+12 137 need dosing help

Our 10 year old cat developed diabetes which was diagnosed a few weeks ago. He's 22+ pounds and was initially put on glargine, 1.0 unit 2x per day by his vet. After 4 days, we saw the vet again and his numbers were still around 450 so she moved us up to 2.0 units 2x per day. We were instructed to take him back to the vet for the full day bg curve after about 10 days, which we did last Tuesday (3/8). During that curve, Checkers' bg levels went from 400s to 85 after 13 hours. (I brought him home just before the vet closed and took him to the ER at the appointed times to get the rest of the levels drawn.) Because I was so new to this, I was afraid that was too low -- and the vet told me not to give him his evening shot. The next day when she called us to see how Checkers was doing, she said to stick with the 2.0 shot but only once a day and to stop giving him the cooked ground whole rabbit which I'd begun switching him over to just a few days before the glucose curve.

We bought a glucometer which we've been using ourselves since the evening of 3/8. His bg quickly rose to over 400 in two hours. Wed and Thur I followed the vet's instructions, but also used the time to read more in this site and continue trying to bring myself up to speed. I was able to be home all day Friday - Sunday and did a full curve each day -- and reintroduced the second shot at only 1.0 units.

My discouragement is that Chechers' bg levels seem to flat line up around the mid 300s and barely bump down -- he's only gotten down to 202 once. His neuropathy has gotten so bad that he has to slide his back feet along and pull himself by his front paws. Each day the flat line high levels go on longer -- Sunday he started out with 342, went up slightly, down slighty, but stayed around there for 12 hours before dipping to 237 for an hour, then shot right back up. What should I be doing?

 

Re: discouraged, need advice

You will get amazing advice and support here. You won't be alone in this journey. I couldn't imagine doing the "sugar dance" without all of the amazing people here. We do not have a good vet yet.

I just want to welcome you to Lantus Land. Sending hugs.

 

Re: discouraged, need advice

It takes time and consistency to build the glargine/lantus shed and you may see high, flat numbers until you do. Are you testing him for ketones? You need to be sure you test him daily for ketones by buying the ketostix and then either holding it under his urine stream or catching some urine and testing it....very, very important you do this. We usually have spreadsheets that we fill out that make it easier for the more experienced people to offer suggestions. In the meantime, can you please list the info you got from his tests on the day you did the curve? For instance, the first number would be his AMPS (a.m. pre-shot number), and then +1 would be an hour after you gave the shot; +2, two hours, and so on. His reaction the other day (85 to 400) is normal and many kitties do it. The body perceives the 85 as being too low and then the liver dumps hormones into the system to counterbalance it and so the BG goes up. You should start treating his neuropathy with a product called xobaline; here's a link:
Xobaline

You've come to the right place for help. Take a deep breath. One of our more experienced folks should be along soon but in the meantime, please read through the stickys at the top of our lantus forum and see if you can put together the Spreadsheet from the directions in the sticky for newcomers. We also follow a protocol that only changes the dose every 3-5 days IF warranted and only by .25u if nadirs are below 300 and by .5 if above so the vet really bumped his dose up ALOT. You could miss the fitting dose by bumping up that fast. Hang on...welcome to where you will find help.

 

Re: discouraged, need advice

Hi and welcome to FDMB and Lantus Land! We are all very upset and discouraged when we start. it gets better believe me.

Have you read the protocol? Lantus needs to be dosed on a very regular basis. Differing doses is not usually recommended unless it is a very special case. You really haven't been using it long enough to know that yet. It sounds like your vet knows that lantus is becoming the preferred insulin for cats, but doesn't know a lot about it yet. I'm not a dosing expert but here are a few lantus basics to think over until one sees your post.

