Help with Lantus Bg levels

Nathalie & Boris

Nathalie & Boris

Member Since 2022
Hi everyone!

Boris has been on Lantus since January, and to be honest after reading and researching more and more I'm starting to question a lot of my vets dosing recommendations. As you can see from my chart I first started off with human meter readings then switched to the AlphaTrak because the vet refused to take into consideration the readings I had.

In the beginning, he almost went into hypoglycemia, or I might not even know if he was because the vet wasn't worried about me testing at that time. The low reading in the beginning was done at the vet office. I've now learned that when Boris gets low, he doesn't have the normal signs other than sometimes the same yowling he does when he is high, and scourging for food. Over the past two weeks he has been very low, and after many calls to the vet, I was told to stop the insulin because he might be going into remission. Then his numbers went high again.

After reading into it further, I've read that Lantus should be weaned off not just stopped. After calling and talking with the vet on duty the other day, they told me to start him back on 2 units, which was not doing the trick. At first 3 was too low it seemed, we moved to 4, he got very low numbers quickly, then down to 3.5 where he got very low numbers, then stopped for a day, then back to 2 units. This is all within a few days after his numbers didn't seem to be moving prior.

After his numbers were high on 2 units I then raised to 2.5 just to see and his numbers were fairly normal. This morning because I couldn't get his BG test, which is impossible at 530 in the morning when he is antsy for food, I decided to go with approx. 2.25. As you can see on the chart he was still high. Tonight I gave 2.5 and when he still wouldn't quit yowling at me, I took his BG and it was in the low 50's. Knowing the typical drops at this point I gave him a little bit of food to make sure he doesn't go down too far.

Does anyone have experience with this and advice on dosing? It would be great if he is going into remission, but at this time I don't have much faith in my vet since they were willing to stop insulin and not do a test until 5 days later because she wants to be there to check him out. When I call the vet, I usually have to talk to the vet on duty and all the info I get is conflicting with the other vets.
 
Note: before we did the switch from 3 to 4 units, a fructosamine test was done at the vet's office and the number was still a bit high.
 
Welcome to LLB. I can look at Boris’s spreadsheet but we need more information. What are you feeding him? Have you looked at our dosing methods sticky? If feeding all wet or raw food you can follow either TR one. Otherwise it’s SLGS.

When vets require an AT many use human meters except when they need to converse with their vets. It’s up to you.

With the pet meters reductions are if the bg is under 68. If following SLGS it’s under 90. 52 is too low so please go back to 2.0 and hold it for at least 6-10 cycles if TR and a week if SLGS unless the bg goes too low again.

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/
 
I do the tight regulatiion. He currently eats 236kcals a day and all wet or sometimes a little dehydrated food mixed in to make up calories. Foods currently are Weruva, My BFF, and tiki cat. I've been mixing in the 0 carb foods because he had not been showing much improvement with the Weruva alone. I feed based on protein, fat, and carbs and read cat nutrition lists. He eats and has shots at the same time every morning and evening. His snacks are dehydrated chicken, cooked chicken gizzards, and a cooked liver once a week.
 
The problem is he keeps swinging if you see the chart. When you do 2u he goes high 450bg, yet every time we have upped the dosage a little bit he goes low. Although the dosage is now lower than the 3u he was not responding to prior. I read this yesterday and wondered if anyone else had to adjust doses with Lantus more regularly because bg levels are swinging to far in one direction or the other? This link implies to adjust as needed. Lantus / Glargine in Cats with Diabetes – Dr Erik Johnson – Veterinarian (drjohnson.com)
 
That all sounds good. So add TR to your signature and the foods you feed please. Als add that you use an AT and date of diagnosis so we don’t keep asking you the same questions. Please read the sticky on how to post here. It’s very busy on this forum so we ask the format be followed.

It’s very important to test before EVERY shot to be sure he’s not too low to shoot. We test, feed, shoot all within 5-10 minutes.

Since the bg was under 68, 2.5 is too much insulin. You need a dose you can safely shoot every 12 hours and not need to skip.

So I suggest you test before every shot. Get another test besides the amps and pmps every cycle. Since Lantus onsets around +2 fomany cats that’s a good test to get. If lower than the preshot another test at +4-7 is a good idea. Vary the times you get the extra tests. .

I would stick with 2.0 for 6 cycles unless a reduction is earned.

https://felinediabetes.com/FDMB/threads/posting-guidelines-please-read.231511/
 
PS. the missing days in the chart are not from not trying. Sometimes I want to cry when I can't get his blood samples.

