9/17 Leo - Trying to get regulated usually over 300 at 4 units lantus

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Susan Shropshire

Susan Shropshire

Member Since 2021
Hello,
I am new to the board. I have a kitty that is 8 years old and was diagnosed in Aug 2019. He weighs 12.5 lbs.
I found out about the diabetes because he had diarrhea that wouldn't go away. They did blood work and his glucose was 425

He started on Vetsulin and they vet at that time didn't like the #s and kept increasing the dose. At the vet check ups the #s were mid to low 200s. Then we had to start seeing a new vet and they put him on Prozinc and the #s have always been in the 300s.

We have struggled to get his #s regulated. We started with Vetsulin then Prozinc and now he is on Lantus. I have also changed vets during the time because I didn't feel they were taking the #s seriously. So this is the 3 vet & we just found that he is leaving to move to another state! UGH! They were ok with his #s being in the mid 300's during the day as long as he wasn't showing clinical signs. I have multiple cats so it's hard to see if his is urinating more or drinking more unless I actually see him. He also had REALLY high triglycerides in his last blood work in February. The vet said that told her that it wasn't being well regulated. We had gotten to 5 units of Prozinc before I asked to switch to Lantus.

He has been on Lantus since 7/29/21. We are currently at 4 units of lantus 2x per day.

My current vet says she doesn't like to tightly regulate them due to it being dangerous to be too low but it can be a little high and be ok short term. She likes to see 250 for the majority of the day but she has been ok with the mid 300s but I am not.

He did have pancreatitis around 2 months ago that required a stay in the hospital with fluids. In the hospital they gave him an emergency insulin so they could control it and his #s stayed in the low 200s. So I know they CAN go lower. I had worried about him being insulin resistant.

He is currently on a total canned food diet. He has food allergies in additional to the diabetes so it has been hard finding a food that works for him that he will eat.

It's weird because it seems his #s go up after injections instead of down. This was his last curve 8/30/21 (1 month after switching to lantus):

Pre-Shot 282 +2 395 +4 346 +6 358 +8 296 +12 372

I don't know what we did different and I really wish I did but he had a couple of low #s in the upper 100s! I haven't been able to figure out anything that made that difference and it was only for a day or two and then it was back where we normally see upper 200's & mostly upper 300s.

Has anyone had a cat on more than 4 units of Lantus. I understand that is supposed to be high and most are on 1.5 -2 units.

Has anyone had an issue with #s going up instead of down after injections? I did try not giving him an injection one night to see if it would make a difference and his #s were high the next morning so I gave him the injection. I wondered if the dose was too high. We did start on 2 units and moved up 1 unit at a time and the #s have improved a little.
His pre-shot #s for the first week at 2 units were: 395, 346, 388, 341, 370, 415, 360, 401 (July 29)
His pre-shot #s for the first week on 3 units were: 375, 451, 372, 355 (Aug 6)
His pre-shot #s for the first week on 4 units were: 419, 403, 345, 363, 386 (Aug 14)

I read a thread about a possible panicky liver that might cause them to go up during the initial does change. So here are his recent pre-shot #s on 4 units (plus we changed to wet food from Tiki Cat Carnivore that was 10% carbs - he is now on less that 1% carbs - that started on Aug 19th)

From last Friday until today his pre-shot #s were: 334, 309, 273, 226, 421, 211, 349, 305
His PM pre-shot #s are: 259, 364, 362, 324, 358, 257, 335

Would love any advice from anyone that has a kitty on more than 4 units of Lantus or that their #s seem to go up after injections instead of down. I plan on doing another curve on Monday. That will be 3 weeks since the last one.

I tried to upload his spreadsheet for 8/30 until now but it said I didn't have permission to upload files.
 
Hi Susan , I can have someone set up the spreadsheet for you
@Bandit's Mom hi Bhooma she will private message you for some info
It you can first set up your signature it's at the end of everyone post

Go all the way up top to you name tap on it and a drop box will appear , you will see the word signature, tap that and just add all your information about Nani and hit save.

