Sticky LANTUS & LEVEMIR - THE BASICS: NEW TO THE GROUP? START HERE!

Discussion in 'Lantus (Glargine) / Levemir (Detemir)' started by Jill & Alex (GA), Jun 25, 2010.

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  1. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    If you're new to the FDMB, please start on FELINE HEALTH: The Main Forum where you'll learn all about hometesting, the basics of feline nutrition, and feline diabetes.


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    *** IMPORTANT DOCUMENTS ***
    Print these out and keep them handy:
    SYMPTOMS OF & HOW TO TREAT HYPOGLYCEMIA - what to do if your kitty experiences a hypoglycemic event
    Jojo's HYPO TOOLBOX - what to have on hand in case of an emergency


    Welcome!
    We've put together information we think will be helpful. Most Stickys and Info posts have links (clickable, in blue font) to provide answers to many of your questions. Although, one of the first things you'll probably want to do is check out the Lantus & Levemir - Syringe & Insulin Info: Handling, Drawing, & Fine doses sticky to learn how to properly care for your insulin so it'll last as long as possible.

    Confused about our jargon?
    Don't let it scare you off! You'll catch on in no time.
    Until then, here's some help:

    • FDMB Glossary - common abbreviations & definitions used throughout the Feline Diabetes Message Board
    Daily Threads & Posting Instructions for this forum
    • Please use one thread for all your comments and questions you have that day since this forum is so busy. This will keep all pertaining to your cat together everyday.
    • Start your thread with the date, kitty's name, and AMPS
    • Your thread will be bumped to the top of the list when you or anyone else posts on your thread.
    • Making the Most of Your Lantus & Levemir ISG Experience

    FDMB SPREADSHEET INSTRUCTIONS

    • Please set up a Google Spreadsheet as soon as possible. Always keep spreadsheets up-to-date! Valuable time may be lost looking for information when a spreadsheet is not up to the minute.
    • If you have not been able to transition your kitty off of DRY food yet, please note it on your spreadsheet and in your signature. A dry food diet will often require higher doses of insulin to bring numbers down. Having this information plainly visible will help us help you.
    UNDERSTANDING THE SPREADSHEET/GRID

    CREATING A FDMB PROFILE

    Blood Glucose Converter Calculator (1 mmol/L = 18 mg/dL)

    FDMB FAQs - Filled with the general basics you need to know (out-dated, but some info rarely changes). Answers to questions often asked can be found in the FAQs.

    Feeding Your Cat: Know the Basics of Feline Nutrition - everything you need to know about proper nutrition and lots more from Lisa A. Pierson, DVM.

    WSAVA Body Condition Score Chart

    Links to Food Charts and Discussions - The following food lists can become outdated quickly because pet food companies are known to change formulas. Manufacturers have six months to reflect these changes on their labels. The lists may not be up-to-date.

    WHY DO SPOT CHECKS OR CURVES?

    Example of a prolonged hypo: Baby begins Lantus (first day, first shot)

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    Meowzi surprised her caretakers one night! Luckily, they caught the low by doing a simple spot check.
    PMPS 241; +4~132; +7~20; +7.25~31; +7.5~47; +8~89; +9~93

    Reference numbers given are for blood glucose meters calibrated for humans, not pet-specific meters.

    US & Canadian Blood Glucose Meter Ratings from Consumer Reports (2016)

    AlphaTRAK meters and AlphaTRAK 2 test strips:
    If AlphaTRAK users choose not to upgrade to the newer AlphaTrak 2 meter, you can continue to use your original AlphaTRAK meter with the new AlphaTRAK 2 test strips. Use CODE 7 for all species. For the most accurate AlphaTRAK® test results, upgrading to the new AlphaTRAK® 2 meter is suggested by the manufacturer.


    Learn how YOUR kitty is responding to insulin:

    • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
    • Peak/Nadir - the lowest point in the cycle
    • Duration - the length of time insulin continues to lower blood glucose
    • How to do a Curve - a simple explanation

    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.

    An active Levemir cycle will have an onset at approximately +4 and a nadir around +8 - +10. However, please keep in mind every cat is different (ECID). Data collection will offer you a better picture of YOUR cat's response to either of these insulins.