I'm a single overwhelmed construction business owner and cat mom that feels like a big failure most days. I've read every veterinary and gov't study on lantus and diabetes in cats etc. Forums on this site...

I work from home a lot which is good for monitoring, yet not for my sanity when he follows me around and yowls constantly.
 
I'd love to get the am preshot tests, but his low point is consistently within 3-5 hours after shot and it is typically unsuccessful attempts. Based on all the Lantus info the preshot is not what I should be looking at from what I've read. I'll try to load all the food etc on here if I get time. Right now I should be finishing a kitchen design and planning subs for the next remodel to start, or sleeping. lol Definitely overwhelmed.
 
No! You are not a failure. Managing fd is hard at first. I cried at first too. What exactly is the problem you are having with testing? Not enough blood? He won’t let you? Be specific so we can help. Do you give a treat after each prick?

Why is he yowling? How often do you feed him?
Tell us everything. There will be someone to help with every issue. :bighug:
 
The preshot determines whether or not it’s safe to shoot. It matters. The dosing is based upon how low
Nathalie said:
The problem is he keeps swinging if you see the chart. When you do 2u he goes high 450bg, yet every time we have upped the dosage a little bit he goes low. Although the dosage is now lower than the 3u he was not responding to prior. I read this yesterday and wondered if anyone else had to adjust doses with Lantus more regularly because bg levels are swinging to far in one direction or the other? This link implies to adjust as needed. Lantus / Glargine in Cats with Diabetes – Dr Erik Johnson – Veterinarian (drjohnson.com)
Click to expand...

Lantus likes consistency. Try following TR as written. Post daily even if just the link from the previous day.
 
It’s good you know he nadirs at +3-5.another thing is try feeding small meals more often. It can prevent big drops and keep the bg more level.
 
If you want to follow TR for dosing, you need to get a test before every preshot, and at least one other in each AM and PM cycle. It's OK to feed a couple zero carb treats before testing in the morning as you try to get the preshot test done. My girl was also very eager for her breakfast, but she learned there was food associated with the test, but the test came first. More than once I woke up to a test number than was below 50 on my human meter, which would have been unsafe to give insulin.

I do like Elise (tiffmaxee) idea of going with a 2.0 unit dose, and holding that dose at least 3 days, unless you see another number under 68 on the AT.

The link you have in post #5 is to the very old 2006 paper by Dr. Rand. What is described in the TR section of this post Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR) is based on the much more recent 2013 paper by her and Kirsten Roomp. The old paper was found to be too aggressive.
 
Nathalie said:
I'd love to get the am preshot tests, but his low point is consistently within 3-5 hours after shot and it is typically unsuccessful attempts. Based on all the Lantus info the preshot is not what I should be looking at from what I've read. I'll try to load all the food etc on here if I get time. Right now I should be finishing a kitchen design and planning subs for the next remodel to start, or sleeping. lol Definitely overwhelmed.
Click to expand...
Hi Nathalie, welcome to the forum, you are doing an amazing job and unfortunately being overwhelmed at the beginning i very much part part it, but i promise it will get easier very soon :bighug::bighug:
You are in the very good hands of Elise and Wendy here so i am most confident they will give you all the support you require. There are 2 things i would love to clarify though:

1. FD is a marathon, not a sprint - it takes time to see results, some cats get results sooner than others
2. You understood very correctly that we decide dosing based on the nadir (lowest bg in the cycle) but we measure preshots, because we don’t want to shoot “blind” too low of a value

Until a cat is regulated nadirs change and preshot values change, its takes a while to make sense of all of this but Boris is doing very well and you are doing an amazing job.

Btw, great decision of second guessing your vet, a lot of us here had a very similar experience

good luck and a loooot of patience :bighug::bighug:
 
tiffmaxee said:
No! You are not a failure. Managing fd is hard at first. I cried at first too. What exactly is the problem you are having with testing? Not enough blood? He won’t let you? Be specific so we can help. Do you give a treat after each prick?

Why is he yowling? How often do you feed him?
Tell us everything. There will be someone to help with every issue. :bighug:
Click to expand...


He yowls because he thinks he is hungry and doesn't like the 2 meals a day. That has gotten better, yet anytime his bg levels are high or too low, he starts the following and meowing. I call it yowling because he is super loud at those times and won't give me a break unless I take him outside for a bit to distract him, where he then tried to eat grass and always pukes afterwards. He used to be an indoor outdoor cat previously, but I know he will go to other peoples homes and find or beg for food.

