LB

Discussion in 'Lantus / Levemir / Biosimilars' started by Anyname, Dec 9, 2011.

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  1. Anyname

    Anyname Member

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    Jun 8, 2010
    I don't have LB regulated yet. He's been unstable for many months now - most of this year in fact. I've had a bit of success of late but there is something wrong with him that causes him to go high for no apparent reason. It could be constipation - I will see how the numbers go tomorrow after giving him duphalac this morning. It's one of the new style poop promoters that is recommended on the forum. I think you call it miralax or something similar.

    So he's had a totally miserable day today with the highest numbers he's had in a very long time. If you are looking at his SS its under Little Boy and it doesn't work on US. Only works on WORLD - but if the numbers don't mean anything to you the colours will tell you his story. I've tried a few different things with dosing - I absolutely hate him being in high ranges. My very excellent vet, I think the best in Melbourne, told me if the numbers are consistently high give him more insulin. I have done better with LB since I followed his advice.

    LB has food allergies - I've been giving him new foods the last couple of weeks so the high numbers might be a result of the change in diet. He's been biting himself quite a bit today. I hate seeing him so miserable - honestly he is almost speaking to me telling me he doesn't feel so good. He got up for a test today and squatted down on his own for the test - I usually have to push him down. He was an eager beaver!

    FD has shown me how clever cats really are. They try to keep it from us but they are so darned smart. He knows we try to help him. The guy at the cattery told me the same thing. He emailed me those exact words. He just knows you are trying to help him.

    Lovely to have the more relaxed forum. I'm not sure that it can do much more but provide comfort for those of us who need comfort and support.

    Marilyn
     
  2. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    Hi Marilyn,
    Great to see you here; big pats for LB!
    You mentioned high numbers, so I looked at your ss and I don't mind that it works on the World tab as I am in Canada LOL.
    And you're right, What's up with those numbers?? With some of the higher doses, I thought have you tested him for any resistance?

    So, what's the new food you started and do you think it's helping his food allergies? If it is helping then like any food or med that helps, just give more insulin. What is the list of ingredients in this food? Maybe there is something in there which is contributing to the higher BG numbers.

    When did he start biting you and how often does that happen? What can you say about how he acts in a normal day? Is he out in the open or hiding or wanting to be alone? Does he have any other health issues and is he getting other meds or supps?

    I think your vet is right about giving more insulin if LB has high BG across the cycles. A couple things on your ss worth a note. There are many times in the pm that there are no ps BG numbers and I wondered why. I ask because with BG all over and doses not constant, the ps tests are good to get before giving a shot.
    If you look at 11/30/11, your am was 19.4, then steady drop through the day, no pm BG but dropped .5u. The next morn you were down to 9.4 and stayed with 6u, then no pm BG again and stayed with 6u. The next morn, he was back up to 17, so it could very well be that he dropped low overnite and bounced up to 17 by morn.

    Most times, I say that there are 3 tests minimum important. The BG before giving a shot so you know that it's safe to give a shot at all... if you had tested at pm on 12/1/11, what if LB had dropped down to blue again and you may have paused before shooting, or you could have shot and then get a test just before bedtime, just to be sure he did not continue dropping ... lots of cats go low overnite and then in the morn, you say whoa what happened here! when you see a high amps. There have been a couple times I tested before bed and had to crack open a can of HC.
    So that's the 3 tests that will help you most to keep LB safe.

    Another thing I noticed on the ss is the quick changes in dose sometimes - look at 11/23/11. Just the am doses are 5u, 4.5u, 6u, 5u, 6u .... too much change for Lantus, so LB's shed is sloshing all over the place. Sometimes you may see a higher ps and think whoa need more insulin butwith dosing based on the low point, if the nadir / lowest BG had dropped really low, then that high ps was likely a bounce and there is a need for LESS insulin.

    But, that's OK for now. See if you can get all the pmps BG numbers and if possible a few bedtime numbers.
    We'll keep a close eye on MR. sneaky LB and figure out what he's doing and what he needs.
     
