NEED HELP WITH INSULIN !!

Hello,

I haven't posted on here lately, due to been back and forth to vet with China. I switched her from Humlin NPH to Lantus to try and get her numbers down,however they don't seem to be coming down that much. Took her to vet because she started peeing outside the litter box which she has never ever done. She had a UTI so was given an injection on an antibiotic that is to last two weeks. However its been two weeks and she still is peeing outside of liter box. Could this be because her Blood Sugar are all over the place and seem to run high most of the time? While at the vet they told me to give her 1.5 units twice a day and would repeat blood sugar check at the vets office in one week, to see how the numbers are on the 1.5 units. She goes back to the Vet Monday to see how her blood sugars are doing. However if you just look at my spreadsheet you will see they have not gotten any better. Should I increase her Dose to 2.0 Units twice a day instead of waiting for Monday? Just because her numbers have been high for so long its making me really nervous, am so afraid of what these high numbers are doing to her other organs.
I am having a real hard time getting her numbers to go down and stay lower or as close to normal as possible. She is always hungry, am afraid I am not feeding her enough. I give her 2 of the 3oz cans of FF wet food a day Is this enough? Sorry for all the questions, I just feel so defeated by this, that no matter what I do it doesn't make a difference and in the end she is the one suffering, cause I can't seem to figure it out. Can someone please help me and give me advice or ideas on what I am doing wrong or what I am not doing that I should be doing. Should I keep her on the Lantus or put her back on the Humlin NPH? I just am so confused.

Thanks in advance
Vickie

hi Vickie
sorry you are having a hard time.... i totally understand how you feel. this process is a marathon and does take alot of time and patience. it looks like you were starting to get some better numbers and then the UTI happened. infections like that can raise the blood sugar levels so maybe she is still recovering from that. i am fairly new too so i will defer to someone else to give you dosing advice. i just want to tell you to relax and take a deep breath. you are doing fine but this just takes alot of patience. also, how is she doing otherwise? does she play, purr .etc? they call it the 5p's playing, purring, peeing, pooping & preening. i have definitely had to learn to be patient with my little sugar cat. anyway welcome .
nadine & tibbs

Thanks for the advice its hard to be patient,when it comes to this but am trying..China does all the P expect for playing,but she really never did as she got older. She just eats sleeps and chills.She loves for me to pet her and give her all kinds of kisses which I love also wont lie. I just worry about her and her health. I will work on relaxing. Thanks again.

Vickie

Hi Vickie,

It's really hard when there's anything wrong with our little ones and it can be really tough on the body, mind and heartstrings in the early days after diagnosis but, as Nadine has already said, it takes time and patience (not something I'm good at but I'm having to learn ) which is really hard when numbers are turning red and pink on the spreadsheet and we're desperate to help our little ones. :sad: There have been many times over the past few months where I felt powerless to help my girl, and there were many, many tears too. Take heart from the fact that you've got a good insulin for China, you're home testing to keep her safe and you've got China on the right food to help her get better. There is an awful lot to get one's head around and much confusion in the early days but that, too, will get easier as you learn more.

The UTI probably won't have helped matters. With unregulated cats, sugar in the urine doesn't help matters.

Like Nadine, I'm a novice sugar kitty parent. Hopefully more experienced members will be along soon to help you out with dosing. The Tight Regulation protocol recommends small dose adjustments, usually of 0.25 IU. Larger dose adjustments can result in missing the optimum dose that works for your kitty. From my own experience of Lantus, once you get the right dose there is slow but steady improvement as the body gradually gets used to healthier numbers and numbers will start coming down. This isn't great for us worried beans because we want good numbers yesterday, but it does happen. It might help you to have a look at my spreadsheet to see where Saoirse started (on Caninsulin - a very harsh, short-acting insulin) and where she is now (on Lantus). I use slightly customised colours in my spreadsheet, but it's clear to see how Saoirse's numbers moved out of the reds and yellows down into the greens as she became well-regulated and then tightly regulated. In particular, maybe have a look from 19 August onwards when Saoirse started on Lantus to see how the numbers have slowly but steadily improved with treatment.

With regards to the hunger, that will lessen when China gets into better numbers. At the moment, because you haven't found the right dose yet, there isn't enough insulin in China's system to get the glucose from the blood into cells to give the energy they need to function. How is China's weight at the moment? What is her ideal weight? With this information and the nutritional analysis from China's food we can help you with working out how much to feed. Unregulated cats may need more food because their cells aren't able to utilise the nutrients in their food properly. It would help if you could give us an idea of what size meals you give and at what times during the insulin cycle you feed China.

Hang in there, Vickie. Things will get better. :YMHUG:

Hi

I would stick with the lantus it is a good insulin but I think that you would ideally get more tests in throughout the cycle as for a lot if the time you only know what the preshot numbers are. Lantus dosing is changed according to how far they drop at their nadir and at the moment I guess it is diffuse to tell if she is dropping and then bouncing or just staying high.

Having said that I am a newbie to and so my only suggestion would be to get more tests in, even if they are +1 or +2. I would also think about changing the dose by only 0.25 if you do change as Aine mentioned.

