BG 425 to 73 in one day after starting Lantus don't know what to do?

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yes everything u just repeated is right and I did just leave some low carb out for him to eat. sorry it took long to answer i dozed off its gettting harder and harder to stay awake I've been up all night and havent slept at all. Thanks again for everything everyone!
 
So where are you up to in the cycle now? I'm thinking it's probably time for another test. You need to test a bit more intensively to start off with than you'll need to going forward because we don't know Sunny's particular responses to lantus.

ETA - it's a good idea to set your alarm for the next test time when you're in this sort of situation because it is so easy to doze off. What time is it where you are? and don't worry that it's going to be like this every night - it's not!

It's great that you left food down though, most cats will feed their own low numbers if the food is available :)
 
I'm starting to think about what to do with Sunny for his morning shot and one thing that needs mentioning is that you should not shoot him less than 12 hours after the shot you gave tonight (you may not be shooting at all depending on his numbers and your schedule), i.e. you were delayed 4 hours for his shot tonight so you don't want to consider shooting until 12 hours after the delayed shot time, not 12 hours after the time that his shot was originally due.
 
I'm guessing (and hoping) that you've fallen asleep and everything is okay. For the morning, please see my post above about not shooting early. If shooting 4 hours later than his 'usual' time is going to mess with your schedule too much you should skip tomorrow morning and get back on schedule tomorrow night. If it works for you to shoot four hours late (you can move the shot time back slowly - 15 mins per shot to get back on schedule) and his numbers aren't too low to shoot 12 hours past the shot you gave tonight - for you at this stage of the game I would say anything under 200 is too low to shoot (unless someone here advises you to and can stay with you through the cycle) then I would recommend that you don't give more than 1.5 units (less if Sunny is still a bit chunky - the starting formula is .25 per kg or per kg of ideal weight if kitty is overweight) and stick with that for a few days unless he goes too low. But best if you post Sunny's numbers here daily at least to start off with so we can keep an eye on you. Especially tomorrow so we know you're both okay :)
 
I just am stopping by to see how things went after I caught a little sleep. Please post when you get your next BG so someone can advise you what to do today.

Please let us know if all is well. I hope we didn't scare you off.
 
Just woke up and tested him now at +10 and he was 137 and he was eating the whole time I was sleeping I'm assuming. Yesterday I had him on strict meals with only very little food in between. Unfortunately I'm assuming that I missed his nadir but at this point guess Ill have to get it on the next curve. I'm still exhausted I might try and sleep a little more before the next shot in 2 hours but how much do I shoot at this point? I haven't had a chance to call the vet yet and ask him what he thinks with levels being this low at this point and I'm not sure he's even in because he doesn't usually work Fridays. But what dose should I shoot when I do him? Like I said my instructions were to do 3 units and he still never dropped too low to go hypo at this point the last shot I did was 2 units so I'm thinking maybe to just keep him at that for now and watch him. I just hope there's not another reason why my vet told me to start him this high that I just don't understand yet cause I don't know enough about this medication. He actually has a cat there that's diabetic that lives in the office that he treats everyday so he has to know something about this stuff and he's not a bad Vet I trust him more then I would any other vet which I probably wouldn't trust at all. I prefer to do most things myself cause I don't usually trust people enough to do things right I always say if you want to do something right then do it yourself cause no one is gonna care more about it then you!
 
I'm glad all is well. Test at +11 and again before insulin time and post results to see if he is heading back up. I would definitely NOT shoot 3 units or even 2. I usually don't give dosing advice so I would post the results in the subject box and ask for dosing advice. If he were my cat I would probably shoot no more than 1.5 but others might disagree.

As for feeding I give Max a little hourly or every other for the first 5 -6 hours of the cycle if he acts hungry. What % carbs depends on his BG numbers.
 
I forgot to add its a good idea to start a new condo every day and include in the subject box the date, your cat's name and test results as well as you get them. If you have a question of course add the question mark and help with dosing or something like that. For today continue here so whoever reads gets the full picture. We also link the condos together from day to day. To do that you copy the url from the previous day and click on the paper clip and then paste it into the body of your condo and click insert.
 
Hi Andrew.

