Queries re proposed paln for Vyktor

Status
Not open for further replies.
Vyktors Mum

Vyktors Mum

Member Since 2011
My vet didn't want to treat Vyktor at first but he is now on board to try the TR protocol. The following is my proposed plan for Vyktor with questions - please advise if I have got anything wrong/could do something better, too much/not enough testing anywhere or if there’s anything I don’t seem to have considered. I want to get this just right and I am terrified of stuffing it up.

INSULIN (LANTUS) – STARTING

I will test every time before I shoot and use the sliding scale. With his BG levels averaging 197 (lowest reading was 149.4, highest reading was 226.8) over a five day testing period his starting dose is likely to be 0.25u.

I understand I do not have to be concerned about whether or not he eats at the time of the insulin shot, is that correct? If not I have been giving him a couple of teaspoons of chicken after his BG tests, is this sufficient?

I should try to inject in his side at least an inch down from his backbone (I can get a nice bit of skin near the front about 3 inches down from the backbone) rather than in his scruff.

The most convenient timing for regular 12hrly shots while I am working will be 6am and 6pm.

I will start the insulin on Friday (which I will take off from work) and give him his first shot at 6am.

I will test his BG at +2, +4, +6, +8, +10. At +10 if his BG is above 150 with rising levels (re test in half an hour if +10 is the first time I see his BG above 150) give another shot of lantus, otherwise continue checking every +2 until his BG is above 150.

Please confirm that I don’t need to wait to see if his BG is rising before giving a shot if it is +12 or later. If his BG hasn’t risen to 150 by +14 (10pm) congratulate Vyktor, go to bed and check again at 6am after a good nights sleep.

If his BG has gone above 150 and is rising at anytime between +10 and +14 give another shot of lantus as per the scale, for Vyktor probably 0.25u. Test BG at +2’s (is this +2 really necessary or is it okay to start at +4) until bedtime.

What should I do then? If further lantus has been given in the p.m. is it best to keep testing 2 or 3 hourly through the night (if Vyktor lets me!) or ok just to set the alarm to test at the point I expect to be his nadir and/or the time I except his BG to go above 150 based on the information I have, or is it safe just to go to sleep?

Continue this routine through the next day or two (is two days of two hourly testing enough or should I keep going for a third day?).

Is this schedule the best idea to start us off, or given that I am going to have to be at work most days, would it be better to stick to 6am and 6pm for Vyktor’s shots. If I don’t I could end up way off my 6am/6pm schedule and could therefore have to leave his BG to climb (if that’s what it’s doing) while I am at work for much longer than the additional two hours he would wait if his BG said he was ready at +10 but I had him wait until +12???

If I stick to the 6am/6pm schedule could I also reduce his BG testing to +3 +6 and +9?

I gather that the BG numbers should show a pattern which means I should now understand how he is responding to the insulin. Is this always the case?

Having watched him for three days is it now safe to inject him in the morning and go to work without worrying about testing his nadir to make sure he’s not too low?

Do I just do the two pre shot BG tests at 6am and 6pm during the week then and do a full or a mini curve on the weekend? Or should I try and get a nadir reading everyday (probably in the middle of the night).

Ongoing, if he has been low enough not to need insulin in the morning (i.e. below 150/) do I need come home and check him mid day or is it okay to leave him until I get home from work (usually around 4pm but I can generally leave earlier if I need to)?

I will post his figures as we go for checking and further advice but I would like to check my plan and make sure my understanding is correct before I start (knowing my luck the internet will go down for a week the day we start!), please correct me if I am wrong. My plan is:

If his nadir is below 50 reduce the insulin dose to 0.1u. If his nadir is still, or goes back to, below 50 cease giving insulin altogether. This is why I am wondering if I have to make sure I get a nadir test everyday (or night as the case may be).

I should not make any increases without consulting the forum and/or my vet.