Thank you for the advice and the kind words Anide, that helps I too am not a patient person when it comes to her. I am going to do a curve today to see where she is at. Its just hard during the week to get numbers after shot because I am at work all day. I try to get some after her PM shot, but that doesn't always happen either. Am working on getting a routine down so its more consistent.
As far as her eating I feed her a 3 oz can of moist FF classic 2x day plus she will eat whatever my other cats don't eat of there food. I have always free feed my cats dry food, and I know the dry food is not good for China so I am taking that away from her and putting it to where the other cats can get to it but she can't.China pretty much lays on a kitchen chair and stays close to the kitchen where she eats other than going to where the litter boxes are. I think that sometimes her numbers are high because she might have been eating the dry food and I didn't know she ate like an hour or so before I tested her which would cause her numbers to be up. So today since I am home all day, I am going to make sure each time I test her that there is no way there is food where she can eat it each time I test her to see what the numbers do.
For her insulin the vet wants her on 1.5 units 2 x day I took it upon myself to raise it to 2 units 2 x day. Should I go back down to 1.5 units and see how that goes today? With me changing her dose back and forth will that mess up her numbers also? OK last question for now, how long after she eats should I give her the injection? I have been waiting 30 minutes.
Again thanks for all the help, and I grateful for any and all advice I can get to get her numbers down and to stay down.

Vickie&China confused_cat

Hi Vickie,

It is possible to test, feed and inject in about 10 minutes with practice. Obviously if China ever experiences problems with eating then you should let your vet know so that the right decisions can be made about insulin treatment under such circumstances.

Lantus is a depot insulin. They work by building up a store of insulin in the body that slowly makes its way into the bloodstream over time. The idea is to adjust doses until the rate at which injected insulin tops up the depot matches the rate at which the cat's body uses the insulin. Finding that optimum dose is where the need for patience comes in. Too low, and kitty's numbers will be higher than we'd like, too high and there's a risk of hypoglycaemia. The patience part is It works best with consistent dosing. It takes several cycles for each dose to settle as the kitty's body takes time to adjust. As I mentioned last night, doses are generally adjusted in small increments. Because most cats only need a tiny amount of insulin it can be easy to overshoot the optimum dose if adjustments are made in increments that are too large. Too much insulin can cause hypos or drive numbers higher because it prompts the kitty's liver to release too much glucose into the bloodstream in an effort to prevent the cat from becoming hypoglycaemic. Too little insulin and the cat is at greater risk of producing ketones as well as being exposed to glucose toxicity. There's no magic formula for the right dose, unfortunately, since each of our kittys is unique and their metabolisms vary.

Have a look at the link below. You'll find a PDF link on the destination page labelled "Management of Diabetic Cats". Have a look at the PDF. It's the published Roomp-Rand Tight Regulation Protocol. Within the document, there are tables that will give you an idea of how doses are held for a number of cycles and then adjusted based on the nadirs produced by each dose. Tight Regulation protocol users adjust doses more quickly than Start Low, Go Slow (SLGS) protocol users, but the TR protocol requires more frequent testing to keep kitties safe.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Also, click on the link to Remi's spreadsheet in Sarah's signature (phlika29). Remi was recently diagnosed and he is responding really well to Lantus. When you view Remi's spreadsheet, you'll see how he started in pinks and reds but then started moving down through the yellows to blues and greens as Sarah homed in onto a good dose for him. Hopefully that will help you to get your head around how a cat's body gradually adjusts to the Lantus and how numbers can improve as treatment progresses.

Your description of China's behaviour sounds like she may be lethargic? If so, it's a hallmark symptom of feline diabetes. If she's eating any dry food then that won't help her numbers. I would urge you to caution when you start to remove it and to test

So China BG at +3 went up from 521 to 527 which isn't a lot however is it safe for the BS to stay so high for a long extended period of time? She is hungry I can tell she keeps walking around in the kitchen looking for something to eat. I just feel so bad for her, but don't want to feed her anything while I am doing this curve so I can get a idea of whats going on. So will check her again in an hour to see if it has gone down any. Will post as soon as I get the number.

Thanks

Vickie

Do you check China for ketones. With the higher numbers it is best to check for the presence of ketones using the urine test strips.

I have also asked for more experienced members to comment of your dosing. But carry on testing in the meantime.

I have probably missed this but what do you feed China and at what times? Feeding obviously affects the readings so if you fed her at +2 then that could be the reason for the slow drop.

Hello again,

I have another question, since China is hungry all the time and I have started her on only moist food no dry, and I have read several places that she should be feed several small meals a day, but if you are doing a curve or checking her BG at least 3 to 4 times a day, how do you feed the small meals? If you feed a small meal wont that affect her next BG reading? Thought and ideas please.

Thanks again
Vickie&China confused_cat

Avia,

I feed china FF classics and I feed her at 7am after checking her BG and was at 7pm after checking BG but I was free feeding her dry food between that.But now I took the dry away and so am not sure how often I should feed her. She is always hungry and during the week when I am at work without the dry food for in between she wouldn't get anything after 7am till 7pm. So not sure if that's OK or not? I don't want her to starve, I have 3 other cats and if I leave a can out for during the day the other cats might eat most of it. Any suggestions?

Vickie&China

Did your vet run a culture on the urine to see which antibiotic to use? I think your cat was given convenia as it's the only long lasting antibiotic I know of and it might not be the correct one to get rid of the UTI. That concerns me.

In your situation I would highly suggest you get an automatic feeder so that you can feed often without a need for dry food which makes it really hard to regulate your cat. I bought a Petsafe 5 meal feeer on Amazon. They have them at the pet stores but it was cheaper on amazon. I haven't used it yet because my cat is afraid of his shadow and I don't want to spook him with it just yet. It would be the ideal solution for you though.

