4/20 Sondance AMPS 400+ New, wildly inconsistent results

[Eric Davies]

Have been giving my cat Sondance insulin for about 7 weeks, just switched from Prozinc to Lantus a week ago because we could never get stable response on ProZinc. Using continuous monitor with top reading of 400.

Currently 1.5u Lantus every 12 hours. Been there for three days after working up from 1.0u. We virtually *never* get preshot values below the max of 400+ regardless of which insulin and which dosage. More importantly the results vary dramatically from one shot to the next. Last two times, we had pretty decent results of lows ~200 and then ~150 for several hours but then right back up to 400+ by the end.

Today however, as I've seen before, the results are basically a dud. Low ~300 for about an hour, then back up to 400+. I keep thinking it must be my injection technique but honestly it's not THAT hard- clearly I'm not doing fur shots. Last three times I deliberately put the shot in the same location. I've tried different locations- the best results are actually around the nape. Every time I try a flank shot I get zero response from him for the whole 12 hours.

He's gained a lot of weight since we started and I don't think his water consumption is excessive any more but we aren't getting this managed at all and I'm very confused...

 

[Kobe (Dean and Lesley)]

Welcome! There are some stickies on the Lantus Forum that would be very helpful to read. The one about The Insulin Depot might help you to understand what the heck is happening!

My cat switched from PZI to Lantus at the beginning of this year. I expected that as soon as he switched, he would be instantly regulated, but it took some time for his BG to start coming down, and then some more time for his body to get used to being at a normal BG again. This forum helped me figure out how to effectively and safely dose my cat.

Rotating the location of the shot is a good practice. I also struggled with the flank. I got good results going back and forth across the shoulders while Kobe was distracted with his meal.

You are already testing at home! Congrats! You are ahead of the game. This is a crucial part of keeping your cat safe. It will help us help you if you can put your cat's BG data in a spreadsheet. You can see an example by clicking on Kobe's Spreadsheet in my signature. We all have them. That way anyone helping you has the information they need right there. Here's the Spreadsheet Link. Most of us use Human meters, but you'll want to pick the template that matches your meter and units.

 

[Bron and Sheba (GA)]

Hi and welcome. If you could set up the spreadsheet and signature that will help us to bd able to help you.
What food are you feeding?
I’m going to ask @Wendy&Neko to move your thread over to the main health page where we like new members to post initially

 

[Bron and Sheba (GA)]

Information for new members
HELP US HELP YOU

 

[Eric Davies]

Hi and welcome. If you could set up the spreadsheet and signature that will help us to bd able to help you.
What food are you feeding?
I’m going to ask @Wendy&Neko to move your thread over to the main health page where we like new members to post initially

I created the spreadsheet and backfilled it with the data since I switched to Lantus. Yes, I really did get strong results the very first time on 1.0 units and then flatline at the top of the meter for the next two days. Upped the dose .25, got ok results for a day then another day flatline at the top of the meter. Upped the dose .25 again. And so on it goes- random responses..

He's actually been on dry Hills M/D his entire life, because of our other cats at the time. He's 16 now. I call him "eating impaired" as he's horrible eating ANY wet food. He just licks up the gravy and leaves the rest. So we haven't changed his diet due to the diabetes.

 

[Sienne and Gabby (GA)]

One of the immediate issues is that the MD is what we would consider a high carbohydrate food -- over 15% carbs. There are only 2 dry foods that are in the low carb (under 10%) range. Dr. Elsey's Clean Protein and Young Again Zero Carb are both low. There are some air or freeze dried raw foods that are also low -- ZiwiPeak and Stella & Chewys that Sondance may find acceptable (but he's a cat so you never know). Unfortunately, most of the dry supposedly diabetic prescription foods are not low in carbs. If your kitty will consider a different dry food, that will offer some immediate help in getting blood glucose numbers into a better range.

It looks like you're following SLGS. That's your only option given the dry food.

