At My Wits End!!

Status
Not open for further replies.
P

pinkfirefly

New Member
So, my cat Alley has been diabetic for two years. She was on Vetsulin without issue until three weeks ago when she developed a UTI, severe kidney infection, pancreatitis, and DKA. She almost died. Well she's slowly come around, but the vet switched her to Lantus due to Vetsulin supposedly being taken off of the market soon. Long story short, her numbers have been all over the place and I'm ready to pull all of my hair out. Earlier this week I rushed her to the vet with a +1 glucose number of 46! The vet assured me that she wasn't going hypo, but her curve numbers are insane! Yesterday's numbers were:

+2=97
+5=251
+10=425
PMSH=455
+4=316
+6=255

Now check out her numbers this morning. I did not giver her insulin at all due to the low numbers.

4:57am= 104
7:41am=82
8:49am=73
9:22am=110
10:49am=183
1:48pm=326
5:39pm= 268
7:22pm=344 (shot at 1.5 8:00pm)
9:09pm= 371
10:30pm=395
12:00am=419
12:52am=432

WHAT IS HAPPENING? I didn't shoot her this morning because her numbers were so low I was scared she'd go hypo, and I shot her this evening and her numbers have gone up...not come done! Seriously people, I'm at my wits end. I spent $2,000 to bring this cat back from near death with a DKA, and I'm terrified that these high numbers tonight will cause it to happen again. I feel so totally helpless and confused.

Amanda
 
Hi there and welcome.. I am so sorry that you and Alley have been thru a lot.
Is your cat on 1.5 units of lantus? did read that right?

From the numbers, it looks like somogyi rebound..
http://www.felinediabetes.com/concurrent-somogyi.htm
The normal response to somogyi is to decrease the dose but with the dka ketone history I do not think you should. I do not have enough ketone experience and will try cross posting to find you some help..

My Merlyn had very weird duration /overlap from Lantus..so that could be going on too.
sending cyber hugs.
 
Yes, I gave Alley 1.5 units of Lantus this evening, but had been giving her 2 units in the morning and at night for a week prior. After the vet saw her low numbers this morning (and the other day with a 46) she said I should decrease her to 1.5 units.

I'm just completely stumped. I'm just so scared she'll get sick again. We've been through so much lately.

Amanda
 
Amanda...ok...deep breath!! I'm a relative newbie in Lantus (one month) and so I do not know what is going on with your baby. However, I do know that Lantus requires a consistent dose and it also requires consistent shooting times so if you shot at 8pm, you should plan to shoot at 8am tomorrow unless otherwise advised not to by one of our Lantus advisors. Please immediately go to our Lantus support group at:

http://felinediabetes.com/FDMB/viewforum.php?f=9

Copy and paste your initial message into a "new topic" in the Lantus support group so that one of the advisors can see it. Sometimes one of them will be up late but if not, we have several on the east coast who will be up early...I'm assuming you are on the west coast? Also, in the Lantus subforum, you'll see a lot of "stickys". It's very important to read them but particularly the first one for newcomers. It has a lot of really important info and will tell you how to set up a google spreadsheet to track Alley's numbers on so the advisors can look at it and help you. They have helped alot of folks transition their cats from other insulins and they are amazing and remarkable. You can look below at my girl's spreadsheet below my signature block to get an idea of how we track numbers, etc. Also...if you have any ketostix at home, check her urine for ketones to keep an eye on whether DKA is redeveloping. Anytime my Gracie's numbers are over 300, I check her urine a couple times a day.

I'll be up awhile..again, I'm not an advisor but at least if you know someone is around, maybe you'll feel better. You've already shot for tonight and so an experienced person will be able to help you before you shoot tomorrow morning. Are you on the west coast?
 
lantus builds up under the skin. so when you didn't shoot, she ran out of insulin, basically, and numbers started climbing.

because of the high numbers and the DKA, i encourage you to test for ketones at least once a day for a while. you have ketone test strips, right? the kind you put in the urine to see whether the cat has ketones (buy at any pharmacy)?
my cat cooperates enuf that i can slip a ladle under her while she's peeing, to collect urine i can dip the ketone test strip into. some cats are difficult to train that way, so people just dip the test strip right into the litter as soon as they've peed and before they've had a chance to cover it up. you'd just take a little clean litter with water and dip a strip into that first to make sure you don't get false positive readings before you relied on that method for ketone testing.

if you look at the links (stickies) at the top of the lantus forum, you will find a link to the Tilly Protocol (you can also find it in the first link of my signature). per tilly, we'd reduce by 0.25u if we hit a low number 40 or less. she was a tad higher and the vet had you reduce by 0.5. just noting that for a similar situation in the future.

for now, please shoot 1.5u every 12 hours. if you see a number too low to shoot at shot time, delay the shot by 15 min and test again. repeat that until you have a shootable number. you can expect that if you miss the shot you will have high numbers for up to a day or two. if you see another number 40 or lower, reduce the dose by another 0.25u. but please plan to shoot 1.5u every 12 hours so she's been on that dose for at least 3 full days (six shots in a row, with no skipped shots) unless you see 40 or under. if after 3 full days you see only numbers in the 300s or higher, increase the dose by 0.5u and hold it for 3 days. if you see numbers under 200 but over 100, increase by 0.25u and hold for 3 days.

the lantus forum has a sticky on what to shoot if numbers are too low, so you should read that. libby and lucy has also started a thread on the topic that you'll see on the forum. hope those two things help you.

don't know if the vet taught you to give subQ fluids. it's a useful skill particularly for owners of former DKA kitties. if you can't give fluids twice a day (or even if you can), it would help to add water to your cat's food to make it a little soupy or gravy like.
 
