12/10 Quintus AMPS 232, 2ui, +4 544

Condo http://www.felinediabetes.com/FDMB/...beginner-other-questions.187779/#post-2084784

Here’s what I’ve understood so far:

• It’s safer to have a cat swimming in sugar for a few days or even weeks than risking a hypo
• Because of depot (and other things) Lantus dose changes have an effect over the next six cycles, so it’s not until then that you can know how that dose is working
• Insulin is a hormone and not a drug, which means the effect of giving it is a little less direct and more complex than, say, amlodipine for blood pressure (which Quintus is also taking): bouncing, WDC...
• I am going to see if I can get ketone strips and U-100 syringes
• The high numbers Quintus had during the second part of this week that I thought were HC food spikes were more likely a bounce following his drop to 75 Tuesday morning
• I am going to transition him gently to DM cans (another reason to be glad I have a salary just now!)
• Varying from shooting every 12 hours can have consequences, so particularly given this week I’m going to be away 15h a day two days in a row, he’s better off on a dose that is too low than too high

Here are the open issues:

• It’s going to be rare that I have a week that allows me to religiously do 12/12. Does that mean Quintus is condemned to staying in black and red numbers, or can I hope for better?
• I’m using my vet’s spare glucometer, which they are generously lending. I guess I should get my own. I struggle with the idea of getting a human one which just feels wrong given what I understand of the different blood composition and glucose distribution in cats and humans. Also, bear in mind I’m in Switzerland, which is not Even Europe, so what I might find here might be very country-specific... that’s how we are
• Tomorrow and Tuesday when I get home around 8-9pm having done the am shot at 6am, what would your recommendations be I do?
• I’m thinking of sticking to 2ui this week, with maybe 1.5 on Tuesday and Wednesday mornings given the late evening shots, and doing a curve on Saturday (I could do one on Wednesday but I’m not sure it’ll be useful given what Monday/Tuesday will look like)
• I’m thinking of introducing some DM food during the week given I’ve lowered the dose and i can already see his numbers going back up (+1 436, +4 544)

Advice, comments, and extra data welcome. It’s already helpful to know you are there, I feel a bit more in control of the situation.

 

I got syringes! (8 of them) -- 0.3ml U-100 with half-graduations. Bloody expensive though, CHF 0.50 a piece...

 

While true, better a day too high, than an hour too low and the TR protocol and SLGS methods are built with safety in mind to prevent hypo, nobody wants swimming in sugar for weeks either. The logic for having high numbers for potentially weeks is to make sure you find the right dose and don't increase too fast. If you pass the right dose, you won't do yourself any favors because too much insulin can look like not enough and give you high numbers anyway. Depending on if you follow TR or SLGS, you will work up to the right dose in due time and sometimes that means a lot of ugly on the SS (look at Asia's SS).

The TR protocol is a published, peer reviewed protocol and it was developed using human meters for cats, it's easier to follow using a human meter, but you can continue to use the cat one if you prefer. It's less about "is this the exact right BG number I would get on a lab for a cat" and more about trends and action number (how low you go before intervening).

I don't know what you should do if you can't dose 12 hours apart, hopefully some more experienced members will chime in. You're a quick study, hopefully Quintus is too and he will be feeling better really soon!

 

Stephanie, I'm impressed, you're absorbing information like a sponge! I'm also interested to see answers from our more experienced members. The weekends tend to have lower attendance on the board, so it may take a while for them to chime in.

 

Thanks for your messages! Always been a fast learner, glad to have that superpower

I'm not sure I'm following either TR or SLGS right now as neither seems really manageable given my schedule! I guess I'm just trying to poke my way to acceptable numbers but it might not be the right strategy. I'll be touching base with my vet Monday morning and will share the info I've found with him. I just dived back in my various messages, posts, and vet clinic receipts to try to reconstruct the timeline of Quintus's food changes, because I think they have messed with the numbers quite a bit (SS updated). I really think changing his food is key but I'm too worried to do it before my next long days at work.

