Old New Member - Sooo Frustrated

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missyandlittlegray

missyandlittlegray

Member Since 2010
I've been here before with my soul mate, Little Gray, and a foster cat who had multiple health problems in addition to diabetes. Sadly, she wasn't with us very long. I'm back now with Myles, a smart, wise former street cat who stole my heart when he was in my rescue group's shelter.

When he was diagnosed in March, he was 465. His numbers have barely budged since then. At first, my vet thought we could get him into remission by tweaking his diet. I wasn't optimistic because I thought he was already on a low-carb diet (all wet food) but I was willing to give it a try. About a week later, he started on Lantus, 1/2 unit twice a day.

Since then, I've been increasing his dose, drop by drop. He's up to two units twice a day now, and he's still in the high 300s or low to mid-400s. I know it takes some time to get to the right dose, but I feel like the insulin is not doing anything for him. I'm wondering if I got bad insulin. Is his Lantus unhappy because my old fridge is too cold for it? Would he do better on Levemir?

He originally came here as a foster. He had a growth in his left ear that had to be removed, and he was going to stay until he recovered from his surgery and then go back to our shelter. But both of us knew he'd never go back, that he was here to stay. The growth was benign and never came back, but he now has a benign growth beside his left eye. I don't test as often as maybe I should because I'm afraid to do anything with the left side of his face and test using just his right ear. That poor ear must get very sore.

In addition to the growth and diabetes, he's in urgent need of a dental, but my vet wants to wait until his numbers are lower. So these are my last questions: Should he be on antibiotics until the dental is done? Or should he have the dental now, despite the highish numbers?

Sorry this is so long. I'm just very frustrated and want my boy to feel better.

Myles:
 
I think you just haven't gotten to a good dose for Myles yet

Unless your fridge has frozen your insulin, it should be fine

If he needs a dental, it's important to get it done sooner rather than later because pain/infection/inflammation from teeth can keep him in higher numbers. Lots of times a good dental can really help with control.

It's also important to try to get more tests in on the PM cycle...at least a "before bed" test so you can see what's going on at night. Most cats go lower at night, and without those tests, there's no way to know.

Finally, I think you're holding the dose too long. Doing that can cause glucose toxicity where it needs more and more insulin to work. I'd forget trying to go up in "drops" and do increases in full .25 unit increments. Doing "fat" and "skinny" doses are only appropriate when you're close to a really good dose and are just trying to "dial it in"

If you're following the Tight Regulation Protocol, you can increase the dose every 3 days (6 cycles) until you start to see some blue.

If you're following the Start Low, Go Slow protocol, you'd increase after no more than 7 days if you're not getting him where you want him to be
 
Looks like he's only got 4 cycles at 2.25 (I'm assuming the 2u+ is 2.25) so you'd want to hold it for a total of 6 cycles

Try to get at least that "before bed" test in on the PM cycle too....and then we'll see where he's at

I'm betting that yes, he'll probably need to go to 2.5 next, but I'd hold the current dose for 2 more cycles
 
Think of fattening and skinnying doses as a technique to use when you're seeing green nadirs and are just fine-tuning the dose. A cat needs whatever they need - so don't have a preconceived idea of what the dose should be. What I mean is that some people think a cat should only need 0.5u or 1.0u, but we see doses from a single drop to 52u per shot.

What I would do is compare your nadirs against the protocol guidelines and re-evaluate his dose every 3 days until he's in better blood sugar range:

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
To be able to know how low this dose is getting him (his nadirs) I'd get 3 days of a minimum of 4 tests a day - both preshots and one mid-cycle during the day and one in the pm cycle. That will let you have confidence that he isn't getting low and bouncing. I don't really think he is, but you want to know for sure before you increase. Here's a post Jill wrote about "Should I Increase the Dose?" that might be helpful.

There is also a new post that some of us put together called "Where Can I Find?" that you may want to bookmark to help you find information.

Hang in there - you're on the right track but just need a little more info to proceed.
 
I've wondered if he's bouncing because he goes into the 400s and stays there every time I increase his dose. I'll try to get those extra tests in. Ouch! Poor ear!
 
Remember with Lantus dosing the focus for making your decisions is how low the dose takes him. The highs will pass, the bouncing isn't that important. What you want to know the most is how low he's getting.
 
Do you know about using Neosporin ointment with pain relief? I put it on Punkin's ear every night and they were healed by morning. You couldn't even tell that he got tested. Just wipe off the excess before you test so it doesn't gum up the test strip.
 
I'd forgotten about Neosporin. I'll get some tomorrow. I know you're right about the bounces. I just really hate seeing all those red squares.
 
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