Atticus update and questions

As some of you may remember, Atticus is 10 years old, diagnosed 12/28/11. Started 1u Lantus 2x daily on 12/31/11. He's been eating wet food exclusively for about two weeks now; we started gradually switching immediately upon his diagnosis.
As you can see from his spreadsheet, one unit twice a day doesn't seem to be enough. I emailed his SS to the vet today (who has been very supportive of hometesting) and she says to increase his dose by one unit, so 2 units twice a day. She says she never increases by half, always a whole unit.

I'm going to give him his regular 1u dose tonight and start with the 2 units in the morning so I can watch him during the day tomorrow. With as high as his numbers have been, I don't think I have too much to worry about with the increase, but I still plan to test throughout the weekend and next week.

Thoughts?

Also, he has a couple little bruises on his ears where I think I got too close to the vein. I've put Neosporin on them. Do I need to worry about this? I don't want to hurt him when I test again.

 

Bumping for more eyes (hope that's ok).

Nervous to be raising the dose today.

 

Yikes... If he were my cat I wouldn't increase the dose by a whole unit, especially not considering you don't have a lot of spreadsheet data collected yet. I know ECID, but it takes many weeks for new cats on insulin to settle, and by increasing by whole units, you might miss his "sweet spot" for the dose and have to deal with constant rebounds and bounces.

For an example, If you look at my SS, you can see Scooter was still pretty high on his 1.25u dose, but then suddenly out of the blue one night he hit 56 - that is why I would personally be hesitant to increase the dose so much so fast, and so soon. His body is still adjusting to the insulin.

I am sure more people will chime in soon.

 

Doubling his dose seems a bit extreme, but is a common direction from vets (I went through the same thing and have seen others post the same). I'd test throughout the day to be sure he doesn't drop too low (better safe than not :smile: ).

As you test today, you might want to post the results as I'm sure there will be folks watching.

 

The vet's been so good so far- I've been really relieved. She encourages hometesting, suggested I switch to wet food (and didn't push the prescription food), lets me text her all weekend. She's young, and seems much more up-to-speed with FD than many that I've heard about. So far we've both been on the same page. I feel lucky to have her and would feel really apprehensive about breaking away from her advice at this point. But I'm so scared to do anything wrong.
I plan to be home all day so I can watch him and test. I've got honey and dry food at the ready. I'll be updating his SS.
Thanks for checking on us!

 

That is so cool, about your vet being so supportive. And I can understand the desire to not go against her advice. I lost sleep many nights going against my old vet's advice...but in the end I'm glad I did. If I had doubled Poopy's dose as directed, I would have had a very sick kitty on my hands. (He has yet to reach that doubled dose amount.)

ECID (each cat is different) though. It is possible 2u may be what Atticus needs. Watching and testing him today to be sure is fantastic! If 2u is too much, there's plenty of folks here to help you keep Atticus safe. :smile:

 

It's wonderful that your vet has been supportive. I would suggest you share this journal article with her:

This is the article that describes the research with Lantus that supports the Tight Regulation protocol. The goal of this dosing protocol is to get a cat into normal BG numbers as quickly and safely as possible. What you'll notice, is that if a cat's nadir is under 300, the dose is increased by 0.25u and if it's over 300, the increase is 0.5u. What leaps out to me on Atticus' SS is that the 1.0u dose brought his numbers down to 63. Much of the higher numbers that you've seen are likely due to "bounces" off of lower numbers. It's quite possible that Atticus is doing better than you thought.

With Lantus, getting pre-shot tests is important for making sure it's safe to give a shot. The spot checks that you get during both the AM and PM cycles are what you look at with regard to adjusting dose.

I would strongly encourage you to monitor closely today. You have doubled Atticus' dose and do not yet have a great deal of data to know how he'll respond to even a small dose increase. Keeping him safe is paramount and getting tests is critical. I'd suggest getting a test at +2.

 

I see from Atticus' SS that you went ahead w/the full 1u dose crease, so please test often today. It's so great that you have a vet that is on the same page with you and so willing to have you hometest. I can't even begin to tell you how many vets & vet techs have told me "you shouldn't even be doing this."

