Hubby Seems To Think...

That Blackie will never become regulated. I know that she's been on the Lantus since July 25th, and this does take time, at least many months, to get a cat regulated. I'm beginning to feel the same way that hubby does, although I'm trying to keep the hope up that she will become regulated. Eventually. I'm seeing a pattern when I increase her dosage, the first day usually is the best one, and then she gets wonky #'s again, and then she's back in the pinks, and doesn't seem to want to let go. Am I increasing too quickly? I'm going according to the protocol, however, I'm thinking I may need to give her at least 2 more days for her body to become adjusted to the insulin increases. I don't know. I'm feeling discouraged. That's all I know.

I know this is the same thing that ya'll have heard me say before, many times, and I'm sorry if I feel like a broken record.

 

To know the road ahead, ask the man coming back.

What you are feeling is perfectly natural; it's something that everyone here has felt at least once.
You need to step back and look at the protocol and the reasoning behind it, plus you need to look to the cat and see how Blackie is doing, because it's NOT all about the numbers. It is for that reason you see people posting the WCR:

Now, what you are doing is searching for Blackie's perfect dose, in baby steps. If you go too quickly with the dose, you are most likely going to jump WAY over Blackie's perfect dose.

The protocol says when to increase, and most times after holding for 6 cycles because some kitties wait till that last 6th shot to give you a better number. Sometimes I have to wait even longer for Oliver like 8 or 10 shots before he 'decides' to give me a better number. He takes his time with everything!

Always keep the shed in mind - you have to fill that bucket before you can tell if the dose is fitting. Right now, you are at still a low dose, so just stick to the plan and watch for the improvements in Blackie. There are some kitties who are nicely regulated at higher doses, so it's that slow slow slow climb up the dosing ladder that can get you down, but ONLY if you let it!

As for never getting regulated, you need to keep in mind that Blackie did not become a diabetic overnight or in a couple months, so just like losing weight, you need to give it time.

The time will depend on the kitty and Mr. Liver and Mr. Pancreas, and not the length of time on insulin.
You are doing a great job and I am sure the Blackie feels the same way.
Don't worry; you'll get Blackie regulated and who knows, maybe even right off insulin!
If you were to look at Randi/Max and see how they were and how they are now, maybe it will help you a bit. Max got up to a high dose around 6.75u or something,
then started coming down and is now OTJ.

As a reminder of the protocol to know if you are increasing correctly:
"General" Guidelines:

--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).

--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).

--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.


Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.

--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.


Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.

--- Try to go from 0.25u to 0.1u before stopping insulin completely.


Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.

There are some circumstances such as ketones present, an unusually low preshot number, a caregiver leaving the cat with a sitter, relatively high flat curves, loss of appetite, infection, a schedule change, ability to monitor, etc. which may call for adjustments to these guidelines.

 

I think that some cats just will not become "regulated". I have been working on my bailey for 6 1/2 years and still he has wide swings in BGs. I have changed insulins with little effect. We can only do as well as our cats will (or will not) respond.

 

mocha also still has wild swings though she has only been at this for almost 1 1/2 years .. For a long time, anytime we saw a green or blue number we both said, THIS IS IT!! This is THE dose that is going to get her regulated, or OTJ .. but that wasn't the case and now we just deal with her numbers as they come. I'm not saying your kitty will never get regulated or go OTJ, but for us, with mocha it seems she will always need insulin.

 

I've been at this since March, and am definetly not working on tight regulating as carefully as you are, but I do know that looking at the big picture has been helpful. Sya is more energetic, her frantic hungries have decreased substantially and she is much less plantigrade in her walking now. If your cat is feeling better than before you have already improved things and made your cat's life better than before. I know how frustrating it can be though...I would really love for someone to say...just give her this much insulin, it will be the perfect amount and she'll feel perfect.

 

k., is sya the siamese in the picture?

 

They said at the shelter she is Tonkinese, but yes. My poor Sophie that left for the Bridge in June is the grey

 

1. hubbies are worriers....and pessimists...and if your hubby isn't as actively involved in this journey as you are then it is easier to have doubts

2. some cats are more easily 'regulated' than others, as has been pointed out. Some patience is most definitely required!

As yourselves if your cat is happier and healthier than before diagnosis...thats the most important thing. We used to always refer to the 5 Ps - peeing, pooping, purring, playing and preening. If these things are improving, then that is a very important step! Numbers don't mean everything....

 

Remember too that you HAVE seen blues & greens with her, so you know it's possible. You know that she will hypo on 8U with food that is much higher carb than what she is on now. So somewhere well under that dose, I am CONVINCED is a dose where you will see better #s with her. The fact that her #s are steady may even work to your advantage. I don't know Lantus well enough to say, but hopefully that means that once you do get to blues & greens, she will be as steady in those as she is now in the pinks. It's just a matter of dose. I don't know enough about Lantus to comment on the protocol, but as long as you are following it and posting regularly for feedback & advice, I think you are in the best position you can be to get her regulated. I know it's frustrating, but hang in there!!!

The one thing I see that might be in order would be to add a fast-acting insulin to get her in better #s until you find her Lantus dose that she likes. I don't know enough about it to advise you at all as to whether or not it is warranted in her case, or how to use it. But it exists as an option - you might ask about it in a separate thread if you are interested, or mention it in your Lantus condo. She's been in higher #s long enough, maybe something like that would help her break the cycle...? Just throwing it out as a possibility... it's not for the faint of heart and it requires a lot more testing, but for some cats from what I gather it can be a useful tool.

 

Joanna, that's nice advice about adding the fact-acting insulin, however, I'm extremely leary about doing anything that extreme, and am shying away from it. Thank you, though. I'll keep doing what I'm doing. She is a consistent kitty, though, which is probably a good thing. Last night, she was preening away like there was no tomorrow. LOL This was after her dinner. It was certainly nice to see that. She's not playing at all at the moment, but, she's peeing, pooping, purring (on occasion, and when she feels like it), and certainly preening. I think the playing part will come when the #'s are lower.

Thank you all for your words of encouragement, and advice. You have no idea how much it means to me. I know that you all have (or perhaps are still) been where I'm at. It's easier for someone who has a diabetic cat to fully understand the emotions that run behind taking care of such a kitty, than it is for someone who doesn't have a diabetic cat, or a cat for that matter.