Two vets, two opinions, thoughts or advice please.

[Christianna]

Noodle has not really shown any movement during his first month on Lantus. I am temporarily staying with my mom who broke her hip in a town not near my regular vet. I had to get Noodle in to see a nearby vet Thursday for a dislocated knee and he says Noodle should go on Levemir. I trust my regular vet more because he knows more of Noodle's history. He says stay on Lantus for a few more weeks. I am so torn what to do. It's hard to handle this "long distance" when he can't see or examine Noodle and it looks like I'm going to be at my mom's for at least 2-3 more weeks. I don't know if I am just too impatient and can't really afford a big outlay for Levemir when I have 2 vials of Lantus but I will find a way if it will help Noodle. A forum member sent me some Lev but I am returning it to her because my indecision and delay in starting it has caused some ugly and untrue accusations. When something is posted as "free" or "free for postage" it does not imply that the recipient must adhere to any conditions and attached strings that the donor desires. I WAS ONLY WAITING TO HEAR FROM THE VETS! Can I ask experienced users' opinions? Is 5 weeks with no real BG decrease unreasonable and should I put the Levemir on hold? Thanks.
If anyone can use BCP PZI please PM me. I have a vial, barely used, to give away.

Christi

 

[Larry and Kitties]

It is a tossup where to keep trying the PZI or change to another insulin. I myself would change and see what happens.
I myself am having problems with Mith Badger wh I adopter a little over a month ago. I am seeing BGs similar to yours (see increase after shot) except occasionally I will get a low preshoot, For example on 8/24 with an evening PS of 444 I gave one unit of Levemir and next morning's PS BG was 60.
This morning with a PS of 371 I gave 0.8 units and at + it was 434 and +6 3/4 it was 365. This evening PS was 329.
I had similar results with Lantus.
I also tried N but I did not like the results. However, I did find out that if I gave either Lantus or Levemir and I gave 0.4 units N at about 3 hours I could get a preshot of about 150.
Sometimes ECID (each cat is different)

 

[Anitafrnhamer]

Is it possible that your having to tend to your mother (new environment) is causing stress that will keep the glucose higher?

I can only tell you my experience with Lantus. Using Lantus and low carb wet food and my cat went into remission in about 9 weeks. Squeaker was a diet controlled diabetic for 8 months then he developed pancreatitis and went back on Lantus for 6 weeks, at which time he went back into remission.

Just like people responsiveness to medication varies from one to another. If you have more confidence in your regular vet you might consider following their recommendation. But I would still check for ketones in the urine as an extra monitoring device.

Good luck to you.

Anita and Squeaker

 

[Christianna]

Thanks so much, Anita. You make a very good point about the increased stress level. It is hard to keep on a good schedule in someone else's home, plus have the two opposing vets. Still I definitely had to get on board with a vet while I'm here in case Noodle had any emergencies. I am so happy to hear of your good experience on Lantus. Gives me hope Noodle did have pancreatitis and sometimes I wonder how one ever knows that their kitty is truly "over" it. One vet said it often is present as a low-grade barely perceptible infection and is underdiagnosed. The ketones have been worrying me and I'm testing twice a day. Today was negative, thank goodness. Thanks so much for answering my post and telling me of your own experience. I really appreciate it.

Christi

 

[Jill & Alex (GA)]

Can I ask experienced users' opinions? Is 5 weeks with no real BG decrease unreasonable and should I put the Levemir on hold?

i rarely post any more, but i've helped lantus and levemir users for 8+ years on the FDMB. imho, noodle is simply under dose. if you have two vials of lantus on hand... why waste them? it's too expensive to waste unless there's tangible evidence the insulin simply isn't working.

you just haven't reached a good dose for him. to complicate the issue he's now experienced a set back after lowering the dose to 0.5u on 8/11. that was quite a risky and unnecessary move when there was no indication what-so-ever on his spreadsheet that the dose was too high at the time... he was actively spilling sugar into his urine! :?

the longer noodle remains in high numbers the more difficult it will be to break though what's called "glucose toxicity". once glucose toxicity sets in it usually takes more time and higher doses of insulin to cause a break through in BG numbers. julie & punkin (ga) put together an excellent post, "Feline Diabetes and Glucose Toxicity links. you might find it interesting.

what's noodle's ketone status? i don't see any notations on his spreadsheet for the last week and a half. does he continue to throw ketones? if he continues to throw ketones you might want to ask the gals in the Tight Regulation Group about fast-tracking him up the dosing scale. remember, the recipe for developing ketones = an insufficient supply of insulin + inappetance + infection OR some other systemic stress.

if you will commit to at least a before bed BG test every night: i suggest posting in the LANTUS (GLARGINE) - Tight Regulation Group for help. they'll give you a hand with breaking through those high numbers.


fwiw, just my thoughts...