  3. Anyname

    Anyname Member

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    Jun 8, 2010
    Great feed-back, thank you. I've wandered off the beaten track with dosing and a forum like this is good for getting a nudge back on to the straight and narrow. A few of the dosing numbers might not be entirely accurate as I filled in the SS a week later and as you noted I've been jumping around a lot. I was dosing according to what I thought at the time in an effort to try something different. In my own defence I've been testing quite a lot - but I do tend to avoid the PMPs test if I've tested an hour earlier and the numbers are ok. (I know they can change suddenly - I will try to get that number more often now)

    ::::: Just the am doses are 5u, 4.5u, 6u, 5u, 6u .... too much change for Lantus,

    I went back and looked at what was happening with his bgs while those doses were given. Yes I based the dosing according to what I thought might help more than sticking to the program. I guess I'm having trouble understanding how lantus actually works (especially when it doesn't seem to work at all). Having been at this for a long time it's easy to get battle fatigue and decide to go it alone. That's why I personally am thrilled to have the new forum as I can get help without feeling like I'm a terrible person.

    The recent changes to my approach started when I left my friend to look after LB for a week and I came home to much lower numbers - I dropped him from 8.5 BID to 6 BID immediately and having done that so successfully; he rode the wave with the change so well I decided to speculate more with his dosing - on the grounds that we do instant drops when numbers are low - so why not instant increases when the numbers are high. But I realise now that I should be viewing the naidar number with greater vigilance, along with watching for a bounce reading. (I am curious to know whether dosing is adjusted upwards in human diabetes according to high readings? - Do humans dose by a similar protocol as Feline dosing with Lantus?)

    There were two things my friend did that I believe brought his numbers down. 1. She reduced his food intake and 2. she only gave him diced raw chicken breast with a flat teaspoon of Royal Canin GI dry on the top. She wasn't testing and if I had been away longer than a week I think he would have hypo'd. He was very low the morning I got back. (16th November).


    He isn't biting me, he's biting himself. He bites off his fur on the inside of paws etc. The new food is Fancy Feast chicken gravy lovers. Just give him half a tin at a time - one tin a day. When he was very low it had little to no affect on his numbers to bring them up in a hurry but I'm thinking that there is an allergen in it that might have put him high. Plus for variety I've let him have the occasional tin of tuna (human) food. The Fancy Feast is likely to have traces of beef it in. Or maybe it's got gluten. He is only safe on chicken with the RC dry and ground rabbit.

    He's been laying around in a quiet corner mostly but it's turned hot here so he normally does that. He's not a very energetic kitty. He's been to the toilet today - I can tell by the dirt on his feet. But I'm also being more careful of diet. So his numbers should come tumbling down. I just don't know if it's diet or if it's constipation that causes these leaps in his bgs. I keep working on it. xxM

    EDITED TO ADD. his +4 number is 3.1 so maybe it's constipation that is the biggest problem with his numbers. I might post to the health forum to learn more about dosing for constipation.
     
  4. Blue

    Blue Well-Known Member

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    Dec 28, 2009
    Don't worry about trying something and it did not work or you wandered off the beaten path.... all that you try produces data and no matter the outcome, you learned something.... it was good or it was bad.
    I think every one of us gets to looking so close that it gets like you can't see a single tree for all the stupid forest!

    I use cubed chicken breast meat for treats and for holding off complainers who want food in the 2hrs prior to ps. Ollie likes it raw and steamed; Shadoe eats only steamed.
    I would be leery of a food called gravy lovers, and I don't know much about the dry being any good for his numbers.... maybe look up the ingredients for the ff flavors and see what's there.... I try to look at the ingredients in foods I get and shy away from any beef flavors. I use tuna in water; I drain the water in the can to use as a chaser after their pain meds, and then the tuna is given as a treat but I add a full can of water to the tuna to moisten it up .... they like the tune but only about once a week for them.

