Starting Over and need your help!

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Smokey

Smokey

Member Since 2010
My Smokey is 14 years old and was previously on Vetsulin for 2 years and for the past 6 months was OTJ (scores of 60-70). He had yeast in his ears 3 weeks ago so I gave him Mometamax ear drops (which I am convinced brought him out of remission). 4 days after first drops, water intake increased dramatically and my meter tested him 188-198. Brought him in the vet who's meter tested at 363 with the bad news that he is again Diabetic! @-)

Urinalysis showed no UTI but did show glucose. I purchsed a meter to match the vets (to make sure I matched the vets from this point forward) and picked up my Lantus!

He started Lantus on 3/28/11 and was on for 2 days. I noticed no improvement what so ever and the water intake actually increased!

Vet told me to go ahead and up his insulin to 2u.

3/31 - PMPS 12+ = 372 (gave the 2 units)
3/31 - 3+ = 257.....started to get hopeful!
4/1 - AMPS 12+ = 428

Pre-Diabetic 2 years ago he weighed 20lb. With diet/regulation, I brought him down to 14lb which took him into remission. He is now weighing in at 11.3 and for him and his body type, that is very skinny.

I am in complete understanding that regulation/dosage takes time but since I am new to the Lantus brand, shouldn't I see some type of improvement just being on the insulin vs. not being on anything?

I am greatful to have somewhere to go where people understand what you are going through! I am just heart broken to see my poor baby look so miserable!

Denne' & Smokey
Florida
 
Hi guys ... sorry to hear you are back dealing with FD again, but hopefully since you believe he came out of remission with his ear drops if he can get weaned off of those maybe his numbers will drop back down? I know others will be here soon to help answer some of your questions .. just remember that it might take time to see a nice number change .. I know it's hard to see our furbabies not feeling well .. but you are doing what is best for him, and that's great!
 
i'm pretty new, Denne', but i think you have to wait for the "shed" or "storage depot" to fill in his body before you get much of a result from the Lantus. Here's the link that explains that:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=150

There's a lot of information in the starred "stickies" at the top of the Lantus forum page, including this one, that will help you understand how Lantus works.

Welcome back and good luck.
 
Hi Denne!

What was his original dose that he was on for two days? 1u? Julie is right that you need to hold the dose for a few days to see what sort of effect the insulin is having on his BG. A full 1u is a large increase to make so quickly, so make sure you're testing and watching for signs of hypoglycemia.

Has anyone provided you with the link to set up a spreadsheet? It would be very helpful for people to look at when giving you advice. Here's the link: viewtopic.php?f=6&t=18207
 
I've posted in Georgia and Simons condo too. They just went through ear drops causing a bg spike and switched drops. Not sure if Simon was on the same stuff though. Welcome to Lantus Land. Sorry you are out of remission :-|
 
Thank you so much for your support & advice everyone!

Smokey was on the ear drops for 10 days and ended them 2 weeks ago!

Yes, he was on 1u for 2 days and since his BG was actually going up, the vet made the determination to bump him to 2u. My kitty is the first kitty he has treated on Lantus (since all his other kitties were on Vetsulin and apparently the owners can still find supply).


nailbite_smile
Denne' & Smokey
Florida
 
I'm sure it took a while for Simon's BG to come down and he was on Lantus the whole time. Others will provide more clear feedback here.

Lantus is shed based too so it takes a while for the shed to fill. I'm so glad we found FMDB and learned about Lantus.
 
Smokey's SS is now up and running!

With the directions, I could not figure out how to make the link say, "Smokey's SS".
 
Welcome, Denne & Smokey!

and i have to say...my Binks thinks Smokey is absolutely gorgeous! :lol:
they look like twins...

you'll get a lot of good help and support here...

celi & binks
 
Thanks Binks! They do look quite similar! I will be updating his picture soon!

I'm just waiting for the, "Shed" to fill up I guess. Does this happen with only Lantus? I don't remember having to wait to see some type of result with Vetsulin.
 
