Please help-correct dosis Lantus + food issues SUSI

[MariaSpain]

Hello everybody!

I found this wonderful forum searching the net for help for my litty sweety, Susi (a boy)

He is 12-years old, and in 2016 has a diabetes bout (most probably caused by impropper food and corticosteroid eye drops) from which he got a complete remission after 2 months of a modified TR with Lantus. He had completely normal blood glucose thereafter (50-80 range most of the time), till some weeks ago. During the treatment in 2016 he was eating strictly wet food, but after the remission I started giving him dry one little by little (measuring the glucose to check for negative impact), and there was no problem at all. The dry one was Satiety by Royal Canin and it never caused a BG elevation

It happened that a couple of months ago we notices one of his front long canine teeth is missing, and the gums are inflamed, so I took him to the vet, had an antibiotic course and started giving him a specialized dry food HILLS ORAL HEALTH. This food seemed to me partucularly greasy, in fact it seems fat (oily) even by the touch...Well: a couple of weeks ago I noticed that he started drinking a WAY more water than usual, and under the suspicion that it might be the diabetes again, I checked his BG and it was 286
Of course, we took him to the vet immediately. The problem is he is terrified of going out, and unfortunately the vet had difficulties to find him a vein to draw blood so it took quite a lot of time, and when the vet finally got the blood, poor Susi had 596 of glucose, his highest ever. During the 2016 bout the highest he ever had was 400 something in the vet, and 300 something at home

So I requested a prescription for Lantus and started it with the insulin already. Since now his sugar is not so high, the dosis is 1,75iU BID and TR

But, here comes my doubt and request for help:

-In 2016 I applied the TR and wrote a diary with daily values and relevant data. So, now I of course re-read it to see what had been the tendency then. What I saw and vaguely remember is that, back then, after about 2 months of rather homogeneus values for BG (180-300 mostly), I made a modification of the protocol and as far as I remember, I started to apply something like (what I now see here is) the Hodgkin approach (with Lantus), and give him as needed some kind of booster doses when the glucose was above some points
The pity is I did not write down the exact criteria I had followed then for this modification, and I am now unable to find what I exaclty used. I say pity, because, about 2 weeks after "modifying the TR protocol" in this way, Susi started to have a completely normal BG and insulin was discontinued

Anybody please, can you help me with a suggestion about what this protocol modificatin might be?

My second question: if what caused him now the diabetes bout is (as I suspect), the fat in the dry food I had been giving him lately, is it wise now to give him very low carb (i.e. high protein and fat) food only? Should I give only wet?

Many thanks in advance for reading me and any suggestion and opinion, would be most welcome!

Maria

 

[Sienne and Gabby (GA)]

Sorry that Susi fell out of remission!

I doubt that it was the fat in the Hill's food that caused the problem. I do think it was the dry food that is the issue. We consider a low carbohydrate diet to be under 10% carb. An actively diabetic cat and a food-controlled diabetic cat should be fed a low carb diet. The Hill's Oral Care is 37% carb. There are only a limited number of dry foods that are low carb. To be honest, canned food is a better choice for cats. Cats have a limited thirst drive and there's virtually no moisture in dry food. For a diabetic cat, moisture will help protect your cat's kidneys. This is a chart that has nutritional information on most of the canned cat food that's available in the US.

I would encourage you to look at the two dosing methods we recommend for Lantus users. The method developed by Hodgkin's was not for use with Lantus. She developed it for Prozinc (then called PZI).

 

[MariaSpain]

Sorry that Susi fell out of remission!

I doubt that it was the fat in the Hill's food that caused the problem. I do think it was the dry food that is the issue. We consider a low carbohydrate diet to be under 10% carb. An actively diabetic cat and a food-controlled diabetic cat should be fed a low carb diet. The Hill's Oral Care is 37% carb. There are only a limited number of dry foods that are low carb. To be honest, canned food is a better choice for cats. Cats have a limited thirst drive and there's virtually no moisture in dry food. For a diabetic cat, moisture will help protect your cat's kidneys. This is a chart that has nutritional information on most of the canned cat food that's available in the US.