You're seeing Sondance's numbers "bounce" after he drops into a better range. This is a normal reaction since his body isn't used to spending time in closer to normal numbers. The liver and pancreas excrete a stored form of glucose along with counterregulatory hormones which cause numbers to spike. It can take several days for the bounce to clear. In addition, chances are as the insulin depot is stabilizing, you're seeing numbers going back to a higher range. The high carb food isn't helping.

There's going to be a good amount of the highs and lows until you find a dose that works for your cat. Please try to be patient. I know it can be frustrating. Lantus is a good insulin given that it is gentle and has a long duration. However, it being gentle means that it can take a while to get numbers where you want them.

 

[Eric Davies]

Ordered the Dr Elsey as that's a name I recognize and have to start somewhere! Nice to not have to deal with prescriptions too.

The 6+ weeks on the ProZinc attempting and failing to get any kind of control has a lot to do with my impatience. Had to basically put my foot down and demand the vet allow us to change. Not home during the day so we had to set up the continuous monitor so I could watch from my phone while he spiked from 400+ into the 50's & 40's. Rushed home to find him perfectly fine and wondering why we were making such a fuss

Fresh start now so attempting a fresh start mindset...

 

[Larry and Kitties]

Is he eating the same amount at eat meal? If not that makes it hard to get consistent results.
Depending upon the BG you are getting when you start the Dr Elsey's dry you may want to reduce the dose.
My experience w/Libres is that @high BGs the Libres will read significantly higher than an ear stick and @low BG the Libre read low. See:

Have you thought about using human meter and learning to take BG using a blood drop from the ear? This is called home testing.

 

[Eric Davies]

While I love my kitty and he's lived his entire life in my house he has the spirit of a wilder cat and isn't exactly one of the cuddly types. I feel glad sometimes he's willing to grace me with his presence and lean against my arm. But no petting, please.

So while I did successfully do an ear draw once it didn't exactly go easy. Nor do his injections. I can't do this libre 3 forever though so eventually I'll have to overcome it. Regardless, two months in (most with Prozinc) he's over 400 on the libre for 4-5 hours each 12 hour period including before and after the shot. Lantus just doesn't last as long as I'd hoped it would, so now hoping his own body will start kicking in more properly during those hours.

Based on his data so far it's looking like I'm going to need to up it another .25u at least. Last night was pretty pathetic with a low of 278

 

[Sienne and Gabby (GA)]

I think Sondance's spreadsheet is what I would expect from a cat that's still early in the process of getting to regulation. If no one has said this, please try to remember that this is a marathon, not a sprint. I also suspect that your cat needs more insulin but stick with the dosing guidelines.

Also, can you please add information to your signature? The information regarding what to include is in this post on helping us to help you. I realize that some of the information is on your spreadsheet but it's helpful to have both.

 

[Eric Davies]

So, things spun out a little this night (still ongoing) and I thought I'd try to get a better vision of what "normal" is. For some reason the day shot took 6 hours to even start kicking in, the numbers never went all that low and he wasn't back to 400 as usual by the evening shot. Instead 240.

I considered reducing the dose for the evening because it was so far from his typical situation, but decided that the ultimate goal is after all to inject *before* he's back at maximum, so I waited a little extra long (half hour) and gave him the standard 1.5. It's been steadily down since, currently +4 hours and he briefly dropped into the 80's, currently 100.

Frankly I don't even know if that's good or bad, assuming it doesn't get any lower. Planning to reduce to 1.25 but the wife is getting freaky.

 

[Sienne and Gabby (GA)]

I'd encourage your wife to read over the dosing methods sticky. With SLGS, you reduce the dose if numbers drop below 90. There's a big "however", though. The Libre tends to give inaccurately low numbers below 100. We encourage members to also have a hand held glucometer to double check a low number from the Libre. There's a very good chance that Sondance's numbers weren't at 87. The graph in Larry's post (#8) will give you a sense of where some of the readings from the Libre are problematic.

Are you still feeding MD dry? If not, can you make the change in your signature? It's likely that the MD has been driving your cat's numbers into high ranges.