Just getting online and wanted to check and see how you and Sunny are doing. I know that we are total strangers to you , and it's good that you like your vet and trust him. So it must be vcry confusing to you for us to be telling you to ignore what your vet said. It's your cat, and you know him best, so of course, the decision is yours. I can only tell you that the people here have an amazing amount of experience with this. Sienne, for instance, has been at this for 5.5 years and she is of a scientific mind so is very thorough about her research. She is one of the people that saved my kitty's life when I would have probably killed him by following the vet's advice. Again, that doesn't mean the vet is stupid or doesn't care. It just means they don't have the time to learn a lot about every disease and the people here live it 24/7. If your vet has a resident kitty that is diabetic, I'd be interested to hear how regulated it is, what insulin it's on, what protocol he's following, how long it's been diabetic. Most vets have the goal for their FD patients of regulation. That's fine, if that's what you want. Here, most people, at least when they start out, have the goal of remission. The two goals require some what different approaches. As time goes on, some of us find out kitty is probably not going to be a candidate for remission, so we switch to working toward regulation, but I don't think any of us ever give up hope that it can happen. Not long ago we had a kitty that had been insulin dependent for 5 years goe OTJ (Off The Juice), so it's not impossible.

I know you're more inclined to shoot the 2.0, but I agree with the people here recommending 1.5. After a drop like Sunny had last night, it's always better to start a little lower than you think you should, because it's safe for the kitty, and you can always increase the dose after a reasonable number of cycles if it isn't achieving the results you want. We take the approach here that better safe than sorry, and better a day too high than a minute too low. We're full of lovely sayings like that!

I hope you'll let us help you and Sunny.
 
Just tested him now at +12 and he was 176. Now trying to decide what to do with his dose it seems to be going higher and higher since reducing it so I'm inclined to shoot 2.5 or maybe the 3 units like my vet said and just watch him real good all day today and see what happens. I did let him eat more food today then yesterday as well though so that could also be increasing it as well. I'm really beside myself right now cause I also notice him drinking more water as well now and yesterday he barely drank any.
 
It will go up as the Lantus wears off. Remember that normal numbers are 50-120 on a human meter. Most get food spikes.

I was outraged when it was suggested I go against what my vet decided and listen to strangers so I understand how you feel. In my case my vet wanted me to hold the dose longer. At least I wasn't risking a hypo and he never had ketones. If you go with the 2.5 or 3 units please test hourly. Lantus builds up over time and Sunny may drop low at any time. For me any times means the night cycle which is why I was awake when you posted. Max dropped to 36 and was sleeping comfortably. I gave him high carb food and brought him up but had I not tested he easily could have been in real danger. A hypo can kill if not taken seriously. I'm not trying to scare you. I just want you to be prepared.
 
I gave him 2.5 for now and hes eating some food right now. The weird thing is when I gave him the shot after I smelt it and then his fur felt a little wet so I think some of it might have came back out or something but it def went into him I watched it pierce his skin. I remember years ago when I was nursing a sick kitten back to health and had to give him fluids that sometimes it would come back out but I was pushing a lot of fluid into him and I remember the vet saying to try and massage it into him or something should I be doing something like that with this? I didn't think it would really matter as much because it's such a small amount of fluid. I'm not outraged by anything anyone is telling me I like to know other peoples opinions on things before I have to make a decision. I know that unfortunately ever cat just like every human is a little different so there really is no 100% right answer for anybody it's all a matter of trial and error till you get it down pat. I read the links that you suggested Sienne and I'm gonna follow the TR protocol cause I have a feeling that Sunny pancreas is still functioning somewhat even now and it seems to make more sense to me that if I keep his values in that range that he has a good chance of remission. I've set aside a lot of time for the next 2 weeks so I can watch him almost around the clock for now and if I'm not here I'll have someone else watch him to make sure he has no symptoms of going hypo and I've instructed everyone in my house what to do in case that happens. For now I sit and wait and keep testing him and I'll post the results up and anyone that wants to chime in no matter what you have to say I appreciate it even if you disagree with what I'm doing in anyway I value all opinions especially now being that I am brand new to all this. Once again thank you everyone for all your insights and help it's awesome to know that I have other people to talk to that understand besides my family and friends that I've already talked to death about all this stuff they're all going to be diabetes experts by the time this is all over along with me. lol
 
Hi Andrew - a welcome to you and Sunny from me too. It was great that Elise, Tricia and Serryn were there to help you last night. The beauty of this board is that we have people from different time zones and there is often someone else on.

