So, here's my deal. My cat has been diabetic for over a year. I've done it the vet's way for the length of the year. Switched to Purina DM, did LC Friskies and FF. Blindly gave 2.5 u Prozinc 2Xday without home testing. However, since the beginning of the year I've taking matters into my own hands. I now home test, keep the low carb wet and give small amounts of YAZ. My cat is doing better, but he's still not regulated. My issue is every time I get over 2.25 it seems to be too much. He bounces high in the morning, then the insulin kicks in, but sometimes I need to reduce the dose. Then he goes high again. It was suggested that maybe I should consider switching to Lantus because it may work better for me. I would really value the advice of experienced owners. Has anyone been through this? Opinions?
You might want to try Lantus....sometimes cats react better to a different insulin and you've given ProZinc a fair try It will take re-learning on your part though. Lantus works in a different way than ProZinc so it's kind of like starting over with what you think you know. If you do decide to try it, let us know when you're ready so we can help you decide on a good starting dose. If you want to save money on it, most of us have bought our Lantus from Canada. Here's the information on Buying insulin from Canada
Ming switched from PZI to Lantus as well. The biggest thing I had to train myself to relearn is that Lantus bases its doses on how low it gets kitty, NOT the pre-shot number. Sometimes, only PS numbers are taken into account (usually if it's a new kitty to Lantus or we have data that points towards doing a certain thing). It means making sure you catch nadirs and learn how low your cat goes. The most nerve-wracking thing I had to learn to do is to give insulin when Ming would give me a PS number of 60-80. I had to tell myself that the insulin will kick in LATER, NOT the moment I give insulin. The depot is also something I had to learn about. That it takes time to build the depot and that the first shot of a new dose doesn't equate to how the dose will affect Ming's body. Lantus needs time to work and in that time, the depot is filled up and it takes up to 10 cycles for the depot and the dose to show us how it works on kitty. The benefits of Lantus is its flat curves compared to Prozinc. The goal for me and Ming is to achieve these flat curves and have Ming stay low for longer periods of time. You can get the same effect on PZI but some cats just do better with the L&L insulins.
My concern is that I am not available to get a nadir over the week at times. I don't have anyone who can check. On the weekends I can be more available, but how would I start it if I'm gone most of the day? How would I adjust the dose during the week if I go by the nadir?
I'd start by looking up the two different dosing methods in the stickies as well as the rest. It sounds like Start Low Go Slow will work best for you. You hold a dose for a week, do a curve at the end of the week, and adjust from there. Nadirs should never reach lower than 90. So it's safe if you aren't able to test so frequently. As opposed to Tight Regulation where you need to test much more and can change doses every 3-10 cycles (depending). And reductions are earned when you hit under 50. Generally, when you start a new insulin, it's best to start when you have a few days free to monitor closely. I would switch insulins the night before your weekend and test frequently.
I haven't finished going through all the stickies yet but I will. So this may be a stupid question, but if the nadir doesn't go under 90 then how does hypo for in? Or is it just because you never give a does that will make him go below 90. So I'd give Lantus on a Friday, monitor it that night. Then Saturday and Sunday keep same does and monitor it? When Monday rolls around I should not have to work for nadirs that week. Then possibly change dose Friday night if it's not working?
Hi there! I'm not sure that I understand that question. In the Start Low Go Slow ( SLGS) stickie, under 90 would be where the kitty takes a reduction. Otherwise, peeps following Tight Regulation ( TR) would not take a reduction until kitty goes under 50 with a human meter or 68 if using a pet meter. In the beginning, all data you can get will be good data to have until you can see how low the dose is taking TuffyKitty. It looks like you all ready test enough through the daytime and evenings which is great. Your could follow TR if it weren't for the dry food you are giving her/him? that requires you to go by SLGS as the dry food hangs in the system a lot longer than wet food. What a lot of peeps that work outside the home do is to get a +2 before leaving work so that if the +2 number is lower they know it could be an active cycle and they might want to give a little MC food to slow things down a bit and also leave some food through out the day. Many of us use an auto feeder that we set up with food to open up when we time it to help keep our kitties safe while we are gone. Some peeps that work have had to change their shot times to an earlier time and/ or get up earlier so that they can get that +2 in. Post again the night before you start and title your thread, Starting Lantus, Need a Starting Dose" so that peeps here can guide you with a good starting dose with the Lantus. .