    For constipatiion, that's easy. Just go to the pharmacy and get a powder that humans use... I use Restoralax and others use Miralax. Ollie has 'slow stool' per the vet seeing his Xrays, so I am 'helping it along' with 1/2 tsp in his 2 main meals with lots of water added. Be sure to add lots of water or LB will end up dehydrated as the powder pulls moisture from the body into softening the stool.

    Because every cat reacts differently and has all their own uniqueness, we all try what we think will work. So long as we remember what is good about the protocol and make careful adjustments, and safe ones, it should be OK.
     
  5. Anyname

    Anyname Member

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    Jun 8, 2010
    Are either Ollie or Shadoe allergic cats? (you mentioned avoiding beef) Water is a big problem - LB won't drink, ever. I think tuna in water is a once a week treat for him now - can't put my finger on why but 'back of my mind' uneasiness about it - used to do it with fresh water but forgot as I stopped giving it to him for a long time.

    I know that traditionally FF in gravy is a concern but he can't eat many of them coz of allergies. I chose the one with chicken only.

    The Royal canin GI dry is at my vets advice. Vet thinks LB has underlying stomach issues. He not sure what though - he said the testing will be extensive and expensive so to try the RC GI for a while and see how he goes. There has been problems previously with constipation (blood in his stool). He has been going quite well - but maybe he has mega colon. The last time he had high numbers I gave him duphalac and the next day he did a massive poop in litter tray - it looked way too much for a cat to have done. :eek: Duphalac is the same as the powder you mentioned but I only give it sporadically - like when his numbers soar. How often should I give it to him? Would every 3 days be enough? He won't drink unless his numbers are high for a day or so. Not sure how to get sufficient water into him.

    Time to go see my wonderful vet. It's been a while which is a good thing in that he's been well for a while. Has some very itchy looking patches around his bag legs. He's just so damned allergic poor little guy.

    The most important thing I need to know is what supplement can I order on line to give LB that covers a few area's of basic requirements. LB's diet is not well balanced coz of having to feed him the things that won't make him itchy.

    many thanks ...
     
  6. Blue

    Blue Well-Known Member

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    Dec 28, 2009
    \

    Nope, no allergies here, luckily, but I avoid beef as others have had issues... I stick with poultry and some seafoods. Somebody had mentioned to look for gluten free, avoid starches, read the ingredients on the foods.

    For the constipation, I used to do like you.... just every once in awhile if Ollie needed it, but I found that it was better for him if I just gave a little bit every day in his morning meal. It does not have to be alot and you could start with say 1/4 tsp once a day, then monitor LBs 'output'. If it's a bit loose, then cut a bit down on the amount you use, and if a bit too firm, add more and be sure to 'soup' his food.... it sounds like he's another Ollie who never ever ever drinks water, very weird. Ollie really likes the watered down foods.

    Do you have any ideas of some items that make him itchy? Have you tried feeding raw? At least there would be no additives.
     
  7. Anyname

    Anyname Member

    Joined:
    Jun 8, 2010
    He seems to be allergic to beef, turkey, fish and kangaroo. I have also wondered if ants might be a problem or mosquito bites - or some funny combination of food and bites - fleas? (no evidence of the latter). I get ground rabbit for him - but the bone in it is a problem as the high ratio of bone is binding. I give him one meal of rabbit a day and sift my fingers thru it to pick out obvious boney bits. Trouble? Him? What are you thinking?