 

[Christianna]

Thanks so much Larry. One thing I'm unclear on--do you mean you give Lantus or Levemir and also some N 3 hrs. later? Sorry if I misunderstood, does this mean you're using a combination of 2 insulins? Thanks for the help.

Christi

 

[Christianna]

Hi Jill and Alex,
I'm very glad you answered my post. Actually, some experienced forum members suggested that I lower the dose back to .5U. I got on and asked for advice because as a newbie I was completely baffled as to why Noodle had more yellows on the low dose and more pinks the higher the dose was raised. May I ask why you might think this is? The forum members did tell me to go back up when ketones appeared. Noodle has negative ketones today and I get a urine sample at least once a day, plus report in to my vet. Noodle acts great otherwise. The vet said because Noodle had pancreatitis he might be "ketone-prone." Not sure exactly what to do about that.
I had been posting on the relaxed Lantus forum but if you think TR forum is better, I will post there. Noodle gets his PM shot at 10p.m., close to our bedtime due to our work hours and I always test him before any shot. Should I test him late into the night (set alarm to do it?) Thanks for the link on glucose toxicity and also for answering my post and questions. I didn't act on my own to lower Noodle's dosage; I did seek help on the Relaxed Lantus forum and that was their advice. :? I'm too insecure right now to do much of anything on my own--you'll see how many panicky posts I've had! :shock:

Christi

 

[Jill & Alex (GA)]

Actually, some experienced forum members suggested that I lower the dose back to .5U.

yes, i saw the notation on noodle's ss. i'll never understand that logic when other indicators say otherwise.

I got on and asked for advice because as a newbie I was completely baffled as to why Noodle had more yellows on the low dose and more pinks the higher the dose was raised. May I ask why you might think this is?

sometimes numbers get worse before they get better. however, in noodle's case i highly suspect glucose toxicity set in. glucose toxicity can set in in a matter of days. the only way to break out of it is to continue to increase the dose. there are experienced members on this board (some more knowledgeable & more experienced than others) sharing and offering suggestions/recommendations. none of us are veterinarians, experts, or dose advisers. we're simply lay persons making suggestions in an internet message board setting. we've never laid eyes on your cat nor are we able to diagnose... especially over the internet. being a reputable message board, we tend to use the utmost of caution to keep your cat safe. i only mention this because while glucose toxicity may set in in a matter of days... our suggestions to increase the dose may come more slowly because safety is the number one priority around here. we take "do no harm" to heart. before you know it, glucose toxicity has set in and takes longer than we care to admit to break through it.

The forum members did tell me to go back up when ketones appeared.

yes, i saw that. wonderful!

Noodle has negative ketones today and I get a urine sample at least once a day, plus report in to my vet. Noodle acts great otherwise. The vet said because Noodle had pancreatitis he might be "ketone-prone." Not sure exactly what to do about that.

my alex has both diabetes and p-titis... along with an assortment of other illnesses frequently found in senior cats. my personal experience: i remain vigilant at all times. if you study the last few years of her spreadsheets you'll see rising BG numbers and astute observation provides clues as to something brewing in her body. also keeping alex as tightly regulated as possible gives me a head's up when something like a p-titis flare is starting (BGs rise). imo, keeping her tightly regulated has definitely helped her feel better sooner.

I had been posting on the relaxed Lantus forum but if you think TR forum is better, I will post there.

i think you'll find more experience dealing with stuff like the p-titis/diabetes/ketones combo in the TR forum.

Noodle gets his PM shot at 10p.m., close to our bedtime due to our work hours and I always test him before any shot. Should I test him late into the night (set alarm to do it?)

random occasional night time tests would be great! i understand it's difficult to get mid-cycle tests when the PM shot time is so late. i presume an earlier shot time doesn't work for you??? sharing a little tip to getting night time tests when you really want to see how low the dose is taking noodle... drink a tall glass of water prior to going to bed. if you're anything like me you're guaranteed to wake up in a few hours! :lol:

Thanks for the link on glucose toxicity and also for answering my post and questions.

you're welcome. have a nice evening!

 

[Christianna]

Hi Jill and Alex,
Wow--that was just a GREAT response! I really am grateful! You answered so many of my questions and I am beginning to feel a little more hopeful. I took your advice and posted on the TR forum last night and have already received some great responses. I feel like Noodle is in really good hands here. Thanks again--so much!

Christi
P.S. Love your suggestion about the tall glass of water Since I have been snacking on watermelon after dinner this summer, getting up in the night has not been an issue!