2 months post diabetes Dx, 1st on Lantus now on Levemir, need help :(

[Millie and Cooper]

Hi all,

My 14-year old baby Cooper (in my profile pic) was diagnosed with diabetes March 29th. He is complicated because he was also diagnosed with Stage 2 kidney disease about 3 weeks before that. From what I understand, these two diseases together can create somewhat of a vicious cycle and make regulation harder.

Let me give you a little more medical history info. Cooper got a nasty GI virus from a kitten we adopted at the end of 2012. He had awful diarrhea and vomiting for months, and was finally diagnosed with IBD via biopsy in March 2013. He was then started on the steroid Prednisolone and it took about a year to get him off of that officially. That was in about March 2014 when he got off that. He did really great until early this year when I started noticing the extra peeing and drinking. He went for his annual visit at the beginning of March and was diagnosed with stage 2 kidney disease. His glucose values were totally fine on that blood work. My vet had us also do another short course of the Prednisolone because she saw pretty bad inflammation on some chest xrays (asthma). Well he still seemed so off for a few weeks, so we kept pushing. Had an ultrasound done which showed dilated kidneys, which indicated that he may have passed some stones OR had some kinf od infection. We had another urinalysis and culture done, which showed glucose in his urine. Went into the vet the next day and she confirmed the diabetes diagnosis with a blood test there. I feel like that short course of Prednisolone may have just thrown him over the edge after being off of it for so long. I wish we'd never done it.

We started him on Lantus and have been doing home testing since the start. We use the AT meter. I know that is not preferred here, but that's what we use for now so no need to tell me you like the Relion better! We tried Lantus for about a month but he was bouncing all over the place. Oh, he does eat low carb food. After his diagnosis, we made sure everything was as low carb as he will possibly eat and that doesn't seem to have had much of an impact on his numbers. I had read so much about Levemir and convinced my vet that we should switch to that, so he's been on that for about a month.

Here is his SS: https://docs.google.com/spreadsheets/d/1q2Gi9kO7CAHAFXBfLprNOnQMXODoblsBDha5d8Kf3T8/edit?usp=sharing

He really has not had good numbers on Levemir yet. However we did see a little progress earlier this week when we went up to 3 units BID. So following the protocol on here, we upped the dose to 3.5 units after 3 days because his nadir was still over 300. He has had awful numbers at 3.5. I know you can expect to see some bouncing when you increase the dose and may temporarily see higher numbers. But these just suck and I don't really see how they're going to get better in another shot or two.

Do I stay at this dose for another 2 shots to see? And then what? Or should we go ahead and go back down to 3 units for 6+ shots and then maybe increase to 3.25? Maybe 3 was too little, but 3.5 was too much. Maybe Levemir isn't working for him? He has a vet appt this Saturday AM for a recheck. Should we go back to Lantus? Should we try ProZinc?

I am stressed and am second guessing every decision I'm making about his dosing. Anybody else on here with a kidney disease/diabetes cat who has advice?

Any suggestions are welcome!

 

[tiffmaxee]

It's not that we don't like the AT. it's the most like a lab. It's just that most of us test so much that it's too expensive. As a result most of us understand the human meter numbers better. By all means use the AT.

I'm not understanding why you want to decrease the dose. Hooefully someone will be along for dosing advice soon. I feel your frustration and understand your desire for better numbers immediately. One thing I've learned is that you can't fast track thus dance.

 

[Millie and Cooper]

I suggested a dose decrease because the numbers are worse. They are just flat, with no nadir. But maybe it needs more time to settle. This is incredibly confusing to a newbie!

 

[Tuxedo Mom]

My Tuxie started out with Lantus end of Nov 2014. He had very poor response and stayed mostly in the high numbers. The beginning of January I started him on Levemir and for him anyway it has shown more promise. I am still battling to get him into better numbers, with some progress then some setbacks. I have been frustrated, angry, given up and had meltdowns on a regular basis the last 6 months. However little by little Tuxie is getting into better numbers....he may not stay there but I am seeing a lot more "healing" numbers. There are different protocols to follow Start Low Go Slow ot Tight Regulation. Both are described in the start page of this forum (Lantus/Levemir).

The other thing is to have your own home testing and have a good grasp of what the insulin does and when it does it. General rule of thumb is to test before each shot and several times in between. Once you see if the numbers stay the same or drop and bounce up then you will have a better understanding on what the doses are doing. Sometimes you need less, sometimes more, sometimes you need to hold. You just need the data to know which way you should go.

BTW I also use the Alpha Trak2 meter so it gets confusing when discussing numbers since I have found that the AT2 gives on average about a 35% higher reading than the human meters. As long as you put it in your thread or on your spreadsheet then people will see and hopefully note the difference.

EDITED TO ADD: You certainly have lots of data..as bad as I am...I also will not give dosing advise as I am still too "green" but some of the long term experienced posters will certainly be able to offer some advise or options.