LOW READINGS

If his BG drops as low as 50 but he is behaving normally do not do anything except increase tests to half hourly. If he drops below 40 or even as low as 20 do not panic as long as he is behaving normally (Is there a point below this that is just too low no matter how he’s behaving that means I should get to the vet?). If he goes below 40 start feeding a teaspoon of FF grilled chicken or turkey variety (higher carb varieties but I believe still comparatively low?? I can’t even tempt him to eat much of the very low carb stuff while he’s healthy at the moment so there’s no way he’s going to be tempted by those if he’s sick) every 15-30mins and continuing testing BG every half hour until he is over 45. Keep testing BG every half hour until he is over 50. Is there ever any point trying to do more, e.g. every 15 mins, or is that just likely to upset the cat and add no real value?

My understanding is that it just shouldn’t happen while he’s on low carbs but if I do see signs of hypoglycemia such as shivering, ‘drunkeness’, or convulsions I should do the same as above but try and get him to eat a greater amount of food - is that right?

If he won’t eat or has more than one seizure I should rush him to the vet and ask them not to give him glucose but to give him valium and to tube or syringe feed him with low carb wet food and since the vet is more than 1/2 hour away if Vyktor is seizing and won’t eat I should give him a little syrup on his gums (is agave syrup ok? It is very low GI) and this is the only time I should ever give him syrup.
 
WELCOME.When giving a shot of insulin, the cat must eat within 1 hour--I actually feed my cat right after she gets her shots...Once the insulin starts to work, the BG can drop very low without food...
I agree with your testing schedule, and encourage it..
I inject my cat just below her shoulder blades, you know it is a subcutaneous shot, Never an intra muscular for insulin....Shots are given every 12 hours, and testing is done so that you can create a curve..
That Means you must get some data as to where his numbers go over a course of the day. and night..
This is done for many reasons, but creating a curve will show you the mid-point of the cycle (the Nadir)
I take bg tests at amprehot(AMPS) then at +3 hrs. as the insulin starts to work at this point, a +4.5 to +5 as my cat's nadir-lowest point of the cycle is between +4 to +6 for Moonie. Then at night I do PMpreshot, and test, and then before bed I check her bg to see where she is--This is a mini curve,,But it is always subject to change..PLEASE READ THE STICKYS at the top of the page & other posts that have been put on our regular board..There are many here to help you.
Oop almost forgot, if your cat is displaying any shaking, woozy, or strange behavior & the BG is low,
GO IMMEDIATELY TO THE VET! Urine testing for ketones is also suggested,,Ketostix are available at most stores.. just slip stick under the cat when he is urinating, & you will get a reading...check it with the chart on the vial--ask questions & post your numbers every day & night so we can see his progress--
Those bg numbers you gave her are pretty good, lantus will improve them!
 
Welcome to Lantus Land!

I'm going to do my best to answer your questions. Please let me know if I've missed something. Some of this will begin to make more sense once you start using Lantus. There's a huge amount to learn and most of us felt overwhelmed when we started out. Just keep letting us know how we can help.

Vyktor's Mom said:
I will test every time before I shoot and use the sliding scale.
Click to expand...
There is no sliding dose scale with Lantus. Most of the other types of insulin do use a sliding scale because dosing is based on the pre-shot test. With Lantus, dose changes are based on the nadir (i.e., lowest point in the cycle). You get a pre-shot test to make sure it is safe to give a shot. That said, when you are just starting out, you don't have data yet and you need data in order to shoot lower numbers. We encourage you to not shoot if you have a pre-shot test that is lower than 150. The starred sticky note that discusses shooting & handling low numbers outlines your options with a low pre-shot. I'd suggest you post if this happens. The difficulty may be that given your location, I don't know how many people may be online when you need guidance re. shooting.

Lantus onset begins roughly 2 hours after you shoot. As a result, you do not need to worry about feeding before your shoot. Most of us will test, feed, and shoot while our cats are eating. (Gabby has her head firmly in her bowl when she gets her shot. She doesn't even notice what I'm doing.)

I should try to inject in his side at least an inch down from his backbone (I can get a nice bit of skin near the front about 3 inches down from the backbone) rather than in his scruff.
Click to expand...

Where you want to shoot is fine. I shoot around the shoulders. This is a chart re. shot placement. You have lots of choices. As long as you choose a spot that lets you get the insulin in and doesn't overly annoy Viktor, you're good.

