9/10 Nana AMPS 299 (Frustrated!!)

doose24

doose24

Member Since 2018
Hi All,

I'm not sure if I should continue to use Lantus. It's not very predictable with Nana. She's at 5.5 U BID.

Here is where my frustration with Lantus. I give the same dose at the same time everyday. Sometimes it seems to do absolutely nothing and other times it drops her to 55! It scares me that I have no idea what to expect during the cycle.

So if I have to step out, I have no idea if Nana will be OK. When I used Prozinc, I would know how low she would go based on the pre-insulin reading. With Lantus, it's a crap shoot!!!

Do others experience this with Lantus? I mean, how in world can I leave during her nadir if I have no idea what it will be? I mean sometimes the nadir ~200, sometimes ~ 150, and then sometimes it's in the hypo range!! That's crazy to me!

Any insight would be greatly appreciated.

Thanks in advance!!!
 
I'll defer to the more experienced here, but looking at her SS, she seems to be bouncing.
 
I'd be tempted to go back to when she wasn't hitting those scary light greens and hold that dose for longer. She might just need longer to break the bounce.
 
Hi. Looking at the SS, I see a few times where you should have reduced. Please reduce immediately to 5.25u. You are doing a great job with testing. Some cats stop bouncing after they acclimate to the new low numbers. Be patient. You will get there!

Are you following TR or SLGS? With TR, the reduction point is 68, but with SLGS, it is 90. It would be helpful if you add that to your signature.
 
It could still be the bounce from that 65. It can take six cycles to clear. Cycle 7 could be pretty flat or active.
 
The reduction number on AT is under 68. To tag on to what Mandy said, too much insulin sometimes can act like not enough. I know how frustrating bounces can be. Max either bounced or didn’t hold reductions for a year. Eventually he was tightly controlled. Hang in there. :bighug:
 
doose24 said:
I'm not sure if I should continue to use Lantus. It's not very predictable with Nana. She's at 5.5 U BID.
Click to expand...
Hi there,
Have you ever thought of ordering the High Dose tests - namely for a condition called Acromegaly ?
It is very common to ask for such test at 5+ Unit dose.

There is also another test that can be done at the same sample/ time - but I forgot the name of it. (auto immune something, I think..)
Sorry, I was fortunate enough not to deal with any but from what I hear one should order such blood tests tru their vets to rule out insulin rejecting/ resisting conditions after the dose of 5U.

@Wendy&Neko - please help if you can.

(I might be confused on this but Wendy is certainly the one to go to in such.)

If there is no underlying high dose conditions then perhaps you can experiment with dose and feeding - I, for instance, got good results after I figured at what time my cat does her usual "drops" (they usually tow in Pink bounce later on in the cycle) - and now I prevent it with feeding her some food just before her shot and then some like an hour before the expected "drop" @+1.5 or +2- works fine, btw! This way I avboid bouncing in higher numbers afterwards.

If that won't work for you- surely, there are other great insulin types to try. Many praise Levemir over Lantus.

P.S. With my bouncy cat I have noticed that if I use 8% or 9% carbs containing food to steer her up from BG in 30s or 40s - she has shorter/ or lighter bounces more often then she had when I was using FF Gravy in 10% - 20% carbs containing foods.
But it might be the ECID thing - try it , thou, the experiment will reveal what's what.
I use Soulistic Autumn Bounty pouch 9% carbs from Petco (pulled chicken breath in pumpkin soup, low Phosphorous per Kcal).

For example, when I look at Nana's SS I see that no test were done prior to +3 and that caught you at PS in 200s with +4 in Green. Such large drop can produce huge bounce in many cats - mine including, and better to be avoided. In many cats the Lantus onset comes at around +2, or even earlier. It might be case with your kitty, too. Yo test as if you were using Prozinc, and probably, you missed the onset or drop.

If you could spread the feeding between Pre-shot meal and +4 on Sept 7th - you would not have seen (most likely) such nasty drop that brought about the bounce - on 9/8/18 PMPS in 300s.

Also taking +2 test / each cycle is good idea. Feeding the same food at preshot and taking the +1 test routinely might reveal what kind of a food spike your kitty gets - and to plan accordingly in the future.

Wishing you the very best!
doose24 said:
Here is where my frustration with Lantus. I give the same dose at the same time everyday. Sometimes it seems to do absolutely nothing and other times it drops her to 55! It scares me that I have no idea what to expect during the cycle.
Click to expand...
Per your Ss it looks like you started testing consistently in May 2018, is that right? I do not see earlier data as sufficient to analyze or evaluate the dose. It is not long enough, IMHO.
If you agree then please try to be patient - Lantus is one of the best for cats.
You haven't given it enough time to work out, IMHO.
@doose24
 
Sorry, just getting on the board now. Crazy days.

