? New Member, May 2, 2023: Lantus dose changes

Hi all,

Recap: after a scare when the Libre sensor was dying, while showing me a graph dipping into th 50s I first skipped a dose then went to a half dose (from 2 units to 1) until I could get a new sensor put on. Maybe I was wrong to do that, but in the moment it felt like the safe thing to do. (they told me later that it can show much lower numbers when it's about to quit, and that normally it tends to show about 10 less especially in the lower numbers).

This earned me a disapproving message the Endocrinologist. He actually took time from his very busy schedule to write me an email for the first time just to scold me and tell me to stop trying to reach them by phone. He didn't even remember Jessi is a cat, and referred to her as 'your dog'. That happened right after a vet on his team scolded me for lowering the dose and messing up injections.

All of this combined with extreme fatigue and stress, triggered a huge meltdown. But onward we go.

Anyhow, now we have a new sensor. The vet (one of the vets on the Endo's team) told me to stay at 1 unit for a day just to monitor the levels before raising it to 2. I asked about going incrementally, but she said this is too imprecise.

She wrote to tell me to do 2 units in the morning and 1 at night. Does that seem right???

She did ask me to remind her (them) to check the sensor results every 2 or 3 days. Yes, that's right, I have to remind them.

I admit I feel a bit caught between their indications and yours especially since they are the ones putting the sensor on and monitoring it (in theory) and giving dose instructions accordingly. They get a little miffed when I go my own way and if I do it too much of that I am sure they will tell me to find another vet. I don't want to do that because very few if any other vets here in Bologna have experience with the sensor and with FD, from what I can tell. A lot of vets here refer their patients to this guy (his name is Fracassi) for FD and at home monitoring with the sensor. I don't want to rock the boat so much that I lose them, no matter how spotty their guidance is.

I know, you need a spreadsheet. And I need someone to help me plug in all the numbers. I will start on my own but it will be slow. I just can't do that for very long every day, even now I have so many things piling up as I put more and more attention on Jessi. She's waiting for me as I sit and write this.

So what do I do? Go with what they are telling me? Is it ok to do two different doses like that? I guess they're trying to avoid a Hypo or just avoid me freaking out when I see low numbers. But can her little body deal with two different doses like that? And is it ok to just jump to 2 from 1, which is really 1.25 because I did increase it a little already

Oh and they told me I don't need to test for ketones at home. I know you'll like that one. Good news is Ketones were at 0 yesterday when we went for the sensor. I had to ask them to test for them. They didn't even check her glucose levels even though I asked for that too, or weigh her, which I forgot to ask. They were just going to put the sensor on and send us on our way.

I guess they just expected me to know that they are only handling the sensor and dosing aspects, for everything else I have to work with a different Vet. I thought he was going to do a lot more than that given his reputation as some kind of genius. Oh well...

I promise I will get to the spreadsheet soon. I am also putting together the Hypo toolbox, which is taking some time. Can you believe it is really hard to get corn syrup here? But the Gourmet Gold (aka Fancy Feast) arrived along with some treats and other things I ordered. Bit by bit, I'm getting it all together...except for sleep and my own physical health, that is...I'll work on that too soon...

AM preshot was 350, lowest number scanned was 131 at +4

Spreadsheet in progress...
https://docs.google.com/spreadsheets/d/1AATN9cUaVniKMpt-T8kcoaNTP6WjcUz-ISFTD7SFOPM/edit?usp=sharing

(with the sensor I take readings at all different ours, not precisely in on hour increments so I wasn't sure how to enter the readings. For example, if it is at +4.5 where do I enter it, in +4 or +3?)

 

You don’t need to plug in all numbers. Just Amps pmps lowest reading for each cycle for a last week will help.

 

ok, do you want to see Caninsulin numbers too?

And if the readings are not on the hour, how do I place them, round up, round down? does it matter?

 

If you test @+4.5 you would put that in the 4 cell or square
Example
300 @+4.5

If they are not done hourly
Example only
0.25 means 15 minutes
0.5 means 30 minutes
0.75 means 45 minutes

 

No need for Caninsulin data.

 

Oh, so you change it on the spreadsheet at the top of the time columns? I didn't even think of that...I'll have to go back and do that because I was just using the closest hour.

Oh wait, except that I am changing the hour for the entire column and it's not the same every day...

 

Time. You list the tests all in the same box on the ss and not the top.so go to the box for 4.0 and write 59@4.0 50@4.5. You the need to manually color the box when you put more than one result in a single box. Make sense?