• 1- Lantus dosing is based on the nadir, the lowest point in the cycle, not on the highest numbers like other older insulins.
  2- Lantus builds up in the body, the shed. Until this shed is developed you are not seeing the total effect of the insulin that you have are giving. You need 5 to 7 days for the shed to establish. Patience is a keyword when using Lantus. Study the tight regulation protocol http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581 Every time you change the dose the shed adjusts and numbers are wonky for a while. You are changing the dose twice a day!
  3- We like to start low, about 1u, and gradually work our doing up if need be. You can shoot several increments in between 1 unit and 2 units. We usually go upor down by .25 units, not a whole unit. There are syringes marked w/ half units. By the way, you are using u-100 syringes aren't you?
  4- Cats get stressed at the vets and their BG goes up. So those numbers are often inaccurate. Home testing is the way to go, Congratulations on getting started w/ that. You can do your own curves at home and save a lot of money.
  5- It is very important to get mid-cycle tests to determine when the nadir is.
  6- Food is very important for controlling FD, as much so as the insulin! The best food for cats is one that mimics their natural diet, low carbohydrate wet foods! The only thing that is good about dry food is that it is more convenient for the humans, poor reason to feed it. Check out this site for a ton of good info on feline nutrition.http://catinfo.org/

I know it is a lot of information in a short time. FD is a steep learning curve, but you will get it. Read all the stickiew (permanent posts0 at the top of the forum. what I gave you is just the tip of the iceberg.

Just remember, you have come to a great place to get information and help for your cat!

BTW what's your name and your cat's?

Ann and Tess

 

Re: discouraged, need advice

Hi - I too wanted to welcome you to this forum. You have found a great place. there are very knowledgeable and caring people here. I won't add any more to what has already been stated - it is a great starting base.

And yes -we all are very discouraged when we start - this is normal, and it will get better. This is a wonderful place for information, and help - for you, and your cat. Welcome aboard!

 

Re: discouraged, need advice

I have no advice but I can offer encouragement. I've had two cats with diabetes. One never got low numbers and hovered in the mid two to 300's. However, she did maintain a fairly flat curve. My most recent cat, Gracie, has been on insulin about 6 weeks and for the first 5, was all over the place. I couldn't figure out was I was doing wrong or why her numbers would vary up to 250 points hour to hour. The biggest disparity in one day was going from 149 to 550. This past week, she's had a breakthrough. My saving grace was this board. Although I couldn't quite grasp why things were happening, others could, and it was normal. The body simply needs to adjust to the insulin. His body hasn't been working normally for some time and needs time to get back to normal. To do that, he needs consistency. That means consistent dosing and shot times. Find a dose you are comfortable giving, and don't skip shots. People will help you with dosing so you're comfortable with giving twice daily shots.

Hang in there. I know it's tough, especially watching him struggle walking. Stick with this board and the advice given here. Vets can be great, but they rarely know diabetes that well, let a alone individual insulins like Lantus. Have you started him on B12 shots for the neuropathy? If not, you may ask for advice about that here as well.

Jason

 

Re: discouraged, need advice

Giving you a bump up to the top of the list. On this board every time there is a s new post you thread (we also call them condos) is bumped to the top of the list.

Reguarding the weakness in the hind legs the form of B12 you need to get is methylcobalamin, not regular B12. Talk to you vet about dosing and be sure to get a cat spesific form that doesn't have any ingredients bad for cats, see this link http://www.laurieulrich.com/jasper/methylresource.html I believe it can be given in other forms than an injection too. to find out more google "feline neuropathy" or "methylcobalamin cat".

 

Re: discouraged, need advice

Thank you all! I had no idea I'd get replies so quickly -- and your words are encouraging, thank you. I'm at work and don't have access to my notebook, so will post his actual numbers on the spreadsheet (assuming I can figure it out) late tonight when I get back. (I'm a visual thinker, so have been graphing everything.)

I'm Laura, he's Checkers. He's actually my older son's cat, and Checkabunny is the affectionate nickname my son uses. I "inherited" fulltime momship of Checkers when my son went off to college.

Since I shouldn't be changing Checkers' dosing -- and it should be the same both morning and evening, what amount should I use -- or do you need to see the nadirs first before suggesting that? ( I think I have the u-100 syringes, and what I have does have the half marking.) When a dosing change occurs, then it should be the same amount in the morning and evening, correct? So perhaps, shoot 1.5 morning and evening? How do you get the 0.25, it's so hard to see the change between the halves!

Checkers, normally quite mellow, seems to say he's had enough with the ear pricks. Any suggestions on what to do when that happens? The lancet I use is from the Accu-Check meter. Is there a better one? Or better place to draw blood?

