Lantus - Rapid Drop From Shot

[nepenthe]

Since the fall, I've been going through a bit of a roller coaster with Chingis' regulation. I have been following the Queensland protocol, going up and down in dosages buy 1/4 unit.

One thing that I have noticed about the protocol is that it tells you to raise by 1/4 unit when it goes above about 11.3 mmol and lower when we get below 4.5 (using the Alpha Trak meter.

What I've been seeing is, one, he is both above and below the recommended high and low guidelines in the same cycle.

Also, I've been seeing rapid drops from high numbers, like 18-19 mmol, and then down to like 2-4 mmol, - boom - right back up again by pm/ps. Could this mean too low a dose or two high when this happens?

* Note, in the past, whenever he had is pancreatitis flares, I would tend to see high, flat numbers, regardless of me going up and down in dose. This time, he has been eating well since late 2013 and gaining weight, and otherwise healthy. Since this past September, I've actually been wondering if he needed reductions, but the numbers don't seem to make any sense - and I am missing shots at night, because I can't test him in the middle of the night. His am/pm shots are at 10am/10pm

food: 2-3oz raw chicken/day + 2 cans minimum fancy feast

https://docs.google.com/spreadsheets/d/1CLGo6DxbKpj4lq4PLHA9v0LU-F0dzVsA47XA0Q5VRNs/pubhtml

 

[BJM]

I'm wondering if you're getting some interaction with the subQ fluids and the Cerenia not being every day. If those aren't consistent, it may impact the glucose levels too.

 

[Wendy&Neko]

I'm not sure what version of the Queensland protocol you are using. Could you provide a link to the document? The version that we use here is described in the Tight Regulation Protocol Sticky. We base our dose decision on the low point or nadir that a dose is taking the kitty with just some consideration to the preshots. On an AlphaTrak, the point at which a reduction is earned is a nadir below 3.8 (68). I see that Chingis got so some very low numbers, 1.9 (34) and 2.2 (40) in mid December when he was on 2.5U of insulin. Either of those events should have triggered a reduction, which you did 2 weeks later. I see that on the 4th he earned another reduction to 2.0U and you took it right away, so that is good, although you just increased again.

Moving forward, I am going to strongly recommend that you get some tests during the night cycle. Many cats (including Neko) go lower at night. It could be that Chingis is going lower at night and earning reductions then. Is it possible to get a test before you go to bed at night? If not, how about when you first get up in the morning? You could be at too high a dose, but without the night time test it's hard to tell.

And BJM is right, giving fluids can lower the blood glucose. Is it possible to give them in the second half of the cycle?

 

[Vyktors Mum]

Missing shots at night or missing tests? Your spreadsheet doesn't show missed shots - you would leave the units shot column blank in that case or put NS for no shot. Agree with Wendy that you seem to have missed quite a few reductions. Also can you confirm that you are testing before you shoot in the am your spreadsheet is saying that you don't test until an hour after you've shot???

Perhaps you could look at adjusting your shot times if you are unable to get at least one pm test on this schedule. As it is you only have half the picture which makes dosing decisions rather difficult.

 

[nepenthe]

Missing shots at night or missing tests? Your spreadsheet doesn't show missed shots - you would leave the units shot column blank in that case or put NS for no shot. Agree with Wendy that you seem to have missed quite a few reductions. Also can you confirm that you are testing before you shoot in the am your spreadsheet is saying that you don't test until an hour after you've shot???

Perhaps you could look at adjusting your shot times if you are unable to get at least one pm test on this schedule. As it is you only have half the picture which makes dosing decisions rather difficult.

Oh, I meant missing tests.

The big big barrier I have to testing him late at night is that I have a sleep disorder, so if I say, were to test him in between his pm and am shot, that would be 3-4 am and I wouldn't get back to sleep. I haven't figured a way around this. If I give him his pm shot early, say, at 6pm, then I'd have to give it to him at 6am.

