Thinking I should try another insulin?? any advise?

Discussion in 'Feline Health - (The Main Forum)' started by Karen Mulholland, Jan 21, 2018.

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  1. Karen Mulholland

    Karen Mulholland Member

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    Hello,
    It's Karen and Rocky. We are relatively new and have been using Novolin N since 11/09/17. I began home testing 12/09/18. From what I have been directed to read from other members regarding Novolin seems to be true. About 4 hours after am shot Rocky's BG tanks. We have had a few times of really low numbers. I have gradually reduced the dosage from the original 3 units (that was with dry food) to between .25-.5 (since switch to all wet FF classic) 2x daily depending on his BG numbers. I'm thinking I should try .25 once a day from now on because I'm scared of those drops and I have to work from 7-5. I have heard however that perhaps switching to Lantus or Levemir may have a gentler onset and last longer. I will contact my vet and ask for his input, but frankly after not being directed to a wet food diet and directed to increasingly large doses of insulin, I'm not feeling confident. Maybe I should look into a new vet. He is supportive of home testing and willing to speak on the phone which is helping financially. I have also read that the Lantus and Levemir is really expensive, but can be purchased from a Canadian pharmacy at a considerable savings. I would really appreciate some feedback. Thank you. P.S. I have kept his SS up to date.
     
  2. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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  3. JeffJ

    JeffJ Well-Known Member

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    I don't have Novolin experience. It is a fast onset insulin. (Rocky's spreadsheet looks empty to me, unless I need special Rocky glasses to see it).

    Generally we like to see most kitteh on (Lantus, Levemir, or Prozinc). Those are all depot insulins. They have slower onsets, and they have longer lasting nadirs (low BG spots). Plus they have lasting effects past the 12 hour mark. Some cats are lucky and they can be regulated to stay under 250 almost the whole cycle with these depot insulins.

    Another insulin supplier - is in the Supply Closet subforum
    http://www.felinediabetes.com/FDMB/forums/supply-closet-for-sale-or-free.15/

    I have done several Levemir orders thru Alan Hamman. All went well. Good prices. On the last one, he intentionally waited until the weather was not freezing. And he insulated the crud out of the package!
     
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  4. Chris & China

    Chris & China Well-Known Member

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    I don't see anything on it either
     
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  5. Karen Mulholland

    Karen Mulholland Member

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    Thanks for your response, I will try to get some help with the SS. I go to Google Drive and enter my numbers. When I do that all of the data is there.
    When I get this figured out, perhaps you can have a look?
     
  6. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Are you entering them on the SS template itself? Maybe that's the issue - but I'm not techie enough to help. @Chris & China can though.
     
  7. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    Personally, I would not "throw away" a vet that is supportive for not being up to speed with FD treatment. Are you otherwise generally happy with him? If he's supportive, that's already a great plus. You can get info on how to treat FD here and bump it back up to him if he's open.

    It's empty.

    If that is what you're doing, my suspicion is that you're entering the numbers on another copy of the SS. When you're on the SS you're entering numbers on, click on the blue "Share" button at the top right. Then "get shareable link" in the little window that opens. Paste that link here in your next message.

    Regarding the change of insulin: I don't have experience with the insulin you're using but it does seem clear to me that longer-lasting insulin is more appropriate. I'm currently looking at a couple of cats going from caninsulin to lantus and the change is quite astonishing.

    Even if Lantus is expensive, it seems like you're on small doses of your current insulin, and chances are you'll be on small doses of Lantus too. If you were shooting 10ui the price difference might weigh heavier. If you were to shoot 1ui morning and evening with Lantus, assuming you "waste" 1ui with each shot (being generous here), that's 4ui a day. A pen is 300 units. That would mean 75 days. It's just an estimate because we don't know how much insulin you'll be giving, but maybe it helps put the price into perspective. And yes, I've seen that ordering in Canada makes it more affordable for people in the US.
     
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  8. Karen Mulholland

    Karen Mulholland Member

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    I have PM Marge for help with the SS. I go to google drive, put my numbers in the first of the 3 SS's?? When I look it's there?? I get back to you when this is figured out. Thanks
     
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  9. ZulusMom

    ZulusMom Member

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    Prozinc is actually an in-and-out insulin, not depot, but it is slower onset and lasts longer than Novalin-N. It taks 1-2 hours for onset, peaks between 5-7 hours and by 12 hours it's usually on its way out. Both Prozinc and the L insulins are good choices, though. Cost for Prozinc might be a little cheaper than the L insulins, but I think (?) you can only get Prozinc through a vet pharmacy (might be wrong on that).
     
