Cats getting too much Lantus

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liewil

Member Since 2012
Hi,

I posted here once before for Tricky, my 9 yr old female cat, diagnosed with diabetes almost 1 year ago now. I can't get her regulated, not even close. She kept having good periods (bs in the normal range) followed by bad ones (bs almost as high as without insulin), each lasting half a day to a bit more than a day, so I suspected maybe she was getting too much Lantus. Lowered the dose and the first few days she seemed to react the same as before, so I thought I was on the right track. But now she had 24 hours above the renal treshhold, so I'm upping the dose again.

Anyhow, I was just wondering if you have any example spreadsheets for me of cats that were getting too much Lantus and did better on a lower dose ? Just so I can compare the patterns. I'm at my wits end, have no idea what to do anymore.
I have her sheet here : https://docs.google.com/spreadsheet/lv?key=0AgjiWUwO2pmydE5wN3l1a3o3ODdBV0laODRxaHRpZ3c, but it's in mmol/l. You'll get the idea from the colors though. I think in the past year she had exectly one flat day, all the rest is crazy random curves. She eats from a timer since beginning of July, so exactly the same every day. Sometimes she reacts to the insulin perfectly, sometimes it's like she didn't get a shot at all ...
 
Hi.

You are welcome to look at my spreadsheet, but I'm not sure it will help you. I didn't give the shots on time; I changed the dose when I probably shouldn't have; and the data is most likely useless except in those spots that an expert can pick out as being relevant. However, on the thread posted below, there is a critique of my cat's spreadsheet that may give you an idea of what those spots are and why they mean what they mean.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=76617.

I think it would be better for you if someone comes along soon to answer your question in more detail after taking a look at your spreadsheet. Maybe you could change your headline to "Please look at my spreadsheet -- is dose too high?'

Good luck
 
Thanks Dale. I had a quick look, but it's all a bit complicated, I'll have to study it when I have had some sleep. Tricky is stunting again, too low to shoot now after upping the dose by 0,25 this morning. It's driving me completely insane :(
 
It is complicated. I don't think I could even come close to figuring it out all alone.

You use a different language, Dutch?, I see, in the notes on your spreadsheet, and you are using a different scale, too, than I do. There is a spreadsheet that will show your number on both scales so that people who use the U.S.-style scale can understand your spreadsheet at a glance. The people who have helped me have been mostly people who use the U.S.-style scale, but some who use the U.K. scale.

See Jane's kitty -- Karre's spreadsheet: https://docs.google.com/spreadsheet/ccc?key=0AuRVyjxJyeuMcE1ZZ3Q4OUdoTmo0dmdhQjZzVDhEQUE#gid=0 . I see it is 8:30 p.m. or so where you are? Jane uses the same time zone as you use, I think, that is if you are in physically in the Netherlands.

Please note that Jane's colors are different -- you are using Blue for all the lowest numbers, and Green for anything in the next category up. Jane uses Green for the lowest numbers, and Blue for the next category up. For any number higher up, her colors are generally the same as yours - Yellow, Orange, Red, Black. I'm using Green for the lowest, then Blue, Yellow, Pink, Red, Black. (Black being super high BG.) When someone looks at my spreadsheet I don't think they look closely at the numbers unless they are all Green or have just a few Blues; they are looking at the colors, and if your colors are not the same as that person's colors, it might cause confusion.

Good luck with your quest! It is so difficult to ride the roller coaster, and I feel for you, but I think you will figure it out eventually.
 
You've described her as having a quite variable appetite, plus not being able to completely switch to low carb canned or raw food. Unfortunately, Lantus works best with consistency - consistent food (carb levels, portions and times), consistent insulin doses and times, and so on.

The net result is an unregulated cat. Been there, done that, and was woefully unsuccessful, too.

In this circumstance, I can think of a couple of options:
1) switching to a shorter acting insulin. If you can get ProZinc or PZI insulin, those would be best. If the only other choice is NPH (ex Humulin N) or Caninsulin, you may need to inject every 8 hours whichever one you use and/or you may have to pick up the food for a few hours before the next dose as the glucose may skyrocket during that period. An advantage to the shorter-acting insulins without depots - you would be able to adjust the dose based on the pre-shot numbers for all of these.

