Suzie's hard to regulate - need advice!

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Maria & Suzie

Maria & Suzie

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Hi,

My 15 year old Suzie, recently diagnosed with diabetes (suspect it has been going on for some time, I switched vets for a second opinion, the first one said it was bad kidneys and old age)
She is on Lantus, and we are struggling with the ups & downs and I just hate to see how bad she feels when the glucose reading hits "hi"

Here are Suzie's readings : (I home test as much as my schedule allows) along with the dose of Lantus given. Up until May 1st she was barely eating, I had to force-feed and coax with non-healthy snacks, from May 1st she started eating exclusively diabetes food (Royal Canin dry, some Hill's soft) and has gained some weight even. She free-feeds on the vet's advice as she had lost so much weight and desperately just needed to start eating again.

April 28
First shot ever at 10pm of 2.5 IU

April 29
10 am Glucose level Hi, Lantus 2.5 IU
1:30pm 471
5:45 417
10pm Hi, Lantus 2.5 IU

April 30
10:15 Hi Lantus 2.5 IU
5:10pm 464
9pm Hi10pm 3 IU

May 1
10:00 489 Raised dose to 3.5 IU on vet's advice
1:15 380
4pm 266
7pm 325
10pm 465 3.5 IU Lantus

May 2
10:30 249 3.5 IU Lantus
1:30pm 137
4:15 134
7:40 258
10:15 485 3.5 IU Lantus

May 3
10:00 268 3.5 IU Lantus
2pm 166
6pm 204
10pm 344 3.5 IU Lantus

May 4
10:00 176 lowered dose to 2.5 IU on vet's advice
1:30 187
7:30 188
10pm 309 0,025 IU Lantus

May 5 (Suzies' 15th birthday !)
10:00 365 2.5 IU Lantus
4pm 334
10pm 466 3.0 Lantus

May 6
10:00 386 3.0 IU Lantus
4:40 284
10pm Hi 3.0 IU Lantus

May 7
10:00 486 3.5 Lantus
4pm 351
10pm 365 3.5 IU Lantus

May 8
10:20 295
4:20 158
10:10pm 492 3.5 IU Lantus

May 9
10:15 347 3.5 IU Lantus
4:45 Hi
7pm Hi

Does anyone have any tips to give? Feeling pretty desperate at seeing "hi" on the glucose meter as early as 4:45 in the day, and Suzie is NOT feeling well. Know not to give booster shots of Lantus, because of it's long effect, but feeling helpless!

Grateful,

Maria & Suzie
 
Hi Maria.
I am rather new to Lantus. However, I do know those here with experience will tell you to stick to your dose for longer periods of time before changing the dose. I also know the feelings of desperation when BGs are high. I have been in your shoes. When Frank's numbers were so high, again and again, I just let people here dictate to me what to do. It was so hard to see the high numbers. Thx to this site, I have managed to be a bit less stressed when I see those high BGs. With consistent dosing, things started to turn around for Frank.

It's great that you are home testing! Keep up the good work. Hang in there....It will get better and the stress will lessen.

Someone will be along soon to help you out. Take Care.

Happy Birthday to Suzie!!
 
Hi, Maria,

You are in the right place to get your sweet Suzie regulated! There are so many experienced people here in Lantus Land.

It's wonderful that you have started hometesting -- that's key to Suzie's success. I know another one of the first recommendations will be to start a spreadsheet. Look in the Technical forum for instructions on how to do that -- it's not too hard. The Lantus forum is "data driven" -- the more you can provide information in an organized, methodical way, the better.

I also think you'll want to make a transition -- slowly, not all at once -- to lower-carb, wet food. It is fine to free-feed wet food (sounds like Suzie needs plenty of access to food right now). The drop in dietary carbs can affect Suzie's need for insulin, so you'll want to proceed slowly.

I too wonder about changing Suzie's dose so frequently. It's been my experience that Lantus doses should be held longer, unless BGs drop low enough to "earn" a decrease. (That would be a BG of 50 in a newly diagnosed kitty like yours.)

Someone more experienced than I am will be able to give you really good input on getting into a healthy routine. You can trust the feedback you get here. I should know -- FDMB got my kitty from a life-threatening situation to remission! :-D

Post here as often as you can, and you'll get great help!
 
Hang in there. A dose advisor should be around soon.

Lantus is different, in that dose is based on nadir (lowest point) rather than preshot or highest number. Nadir is often around +6 (6 hours after the shot), but it can move around. That's why we test so much. It also needs consistency in dosing because it has long acting effect and builds up in the system. Sometimes of a cat goes low at nadir there is a bounce or rebound which pushes the numbers up at preshot time.