 

[Millie and Cooper]

Thank you Tuxedo Mom! I'm sorry to hear you are still struggling, but it is reassuring to know I'm not alone. I have data and am testing as much as I can (always before shots, and as much as possible in between as work and sleep allow), but the thing is, I don't know what it means always! It's so confusing that high numbers can mean too little insulin or too much insulin, and bouncing can mean the dose isn't settled, the liver is panicking or the dose is too much. I still am not able to interpret the data very well.

 

[Tuxedo Mom]

Thank you Tuxedo Mom! I'm sorry to hear you are still struggling, but it is reassuring to know I'm not alone. I have data and am testing as much as I can (always before shots, and as much as possible in between as work and sleep allow), but the thing is, I don't know what it means always! It's so confusing that high numbers can mean too little insulin or too much insulin, and bouncing can mean the dose isn't settled, the liver is panicking or the dose is too much. I still am not able to interpret the data very well.

I hear you!!! There are so many explanations for why and how and when. However you are 2 months into the "dance". My first two months were terrible...mostly blacks and reds with an occasional pink thrown in to give me (false) hope. Have you ruled out any other potential problems...UTI..even if the basic urinalysis does not show anything? I had a culture done on Tuxie even though he had no symptoms, since diabetic cats are more prone to UTIs. He was negative but still ended up with a UTI a month or so later. Also have you had a dental and or x-ray done. Sometimes there are dental problems other than just tartar or inflammation. If you have had a full blood work done recently then you should have a good idea if there are any other things going on. As well have you had his thyroid levels checked..separate test. With Cooper having kidney problems it certainly does make the treatment more complicated .Once you rule out any extraordinary problems then it is a matter of trying to find the right dose, slowly, but surely.

 

[Millie and Cooper]

I hear you!!! There are so many explanations for why and how and when. However you are 2 months into the "dance". My first two months were terrible...mostly blacks and reds with an occasional pink thrown in to give me (false) hope. Have you ruled out any other potential problems...UTI..even if the basic urinalysis does not show anything? I had a culture done on Tuxie even though he had no symptoms, since diabetic cats are more prone to UTIs. He was negative but still ended up with a UTI a month or so later. Also have you had a dental and or x-ray done. Sometimes there are dental problems other than just tartar or inflammation. If you have had a full blood work done recently then you should have a good idea if there are any other things going on. As well have you had his thyroid levels checked..separate test. With Cooper having kidney problems it certainly does make the treatment more complicated .Once you rule out any extraordinary problems then it is a matter of trying to find the right dose, slowly, but surely.

We had a urine culture done at the end of March, as well as a really good dental exam. At the end of April, he had another full blood panel done but didn't do a urine culture again. When he goes for his recheck at the vet this Saturday, I'll ask about doing another culture and getting some dental xrays done along with his blood work.

 

[Tuxedo Mom]

We had a urine culture done at the end of March, as well as a really good dental exam. At the end of April, he had another full blood panel done but didn't do a urine culture again. When he goes for his recheck at the vet this Saturday, I'll ask about doing another culture and getting some dental xrays done along with his blood work.

If he hasn't been tested you could ask for the thyroid test..it is a separate test not done on a basic blood panel. Once you rule out as much as you can then you deal with dosing and increasing as needed. I have even gone to the point of having Tuxie tested for insulin resistance problems..all which came back negative. But I was getting so frustrated at no results even with increasing and then changing insulin from Lantus to Levemir. I have really had a hard time with learning patience, but sometimes that is what is needed. Every cat is different, so every cat reacts differently to insulins and increase/decreases. But you have lots of information on Cooper so you are well armed with information.

Just another question...what type of food do you feed? A low carb wet food is better. With kidney problems you are having to deal with the proper food for that as well, so that makes it much harder. You have to feed the right food for kidney health for sure and then see if there is one that works with diabetic diet too.

EDITED TO ADD:

I was trying to find the link for Tanya's which lists foods good for kidney failure, but darned if I can find it right now. Hopefully someone else will come along and give you the link.

 

[Millie and Cooper]

If he hasn't been tested you could ask for the thyroid test..it is a separate test not done on a basic blood panel. Once you rule out as much as you can then you deal with dosing and increasing as needed. I have even gone to the point of having Tuxie tested for insulin resistance problems..all which came back negative. But I was getting so frustrated at no results even with increasing and then changing insulin from Lantus to Levemir. I have really had a hard time with learning patience, but sometimes that is what is needed. Every cat is different, so every cat reacts differently to insulins and increase/decreases. But you have lots of information on Cooper so you are well armed with information.

Just another question...what type of food do you feed? A low carb wet food is better. With kidney problems you are having to deal with the proper food for that as well, so that makes it much harder. You have to feed the right food for kidney health for sure and then see if there is one that works with diabetic diet too.

Yes, I am really having to learn some patience here, which is not one of my strengths! For the thyroid test, are you talking about the Free T4 test? His Total T4 has been normal, but we haven't had the Free T4 done. As for food, he eats low carb canned...different varieties include Weruva, Friskies, BFF, etc. Not feeding Fancy Feast due to those having such high levels of phosphorus.

