EZ _3 BG readings read HI_using Lantus_UPDATED Sat AM

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Easy!Foop

Member Since 2014
Hello,

Posting for EZ - 18 y.o. male cat (from VT).
Long story follows - question re "HI" readings glucometer 12/17PM and 12/18AM.

EZ diagnosed w CKD March 2015 - subq fluids daily and phos binder, pepcid sq as needed, and VIT B12 SQ weekly since then. Was started on calcitriol. Was on omega 3 oil.gets 4 renal essentials and 4 liver essentials tabs by Vetri Science twice a day on a bit of FF classic.

Doing well until Sept 2015- BG began to climb from 150ish range to 175 to 195 by Nov when he began eating less and less, seemed to have no oomph. drinking more and urinating more.
Had been a canned food eater for last 10 years - NO dry food. Started on SD KD when diagnosed w kidney probs April 2015; I took him off the KD (high carbs) and he has been on Wellness canned (turkey, chicken, turkey and salmon) since then _ lowest phos and carb canned pate that he will eat.

Around Tgiving he was seen by an internist and had ultra sound: BG still elevated high 200s, liver enzymes elevated - looked like ?pancreatitis ? liver problems ? lymphoma; also non regenerative anemia and the previous kidney disease: Told to discontinue calcitriol, started on Clavimox, if no better to start on denamarin
for liver, keep up kidney protocols, and if BG rose or diabetes signs to begin on insulin.
Weight had decreased t0 10.1 from 12.3 in April 2015.

Dec 6 showing signs of difficulty walking, blood work taken and sent to IDEXX - results came back with high liver, kidney, BG values, and wgt 9.9. urine culture clear, glucose in urine, trace ketones.
Between Dec 6 and Dec 8 began eating better and acting better.

Started on Glargine 1 unit Dec 8 PM. Reading in mid 400s AM and PM including some +4 readings
Increased Lantus to 1.,5 units (as per vet) after 6 cycles - 3 days.

On 1.5 units (Sun 12/12) AM+7 325, PM 352, PM+6 228; next day (12/13/2015) AM 167 - then I panicked since I was not going to be home for the rest of the day and only gave him 1 unit Lantus instead of staying the course on 1.5 units; 12/12/2015 AM +8 461, PM 548 and went back to the 1.5 units Lantus and have stayed with that dose since.
12/14 AM 577, 12/14 PM 349, 12/15 AM 162 (gave 1.5 units Lantus), 12/15+7 414 , 12/15 PM 545
1216/ AM 343, 12/16 PM 474, 12/16 PM +5 412,
12/17 AM 284, 12/17 PM "HI"
12/18 AM "HI"
Both times I got the HI reading I tried the other ear to check that the reading was correct.
I use an Ulta touch mini glucometer.
He continues to be on 1.5 units Lantus BID, Clavamox BID, Pepcid SQas needed, B12 sq once a week, stopped the Denemarin after 1 dose since he was starting on insulin and did not want to be introducing 2 things at same time; and 100ml Lactated Ringer's every night.

EZ is acting great - eating well (about 1 and 3/4 cans Wellness every day). He feels heaver to me like he has put on 1 lb pounds since vet visit Dec 8. When his numbers went a bit lower he was drinking a bit less water
and urinating less frequently. In the last day or so with readings "HI" he has been drinking a bit more again
and urinating more frequently again.
He has no vomiting, a good appetite (yay!!!), no diarrhea or constipation. He seems very comfortable and walks around. Last night before the "HI" reading he actually came upstairs for the first time in about 3 weeks. This morning he ate well, drank well, urinated well; moved around ok but slow.
NOTHING has changed in the household in the last week, he gets the same amount of food.
I d oknow that anemia can cause abnormally high or abnormally low BG readings. Sigh.

so - Looking for guidance, advice etc etc.

Regular vet off today - vet covering says "stay the course," he has only been on insulin for 10 days.
Keep on the 1.5 units , get an at home curve this weekend (which I was planning to do anyway).
Check in with AM reading and AM+2 reading with them tomorrow.
As long as eating ok, moving around a little and is comfy.
He gets insulin at 6:45Am and 6:45PM give or take 10 minutes. I do BG, then he eats, takes him a while - he has about 1/2 can; I shoot; he gets about 1/8 to 1/4 more of a can . . test, shoot, eat within about 20-30 minutes.

I leave home around 7:15-7:45AM (I get up at 4 to remove his food dish where there is 1/4 canned food for him to munch during the night, he likes to eat a bit of something during the day and night in addition to
his 1/2 -3/4 can food at AM and PM mealtime).
And get home by 4pm to again remove his dish! for a 2 hour fast before 6:15PM BG testing.
I can get a PM 4+ or 5+ reading during the week; and do a curve on the weekend.