Food is really important in regulating diabetes. Low carb wet is what is best, or raw. Too many cat foods are stretched out with high carb fillers, which turns into serum glucose! Some of the "prescription foods are worse than the cheapest canned. There is a list here that a lot of very dedicated peeps have spent a lot of time putting together. Tne manufacturers don't think we need to know that kind of information!

I'm sure someone else will be around soon, in the mean time read the permanent posts at the top of the Lantus site to get more (actually a lot more than you ever thought you could absorb) information.
 
Welcome Maria.

Delma is correct -- we work from a start low, go slow model for dosing here. Most of the cats are started on a lower dose than what Suzie was started on. If you look at the dosing protocol we use, the initial dose can be based on ideal weight (dose = 0.25 x kilograms ideal weight). Doses are also raised in increments of 0.25 to 0.5u so that what may be an ideal dose isn't missed.

It also looks like you are not testing during the evenings. It is important to get tests in, at least a before bed test, during the PM insulin cycle. If you are not testing at night, you are missing half of your data which is further complicated by many cats having lower numbers at night.

It sounds like Suzie is eating again. That's great. We strongly encourage feeding a low carb (LC - less than 10% carb) wet food diet. Dry food, even the lower carb varieties, still raise blood glucose (BG). There are a number of kitties here whose numbers have dramatically improved once dry was eliminated from their diets If you are not familiar with these sites, please look at Dr. Lisa Pierson's website on feline nutrition and Janet & Binky's food charts which will give you the carb counts on most varieties and flavors of cat food. Frankly, I would suggest bringing home some cans of low carb Fancy Feast which is a far better quality of food than the Hills (lots of by-products vs. muscle meat) and not feeding the Royal Canin (24% carb which is very high carb food). The Hills is also 14% carb which, by our standards is a medium carb food. Most of us feed Fancy Feast varieties that are in the 4% range of carbs.

Unfortunately, many vets are not terribly familiar with diabetes management. I'm glad you found a vet who could do better by Suzie. It dose seem, though, that some of the information that he is basing his treatment recommendations on, such as food choices, are based on some dated information or like most vets, he got minimal training in this area during his training.

I do think that we can offer you some help in managing Suzie's diabetes. If you think we have something to offer, you will need to set up a spreadsheet. We are very numbers driven and rely on input of forum members to make dosing recommendations.
 
Thanks for your replies, I almost started crying because it's a relief to get some sympathy & help !
I don't want to write Suzie off just because she is 15, but we are really "toughing it". Suzie is being co-operative with our ear-pricking, blood sampling and shot-giving. I'm frustrated at that over a month was wasted with our regular vet who ignored my suggestion that it was diabetes and prepared me that "Suzie is old and her time is nearing", only to discover when I went for a second opinion that it's indeed diabetes!

Suzie, bless her, has no teeth (a fact I recently discovered when I looked in her mouth to see if there was a problem that meant she had stopped eating), so she has a hard time eating soft food. I try pureeing the soft diabetes food so she can lick, but she does not get enough down, and the dry food, the Royal Canin diabetes dry food are large-ish and flat/rectangular in shape and she can get these down easier than the small round Hill's or Purina ones. I have witnessed her trying to eat foods she simply can't keep in her mouth due to no teeth and give up after a while.

After her barely eating for weeks on end, we are in the mode of "eat what you can, when you can Suzie" and she is quite interested in the Royal Canin dry. I would happily cook for her, but she has never been interested in "human food", chicken, etc... don't interest her at all, tuna & salmon from a can sometimes get her interested, but she struggles to get it down and only eats minimal amounts.

I know I need to post a chart and follow protocol better on the messageboard, but I'm pretty desperate at seeing her recent values today. Her next shot is due in 15 minutes and I don't know what else to do but to stick to the 3.5 IU dose.

It's so hard to find time for everything and do a full-time job. Suzie & I live in Belgium, so we don't have Fancy Feast here, I am scouring the local websites for food-tips, but this board is by far the best I have seen.

Suzie has no teeth left to grit, but I do !

Thanks for the replies so far!
Maria & Suzie
 
(((Maria))) -- in Lantus Land, that means... hugs!

Just be sure to keep testing, and remember that the peak effectiveness of Lantus often occurs somewhere around 6 hours after the shot. That will help you keep Suzie safe while you're finding the best dose. Many of us have even started over -- reducing the dose down to 1 unit -- just to work gradually up to the right dose, so that we could KNOW it was the right dose, based on testing.

