Trixie in the reds, greens, and all in between...

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KittyPurry

KittyPurry

Member Since 2014
Hi all. I need some help/opinions about Trixie. You can view her spreadsheet from the link in my signature or clicking here. She's on Lantus, and eats Fancy Feast classics exclusively.

Her numbers are all over the place with a reading in the green yesterday. More often than not, her numbers are low enough in the morning that I don't feel comfortable giving her juice in case she were to head too low while I was at work. Because she doesn't always get the AM shot, her numbers jump right back up in the PM. Since this jump was happening on a 0.25 u dosage, at the suggestion of some board members I took it down even further. I wanted to find a level I could consistently give her morning and night without constantly skipping a shot. I'm eyeballing it the best I can and trying to be as consistent as possible. Of course, this is hard since there are no markers lower than 0.5. I'm not sure if 'human error' in the dosage is the most likely culprit in her bouncing all over, or if there are other factors at play too. Am I hurting her or damaging her by not giving every shot? I don't want to be unintentionally hurting my cat.

I'm still working on trying to grab more tests during the cycle. Trixie is cooperating much more with testing, so at least that working in my favor :) It just seems like the times I'd be around to test more often usually coincide with the times when she didn't get a shot. *eyeroll*

Edit to add: She does seem to be feeling better, and looks a LOT better. She doesn't drink like she's dying of thirst anymore (which means no bricks in the litter box), her coat looks better, and she's been playing a lot more. The playing just makes my heart sing... I can tell she's on the mend.

Edit 2: I just learned that you aren't supposed to roll/shake/jostle Lantus at all from the "Lantus Handling and Storage" sticky. The vet told me to roll it every time gently between your palms and that if there are ever "snowflakes" in it, to just roll until they mix back in :( So there's another thing I've been doing wrong...
 
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Magnifiers are your friend! If you wear glasses already, try Carson Clip and Flip. They have them on Amazon.
If no glasses, the over the counter readers can work pretty well.
An option to consider with the dosing: if you slightly increase the carb amount, you might be able to shoot more consistently and safely.
What is your no shot number? If you're testing mid-cycle and have data showing it is safe, the initial limit of 200 mg/dL for folks without test data may be dropped to 150 mg/dL as long as the nadir remains above 50 mg/dL on a human glucometer. And, if you follow the Tight Regulation protocol, it may be dropped, carefully, further.
 
Do you think that is the most likely culprit? Or are there other reasons/contributing factors to her jumping all over? Would you have mentioned that if I hadn't first?

I hadn't considered about the carbs... she is eating all 4% carb wet fancy feast flavors. It's not 4% for any particular reason, just that those were the flavors I chose for her.

And to answer your question about "no-shoot" number, I'm using under 200 mg/dL (but every time I didn't shoot she was actually under 150 mg/dL). Since I don't have many tests during cycle (only one at potential nadir, +6) it's hard to know how how low she is generally going. I'll work on grabbing more tests mid-cycle to hopefully get a better idea of her patterns.
 
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If necessary, some folks set an alarm at night to get up and check once in the likely nadir period. Try to do this on a multiple of 45 minutes, as that is the length of the average sleep cycle and it can be easier to wake up at the end of a sleep cycle, rather than in the middle, deepest, sleep.

If you find that the lowest test is safely above 100 mg/dL on a human glucometer, then you have room to cautiously drop your no shot limit a bit at a time, down to 150 mg/dL on a human glucometer, as you get data showing it is safe.
 
Another vet who doesn't understand that there is nothing in Lantus or Levimir to "Mix". It's only with the cloudy type insulins, the NPH types like Humulin, Novolin and Prozinc, PZI, Caninsulin/Vetsulin that you want to roll and mix. Those insulins are cloudy because there are small particles suspended in solution. Those particles can and do precipitate out of solution. The rolling is to get the particles mixed up evenly again in the vial.

If you ever see particles or "Snowflakes" in your Lantus or Levimir, the insulin has gone bad and it's time to replace the vial or pen. It might have frozen or become contaminated with bacteria if you see those particles in the Lantus.

Lantus is not quite as fragile as that sticky implies. If you don't have those "snowflakes" in the vial or pen, you are probably ok.
 
@Deb & Wink That makes me feel a little better. No snowflakes or anything, the insulin is still pretty new (few weeks). Just bummed I was misinformed by the vet...
 
KittyPurry said:
@Deb & Wink That makes me feel a little better. No snowflakes or anything, the insulin is still pretty new (few weeks). Just bummed I was misinformed by the vet...
Click to expand...
It happens all too frequently. Perhaps you could gently educate your vet about the Lantus insulin so this misinformation does not get told to the next diabetic pet owner.
 
Yes, I think that would be good, too. I don't want other unknowing pet parents to just follow along with what they were told and end up doing the wrong thing like I was. Not sure when I will have an opportunity (or the best way to tell her she misinformed me...) as I think I should probably find a different vet.

As far as my original posting, am I just not asking my question correctly? Or clearly enough? Should I be in the Lantus forum with this one for a better shot at replies? Just trying to figure out why her numbers are all over the place and what I can do to help.

I can keep working on trying to get tests at potential nadir time when she's had the shot to see how low she gets, but will those results even be typical/generalizable? IIRC, I was told it takes 5-7 cycles for Lantus to build up (sorry not sure the right words to use for this) to a consistent level. She is skipping a shot every third day or so, so she's never even BEEN on lantus for 5-7 cycles at a time.
 
There could be a number of factors for Trixie bouncing all over the place. Perhaps she's getting a longer duration than many cats from the Lantus. Perhaps she has a sputtering pancreas that is starting to produce some insulin on it's own. Yes, the skipped shots contribute to the roller coaster effect, but you just don't have enough data mid-cycle to know how low the insulin is dropping Trixie and to help keep her safe. So, you need to skip which starts the roller coaster effect all over again.

You would be in good hands of you posted over in the ISG for Lantus(glargine)/Levimir)detemir). There are far more people over there experienced at reading spreadsheets than I am. My SS reading and interpreting skills have become a bit rusty.

You will probably be asked if it's possible to get a "one last test before you go to bed" test on a daily basis. It would add some more data points and can be helpful in determining if your Trixie is one of those cats that tends to drop much lower overnight.

Sorry Scarlett, sometimes we do get sidetracked and don't answer your original question. My sincere apologies.
 
If you'd like to start posting in the Lantus forum, you'll get replies from folks who are focused on using that insulin.
 
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