I totally agree w/Sienne. When I looked at Atticus SS that 63 on the 1.0u dose leapt right out at me too. She is right, much of what you are seeing could be a bounce. & like Sienne also says, with Lantus, it is important to get the pre-shot #s to make sure it's safe to shoot but it is the nadir, or mid-cycle #s that you base any dose adjustments on.

I try to follow the TR protocol w/my 2 diabetic kitties, if you haven't read the sticky yet you might want to take a look at it if you decide to treat Atticus that way. When we raise or lower a dose (they are both on Lantus) we usually adjust by either .25u or .5u and hold the dose for no less than 6 cycles (3 days), unless of course s/thg weird happens like a super-low (under 40) BG #, then we reevaluate. But again it's important to remember that dose adjustments are based on mid-cycle #s and not pre-shot numbers.

I would make one suggestion and that is that you add a few cans of HC w/gravy food to your "HC kit". Sometimes if it's needed it is easier to get a kitty to lick the gravy off the HC instead of getting kitty to eat s/thg like dry food. Also I believe it takes longer for the dry to bring the #s up (s/one please correct me or clarify this if I'm wrong). Also if you have to keep feeding to bring a low # up, you don't want Atticus to get too full, the HC gravy will bring his #s up and allow him to keep eating if need be.

I love your kitty's name: "Atticus". Assuming he was named after a famous (or is that infamous?) attorney, that book is one of my all time favorites! What a great name for a cat!

 

My guy has pretty hairless pink ears and I see every little nick and bruise I cause. I've hit the vein many times. All bruises I've caused heal in a few days and I've caused less bruises as I've got more practice, just move around the ear as best you can. A few ear bruises are a small price to pay at this point for the peace of mind and valuable data you can collect.

You vet sounds great, but always remember it's your cat. If you aren't comfortable with something she suggests, tell her why. A good vet should be concerned about both the health of the pet and the effect the treatment has on the owners sanity/stress.

Do you have syringes with 1/2 unit markings on them? Some brands of u100, 1/3cc syringes do, you might want to look into it. Some vets might not even know these exist and might staw away from even 1/2 unit changes as a result. If you want 'ammo' to give your vet to justify smaller changes in the dose that she might take more seriously than what you read on an internet message board, you can check out this paper (full pdf is available at link**): http://jfm.sagepub.com/content/11/8/668.abstract . It's a protocol that calls for changes by 0.25u at the low dose you are at.

Good luck with the increase in any case.

**EDIT-I see Sienne posted this article as I was typing. I type slow.

 

Just tested at +2 and he's at 271.

I do have half unit markings on my syringes. I could do 1.5, I suppose; I just worry about going against the vet's advice. I could call her today and discuss it further, but I'm leery of using up too much of her time outside of office visits. I don't want to wear out my welcome. If I do decide to do 1.5 instead, will that mess him up since he got 2 units this morning? I went ahead and did what the vet recommended since I hadn't gotten replies at dosing time.

I gave her a copy of the Queensland paper a couple weeks ago; we haven't discussed it yet.

Yes, DD, he's named after Atticus Finch! I was in law school when I got him and his sister, so I gave them law names. She's Miranda, like the rights.

I'll post again when I test at +4.

 

I kinda look at the dose issue this way. You'll give Atticus 2.0u -- just in smaller steps. I tend to think that if you were to tell your vet you are very apprehensive about increasing the dose that much, she would understand. If part of your concern is that you don't want to burn out your relationship with your vet and if Atticus were to drop into low numbers and your vet wasn't available, it would be terrifying. (Usually vets are pretty empathic if you are telling them you want to respect their time and availability and that something they are suggesting is outside of your comfort zone.) The first time Gabby dropped into low numbers, was after office hours and my vet doesn't check her office e-mail after hours. I was able to reach one of the vet techs who was my catsitter, though. I didn't have enough experience with FDMB at that time to know that when you yell, "Help," the response is almost instantaneous.