Until the BG is regulated in good numbers she will be very hungry and need to eat more often. Some use Young Again dry which is supposed to be 0 carbs but most don't think it is.

Convenia is absolutely the wrong choice for a UTI, it is designed for skin issues and infections. So if that is what your vet gave, then more than likely China still has an infection. Plus Convenia isn't really terribly safe to use in cats in general.

Part of the problem could be the starting dose as well, since N and Lantus work entirely different from each other, they need to be dosed differently. What is China's ideal weight?

Mel and The Fur Gang

Okay. I just looked at the ss and am totally confused with it. I am NOT a dosing advisor but do know that lantus does best when you give the same dose twice a day and 12 hours apart. You appear to be jumping all over the place. For example, I don't understand the last reduction. There may be a very good reason for it but I just don't see it. At some point I hope one of the advisors looks at your ss to help you. When you are home I would experiment with feeding smaller meals every couple of hours until +6 and see what happens. It will help you figure out when to set the auto feeder if you get one. We do try not to feed two hours before insulin and in the second half of each cycle as it seems to work best with lantus.

Oh good. You have someone with experience to help you.

animallvr64 said:

If you feed a small meal wont that affect her next BG reading?

Click to expand...

Food always affects BG levels. If you want to learn by how much food is influencing China's numbers, it's helpful to keep a log of the size and times of meals during the cycle so you'll know how long it was since the last meal when you do a BG test.

I think the general recommendation on the forum is to not feed 2 hours before pre-shot tests to get a fasting BG level and to ease off on feeding towards the end of the cycle when the insulin dose is wearing off. However, every cat is different and may have specific feeding requirements that don't fit with the general recommendations. For example, Saoirse is recovering from a pancreatitis flare and her BG tends to spike if she goes more than a couple of hours between meals. Therefore, I feed her very small meals throughout the day, but I normally lift her food 2 hours before PS BG tests.

Max and Mel

Yes the vet gave her an injection of Convenia which she stated last 2 weeks and would take care of UTI and they did a Urinalysis. I don't think the medication is working at all. She goes to the Vet tomorrow so am going to have them check her again and if still there give me something else. She was given amoxicllon with the first UTI and that worked fine don't understand why they didn't do the same again.
I will check out the auto feeder thanks for the advice on that? Is the feeder for moist food or just dry food? The dry food I was feeding her is the Natural Balance Limited Ingredients Grain Free.
China weight right now is 9 lbs and vet said that it should be between 7 to 9 lbs. So that seems to be OK so far. I increased her insulin my self due to the high numbers, but when I took her to the vet she insisted that I take her back to 1.5 units 2x day and don't change it until she is seen again. I am not sure If I agree with that or not. So that is the reason for the reduction in the insulin. I just get really freaked out when I see the high numbers so I think that I need to give her more insulin to get her number down. I am sure this is the wrong way of thinking, but that is what I have been doing. Please help !!

Vickie&China

animallvr64 said:

I just get really freaked out when I see the high numbers so I think that I need to give her more insulin to get her number down.

Click to expand...

Because of the workings of the body's natural regulatory mechanisms it isn't a case of 'More Insulin = Low Numbers.' Too much insulin can result in high numbers as well, Vickie, because it can cause the liver to panic and dump glucose into the bloodstream to stop the cat from becoming hypoglycaemic.

Ok so I just did her +6 and her number is 554 its even higher. She has been in the 500s all day today !! Should I be doing something about this or just waiting till her next dose of Insulin? And should I just go back to he 2.0units like I had her on? I just feed her so can't check her numbers again for a couple of hours. Scared and confused by this.

Vickie confused_cat

Do you think you could have missed the shot and done a fur shot?

This is what I do with regards feeding. I aim to fed remi one small can in the morning and one in the evening so this is how I split it:

AMPS -test then feed 1/4 of the can
+2 -test than feed 1/4 of a can
+4 -test and feed 1/4 can
+6-test and feed 1/4 can

PM repeat. So in theory each time I test the affect of the food won't be too much. I don't always stick to this testing regime but I. Do try to split the food every couple of hours.

Can I just check you are giving the lantus strictly 12 hours apart?

Also just wanted to check that you know how to store and handle the lantus. It might be different from your other insulin. For example You don't ever shoot any excess insulin back into the lantus vial, etc.

Have you read this sticky

viewtopic.php?f=9&t=151

Hi Nadine and China -

You sure have a lot of different things going on here.

It's entirely possible that China's BGs are running so high right now because of the infection; once the infection clears, her BGs may come down quite quickly. However, as others have pointed out, Convenia was not the right AB for the job! I think vets like to administer it because they think it's easier for the owner, but it really isn't appropriate for UTIs. Hopefully once you get the right AB, the UTI will clear up quickly, so as soon as you start the right AB, you want to be very vigilant about testing in case China's BGs suddenly start coming down.

It sounds like your vet is very typical; however, since you are home-testing, there is no need to have her BGs check at the vet, and in fact, this can be counter-productive, as BGs often go up under stressful situations.

