Please meet Hobbs, Calvin, and Me

[HobbsMom]

Hello,

My name is Jennifer and I am the fur mom to Hobbs, a male feline born around May 15, 1998. Hobbs was part of a 4 or 5 cat litter to a stray and became my fur baby, with his littermate and brother Calvin, about six weeks later.

They have both maintained weights ranging from 9-10lbs and present as very happy. (Meaning they sleep well and play full out when play time... picking their toys from a toy bin that is always out for them, or coxing a human to join in. There are some days when toys are spread around the house - as they should be because, let's face it, it's hard to pick just one )

They greet humans at the front door, unfortunately fighting with each other to get there because I taught them that the first to arrive receives love first. Rule is: humans first, then fur babies in the order in which they arrive... UNLESS one fur baby CAUSED the other fur baby to arrive late... whereby the inside house human is responsible to share this information so that the arriving human may dish out love accordingly.

I also taught them to relax when being handled by a human… yes, prodding and poking, squeezing legs, feeling abdomens, etc... so that if they were in trouble, a human could help them.

August 2013 they both received GREAT reviews from two vets stating that all their numbers and energy level seemed like they were 7 years old. (The only thing one vet mentioned was that Hobbs might have a high metabolism, but when she read me the acceptable range, he was in it... and not at the very top. Being that he's always been a good weight, I asked if the number was rare for healthy weight cats versus what she perceived as "high" due to her frequency of seeing heavier cats? I question people when they use descriptive terms without correlation to numbers and reasoning.) As a result of the great reviews, we moved forward with teeth cleaning and needed extractions. (I knew this would happen as I stopped brushing their teeth 7 years prior.)

On February 18, 2014, Hobbs glucose level was 661 and he had lost 1.25 pounds weighing 8.25 lbs. He lost muscle seemingly quickly. (It's a longer story than that as I had taken he and his brother to the vet at least four times because "something was going on..." they were sneezing, there was pee in places where they slept, more urine in their litter boxes, … then finally one day I SAW Hobbs have seizure, so things started coming together. The main thought I had was that the general anesthesia did something to his brain the way it gives human brain bruises (traumatic brain injuries.))

The following day Hobbs started on 1iu of Lantus and no REAL education for me. (Lantus was chosen because I used to have an active lifestyle such that one injection a day would be ideal for me... if in the best interest of Hobbs.) I switched all their food to DM and AD for his diet and started getting educated about how I, unconsciously was feeding them the equivalent of Lucky Charms for 15+ years... no wonder his little body got worn out.

(FYI - We are calling it Feline Diabetes because his symptoms match up with FD. If, however, it is a tumor or something like that, I have limited funds and so, unfortunately, have to put a price limit on my ability to help him. However, managing his symptoms, is something I am absolutely able to do... and can and will put as much time and energy into it as needed.)

I went crazy researching and sooo sorry to say didn't find you. I bought a meter at the local grocery store and found out later that it was over 100 points off... INCONSISTENTLY - some times it was only 3 off. SOOO I purchased the same meter that my vet has and made certain it was consistent with their readings. Once that happened (about five days after being diagnosis) .. .and week of learning (poor guy living in the high ranges) ...I've been able to, about 80% of the time for the ten days, maintained his blood glucose levels between 40 and 130. (Only time he's out of that range is when he needs insulin- which is still alluding me as he seems to range between 8-15 hours. THIS range is kicking my butt and I could really use HELP on figuring this out.)

I moved both Calvin and Hobbs to Feline's Pride raw food within 10 days and IMMEDIATELY saw positive changes. I added potassium to the Hills Rx a/d (as I am mixing that with Feline’s Pride to get Hobb’s muscles back – and it’s working. I increased his mucle mass by 1lb within a week… and decreased Calvin’s fat by about ½ a pound so now they are both within the “perfect” weight zone. (Whatever that exactly means.)

However I just learned about B12 so will be adding that when I learn what kind is acceptable. (I have some injectable B12 at my house as well as sublinqual (because I need it due to my lack of a thyroid).. so that will be nice if I can just mix that in or something. (Help on this too would be great… even though I’ll start researching it as well.)

Hobbs seems to do best when free fed versus set scheduled, so I keep the food in a shrimp cocktail like container set up that maintains being as cold as sushi bars. I also refrigerate it when I’m home if I notice they are sleeping and I’m attentive… as I’ll bring it out and usually to him to see if he’s hungry.

The Lantus DOESN'T seem to work for 24 hours.. and after reading some articles about it, studies, etc... I realized that there are probably a lot of other things effecting him (which seem common on this site so I am happy to have found you.)

Sorry, I'll get to the point so that you can properly meet us and provide any assistant and thoughts you might have. I have been keeping a spreadsheet and update it daily. It is available via this link: http://1drv.ms/OsRKXV. (a more condensed version is attached.) Feel free to look at the spreadsheet as the original is ALWAYS on my computer - this link is for people that might be able to help me and are interested (so that I don't need to update friends when I could instead get some sleep.) (If I should upload it here, please let me know and I will. I will attach it too.)

The linked spreadsheet has many pages. (the attached only has the first two)
-The first page is a chart that lists out his glucose numbers on one axis and a secondary access for his insulin.. with the horizontal date line matching so that I can see any trends.
-The second page is a highlight of just the last week.... as it really has only been about a week and a couple days since I've been able to maintain him so I wanted to look more closely at exactly what I'm doing during that time in order to help predict the best ways I can keep him as consistent as possible within a 40-130 glucose state. I've found that if I keep the dose under 1.5 (meaning even 1.4 or 1.3... he doesn't get below 40... YAY!!! And if he ever does... he eats and life is good again.
-The third page is the reporting page where all the information is placed and then feeds into the other page charts.
- The fourth page is only his insulin numbers (fed from the reporting page)
- The fifth page is only his glucose numbers (fed from the reporting page)
-The last two pages are either old information that is being fed still to some charts, as I've been learning a lot more about excel and making it better, or trying to figure out if I can see a pattern that I am missing so I add additional pages to give myself the ability to check things out without ruining my data.

I'm not sure what to ask, except... any help or information you can provide would be GREAT! It is killing me that his need of insulin ranges from what looks like 8-15 hours. I am hoping to better predict so that I can go out to dinner with friends or schedule my cat sitter which is also a vet tech to inject him if I have to leave town.

Thank you in advance, and I look forward to learning more and eventually helping people so that their fur babies don't have to live the consequences of lack of information like my little baby did.

Fur Mom - Jenn
Sugar Feline - Hobbs (almost 16 years old)
9.5 lbs
Diagnosed 2.18.2014
Tight Regulation
Lantus 1.25 every
Food Now - Feline's Pride and Hill's Rx A/D
UPDATE as of 3.24.2014: Attached is a new spreadsheet in FDMB format and the link is still active http://1drv.ms/OsRKXV)

 

[Larry and Kitties]

- You said "The Lantus DOESN'T seem to work for 24 hours.. ". That is correct. Almost all cats need two shots a day. From your data are kinda doing that but not dosing about every 12 hours. When you dose seems to vary
- You have occasionally getting low mid-cycle GB like 45, 84, 71. That for me would be indicate a does reduction.

 

[blu]

As mentioned, the Lantus should be given every 12 hours. I'm sure some more experienced folks will be responding soon with more information on that and other insulin advice, I'm not an expert ... but yes, 12 hour dosing is pretty standard.

I don't think you should give him the "people" B-12 until you check it carefully. It HAS to be the form of B-12 called methylcobalamin. Also, sweetners like xylitol are common in human supplements but are toxic to cats. For injectable B-12, I have no clue but would be wary. There are a couple commonly used B-12 supplements people seem to use on this board. A common one is Zobaline : http://www.ilifelink.com/zobaline-for_d ... blets.html

Zobaline is made for cats and is what I am using and it is an extremely soft pill so you can just pinch it between your fingers over some wet food and it turns to powder. No need to pill a cat (thank goodness - dreaded chore).

