Old timer needs fresh help

Hi all,

I've mostly been a lurker here and on Facebook, but now I have to admit I don't know what the heck I am doing and get some help.

Miles is a sweet, loving 11 year old cat, diabetic for almost 4 years and no closer to being OTJ now than at any point in the past. He is on Lantus and his numbers are horrible, although he never appears ill. More than likely he's bouncing, but lately it doesn't seem to matter what dose he gets, he's just higher than I'd like. I'm aware of several things that will be observed on my spreadsheet: doses are inconsistent, times are inconsistent, mid-cycle tests are inconsistent. I've also been struggling with forgetting to give insulin in the morning. Two mornings ago I remembered to inject him - but there was nothing in the syringe. (DH said, "You stuck the cat full of air?" :? ) Yeah, not sure why I have been so distracted! I never forget to test - that is the only thing I'm good about - and Miles loves to be tested, seriously. :razz:

Anyway. We paid $375 for this set of 5 Lantus pens and we are only halfway through the first pen. :roll: I think he would do better on Levemir, but obviously I need to make sure my routine is as steady as possible before making any other changes.

Miles eats Fancy Feast classics (but he dislikes beef and we rarely feed fish) as well as the chunky varieties of chicken, turkey and chopped grill feast. Also occasionally a bit of Nature's Variety raw (chicken). He doesn't care for it but will eat it if he's hungry enough. I should also mention that he is quite overweight at 19.5 pounds; I believe this is due to his numbers being high for so long, though that's just a theory on my part.

I have a three-day weekend starting now, so I could formulate some sort of plan if anyone wants to offer any advice. I thank all of you in advance for helping us out.

 

Welcome Marnie and Miles! I don't have time to go thru your ssheet right now but wanted to say Welcome and we'll do our best to help with extra sweet boy!

HUGS!!!

 

If you've a cell phone with a calendar option, you might try setting yourself reminders with notes (test, feed, shoot; test only) etc.

 

Hi Marnie!

You really seem to understand what you're doing "wrong" already...Yes, you need consistent dosing, as well as getting some tests in on the PM cycle

And yes, you need to make sure there's insulin in the syringe! :lol: (you're not the first person to do that either, so don't feel bad!)

You're going to need to do whatever you need to do to make sure to get those shots in every 12 hours....setting several alarms to make sure you wake up is one idea...make sure at least one of them forces you to get up to turn it off. It's too easy to turn off the one next to the bed and go back to sleep!

On the PM cycle, it's even more important to get some tests in....Most cats go lower at night. If you can at least get a +2 in, that'll give you a good idea of where he might be headed later in the cycle. If the +2 is lower than the Pre-shot, that's an early warning system that he might be going even lower later in the cycle, so it's VERY important to get more tests later in the cycle...and trust me, nobody enjoys getting up at 2am to get a test in! It just has to be done, so you do it! The +2 is a good test to get in every cycle if you can because it does give you a "heads up" on what might happen later.

If the +2 is about the same as the pre-shot, that usually means a "normal" cycle...one that gradually goes down, then gradually comes up again.

If it's higher than the PS, that can indicate he's starting to bounce, and on those cycles, it's usually safer to get some sleep and not do as much testing.

It won't help to change to Levemir at this point. Levemir is dosed in the same way Lantus is, so if you're not giving the Lantus the way it needs to be given, it won't help to change insulins right now.

There's also no reason you need to pay so much for the Lantus. I found a great pharmacy in Canada that will sell a pack of 5 pens for $133.99 plus shipping. They're very dependable and it makes it a whole lot easier on the pocketbook!

Can you try really sticking to the protocol for a few weeks and see if you start to see some better numbers? I think if you start to see some progress, you might feel more hopeful about the whole thing

Edited to add....adding some exercise to his day will help with both the weight and possibly his numbers. Exercise makes the cells more receptive to insulin. My China LOVES Da Bird and will chase it to the point of exhaustion!

 

Hi Marine!!

As I promised on FB I am back here. I think Chris recommendations are very accurate. With Lantus (and other insulins) you have to be consistent on dosing and testing. It certainly is a hard job, but as all jobs it needs some effort and there are people here much more experience on dosing that can guide you through the process.