Since your total dose is over 5 units, we make changes by 0.5 units at a time (instead of 0.25 units), unless you are just tweaking a dose. Since you saw under 68 on that AT, a reduction to 5.0 units was earned.

Tanya mentioned the "high dose" conditions above. Typically we suggest waiting until kitty gets to 6 units before getting the tests done for acromegaly and insulin auto-antibodies (IAA). My Neko had both, some have one or the other. One in four diabetic cats has acromegaly, which is a benign tumour on the pituitary that sends out excess growth hormone, which eventually causes the diabetes. But I also put the "high dose" in quotes above, because some kitties have acromegaly but on much smaller doses. It's just that kitties can have other issues, like needing a dental, eating dry food, etc. that can cause a need for higher doses and we've seen some of these kitties get up to 5.5 units before turning it around. It looks like you have some dry food in the picture? However, since you did get to 7 units on Prozinc, you might want to consider getting those tests done.

As for knowing when you can leave her, you learn her patterns on Lantus. Those patterns can occur over several cycles, not just one. And first and foremost, keep her safe by taking reductions when earned. Following one of the dosing methods here, Tight Regulation or Start Low Go Slow Method, will tell you when those reductions are earned and help keep her safe. Many people also use autofeeders, timed to open up around the time of peak insulin action, or nadir, so kitty has food available when they might go low.
 
Thanks everyone for the replies! I did reduce the dose to 5.25 units.

Tanya and Ducia said:
f you could spread the feeding between Pre-shot meal and +4 on Sept 7th - you would not have seen (most likely) such nasty drop that brought about the bounce - on 9/8/18 PMPS in 300s.
Click to expand...

Nana is a grazer, so she eats very small amounts throughout the day.

Tanya and Ducia said:
In many cats the Lantus onset comes at around +2, or even earlier. It might be case with your kitty, too. Yo test as if you were using Prozinc, and probably, you missed the onset or drop.
Click to expand...

I did lot's of +2 hours last month. Lantus onset with Nana is +2. I just hope I can get some predictability with Lantus.


Tanya and Ducia said:
Have you ever thought of ordering the High Dose tests - namely for a condition called Acromegaly ?
Click to expand...

I spoke with the Vet on her last visit (8/4) about running those tests. He had to look into it for her next visit. He did however say that Nana is in great shape. Teeth and all blood work is normal. He also thinks 5 units is completely normal. So we will see when I take her back for her 6 month follow-up.

I am happy that since yesterday, she has been dropping to the same range. Let's see if that stays.

Again, thanks everyone! Your advise is greatly appreciated!!
 
doose24 said:
I did reduce the dose to 5.25 units.
Click to expand...
Keep a close eye on her, that may have been too small a sized reduction.

Acrocats (cats with acromegaly) can look completely normal for a long time, except for the blood sugar and sometimes larger dose needed. With cats eating dry food, 5 units is not unexpected. It would be fairly high for cats on low carb wet or raw food.
 
Here we go again! Last night Lantus didn't do a anything! Might as well have injected her with plain water!!

I'm about to throw this Lantus pen out the window. I can only get 2 or 3 days of active cycles with Lantus!! Then 2 days of high numbers. Nana will never heal like this!

I'm seriously considering switching back to Prozinc and be done with Lantus forever!
 
She's bouncing still. She had a nice stretch of blue yesterday, then just straight yellow. You know this is a marathon, not a sprint. Something that keeps me sane through the bounces is reminding myself of that, and looking at this link from the 'new to the group' sticky on the LLB forum.
 
Yeah, I know it's a marathon. But I have been at it for almost 6 months already. I would think by now she would stop bouncing.
She didn't bounce like this with Prozinc or even Vetsulin.

This is my issue with Lantus, I have no idea if she will be OK at the nadir if the cycles are all over the place. I just can't wrap my head around it. One day she has an active cycle, then the next day she doesn't

I am not looking for remission, that's just a pipe dream at this point. I just want some predictability so I can have some piece of mind.

It's taking it's toll on me. I am also wary of taking road trips or being far way from home because I have no idea what to expect with Lantus. I would never forgive myself if she went into hypo and I wasn't around to help her.

But in the mean time, I want to get her into normal ranges so she can her feisty self.

I know I am ranting at this point. But I am beyond frustrated!
 
Neko still bounced after five years and three insulins. She bounced the least on Levemir, but maybe her body was finally getting used to better numbers. Try to ignore the bounces. We dose primarily based on how LOW the cat goes on a particular dose. The highs just happen, and are a good time for one to relax the tesing and do something for yourself.

Ever though of taking Nana on the road with you? In spite of initially hating the ten minute trip to the vets, Neko did long three day road trips, ferry rides and even travelled via plane. We've had people go camping with their diabetics.
 
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