can't regulate Sammie

[sammiehyde]

Hi. I'm fairly new to this site and am not good with computers, so please bare with me. I've posted in the intro and main forum sections, and have finally finished Sammie's spreadsheet. Since he is on Lantus now (his third insulin), I'm asking for suggestions from those of you familiar with Lantus. He has had a few "good" curves, but mostly his glucose runs 300-400 or so. Clinically, he seems fine-no excess peeing, drinking, or starving. Twice now, he has not eaten well for a few days and seems to have trace amount of ketones in his urine. This lasts a few days, and then he's back to normal. The last good curve he had-2/22, the vet was pleased and said to keep him on 5.5 units for a couple months and do another curve unless he has any problems. I have poked his poor little ear periodically( he hates the ear pokes, but immediately forgives me when I comb him afterwards) since then and he has run from 212 -484 , mostly mid 3-400s. I'm wondering if he is getting too much insulin and I should decrease his dose and see what happens. Most of the increases all along have been due to the advice of my vet-before I started reading info on your site.

 

[Chris & China (GA)]

I think it's totally possible that you missed what could be a good dose for Sammie.

Also, Lantus craves consistency, so it needs to be given at the same dose both AM and PM.

I'd suggest going back down to 4U (we don't want to take you down TOO far in case Sammie is one of those cats that needs a higher than normal dose) and start testing daily.

Get both Pre-shot tests (before feeding/shooting) and then at least 1 mid-cycle test on the AM cycle (like 5-7 hours after the morning shot) and a "before bed" test on the PM cycle. If you can get more tests in, that's even better!

Hold that dose for 3 days (unless he drops below 50 on a human meter, 68 on a pet meter) and let's see how he looks.

What are you feeding him now?

 

[Bobbie And Bubba]

Hi and Welcome to L & L. To echo Chris, Lantus needs consistent dosing and to follow the protocol for increasing. When you jump around in dose, the depot gets confused and can't get stable then it's really hard to know what the dose could be doing.

And good job staying on top of ketone testing which is very important while he is running higher and/ or not eating well and seems "off" Has he ever had DKA?

 

[Wendy&Neko]

A couple questions on your spreadsheet. Are you giving insulin at night? The PMPS units cell is mostly blank. As much data as you have will really help us help you and Sammie.

Second question,what were his numbers like when he was on 8 units of Prozinc? Chances are he will need more Lantus, rather than less.

When we dose Lantus, we look at how low that dose it takes the cat. That 100 today was a good number.

 

[sammiehyde]

I think it's totally possible that you missed what could be a good dose for Sammie.

Also, Lantus craves consistency, so it needs to be given at the same dose both AM and PM.

I'd suggest going back down to 4U (we don't want to take you down TOO far in case Sammie is one of those cats that needs a higher than normal dose) and start testing daily.

Get both Pre-shot tests (before feeding/shooting) and then at least 1 mid-cycle test on the AM cycle (like 5-7 hours after the morning shot) and a "before bed" test on the PM cycle. If you can get more tests in, that's even better!

Hold that dose for 3 days (unless he drops below 50 on a human meter, 68 on a pet meter) and let's see how he looks.

What are you feeding him now?

He eats mostly canned Friskies or Fancy Feast pate. I must admit, he does occasionally sneak some dry from my other cats (I have 7, several of which will only eat dry food), but I do my best to keep him away from the dry. I even make him his own dry by dehydrating his canned food so it's at least crunchy.
I'll do my best with more tests-mornings are hectic and I work 9-12 hour shifts, so the mid cycle tests I can only do on my days off, which are usually Sun and Thurs. I have been getting preshot numbers at nite off and on , I just didn't put them all in the spreadsheet. The lowest was 268 on 3/4 , but the rest have been 300-450 or so. I can put those in as well if it will help.
He does get 5.5 units twice a day, close to 12 hours apart. I usually feed him and then wait half an hour or so before injecting.

 

[sammiehyde]

A couple questions on your spreadsheet. Are you giving insulin at night? The PMPS units cell is mostly blank. As much data as you have will really help us help you and Sammie.