I understand your frustration about wasting time. I lost FOUR MONTHS following poor dosing advice... and my kitty still was able to achieve remission. So keep testing and have hope. You can improve Suzie's health.

Cat food: There are several LL members who live in Europe. You might try putting "need European Low-carb foods" in your next subject header to get some good advice on that.

As for the consistency, try adding water to the wet food, and hold the plate at an angle. There are several kitties with no teeth here, and they all eat soft food successfully.
 
We have several members in Europe. I'm going to send a PM (Private Message) to two who live in Germany and are familiar with what's available overseas. Also, the Janet & Binky chart that I sent has a page for the international foods. This Board does have members from all over the world. It's why there is usually someone here 24/7 -- we're all in different time zones.

There are also plenty of kitties here that are toothless. We need to find a low carb food that Suzie will eat -- preferable canned.

I love your attitude!! The people here are a community and we will help you fight for your kitty and do what we can to get her regulated. Again, welcome!
 
Welcome to LL!!!

Honestly I don't think Suzie is that far off. It's funny how Lantus dosing works, you build up the dose slowly and it looks like nothing is happening, then one day you do a teeny tiny dose increase and BAM! All of a sudden the numbers completely change.

My thoughts looking at your numbers are that 3.5 is probably pretty close to a good dose. Maybe not exactly there, but it seems like a good place for us to work from. You want to focus mainly on the mid-cycle numbers and try to ignore the high numbers at the beginning of each cycle. Suzie is getting some decent mid-cycle numbers in the 100's. What happens is her little body is overreacting to the lower numbers - it sees a number in the 100's and thinks "OMG, HYPO!" and dumps extra sugar into her bloodstream. Never mind that she is nowhere near hypo, but she IS in lower numbers than she has been in a long time. The bounces are normal, and eventually they level out. You want to focus on the low point of the cycle and dose to where you have that number where you want it, and usually the high stuff will come down on its own eventually (and if not, we can tweak later, but not right now).

I also agree that you should try to get at least a bedtime check every single night. You can tell that her night cycles are different than her day cycles (most cats are lower at night) by the fact that her AM numbers are usually lower than her PM numbers. It's important to know what is going on at night too.

And then, yes, the spreadsheet will really help. It's surprising how much easier it is to see patterns when the color coding is there.

I hope this helps a little and I hope to see you back here again!
 
Hi Maria,
Welcome to the site and here's what I have to say.

First of all, look to the now and the later, the regulating will come in time, later on, so first things first. How is Suzie now compared to before her dx? Look for her to improve way before you see her numbers improve. Watch for the old Suzie to return in small ways because it WILL happen.

I think it would be a good idea to ask around this board for others in your part of the world, and find out what foods they are feeding their kitties. Some feed a raw diet, and most others are feeding wet food and low carb wet food. If you want to give Suzie's numbers a kick start to come down, get rid of ALL the dry foods. Those dry foods are just NO GOOD and are likely contributing to Suzie's HI numbers! There are actually many kitties who are DIET CONTROLLED so just by feeding proper foods, they don't need ANY insulin! Not every kitty can be diet controlled but it is certainly possible!

So once you have that food issue sorted out, you may likely see those BG numbers come tumbling down, and there won't be a need for so much insulin at all.

Others will be along who can instruct you on dosing and how to make changes according to the food changes.

One more thing on the food issue and no teeth - I add water to all the foods I feed Shadoe and Oliver; it makes for easier eating. I started adding lots of water to Shadoe's foods when she had a bad pancreatitis attack and needed fluids and also had some bad teeth issues, so I fed her what I called 'soupy slop'. Wouldn't you know it, to this day, I get dirty looks if I put down food and there is not enough water to her liking! So there's no need for her to have teeth to eat! It really doesn't matter that the food is watered down for her, so long as it's got all the nutrients she needs. The dry food is just bad for diabetics, so no big loss for Suzie there!

Now, the dose changes can't be frequently changed from one shot to the next. To understand how Lantus and Levemir work, you can read the sticky about them and the shed. I don't know why, but I keep coming back to my gas tank example when I want to explain the shed. I don't even drive so what do I know about a car's gas tank! But here goes.

So you have a gas tank in your car but you also have a spare can in the trunk, that we will call your shed, OK? Now you want to drive your car and need gas so you go to get some gas (that's your 1st Lantus shot). The garage puts 95% of it into your spare can and only like 5% into your car's gas tank! OMG! You sure can't go far on that, can you! So, of course you don't get far, or in Suzie's case, she sure does not have any improvement in her numbers, because most of her 1st shot went into her shed, her spare can.