There is lots to learn here, but please keep asking questions. The best thing you can do to help us help you is to create a spreadsheet showing Sunny's blood sugar values. Here is the post that shows you how.

All of the Sticky Notes at the top of this forum have a lot of good information in them. That includes the one on the Insulin Depot. We determine the dose of Lantus (and Levemir) by how low it takes the kitty, not how high he is at preshot time. Lantus works best with consistent dosing, so don't change the dose if you see a higher number at shot time. Since you said you'd like to use Tight Regulation, we hold each dose (give the same dose no matter the preshot values), for a minimum of 6 cycles, unless he earns a reduction in dose by going below 50. It's natural to see some variation in numbers at the beginning (or longer for some cats).
 
Hi Andrew! What was Sunny's BG when you shot? Sometimes a little can leak out, or there could have been a little insulin on the outside of the barrel from when you adjusted the dose. Insulin has a very strong smell and a little goes a long way.

Having a cat go that low so soon after starting Lantus is unusual. The shed usually take 5 to 7 days to build up and until that time you don't see the full effect of the dose. I agree w/ the others that 1.5 u would have been safer, but since you shot a higher dose be prepared to keep testing and be ready to intervene w/ higher carb food or syrup/honey. Ice cream works too (and you can give yourself a treat at the same time ;)), anything w/ lots of readily absorbed sugar. This could be another very active cycle or Sunny's BG could bounce from getting into number his body isn't used to. The liver can "panic" and release glucagon and counter regulatory hormones to counteract what is perceived as a hypo. The body is used to nigh BGs and sees normal numbers as dangerous.

FD is a marathon, it took a while for it to develop and it takes consistency and patience to reverse those effects. It is far safer to start at a dose that might be too low and work up to a good dose, than to start too high and risk hypoglycemia. Hypos can come on suddenly and are much more dangerous to a cat than a relatively short time in higher numbers.

You are also now in a situation of shooting 4 hours off from you preferred shot time. As Wendy mentioned, Lantus likes consistency, in timing of dose as well as the amount. You can readjust your shot time by 15 minutes a cycle or 30 minutes a day. However, if he goes quite low again and you decide you need to skip the shot, you can reset your shot time to when you want it to be. Usually when we stall for a low preshot number, after 2 hours we just skip the shot. This will drain the excess in the shed and allow you to get back on schedule, otherwise it takes too long to get back to the preferred shot time.
 
He was 176 before shooting his last shot about 3 hours ago Im about to test him again now. I stalled by 4 hours last night and also reduced his shot from 3 to 2 so by doing that it was prob like giving him a 1.5 if Im not mistaken because stalling the shot like that can also in term lower the dose from what I've read on here. Because he was a little higher on the preshot today I then increased him to 2.5 but now from what your saying I shouldnt have done that so not sure what Im gonna do next at this point I guess I need to find a dose and just stick with it. Is there anyway that his body metablozies faster or something that Im seeing such drastic changes so suddenly? I mean for the most part hes not really in the danger zone right now but from what everyone is saying that could change in the next few days on the same dose hes on now even if he seems to be good on it now so Im not sure what to do. I still havent talked to the vet but I have a feeling hes gonna tell me to just keep him on the dose he told me to start him on for now until he can evaluate him personally.
 
I just tested him and now hes 267 so now Im really freaking maybe the last dose didnt go in or maybe I shouldnt have lowered his dose Im really beside myself with this.
 
Amother thing that cats do is bounce higher when they experience lower numbers than they are used to having. A bounce can take as many as three days to clear but can clear fast too. Max bounced for over a year and still does if he gets too low. Have a look at some of our spreadsheets and you will see. Just click on them in our signatures. You can look at my first one from 2014 and then see the change in 2015. This is all normal the fluctuations that you are seeing. Also, meters can be off by 20% and that means 20% high or low as someone explained to you. It's also possible he got a fur shot or partial fur shot. When you suspect that you never want to shoot more the next time because if it did get in you would overdose him. I've been sure of a fur shot before only to be wrong.
 