I think it's great that you are researching and delving into this site. It really helped me.

 

[Larry and Kitties]

Why do you think you need B12? Methylcobalamin B12 is used for neuropathy caused by high BG numbers. Typically oral is used. Cyanocobalamin B12 is used for intestinal issue like CFF or IBD since the body sometimes does not produce enough. Typically the injectable one is used. Human or vet stuff is used, the vet stuff is less expensive.

 

[Elizabeth and Bertie]

Hello, and a very warm welcome to you, Hobbs, and Calvin. :smile:

You've found the best site on the planet for help with feline diabetes.
There are a lot of experienced Lantus users here too, and I'm sure they will be able to help you.

Welcome aboard,

Eliz

 

[BJM]

Lantus needs to be given in equal doses every 12 hours, or as close to it as possible. You would do better to cut the dose in half, then give that every 12 hours. That way, the doses can overlap, and keep the glucose at a more steady level.

The lowest point between the shots is called the nadir. That level determines if the dose needs to be increased or decreased. Once you are shooting twice a day for 3 to 5 full days , getting tests around the nadir - about +5 to +7 hours after the shot - will let you determine what adjustments may be needed.

For food recommendations, Cat Info is a terrific resource written by veterinarian Dr Pierson who has studied feline nutition. The food list there will let you see if your food choices are less that 10% calories from carbohydrates (hint: A/D is higher than 10%)

 

[HobbsMom]

- You said "The Lantus DOESN'T seem to work for 24 hours.. ". That is correct. Almost all cats need two shots a day. From your data are kinda doing that but not dosing about every 12 hours. When you dose seems to vary
- You have occasionally getting low mid-cycle GB like 45, 84, 71. That for me would be indicate a does reduction.

... Thank you soooo much for your reply. So, if you don't mind, what range are you looking for? I thought the goal range was between 40-130. Calvin, his brother, who we can't 100% say is healthy but is currently not showing any symptoms and whose blood tests show all within the healthy range... I use as my control. His numbers are consistently between 40-100. When I test to see if I can get on a 12 hour cycle... Hobbs'b numbers get out of range. I'm starting to see a pattern that he averages 10 hours (when injected during the normal day or night), but when injected in the early evening, evening hours... his need for another injection is around 8.5. Do you know this as normal... especially since we are only a month old at this point?

 

[HobbsMom]

Lantus needs to be given in equal doses every 12 hours, or as close to it as possible. You would do better to cut the dose in half, then give that every 12 hours. That way, the doses can overlap, and keep the glucose at a more steady level.

The lowest point between the shots is called the nadir. That level determines if the dose needs to be increased or decreased. Once you are shooting twice a day for 3 to 5 full days , getting tests around the nadir - about +5 to +7 hours after the shot - will let you determine what adjustments may be needed.

For food recommendations, Cat Info is a terrific resource written by veterinarian Dr Pierson who has studied feline nutition. The food list there will let you see if your food choices are less that 10% calories from carbohydrates (hint: A/D is higher than 10%)

... Thank you sooo much for your reply. When I cut the dose, and I mean by only 1/4iu... he begins to spike at 6-8 hours (versus when I would normally expect the nadir, right?) With 1.25iu he needs injection between 8-14 hours... averaging 10.5 hours when injected in the night or day, and when given in early evening or evening he seems to average needing a dose at 8.5hours. (Because the range is soooo vast I've been trying to figure out what other elements are at play.) When I increase to 1.5iu he drops below 40... consistently, so I do all I can to stay away from that amount. (The little fur ball is giving me a run for my money. If I need to go somewhere for a longer period, I am learning to dose him less... calculate the times it will run out so that I can dose him about an hour before he'll get out of range... and leave without worry for about 8 hours.)

I'm trying to figure out the proper amount of overlap for him... as I would LOVE to avoid his spikes (except when he is playing, of course.) I'll read more about it and right now assume I'm overlapping by about an hour based on his blood glucose numbers +1, +2, etc after injection.

We are only a month into this... is it right for me to think that his body is still in the settling stage? (I can say in just the last week and even the last 72 hours, he is acting more like the cat I know him to be. He and his brother are walking around the house, he's joining me when I'm on the computer, snoring in his drawer (I do LOVE that)... but still, not as consistent as I'd like.

 

[HobbsMom]

Hello, and a very warm welcome to you, Hobbs, and Calvin. :smile:

You've found the best site on the planet for help with feline diabetes.
There are a lot of experienced Lantus users here too, and I'm sure they will be able to help you.

Welcome aboard,

Eliz

...

Thank you!! I think you are right ))

 

[HobbsMom]

As mentioned, the Lantus should be given every 12 hours. I'm sure some more experienced folks will be responding soon with more information on that and other insulin advice, I'm not an expert ... but yes, 12 hour dosing is pretty standard.

I don't think you should give him the "people" B-12 until you check it carefully. It HAS to be the form of B-12 called methylcobalamin. Also, sweetners like xylitol are common in human supplements but are toxic to cats. For injectable B-12, I have no clue but would be wary. There are a couple commonly used B-12 supplements people seem to use on this board. A common one is Zobaline : http://www.ilifelink.com/zobaline-for_d ... blets.html

Zobaline is made for cats and is what I am using and it is an extremely soft pill so you can just pinch it between your fingers over some wet food and it turns to powder. No need to pill a cat (thank goodness - dreaded chore).

I think it's great that you are researching and delving into this site. It really helped me.

.. thank you sooo much for your reply. Methylcobalamin.. AWESOME to know!! Thank you!! and a soft pill.... ohhhh what a TREAT! (crazy how the little things make such a difference now ) that doesn't have extra stuff that will kill him... perfect!! I will definitely go for that (it will be nice to trust something than having to do research from scratch ) Best to you and your Sugar baby

 

[HobbsMom]

Why do you think you need B12? Methylcobalamin B12 is used for neuropathy caused by high BG numbers. Typically oral is used. Cyanocobalamin B12 is used for intestinal issue like CFF or IBD since the body sometimes does not produce enough. Typically the injectable one is used. Human or vet stuff is used, the vet stuff is less expensive.

.. Hobbs lost a LOT of muscle mass and we are trying to put it back on him. I was under the assumption that potassium would help with that - but in stead potassium is helping his liver... and still want to make certain I have what he needs to build back his muscle (that's also why we are keeping him on a mix of raw and Hills Rx a/d.. because we wanted to build his little body back up again. PLEASE if I am not understanding something - please help correct my thought process... that's why I'm here ))

 

[Larry and Kitties]

You asked
... Thank you soooo much for your reply. So, if you don't mind, what range are you looking for? I thought the goal range was between 40-130. Calvin, his brother, who we can't 100% say is healthy but is currently not showing any symptoms and whose blood tests show all within the healthy range... I use as my control. His numbers are consistently between 40-100. When I test to see if I can get on a 12 hour cycle... Hobbs'b numbers get out of range. I'm starting to see a pattern that he averages 10 hours (when injected during the normal day or night), but when injected in the early evening, evening hours... his need for another injection is around 8.5. Do you know this as normal... especially since we are only a month old at this point?

40 is too low for a ct on insulin. Ideally you would like between 80 and 130 with insulin. However, that is not always achievable, I would say that is seldom achievable. So you error on letting the BG go higher than 130 vice lower than 80.

 

[BJM]

...... Thank you sooo much for your reply. When I cut the dose, and I mean by only 1/4iu... he begins to spike at 6-8 hours (versus when I would normally expect the nadir, right?) With 1.25iu he needs injection between 8-14 hours... averaging 10.5 hours when injected in the night or day, and when given in early evening or evening he seems to average needing a dose at 8.5hours. ...