I will test his BG at +2, +4, +6, +8, +10. At +10 if his BG is above 150 with rising levels (re test in half an hour if +10 is the first time I see his BG above 150) give another shot of lantus, otherwise continue checking every +2 until his BG is above 150.

Please confirm that I don’t need to wait to see if his BG is rising before giving a shot if it is +12 or later. If his BG hasn’t risen to 150 by +14 (10pm) congratulate Vyktor, go to bed and check again at 6am after a good nights sleep.

If his BG has gone above 150 and is rising at anytime between +10 and +14 give another shot of lantus as per the scale, for Vyktor probably 0.25u. Test BG at +2’s (is this +2 really necessary or is it okay to start at +4) until bedtime.
Click to expand...
I think I understand your question. I wouldn't get all caught up with where numbers are at +10. I also would suggest re-testing more often than every 2 hours if you are waiting to see if numbers are rising at shot time. Generally, when we suggest that you stall, you want to re-test every 30 min. You want to catch the rising numbers as soon as possible. The reason for this is that when you stall, your next shot time will be 12 hours from the actual time you shot. So, if you are shooting at +14, you would give your next shot at 10:00 and that would put you 4 hours off schedule. For many of us, being that far off schedule isn't feasible. For Lantus, you can move shot times by no more than 30 min. per day (30 min. once a day or 15 min. twice a day).

What should I do then? If further lantus has been given in the p.m. is it best to keep testing 2 or 3 hourly through the night (if Vyktor lets me!) or ok just to set the alarm to test at the point I expect to be his nadir and/or the time I except his BG to go above 150 based on the information I have, or is it safe just to go to sleep?
Click to expand...
It's also not necessary to test every 2 or 3 hours all the time. Personally, I encourage people to get a +2 test. It can give you an indication of where the cycle is heading. Beyond that, it's important to get a minimum of one test per cycle (in addition to your pre-shot tests).

The point of doing a curve is to learn Lantus onset, nadir, and duration for your cat. Despite what the "rules" say, every cat is different (ECID). Gabby's onset can begin early and she typically has an early nadir. You need to learn your cat's patterns. Getting up to test will depend on what Vyktor's numbers are telling you. Some nights you may need to do that; other nights you can sleep.
I gather that the BG numbers should show a pattern which means I should now understand how he is responding to the insulin. Is this always the case?

Having watched him for three days is it now safe to inject him in the morning and go to work without worrying about testing his nadir to make sure he’s not too low?
Click to expand...
It would be lovely if our cats always kept to the same pattern. However, they are cats. Unpredictability is the rule. No one can give you a guarantee that numbers will always be in a good range. Many of us use a timed feeder so there will be food available should our cat's numbers begin to drop.

The first few days of using Lantus will not be typical. This is the period within which Lantus is forming a depot, or "shed." Often, you do not see much of an effect of the insulin on BG levels until the shed has formed. It often takes 5 - 7 days for the shed to form.

Ongoing, if he has been low enough not to need insulin in the morning (i.e. below 150/) do I need come home and check him mid day or is it okay to leave him until I get home from work (usually around 4pm but I can generally leave earlier if I need to)?
Click to expand...
If you skip a shot, I wouldn't worry about coming home early. If there's no insulin on board, there shouldn't be any concern about low numbers.

LOW NUMBERS
I don't think you're getting the concept here. The idea is that it's better for a cat to spend a day in high numbers than 5 minutes in too low numbers. Not to be overly dramatic but hypoglycemia can kill. There is a difference between symptomatic hypoglycemia and low numbers, though.

Numbers below 50 do require that you do something. A lot depends on carb sensitivity but most people will feed high carb (a small amount) to help bring numbers back into a safe range (i.e., above 60). For a newly diagnosed cat, numbers below 50 indicate that a dose reduction is warranted. The point, though, is that Vyktor's numbers are in a range that is below where you want them to be. Numbers that drop below 40 definitely require a quick intervention.

Most cats like the gravy that's in high carb (HC) food. Generally, you need about a teaspoon of the gravy to bring numbers up. You can also add corn syrup, honey, etc. to LC food to have the same effect.