Yes, I started B12 on Friday, but it wasn't the methyl B12 I've read is better for cats. My vet had a liguid injectable B12 I thought I'd use till I could get my hands on a methyl B12 since I've read injection is better for humans because it bypasses the liver. My vet said to give 2.5 ml of the liquid B12 once a week -- relative to the insulin it's a lot! Is xobaline a methyl B12?

I know I need to get the ketostix -- another thing to learn how to use and figure out how to get the samples!

 

Re: discouraged, need advice

I'll leave the dosing advice to the experts who will be on later, but they will want to see Checkers numbers before they give advice. We use some conventions here that you need to get used to. One is test times in relation to shots. The test just before the shot is the AMPS or PMPS depending on morning or evening, then we refer to the number of hours after the test w/ a +, so one hour after the shot is +1, 2 hours after is +2, etc. You can just include the info in your post until you get the SS running.

really good magnifying glasses. :lol:

Many of us prefer the BD brand , either 30 or 33 gauge. The seem sharper and hurt less. Always give a treat even if the test is unsuccessful. he will come to associate treats w/ testing. Tess purrs through the whole thing.

Yes. but it may contain XYLITOL which is toxic to cats, this brand is made specifically for cats LifeLink You can search the web and maybe find it cheaper.

That is the hard part. :lol: You can try to sneak up on him in the act, some peeps use ladle, cover the litter w/ plastic wrap (I've never figured out if that would actually work) or switch out the regular litter box for one w/ non absorbant aquarium grave. There is some stalking involved. :lol: :lol: :lol:

 

Re: discouraged, need advice

hi laura! welcome! just to encourage you - i'm new too. what you're going through is so normal and everyone here is very helpful. you'll be able to help checkers in no time.

you're getting lots of info, so don't let it discourage or overwhelm you. it's taken me a couple of weeks to feel like i've kinda got some of it some of the time! :lol: someone told me it's a marathon, not a sprint, and that helped me not feel like it was quite such an emergency that i understand it all TODAY.

about the ear testing - i had to burrito wrap punkin for about the first 2 weeks and now am able to test him without wrapping him. if you look on youtube there are videos on how to do it. you use a beach towel and wrap them up to keep their little legs from sabotaging your efforts. it also helps to switch places around on on the ear and to use both ears - keeps it from being quite as sore in one spot. at night i put on neosporin cream with pain relief and that seems to have really helped his ears recover for the next day.

also, i haven't tried it yet but one person said to have a spare litter box (i use a box lid inside a garbage size plastic bag for a travel box) and lentils for testing for ketones. they don't absorb the urine and they don't change the test strip. you can tip it to one side to get enough to test.

hang in there! julie

 

Re: discouraged, need advice

Hi laura and checkers! Welcome to the board where you will find all the help and support you could ever want .. I know it is frustrating in the beginning trying to figure out the best dose for checkers without having him go high or go low .. Remember no question here is ever silly or stupid and someone is bound to know the answer! :thumbup

 

Re: discouraged, need advice

Hi Laura and welcome to Lantus Land.

I'm at work and need to be relatively brief. You've gotten some great information already. It will be very helpful if you can put the data you've been collecting into the spreadsheet template that we use here. Most of us that routinely look at each others spreadsheets are visual with the information, as well. The spreadsheet is color coded. I linked the instructions along with how you can attach the SS to your signature.

It does sound like your vet suggested you change Checker's dose more aggressively than what we do here. In most cases, doses are changed in 0.25u increments. (You'll need to get syringes that are marked in half unit increments.) Likewise, Lantus is a twice a day (BID) insulin in cats. With once a day dosing, you'll find that you're cat's numbers will be high after about 14 hours. It would help me enormously to see Checkers' numbers before saying much of anything about dose. It does sound like 2.0u twice daily was too much, though. The initial dose of Lantus can be based on a cat's ideal weight. Is 22+ lbs Checkers' ideal weight or would you say there's more of him to love?

As others have suggested, please read the starred, sticky notes at the top of the page. The amount of information contained in those notes is, frankly, overwhelming but it will give you a perspective on dosing, how to best use this Board, how to maximize the lifespan of your Lantus, etc. It will take several readings to begin to integrate the information. We've all been there.

Please let us know how we can help.

 

Re: discouraged, need advice

Just wanted to stop in and say Hi! and Welcome!

There is lots to learn and many, many great people around here to advise you.

