Love those blues and dark greens--Sake,4/12 AMPS=90,5+=56,PMPS=103,4+=104; 4/13 AMPS=97

My cat, Sake is in her 3rd week on Lantus. Since I recently started home testing her, her numbers were so great this weekend that I didn't give her any insulin from Fri morning until last night at dinner, when I reduced her dose from 1U/b.i.d. to .5U/b.i.d. I didn't have a chance to test her this morning before breakfast, but I went home at lunch and her BG was 241, 6+. I gave her 1.5 oz of food so she wouldn't be hungry, and because she needs to put weight back on since she lost so much prior to being diagnosed. I will test her prior to dinner in another 5 hrs, but should I increase her dosage back up to 1U, or keep trying the .5 for a little longer, or is it just too soon to tell? I just don't want her to be so close to those 300s Thanks in advance.

 

I'd strongly encourage you to look at the sticky notes on the Tight Regulation Protocol and Start Low Go Slow and decide which approach to dosing you're most comfortable with. Sake's numbers are good, not great. We look for cats to be in normal BG numbers for 2 weeks prior to removing insulin and prior to discontinuing insulin, we gradually reduce the amount of insulin in order to provide support to a healing pancreas. There really is science behind the process of treating feline diabetes and a lot of that process involves your being patient.

Normal BG numbers are in the 50 - 120 range (with the bulk of the numbers being below 100). I'm not sure how your initial dose was arrived at. With SLGS, the starting dose of Lantus in 0.5u. With Tight Regulation, the starting dose = 0.25 x cat's ideal weight in kilograms. This is usually somewhere in the neighborhood of 1.0u for an average sized cat (10 lbs). Given that Sake has lost weight, we would use her current weight, rather than her ideal weight. Without any information on weight, I would probably start at 0.5u and follow whichever dosing method you decide on to the letter.

At this point, whatever headway you made toward getting the insulin depot established, is gone. It takes about 5 - 7 days for the depot to form. Once you resume insulin, you also need to get some tests during both the AM and PM cycles. Lantus dosing is based on the lowest point in the cycle (i.e., the nadir) and not on the pre-shot values. Many cat's have lower numbers during the PM cycle so it's important to test in the evening in order to keep your cat safe.

 

Here's a link to your previous thread: http://www.felinediabetes.com/FDMB/...ied-from-the-feline-health-main-forum.193818/

On this forum we like to include the link to the previous day in our posts, because it helps people follow up on the story and understand the context better. We also try and title our posts with the date, name of the cat, and the values we measured. Look at other posts in the Lantus forum for examples. You can edit your post title as the day progresses to add new values or questions as they come.

Now for your question: as Sienne says, the numbers are good but not great. For me, we don't have quite enough data in the spreadsheet to tell if she is going lower than we think and bouncing, or if she actually does need the insulin she is not getting.

Would it be possible for you to get a preshot test before each shot? Test, feed the cat, then shoot -- try and do it in 15 minutes if you can (it might take longer initially).

It would also help if you could do a curve soon: that is when we measure BG every two hours to get a clear picture of how it is evolving during a cycle. If you can't do a whole curve, you could do partial curves: for example maybe you can get +2, +4, +5 one evening (if you go to bed late!). Are you generally at home during the day or are you out working?

I tend to be quite optimistic about cats going off insulin. I'd definitely not give more than 0.5ui at this stage, and given what yesterday morning looked like (110 48+ hours after her last shot) I would err on the side of 0.25. But more importantly, I'd get more tests in so we have a better view of what we're dealing with -- if that's possible.

 

Hello, and thank you for responding. I did look at those stickies last night, and it was all a bit confusing to me. Sake's weight is currently 8 lbs (hopefully, at this point, it's 8 lbs+ since she's been eating more.) I added it to the bottom of my signature. Using the formula for Tight Regulation, if I did the math correctly, her starting dose at her current weight would have been just shy of 1U, and at her "ideal" weight, which is about 10 lbs because of her arthritis, it would be 1.13U, so I'm not sure why my Vet would start her out on 2U/b.i.d.

I will definitely get a BG sample from her PMPS and also before bed tonight, so I have a better idea of where she is. I'll also go back and read those stickies again, and see if I can better understand them.

 

I had NO idea you can edit your thread titles! I'M so embarrassed! I will respond to this message properly once I am home from work, and have new #s to report. Thanks, Stephanie

 

Don't be! We all have to learn.
You might like this thread: http://www.felinediabetes.com/FDMB/...emir-isg-experience-updated-02-21-2018.46014/

 

Vets seem to have 2u as their standard starting dose. I was told the same as well as many others on here.