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  10. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    Try getting the sharing link by clicking on the blue button :)
     
  11. Karen Mulholland

    Karen Mulholland Member

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    https://docs.google.com/spreadsheets/d/1MxJb1v4C1dOEPYVab_kpgcC8nRoc2-M6tpIYPg_UBbQ/edit?usp=sharing
    I hope this works, thank you so very much for your help.
     
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  12. Karen Mulholland

    Karen Mulholland Member

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    Will do, thanks. I do think your right about the vet. He has been kind to my animals over the years and that means a lot. The board members have been fabulous and I'm learning a lot (even if my tech skills are limited!!)
     
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  13. Julia & Bandit

    Julia & Bandit Well-Known Member

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    A 5 pack of Lantus pens from Canada is $180. That will last you minimally a year, so it works out to be about $15 a month (or less). Plus, Lantus has a really good track record for effectiveness in cats, where Novolin does not, so you are getting far more value for the Lantus than the Novolin. The only difference is that the majority of the Lantus cost is being paid up front instead of spread out over many months.

    As for your vet, you just need him to write you the script for the Lantus, and that's it. If he gives you resistance, you can point him to the AAHA guidelines where Lantus is recommended over lente insulins (Vetsulin, that has a similar duration of action as Novolin N). I've also attached a couple articles you can bring him. Ask him why he won't give you a script when the current veterinary literature recommends longer acting insulins.
     

    Attached Files:

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  14. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    That's it!

    Next step is to fix the link in your signature. Copy that link like you just did. Go here: http://www.felinediabetes.com/FDMB/account/signature

    Highlight the text that says "Rocky's Spreadsheet". Click on the link icon (the one that looks like a little chain link). Erase the link that is in there and paste the one you just copied. That should do it.
     
  15. Karen Mulholland

    Karen Mulholland Member

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    O.K. I did it (I think) only thing ....I did not have to erase anything before pasting in the new one, because it was empty?? Thanks again
     
  16. Karen Mulholland

    Karen Mulholland Member

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    Fantastic, I will. I am more than willing to pay upfront for the Lantus if it will help Rocky. He's a warrior!!! He has been through many challenges and still remains loving and (fresh some times too!!, but there again he is a cat!). Thank you again for your help. I will let you know how it goes. It freaks me out thinking he's at home alone and could have another really low number. I have a feeder set for every two hours to try and help to keep his BG up in case of a drop.
     
  17. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    Link in your signature working fine, mission accomplished!
     
  18. Karen Mulholland

    Karen Mulholland Member

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    Thank you again for your help, you have been wonderful. I'm going to speak with my vet tomorrow about starting Lantus.
     
  19. Karen Mulholland

    Karen Mulholland Member

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    Good news! My vet agreed to start Rocky on Lantus:) He said he would rather start it in office, but it was up to me. Rocky goes absolutely berserk when put in the carrier none the less at the vet. It was the main reason why I wanted to home test. I thought all the stress would kill him. He said to start with 1 unit once a day. He is currently on Novolin at .25 units once a day and if number is over 270 at 12 hour mark another .25 So is 1 unit a correct dose?? I'm terrified of having another really low episode and 1 unit seems like a lot even though it's a different insulin. Thank you all for your help.
     
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  20. Karen Mulholland

    Karen Mulholland Member

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    Also I remember hearing that the Lantus pens were better and would last longer due to the expiration date?
     
  21. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    So, one thing you might want to do before you get started is read the TR and SLGS stickies. Try and see which of the dosing methods/protocol you'd be most comfortable with.

    I bring this up now because both of them have starting doses built in. So depending on which path you choose, the starting dose might be different.

    SLGS is "easier" than TR but makes you go slower. TR is more aggressive but requires more monitoring.
     
  22. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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  23. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    Oh, one important thing: TR requires the cat to be eating only low-carb wet food. So if Rocky is not on low-carb wet food, you'll be looking at SLGS :)
     
  24. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    Lantus pen has less insulin in it than the vial. They keep beyond the expiration date, according to the experience of people here. Store in the fridge. We use such small quantities for our cats that the pen is more than enough.
     
  25. Chris & China

    Chris & China Well-Known Member

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    I think I'd start at .25

    You can always go up if you need to....You can't take it out once it's been given.
     
