? Need suggestions for handling unpredictable swings down

[Ramon's mom]

I am looking for a little advice: My cat has been having super erratic readings (see below) that seem to have no relation to what he eats, which is strictly low-carb. Since he has been having some very low readings (on Libre which do seem to run lower than his normal blood meter readings, but even so they are all running low).
I've been doing almost hourly readings and trying to give a few hi-carb treats to offset the low readings which may or may not be the reason 8 hours later he swings very high briefly. Earlier in September I lowered his dose by 1/4 to try to level it out. That worked for a week or so but now he's swinging hugely and I don't know what to do except maybe drop it again?
He's always been difficult to regulate as he has pemphigus and is on a med for that. But he has never had such low readings before. I do know that skipping doses sends him up into the 400's so that's not a good option. Anyone have some suggestions for me? We're about an hour away from his PM dose for today.

 

[Chris & China (GA)]

3.25 has taken him below 50 three times so you need to reduce the dose, even if he's high at his next shot time.

LO means below 20 which causes brain damage (luckily, we can spare a few million brain cells) but it's not something to trifle with.

I'd reduce him to 3 units tonight.

Your signature doesn't say which dosing method you're using. Are you using Tight Regulation or Start Low, Go Slow? (it makes a difference in the advice we give...but not tonight)

 

[Katherine&Ruby]

Hi there, here is your last post from May for continuity: https://www.felinediabetes.com/FDMB...-numbers-and-how-to-dose.246865/#post-2784582

Because of the LOW reading you got today, which I assume is a number below 40 on a Libre, you would reduce the dose at the next shot by .25 regardless of which dosing method you follow, and it seems like you still have not chosen one to stick to. Because we give advice according to either the tight regulation protocol or the Start Low Go Slow method, it's a little hard to offer you advice on how to proceed.

Some cats simply have a hard time getting regulated, regardless of the method followed. It could be because of underlying, undiagnosed conditions, steroid use, insulin auto-antibodies (IAA), acromegaly, ear infections, dental disease...the list goes on. Ramon could be one of them. But unless you follow one of the two methods suggested for Lantus users and post regularly for us to know what happens to him on a daily basis, it's hard for us to say definitively what might be going on.

 

[tiffmaxee]

On a hunch I googled atopica and it can raise bg. You might want to ask your vet about that.

 

[Ramon's mom]

3.25 has taken him below 50 three times so you need to reduce the dose, even if he's high at his next shot time.

LO means below 20 which causes brain damage (luckily, we can spare a few million brain cells) but it's not something to trifle with.

I'd reduce him to 3 units tonight.

Your signature doesn't say which dosing method you're using. Are you using Tight Regulation or Start Low, Go Slow? (it makes a difference in the advice we give...but not tonight)

I mostly do SLGS but because he responds oddly I don't always follow it. I did give him 3 units tonight and will hope for the best. Most times when I reduce his dose he swings even higher but now that I am using (temporarily) the Libre I can see his curves much better. The numbers in the last 2 weeks are on the Libre which runs a good 25 points lower than the Relion Prime meter I otherwise use. So when i double check those low Libre readings the Relion has always been higher, not lower.

 

[Ramon's mom]

Hi there, here is your last post from May for continuity: https://www.felinediabetes.com/FDMB...-numbers-and-how-to-dose.246865/#post-2784582

Because of the LOW reading you got today, which I assume is a number below 40 on a Libre, you would reduce the dose at the next shot by .25 regardless of which dosing method you follow, and it seems like you still have not chosen one to stick to. Because we give advice according to either the tight regulation protocol or the Start Low Go Slow method, it's a little hard to offer you advice on how to proceed.

Some cats simply have a hard time getting regulated, regardless of the method followed. It could be because of underlying, undiagnosed conditions, steroid use, insulin auto-antibodies (IAA), acromegaly, ear infections, dental disease...the list goes on. Ramon could be one of them. But unless you follow one of the two methods suggested for Lantus users and post regularly for us to know what happens to him on a daily basis, it's hard for us to say definitively what might be going on.

I am not able to stick closely to either protocol, though the SLGS is the closest. He does not respond the way these protocols suggest so I have to go with what I have learned while working with him over these years. I actually asked this in the FB group because I just wanted to see what other people do in similar situations. I was directed to post it here too so I did but yes, I cannot usually follow a lot of the advice given here because of his not responding per these protocols. He has pemphius and is on a med that interferes. However I do get some good ideas and try them out. If people cannot give me advice because I don't follow the protocol strictly then that's just the way it is. But my vet doesn't give helpful advice so i need to glean it where I can.

 

[Ramon's mom]

On a hunch I googled atopica and it can raise bg. You might want to ask your vet about that.

The only other treatment for pemphigus is steroids, which is how he got diabetes. The Atopica is the lesser of two evils in terms of controlling that condition. He otherwise is in pretty good shape. His bloodwork is excellent.

 

[Chris & China (GA)]

The last time you posted here was in May and before then it was all the way back in July of 2019.