 

Silver is so cute! I love his face Is he a Calico, or some kind of tabby mix?

 

His sister is a calico - I did post a pic of her yesterday as she was mourning Silver being away (overnight stay in the hospital). Silver is a plain old (but gorgeous) Silver tabby.

 

So your current profile pic is his sister then? "Plain old Silver Tabbys" are indeed gorgeous, and I'm sorry he is in the hospital, and hope he returns home soon.

 

No that's Silver. No calico coloring tho. Here is the two of them together. They are similar very rare to find a male calico Sasha is the calico at the back of the chair Silver at the front He got home last night and I am home watching him today.

 

There is a huge volume of information to read, let alone understand at the beginning of this journey. Please let us know if you have questions or something doesn't seem to make sense. The people here are extremely generous with their time and knowledge. We're here to help.

 

http://www.felinediabetes.com/FDMB/...ied-from-the-feline-health-main-forum.193818/
Hello, Everyone. So I know Sake's Spreadsheet is kind of sparse over the last 24 hrs, but it's really difficult to get her tests in w/my FT job when I have my 4 yr old son with me--we are literally gone for 12 hrs/day, and when we get home, it's non-stop until he's in bed,etc. Oh, and did I mention I have atrocious time management skills? I do not have him with me for the next 5 days, so I should be able to get 2-3 more tests/day during the week, and could do a full curve this weekend.

Anyway, I have 2 main questions:
1. Since I still don't really understand a lot of the aspects of the SLGS method, I'm still a little fuzzy on what exactly the insulin depot is. That being said, is it kind of like the half-life of a medication? Would it explain why when I temporarily withheld Sake's insulin for the better part of last weekend, her numbers were much better (there were a lot more blues,) than now, that I have her on .5U/b.i.d., and there are a lot more yellows--were her numbers a result of the 2U/b.i.d that were still in her system from last week?

2. Sake has her bi-monthly blood test at the Vet's on Sat morning (because the Vet was not in favor of me home-testing her, or felt it was "unnecessary,") and does not yet know that I have been home-testing her since last week, and that I have adjusted her insulin amounts. Since the Vet reduced her original dosage from 2U/b.i.d to 2U/s.i.d the last time we were there on 3/31, I was wondering if perhaps I should increase her back again from .5 to .75/b.i.d. so her numbers will be more reflective of what they were when we were last there, or if it's unhealthy for her for me to increase it when she's only been on that reduced amt for 2 days? I don't want the Vet to be upset with me, but I certainly don't want to hurt my cat. I know a lot of people on here have dealt with "stubborn"/less-open-minded/proactive Vets and similar situations, so I thought I would see what you guys thought. I probably sound like a complete basket case, but my ultimate goal is to do what is best for Sake, whatever that may be.

Thanks in advance

 

This might help: http://www.felinediabetes.com/FDMB/threads/lantus-levemir-what-is-the-insulin-depot.150/

 

A depot-type of drug is not the same as the half-life of a medication. The half-life tells you more about frequency of dosing. A depot is more like having some of the drug in "storage." With Lantus, the insulin forms microcrystals that are deposited in adipose tissue (fat). This is the depot. Some of the insulin dissolves over the course of the cycle; some stays in storage. Ideally, there is a balance between the amount available for use and the amount you're injecting. This is also why unlike other types of insulin, the "ideal" curve is flat -- there's a steady state of insulin available and there is carry over between doses.

I look at a lot of spreadsheets and I've been hanging around here for a long time. I would not conclude that Sake's numbers were better over the weekend. First, since the depot is a reserve, some of what you're seeing is the result of there still being insulin in her system. You used up all of the insulin that was in the depot and now you're having to wait a week until the depot is replenished. The numbers are reflecting this. Secondly, there's way too much white on Sake's SS to draw any definitive conclusions.

You base your dose on what your test data tells you, not on whether your vet will approve. Unless your vet is going to be accessible to you 24/7, you are following a protocol (well, sort of following) that has been highly effective for getting diabetic cats regulated. The American Animal Hospital Assn has published guidelines for the treatment of diabetes in dogs and cats. In the section on home monitoring (pg. 11) in the publication I linked, they state, "Obtaining a BGC (blood glucose curve) at home is strongly recommended both for dog and cat owners, but even more so in the case of feline patients due to the chance of stress hyperglycemia in a hospital setting." I strongly doubt that your vet is going to take issue with the AAHA. Feel free to print out the publication and share it with your vet. I deal with a lot of medical professionals on a daily basis. I've always found that digging out a piece of research or a summary from a reputable source and innocently pointing out what I read and asking what they think helps to make them less defensive. (In other words, beat them over the head with science.) f the vet continues to act like a jerk, it may be helpful to tactfully remind the vet that you are Sake's advocate and the vet is working for you. It's the vet's job to provide you with ALL of the alternatives so you can make an informed choice. If the vet cannot provide you with the information, you are not able to give informed consent. (And, it's malpractice to not give you the information so you can give informed consent. You need to know all of the options and the risks and benefits that are associated with each option.)