His am/pm test and shot are at 9am/pm. Test, then shot.

But if you look at my SS, I messed up by putting his am pre shot readings in the +1 column.

What would you think if I did this: give him his am at 9am, his midday test at +3-+8, then his pm at 9pm, and then one post pm at +3, which would make it about midnight? (I might not ever be able to tell how far he does drop with this, only would have some idea of how quickly)

 

[nepenthe]

I'm not sure what version of the Queensland protocol you are using. Could you provide a link to the document? The version that we use here is described in the Tight Regulation Protocol Sticky. We base our dose decision on the low point or nadir that a dose is taking the kitty with just some consideration to the preshots. On an AlphaTrak, the point at which a reduction is earned is a nadir below 3.8 (50). I see that Chingis got so some very low numbers, 1.9 (34) and 2.2 (40) in mid December when he was on 2.5U of insulin. Either of those events should have triggered a reduction, which you did 2 weeks later. I see that on the 4th he earned another reduction to 2.0U and you took it right away, so that is good, although you just increased again.

Moving forward, I am going to strongly recommend that you get some tests during the night cycle. Many cats (including Neko) go lower at night. It could be that Chingis is going lower at night and earning reductions then. Is it possible to get a test before you go to bed at night? If not, how about when you first get up in the morning? You could be at too high a dose, but without the night time test it's hard to tell.

And BJM is right, giving fluids can lower the blood glucose. Is it possible to give them in the second half of the cycle?

Hi Wendy, here is that protocol. I use the second table, 3B, which is for Alpha Trak meter.

From what I see, going back to September - there have been quite a few lows, like those ones you mention mid-December. A week ago, on the 4th, when he went down to 3.6 I dropped him down to 2U.

What you are saying, it could be that he went low sometime like on the 6th, which triggered these highs?

What if I to this for a week - test him like at +3 or +4 post pm shot and then don't see anything much different then what I am seeing in the day?

 

[nepenthe]

I'm wondering if you're getting some interaction with the subQ fluids and the Cerenia not being every day. If those aren't consistent, it may impact the glucose levels too.

I haven't noticed any correlation between his getting sub-qs or Cerenia and lower BG values. (with Cerenia, we can't give it every day and need to have him off for a few days so that his "p-substance" receptors don't desensitize)

 

[Wendy&Neko]

What you are saying, it could be that he went low sometime like on the 6th, which triggered these highs?

What if I to this for a week - test him like at +3 or +4 post pm shot and then don't see anything much different then what I am seeing in the day?

Bounces can last 6 cycles, so yes, if he went low even the night of the 7th, he could still be bouncing. The other thing that can happen on dose increases that can cause a temporary increase in blood glucose is something we call New Dose Wonkiness.

For night time testing, even a +2 test can tell you if he's going lower at night. If the +2 test is quite a bit lower than the preshot number, it's an indicator of an active cycle. Depending on when you sleep, the +10 can also be informative.

 

[nepenthe]

Bounces can last 6 cycles, so yes, if he went low even the night of the 7th, he could still be bouncing. The other thing that can happen on dose increases that can cause a temporary increase in blood glucose is something we call New Dose Wonkiness.

For night time testing, even a +2 test can tell you if he's going lower at night. If the +2 test is quite a bit lower than the preshot number, it's an indicator of an active cycle. Depending on when you sleep, the +10 can also be informative.

So, looking at his numbers over the past few months, it would be more likely that he was needing reductions vs increases?

Do you think I should have raised it on Saturday night, or waited it out?

 

[Wendy&Neko]

I think he was giving you several indications that 2.5U was too much insulin in the last couple of months. Every time he went below 3.8 (60) on the AlphaTrak said he was getting too much insulin. Of course the problem is that he'd then bounce giving you high numbers which looks like he needed more. It can be tricky figuring out the dosing when too much can look like too little.

I would have given him 6 cycles after his 4.7 (85) on the 7th before deciding if he needed a dose increase.