 

[Tricia Cinco(GA) & Harvey]

Hi and welcome to L&L Land!

Everyone here has been where you are, so you are in good company. In order to help you out we need to get a little more info from you about your kitty. Have you read any of the stickies at the top of the page? If not, please start with New to the Group? There's a ton of info there, including a link to directions for setting up your spreadsheet. We are very data driven here, and in order to help you with dosing advice, we need to see what your kitty has been doing so far. If you need any help with it, just ask. You can also get your signature block set up. We like to have your name, diagnosis date, what kind of meter you're using (please put this in bold as you are using an Alpha Trak and we need to make sure advice givers realize this), the type of insulin, and a link to your spreadsheet. Again, ask for help if you can't figure out how to do it. You can look as some others' posts to see what sort of info they include. We will also need to know your kitty's weight to help figure out dosing. It helps if you say where you live (city or region and state or country), too, so we know what time zone you're in, etc. These are just the basics.

Many kitties here have other issues. A lot have kidney disease. Have you seen Dr. Lisa's food chart? It can be very helpful in finding low carb, low phosphorus foods.

BTW, the Alpha Trak actually has a differential from a human meter that varies according to the BG. The lower the BG, the closer the meters are in numbers. I keep forgetting the exact ranges I was told (by noted endocrinologist, Dr. Richard Nelson), but it's something like: Under 70 - no difference. Between 70 and 150 - about 5-10 points. Between 150 and 300 - 10-30 points. Over 300, the difference is much bigger. He didn't even give me a number, just said it was too much. But really, once you're over 300, all you really need to know is you need to get kitty down!

Again, we're happy to have you here and to learn about you and your kitty. Please keep asking questions! There's a LOT to absorb here and it can be very overwhelming.

 

[Suzanne & Cobb(GA)]

It's definitely possible the prednisone threw him over the edge.

Questions...what prompted you to go up by .5 units instead of .25 units? It's possible you missed the optimal dose, but given the data you have, and nighttime tests (good job!), I doubt it. Also, I know you said Cooper was bouncy on the Lantus, but the switch a month in was a very quick switch from Lantus to Levemir. I definitely recommend you give Lev more time than a month to show some good results.

I know on the Atlanta vet thread you said you were willing to go out of the city to find a good vet. My recommendation is Dr. Wilfert at Bells Ferry Veterinary Hospital. Here's their contact info:

• 6410 Highway 92
• Acworth, GA 30102
• Phone: (770) 926-5311

It's about 30 minutes north of midtown, up 75. It has an Acworth address, but it's really in the Woodstock area. She is 1) very calming, 2) very logical, and 3) really appreciated the data I gave to her. She knows about FDMB. She seemed to trust the advice that is given here (something I know a lot of vets that we've heard from don't). She also likes Levemir as an insulin for cats. I wish I had found her just after Cobb's diagnosis versus the latter. But I will say if we ever have another cat, she will be my first choice in vets to go to -- even though we are trying to move further away from her office.

 

[Tuxedo Mom]

Yes, I am really having to learn some patience here, which is not one of my strengths! For the thyroid test, are you talking about the Free T4 test? His Total T4 has been normal, but we haven't had the Free T4 done. As for food, he eats low carb canned...different varieties include Weruva, Friskies, BFF, etc. Not feeding Fancy Feast due to those having such high levels of phosphorus.

Sounds like you are doing all the right things. I only had the Total T4 done. From what I understand it is a pretty good indication of whether there may be problems. I never had the Free T4 done since I spent so much on other testing...Cushing's, Acromegaly, and IAA. I had all these done in the first 2-3 months since I was so frustrated at seeing nothing happening that I just wanted to rule out EVERYTHING. Since then I just sort of plug along and test and monitor and do dose increases (for me I use every 5 days even for tight regulation since Tuxie seems to take a bit longer to adjust to increases/decreases). Patience is a rare commodity but very necessary with the "sugar dance"

 

[Millie and Cooper]

Hi and welcome to L&L Land!

Everyone here has been where you are, so you are in good company. In order to help you out we need to get a little more info from you about your kitty. Have you read any of the stickies at the top of the page? If not, please start with New to the Group? There's a ton of info there, including a link to directions for setting up your spreadsheet. We are very data driven here, and in order to help you with dosing advice, we need to see what your kitty has been doing so far. If you need any help with it, just ask. You can also get your signature block set up. We like to have your name, diagnosis date, what kind of meter you're using (please put this in bold as you are using an Alpha Trak and we need to make sure advice givers realize this), the type of insulin, and a link to your spreadsheet. Again, ask for help if you can't figure out how to do it. You can look as some others' posts to see what sort of info they include. We will also need to know your kitty's weight to help figure out dosing. It helps if you say where you live (city or region and state or country), too, so we know what time zone you're in, etc. These are just the basics.