FWIW, I really like my vet. However, she recognizes that I have a solid grasp on managing my cat's diabetes. She's actually aware that I know more about the Tight Regulation Protocol than she does (I gave her the articles.) and that regardless of the health issue or medications that she suggests, I do my homework and read about the drugs, treatments, etc. We work as partners. The one advantage you have over the vet is that you are with your cat, you know what is normal behavior for your cat, and you are the best observer possible and can communicate what you're seeing with your vet. Your vet may be excellent but she doesn't have the advantage of spending hours and hours each day with your cat. You can work together.

 

We understand about not wanting to go against your vet's advice. However, you have to understand that the people of this forum are the ones who have lived beside and treated their own diabetic kitties and helped others with theirs, saved lives and helped kitties get regulated and OTJ, 24/7/365. They have studied and practiced multiple dosing protocols with multiple insulins on thousands of cats. They know the song and dance, inside out.

If we lived in an ideal world, we could trust whatever our vets say and not have to worry about our pets safety. But that's just not how it works, unfortunately. Spend a few days on this forum, or any pet forum for that matter, and you will see lots of vets giving out scary advice, like starting cats on really dangerous high amounts of insulin. Feline Diabetes is a pretty specific disease and not a lot of vets have done more than minimal research/study on it. Some read about it, some go to short seminars about FD, and that's usually about it. And even then, a lot of those are based on old protocols for human insulins like Humulin N that are dosed in a completely different manner than Lantus.

I'm not saying your vet is bad, or your vet is wrong... but this is not about your vet, this is about your cat, and you should *never* do anything that makes you uncomfortable or might put your cat at risk. Talk to your vet. You need to have an agreement with them. You need to work together, or things will not be pretty. They should understand, and work with you to find a middle ground that you are both comfortable with.

You essentially doubled the insulin your cat is getting without at least waiting for a second opinion, and without having a lot of solid data to back up the increase with. That is dangerous, and 1 of 2 things tend to happen in this situation - your cat will hypo, or your cat will drop low, and then rebound with sky high numbers - and your vet will see those high numbers and say "must be time for another dose increase"... and it will go on and on... you will never see your cat regulate. Increasing the dose isn't really the problem, increasing by large amounts without giving enough time to settle is. Like Sienne said, you may have reached a 2u dose in the end anyway - but taking it on slowly gives your cat the best shot at recovering and the least risk of going hypoglycemic.

He is probably safe for today, but you never know when their body will stop rebounding and they hit those scary low numbers. It takes time... and patience.

In my case, Scooter had been pretty much consistently between 200-300 with the occasional dips into blues. We increased his dose after a long settle period by .25 units... he still appeared to be high... and then all of a sudden he hit 56 one night! And then he rebounded really high after that... and dropped back down a few days later... If I had continued increasing his dose every time those high numbers came back he probably, if not surely, would have hypoed. He almost actually earned a dose DECREASE when he hit that 56. It's a fine line we have to walk on.

 

174 at +4.

 

I have to agree with Sienne, those numbers look like a "bounce" from the liver hormones. Generally it will take a new diabetic cat up to 72 hours to clear those hormones.

You may be in for a long afternoon and evening. Keep testing and keep us updated.

If you start falling below 100 Post for some help as we'll be working against the insulin. If you have not reviewed the sticky at the top of the forum about handling hypos...might be a good time to do so now.

 

good morning! you've gotten some really great advice. i know we've talked before, and all i can add is that we have the collective experience and wisdom of literally thousands of diabetic cats. most vets treat very few - my previous vet's office of 3 vets had 2 diabetic cats, mine and one other. i wouldn't hold it against your vet at all. if she's young it might be that she has learned about it in school, but perhaps doesn't have too much experience yet. that's how we all learn.

what helped me was to see first-hand that cats respond to a change in dose of .25units. it's amazing. some cats respond to dose changes of just one drop. it's all about Atticus, in this case, and how he will respond.

there is a "thing" that happens when a dose gets increased in many cats - they respond with higher numbers for a couple of days, then the new increased dose settles in and you can see what it really does. we call it "New Dose Wonkiness" because that says it all! :lol: i'm having that with punkin right now. increased his dose last night and his numbers went higher, but in the next day or so they will settle down and be lower than they were before.