What I mean is So, why do the Nadirs not get lower than 90? Is that just because you don't give as much isulin? What is MC food? So I can test his BG at 5 am, then poke and test again before I leave at 6 am. Would that work? If I do it earlier I won't be home in time to do the PMPS. A timed feeder won't work in the area that I have Tuffy's food. At least not at this time. I have a dog and I keep his food raised, but I'm also very limited in space. However, I leave the wet food down with added water and he snacks at different parts of the day so if he does need food he has access. Is that okay or should I think of something else?
The 90 number is just for safety for people following the SLGS method. The TR method is a more aggressive protocol so the reduction number is lower ( under 50) . TR has a higher remission rate than SLGS. If you kicked the dry YAZ and can test always pre shots, a test mid cycle and in the PM before you go to bed at night, you could follow TR. MC is Medium carb food. LC Low Carb wet 0-10% MC Medium Carb wet 11-15% HC High Carb wet 16-25% Getting a +1 before you leave the house is better than nothing. Sometimes there is a food bump in that number so it's not as helpful as the +2 test.
By taking reductions at 90, when you see them it gives you a greater margin of error, so it's considered to be a more cautious approach to dosing. Having an auto feeder to leave timed meals out for TuffyKitty, will also be really useful. You will need to run a curve at least once a week, as Bobbie mentions the more data you have the better, so if you can run a curve on two seperate days then great, or if you get home early and can grab a test that is also useful as is always at least getting at least one test before you head of to bed.
I would be able to test more often on the weekends, occasionally a weekday depending on if I work. I might be able to get a +9 sometimes. Can I SLGS then eventually go into TR?
Yes it's not uncommon for folk to start on SLGS and then move to TR, the only thing would be you would have to cut out all the dry food. It's a prerequisite of TR that they are on a LC wet diet.
We have had kitties go into remission when following SLGS, but it is more common to see it with TR, this is because with the more aggressive approach you are more likely to get kitty regulated quickly, and studies have shown that the quicker one is able to attain regulation with a newly diagnosed cat the more likely the chance of remission. We have had cats go into remission after 7 years on insulin so as we like to say here Every Cat Is Different (ECID) I do think that Lantus with its slower action and more gentle curves will give you a better chance of achieving BG in a healthy range for most of the day, it's not going to happen overnight, but you will get there. When we started out my goal was regulation first, I was fortunate that George went into remission in about 6months, he was doing really well for about 2 1/2 years he's back on insulin now after a shot of steroids set his diabetes off again. FYI TuffyKitty has been diabetic for over a year now so he would be considered a long term diabetic. Could you add his date of diagnosis to the signature, it's a consideration when taking reductions on TR.
No problem ask away, there's a lot to take in. We make long term kitties 'work' harder to earn those reductions it tends to help the reductions stick. From the TR Sticky on when to reduce the dose Reducing the dose: (numbers are for Human Meters) The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus, Basaglar, & Levemir ISG safe by taking reductions when appropriate. 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, try to make sure kitty maintains numbers in the normal range of a non-diabetic cat (50 - 80mg/dL) for seven days overall before reducing the dose any fur Please do not let yourself become complacent or blasé about drops into the 20s or 30s. Please ask for advice immediately. If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are few exceptions given to caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out. Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more. If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction. Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding an in-between the dose. We've found many kitties benefit from reducing the dose from 0.25u to 0.1u before stopping insulin completely. During a two week OTJ trial, you want to see mostly green numbers (under 100) with only a few random blue numbers between 100 - 120 to help ensure a strong remission. Most kitties will be in the range of a healthy cat (50 - 80 mg/dL) overall.
No you don't need it every day. There is a really great info post by one of our members who worked long hours and followed TR, there are some great tips in there. Here's the link. http://www.felinediabetes.com/FDMB/...ion-possible-with-a-full-time-job-yes.129378/
If you have any questions just keep asking. We all remember how overwhelming it is to take in all the information, and though you've at least got the testing and shooting down to a fine art by now, Lantus is a whole different ball game to Prozinc. I know from reading posts of folk that have made the swap that it takes a while to wrap your head round the differences. You'll get there. Remember thought with TR you would have to get rid of the kibble, even the Young Again Zero.
I've cut down a lot as is on dry. I'm not opposed to killing it altogether. If I had a vacation or a few days off in a row then I could start the switch. Theoretically, if I did the TR would this work? Weekdays: 5 am test-feed-shoot. 6 am test Around 3-4 test occasionally 6 pm test-feed-shoot 8pm test 10pm test Start a new does Friday night, that way it may kick in Saturday and I can monitor it. (Or possibly start Thursday depending when it kicks in) The weekends I can adjust doses and then during the week it should be fine?
