Advice on Lantus - very confused.

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Renae & Skye

Member Since 2011
I originally posted in the Main Health forum and it was suggested that I try to post this here.

I will give a little back ground first. I have a 10 (she will be 11 in Oct) year old cat named Skye. She was diagnosed with diabetes 4 1/2 years ago (December of 2006). She was on Lantus insulin for around a year before she started to honeymoon. She did not need insulin until about 1 1/2 months ago. When she started showing signs of beind diabetic once again. I checked her BG levels and it was around 360 (before eating) and 450 (after eating).

I brought her into the vet and got another prescription for Lantus insulin. She has been on it since 6/22/11. I have been taking care of the insulin and making sure it isn't stored in the door - basically doing everything I can to make it last as long as possible.

What has me confused is how she seems to be reacting to the insulin. She is currently up to 3 units twice daily. Since Skye has started taking it her pre-shot levels have risen to be in the 500's. When she hits her peak it is anywhere around 280 - 380. She was started on 1.5 units and when she was started on 2.5 units her BG dropped to 96 (at her peak). however, it only remained like that for a couple of days before rising back up to being btwn 280-380 at her peak. And it is usually at the higher end of that level. It only seems to be working at a dosage for a couple of days before rising to what I consider unacceptable levels and she is still drinking water and peeing like crazy (even more now then when she was first re-diagnosed). And her being on 3 units hasn't seemed to make any progress - but she was just started on that dose.

Then we have last night. I usually give her her shot around 7 am and 7 pm. However last night I had birthday dinner to attend for a friend and did not get home until 11pm. I decided to give her a partial dose and then give her a full dose in the morning. However, when I checked her BG level it was only at 290 - this is 16 hours after her last dose. I decided to only give her 1 unit. then when I checked her BG level before her dose this morning it was 456 (this was before eating).

I am very confused to what is happening here. It does seem as if the insulin is working because her BG does get lower at her peak times. But it doesn't seem as if her peak times are lasting very long - it appears as if her peak is btwn 4 - 7 hours after a shot. and her pre-shot numbers are higher now then when she was started on insulin. You add into that the fact that it was only at 290 when she had not had a shot in 16 hours and this makes me very very confused.

Just to note - I feed her when I give her her shot but I have a roommate with a cat who eats dry food and Skye is often guilty of stealing her food.
 
Thank you for the link! I have actually been on this board before but it has been a couple of years. I remember it being very helpful (life saving actually) when Skye was first diagnosed a few years ago. So I guess you could call me new again! ;-)
 
Renae:

There could be alot going on here and without a spreadsheet, it's going to be difficult for anyone to help you. How much are you testing? It is possible she is going really low at night and bouncing up in the mornings. Can you put a Spreadsheet up for us so we can see what she's doing? The experienced eyes look at the dosing, the numbers, the feeding, the shot times, etc. Lantus really likes consistency. For instance, last night, I would not have shot at 11pm. I would have skipped the dose and then gotten back on my regular schedule today. Shooting at 11 last night should have had you shooting at 10:45 this morning as you can't make up the time like you did.

We'd love to help but we'll need to see the SS first. Thank you so much.

Here are the directions for a SS:

How to Make a Spreadsheet
 
Hi Renae - welcome back. :-D I agree with Marje - it is difficult without a SS. Lantus really likes consistency: shoot times, dosing. I think too that part of the problem may be that she can get to the kibble, it is alarming how much that can up BG's, and the length of the time that it stays in their systems. I hope that one of the experts will be along shortly to help you out.
 
Hi, Renae!!

The girls are right... the best way for us to provide insight is to see the numbers. One other question, though... is there any chance that Skye might have an infection or dental issues that would be contributing to her high numbers?

Welcome back to Lantus Land! Hope we'll be learning more about you and Skye soon!
 
I will put together a SS then! Unfortunately I left all of my data at home.

Basically I have been doing a blood curve once a week. and spot checking the rest of the week or mini curves the rest of the week. But with how much of a food theif she is it can be really difficult to know when she is stealing what from my roommate's kitty. My roommate does try to limit the amount of food in her cat's dish but her cat is such a scrawny thing and is so skittish when it comes to eating that it can be difficult to do that. Plus she shoo's skye off everytime she is trying to do that. Skye loves her food and always wants more. Which is what got her in this situation to begin with.

As far as infections go.... I am concerned about her teeth. That canned food is no friend to a cat's teeth. It could very well be that. However, when I brought her in to get her prescription the vet told me her teeth weren't great but that there wasn't anything to worry about. I will have to try to take a look when I get home I will have to try to take a look. Skye is very chill when it comes to most things but she absolutely hates, hates, hates people poking around her mouth. I know her breath hasn't been smelling bad....

Thank you for the suggestions though!
 
Thanks Renae. And Michelle and Christie are right...the dry food can be doing bad stuff to her BG. And Michelle can tell you how much less insulin she is giving Mannie after he had a dental.
 
LOL. Yeah that would definitely solve all of my problems but to make things more difficult her cat gets really sick on canned food for some reason. She likes it but just can't hold it down.
 
What kind of wet food is causing the other cat to get sick?
Commonly fed is fancy feast pates and friskies as the price is reasonable and they are low carb.

I can say that a dental problem can cause problems, and when I had one extraction done on my cat, her dose dropped way down. She is also the one whose BG will soar to 400s if she eats even just a few pieces of dry food.
 
A couple of observations...

The door of the refrigerator is the worst possible place you can keep your insulin. The door is the part that is open and exposed to warmer temperatures. As a result, there's much greater variability with regard to temperature for items stored on the door. A crisper drawer or some location more in the middle of the refrigerator is going to give you more consistent temp.

