BG consistently high/considering insulin switch

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William's Mom

William's Mom

Member Since 2015
We recently made the switch to Lantus (3 weeks ago) from Prozinc after only a month on the latter. As soon as we began the Lantus I started seeing higher numbers than ever before and very few, if any lower mid-cycle numbers. Most of his mid-cycle numbers remain in the mid 300s. He does have some stressful extenuating circumstances that have requiered frequent visits to the vet ( a vet tech scraped him while trying to draw blood, William licked it to death and now we're dealing with bandaging and wound care, plus the strange effects of a CONVENIA shot) and what looks like a pancreatitis flare which I'm doing everything in my power to battle. I know that these other issues complicate dosing and raise bg levels, but the pancreatitis was present before Lantus and seemed more manageable while we were still using Prozinc. At least then he would go into the 200s on a semi-regular basis, and, of course, we hadn't even had time to find the optimum dose for him.

His one blue number was taken by the vet while he was on Valium to calm him during the visit. He was VERY relaxed.

Also, I have encountered some problems maintaining a strict 12 hour schedule. I normally can make it work, but my job is unpredictable and there were some very clear benefits to the flexibility in shooting with Prozinc on my end of things, not to mention, he seemed to be responding a bit better to it, possibly in part because I was able to shoot a little earlier in the cycle.

Thoughts?
 
Switching back and forth between insulin is not the best for a cat. It takes a week or two just for it to get settled and working effectively. If you feel you need to go back to Prozinc for flexibility reasons, you should really plan on being on it for the long haul. Some cats do adapt and come down quickly, but not all. It isn't likely the type insulin that has him still on higher numbers but the earliness in his treatment and the pancreatitis. Flat cycles can definitely be a product of Lantus. When they are still in high numbers it is frustrating, when they come down it is really nice.
It can be really frustrating on the boards sometimes to see other cats come along and quickly drop, some cats take longer to heal and some just find a place where they maintain well. Most cats need some time on steady treatment with a few dose increases before they come down. If you think Prozinc's flexibility will be better for your schedule and working with the pancreatitis, then it might be a good choice to go back to that insulin. If you want to make the change out of frustration on not seeing improvements fast enough, you might want to give Lantus a little more time to see if you find his optimal dose.
 
Poor baby. :( He sure has a lot going on. I'm so sorry! I'm still a newbie so I don't have a lot of advice to offer. We switched Cooper from Lantus to Levemir after only a month and his numbers got worse looking to me and I was so frustrated just like you. However, I see you haven't been on Lantus very long at all and it can take quite some time to find the best dose. I hope things will get better.
 
I have a couple of thoughts. First, he may be having an allergic reaction to Convenia. It's not an antibiotic that most of us will use even if it was being prescribed appropriately for the skin lesion. Because it has a more than 2 week duration, if your cat is allergic it takes a long time for it to get out of his system. An allergic response -- whether to a drug or to pollen -- is an inflammatory response. Any inflammation or infection can raise BG numbers. Thus, between the Convenia, the skin lesion, and the pancreatitis, it may explain why William's numbers are higher than when he was on Prozinc. The other issue is pain. Pancreatitis is painful. Did your vet prescribe any pain medication? Most of us will ask for buprenorphine for pain management. (You do not want Metacam or any other nonsteroidal anti-inflammatory drug since they can cause kidney failure in cats.) Pain is another reason why numbers can be high.

The other factor is that unlike Prozinc, Lantus is far more gentle. It doesn't "yank" numbers down. Once numbers start coming down, Lantus can "grab on" and pull numbers lower. I would encourage you to look over the Tight Regulation Protocol and consider adjusting William's dose every 3 days if his numbers are higher than desirable.

You mention on your spreadsheet that William has been lethargic. Are you or your vet testing for ketones? With an infection/inflammation and not enough insulin and especially if he's not eating well, it can be a recipe for ketones developing. I always get nervous about ketones when people note that their cat is lethargic.

