2/13/10 Vicky amps 5.9

I was told to do a mini-curve today - Vicky's amps was 5.9 (106.2?),
and her midpoint check was 4.4 (is that 79.2?) We're Canadian, her
measurements are in mmol.

Still safe but lower than I've ever seen.

She's been on Lantus for 2 months now.

Is this typical/normal/okay?

She'll be seeing the vet soon for a "spa day": fructosamine, full
curve, anything else that comes with the territory. I'm hoping that we
might be headed for the much anticipated honeymoon period where she
can be weaned off insulin, but I don't know if these numbers are good
news/bad news or just news.

Laurelei




http://spreadsheets.google.com/pub?key= ... utput=html

 

Most of us, even the Canadians on the Board, use the US version of the numbers - using mmol makes your spreadsheet a bit of a challenge for us measurement dependent folks in the lower part of the continent.

While these numbers you mention are certainly good, there really isn't enough information on Vicky's spreadsheet for me to offer much input. We tend to get a lot more spot checks than what you have on your spreadsheet. I'm probably at the extreme end of those of us who gather test data (Ok, I'm a testaholic!), but you are shooting blind more days than not, don't routinely get mid-cycle checks during the AM cycle and you have no data during the PM cycle. There's no way of knowing whether today is an anomaly or if this is actually where Vicky's numbers really are.

 

Hi Laurelei and Vicky

Welcome to the new Lantus forum! I see you are in beautiful B.C Canada! I'm in Ontario - lots of Canadians here in Lantus Land, by the way - so welcome!

I'm going to throw some links at you with important questions, if you have some time, it would help us all get to know a bit more about Vicky.

Tilly Protocol: here in the Lantus forum, we follow the Tilly protocol, which has had a high success rate.
http://www.tillydiabetes.net/en_6_protocol2.htm

From the stickie up above "New to the Group"
viewtopic.php?f=9&t=157

This chart is key to knowing what is going on in each cycle while on insulin.
Spotchecks BG testing at Preshot, +1, +3, +6, +9 and +11 are some of the most important to grab.

PRESHOT testing is a must. Let me put it this way - if Vicky was your child, would you inject insulin not knowing if she needed it or what her current BG levels were? On top of that - - I don't want to scare you, but in all honesty, shooting blindly without that preshot test is just not safe.

Learn how YOUR kitty is responding to insulin:

Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
Peak/Nadir - the lowest point in the cycle
Duration - when the insulin is strongest or works the hardest
How to do a Curve & Example of a typical curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

Carryover - insulin effects lasting past the insulin's official duration
Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect
Insulin Depot - (aka "storage shed" in Lantus Land) "spare tank" of insulin, which has yet to be used by the bod

Dosing Lantus is not based on preshot numbers, since u have very few, can you tell us how you reach to 4 units? Are you working with your vet to reach this dose?
We really encourage spotchecking here, not only does it guide you along with dosing, but helps to know kitty is safe and not going to low.

Becoming Data Ready: Again, you will need more spotchecks to see how Vicky is doing on Lantus
viewtopic.php?f=9&t=147

Treating Hypo:
http://www.gorbzilla.com/treating_hypog ... elissa.htm

List of hypo symptoms: Again, not trying to scare you - but it is very important to know what to look for.
http://www.felinediabetes.com/phorum5/r ... msg-925783

Spreadsheet help plus adding a U.S spreadsheet, from the TECH forum:

viewtopic.php?f=6&t=16

A lot of our members are from the U.S, and reading spreadsheets in U.S numbers is quicker and easier to help with suggestions and feedback, when you have some time, it would be great if you could add a U.S spreadsheet for Vicky. If not, you will have to do a lot of math converting the Canadian numbers x 18.

What diet is Vicky currently on? If you need help and info on nutrition, this link will take you to Dr Lisa's Feline Nutrition site.
Dr Lisa's Feline Nutrition:
http://catinfo.org/

Need help picking low carb (LC), medium carb (MC) and high carb (HC) wet foods? See this link:
Janet & Binky's (GA) Food charts:
http://binkyspage.tripod.com/canfood.html

Some other questions, what does Vicky weigh?
What is your schedule like for spotcheck availability? For curves?

We're all glad you're here with Vicky, and we here to help and guide you along to reach the goal of a healthy happy kitty.

And please, consider getting into the habit of preshot testing before shooting insulin.
As well as spotchecks, there really is no way of knowing if Vicky needs to be kept on 4 units or if she has earned dose decreases.

Hope to see you posting often!

 

Vicky is under the care of our vet, the same vet we have worked with for about 10 years. I am following the instructions I have been given, and others more experienced than I have assured me that my vet is knowledgeable and competent about feline diabetes and its latest treatments. She loves my cat as much as I do, and I trust her.