 

I think I got it, but now it takes even longer to do this.

I thought you only needed the preshot and the lowest BG, should I be putting more than one result in one box? I didn't write every scan I did. There are many.

 

In the morning I'm supposed to give 2 units according the vet's instructions and only 1 in the evening. To me it doesn't feel right to have two such different amounts. I was hoping to get your opinions on this before morning.

Anyone?

 

@tiffmaxee
You should not be giving 2 different doses
Can you please look at Stefanie's SS she did put some lantus test numbers in, but she is chopping up the dosings. She hasn't picked a dosing method yet
Thank you Elise

 

Let me look.

 

Hi Stephanie. Diane is correct and so are you. Lantus likes consistency. It’s a depot insulin and build up with consecutive dosing. Some vets just don’t understand this. They don’t get a lot of training. It could explain a lot about it being hard to regulate. Cats do drop lower sometimes at night but you feed them accordingly. We can help with that. I think you should give the 1.25 both cycles and let’s see if more is needed. The nadir was not bad at all.

What do you think?

 

I did c

I did choose SLGS. I just hadn’t seen that I needed to fill that in in the spreadsheet until earlier.

Chopping up was not my idea. I think by that you mean two different doses. It is the vet who wants me to do that.

I have read on this forum about giving a slightly higher dose during the day that at night, but 2 and 1 seems to big of a difference to me. Is that what you mean by chopping up

It’s 2am here I don’t think I can stay up much longer.

As I said in my messsge above, if I don’t do what the vet says I jeopardize my relationship with him and his resources. That is a big deal in my situation. If we can up with a way to adjust the dose to make it optimal but also keep aligned with his/her prescription, or at least make it come out so he wouldn’t even notice, that would be best. Of course, they may not notice anyway, they’re so busy...

 

You don’t need to plug in all scans but until we all have a handle as to what is happening would you please plug in Amps, pmps, +2 or +3 the lowest, and one at +5-8 and vary the so one day plug in +5, next day +6-7.

 

Stephanie, you are in Italy, right? The foods will be different. I don’t know if others are here from Italy if that’s correct. Do you know Diane?

I was at the vet when you asked. We are from all over the world and volunteers so we won’t always see your questions right away. Since you don’t always follow your vet’s advice, I would listen and then dose the way it makes sense to you. It’s your cat and sometimes that means listening to your vet and doing what you think is best.

 

Not now but after you get some sleep write SLGS in your signature and on your spreadsheet or we will continue to ask you. Too many cats so we can’t keep track and need it to be in print.

 

Rabbit, Rabbit/Turkey, Beef/Rabbit

Very low carbs, between 3 and 1 percent if I remember right.

 

Yes go to the top of your spreadsheet and add SLGS up top where it ask you

You need to put it in your signature also so members know
Tap on your name up top then tap the word signature and add it then tap Save or Done

 

OK that's good

 

Good. Do you have some food 10-15% and some over that in case the bg drops and you need carbs to get it up?

With SLGS you will hold the dose, hopefully the same for both cycles, for 7 days unless the bg falls under 90. If that happens you reduce by .25.

 

1.25 is what I have been giving the last couple of days. It doesn’t seem like it’s enough. Too many high numbers. Maybe 1.50 would be good

 

Yes she's in Italy , I searched all over for members from Italy ,I know there are some but let me look again, they might not have been on for awhile

 

If your vet doesn't ask to see your spreadsheet you don't have to tell him what does you are giving, just nod your head and smile. If it wasn't for the experienced members here and taking there advice and not my vets Tyler would not be in remission as of 1-24-21
I have to say the members here know way more about diabetes than most vets do
I would agree with Elise to try giving 1.25 units for both cycles for 7 days ,unless he drops under 90 at any time you would then reduce the dose by 0.25 units

 

I only saw you gave 1.25 twice which was today last night you have 1.2 units did you mean 1.25? ,it takes 5-7 days for the depot to fill to see how it's working
Read all the yellow stickys about Lantus on the Lantus link
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

 

I found a member from Italy and her spread sheet is up to date
I will tag her ,hopefully she will see the tag
@Sofia
Sofia
@Stefania S is a new member from Italy also
Can you tell her what medium and high carbs food you feed if needed and where she can get them
Thank you
11% -15 is medium carbs.

16- 24 is high carb.

 

Whichever dose you give start now and give it every cycle for 7 days unless the bg goes under 90 which means a reduction is earned. I’m fine with 1.5.

