Portia starting insulin tomorrow.Need advice on protocols

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portiarita

Member Since 2013
Hello all,
So I spoke to the vet and she has basically asked me to give portia Glargene (which is the generic form of lantus).Portia's BG range is between 275-350mg/dL at home right now and so she wants to start her on 1unit glargene/2 times daily.

Any advice on how often I should be testing glucose at home?Should I always test before giving her insulin? Feeding recommendations? etc. Im quite new to this and Ive got a lot of help from this group with home glucose testing so I would appreciate any input with insulin. I dont even really know what to ask so any additional thoughts/tips/suggestions would be greatly appreciated.

I will go and buy some syrup for hypo emergencies.

Rita
 
Re: Portia starting insulin tomorrow.Need advice on protocol

Welcome to FDMB.

Home glucose testing can help keep your ctat safe and alert you to intervene when needed.

Always test before you shoot.
- For beginners, do not shoot below 200 mg/dL (11.1 mmol/L) as measured by a human glucometer or 230 mg/dL (12.7 mmol/L) as measure by a pet-specific glucometer. As you collect mid-cycle test data, you will be able to slowly lower the no shot number.

The ideal dose is one which takes the cat no lower than 50 mg/dL (2.7 mmol/L) and otherwise keeps the glucose as low as possible. The expected low point, or "nadir" is roughly +5 to +7 hours after injection. Tests taken in that period are used to monitor and adjust dose following specific rules.
 
Re: Portia starting insulin tomorrow.Need advice on protocol

Lantus is a great insulin and 1u is a good starting dose. We have a Lantus Forum with "Stickies" at the top to help guide you through the process, which I've summarized for you below:
  • New to the Group?: General Info on Lantus, glucometers, syringes, dosing, what a typical Lantus curve might look like, food lists, etc....
  • Tight Regulation Protocol: dosing information.
  • Info, Proper handling, & Storage: syringes, pens vs. vials, etc....
  • Insulin Depot: explaining how the depot works and how Lantus and Levemir differ significantly in dosing from all the other insulins available (i.e. PZI/ProZinc).
  • Shooting and Handling Low Numbers: What to do when you see numbers under 200 when first starting out or 150 after you've been doing it for a while. Specifically for introducing the "shoot low to stay low" method of the Tight Regulation protocol. (I wouldn't worry about this one just yet.)
As for testing, I always try to get at least 4 tests minimum each day:
  • AM Pre-shot test to know if it's safe to give a shot
  • AM mid-cycle test, if possible (this one I sometimes skip because of work). It lets me know how the dose is working and how low Mikey might go
  • PM Pre-shot test to know if it's safe to give a shot
  • Before-bed test to see how low he might go overnight while I'm sleeping
All other tests, I consider them as more data points on how Michelangelo reacts to the insulin in that particular cycle, how food and/or activity affects his numbers, if he needs an increase or decrease in dose, how he might be handling a new dose, etc.... I basically play fill-in-the blank across the week and try to grab tests at different times across different days with a few repeats thrown in.

We recommend for new members to take up all food 2 hours before the next shot time so it doesn't influence the pre-shot number with a food spike and make you think Portia is higher than she really is. Over time, you'll soon pick up on Portia's BG reaction to food and you can be more lax. Other than that, most people here free-feed or feed frequent small meals (using timed feeders or freezing food into meatcicles) since that helps support the pancreas the best.

For food, what are you currently feeding Portia? I didn't see it mentioned anywhere in your past posts, but I might have missed it somewhere. Found it in your signature! Never mind. ohmygod_smile I'm not too familiar with the ZD or IBD, but I suspect that you can probably get away with some other OTC lower carb foods that are cheaper than the "prescription" swill and better for Portia. I would suggest you create a new post with a subject along the lines of "Diabetes and IBD food options?" as I know there are a few other people here with cats who have both as well.
 
Re: Portia starting insulin tomorrow.Need advice on protocol

Thank you both so much for your response and the great links! They were very helpful. Just to make sure I understand correctly, when I start the insulin tomorrow, I should
1) check her glucose prior to injection and make sure it is above 200
2) Feed her 1/4 can of food
3) Inject her with insulin
4) test her BG every 3 hours for 12 hours to obtain a glucose curve on insulin

I only need to do this on the first day. From the second day on, I will just do 4 measurement. 1 before her insulin in the am, 1 at 4-6 hours+, 1 before her insulin at pm and 1 before I go to bed.

