Tremendous progress after adding fast-acting insulin to Lantus TR treatment for long-term diabetic

Justin & Sebastian

Justin & Sebastian

Very Active Member
Preface: Every cat is different and nothing I'm about to say is advocating this method for your cat. Sebastian has been diabetic for 6 years, has an IAA of 85%, and his circumstances are fairly unique and my results may be a result of that uniqueness. This post is simply to provide data and an argument in favor of the usage of fast-acting insulin where appropriate.

I started incorporating Novolin-R usage into Sebastian's regular Lantus usage about a month ago. The results speak for themselves. We're going on almost a month now of never spending more than 24 hours over 200. We've had more green/blue days in the past few weeks than we had for the entire previous 8 months combined. I'm still dialing in the appropriate dosage based on his BG movement but things have been great. He's gotten back to his normal weight just shy of 13 lbs and he's got good energy.

So how did I get here? As you can on the sheet, about a month ago we were up to 9 units of Lantus and not seeing much change, still pretty firmly in the 200s with only occasionaly dips below, and not much difference between 9 units and 5 units, or any other dosage. My gut told me this was wrong, so I started to do a bit more research. I'd seen talk thrown around the forums about resistances, both IAA and glucose toxicity, but I had never really seen the actual specifics explained of how those resistances functioned. I looked into glucose toxicity and what I learned changed everything. Glucose toxicity occurs when the BG is too high and it begins to impede the body's ability to use the insulin. The condition worsens the longer the BG is too high, so you get into a downward spiral where you need more and more insulin. This is where we at. His resistance was high and the TR treatment alone wasn't getting us ahead of it.

I knew that human diabetics don't treat it with slow-acting insulin alone. They use a combination of slow-acting and fast-acting. I didn't see why cats should be any different. Normally humans will use the fast-acting right after they eat so it's counteracting the spike. Sebastian is a free-feeder and eats about every 3 hours, so I knew I needed to do it a bit different. Fast-acting insulins have a maximal effect range between 2.5 to 5 hours and last for a total of about 8 hours. So, with those ranges in mind, and knowing Lantus was going to nadir at around +6, my goal was to use smaller dosages more frequently to layer in the effect ranges. So I dosed fast-acting at +0 and +6. This way we weren't doubling up on nadirs, rather spreading them out so the whole day is effectively a nadir, keeping the numbers low and even throughout the day. It got us consistently below 200 pretty quickly and the resistance seems to be reducing already, since I've been lowering the dosages of both types of insulins now.

Hope this helps those that need it. Edit: And as @Sienne and Gabby (GA) mentioned below, if you do decide to try it out, seek help and guidance first. We're usually flying without vet guidance in the first place so it's best to get whatever help you can.

direct ss link: https://docs.google.com/spreadsheets/d/1SDnZTgt1uI1yGNIe4j8IoAs7VvC-ocxdHnglQ6MJVi8/edit?usp=sharing
 
Last edited:
Thanks for the update, It’s so great to hear that Sebastian is doing well! His spreadsheet certainly looks good :D:cool:
 
A word of caution to those reading...

We strongly advocate that if anyone does have their cat tested to determine if a high dose condition is present, that you work with a member who is experienced in the use of a fast acting insulin, such as Novolin/Humulin R. There is a great deal of nuance to the use of R and if not used properly or if used aggressively, it can cause more bouncing than before or it can be lethal. We have several people who are experienced with the use of R so if this is something you are considering please post and let us know.
 
I’m glad Sebastian is doing well.

