re-posting from tight Lantus

[George&Bert]

I am posting here so more people will read it.

My cat "Matilda" was diagnosed six months ago and is on Lantus.

I will put her on 1.o units BID and her numbers climb so I increase it in .25 unit increments for ten days at a time. ( I don't test every day )

Then I get up to around 2.0 units BID and her numbers at 5/6 hours are in the 80s/90s range. Today she just tested to 94, 1.5 hours before shot time and she has been getting 1.75 U BID. The doc says don't shoot below a hundred, but I am willing to bet the number has been in the 90s zone for a week.

I work two jobs, have two sugar cats and 18 civies ( lost three this year to various causes). I am just not home or have the time to do more than I am so I am doing what I can.

Randomly I test with no particular schedule in mind and test when I think I should and it's always the same. I get a number from 60 to 90 and so I back off on the dose a lot. Then I start low and continue testing periodically until I reach around 2.0 u BID and test to make sure.

Today 20 hours later her number is 160. I am guessing she needs the dose she is on to stay level.

Any thoughts?

 

[rhiannon and shadow (GA)]

You said the key word .... You 're guessing.

I wish you wouldn't guess. IF you really can't get at least a amps , nadir, and a pmps, then you are playing russian roulette with your kitty.

You don't know if the insulin is at its peak at 6 hrs after the shot, or 3 hrs after the shot.
You just don't know . And to actually regulate diabetes, You HAVE to know when the insulin is working.
If you have that low of a number right before you give the next shot, then you are really risking a HYPOGLYCEMIC reaction especially giving that much.

I think you've just been lucky so far if you haven't damaged your kitty doing it this way.
Would you drive to work with a paper bag on your head?

No one here wants to harm your kitty so our hands are tied to try and advise you until you are ready to make that full commitment .
We just can't play " kitty dartboard " with any amount of insulin.

I think I speak for many.

 

[Deanie and Boo (GA) and Scout]

IF you really can't get at least a amps, nadir, and a pmps, then you are playing russian roulette with your kitty.

I think I speak for many.

Ok, this is ridiculous. Everyone can't sit home and micro-manage their diabetic cats all day. People have jobs that they need to go to and running home multiple times a day is just not an option for most people. I do agree that preshot values are important (completely necessary, in fact) but getting daily nadir readings is not playing russian roulette with your cat.

I managed a diabetic cat for nearly 5 years on daily preshot values, with a weekly curve on my day off. That was while working night shift and then transitioning to 12 hour days shifts, which really threw off his shot schedule. He managed to survive despite my irregular hours and infrequent testing.

People have to do what fits in with their everyday lives. You can't ask anyone to do more than that.

 

[Carl & Polly & Bob (GA)]

George & Bert,

I read your thread in Lantus and saw you had posted here as well. I agree with Deanie - everyone of us can only do what it is possible to do. You're life is hectic, you're trying to keep up with two jobs and a herd of other pets.

Can you tell us this - are you able to shoot insulin twice a day, as close as possible to 12 hours apart? Does that fit with your current life schedule? Where I am going with that is.... if you can shoot insulin, it only takes 2 more minutes to test the BG. If you can test before shooting, you are at least introducing some measure of safety into the process. If you can only test mid-cycle one day a week, then that's all you can do, right?

Take a look at the SS in my signature. "Zoe" is not my cat, and that is not "my" spreadsheet. Zoe's parents are using Lantus too. I created that SS for them, and then gave them access to update it every day, or anytime they choose to. I can do the same thing for you. I'd just need whatever numbers you have jotted down, and what the doses were each day. You can send all of that to me by "private message" - just click on the PM button under Bob's picture. Send me your email address too. Then all you have to do is set up an account at google docs (If you have a google email address, it takes only a couple minutes to do). After I set it up, using your google account you will be able to update it as you can, and the updates would show up anytime somebody clicked on the link in my signature. I can also give you instructions on how to add it to your own signature.

If you look at Zoe's SS, you'll see that they have not been able to test too often except at shot time. But look at Zoe's numbers, they're pretty good. The hard part, even with those numbers, is trying to figure out if the dose needs to be just a little more, or a little less and that's where those extra tests are so valuable. But we can do this is small steps, not all at once.

Let me know if I can help. The important thing to all of us, and I am sure to you as well, is that Matilda gets treated, and treated in a safe manner so that she can get better. That's what really matters.

Carl

 

[George&Bert]

Her's how I see it....

We are treating the cat and not numbers. I think all that testing is a bit crazy and obsessive and I pity the poor animal.

I read the results of a test comparing insulin(s) one being Lantus. The cats were not tested even once a day or week. They just were given the same amount for weeks and eight went off the juice.

One of my sugar cats I take to the vet every three weeks for a test because I can't test him alone. He is too big and strong and it is gentler having the girls he likes do it because they take it from where he can't see. The ear thing is out. His pancreas was damaged by a severe infection. Thus the diabetes. I hope and pray he continues to thrive as he gets bigger and stronger and acts normal. I have only modestly adjusted his dose, but have not in five months.