Denne, My cat Simon was diagnosed in November and was getting ready to do an OTJ trial the end of February when my vet discovered Simon had an ear infection. He put him on tresaderm ear drops 2x/day. I'm not sure whether the ear drops that your cat is on has a similar make-up as Tresaderm, but I noticed an immediate spike in Simon's bg. If you look at his spreadsheet you will see how much he spiked in just 3 doses of the ear drops. Before the drops, he was in the 80's and 90's and then while he was on the drops, it went up to over 300. I switched Simon to a non-steroid ear drop that my vet recommended called Zymox. Not sure this will help with your kitty's yeast problem. Even though the vet didn't think the tresaderm would raise Simon's bg, I am convinced that it was the culprit. Your kitty's bg might drop off once he is off the ear drops, although it might take a week or longer to get it all out of his system. Hope my experience helps a little and I know you will get great advice and support from others here in Lantus Land.
 
Hi Georgia and Simon!

If I could drive up to you guys right now from Florida to hug you I would!! Your story is just like mine!

Smokey's OTJ numbers were never above 70 for 6 months and he was perfectly fine without any insulin! I knew the drops caused this to happen but the vet told me that the systemic absorbtion of the cortisteroid was so minimal that it would not have effected him! He added that he had never heard of something (some what topical) increasing BG. I just knew in my heart that this is what happened!

He has been off of the drops for 2 weeks now and no improvement! Looks like your kitty got somewhat better in 4 days or so!

I just can't wait for poor Smokey to start coming down a bit. He just looks miserable right now and every time he walks to the water bowl I cringe!! nailbite_smile
 
Hello and welcome! So sorry your Smokey is out of remission, but hopefully you can get him back on track in no time! Binks is right... Smokey is gorgeous!!

Lantus and Levemir are the two shed based insulins... think of it as an actual shed in the back yard that has to have a certain level of insulin in it for everything to run properly. Each shot you give, Smokey hauls some of his insulin out back to the shed for storage, then uses the rest to decrease his BG. At first, quite a bit of each shot goes to the shed, with less going towards BG reduction, which is why you saw little to no results at first. However, after 5-7 days, the shed is pretty much full. Now, Smokey will only take a small amount out to the shed with each shot, with most being used for BG reduction.

This type of delivery system means that it is very important that Lantus be dosed consistently and as close to a 12 hr schedule as humanly possible, with adjustments of no more than 30 minutes per day unless absolutely unavoidable. The more you tinker with dose amounts and shot times, the more the shed gets messed up, and the more you spend on insulin that isn't regulating your cat. The good news is, Lantus is very gentle and very effective and gives you a very good shot at once again achieving remission.

Another thing... be sure not to shake or roll your lantus vial/pen. While this is necessary with other insulins, it can quickly destroy your lantus and make it worthless. Also, don't shoot any bubbles back into the vial, and if you make a mistake, start over with a new syringe. Lantus is very delicate, and air or the coating from the syringes can degrade it as well. Keep it in the fridge, and if you have a vial, keep the vial in some container (the original box works fine) that keeps out light. Also make sure that it doesn't freeze (again, insulin destroyed at that point). These steps will all make sure that your insulin lasts as long as possible. Did your vet give you a script for pens or vials?

I know it must be frustrating not only to be back from remission for something like eardrops. Lantus is so different in so many respects, you really are starting over. Keep an open mind... especially when advice about lantus doesn't seem to jive with your experiences on vetsulin. they really are very different, and the protocols differ accordingly.

I look forward to learning more about you and Mr. Smokey! Please continue to ask lots of questions when you have them! :)
 
Welcome to Lantus Land!!

To succinctly answer your question, both Lantus and Levemir are depot-types of insulin. We colloquially refer to the depot as a "shed." It takes approximately 5 - 7 days for this reservoir of insulin to form. Until that time, a small amount of insulin is essentially unavailable for use. As a result, those of us using either Lantus or Lev learn to be patient! What I will underscore is that your having used a different insulin will mean you are going to have to re-train your brain when it comes to dosing. Lantus is long-acting and does not "pull" numbers down the way other types of insulin do. Further, dosing is based on the nadir, not on the pre-shot value. It's important that you get at least one test during both the AM and PM cycles in addition to your pre-shot tests.

If 14 lbs was an "ideal" weight for Smokey, roughly 1.5u would be the initial dose of Lantus. (initial dose = ideal weight in kilograms x 0.25)

There is an overwhelming amount of information contained in the starred, sticky notes at the top of the Board.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Becoming Data Ready: What data you need in order to be able to work toward remission or tight regulation.