I am treating the cat and not the numbers (as the CKD folks advise) since he appears to be feeling ok.
I have downloaded the spreadsheet and using it to track everything; and I made a small chart of his readings so far. Not sure how or where to post it.

Oh - I have to internet access at home - so will only be able to check back infrequently during the night and weekend.

Apologize for such a lengthy post (and any spelling glitches).

Thanks for any tips etc, guidings
Stefanie (and EZ)
 
Hi Stefanie and EZ,

It sounds like you and EZ have been through some trials! What a great job you have done caring for him.

I don't use Lantus so posted for some help for you on the Lantus forum. Hope they will come over and give you some advice. One thing I know they will want is some mid cycle numbers - 5 to 7 hours after the shot- as the dose is determined on the lowest point in the cycle.
 
Sue and Oliver (GA) said:
Hi Stefanie and EZ,

It sounds like you and EZ have been through some trials! What a great job you have done caring for him.

I don't use Lantus so posted for some help for you on the Lantus forum. Hope they will come over and give you some advice. One thing I know they will want is some mid cycle numbers - 5 to 7 hours after the shot- as the dose is determined on the lowest point in the cycle.
Click to expand...

Thank you Sue, for the re-posting and the kind compliment. I was not sure where it should go, but since it was so long I put it here -:).
EZ is the last guy from a large household of cats . . .and he never had any problems before this past March, so of course he was mostly a background guy whilst the others with all sorts of problems and emergencies got attention. But he truly is an EZ guy.
 
The instructions here, tell you how to attach your spreadsheet to your signature.

Getting the mid cycle tests are key in telling you whether the 1.5 units are too little, too much, or just the right amount of insulin. If you can test as soon as you get home during the day, on the weekends, or at night before bed, you will help fill in the picture. And good job getting going on the testing so far! We determine whether a Lantus dose is the right one by looking at the nadir, or how low it takes the cat. Different cats have different nadirs, but some tests in the +4 to +7 range will help. Even those "in the door" at end of day tests will fill in pieces of the puzzle.

It is possible that EZ is doing what we call bouncing (second post here). In other words, seeing lower numbers than he is used to and his body is trying to protect him. In that case, those high numbers will pass.
 
When Squeaker had a reading of HIGH that meant his BG was over 600, too high for the meter to read. I think I would try some new strips or a different meter. It sounds like there could be either a problem with your meter or maybe the strips.
 
Neko had a reading of "Hi" on the meter when she started out. It just meant her blood sugar was over 600 and too high to read. I tried a different brand of meter, and got the same result.
 
Hi Stefanie!

I always joke that I'm just a "cheerleader" here in the FDMB as I would never give dosing advice myself :) But definitely do your next post in the Lantus group.

Never apologize for the "long read" as you've done a FANTASTIC job keeping track of everything!

See you over in the other group!
Darcy and Lebowksi
 
Sue and Oliver (GA) said:
Sorry you haven't gotten any responses. One suggestion is to go back to your original post, choose Edit and add Lantus to your subject line.

Meanwhile, here's a link to the Lantus forum. The stickie threads at the top of the page will give you lots of info on the insulin, how it is best dosed, etc.

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/
Click to expand...

Hi Sue,

Thanks for tracking this.

Quick update after another reading of "HI "at 6:15 PM last night, after which he had his usual 1.5 units Lantus,
this morning EZ had a reading of 293. Doing a curve today and at 6:15am BG 293 and AM +2 BG was 278.

I did know that a reading of "HI" indicated above 600 . . but since he was eating well, not vomiting and acting ok I did not know what to do about it -:)
I followed the vet's advice to stay the course.

I THINK I know what the problem is/was based on the 2 drawings this AM . . we shall see if I am correct.
EZ bleeds VERY easily - I know, everybody should have this problem!
I use the terumo needles that I use for his sub q (18 G) and I barely have to touch his ear and a large bit of blood appears, since he stays

I THINK I was getting too much blood on the test strip for the readings that yielded "HI."
This morning for both BG tests I was very careful to get only a tiny bit on the test strip . . and the readings were in the 200s.
So we shall carry on . . and hope that "too much blood" was the problem.
EZ continues his unruffled self.

I have studied ALL the files, folders, stickies etc on the site in the last week and been very well educated.
I am keeping both the recommended spreadsheet template copy for EZ and an actual chart of that data.

Thanks to all who post comments and advice here.

And thank you again Sue, for herding me in the right direction.
Stefanie and EZ
 
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