  26. Karen Mulholland

    Karen Mulholland Member

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    Thanks Stephanie, I will read them both and see which is the best fit. Your help is very much appreciated. Thanks again:)
     
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  27. Karen Mulholland

    Karen Mulholland Member

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    I called my vet back and asked that he write the script for the pen and he agreed. I am going to buy the first one at Walmart and then look into getting subsequent pens from the Canadian pharmacy that others on the board have mentioned. I understand it is much cheaper that way.
     
  28. Karen Mulholland

    Karen Mulholland Member

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    Thank you, I feel more comfortable with that.
     
  29. Karen Mulholland

    Karen Mulholland Member

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    Stephanie, thank you. I have been feeding Rocky only FF classic and fortunately he transitioned easily and really enjoys it.
     
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  30. Karen Mulholland

    Karen Mulholland Member

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    Julia, my vet has agreed to Lantus:) can you please give me the contact information for the Canadian Pharmacy where I can get the Lantus pens for $180. The cheapest I can find around here (Eastern Panhandle of WV) is at Walmart. One pen is $96 dollars. What do I use to inject with? Does the pen come with a syringe/needle?
     
  31. Chris & China

    Chris & China Well-Known Member

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  32. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    There are needles for the pen but they will only allow you to draw whole units. There is a sticky about syringes if you check it out. You’ll want something like the BD micro-fine 0.3 ml + Demi (half-graduation marks). Make sure they are U-100 syringes and not u-40.
     
  33. Chris & China

    Chris & China Well-Known Member

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    All these syringes have half unit markings (very important when you're doing microdosing) and are the correct syringes for U100 insulin and are available from ADW online:
    UtiCare
    Monoject
    Carepoint
    Sure Comfort
    B/D

    They're also available at WalMart if you have one near you. Their Relion brand 3/10ml, 30 or 31 gauge, 6mm or 8mm insulin syringes all come with half unit markings and are only $12.58 for a box of 100 (although a lot of them don't realize they DO come with half unit markings!)
     
    Last edited: Feb 22, 2018
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  34. Karen Mulholland

    Karen Mulholland Member

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  35. Karen Mulholland

    Karen Mulholland Member

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  36. Karen Mulholland

    Karen Mulholland Member

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    Chris that would be .25 2x daily correct? According to what I have read it is a 12 hour insulin. I'm starting tomorrow (I'm taking the day off from work so I can monitor him)
     
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  37. Karen Mulholland

    Karen Mulholland Member

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    Also according to the sticky, I need to use a human meter. I have an alpha trac, so I assume I should get on from Walmart today??
     
  38. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    You can use the AT but the strips are more expensive and it will read “higher”, giving “real” numbers. It’s not very important except
    - cost
    - with low numbers we have different “take action” numbers for human meter or AT
     
  39. Chris & China

    Chris & China Well-Known Member

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    Yes

    you can use the AlphaTrak if you want to. The reason most of us don't is due to the cost of the strips. Even if I could afford $1 per test, I'd have to hesitate to test as often and I never wanted anything to come between me and my ability to test as much as I wanted to.

    The AT strips are about $1 each....the Relion Confirm or Micro are about .36 cents (although you can sometimes get some good deals on Ebay)
     
  40. Critter Mom

    Critter Mom Well-Known Member

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    There's a problem with the linked spreadsheet for Rocky. I got a warning message that the file is now in the file owner's trash and I will shortly lose access to the data. Clicked on another link to his sheet and that seems OK.


    Mogs
    .
     
  41. Karen Mulholland

    Karen Mulholland Member

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    Thank you, I went ahead and bought a Relion and the strips; here's to another learning curve:)
     
  42. Karen Mulholland

    Karen Mulholland Member

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    Thank you Chris, I bought a Relion meter and strips at Walmart today and picked up the Lantus pen. I'm planning to begin with the Lantus tomorrow. I'm taking the day off, so I can watch him. The low's with the Novolin were really scary. I'm optimistic that the Lantus will work better. I couldn't do this without all of the support I have gotten. It really does make the world a better place:) Thanks again
     
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  43. Karen Mulholland

    Karen Mulholland Member

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  44. Chris & China

    Chris & China Well-Known Member

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    Do you understand that you just use regular insulin syringes and pull the insulin out of the pen? You don't use the special "pen needles"
     
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  45. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    Another think about Lantus: keep in mind the dose will take a few days to show its magic so don’t be dishearteend if you see higher numbers at first. It will get better.
     
