Consistent high BG’s no matter what I increase/decrease dose to!

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Jenny & Cashmere

Jenny & Cashmere

Member Since 2020
My cat’s BG has been high since I adopted him a year and a half ago! He eats only pate wet foods, Tiki, weruva and fancy feast. I home test 3 times a day and do regular curves, he had a dental done 2 months ago and all his bloodwork looks great. He is on Lantus (pens) and no matter what I do, I am unable to get his numbers down! I just recently did a “reset” and started over at a dose of 1 unit, held the dose for a week, did a curve and increased and based on the curves, I continued to do curves and increase and now back at 2.50 units, I’m completely stumped! His numbers remain in the high 300’s and low 400’s it seems like no matter what dose, the numbers stay the same. Any suggestions would be much appreciated. https://docs.google.com/spreadsheets/d/1mj5bL8n_bBVU0J0QAQUm6mvQxHtQVkLEoQb6uKx7CsQ
 
This link has the steps to share that google sheet here.
FDMB Spreadsheet Instructions
Start at step 5 through 10 to make sure you did the view permissions correctly.

Then follow the steps after Instructions for pasting the SS link in your FDMB Signature block:
to paste that link into your "Signature" block. Steps 1 through 6.
 
First off, the spreadsheet template you are using came from a FB group not associated with us. It has a known bug in it that has problems on some platforms. Part way looking through it on my iPad, it killed Google Sheets. If you could copy your data to the spreadsheet template that Deb linked, that would be much appreciated and more people will be able to help you.

I can see the spreadsheet on my laptop however and see what the problem is. Cashmere seems to be forever in high numbers because you don't seem to be following any particular dosing method. Once a cat's body gets used to high numbers, you have to increase to get over it. The "reset" was the wrong thing to do. Not your fault, that's another thing that FB group people do. Resets just make the problem worse as his body gets more used to high numbers.

You might want to look over on our Lantus/Basaglar/Levemir forum, and especially the yellow starred Sticky Notes. Take a look at the one on Dosing Methods, specifically the one called Start Low Go Slow. You are holding the same dose too long and reducing the dose by too much and too soon. With SLGS, we reduce by 0.25 units when they go below 90.

The past is the past, we can help you going forward. First, time to do a curve on that 2.5 unit dose. If you don't see anything below 90, it's time to increase to 2.75 units. And don't worry about the size of dose. A cat needs however much insulin they need. My girl was on a lot higher dose than you have done.
 
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Cashmere needs more insulin.

Most of the experienced people in a group, would not have suggested that you do that reset.

It's ok, the past is the past, you can't change that. We sure do hope you will let us help you get Cashmere better. We have a lot of experience on this message board. Decades in fact.

If we are not sure of something, we let you know and tag someone more knowledgeable.

p.s. Did your vet suggest you lower the dose back to 1 Unit? Or how did that come about?
 
Thank you both so much for the advice! I will do a curve tomorrow and continue to increase insulin, using the TR protocols.
And yes my vet did advise me to do a “reset” and I was hesitant to do it, I should have listened to my gut
I can’t figure out how to copy my data over to the SS that y'all use, I’ll keep working on that!
again, Thank You, Thank You for your advice! I appreciate you so much!
 
Jenny Reese said:
I can’t figure out how to copy my data over to the SS that y'all use, I’ll keep working on that!
Click to expand...
You'll probably have to redo the data entry, on our version of the spreadsheet.

Start with the most recent 2 weeks. That is what matters most at this point.
 
hi Deb & Wink, when you get a chance, can you look at SS and see if I did it right? and just take a peek at Cashmeres numbers?
doing a curve today and from the looks of it so far, I will need to increase dose again! to 3.25
 
If you want to follow Tight Regulation for dosing, we don't always do curves. We get a test before each and every shot, plus at least one additional each cycle, ideally somewhere in the +2 to +10 range. Are you away all day on those days with no AM data? That's OK, we'll work around it. Your spreadsheet also has a few preshot data values missing. And it looks like your curve today is while Cashmere is starting a bounce.

Are you home during the day tonight? tomorrow? Just trying to figure out when the best time is for an increase, which I agree she does need.

To tag someone, you need to put the "@" symbol in front of their name, Such as @Deb & Wink
 
Due to the current situation of The corona virus and the shelter in place, I’m home all day and night indefinitely
The preshot data that looks like its missing, actually isn’t missing, long story short- I’ve changed shot times to 9:00 instead of 8:00 and just couldn’t figure out how to change that on the SS, so the morning data isn’t missing, it’s just an hour later than it used to be.
I’m just trying to figure out if I should go ahead and increase his dose for tonight’s shot or if I should hold the dose at 3 units until I can figure out why he’s bouncing?
 