Many kitties here have other issues. A lot have kidney disease. Have you seen Dr. Lisa's food chart? It can be very helpful in finding low carb, low phosphorus foods.

BTW, the Alpha Trak actually has a differential from a human meter that varies according to the BG. The lower the BG, the closer the meters are in numbers. I keep forgetting the exact ranges I was told (by noted endocrinologist, Dr. Richard Nelson), but it's something like: Under 70 - no difference. Between 70 and 150 - about 5-10 points. Between 150 and 300 - 10-30 points. Over 300, the difference is much bigger. He didn't even give me a number, just said it was too much. But really, once you're over 300, all you really need to know is you need to get kitty down!

Again, we're happy to have you here and to learn about you and your kitty. Please keep asking questions! There's a LOT to absorb here and it can be very overwhelming.

Thanks Tricia! I will get my signature block set up. This is the spreadsheet I already have: https://docs.google.com/spreadsheets/d/1q2Gi9kO7CAHAFXBfLprNOnQMXODoblsBDha5d8Kf3T8/edit?usp=sharing. Does this not work in this group? Cooper is 13 lbs btw.

 

[Tricia Cinco(GA) & Harvey]

That's it! I didn't know you had one already. If you can put the link in your signature block, it will make it easier for those that want to help.

 

[Millie and Cooper]

It's definitely possible the prednisone threw him over the edge.

Questions...what prompted you to go up by .5 units instead of .25 units? It's possible you missed the optimal dose, but given the data you have, and nighttime tests (good job!), I doubt it. Also, I know you said Cooper was bouncy on the Lantus, but the switch a month in was a very quick switch from Lantus to Levemir. I definitely recommend you give Lev more time than a month to show some good results.

I know on the Atlanta vet thread you said you were willing to go out of the city to find a good vet. My recommendation is Dr. Wilfert at Bells Ferry Veterinary Hospital. Here's their contact info:

• 
  
  
  • 6410 Highway 92
  • Acworth, GA 30102
  • Phone: (770) 926-5311

It's about 30 minutes north of midtown, up 75. It has an Acworth address, but it's really in the Woodstock area. She is 1) very calming, 2) very logical, and 3) really appreciated the data I gave to her. She knows about FDMB. She seemed to trust the advice that is given here (something I know a lot of vets that we've heard from don't). She also likes Levemir as an insulin for cats. I wish I had found her just after Cobb's diagnosis versus the latter. But I will say if we ever have another cat, she will be my first choice in vets to go to -- even though we are trying to move further away from her office.

Thanks Suzanne! I went up by 0.5 units because his nadir was still so high and I thought that was what the protocol said to do (after 3-5 days, go up by 0.5 if the nadirs are still over 300). I have done .25 increases before and maybe I should have this time. Honestly, I don't know. It gets so confusing. Yes, maybe we should have tried Lantus for longer but he was bouncing so much and the Levemir sounded so promising with smoother curves.

 

[Millie and Cooper]

Anyone have dosing advice for tonight?

 

[Wendy&Neko]

Hello and welcome Millie and Cooper. Thank you for getting the spreadsheet set up. How long until you shoot?

I think it's possible you've bypassed a good dose. Lantus and Levemir require patience, not my strong suit at first. You have to wait for the depot to build and to see the result of changes to doses. We hold at least 6 cycles, and more if kitty is seeing numbers in the blue - which you saw at the beginning of your Levemir journey. Think of dosing Lantus and Levemir like moving a very large ship in the water. Small changes nudge the boat over time.

If you are following the Tight Regulation (TR) Protocol, it's very important to get two tests each cycle. Getting a before bed test will really help figure out what is happening at night. Many kitties (including mine) go lower at night. It's possible Cooper is going low at night then bouncing during the day. Without the night time data, we don't know if he's on too high a dose (low at night and bouncing during the day), or too little (also high at night).

If you are following the Start Low, Go Slow Method (SLGS) for dosing, each dose is held for a minimum of one week. It would be helpful if you'd read the TR and SLGS stickies and let us know which one you'd like to follow, as the dose advice differs depending on which you want to use.

 

[Millie and Cooper]

Hello and welcome Millie and Cooper. Thank you for getting the spreadsheet set up. How long until you shoot?

I think it's possible you've bypassed a good dose. Lantus and Levemir require patience, not my strong suit at first. You have to wait for the depot to build and to see the result of changes to doses. We hold at least 6 cycles, and more if kitty is seeing numbers in the blue - which you saw at the beginning of your Levemir journey. Think of dosing Lantus and Levemir like moving a very large ship in the water. Small changes nudge the boat over time.

If you are following the Tight Regulation (TR) Protocol, it's very important to get two tests each cycle. Getting a before bed test will really help figure out what is happening at night. Many kitties (including mine) go lower at night. It's possible Cooper is going low at night then bouncing during the day. Without the night time data, we don't know if he's on too high a dose (low at night and bouncing during the day), or too little (also high at night).