Lots of amazing info here! Sorry about my wording earlier. It was definitely confusing. Kitty can definitely go under 90 whether or not you’re doing SLGS or TR. We just try to keep kitty above it for that particular dosing method because there’s less testing involved. I also want to say that some kitty’s nadir might not be at +6 because ECID. For now, the more data you can get, the better so you can figure out how TuffyKitty reacts to Lantus. As well, with TR, when you change your dose can vary. If you’re not seeing good numbers, you may be advised to change doses earlier but of course, you also have to find a good time to change where you’re able to monitor as well. Has TuffyKitty had a history of DKA? Ming does and it’s why I try not to hold doses that aren’t working too long or he can develop ketones or glucose toxicity. But if TuffyKitty hasn’t then that works in your favour.
This also depends on the cat. I find SOMETIMES Ming will react to the first dose change because at the same time, he’s clearing a bounce. His third cycle is usually always yucky and high. His second cycle of a new dose usually see action. His 7th or 10th/11th cycle is the cycle that usually tells me if a dose is working. I’m not saying TuffyKitty will be the same. Best if you’re able to monitor the first few cycles when you start lantus so no surprises go unnoticed.
He has not. So I should increase the insulin on a day that I can monitor him to make sure that he's not going too low. Will his nadir be different whether he's on Lantus or Prozinc?
So on a Saturday I can monitor for the weekend and the kinks should be worked out by Monday? I need to determine if TR or SLGS is better for Tuffy. I feel like the TR would be more beneficial to him, but I'm so new to the switch I'm thinking the second method would be wiser for me now. I feel so cheated because I wasted a year listening to the vet when I could have done better for my cat. In my mind he's behind and I ruined his chances of him going in remission. I just don't want to waste anymore of his time.
It’s always best in the beginning to change doses when you can monitor until you learn what TuffyKitty does with new doses then you can make a decision in the future when you feel comfortable changing doses. Nadirs can definitely be different between the two insulin’s. Ming sort of has a mini nadir at PS sometimes where he’ll go up at +10 and then be lower at PS. But his typical nadir is between +5 to +7. But for some doses, he goes way way lower at shot time. We haven’t found a good dose for Ming yet so it makes me wonder if his Nadir is at PS time. But I digress. You won’t figure out TuffyKitty’s insulin in a weekend. What may work this weekend, may work differently the next. Remember, Lantus is a despot insulin. What happens in previous doses will affect future doses. Unlike PZI, where the insulin leaves the body around 14 hours. Lantus is constantly building up in the body via the depot. So you might not see much action this weekend as the depot builds. So he might go much lower once the depot fills up after 6-10 cycles. If you can monitor Friday night, I’d start on Friday.
To clarify: because we don’t know what TuffyKitty will do with Lantus, it’s why it’s good to monitor closely when you start and when you increase doses. But at the same time, not much might happen. We just don’t know until we try You might be feeling like you need to time TuffyKitty’s future actions out to days where you can monitor but we really don’t know when that is and can’t predict TuffyKitty’s specific reactions to Lantus. (That’s how I felt in the beginning). But the safest thing to do right now is monitor when you change to Lantus and gather as much data as possible.
Yes that would work, you may have to be a little more conservative with dose increases, waiting till thursday/friday to take the dose up. If you took the dose up on Friday am by Sunday you would be getting a pretty good idea of where the dose was taking him. Getting the +1 regularly, and the +10/+11 will help you build a picture, then running a curve on one day at the weekend at least getting some extra checks on the other day. Will allow you to build a picture of what his cycles are doing.
Right now I'm still wrapping my head around it all. Not ready for the change quite yet, but I did update my vet. I'm curious to see what they say. I was also considering changing to a vet that specializes in cats. If I have a good time frame where I can get a lengthy break, that'd be perfect... But I don't see one anytime soon. Which, since I'm not ready anyways it probably doesn't matter. So if I start the best thing to do is do it slow and monitor as much as crazy to help with the change. As far as the PS go, I test, feed, then shoot. Do I have to wait an amount of time before I shoot? I can't remember which insulin needs a 1/2 hour before shooting.
No need to wait we test feed and shoot all in about 10min. I usually give my boy his shot while he still has his head in the bowl.