personally, if i were you, i'd drop the dose back to just a tiny bit over 1 unit tonight - see if you can eyeball 1.25units. some people use a magnifying glass. it doesn't matter if your 1.25 matches someone else's, it just matters that you can do it again. you can use an old syringe with colored water to save as a model to copy again with your future doses, too. anyway, i'd drop it to 1.25 and then hold it for several days. keep posting so we can help you interpret what's going on and give you advice.

the reason i'm suggesting that is that sweet little 63 that's sitting on atticus' spreadsheet. if he got to 63 on 1 unit before, he will get there again. doubling his dose after 1unit got him to that point is a little scary to me.

what most people do is get their dosing advice here and just tell their vets that they aren't comfortable making big changes at once and are going to just do a tiny change for the moment and see what happens. you're home-testing and you'll be able to keep atticus safe. Lantus is complex enough that i don't know how any vet would know about the NDW and the bouncing without having followed the protocol themselves. it simply takes a while to learn.

if you want to follow the Rand/Roomp protocol, you can post on the Lantus TR support forum and we'll be glad to teach you how to "read" the numbers so you know what to do to help atticus the most. somewhere around 50 people a day post - so there's almost always someone on who has a lot of experience with lantus and the protocol and who would give you a hand. just an invitation.

 

107 at +6.

Spoke to the vet. She says she understands, and wants me to be comfortable. We're going to go down to 1.5 (I'll probably make it on the skinny side) and hold it there for a week. She says to keep testing and recording and we'll go from there.

I'll post again when I test at +8. Thanks for all the help; I feel better about it all now.

 

Maybe I'll go ahead and do as close as I an get to 1.25 and just show the vet the numbers in a week. It's easier to get forgiveness than permission, right?

 

heehee you're cute! i've followed that idea many times!

he's your cat. you don't need permission or forgiveness for doing what you think is best. here's the deal - if it's not enough, you can always increase in a few days when you see what the new dose really does. if it is enough - then BINGO - you've hit a good dose!

here ya go - a little giggle for you! i love this cat!

 

Atticus is at 115 at +8 (really +8.5).

Julie, I love that pic! I need that as a poster on my wall. Atticus is also black and white! Working on finding a good pic for an avatar.

 

Hey there, I'm new too. . .
My cat's spreadsheet was looking very similar to yours in the first 10 days. However, even with holding the 1 unit dose, he was trending downward over time. I had to reduce his dose this week because I went out of town and his caregiver couldn't test him. I am intrigued to see what happens when I get back, because I have kind of wondered if he may need a slight decrease because he keeps bouncing so much (very steep and fast drops). Not that your kitty needs a decrease, but I think the .25 increase would be good. Then hold it for quite awhile and watch what happens! I would go ahead and post over in the Lantus group--as you are learning the protocol, the people can really help you!

 

He's at 135 at pm pre-shot now. Should I wait a bit to shoot or go ahead with the 1.25?

 

Have you already shot? I'm sorry no one's here to answer your question. I've PM'd Julie and called another experienced person to see if I can get some eyes over here for you. If it were my cat, I would skip the shot since it's below 150. We tend to discourage shooting below 150 unless you have a lot of data. Let me know if there's anything I can help you with.

 

Here are the options in the FAQ for lower than normal preshots:

Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?

Keeping in mind that you increased Atticus's dose today, and that Lantus has a cumulative effect so we don't usually see the full effect from a dose increase for a few cycles, I would probably skip tonight's shot to let his shed drain a little, then resume at the lower dose in the morning.

 

just checking in to see what you decided to do tonight . . . let us know.

 

I fed, waited about an hour and a half, then shot 1 unit. He's acting fine. I'm going to test in a little over an hour, which will be at +3. He's gotten pretty fussy with me the last couple of pokes. He's just had a small snack of FF Turkey and Garden Greens.

 

i think i'll check back in with you then. can you tell me what time you'll be testing again and i'll make it a point to check back with you? if you need help it's a lot easier if someone is there to talk with. i'm on the west coast and typically stay up late.

do you have karo syrup, honey, pancake syrup on hand? something like that?

so texas - what time zone and what time?

and forgive me if you've already said and i've missed it - but what's your name?

