BG numbers dropped fast! - Is this normal?

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Angel and Ducky

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So, I have been giving Ducky 1 unit of Glargine Lantus twice a day since last Tuesday, and his numbers have stayed pretty much in the 250 - 400 range.... one time it got down to 173. So on Thursday this week 06/03 I took him to the vet and they tested him at 380. She asked me if there were any signs such as thirst, hunger, frequent urination and I replied that he still had all the symptoms so she raised the dose to 2 units twice a day. So we gave him his first 2 unit dose last night and at +2.5 he was at 342. My husband gave him his am shot at 5:30am and I checked him at +2 and +7 and he was 291 and 210. Then my husband gave him his pm shot without testing him, so I tested him as soon as I got home at +1 and he was 66!! So I gave him some treats, and he had just got done eating so I didn't know if I should give him more food. He was not showing any signs of distress, so I tested again at +2 and he was 64 and again just now at +6 and he is somewhere between 66 and 74 . (I got another meter and tried both for comparison) I am really worried and I don't know when Lantus peaks. I am going to test him again in the morning before his shot... at what level should I decide that he should not have another shot? I am worried about my Duck...
 

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ok, so it looks like he's doing what we call surfing (coasting in relatively similar numbers). that's good. because of the large dose increase unfortunately his nadir could be later than normal. i probably wouldn't relax til close to the next shot time unless his numbers rise over 20 points and stay higher rather than dropping again.

peak times (nadirs) for lantus are normally about 5 to 7 hours after injection, but some cats drop late habitually or even drop twice (cleo's nadir is normally around 4.5 hrs after injection). you won't have a better idea of your cat's nadir until you have more midpoint glucose readings on him.

if you check out the Lantus forum in the insulin support groups you'll see a bunch of stickies on how this insulin works and how to determine dosing. one thing we've learned is not to increase by more than 0.25u increments (rather than a full unit) unless they have a condition like acromegaly or insulin resistance (requiring huge doses). we stick to a dose for at least 3 days before increasing, but reduce a dose immediately if their nadir is too low (40s for some kitties and 30s for others).

he's actually done pretty well with this increase, but lantus builds up under the skin so overlap could cause much lower numbers with the next shot. are you okay with going to 1.25 units instead of 2 units at the next shot time and then checking one or two hours after you inject the insulin? that would be my suggestion at next shot time. [my concern is that it takes a while for the lantus to build up initially so he finally got a number in the 170s and it may mean the original dose wasn't too bad; so to be cautious and not fly past his ideal dose i wouldn't want to try more than 1.25u twice a day for 3 days or so to be cautious.]

i'd also probably make sure his blood glucose level is at least 150 before i shoot, just until you have more data on how he's doing numbers-wise.

if he's just recovering from diabetic ketoacidosis (ketones), then i'd check for ketones when he pees again just to make sure he's getting enough insulin. you can get ketone test strips at the pharmacy. just stick one in his urine right after he starts peeing or collect some pee from him (i slip a ladle under there) and dip the stick in it. i think they're about $15 at the drugstore. most of the time you don't get false positives from the litter so you could dip a test strip in the litterbox before he has a chance to cover his pee after he goes.

hopefully jill & alex will see your post. if she advises something different, please follow her advice.
 
Hi.......

I am sorry you are all alone out here tonight. I have posted this on the lantus insulin support group as well and asked for some folks to come and offer their support.

Right now, i would think that the leap from 1 unit to 2 units is proving too big of a change for your kitty.
Often a dose is increased by 0.25 of a unit for example.

If you could get a few more tests to make sure he does not go any lower that would be really good. Lantus tends to have a later peak period, often after about 9 hours from shot time, sometimes even through 12 hours after shot....and in this case, I am betting that 2 units was still causing some drop when your husband gave that shot without a test.
Always crucial to get that preshot test. Not to beat you up about it now though, we have all been new and learning and you are in the right place for great info and support now.

You can see, not quite out of the woods yet. Under 40 would be a cause for alarm and higher carb food. The 60s are a good watch, test and see level.
I would offer a little food again now and perhaps a little bit later as well.

If you are worried and need some sleep now, offer a little higher carb food, something with gravy fro example, and do a test to ensure there is a rise after eating after about 35 minutes. I personally would try and stay up til you see three consecutive rising numbers above about 70.

I would not shoot anything under about 180 in the morning, and I would hesitate to shoot 2 units again. But I would go to the lantus forum here..viewforum.php?f=9

Do have a read through the stickies at the top of that page and ask lots of questions before your next shot time okay?
Hang in there....the early morning peeps in lantus will be rising and though I must get to bed......I will check in again in case you see this in a bit. :)
How does kitty seem with these levels?