  46. Karen Mulholland

    Karen Mulholland Member

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    Stephanie, I think you just read my mind!! I just gave Rock his first dose! I'm, going to monitor closely, try not to panic and, as instructed, hold the dose.
     
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  47. Karen Mulholland

    Karen Mulholland Member

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    Yes, Chris I do. The needle only gives 1 unit increments, and I'm starting Rock (I did this a.m.) on .25. I have tried to read all of the info. available on this site. Now the real challenge is to remember all of it:)
     
  48. Karen Mulholland

    Karen Mulholland Member

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    Oh boy, at the 12p.m. BG he is at 117 AT and 47 Relion. We started at 8 with 274 AT and 261 Relion, 10 180 AT, 117 Relion. I beginning to get nervous. At 8, 10. and 12, 1/3 can FF was given? I will retest in 30 minutes.
     
  49. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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    6a00e5500f82a3883401a73dd73951970d-600wi.jpg
    Karen, hope you're remembering to breathe! Pls post new test asap. If still low you'll need more than the lc ff. :bighug: karo or hc on hand?
    6a00e5500f82a3883401a73dd73951970d-600wi.jpg
     
  50. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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    Karen are you guys ok?
     
  51. Karen Mulholland

    Karen Mulholland Member

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    94 AT, 49 Relion: I gave him more food.
     
  52. Karen Mulholland

    Karen Mulholland Member

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    Thank you Myagi for checking. I think so.
     
  53. Karen Mulholland

    Karen Mulholland Member

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    Yes, I have all the emergency things on hand is 49 ok on a human meter?
     
  54. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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    Still low. Do you have any higher carb to give just a tsp and retest 20 mins?
     
  55. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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    Btw, under 50, Rocky has already earned a reduction!
     
  56. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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  57. Marje and Gracie

    Marje and Gracie Well-Known Member

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    I’m not that worried with a 94 on an AT as it is the more accurate for a cat. He’s getting close to nadir so I’d feed him some higher low carb and retest in 30.

    Where is he in the cycle? About +5 I’m thinking? The SS is not updated.
     
  58. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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    Yeah first day on lantus and human meter. Should be+- +5 I think too. The 47 scared me. Not familiar with at numbers.
     
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  59. Marje and Gracie

    Marje and Gracie Well-Known Member

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    I understand. If I hadn’t used an AT2 myself, I would also be very cautious.

    Karen...we need to get an update from you and it would be best if you pick one meter and stick with it. It’s confusing for other members helping if you are using both meters.

    As an example, with the AT2, he didn’t earn a reduction even under our Start Low Go Slow method. But he definitely did with the human meter.
     
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  60. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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  61. Karen Mulholland

    Karen Mulholland Member

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    O.K. just tested again. AT 96 The Relion is 55. I am doing side by side to try to get an idea of differences. I like the Alpha Trac but as you it expensive! Thanks
     
  62. Marje and Gracie

    Marje and Gracie Well-Known Member

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    Did you feed him when you got the 94AT and 49 ReliOn?
     
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  63. Karen Mulholland

    Karen Mulholland Member

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    Eating again, I have been keeping him to about 190 calories a day as per Dr. Lisa for weight reduction. I think he is about 2 lbs overweight. Maybe that's effecting numbers?
     
  64. Karen Mulholland

    Karen Mulholland Member

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    Yes I did. I try to feed him every 2 to 3 hours.
     
  65. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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    Yes she gave more food at 49 relion.
     
  66. Marje and Gracie

    Marje and Gracie Well-Known Member

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    Doubtful that the weight is the issue.

    I’d give him 30 minutes after he’s done eating and just make sure he is continuing up. If he is, you can give him a testing break for an hour....or more if he’s zoomed up.

    That might be one of the reasons he dropped on you so much on Novolin and might do the same on Lantus. We will have to see his patterns but many cats need more of a feeding schedule to work with the insulin.

    I’m on the way out but Heidi will watch for his numbers and I’ll check back in when I get back.
     
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  67. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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    Karen when you're numbers are lower and you need to get them up for safety it's good tho keep in mind: feed a little and retest, don't worry about regular food schedules, don't feed too much cause you might need kitty to keep eating to raise bg. :bighug: when will you test again? Can you update the ss?
     
  68. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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    @Karen Mulholland
    When is next test? I'll stay with you but want to do some things in between.
     
  69. Karen Mulholland

    Karen Mulholland Member

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    Next is 3 p.m. I have updated SS and enter only Relion numbers. I got the Relion because on the Sticky regarding Lantus that is what was suggested. AT is as you know expensive. Thank you again for all of your help.
     
