Unregulated Diabetes - Need Help!

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ftsang & Jessica

ftsang & Jessica

Member Since 2013
My cat Jessica has been diagnosis with diabetes since Mid February 2013 and was currently administrated 1.75-1.85 units of Lantus twice a day. Her situation does not improve much. Please see attached Jessica BG chart and tell me what to do.

Thanks
 
How are you able to measure such tiny increments? i have a hard enough time gauging a 0.25U difference.
I see a fair amount of dose jumping. You want to hold a dose steady for at least three days before changing it.
 
The tiny changes are just a reference point. Its simply just guess. Should I increase her dose later? She still very hungry but drank a little bit less of water. All her PS BC level were took after 15 to 30 minutes after feeding. It is impossible to take her BC level when she was very hungry.
 
If you have to feed her before the test, I would suggest just a small amount, a teaspoon or so to stave off her hunger, then get the test asap before you give the rest of breakfast. You don't want pre-shot tests to have food, since food alters the numbers. (*ideally no food 2 hours pre-test for the amps/pmps)
 
ftsang said:
My cat Jessica has been diagnosis with diabetes since Mid February 2013 and was currently administrated 1.75-1.85 units of Lantus twice a day. Her situation does not improve much. Please see attached Jessica BG chart and tell me what to do.

Thanks
Click to expand...

I think the first point to make is that Lantus works much better with consistency, so by changing the dose every shot, even by a single drop, will make regulation, steady numbers pretty much impossible.
Stick to a dose every single shot, for only 6 shots, and if you don't see improvement, up the dose.

If you are not using U100 syringes with 1/2 unit markings, get some. Guessing is not good, but eyeballing between the half and full unit markings is OK. That means your doses will be in 0.25u increments.

The dose you are on right now has been held for too long as you are doing a great amount of testing, so your next shot should likely be a full 2u. Hold that 2u dose for 3 days / 6 shots, and then decide if it's good or not. If you are still getting all those 300s and a few 200s, up the dose to 2.25u and hold that new dose for 3 days / 6 shots.

For food, you can try to hold / remove food during the 2 hours before shots so that your preshot test numbers are not food influenced. It's perfectly fine to feed a meal at shot time; many people give the shot while the cat is eating.
Your spreadsheet looks very nice and it's quite helpful for others to see what you are doing and how the cat is reacting.

Gayle
 
Thanks. I am using BD U100 syringes with 1/2 unit markings. However, not all the quatities are the same. Some of them with the scale printed not exactly at zero line, some of them with unclear scale and even slightly deformed. I was a little bit disappointed with the quatities for that prices. Yes, I will increase the dose to 2U.
 
I say there is no really difference between 1.75 and 11.85 units of Lantus. Any difference is within difference of how much the cat eats and other variables.
Are you feeding the canned DM?
Is Jessica eating the same amount each time and about the same time? You seemed to be getting better/lower BGs with a lower dose. Maybe the dose is too high.
 
There are three key factors to managing diabetes: food/nutrition, home testing and insulin

As you are home testing and using lantus, I will touch on the first one Food:

1) Feline Nutrition: Now, as far as diet - definitely dump the dry food (if you are feeding any). I see you are feeding DM. ALL cats, and especially those with diabetes, do best on a species appropriate diet that is high in protein and low in carbs. Dry food DOES NOT fit that bill and DM food, even canned, just really isn't that great as far as quality and is higher in carbs than we like to use. Most here on FDMB feed low carb/high protein canned or raw bought from a pet store or they make their own.

Here is a link to a site by a vet "Dr. Lisa DVM" ... who also posts on this board from time to time ... www.catinfo.org

If you look on the right side of her site, she has a food comparison chart to help you figure out what food you want to get based on the carb %.

You want to keep the carb % below 10% and around 7% is great. (Personally, I stay between 0-6% carbs.)

While on her site, you can read about in-depth info. on nutrition and how to make raw food, etc.

Here is another link that will give more information about food/nutrition

Nutrition/food info

If you have more than one cat, you can safely use the same food for all your cats and it may save you some costs and headaches of having to do separate feedings and keeping track of what they are eating.


If you have not already been to the Lantus forum, I suggest you go over there and read the starred (sticky) information. It talks about tight protocol, home testing, when to change the dose, how long to keep a dose, and the whys about this.

STICKY: LANTUS & LEVEMIR - NEW TO THE GROUP? PLEASE READ... viewtopic.php?f=9&t=18139

STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL... viewtopic.php?f=9&t=1581

STICKY: LANTUS & LEVEMIR - WHAT IS THE INSULIN DEPOT?... viewtopic.php?f=9&t=150

STICKY: LANTUS & LEVEMIR - INFO, PROPER HANDLING, & STORAGE... viewtopic.php?f=9&t=151

I get that this is a lot to read, but it is important for you to start looking at this, so that you can better understand when to adjust the dose.

Here is an excerpt from the links above:

"General" Guidelines:

Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).

Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).

Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.


Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.


Reducing the dose:

If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

If an attempted reduction fails, go right back up to the last good dose.

Try to go from 0.25u to 0.1u before stopping insulin completely.


Random Notes:

Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.

Hopefully, this will help explain why others are telling you not to change the dose every time you shoot and how long to hold the dose.

Please let us know how else we can help.
 
She's still very hungry and drank more water after dose increased to 2U. Is this a bouncing effect after a sudden increase in dose and the liver needs to adjust for a sudden drop in BC.
 
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