Spreadsheet looks fine Jenny.

Put the pre-shot tests in the column before the dose column. Make a note on the SS in the Remarks column that you changed the shot times.

The + times on the SS are always the times after you gave the shot, doesn't matter that you changed the shot times, the tests still go in the column that corresponds to the number of hours after the dose of insulin.
Does that make sense?

I do think you need to use the TR protocol to increase doses until you get past those high BG numbers, in the red and pink ranges.

Cashmere dropped to the yellow range numbers at PMPS cycle last night, 3/26/20 and then as Wendy said, Cashmere is bouncing to those higher reds and pinks this morning. You do not usually want to increase when the bounce is clearing, but that is difficult to tell until you get those next pre-shot tests. But, with Cashmere in such high numbers, you have plenty of room to increase, even during the bounce.

The reason you don't usually want to increase when a bounce is clearing, is because you need to monitor more, to guide the numbers if they dip into the greens. I don't expect that to happen with Cashmere, but cats can always surprise you. Clearing a bounce and doing an increased dose at the same time, means there will be a wider swing in the BG numbers and you need to monitor. More "action" during the cycle.

Please add some more information to your User Id profile, especially the "Signature" portion.
Signature instructions.

Sure would love you to take 60 seconds and put some helpful information in your User Id profile, including the "Signature" portion.

Go to the top right corner of the screen, click on your user name, a drop down list will appear, select "Signature" from that list. Start typing in the text box that appears and be sure to click on the "Save Changes" button at the end of the text box.

Information like your first name, your cat's name age and sex, DX: (diagnosis date), insulin used, meter used (when you get one), food fed, and then the SS (spreadsheet) link when you get that setup are so, so helpful to those of us responding to members. That signature information will be "magically" attached at the end of all your posts. Signature and other user profile information can be updated as needed.

While you are there, editing your user profile, if you could update your profile to include your location, that is helpful also.

Once you do that, you could move over to the Lantus ISG forum, for more lantus specific dosing advice.

Almost forgot to say. I do think you could increase Cashmere's dose, from 3 to 3.25U. As I said in my reply earlier, Cashmere has a long way to drop before the BG numbers are in the greens, and even more before he would be in the neon greens and you would scream for help.

p.s. Sorry to hear you are home indefinitely due to the virus. It's hit a lot of people that way.
 
@Deb & Wink, Thank You so much for all your help! I think I have made all the adjustments to my profile and signature. I’m a little lost learning how to work everything on this page, so let me know if I did all that’s needed and hopefully I did it correctly
I’ve increased Cashmere’s dose to 3.25 this evening. In your previous comments you mentioned that if following TR, you don’t always do curves, so after 6 cycles on the 3.25 dose, I won’t need to do another curve before increasing? As long as I get preshot numbers and and a few in between?
 
Spot checks throughout each cycle, especially near mid cycle if possible, can give you as much information as a curve, sometimes more. If uncertain, just post here during your sixth cycle and we'll help you figure out if you need to increase. When you start to see blue and green numbers, and you will!, then you slow down the increases.
 
Jenny, Your signature is great! Thanks for making those additions. Yes, this message board takes a bit of getting used to but you are doing fantastic!

Like Wendy said, just ask and we'll try to get you answers. I'm not a night owl, like Wendy is. It helps that folks like her live on the west coast of North America, so people can get help later in the evenings.

A good test to always get is a +2 test. That is the test 2 hours after you have given Cashmere the insulin shot.
That test can be an indicator of what direction the BG levels are headed.
"The +2 is like an "early warning" for most cats!
If the +2 is about the same as the PS, it's usually a pretty normal cycle...dropping down to nadir and then rising back up again.
If the +2 is higher than the PS, that usually signals a bounce, and those are the cycles when you can usually take a break from testing.
If the +2 is lower than the PS, that's your "Early warning" that kitty might be going much lower later in the cycle so it's important to plan on getting another test or two (or 6) in."

It doesn’t work every time or with every cat. But it does hold true most of the time, so keep this in mind for next time.

It can be so stressful, to learn how to best take care of a diabetic cat. Add the stress of dealing with covid-19 also, and sometimes I want to just go hide from the world. My healing place, my place for joy and renewal of my soul is to go outside. A walk, a bike ride, watching nature, wandering through my woods, playing in my gardens. Mindfulness breathing helps me too.

What do you do for stress relief Jenny? Yoga? horse back riding? Watching a silly movie? What is it that helps you during this time?
 