    Initially, don't expect to see "active" cycles after every single shot whether you're using Lantus or Levemir. Chances are, your kitty had diabetes for some time before diagnosis. It requires time for kitty's body to become used to dropping into lower numbers than their bodies have become accustomed. Don't expect immediate results! Regulation takes time and patience:

    • Also worth noting: "Many cats will occasionally react to an increased dose with increased BGs - within the first 2 to 3 days after an increase, usually lasting for less than 24 hours. Nobody really knows what the reason for this phenomenon is (perhaps a "panicky liver"?) - hold the dose and ignore the fluctuations." http://www.tillydiabetes.net/en_6_protocol2.htm. Here in the Lantus and Levemir Insulin Support Group (ISG), we've affectionately dubbed this unexplained phenomenon "New Dose Wonkiness" (NDW).
    A full understanding of the following concepts will go a long way in helping you regulate your kitty's blood glucose when using Lantus or Levemir:
    • Carryover - insulin effects lasting past the insulin's official duration
    • Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect
    • Insulin Depot - a "spare tank" of insulin, which has yet to be used by the body
    • LANTUS & LEVEMIR: WHAT IS THE INSULIN DEPOT?
    • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

    Approaches to Regulation

    Many here choose one of two methods to hopefully achieve regulation: Tight Regulation Protocol with Lantus or Levemir or a less intense method with fewer blood glucose tests required called Start Low, Go Slow (SLGS).

    Both approaches were created and developed by laypersons using human meters. Reference numbers given for blood glucose numbers are from blood glucose meters calibrated for human use.

    As of this writing, the Tight Regulation Protocol with Lantus or Levemir for Diabetic Cats is the only published protocol we know of for use with Lantus or Levemir. This approach was created by laypersons from the German-Katzen Group and was eventually published several years later.

    The TR protocol is the same, but presented in different formats here:

    Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of the Tight Regulation Protocol for years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting this Insulin Support Group.

    If the Tight Regulation Protocol isn't the right fit for you, the FDMB's Start Low, Go Slow Method (SLGS) offers an alternative method for regulation. SLGS offers caregivers a less intensive approach to managing their cat's glucose levels.

    Guidelines listed for each of these approaches are not intended to portray the ONLY way you can use Lantus and Levemir insulins. The guidelines on this website suggest how to best use Lantus or Levemir when following one or the other of the protocols mentioned above. Be aware there are other feline diabetes message boards on the web using different dosing methods/protocols successfully.

    Once you have learned the onset, peak/nadir, and duration of the insulin in your cat by collecting data from spot checks and curves you'll want to be sure to read Lantus & Levemir: Shooting & Handling Low Numbers if you're following the Tight Regulation Protocol.


    Links to more information and discussion:

    • 2014 ~ 39th Congress of the World Small Animal Veterinary Association (WSAVA)
      • Which Insulin in Cats - p 156
      • Management and Monitoring of the Diabetic Cat - p 160
      • Feline Diabetes - p 229
      • Diabetes Mellitus and Quality of Life - p 730
      • Acromegaly in Cats – p 733
      • Insulin Resistance – p 737 (description of mechanisms of resistance on p 738 under heading Pet)
      • Medical and Nutritional Management of Diabetes Mellitus – p 739 (description on p 741 of glucose toxicity and lipotoxicity)
    Please be aware: There aren't any "dose advisers" on the FDMB. The FDMB is an open board subject to peer review where laypersons with varied degrees of knowledge and experience are free to share their own thoughts and opinions through explanation and by making suggestions.

    We are not veterinarians. It is not our intention to take the place of your veterinarian. Please discuss dosing, methods, medications, and care for your cat with your veterinarian.


    Hope this information helps ease your way through this journey...


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    WELCOME to the LANTUS and LEVEMIR
    INSULIN SUPPORT GROUP!




    ======================
    This document was written by FDMB members Jill & Alex (GA) and jojo and bunny
    with contributions from Libby and Lucy and wcf and meowzi.
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    Last edited: Jan 3, 2018
    Reason for edit: removed/fixed dead links
    Yong, Jared, Laurie D. and 3 others like this.
  2. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
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