Rebekah and Ole

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Rebekah

Rebekah

Member Since 2013
Hi!
My name is Rebekah, I registered to this forum today. 7 years ago I adopted a scrappy little kitten and named him Ole (pronounced O-lee). He had been found in a dumpster on the reservation. Even though I have always fed him a grain free dry food, he was diagnosed with diabetes in April of this year. His initial glucose reading was 312. He has proven to be insulin resistant, and has been difficult to monitor. He did have a period in August through September in which he was off insulin, but he was diagnosed with pancreatitis (after antibiotics and further testing, his pancreas is secreting enzymes normally) and was back on insulin the first week of November. He is between 7-8 years old and has never been over weight. He has a voracious appetite but very thin at 8lbs. I feed him 4.5 oz FF Classic 2x each day. His current dosage of Glargine is 5 units 1/2 hour after eating. I home monitor, and Sunday's readings were 411@6:00am and 345@1:00pm. He has seen an internist in PHX and all of his tests and ultrasounds read completely normal, except for blood glucose levels. As I mentioned, he is very hungry all of the time and gets little sleep because of it. Last week I caught him gnawing on a wine cork, serious. I started giving him a chopped up leaf of romaine lettuce with his evening meal because he loves it and I feel he needs the roughage. He is a happy cat who gets lots of exercise because he also loves to play fetch. He's just completely manic when it comes to food. Otherwise a darn good little patient. I would appreciate any input as even the specialist has been stumped by Ole, my kitty. Thanks! Rebekah
 
Hi!

Thank you for your reply! I'll ask my vet about high dose.

His only behavior change, besides trying to grab a piece of pizza off your plate as fast as a trout strikes at a fly, is that he doesn't like to cuddle like he use to. He'll sleep on the floor next to the bed, but not on the bed. It's almost as though he is warm and cozy intolerant. It's cold and the weather is frightful, so I find this behavior weird.

Thank you again! R
 
A couple questions for you, which are some things to just verify:
What dose of Lantus (glargine) did you start with?
How big were the increases each time?
How long did you stick with an increase in dose before changing it again?

Here are some notes on Lantus, just to make sure you have some background information on how it is best used. (You may have done all these.)

The starting dose of Lantus is calculated using the lower of current or ideal weight, in kilograms (pounds /2.2), multiplied by 0.25, then rounded down to the nearest 0.25 units. This may need to be eyeballed on a syringe because at most, they mark half units.

Because cats are so small, dose adjustments are in 0.25 increments, so that you don't skip over an ideal dose.

Lantus has a depot, or overlap between shots. This is part of what makes it a good insulin for cats. However, it means that holding a dose the same for 3 or more full days should be done before making an increase, in order for the dose to reach a smooth rolling level.

It is also very important to be as consistent as possible in shooting 12 hours apart, due to this overlap.

If you store Lantus on a stationary refrigerator shelf, you may be able to use it for up to 6 months before needing to change the bottle or pen.
 
Hi!
Ole was on a different insulin when he was first diagnosed on April 20, 2013. unfortunately, I can't remember its name, but it was about $30/vial. He started with 1 unit 2x each day. I began home testing right away on Sundays. The units increased 1 per week as his numbers hovered between 350-500. He was switched to Glargine on 6/20 coming down from 6 units of old insulin to 3 units of Glargine. This is when I put him on a wet lc diet FFeast classic. I continued to test him weekly, increasing his insulin by 1 unit. He topped out at 8 units during the week of July 28. He then began to bounce and I began to taper him off. He was OTJ between 9/9 and 11/8 when he tested positive for pancreatitis. After treating him for a couple of weeks with antibiotics, we put him back on Glargine on 11/22 beginning with 1 unit and testing weekly. He is currently on 5 units which we started on Sunday. His numbers were 6:15am 411 and 1:00pm 316.
I've kept quite good records and have been accurate with my 12 hour separation between doses by keeping a daily diary.
I had been keeping the insulin in the frige door, until I read all about Glargine today. I could have used that info earlier! At $180/vial at Costco, I don't believe it is compromised. We have never shaken or dropped the vial.

Sorry so long, thanks for all of your advice, I really appreciate it! He eats 9oz food /day, with gusto and weighs about 8 lbs.
 