 

I'm tagging one of our members (@Gill & George) who's in Europe. She may have info on supplies.

I would not give your cat DM. When you have a chance, read the ingredients. The food contains a lot of animal by-products. For what you'll spend on a prescription food, you can buy a human grade, quality cat food that is lower in carbohydrates. There is nothing special about DM that makes it a good food for diabetics.

It is decidedly better to have your cat in higher numbers than to have a symptomatic, hypoglycemic episode. However, having your cat stay in higher ranges can cause your cat's body to acclimate to being in those higher numbers and treat that range as the new "normal." This is called glucose toxicity. (The name sounds worse than it is.)

While the effect of a dose change isn't immediate, that isn't a hard and fast rule. Every cat is different (ECID) and the effect of a dose change can vary. Sometimes a dose is increased and numbers are higher for a cycle or two (NDW or "new dose wonkiness"), sometimes they drop, and other times it takes a while for the depot to catch up. The effects of a reduction and be similarly variable. The issue is both with the depot, the cat, and anything else that can be a factor like the phase of the moon (and I'm really not kidding about the last point -- some cats have a somewhat reliable response to the full moon -- go figure!)

Not shooting 12/12 does have an effect on numbers. An early shot acts like a dose increase and a late shot acts like a dose reduction. It also messes with the depot. While it's not ideal, you may want to skip a shot or consider shooting twice at 18 hrs if that's a possibility given your schedule. If you're going to be off schedule by more than 2 hrs, it can be an issue. Typically, if your timing is off, we adjust shot time in small amounts (15 min twice a day or by 30 min once a day). Generally, if you're off by 30 min it's no big deal. Also, don't fall into thinking that if one shot is late, you can course correct by shooting early the next day. Because Lantus is a depot insulin, it doesn't work that way.

It looks like you reduced the dose this AM in response to the 232 at AMPS. That is a safe number to have given the full dose. If you're not sure about what to do, test, don't feed, and post. Hopefully, there will be someone on the board who can help you weigh your options about shooting. There are often people on the board 24/7 but it gets a bit challenging when you're in a very different time zone.

As far as meters, I used a human meter for 6.5yrs. It served us well. Strips are cheaper and far more readily available than AlphaTrack strips. If anything, a human meter reads a little lower than an AT meter at the lower end of the range but the results of the meters is negligible at the higher range.

With regard to syringes, I'm hoping Gill can make some suggestions as to where to get U100 syringes. They should be readily available since they are what's used for insulin that's prescribed for humans. See if you can track down U100, 3/10cc syringes with half unit markings. Most dose changes are in 0.25u increments. If you can't find syringes that are in half unit increments (I think BD syringes are available in Europe), you may want to consider getting digital calipers which will help you to dose consistently.

Please keep the questions coming. People are very generous with their time and knowledge. We're here to help.

 

Thanks!

I'm not sure I understand this. I have no "wiggle time" in the morning: up at 5.30, out of the door at 6.30. I can only very exceptionally be home before 6pm. I crash for bed between 9 and 9.30pm. This is Mon/Tues/Thurs/Fri -- Wed/Sat/Sun I have flexibility. So in this cas, unless I'm off sick the next two days (possible, I've been sick all the extended week-end), I'll be able to shoot Mon 6am/8pm and Tues 6am/8 or 9pm. On Wed am I can shoot later, but Thur and Fri I am back to 6am.

"Acts like a dose increase" = by how much? It looks like I should give him less on Tues/Wed morning. Half dose? More? Full dose all the same? I have no possibility of monitoring him Tues.

I actually reduced the dose following this discussion with @Wendy&Neko, not in response to the AMPS. Would you have stuck with 3?