Hi Andrew.

No worries - blood sugar goes up and down even if the dose is held the same. I think what you are seeing is a result of him getting lower than he was used to and his body responded by "bouncing" to a high number. Don't worry about it. There are times when a high number DOES NOT mean that more insulin is needed. This is one of those times.

When we look at the dose, we're looking at how low the current dose has taken the cat over the past several days. Because of the way Lantus works, one cycle isn't very meaningful, but the past several days tells the story.

I'm going to suggest that you drop back down to 1.5u and hold it there for at least 6 cycles (3 days) so we can see what that dose can do. Lantus builds up in the body and sort of slow releases, so you don't change the dose every time you see a high number. IT's really counterintuitive, but that's the way Lantus works. You don't want to have to stay up all night every night (and you won't be able to anyway) because he is overdosed.

And a little side note - an overdosed cat will have high numbers because the cat's body is trying to keep the cat from having a hypo.

I hate to say "trust us" but that's what i'm going to say. It's very important not to start with too high of a dose, but of course, you are free to do what you want. The choice is yours.
 
Here's some more information on bouncing - the second post in the thread.

The reason for holding one dose for several cycles is because changing doses is sort of like rocking the boat. If the lake is still, we can see deep into the water. We need the lake to be still to figure out if a dose increase is needed. Keeping the dose the same for at least 3 days allows the lake to calm so we can evaluate the dose.
 
Hi Andrew.

If you were to look at Cinco's spread sheet from when he was first diagnosed in 2011, you would see that when he was on 3.5 and 3 units, he had huge swings in numbers. I kept talking the vet into letting me reduce the dose. When I joined the board and got advice from the people here, they thought he was still on too high a dose so I reduced it again, and his numbers started to even out. More and more they were in the healthy range. In a very short period of time I had him off insulin completely. So reducing the dose can really be the best thing. I know the natural reaction to a number you perceive as high is to want to give more insulin, but that isn't how Lantus works!!!

It's possible you got "a fur shot", which means the insulin just impacted on the surface and didn't get under the skin. If that is the case, you are in good company. I guarantee you there isn't a person on this board that hasn't done that, way more often than they want to think about. The furrier your cat is, the harder it is to be sure you got the needle in far enough. Smelling the insulin is usually a good clue. Don't sweat it. You just pick up where you left off and carry on. You have not done your cat any harm!!!! Just take a few deep breaths and consider all you've learned so far as you decide your next step. Remember, we're here to help you!! It's going to be okay!
 
I'm going to chime in and encourage you to follow what Julie said, and go with 1.5 units. Julie is one of the angels that helped me when I started out here over 3 years ago. My kitty Neko's numbers were WAY worse than Sunny when I started out. As it turns out, she has two high dose conditions. So I get the frustration. I hated waiting for better numbers, but that's what you have to do.

Another saying you will here all the time is that feline diabetes is a marathon, not a sprint. Sunny didn't become diabetic over night and he won't get regulated overnight. Time for those deep breaths and some patience.

I also admit to more fur shots than I'd like. When that happens, take a break for a cycle. You can ease off on the testing. Do something for yourself and give Sunny some cuddles. The next cycle is a do-over.
 
I just tested him now again at +7 and hes 383 now I'm assuming that last dose didn't go in or something so I have to figure what dose I'm gonna give to him next and just stick to it I guess cause I'm basically starting all over again this is really stressful and it's not helping that I only slept a few hours on top of the computer so uncomfortable to boot. I wanted to get him at +6 but he was squirming too much and hes pretty docile he takes pills easy and usually lets me do whatever I want but I guess all this poking and pricking is starting to get to him too, it's stressful on both of us but I guess you all already know that. Thanks for all your input anyone else with any other thoughts feel free to chime in. In the mean time I have a lot of reading and thinking to do about what to do next.
 