Does this right? It sounds like for the first couple of weeks, I may not hit the target numbers (which is less than 200 through the day(?) or at nadir (?)) because it takes a while to regulate but I should expect to see her levels come down after a 2 weeks. Is that right?

Once I start the insulin, I will post her numbers and hopefully you guys will help guide me then. Im happy to see that so mnay cats go into remission and Im really hoping Portia is one of them!!

Thanks a lot for your help.
Rita
 
Re: Portia starting insulin tomorrow.Need advice on protocol

Also,
I was just setting up Portia's spread sheet I noticed a column called AMPS. What does that mean?
Thanks
Rita
 
Re: Portia starting insulin tomorrow.Need advice on protocol

AMPS= a.m. preshot
PMPS= p.m. preshot
U = units of insulin given
and the + numbers are how many hours after injection

There are two Lantus forums both Tight Regulation and Relaxed Lantus. The choice is yours where to post.

Mel, Maxwell, Autumn and The Fur Gang
 
Re: Portia starting insulin tomorrow.Need advice on protocol

Great! thanks Mel. Ive been trying to figure out what the difference between tight regulation and relaxed are and Im not sure I get it. If its not too much of a bother, could you please help explain the difference? I'm sorry for asking so many questions.
Rita
 
Re: Portia starting insulin tomorrow.Need advice on protocol

Really the only real difference is the amount of testing and the target range for the BG levels we seek to hold the cat. Since I don't do Tight Regulation I will let someone that does explain. However, I'm on Relaxed so I can explain it.

Relaxed is Start Low Go Slow protocol. We test at least preshots random spot checks when possible then on a day off run a curve ( testing every 2 hours). Because we test less often we hold a dose longer before going up.

We are less formal in our posting style because we are a smaller group than TR so tend to do more chatting and have more time to give in depth explainations IMHO. The drawback is because we are smaller sometimes no one is around to give a quick answer. We also have fewer cumulative years of experience as we are a fairly new forum. Otherwise, we raise the dose the same way, cats earn dose reduction the same way. And we have the same goals...regulation with hopes of remission. Feel free to check out both groups and decide which fits best. And you are always welcome to post in both just if you do we ask you link them together so we aren't repeating information.

Oh yeah...questions are GOOD!! The only stupid question is the one that goes unasked. We are happy to repeat everything a thousand times if we have to.

Mel, Maxwell, Autumn and The Fur Gang
 
Re: Portia starting insulin tomorrow.Need advice on protocol

Thanks Mel. That makes more sense now. Ill just have to see how it goes. Im finding it really difficult to figure what I should I do and I guess once I start administering insulin I can take a call on which method to follow. Atleast for the week or so, I will probably test more often so that I can make sure she's ok and then we'll just have to see.ITs a little overwhelming

Thanks for your help.
Rita
 
Re: Portia starting insulin tomorrow.Need advice on protocol

Lol oh trust me, we all were right where you are now, confused, scared and worried sick about our furry baby. And I'm a confirmed testaholic :lol: Poor Autumn got turned into a pin cushion when I first adopted her until I got to know her patterns, and now almost 2 years later I still test about 4 times a day. But now its mostly because she's trained that she gets tested before she eats and will wait in her testing spot. And with 13 other cats they will gleefully devour everything in sight while she's waiting to be tested. lol

I just choose to not hold her as low as tight regulation does because I like her having a little more wiggle room to drop if for some reason I can't stay with her and she decides to drop lower than normal.

Plus I can't wake up at night and then get back to sleep, once I'm up I'm up for the day. So very seldom do I test her during her p.m. cycle.

Mel,Maxwell, Autumn and The Fur Gang
 
Re: Portia starting insulin tomorrow.Need advice on protocol

Gee, Mel! Now you've got me wanting to post in Relaxed Lantus. ;-) I've considered it in the past, but always felt that I test "too much" to really be posting there. But now I think I'm gonna have to join you over there. :lol:
 
Re: Portia starting insulin tomorrow.Need advice on protocol

Come on over. :-) We don't yell at you for testing too much all data is welcome and testaholics as well. lol. Its just a different protocol and a smaller group.

Mel, Maxwell, Autumn and The Fur Gang
 
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