2) continue with Lantus, but use a much lower "basal dose" and add a supplemental, shorter acting R insulin as a bolus when she rides high. This can be very tricky and requires extremely diligent monitoring. It is not for the faint of heart. You must be scrupulous in monitoring what is being eaten and when (to estimate calories and carbs), as well as meticulous in recording the response to both the basal and supplemental insulin. There are a few individuals with posts on the board who have dealth with Acromegaly or with insulin auto-antibodies and have used R type insulin successfuly; however they may not have had an extremely erratic diabetic cat. It requires you to try very tiny supplemental dose (like 1 drop) and check, check, and check again over the 4 hour period that R lasts, to see how it works for your cat. It can be a painstakingly slow process to develop a system which works for your cat.

Keep working at the diet and appetite. It may be helpful to do 15-20 minutes of active play with her prior to meals to stimulate the natural hunt-catch-kill-eat-groom-sleep behavior cycle. It may improve her appetite.
 
I would NOT suggest using an insulin like Humulin R and certainly not without a great deal of guidance. You could easily overdose your cat. This is not a type of insulin that is routinely recommended.

I can't state that your cat is getting too much insulin. What it does look like is that you are changing your doses frequently and the dose isn't stabilizing. I also don't know how your arrived at your current dose. With Lantus, if you are following the Tight Regulation Protocol, dosing is done in a very systematic fashion. Doses are held typically for 3 days and evaluated prior to increasing. It would also appear that you're not taking dose reductions when numbers have dropped. For example, the 1.7mg/L (31 mmol/dL) should have resulted in your lowering your cat's dose of Lantus. From what it looks like, you haven't had a method for determining dose reductions or increases. In addition, dose changes are generally made in 0.25u amounts.

I would encourage you to take a look at the starred, sticky notes at the top of the Lantus forum. The information there will help you to sort out what you may need to change with respect to how you're using Lantus.

Please let us know what questions you have and how we can help.
 
I don't have my numbers posted, but my cat (Gus) was on too much insulin. The first thing the new vet said is that his dose was too high and that's probably why he didn't feel good. Fructosamine testing confirmed things weren't going well despite having numbers in the 100s and mid 200s. My cat has pancreatitis so I don't think a comparison to our numbers would help you anyway. It drastically effects regulation and my vet and I now have a plan worked out for him.

Getting a fructosamine test will give you a global picture of a two week period of what's going on with your cat's glucose levels. There are a lot of nay sayers who think home testing is the cure all and that fructosamine tests are pointless - but a vet named Dr. Graves in Chicago - who has studied feline diabetes will tell you that home testing doesn't give you the full picture and that fructosamine tests are a necessary aid if you are having problems with regulation. Because my cat has pancreatitis, it is constantly running in the background and changing his levels - unlike a straight diabetic. Fructosamine tests helped me sort all of that out.

Also - food - even low carb wet food - was effecting my cat's BG because he has IBD to boot so I can only feed him a limited selection which doesn't cause problems. I completely sympathize with you because it can take a lot of managing to get them under control. My vet always tells me that my cat is extremely complicated and you might have one of those too (hopefully you don't). Is there any suspicion she could have pancreatitis? This will cause those swings in numbers.

Also - a few people have switched insulins here and gotten better results, but that's a big change and it's better to see if you can get your current insulin to work.
 
whenever you have dry food being fed you are going to have problems regulating ..... if Tricky is carb sensitive, you may well see high numbers from the dry food and then when it wears off, you get the drops in numbers.

you say that Tricky is eating some wet food.... why not take away the dry food? It's not like you have a cat who will not eat wet food. A word of warning: you will need to drop the insulin dose because with no dry food, you may need much less insulin.

When you are making the change to all wet food, be sure to test Tricky's urine for ketones because you will have lowered the dose, maybe to 2u Lantus am and pm, and will see some high numbers.

The trick to regulating Tricky is to remove that dry food.
 
Oh no, typed a long answer on the ipad but it's gone now.
So just : thanks for all the extra advice. Nothing really new there, but I think I can rule out that she's getting too much insulin, which is something. In the mean time, every measurement is a surprise, could be high, low or anything in between, hard to follow any protocol then, there's no logic at all. Just my bad luck I guess.
Her eating is completely under control now by the way, 10-9-9 grams of Applaws = dry food with 13,5 % ch, in a timer thingie every 4 hours. She won't eat anything else, the wet food never really worked, alas.
I'll review the info I got, maybe I'll get some new inspiration, and otherwise there's nothing I can do but soldier on ...
 
liewil said:
Oh no, typed a long answer on the ipad but it's gone now.
So just : thanks for all the extra advice. Nothing really new there, but I think I can rule out that she's getting too much insulin, which is something. In the mean time, every measurement is a surprise, could be high, low or anything in between, hard to follow any protocol then, there's no logic at all. Just my bad luck I guess.
Her eating is completely under control now by the way, 10-9-9 grams of Applaws = dry food with 13,5 % ch, in a timer thingie every 4 hours. She won't eat anything else, the wet food never really worked, alas.
I'll review the info I got, maybe I'll get some new inspiration, and otherwise there's nothing I can do but soldier on ...
Click to expand...