 

I don't necessarily disagree with Wendy -- it was my assumption that the decrease was due to the AMPS. The other issue is that you've been increasing by 1.0u. We change doses in much smaller amounts. I'm sure that was a factor in Wendy's suggestion.

Unfortunately, Lantus doesn't give you a great deal of flexibility around shot time. Let me do a bit of brainstorming with some of our experienced members and see if anyone has a thought about how to deal with your schedule.

 

Thanks! FWIW I now have a handful of syringes (8), so I could in theory do more subtle changes than just with the pen.

 

We don't use the pen needle! You really can't fine tune doses and cats don't typically need the same amount of insulin as humans.

See if you can find an online source for syringes. Even in the US, most of us buy our syringes online. It's cheaper!

 

I know you don’t use the pen needle but hey, initially people who arrive on this forum have been following instructions from their vet.

I’ve been sick the last three days and haven’t left the house. Things are closed here on Sunday, it’s a miracle my brother was able to get syringes for me this afternoon.

“Europe” is not a unified thing, and Switzerland is not even part of it, so all the info about what to do/get/buy in the U.K. is pretty much useless for me and I have to do my research from scratch.

I joined the forum yesterday.

So yeah, I’ve been doing what I could until now.

 

Hi Stephanie and Quintus! Been replying to some of postings over on the Facebook Feline Diabetes page. Thanks for the link to your post over here on the message board. Searching for Quintus wasn't finding any results for me. Following this thread now.

You seem to have some of the basics down pretty well. Good job! Remember to take those deep breaths, hold, release slowly and repeat as needed. For someone who only joined the FDMB on 12/9, you've done so much already. You set up your profile, put that helpful information in your signature, you have a spreadsheet setup, you are home testing, you are trying to switch Quintus to food, a lower carb one, to hopefully help bring his blood glucose (BG) numbers down. Pretty FANTASTIC I'd say!

This "sugardance" as we call it takes time. It's a marathon, not a sprint.

Remember, you know your cat better than anyone here. You know your schedule and what else you have going on in your life. You've been working really hard to help Quintus and we should acknowledge that. Sometimes folks get rather gruff here in their responses.

Please take what people are saying and see if it can work for you. Some things may not, some things may. Take what is said 'with a grain of salt' as the saying goes. You are the best judge of what you can do and how Quintus is doing. Remember that please.

I think you are doing fantastic in getting yourself more knowledgeable about Feline Diabetes. Keep it up. I like to think that 'knowledge is power'. But sometimes, we don't always agree. Remember, ECID Every Cat is Different, EOID Every Owner is Different.

Hoping that you feel better soon. Sending healing thoughts to you and Quintus. Give Quintus a hug from me if you would please. He has a lot going on with him health wise.

 

Given how early you are in this FD marathon, I think you've grasped a lot of the more complex issues very quickly and are doing amazingly well. You always have to look at the advice here through the filter of what's possible for you given your specific circumstances.

 

Exactly Kris.

 

Thanks all!

I have a specific technical question: I was planning to take a +3 in 20 minutes. Quintus has just gone and eaten a healthy portion of his HC food. Is it still worth measuring that +3? I'll be going to bed after that so no more measures until AMPS.

I'm guessing it's still worth it but it feels a bit silly to measure when he's clearly going to have some kind of post-food spike.

What are habits and opinions on that question?

 

I always tried to get a before bed test, so if the +3 is the only other data point other than PMPS, it's worth getting. to get an idea how the cycle is going. It typically takes 20-30 minutes for carbs to go from the plate to the blood stream, so if you test in that window, it's still worth getting.

 

That's good to know! So in this case, when I saw him eating 20 minutes before my planned measuring time, what I could have done is catch him 10 minutes before the +3, which is a tad early but would give me a measure less influenced by food.

I'll keep that in mind for next time!