If you are following the Start Low, Go Slow Method (SLGS) for dosing, each dose is held for a minimum of one week. It would be helpful if you'd read the TR and SLGS stickies and let us know which one you'd like to follow, as the dose advice differs depending on which you want to use.

Thanks. I guess we have been following a blend of the TR and SLGS methods. Do you have a recommendation based on how Cooper has done so far? I try to get nighttime readings when I can. From the ones I have gotten, he doesn't appear to be dropping low over night. It seems he more often climbs overnight. I look back at the numbers now in the beginning of starting Levemir and wish I had held the initial 1.5 units longer than I did. After seeing all the bad numbers that followed from dose increases, it looks like 1.5 might have been a good one. We dropped back down to 1.5 to try it again and it didn't help. We shoot in about an hour and 20 minutes from now.

 

[julie & punkin (ga)]

Millie, how long until you shoot tonight?

 

[julie & punkin (ga)]

we posted at the same time and hey, thanks for answering my question before I'd even asked it!

 

[Millie and Cooper]

We shoot in about an hour and 10 mins from now.

 

[julie & punkin (ga)]

what has the vet said about the dose?

some of us are talking about ideas on how you might proceed.

 

[Millie and Cooper]

Well I put a call in to her this afternoon, but not sure if I'll hear back from her before shot time tonight. I emailed her a few days ago with an update when he was still at 2.5 and she was kind of vague. Just said we may need to go up in dose or switch insulins, that she didn't think Levemir was doing much for him. They have treated dogs at their clinic with Levemir, but not cats. They have generally done Lantus for the cats. We have an appt with her Saturday for Cooper's recheck and I told her we could discuss more then about a new plan, but I don't want to go until Saturday without some guidance.

 

[Wendy&Neko]

My Neko is on Levemir, and I love it! But that was after over a year on Lantus. We generally suggest people try an insulin for 6 months, unless there is a reason to change. Some kitties feel the sting of the acid base of Lantus at higher doses. Neko didn't, and she got to 8.75U of Lantus.

 

[Millie and Cooper]

Well now I know about switching. I do not plan on switching off of Levemir anytime soon. I really want to make it work, just need to figure out how!! And I do notice Cooper being less uncomfortable with his shot using Levemir vs Lantus, so Lantus must have stung him some.

 

[Wendy&Neko]

If we can't get back to you with a plan before shot time, it might be best to just hold the dose for a couple more cycles and keep testing. Is there a reason you sometimes can't get a night time test in? Even a +2 or +3 test provides a lot of data about the cycle. Or if shot time is right before bed, then test when you either need a bathroom break or when you get up in the morning.

 

[julie & punkin (ga)]

I don't think either the Lantus or the Lev are the problem. I think it's a dose-related issue. Because these are depot insulins, they have to build up in the body and then sort of "slow release" - think timed release drugs. When the dose in increased, the depot has to increase too before you can see what the dose will do. That's why we allow a week on the starting dose of either insulin before adjusting it, unless there are obvious problems.

Millie, probably what you are seeing with Cooper is some Glucose Toxicity. When a cat sits in high numbers, their body gets used to it and perceives that high range as "normal." It doesn't matter if the high numbers come from not enough insulin, or if they are caused by too much insulin - the result either way is high, and high creates glucose toxicity. It sounds more ominous than it is - it just means that the body has forgotten what normal blood sugar numbers are. You can read about it here.

 

[Meya14]

Max had to go up to 7U twice a day on the levemir to overcome the glucose toxicity after he was first diagnosed. Really, you aren't in the "high dose" territory until you reach about 6U twice a day so you have a lot of room for increases before you should consider that the insulin isn't the right one. Switching is a major setback, especially when the cat turns out to be a higher dose cat. We switched from lantus to lev and started from scratch, and probably wasted another 3 months until he was regulated, but now he's regulated great on the Lev, just took a whole lot of patience.

 

[Millie and Cooper]

If we can't get back to you with a plan before shot time, it might be best to just hold the dose for a couple more cycles and keep testing. Is there a reason you sometimes can't get a night time test in? Even a +2 or +3 test provides a lot of data about the cycle. Or if shot time is right before bed, then test when you either need a bathroom break or when you get up in the morning.

Honestly, I am so exhausted from my day that I usually pass out on the sofa right after dinner and don't wake up until 1-3am and stumble to bed. IF I am coherent enough, that's when I will test and why you see some spot checks late at night. I will try to do better! If you can't get back to me tonight, do I need to start a new thread tomorrow?

 

[Wendy&Neko]

We usually start one thread per day, and link back to the previous day's thread so people can follow along. Otherwise it can be a long read.

My cell phone alarms are my best friend.

 

[Millie and Cooper]

I don't think either the Lantus or the Lev are the problem. I think it's a dose-related issue. Because these are depot insulins, they have to build up in the body and then sort of "slow release" - think timed release drugs. When the dose in increased, the depot has to increase too before you can see what the dose will do. That's why we allow a week on the starting dose of either insulin before adjusting it, unless there are obvious problems.