I am thinking it is possible that the dose and/or dose increases may have been too big. The first insulin was probably Humulin or Novolin, which last about 6-8 hours in the cat, resulting in very high pre-shot numbers many times, so when you switched to Lantus, it also is possible that he might have started on too high of a dose. What this can do is trigger compensatory hormones that fight to keep the glucose high enough for survival by releasing stored glucose (glycogen). Note that this is just a possibility, as is the possibility of a high dose condition. Figuring out what will work best for your kitty may take some diligent record keeping for a couple of weeks.

One thing that will help us help you is an online spreadsheet, using Google Docs. You set this following these instructions and record your morning and evening pre-shot tests (AMPS and PMPS), the units given, and any other tests done in between the pre-shots, referenced by how many hours it has been since the test (ex. if you test 6 hours after a shot, that goes in the +6 column, 7 hours after a shot in the +7 column). We do it that way so no one has to figure out time zones and convert them, which is particularly helpful if the cat is going low, so we can see if it is before or after the nadir, the lowest point between shots. This spreadsheet is shared in a read-only format so others with the link may see it and give feedback. Over time, you may identify patterns of response which suggest dose adjustments or other issues.

Have you ever done a curve at home? That means taking serial glucose measurements from pre-shot to pre-shot, every 2 hours. If you can manage one of those and put it on the shared spreadsheet, some of our very experienced Lantus users can give you more feedback.

* * * * * * * * * *​
Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]
 
Thank you for the information, and will begin the spread sheet today. Ole and I use Alfa Trak, and because I made a few adjustments in his food as a result of reading this forum, I took out some Instinct Rabbit kibble that I was adding to his wet food for calorie supplementation. He tested this morning at 545, and I'm about to give him his dose. He is very agitated before he is fed, which I'm sure increases his bg. I'll test him again at 1:00. I can try to do a curve too, perhaps next week.

Also, yes, the insulin he started on was Huminlin.

Thank you again, and enjoy your day.
 
Hello!

I believe I just posted Ole's SS. I hope it is how it is suppose to be, and that it is helpful. Going back through it all, it has been a long process for sure. I hope we have not done anything horribly wrong as we have done our best for Ole. It's been a team effort between Alex and I, our vet, our neighbor and Ole's feline companions Loki and Fifi. Ole is a good little patient, not minding getting tested at all. Well, actually he hated his ears being poked, but doesn't mind his feet. He's sitting right here on my lap purring away, and says hi!

I await further instructions, and thank you for all of your time and effort.

R
 
I'm going to ask the Lantus forum to come over and take a look at your spreadsheet.
 
Hello, if it is helpful, the symptoms that brought me to take Ole to the vet was his increased appetite and his fur had lost some luster. He never was overly thirsty or peeing a lot. No vomiting or diarrhea throughout the whole process, only weight loss and ravenous appetite. He currently weighs about 9 lbs.

I have been diluting his meals with about 1/3cup water. This serves to slow him down a bit and keeps him hydrated. He rarely takes in more water during the day. He pees a bit more than normal and has at least 1 poo, sometimes 2 poos a day, yahoo!

Thank you again!
 
Hi, Rebekah! I'm one of the denizens of the Lantus board that responded to BJ's post.

One quick question -- was Ole tested for hyperthyroid? When you mention his appetite and his not gaining weight, while this may be due to diabetes, it's also typical of hyperthyroidism.The vet should run a total T4 and free T4 to diagnose the condition. Hyper-T can also cause blood glucose levels to be elevated.

The thing that stands out on Ole's SS, at least to me, is that doses were raised too rapidly. With the Tight Regulation Protocol, dose increases occur typically every 3 days in 0.25u amounts. If doses are increased too rapidly, it's possible that you may miss what could be a good dose for your cat. Unfortunately, too much insulin can result in numbers that resemble too little insulin. The other aspect of what would tell us more is that most of us test at least 4 times a day -- at pre-shot and at least once during both the AM and PM cycles. Without some data from the middle of the cycle on a daily basis, there's no way to really know if Ole is seeing some lower numbers and since he's not used to spending much time in normal BG range, his numbers bounce back into the upper range.

