7/21 Smudge AMPS 414 +2 412 +4 382 +6 348 +8 404 +12 460

[billy]

Hi guys!

My cat was diagnosed as diabetic just under two weeks ago. I started on the vets recommended protocol but after a lot of reading (mostly here) I'm wondering about switching to the tight regulation protocol. He's 8 years old and about 11-12 lbs. Diet was wet food (not as low carb as the Fancy Feast Classic), switched to Fancy Feast Classic (mostly Turkey & Giblets). Here's the first 6 days of treatment.

07/16
AMPS - 450 - Fed meal - 1.00U Lantus shot
+6 (232)
PMPS - 194 - Fed meal - 1.00U Lantus shot
+6 (310)

AMPS - none - Fed meal - 1.00U Lantus shot
PMPS - 408 - Fed meal - 1.00U Lantus shot

AMPS - 396 - Fed meal - 1.00U Lantus shot (+12)
PMPS - 356 - Fed meal - 1.00U Lantus shot (+12)

AMPS - 381 - Fed meal - 1.00U Lantus shot (+12)
PMPS - 350 - Fed meal - 1.00U Lantus shot (+12)

AMPS - 381 - Fed meal - 1.00U Lantus shot (+12)
PMPS - 350 - Fed meal - 1.00U Lantus shot (+12)

AMPS - none - Fed meal - 1.00U Lantus shot (+12)
PMPS - 389 - Fed meal - 1.50U Lantus shot (+12)
+6 (327)

AMPS - 414 - Fed meal - 1.50U Lantus shot (+12)
+2 (412)
+4 (382)
+6 (348)
+8 (404)
PMPS - 460 - Fed Meal - 1.50U Lantus shot (+12)

Yesterday was when we went to 1.50U. We're going to do a curve today (7/21). Our Vet didn't instruct us to take BG readings until after 2 weeks but we wanted to keep an eye on it. The fact it's stayed pretty high is worrying. The fact it did well the first day then has stayed high could that be a somogyi rebound? At this point I'm not sure if we could be raising or decreasing the dosage. How soon should we consider a change to PZI?

Based on my reading, my first step should be to do a curve to get more data. I'm just not sure if these numbers mean he's not responding, it's too much insulin, not enough insulin, or it just takes time to regulate? Overall he's in good spirits, just a little lethargic (which is what led us to take him to the vet). Thanks for any insight you can offer!

Edit: Uploaded a picture, he's not too pleased about all this ear pricking.

 

[Dyana]

Re: Switching protocol? Unsure what these numbers are showin

Hi, and Welcome.

First of all, I would never shoot any insulin into my cat without testing his BGs first before shooting. Also, the Lantus dose is based on the nadir (usually around +6 (6 hours after the injection) in Lantus), so you need to get those +6 tests, to find out how the dose is doing, and whether it needs adjustment. I would give Lantus a few months or more of time, before thinking about switching to a different insulin.

Good job on the testing. Now, we need to get you to create a spreadsheet. Someone, will be along to help you with that.
Are you doing the curve, today?

 

[billy]

Re: Switching protocol? Unsure what these numbers are showin

Thanks! I was a little surprised the vet told us not to test the BG again until day 14. We did two 6 hours BGs yesterday and we're going to do the curve today.

Hi, and Welcome.

First of all, I would never shoot any insulin into my cat without testing his BGs first before shooting. Also, the Lantus dose is based on the nadir (usually around +6 (6 hours after the injection) in Lantus), so you need to get those +6 tests, to find out how the dose is doing, and whether it needs adjustment. I would give Lantus a few months or more of time, before thinking about switching to a different insulin.

Good job on the testing. Now, we need to get you to create a spreadsheet. Someone, will be along to help you with that.
Are you doing the curve, today?

 

[Dyana]

Re: Switching protocol? Unsure what these numbers are showin

Good. After each test you get, go to your first post of the day, and edit the subject line with the latest bg numbers, and then press the submit button, so we can see how he's doing during the coarse of the day.

You could test every 2 hours, if you want to. Or every 3 hours would be okay, too, but the more data the better to see what's going on. Look at some of our spreadsheets attached to our signatures, when you get a chance, and read through the stickies at the top of the page, and ask all the questions you want.

 

[Sienne and Gabby (GA)]

Re: Switching protocol? Unsure what these numbers are showin

Welcome to Lantus Land!!

I agree completely with Dyana. Lantus dosing is based on the lowest number (nadir) in the cycle -- 2 cycles each day (AM and PM) that start with each shot. Ideally, the nadir is at +6 but this varies from cat to cat. Just to complicate things, the nadir can change. It's also viable to get spot checks at random times. In many ways, this is better than always getting a test at nadir since the checks at various times gives you a bigger picture of what the cycle looks like.