  70. Karen Mulholland

    Karen Mulholland Member

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    I wonder if amount of water would have an impact. Every time I feed him, I add water so it's almost a soup. Dr. Lisa suggested as much H20 as possible. So he is indeed getting a lot of water?
     
  71. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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    Is that in half hour?
     
  72. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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    Not the water. He needs the water.
     
  73. Karen Mulholland

    Karen Mulholland Member

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    He is at 57 Relion.
     
  74. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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    Ok. He's moving slowly right direction. Can you give him a higher carb snack fur safety?
     
  75. Karen Mulholland

    Karen Mulholland Member

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    I will test again in 2 hours, 5 p.m.
     
  76. Karen Mulholland

    Karen Mulholland Member

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    yes I have the FF for gravey lovers.
     
  77. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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    Cool. Give him some now and we'll check in later! :bighug::bighug:
     
  78. Karen Mulholland

    Karen Mulholland Member

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    If I am in fact going to reduce his dose, how do I get less than .25?
     
  79. Karen Mulholland

    Karen Mulholland Member

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    If I could hug you I would, thanks again.
     
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  80. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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    Wait fur someone senior on the reduction. But I eyeball it between the lines. Some use caliper. Hugs back!!;)
     
  81. Marje and Gracie

    Marje and Gracie Well-Known Member

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    Just an observation to toss out there but, generally, after mid cycle or nadir, unless kitty is hovering under 50 or has dropped suddenly, we want to feed low carb food. If you feed a higher carb food later in the cycle when numbers are rising, you risk ruining the duration of the cycle.

    Since you’ve decided to stick with the human meter, then I would go ahead and reduce and see what he does. You might have to go back up but since he is new to Lantus, we should be cautious and opt for safety. I would suggest you drop him back to 0.1u. The sticky on Syringe & Insulin Info & Drawing Fine Doses has a picture of 0.1u for you to look at. Your 0.1u doesn’t have to look exactly like this but you want to try and draw it as consistently as possible. You might want to practice just using water.

    I’d like to suggest that you post on the Lantus/Levemir ISG as there are many more eyes experienced with Lantus there. Thankfully, Heidi saw your post on Health. We have a bit of a different protocol for posting there so if you have a few moments to read Making the Most of your Lantus/Levemir ISG Experience, it will be helpful to you. I’d also recommend that you start to read the stickys at the top of that forum as well. Lots of good info, especially New to the Group.

    If he were my cat, I wouldn’t wait two hours to test. If you fed him gravy, it would be good to see what that does for him and how it affects his numbers. The goal in his diabetes treatment is to get him well regulated and you have to know how he responds to different foods (i.e. % carbs) at different times in the cycle. It would be great info for you to test him an hour after he finished his last meal to see what it did to his BG.
     
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  82. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

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    Oct 30, 2017
    Fyi when Myagi reduced to 0.25 and 0.1 and 1 drop, I practiced with Grape juice so I could see it for sure! ;) :bighug:
     
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  83. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    Great idea!!!
     
  84. Karen Mulholland

    Karen Mulholland Member

    Joined:
    Dec 26, 2017
    Thank you Marje, he is at 90 now. I will look at the sticky for info on the o.1 dose and definitely practice first. I will also post on the Lantus/Levimir site.
     
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  85. Karen Mulholland

    Karen Mulholland Member

    Joined:
    Dec 26, 2017
    Good idea I don't have grape juice, but I guess I could use ice tea?
     
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  86. Myagi (GA) and Heidi

    Myagi (GA) and Heidi Well-Known Member

    Joined:
    Oct 30, 2017
    Anything colored! :p
     
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  87. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    Wonderful!!! We’d love to have you. It’s a very close group.

    I would suggest you give yourself about 15-20 mins before PMPS to test him and post for help in the Lantus/Levemir forum in case he’s 150 or below. If he is 150 or higher, go ahead and shoot but if he’s below 150, don’t feed him. Post for help and we can walk you through the options.
     
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  88. Karen Mulholland

    Karen Mulholland Member

    Joined:
    Dec 26, 2017
    Marje, I did post to the Lantus group and his pmps is 120. I have not yet gotten a response. Thanks
     
  89. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    I am really sorry. Are you still there and can you shoot two hours late and catch up 30 min a day?
     
  90. Karen Mulholland

    Karen Mulholland Member

    Joined:
    Dec 26, 2017
    Nothing to be sorry for. Your support is invaluable.
     
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