Second question,what were his numbers like when he was on 8 units of Prozinc? Chances are he will need more Lantus, rather than less.

When we dose Lantus, we look at how low that dose it takes the cat. That 100 today was a good number.

He does get 5.5 units twice per day, I just don't test at nite.
His numbers on 8 units of Prozinc are on the spreadsheet 6/29/17- in the 300s all day. Since he does occasionally have low numbers, like on 2/22/18, I'm afraid to give him more insulin. I think I'm going to drop his dose a little and test as much as I can for a few days as Chris and China suggested.

 

[Juliet]

I think it's totally possible that you missed what could be a good dose for Sammie.

Also, Lantus craves consistency, so it needs to be given at the same dose both AM and PM.

I'd suggest going back down to 4U (we don't want to take you down TOO far in case Sammie is one of those cats that needs a higher than normal dose) and start testing daily.

Get both Pre-shot tests (before feeding/shooting) and then at least 1 mid-cycle test on the AM cycle (like 5-7 hours after the morning shot) and a "before bed" test on the PM cycle. If you can get more tests in, that's even better!

Hold that dose for 3 days (unless he drops below 50 on a human meter, 68 on a pet meter) and let's see how he looks.

What are you feeding him now?

Doesn't that presume she's going to follow TR?? She can't if he's getting dry food.

 

[sammiehyde]

Hi and Welcome to L & L. To echo Chris, Lantus needs consistent dosing and to follow the protocol for increasing. When you jump around in dose, the depot gets confused and can't get stable then it's really hard to know what the dose could be doing.

And good job staying on top of ketone testing which is very important while he is running higher and/ or not eating well and seems "off" Has he ever had DKA?

Thanks. He's never had DKA (I had to look that one up), just those few trace amounts of ketones on the keto-diastix strips.

 

[Bobbie And Bubba]

He eats mostly canned Friskies or Fancy Feast pate. I must admit, he does occasionally sneak some dry from my other cats (I have 7, several of which will only eat dry food), but I do my best to keep him away from the dry. I even make him his own dry by dehydrating his canned food so it's at least crunchy.
I'll do my best with more tests-mornings are hectic and I work 9-12 hour shifts, so the mid cycle tests I can only do on my days off, which are usually Sun and Thurs. I have been getting preshot numbers at nite off and on , I just didn't put them all in the spreadsheet. The lowest was 268 on 3/4 , but the rest have been 300-450 or so. I can put those in as well if it will help.
He does get 5.5 units twice a day, close to 12 hours apart. I usually feed him and then wait half an hour or so before injecting.

You want to give the shot as soon as he's done eating. You don't want to have a 30 minute lag time. Otherwise the food gets ahead of the insulin.

When you can if you can add the data you do have that would be very helpful.

 

[Chris & China (GA)]

I must admit, he does occasionally sneak some dry from my other cats (I have 7, several of which will only eat dry food), but I do my best to keep him away from the dry

If he's sneaking even a few pieces, that could be enough to keep his numbers high. We've seen cats here that would eat just 3-4 pieces of kibble that would raise their BG 200+ points.

You might want to look into feeding a low carb kibble if you have to feed kibble at all. There are only two kinds though and they're kind of pricey (but they don't eat as much of it because it's calorie dense)

They are Dr. Elsey's Clean Protein (available at Chewy.com) and Young Again Zero (available on their website only) Both companies will send you samples to try first if you call and ask them.

 

[sammiehyde]

If he's sneaking even a few pieces, that could be enough to keep his numbers high. We've seen cats here that would eat just 3-4 pieces of kibble that would raise their BG 200+ points.

You might want to look into feeding a low carb kibble if you have to feed kibble at all. There are only two kinds though and they're kind of pricey (but they don't eat as much of it because it's calorie dense)

They are Dr. Elsey's Clean Protein (available at Chewy.com) and Young Again Zero (available on their website only) Both companies will send you samples to try first if you call and ask them.