Take a look at my signature all about Tyler all signatures are at the end of everyone's posts in gray

Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
 
Susan Shropshire said:
Has anyone had a cat on more than 4 units of Lantus. I understand that is supposed to be high and most are on 1.5 -2 units.
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My Neko got to 8.75 units, there are a couple here on the 10-20 range, and we've had some on higher. Don't let a magic number of units bother you. A cat needs however much insulin they need. The important numbers are the blood glucose numbers and having your cat go no lower than 250 during the day is really hard on them. That's likely over renal threshold and making his kidneys work really hard. A cat doesn't have to be tightly regulated, but moderately regulated is a good goal.

We'll be able to help you more with dosing once the spreadsheet is set up.

I'm moving this post to Feline Health, where we ask new people to post first.
 
Hi and welcome to FDMB. When you switched insulins, did you start at the same dose as the previous insulin or start with a lower dose. Also when the doses were increased, was it by a whole unit or in smaller increments like .25 or .5 unit?

The reason I am asking is you may have missed your optimal dose. Too much insulin can also make the glucose levels higher. It's the way a body will try to protect itself from hypoglycemia. If too much insulin is given the body releases extra glucose to keep the levels from dropping to low.

There are some medical conditions that do require high doses of insulin, but most cats need 1-2 units to maintain their BG.
 
Lisa and Witn (GA) said:
Hi and welcome to FDMB. When you switched insulins, did you start at the same dose as the previous insulin or start with a lower dose. Also when the doses were increased, was it by a whole unit or in smaller increments like .25 or .5 unit?

The reason I am asking is you may have missed your optimal dose. Too much insulin can also make the glucose levels higher. It's the way a body will try to protect itself from hypoglycemia. If too much insulin is given the body releases extra glucose to keep the levels from dropping to low.

There are some medical conditions that do require high doses of insulin, but most cats need 1-2 units to maintain their BG.
Click to expand...
When we changed to Lantus we were at 5 units of Prozinc. We started Lantus at 2 units and increased 1 unit at a time. The #s were still quite high between changes, I have only recently seen the 2 times that it was in the upper 100s and low 200s. The #s he is having now are the lowest we've seen yet.
 
Wendy&Neko said:
My Neko got to 8.75 units, there are a couple here on the 10-20 range, and we've had some on higher. Don't let a magic number of units bother you. A cat needs however much insulin they need. The important numbers are the blood glucose numbers and having your cat go no lower than 250 during the day is really hard on them. That's likely over renal threshold and making his kidneys work really hard. A cat doesn't have to be tightly regulated, but moderately regulated is a good goal.

We'll be able to help you more with dosing once the spreadsheet is set up.

I'm moving this post to Feline Health, where we ask new people to post first.
Click to expand...
It's good to know that I am not alone with the higher doses. I had really started to worry about another condition causes insulin resistance, but when I saw the lower #s I had renewed hope that it just needs to be a higher dose. My vet did say that sometimes they will overtime be able to come back down. That is also good to know about the kidneys. My vet had told me 300 was the threshold where it would be in their kidneys. I would really like to see lower numbers. I would be in that moderately regulated group. I wouldn't want to continually worry about it getting too low but I also don't want it to be too high. The Vet had said if given a choice, going a little higher is better than too low. That is why she likes the target of 250 for the majority of the day. She said you can come down a little and you are ok and go up a little and you are ok. She said a higher number short term wouldn't do significant damage, but a number too low only has to happen once for it to be deadly. I am in between that.... I would like to see between 200-250 for the majority of the day. 250 being the highest.
 
Welcome, Susan.