 

Found another member who used to live in Italy I'll try tagging her
@MISSY + Simone&MICIO (GA)
Hi Simone we have a new member here from Italy , @Stefania S
and remember you used to live in Venice, would you have any suggestions for med and high carb food for her and where to buy it
Thank you
11% -15 is medium carbs.

16- 24 is high carb.

 

These are the only members from Italy that night reply I even private messaged them
All the rest I found haven't been in on in years, I think my head is going to explode from trying to find members from Italy but I am glad to do it
I hope one of then gets back to us
@tiffmaxee

 

Hello Diane! @Stefania Ciao, my name is Simonetta (I go by SImone) and I'm from Vicenza, not too far from Venice. I do live in the US for the last 20 yrs now and not sure how I can help you with pet food brands available at stores in Italy.... I grow up with cats and dogs but, back in the days, pets were fed mostly with human food, scraps and dry food....YES, what a horror, I know and I wasn't even allowed to have them in the house and love them as I wanted to but hey, here I am now and spending every single minute and breath I have with my cats and any animals or live creature out there in the best way I can.
I have been feeding my cats raw meat diet with supplements (EZ Complete) for at almost 12 yrs after finding out my now 14-1/2 yrs old Missy had IBD since she was little, a total life saver and now, with diabetes, it's probably the best nutrition I can give her. I also add a tiny amount of high quality canned food too with her raw meat meals. I think if you can find a trusted brand with high quality canned food (low carb, high protein, no grains...) and also easy for you to find/get either at stores or online it should be fine.. As for the Low, Medium and HIgh Carbs canned food you would have to either see if any of the brands listed in here: Food Chart 2017 FIX NATION 12-3-18 (catinfo.org) ( is available in Italy or you can always called the company and ask for a detailed nutrients analysis).
If you have troubles finding corn syrup I think honey is ok too in case of an hypo event.
Sorry, wish I could help you more.

 

Just letting you know that I got your message! When I have a chance during the day I’ll write back

 

Hello,
So just doing a quick search (also to refresh my own memory), I’ve found these options: (going by the BalanceIt calculator)

Medium carb (12.21%)- Almo Nature DAILY chicken

High carb (19.02%)- IAMS Delights in Jelly

Honestly, if needed in an emergency, most cat foods that you can find in a supermarket here, more so ownbrand food, will likely be higher carbs.

Just to add, the low carb food I use is Bozita beef pate, and also Carny (cocktail multicarne) and we’re doing well with these, if remember well they’re around 2 or 3 %. There are others, Purina Beyond Grain free beef pate is also a great option but for me it’s too expensive, having to feed 3 cats.

The Purina you can find on Amazon, Almo Nature DAILY I’m quite sure from decent pet shops or supermarket or even from ZooPlus, and all of the others that I mentioned (IAMS, Bozita, Carny) I get delivered from ZooPlus.

Hope this is of some help!!
Sofia

 

Hi all, thanks for all your input.

But can I ask why are we talking about food on this thread? This post is specifically about dosing and it's a bit overwhelming to find all these messages about food and other things here.

I have a thread just for that and it is specifically for high and medium high carb foods. If you could post food related comments there, I would appreciate it.

I already have a low carb food that I feed Jessi called Terra Felis, I give Rabbit, Rabbit-Beef, and Rabbit-Turkey. You may not know the brand, but before trying to replace it, could you look into it thoroughly first. I did call the company to check for any undisclosed ingredients and make sure the guaranteed analysis percentages were current and accurate, after that it's a question of taking them at their word.

I can't change foods right now until things are more stable, and it can be quite hard to get Jessi on a new food until she decides it's time or I find just the right one. I have done a lot of research over the years so my choice is based on a number of factors including carb content, quality, allergens, digestibility, and palatability. I know it isn't perfect and I have it in my mind to find something better in the future, so your suggestions are definitely welcome. But, unless you have a specific objection to the Terra Felis, I will keep giving her that until it's time to change.

I have Bozita chunks in sauce as a medium carb food and I have Golden Gourmet (Fancy Feast) as a high carb food (though I think it's a lot lower in carbs here than in the States from what I calculated), so, if anything I could still use a high carb food easily available in Italy, if you know of one.

But like I said, please keep that in the thread specific to that topic, linked below.

https://www.felinediabetes.com/FDMB...h-medium-high-carb-foods.277676/#post-3072828

Again, I appreciate your support and information, I would just like to ask that you try to keep the discussion focused since dosing is so critical and time sensitive and I am still learning about it. I need to be able to easily find replies to the dosing question.

