Treatment Question...

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spj

Member Since 2014
So - my husband and I stopped giving Todd insulin after he was on it for just ONE day (Sunday the 23rd - he rec'vd 1 unit of Lantus twice on that day). We stopped the doses because he's so close to 200 every time we test him, so we don't want to overdose him since he's newly diagnosed and we're not home during the day. He's been on an all wet food diet for over a week.

I haven't started a chart yet, but here are the random tests we've done since his one day on insulin (all before feeding him - and I don't know if the fact he gets super upset about being glucose tested affects his blood sugar, too):

11/27 9:30 pm 263
11/28 7:18 pm 165
11/30 10:34 am 204
12/1 6:10 pm 223
12/2 6:27 pm 209

We're considering just a .25 dose of Lantus...maybe .50 - but I don't know what to do because he's so close to 200 and we both work during the day. I thought starting with 0.25 or 0.50 would be safe...but it's so hard to eyeball the 0.25 dose. Anyhow - thoughts? PJ and Todd
 
Hi. I'm too new to be able to help you with dosing question but I saw you hadn't had a response yet so bumping this up.

Can someone pop in and help?

Juliet and Silver
 
I'm a newbie too so sorry can't advise on dosing.

I do have a recommendation.

Why don't you pop on over an introduce yourself in one of the Lantus support groups?

There are two to choose from; tight regulation and relaxed.

They would be the ones to advise on dosing.

My sugar kitty is on ProZinc and I'm in the ProZinc support group.

They have helped me out when I've been unsure of dosing for Hank.

Check it out by going to home page, scroll down and click on support groups and then click on either tight regulation or relaxed, your choice.

Kimmie
 
I peeked at your post earlier, but didn't have time to go back and read up on your previous posts to find out some backstory on your kitty. So lets see if I got the history right.

At diagnosis Todd was 354. He was dry food fed with some Whiskas wet.
You gave 1 day of Lantus 1U b.i.d. and were going to switch to feeding all wet.

Have you completely switched to wet food only? No access at all to dry food? What is the wet food you are feeding? I don't know that we have the numbers for the Whiskas on the board... I haven't seen them. I think it is low carb, but could it be possible to switch him to something with a known really low carb content, like under 5%?

Have you tested more than once in a day? It would be interesting to see some tests pre-food and post-food to see how his pancreas is responding to food.

It looks to me like the food change help a lot, but he's not quite there yet and needs either a little more tweaking on the food or a small amount of insulin support for a little bit.

The calculation for dose is 0.25U per kg of ideal weight. It sounds like 0.25 and 0.50U are well below that. Starting below and working your way up to the confortable dose is always an option when you feel like that is too much. My last foster ChrisFarley's dose calculated out to be around 1.75U, but I started him on just 1U because of how reactive he was to Vetsulin and we never made it past 1.5U.

So what to do about treatment? First I'd look at his food and see if there is anything else he is getting to eat that might be contributing to the higher numbers and remove that. If there is any high carb/dry food in the house, get rid of it. If there isn't anything in his diet that seems to be contributing, then me personally, I'd give him some insulin support for a little while to get away from going into those 200s. I'd lean towards a start dose of 0.50U myself and get some testing in when you are able, but I think if you were more confortable with 0.25U that would be fine too, you can always work up if its not enough.
 
This is the starting dose calculation for Tight Regulation:

Using a weight based formula for determining a starting dose of Lantus or Levemir when following the Tight Regulation Protocol:
the formula is 0.25 unit per kg of the cat's ideal weight
if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
Online Calculator for Converting Pounds to Kilograms

There are circumstances such as ketones present, an unusually low preshot number, a caregiver leaving the cat with a sitter, relatively high flat curves, loss of appetite, infection, a schedule change, ability to monitor, etc. which may call for adjustments to these guidelines.
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Oh and do you have syringes with half unit markings? Much easier to eyeball the .25 units that way. If you look at the Health forum (this one) someone posted a question about syringes snd I posted a pic of U100 3/10cc syringes with half unit markings.
 
Thank you EVERYONE for your replies - he has been on all wet food now for over a week. Just yesterday I got the syringes with the half markings (suggested here in a past post), MUCH better. I think we'll start with a max dose of 0.5 and go from there - I know he could do more, but his numbers fell really quick the one day he only received two doses of 1 unit. I think I just got a little confused because as newly diagnosed they say don't shoot if he's as low as 200, and he's usually right around that mark. All of the suggestions I've received on this thread and my two others have been SO helpful! Thank you!!! PJ and Todd
 
spj said:
Thank you EVERYONE for your replies - he has been on all wet food now for over a week. Just yesterday I got the syringes with the half markings (suggested here in a past post), MUCH better. I think we'll start with a max dose of 0.5 and go from there - I know he could do more, but his numbers fell really quick the one day he only received two doses of 1 unit. I think I just got a little confused because as newly diagnosed they say don't shoot if he's as low as 200, and he's usually right around that mark. All of the suggestions I've received on this thread and my two others have been SO helpful! Thank you!!! PJ and Todd
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I would pop over and start a thread in Relaxed Lantus or Tight Lantus depending on what protocol you want to follow - as the "no shoot" number depends on which protocol you are doing. I am doing Start Low, Go Slow as I am not around to test during the weekday when I am at work. If you're around though and can do a lot of testing - then the TR might be best for you. Check them both out. That way, you can get more direct help with dosing, according to the protocol.