How out of kilter does your schedule get?
 
Thank you all for the support.
@Sienne and Gabby YES!!! Thank you for acknowledging the Convenia connection! I feel like people think I'm nuts because William was obviously not in perfect health before, but I honestly think it's a huge contributor here and it was the one variable added that, over night, changed what was a bit of a challenge, into something that seems to have gone out of control. Before that he was behaving relatively normally even with higher numbers, was eating, pretty social and seemed to be coming around. The vet practice manager gave me a line about how they've given thousands of Convenia shots with very few reactions. I told her she can add another to the list. If I'd had any idea the controversy surrounding that medication I never would have chanced it and I feel totally sick about it.

I know it's a bit of an impulsive thing to just want to switch to another insulin, and I recognize that it's coming from a desperate place, so I'm not planning to do that right now in the midst of the upheaval that's happening in his system.

He has been in and out of lethargy since the injection, but I have worried about ketones, as well, and I haven't tested for them. I know I can get the strips from the pharmacy and it may not be a problem getting a sample since he keeps peeing outside the box :/ There's so much that I have to mention to the vet these days that I forget to mention things here and there and I keep going home and going "why doesn't anyone seem concerned about ketoacidosis?!". From having major medical problems in my own human family and a sick kitty before, I know I have to be my own advocate and that I need to not get swept up when at the vet thinking they'll remember everything that needs attention, or that they even know the best solution, for that matter. He has only in the last couple of days been a particularly bad eater, though I can still get him to eat baby food on his own and a decent amount of it. I know that syringe feeding comes next. Just hoping it doesn't come to that. He's really an extra sensitive boy and all this stuff shoved down his throat, plus bandages and a t-shirt over that have really bummed him out.

My schedule is usually managable. I just have to get someone dependable trained in case I can't be there. Normally, it's fine or I've pushed shot time earlier/later in increments over the course of days to accommodate fluctuations.

I was trying to SLGS, but I think I'm too much a micromanager for that, so TR might be the right way to go. I've been a little intimidated by it, but I know I certainly have a good resource here. I'll look it over again.
 
Also! I do have a couple doses of buprenorphine (oral) left. I hadn't given it again so that I could see if the lethargy was linked to Convenia or a result of the pain med. I also have cyproheptadine for appetite stimulant and antihistamine (to hopefully counteract the Convenia response and the inappetence), but that makes him drowsy, too, so it just seemed like a lot of sedation happening and it scared me.
 
It seems like you have a handle on the balls you're juggling. I also noticed that you commented that William was having some issues with diarrhea. One thought is to try giving him some FortiFlora. If you're not familiar with it, it's a probiotic so it can help with the GI issue. Many cats find it irresistible. You sprinkle it on their food or mix it in and it acts like an appetite stimulant. It may be a way to avoid giving the cyproheptadine.

For a cat in high numbers with pancreatitis and all of the other things going on, getting Ketostix is an inexpensive bit of prevention or early warning. DKA is hugely problematic and expensive so whatever you can do to avoid going down that road is proactive.

My rationale for suggesting Tight Regulation is more that the dose increases are more frequent. Especially with a cat that isn't feeling great, I tend to want to see a more aggressive approach to dosing to avoid a problem with DKA. With SLGS, you wait a week to increase the dose. As long as you can test they way you have been (at least 3 - 4 tests per day minimum), you should be fine with TR. Is there any way you can get an early test (e.g., a +2) during the AM cycle? I'd also encourage getting tests during the PM cycle on a routine basis. Many cats will drop into lower numbers at night.
 
:bighug::bighug::bighug: When there are so many variables it can be so hard to know what to do.

Do get some ketone strips and start testing. The road to DKA is infection, not enough insulin and not eating. What antihistamine were you given for an appy stimulant, cyproheptadine? Many vets recommend too high a dosage. Ours said 1/2 to one, 4mg tablet. We give Tess 1/16th or less and it gets her eating in about half an hour. It could be that if the dose is too large, that is causing the drowsiness.