The dose you give Suzie is the same size as her shed. She will use that shed if you are late with a shot or when you decrease your dose. On first starting Lantus or Levemir, the starting dose needs to be held the same for 5 to 7 days, that 10 to 14 shots, and just to get that shed full. Later on, you need at least 4 shots and sometimes up to 6 shots to top up a shed when you increase Suzie's dose.

But let's get back to the filling the shed to start. Each of those shots put some insulin in the shed, and then some to Suzie. With each shot, less goes to the shed because it's getting close to full, and more goes to Suzie. Once that shed is full, only THEN with the full shot be going to Suzie and her lousy BG numbers. THEN, you will start to see BIG and BETTER changes in the numbers. That's what is great about the spreadsheet so that you can actually SEE the improvements and the others who can help you with dose changes can also see what's going on with Suzie. That data matters. Just click on anybody's spread sheet links in their signatures and you will see how their kitties are doing.

OK where am I now?
We have done the food thing - scrap all the dry, and feed low carb wet food.
Stick to a dose long enough so that Suzie's shed gets filled.
Record all BG numbers and other infos on a spreadsheet so you and others can track Suzie's journey to regulation.

I need to go back to the dose issue again. Most people start at a dose of 1u Lantus, hold that dose for 10 to 14 shots, and then increase according to the protocol rules, which are all in the other stickys along by the sticky with the shed infos.
With your being up at 3u and then 3.5u and then changing it frequently, I think it may get mentioned that you should start over, down at the 1u and hold to get Suzie's shed stable and to know for sure if she needs such a high dose. There is always a possibility that you have jumped right over Suzie's perfect dose!

I think now would be a good time to say that I am wordy, but I think you already know that by now!

Finally, ask questions non-stop. No question is a bad question. The most knowledgeable ones here have spoken and they sure have helped me so very much with my two kitties, so you are in good hands around here!

To know the road ahead, ask the man coming back.
 
Thank you, it is almost 12:30 at night here in Belgium, I will test Suzie before I go to bed. I gave her 3.5 IU at 10:30pm, so 2 hours ago.

At night she is simply less active because I have to lock her into the bathroom with her food. I have other cats and the house is open plan, so they wolf her food if I am not there to sit with her when she eats. So I thought it was best to be sure she can eat at night, since she gets a 10pm shot. So she goes into the bathroom with food and water for the night.

During the day she eats more and moves around more. Also, she went from barely eating to eating and gaining a little weight in less than 10 days, so that's probably throwing her body off as well.

Bless her, even with the high figures, she's still eating, which is a relief, we had a few weeks of hell before we got a diagnosis and started treatment and got her eating again. I know the dry Royal Canin diabetes food is not considered to be the best, but considering that she used to eat regular dry food + Temptations pre-diagnosis, I figure it's already a step in the right direction and will work on transitioning in more wet food (tough one, she has never been crazy about wet food)

One good thing about the no teeth = dead easy to force-feed when we had no choice, to keep her going till the treatment kicked in (vet tried Glipizide for 5 days until I read up on it and begged her to go on insuline, Suzie would have starved to death before the Glipizide would have kicked in, if it would have worked at all). No messy syringe needed, just rolled the soft diabetes food into little balls and shoved them in her mouth as if I was giving her little tablets, worked like a charm.

Your explanation about the bounces and her body not having had low figures for so long makes perfect sense. Am going to test her before I stagger to bed. These high figures and seeing her feel bad stresses me out (probably her too!)

My husband helped me get her chart set-up, hope everyone can see it ok.

Good night & thanks!

Maria & Suzie
 
Where in Belgium are you? I have friends in the Antwerp area or did they move to the country?

Anyway, welcome to the group and Gayle gave you the water down the food trick. I do the same thing here. I typically put about 1/2 can of water to one can of food. Mix it up real well and it becomes very soupy/puree like. That should make it easier to eat.

You got advice on everything else, so I won't repeat. When you post and talk about your BG times, do it using the clock as 1-12 - like this. you start with the morning:

AMPS = morning pre-shot number
+1
+2
all the way to +11
then PMPS = evening pre-shot number

So May 3rd would look like this:

AMPS 268 3.5U
+4 166
+6 204
PMPS 344 3.5U


And if you got any evening tests in, they would be + and the number

The + is the number of hours after the shot time.

We do it this way because we are all in different time zones and it makes it easier and more uniform to read, we don't have to know what the actual time is where you or I are, rather how many hours since the shot or last test.

Hope this makes sense - when you see the ss and start inputting the numbers there, it should make more sense to you and the rest of us.
 
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