8/21 Cheshire - PMPS 363 - having a high night. Ideas?

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Chris & Cheshire

Chris & Cheshire

Member Since 2013
Having a weird, high night. Wondering if there are patterns/normal responses that would explain this.

Switched to Lantus Saturday, things evened out pretty quickly into a 180ish-280ish range. We didn't get as low as we did on the Humulin, but I know over time we'll tweak the dose up and bring him further down.

All was well until tonight, when he clocked in at 348 for PSPM, and has pretty much stayed in the 300s, except for +4. I don't think I fur-shot this morning or tonight. Diet's the same. Just not sure why he's suddenly so high. Are there normal patterns when you start Lantus that would explain this? Is he staying too high most of the time, and needs a dose increase already?

This is all complicated by the fact I'm leaving town for 8 days starting tomorrow morning, so he'll be boarded with a (new) vet for the next week. Any advice is appreciated.

AMPS: 225
U: 0.5

PMPS: 348
U: 0.5
+1: 363
+2: 337
+3: 339
+4: 289
+5: 339
 
Hello Chris.
There is such a thing as new dose wonkiness but it's hard to be sure yet.... since you just started Lantus.
The depot has to build up .
Hairballs /throwing up can temporarily raise numbers but it's usually only for a few hours.... ( at least that's my observation)

I'm not familiar with your story so I'm trying to scan thru your previous posts...
I'm guessing you still have your out of date vet and he'll be taking care of Cheshire.


Be advised that most vets don't monitor at night.... they just shoot the insulin and leave ..... unless they have a night person.
You might want to give him a specific number to test and not shoot if he's under that number.....
the problem is Lantus depends on the nadir ( the lowest point somewhere mid cycle) and not on the pre-shot numbers.
I'd also make sure he's going to keep the dose in the half unit to 3/4 unit .....
So many vets only dose in whole unit increments..... and seem to forget there are lesser amounts so I myself would be having a conversation to make sure he doesn't revert to old ways .... ( they do tend to shoot humulin that way)
And your vet should definitely test for ketones...

I wish you much luck and will watch for your updates when you return from your trip.


I have family down in LA. Crowley, Lafayette and N.O.
 
Hey Rhia - Thanks for your advice. "New dose wonkiness", eh? Well, I'm going to hope for that, then. :)

We're down to 314 at +6, but that's just not much movement. I'll get a +7, then test again in the morning. If he stays high like this, I think I have to have the vet bump him to 0.75, as nervous as it makes me to do that without closer supervision. I think I'm probably going to end up calling them every day or so for updates. They're going to hate me, lol.

The one good thing is that I'm not using the out-of-date vet anymore. The people I'm going to now are proper, modern vets who typically prescribe ProZinc. The bad news is that we're brand new to them.

I've written up a one-sheet on Cheshire for them - background, diet, Lantus protocol, and specify that they shouldn't shoot if he's below 150.

My family comes from Crowley, actually. Well, in the way-back. They moved out of Crowley to Lake Charles in the mid-1950's. :)
 
interesting.
My MIl and FIL are part of Crowley history.... your family might know them.
Bergeron and Cossey/Duson . The Duson's founded the town.... apparently there is some colorful history there.


Hope Cheshire has a good run while you are gone.
Don't worry about driving them crazy. You hired them.
 
I don't think it's New Dose Wonkiness or NDW because that can happen for the first 2-3 days after an increase, and Cheshire just started Lantus. Another possibility is that Cheshire got to some low numbers sometime during the day, or at least lower numbers than he is used to and bounced.
Bounces - what are they and is my cat doing them?
When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.
Click to expand...
We like to see at least two tests per cycle, one in addition to the PS test, as it gives us an idea of how the cycle went. Without that, it's hard to tell what might have caused those high numbers.

You'll have to ask how often the vet is going to test while you are away, before increasing the dose. People here often lower the dose for a petsitter, to keep them safe while they are gone. I think I'd stick to the same dose you are on. We normally suggest a starting dose is held for 5-7 days to build the depot, then increase if kitty isn't getting into good enough numbers. So I think if you were home we'd suggest an increase, but if you were home to monitor.
 
Hey Wendy -

Thanks - bounce sounds really plausible and I'm really thankful for the education. :) And you've convinced me against reacting too quickly and bumping the dose. I've got to remind myself, "Hypo kills fast; hyper kills slow."

The vet has agreed to do AMPS, +6 and PMPS, so I'll actually have better daytime data than I get when I'm in town.

+7 is 305, so at least it's slowly moving in the right direction. Also, BINGO! I finally got a +7 test - first one - and it was the only timeslot missing. Gotta celebrate the small stuff, right?

Rhia - I'm from the Breaux/Broussard family; we're distantly related to the Dusons somehow. Small world!

Good night to both of you - thanks for helping me out tonight.
 
Chris & Cheshire said:
Thanks - bounce sounds really plausible and I'm really thankful for the education. :) And you've convinced me against reacting too quickly and bumping the dose. I've got to remind myself, "Hypo kills fast; hyper kills slow."
Click to expand...

"Better high for a day than low for a minute." :lol:

Let us know how things go when you get back and have safe travels. :-D
 
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