Is he totally uninterested in food or does he take a lick and turn away? Lip smacking? That could be nausea and you might ask for ondansetron. Again about 1/8 or less of a 4mg tablet.

We went through DKA w/ Tess in March, the ER vet stressed that the first thing was to get her eating! Whatever he will eat, forget about the carbs.

One other thing that I noticed is that you are still not up to the dose of Prozinc that was giving you better numbers. It is recommended to start at a lower dose of Lantus, not because it will be as effective, but to be safe in case it does drop numbers more than the other insulin.
 
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Welcome to Lantus and Levemir Land. I'm sorry William is diabetic but this is the best place to get advice and support. We also gave cyproheptadine to Zener, just a tiny crumb at first, twice a day, about 30 minutes to take effect.
Liz
 
Thank you, all.

We went to the vet earlier today and his skin issues are healing beautifully! So, we won't be going back for a while and I'll be managing that part at home and much stress and money spent can be avoided.

Also, no ketones! He does have some white blood cells and a bunch of glucose in his urine, though. I'm going to start him on Clavamox when he starts eating better. He responds just fine to that.

It's clearly imperative that we get that bg down, though so we are upping the dose. I told my vet that I wanted to follow the TR and be more aggressive, told her that I do plenty of monitoring at home and she seemed a bit uncomfortable, as I think they all might be at first, at least. She suggested that I increase the dose to 2.5 for one dose and 2.0 for the other. I told her if I do that I would do the larger during the day, since he seems to have a bit of a lower night (I think!). Has anyone heard of this being done? Seems a bit weird to me. If it's not topsy turvy, I guess I'll give it a try, but it seems like something you would do only if you were very certain your cat had very different day/night cycles. Does that not confuse the system? I think doing 2.5 for both doses would be perfectly safe given how he's going high high higher. But what do I know? Probably worth a separate post.

Good to know about the dosing of cyproheptadine. Makes me feel a bit easier about it. I was told to give him 1/2 of a 4mg tablet, and I reduced it to a quarter the other day because it was horrible to see him so doped, but tonight I gave him a full one because I didn't want to play around with appetite. He did eat DM of his own accord even before I gave it to him. Not a ton, but we're getting there. And then some more just a bit ago.

It's a big relief to know we won't be needing constant trips to the vet and that there's a plan and that there's a group like this.
 
You really don't want to shoot different amounts at AM and PM shot times. The reason is that Lantus is a depot-type of insulin. Every time you change a dose, you need to give that dose time to stabilize. If you shoot alternating amounts, the depot never stabilizes and you end up with wonky numbers.

With TR, when nadirs are 300 or above, you can increase by 0.5u. However, it's your call whether you want to increase by 0.25u or 0.5u.

Do you think William has a UTI? Generally, you want to get a cystocentesis and a culture and sensitivity to make sure that the urine sample isn't contaminated and that you're using the appropriate antibiotic.

 
That's what I thought regarding insulin dosage. I gave 2.25., I think. Not sure how people here seem to give such precise amounts. I've seen dosages with very specific decimals and I don't understand how people know they're giving 2.27, for instance. But, either way, I gave an amount roughly between the lines. I'll do that AM and PM and see what happens after a few days. I just started Clavamox so I guess that could change things. They drew out the urine with a syringe directly from his bladder, so it was sterile. I have spent thousands of dollars over the last few months, so I opted to treat it as a uti with the med they use for uti's that has worked for us in the past.
What about prednisolone. For the p-titis and allergic reaction. I know that it's not great for the liver, that it's not great for the bg, but I have had to use it in the past with him as a wee one and with my girl who's now gone, and despite the downsides, it kept them alive. I don't know how else you get massive inflammation in the body down without it. I see other people use it here.
 
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