You can test more often than every 30 min. You may need to do so if numbers are below 40 or for your own comfort. Usually, if you're going to test more often, I'd suggest every 20 min. since you need to give the food some opportunity to get into Vyktor's system.

There are some cats who are gluten sensitive. The gravy that's in HC food contains gluten. My cat will end up with diarrhea if I give her too much gravy. I use honey to steer her numbers. Likewise, if you are having difficulty getting numbers to come up, adding a drop or two of syrup to gravy is a good way to boost numbers. There is no "do not use syrup" admonition. You do what works for your cat.

If your cat is symptomatic, you do whatever you need to do to get numbers to come up and then get to the vet. If seizing, it will be hard to get any syrup into your cat's mouth. There are other ways to get syrup into a cat (e.g., rectal administration) but I would hope this never happens. It can be important to get to the vet since once HC wears off, numbers can drop again.

I'm not sure that I answered everything. Like I said, sometimes it's a matter of having been in the actual situation in order to have all of the pieces come together. I hope you will post often and that you'll continue to ask questions.
 
welcome to Lantus Land, Vyktor's Mom!

From reading through your detailed plan (impressive!), it sounds like you have been doing research on multiple feline diabetes websites. Many of your notes sound like they come from another website that uses a protocol that has been very successful with PZI insulin, but can be dangerous when used with Lantus. The insulins act completely differently and it does not work to use the same approach with Lantus.

If you'll read through the stickies at the top of this forum you'll see the Tight Regulation with Lantus or Levemir protocol we use here. The New to the Group sticky is another must-read. Then if you'll start putting your data together we can help you interpret everything.
 
Sienne and Gabby said:
I think I understand your question. I wouldn't get all caught up with where numbers are at +10. I also would suggest re-testing more often than every 2 hours if you are waiting to see if numbers are rising at shot time. Generally, when we suggest that you stall, you want to re-test every 30 min. You want to catch the rising numbers as soon as possible. The reason for this is that when you stall, your next shot time will be 12 hours from the actual time you shot. So, if you are shooting at +14, you would give your next shot at 10:00 and that would put you 4 hours off schedule. For many of us, being that far off schedule isn't feasible. For Lantus, you can move shot times by no more than 30 min. per day (30 min. once a day or 15 min. twice a day).
Click to expand...
What Sienne really means to say here is if you are shooting at +14, you would give your next shot at 8:00 and that would put you 2 hours off schedule. I didn't want you to get confused.
 
for many of us it's easiest to learn this whole protocol with help. you've gotten great advice and feedback on your plan, so i will just add that you can post here as you go - many of us post daily, many others post when they have questions - and we'll help you learn it a step at a time. you probably won't need to test that often every day - but the testing tells us how your cat is responding to lantus and will help us help you.

welcome to you and vyktor!
 
Thank you everybody all advice is most appreciated. My name is Serryn and I have been looking at two different forums. The other forum does have a sliding scale for lantus but someone mentioned it is dangerous. Why is that?

Based on the slding scale on the other forum I would only be starting Vyktor on a dose of 0.25u based on his BG. Based on the TR protocol in the sticky here I would be starting him on about 1.25u-1.5u based on his weight. This is a big difference!

Given that he has relatively low numbers as compared to most other cats I have been reading about that seem to start with 300+ numbers I am a bit concerned that dosing based on weight could be too much for him. Your thoughts?
 
I presume you're referring to the "Your Diabetic Cat" forum? If so, their dosing protocol was developed using another insulin -- not Lantus or Levemir. I believe their method was developed using PZI which is an intermediate acting insulin and is not pharmacologically similar to Lantus. PZI has no insulin depot and no overlap between doses. As a result, the method of dosing is very different. There have been some very tragic events with people using that protocol when dosing with Lantus.

As for a starting dose, you do not have to use the weight based formula. You can always start at a lower dose. Many people here start at 1.0u.
 
Also, and I know it's already been said, but Lantus needs to be given every 12 hours. Sometimes life happens and you're late giving him his shot, but then you have to give him his next shot 12 hours from the actual shot time, not the time his shot was supposed to be given. If you need to change the time his shots are given, you can move shot times by 15 minutes per cycle or 30 minutes per day.
 
Status
Not open for further replies.
Back
Top