Sometimes I am so busy with my work that I forgot about everything else, now I set reminders on my phone and had an alarm 45 minutes before shot time, then if I was still at the office, that way I knew I needed to leave and run home to test and shot Bruno, same if I was home. If I was watching a movie or reading a book, I forgot to shot or when I realized it was too late, if I heard the alarm I knew I needed to be ready to test.

Another tip, the ss I would try to have a notebook close to register information I can not register immediately on the ss. For example, in the morning, I am running to work, I test and write the number on a small notebook, when I arrive at the office I open my ss and register the info.

As for the insulin, I know than Lantus is a great insulin for most of the cats, unfortunately, not all of them read the Protocol. Bruno was a bouncing master. He was on lantus for 3 months with numbers all over the place. Then I started reading the posts of some people that have switch to levemir and decided to give it a try. Hugh difference! And after one month on Levemir we started OTJ Trial, I know I was lucky since other people have switched and do not get results immediately. It seems to be a relation on how long the cat has had diabetes and how long he has been using another insulin. But even with Levemir, you will need an organized schedule to test and shot and fed, it can be a little bit more flexible than Lantus, shooting one hour late is not that uncommon since nadir comes sometimes at shot time, and you need to see if the numbers are raising or still going down. And as I mentioned, I had a crazy week at the office and during this time I tried SID (gave only am shot) and he was ok with that, although I know it is not recommended, he reacted ok to this system.

I would say that if your cat is not doing well with one insulin is ok to change and try a new one. Kate Passa, created a think tank about people that have switched to Levermir, I suggest that you read it: viewtopic.php?f=22&t=122941

But is also hard to know if Lantus is working or not without a schedule :?

I hope you can manage to arrange a schedule and decide on the insulin that is best for you! Sending you good vines and paws hugs to your sugar baby to get better

 

I tend to agree with what the others have posted. With Lantus or Lev, you will not only need to get pre-shot tests (which you've been very good at getting) but you will need to get at least one test per cycle whenever possible. I suspect that because you are not routinely getting spot checks, you may be missing some low numbers.

As for switching to Lev, it's possible but you need to get your testing routine down or you are going to be in the same predicament. You need data in order to make good decisions about dose. The Tight Regulation Protocol was developed for BOTH Lantus and Levemir so regardless, you will need to get some additional tests.

You may want to review the starred, Sticky notes at the top of the Lantus board:

• Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM in one of the top vet journals.
• New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
• Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
• Lantus depot: This is an important concept for understanding how Lantus works.
• Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.

 

If you do end up switching to Levemir, be sure to try and sell/give away those extra pens on "the supply closet"

I'm eternally grateful to the member who sold me one pen!

 

Update: It's been a few weeks since I posted. We've started using the alarms on my phone to establish test/feed/shoot time for Miles at 7:30 am/7:30 pm. It's working very well. I am also grabbing a +2PM, and either DH or daughter will test around +8 (after school), assuming one of them remembers to do so.

Now that I have more data, I do feel more optimistic. In fact, I was going to reduce his dose tonight after nice numbers in his full curve, but then I ended up not being home at 7:30. DH gave 2 units as usual and Miles bounced to 316 at +3. Dose reduction tomorrow!

Thanks, everyone, for your help. It is possible to make improvements - and see improvements - even after four years. Miles looks great and he's even a teeny bit more active!

 

Sorry to jump in with a question on someone else's thread but I havf t seen you in mine yet. Where in Canada do you get the pens and how do you use them? Also how do you do +2 when working? I test feed shoot at 6:30am and go to work. Please copy this and reply on my thread so im not hijacking this one. Thanks.

 

Searching the board posts:

The message board has a number of search features that can help you review your posts or find other posts on a given topic, for example - fleas, constipation, renal failure, cheap insulin, and more.

1) You can search for your posts by clicking the link in the top left which says "View your posts".

In the upper right corner are 2 search options

2) a simple search box - just fill the box with a word or phrase and hit enter
3) an advanced search link - select that and your search can specify date range, forum, author, topics, etc.

4) if you click on a specific person's name from a post, a summary page for that person displays. In the right side of that is an option to search the person's posts. That once is good if there is a specific topic the person explains well, or a post of your own you want to copy. (Ex click on me, BJM, then search my posts for 'spreadsheet grid', or 'relaxation breathing')