Matilda has had many adjustments up and down as I test her usually once a week or if I think something is brewing.
I shoot her almost to the minute every day, but it is shoot them and literally run to work.

She actually looks and acts perfectly well and has a good attitude and healthy appetite. I am writing because every time I test her on her 1.75 u bid dose she is at 100 or even a little less. AS a test I stopped the shots to see what happens. In 24 hours she went from 94 to 160 and 24 hours after that 240. I will now put her back on a re-starting dose of 1.0 u bid.
I believe now that the 1.75u bid she was on is just a bit too high. I will test her more frequently, but not three times a day.

I just wanted to see if anyone else was shooting a high dose and getting flat numbers like I do. Shot to shot the numbers hardly change.

PZI was very predictable, but I don't find Lantus is that way. Please keep in mind..regardless of testing and the numbers we are ALL guessing at the dose. I don't care how good your chart is, dosing is a sot in the dark. If out cats survive it is by the grace og God and the ability of the cat to deal with it. Diabetes is a *****!

Thank you for offering the chart that was very thoughtful. I used to have a chart with my Bert who passed on two years ago from cancer. I used to test him at least twice a day.

 

[Carl & Polly & Bob (GA)]

PZI was very predictable, but I don't find Lantus is that way. Please keep in mind..regardless of testing and the numbers we are ALL guessing at the dose. I don't care how good your chart is, dosing is a sot in the dark.

I don't think I agree with a lot of that. I understand you thinking that way about PZI, because it is more of a "if this, then that" insulin than lantus seems to be. You sort of know what to expect (although cats are always throwing surprises at us) when you give a 1u dose on a certain range of Preshots, and have a good idea what the nadir might be.
And you don't see that with Lantus. But that is because Lantus is designed to work differently. It is supposed to produce a flatter curve, and the nadir numbers are the ones that indicate if a dose is right or not. It has a "depot", there's overlap of doses, and it just works completely differently in their bodies than PZI does.

Dosing, no matter what insulin, is not a shot in the dark at all. If you were a diabetic, or even better, if your child was, would you just keep shooting the same dose without checking your blood glucose? What happens on that day when your three year old kid has "normal" BG at shot time and you go ahead and shoot 10u anyway? You might know, by the way you feel, whether your sugar is low or high, and treat accordingly. But a little kid, or a cat, can't communicate that to you, so you have to test. Or risk hypoglycemia. The whole point in gathering data is to manage the disease safely. I understand an inability to test, whether because your cat doesn't cooperate (there's tons of ways to deal with that), or because your schedule doesn't allow you to test every day 3 or more times. But shooting insulin without a test is russian roulette, and unsafe.

Some people may be "crazy and obsessive", but their primary concern is the safety of their cats. I'd pity an animal that was given too much insulin and goes into shock or a coma for sure. A heck of a lot more than a cat who gets his ears poked a half dozen times a day. I haven't seen a cat that has died from excessive testing, but I have seen several in the past year who have died from hypos, some of which were due to skipped tests. I watched a dog take a day and half to die from an insulin overdose. It's the worse thing I've ever seen happen to a pet.

I've read the same study, and yes, all 8 Lantus cats went into remission. But they were not as unmonitored as you make it sound like they were. They had curves run at the vet every week, then every two weeks, and their doses were adjusted per a protocol. The study wasn't run to get cats off the juice. It was run to compare Lantus against PZI and Humulin, and Lantus proved to be the best insulin of the three.

Yes, we are treating the cat. But it is impossible to do so without "the numbers", whether they come from home testing or vet testing. Doses are determined to be correct and safe "by the numbers", not just from observation.

If out cats survive it is by the grace og God and the ability of the cat to deal with it.

Thousands of cats, and their owners, would definitely disagree with you there.
An untested cat might survive by the grace of god, but people who home test have a little bit to do with the survival of their cats.

Carl

 

[Melanie and Smokey]

She actually looks and acts perfectly well and has a good attitude and healthy appetite. I am writing because every time I test her on her 1.75 u bid dose she is at 100 or even a little less. AS a test I stopped the shots to see what happens. In 24 hours she went from 94 to 160 and 24 hours after that 240. I will now put her back on a re-starting dose of 1.0 u bid.
I believe now that the 1.75u bid she was on is just a bit too high. I will test her more frequently, but not three times a day.

I just wanted to see if anyone else was shooting a high dose and getting flat numbers like I do. Shot to shot the numbers hardly change

.

I don't follow why you think 1.75 is too high of a dose? 100 is not a low number, perfectly normal and if she is flat at 100 with no change between shots (though when it sounds like you are not testing much for nadir, I'm not sure how you would know she is flat since Lantus typically does curve some). The Ls are flatter insulins, that is what is good about them, you don't want a large difference highs and lows.

You are also not really at a high dose at approaching 2 units. That is a pretty normal dose. Many of us got to 2-3 units before we saw the pancreas start to work again and came back down.

If you are not seeing anything like 40s, I would stick to the 1.75U and test when possible. Keeping cats in that 50-100 range helps the pancreas heal and possibly start working again. The constant taking away of insulin and allowing her to rise is taxing her pancreas and could cause more damage.