How Many Doses Before Cat Responds (on average)

Discussion in 'Feline Health - (The Main Forum)' started by philar21, Sep 13, 2017.

  1. philar21

    philar21 New Member

    Joined:
    Sep 12, 2017
    Hi Everyone,

    My cat was newly diagnosed. Just wondering how long it should take to see ANY response to the insulin?

    We just started treatment yesterday. Giving 1 unit of Lantus every 12 hours to start. I've only given two doses so far, but there was no change from the pre-dose bg to the +6 nadir after first dose.

    Is this normal...hoping he is lower when I check him again in 6 hours. Just dosed him again (2nd dose ever). His pre-dose BG was 22 using an AlphaTrak.

    He seems to just be staying in that 22-24 range...no response yet.

    I really want to see *some* kind of response. He's lost a lot of weight and it pains me to think he is basically starving every day.

    Also, un-related. I believe my vet said *not* to dose my cat if his BG is 15 or less at the pre-check...that seems totally wrong based on everything I've read here and elsewhere. 15 is way too high (ever), am I right?

    Thanks...lots of questions.
     
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Welcome! :) There's a lot of help here for you. It seems you're testing BG at home and that's great! It's the essential tool in figuring all this out.

    Lantus is a depot insulin and part of every dose goes to filling that depot. The depot acts like a sort of time release mechanism. The size of the depot depends on the dose. You've just started giving Lantus so that depot has not yet built up and is the likely reason you're seeing no response yet. It's also possible that the dose is too low but you'll need more test data over at least a week to know.

    Kudos to your vet for wanting you to test pre shot! Your vet is saying no shot under 15 (you're not in the US, are you?) to keep your kitty very safe. That's great! I think this is a good guide for the first week or two until you have more info about your kitty's response to Lantus. So many people come here with a kitty started on too high a dose and a vet that is against home testing.

    What you do in the initial stages of insulin therapy is all geared toward cautiously and safely assessing the cat's response to a good starting dose (and 1 unit twice a day is that!) in order to see where to go next. You have those bases covered. We can help you with the "where to go next".

    This is the testing routine we recommend:

    1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
    2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
    3. do extra tests on days off to fill in the response picture
    4. if indicated by consistently high numbers, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
    5. post here for advice whenever you're confused or unsure of what to do.
    Step 4 is for later on. Many vets will recommend half unit or even whole unit increases. Our experience here is that's too much, especially at lower doses. I suggest you go introduce yourself on the Lantus forum. There are very many expert advisors over there to help you.

    You're off to a great start! :smuggrin:
     
  3. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
  4. philar21

    philar21 New Member

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    Sep 12, 2017
    Thank you so much. This is very helpful. I work from home so I can really zone in on treatment. Our vet supports at home testing and I will do a full curve at home in a few days.

    Right now I am tracking the pre-dose BG and then measuring again 6 hours later. I'm also considering buying a baby/pet scale to monitor his weight. He hates going to the vet like no cat I've ever seen. The only way I can avoid a vet visit and still monitor his weight every week is to weigh him myself.

    We've also eliminated dry food and are now just feeding friskies turkey & giblets pate (5% of calories from carbs).
     
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  5. philar21

    philar21 New Member

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    Sep 12, 2017
  6. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Dec 2, 2014
    Welcome from a fellow Canuck...Winnipeg, Manitoba [​IMG]

    The spreadsheet is a wonderful tool. Since you are using mmol/L and the AT2 meter this is the spreadsheet you would want to use.

    https://docs.google.com/spreadsheets/d/1hLCvQ-GPSqWBSD6X5afzxSzxFEGx7wTNZbIr12GPBVg/edit?usp=sharing

    You enter the numbers on the "world" tab (mmol/L) and it will automatically convert to US numbers on a separate tab so that US members "understand" the readings. Instructions for setting it up are here:

    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/


    Lantus is a slow acting insulin with a "usual" onset around +2 hours after shot and a nadir (lowest number) "usually" around +6 or +7 hours after shot. This of course can vary from kitty to kitty. This post gives an idea of what an active cycle (time between shots) might look like:

    http://www.felinediabetes.com/FDMB/...the-basics-new-to-the-group-start-here.18139/

    Example of an ACTIVE, but NOT necessarily typical Lantus cycle:
    NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.