Vicky is 14.5 years old, and was hyperthyroid just over a year ago. She received radioactive iodine treatment and is hypothryoid as a result. She had no other health issues. She is a slightly pudgy girl at 11 or 12 pounds.

Vicky started Lantus 2 months ago, in December. She began on 2 units, twice daily, was increased to 2.5 briefly, then up to 3.0 for 9 or 10 days, then to 3.5 for another 9 or 10 and has been at 4.0 for just over a month.

I am not adjusting her dosage myself, I am working closely with her vet to determine her course of action.

As for food, my vet urged me to wean Vicky off her beloved dry food (Go Natural- Grain Free) and onto canned. I understand that even this is considered controversial, and I'm still trying to sort out what Vicky should eat, compared to what Vicky will eat. She's been eating Purina DM Dietetic, and Natural Source, plus the occasional tin of salmon or Evo... we're still experimenting. I believe that our goal is to find a high protein, low fat food, that she will actually eat.

I do work full time, so checking midday is impossible during the week. Vicky's schedule of a morning shot at 6:30 and an evening shot at 6:30 works best.

 

Well, that's just wonderful that you have a good vet working with you!
I highly encourage you to consult with your vet regarding Vicky's progress and follow their advise.

Good luck to you and enjoy the Olympics!

 

hello laurelei. it sounds very much like your vet is following the "old" Rand Protocol (University of Queensland)... initial starting doses were based on 0.5u per kg and increases were made in increments of 0.5 unit. in light of Rand & Roomp's recent research published this past year in the Journal of Feline Medicine and Surgery (2009) 11, 668e682 doi:10.1016/j.jfms.2009.04.010, Rand has thrown out that old protocol in favor of one which is almost identical to the one we've been using here for the past couple of years.

for you to compare:
Rand's "old" 2006 protocol": http://romlin.com/jock/LongInsulins/Rand_Science_Week.htm
Rand's "new" 2009 protocol: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf
"Human diabetic patients routinely self-adjust their insulin dose using a protocol
and home monitoring, and perform equally well or outperform physician
directed adjustments. The objective of this study was to report the outcome of
home monitoring of diabetic cats by owners using a protocol aimed at achieving
euglycaemia, using ultra-low carbohydrate diets (10% metabolisable energy)
and the insulin analogue glargine for >10 weeks and/or until remission was
achieved. Fifty-five cats diagnosed with diabetes mellitus, whose owners joined
the online German Diabetes-Katzen Forum, were included. An overall remission
rate of 64% was achieved in the cohort. Significantly higher remission rates were
observed if good glycaemic control was achieved soon after diagnosis: 84% for
cats started on the protocol within 6 months of diagnosis went into remission,
and only 35% for cats that began more than 6 months after diagnosis (P < 0.001).
Only one mild clinical hypoglycaemic episode occurred observed despite tight
blood glucose control. In conclusion, intensive blood glucose control is safe and
effective in diabetic cats using home monitoring and treatment with glargine.

Date accepted: 28 April 2009  2009 ESFM and AAFP. Published by Elsevier Ltd. All rights reserved."

you might want to share the newest study with your vet...

 

Dear Jill;

Laurelie's vet was already using the "newest" information with us before Vicky was diagnosed with feline diabetes.

In fact, our vet is also aware that the Greco et al. study being quoted as stating that "low carb" and "canned" are the terms proven to be effective for feline diabetes maintenance feeding are false. For anyone who has read the study they are aware that it makes no mention of dry food at all, there is no reference to processing methods other than that canned food was incidentally chosen to ensure the only difference between products was the ingredient list. In actual fact, while similar amounts of carbohydrate were used in both types of food, (low vs moderate carbohydrates), the big difference between the two types of food was the fat content, which was "low fat", (LF), in one food and "high fat" (HF), in the other, which supports Deb Zoran's most recent papers discussing the influence of fat on our sedentary house cats that have been exposed to gonadectomies. I mention this because the "Tilly" protocol has misquoted the study results for some strange reason - perhaps because no one bothered to put out the expense to purchase and actually read the study results for themselves? Their theories do not match the most recent scientific papers that are presently being published around the influence of fat on insulin resistance and obesity in companion animals.

PatC
http://tinyurl.com/ydebpcm/

 

We use a modified version of the Tilly Protocol to guide dosing decisions.

For nutrition, most of us use the website authored by Lisa Pierson, DVM on feline nutrition as well as Janet & Binky's food charts. We are attentive to issues surrounding feline obesity and this subject is discussed in considerable depth on Dr. Lisa's site. Given that cats are obligate carnivores, most of us have found that a canned food or raw diet has had uniformly positive effects on weight related issues as well as appropriate hydration, and coat and skin quality. In fact, we have had a number of cats who, after switching from a dry food diet - even a quality, lower carb dry food - have become regulated once the dry food was eliminated from their diet.