Kimmee

Lots of kitties hang in great numbers on lantus, it is why it works so well, just want to make sure there is not a lot more drop, and that he is okay.
 
Here are some links for you; come on over to the Lantus group to post so that the others using Lantus can help you. I saw the cross post in the Lantus section, so came over here to reply.
Please read the hypo one so that you and your husband know what to do for Ducky if you get low numbers again.
List of Hypo symptoms

This one has lots of useful info for you - it seems like alot in the beginning, but if you have any questions, please ask. Someone will be along shortly to help you.
Near the bottom of the page, please see "Protocols for use with Lantus or Levemir:" - this section will tell you a bit more about Lantus and the protocol many people here follow. You will see the explanation why increasing from 1u right up to 2u is too large of an increase.
It comes down to going up and possibly over the dose that is just perfect for Ducky, and you will never know it. Best to go up in baby steps getting closer, closer, closer.
New to the Group

Recording your numbers from Ducky's tests and putting his personal info about his diet and other health issues, etc all give a whole picture and better able others to assist you in caring for Ducky. It sure cuts back on many people asking over and over the same questions, and when you are worried about something, you sure don't need all the back and forth with questions and answers!
If you like, just click on the links in my signature for Shadoe and Oliver; you can see what sorts of stuff I put in their profiles and also how I record my test results for the two of them.

This one is a great tool to track Ducky's numbers, and even more important is that others can see what Ducky has been doing and be able to help you sort out patterns and doses.
Spreadsheet Template and Instructions

This one will help you set up Ducky's profile. You can see many of the other people's profiles in their signature; have a look at what they put in theirs and it will help you determine what is needed to be known about Ducky.
Profile Creation

These will help with putting stuff into your signature.
Help with signatures/links/images/avatars
Creating spreadsheets & attaching them to your signature

And finally foods! The foods Ducky eats is very important. There are many kitties who are diet controlled and don't need insulin! Just imagine if you changed Ducky's foods and you saw a BIG improvement.
Just cutting out ALL DRY foods will show you better numbers.
Binky’s Food Lists

So that's it for my reply. Others will be along to help you more, and we may have repeated some things but it's all useful.

I hope Ducky starts coming around soon. It's slow but in time, you will see your old Ducky come back.
 
It's great that you are home testing.

What seems to have happened, is you took Ducky to the vet, she tested him, saw the high BG and told you to up the dose. The problem with that logic is that Ducky's BG was probably artificially inflated due to vet stress, car travel, etc.

And this is the only number the vet saw. If you follow Gayle's instructions and set up a spreadsheet where you can track his bg's since you are home testing, next time you go to the vet, you print a copy of the spreadsheet to show the vet, just how he is doing. If she still recommends changing his dose, then you can discuss it - however, we recommend changing doses in very small increments - like .25 or .5 never 1 unit at a time.

Don't fret, going forward you will be better prepared and equipped to say no and show the vet your progress.

looking forward to seeing you in lantus land.
 
Thank you all for the advice. I have posted his SS and our profile to give a little more information. After a long night of Ducky's numbers staying at 60-70, when time for his AM shot came around he was at 74. So I decided to not give him a shot. I was worried that another shot may be too much. At +3 he is now at 174. He still has a long while to go until his next shot and I am beginning to wonder if I should have given him a small shot. Like half a unit. Now I will have to wait and give him his PM shot and try to figure out the best amount. As you know the vet told me to give him 2 units up from 1 unit. So should I give him 1.25 units tonight? Will it be okay if his numbers keep going up? And if i give him a shot and in the Morning he is around 74 again, do I skip his shot again? I am confused about the skipping a shot thing.
 
Hi...
I agree that you will want to give him something before it rises too much.
As I have not personally used this insulin I am going to encourage you to ask this same question to the lantus forum peeps, can you find it alright? If you go to the board index, you will see, "insulin support groups", just click on the "lantus" section and it will take you there, but meanwhile here is a short cut :) click on this link...viewforum.php?f=9

I would consider a dose perhaps about 1 unit at 200, but I would also wait and see what others have to say before making the decision.
I do think 2 units as per the vet, is proving to be too much over the course of a couple of doses and think soemthing more like 1.5 may be a good dose eventually, once back on track.
hang in there, you are doing great so early on in this.
 
Hi Angel,

I agree with what was said before, 1 full unit increase seems way too much too fast.

Goodie was/is a Lantus user and we have had great luck with it.
Goodie was diagnosed 3 years ago when her numbers were in the upper 400's (like Duck). She was put on Launtus and 4 months later (and a switch to canned food) she went into Honeymoon for almost 3 years.
She became diabetic again a couple months ago and we started Lantus again, and I can tell you she is currently on her way to Honeymoon again - this time with a much lower starting dose that before (.5 / .25 unit).