    He started his allergy journey about 3 - 4 yrs back when he was found to have an eosinophilic granuloma on the back of his tongue. Just looked up the following for you and will probably now read away to see if I can learn anything new since the last time I looked. http://en.wikipedia.org/wiki/Eosinophilic_granuloma

    A while after the tongue lump was found, the vet put him on steriods to shrink the lump - vet afraid it would rupture and he would bleed to death. You can guess the outcome. granuloma went down but other problems replaced it. Since dx for FD he's been itchy/biting himself. I had changed his diet from tinned food/dry food to raw. He started to itch a couple of months in to the FD experience. Lots of vets had a look at him - they all say he's magnificent but no one quite knows how to deal with it in the FD setting. it's all very well suggesting the food trial. He gets so bored after a few days of the same thing - doesn't want to eat it any more. I try to balance his symptoms with his enjoyment of the day to day experience. I mean to say, this boy, like so many other cats on FDMB is looked after like a prince. He's a good boy - a smart boy and he's got a lot of dignaty. Does not like to poop inside the house - he won't even do it on his yard but prefers to visit the neighbours yard. :oops:

    I will possibly only give the poop syrup every second day and see how it goes... obviously monitor, monitor, monitor is the name of the game?
    Mxx
     
  8. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    Yes, monitor the 'outcome' and adjust the syrup as needed.

    While you were talking about allergies, and the itching/biting, what came to mind was benadryl or something along that line... you know how some people have allergies, or some have meds that result in dry skin and bad itches, so what about something for cats?

    What do you think? Or could part of it be part stress?

    you get the rabbit already ground or do you grind it? Does it help to take the bony bits out?
     
  9. Karen & Pearl

    Karen & Pearl Member

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    Dec 28, 2009
    I wonder what happened between July and Sept. that required this raise in dose? Overall, the numbers don't look horrible but I really really think that you need to be a little more systematic and pick a dose and stick with it a few cycles then decide which direction to move. You can't let an occasional preshot into higher numbers drive your dose, which I think may be happening. High numbers happen (as do low) somewhat randomly, even in humans. But it sure looks like something changed at that time period. Was that when constipation started? (ETA: have you tried for constipation, instead of syrup, something like a fiber additive? Like I use http://www.helpforibs.com/shop/suplmts/acacia.asp - because I have it and it is flavorless. I also have started giving both of mine http://www.amazon.com/FortiFlora-FE...YL22/ref=sr_1_3?ie=UTF8&qid=1323532306&sr=8-3 which has the added benefit of they seem to think it is a tasty flavor. It's not going to hurt to add it and may help.)
     
  10. mybuddybinks

    mybuddybinks Well-Known Member

    Joined:
    Aug 11, 2010
    Hi, marilyn!

    good to see a "Tiny Guy" condo :lol:
    (he's such a handsome devil)

    i don't know if this is helpful, but Binks gets 1/8 tsp of powdered miralax twice daily...
    helps him immensely...

    hugs to you and a big sloppy kiss to Little Boy for Binks!




    celi
     
  11. Anyname

    Anyname Member

    Joined:
    Jun 8, 2010
    Thanks muchly for input once again. Took yesterday off as gotta CLEAN house with 'fine tooth comb'. DD arriving from UK tomorrow. She allergic to cats. :eek: She staying at in-laws too - they also have a cat! :roll:

    Need to update my SS. LB continuing to bungee jump bgs. ohmygod_smile I think food is the culprit. Out of respect for the opinion of helpers on the new forum I've tried to stick to one dose BUT I went early last nite - 2 hours early with 4 units then added the other two at bed time (to complete dose). I am not sure what the forum thinks of splitting the dose but I wanted to see if it helped. I am going to keep him away from tinned food for a while and watch carefully.

    Duphalac is the same as miralax. I read a lot about adding fibre a few months ago. Australians don't eat tinned pumpkin - we eat pumpkin in same quantity as we eat potato - no one would buy it in a tin. I'll read the url supplied about supps thank you. Supps are of concern at present. He needs something that won't upset him. Previously oils have upset him - I suspect a touch of pancreatitis when administering oils. Specialist vet prescribed evening primrose oil but hard to get the dose right.

    LB has two forms of eosinophilic granuloma. The skin eruption form and a mouth plaque (large lump on back of tongue). It was this that lead to steriod treatment that led to FD. His skin is very dry but not from antiystimines as I don't give them much. One a week at the most. FortiFlora interests me as long as it's not too rich/oily. I also want to find something that includes taurine. (sp?). WE often wash his back as dandruff so bad.