You already have received great direction and don't get discouraged ....

our extra sweet cats get better....they really do.

 

Re: discouraged, need advice

After you get the testing under your belt, you may wish to alter some of what you are feeding. We recommend low carb (10% carbohydrate calories or less), which includes food such as Fancy Feast pates.

Why wait? Because a diet change to low carb may drop the blood glucose as much as 100 points (another member's experience).

You can look at a compiled list of various foods and the % calories from carbohydrates on Binky's Page

Some higher carb, gravy food may be kept on hand for treating any minor hypoglycemic signs.

 

Re: discouraged, need advice

Hi Laura, a warm welcome to fdmb! This really is the place to be. Feline diabetes is a crazy situation and these people have seen it all. Whether you need a hug or quick answers, this message board is always here for you both literally and figuratively; practically and emotionally. You can do this! Remember to breathe. Deeply. Checkers can do this too.

What a wonderful mum to take him in lucky son and cat!

I just started treating 3/9/2011 myself and with the help and support of this group have been able to get a grip on both the emotional roller coaster that is feline diabetes diagnosis & initial treatment AND on the basics of what feline diabetes means for me and my cat. I found the beginning is very rough - my heart goes out to you and yours with every up and down. There is so much information and so many things happening that it's impossible not to get overwhelmed and scared. This board is here for you!

My vet finds it easier to prick from the paw pads but somehow the idea of that doesn't quite sit right with me so I haven't tried it. I found This Video extremely helpful.
The lancet I use is Abbot "Thin Lancets", 28 gauge. I don't have anything to compare it to really, but they're very thin and a quick prick doesn't seem to mind Simba so much.

Because we're new to this, my cat is also starting to resist the ear pricks. The ears will 'grow' more capilliaries over time, according to my vet appointment today and things WILL get easier. For now, I'm trying to rotate ears (do left one time and right another time) & keep doing different areas on ears and also prick the areas that look & feels the least inflamed.

I also found that using a warm light to bring the blood to the ear helps tremendously, as does soothing words and a nice ear massage (being careful to keep salty fingers away from the edges, starting at the base in the middle and drawing the massage up to the vein along the edge. When I prick, I hold a round compressed-cotton makeup-removal applicator to the underneath of his ear. This protects my finger (so I'm not worried about f'n up the reading) and also keeps salty fingers from irritating his multiply-pricked ears.

I got some GREAT advice on this when I had the question of how to get a sample.. Creating a dip in the litter where he usually pees and lining the dip with a nice-sized square of saran wrap worked beautifully for Simba. (so far!!) I anchored the edges by tucking the corners into the litter. This worked for me because Simba usually pees in the same general area. I also heard of people using lentils and half-burying sample bottles:

I also tried just emptying the litter box completely. While this worked, (he doesn't usually scratch at litter), he did leave pee drops for me to clean up all over the floor! I tried lining the box with plastic, but he would have nothing to do with THAT.

In the past, I've also gotten these little black pellets from the vet that are non-absorbant and let your kitty scratch AND give you a good, steril sample. They work great, I just kept forgetting to get them for him and really, if the more 'natural' ways work, the better!

I wish you all the luck in the world with your adopted kitty. I know it's hard but I also (now) know it's manageable, especially if you take good time to breathe and go easy. What I've found great is the fact that petting your cat is relaxing for both you and him. Talk about symbiotic!

warmest thoughts and best wishes,
Sarah.

 

Re: discouraged, need advice

Just sending you a BIG welcome to LL from Do Lou and I you are going to find so much wonderful help here :mrgreen:

 

Re: discouraged, need advice

Hi Laura. Welcome to the board.
You will get wonderful help from everyone here.

I bought some cotton baby socks. Put some rice in one and tie it closed. Heat it in the microwave for about 15 seconds or to warm it.
I just hold it under DC's ear and give him some cuddles for a bit while the ear gets warm. Then I prick the ear. I keep the rice sock under the ear for a backing. That way I don't get my finger.
He seems to like the warmth and it doesn't bother him as much.
I also use Polysporin cream with pain relief at the end of the day, I just rub it onto his ear.
We can't get Neosporin in Canada so we use Polysporin.

