Will it ever happen???

I'm getting pretty frustrated with Hannah Belle's numbers. When she was first diagnosed in December of last year, the vet thought she was a good candidate to go OTJ. Here we are 11 months later and her blood count averages from 200-250 on 2 units of Lantus twice daily. I wonder what I've done wrong and if she (and I) will ever get a break.

 

Hello,

I'm sorry you're feeling frustrated, but you've done absolutely 'nothing wrong'. You've done a good job. Those numbers really aren't bad! (It took me several years to see numbers as good as those!) And you're managing to keep your kitty's numbers mostly below the renal threshold, so that's good for her kidneys.

Everyone hopes their cat will go into remission, but not all cats do. Though I see from looking at another of your posts that your kitty's diabetes could have been steroid-induced. That would have been why your vet thought she'd be a good candidate for remission. (Steroid-induced diabetes can be 'transient').

Maybe there are some changes you could make that could improve her numbers further and/or increase her chance of remission. Are you posting for advice on the Lantus forum here? There are some very experienced folks using the same insulin as you that may be able to help you there.

And what are you feeding your kitty? Is it possible to further lower the carb content of her food? (If you do this, do monitor her blood glucose carefully during any transition.)

Eliz

 

HI!
Elizabeth gave you great advice. Lantus is a good insulin. Yet, if you lost some hope, you might try this: switch insulin to Levemir or ProZinc. Statistically Lantus is great. Yet, the best insulin is the one your kitty responds to & one that supports your hope. Levemir gives smoother curves than Lantus. ProZinc & PZI are made especially for cats. I was absolutely sure that my Pudge would never go OTJ, but he did. First remission was on ProZinc, his second on Levemir.

Best wishes,
Sophie

 

Hannah's numbers aren't so bad... What are you feeding her and what's her weight? As others have mentioned maybe you just need that little extra kick. :razz:

 

My other cat, Raya, had the steroid induced increase in blood sugar which went back to normal when she got off the medicine. Fortunately, she is not diabetic. I'm sorry the spreadsheet isn't up to date; it doesn't reflect recent numbers, which have been mostly 200-250.

I'm not a member of the Lantus group; maybe that's a good step. My vet says 2 units is the "magic number," but isn't 200-250 an abnormal range? Shouldn't she be maintaining levels in the 100's?

Hannah Belle gets primarily Fancy Feast Classics (as well as Fish and Shrimp which is 0 carbs) and Friskies pate. I have also given her Pro Plan chicken and Sheba pates to keep her from getting tired of the food. Everything (except Sheba) is on the catinfo list as under 10% carbs with Fancy Feast and Pro Plan at 5% or under.

 

Dusty Bones, her weight is 14.2 lbs. She could stand to lose a pound or so.

 

Yes, unless she's a coon cat or other large cat breed she is heavy. Normal weight for an average female cat is 9-10 pounds. That may be part of the problem or part of the solution, have her slowly loose some weight. flip_cat Both my male cats currently weigh 11.4 lbs. Dusty weighed almost 19 lbs when he started to go downhill. At diagnosis he was down to 10.6 lbs.

 

Deb & Wink provided this link http://vet.osu.edu/vmc/body-condition-scoring-chart to help assess your kitties weight.

 

Hi,

As far as I know there is no "magic number" regarding insulin dosage (some cats need a little and some need more). But maybe your vet means that 2 units is a "typical" dosage...?

Regarding the numbers you're seeing currently - 200 to 250 - yes, these are above the normal blood glucose range. But they are not at all bad for a cat on insulin.
Yes, the ideal scenario would be if the cat could be kept in, or close to, the normal blood glucose range (while at the same time remaining safe from hypoglycemia); but that isn't always possible. Some lucky cats do stay in normal or near-normal numbers. But many of us have cats that have numbers above the normal range. And some people struggle just to keep their cats out of quite high numbers. So, you ain't doing too badly! ;-)

Eliz

 

Just do not give up. I presently have four diabetic cats on insulin and had eight diabetic cat that I had to say goodbye to. None went off the juice.
As Eliz said 2 units may be a the typical/average dose but it varies. My Smokey is on about 1.2 unit while my Dante/MurrFee is on 11.

 

Is she still getting access to the dry food in the house? That won't help if she is. You might want to switch it to a low carb dry if you can't take it away altogether. i.e. Innova Evo Cat & Kitten 8%, Nature's Variety Raw Instinct chicken 7%, and Young Again zero Carb 0%

Can you update her SS? I would like to see how she is doing the last few weeks. We might be able to advise more on dose etc.

thanks

Wendy

 

I updated the spreadsheet and actually her numbers are all over the place, not as consistently in the 200's as I thought I remembered. As for dry food, she likes to sneak a few pieces of Raya's kibble sometimes when I'm not watching, but the amount in minimal and it's Instinct Chicken, which is one of the lower carb options.