With dosing, Lantus likes consistency, and as someone else mentioned, it is a depot-style insulin. Lantus dosing is based on the nadir, or the lowest point in the cycle. Since it is a depot insulin that likes consistency, dose-hopping will only add to the problem. We raise the dose slowly and systematically, in order to keep the kitty safe from hypo. Until that UTI is cleared up, it's hard to say for sure what the ideal dose for China is, but I agree that she definitely does better on 2.00U than she did on 1.50U.

This is an excellent post over in Lantus TR forum that contains a collection of commonly asked questions...some of this may be helpful to you: Where can I find ______

Hi Vicki,

I saw Sarah's request for help for you on the TR forum. I can offer a couple of things that might help you.

The dry food - we know from members' experiences that even 3-4 little pieces of dry cat food can send a cat's blood sugar soaring several hundred points and it can stay there for a day or so. So if she's been eating even a bite of dry food every day, that would explain her high blood sugar numbers.

I'd get rid of it entirely. If you think there is any chance she's been snitching some, you want to gradually reduce the amount she's getting while you are testing so you can reduce the insulin if it's too much. The carbs in dry food are typically very high, and when you get rid of the excessive carbs she won't need as much insulin.

Most people have found the only way to make sure to keep the diabetic cat from the dry food is to change over all the pets. Dry dog food is just as bad. For your other cats just consider the change as diabetes-prevention for them. No one wants it if it can be avoided.

Her high numbers - they may be from 1) too many carbs in her diet (ie, the dry food) or 2) not enough insulin for whatever level of carbs she's eating or 3) from bouncing from hitting low numbers somewhere in between tests. A description of Bouncing is found in the second post in that link. They may also be from her infection.

I'd encourage you to do a couple of things.

Step up the testing - not all day today when she's in the 500's. I wouldn't test anymore now til pmps. She's high - take a break and save the strips. Get a preshot at every shot and at least one test in between the shots. Somewhere +3-+10 is ideal, but as Sarah said, even if it's +2 it's very valuable information.

You don't have to test MORE, just differently. One mid-cycle test per cycle will provide the info you need to know (or should I say we need to see in order to help you) to figure out her dose changes.

Now that you're at 1.5u, I'd stay there as your vet suggested. Lantus likes consistency in dosing, so when you change the dose things can go a bit wonky. The first post in that thread I linked above about bouncing mentions New Dose Wonkiness - the weird phenomenon that shows up in some cats when the dose in increased. Some cats get higher blood sugar for a day or so before the dose begins to work and you can see what it will do.

She's a small cat. When the dry food is gone, the 1.5u may be too great for her. But . . . some cats just need more insulin than others regardless of their size. When you have a full day after there's been any possibility of dry food being in the picture, you'll know more.

About feeding her - the formula for how many calories a cat needs to eat can be found on http://www.catinfo.org. I don't recall it off the top of my head. as long as her blood sugar is high, the energy from her food (glucose) is floating about in her blood stream instead of getting into her cells. So she is literally starving. Your goal is to feed her enough that her weight remains stable while you're getting her blood sugar regulated. That might mean more low carb canned food than you would think, but as her blood sugar comes down she won't want so much food. There is a good post on "Feed Kitty as Much as She Wants?" - look here - from this link click on the "new to the group?" sticky and scan down until you find that post.

However much you're going to feed her, I would divide it into 4 portions or so per day. I fed punkin (13ish pounds) 1 can of fancy feast with each shot and 1/2 can at +3, both am and pm cycles. I fed and then tested. Don't worry about it influencing her test numbers - the only test that's really significant in relation to having just eaten is the preshot test. That's because if she's running low (say under 75 at preshot) and she's just eaten, and you might think she's high enough to shoot when it's really just a bump up from the carbs she just ate. Feeding her regularly will help even out her blood sugar. You want most of the carbs to be in the first few hours of each cycle when the insulin's action is strongest. If she's hungry later in the cycle, give her a few bites of boiled chicken breast, or some other pure meat that is zero carbs.

I hope that's helpful. Your vet is right in that you want to stick with the same dose for a period of time. I think the dry food is likely a large part of her high numbers. We had a cat, Scooter, go from 5.5u per shot to off of insulin when his cat family of 13 cats all went off of dry food. He'd been snitching when Linda thought that he didn't even want the dry!

When you do adjust the dose, however, I'd encourage you to take a look at the Tight Regulation dosing protocol that people have given you. Adjustments are made in 0.25u or 0.5u increments, depending on how low the dose is getting China's blood sugar. Adjustments of more than that are inappropriate and will likely put her overdose. Stick to small increments.

Most people want help figuring out when and how to adjust the dose, so if you want help, just ask.

I will add that newly diagnosed cats have the best chance of having their pancreas heal and going off of insulin if their blood sugar gets controlled as quickly as possible (done safely), which means their blood sugar is brought into the normal range for a non-diabetic cat (50-120). That's what Tight Regulation is - people following that dosing protocol because they are trying to get their cats to become diet-controlled and go off of insulin. An essential component of pushing your cat's blood sugar into normal range so they can heal is that you have to test at least 3-5 times per day. That's the only way to keep a diabetic cat safe. Even people who work can do this with the help of a feeder and some ingenuity!

Hang in there - You've done a great job to start with - you've mastered hometesting, you've gotten information about food, you've found the right website to get help pretty much 24/7! That's a lot! Her high numbers will pass and she'll get better.

Hi, Vickie. Amy asked if some of us from the Lantus Tight Regulation board would stop by.