I would encourage you to look at the two dosing methods we recommend for Lantus users. The method developed by Hodgkin's was not for use with Lantus. She developed it for Prozinc (then called PZI).

Hello,

Thank you very much for the quick reply!

The chart with nutritional info is very interesting, I will check it in details and purchase the wet foods accordingly!

Regarding the dosing methods, thanks, I had in fact already reviewed the info in the sticky posts and the webs, and there I saw the name of the methods (Hodgkin's) which I deduct I used (kind of) in 2016. Yet I am not sure it was this exaclty, since in my diary I did not mention the exact method, I just wrote down that I gave 0.5iU as an auxiliary small dose once or twice dayly when the glucose was higher than 150. And I also gave different doses as base ones in the moring or night depending on the BG values, for example, if >200 I gave 1,75, if < 200 I seem to have given 0,75 or 0,50iU only...Strange enought, I see some days I gave only one principal dose and 1 auxiliary, or even only 1 auxuliary. And as I mentioned, precisely after following this peculiar approach for a couple of weeks, all numbers got completely normal. This is why I would like to find the exact approach I followed then for these last weeks of treatment, but no luck so far. I read yesterday that is was developed for PZI insulin, yet I used Lantus all the way (exept for the first 1-2 weeks when the vet had given me Canninsulin, but I passed to Lantus and it was till the remission)

Thanks again anyway for your reply and help!

Maria

 

[MariaSpain]

Hi,

I have another question about the dosis in the first couple of weeks

In the TR protocol I see the following (copying below)

So, I have a doubt: my cat fullfills 2 criteria for reduction, yesterday it had a 48 nadir, and now it has a 102 PS value. So, should I reduce the shot now (I am shooting 0,25iu per kg BID), and reduce from 1,75 to 1,5? Or even to 1,25 in case that 0.25 should be applied to EACH reduction criterium?

Pls help!

Thanks

Reducing the dose:

The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus, Levemir, & Biosimilars ISG safe by taking reductions when appropriate.

• 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, attempt a reduction when the cat regularly has its lowest BGs in the normal range of a non-diabetic healthy cat (50 - 80 mg/dL) while staying under 100 mg/dl overall for at least one week.
• Please do not let yourself become complacent or blasé about drops into the 20s or 30s. Please ask for advice immediately.
• If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are few exceptions given to caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
• Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more.
• If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction. Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding an in-between the dose.
• We've found many kitties benefit from reducing the dose from 0.25u to 0.1u before stopping insulin completely. During a two week OTJ trial, you want to see mostly green numbers (under 100) with only a few random blue numbers between 100 - 120 to help ensure a strong remission. Most kitties will be in the range of a healthy cat (50 - 80 mg/dL) overall.

Remission:

 

[Sienne and Gabby (GA)]

With Lantus, you do not want to adjust your dose based on the pre-shot value unless when you test, the pre-shot result is in dose reduction territory. Dose reductions are based on the lowest number in the cycle. If I'm understanding correctly, wasn't Susi first diagnosed several years ago and you're now seeing diabetic numbers again? If so, with the TR protocol, a dose reduction for a long term diabetic cat occurs if test numbers are less than 40. (See the first bullet point in the information you quoted.)

If more than one criteria are met, the reduction is still 0.25u. It looks like you made the right choice.

I see some days I gave only one principal dose and 1 auxiliary, or even only 1 auxuliary. And as I mentioned, precisely after following this peculiar approach for a couple of weeks, all numbers got completely normal. This is why I would like to find the exact approach I followed then for these last weeks of treatment, but no luck so far. I read yesterday that is was developed for PZI insulin, yet I used Lantus all the way

This is exactly the problem with using Hodgkin's approach to tight regulation. Lantus is very different from PZI. Lantus forms a depot which gives Lantus it's long duration and causes an overlap between doses. If you give an auxiliary dose during the cycle, you disrupt the depot, cause the insulin to have 2 nadirs, and can easily cause an overdose. You also need to hold doses for at least 6 cycles/3 days with Lantus to allow the depot to stabilize. PZI is shorter acting, does not have a depot, and you can adjust doses with each shot. Hodgkin did not take the difference in the pharmacology of the two types of insulin into account. I would strongly advise you against trying to use her method with Lantus.