If there was any chance you could set up a Spreadsheet and add it to your signature the way a lot of us do, then people can pop in and take a look. You would get better advice that way.

here is the link to setting one up.

viewtopic.php?f=6&t=18207


Juliet and Silver
 
I think I just got a little confused because as newly diagnosed they say don't shoot if he's as low as 200, and he's usually right around that mark.
Click to expand...

This DOES get confusing! When I first came here with Smokey she was rarely above 100, had already been on insulin for a couple of months and was up to 3U. We followed tight regulation and some times my brain would about explode seeing the "don't shoot over 200", "shoot low to stay low"... ARRRGGGG!!!! The way I wrapped my head around giving the insulin is that I thought about where I need the cat to be, 50-120. If I take away the insulin support at 200 every time, then I may never get to the range I need to be in. The 200 no-shoot mark is a safely line for beginners before they've tested enough to know what kind of pattern their cat follows. Once you are testing enough, you start to lower that line until you can be shooting the lower numbers to keep him from ever getting back to 200.

I think you are in an ununsual starting position where he has responded very well to the food change, just hasn't quite made it all the way back to normal. I haven't seen your other threads or the advice you received there, but if you've only been on the wet diet for a week, I think you could possibly watch a little longer and see if that settles in a little more.

Glad you are on the boards here with whatever you decide to do!
 
Well put Melanie....

I think its important to mention though that the two protocols are very different - Tight Regulation has one set of rules; the Start Low Go Slow has a totally different set. So its important to decide on the protocol you are going to do FIRST. Then its a lot less confusing. For me the decision to do the SLGS was based entirely on the fact that I am out at work 12 hrs a day Mon-Fri and cannot get home in the day to test. Both protocols work very well - it just depends on what fits your life as to what you choose.

Juliet and Silver.
 
I think its important to mention though that the two protocols are very different - Tight Regulation has one set of rules; the Start Low Go Slow has a totally different set. So its important to decide on the protocol you are going to do FIRST.
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Nothing in my post is TR specific. Both protocols start with a no-shoot number at 200 for newbies and both lower it as the caregiver becomes more experienced. The normal range for BGs in a cat is also the same for both protocols 50-120 on a human meter.

Yes, there are two protocols. Both have pluses and minuses. Both can be done on a full time work schedule, both can be done if you sit at home with your cat all day. Both of them in the beginning, hopefully, have regulation as a goal, remission as a hope. I don't see the two protocols as really that different. It comes down to how much you want to test. The more you test the tighter you can regulate things, the less you test the slower you should to go to be safe.
 
welcome to the FDMB PJ and Todd! sorry about hijacking your thread below.
good luck with the 0.5u dose. try to get some mid-cycle spot checks when you can. they'll tell you how low the dose is taking Todd.
hope to see you posting often!


KittyMom777 said:
Melanie and Smokey said:
Both can be done on a full time work schedule, both can be done if you sit at home with your cat all day.
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Click to expand...

Not if you work a 10 hr day with a 2 hr each way commute you can't.....
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juliet:
i know you've been here a whole month now and you're very enthusiastic, but there's a lot that's been going on here for years... practices that you may not be aware of. i believe this is just one of them.
we have had many caregivers who work full time... out of the house for 10 - 12 hours at a stretch... follow the tight regulation protocol. as a matter of fact, the very first person on this board who followed the TR protocol to the letter worked a 10 hour day and put up with heavy traffic in washington, dc. her commute was at least an hour each way... every day.
libby, another moderator, recently started a thread because of some spreading this kind of nonsense. you might want to read it or at least familiarize yourself with the subject:
STICKY: CAN I DO TR WITH A FULL TIME JOB? YES!.
if you want to talk about it, please send me a PM so this thread isn't hijacked any further.
thank you
 
You got a whole lot more thoughts there than you were asking :)

What we just wanted make clear is your options are open. There has been some talk on the boards that people can't do TR because of full time jobs so we try to disspell that notion when it is said. Maybe you don't care! Maybe you don't give one hoot about the protocols, but we want to make sure you have correct information when you make decisions about treating your cat. Hopefully you will post either in Health here or one of the Support Groups if/when you start giving insulin so everyone can see how your progress goes.
 
Actually, most people don't get bogged down with protocol selection before they've even started giving insulin. They get used to treating and testing their cat first. Once they are used to that, then they can decide if and what kind of protocol they want to follow and move to the support forums at that point. No one really has to follow any protocol, though its recommended because having those guidelines helps make decisions. New members are always directed to this forum first to get their feet under them on treatment basics before going to the support groups.
 
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