I agree with Mel. Convenia may be the wrong antibiotic for a UTI. The urinalysis may tell your vet if there's an infection. It doesn't tell you what the best choice of antibiotic is, though. In order to know that, your vet would need to have done a cystocentesis (using a needle to draw a sterile sample from your kitty's bladder) and then done a culture and sensitivity to see what bacteria grew (the culture) and what antibiotic will work the best (the sensitivity).

When did you actually start Lantus? (It would be helpful to note that on your spreadsheet.) It takes Lantus a few days to build up and form a depot. As a result, numbers may be higher than desirable. Also, like others have noted, the dry food may not be helping to keep China's numbers in check. Some of what I'm seeing look to me like "bounces." Every time China drops into yellow numbers, it's usually a fast drop from much higher numbers. This is likely triggering a bounce. Since China isn't used to spending much time in lower numbers, this is a normal reaction -- annoying, but normal.

Hi Vickie

I was asked to pop in from the Lantus TR ISG to look at China's spreadsheet and see if I could offer any thoughts.

China should have been started at 1u Lantus every 12 hours and, as many others have said, slowly increased in small increments. Sometimes when a cat has been on another insulin, it makes sense to start at close to the dose of that insulin if there was a response but China was not on NPH that long before you switched her. I think even if you had started her at 1.25u of Lantus, it would have been ok.

A couple of things:
-- a urinary tract infection cannot be properly disgnosed without cystocentesis. That is where a sterile sample is obtained by the vet and sent to the lab. A free catch of urine can become easily contaminated with bacteria. If the kitty has a large enough bladder at exam, some vets can express it to get urine but depending on how they catch it, etc, it could also get contaminated. Mel is very correct that convenia is not the a/b for UTIs. My suggestion for checking for a UTI is insist the vet collect it by cystocentesis and then if she does have a UTI, she needs a more appropriate a/b like clavamox, amoxicillin, orbax, etc. I would discuss these with your vet, if China has a UTI, and see which one is less likely to give her an upset tummy or put her off her food. Also...sometimes vets give a/bs that are liquid and have sugar in them. Beware of these. If you can pill China, that is a safer bet OR if you need the liquid, just be absolutely certain there is no sugar or artificial sweetener such as maltodextrin.

She might be peeing outside the box because her numbers are high. So just insist on the cysto just to be sure. She's also likely very hungry because the numbers are high. A 9 lb cat should have about 195 calories per day and for a diabetic, it's better to divide it into smaller portions as has been mentioned. It puts less stress on the pancreas. So first, if she's off the dry, keep her off the dry and figure out how much food is needed for 195 calories/day. Usually the number of calories is in the can. If it says "90 kcal ME" or something like that and it's a 3 oz can then there are 30 calories an ounce which would mean, as an example, she would get 6.5 ounces/day.

Very important to note is that cats, like people, might have different calorie needs so it's best to weigh her, feed 195 calories/day for a week and weigh her again to see if she has gained or lost and then slowly make adjustments. Or, if she has been steady on her weight, figure out how many calories/day you've been feeding her and stick with it.

Others have said Lantus requires consistent dosing and you have to give a dose time, when you increase, to settle. It can take several days. You've also gotten good advice that you should not dose on the preshot. When you shoot Lantus, you aren't shooting the number you see but what the nadir (or low) might be. I know it is difficult to get tests when you work but if there is anyway you can adjust her shot time so you can get an AMPS test, a +2 test before you leave (or an out the door test), an in the door test, a PMPS, a +2 and/or before bed test. I've seen cats go from 300 to 40 to 300 in one cycle and I suspect China is doing this and bouncing back up hard and high because she either dropped too fast or she got too low.

I think her doses have been increased by too much and sometimes too fast. However, I'm cautious about dropping a dose back too much to do a rebound check because sometimes it's decreased way too much and then the cat is left in high numbers building insulin resistance.

When a cat gets into lower numbe or drops fast, they can bounce for up to three days...six cycles! Another member has already told you about the counterregulatory hormones which can raise the BG.

If China were my cat, I would leave her at 1.5u and get as many spot checks as I could, even if you have to get up a night or two around mid cycle just until we can find out if she's going low or not. The last time I see that she could have gone low was the night of 11/7 so if you can just up the spot checks as much as possible, given your work schedule, through Tuesday night, then we might have a better idea of where she is. Even if your vet says to raise the dose, say yes, but don't. I definitely think 2u is too much for her right now. Give her some time at 1.5u and let her clear the bounce and find out how low she is going or how fast she is dropping. Then we'd have a better idea of whether she needs to go up or down.

Also, we would not raise the dose in a cat at this lower dosage by 0.5u unless nadirs wore consistently above 300. China has gotten into lower nadirs so resist the temptation to take her up until we know what she's doing. She might actually need a reduction.

Possible to do? I don't know what kind of work you do or if you have the ability but it might even be worth taking Mon and Tues off, if at all possible, to figure it out. If you can't, you can't but then do the best you can to grab as many spot checks as you can.

Pls let me know if you have questions.

Hi there

Lot's of good advice today.

I'll add my voice to the "make sure you test Chinas urine for ketones" chorus. A kitty can be vulnerable while transitioning from NPH to Lantus.

