BG climbing after day off lantus

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Laura Nels

Laura Nels

Member Since 2015
Vivian's BG yesterday a.m. was 81 so I didn't give insulin. Numbers later in the day were 123, 125, 124 so I ended up not giving insulin in the evening either. She gets spooked by blood testing and I wasn't sure how much she would eat...I'm also still not really clear about when to give and when to withhold insulin. The advice given by posters, the frequently asked questions here, and my vet are all different. Anyway, this morning she was at 134 so I gave her the regular .25U - I already know what that is going to do, by +4 hours her BG is going to be way down in the 40's or lower. I think I am learning that I should push food on her at +3 hours. Today I am home and I can do that. Normally I am not home and can't tend to her during the day and in the night when her numbers go low. Does she need less than .25U if her numbers are going that low and I can't be around to push food? Given that she was back up to 134 this morning it doesn't appear she is in remission. I did email this info to her vet and will receive advice within a couple hours, but this vet told me to take her off insulin after one week because she was going so low at +4. She thought Vivian was already in remission, she wasn't - her BG climbed into the 200's, she began peeing a lot, so the vet said put her back on original dose. I was the one who put her on half the original dose, which she is on now. The point is this is a busy primary care vet and not a diabetes specialist, her advice is not always the best, but she is open to my researched ideas. That's why I am asking here if further reduction, such as 1/8U is advisable. I'd have to find a better way to measure, the vet has offered sterile water, not sure how that works. Of note also is that Vivian is transitioning to lower carb food and tapering from pred, both of which should lower her #'s naturally.
thank you
Laura
 
I am not comfortable offering dosing advise, I will leave that up to the more experienced members. One thing...it might be useful to get a couple of evening readings, even if she is not getting her shot. It is nice to see how the evening numbers compare. My kitty for instance seems to be more active in his evening cycle than during the day.

Vivian's numbers are looking very good considering this is not long after starting insulin. She may very well need a further reduction, but it would be good to see a few evening numbers so you have the bigger picture on how she reacts to insulin/food. Yesterday she stayed pretty flat in the blues even with no shot. It sounds like you know your kitty well and have made some good judgement calls on her dosing. IMO she stills needs some dose but I will let more experience people sound off on that.

One thing many members who can't monitor for periods of time do, is use an auto feeder so that there is food available at various times while you are away.

You can also pot your questions in the Lantus/Levemir section. There are usually a lot more people there throughout the day/night so you will probably get more feedback:

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/


:)
 
thanks tuxedo mon - it's not that there isn't food available to Vivian 4 hours after insulin, it's that if I'm not here to push it on her she won't necessarily eat it b/c she's sleeping. I hear you about getting some evening #s, but the truth is that after a day of ear poking Vivian is so spooked she stops eating, she's hiding and I've had enough of stressing out the cat for one day
 
From reading your other posts I think you are using Evo dry food. Although it is not as bad as some other dry foods it is still higher in carbs than a diabetic cat should have. I don't know how Vivian is about wet food, but if she will eat that instead, you may see a further reduction in her sugar levels. Of course with using the prednisolone it makes it more difficult to regulate the numbers, but you do what you need to do for all the conditions. When my Tuxie hits low numbers he will actively search out food or chase me to feed him. If you have food out when you are not there perhaps Vivian will eat if her numbers drop, although we are always concerned about the numbers dropping too low.

It took me a long time to get Tuxie used to all the testing I did. I am fortunate because he is VERY food motivated and he always got a bit of his regular food, or chicken or bone broth etc after each test. Now he actually goes to the test area and sits down and meows whenever he thinks he should have more food. Maybe a special treat for Vivian at test time, or even extra cuddles and pats (that is all some cats take) could make the testing easier.

Hopefully someone with more experience will be by soon and be able to give you a better idea on the dosing regime.
 
I do give Vivian canned food in the morning and evening. On a good day she eats the canned food and less dry, many days she will have nothing to do with canned food, she'd rather eat nothing. She is a 10-11 year old cat who has eaten dry food her whole life, on the vet's advice, and is not having an easy time with the transition. The EVO dry I am transitioning to may not be perfect for diabetic cats but it is tons lower in carbs than the Hills prescription dry food she is transitioning from - so that's something. We're talking 30% vs. 12% carbs, it's not perfect but it's a step in the right direction. EVO dry is actually lower in carbs than the Hills prescription canned food she's currently eating, which she will also transition from when the time is right and her system is handling the dry food transition - one thing at a time for this sensitive system girl. All the foods I am trying to get Vivian off are exactly the foods that have been recommended and sold to me by my veterinarian! Even after she became diabetic there was no suggestion that I switch foods, this has all been my idea, that the vet is "fine with". Frustrating.
thank you
 