Like everyone is saying, the dry food is likely to be a big part of the problem. Unless your roommate is feeding a lower carb food (e.g., EVO), Skye is getting very high carb food. If your roommate's cat is vomiting from canned food, chances are that her cat is sensitive or allergic to beef and/or fish. Fancy Feast Classic Chicken or Classic Turkey are gluten free and (obviously) not beef or fish. (You may need to look at the labels -- one of them does have some fish in it.) EVO 95% turkey and chicken is fine as are the Before the Grain varieties -- some of which include novel proteins (e.g., duck, quail, lamb) which are good for cats with food allergies.

Canned food is actually better for cats with dental issues than dry. If you take a look at Lisa Pierson, DVM's site on feline nutrition, she dispels a lot of the myths about dry food.
 
Sorry, I have not gotten back to anyone. I got home the other night and found out my niece was in the hospital. She ended up having to undergo a 4.5 hour surgery on her small intestines. They were sucked up into her large intestines when she was baby and kind of exploded. She almost died and was on various stages of life support for 6 weeks and in the hospital for months. She turns 8 this Sunday though! However, it sounds like she will be spending it in the hospital. She has been having some serious problems with the scar tissue. Poor girl has to go to the ER everytime she has stomach ache!! She is doing a lot better though and seems to be recovering well.

Basically putting together a spread sheet has not been a priority. I do have every intention of putting one together because they seem to be very helpful. I ended up putting her on a dose of around 2.25 units and that seems to be working great. Her numbers are extremely better with that and no longer through the roof. I think 3 units was too much and that she may need to be increased in smaller increments then 0.5 units at a time. I will hopefully have spreadsheet(s) put together in a few days to compare. I want to put something together for every curve I have done and the strengths of each.

I have talked to my roommate about switching her cat to a food that has lower carbs and higher protein. Her cat has a sensitive stomach but she is willing to try it out. She is currently on Friskies indoor cat food (it isn't on binkies chart so I am unsure of the carb content but I am sure it is high). I was given a bag of the purina dm dry cat food for free last time was into the vets office. I am also going to try giving Skye a little bit of that after feeding her the canned food and see if it helps cut back on her stealing. I doubt it will though - that cat has always loved her food! I have been battling her weight since she was 1.

Everyone - thank you for all of your suggestions it is greatly appreciated!!


Sienne and Gabby said:
A couple of observations...

The door of the refrigerator is the worst possible place you can keep your insulin. The door is the part that is open and exposed to warmer temperatures. As a result, there's much greater variability with regard to temperature for items stored on the door. A crisper drawer or some location more in the middle of the refrigerator is going to give you more consistent temp.

Like everyone is saying, the dry food is likely to be a big part of the problem. Unless your roommate is feeding a lower carb food (e.g., EVO), Skye is getting very high carb food. If your roommate's cat is vomiting from canned food, chances are that her cat is sensitive or allergic to beef and/or fish. Fancy Feast Classic Chicken or Classic Turkey are gluten free and (obviously) not beef or fish. (You may need to look at the labels -- one of them does have some fish in it.) EVO 95% turkey and chicken is fine as are the Before the Grain varieties -- some of which include novel proteins (e.g., duck, quail, lamb) which are good for cats with food allergies.

Canned food is actually better for cats with dental issues than dry. If you take a look at Lisa Pierson, DVM's site on feline nutrition, she dispels a lot of the myths about dry food.
Click to expand...


I am guessing you misread my post. I do NOT put lantus in the door for those very reasons. That stuff is expensive and I aim for it to last as long as possible. Thank you for the link though! It is good to know that the canned food isn't what is destroying her teeth! There is no sign of infection that I could see but I a plan on having the vet take a closer look next time I am in. And thank you for the suggestion about my roommates cat being allergic. Skye eats Friskies canned food and I know Thumper (roommates cat) got sick from one of those. I do not recall the flavor though. And my roommate is adamant about thumper getting sick off of canned foods in the past. She used to have this ancient cat (the cat lived to be close to 20 yrs old) before living with me that was on canned food and she had to make sure thumper stayed away from it because of that.
 
Thank you so much Marjorie!

She is a very strong girl! It just kills me that she is having so many problems with the scar tissue from what happened when she was a baby (her small intestine exploding). She is full of spitfire though. She finally can talk again - she couldn't for a bit because of all the tubes that were down her throat - and one of the first things she wanted to do was give the Dr. $20 she had received as a present - as a bribe! In order for him to let her leave. Could care less that she is hooked up to lots of machines and is in no condition to leave yet. My biggest concern is that she will not tell anyone the next time she has a stomach ache - which could lead to some terrible things happening to her.
 
Welcome back to LL, but sorry you had to visit for these reasons. I'm sorry to hear about your niece, I hope the surgery solves things for her. Sounds like she has been through a lot.

There have been a lot of cats who have had big turn arounds after dentals. If there is infection present it can do a number on the BGs. One of the best things for cat's teeth is raw chunked meat. Tess will leave anything else for it. Try giving Skye a little next time you are cooking chicken. make it big enough that she has to chew on it. Even better are chicken hearts, you can get them from the butcher.

The dry food isn't good for your roommates cat either. Check out the section on IBD on the link to Dr. Lisa's page that Sienne gave you. Even apart from the high carbs dry food tends to be easily contaminated by mold and other things. The low water content is also bad for the kidneys.

.5u is a larger dose change up or down than we usually do. .25u is usual, but many of us just shave by a drop. When you are increasing especially w/ a larger increase you can get NDW (New Dose Wonkiness) where the BG actually rises instead of dropping for several cycles after an increase.
 
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