1/7 Rumi - Week 3 on Lantus - +4: 21.6... Increase the dose?

Hello everyone! This is my first post here, but I've been reading these forums for the last few weeks ever since Rumi got diagnosed. I learned the basics, from testing to dosing to shooting, from you all, and I'd be remiss if I didn't start with my heartfelt thanks. These forums are an incredible resource!

Now the question - I went with SLGS as Rumi is an older cat and I wanted to make sure I'm not overdoing it. I started with the suggested 1u BID even though he is on the bigger side and so usually gets higher doses on meds, and as expected his readings inched down (and his excessive thirst/peeing came under control) but I still gave it some time. After 5 days I moved up to 1.5u, which made a difference but not a lot, so after another 5 days I moved up to 2u. However, today is his 5th day on 2u, and he just tested at 21.6 at +4, so I'm now wondering if I should move up to 2.5 or even 3 u?

One issue I'm facing with testing is that these days I'm out for work all day, so I'm only able to do AMPS and PMPS, and I wouldn't be able to tell his nadir (I'm off today but have to go back to work from tomorrow). I guess one option is to wait until the weekend, when I'll be home all day, before starting the dose. However his pre-shot readings are persistently high, and I'm wondering if there's anything that I'm missing! Could it be testing error? Food intake?

He only eats dry food - right now he's on Hill's GI due to his earlier constipation issues - I have now got Dr Elsey's Clean Protein Chicken Recipe which I've started to mix in gradually, but he's being picky and I don't want him to not eat and go into hypo. But I'm controlling the quantity a lot, and only feeding him twice a day right after the shot (he does complain as earlier he used to eat in 4-5 small doses through the day based on the total quantity on the bag, but I'm not giving in).

So basically do I 1) increase the dose from this evening; 2) increase the dose from the weekend; or 3) try something else?

Thanks again all!

Hello and welcome! Sorry you haven't been answered yet, this is a very busy forum and newcomers are often encouraged to post in the main forum for introductions (more eyes on your post) due to being overlooked alot on this one. I can tag some that might be able to help you. I'm not qualified to give dosing advice by any means. But I can say you've come to the right place.
@Wendy&Neko, @CORKY, @squeem3, @Sienne and Gabby (GA)

Monster's Mom said:

Hello and welcome! Sorry you haven't been answered yet, this is a very busy forum and newcomers are often encouraged to post in the main forum for introductions (more eyes on your post) due to being overlooked alot on this one. I can tag some that might be able to help you. I'm not qualified to give dosing advice by any means. But I can say you've come to the right place.
@Wendy&Neko, @CORKY, @squeem3, @Sienne and Gabby (GA)

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We all try to answer all the post according to the concerns of the member, please do not feel neglected, some member have a full time job, so I apologize for everyone, it is not intentional in any way, I for instance can help in many areas, except dosing advice, many members have an expertise in medical issues which can assist you in areas some of cannot, I will tag Sienne, she has the qualifications in all, especially in dosing advice for Lantus, I will tag her, it might take a few for her to plug in, I can assure you, that I can and will be able to assist you as well as other members, if you come across a hypo episode, if needed, I can walk you thru it as long as it takes to stabilize Rumi
@Sienne and Gabby (GA)
@Wendy&Neko

What are you feeding Rumi? And how many times a day? If you are not home during the day, you may want to purchase a wet food feeder, some have chips, some have camera, a diabetic cat needs to have a diet of wet can or raw diet between 0-10% carbs, dry food or kibbles and grazing all day, is not good cats cannot digest carbs and dry foods contain over 20% carbs, as well as the “prescribed foods vets recommend,”
Most member use Fancy Feast pates between 0-10% most feed up to 5%, if you are feeding wet can that contains gravies those contain any from 16-24% carbs, diet is one of the most important factors in stabilizing Rumi, and you are giving the right insulin, keep posting you concerns

Hills GI, has a lot of carbs so is good you have made most of the transition, for constipation you can purchase over the counter Miralax, 1/4 tsp twice a day in the food is tatesless, for about 4-5,days once he poops you can put 1 tsp daily for a few more days, then diminish the days of the week ,both Corky and Coco have constipation issues, also to change the diet, the transition has to be a slow one, for every meal, you take away 1 tbsp of dry to 1 tsp of wet, until all he eats is wet, you do not want to fast transition since it upsets the stomach and can lower the BG down, I see good greens though, and the dose should always remain the same for AMPS/PMPS, at least for several cycles, unless it needs to decrease due to lime BGs or recommended by the proper member, and it seems tge Dr Elsys food is working I just saw that in your remarks of what you fed, I think we should wait to one of the members I tagged can decider better your concerns, We were under the impression that Corky was one if not the only most regulated cat in this Forum! Congratulation is in order! Rumi is doing amazing, or I must be missing soothing

Hi Rumi's Mum!