Lantus has overlap and the effects build up over 3 to 5 days, so you can't determine what is the best dose based on 1 shot. You have to hold a dose steady for 3 to 5 full days, then test during the nadir period to see how low he is going. And, better too high for a day than too low for a moment. The half dose suggestion was to get him stable on 2 shots a day, then work up from there, rather than going with a higher dose and trying to titrate down, as that could set you up to overdose him. We have a tight regulation protocol for using Lantus here. Please read it over carefully, then ask what questions you have.

 

[Wendy&Tiggy(GA)]

Any chance you can add a tab to your sheet thats in our format? It would really help us be able to glance and advise on whats going on : http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

key thing I see right now is your shot time. Try and shoot every 12 hours give or take 30 minutes. Lantus works best that way. Otherwise if you shoot early it acts as an increase , or shoot late it acts as a decrease - and messes everything up so you don't know how well that dose is working. If you do have a schedule that means you can't make it - then see if you can plan accordingly - you can move the shot back or forward in time by 30 minutes a day.

Allowing for the fact you are moving the shot time around too much, I think I would drop him to 1unit for a few days and see how it goes - he went under 50 and that means dose is too high - reduce by 1/4 unit.

Wendy

 

[HobbsMom]

- You said "The Lantus DOESN'T seem to work for 24 hours.. ". That is correct. Almost all cats need two shots a day. From your data are kinda doing that but not dosing about every 12 hours. When you dose seems to vary
- You have occasionally getting low mid-cycle GB like 45, 84, 71. That for me would be indicate a does reduction.

I've reduced his dose for the last three injections and so far he's needed another dose at +9:13 and another at +12... which is GREAT... meaning that his ranges are getting closer. (Since you already gave me an inch, would a pen be a better bet for making certain I am getting the small doses this accurate or eying a syringe that breaks into 1/2ius... is just the way we must do it?)

 

[HobbsMom]

Any chance you can add a tab to your sheet thats in our format? It would really help us be able to glance and advise on whats going on : http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

key thing I see right now is your shot time. Try and shoot every 12 hours give or take 30 minutes. Lantus works best that way. Otherwise if you shoot early it acts as an increase , or shoot late it acts as a decrease - and messes everything up so you don't know how well that dose is working. If you do have a schedule that means you can't make it - then see if you can plan accordingly - you can move the shot back or forward in time by 30 minutes a day.

Allowing for the fact you are moving the shot time around too much, I think I would drop him to 1unit for a few days and see how it goes - he went under 50 and that means dose is too high - reduce by 1/4 unit.

Wendy

Wendy - absolutely re the spreadsheet... I'll look at your format and add a page. (I did this without knowing people's formats so I'm sorry for that.) I have been trying to get him to a 12 hour shot time, but each time I do... he shoots into bad numbers super quick. Either WWWAAAYYY too high or wwwaaayyy too low. (I've been trying to figure this out with just what I could find online and reviewing the feedback from the chart so NOW listening to you guys... hopefully we'll get there in a couple days ) As of Saturday, I moved him to 1.1 (based on users feedback - THANK YOU ) and so far the window range has reduced to 3 hours versus the crazy 8 when he was 1 or 1.25... I didn't realize that 50 was too low as his brother usually keeps a low range. I was thinking 40-130 was good.. but knew at anything less than 45 I made CERTAIN he ate (giving him his regular food... and testing versus giving him anything sweet which would just throw his little fur body totally off.) Okay.. so for diabetic felines on insulin and raw food... we want to think that before 50 isn't good... I can TOTALLY do that!

Your input has been priceless. I'll work not the spreadsheet today and keep you informed. (What can I do to begin paying it forward? I'm telling people about you guys and helping people that live near me learn about the food issues... but I feel like that's not enough. It's crazy how much I didn't know 1 month ago, and how when I look back in two weeks I'll realize how little I actually knew now. )

 

[HobbsMom]

...
For food recommendations, Cat Info is a terrific resource written by veterinarian Dr Pierson who has studied feline nutition. The food list there will let you see if your food choices are less that 10% calories from carbohydrates (hint: A/D is higher than 10%)

Oh shoot! I just reread but actually HEARD this.... a/d is higher than 10%... that's a problem. I knew a/d wasn't going to be long term, mainly to get this muscles and body back... so I will look more at that. I know my Feline's Pride is the % he needs... GREAT information. Sorry I missed that the first time (was sooo focused on the Lantus.) (So Hills Rx is about 15.3%.... GREAT to know!!) I'm SOOOOO happy I found you guys. I don't feel as alone AND I keep replaying that SugarCat letter to mom that was posted in 2010... cracks me up and makes me keep a really great attitude about this whole thing (Especially the part about being hot... it's just how they are sometimes )

 

[Suzanne & Cobb(GA)]

I've reduced his dose for the last three injections and so far he's needed another dose at +9:13 and another at +12...

Just to be clear...you aren't giving him insulin at +9 and +12, are you? You're only doing two shots a day, right?

 

[HobbsMom]

...... . We have a tight regulation protocol for using Lantus here. Please read it over carefully, then ask what questions you have.

thank you sooo much. I've been looking for that! THANK YOU!!! (and I didn't know about it's staying power of 3-5 days because it seemed as though when asked to test at +5 or +7 sometimes those were his high peaks.... I'll read which will be great as it will lessen my questions

 

[HobbsMom]

I've reduced his dose for the last three injections and so far he's needed another dose at +9:13 and another at +12...

Just to be clear...you aren't giving him insulin at +9 and +12, are you? You're only doing two shots a day, right?

--- Yes, he's getting between 2 and 3 shots a day spread out depending on his glucose curve. For example, his bg#s showed that he needed 1.1iu at 12 hours, then before that 9hr13min, then before that 12hr25min, then before that 9hr41min, before that 6hr 25 min, 9hr 51 minutes, 9 hours 04 minutes.... I"m testing to see where he's at... if he's over 130 and it's over 8 hours since 1iu I'll give him his next dose(either 1.1 now or 1.25 before I moved him down a little 3 doses ago.) I've been doing this because when we started it seemed as though his blood glucose curves were a LOT shorter than anything I was reading or heard from my vet. The insulin effected his glucose within an hour and his nadir is sometimes at +3 or +4 hours, instead of the +6 or later. This is what's kicking us... I've been trying to figure out what he needs based on his glucose curve and trying to keep it consistent. If I wait for 12 hours between a shot, he quickly gets up to the 300+... but if I move the dose according to his numbers, his blood glucose curve seems to be more stable, less erratic.. keeping him away from highs and lows. (He seems to match more of his brother who doesn't have diabetes numbers.)

By shooting him and testing him this way, I've been able to maintain him in an average healthy range for more than a week now (which is incredible to me because he started at 661 and I wasn't able to get him to anything that was even close to healthy for over a week. In the last 12 days I've been able to keep him away from any number higher than 331 and the only times he's above normal is close to injection time (or super stress when some workers were in my house.. causing him to freak, which is normal for him when big people are banging around.) He's at normal ranges more than 80% of the time but I'd really LOVE to figure out how much he needs on a consistent basis.

Your feedback has been priceless. I TRULY appreciate ALL your help!

 

[Suzanne & Cobb(GA)]

Ok, Lantus is based on the lowest point of the cycle, not the preshot tests. He shouldn't be getting more than 2 shots of Lantus a day. The onset of the insulin takes a few hours, so if you're seeing a drop within an hour, it is from the previous dose, not the dose you've just administered. The goal when you're on Lantus is to find a dose that you give every 12 hours. By giving more, he is possibly getting too much insulin. Too much insulin can have the same effect as not enough insulin (counterintuitive, I know). But he could be overdosing on insulin since you're giving it 3 times a day sometimes.