@Deb & Wink can you take a look at Cashmere’s SS, I’ve been testing consistently and increasing his dose, His numbers are still high, I’m so frustrated do I keep increasing? And how will I know for sure when I’ve reached the perfect dose? Looking at his SS do you think his numbers are high because the dose is too high?
I’m at a loss here
 
Since you are using TR with Lantus, you should not hold the dose more than 6 cycles, before you do another increase.
So yes, you keep increasing until you see some better BG numbers.

How old is your lantus pen?
What storage conditions has it been under?
Do you have an extra lantus pen by any chance?

Jenny & Cashmere said:
And how will I know for sure when I’ve reached the perfect dose? Looking at his SS do you think his numbers are high because the dose is too high?
Click to expand...
I don't think the dose is too high.
You'll know the dose is a better dose when the numbers come down from those >300 BG's to the yellows (200-299) and blues (100-199).

You may be having to break through some "insulin resistance" since the 2U dose was held for so long, without seeing many lower numbers.

Maybe tag someone else, or post over in the Lantus forum for some feedback.
There are a lot of experience Lantus users over there.

Sorry I'm so late getting back to you.
My "honey do list" for myself and things that need to be done at home is getting longer by the day. And I'm the only "honey" to do everything. ;)
Knocked off a few more things on the list today. But the list keeps growing.
 
Deb & Wink said:
Since you are using TR with Lantus, you should not hold the dose more than 6 cycles, before you do another increase.
So yes, you keep increasing until you see some better BG numbers.

How old is your lantus pen?
What storage conditions has it been under?
Do you have an extra lantus pen by any chance?


I don't think the dose is too high.
You'll know the dose is a better dose when the numbers come down from those >300 BG's to the yellows (200-299) and blues (100-199).

You may be having to break through some "insulin resistance" since the 2U dose was held for so long, without seeing many lower numbers.

Maybe tag someone else, or post over in the Lantus forum for some feedback.
There are a lot of experience Lantus users over there.

Sorry I'm so late getting back to you.
My "honey do list" for myself and things that need to be done at home is getting longer by the day. And I'm the only "honey" to do everything. ;)
Knocked off a few more things on the list today. But the list keeps growing.
Click to expand...
 
Jenny, you only quoted my post. Nothing else.
Try simply typing what you want to say in the text box at the bottom of the thread.
 
Deb & Wink said:
Since you are using TR with Lantus, you should not hold the dose more than 6 cycles, before you do another increase.
So yes, you keep increasing until you see some better BG numbers.

How old is your lantus pen?
What storage conditions has it been under?
Do you have an extra lantus pen by any chance?


I don't think the dose is too high.
You'll know the dose is a better dose when the numbers come down from those >300 BG's to the yellows (200-299) and blues (100-199).

You may be having to break through some "insulin resistance" since the 2U dose was held for so long, without seeing many lower numbers.

Maybe tag someone else, or post over in the Lantus forum for some feedback.
There are a lot of experience Lantus users over there.

Sorry I'm so late getting back to you.
My "honey do list" for myself and things that need to be done at home is getting longer by the day. And I'm the only "honey" to do everything. ;)
Knocked off a few more things on the list today. But the list keeps growing.
Click to expand...
Deb & Wink said:
Jenny, you only quoted my post. Nothing else.
Try simply typing what you want to say in the text box at the bottom of the thread.
Click to expand...
oops! I’m still getting used to how to use the message board!
I meant to reply and say that the Lantus pen is fresh
 
Jenny & Cashmere said:
oops! I’m still getting used to how to use the message board!
I meant to reply and say that the Lantus pen is fresh
Click to expand...
Jenny, I think my cat is in the same position as Cashmere. My cat just started on insulin a week ago. His glucose steadily dropped for 4 days and I was so happy. The last 2 days, it has been climbing. I thought the first day that maybe I missed and gave a fur shot. I know I didn't miss today and his glucose level is climbing.
He has been at the same dose for a week now. I have to go to the vet tomorrow to pick up a prescription. I am going to ask him if I should increase the dose.
I noticed that you are in Texas. I am in Texas as well and I don't know how to do the spread sheet or navigate the board. I am not very tech savvy and just reading the instructions on how to do the spread sheet was beyond me. I just write everything in a notebook.
Just hang in there and try to stay calm. Remember that before we found out they were diabetic, we thought they were okay. Some people go for years with diabetes before getting treatment. As they say, "Ignorance is Bliss." My life was so much happier before I found out he was diabetic.
Now, we just have to work hard at getting our babies feeling better. I know both of us want a fast fix but looking at the posts on this board, it doesn't happen that way. It has been hard for me to even get my work done around the house for worrying about my baby. But, I have been making myself get up and mow the yard and clean. It will make you feel better and clears your mind. It makes you put your worries in perspective instead of stressing on them.
Try not to worry. With the help of the people on this board, we will get our babies feeling better.
 
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