I seriously doubt that Rand has difficulty securing recent research articles. The data base used for the study that Jill cited was the German Lantus forum that developed the Tilly Protocol. If you would like to provide the full citations or links to the articles you mentioned, several of us have access to medical libraries and can evaluate the research you have mentioned.

 

lol are you from ydc? pls note where you are posting, before posting. kthxbai

 

hello pat. welcome to the group! regarding the statement above... i hope the most recent published study worked out as well for you as it did me (see alex's levemir spreadsheet linked in my signature) and all of our other kitties who have gone OTJ (off the juice) in the last several years. we use a slightly modified version of the protocol here in the group.

as we are a numbers driven foum, this might be a good subject for you to bring up on the Think Tank Forum and/or the Diabetes-Katzen Forum if it's something you would like to discuss. i'm sure it would make for some interesting conversation.

 

Dear Ronnnie;

[quote="Ronnie & Luna- I don't want to scare you, but in all honesty, shooting blindly without that preshot test is just not safe.

(snip)
>getting into the habit of preshot testing before shooting insulin.
>As well as spotchecks, there really is no way of knowing if Vicky needs to be kept on 4 units or if she has earned dose decreases. [/color]

Could you please support what you are stating with scientific references in relation to how this is supposed to work with Lantus/Glargine? This type of insulin takes so long to develop full influence over a cat's blood glucose levels that it takes a number of days for changes to register, so how a "pre-shot" test is supposed to give any indication regarding what will happen to the cat AFTER the shot has been given, I just can't understand. I know that with older insulin types some people thought that testing before the shot gave an indication of what was going to happen in the cat after the shot, but that was not the case as it depended very much on how deep the individual cat's curve would go, and other variables such as activity level. Some people even thought the practice was necessary based upon how simple carbohydrates behaved in humans, but cats don't register carbohydrates because they don't have the enzymes in their mouths to process simple carbohydrates right after consumption:
http://www.ncbi.nlm.nih.gov/pubmed/11714241
"An overnight fast did not significantly alter morning blood glucose in diabetic cats. No demonstrable appetite stimulation occurred following an occurrence of low blood glucose; however, recorded incidences were few. No post-prandial hyperglycaemia was seen in the 10 diabetic cats during a 2-h period following the ingestion of typical cat foods."

I have a major problem understanding the principles you are trying to convey here as we have been feeding our boy frequent small meals of mostly dry food for many years, most of those not using insulin, and his numbers are far more stable than the other charts I see here on FDMB. As he has a major lump on his pancreas that interferes with consistant insulin production, we should be having problems if anyone should, but we aren't, and he is getting quite old, now. We are finding great success by following scientific studies rather than protocol 'fads' that come and go with the tide. I would be very interested to know why protocols are being promoted when they are not supported by scientific, peer reviewed papers? I am asking that question because so many people on this list seem to be having a very difficult time stabilizing their cats according to the charts we see, and yet these members attack Laurelei whose cat has become stabilized enough to be in the "normal" range for the full day after a very short period of time. Why do people on the group think they have a better method? PLEASE provide some science here?

Our cats are surfing within "normal" range for the full 24/7 period, as the experts claim should be the case, so why are our methods being questioned, and or criticized?

PatC
http://tinyurl.com/ydebpcm/

 

Our cats are surfing within "normal" range for the full 24/7 period, as the experts claim should be the case, so why are our methods being questioned, and or criticized?

PatC
http://tinyurl.com/ydebpcm/[/quote]

we have a saying here.. RTFS.. read the stickies. Don't ask for information that has already been provided. It's lazy and tacky.

 

please pat, let's not hijack laurellei's thread, k? the conversation you're looking for is appropriate for the Think Tank Forum.
please start a thread over there.

if you're here to get help with your cat, please start a new thread with the date, cat's name, and preshot number. although, we encourage all newbies to introduce themselves on the Health Forum where you will receive a proper welcome and where we'll be able to "get to know you and your cat". :smile:

 

Are you saying that if I'm following a different procedure, this is the incorrect forum?

Thank you for the links - I had found this information prior to posting. I checked message protocol as well, since I haven't posted on the "new" message board.

Laurelei


Tilly Protocol: here in the Lantus forum, we follow the Tilly protocol, which has had a high success rate.
http://www.tillydiabetes.net/en_6_protocol2.htm

From the stickie up above "New to the Group"
viewtopic.php?f=9&t=157

This chart is key to knowing what is going on in each cycle while on insulin.
Spotchecks BG testing at Preshot, +1, +3, +6, +9 and +11 are some of the most important to grab.