A curve by definition is 12 hours. If the insulin doesn't last that long then the insulin dose isn't high enough.

Moving the time of the dose before 12 hours acts as an increase. Waiting longer than 12 hours acts as a decrease. Because you're shooting all over the place, there's no way to tell how the dose works.

You really need to pick a dose, shoot it every 12 hours (no sooner), and hold that dose for 5-7 days. By shooting more often, his depot is going up and down and while it looks like his numbers are in the normal range, it is confusing his body.

Have you read the TR protocol BJ posted? It shows a normal Lantus curve. It is okay to have numbers going up and down. Your goal is to keep them as normal as possible, but Lantus isn't the right insulin to be shooting more than twice a day.

 

[Wendy&Tiggy(GA)]

Ok heres the thing - don't give him more than 2 shots a day - every 12 hours. I know he goes to 300 but if you let lantus do its job and give it time and do it properly.. it will work out better! you will then be giving it a chance to settle and will see better numbers in the longer term.

The problem is that Lantus is a depot insulin and when you see a high number and shoot more insulin you won't actually seeing the effect of that increase insulin for at least a day or two.. the three times a day dosing and late times are messing him up big time.

try it twice a day and you should see him get more stable - maybe even into remission if you allow the protocol. Otherwise you are likely setting him up for chronic bouncing .. indefinitely.

Wendy

 

[BJM]

The Insulin depot.

 

[HobbsMom]

Any chance you can add a tab to your sheet thats in our format? It would really help us be able to glance and advise on whats going on : http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

key thing I see right now is your shot time. Try and shoot every 12 hours give or take 30 minutes. Lantus works best that way. Otherwise if you shoot early it acts as an increase , or shoot late it acts as a decrease - and messes everything up so you don't know how well that dose is working. If you do have a schedule that means you can't make it - then see if you can plan accordingly - you can move the shot back or forward in time by 30 minutes a day.

Allowing for the fact you are moving the shot time around too much, I think I would drop him to 1unit for a few days and see how it goes - he went under 50 and that means dose is too high - reduce by 1/4 unit.

Wendy

Hi Wendy,

Thank you sooo much for your reply.

I added a tab to my sheet and attached just the FDMB format here. (Size constants - full sheet still at Skydrive link: http://1drv.ms/OsRKXV.) Where I seem to get the MOST stuck (although this site is going to help me immensely is where I did last night.) Yesterday at noon was the 3rd time I injected with 1.1iu Lantus versus the 1.25 I've been doing on average for a week. At the 12 hour point he was 37 (the lowest he's been that day and only once before low like that in a week) and then, on his own with a little Feline's Pride and a/d got to 133 at 6:30am which was 18 hours past the 1.1iu injection. I, of course, didn't inject him when he was at 37... or at +14 when he was 55 or +16 when he was 92... or +18 when he was 133 (as I wanted him to get food before the insulin and check to see if it was going up or down.) 1/2 hour later he was 138 so I gave him 1.1iu to keep the dose as consistent as possible since reading the 3-5 day rule. Is it me, or is Hobbs' body doing something different than we would expect?

I've also read a bunch and don't understand two seemingly major things:

(1) the Tight Regulation I read, http://yourdiabeticcat.com/protocol.html - which I saw before I found you guys, said to keep between 40-130, if you can. Since I am able to monitor him like crazy, that has been my goal (Also his brother, my 'control' ranges before 80 on average. I don't understand why we goal at 80-130... which is 30 higher than a healthy cat's range? even though we are supposed to be naturally supplementing his insulin. And...

(2) I don't understand why the charts color codes in groups of 100... making it look like 100 is just as bad as 130 or 180 or 199... I thought that after 130 is when their bodies start reacting negatively... and then no doubt it gets worse at 250, then even worse over 300... and by the time you are over 400... it kind of is as bad as the 500s...

I know you've already been incredibly helpful and that I'm asking for a foot even though you gave me one already. I would truly appreciate your help.. and hope the chart makes it easier to review Hobbs through the format we use here (Thank you again for sharing that.)

 

[HobbsMom]

The Insulin depot.

Thank you sooo much for this. When I started seeing Hobbs' numbers and reaction to Lantus not seeing 'normal' I did some research and found some research articles on the small population that seems not effected by the "long lasting" agent. Their were also articles on the effects of hyper and hypo thyroid humans. Of course, Hobbs would no doubt be considered hyper since a cat's metabolism is double that of humans and dogs. And since he's always maintained a weight of approximately 9.5lbs, I assumed that he even had a good or healthy metabolism as compared to other felines.

HOWEVER, I am learning sooo much more and am trying to do all I can to keep him on a 12 hour cycle... except last night for example when he was low... so I had to wait +18 hours until he reached 138 (133 a 1/2 hour before)... so as to not to harm him...

 

[Suzanne & Cobb(GA)]

The reason Hobbs' body is doing something different that what we'd expect is because his dose is all over the place. The depot in his body is constantly adjusting because he's getting shots more than twice a day, and not 12 hours apart. The insulin is overlapping, giving him numbers too low to shoot. Lantus is a longer acting insulin, so you need to give it time to do the work. The reason it might cut out at +8 could be because the dose isn't high enough. Instead of giving another shot, wait another 4 hours. The numbers will be higher at that time but it will give you, and advisers here, the right data so you can find the right dose that will last 12 hours.

37 is way too low for a diabetic cat. If you're using an AlphaTrak meter, it is WAY too low. You want him above 50 on a human meter (80 on AlphaTrak), otherwise you're risking a hypoglycemic episode. Hypo can kill...quickly. Higher numbers are safer in the short term. A diabetic cat's numbers should not be as low as a normal cat. It is very risky. You goal between 80-130 to keep him safe.

(2) I don't understand why the charts color codes in groups of 100... making it look like 100 is just as bad as 130 or 180 or 199... I thought that after 130 is when their bodies start reacting negatively... and then no doubt it gets worse at 250, then even worse over 300... and by the time you are over 400... it kind of is as bad as the 500s...

The colors are to show patterns and account for meter variance. The FDA allows for a meter can be up to 20% off...meaning a reading of say, 250 can really be anywhere between 200 and 300. The individual number isn't as important as the pattern you see. If you look at Cobb's spreadsheet (disregard the dosing, he has an undiagnosed high dose condition - soon to be diagnosed), you'll see his numbers start in black and as I have manipulated the dose, it shows more red, then pink, yellow and now we're seeing more blue with some hints of green. You see the pattern of the dose getting better.

The pros to home testing definitely outweigh the cons, but one con is that we want to bring those higher numbers down immediately, and if we aren't following the protocol and shooting every 12 hours, that could get our kitties in trouble and possibly kill them. Lantus is not the right insulin to immediately change the numbers. It slowly steers the numbers downward.

Since Hobbs dropped so low, you need to drop your dose. He earned a reduction. Others will weigh in, but if he were my cat, I would cut his dose to .75, ONLY give it at 12 hour intervals, and hold it for a week. Since he dropped so low, he will most likely bounce into higher numbers. This is completely normal. It happens when a cat's body reacts to low numbers and releases counter regulatory hormones to prevent a hypo. Don't take those numbers as a sign that you should increase his insulin. It can take up to 3 days to clear a bounce. The reduced dose will also give Hobbs' depot time to drain so you can really get a grasp on how much insulin he needs.

Please keep asking questions. Hobbs' safety is most important to us!

~Suzanne

 

[Elizabeth and Bertie]

...I've also read a bunch and don't understand two seemingly major things:

(1) the Tight Regulation I read, http://yourdiabeticcat.com/protocol.html - which I saw before I found you guys, said to keep between 40-130, if you can. Since I am able to monitor him like crazy, that has been my goal (Also his brother, my 'control' ranges before 80 on average. I don't understand why we goal at 80-130... which is 30 higher than a healthy cat's range? even though we are supposed to be naturally supplementing his insulin.

