Glucose numbers not making sense.

My Princess started on Vetsulin and I made a few mistakes while she was on it, I left the vial in the syringe box out of the refrigerator overnight on day one when I got home from the vet (I started reading all the material and forgot), then I was shooting the extra insulin in the syringe back into the vial when drawing doses.

After researching and learning about cat diabetes, I decided to switch her to Lantus. I was fighting with my Vet over everything, Home Testing, Coming in for Curve at Vet when she had access to my home tests, Wanting full Lab Tests again, Switching to Lantus (if I switched she wanted Princess on Prozinc), after days of emails back and fourth not being able to get the prescription from my vet and having Vetsulin Insulin I felt was going bad quickly, I got my Lantus from Craigslist private party - a little old lady whose insurance sent her cold box of Lantus every month and she had (6) boxes of (5) Lantus Solostar Pens that she said she kept refrigerated, so I got a sealed box of (5) Pens with an August 31 2020 expiration on them. I felt pretty good about the purchase.

With that said I have been struggling with her Glucose Numbers, both on Vetsulin and now with Lantus.

I think I should wait a day or two before changing dosage, but I have had mixed opinions, some thing she was doing better on less of a dosage, others think I should increase it. I do plan on getting Ketone test on her after I go get some strips.

Can you look at the numbers and my notes and give me your opinions. Thanks!!!!

This link will open up to where I started Lantus on 7/6/2018, but you can scroll up to see the Vetsulin results from when she started on Insulin on 6/1/2018

https://docs.google.com/spreadsheet...SbVvTq35lGSGH4Gc/edit#gid=361360320&range=A44

Thanks, Bryan

 

Hi Bryan,
Are you following the Start Low, Go Slow protocol or the tight regulation protocol?
Both the yellow stickies are at the top of this forum page. Have a look and decide which one suits you better.
We recommend only going up in 0.25 unit increments, it is not only safer, it means you won't miss the best dose.

I would recommend you get the ketone strips and test. If there is an issue with ketones it is far easier to deal with if caught early.

You did start seeing some yellows and a couple of blues on the smaller dose. And then some yellows with the 1 unit...it is a shame you did not increase to 0.75 units....the red after the yellow on 7/12 could be a bounce as could some of the pinks following yellows earlier on.
Probably the only way you will be able to tell if you need less or more insulin is to increase to 1.25 units and see how she goes.
I would also recommend you get some more tests in after the PMPS as cats often go lower at night .....and we also need to see numbers in both cycles to be able to help you

 

Thanks, I started at .5u (so I thought I was starting low) then went to 1u that was suggested to me on Feline Diabetes FB forum, .75 probably would have made more sense but my numbers were so high I went with the .5 increase to 1u thinking that was what was needed.

I plan on getting Ketone Strips tomorrow and testing.

I am doing a +2 and +4 tonight.

Thanks for your input Bron !!!!!

 

I didn't mean to post the above without replying ! Stupid iPad
You did start Low which is good.
Have a look at the two protocols and see which one you want to follow.
Overall I think you are getting better numbers on the Lantus because it is a longer acting gentler insulin.
You are still very early in your FD journey and Princess is responding to the insulin, just not as much as needed yet. . It takes time to find the perfect dose and it can't be rushed. The biggest thing I learnt here on FDMB was patience.......and I tend to be an impatient person!

You are doing really well. You are home testing, feeding the correct diet, changed over to Lantus ...which is great..and you are posting on here to get help and advice......all fantastic for Princess...she is a lucky girl to have you in her corner.
Keep your SS up to date so we can see it to help you.

Princess is gorgeous!

 

Welcome to the Board!

I have a couple of thoughts.

When switching from a shorter acting insulin such as Vetsulin, you do not need to start back at a lower dose when you start Lantus. (Frankly, I'm not sure why you dropped your dose of Vetsulin from 2.0u all the way back to 0.5u.) At this point, I don't think Princess is getting enough insulin to get her numbers to budge.

Lantus and Vetsulin are very different types of insulin. You base your Lantus dose on the nadir (lowest point in the cycle) and not on the pre-shot numbers the way you dose with Vetsulin. Practically speaking, what that means in you need to get at the bare minimum, one test each cycle in addition to your pre-shot test. When you increase or reduce the dose depends on whether you are using the Tight Regulation Protocol (TR) or Start Low Go Slow (SLGS) to guide your dosing strategy.

The dosing method also dictates how long you hold the dose before increasing. Tight Regulation is a more aggressive approach -- if your cat's numbers aren't in a good range, you increase the dose every 3 days. With SLGS, you hold the dose for 5 days. Because Lantus is a depot type of insulin, changing the dose too soon does not allow the depot to stabilize/catch up with the dose change. The result is wonky numbers. (There are times when we "fast track" a dose, though.)