Millie, probably what you are seeing with Cooper is some Glucose Toxicity. When a cat sits in high numbers, their body gets used to it and perceives that high range as "normal." It doesn't matter if the high numbers come from not enough insulin, or if they are caused by too much insulin - the result either way is high, and high creates glucose toxicity. It sounds more ominous than it is - it just means that the body has forgotten what normal blood sugar numbers are. You can read about it here.

Yes, I know now that we shouldn't have changed the dose on Lev so soon in the beginning. I agree with you that it is probably glucose toxicity. How do we break it??

 

[Millie and Cooper]

Max had to go up to 7U twice a day on the levemir to overcome the glucose toxicity after he was first diagnosed. Really, you aren't in the "high dose" territory until you reach about 6U twice a day so you have a lot of room for increases before you should consider that the insulin isn't the right one. Switching is a major setback, especially when the cat turns out to be a higher dose cat. We switched from lantus to lev and started from scratch, and probably wasted another 3 months until he was regulated, but now he's regulated great on the Lev, just took a whole lot of patience.

Yeah, I have no plans to switch or start over after this thread. I hope Lev will work for us!

 

[julie & punkin (ga)]

Was your insulin purchased from a people pharmacy?

 

[Millie and Cooper]

Was your insulin purchased from a people pharmacy?

Yes, Target.

 

[Meya14]

Regular increases are the only way to tackle the glucose toxicity. For levemir, sometimes there is a "breakthrough" dose where the numbers are terrible, and suddenly you have lots of numbers <100. It's scary at first when this happens, and often you can reduce the dose once the glucose toxicity breaks.

 

[Millie and Cooper]

Regular increases are the only way to tackle the glucose toxicity. For levemir, sometimes there is a "breakthrough" dose where the numbers are terrible, and suddenly you have lots of numbers <100. It's scary at first when this happens, and often you can reduce the dose once the glucose toxicity breaks.

That is what I am hoping for. Just don't know how often or how much to increase. Feel like each change I make is wrong! Ahh!

 

[julie & punkin (ga)]

don't beat yourself up over any of this - believe me, you aren't the first person to be in this spot. We've all made mistakes - it's ok - just learn from it and move on. None of us point any fingers.

The reason that Wendy is suggesting at least one test in the pm cycle is because we see very often that cats go lower at night than during the day. And the tricky thing, but most very important thing, to wrap your head around with Lantus and Lev is that the dosing is based upon how LOW the dose will take the cat. So the focus is on that low point, and to some extent you learn to ignore the high numbers. So the night cycle is really important. A peek of blue or green in there would be hugely significant in making a dosing decision.

As Meya said, regular increases are the way to break though glucose toxicity - however that doesn't mean too fast and the thing to be aware of in this case is that he may come down hard when he does break through. In other words, in a cat that has worked up to a dose methodically, per the Tight Reg dosing protocol or using Start Low Go Slow's dosing guidelines, if they go low because the dose is too great, it's likely going to be going into the 40's. In your situation, he may drop lower than that. There's no way to know.

For now, i'd suggest that you don't increase until you get advice here on the Lantus/Lev group. Most people won't give dosing advice unless they feel pretty confident. If you can post every day we'll keep an eye out for you. I'd hang on to this dose for a full 6 cycles, getting a test somewhere in the pm cycle as best as you can.

 

[Thaiger & Katie]

It's nice to know there are more of us Atlanta folks on here - good forum friends to lean on in case of an emergency. If you guys ever need anything, let me know! I am by no means an expert but have learned to BG test at home and do curves. I was lucky though and my kitty went OTJ after only 3 shots of ProZinc. Speaking of which, I have a basically full bottle of ProZinc that was opened in early February - I think they are good for 6 months? If you end up getting switched to ProZinc, let me know and you can probably have my bottle. I've been holding on to it *in case* she slips backwards on me.

I don't want to put a bad omen out there but if you ever have an emergency with Cooper, Dr. Kelly O'Neil is at St. Francis Vet Specialists (the 24 hour emergency place). I've ended up there before and she actually has diabetic kitties of her own and really knows her stuff!

 

[Marje and Gracie]

I'd like to throw some thoughts out there just as an observation.

First, you are more than welcome to use your AT if that is the meter you prefer. I have an AT2 and would dearly love to use it all the time but the strips are too expensive for as much as I test. If you look at my Gracie's SS, you will see a tab for AT2/Micro comparisons and you will see it states in bold red letters that the comparisons are for the AT2 and Micro meters I have. Roomp/Rand (authors of the 2009 and 2013 versions of the Tight Regulation Protocol that we use here) state in the 2013 version that the difference between the AT2 and human meters at the lower end of the normal spectrum (50 on human meter) is about 18 mg/dL and at lower numbers can be 30-40%. Because one meter can vary 20%, you can see how the numbers could be very different in comparing the AT2 and Micro...which is what I found to be true with my meters. I'm saying this only to be sure it is clear that no one should draw an assumption of what a reading on an AT2 would be on any human meter and vice versa.