Sorry she is eating only dry food because that is likely the main reason for those numbers being all over the place.
For her health, it would be good to start a transition onto wet food. There are plenty of methods that others have used to switch their cats, and you will find it makes a big difference in her numbers, and she will also feel better once her numbers are not fluctuating so badly.
 
Sienne, I just looked at Gabby's sheet, and her sugar levels seem all over the place as well ? And she's been on Lantus since 2009 :S Doesn't exactly give me hope :(
I read somewhere that female diabetic cats just don't respond as well to the protocol as males, do you think that's true ? And does Gabby feel OK with those bouncing levels ? Tricky doesn't ...
 
Just an FYI:
The glucose levels when using insulins like Lantus, Levemir, ProZinc, and PZI are supposed to gradually decline while the insulin is taking effect, then gradually increase as it is wearing off. With Lantus, this is roughly a 12 hour period. Serial glucose measurements over that time generally make a smile shape if you connect the dots. In other words, it doesn't drop the glucose down to 1 static level.

And I think folks may have missed the whole erratic appetite issue which you've mentioned on prior posts. Those WILL make the glucose levels jump all over the place. And that was why I suggested either switching to a non-depot insulin, or trying a basal-bolus approach. (Also, I knew the latter would provoke responses from several other posters... and it did)
 
See my answer a bit higher up : her appetite is under control now, though her food of choice is not ideal. And I have seen sheets of many cats who stay within 1 color at least on Lantus, with a shallow smile shape if you like. It's the whole goal of the Lantus protocol to keep the cat under the renal treshhold 24/7, no ?
 
In the mean time, every measurement is a surprise, could be high, low or anything in between, hard to follow any protocol then, there's no logic at all. Just my bad luck I guess.
Click to expand...

The key with Lantus is you aren't making changes based on each test. You are making dosing adjustments every 3-7 days based on the pattern of the nadir. If you try chasing preshot numbers while using Lantus you will fail to regulate every time because that isn't the way Lantus works. Lantus is a insulin with a shed. You build a "shed" on Lantus at first and once that is full, then your cat starts using it. If you are changing doses without following a shedule based on nadir, that shed is going to get depleated or over full and the cat will be workinng on fixing the shed instead of using the insulin to regulate BG.

(regarding our spread: Yes, we went from regulated on Lantus swiftly to no longer regulated and high dose, switching to Lev now. Smokey has pancreatic nodular hyperplasia - nodules on her pancreas including one large one - which means her pancreas will likely never work again so our spreadsheet is not a good example the second time around. Her first dance with Lantus shows a good systematic adjustment to step her off of the insulin)
 
I'm trying to follow the protocol, but it's hard to find a nadir without much logic in the numbers. I also suspect she's much lower during the night since her evening preshots are lower than her morning preshots (a lot lower, 180 lower), but I can't get up every night to measure her (though she would love that ;))
On the Dutch forum I'm on, they base their dosing on preshots and there are a lot of cats going under 36 regularly, I think here you would freak out then (like I do, I don't take that risk). But I must admit most Lantus cats there are doing very well, they are stable 24/7, which is what I hoped for for Tricky. It's all very complicated and there's a huge lack of scientific data. And vets are no help at all here, it's unbelievable how little they know. My vet still seems to think a cat is just a small dog :S And that's vet nr 3 ...
 
I know how hard it is when you can't find a nadir. Pasted below is some advice I got from Libby (and Lucy) here. It was general advice, but the fact that your cat eats dry food might make this advice inappropriate for you. You may be having food spikes instead of true bounces, and that may make this advice inapplicable to you. I suggest that you Private Message Libby and ask her if she will look at your thread and see if this applies to your cat:

Libby wrote:

"How to know when to increase/decrease the dose during bounces is different. In the beginning we tend to be cautious about having people increase dose during a bounce. Overall, though, you just ignore the bounce cycles when you are making dose decisions. That's why we encourage people to try to get at least one spot check in every cycle, whenever possible. That makes it easy to know if they are still bouncing or if they went low again and started a whole new bounce. You don't really want to look at your spreadsheet one cycle at a time. Look at a 3-4 day period. What was the lowest number during that period? In general, that is the number you want to base your decisions on."
 
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