I have a bias. I think you will get excellent support from the Facebook group. I think there is a much greater level of experience here and we have the benefit of looking at your spreadsheet. No one will give you advice about dosing without looking at your spreadsheet which is not something that happens on FB. Most of the people in the FB group are new to feline diabetes and they are encouraged to post here if they want help with dosing -- dosing advice is not permitted on FB. So again, welcome to the group.

 

Sienne,

I started here the first 4 weeks after diagnoses, and joined the FB page just over 2 weeks ago and it was here that many thought my Princess was bouncing on too high of a dosage on Vetsulin, as well as here that suggested starting at .5u I believe (not 100% sure), in any case I had better results at lower dosages when on vetsulin so I decided on .5u on Lantus and was going to work my way up.

NOTE: on FB page I always post a link to my spreadsheet with my questions.

Both places have their advantages, Both have had 3-4 people that really seem to know what they are doing that reply. And one lady on FB has been really good to me in not only saying what to do but about explaining the why things are that way (which always helps things make sense to me) I like forums because you can search and go back to reread past advice easier, I like FB because I get more answers, answers come quicker, I receive notifications quicker between phone and being on FB alot. NOTE: I have been online since the days of 300 baud modems and BBS sites LOL

The main thing is I always like to get as much advice as possible and then make up my own mind based on those answers.

On Lantus my first change was after 4.5 days (9 shots) and this time was after 5 days (10 shots) although I did mess up one day, neither time was I even close to getting close so I felt I was OK to change doses. These 45+ days of crap test results is getting me frustrated and wanting me to find the solution, I know I should be more patient but it does not take more than 1 or 2 people to say go ahead and try changing the dose now for me to follow that advice.

I appreciate your input and advice,

Thanks Bryan

 

Hi, Bryan. I just wanted to pop in here to say that things are quite different in the world of Lantus than they are in the world of Vetsulin (or even ProZinc). There are two documented protocols, and as I am sure you have noticed, each person asks you which one you plan to follow since that impacts when you should do dose increases. For the most part, from what I have observed on this forum, they try to assist people in making decisions within the context of the protocol being followed. The protocols, especially TR, have had wonderful results. So, at least starting out following one is a good idea. Of course, every cat is different, and there may be things that arise that impact whether you can follow it to the letter or not, but it is a great place to start.

Have you selected one to follow or are you just going a different route?

 

Well I started out at .5 so I thought I started the SLGS method, yes I jumped up .5 vs. .25 on the first dosage increase - my bad, but at this point I don't think I should start over. If I did the TR method I have no idea of what her ideal weight is, but she is 14lbs = 6kg or a shot dose of 1.5 (but as I said I was already at 1u, then today decided to bump up to 1.25u before reading the latest comments, so I might as well continue the SLGS method, see how 1.25 does - and both suggest if numbers are in the 300 or nadar is over 200 to bump the doses up after 3 days (6 shots) so I am not sure what I am doing wrong short of when I went .5 unit to 1 unit, maybe I should have gone .75u. PS: Some days I just can not collect the curves as they suggest, I thought I was doing a much better job though..... and my Princess hates curve days (she starts hiding when its every 2 or 3 hours), so I try to give her a break sometimes - otherwise she seems to get really stressed.

 

I am in no way an expert on the protocols, but it sounds to me like, if you are willing to do ongoing daily monitoring and take a more aggressive approach, TR is the way to go. If, on the other hand, you are just going to do weekly curves, SLGS is better/safer. You do plenty of testing for the TR protocol. I do not think it matters that you do not know her ideal weight. I believe you could start where you are today, if you want to do TR. (It looks almost like you are trying to do a curve every day which neither requires. SLGS says to do one every week. TR says to get multiple tests per day (says an average of five).)

I believe SLGS says dose increases are done weekly, and TR says (after the first dose is held five to seven days) they are done every three to five days.

 

If you switch from one dosing method to the other (only TR is a formal protocol), you don't restart at the starting dose. Rather you just carry on with the same dose and switch the length of time between increases and the reduction points.

Note that the cycle count between increases is for consecutive cycles at a particular dose. If you reduce for one cycle or do fur shot, the cycle count starts over. You need to wait enough cycles for the depot to build. Your spreadsheet says the morning of the 12th might have been a fur shot. That means the cycle count would have restarted at one that night and you should have waited until tonight to increase, as last night was just the fifth consecutive cycle at 1 unit.

 

I did get her Ketone Levels, it was negative. a little litter got kicked into the bottom of the bathroom cup but with so much of a sample I don't think it negated the results (3" deep cup). I have to say I was pretty amazed she was so good with her aim, I cleaned the litter box (a daily thing), and then put the cup in her favorite area, and wham she filled the cup like a champion. Where her box is (enclosed on 3 sides) getting in there to hold the ketone strip would be challenging to say the least.

 

That is awesome