As for blood, sometimes I don't get enough blood or he shakes or kicks it off, or fights me. Most of the time he is fairly complacent with bg readings. I just have to do everything quick. I live alone, so there is no one to help hold him etc when doing this. Some days are successful, some are failures. I'm learning to not take it so hard. I feel I've been doing pretty good so far, for if I had left it in the vets hands and them not wanting me to do bg readings he would probably be dead or hospitalized at this point.
 
Boris's Insulin Sreadsheet - Google Sheets
As you can see the 2u seems to have his levels go back up, where 2.5 is too much. Two weeks ago, 3 units was too low, and once they started switching the units I give, he has gone very low a few times even though we are less than where we started.

I'll keep the 2u through tonight and tomorrow to see what happens.

We have an appointment with the vet tomorrow to get his wellness shots and take his bloodwork there. I'll try to get the preshot values in the am as well. Guess this means no more going back to bed after feeding and giving him his shots in the am because I'll be fully awake after that point.
 
tiffmaxee said:
It’s good you know he nadirs at +3-5.another thing is try feeding small meals more often. It can prevent big drops and keep the bg more level.
Click to expand...

I've asked about that, but the vet wants me to keep him on the twice a day feeding. They just told me last week I should only be feeding him one type of food, one flavor and nothing else. That I question, especially since they just mention this after 2 months of going through this. The info they have given is minimal, and they don't seem to like when I question what they are doing or show them AAHA papers etc.

Do y'all keep your kitties on one flavor of food?
 
Nathalie said:
I've asked about that, but the vet wants me to keep him on the twice a day feeding. They just told me last week I should only be feeding him one type of food, one flavor and nothing else. That I question, especially since they just mention this after 2 months of going through this. The info they have given is minimal, and they don't seem to like when I question what they are doing or show them AAHA papers etc.

Do y'all keep your kitties on one flavor of food?
Click to expand...

for some reason, that is something that we see here on the forum time and time again -- people report that their vets are insistent the kitty only eat twice a day, and only one kind of food/one flavor!

It is absolute and complete hooey. Balderdash. Crap. False! Untrue!

My vet said the same thing. It is very old school thinking that is still taught in veterinary school today...you know, in that one hour of one day that they review the chapter on Feline Diabetes. Fact is most vets know very little about how to treat diabetes in animals, and if they know anything at all it is usually about diabetic dogs not cats.

firstly, it is actually much easier on the pancreas for a cat to eat multiple smaller meals throughout the day and better for the kittie's blood glucose management and insulin response. One of the first things I learned here was to feed larger meals at shot-time, but also feed smaller, snack-sized (1-2 TBSP) meals about an hour after the insulin shot, 2 hours after, and often 4-6 hours as well. And we feed ALL sorts of flavors, it is important to keep a variety on hand imo. Sometimes the flavor of canned food that he LOVED yesterday he doesn't seem interested in today so I try something else.
 
Nathalie said:
As you can see the 2u seems to have his levels go back up, where 2.5 is too much.
Click to expand...
I suspect 2 units is also too much and he is bouncing. He got down to 52 last night, and then you stopped testing so he could have gotten even lower. I recommend you lower the dose to 1.75 units. I also think the yowling could be because his blood sugar levels were too low and he knows he needs food to bring the numbers up. Try testing next time he is yowling for food.
Nathalie said:
He yowls because he thinks he is hungry and doesn't like the 2 meals a day.
Click to expand...
Why are you feeding just two meals a day? That's not the best way to feed a diabetic cat, and is rather old school with older types of insulins, not for Lantus which is a much gentler insulin. It's fine if kitty is a grazer or you feed several smaller meals throughout the day and night, preferably mostly in the first half of the cycle. One flavour of food is also rubbish. Rotating proteins is much better for kitty. And it doesn't have to be all zero carb foods, many kitties do better on mid range 4-6% carbs. As you said in your first post, there are many things your vet is saying that sounds like a limited experience with feline diabetes.
 
I live alone too and had no help. The hunger is often due to bg dropping or uncontrolled bg. As mentioned by the others feeding mini meals will solve that. If he’s underweight he needs more calories.
 
Hendrick's mom and dad said:
for some reason, that is something that we see here on the forum time and time again -- people report that their vets are insistent the kitty only eat twice a day, and only one kind of food/one flavor!

It is absolute and complete hooey. Balderdash. Crap. False! Untrue!