I'm hoping that someone can give you a hand with the color coding on your SS. It looks like you may need to re-set the conditional formatting so the entire SS retains the color coding.
 
Hi Rebekah and extra sweet Ole!!

I'm not the most experienced eyes, but this is what I see so far (and a lot of it is the same as you've already heard)

I seriously think you might do better to start over at a lower dose of Glargine because it's very possible he's past his "best dose" already. We generally start at 1 unit every 12 hours, and test before each shot and at LEAST once during each cycle to see how low each dose takes him. We hold the dose for at least 3 days (6 cycles) so we can really see how that dose works.

Ole has been increased a LOT faster than we do here..we increase only in .25 unit measurements. Each cat has a "best dose" and the only way to find it is to go slowly and carefully or you can go right past it...Too much insulin can cause high blood glucose numbers just like too little can...as well as if you're giving too much, they can develop resistance to the insulin and you have to keep giving more and more, when it would have been possible to start at much smaller doses in the first place.

This is a very common thing we hear here though..Even the best meaning vets can't keep up to date on the latest treatments for every disease in every animal they care for. The people here have one purpose...controlling their cat's diabetes and the diseases that come with it (like pancreatitis)

Also, you are relatively speaking, really a "new" diabetic...Less than a year since diagnosis, so I think it may be in Ole's best interest to drop back and start over.

Adding to the possible reasons he's not responding is the fact he was recently on a steroid. Steroids raise blood glucose numbers and can take several months to clear out of the system, so it may just be a matter of time.

Good luck with Ole, and please ask any questions you might think of. We're all here to help you and will do all we can to get him feeling better!
 
Hello!

Yes, Ole has been tested 2x for hypothyroidism and both times has tested negative. As I've noted, all of his tests and ultrasounds show that all of his organs are functioning within normal parameters, except his bc.

If it is the consensus, I will try a different treatment as long as I have guidance. My wonderful vet will be happy to go along with my wishes as Ole has not been responding and we are trying to learn as we go along. I only stumbled upon this forum yesterday. I am able to work from home, but do need to be on site a couple days a week.

Keep the advice coming! It is so appreciated!

Kindest regards,
R
 
I just talked to my vet, and she is all in.

Tomorrow I am going to do a curve, testing him every 2 hours throughout the day. Does that sound good?

He has had a test,...starts with a f....that followed his bg over time. His #s were consistently high. I believe that it was done in August.

It's snowing and Ole was out chancing snowflakes.

Thank you to all!
 
The "f" test was probably fructosamine, a measure of average glucose over time.
If his dose is too high, he may be producing compensatory hormones to offset too much drop and these release stored sugar (glycogen).

If you want to start over, this is a calculation for the starting dose of Lantus for a new insulin user:

Lower of current weight or ideal weight
in kilograms (pounds divided by 2.2
multiplied by 0.25
rounded down to the nearest 0.25 units.

So, how much does he weigh and how much should he weigh?
 
Also, many vets haven't much background in newer insulin, so you may find it helpful to read and printout the Sticky Notes from the Lantus Tight Regulation forum to share with your vet. Once you have a spreadsheet up and going, you may want to post over there, too, for daily support and feedback.

STICKY: LANTUS & LEVEMIR - NEW TO THE GROUP? PLEASE READ...

STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL

STICKY: LANTUS & LEVEMIR - INFO, PROPER HANDLING, & STORAGE

STICKY: LANTUS & LEVEMIR - WHAT IS THE INSULIN DEPOT?

STICKY: LANTUS & LEVEMIR - SHOOTING & HANDLING LOW NUMBERS
 
Hi all,

Ole begins his first curve today. He has had his first 2 readings. I have also fixed the issues with his spread sheet.

His weight this morning, before his breakfast was 8.6 lbs. I think he is about a pound under weight, but I'll ask my vet today.

Wish me luck!

Best, Rebekah
 
The first dose level of Lantus takes about 5 days to stabilize

If you have not been on it at least 5 days, the curve will be meaningless and should not be used for any dose increases. If the nadir (lowest glucose level) goes below 50, however, you may be able to reduce the dose by 0.25 units (eyeballed, as syringes don't measure that precisely).
 