Thank you

 

I went with 1.5 since we were originally at 2 and she had some pretty low numbers, while 1.25 was seeming way too low. I hope this will be alright. I will watch the numbers carefully with my low carb foods and corn on hand. Lol! That's a reference to another thread, where I mentioned that Jessi loves corn and I gave her some the other day when I was worried the BGs were going too low. She loves it more than anything, little carb junkie. But don't worry, I haven't given her corn in about 7 years and the last time was by accident. I know it isn't good for her.

 

Hello Sofia! Just want to add a note about Almo cat food: unless the company recently changed the nutritional composition, as far as I know it's not a daily complete nutrition for a cat Here's an article I found on Feline Diabetes group on Facebook: Almo Nature Pet Food, Complete Diet? – Truth about Pet Food. But I'm sure it makes a great topping or treat ...in fact, I do add a tiny bit of Weruva Chicken Freek-a-zee (which I believe is similar to the Almo version) on top of my Missy regular raw meat meal

 

Please remember to update your ss. It’s easiest to do that at amps and pmps. There are people using the Libre that know how to get it done automatically. I’ll look later and see who might be able to tell you how to do that if you want.

 

@MISSY + Simone&MICIO (GA)
@Sofia
Thank you ladies

 

Hi Stefania the only reason we were giving suggestions about med and hc food was because we wanted to be sure you had them on hand in case you needed to bring
Jessi's BG up if needed

 

Automatically? Well, that would be amazing! I can't imagine how but if there is a way I would love to know!

 

It is very time consuming to have to hand write in the times with quarter, half hour, three quarter hour and calculate the distance from the shot each time. I have trouble focusing enough to do more than just a few numbers at a time. I will see if I can send some screenshots of the Sensor Logbook to Bhooma, but I would like to find out ASAP if there is an easier way from Libre to the spreadsheet.

Update: I am starting to get the hang of the spreadsheet. If I do it regularly it's easier. Still, it would be so nice if there was a way to do it automatically!

 

Now I'm feeling a little nervous about the dosage again. 1.5 seemed right but with all the comments saying I should start at 1.25 and all the talk about food in case of low BG, it's making me pretty anxious. I really do need to get sleep and if I am worried about a low BG how will I do that?

Should I take it back down to 1.25 to avoid that altogether? How long does it take for it to build up to see the effects of the increased dose? I noticed today already the high numbers are a little bit lower. I wish I understood better how Lantus works. Caninsulin was pretty straightforward. Lantus feels too mysterious.

 

Don’t take it down. We will know soon if it’s too much or not. Moving the dose around so much is not helpful. I don’t have time now but later will look for someone that has all the readings from the Libre automatically transfer to the ss. I know it’s possible. I just never used a Libre.

 

Ok. I went ahead and plugged more numbers into the spreadsheet. Hope I did it accurately. It's hard! It takes a lot of mental focus and time.

And, of course, as the BGs are going down Jessi decides she doesn't want her food. I notice this ironic situation, as she starts feeling better because BGs are in better ranges, she gets more normal, which means, she eats less and sometimes even gets picky about her food. Which of course then means that the numbers will go down even more and it could get dangerous. Today I gave her some new treats and she loved them so much, she wants me to give her those instead of her normal food. But I can't just give her treats as a meal, plus it's a tiny bag and we'll run out fast.

So now I have to get Jessi to eat her food so that I can relax a little and maybe get a few hours of sleep. I already tried putting the treats in the food. She figured that out fast, licked the top and left the rest. She's holding out for treats, refusing to eat the food that until this morning she devoured happily.

 

She doesn’t need to eat a lot to bring up the bg. When dropped advice just a teaspoon or two at most to keep the, hungry. You also have 2 hours before lantus kicks in to get her to eat.

 

Nice nadirs b

 

@tiffmaxee she ate in the end, so it was ok. I don't really understand what you meant by 'when dropped' you mean when BG is low, how low? Only a tsp or two at most to keep her hungry, did you mean? why not more? I pretty much feed her when she's hungry except for 4 hours before the next shot so she'll be hungry. But I though Lantus having a longer duration, and a much slower release, having frequent meals throughout the day was fine.

What did you mean I had 2 hours before Lantus kicks in? Doesn't it start kicking in soon after the shot? I thought around +6 was typically the nadir.

What makes them nice? Aren't they high?

Today BGs haven't gone below 237 yet and that's at +7.5. I'm so sure the shot went in, I saw it with my own eyes....

 

Maybe I'm feeding her too much or too often...but she is just starting to put some weight on after being so skinny for too long....