    +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. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
    +3
    - Often lower than the PreShot number.
    +4 - Lower.
    +5 - Lower.
    +6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
    +7 - Surf (hang around the nadir number).
    +8 - Slight rise.
    +9 - Slight rise.
    +10 - Rising.
    +11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
    +12 - PreShot number.


    Lots of good reading in the stickies at the top of the Lantus/Levemir forum:

    http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

    Also since you are removing dry food from the diet ( YAH FOR YOU!! ) you should be extra vigilante about doing readings since some kitties can drop a fair bit just with going to a low carb wet food.

    There are lots of experienced people here that can help make your FD experience less stressful and give lots of advice and first hand experiences.
     
  7. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I'm in Ottawa. :) That's why I understand the mmol/L numbers. If you set up the spreadsheet we use and enter your mmol/L numbers on what's called the "World" sheet, they show up on the US sheet automatically converted.

    Re baby scale: it's a good thing to have and they aren't that expensive. Good for tracking a diabetic kitty but also one that might be a bit too "fluffy".
     
  8. philar21

    philar21 New Member

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    Sep 12, 2017
    Thanks for the help. One more question haha.

    I just tested 6 hours after this morning's dose (he is also 18 hours into no dry food diet). That was his second insulin dose and I gave him 1.25 units (it was before I read your advice and will go back to 1 only).

    Anyway, his reading was 3.2. I made sure to feed him. That testing was probably our hardest yet (normally it's quick). It seemed the blood was much harder to get and I really had to push it out and prick him a few times. Given how stressed he was I haven't attempted another re-test.

    What do you think the chances are it was a false low reading. Does that happen often maybe from my hands pushing around?

    I won't dose him tonight if he is above 15...I guess we will find out in the days to come if that was a false reading. He was showing no outward signs of being hypo. In fact he seemed like he had a bit more energy and maybe drank less water today.
     
  9. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    It's possible that was a dud test. However, that's a very low number so I'd try to test again in an hour or so. Keep a close eye on him.
     
  10. philar21

    philar21 New Member

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    Sep 12, 2017
    Did it again and got an easy, big drop of blood.

    17.6 (1 hour later) or +7 from 1.25 unit dose

    Guessing first one was contaminated by my fingers. What is the ideal nadir for a stabilized diabetic cat? 5?
     
    Last edited: Sep 13, 2017
  11. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Whew! Here's the guideline my vet gave me: BG between 5 and 9 is a very good range, up to 12 is acceptable, down to 4 is OK but on the low side and down to 3 or lower is too low. That's using an AT meter.
     
  12. vbc2000

    vbc2000 Member

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    Jul 18, 2017
    My Tigger immediately started drinking and peeing less even though it took him a few months to get him regulated. So I knew something was happening and he was also gaining weight so those clinical signs are good signals that something good is happening.
     
  13. Mandy Lai

    Mandy Lai New Member

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    Sep 12, 2017
    Hello, our Siu Bo (10 years old male, 7kg early August and 6 kg when diagnosed) was also newly diagnosed on 8 September (one week ago), blood glucose 24, he's been on Lantus since then, on the first night he was given 3 units, then the next morning his BG plunged down to 1.9 and he had to be hospitalised for the day for IV.

    Allow me to list down his reaction to Lantus as below for your reference:


    170908/20:00-BG24, Lantus 3 units

    170909/10:20-BG1.9, hospitalised for IV, 19:00 BG16.5, Lantus 1.5 units

    170910/08:00-BG22, Lantus 2 units, 15:30/BG2.6, 18:15/BG2.3, 20:00/BG3.7, 22:00/BG4.3

    170911/00:00-BG4.8, 03:00/BG7.5, 08:00/BG12.2, Lantus 1 unit, 17:00/BG9.8, 20:00/BG17.6, Lantus 1.5 units

    170912/00:15-BG11.6, 08:00/BG8.3, 12:00/BG4.9, 16:00/BG7.0, 20:00/BG16.6, Lantus 1.5 units

    170913/00:00-BG5.4, 08:00/BG3.8, 20:30/BG17.8, Lantus 1.5 units

    170914/00:58-BG10.8, 07:37/BG3.3


    He’s been in and out of the vet’s daily to treat his eating problem due to low level of potassium, but from what the vet say, he seem to be stable on 1.5 units of Lantus which could last him for around 24 hours. He just started eating again today, and the vet said the most important task is for him to eat.