One thing I can tell you is that the road to regulation is HARD. In Goodie's situation her numbers stayed the same for a long time before we saw results. It was very frustrating many times, before one day all of the sudden things started happening. I would suggest to increase gradually the dose (maybe .5 unit) and see how that goes.
As someone else mentioned, you have to increase gradually and give it a few days before you change the dose again. Lantus seems to linger in the system for a while and have like a build up effect kind of. So you may think is not really working and then it does work!

Personally I am too chicken to shoot insulin at a number below 140. You have to really know how your kitty reacts to the insulin to shoot at lower numbers. In our case, Goodie threw some curve balls at me so many times that I am very cautious to shoot at those levels. I think your quick thinking in testing after the second 2unit shot probably spared Duck from a Hypo.

Increase slowly and continue gathering data to support increasing/decreasing the dose.
One more thing I forgot to mention, Goodie seems to get a longer duration than average while on Lantus. When her dose was 1.5units her nadir was at 10-12 hours so we always shot SID. This time around I was too paranoid and scared to shoot more she needed so we started at .5 BID and that made her nadir at around 6 hours but at a more flatter curve. From our prior experience I wanted to avoid sharp curves (like nadir 70 , PS 400), so this worked out better for us this time. However, as time went by she again got longer duration from the Lantus and I found myself shooting BID again! So just be careful and always, always test before shot.
 
don't know if you posted elsewhere for more answers by now but we weren't recommending you skip a shot. rather, we were recommending you shoot late when you finally get a shootable number. many longer-time lantus users shoot at double digit numbers but til you know more how your cat does (via more data gathering) it's best to be more conservative. that's why i said 150.

if you can't afford to change shot times too much, you could then shoot again about 15 min early each time til you get to a workable shot time.

your 174 at +3 told you that he was running out of insulin and starting to go up. so you'd note to yourself in your spreadsheet that he probably needs a shot before +15 if he's too low at +12. (as you get more data you may come to a firmer decision about how long he can handle going without more insulin -- most cats on lantus need shots every 12 to 13 hrs.)

yes, re dose, from now on you try 1.25u as your dose twice a day til you have a better idea of how it's working. (if he needs more, you'd increase by 0.25u again in 3 days, to 1.5u.)

missed shots happen, as do partial shots (when they move and not all the insulin gets in). we're not thrilled when it happens, but we just wait til the next shot time and go from there. (if it's a case of a missed shot or delayed shot and we don't have schedule restraints, we just shoot when we can and schedule the next shot for 12 hrs later, and that'll be our new shot schedule.)
 
Thank you for the help, I am having issues figuring out the dose. You can tell from my SS. I am starting to think that with the diet change 1 unit may have been enough, but the vet (and I) didn't wait long enough to see the changes. We gave him 1.25 this morning and he dropped really fast. So maybe I should just go back to 1 unit for a week and see what happens?
 
stick with 1.25 for now. What we can tell by the ss and the bit of data already collected is that 1 unit is too little and 2 units too much. His ideal dose for now is somewhere between the two.

To play it safe, keep with 1.25 and let's monitor that each cycle. While I'm not a dosing expert by any means, I do know how to play the safe game.

Several things have happened, looking at your ss:

1) you went from 1 - 2 units and he dropped into greens very quickly - while these are good BG's, you then

2) skipped his am shot, so that blew him out of the water (so to speak) - his shed got depleted and he went up to pinks and red. Then

3) you dosed him at 1.5, where he was going through rebound from increase, then missed shot and now a new dose

4) finally you shot at 1.25 and he got a nice run of greens.

So - shoot your pm at 1.25 - let's see how this works for him - keep the kibbles in the closet, if he drops below 50 and you need to HC - pull out a can of food with gravy and:

put two tsp of gravy on top of one tsp of LC food and give him that - you can also give him the gravy on it's own. Then wait 30 minutes and test. See if he goes up. If he doesn't repeat this process.

The idea is to control him from dropping too low as well as bouncing too high. Depending on the situation, you may want to feed gravy only, or give some LC with the gravy - but very small amounts, hence the teaspoons recommendation. Because if you need to repeat this several times, you don't want him getting full and then not eating.

Dry food, while it can work in a pinch, can also make him rise very quickly and take too long to get out of his system.

Do you have any HC (high carb) canned food on hand? If not, then a tsp of karo or any sugar product will work the same, the preference is the food as it won't spike and lower as quickly as sugar.

Hope this makes sense.
 
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