 

There's another member I found from Switzerland @kimouette, she hasn't posted in about a year though. Maybe you could pm her and see where she got supplies? There is a post where she found some good cat foods for diabetics available in your country, go to post #10 in this thread:

http://www.felinediabetes.com/FDMB/...for-europeans-and-international-buyers.64843/

 

Very interesting discussion here...

Hi Stephanie, I got it - your work schedule is busy and somewhat unpredictable on the longer hours side..

By any chance is it realistic that you could have an hour or so off at a lunch time and be able to go home to test?

If Yes, than I wonder if any other insulin types, the "in and out" types like Canninsulin or Pro , would be a better solution for Quintus?
I have no personal experience with either of them but I read a lot about them affording better flexibility in hours to shot/ dosing and also allow some to shoot every 8 hours v. every 12... I might be mistaken of course... But given that your surely to be detained at work rather often than not I'd make some inquiries..

It worth it's while only if you are able to get home for lunch - if you don't I won't force my memory on producing any names of ppl who are proficient in dose manipulations with a non depot type insulin.

PS. You ARE a fast learner!Wow!

 

Even if Kimouette isn't on any more, I'm wondering if there is some information in some of her posts that would be helpful to Stephanie. Just an idea. Kimouette often posted in the forums for other cat owners that did not speak English, or where English was not their primary language. If I remember, she was fluent in French and English. So I'm not sure how much use it might be to look through some of those past posts, since there were not all about Kimouette's cats.

FYI Quintus has already been on Caninsulin and has recently been switched to Lantus (glargine). See the SS at the top for more notes that Stephanie put in for some more background.

 

Thanks Deb, but the only non English speaking participant of this discussion is me... not Stephanie, the poster of it...

whilst on Caninsuline he 've never consulted with this Forum, has he? He might have missed a lot of options...

My hope is that an alternative schedule of shots might be effective and doable with an insulin types other then the time demanding Glargin/ Lantus.

Thank you for sparing the time - even if it was to point out my language inadequacies, I always welcome such...

I just searched for the Kimouette posts - got some - and going to look thru all of them life permitting... I am sure they are just as educating as you said - for a non English speaker esp.

 

Tanya, I think Deb was responding to my post. Kimouette also lives in Switzerland, like Stephanie, and might have some insight on her old posts about where she got supplies, what meter she used, etc. Deb was just adding that in addition to posting about her own cat, Kimouette helped some non-English speaking people with their diabetic cats and posted about them on the forum (and those cats and their beans were not in Switzerland, thus some of her posts may not be helpful or relevant for Stephanie). Your English is fine, by the way, I had no clue you weren't a native English speaker.

 

Hey, thanks for the ideas, just a quick drowsy response:
- I do indeed speak French (my German sucks) and have PMed Kimounette
- there is no way I can get home at lunch, the reason for my long days away is that I commute somewhat over an hour to get to work; I’m on a couple of boards and the meetings are usually straight after work, hence the 15h-days when those happen (they already make me leave work somewhat early so I can’t really leave any earlier to be able to drop in home)

 

Bonjour Stephanie!

As you have noticed I am no longer very active on the forum, but I will answer any PM I receive that's for sure! I am glad to help whenever I can.
I no longer live in Switzerland, but I can clearly guide you in terms of good quality/diabetic and renal friendly food available in Switzerland.

When I left the country I was so mad to find out I could not import the food I wanted to keep feeding my cat with. You guys have access to one particular brand that everyone in the America should envy.
The one I am talking about is Terra Faelis. And especially the "Chicken,Squash and catnip" one.
Seriously, if your cat loves the taste, I dont see any reason why to look elsewhere.
It's available here : http://www.zooplus.ch/fr/shop/chat/patee/terra_felis/terrafelis_getreidefrei/611393
If you find that it suits you and your kitty well, then you can do as I used to : buy them less often, but in bigger quantities to benefit from the free shipping and lowest cost on the food : http://www.zooplus.ch/fr/shop/chat/patee/terra_felis/terrafelis_getreidefrei/sparpakete/290145