    A friend (a human doctor) did advise me that using Lantus is a bit tricky since we should aim for an average instead of a stable curve.

    Our vet has given us this rule: below 10, no Lantus, 10 to 15, 1 unit, above 15, 1.5 units. Siu Bo seems to be okay with this.

    I hope your cat will start showing favourable reactions soon! Since the vet told me that Lantus is the only insulin that has a chance to cure.
     
  14. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    If you could repost all this in your own thread it'll get attention. Right now it's buried in another person's thread. :)
     
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  15. philar21

    philar21 New Member

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    Sep 12, 2017
    I've already noticed that my cat is now drinking less. I assume this is good. Things seem to be getting on the right track slowly but surely.

    Will do a full curve in a few days after 1 full week of 1 unit doses twice daily.

    Thanks everyone. In a weird way this has made me closer to my cat. There is a sort of bonding ritual through this process and all the pokes.

    My cat lost 25% of his weight but he still could lose more. In the interim I just want his weight to stabilize so I know he is getting nutrition. In a few months we can start working on a diet and get him to a healthy weight.
     
    vbc2000 likes this.
  16. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    We all find this is true. My guy is an attention hound by nature so he LOVES all the extra TLC! :)
     
  17. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    I just bought one of the cheapy digital scales that they sale at Walmart. Weight myself then weight with holding Zeke. Take the difference to get his weight. :)
     
  18. philar21

    philar21 New Member

    Joined:
    Sep 12, 2017
    Hey Everyone,

    I am wondering if it's time to increase the dose. I have been giving him 1 unit of Lantus 100 for a week, twice a day on a low carb diet.

    I did a curve today. This was the result.

    2017-09-18 9:30am, 23.7 (420)
    +3 18.3 (330)
    +6 21.7 (390)
    +10 23 (414)

    I am thinking about increasing to 2 units. He has not shown any signs of being anywhere close to hypo today or in any of my other sporadic bg measurements.

    He definitely seems to be drinking less since we started treatment and eating quite a bit.
     
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  19. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    Which protocol are you following? Also it would he greatly helpful if you create your signature with info on ur kitty and include a link to your stylesheet. Without seeing your data, noone can safely advise you on dosing. One thing that I can say on your question though, it is NEVER safe to increase by whole units.
     
    W.K. likes this.
  20. W.K.

    W.K. Member

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    Feb 16, 2017
    I'm not familiar with lantus, but it's a depot insulin. So one cycle can easily affect the next. I'd hold off on that increase till you get a few more eyes on this. Maybe post under the lantus/lev forum. It has alot of traffic so you might get some better advice there rather than here, as there are MANY experienced users there. However, without data available for them to see most might be hesitant on giving dose advice.
     
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  21. philar21

    philar21 New Member

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    Sep 12, 2017
    Thanks. I have created a spreadsheet in my signature. Will likely increase to 1.5 units tonight and monitor. I did that dose once before (earlier than I should have) and he was fine with it. I would like to try 1.5 units for the next week and see.

    Meeting with the vet on Wednesday to discuss. I think it will be fine. This cat requires more than 1 unit, I feel pretty certain of that.
     
  22. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
    Be sure to read over the protocol stickies on the Lantus/Levemir board. It will help you a lot on knowing when to adjust dosing etc. Check out my signature for more things for adding to yours. I also list which protocol I am following.
     
  23. Meridith and Zeke

    Meridith and Zeke Well-Known Member

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    May 22, 2017
  24. W.K.

    W.K. Member

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    Feb 16, 2017
    Some do. As long as you feel confidant with that and can grab a test before bed, then go with it. But the Lev/Lantus board and the stickies at the top of it will be a huge help for you and you're extra sweet kitty :)
     
  25. Meridith and Zeke

    Meridith and Zeke Well-Known Member

    Joined:
    May 22, 2017
    Something you should know, too much insulin can also look like not enough insulin. So you can get high numbers with too much insulin. That is why we normally adjust dosing in baby steps of .25 units. When you will find most dosing falls between 1.5u and 3.5u for the largest part of the kitties, trying to go up too quickly can cause you to miss that perfect dose.