Second, I am also a levemir user that converted from Lantus. I have seen cats dip their toes in blue numbers but the dose still had to keep going up. I do think you dropped the levemir dose back way too much when you switched and I'm glad you fast tracked the increases.

Third, I think, for the most part, you've made good decisions on the increases on levemir based on the nadirs you were seeing. Would some nighttime tests help? Yes but because levemir onsets at around +4 and nadirs later (+8 to +12 or after) I'm not seeing how a cat on levemir could be in the 500s at PMPS, 500s at +8, and 500s at the following AMPS and have gotten into blue or green numbers in four hours from onset to nadir. Even considering bounces and lack of duration, and I have seen cats shoot up really fast in an hour, I'm just not sure I believe he's done that on nights when you've tested. Could he have seen lower numbers in the nights you didn't test? Absolutely. But his patterns seem pretty consistent. And remember that at the numbers you are talking about, he's pretty flat when you consider a 20% meter variance possible.

IMHO, if this were my kitty, I'd keep moving up according to the protocol (for nadirs over 300, increase 0.5u every six cycles...remember that 300 is for a human meter). In some situations, we've even gone a bit faster where we think glucose toxicity is an issue and some of us are discussing whether Cooper might need some fast tracking.

Edited to add:If we suggested that, it would mean raising his dose every four cycles until he sees more yellow but you would absolutely need some nighttime tests every night. What would you think about that (and keep in mind he probably did see some yellow on the 3u dose).

We are glad you found us and we we always happy to help.

 

[julie & punkin (ga)]

I think marje has made some good points and I can see the benefits of increasing every 4 cycles to get on top of his blood sugar.

if you want to go this direction, please post on here every day so we can help you do this safely.

 

[Millie and Cooper]

Marje, I agree with you. I feel like his patterns have been fairly consistent and I really don't think he got into blues and greens very often, if much at all, on nights I didn't test overnight. So what would the comparable BG be on an AT2 if it's 300 on a human meter? Probably 450ish?

Take a look at the nighttime readings I got last night. He stayed pretty flat overnight and was in the 400's this morning. When I checked him at lunch, he had jumped back to 533. I am crying here.

So if we fast track his dosing and go up every 4 cycles, would we go up .25 or .5 units? I can definitely get nighttime tests in. I will just set my alarm and my husband's alarm and between the two of us, one of us will get up and do the tests! So we've done 6 cycles at 3.5 as of this morning, so time to go up tonight? To 3.75 or to 4?

Is this the consensus among those of you that have been discussing Cooper?

This gives me great comfort that you guys are taking the time to look at my Cooper's case and try and help me. Thank you.

 

[Tuxedo Mom]

Sorry if this was already discussed..I looked and couldn't see it.

Has Cooper been checked for other issues...UTI, dental problems, thyroid levels, kidney problems full blood panel etc. If there are other issues at work here that could most certainly be affecting the glucose levels.

Also has the insulin been stored properly and is it still clear...no cloudiness or "floaters"?

How is Cooper's eating and pooping? Does he seem lethargic at all or is his energy and general demeanor seem normal?

I found for myself that Tuxie seemed to get better absorption when I shot him in the flank or stomach area other than the scruff. If you are shooting somewhere that there is a lot of fat under the skin, it can slow down the insulin absoption.

Just trying to cover any possible outside reasons for Cooper's poor response. If nothing else is going on then it would be a matter of increasing the dose. For tight regulation the dose is increased by .25 units every 6 cycles (3 days) if the readings remain this high.

I am sure someone more experienced will come by and add to this.

 

[Millie and Cooper]

Sorry if this was already discussed..I looked and couldn't see it.

Has Cooper been checked for other issues...UTI, dental problems, thyroid levels, kidney problems full blood panel etc. If there are other issues at work here that could most certainly be affecting the glucose levels.

Also has the insulin been stored properly and is it still clear...no cloudiness or "floaters"?

I found for myself that Tuxie seemed to get better absorption when I shot him in the flank or stomach area other than the scruff. If you are shooting somewhere that there is a lot of fat under the skin, it can slow down the insulin absoption.

Just trying to cover any possible outside reasons for Cooper's poor response. If nothing else is going on then it would be a matter of increasing the dose. For tight regulation the dose is increased by .25 units every 6 cycles (3 days) if the readings remain this high.

I am sure someone more experienced will come by and add to this.

He was last checked for a UTI and dental problems at the end of April, and there was no evidence of either. And yes, he has kidney disease. He is in Stage 2 of that. That was diagnosed at the beginning of March, 3 weeks before his diabetes diagnosis. He goes back to the vet this Saturday AM for a bloodwork and urine recheck.

Also, we have been injecting the shot in his flank area. The insulin has been stored in the fridge on a shelf with no jiggling. No floaties in there. We have even tried a 2nd pen and no difference.