 

Thank you; I really appreciate it.

It'll be 11 pm CST; in about an hour.
I've got honey, syrup, and dry food.

I'm Monica. Nice to "meet" you!

 

hi monica! nice to meet you too! this is the best place you never wanted to be - that's our slogan!

you won't want the dry food - it takes too long to get into their system and then it stays too long.

might be a non-event, but it's always better to be prepared than surprised!

so tell me - when atticus was diagnosed, was he eating dry food? and now you've switched him to canned low-carb, is that right? some cats will drop 100 points or more in that switch.

i'll make sure and check in 41 minutes. just get your BG test and post it here. there are many others who could help you too - we just want to make sure that you're not alone.

 

He's at 307. Hmm.

Thoughts? Think I can test in another 7 hours (+10)?

And yes, they were both eating Nutro MaxCat before his diagnosis. We started gradually switching immediately. He's been wet-only for two weeks.

 

that's fine. you're seeing a bounce from those lower numbers earlier today. it's his liver keeping him safe. here's some info that explains how that works. if i were you, i'd head for bed and get a good night's sleep knowing he's safe.

so in the morning, monica, follow the guidelines that libby posted above. if he's under 150 don't shoot. it would be really great if you could check him at +11 and again at shot time (amps) - the reason i say that is that we don't want to shoot a dropping number. once you know your cat better this gets easier, but if it's possible for you to get a +11 and an hour later get the preshot number that would be awesome. if the preshot number at +12 is lower than the +11, also don't shoot. post and ask for guidance. if you want help along the way, just post and ask. if you don't get an answer here, there's a ton of traffic in the Lantus TR forum and anyone can help you with Lantus questions fairly immediately.

i won't be up in 9 hours, but others can help you just as well.

good job today! sleep tight!

 

btw, monica, i'm really glad you dropped back to 1unit tonight. that was an excellent call. when i see atticus' 63 a few days ago on one unit, followed by those high numbers after that - i would guess that was a bounce. he will get back into that 60ish range again.

thanks for the info on the food. the change in food after diagnosis is going to change the picture and his insulin needs will likely change, ie, he may need less insulin.

 

Yep, that's confusing. I've read the whole post and I'm gonna ponder that for some time. Thanks for the long explanation Julie.
Hope you're sleeping already Monica. Atticus: be good.

 

when you can see the numbers on a spreadsheet it becomes really clear. for me, at least, i need to see it laid out.

i should add - that what we expect with lantus, once a cat is starting to get stable on it, is to see the highest numbers around the shot time. in between the shots, we expect to see a curve down to lower numbers somewhere in the middle.

so if we see a set of numbers that go straight up, none of that downward curve that we're expecting, then we scratch our heads and start looking for why. that's why i said in that quote above that if you then look backwards and see a lower number than usual, we might suspect a bounce.

 

Thanks so much, everyone!

I've been a little keyed up, but I'm off to bed now.

I'll update in the morning. Whew!

 

Please remember that your AM shot time is 12 hours from the time you actually shot tonight. With Lantus, you can move a shot 15 min. at each shot time or 30 min. once a day.

 

Just for information purposes, the FF turkey and garden greens you fed isn't a low carb food. I believe it's one of the Elegent Medley's varieties. It's actually a mid carb food, somewhere in the 9-11% range. Some cats are very carb sensitive and even a mid carb food can spike them up pretty high (Champ is one of those). I would keep those flavors for when you need to raise Casey's BG whenever he gets too low.

 

He's 388 at +11. Going to try for another test in an hour, but I doubt he'll drop.

 

It should be normal to go up as the insulin is wearing off. :smile: And the numbers very well could still be showing the bounce. :smile:

Our kitties do keep us on ours toes, don't they? ;-)

 

OK, so he's 331 at AMPS. What to do?

He's ready for breakfast, poor guy. He hasn't eaten in 10 hours. Feed and shoot the 1.25?

 

I've asked the folks from Lantus to come help you since Attucus' +11 was higher than his AMPS. :smile:

 

OK. I went ahead and fed him a bit. I don't want to push his shot back too much later.