Some vets are put off by a knowledgeable caregiver. I won't work with a vet that is defensive and thinks s/he is smarter than I am. I don't know everything the vet knows. What I do know is how to ask questions. If a vet doesn't want me to ask questions and instead, wants me to accept what s/he is saying at face value, I'm out the door. I have been fortunate to have had very good vets. I have access to lots of library resources and can make sense out of many of the technical articles. That makes my situation different than most people. What you have is a community of dedicated caregivers who eat, breathe, and live feline diabetes to help you understand the disease and it's treatment. I doubt that your vet has seen the number of cats with FD that we have.

 

http://www.felinediabetes.com/FDMB/...ied-from-the-feline-health-main-forum.193818/

Okay, I am trying REALLY hard not to freak out right now, but her BG has never been this high since she was diagnosed! Tonight was an EPIC FD Mom FAIL in that when I went to test and feed/shoot Sake a little early at 6:15 pm, I was horrified to find I had run out of test strips! I had a 6:30 pm appt so I had to leave, but was going to stop on the way home at 7:30 for more strips, which I did. So Sake was almost 2 hrs late in eating/getting her shot from this morning (13+) As soon as I got in the house, I took her BG and it was 433! It has never broken 364, so out of panic, I went ahead and upped her dosage from .5U to .75U because I'm really concerned about that #. She's not acting out of the ordinary, or any hungrier than normal, but I REALLY hope I did the right thing... I even wasted 1U + a syringe just because I don't think it was exactly .75, and I wanted it to be perfect. I have a slight tremor from a med I'm on, so unfortunately, that makes these tiny increments a little difficult for me to get.

Anyway, will someone please tell me I did not do something horrible to my cat? I'm seriously feeling like the worst Cat Mom ever right now

 

Ok so firstly the reason for the higher number is highly likely due to the fact that she was two hours late getting her shot. It happens. Don't worry. But you should never increase dose based on he preshot number bit based on nadir. The lowest number in the day. Panic adjustments to dose are not a good idea.

Did you read up on the SLGS method? I am also gone 12 hours a day with work/commute so I find that the safest method. You haven't done anything that can't be recovered from. So as others have said to me today - breathe.

Try as hard as you can to stick to 12 hr dosing as now, her am shot is going to be two hours early. Others can advise what you should do. @Chris & China @Sienne and Gabby (GA) and @Stacy & Asia have been around a while and can help you.

I can only manage a curve on Saturdays which basically means I can't go anywhere on Saturday. Tough with a small kid. But do what you can. I rarely manage a +2 because I need to sleep. If you can catch nadir - +6,7 and or 8 that will help.

 

First, breathe! You can manage this situation. Increasing without knowing how low the 0.5 unit dose can take Sake was not the right thing to do. We determine how to dose a cat based on how LOW the dose takes the cat, not the high numbers. However, you are by no means the first person to panic at an ugly number. Since you did increase, you will have to be more vigilant about testing tonight. I would start with a +2 test if you can. If it's lower than the PMPS test, you may have to stay up later testing to keep her safe.

There are several possible reasons for the high number tonight. Without any testing since AMPS, we can only guess why. She could have gone lower during the day and this could be a bounce. Any chance she got into some higher carb food somewhere? Shooting a couple hours later would have made the high number even more so, but likely not that much given the numbers you had seen on no insulin.

Since you shot 2 hours late tonight, your shot tomorrow should be 12 hours after the time you shot tonight. You can move it up to 11.5 hours after tonight's shot.

 

Thank you for responding, Juliet, especially w/everything you've been going through w/Silver. I actually wasn't basing my decision to increase her dose by .25U on this morning's nadir; I was basing it on the fact that she's never been in the 400s, and I thought that maybe my Vet might have been right when she put her on the 1U/b.i.d., and that my actions deviating from her plan, might have been a bad idea. The good news is, I don't have to leave my house until 8:00 am on Thurs & Fridays because I don't have to take my son to school, so Sake usually gets her shot a bit later on those days anyway, so it should even out. This morning was extra early because I was trying really hard to get us out of the door so that we wouldn't be late like we had the last 2 days. Normally, she eats/gets her shot closer to 6:45-7.