 

[Meya14]

Once his numbers are closer to normal you might want to get his kidney levels rechecked. Sometimes they improve, because the dehydration and diuresis from high BS can cause more of an acute kidney issue. It can resolve somewhat.

 

[Millie and Cooper]

Once his numbers are closer to normal you might want to get his kidney levels rechecked. Sometimes they improve, because the dehydration and diuresis from high BS can cause more of an acute kidney issue. It can resolve somewhat.

Don't worry, we're checking his blood work every month, sometimes more. I'm hoping the kidney issues will get better!

 

[Tuxedo Mom]

He was last checked for a UTI and dental problems at the end of April, and there was no evidence of either. And yes, he had kidney disease. He is in Stage 2 of that. That was diagnosed at the beginning of March, 3 weeks before his diabetes diagnosis. He goes back to the vet this Saturday AM for a bloodwork and urine recheck.

Also, we have been injecting the shot in his flank area. The insulin has been stored in the fridge on a shelf with no jiggling. No floaties in there. We have even tried a 2nd pen and no difference.

That is great. It sounds like you have covered all the bases at this point It there are no outside issues then the poor response could be from the kidney disease. Since I have never dealt with CKF I don't know how much that affects the treatment process. You certainly have lots of data so it does not appear that Cooper is bouncing from hitting lows.

You might want to start a new thread for today and link this thread to it. A lot of people will see an older thread and think it has been dealt with. Also putting the ? like you did with "dosing question" should get more replies.

I know how frustrating this is, since my Tuxie did almost no response to insulin in the start 6 months ago. I switched him to Levemir, same as you have done and it still took another month or so to start seeing his numbers start coming down. Although you are not at a high dose at this point, there is always a chance that he may have a high dose condition. It is still early in the treatment process to worry about that, but something to keep in mind.

I wish I could offer more help, but Cooper's numbers are very baffling.

 

[Millie and Cooper]

That is great. It sounds like you have covered all the bases at this point It there are no outside issues then the poor response could be from the kidney disease. Since I have never dealt with CKF I don't know how much that affects the treatment process. You certainly have lots of data so it does not appear that Cooper is bouncing from hitting lows.

You might want to start a new thread for today and link this thread to it. A lot of people will see an older thread and think it has been dealt with. Also putting the ? like you did with "dosing question" should get more replies.

I know how frustrating this is, since my Tuxie did almost no response to insulin in the start 6 months ago. I switched him to Levemir, same as you have done and it still took another month or so to start seeing his numbers start coming down. Although you are not at a high dose at this point, there is always a chance that he may have a high dose condition. It is still early in the treatment process to worry about that, but something to keep in mind.

I wish I could offer more help, but Cooper's numbers are very baffling.

Thanks Mary Ann! Yes, his baffling numbers visit me in my dreams. I am losing my mind. I know I'm only two months into this, so there is definitely still lots of hope for things to improve. I'll go ahead and start a new thread.

 

[Sienne and Gabby (GA)]

I think Marje made some very good points.

To respond to your question regarding how much to increase by, based on the Tight Regulation Protocol, Cooper falls in a gray zone. He's not on a "large" dose of insulin, so based on that, you'd increase by 0.25u. However, his numbers are high which would allow you to increase by 0.5u.

The way I'm thinking about Cooper's situation at the moment is if you are going to fast-track the dose (i.e., increase every 2 days/4 cycles), you might want to increase by 0.25. If you stick with increasing every 3 days/6 cycles, you could increase by 0.5u. The TR Protocol is, by its very nature, aggressive, Until I know more about Cooper, I wouldn't want to suggest an approach that could turn out to be overly aggressive.

Let's see what others have to say, as well.

 

[Millie and Cooper]

I started a new thread for today: http://www.felinediabetes.com/FDMB/threads/do-we-need-to-fast-track-cooper.138540/

 

[Millie and Cooper]

It's nice to know there are more of us Atlanta folks on here - good forum friends to lean on in case of an emergency. If you guys ever need anything, let me know! I am by no means an expert but have learned to BG test at home and do curves. I was lucky though and my kitty went OTJ after only 3 shots of ProZinc. Speaking of which, I have a basically full bottle of ProZinc that was opened in early February - I think they are good for 6 months? If you end up getting switched to ProZinc, let me know and you can probably have my bottle. I've been holding on to it *in case* she slips backwards on me.

I don't want to put a bad omen out there but if you ever have an emergency with Cooper, Dr. Kelly O'Neil is at St. Francis Vet Specialists (the 24 hour emergency place). I've ended up there before and she actually has diabetic kitties of her own and really knows her stuff!

Katie, thanks for mentioning St. Francis! We've been there many times actually. Cooper was treated there for his IBD in 2013-2014 by Dr. Belz & Dr. Smallwood and then one of our other cats, Petey, was treated by Dr. McGown for his adrenal gland tumor earlier this year. I've never met Dr. O'Neil. I'm glad to know she has diabetic kitties of her own! That may be a good next step for us, to get a consult with her.