 

Re: discouraged, need advice

Another welcome! My Willie was diagnosed on December 7th, 2010 and I still remember how overwhelming it all was! You've gotten some great advice here, so I won't repeat... just wanted to say hello! I look forward to learning more about you and Checkers soon!

 

Re: discouraged, need advice

Hi Laura and Checkers!

Welcome! We're pretty new to LL too, and being here has been a lifesaver. The first few weeks of this thing can definitely be overwhelming and stressful, but just like everyone says, it really does get easier!

One thing I do with Trixie while I'm waiting for the magical drop of blood to form is I gently hold her head from behind and scratch both her cheeks with my fingers. That both pleasantly distracts her, and helps prevent her from shaking her head, causing the drop to go flying.

Best wishes, and again welcome!

Amy

 

Re: discouraged, need advice

just stopping by to say Hello, and welcome!!

you've found the right place for help
I got a Breeze litterbox for binks, and just don't put the pee pad in the bottom compartment...
works like a charm for checking for ketones...

celi & binks

 

Re: discouraged, need advice

The suggestion of wrapping Checkers like a burrito was great! And giving him a treat for each of my attempts to draw blood. Boy did he score on the treats this morning! I gave 1.0 unit pm shot. Couldn't figure out the spreadsheet, so will try during break at work where I can ask an IT person for help.

But I could use advice for what to do this morning for a shot because his number was 137. (I like it!) Here's what I have so far from past week's records. Remember, the vet had us giving 2.0 units DIB (?) , but moved us to one shot a day during the first curve done mostly at the vet's. I re-added the second shot three days later, but at a lower dose because I bought a meter and began home testing the evening of getting Checkers back from the vet. AM shots are all 2.0 units, when reintroduced, PM shots are 1.0 units. I haven't given a shot yet this morning. What should I do?

3/8 AMPS:401 +2 (345) +4 (314) +6 (255) +8 (230) +10 (189) +12 (85) +14 (111) +16 (434)
3/9 AMPS:417 +2 (391) +4 (383) +9.5 (356) +12 (357) +14 (315)
3/10 AMPS:297 +9(279) +12 (202)
3/11 AMPS:437 +2(389) +4(386) +6 (332) +8(285)
PMPS:270 +2(283)
3/12 AMPS:347 +3 (329) +6 (331) +9 (274)
PMPS:223 +2 (196) +3(181) +6 (195)
3/13 AMPS:344 +5(352)
PMPS:322 +3(227) +6(264)
3/14 AMPS:356
PMPS:242
3/15 AMPS:137

 

Re: discouraged, need advice

Go to your very first post and hit the edit button to change your subject. "+12 137 need dosing help"
Bump.
If you haven't shot a 137 before and have to go to work I'd skip it if you don't hear from an expert. How long until you have to leave?

 

I should have left for work about 30 minutes ago, but was waiting to hear back from someone. I'm worried that I couldn't stick around to test for too long. I could be home about another hour. It's a short work day for me, but I'd still be away for about 6 hours.

 

Your shot times need to be 12 hours apart. So if you can't shoot 12 hours from now and 12 hours in the AM, I would skip the shot and get back on track tonight. If you can stall and wait for advice and keep the 12 hour schedule on track, then someone hopefully will be along with advice.

 

i agree with karrie. you don't have the data to support shooting a 137 and you won't be home to monitor.
in the interest of safety, i'd skip this morning and start fresh tonight.

 

I can be with Checkers for the proper dosing times, just not for checking his bg levels throughout the day. Is changing the amount I give him for this am shot a bad idea -- like taking it down to 1.0 units?

And should I just have started a totally new post?

 

i'm not comfortable suggesting a shot (even a reduced shot) because you don't have the data to support shooting and you're unable to monitor today. i'd simply skip the shot this morning and start over tonight. consider it a "fur shot".

 

The experts here know what they are talking about. Trust their experience. That is a low preshot and even a 1 unit or less can make him go hypo quickly. Its better to play it safe than be sorry. Preshot values are just one factor in dosing.

Its easier to think of it as a furshot (when you shoot but the insulin goes onto the fur instead) instead of feeling like you aren't shooting when you should. Furshots happen to all of us even the experts. So its an unintentional missed shot, but a missed shot just the same.

Do you have a hypo kit put together? Everyone needs to have one.