I had contacted Terra Faelis directly couple of years ago to get the full nutrient profile of their food and they shared it with me. They are really transparent and care about their customers.
More info on that brand : https://www.terrafaelis.co.uk/katze-huhn-mit-kuerbis-und-katzenminze.html

What's really rare with this food is that they managed to create a food low in carb and low in phosphorus (low enough considering Tanya's phosphorus requirements for a CKD cat : http://www.felinecrf.org/ ) ... in other words, it will help with both CKD and diabetes. All of this, without any unwanted ingredients and of course no grains (which helps with arthritis and simply assist with not putting any crappy ingredients in an aging kitty).
By the way, if your cat suffers a lot with arthritis, you should consider supplementing with Cosequin. Not the crappy chewy one, but the pure formula. I used to buy mine here : http://www.vetmeds-shop.ch/product.php?id_product=37
Simply sprinkle over your cat's canned food once a day. Cosequin is also known for helping prevent urinary infections. )

Stephanie, I dont know exactly where you are at in the treatment of your cat's diabetes, but just in case this is all new to you, be very careful if you switch from dry kibble to Terra Faelis (or any other low carb/high quality wet food), cuz it will affect your cat's BG levels positively... You will have to lower the dosage of you insulin for sure, and hopefully, get to the point where you can completely forget about the insulin injections!

I just took a look at Quintus's spreadsheet, and I would say : dont wait any longer! Order the food as soon as possible and follow FDMB's protocol for Lantus beginner users. Those BG levels have to go down as possible to insure his pancreas goes back to a normal state.

Is your cat under treatment for his hyperthyroidism? I hope he is!

Oh and just in case you want to learn all sorts of interesting facts that could help you and your diabetic kitty, I have couple of documents that I translated in french that I have put together. They might not all be up to date, but they are still worth reading : https://drive.google.com/drive/folders/0B-mMJBQ_r05GYnVNbXpFV2l2ZUE

And I dont know if you have found a vet that agrees with the way you want to treat your cat's disease, but in case you need one :
Schmid Natacha
rue de l'Eglise Catholique 14, 1820 Montreux
Téléphone *021 963 80 80
..... I am not saying that she knows anything about appropriate food for diabetic cats, but still, she is one of the rare vets in Switzerland that will agree with treating your cat with Lantus and do at home tests with your own glucometer. I just wouldn't want to know her opinion about the food!

Otherwise in Lausanne there's this one :
Pfister Jean
rue Marterey 52, 1005 Lausanne
Téléphone 021 312 56 08
.... He is a really good vet, but I really had to fight with him over the topic of food. He clearly gets $$ out of every bag of Royal Canin crappy kibbles that he sells. But like I said, otherwise he is a very good vet, one that I would trust over any other topic than food.


Hope this helps...
Keep me in touch!

PS : Most of you guys living in Europe have access to a regional version of Zooplus. You clearly can rely on that online store to find some good quality food for your diabetic or CKD kitties!

 

Thanks so much for all the info @kimouette!

Here are my replies:
- thanks for Terra Faelis, will look into it. do you still have the nutrient profile they sent you?
- Quintus has spent years on Cosequin. we recently stopped it because he's taking so many meds, and his arthritis is so advanced there's probably not much cartilage to help anymore. his hyperthyroidism is treated and under control (it's recent so I guess we'll be checking it again in the near future).
- my vet is fine for home testing, a bit more aggressive than I might be comfortable with when it comes to upping insulin but otherwise we have a great working relationship, so I'm all good on that front! I met Dr. Pfister once, the sad day I had to say goodbye to my beloved Bagha (he was "de garde" and put him to sleep).
- definitely trying to get those levels down! going to continue transitioning to DM (cautiously, I know) for the time being, while I look into Terra Faelis (this evening's numbers are already looking better)
- going to look at the FR files, I know some francophone cat ladies it might be useful for!