Hello again :) awesome you've decided to try TR that will give Sunny his best shot at remission on lantus. I also have 'trust issues' so, as you no doubt are doing, the more research you can do yourself the better. By the time Vyktor started taking insulin I had done all my research and decided TR was the way to go so it was much easier for me to give myself up to the board and trust the advice I got here.

I suspect that your vet is more used to dealing with other insulins where the dose is based on preshot numbers and that is why he's gone a bit wrong here. No offence to your vet there is so much they need to try and be across. If you google qld university feline diabetes you will be able to find the TR protocol from their vet studies which you can share with your vet. He doesn't sound like a bad vet and you seem to have faith in him so I'm guessing that he'll be interested. There's quite a few of us that have taught our vets how to use lantus ;)

Are you giving Sunny a low carb treat after each test? If not do, it makes it a pleasurable experience for them and after a short while most cats start looking forward to their tests. Another thing to watch out for that can make them antsy about it is if you are stressed. Our kitties tend to feed off our stress so you need to put your head in the right place and be calm and relaxed before you try to get the test. I know that seems easier said than done at the moment while you're so stressed about the diagnosis but it's really important. Some people sing to their kitty to keep themselves and their cat calm, I just used to take a few deep breaths and sometimes shake out my body to get myself relaxed and focussed. Before you know it neither of you will be at all fussed about it.

I would be astounded if your vet said keep him at 3 units after the numbers he's given you without the depot even being full yet. I don't think your vet would disagree with the advice being given here - particularly if you show him a copy of the qld university tr protocol - to give him the normal starting dose of .25/kg which for Sunny would be 1.5 units so why don't you check in with him and ask what he thinks about doing that. It could help put your mind at ease :)

You are going to need to be patient though and don't freak out about high numbers while Sunny is getting regulated. Check out Vyktors spreadsheet for an example of how tr on lantus works. Vyktor has been in remission for over three years now but you can see from the earlier data in his spreadsheet that it wasn't pretty to start with.

Now, with the diagnosis just being new, so much confusion and so much to learn is the worst time so try to keep that in mind - it is going to get easier on you very quickly you're just in the worst phase right now :bighug:
 
Are you giving him a treat every time after you test? I use freeze dried chicken or turkey. They soon don't mind the tests and look forward to the treats.

I really think one of two things happened. Either he didn't get the shot or he is bouncing. Give both of you a break and stop testing until before the next shot. Get some sleep and regroup.
 
Hey Andrew, just wanted to say you are doing an awesome job, so hang in there! My vet started Miles on 4 1/2 units, can you believe it? I wish I would have worked harder to follow the protocol more quickly. We figured it out - lowered the insulin, switched the diet, started home testing - but it took longer. I hope you will be rewarded with fairly quick regulation for Sunny (with the occasional inevitable bounce, of course...they happen).
 
I'm not giving him treats after testing but I am giving him a little bit of his wet food after. My vet originally said that he was gonna start him on 3 units twice a day and that he was probably gonna have to increase that dose at that point but he was gonna do a full blood test and glucose curve that day as well. He is the one that recommended using the Lantus in the first place because he said it works so well at keeping the levels stable and that it was well worth the money it costs compared to other insulin on the market and he wasn't selling it to me he wrote me a prescription for it to get it from wherever I want to get it from and told me that it was gonna be expensive. He also has a diabetic cat living in his office that's on it as far as I know though I didn't specifically ask him what insulin it was on I just assumed because he told me about him that it must be the same. I keep thinking he must know something I don't know about it I'm trying to connect the dots here but it's just not connecting and I trust what all of you are saying to me too I don't think that you would all be on here dedicating your time for nothing if it wasn't to help someone in need like me at the moment. I know a year down the line after experimenting with all these different things I would know what to do and hes had that cat for 2 years already so how could he not know but then again I know that every cat is a little different just like humans are and stuff like when there eating and what there eating also make a huge difference. I had blood work done on him almost 2 years ago when he was 19.5 lbs and his sugar was already 137 and he didn't say a word to me about it but according to the lab the bloodwork was done at he is in the safe range which they give as 72-175 but maybe thats on the alpha scale or whatever they use for pets that I heard a few mention. Still not sure what I'm gonna do at this point but I'm leaning more and more towards the lower dose maybe do a 2 at the most and watch him and then lower him if needed. I don't I guess more reading for now talk to u all in bit.
 