Hi again Rebekah!

I'm still going to strongly suggest you drop back to 1 unit and increase the number of tests you're doing since before, you were only doing tests once/week. The reasoning behind this is that you've never tested during your cycles, but back in August/September, you were getting some pretty decent numbers on MUCH less insulin. This leads me to believe (and again, without testing especially during the PM cycle, it's impossible to say for sure) that Ole may very well be overdosed and it's causing him to "bounce", which is why you're seeing those really high numbers lately.

Bouncing happens when the blood glucose goes lower than the cat's liver is "used to", so it thinks there's something wrong and releases hormones and sugars to bring it back up fast. It's normal (although frustrating) to bounce, but as Ole spends more time in "normal" numbers, his liver will have to re-learn what "normal" is so it won't react quite so crazy.

There's no reason you need to do a curve if you do the testing we recommend, although a lot of people do them occasionally. The tests we recommend are

Always before shots..these are the Pre-shot tests (AMPS and PMPS)

During the AM cycle, at LEAST one test somewhere between +5 and +7...of course if you can get more, and at different times during the cycle, it will help fill in the gaps that a lot of people tend to forget...like +1 and +2, and +10 and +11....those "forgotten" tests can teach you a lot about how Ole is doing on each dose, as well as helping to nail down what his "Usual" curve is going to look like.

During the PM cycle, at least a "before bed" test (whenever that is for you)...the reason here is that MOST cats go lower at night, so if you get a "before bed" test that's lower than expected, you'll know it's best to go ahead and set an alarm to get up later and get more tests in. It's really important to get some testing during the PM cycle and it's just as important as the AM cycle tests. Without them, you're only going to see half of the picture

There's no such thing as too much data, so of course the more testing you can do, the better you'll learn about Ole and how he's really doing, but it's also not necessary to chase them around all day with a lancet trying to get a test every hour on the hour..."Spot checks" are usually much more revealing anyway..the ones you just do for no particular reason.

I think it's entirely possible that Ole is overdosed because he was getting such better numbers not long ago...The pancreatitis is more than likely what caused his BG numbers to go crazy, but as long as he's recovered from that, his numbers should have started coming back down on their own. It takes time though, and he was never given that time (while being tested) to truly see how he was doing any any of those doses before he was increased again.

He was also given a steroid at that time, and steroids cause blood glucose numbers to go much higher, and can take quite some time before they come back down..even after the steroid is discontinued

Treating diabetes isn't a sprint..it's a marathon, but between all the people on this board, we have tens of thousands (if not more) hours of day to day experience with treating it and I'm sure we can help you with getting Ole feeling better as well as under better control!

Would you consider dropping back to 1 unit and getting those tests in for awhile? If you do, you'd hold that same 1 unit for at least 3 days (6 cycles) before making any changes, UNLESS he was to drop below 50 during any cycle...That's an immediate reduction.

We won't let him hang in high numbers too long without reconsidering if he DOES need more, but it's totally possible he needs a lot less than 5 units too

Good luck, and I hope you'll give it a try. We'll be here every step of the way!!
 
Hey!

I am happy to reduce down to 1 unit, but I am following my vet's recommendations in keeping his units at 5 for the curve.

I appreciate all of your experience, and the experience of this forum. I am trying to the right thing by Ole and my vet, who has really given Ole's care her all. She also appreciates that she is not a Lantus expert, and perhaps I didn't relay the information to her correctly, but I'm doing my best. Because he does not mind being tested, and I saw the gap in my data when compiling the spread sheet, I thought a curve, testing every 2 hours, was a good option. Sorry, I seem to have been wrong.

He will be reduced to a lower level tomorrow morning. One question I have is does the am shot and the pm shot have to be the same units?

Thank you for your support and understanding as we try to figure things out.

Rebekah
 
If you haven't been able to get mid-cycle tests then a curve is the right thing to do.

I've got to curve my Gracie this weekend, because barring a drive home from work mid-day, I don't get many mid-cycle tests except some weekends!

(Sorry - was using my phone and didn't check how long you'd been on the Lantus. Just wanted to make sure it was worth doing a curve because the dose had been stable long enough)
 
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