If your vet is new to Lantus, you might want to share this journal article with him. It is from a top tier vet journal and contains the formal version of the dosing protocol we use.


Please ask questions and/or let us know how we can help.
 

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Thank you for taking the time to write such detail! I am a very detail oriented person and I love to take in all the information! So, I thank you again!

Am I understanding correctly that with Lantus, I should be basing dosages on the 6+ (nadir) instead of the 12+ reading? My vet said we would look at the dose in 1 week and asked me to call him with the 12+ reading before giving him the next shot. In your experience, should I be calling him with the 6+ reading instead? Since he has been on this new dose of 2u for 2 days now, should I wait a week or so before doing a curve to get accurate readings (after my shed is full)?

Even prior to remission (2 years of insulin), I am extremely diligent about feeding/shot at 6:15am and 6:15pm! I have missed vacations, business meetings, birthday party's, dinners, etc. just to make sure my baby is taken care of right at that time! Then, when the time changes twice a year, I break out in hives trying to figure out what to do!! :o
 
Hi ! I just wanted to say welcome aboard! You've found a very good and informative place, with lots of very knowledgeable can caring people. I won't add anything more to what has already been said- there is a wealth of information there. I do encourage you to print of the document that Sienne provided for you, and take it to your vet. It will help him learn about lantus. I know when we started my vet knew nothing about how lantus worked. She knows FD, just not Lantus.

To get "Smokey's SS" try the following:
then Type Smokey's SS, followed by
it should be all one line. I hope that makes sense - explaining things is not my forte. maybe somebody who is more techy than me will do better....

and yes, dosing is based on nadir. It usually is around +6, but can be earlier or later. I would bring your vet both. For me, I love data, I'd start the curve now, it won't hurt anything, could be useful information, for you and your vet. I just wouldn't change the dose until you have given Lantus a chance to work.

and I know on the time change thing - we all do too! :lol:

Once again - welcome aboard!
 
In answer to your question, this is from the Tight Regulation sticky:
WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR...

* Kitty should be monitored closely the first three days when starting Lantus or Levemir.
Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
More monitoring may be needed.

* It will be necessary to test kitty's blood glucose levels multiple times per day.

* Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.

* Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).

* Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.

* Feed a high quality low carb canned or raw food diet.

* Feed small meals throughout the day. Some kitties adapt well to free feeding.
Click to expand...
Getting tests at +3, +6, and +9 (a mini-curve) will help you to find when Lanatus onset and nadir are as well as what the duration of action is. It would be reassuring to tell you that nadir is always at +6. Unfortunately, it's not. If you look at Gabby's SS, her nadir can be anywhere from +3 to +7. And, it moves around. It's helpful to not think of nadir as a static point. I would begin to collect whatever data you can. I suspect that by day 5, you'll start to see some shift in numbers.

I tend to think you are going to need to educate your vet as you are learning about Lantus. It wasn't all that different with my vet. She knew that many cats had a better chance of remission/tight regulation with Lantus, but she hadn't seen the journal article I sent you. If you can e-mail it to your vet, it may be a means to start a dialogue about Smokey's FD management.

You are clearly a dedicated cat mom! You're in good company. I'm lucky to have friends who understand that life revolves around shot time. And no need for hives. At the start and stop of daylight savings time, we post instructions on how to make the change with as little impact as possible on shot time.
 
Denne, my cat Simon's numbers changed around in about 4-5 days but he only had 3 doses of ear drops before I stopped giving him the steroid drops and switched to the other. Since Smokey was on the drops for 10 days, it will probably take a little longer to get it out of his system.

Definitely do a curve now -- the more info the better. I ended up switching vets after Simon was diagnosed to another vet that would work with me. My new vet really didn't know too much about the protocol and I brought him all the information and a copy of Simon's spreadsheet. He was really interested in reading all the literature so I recommend you printing it out and showing it to your vet.

Have a good evening and I know things are going to turn around for you and Smokey really soon.
 
I've emailed my vet the link to the protocol as well as the link to Punkin's spreadsheet. I doubt that he checks it all the time, and just in case he hasn't seen it recently, every time i go in i print out the spreadsheet and deliver it. :-D
 
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