I might try to do an 18 hr curve this weekend, since I'm by myself because as I learned from the earliest days when my son was an infant, I am a complete psycho on sleep increments of less than 3 hrs, so the 2 hr thing is not the best idea. I figure we'll start out with our first # (PMPS) being the one from the Vet because she has to fast before that appt anyway, and then I'll do every 3 hrs from there.

I hope Silver is doing better, and that YOU are doing much better as well

 

Silver seems to be doing great - me, not so much. Little too much stress going on but hopefully it is in manageable bite sized chunks. Dealing with diabetic cat isnt easy on any of us. We all panic and think we have harmed our cat. Re the dosing - mostly the vets don't really know much about feline diabetes. If you want my honest opinion, you should be following SLGS because you are out 12 hours a day and are unable to get the frequent testing TR requires.

To put it simply - SLGS (Start Low Go Slow) - hold each dose for a week; after a curve increase or decrease based on nadir - not preshot - but as @Wendy&Neko said, the lowest number (which you will only be able to get when you do a curve as you have no way of knowing that lowest point otherwise). The sticky will tell you the numbers you need for reductions or increases. If you follow the protocol, you can't go far wrong.

I would encourage you NOT to shoot early or late - it works best if you give the insulin every 12 hours - if you give it an hour early it acts like an increase - and as you saw tonight - an hour (or 2) late acts as a decrease and numbers will rise.

As Wendy said - shoot an hour and a half late (than his usual time) tomorrow morning. Shoot an hour late tomorrow evening; half an hour late Friday morning and you will be back on schedule for Friday evening shot. Make sense? The shot times are important.

 

http://www.felinediabetes.com/FDMB/...ied-from-the-feline-health-main-forum.193818/

It's a new day, and I am much calmer now, and will remain so regardless of any numbers we receive today... I am however, exhausted because SOMEbody did not want to come anywhere near my lap, so I could test her ear post-shot/feedfing last night, and I didn't get my post-shot # until 1:00 am. Anyway, once I saw that it had come down considerably from the 433, and wasn't anywhere in the hypo range, I decided I could finally sleep. Was able to get a # this morning, and it was a 90, which is right in line with her last Vet appt AMPS test, so at the moment, I'm feeling okay about that number, and am going to hold the dose at .75U for a week like the SLGS method prescribes, unless of course, my Vet tells me something drastically different, and then, I'll have a decision to make... I'm going to go home on my lunch today, and check on her, so that's less than 2 hrs from now, almost 4+. I'm sure I'm going to get another one of those looks when I get out my lancet again. Sigh...

Thanks, Everyone for your continued kindness and support.

This is the look I get when I tell Sake we have to test her ear again... "Really, Mom?!" [/URL][/IMG]

 

...it’s so funny CUTE PIC... I instinctively start looking for the vein in the ear... and catch myself...
Love the pic!

 

Same look I get from Jones. That is the look in my avatar. I was doing a curve with him in my lap. So I took a selfie of him.

 

I FINALLY stopped hitting the vein! After about 3-4 times last weekend, I finally found the "sweet spot." The vaseline trick has been everything though. It makes all of the difference for me in getting those meter-friendly droplets. I use a ReliOn Prime and it times out so fast--it's ridiculous!

This is Toulouse, Sake's much younger brother, wondering why she is getting so much attention, and better food than he is...

 

Okay, I am still going to remain calm... Just got back from lunch, and Sake was 56 at 5+. She was not acting any different at all--absolutely no signs of hypoglycemia, but like the time when she was 76, I gave her some higher carb cat treats, and 2 oz of food. Now though, I'm pretty confused. I increased her dosage up to the .75 because I panicked when I saw that 433 last night, but as many of you guys have said, I should not have hit the panic button & immediately upped her dosage. And then, there's this from the SLGS Sticky:

• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

So now, I'm just not sure what to do re: tonight's shot because it seems like her #s were better when she was on the 1U b.i.d. per the Vet's instructions, but I also wasn't testing her much until I withheld her insulin over the weekend, so I really don't know what her exact #s were on the Vet's regimen. In addition, if I hadn't deviated from the Vet's plan and started home testing/reducing her insulin, who knows what her exact #s might be because she was only being monitored every 2 weeks by my Vet. So she could have been teetering on the verge of dangerously low levels, and I never would've known. I mean, I know that even with all of my errors in judgement of late, she is still in a better place now because she is on a lesser amount of insulin than what the Vet had her on, which will help her pancreas work on functioning on its own again, if that's eventually possible for her.

But at this point, should I heed the SLGS protocol, and go back to the .5 or should I keep her on the .75?