My vet said the same thing. It is very old school thinking that is still taught in veterinary school today...you know, in that one hour of one day that they review the chapter on Feline Diabetes. Fact is most vets know very little about how to treat diabetes in animals, and if they know anything at all it is usually about diabetic dogs not cats.

firstly, it is actually much easier on the pancreas for a cat to eat multiple smaller meals throughout the day and better for the kittie's blood glucose management and insulin response. One of the first things I learned here was to feed larger meals at shot-time, but also feed smaller, snack-sized (1-2 TBSP) meals about an hour after the insulin shot, 2 hours after, and often 4-6 hours as well. And we feed ALL sorts of flavors, it is important to keep a variety on hand imo. Sometimes the flavor of canned food that he LOVED yesterday he doesn't seem interested in today so I try something else.
Click to expand...
I’ve thought it was hooey too. And they know very little. A lot of times when I ask a question they look bewildered because they don’t have an answer. All they wanted me to do was buy the freestyle libre, buy their prescription foods, and let them handle all the blood testing. $$$ I refused. I feel we know our babies better and are the ones caring for them. Glad to know about feeding small amounts. Only problem is it will be harder for me to be consistent daily with the smaller feedings. I have to run out to job sites or client appts randomly during the day.
 
tiffmaxee said:
I live alone too and had no help. The hunger is often due to bg dropping or uncontrolled bg. As mentioned by the others feeding mini meals will solve that. If he’s underweight he needs more calories.[/QUOTE.
He weighs 13.7lb but is very long and muscular. .

I’ll try to work in a smaller portion in between to see if it helps stabilize.

I’ve been giving small portions anytime I see his levels drop.
Luckily he’s past the opening cabinets and searching for food just out of schedule change. Now when he does that or is scavenging it cues me in he’s got a swing in one direction or the other.
Click to expand...
 
Nathalie said:
Do you use that for wet food? He’s no longer gets any dry food.
Or is there a dry food that can supplement in between that is low carb/ calorie?
Click to expand...

There are a few low carb dry foods, Young Again, and Dr. Elsey’s, but many still have higher bg using them and you would need to follow SLGS. It depends on your goal. If you hope to get Boris food controlled and off insulin then TR gives you the best for that. Cats do go otj with eating some dry food but not as many.
 
tiffmaxee said:
There are a few low carb dry foods, Young Again, and Dr. Elsey’s, but many still have higher bg using them and you would need to follow SLGS. It depends on your goal. If you hope to get Boris food controlled and off insulin then TR gives you the best for that. Cats do go otj with eating some dry food but not as many.
Click to expand...

I’m trying to get him into remission if I can. Ive already made it this far, so I don’t want any backslides.

Thanks for all the advice! I’ve pretty much been doing the TR method you have listed up to this point other than starting to handle dosing myself. I’m going to tighten up the things I’ve been doing to match the stickie on here and see if that helps.
 
Yes, you can use the Petsafe 5 with wet food. It's a rotating feeder with a small spot below the tray where you can fit a frozen gelpack, or ice cubes. Or you can put an ice cube on the food to keep it cool and add water as it melts.
 
Wendy&Neko said:
If you want to follow TR for dosing, you need to get a test before every preshot, and at least one other in each AM and PM cycle. It's OK to feed a couple zero carb treats before testing in the morning as you try to get the preshot test done. My girl was also very eager for her breakfast, but she learned there was food associated with the test, but the test came first. More than once I woke up to a test number than was below 50 on my human meter, which would have been unsafe to give insulin.

I do like Elise (tiffmaxee) idea of going with a 2.0 unit dose, and holding that dose at least 3 days, unless you see another number under 68 on the AT.

The link you have in post #5 is to the very old 2006 paper by Dr. Rand. What is described in the TR section of this post Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR) is based on the much more recent 2013 paper by her and Kirsten Roomp. The old paper was found to be too aggressive.
Click to expand...
Help! lol

today started out pretty good on 2u, except I've been thrown a curve. Instead of bouncing back up before feeding in 15 minutes his BG has consistently gone today from 128 - 90 -61 preshot test. Do I drop another .5 unit for mealtime. I fed him a little bit to hold him over until I figure this out.
 
Wendy&Neko said:
Repeating myself here. Please reduce the dose to 1.75 units. 2 units is too much. Best to skip tonight and resume with the new dose tomorrow morning.
Click to expand...
Wendy&Neko said:
Repeating myself here. Please reduce the dose to 1.75 units. 2 units is too much. Best to skip tonight and resume with the new dose tomorrow morning.
Click to expand...
I just saw that post amongst the others today, and is what I plan to do in the am. I'm trying.

His BG level just came in at 476. Now this is what I don't like, nor know what to do. Still wait until the am to give shot?
 
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