testing him so infrequently that I doubt it will tell us anything. I was only testing every 3 or 4 days and I was testing mid day. I can post it later if you want, but I didn't understand the need for a curve / multiple tests a day / frequent testing until I found this website 4 days ago. I so wish I had found you all immediately! I do not work, but I have two small very active children, and I am very often not home all day because I am out and about with them. I was able to test half and hour ago, so I just updated his SS. Thanks so much for all of the help! I can see that some of you disagree about how we should proceed. I will do some reading . . . . Should I move over to one of the Lantus threads? Or is it okay to post here still?
Click to expand...

You can still post here if you like, but if you move over to the Lantus TR forum, you will have some more Lantus users there to offer suggestions.

i would hope that members who don't understand the insulin well first hand and don't understand what fast tracking is, why it's done, what to watch for, and when to slow down, should not be telling you what to do.

The numbers that you are getting are fine with the dip in mid cycle, so there is no need to push you to go faster. If a cat is all upper 300s and lots of 400s and higher, they need some fast tracking.

Follow the general guidelines, holding a dose for 6 shots, then up the dose by 0.5u or 0.25u.
Fast tracking is merely holding a dose for 5 shots and maybe using some R to pull down the high preshot numbers.

One thing for sure, I'd drop the AT meter and just stick with the Relion to save yourself money and be able to test more often. And you don't need to post the past numbers now.... if you want, for later, you can add them just so you have the history, but you're right. They are of little use because they are sporadic and on a diff meter. Stick to one meter, whichever one you like, and go with the numbers looking forward.

Do not hold the dose at 5u; you have gone 6 shots on this dose and there is no progress, so up you go. There is absolutely no reason to hold the 5u any longer, and anyone who makes such a suggestion knows nothing at all about resistance, or dosing.

If you want proof, just look at the amps and pmps for the last 3 days..... they are INCREASING not DECREASING. If this 5u dose were adequate and just needed more time to settle, you would see a progressive improvement in the preshot numbers.
Look at the amps: 321, 380, 390. Does that look like the dose is good? No.
Look at the pmps: 372, 392. How about those numbers? Nope, the numbers are rising so you need to get in front of the resistance.
Up the dose to 5.5u.

Gayle
 
laurencuth said:
Deb - the problem with the Alphatrak is that I was testing him so infrequently that I doubt it will tell us anything. I was only testing every 3 or 4 days and I was testing mid day. I was able to test half and hour ago, so I just updated his SS.
Click to expand...
What were some of those mid-day numbers? Just give me a couple, say the last 3 and the dates. I'd like to see how low he was going on the 10U dose.

I can see that some of you disagree about how we should proceed. I will do some reading . . . . Should I move over to one of the Lantus threads? Or is it okay to post here still?
Click to expand...
Your choice to stay here or move to one of the Insulin Specific Forums. Lantus TR has more experienced users than Relaxed Lantus. I can also PM a couple of the Lantus experienced people and have them come over here for another opinion.

I do not work, but I have two small very active children, and I am very often not home all day because I am out and about with them.
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I'd call that working! And very important work too, to be raising two small active children. The pay and benefits may be a bit more intangible then $20 per hour or health insurance but the rewards are immense.

To clarify, I have NOT told you to fast-track the dose.

Lauren, would you please update the SS and add a row to show at least one dose at 10U and make a note in the Remarks column that you recently increased from ? to 9U and what the date was of that change.
 
If you do decide to head over to one of the Lantus forums, I'd suggest the Tight Regulation one as there are many more folks there who are likely to see any posts, and a number of them are highly experienced.

There are some Secondary Monitoring Tools in my signature link. The most important is urine testing for ketones. Ketones are a by-product of fat breakdown for calories and too many may indicate diabetic ketoacidosis (DKA), a complication of diabetes. The others are some of those more subtle signs that indicate how your cat is doing and may be things your vet asks - how the cat is eating, drinking, peeing, defecating, etc.
 
We were at 9u. That was as high as we went. I will get the numbers off the Alphatrak this evening and add them in. Yes - parenting two active boys is work! :)
 
Okay - I have added some test results from the Alphatrak. If I understand all of this correctly, I was getting high mid-range numbers with the 9u, so that means my dose was too high, correct? So now we just have to find the magic number between 5 and 9. Right?
 
Thank you for those additional test numbers. One small request. Could you put the actual dose in the U column please? and put the dose in for 7/20 AM and 7/19 AM and PM.

laurencuth said:
Okay - I have added some test results from the Alphatrak. If I understand all of this correctly, I was getting high mid-range numbers with the 9u, so that means my dose was too high, correct? So now we just have to find the magic number between 5 and 9. Right?
Click to expand...
Maybe. Sometimes, cats can have higher numbers with too much insulin as well as too little insulin. ECID. Every Cat is Different.

You had at least one low number on 6U, and that was very late in the cycle. You could have been much lower earlier in the cycle. No way to tell.
 
laurencuth said:
Okay - I have added some test results from the Alphatrak. If I understand all of this correctly, I was getting high mid-range numbers with the 9u, so that means my dose was too high, correct? So now we just have to find the magic number between 5 and 9. Right?
Click to expand...

It could mean the dose may not be high enough yet, since you have a higher dose kitty. I believe you may be able to increase 0.25 units to get the nadir below 200 mg/dL, as Gayle mentioned in her previous post.
 
Or it could mean you bypassed the appropriate dose since you were raising in full 1U increments instead of the protocol, 0.25U increments.
 
And a third option is to just hold it and get midcycle tests when you can. The test results will eventually clue us in as to what to do.

If you hold the insulin dose steady another day or two and the nadirs keep rising, I'd probably increase.

If you got a sudden low pre-shot or nadir, I'd be more inclined to think the dose needed reducing.
 
laurencuth said:
Thank you! This is all very overwhelming. I know that we are not using the correct syringes, but we are using the ones our vet gave us - but they don't have 1/2 unit markings. I've looked on the frequently asked questions, and I see the recommended syringes, but I don't understand the conversion. Can you tell me which syringes to purchase and explain the conversion to me in a different way? If I convert, do I put the conversion amt in the spreadsheet or do I just put the amt before conversion. Is it possible to purchase U-40 syringes with 1/2 unit markings? I think I'm making this more difficult than it is! :-)

And please tell me what to do - hold him at 5, go up to 5.5? I'm not sure I could approximate 5.25 with my current syringes. I will get the right ones tomorrow!
Click to expand...
What kind of syringes are you using now?
Lantus is a U-100 insulin; you should use matching U-100 syringes.
U-100 syringes can come with half unit markings.
There is no conversion to be made when you use matching syringes.
Just do your best to suck in slightly more insulin above the line for 5 units, but less than 6 units.
 
Yes, I am using U-100 syringes, but they are without .5 unit markings. It is time to buy more anyway, so I will look for the ones mentioned in FAQs. Thanks.
 
If you can, it's a good idea to get a "last test before you go to bed" test. Many cats drop lower overnight.
 
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