Hope to see you posting often![/quote]

 

So the "rules" of the FDMB have become that one must present a "preshot" number before posting????? That brings me back to my original question; where is the science that suggests preshot readings have ANY value at all? How does a "preshot" test predict how a dosage of insulin is going to be responded to by a given cat? Preshots are only useful if you are doing a full curve, to uncover the depth of the delta in the curve. They cannot tell you how low a cat is going to go on a dose of insulin. If you think you are right, then post the science.

Sorry, I don't have time to continue to post on a group that is not willing to look at science and options. The reception you all gave Laurelei was the most negative attitude I have ever read toward someone who HAS regulated their cat, and in record time. If you want to read the science behind what we are doing, feel free to check it out:
http://tamingthecurve.blogspot.com/2007 ... c-cat.html

The scientists who have REAL training in companion animal nutrition are writing articles such as the following:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2387258/, and
http://debsarticle.blogspot.com/ so I don't understand why it is acceptable on this group to be pushing "protocols" that have no scientific basis and are being pushed by retired veterinarians with no nutritional training?

Is this still a forum dedicated to the health of feline diabetics or has it just become like any other Jonestown cult of followers who can't question and think for themselves?

PatC
http://tinyurl.com/ydebpcm/

 

Thank you for your input - but fortunately in this board, we like to keep all kitties safe by obtaining a preshot number before injecting ANY insulin

A preshot test is not going to tell us where the cat will go in the cycle, it will tell us if it is safe to shoot - high or low number, and how much to monitor the starting BG test.

Have a nice day.

 

Love to see you trolls, and if you want to endanger your cat, you go right ahead and do it but please don't brag about it to the point that we feel terribly bad for any animals in your home. We love our cats here and we love yours too so we darn sure don't need to think about what your cat is going through right now. What we propose, follow, encourage and depend upon on this site are methods we have found, practiced, shared and fine-tuned for many many years.

Please do stop your silly and inane prattling and leave with your head held high that you have successfully made it very clear that you are a complete and total waste of the oxygen provided to us here on earth.

 

imho, janet has summed things up nicely. thank you, janet.
i don't feel a need to comment further.
good day, pat.

 

Let me perhaps present a very practical reply. If you had a child, would you give that child a shot of insulin without first knowing what his or her BG values were? I don't know of a single physician who would suggest this course of action for an adult, let alone a child. At least for me, common sense would dictate that shooting blind presents an unnecessary danger. If you spend any time reading this ISG, you will see that people will often ask for assistance when they encounter an unexpectedly low pre-shot value and they do not yet have the data to support a safe course of action. Whether the options that are available have evidence to support them is a question I do not personally have the answer to. However, no one really knows aspirin's mechanism of action but it is still widely used because it does work. Having pre-shot values works because it keeps our cats safe.

Further, I think that you have lost Jill's point that the Tilly Protocol is, in fact, based on peer reviewed research and has been published in a respected veterinary journal (Roomp & Rand, Journal of Feline Medicine and Surgery (2009) 11, 668-682). If you do not have easy access to the journal or article, if you send me a PM, I will be more than happy to send you the pdf.

People on this forum do share a perspective that embraces home testing (again, a principle born out by the Lantus research literature) both at pre-shot and during the mid-cycle. Are there cats here whose companions utilize a "mini-meal" approach? Of course there are. Most of us do not relegate our cats to 2 meals per day. Perhaps one large difference is that there have been hundreds, if not thousands, of cats who have been involved in both this Board and it's German counterpart all of whom have used the Tilly Protocol in one or another of its iterations. In the last two (or maybe three) years, there are at least 200 cats who have achieved remission on this Board alone. There are countless others who do not post regularly who have cats that are tightly regulated. You have only referenced having information based on your personal experience and that of one other person.

The "rules" of this ISG, such as they are, do not dictate that anyone who posts do anything that they are not comfortable doing. How someone chooses to treat their cat is their business and we have a fundamental respect for the principle that every cat is different (ECID). If you or Lorelei do not feel welcome or chose to not utilize the resources here, posting on the Health board is always an option. There are Lantus users on Health. By the same token, the members here can choose whether or not they are comfortable posting to a particular thread. Ad hominim comments will not encourage a dialogue. Citing a review article (e.g., Buffinton) or conference presentations (especially when the source is a blog) that represent unpublished data rather than primary, peer-reviewed empirical research that has been published does little to support a point. Fortunately, or unfortunately, there are any number of us on this ISG who are researchers, medical, or veterinary professionals. We do critically review the literature (sometimes to the detriment of what we should be doing on our "day" jobs) and we routinely search that literature to answer questions. You are welcome to your opinions just as we are welcome to ours. We are much more interested in a dialogue (although Think Tank is more the place than here) than throwing bricks.