Finding the right dose - the struggle is real

[sassycatlady]

I've posted a few times here and there on this board, but I'm compelled to post again because I am struggling MIGHTILY with finding the right dose of Lantus for my cat, Zander. He's been on Lantus for well over a year now and during this time has never been regulated properly. Right now I have him on 3 units, which is the highest I will go based on some of his readings; yet in the past, when he's gone into the lime greens on the 3 units, every time I take a reduction, it never sticks. On the 3 units, most recently, he has days where he's in the blues and greens and looks really great; other days he's in the yellow and pinks. So, 3 units may be too high, but it doesn't seem like anything less than that is enough to get to where he should be. Here is what I know & suspect, but I sure could benefit from some of the collective wisdom of this group!

• Pretty sure Zander is a "bouncer" - he is one of those cats that will go low at night and then overcompensate the next day with high BG readings all day long. I try to give him a small snack before bed to help mitigate this, but this doesn't occur every night.
• I suspect that he goes too low at night and I'm missing those readings because.... sleep! More PM readings I know would be very helpful, because I suspect he is diving low during the late/early morning hours before AMPS, but since I can't catch it with a BG reading, I'm not sure if this is the real problem or not (seems very likely though, because I can't think of any other reason his BG would be so high the following day).
• When I've lowered his dose, taken his readings during the day, and they are all still high, is it possible he needs to actually go LOWER from a possible bounce from a low reading during the night that I missed?
• He is an erratic and picky eater - I have him on FF Flaked food since this is the only type of canned food he will eat (he will NOT eat pate, but of course will eat the type of food with gravy, b/c it's high in carbs and yummylicious ) and even then sometimes he just picks at it, goes away, and comes back to eat more. Sometimes I have to entice him to eat it by giving him a small handful of dry kibbles (he was a dry food addict pre-diagnosis). I'm a bit concerned maybe he's not eating enough; his weight is stable but he shouldn't lose anymore or he'll be too thin. I try to give him at least 3 cans of FF a day right now, which should be enough, calorie-wise, but he doesn't always eat the entire portion. He sees my other cats eating dry food and then he doesn't want to eat his canned food - I have to repeatedly haul him back to his dish on the counter.
• Clinically, his diabetes symptoms are well-controlled - he doesn't pee bricks and flood the litter box like he used to; he doesn't drink excessive amounts of water (probably b/c of the canned food). So I'm wondering if maybe I'm just freaking out unnecessarily by focusing on his numbers? I'm a data nerd, so quantitative evidence is like gold, but I recognize that looking at the situation more holistically is important, too. When I bring up my concern to our vet for Zander's numbers being up and down (she has access to his spreadsheet) she seems to think he's doing OK since his physical symptoms are under control. But, I don't know. Am I focusing too much on numbers and missing the bigger picture here?

As a last-ditch effort, I am contemplating switching Zander to Levemir to see how he does on that. Though I would like to use up the remaining 3 Lantus insulin pens I have left first...

Thanks for any insight the collective knowledge base can provide

 

[Sienne and Gabby (GA)]

He may be bouncing. Getting a before bed test EVERY night may help to figure this out. Also, if you wake up during the night, get a test. Gabby was a bouncy cat, too. I could not, knowing how her numbers could drop, go to sleep seeing a green number (e.g., 4/11) and not knowing her numbers were heading back up or at the very least, putting more food out for her.

How often are you feeding Boris? Given your concern about the PM cycle, a timed feeder may help. Giving Boris dry food may be adding to his bouncing around. Maybe trying some of the Weruva or Tiki cat foods that are shreds may help. Many cats like freeze dried chicken sprinkled on their food.

I would not encourage you to take the position that you won't dose over 3.0u. A cat needs whatever dose brings numbers into a better range. What ultimately helped me with Gabby was to do whatever I needed to do to prevent a dose reduction. The idea being that I wanted her to spend as much time in green and blue numbers as possible. So, if I saw numbers heading down, I would feed the curve and prop the numbers up. Ultimately, she would get a reduction but she was spending more time in better numbers.

Levemir is certainly an option. I never switched over because of my schedule. I work full time. Gabby had an early nadir so I had an early shot time that allowed me to get tests in before I left for work and I could intervene when I say her numbers dropping by +2. Because Lev has a later onset and nadir, it would not have worked in my situation.

 

[JeffJ]

Some cats are just bouncy. While Leo has acro, he has always been bouncy. But we have seen low dose cats bounce around too.

Consistent feeding is important, if your kitteh is eating regularly.

 

[learjetta]

He may be bouncing. Getting a before bed test EVERY night may help to figure this out. Also, if you wake up during the night, get a test. Gabby was a bouncy cat, too. I could not, knowing how her numbers could drop, go to sleep seeing a green number (e.g., 4/11) and not knowing her numbers were heading back up or at the very least, putting more food out for her.

How often are you feeding Boris? Given your concern about the PM cycle, a timed feeder may help. Giving Boris dry food may be adding to his bouncing around. Maybe trying some of the Weruva or Tiki cat foods that are shreds may help. Many cats like freeze dried chicken sprinkled on their food.

I would not encourage you to take the position that you won't dose over 3.0u. A cat needs whatever dose brings numbers into a better range. What ultimately helped me with Gabby was to do whatever I needed to do to prevent a dose reduction. The idea being that I wanted her to spend as much time in green and blue numbers as possible. So, if I saw numbers heading down, I would feed the curve and prop the numbers up. Ultimately, she would get a reduction but she was spending more time in better numbers.

Levemir is certainly an option. I never switched over because of my schedule. I work full time. Gabby had an early nadir so I had an early shot time that allowed me to get tests in before I left for work and I could intervene when I say her numbers dropping by +2. Because Lev has a later onset and nadir, it would not have worked in my situation.

Thanks for this! I missed this last night because the reply came to sassycatlady's post. Boris's current info is over here.

I'm only taking the position about 3u because we are traveling 6/8 - 6/13, and he'll be getting shots from a pet sitter. Since he won't be constantly monitored during that time, I won't up his dosage that high considering his reaction last time - the vet dropped his insulin back to 1 as his BG was all over the place. We are going to kind of keep the status quo as much as we can until after we return, but I'm hoping to move to wet food only when we get back.

Consistent feeding is important, if your kitteh is eating regularly.

Our other 2 cats were having a difficult time eating the bigger portions, so today we are switching to 1/4 can + 1Tbsp dry every 6 hours. Better for Boris, and I think it'll be better for the other 2 as well!

Thanks!

 

[learjetta]

Pretty sure Zander is a "bouncer" - he is one of those cats that will go low at night and then overcompensate the next day with high BG readings all day long.

Boris just experienced his first bounce, and I have to say it was a bit scary!

Actually, now that I reread your post and the replies, I think they work for both of us!

 

[Sienne and Gabby (GA)]

I may have missed that you've be travelling. If you take a look at Gabby's SS, I have the dates grayed out when I traveled. I reduced her dose since I had a pet sitter giving Gabby her shot. Gabby had a firm rule -- no one except me could test unless that other person didn't want to have their hand intact.

 

[learjetta]

I reduced her dose since I had a pet sitter giving Gabby her shot. Gabby had a firm rule -- no one except me could test unless that other person didn't want to have their hand intact.

Gabby is a one human cat! LOL

That is something my fiance and I have been discussing today - reducing his dose while we are gone if his numbers are wildly erratic before we leave. If they're just running a little high, I'll probably leave his dose as is. I'd prefer he run a little high than run the risk of bottoming out.