I"ve finally finished Sammie's spreadsheet, so I'm hoping to get more advice on what to do with him. I have lowered his insulin dose as suggested, although his numbers aren't much different as far as I can tell. I may look into those other dry foods, but I can't really switch all my cats to those expensive foods. From what I can tell, they are fairly high in fat which wouldn't be good for my chubby cats and I have a cat with irritable bowel disease whom I have finally seemed to get straight with steroids and am hesitant to change his diet. I may get some just for Sammie to satisfy his dry food cravings so that he may leave any other dry food alone. For now, I make him his own dry by dehydrating his canned food-he seems to like it ok, but not as well as real dry food.

 

[tiffmaxee]

Welcome. It’s really near impossible for me to figure out what’s going on. We need to fill in the puzzle. Please get preshot tests in before each shot. Most test, feed, shoot within 5-10 minutes. You don’t have to wait with lantus. I understand it’s hard with a full time job but if you can get a before bed test that will help too. Many find a +2-3 test will let you know what will happen the rest of the cycle. So if you can possibly change shot time a little so you can get a test in before you leave for work that might help as well. If not possible with your schedule I get it.

 

[Wendy&Neko]

In order for us to evaluate how a dose is doing, we need to see certain data. First and foremost, you need a test before each and every shot, mostly to make sure it's safe to give insulin. I see that the majority of them are missing lately, you are also missing the rows for the 6th and 7th of April. Next, we need to get an idea how low the dose is taking the cat. That means some tests in the middle of the cycle. You also need to know how low the dose is taking the cat before changing the dose. You did say you are getting tests most nights, but haven't entered them into the spreadsheet. If you could do that, it will greatly help. Many cats go lower at night, and since we are trying to see how low a dose takes the cat, we want to gather data when they go lower.

I noticed you dropped the dose on the night of the 4th when you got a yellow preshot. You should be fine giving full dose to any number over 200. That is one way Lantus is different from Prozinc. Cycles tend to be flatter when you shoot lower numbers. We change dose based on the nadirs, or low points in the middle of the cycle, not so much the preshot.

 

[Sienne and Gabby (GA)]

If you are familiar with using Prozinc, Lantus is very different. With Prozinc, the dose is based on your pre-shot number. With Lantus, the doses based on your cat's nadir. Since you're to home during the day, it's very important go get tests in the evenings. The minimum is getting a test before you go to bed each and every night. It will also be helpful if you can get additional tests on your days off, holidays, and any time when you're home. There's no way to know based on the information on your spreadsheet if Sammie's numbers may be dropping and when you are testing, you're seeing a bounce back into high numbers.

 

[sammiehyde]

In order for us to evaluate how a dose is doing, we need to see certain data. First and foremost, you need a test before each and every shot, mostly to make sure it's safe to give insulin. I see that the majority of them are missing lately, you are also missing the rows for the 6th and 7th of April. Next, we need to get an idea how low the dose is taking the cat. That means some tests in the middle of the cycle. You also need to know how low the dose is taking the cat before changing the dose. You did say you are getting tests most nights, but haven't entered them into the spreadsheet. If you could do that, it will greatly help. Many cats go lower at night, and since we are trying to see how low a dose takes the cat, we want to gather data when they go lower.

I noticed you dropped the dose on the night of the 4th when you got a yellow preshot. You should be fine giving full dose to any number over 200. That is one way Lantus is different from Prozinc. Cycles tend to be flatter when you shoot lower numbers. We change dose based on the nadirs, or low points in the middle of the cycle, not so much the preshot.

I do appreciate the advice from all of you. My schedule is so crazy it's hard to get in all the testing I should. I really do try my best, though. All the data I have is in the spreadsheet. I will continue to try to get morning, evening,and before bed tests, but he hates the ear pokes so much, I feel bad for him. Mornings are the worst, when I have 7 hungry screaming cats waiting for breakfast and I'm trying to get him tested before they all eat. Then I have to make sure he eats before he gets his shot and my irritable bowel cat gets his pill and all the others eat so I can take up the dry food before Sammie gets to it. Even on my days off, I'm rarely home much, but I do try to get mid-cycle tests in when I can. I dropped the dose down on the night of the 4th as suggested by Chris and China- my plan was to get him down to 4 units- in case I had missed a good dose for him-and hold it there for a bit to see how his numbers do.