PS: I'm on the market for an AlphaTrack 2 if anybody in CH or neighbouring Europe has one to offload

 

-See the file attached file for the Terra nutrient profile.
-About Cosequin... I'm not sure why they asked you to stop giving it to him cuz contrarily to the meds, Cosequin is a supplement (not med) with no possible interaction with other meds. Well anyway, if you notice that it starts to get worse, then I would start giving it back to him... (again, I insist, we're talking about the pure form of Cosequin, not the chewy one full of carbs).
- When you talk about DM, you mean Purina DM right? It will be better than any dry kibbles, but wont be the best in terms of carbs and not any help for his kidney disease (way too high in phosphorus).
http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

I know that talking about Terra, home testing and FDMB's protocol probably puts you on a path that's different from your vet's... but I can assure you that the high quality food and following FDMB's Lantus protocol will give your cat the best treatment he can get for his diabetes. You could print it out and show it to your vet if you really want him to be on board with you, but personally, I would trust this forum's protocol (and experienced users) more than any vet.

P.S : Alphatrack glucometers are not required to test your cat.
Dr Lisa Pierson mentioned it in one of her most popular document. Translated in French here : https://drive.google.com/open?id=0B-mMJBQ_r05GdHZVbWhsTnI1SGc
Original one here : http://catinfo.org/feline-diabetes/
Basically, she says that the test strips are very expensive and not required to test a cat.
You can use Bayer Contour or Prodigy, they will work just as well, but it wont be hard to get the test strips on the net or in any pharmacy. Plus, they wont cost as much.

 

In case you weren't aware, there is a Lantus forum out of Germany. This is a link to Tilly's page and there is a link to the German Diabetes-Katzen Forum on the Protocol page. There may be additional information about what's available in Switzerland on their forum. The person who created the website and forum is Kirsten Roomp who is one of the authors of the Tight Regulation Protocol.

 

Hi sorry on vacation otherwise would have responded sooner.

Syringes

Try this site www.hyperdrug.co.uk/BD-Microfine-Insulin-Syringes-03ml-pack-of-100/Productinfo/BDMICROFINE03ML

Our Australian members get their syringes from here so you may find they will deliver.

I use also use zooplus, Terra faelis is one of George's staples.
Another very good quality food is granata pet symphonie
http://m.zooplus.ch/esearch.htm#q=GranataPet%20Symphonie&catl=4Katze>Katzenfutter nass>GranataPet>GranataPet Symphonie&cats=4Katze%3EKatzenfutter%20nass%3EGranataPet%3EGranataPet%20Symphonie

Although Switzerland is outside of EU I think that you will find that a lot of the pet food is available throughout Europe especially with zooplus.

Take a look at the chart for UK food, it has the nutrient profile calculated for each brand, I'm in Spain and though the chart was put together by our friends in the UK it has been an invaluable resource,

https://docs.google.com/spreadsheets/u/1/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml

As for pet meters I use an SD code free human meter, strips here in Spain are very expensive, so I ordered my meter and strips from UK, this company delivers all over the world.
uk.com/all-products/sd-codefree-test-strips-to-be-used-only-with-the-sd-monitor/
250strips for about 60 Swiss francs.

You could look on Amazon for supplies, but Amazon Spain was still very expensive for supplies. You could try amazon.de though I found that German companies woulnt deliver to Spain..... might be different with Switzerland.

ETA
George has early ckd too so I look to keep his food under 1% phosphorus.
I feed

terra faelis (0.6%)
Thrive chicken breast (0.9%
Feringa (0.9%)
Granata pet symphonie(0.9%)

In the chart I linked above you will be able to see which varieties of these brands fall into the categories. Although the terra faelis is certainly better from a phosphorus perspective, I like to give George some variety in texture/flavour nto avoid problems with him getting bored or developing an aversion) the brand's above all use good quality animal protein, this is important with ckd.