Hi,

The tight regulation protocol at 'yourdiabeticcat.com' is not the same as the protocols used on this forum. The 'yourdiabeticcat' protocol is one developed by Dr E Hodgkins. Insulin is usually given 3 times a day and doses vary on a sliding scale according to the preshot blood glucose level.
The sliding scale method of dosing can actually work well with some insulins and in some cats (mine for example); but the general experience here is that Lantus works best with consistent dosing given every 12 hours. This is also the view of Aussie vets Roomp and Rand who worked quite a lot with Lantus.

And the reason that the blood glucose level is allowed to go lower at 'yourdiabeticcat' is because of a belief that is held there; ie, that a cat on a low carb wet diet cannot suffer adversely from hypoglycemia. It's not true.

 

[HobbsMom]

I've reduced his dose for the last three injections and so far he's needed another dose at +9:13 and another at +12...

Just to be clear...you aren't giving him insulin at +9 and +12, are you? You're only doing two shots a day, right?

Cobbs... one letter away from Hobbs... are they soul mates???

 

[HobbsMom]

The reason Hobbs' body is doing something different that what we'd expect is because his dose is all over the place. ...

Please keep asking questions. Hobbs' safety is most important to us!

~Suzanne

Is it okay to say that I think I am in LOVE with you! This is SOOO helpful. I have been figuring out all this on my own and research as my vets, friend's vets, etc... have been of no help (well vet a little but mainly their admission that he was acting different than others, even though they though Lantus was a 24 hour insulin for felines,- before I started testing at home... that's why you'll see the spreadsheet in the first couple weeks is soooo messed up...then I really took charge (as much as I could thinking it was better than the results we were seeing) and started getting his numbers down and read tons of medical studies.) Since Friday I've altered his treatment according to the input I'm getting here, dropping him to 1.1iu... but still haven't been able to do every 12 hours... as you will see this morning when he was supposed to get his +12 shot at midnight his numbers wouldn't allow it... so I didn't inject him until his numbers, I thought, told me it was safe at 6:30am.

Soooo.... even though I dropped him to 1.1iu on Saturday morning (just a smidgin under the 1 mark on my 1/2iu marked string), I should still drop him to .75?...(just breathing calmly and saying mantras when his BG jumps up.... until the 12 hours... he looks so horrible at high BGs... I hate the way his eyes look... (but I can do whatever is best for him and breath through it).. to help his little body get more stabilized? He's 9.5lbs which is 4.3kg and I believe the standard dose protocol is .25iu per kg so that means that 1.075 per dose which is why I've been.) I can start that today at 6:30pm... (should he have high blood glucose as I don't inject when his numbers are lower than 130.... (you can see how I tried but unfortunately haven't stabilized him.)

I also checked my meter with two of my vet's meters, one hand held one and one they use in the back that is supposed to be more accurate. So far I've checked it at least 5 times and it's been either on the button or 3 away. (It is a human meter, OneTouch... which is QUITE expensive, but I'm afraid to change meters until I can make certain it's calibrated with my vet or working properly. Before OneTouch I went through 3 meters that were all showing HUGE disparities... so that really freaked me out.)

Attached is his numbers in FDMB format since the beginning and a 7 day chart to see his progress so far.

THANK YOU! THANK YOU! THANK YOU! THANK YOU!

and especially for the patience of helping save him!

Jenn

 

[Suzanne & Cobb(GA)]

A lot of vets aren't up to date when it comes to FD. Most of us see our vets for the annual visit and to get prescriptions renewed. We don't send them curves or ask them about dosing changes. I also had to take charge and I've been doing it without my vet since November. I'm actually switching vets this weekend.

Since Friday I've altered his treatment according to the input I'm getting here, dropping him to 1.1iu... but still haven't been able to do every 12 hours... as you will see this morning when he was supposed to get his +12 shot at midnight his numbers wouldn't allow it... so I didn't inject him until his numbers, I thought, told me it was safe at 6:30am.

Since you shot him at 6:30 this morning, you'll want to shoot him at 6:30 this evening. Can you stick to a 6:30/6:30 schedule? If not, we can help you manipulate your shot times to when it is most convenient, without losing momentum on the insulin as moving the shot time can act as a dose increase or decrease. Stick to every 12 hours. Resist the urge to give more insulin! :smile:

Soooo.... even though I dropped him to 1.1iu on Saturday morning (just a smidgin under the 1 mark on my 1/2iu marked string), I should still drop him to .75?...

Yes, he earned his reduction by dropping so low. While the drop was probably because of the extra insulin in his system, he earned it. You may have to increase later on, but don't increase when you see him bounce. It can take 3 days to clear a bounce so he might stay in higher numbers for a few days. His liver has to learn those low numbers are okay. My Cobb is still bouncing on the dose he's on right now and he's been on it for a few weeks. He dips and bounces, rinse and repeat. Eventually (hopefully) his liver will learn those low numbers are safe. Just keep breathing through those high numbers for the next few days.

Regarding meters...a lot of us use Walmart's ReliOn Confirm or Prime. They are pretty cheap and the strips can be ordered in bulk from americandiabeteswholesale.com. Your meter doesn't really need to be calibrated with the vets. If you're concerned, some people know their vet's meter reads 30 points higher, so if they send a curve to them, they know that and it is taken into account. Remember, vet stress can raise a cat's blood glucose by 100 points. That's one reason we encourage home testing. It is more accurate.

You can do this!! :smile:

~Suzanne

 

[HobbsMom]

...I've also read a bunch and don't understand two seemingly major things:

(1) the Tight Regulation I read, http://yourdiabeticcat.com/protocol.html - which I saw before I found you guys, said to keep between 40-130, if you can. Since I am able to monitor him like crazy, that has been my goal (Also his brother, my 'control' ranges before 80 on average. I don't understand why we goal at 80-130... which is 30 higher than a healthy cat's range? even though we are supposed to be naturally supplementing his insulin.

Hi,

The tight regulation protocol at 'yourdiabeticcat.com' is not the same as the protocols used on this forum. ...

Ohhhh thank goodness. I was starting to this I was either an idiot or SERIOUSLY misbehaving. Ok... that makes me feel sooo much better. Thank you!

 

[HobbsMom]

A lot of vets aren't up to date when it comes to FD. Most of us see our vets for the annual visit and to get prescriptions renewed. We don't send them curves or ask them about dosing changes. I also had to take charge and I've been doing it without my vet since November. I'm actually switching vets this weekend.

Since Friday I've altered his treatment according to the input I'm getting here, dropping him to 1.1iu... but still haven't been able to do every 12 hours... as you will see this morning when he was supposed to get his +12 shot at midnight his numbers wouldn't allow it... so I didn't inject him until his numbers, I thought, told me it was safe at 6:30am.

Since you shot him at 6:30 this morning, you'll want to shoot him at 6:30 this evening. Can you stick to a 6:30/6:30 schedule? If not, we can help you manipulate your shot times to when it is most convenient, without losing momentum on the insulin as moving the shot time can act as a dose increase or decrease. Stick to every 12 hours. Resist the urge to give more insulin! :smile:

Soooo.... even though I dropped him to 1.1iu on Saturday morning (just a smidgin under the 1 mark on my 1/2iu marked string), I should still drop him to .75?...

Yes, he earned his reduction by dropping so low. While the drop was probably because of the extra insulin in his system, he earned it. You may have to increase later on, but don't increase when you see him bounce. It can take 3 days to clear a bounce so he might stay in higher numbers for a few days. His liver has to learn those low numbers are okay. My Cobb is still bouncing on the dose he's on right now and he's been on it for a few weeks. He dips and bounces, rinse and repeat. Eventually (hopefully) his liver will learn those low numbers are safe. Just keep breathing through those high numbers for the next few days.