Sounds like you've had a similar experience to myself when getting started with Kitty (whois also a 2012 baby!). I am still figuring it out as we go along and definitely not as experienced as a lot of the members here, but 2 months into insulin and something that has helped get more stable numbers recently is returning to her pre-diagnosis food schedule.

Similarly to Rumi, Kitty only ate prescription/diet dry food before being diagnosed and she ate frequent small meals throughout the day (little snacks here and there when she would ask). When we were diagnosed I transitioned to wet food and gave her two big meals per day before each shot and pretty much nothing else. After a few weeks of confusing numbers and no real patterns or stabilisation, I decided to try split her meals into more frequently smaller portions, and as of the last 3 days she has had a clear curve appear.

I just split her normal food amount over the day, bought a refrigerated auto feeder and now give her an 11am, 10pm and 2am snack around her 7:30am/pm meals (the 2am was more a test to see if it stopped her high AM readings in case she was bouncing due to becoming low overnight - she is yet to figure out that it is there at that time of night )

You could try increasing meals throughout the day on the weekend when you're home and see if this makes a difference to the nadir or the curve, before you commit to an increase?

I should add that the reason I thought to increase meals/snacks was because of reading about bouncing and rebound hyperglycemia due to too much insulin, or the cat not being accustomed to having lower BG levels and the body over-compensating with hormone release (also sometimes referenced as the somogyi effect)

Hello and welcome.

The SLGS (start low go slow) dosing method (developed at FDMB) says you increase by 0.25 units at a time, after being on a dose for 1 week. You are increasing Rumi's insulin both too fast and by too large an increase at once. The goal with SLGS is to get to a dose where nadirs (low points) are in the range of 90 to 149. You did see at least one nadir in that range on January 3rd. You should have stayed with 2 units at least 3 more days.

Size of cat is a factor when figuring out starting dose with another dosing method, but isn't a factor in what ends up being a good dose for a cat. We have large cats on small doses and tiny cats on larger doses. We have a saying there ECID or every cat is different. Another saying here is that managing feline diabetes is a marathon, not a sprint. Regulation can take a while.

The high carb dry food is definitely part of the problem, and I'm glad you are slowly switching him to another food. Several smaller meals are best for diabetics. Many people use automated feeders both the spread out the food and to have food available during their cycles when they might below. A post that might help: Transitioning your cat from dry to wet food

Part of what you are seeing which results in higher numbers is bouncing, totally normal for the newly diagnosed cat, and even some not so new. Here is the definition of bouncing:

Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

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Bouncing is only due to lower numbers than they are used to, or fast drops. The fast drop he saw from PMPS tonight to +3 is likely what his body will see as a fast drop. Somogyi is not bouncing and has been proved to be very rare in cats on long lasting insulin.

Bouncing is real, but I just wanted to let you know that the "somogyi effect" has been debunked.

If you look at Marje and Gracie's Sticky General Information and Important Links - Please read:

• There is also a common misconception, often by vets, that bouncing is caused by chronic Somogyi rebound. Michael Somogyi published one paper based on a very small number of human diabetic subjects on the topic in 1938 in a local St. Louis medical journal. There has been no replication of the research and, in fact, anyone that has attempted to replicate the research with humans failed to find similar results. The research has never been done with cats and, just as importantly, has never been done with cats (or humans) using a long-acting insulin.
  
  

To add to what @Lara & Luciole (Lu) said above, The Somogyi research was done on fast acting insulins, and the research was not peer reviewed. There has been some research done with Lantus proving it is very rare:

• Rebound hyperglycaemia in diabetic cats.pdf

Thanks Lara and Wendy! I had seen that Somogyi is unproven and likely not the best reference point so apologies for including in my reply.

I noticed that it is often the phrase that pops up if you’re googling info about bouncing numbers. Does anyone know why it is so widely referenced online if it’s not a likely cause?

No worries, some of what we say is for you, but also for any lurkers reading these posts.

At one point it was widely taught to vets, hence it's still common use.