Laura Nels said:
I do give Vivian canned food in the morning and evening. On a good day she eats the canned food and less dry, many days she will have nothing to do with canned food, she'd rather eat nothing. She is a 10-11 year old cat who has eaten dry food her whole life, on the vet's advice, and is not having an easy time with the transition. The EVO dry I am transitioning to may not be perfect for diabetic cats but it is tons lower in carbs than the Hills prescription dry food she is transitioning from - so that's something. We're talking 30% vs. 12% carbs, it's not perfect but it's a step in the right direction. EVO dry is actually lower in carbs than the Hills prescription canned food she's currently eating, which she will also transition from when the time is right and her system is handling the dry food transition - one thing at a time for this sensitive system girl. All the foods I am trying to get Vivian off are exactly the foods that have been recommended and sold to me by my veterinarian! Even after she became diabetic there was no suggestion that I switch foods, this has all been my idea, that the vet is "fine with". Frustrating.
thank you
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You are probably better informed than your vet when it comes to the better foods for Vivian. Vets are given a very short course in pet nutrition when they do their training and quite often that course is given/sponsored by the pet food companies.

I know how hard it is to transition kitties off of dry. When I stated making my own food 8 years ago I was lucky with Tuxie...he had never eaten dry, but his sister Maxie was a dry food addict. It took me months to get her to eat my home-made. Even now if given the choice between wet and dry, Maxie would easily choose the dry. Funny how it goes...Tuxie never ate dry in his life and yet he was the one who ended up with diabetes!! Go figure!!!
 
Tuxedo Mom said:
From reading your other posts I think you are using Evo dry food. Although it is not as bad as some other dry foods it is still higher in carbs than a diabetic cat should have.
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As long as it is EVO Cat and Kitten, it is one of the few dry foods that is not higher carbs than recommended for diabetics. We on the board just don't recommend and dry food for diabetics if possible. If a caregiver needs to feed a dry EVO is one that is recommended.

Vivian can go to 0.1U 2X per day if you think that the 0.25U is too much. Often that drop from 0.25U to nothing can be too much for a cat to handle. To measure 0.1U I pull back a little extra in my syringe, then push out so that my plunger is just barely touchs the 0 line. There will be insulin between the 0 line and the needle. Others use calipers to measure, I am not so patient :smuggrin:
 
Didn't hear from vet or anyone here before insulin time, so gave Vivian as close as I could come to .15U last night and (I am away overnight) she was given the same this a.m.
Pushing food at +3 hours to avoid low numbers at +4
Will continue .15U, transitioning foods to decrease carb intake as she tolerates, tapering pred slowly to the extent she tolerates, testing BG when I can -
Feeling a little out there on my own but that I have learned enough in the past few weeks to safely get Vivian to remission, if that is in the cards.
Tight regulation/low and slow? Yes I follow guidelines to extent they make sense for Vivian and for me. These two protocols are at odds with each other in places,
but I generally get it.
Thanks for tip Melanie, it is consistent with what I ended up deciding for Vivian.
 
Sounds like she may have steroid-induced diabetes. My cat Marshmallow got that after a shot of steroids. But it's great that you've been able to reduce the Lantus that much! Hopefully after she's off the pred and fully transitioned to Evo, she may be able to go OTJ.

I think Marshmallow has IBD and several people here mentioned I could put her on budesonide instead of prenisolone. Apparently it won't raise her BG. That might be worth discussing with your vet if she doesn't do well after you stop the pred. Good luck!
 
Vivian's diabetes most likely is pred induced. My understanding of budesonide is that it is less likely to cause diabetes because is works directly on the intestine and not systemically.
I have mentioned it to my primary vet in an email, but neither she nor the internal med specialist have recommended it, in fact they recommended chlorambucil. I think any time a cat presents with diabetes, any steroid is not advisable if you can avoid it, it can cause side effects similar to pred, and I understand it is very expensive. That said, if the cat is in need of something for inflammation, and you can afford it, budesonide may be your best option. It would be interesting to hear what your vet has to say about the idea.
 
Chlorambucil pills are very expensive. You can get chlorambucil compounded into capsules or even a liquid and it is a lot less expensive. Pharmacies that do that include Roadrunner and Diamondback.
 
Yes Vivian takes 1.8 mg capsules compounded generic chlorambucil, which is considerably less expensive than brand name chlorambucil, called Leukeran. It's nuts - $11 or $12 per pill - and you can't have generic chlorambucil compounded into 2 mg capsules b/c that's the dose Leukeran sells. So you have to get random doses like 1.8 mg or 2.2 mg for tons less $$ - crazy.
 
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