Fluctuating numbers have us stumped...

[Sunast3]

Hello all!

My cat Stoli (who will be 15 on Wednesday!) has recently come out of diabetic remission after 6 years. We found out because he also has early CKD, and while we originally took him in to get a kidney reading, his BG came back high (444).

We got him started on 2 units of Lantus twice a day that night. We also got an AlphaTrack2 so we could do home checks. After a few weeks and a series of conversations with our vet, we dropped down to 1 unit twice a day. He continued trending in a positive direction, and soon we then dropped down to 0.5 unit ONLY when his BG climbed over 400 as we were seeing his values drop quickly after a dose (we do daily checks before AM and PM feedings).

Here’s where we are confused... we were averaging giving 0.5 units of insulin roughly every 3-4 days. However, the past few days his BG has been swinging like a pendulum and we have been giving insulin daily. For example:

4/3/21 7:00 PM - 412 (gave 0.5 U w/ breakfast)
" " 1:30 PM - 308
" " 7:45 PM - 245
4/4/21 6:30 AM - 558

I was so surprised to see it swing that high (he hasn’t yet been over 500) that I took it again to make sure it was correct. Does anyone have experience with this? Looking for a little guidance to help stabilize his levels a bit more while not dipping too low but not soaring so high.

I can attach spreadsheet and/or provide any additional information that would be helpful. Stoli is eating Halo Turkey & Duck, could diet be playing a role? Any insight would be GREATLY appreciated!

 

[Sienne and Gabby (GA)]

A spreadsheet would be very helpful We're pretty numbers driven here. This is a link to the spreadsheet we use

The sings in numbers could be caused by a few things. Without seeing numbers it's hard to know what's going on. You may not be dosing enough insulin. Generally, we make dose adjustments in 0.25u increments so dropping the dose from 2u to 1u and then to 0.5u may have been too speedy of a decrease. Bigger drops in numbers can cause your cat's body to go into panic mode. When this happens, counterregulatory hormones and a stored form of glucose are released which causes numbers to spike.

 

[Sienne and Gabby (GA)]

There's another piece of the puzzle from your spreadsheet (SS). Lantus is a depot insulin. What that means is that a small amount is deposited into the fat cells in the form of micro crystals. Most of this dissolves over the course of the cycle but a little is kept in storage. As a result each dose builds on each other in order to give Lantus it's duration. There's more information about this in the sticky notes at the top of the Lantus board. It looks like you've been skipping a fair number of doses. In fact, I strongly suspect that you've skipped enough doses that your cat's depot is completely depleted. You're shooting so infrequently (I'm presuming that NS = no shot) that your cat is effectively not getting any insulin. It's not a surprise that you're seeing high numbers. Lantus will not be effective in "shooting down" high numbers. A depot insulin doesn't work that way. From what's on your SS, Stoli needs to be on a consistent dose of insulin. His numbers are in diabetic range.

With any insulin, you will need to get additional tests. It's important to test before you give a shot (i.e., your pre-shot test). It's also important to get spot checks so you have some idea of how low the dose is taking your cat's numbers. with Lantus, many cat's low point (i.e., nadir) is around +6 -- 6 hours after you gave the injection. However, not all cats have their nadir in the middle of the cycle. Every cat is different (ECID).

I'd also encourage you to read over the sticky notes on the dosing methods with Lantus. You're skipping shots that are high enough for you to give a dose of Lantus safely. The dosing methods will provide more information on how to deal with the numbers.

Is your kitty on a low carb, canned food diet?

 

[Sienne and Gabby (GA)]

You may want to consider Prozinc over Lantus if you are going to intermittently dose. Prozinc is not a depot insulin.

 

[Fluffsmom]

Hey there and thanks for your response. I should have clarified a couple of things: Stoli had diabetes and went into remission very quickly and has stayed that way for the last 6 years. Just recently, he came out of remission, and we're aware that his body responds very quickly to insulin. Our vet is admittedly very careful and conservative when it comes to insulin, and definitely prefers Stoli to be "too high" than "too low". Our vet (who we've been in close contact with) advised that we only dosed if his BG was above 150 and lowered his dose as he was trending in a similar direction before (his transient diabetes was very short term the previous time). His numbers continued to dip and fluctuate and we were then advised to only dose if 300+. He swung from 380 to 86 and from there we were advised to hold insulin unless BG was 400+ and to dose 0.5U. We don't want to cross into hypoglycemic territory and given Stoli's history, it's a possibility. That being said, we are interested in other's input and research so truly thank you for taking the time to look over Stoli's chart.

I have researched more food than I can begin to tell you. He is currently on Halo Turkey & Duck (~5% carbs and lower phosphorus) but I am always searching for something better. With his history of early kidney disease, phosphorus levels are a priority in addition to carbs. He of course insists on pate only! These cats, they sure can be picky...!

I am going to research a bit more about Lantus and dosing, thanks for the tip.

hounds and gatos may make a good pate. Tiki cat is excellent for kidneys but comes in shredded. Cats seem to love it though. It is possible to transition a pate lover to shredded or chuck as long as it is palatable. Maybe try half pate half shred mix to acclimate.