 

Oh my!
Last week when Checkers' numbers went down and the vet took him off the PM shots, I did my first ever posts, but on the "newbie" site. My take away from those posts were to not skip doses because of the shed effect and that the vet likely had us too high too fast. I also noticed how quickly Checker's numbers shot up.

I checked the levels one more time and at +12.75 it'd gone up to 253, so just gave him a skinny 1.0 unit shot (at least half of his normal amount). I also gave Checkers a second smaller breakfast. I emailed in to work that I'm going to be late. I'm going to recheck his bg levels again. (This whole thing is rather scary. nailbite_smile )

Yes, I made sure I have a hypo kit on hand -- and am grateful that Checkers' favorite line is "food -- my favorite!" -- he's always been a good eater -- no picky with him.

 

When you have the "right dose" - you don't skip shots. You are correct in how Lantus works - but its more in depth than that. Its good that you knew you were shooting a rising number today. You didn't know if the 137 was a dropping number or a rising number.

And you want to keep shot times consistent. Ideally 12 hours apart. Moving up the time acts like a dose increase. So we only like to move shot times 15 minutes ahead at a time to avoid a big impact on blood glucose.

You are very lucky that Checkers isn't picky. Maverick is on the opposite end of the spectrum. It took him four months to eat enough wet food on his own. ohmygod_smile And after that he has to have it cut up a certain way, and only two flavours of food so far. ohmygod_smile

 

When you have a chance, review the information in the getting data ready sticky. In order to shoot lower numbers, you need to accumulate enough test data that you have a reasonable idea what your cat will do. In the beginning of this process, you just don't have the data and sometimes you need to skip or if skipping becomes a pattern, the dose needs to be adjusted so you can safely shoot twice a day.

Lantus likes consistency. You will get wonky numbers by shooting different doses in the AM and PM. I would suggest shooting 1.0u twice a day for the next couple of days so you can get Checkers' numbers to stabilize a bit more. Then, you can adjust the dose.

It would be very helpful if you could transfer your data to the spreadsheet template that people linked above.

We do typically open a new thread (we call them "condos") each day for Checkers. We use a format of the date, cat's name, and +time with BG #s.

 

Super! thank you for the link to that stickie. I want to get to my pc (at work) so I can get the numbers on the spreadsheet. I wasn't able to get my old Apple laptop at home to "rename" so I could actually start entering the data. And I see from the stickie the importance of the other numbers. I'll stick to the 1.0u twice per day and get those waning hour numbers. That was interesting about the build up for the shed.

I still don't understand ketones and how that plays into this. Where would I go to find more information about that?

Thank you for the help with the convention for starting a new condo!

 

morning laura! glad the burrito thing helped - i was ready to wrap up punkin again this morning to try to shave his ornery little neck so i have better luck with the shots.

yay for advice from the FDMB experts! you'll get it down and get on track with checkers.

btw, punkin's favorite food is the same! near unlimited ability to eat more. nom nom nom is what we should've named him! :lol:

 

Here's info on ketones.

 

Hi Laura & Checkers and welcome to Lantus Land!

You have gotten great info. thus far, and we all understand that it is difficult to process so much new information in a short time. So take a deep breath and don't panic. Sienne advises giving 1 unit of Lantus twice a day (every 12 hours: at AMPS and PMPS times). You really do need to follow this advice. At present you want to get Checkers into a routine. After a few days the knowledgeable people will better be able to evaluate where Checkers is and whether you need to change his dose.
Good luck with getting Checkers' spreadsheet up and running. That will greatly help those who are helping you with dosing.

Again, welcome! We're glad you found this board.

Ella & Rusty

 

Good morning Laura! I hope the IT at work can help you get the SS up, it helps a lot.

Is there any chance you can run home to check on him during the day? That is a low numbers when you don't know how he will react.

You stalled you shot this morning right? That means that the PM shot needs to be 12 hours after the time you actually shot, not the normal shot time. A delayed shot is like a dose reduction and an early shot is like an increase.

 

Phew! Checkers, stop scaring her like that!
yay you
Sarah.

 

LOL@purrito!!!

 

heeheehee my punkin burrito is quite a bit bigger than that. we could call him a pork burrito!

ya gotta laugh while you can when you're trying to figure all of this out!