    I noticed on your ss that you went ahead and gave 1.75u tonight. Be sure to get a +2 at least tonight. You never know what a dose will do to a kitty which is why most of us do our dose changes in the am so we are more easily able to monitor. You can look at my ss and see that our last dose change lasted 1 cycle, we went right back down. That one dose increase caused him to drop to low numbers and I had to work for awhile to keep him from dropping into a hypo. It was only an increase of .25u.
     
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  26. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    Hello from BC.

    Great job getting the spreadsheet started. We are quite data focussed here. Try getting some night time tests in too. Many cats go lower at night. A test just before bed is a good one to get.

    One more thing: to answer the question in your subject line, a saying you will hear a lot here is ECID, each cat is different. Some cats have other things going on that impact how long it takes to get regulated. It really is all over the place.
     
  27. philar21

    philar21 New Member

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    Sep 12, 2017
    Thanks. Will do that tonight. This morning was the first time I saw him get in the 10 range ever. I waited an hour and gave him half the usual dose I would give when he measured 12.5 an hour later. It seems the sweet spot for him may be around 1.5-1.75 units twice daily but I will need a few more days data at least.

    One thing I have noticed is he has definitely stopped drinking so much water. Like way less. But at the same time it seems he is now eating way more than my other cats. He is always devouring the food I provide. I have 3 cats that I am now all feeding a high protein/low carb diet to. Only 1 of the 3 is diabetic but the diabetic one is definitely eating more.

    I am wondering if this is a good sign (i.e. he lost a ton of weight and is now eating as much as he can to replenish nutrients OR if this is just another symptom of his bg being too high to actually process food properly).

    Basically, is increased appetite and less water drinking generally a good sign, a bad sign, or not something to read into?

    Thanks.
     
  28. Chris & China

    Chris & China Well-Known Member

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    May 10, 2013
    Sorry nobody has gotten back to you sooner! If that happens again, make a comment on your post to bring it back up to the top of the wall.

    One of the first things I noticed about China was that she stopped drinking insane amounts of water....and how much less litter we were going through!!

    That's a good sign!!

    One thing I do see on your spreadsheet.....You need to give the same amount of Lantus at both AM and PM....Lantus craves consistency. Unless you get a Pre-shot less than about 180 (on the Alpha Trak), I'd give the same 1.75 dose

    It's also very important to get some tests on the PM cycle....Most cats go lower at night so it's important to know what's going on then too! You don't have to stay up all night testing, just make sure to grab a "before bed" test at night .....if you see she's dropping too quickly or too low, you may have to set an alarm to get more tests later

    If you do get a Pre-Shot under about 180, we'd suggest you stall, don't feed and post for help. Test again in about 20-30 minutes to see if the number is coming up on it's own without the influence of food. The first few times you shoot a lower number, we like to have someone with experience watching out for you and able to stay online with you as long as necessary to keep Spink safe (and you sane!)
     
  29. vbc2000

    vbc2000 Member

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    Jul 18, 2017
    Decreased drinking is definitely good. The increased hunger may be an indication he needs more stabilization. Is he gaining weight? If so, that's a very good sign. When my Tigger was undiagnosed, he was ravenous but losing weight. When he started getting the benefits of Vetsulin, he started gaining weight and eventually his appetite has stabilized. Just a little ways to go, but good stuff! Good job. It took us a few months to stabilize so keep that in mind.
    Stephanie
     
  30. philar21

    philar21 New Member

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    Sep 12, 2017
    Hey everyone,

    Would you mind looking at my chart. I have noticed that his bg levels are steadily decreasing. I have basically reduced the dose now back to 1 unit. 1.5 units seems like it would risk pushing him hypo at this point.

    I wonder if he could be possibly be on track for remission.
     
  31. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Good move. Get data at 1.0 u for a couple of days. It's possible that you might need to go to 1.25 u but the numbers will tell you. Mid cycle or evening numbers are key with Lantus because dose is decided on the nadir BG, not the pre shot BG.
     
  32. philar21

    philar21 New Member

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    Sep 12, 2017
    Hi Everyone,

    What do you think of the latest numbers? I've stopped giving him insulin for now.

    Is there any chance I could have gotten a bad batch of strips? I tested myself and I am in the normal range for a human so probably not. I am using the official AlphaTrak strips.

    Cat seems in great health. Eating/drinking normally. I am thinking about getting a control solution to confirm my meter is broadly accurate.

    Thanks
     

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