Regarding meters...a lot of us use Walmart's ReliOn Confirm or Prime. They are pretty cheap and the strips can be ordered in bulk from americandiabeteswholesale.com. Your meter doesn't really need to be calibrated with the vets. If you're concerned, some people know their vet's meter reads 30 points higher, so if they send a curve to them, they know that and it is taken into account. Remember, vet stress can raise a cat's blood glucose by 100 points. That's one reason we encourage home testing. It is more accurate.

You can do this!! :smile:

~Suzanne

BTW- Good luck this weekend switching vets. I look forward to hearing your thoughts. I went to a different vet last year, came highly recommended because quite costly, and I wasn't happy with them AT ALL. At least this guy that I see now admits when they don't know and as I'm learning they are soaking it in. They are going to let me provide a Welcome to Feline Diabetes' kit. It will have a culmination of the information I've learned, websites, etc. and if the new Sugar parent writes me, I'll send them my spreadsheet... or any others that I learn about so that they can hopefully get in at least a FEW hours of sleep. I know nothing now except Lantus does NOT last 24 hours, food makes a HUGE difference, and know AT LEAST what to do when getting close to or in hypo... and read that Sugar Cat to a Sugar Mom story... changes everything

 

[BJM]

No need to calibrate the meter.

We suggest using an inexpensive human glucometer with pet-specific reference numbers. One many of us use is the WalMart Relion Confirm, or Confirm Micro, which is also sold at American Diabetes Wholesale as as the Arkray USA Glucocard 01 or 01 Mini (same manufacturer - Arkray USA). It uses a tiny blood droplet and the cost is significantly lower for test strips (like $0.36 each).

Comparing a human glucometer to a pet-specific glucometer is like reading temperature in Celsius vs Fahrenheit. Both are correct. You just need to know the reference ranges to interpret what the numbers mean.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

* * * * * * * * * * * * * * *​

Examples of using the chart:

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)

 

[Jill & Alex (GA)]

welcome to the FDMB, Jenn!
i'd like to make a few comments...

from the STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL:

"As of this writing, this protocol for tight regulation with Lantus or Levemir for diabetic cats is the only published protocol we know of. For the most part, the guidelines/suggestions made in this forum are for those who wish to follow this particular protocol or a slightly modified version. The guidelines are not intended to portray the ONLY ways you can use Lantus or Levemir. The guidelines listed are how to best use Lantus or Levemir when following this protocol. Please be aware there are other feline diabetes web sites on the Internet using different dosing methods /protocols successfully."

the Tight Regulation Protocol quoted by most of the responders on this thread is what they know... a method some on the FDMB use to work towards regulation and oftentimes remission. however, it's not the only method for using lantus. as you can see from Hobbs spreadsheet, Jenn is using a different approach which imho, is working quite nicely for Hobbs.

for another example: take a look at Alex's 2006 spreadsheet. the link is in my signature. click on the Lantus 2006 tab at the top of the page to view. this spreadsheet illustrates yet another "way" a cat was led into remission. in 2006 lantus was relatively new in the United States. we muddled our way through... doing the best we could. at that time we often stalled or skipped shots, sometimes adjusted doses based on preshot numbers, didn't always dose consistently, held onto doses for a week or two (sometimes more), didn't always shoot on a 12/12 schedule, etc. GASP!

today, most of you would call all those things "wrong". yes, they're wrong if you've decided to follow the Tight Regulation Protocol some in the Lantus TR ISG use, but not-so-wrong if you're simply "using Lantus" for your diabetic cat. if they WERE wrong, alex would never have experienced a remission of almost 3 years after only three months on insulin. and the thing is, alex is not the only one who achieved remission on what would be called unorthodox methods today. there's a long list of others who went OTJ in a similar fashion.

Jenn, like i mentioned, Hobbs spreadsheet is looking pretty darn good to me. if you have a real good feel for his response, i'd tweak your method rather than change it entirely by switching to a different protocol. personally, i don't like my own cat dropping into the 30s so that's probably where i would start tweaking with Hobbs.


O/T, but FYI:
in an effort to stay current, those offering advice on lantus might be interested in this document: i've been trying to update the Stickys in the Lantus TR ISG, but have not as yet completed the task. there are a few noteworthy changes such as the differences between AlphaTrak and human meters (roomp & rand have narrowed down the difference between a human meter and a meter for feline use to "about 18" in the target range (low range). Note: that's the low range only. with everything we know about the accuracy of meters, one could expect larger differences in higher ranges. see the explanation on page 254 of the document. they're stating a 30%-40% difference. another change is in regard to diluting lantus and levemir. if one reads carefully, there's a whole lot of interesting stuff in this document! :mrgreen:

 

[Libby and Lucy]

I have to agree with Jill. It appears that what you are doing is working very well for Hobbs. I think some tweaks could be advised, as she said probably to keep him out of the 30s for starts, but overall he looks really good.

Over the years we have seen a number of cats who do best with Lantus shots at less than 12 hour intervals, and some for whom a cycle longer than 12 hours works (especially when they are getting close to going off insulin). If you are comfortable that you understand his response and how to keep him in a good range (not too low), then use what you know.

 

[Elizabeth and Bertie]

...Over the years we have seen a number of cats who do best with Lantus shots at less than 12 hour intervals, and some for whom a cycle longer than 12 hours works... If you are comfortable that you understand his response and how to keep him in a good range...then use what you know.

I find this very interesting and also rather refreshing to hear...
I don't use Lantus but the majority of folks on this forum do seem to use Lantus; and something I see mentioned time and time and time again in posts is the need for 12/12 dosing.
I feel we could almost do with a thread (maybe on Think Tank..?) for folks on this forum who aren't dosing in the usual/typical fashion!

 

[Libby and Lucy]

don't get me wrong, I think our modified TR protocol is the best way to start. It has plenty of built-in safeguards to allow you to work safely toward getting your cat into a healing range quickly. Once they are in that range 24/7, the beta cells will often start to heal VERY quickly.

If you are shooting consistently at 12/12, you will be removing some variables, allowing you to learn your cat's patterns and responses to food and insulin. Once you learn those things about your cat, then you can take what you have learned to tweak your usage of the insulin to best fit your cat. It's hard to figure out the patterns if you have too many variables, like changing doses too often, changing food all the time, changing shot times. So do the homework up front and learn how your insulin works for your cat.

Usually the limitation is *us.* For a while, I really wished I could have shot KK at +10 consistently. Later, I wasn't even shooting every 12 hours. Unfortunately my schedule is not that flexible, so giving +10s would have meant also giving +14s in some cycles, and for him that would have made matters even worse. I kept with +12 because of the choices that were practical for me, that was the best one.

In Hobbs' case, things are a little different. Hobbs is already tightly regulated, so (IMHO) there is no reason to reinvent the wheel. She probably just needs some help tweaking what she already knows to help him stay there so he can heal.

Good discussion!