Hang in there - and hang in here

I just wanted to chime in about an autofeeder. While Cedric passed away, his "brother" Dallas and the new Kitten, Ace, get a snack in the middle of the day via the auto feeder. I freeze about 1 oz the night before then set up the feeder the next morning before I leave for work. The feeder I use has an ice pack, which helps keep the canned food cold, since it will open about 5 hours later.

http://www.petmountain.com/product/elec ... eeder.html

this is the one I got and I did get it from here, as the price was the best I could find. I have been using them since 2011 (I have 2). Good luck!

I hope we didn't overwhelm you with information! When Sarah put out the "help!" that brought out a bunch of us!

Timed feeders are fantastic for helping with a diabetic cat. I used this one, the Petsafe 5 compartment feeder. The complaints about it are that it doesn't always open all the way, but I discovered that only happens if a person doesn't get the food tray fully seated in the base. There is a button to push that will rotate the tray, so we always put it in and did that rotation to make sure we had it fully seated. It always works if you do that.

This one has space for you to have 4 compartments full of food covered up. When I went back to work, I set ours to always open at +3, and if i thought punkin was going to maybe be headed lower, I'd put some food in the other 3 compartments too, then set it to open every half hour for 2 hours. Pretty great. If I was really worried, either my husband or i would run home, test punkin, refill and reset the times on the feeder and go back to work knowing that he would have food available to him if he needed it.

Let us know if you have other questions and we'll be glad to help you.

Thanks Everyone for the advice!! I am new to this so it is a little overwhelming. I know it takes time to get the hang of it I guess I am always second guessing what I am doing and get freaked out at the high numbers. As mentioned before by another member, that 2 units is to much for her, that she should be at the 1.5 like the vet suggested. I am going to do the 1.5u for a while and see how the numbers go, and go from there. I have her off dry and is getting Wellness Core Grain Free moist food, she never really cared for the dry food always liked the moist, so was a easy transition. I just need to learn to releax and do the best I can for her and let the medication work.

As far as the UTI looking at her records from last visit they did a urinalysis in house and also a ultrasound guided cystocentesis,and like I said before gave her an injection of Convenia which has not seem to have helped her UTI at all, she is still peeing outside of litter box, and I truly think that could be one reason for her high numbers as well as why she is peeing outside the box. So have called the vet to see if they will give me amoxicllen which she was given before when she had a UTI and it helped her. If I can get the UTI cleared up I think her numbers would go down some.

Am working on getting more spot checks after injections, is hard after AM injection due to being at work, unless its the weekend. Able to do more checks after PM injection as you will see. Is there a certain time after injection where its the best to check where she is more likely to drop to an ideal number or her nadir (think that is what it is called)? I am still a little fuzzy on the nadir part, but working on it.


So any advice given is appreciated.

Vickie&China
So any advice given is much appreciated.

I received this PM from Vickie:

Thanks for all the great advice!! I do have questions I hope you don't mind me asking? As far as the amount I am giving her, it 1.5 might be to much then how come I couldn't get her out of the 500 ? She seemed to leave the 500 once I increased the dose, or am I just not giving it enough time. How many in between checks should I do? I work Mon thru Friday with Monday being my long day being at work from 7am to 6p. So it does make it hard to get them after her AM injection. But can and will get them after her PM shot and will do them often as I can during the day as well.
Now China is always hungry, what I started doing is in the AM before work I do her AMPS which is usally abuot 5am then I feed her 5oz can of Wellness Core moist food let her eat till 5:30am then I give her the insulin. I will leave whatever she dosen't eat down for her in case she gets hungry while I am at work. Then when I get home from work I do a spot check and as long as it wont be too soon for her injection I wil give her 1/2 of a 3oz can of wellness moist food . Then do her PMPS when due and feed her a 5 oz can of Wellness core again, and do spot checks after her dose of insulin. Any ideas or suggestions on what I am doing? I am also going to get a automatic Pet Feeder for during the day when I am not home. I looked at your spreadsheet what is the best times to do the checks? Like is there a peak time after giving the injection that her number should be lower? And if its not lower during the checks do you know what that means? Sorry for all the questions and I hope they make sense to you. I am just new to this and want to do whats best for China. So any ideas or suggestions you can give me would be much appreciated.

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I am responding here to keep all advice/suggestions open to the board.

As far as the amount I am giving her, it 1.5 might be to much then how come I couldn't get her out of the 500 ? She seemed to leave the 500 once I increased the dose, or am I just not giving it enough time.

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How lantus works can be very confusing. Most of the shots you give at a specific dose go towards building a "depot" and once that depot under the skin is full, the kitty starts fully using the shots you give twice a day. That's why it takes time to see dose changes. Think of it as a big ship....you can turn the wheel to move the ship, but the ship moves very, very slowly in response to a change of course. Any time you make frequent changes to the amount of insulin given, it throws the depot off. So it's super important to be very consistent. Between the dose changes and the skipped shots, her depot has really gotten "wonky". That also makes it very hard for those of us helping you to decipher what is going on. That's why many of us suggested you just hold the 1.5u dose for a bit until we could actually see what the dose is doing; but we also have to have more tests because it's hard to tell without them. In the past, China has gotten down into some lower numbers at 2u but we don't know how low. So by starting at a lower dose (which might put her in a little higher numbers for a while), we can see how much more insulin she needs. Raising her from 1.5u to 2u might be way too much. Maybe she just needs 1.75u. With the TR protocol, you wouldn't raise the dose by 0.5u with yellow nadirs....which she has had on the 1.5u. And we don't want to go lower than 1.5u because it might leave her in really high numbers unnecessarily.