Last dosing protocol the vet and I tried was 2 units for readings 100+, 1 unit for 60-99 and none below 60. As you can see, lowering the dose causes high numbers. I tried it once at one unit and once at 1.5. Now I just stick with 2 units ("the magic number").

 

Oh she is such a cutie.

I am glad you aren't doing sliding dosing any more. It generally doesn't work well for lantus.

Anyway from what I see here is she is bouncing up and down. Bouncing means that she is getting lower numbers than she is used to and her body panics and the liver causes the sugar to rise.. Which can last up to 72 hours. The low that triggered the bounce may be dangerously low, or lower than she is used to. And you can tell bouncing when the SS doesn't seem to follow the normal lantus curve.

Anyway She may be going too low. Maybe even hypo. But we can't tell without more tests. Can you get a before bed test a few hours after your nighttime shot , especially if her preshot is blue or green. And/or a midday test on the days you can. We are looking for numbers under 50 which means a decrease would be necessary of 0.25units

Wendy

 

Seconding what Wendy said. If you are able to take more BG readings through the day it would be helpful...it does look like your kitty's bouncing.
You should join the lantus tight regulation user's group (even if you don't intend to do tight regulation) then you can ask for specific advice and lots of eyes will be on your BG readings. They can help you tweak dosing, BG reading times, food etc. If you'd really like to try for remission,
they've got great results. Not every kitty will go into remission but many do. Even just reading the pinned topic posts at the top of their board is very helpful, particularly the tight regulation protocol, recommended dosing and testing "rules" recommended for lantus....most important how to handle hypos and when to lower the dose.
Also reading other people's posts in that group and looking at the spreadsheets of other users and watching how they're dosing and responding to the BGs they see is educational. You've been doing this a while so probably know all of this already, but perhaps there's a few tidbits of information that will be of use to you :smile:

Edited to add: Hanna Belle is so adorable! What a cute picture!

 

I'll try to get an additional number before bed. Can get a few midday readings next week while I'm off work.

Will join the Lantus group.

I've got another simplified spreadsheet I'm keeping that is emailed to my vet on a weekly basis. It gives time of BG test, results, time of shot, number of units and also includes the two pre-shot feeding times (she gets a third meal at bedtime). I'll see if there is a way to attach it to my profile.

 

I can sympathize! I can't make heads or tails of Heff's numbers. The dose changes don't seem to make a difference. I have little hope for remission.

 

I'm glad you did not follow with this dosing. Lantus is a depot insulin and is most effective when the same dose is given twice a day. That being said, from looking at her spreadsheet, you are giving shots when she is already low (in double-digits). We don't even recommend for new users to give shots below 200 and you're giving the full dose at numbers even I would think twice about. Without a few mid-cycle tests to see how low she might be going, it makes it difficult to tell what's going on, however, the low pre-shot numbers is a sign that the dose is too high. The swings you're seeing with the pre-shot numbers going from high to low to high again is another major red flag that the dose is too high. I would recommend at the very least dropping the dose across the board to 1.75 or even 1.5u for a few days to see if these bounces stabilize a bit and her pre-shot numbers level out. But please, try to get some of those mid-cycle tests when possible, like a before-bed test every night, so we can see how low she's really going.

 

Can you get a before bed test - say 2-3 hours after the PM shot? That will tell a lot- especially when the pre shot is green! If this number is lower than pre shot you will want a mid night test. I am concerned she is dropping low under 50 mid cycle (especially with the green pre shot) which will mean her insulin dose is too high.

 

Doing a bedtime check now.

Had a bit of a scare on Thursday. 12 hours after her AM insulin shot, her BG was 48. 2 hours later is was down to 40. Gave her some higher carb food, which stopped the drop. Called the vet in the AM and dose was reduced.

Thanks everyone for your continued advice! I come from a diabetic family (runs on both sides), so I came into this diagnosis with a strong familiarity of the disease. I'm not, however, familiar with insulin-dependent diabetes and this has been quite challenging.

 

You're getting the hang of it.

Have you read over our protocol for managing low numbers? Here.

 

For the first time, I think I may getting the hang on it. Although, my favorite part of managing low numbers is "don't panic!" Yeah, haven't quite mastered that concept yet. ;-)

 

Yay! Brilliant stuff! :RAHCAT

 

Looking good - lets hope this dose decrease holds! will be interested to find out what this mornings AMPS was.