 

[HobbsMom]

welcome to the FDMB, Jenn!
i'd like to make a few comments...

from the STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL:

"As of this writing, this protocol for tight regulation with Lantus or Levemir for diabetic cats is the only published protocol we know of. For the most part, the guidelines/suggestions made in this forum are for those who wish to follow this particular protocol or a slightly modified version. The guidelines are not intended to portray the ONLY ways you can use Lantus or Levemir. The guidelines listed are how to best use Lantus or Levemir when following this protocol. Please be aware there are other feline diabetes web sites on the Internet using different dosing methods /protocols successfully."

the Tight Regulation Protocol quoted by most of the responders on this thread is what they know... a method some on the FDMB use to work towards regulation and oftentimes remission. however, it's not the only method for using lantus. as you can see from Hobbs spreadsheet, Jenn is using a different approach which imho, is working quite nicely for Hobbs.

for another example: take a look at Alex's 2006 spreadsheet. the link is in my signature. click on the Lantus 2006 tab at the top of the page to view. this spreadsheet illustrates yet another "way" a cat was led into remission. in 2006 lantus was relatively new in the United States. we muddled our way through... doing the best we could. at that time we often stalled or skipped shots, sometimes adjusted doses based on preshot numbers, didn't always dose consistently, held onto doses for a week or two (sometimes more), didn't always shoot on a 12/12 schedule, etc. GASP!

today, most of you would call all those things "wrong". yes, they're wrong if you've decided to follow the Tight Regulation Protocol some in the Lantus TR ISG use, but not-so-wrong if you're simply "using Lantus" for your diabetic cat. if they WERE wrong, alex would never have experienced a remission of almost 3 years after only three months on insulin. and the thing is, alex is not the only one who achieved remission on what would be called unorthodox methods today. there's a long list of others who went OTJ in a similar fashion.

Jenn, like i mentioned, Hobbs spreadsheet is looking pretty darn good to me. if you have a real good feel for his response, i'd tweak your method rather than change it entirely by switching to a different protocol. personally, i don't like my own cat dropping into the 30s so that's probably where i would start tweaking with Hobbs.


O/T, but FYI:
in an effort to stay current, those offering advice on lantus might be interested in this document: i've been trying to update the Stickys in the Lantus TR ISG, but have not as yet completed the task. there are a few noteworthy changes such as the differences between AlphaTrak and human meters (roomp & rand have narrowed down the difference between a human meter and a meter for feline use to "about 18" in the target range (low range). Note: that's the low range only. with everything we know about the accuracy of meters, one could expect larger differences in higher ranges. see the explanation on page 254 of the document. they're stating a 30%-40% difference. another change is in regard to diluting lantus and levemir. if one reads carefully, there's a whole lot of interesting stuff in this document! :mrgreen:

Wow... I feel really the love. What an amazing job you did with Alex and thank you. I'll read the document and already downloaded and looked at Alex's chart. (I'm still learning how to interpret - but WOW!!! Remission - AWESOME JOB! Hobbs is only a month old at the insulin/proper food/ hovering fur mom... so I truly appreciate your share.

Yes, I've been adjusting Hobbs to get out of the low as the 30s SCARE the JUNK out of me.. and him (and of course not understanding about depot until the last few days...). (ONe of the things I realized after his diagnosis is that he was in the low at least 2x a week... because he'd have seizures and that was the pee in his resting places.. .so even though he tested at 661. Finally I got a clue... had the meter and tested him (and we know they drop after a seizure) but that's when I started tying everything REALLY together. My goal has been to keep him away from 30s and no higher than 130s (except when play or other stressful things would increase it.)

Yesterday I dosed him at 6:30am and at 6:30pm he was 112, dosed him again and this morning at 6:30am he was 129. (In my book that's GREAT... but I'll check him again tomorrow or Thursday, every two hours, to REALLY see how it is (today we have maintenance people again and tomorrow is vet day... so the numbers won't be accurate. I might test every 2 hours after tonight's dose (and YES, I ALWAYS test before the dose and don't give him any if his numbers are lower than I would like.)

BUT now I guess I have this question. HOW do you know when he's entering remission? AND how do you help him when he is getting there??? (My thought is that when his numbers are w/in the normal range, I start lowering the dose... and if he stays consistent... that means he IS going into remission... and eventually that means the dose will be reduced... and if he starts coming back.. I'll know and be adjusting accordingly (understanding now about depot.) And then... should I start a new post??? (Still learning protocol and don't want to misbehave.) (I also really liked how you separated the weeks out. Because of Hobb's previous shots - I needed to alter the chart to allow for more hours after each dose - so instead of one a day, each line is a dose line. I hope that's okay for everyone and I changed the color to a light green for below 40.)

MEOW from Calvin and Hobbs - thank you sooo much! To EVERYONE!!!! I am TRULY TOUCHED!!!

 

[BJM]

Its the nadir that is most important; the pre-shot is of secondary concern.
Keep him above 50 mg/dL at nadir. When you get something below that, decrease the dose by 0.25 units and stick with it a bit to see how it settles out in 3 days or so, before tweaking again.

As insulin needs go down, so does the dose. When you start getting to o.25 unit doses, or drops of insulin, you can pull back to twice daily, and if your schedule permits it, chasing the numbers until they are high enough to shoot safely.

At some point, you do an OTJ trial where you monitor, but don't shoot unless over 150 mg/dL or so.

 

[HobbsMom]

Its the nadir that is most important; the pre-shot is of secondary concern.
Keep him above 50 mg/dL at nadir. When you get something below that, decrease the dose by 0.25 units and stick with it a bit to see how it settles out in 3 days or so, before tweaking again.

As insulin needs go down, so does the dose. When you start getting to o.25 unit doses, or drops of insulin, you can pull back to twice daily, and if your schedule permits it, chasing the numbers until they are high enough to shoot safely.

At some point, you do an OTJ trial where you monitor, but don't shoot unless over 150 mg/dL or so.

AWESOME to know! Okay... so this protocol doesn't believe in shooting at less than 150 mg/dL even if is' at 12 hours. Or do you shoot at 112 and 129, like I did the last two days because he was new to 1.1 from 1.25 and I am trying to clear out the depot??? (sorry, I swear, I AM reading... just getting caught in some of the exceptions.) In the past (and yes, only a month at this) I would never shoot below 115... instead I used to chase it until it got close to or over 130... then dose. AND a smaller amount than I did previously b/c I didn't understand the depot and learning to adjust my methodology accordingly. (Being respectful though of his results so far.. getting him to blue and green more than 80% of the time, with blue at time of dosing.

 

[BJM]

Actually, if you follow the tight regulation protocol, you can shoot below 150. You need to have test data which shows it will be safe and be monitoring diligently the first times you do so to make sure the cat is OK.

And then there are the clients who don't test, take the cat to the vet, and the vets says drop the dose, its too high.

Or the gal I helped who couldn't test due to poor vision and arthritis. I went over to spot check and Dusty was all of 31 mg/dL! Obviously, no shot. I checked him several times that day; he never went above 130, so we held insulin for 2 weeks and he was off the juice (OTJ). (In a whopping 4 weeks)

 

[Jill & Alex (GA)]

BUT now I guess I have this question. HOW do you know when he's entering remission? AND how do you help him when he is getting there??? (My thought is that when his numbers are w/in the normal range, I start lowering the dose... and if he stays consistent... that means he IS going into remission... and eventually that means the dose will be reduced... and if he starts coming back.

your thoughts are correct. generally speaking, when following the Tight Regulation Protocol as described in the Lantus TR Forum on the FDMB, we lower the dose when kitty's numbers stay in the normal range for about a week or if kitty drops below 50 on a human meter. we repeat and continue the process until kitty can remain in mostly normal numbers on a drop of insulin. then we start an OTJ trial.

i am not well versed in the process/guidelines of the protocol you've been following. please check with the members of that web site who are following that protocol for specifics.

however, and i believe this is very important... i highly suggest picking a protocol and sticking with it. bouncing between two protocols, borrowing a little of this and a little of that from different places... imho, has the potential to set yourself up for disaster or at the very least... possibly hindering kitty's progress. every protocol has certain guidelines set up for a reason... to keep kitty safe while attempting to pull his BG numbers down. follow one protocol or follow another. please don't try following bits and pieces from various protocols.

FDMB members in the Lantus TR ISG are very familiar with the Tight Regulation Protocol described here: STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL
if you should choose to switch to that method.