It's not necessary to give China food 30 mins before her AMPS. Is it possible when you get up at 5 to test her and then immediately feed/shoot all within about 10 minutes? Then you could grab a test right before you leave which is maybe what....6:45? Of course, the difficulty to this is every Monday you work late. Is there anyone else in your home that could give her insulin at 5pm on Monday nights while you are working? Anyone available to grab a mid-cycle test during the day while you are at work?

We usually recommend you don't feed her for two hours prior to her shot at night. If you are feeding her when you get home before you test/shoot, it could be why her PMPS is high sometimes. Sometimes it's not because she's headed down from clearing a bounce which tells me she has gotten lower or come down fast somewhere (10/29). I think it's good to get an automatic feeder for during the day.

I looked at your spreadsheet what is the best times to do the checks?

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Well...you can't go by Gracie's SS because (1) Gracie is on levemir so her curves are very different than lantus curves and (2) I'm a testaholic and I would never ask anyone to test as much as we do....one of us is here with her constantly if she's running blue or green. We are fortunate our schedules allow that but most people don't have that luxury so you have to do the best you can.

A "typical" lantus curve would have her peak action of insulin (or lowest point) being around +6 after her shot. But cats vary. Some nadir earlier, some later. Sometimes you aren't able to catch the nadir and so she just looks high; that could either indicate she needs more insulin or she's bouncing. Again, it's hard to tell. For example, the morning of 11/12, you weren't able to get a test. you could have potentially shot a lower number because she went straight up. When they bounce, it can take at least six cycles to clear the bounce; a few cats have taken longer. For instance, if during the day of 11/10, she came down fast or went lower, she could still be bouncing today and possibly clear tonight. If you shot a lower number yesterday, and she started the bounce last night, she could bounce up until 11/15. And a higher dose of insulin can affect the depot up to six subsequent cycles so we don't know how much that 2u might be affecting the numbers now.

Because it can be complicated in determining what is going on, I again would encourage you to hold this 1.5u dose for three days and grab as many tests as you can....always a pre shot test, out the door, in the door, +2 any time you are able, before bed, etc. And then on weekends, we can focus on spot checks and see if we can catch where she's going. Once we have an idea of what she's doing at a dose, we are in a much better position of helping you get her doing better.

I know you love her and want to do what's best for her and we will do all we can to help. I also know you are doing the best you can. :YMHUG: :YMHUG: :YMHUG:

Marje gave you a lot of great advice and I know it is so hard to be patience when our loved one is sick.

One thing about amoxicillian while it is a wonderful broad spectrum antibiotic, it isn't a great one for a diabetic as it is loaded with sugar, because it is made mostly for human children so they make it bubblegum flavored and very sweet. If you can get your vet to give her either Baytril or Clynamyician (sp?) either of those would be a better choice. Clamoxian is also another good one as it is basically amoxicillian without the flavoring or sugar added.

Hope you can get something that works better for your baby girl and not only does she start using her box again properly but you see better numbers as well. Which you should once the UTI goes away. Because UTI hurt, and both infection and pain can drive numbers up.

Mel and The Fur Gang

Vickie

Great job getting those +1 tests and last night!!! :thumbup :thumbup

I know this is tough to wait it out but she might be getting a little flatter and by tomorrow morning, she will hopefully let us know if these are bounce numbers from maybe a lower PS on 11/12. hang in there!!!

Marje,

Thanks for the boost of confidence!! I think I figured out on getting at least one spot test done before I leave for work. However I am confused about something, and maybe it has been answered before so please forgive me if I repeat myself. Please correct me if I am wrong, but I thought you are suppose to pretest, feed,shot for both the AM&PM? But read that you shouldn't feed 2hrs before PM shot is this correct? Should that be the same for the AM shot as well? If not why is it just the PM shot? I thought you had to feed before the shot so they don't get sick? So if you or anyone else can clear this up for me I would appericate it. My routine right now is that I do an AMPS test,feed her wait about 30 minutes and then give her the insulin, and I do same for the PMPS. When I am doing spot checks (which is usually at night) in between I make sure she hasn't eaten anything 2hrs before doing the check is this correct? Also when I do the 1hr check in the AM after shot she ate like 1hr before or maybe less is that not right either? Should I be timing it to where that +1 check is 2hrs after she has eaten? Please if you can clear these questions up for me would appericate it. Cause I am thinking that could be some of the reason for her higher numbers is the way I am feeding and testing her.

Thank so much!!!
Vickie&China

With N you do need to feed first wait 30 minutes then shoot because N hits hard and quick with Lantus it doesn't kick in for 2-3 hours after you shoot and is a very gentle drop down. Most of us test, feed and shoot while their eating so the whole process takes maybe 15 minutes total.

For both preshots you want a fasting number so no food for 2 hours before you test and shoot.

Never apologize for asking for clarification. Only stupid question is the one that goes unasked.

Mel and The Fur Gang

I agree with Mel. I'd just add that you don't need to worry about the timing of testing and feeding during the cycle. Just test when you think you need to test without worrying too much about when she ate last.

The reason that people usually avoid feeding in the 2 hours before the shot is only so that when you're making a decision about whether or not to shoot, you can be confident the preshot number isn't a food spike, for example.

If you have reasons that you need to feed a cat in those couple of hours (your cat has lost a lot of weight, kitty is sick, etc.), then go ahead and do it, just know that the preshot number may be higher because China just ate.

