Welcome to Lantus Land.
I've sent a note to someone I know in the DC area who may have some recommendations. This is what D/Noisy passed along:
Diahann & Noisy said:
My favorite ER, I would drive 100s of miles to get to if I had to, place is
Southpaws.
My all around favorite vet (we know more in LL about diabetes than he does but he is very supportive of what LL does and has asked me advice a few times).
Dr. Morgan, he's in Georgetown (not too far from Bethesda).
You are very close to
Friendship Animal Hospital. Personally, I will not go there unless I have no other choice. The issue I had is OLD so they might be fine to go to. I just won't go there. I know they get good ratings but it's a big place and if the person goes there they should first research the doctor and then ask for him/her specifically. I don't trust the place, but I might trust a specific doctor there.
Great job with getting your SS up and running and getting started with testing. Those are two big hurdles. One other item to add to your signature line is a
Profile. This will give us background info on Louis and we won't keep asking you the same questions repeatedly.
Please make sure that Louis is eating. As the folks on Health noted, an unregulated diabetic cat refusing food can be a set-up for other problems. It's important at this stage of the process to be testing for ketones. This is very easy. You need to pick up Ketostix (tests for urinary ketones) at any pharmacy. They are inexpensive. You dip the end of the stick with the sample pad into your cat's urine. It does means stalking your cat to the litterbox but knowing that your cat is not producing ketones will save you a fortune in vet bills and potentially save Louis' life. Diabetic ketoacidosis (DKA) can be lethal if not treated in time.
Please familiarize yourself with 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.
The vast majority of the members of this Insulin Support Group are using a dosing protocol that is based in clinical research and that has been published in leading veterinary journals. It is referred to as the Tight Regulation (TR) Protocol (or by other names as well, the Tilly Protocol or the Rand/University of Queensland Protocol). They are all the same. A modified version of the protocol and links to the formal versions is available in the Tight Regulation sticky. A TR approach has been successful in helping many cats reach remission. It is not mandatory that you follow this approach. However, you should be aware that most of us do and it is how we approach dosing decisions. As a result, we are very numbers driven.
There are also several expectations that you will want to be aware of:
- the protocol we use was developed by lay people, who are members of the German Diabetes-Katzen Forum. It has since been published in the Journal of Feline Medicine and Surgery
- following a Tight Regulation Protocol it is more time-consuming than most other protocols, but still definitely doable if you work a regular full-time work week
- it is more expensive than most other protocols, but costs can be reduced (e.g. buying glucose test strips from online pharmacies or reputable sellers at eBay or on Amazon). In other words, you need to test at pre-shot times and at the bare minimum, once during each the AM and PM cycles. More, however, is better especially as you are building data to help you understand how Lantus is working for your cat.
- members typically buy 3 ml Lantus/Levemir cartridges, refrigerate them after opening - when refrigerated, opened cartridges of these insulins are extraordinarily stable
- you will need to test the blood glucose levels of your cat multiple times per day
- you will need to know about hypoglycemia and be prepared to deal with it. This post on managing low numbers will help and provides links to information on hypoglycemia.
- you will need to test for ketones regularly to start with and know about ketoacidosis, but be aware that ketones don't occur once a cat is (and remains) properly regulated
- you will need to use syringes which allow you to measure tiny doses: U100-type, 3/10 cc = 0.3 ml volume and with the half-unit increments printed on the barrel
- you will need to feed the right diet: high-quality low-carb canned food or raw food exclusively
- you will need to feed your cat lots of small meals spread over the day, free-feeding canned food can be an option for some cats
If you can't find the means to incorporate these steps into your cat’s diabetes management, for whatever reason, using a TR protocol may not be for you. As overwhelming as it may seem right now, these steps are not that hard to carry out and we've seen many people who didn’t think they could do this, slide into a TR approach once they got started.
Home testing is a critical part of this approach. Like other insulin, in order to insure that blood glucose levels are high enough to safely give a shot, you need to test prior to injecting insulin -- your AM Pre-Shot (AMPS) and PM Pre-Shot (PMPS). Unlike other types of insulin, Lantus and Levemir dosing is based on the nadir, or the lowest point of the cycle. Thus, you will need to test frequently enough so you know when the nadir is. (The nadir can change.) In addition, it is important to know when Lantus or Lev “kick in” – their onset as well as how long the insulin is effective for your cat (duration). You can learn this by doing a curve as well as by getting frequent spot checks.
No doubt, you’re feeling more than a little overwhelmed. If you take a look at the number of people in this forum, you’ll realize that there is a lot to learn and a lot to do but it is very manageable once you learn the ropes. The front end of the learning curve is rather large, though. The people here will answer your questions and help you. All you need to do is ask!
This is a huge amount of information to try and digest. Please don't expect to be able to integrate everything all at once. Most of us were more than just a little overwhelmed at the beginning. Please ask questions. The people here are extremely generous with their time and their knowledge. We truly are here to help.