Miles how long did you keep him on 4.5 and what happened? I checked your spreadsheet but I guess you weren't tracking him at first. Also how much did he weigh and what were you feeding him?
 
Our motto here is safety first. We've seen a lot of cats come in at too high a dose. We've also seen a lot of cats with higher doses need far less insulin once they switched to all low carb wet food.
 
I can't remember exactly - it was so long ago - how long Miles stayed on the 4.5. Not long - my initial research was indicating that was too high. He was on the dry Hill's m/d, which of course he liked (having developed diabetes from the senior Hill's dry which he craved), but he was causing quite an unlovely scent in the litter box. Also, the vet was having us come for weekly curves. Between the two, I started to get smart. I learned to test, saw his numbers were bad, switched him to FF classic. Numbers started to improve, litter box air cleared out significantly. ;)

Much later, I switched from writing down everything to using the spreadsheet. And, much MUCH later, my husband and daughter now share in the testing so we can get at least one number in the middle of the day, and they are on board with me. Now if only my vet would follow suit, but that's another story. :(

To answer your other question, Miles weighed 22 lbs at his heaviest and was 11 at the time of diagnosis. Now he is about 17 lbs. He could stand to lose a couple, but he's eating well, and he's in blues and a few greens. I can't complain. It really does get easier.
 
Hi andrew,

Just wanted to give you a little more info about the starting dose. We use two dosing methods here on FDMB. Sienne gave you links above to both.

The Tight Regulation Protocol uses a weight-based calculation, 0.25u per kg. At 14 lbs (6.35 kg) that would be 1.5u per shot.

The Start Low Go Slow method calls for a starting dose for all cats on low carb food to start at 0.5u per shot. If there is dry food still being fed, the start dose is 1.0 per shot.

With both methods, the dose is then held for one week unless there are unusual circumstances.

This is the reason that so many of us are suggesting you decrease his dose and then hold it there for a week. It is far safer for the cat to need his dose increased than to have the cat getting too much insulin.
 
I just tested him a little while ago at what would have been +11 if the last dose actually went into him which I'm not even sure of now because his fur felt a little wet afterwards and smelt like lantus and he was 353. Also in my readings I have found that people have found problems using the freestyle lite meter giving lower then usual readings so now Im wondering if that thing could be off as well and maybe I panicked for no reason. I tested it on myself against another onetouch ultra meter that I have and it was only off about 10 but on my dad it was off about 20 which doesnt sound like much but Ive read of other people off reading by as much as 150 with this thing. I would just use the onetouch ultra but it needs so much more blood and it usual winds up erroring out if you don't get the exact enough amount its really annoying. I need my own vet lab here doing this at home with limited tools really sucks.
 
If you're near a WalMart you can get a Relion Confirm or Micro (same meter, just different sizes) for about $15 and the strips are only $35.88 per 100 (and you can get them even cheaper through ADW (American Diabetes Wholesale)

They take the tiniest sample size of any meter and is one of the favored meters around here. Lots of us use them
 
Wish I would have known this yesterday before I just bought the freestyle from there. I thought the freestyle took the smallest blood amount thats why I got it. That and my friend uses the same one and said it worked good for him but hes not a cat.
 
most of us have 2 or 3 meters...One we use 99% of the time and the others are back-ups for just in case the main one decides to fry at 3am in the morning and our kitties BG is 33....so it's nice to have a backup meter in the house!

Looks like the Freestyle lite takes the same tiny sample size as the Confirm/Micro 0.3 µL
 
I started with the freestyle and loved it. It measures differently and the result is that you won't see the high numbers That others see using the relions. In low numbers it will be comparable to anyone else's meters, but with freestyles most of the time you won't see high tests.

We switched in February of 2012 if you want to see the change in a ss from freestyle to a relion. It's quite obvious on the spreadsheet.

Go ahead and start a new thread (we call them condos) with your next comment. This one has gotten super long and we suggest people start one new condo each day to help keep things manageable on the board.
 
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