 

If you're going to follow SLGS, then the instructions are to reduce the dose.

 

And also. The increased dose from last night won't have taken effect yet. She's still using the depot of the lower dose. The increased dose topped up the depot (someone told me to think of it as a funnel) I would reduce back to 0.5. Remember the high number highly likely due to your late shot. Did you dhoot late this morning?

 

Not later than usual, but her shot/feeding time varies a little between the beginning of the week and the end of the week because I have to leave my house so redonculously early on Tue & Wed, but not on Thur, Fri, &every other Mon, so I kind of split the difference between the 2 times because I know you're supposed to get it within the hour of the regular shot time. So on average, she gets it between 6:45-7:30am and 7:00-7:30pm because due to my son's school location/traffic, I can't leave any later on the mornings I have him, and I can't get home any earlier. Today, I think I finally got a sample from her around 7:45am, and gave her the shot/food immediately following. I know it's not ideal, but unfortunately, it's my life as a single Mom w/no family in the area, and it's the closest thing to a "regular" schedule that I can do for her.

 

Toulouse is just Adorable - what a character!!!!!!

 

Reduce the dose to 0.5 units. You should not have increased without more data showing you what 0.5 units can do. It's entirely possible this is the 0.75 unit dose showing what it can do. It's too much insulin if you are following SLGS.

 

A character is right! He and my 4 yr old son are actually "frenenmies" in that they are both jealous of each other, and compete for my attention. It's really bizarre. Magic Mouse is adorable, as well. I just adore Tuxedos! They all seem to have such unique personalities

 

I hear you. I'm alone too. No family in this country. You're doing great!

 

I LOVE the pic of Sake's face pre ear test. Made me

 

Thank you! She's always been a very expressive girl. She talks more than any cat I've ever had, supposedly because I talked to her like a person so much when she was a kitten

She just allowed me to get another test in, and we're currently at 103, so for now, I'm happy, and so is she, since she just got some yummy Whole Life Salmon Treats

 

I heart you, Juliet! Thank you What country are you in, if I may ask?

 

Crike. I just realised she is a fancy 15. She certainly doesn't look it.

 

She will be 15 on April 30th! She doesn't really play much any more, but she did briefly paw at the laser mouse laser on Toulouse's birthday, about a month ago. I almost fainted from the shock as it had been so long since I had seen her play. She can also hold her own now when Toulouse starts trying to be the "big cat around the house"--I've actually caught her chasing him in retaliation several times now that she's getting better. Before she was diagnosed & I switched her diet, she would just make the "get away from me" cat noise, and get out of his path--now, she's back up to her usual badass self, and and getting back to her fighting weight as well, since I think she may have already gained back 1 pound! I'll know for sure when she goes to the Vet on Sat, but I weighed her while holding her tonight, and she was exactly one lb heavier When she seemed to be at her sickest this Fall, she was most likely under 8 lbs since it scared me how light she had become when I picked her up one day. In the past, she has been as heavy as 15 lbs, and at her last healthy blood panel in 2016, she was 12 lbs, so I think she lost over 4 lbs in a year and a half while she was sick. This one pound gain makes me ecstatic, since she has also lost a lot of muscle, and I am hoping she is now regaining some of it in the process

 

I'm in Canada. Transplanted from Scotland.

 

We're finishing off the day with a nice pretty shade of blue (104) and midnight snacks for both of us In fact, all of our numbers today were either dark green or blue, and they sure look a whole lot nicer/less worrisome than those yellows, pinks and horrible reds. I gave Ms Sake 1.5 oz of food, just in case her numbers started dropping overnight, and because she was of course, hungry as per usual.

 

Happy Friday, FDMB Peeps! Sake started out her morning with a big breakfast and an AMPS of 97 I won't be able to go home for lunch today, so I'm hoping that big breakfast is going to hold her over until 6:30pm tonight when I get home. I'll probably have to test, give her a snack, and then feed & shoot at 7:30 just to keep her on schedule. Planning on doing an 18 hr curve tomorrow, starting with our 8:45am Vet appt, so her shot will be about an hr late tomorrow morning, but that's the only appt I could get, and she has to fast before it. I'm going to test her when I wake up, so that I have a more accurate AMPS # to give to the Vet. Hopefully, the delay in her shot time won't affect her #s too much throughout the day.

 

It's easier if you start a new thread each day and post a link to the previous day's thread at the top of the first post. Call it date-name of cat-name-AMPS and then the number

04/13 Sake AMPS -----

Then we can easily know it's new info.

 

Thanks for letting me know. I hope you, Silver, and Sasha are doing alright today