 

[BJM]

You ask a question on your spreadsheet about the key - you're welcome to modify your key and format the cells based on your conditions.

I modified mine so I could see if the pre-shots were shifting to a lower range or not. and I have it flagging the 40-49 range with different color text so it alerts folks that when on insulin, being in the 40s can be dangerous, as you're approaching the levels at which some cats hypo. Aldo note that this is using a human glucometer in mg/dL.

'Nother note - glucometers are allowed to read within 20% of what a lab would get. That means any test represents a range of numbers from - to + 20%.
Ex
50 -> 'true' value falls between 40 to 60
100 -> 'true' value falls between 80 to 120
...
500 -> 'true' value falls between 400 to 600

 

[HobbsMom]

Glucose conversion chart...

I'm not sure if I already said this, but THANK YOU. I am rereading all the posts and taking notes so that I don't ask the same questions twice and believe that the more I read it, the more I am understanding it.

Thank you for this chart. It will be nice to change to a less expensive meter (fortunately someone had some test strips on ebay that are set to expire next month, so I order 200.

Do you have any idea how much leeway past the expiration people really have? (I have control solution from OneTouch but the range is just SOOOO great I prefer to have a more consistent (even if really inconsistency... if you know what I mean.)

 

[HobbsMom]

don't get me wrong, I think our modified TR protocol is the best way to start. It has plenty of built-in safeguards to allow you to work safely toward getting your cat into a healing range quickly. Once they are in that range 24/7, the beta cells will often start to heal VERY quickly.

If you are shooting consistently at 12/12, you will be removing some variables, allowing you to learn your cat's patterns and responses to food and insulin. Once you learn those things about your cat, then you can take what you have learned to tweak your usage of the insulin to best fit your cat. It's hard to figure out the patterns if you have too many variables, like changing doses too often, changing food all the time, changing shot times. So do the homework up front and learn how your insulin works for your cat.

Usually the limitation is *us.* For a while, I really wished I could have shot KK at +10 consistently. Later, I wasn't even shooting every 12 hours. Unfortunately my schedule is not that flexible, so giving +10s would have meant also giving +14s in some cycles, and for him that would have made matters even worse. I kept with +12 because of the choices that were practical for me, that was the best one.

In Hobbs' case, things are a little different. Hobbs is already tightly regulated, so (IMHO) there is no reason to reinvent the wheel. She probably just needs some help tweaking what she already knows to help him stay there so he can heal.

Good discussion!

Libby,

I don't know if I thanked you enough for your comments. Also, I knew I needed to get him to a healthy place to rebuild but giving me the term "beta cells"... thank you! I will definitely research more about this. If you have any suggestions, please link me up. Otherwise I tend to like to put as much information in my brain as possible so that I can sort well

Once again, THANK YOU SOOO much for caring about my fur baby. The insight from this site is SOOO helpful.

The next steps I'll be researching (and please feel free to direct me if you'd like) is find out HOW do I know he is going into remission and how do I support that? That way I know what he is looking for. We know he has had high blood glucose for less than 6 months... and I started treating him immediately dropping him out of what I call the "death zone"... blacks and reds, for the most part, after two weeks. Soooo of course, (as I must) I am hopeful his body will stay on my side and show that pancreas that producing insulin IS the RIGHT thing to do ) More of that, on it's own... and he will get as many fake mice and cat dancers and sticks with string as his little heart desires (AND Calvin too... because Calvin only knows I'm giving Hobbs attention... without a reason... so I am making certain I give Calvin as much love as I can to try and even it out from his point of view.)

Thank you! Please continue all the great work you are doing to help new bees like Hobbs and me.

 

[HobbsMom]

Actually, if you follow the tight regulation protocol, you can shoot below 150. You need to have test data which shows it will be safe and be monitoring diligently the first times you do so to make sure the cat is OK.

And then there are the clients who don't test, take the cat to the vet, and the vets says drop the dose, its too high.

Or the gal I helped who couldn't test due to poor vision and arthritis. I went over to spot check and Dusty was all of 31 mg/dL! Obviously, no shot. I checked him several times that day; he never went above 130, so we held insulin for 2 weeks and he was off the juice (OTJ). (In a whopping 4 weeks)

YAY! OTJ in 4 weeks... that's AWESOME!!!! AMAZING!! I LOVE hope!

 

[KPassa]

Welcome Jenn and Calvin and Hobbs! :YMHUG: (My most favorite comic of all time, btw. )

I'm jumping in late to this fantastic conversation and I think everyone has covered most everything for you guys already and you're in great hands here. :thumbup

Hobbs seems to do best when free fed versus set scheduled, so I keep the food in a shrimp cocktail like container set up that maintains being as cold as sushi bars. I also refrigerate it when I’m home if I notice they are sleeping and I’m attentive… as I’ll bring it out and usually to him to see if he’s hungry.

I just wanted to point you to this thread about feeding kitty as much as they want (within reason) that might give you a few more ideas regarding the food. Another thing many of us do here is add extra water to the wet food. This helps keep it from drying out and makes it last longer.

The next steps I'll be researching (and please feel free to direct me if you'd like) is find out HOW do I know he is going into remission and how do I support that? That way I know what he is looking for. We know he has had high blood glucose for less than 6 months... and I started treating him immediately dropping him out of what I call the "death zone"... blacks and reds, for the most part, after two weeks. Soooo of course, (as I must) I am hopeful his body will stay on my side and show that pancreas that producing insulin IS the RIGHT thing to do ) More of that, on it's own... and he will get as many fake mice and cat dancers and sticks with string as his little heart desires (AND Calvin too... because Calvin only knows I'm giving Hobbs attention... without a reason... so I am making certain I give Calvin as much love as I can to try and even it out from his point of view.)

There's no way to "know" he's heading to remission until he's actually in remission. Some kitties seem headed that way but then maintain on a miniscule dose for the rest of their lives. Other kitties just jump the gun and go straight from 1u twice a day to suddenly needing no insulin. You're already doing what is best for achieving remission by feeding a low carb food, monitoring his BGs, and giving him a great insulin. From that point, as BJ mentioned above, you start to lower the dose as necessary. Any time he drops below 50, that's a dose decrease. If he maintains good numbers on his current dose for a week, that's another time you attempt to decrease and see if it sticks. Over time, you continue decreasing till there's nothing left to decrease to and that's when you start what we call an "OTJ Trial" (Off The Juice Trial). If he's able to maintain numbers between 40-130ish with the majority in double digits for 14 days, then we consider the kitty in remission. It might even be that Hobbs is extra carb sensitive and the a/d food is what is currently keeping him from remission and you'll see his numbers drop further once that's out of the picture.

And yes, Calvin needs some loving, too. ;-) My Henry will often jump on my lap after I've finished testing Mikey because he feels left out of the testing process. Sometimes, I'll even test him, too. :lol:

 

[HobbsMom]

Hi everyone,

Just to give you a quick update. I've reduced him to .75 and he is on a 12/12 schedule (unless his numbers tell me to extend it or reduce it further.)

He seems to be doing better... and is looking at me like... Mom... sleep... so I'm going to listen to him

 

[HobbsMom]

Update: He is now reduced to .25 iu... and staying within green with one bump to blue (100) at the +12 mark. I'm holding back the dose because with his numbers... think best to withhold if he's entering remission than give him .25 which would make him hypo. I'll keep testing him, and if his numbers start rising... versus the surfing he's been doing... I'll give him the .25. If I understand protocol.. this is the right thing to do.

 

[BJM]

He looks very much like he is ready to go off the juice (OTJ).

The drop method of dosing:
fill a syringe to 0.5 units with some colored water.
Practice squeezing out equal sized drops until you can get the same number all the same size.
Then, when you want to dose drops, you can fill to 0.5 with insulin, then squeeze out what you need to lower the dose further.