? 10/10 Nika AMPS 299 (First post, need some help)

[dov]

Hello everyone,

I can't seem to understand my cat glucose numbers, there are days where her glucose goes to blue numbers, but after that the following days is just high numbers again, it's confusing to me because I was planning on increasing the dose to 1u on 09/10 but after doing 12 hour glucose curve I aborted this idea. This is why I am making this post, because I am not sure how to move forward from this point, what exactly I am supposed to do with the dose, and why her numbers so high today again, even though I gave her full dose.

Thanks in advance for your help.

 

[Connie & Parker & Moonie]

Bumping this up for visibility. I see that you’ve been changing doses a good amount, and you probably would benefit from someone experienced taking a look and giving you advice. Because Lantus is a depot insulin (where the insulin forms a precipitate after being injected and microcrystals are slowly released - resulting in a cumulative effect where what happens in one cycle can affect multiple subsequent cycles) - it really does best when you are consistent with dosing over some period of time.

What you’re seeing with fluctuating numbers is bouncing. Unfortunately bounces are quite common. I know that they’re really frustrating. When a cat’s body is used to running on high sugar levels, the liver can freak out when those levels fall even if it’s to normal or higher than normal levels. They can also happen if blood glucose levels drop too quickly. The liver and pancreas will then release stored sugar which will spike blood glucose levels. Bounces usually clear within 6 cycles.

 

[Clarice & Mami Cat]

Bumping this up for visibility. I see that you’ve been changing doses a good amount, and you probably would benefit from someone experienced taking a look and giving you advice.

Bumping you up.
Welcome, Dov.
Bounces are really common, as Connie explained so well. Stick around, and you’ll learn a lot. Over time, things will become clearer to you.

 

[Bandit's Mom]

Hello and welcome!

Lantus dosing is based on nadirs - how low a dose takes the cat. It's common for numbers of a newly diagnosed cat to be all over the place. Like others have explained, we call it bouncing and it's the cat's body's reaction to lower numbers than they have been used to in the recent past.

"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)."

I see that you have chosen the SLGS dosing method. With SLGS we hold doses for a week (unless a reduction is earned) and the aim is for the cat to spend as much time as possible in the 90-150 range. Since Nika is on a low carb canned diet and you are testing so much, you could also follow TR, if you'd like.

Lastly, dose changes are in multiples of 0.25U (till doses up to 5U). The "micro" changes you are making to the dose will not make much of a difference. I would suggest that you go up to 1U (you were on 0.8U till the 9th) and see how she does on that.

 

[dov]

Hello and welcome!

Lantus dosing is based on nadirs - how low a dose takes the cat. It's common for numbers of a newly diagnosed cat to be all over the place. Like others have explained, we call it bouncing and it's the cat's body's reaction to lower numbers than they have been used to in the recent past.

"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)."

I see that you have chosen the SLGS dosing method. With SLGS we hold doses for a week (unless a reduction is earned) and the aim is for the cat to spend as much time as possible in the 90-150 range. Since Nika is on a low carb canned diet and you are testing so much, you could also follow TR, if you'd like.

Lastly, dose changes are in multiples of 0.25U (till doses up to 5U). The "micro" changes you are making to the dose will not make much of a difference. I would suggest that you go up to 1U (you were on 0.8U till the 9th) and see how she does on that.

Hi,

Thanks for your reply, I'll try bumping the dose to 1.0u.

And to clarify she's not really newly diagnosed cat, she's been on lantus for good amount of time (diagnosed on april 26), previously she was on caninsulin (vetsulin) for less than a month, then I asked my vet to prescribe my cat Lantus, unfortunately I didn't do good amount of research on my behalf and I didn't know very well how this insulin work during this whole period I was trying to eye ball the dosage, her numbers was all over the place, another thing that didn't help the fact that the syringe markings had a lot of inconsistencies, this made the eye balling dosages even worse. It's just very recently Embecta syringes became available in my country, but those syringes are even more awful when comes down to the markings the variance can be as big as 0.5u+-, but I am not using the markings anymore, I printed sheet of paper with dosage markings specifically for the Embecta syringes.

Also I decided to go for SLGS method instead of TR, because I can't test her at +3 and +6 all the time during the day, there are days that I am very busy with work.

 

[Bandit's Mom]

And to clarify she's not really newly diagnosed cat,

My mistake. I only looked at the dates on the rows of the SS and missed the Dx date at the top and in your Signature.

Do the Embecta syringes come with half unit markings? And yes, the markings on the syringes can be quite off. I started using callipers to measure the dose to ensure accuracy and consistency.
Dosing with calipers


This is a syringe used in the UK and Europe. Is it available in Lithuania?

 

[dov]

This is what I am using currently, and for dosing this template: https://www.diabetes-katzen.net/insulinruler.pdf

The markings on these syringes are very incosistent, previously I used some non-brand chinese syringes with no half unit markings.

 

[Bandit's Mom]

This is what I am using currently,

Yeah, these seem to be 0.3 cc syringes with half unit markings.

Also I decided to go for SLGS method instead of TR, because I can't test her at +3 and +6 all the time during the day, there are days that I am very busy with work.

Take her up to 1U and let's see how she does. With TR, you don't need to test at +3 and +6 (or any fixed time) on all days. TR requires at least 1 test during the cycle in addition to preshot tests. We have a lot of members who follow TR when working. The idea is to collect enough data on days when you can get tests to be able to get an understanding of how she responds to insulin - onset, nadir, etc

IS TIGHT REGULATION POSSIBLE WITH A FULL TIME JOB? YES!

 

[dov]

Yeah, these seem to be 0.3 cc syringes with half unit markings.


Take her up to 1U and let's see how she does. With TR, you don't need to test at +3 and +6 (or any fixed time) on all days. TR requires at least 1 test during the cycle in addition to preshot tests. We have a lot of members who follow TR when working. The idea is to collect enough data on days when you can get tests to be able to get an understanding of how she responds to insulin - onset, nadir, etc

IS TIGHT REGULATION POSSIBLE WITH A FULL TIME JOB? YES!

Thanks for your help,

I am increasing the dose to 1.0u and I will be making a switch to TR protocol. Let's see how it turns out.

 

[Bandit's Mom]

I am increasing the dose to 1.0u and I will be making a switch to TR protocol. Let's see how it turns out.

Good luck with the increase and the switch to TR! With TR, you evaluate the dose every 3-5 days. If you don't see anything below 200 after 3 days at 1U, she might be good for another increase. Let's evaluate after 3 days at 1U.