 

I'm hoping someone from Lantus will be here soon. :smile:

For what it's worth, the way I'm reading the posts, it was being suggested to shoot only 1u. I don't work with or follow Lantus so I can't say what I think is best - because I don't know. :sad:

Sorry I can't be more help. :cry:

 

Thanks, Teresa. I went ahead and posted in TR. I'm starting to think I should skip this morning's dose and give either 1 or 1.25 tonight.

 

I posted on Lantus, asking for some eyes to come help but it seems to be really quiet this morning. :sad:

 

I think since is AMPS is still high, it's not going to be too dangerous to shoot. I didn't want to get his schedule too off since I have to work tomorrow, so I went ahead and dosed 1 unit. Going to try to test at +2 or +3.

 

I'd skip the +2 unless it's been 3 hours since Atticu ate, otherwise it will reflect the food spike. :sad:

And I think that's a good call on the dose. I'd much rather shot too little than too much.

 

would you consider .50...
did you get a nadiar test?? I believe that lantus is shot on nadiar numbers... I am a PZI user... small amount is better than too much..
will you be home to test?
I would grab a +2 or 3 for sure and leave some foods - low carb out in case he gets hungry - could if he drops low...

 

you were fine to shoot. i'm very glad you didn't skip - lantus needs consistency for you to see good results. according to the guidelines that libby posted for you last night, if you had over 200 you were good to go ahead.

your new shot time tonight is 12 hours from whatever time you shot this morning.

the reason for getting the +2 is that it tells us what direction the cycle is going and gives you a guideline for when the next tests should be. with lantus, the +2 is generally about the same number as the preshot.

if you get a +2 and it's significantly lower than the preshot number then it tells you that you need to pay extra attention to testing in the near future.

if the +2 is significantly higher, then you probably can relax a little bit and just try to catch a +5 or so to find the lowest point (nadir.)

if the +2 is about the same number as the preshot, you're likely going to see a "normal" gentle curve to the lantus.

what you're doing at this point is gathering information to find out how atticus' body responds to the lantus, and just making sure to keep him safe.

good job going ahead with the shot! would you get a +2 and repost the # please?

 

LOL! This is why I hate posting what I think when other insulins are used. :smile:

I'm glad you have better information from those more experienced.

Looks like a +2 reading is just what you need then. :smile:

 

OK, so it's more like a +2.75 (took three tries) but he's at 118. *sigh*
He's having a snack now, I'll test again in another 2-3 hours.
He was really hoping we could ease up on the testing today, but oh well.

 

actually, I would test again in 1 hour. Sorry, Atticus! That's a big drop from AMPS, and in most cats Lantus doesn't even start to kick in until about +3.

 

He's 116 now at +4. Everybody think "hold steady" for my boy!

 

Wow...look at Atticus go today!

Well, the testing will slow down once you get a better idea of what his cycles are doing. I know this is pretty nailbite_smile right now, but it does get better.

Now with a drop like that in a short window and new to insulin ...he is going to bounce again.

The 'bouncing' wil subside overtime and fine tuned adjustments or his body will set-up a bit of resistance. Both of which can be dealt with successfully.

My Atlas (Attie) did the resistance thing before his body go acclimated to lantus. We're back to a resistance thing now because he got very sick in Dec. and it threw everything wonky. But ...this time I know what to watch for and how to handle him now that he is back in Liver Training School.

 

hi monica! and i see now you've got 116 at +4! that's a really great response to the 1.1 u dose. i'm glad you retested at +4. can you get another test at +5 and +6? don't want to overwhelm you, but you can see how atticus is responding.

 

I would suggest you test again much sooner rather than later. If he's clearing a bounce, he may continue to drop at this rate.

 

113 at +6.

 

Perfect. Looks like he is slowing himself down. Now let's see if he'll surf or bring himself back up.

This is an opportunity for you to collect some data; It's up to you but I might suggest a test in an hour, if he is easy to test. Although nadirs can change and are not always the same, it's just a bit of data that will help you see his overall patterns.

 

Beautiful surfing in the blues for your boy today!

 

Atticus is at 257 at +9. I think that's not too bad considering what's been going on.

 

not bad at all! atticus had a super afternoon!