As you know, we’ve all had discussions about your use of R with Sebastian. It’s incumbent that we point out a few things for those members, especially new ones, not familiar with using R.
  • R has been used for different situations in this forum for well over a decade; Sandy was the first to use R, quite successfully, to combat IAA; Black Kitty went into remission and stayed there. There is a ton of data already out there on existing SSs and the knowledge base for using R on this forum is quite large; no one needs to argue in favor of it.
  • As Sienne pointed out, there are a lot of caveats to using R to keep its use safe and it is important members who wish to use it work with an experienced R user before doing so; experienced R members can be tagged or PMd for help; most of us have it in our signature block if we’ve used R.
  • Your use of R really raises some red flags and, for those of us experienced using R, we believe Sebastian has been put at risk for hypoglycemia:
    • On 11/1, you shot 1u of R into a dropping 70 and didn’t test again for three hours at which time he was in the 30s. You then failed to reduce the dose even though TR states that dose reductions need to be given for BGs below 40.
    • On 11/2, he dropped into the 40s but you still didn’t drop the dose.
    • On several occasions, you’ve given 2-3u of R and either not tested for three hours or not tested again at all (10/19 pm cycle).
  • IAA is self limiting after a year; we don’t how long he’s had IAA but he was up to 7u of insulin bid in Jan, 2019; point being that it could be R helping out, it could be the IAA waning out of the picture, it could be a mixture of both.
We are all for members sharing success stories and I appreciate that you were very clear that you believe this is what worked for Sebastian and that it is ECID. That latter point cannot be overemphasized.

Justin & Sebastian said:
I'd seen talk thrown around the forums about resistances, both IAA and glucose toxicity, but I had never really seen the actual specifics explained of how those resistances functioned.
Click to expand...
I’m really not sure how you missed that on this forum. There is an entire post that deals with glucose toxicity and has references. It’s been around much, much longer than you’ve been a member here. There have also been alot of discussion and posts regarding IAA; Wendy and Sandy are two experts on it. They have frequently explained how IAA functions (and it’s not rocket science) as well as glucose toxicity and what it means has been addressed in many discussions.

I’m glad Sebastian has gained weight and his dose has come down. My goal here is not to be discouraging but to point out to active members and lurkers that R is not being used safely in every instance that you’ve used it and that we have a team of members who can help learn how to safely use R. We often suggest it to members where we think it will help; however, many members choose not to use it because, to do it safely, it does involve a time commitment in testing.

Best of luck. :)
 
Last edited:
Yeah, definitely don't do exactly what I'm doing. I assure you there's a method to my madness backed up by data and my constant attention but I didn't expect it to look like anything other than recklessness to anyone who's not in our shoes. I knew I'd get the scolding but felt it was worth it to argue in favor of R, because despite what you say, it very much seemed like it needed some advocates for it being an important addition where appropriate.
 
Justin --

You're missing the point. No one is saying to not use R. It can be an enormously helpful tool. There is a HUGE caveat with respect to it being used carefully. For example, did you bother to run a curve for 4 hours after you injected R? Were you aware that the nadir for R and Lantus should not overlap? I suspect these are not factors you thought about. Working with an experienced person would have alerted you to potential pitfalls.

So, again, I will underscore for anyone else who is considering using R, please post and let us know and we will team you up with someone experienced in the use of R.
 
Justin & Sebastian said:
Yeah, definitely don't do exactly what I'm doing. I assure you there's a method to my madness backed up by data and my constant attention but I didn't expect it to look like anything other than recklessness to anyone who's not in our shoes. I knew I'd get the scolding but felt it was worth it to argue in favor of R, because despite what you say, it very much seemed like it needed some advocates for it being an important addition where appropriate.
Click to expand...
I also think you are missing the point(s).

Nothing is meant as a scolding. You aren’t a child. ;) It’s a teaching lesson for others thinking about using R.

Using R needs no advocates. I used it a great deal and with great success for bouncing. I’m a huge fan. It’s invaluable for post DKA cats, high dose cats, and bad bouncers. I’d say 90% of the time when I suggest it, CGs say, “no thanks” because it does take constant attention,

Although your definition of “constant attention” and mine are different. :rolleyes: R is not a “shoot and come back three hours later or not” insulin. It’s a “test every hour” for a few weeks until you have overlaid R and L curves at different times, see a definitive pattern, and done an R scale; after that, depending on what the BG tells you, you could perhaps go two hours.
 
Sienne and Gabby (GA) said:
Were you aware that the nadir for R and Lantus should not overlap? I
Click to expand...
I did! I even mentioned as much in my post. Believe it or not, I'm not the idiot you guys seem to think I am. And, once again, I would have been happy to accept guidance and advice but none came after multiple attempts.