It's primary importance is if the preshot number is lower than you've got experience shooting.

Vickie

You've been doing super testing and now it's time we Increase the dose. It looks like 1.5u is not enough. Under the TR protocol, we would increase by 0.5u to 2u. I know that is where you were with her but we just needed to get her on a safe dose to figure out what she needs.

Because you work and have limited testing ability, I might go for a dose you can safely shoot twice a day and see how she does. I would like to suggest 1.75u. That might still not be enough but it would give you a better comfort level, I think, if we ease into the increases instead of put her right back at 2u and potentially have her come right back down when you can't test. At 2u before, you were having to skip shots. We'd rather have consistent shots....it's better for her at this point.

However, the call is yours.

Thanks Marje! I am concerned about her numbers going to low when I am at work also. I think 1.75 is a good idea, but was also wondering what if tomorrow with her AM shot I gave her the 1.50 as normal,but then with her PM shot I gave her the 2.0 units so that I am able to spot test her to see where she is going with the numbers? Or would the one dose of 2.0u not be enough to really give me a good idea how it will effect her? I just don't want her to bottom out either and me not be there to correct it, and I don't have anyone that could come and check on her either. So give me your thoughts on this or should I just do the 1.75 starting with her AM dose and keep her on that for a few days to be safe? Any thoughts or ideas on this is much appreciated.

Thanks !!!
Vickie&China

You're welcome!

Do you mean give her 1.5u every morning and 2u every evening or do you mean leave the 1.5u dose through tomorrow morning and then raise to 2u tomorrow night and leave her until she needs a reduction or increase?

If you mean shoot two different doses between the a.m. and p.m. shots each day, it doesn't work with Lantus. You could easily do it with Humulin N but not Lantus because of the depot. Again, Lantus likes consistency so you have to shoot the same dose until she either earns a reduction by going under 50 or she needs an increase.

This is why I suggested 1.75u; it allows us to gradually take up the dose. If you were there all day to monitor, I'd say raise her to 2u tomorrow but you need to work so you can buy all her supplies and take awesome care of her. So....you need to keep her safe and she has shown on 2u that she can dip down. We might have to take her up to 2u but I just am concerned with starting the roller coaster again by having to skip shots because you are concerned about leaving her.

What do you think?

It can take 3 to 5 days for a lantus dose change to stabilize its effects, so you're not going to be able to tell after just 1 shot of a dose that is just 0.25 units different.

Thanks Marje and BJM

I am going to increase her dose today starting with her AM shot to the 1.75, I want to do whats best for her and keep her safe!! and with me not being home till later tonight I think that is the best idea and will keep her on that dose for at least 3-5 days like BJM stated to see what kind of response I get from it, then go from there, and if an increase needs to happen after that time will do the increase on a weekend when I am home and can watch her and get spot checks.

Thanks again
Vickie&China

Hello,

Have a question. I raised China's dose to 1.75 units starting with AM shot this AM due to being at work all day was unable to get spot checks, just got home from work and did her PMPS and it was 161 so I fed her, but should I still give her the 1.75u tonight or should I wait? Don't want her to bottom out. If I understand I was told that until I get numbers in between shots that I shouldn't shoot anything under 200 is that correct?
Please help !!

Thanks
Vickie&China

Vickie

Can you stall a bit...don't give her any more food. Any time you get a number that you are worried about shooting, don't feed her, but post and ask for help. The reason is because we don't want you to shoot a food spike and then have the numbers come back down.

Can you stall up to an hour which would mean you will have to shoot approximately 12 hours from that stalled time. Do you have any high carb food there with gravy, any karo or honey, and lots of test strips? Would you be able to shoot knowing her numbers might come down and you might be up for a few hours, or more?

Marje,

Yes I can stall for an hour and test her again then. I didn't give her the shot, I tested her, feed her, and held shot cause wasn't sure if I should shoot her or not, cause afraid
it would go down even more.
And yes I have honey here, and I have test strips, I don't care how long I have to stay up !! I just want to do the right thing. So if her number is still under 200 after I stall for an hour should I not shoot her or what should I do? And if its over 200 then it would be safe to shoot her correct?

Vickie&China

Vickie

Pls don't give her any more food and test one hour after you fed her and post with her number and then we can decide whether you should shoot or not.

This is a very shootable number and learning to shoot lower benefits her but it might keep you up. I don't know if she's dropping or not and that's why we want to stall.

How much did you feed her and was it low carb?

i'll be watching for you.

BTW, is it at all possible to open up a thread in the Lantus TR ISG because I'm watching some kitties over there and it just helps me not to go back and forth. You could just open a new topic and in the subject line put:
11/16 China 2 PMBG 161 and then link this current thread by putting the following link: posting.php?mode=reply&f=32&t=128136 between the boxes. In other words, when you op...l] and it will put this in the text box [url]. Copy and Paste the link above in between the boxes: PASTE LINK HERE

Then just put in the text box after that that you are stalling and waiting for numbers to come up. I'll look for you there. Thank you (gotta give my girl her shot).

Marje,

No problem will post the link in the other room, I really truly appericate your help with this!! I feed China at 8pm, and she got about 5oz of a low carb wet food. I am going to link this post now in the other room. I want to wait until 930p before I test her again.

Thanks Vickie

Thank you. I'll look for you there and subscribe to your condo so I'll get your posts right away.