Would it be possible for you to split the dose, and give 0.75U on a 12-hour schedule? Eeyore does decently now on a once-daily dose, but not always...sometimes I need to "help" things along.

Another thought is how familiar are you with Humulin R? I've used that in combination with lantus successfully with Eeyore at times when the numbers were sky-high, and Lantus wasn't touching it. I used a small, small dose to bring his numbers into "lantus-range", and it really did help. Note: it doesn't help Esse at all, so it's a hit/miss kinda thing with R, in my household...works for one, and not the other. Go figure.

And the last note is it may be that Alley is brewing an infection. Esse recently developed an anal abscess, and it blew the other day. I knew something was going on because her numbers went skyhigh, and the normal treatment wasn't doing much for her. Once the abscess blew, I understood what was happening much more clearly.

If this were me, I'd decide a "no shoot" number, and a "low number dose". For Eeyore, I'll shoot at 100, but not under, and only shoot a 0.25 - 1 drop (which means barely anything...). Do you have a no-shoot number? If not, that may be something you can do. I also have an "R" number - if I get this number, I shoot 0.25U of R, as well as Lantus, and it brings it down nicely over a period of a few cycles.

Hang in there...my bet is that some sort of infection is brewing, and that the 1.5U is too high. Split the dose, and see what happens...you might be pleasantly surprised at the answer.

Best-
Michele
 
Did you start right out on Lantus at 1.5 or 2 units? Because we recommend starting at 1 unit every 12 hours

The bouncing around can be from rebound -- too much insulin then skipping shots.

Lantus is very different from Vetsulin, so please go to the Lantus Insulin Support Group and read the posts at the top of the list ("sticky" posts) that give info about using Lantus.

so -- I'd suggest lowering the dose and giving the same amount every 12 hours.

Since your kitty did have DKA -- get the Keto-strips so you can check the urine at home as described above.

DKA can be aggravated and/or recur from not enough insulin -- so while we are recommending a dose decrease, we need to make sure the DKA does not come back.
 
The vet originally started Alley out on 1 unit every twelve hours. After one week of high numbers, we upped her to two units every 12 hours. This made a huge difference. Alley perked up, started feeling better, and was doing great. After 4-5 days however, her numbers started dipping into the mid-40's in the morning. Having used Vetsulin for two years, I'm afraid to shoot her with such low numbers in the morning. I skipped her dose yesterday morning at the Vets suggestion, but watched her numbers climb all night. She is testing negative for ketones and her numbers finally started to come down at around 5:00am this morning, and her BG was 268 three hours after her 8:00am shoot of 1.5 units.

Thank you guys so much for the support and help. I'm feeling a lot better now that her numbers are lower, but am still trying to figure out this Lantus stuff.

Amanda
 
Lantus is nowhere the same as vetsulin in how it works, so you'll have to relearn a few things. You can shoot on lower numbers, and it builds up a 'shed' as in it takes time to reach full effect (over a week). I'd follow the suggestions above and 1. decide on a shoot/no shoot number as well as a reduced dose number and 2. read more at the lantus insulin subgroup

Jen
 
pinkfirefly said:
The vet originally started Alley out on 1 unit every twelve hours. After one week of high numbers, we upped her to two units every 12 hours. This made a huge difference. Alley perked up, started feeling better, and was doing great. After 4-5 days however, her numbers started dipping into the mid-40's in the morning. Having used Vetsulin for two years, I'm afraid to shoot her with such low numbers in the morning. I skipped her dose yesterday morning at the Vets suggestion, but watched her numbers climb all night. She is testing negative for ketones and her numbers finally started to come down at around 5:00am this morning, and her BG was 268 three hours after her 8:00am shoot of 1.5 units.

Thank you guys so much for the support and help. I'm feeling a lot better now that her numbers are lower, but am still trying to figure out this Lantus stuff.

Amanda
Click to expand...

Taking several days to see results is very typical of the longer lasting insulins, Lantus and Levemir. Lantus should not be increased in unit doses, but in .25U amounts, slowly, meaning you raise dose to 1.25U, continue that dose for at least 3 days then test BG every 2 hours to see what the nadir or lowest number during their cycle is and deterine if you need to increase the dose again based on the nadir number, not the preshot numbers. It's all in the Tilly protocol, which the vet could learn from as well, so maybe print it out for them to read.

At this point it's probably safe to say her optimum dose is somewhere between 1U and 2U. You may and really should begin to see normal blood glucose ranges at the 12 hour mark when it's time to give the next shot. This is normal if you are at or near the optimum dose! Yes, it's very different than Vetsulin - Lantus and Levemir work best by producing steadier blood glucose levels, not the more pronounced curves of faster acting insulins like Vetsulin.

But you're doing great so far!! It gets easier, it really does.
 
Status
Not open for further replies.
Back
Top