    The break in numbers in August/Sept - he 4 weeks at cattery. They had all sorts of problem with him. He was high most of the time but they wouldn't increase his insulin incase he hypo'd. He was unresponsive to increases for a long time on returning to us.

    He will never come off insulin. I suspect his high numbers are a result of inflammation from eosinophilic granulma complex - it is more severe than a normal allergy - I think it causes internal storms when it's acting up - will see vet asap to talk more about trying something new. The rabbit he eats is ground up with bone from the butcher. I try to pick out gritty bits.

    I really can't imagine having a cat that I just feed twice a day and leave to be a cute happy house mate. Does such a thing exist?

    thanks all for helping - it's lovely to have some support... my friends think I'm insane.... not sure what their point is? I'm comfortable with insane - always loved cats since the moment I knew they existed!

    marilyn
     
  12. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    Forti flora is dry powder form. When I open a packet of it and wave that under Shadoe's nose, her eyes almost pop right out of her head! If I sprinkled some on dirt, she would eat it!
    Shadoe once had lots of pancreatitis issues, so I used it to get her to eat a little bit.
    Since I started giving her and and Oliver B12 shots, she has had only a few minor issues.
    I do keep fluids and pepcid and bupe on hand just in case.

    If you suspect a touch of pancreatitis, maybe try some pepcid first to settle any upset feelings.

    Oh, I really don't know about splitting the dosing on Lantus because now you will have to contend with 2 separate nadirs, and then your next ps value at +12 for the 4u will really be the +10 of the 2u, so what will that first ps be - it will be influenced by the 2nd shot.

    You will have to get some testing done to see just how LB reacts to this kind of dosing, and then you can learn if it's something that will work for LB or not.

    For info on supps, you could try posting in Health with a subj like 'What supps for cat with eosinophilic granuloma'
    Hopefully, you will get some good feedback and suggestions.
     
  13. Blue

    Blue Well-Known Member

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    Dec 28, 2009
    Marilyn,
    You may want to take a look at the posts for Musette as she is trying split doses - maybe you can read how it's been going so far with splitting dose shot times.
     
  14. MommaOfMuse

    MommaOfMuse Well-Known Member

    Joined:
    May 26, 2010
    Hi Marilyn,

    Gayle asked me to look in on you since I'm split-dosing Musette. At least for Musette this has been the magic bullet, but I'm also not working with a kitty that has other health problems like it sounds like you are with Little Boy. Musette's main problem I think was that while she needed a full unit she is so tiny (maybe 7 lbs) her body just couldn't handle that dose all at once...I tried for awhile to stick to the twice a day shots but ran into her either dropping into the basement or shooting for the sky if I reduced.

    If you look at her spread-sheet you will see I give her .5u at her normal time and then the other .5u 2 hours later, since we started this 5 days ago her numbers are remarkably better and her curves are flatter and more gentle. I really haven't seen two nadirs with her, her nadir still remains right at +6 but she gets a much longer duration throughout the day, before once she started rising after her nadir she would try to shoot for the stars. We are still early in the game but I would be happy to help with LB in anyway I can with split-dosing, it has really been a sanity saver for us.

    Mel, Maxwell, Musette & The Fur Gang
     
  15. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    You can somewhat visualize the dose splitting as the following,
    - if and only if the cat breaks down the Lantus the same way for each dose
    - and has approximately the same amount of calories coming in
    - at roughly the same rate (this isn't likely, but it is a starting point to "see" it)

    1) take the regular dose curve - maybe draw it on graph paper

    2) draw another curve and reduce the height of the curve by the amount of the split - if half, make it half the height, if a third, make it 1/3 the height, if 2/3 make it 2/3 the height.

    3) lay one dose on top of the other - if you calculate some estimated values for the data (1/2, or 1/3), you can actually add them together

    4) sum the estimated values to get an approximation of what the total glucose might equal and plot that - compare with your testing data.
     
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