Okay, this has taken the expected turn and nothing constructive will be forthcoming. Ive said my piece so that'll be that.
 
Justin & Sebastian said:
Believe it or not, I'm not the idiot you guys seem to think I am. And, once again, I would have been happy to accept guidance and advice but none came after multiple attempts.
Click to expand...

Wow. Nowhere in this post do I get, “we think you are an idiot”. I’m not sure why you’ve gone down that path again. Just because a member does something I think is unsafe, doesn’t automatically translate to “= idiot”.

And Mea Culpa that we missed your request for help earlier in the fall. Sometimes it just happens that we are all off the board at the same time because of vacation, work, family obligations. It wasn’t personal. I was hoping that by my post, you would see it as, again, teaching comments instead of “he’s an idiot”.:confused:

Whatever you might think you know about using R after about two months, let me just say that after years of using it, when Gracie got sick, I asked for help from Jill and Libby and they came to the rescue. It’s never too late to learn something new or something else.
 
Hello Sebastian
I just want to correct a misconception about when you asked for help about using R.
When you posted and asked for help both @Wendy&Neko and @Sandy and Black Kitty both responded to that thread and offered to help. Wendy also offered to ask around for help for you.
You could easily have PMd them to start a conversation about R, knowing they were willing to help.
I also saw on another thread that Wendy tried to advise you on the use of R once you had started it.
I have seen R used several times here and it is always done under the guidance of an experienced person.
I think we all need to remember that this forum is run by volunteers who give up their time to help other people's kitties. I'm sure if they are like me, they live very busy lives but they make time, day after day, so that FD cats all over the world can lead better lives.
 
I’m glad to hear Sebastian has regained the lost weight. That is a really good sign – evidence that he is getting enough calories and enough insulin to metabolize those calories and deliver the resulting energy to the cells of his body.

What was your rationale in drastically reducing the L dose at the same time you started R?

For folks that do not know me, my Black Kitty was the first FDMB kitty to test for IAA; it was late summer, (I believe) 2008. His result was 84%, which is considered ‘extreme insulin resistance’. However I started using R well before the IAA diagnosis. BK was hospitalized for DKA twice in a little over a month and was down to a little over 7 lbs. His ideal weight was around 11.5lbs - I had to get more insulin and calories into him, he would not have survived another episode of DKA. I used a lot of R.

R is very powerful and can be downright dangerous if not used with care.
R is also very seductive; (all the lovely numbers)

A few red flags regarding safety:
  • I’m not seeing that you created any R scales to guide you
  • Shooting R at a green number, it’s far too risky for any cat, especially one with IAA as the antibodies could give up the ghost at any time.and when insulin sensitivity returns, it can happen quite suddenly. At these times, large amounts of insulin previously bound to the antibodies may be released into circulation .
  • Justin & Sebastian said:
    Fast-acting insulins have a maximal effect range between 2.5 to 5 hours and last for a total of about 8 hours.
    Click to expand...
    IAA can lead to an increase in the half-life of free (unbound) insulin in circulation because some bound insulin gets released back into circulation. The increase in half-life can lead to prolongation of action.
  • On 11/2 you had to feed HC to a 43 at +6 and then at +8 shot .5uR at a 97. Was it to head off a potentially ugly bounce from the 43 (which was likely caused by previous R shots)? This is a very slippery slope. I've seen it happen many times. A CG sees a number they don’t like and decides to shoot it down with some R. However the R drops the kitty too far and/or too fast, resulting in a bounce. So to head off the bounce, out comes the R… and the continuous loop of chasing numbers begins The only way to escape the endless cycle of causing a bounce followed by an attempt to put a ceiling over how high it will go is to stop R completely.
What is your goal for Sebastian - to be well regulated, tightly regulated, remission?
Where do you plan to go from here? Continue with +6 R around the clock? I did it for 5 weeks or so after BKs second DKA. It was rough; wore me out.









 
You must log in or register to reply here.
Back
Top