Looking at your spreadsheet, I have a couple of thoughts.
  • It would be exceedingly helpful if you also got at the minimum, at least one test during the PM cycle. Without PM tests, you have no idea if numbers are lower at night, and many cats do go lower at night. It's possible that if numbers are dropping during the PM cycle,, you're seeing bounces.
  • There's a risk with holding doses for as long as you've been holding the dose at 4.0u. If the numbers are "stuck" in a higher than desirable range, glucose toxicity can develop. The term sounds worse than it is! Basically, it means that your cat's body treats that higher range as the new "normal" making it harder to get the numbers into a better range. You will likely need to be more aggressive about dosing. The two dosing methods we use, Tight Regulation and Start Low Go Slow, suggest evaluating the dose after 3 days or a week, respectively and increasing if numbers aren't where you want them.
  • It sounds like you were increasing doses by 1.0u. It's possible that you whizzed past what may have been a good dose. We increase doses by 0.25u. (If you are using the Lantus pen to dispense the dose, you'll need syringes.)
There are cats that need higher doses of insulin, just as Wendy indicated. You cat needs what your cat needs. We tend to look at tight regulation as a cat being in normal range (50 - 120). Vets like their client's cats to be in a higher range since they fear that the cat will become hypoglycemic. We're much better at teaching members how to handle low numbers. Keeping a cat in higher ranges can be tough on the kidneys and diabetes is tough enough on the kidneys all by itself.
 
Thank you! I will try to get PM #s. My vet actually frowns about me taking regular #s at all. They seem to go more by the clinical signs but I disagree. They have also told me to stay where I am at on dosing but again I disagree.
Would you suggest I go back down and start at a lower dose to see if I missed the right dose or go up to 4.25 units?
 
Susan Shropshire said:
Would you suggest I go back down and start at a lower dose to see if I missed the right dose or go up to 4.25 units?
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Do not go back. That's a waste of time. If your cat safely got up to 5 units of Prozinc, we would have had you start at 5 units of Lantus. Is it possible for you to get any tests at night, say just before you go to bed, as long as it's at least 2 hours after PM shot time? Many, probably most, cats tend to go lower at night. Those before bed tests will tell us if you are missing some lows. My kitty once went months going low and earning reductions at night and bouncing high during the day. If I had not been getting night time tests, I would have increased her dose when I should have been decreasing. This is not an uncommon scenario.

If you can get a later test tonight, it'll help tell you if it's safe to increase tomorrow.

We've had more than one caregiver arrive here with a cat in a low numbers crisis, and a vet who didn't believe in home testing. Thanks goodness you disagree with the vet. Home testing blood sugars is how to keep your cat safe.
 
Wendy&Neko said:
Do not go back. That's a waste of time. If your cat safely got up to 5 units of Prozinc, we would have had you start at 5 units of Lantus. Is it possible for you to get any tests at night, say just before you go to bed, as long as it's at least 2 hours after PM shot time? Many, probably most, cats tend to go lower at night. Those before bed tests will tell us if you are missing some lows. My kitty once went months going low and earning reductions at night and bouncing high during the day. If I had not been getting night time tests, I would have increased her dose when I should have been decreasing. This is not an uncommon scenario.

If you can get a later test tonight, it'll help tell you if it's safe to increase tomorrow.

We've had more than one caregiver arrive here with a cat in a low numbers crisis, and a vet who didn't believe in home testing. Thanks goodness you disagree with the vet. Home testing blood sugars is how to keep your cat safe.
Click to expand...
I will do the normal 4 units tonight and do a +2 and try to get a +4 or +6. I do his injections at 9:00 so I can stay up a little later and then maybe get up during the night. If I’m still seeing around the same #s I will try the 4.25 units starting in the morning. I do have syringes with a .5 mark so I’ll try to get between the marks.
Then if I understand, I keep that for at least 3 days and reevaluate.
 
If you can keep your spreadsheet update with your latest data, that'll help us help you on dosing. Hope it went OK last night.
 
Wendy&Neko said:
If you can keep your spreadsheet update with your latest data, that'll help us help you on dosing. Hope it went OK last night.
Click to expand...
Thank you! I wasn’t able to get #s last night. He got into a few pieces of food from one of my other cats. I can usually keep them separate but he was extra sneaky last night and snuck a bite before I could put her food up. I’m going to try tonight. I knew that food, even though just a bite or 2, would skew the #s.
 
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