If you could try posting here daily (or at least every other day), we may be able to help you more.

Learning how to "read" spreadsheets can take a long time and cats (being cats) don't always like to follow the rules, so getting some experienced eyes watching over him for awhile may allow his numbers to settle better.

I'm totally not surprised by the high numbers tonight and wouldn't be surprised if they run high for a few days due to the extreme lows today so please don't increase him based on higher than normal numbers for up to 6 cycles.

I do hope you'll be able to fit in a daily or bi-daily post and take advantage of the experienced people here.

 

[Ramon's mom]

The last time you posted here was in May and before then it was all the way back in July of 2019.

If you could try posting here daily (or at least every other day), we may be able to help you more.

Learning how to "read" spreadsheets can take a long time and cats (being cats) don't always like to follow the rules, so getting some experienced eyes watching over him for awhile may allow his numbers to settle better.

I'm totally not surprised by the high numbers tonight and wouldn't be surprised if they run high for a few days due to the extreme lows today so please don't increase him based on higher than normal numbers for up to 6 cycles.

I do hope you'll be able to fit in a daily or bi-daily post and take advantage of the experienced people here.

I can try to do more frequent posting but I am sensitive to a lot of the criticisms and pressure to obey here that I just come back for when his readings really don't make sense.

 

[Katherine&Ruby]

I can try to do more frequent posting but I am sensitive to a lot of the criticisms and pressure to obey here that I just come back for when his readings really don't make sense.

I understand your frustration, believe me! Please take a look at my Ruby’s spreadsheet. She is on prednisolone, which has knocked her out of regulation and she experiences wild swings too. The inflammation from her small cell lymphoma and her various additional illnesses are all variables that cause her BGs to go up and down. Short of having the weekly input of a specialized feline endocrinologist, the FDMB is the best resource available to me. While neither SLGS or TR are the most perfect options for unregulated kitties, both are CONSISTENT and well, METHODICAL, and based on what we and veterinarians know about the action of Lantus on cats. They have built in safety features to prevent hypoglycemia and can help get ahead of higher numbers to prevent prolonged hyperglycemia and the possibility of DKA.

There have been days you have increased his dose when he went below 50 (9/5/21) and then did not test during the next cycle. Data in both the day and night cycles are really helpful to know better what is going on. It's great that you have the Libre now, I have used it myself and it's great as long as the cat doesn't rip it off. Especially if his numbers swing, getting as much data as you can is really helpful to members here to help you.

The high numbers you got are a bounce from the lows yesterday. Please do not increase his next dose based on these numbers. Let the bounce clear for a few cycles to know if this reduction to 3 units failed and then you can take him back up to 3.25 again.

These are GUIDELINES. You always hold the syringe. It's not about obeying. We are all cat mamas with years and years of accumulated knowledge, experience, and above all, COMPASSION. I know you feel like you're alone in this with Ramon, but you're in good company here. If we can't help you control Ramon's BGs, and again, not all kitties follow any strict pattern especially if there is something like steroids or Atopica in play, the best we can offer you is support.

 

[Ramon's mom]

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The high numbers you got are a bounce from the lows yesterday. Please do not increase his next dose based on these numbers. Let the bounce clear for a few cycles to know if this reduction to 3 units failed and then you can take him back up to 3.25 again...

Overnight he went back down into the 50's and is refusing to eat. AT +7 I forcefed and gave maple syrup and now at his AM dose time he is up to 258 again but still refusing to eat. I don't even know whether to give him insulin now and at what dose!

 

[Katherine&Ruby]

Sorry (I don't know your name) I wasn't around today as I was at work to help you with your question. Could you please make a new thread each day with your questions? That will get more eyes on it. Here are the posting guidelines for the Lantus forum that will help us help you in the best way we can:
Make the Most of Your Lantus, Basaglar, & Levemir Land Experience

If you chose a method to follow, you would know which dose to give. This is not a criticism, only humble advice from another cat mom for how to go forward without getting superbly stressed out at every shot. I see in your notes that your vet advised you not to give insulin below 90 and a reduced dose below 200. Here are a few thoughts:

-With SLGS, you would not shoot any number below 90, and that follows your vet's advice.
-Reduce dose below 200: reducing doses based on preshot numbers doesn't make a lot of sense. Lantus craves consistency and should be dosed based on how LOW it takes the cat, not how high.
-If you were following SLGS, because of that 78 you got yesterday, you would have reduced the dose by .25 last night at PMPS to 2.75 where he is now, and there is a possibility that he may not have dropped as low as he did overnight to get that 53 at +8. That's only speculation on my part, as regulated kitties do pretty much what they want.
-Lantus is very good at keeping low numbers low and steady. If you shot reduced doses for anything below 200, you are not allowing Lantus to do what it is good at, which is help to heal your cat's pancreas and train the liver to stop dumping sugar into the bloodstream in a panic. Getting your cat into lower numbers actually helps stop the higher numbers from happening as frequently.