Here's the link to setting up a spreadsheet. The spreadsheet (SS) will help you keep track of your cat's numbers and allow us to take a look and lend you a hand.

As far as the numbers, it takes roughly 5 - 7 days for Lantus to build up and form an insulin depot. Until the depot has formed, there's a good chance your cat isn't getting full benefit from all of the insulin you're shooting -- a little bit from each shot is "stored" in the depot. The other factor with the numbers is that you don't know how low those numbers have gone without spot checks. Raising the dose today is just what we would have recommended although we would not recommend any change in dose without benefit of spot checks. (We're a bit hard nosed about knowing what the nadir is so you don't risk putting your cat over what is a good dose.)

Also, just a word about Somogyi. This is from Max's condo. There's a discussion about Somogyi -- it's a relatively long condo (we call a thread a "condo"). Given the amount of information that's being thrown at you, you may not want to dive in to that condo.

A couple of things...

Somogyi is a soapbox issue for me. I've researched it. I routinely read clinical research. I have access to both medical and veterinary databases. The strongest statement that can be said about chronic Somogyi rebound is that the original research, which was done in 1938, has never been replicated. At best, the phenomenon is controversial. More likely, it does not exist and has taken on the proportion of urban legend. I have an exceptionally difficult time when people make statements that ignore research evidence and that that happens all the time when it comes to this topic. There is no research data, none, zero, zip, nada that supports the existence of chronic Somogyi rebound in humans and there is even less that addresses Somogyi in cats. And to further ice the cake, the original research was not done with a long acting insulin such as Lantus or Lev. The 1938 study in not generalizable to cats on Lantus.

The following is from a Wiki article on Chronic Somogyi Rebound. While I do not consider Wikipedia to be a definitive, scientific resource, I have gone to the original research and read what's out there.

Although this theory is well known among clinicians and individuals with diabetes, there is little scientific evidence to support it. Clinical studies indicate that a high fasting glucose in the morning is more likely because the insulin given on the previous evening fails to last long enough.[5] Recent studies using continuous glucose monitoring show that a high glucose in the morning is not preceded by a low glucose during the night.[6] Furthermore, many individuals with hypoglycemic episodes during the night don't wake due to a failure of release of epinephrine during nocturnal hypoglycemia.[7] Thus, Somogyi's theory is not assured and may be refuted.

There is a fundamental difference between chronic Somogyi rebound and a bounce. Many of the people who bandy the term "Somogyi" about are actually talking about a bounce. You don't deal with a bounce by reducing the insulin. If you reduce the amount of insulin, you're going to get potentially flatter numbers but they will be high. Once you have a cat sitting in high numbers for an overly long period, you have to deal with glucose toxicity and greater long term risk for organ damage.

It is possible that your cat is bouncing off of lower numbers that are occurring during the cycle. Or, and I suspect this is the more likely scenario, your cat may simply need a dose increase.

The only other immediate suggestion I have is to encourage you to test for ketones. If you purchase Ketostix from any pharmacy, you dip the test strip into your cat's urine stream, wait 15 seconds, and compare the color on the paper end of the strip to the color code on the container. Ketones can be life threatening if they go untreated. Testing for ketones is the best bit of prevention you can do.

Please let us know if you have questions. People here are very generous with their time and information.

 

[Dyana]

Re: 7/21 Smudge AMPS 414 +2 412

Good job, editing that subject line.

I agree with Sienne and often push people to buy those ketone test strips and test for ketones when a cat is high, especially when he's been high for awhile. A hospital stay for ketones can be long (J.D. stayed for 8 1/2 days) and expensive, and cats don't alway survive DKA. I would test for ketones every chance you get, and let us know if you have questions.

Come on down, nice and easy, Smudge.

Nice picture of your handsome boy

Thanks for sharing. We like pictures.

 

[billy]

Re: Switching protocol? Unsure what these numbers are showin

Awesome thanks for the suggestions. I've updated my signature with a link to the spreadsheet and I'm doing the curve today. =)

Welcome to Lantus Land!!
Please let us know if you have questions. People here are very generous with their time and information.

 

[billy]

Finished the first curve. Ended at 460 which is probably due to the constant pricks every two hours, he was having none of it by the end of the day. Ate his meal up and seems in decent spirits given his two bruised ears. I'm going to try another 3/6/9 curve Monday/Tuesday which is around when I'd increase the dosage to 2.00 if his levels stay this high? I believe it's 3-5 day range for an increase if he's 300+ on his nadir. Still trying to get his ketones tested hopefully at some point tonight. Thanks for all the help!

 

[Sienne and Gabby (GA)]

Thanks for getting your SS up and running. If I may, I'd like to make a suggestion. You will not always be testing at +2, +4, +6, etc. You really will need all of the hours included.

Your +12 is actually your PMPS.