FRED: super HI numbers--need dose advice

[Martica and Fred]

Hi
Could some of you please help analyze Fred's numbers and dose?

I haven't posted about numbers in a very long time but need some extra thinking caps because Fred's numbers have been over the roof and I have no idea what to do. I've ranged his dose in the past two months from .5 to 1.5 units and can't seem to discern if he needs more or if I should go back down. His rear-leg situation is seriously worse—he wobbles a lot and often falls and can’t get back up—and this has worsened in the past week. I'm pretty sure it’s because of his chronically high numbers because he absolutely walks better when he’s in the 200s and 300s, even 400s. But lately he’s been in the 500s and HI (600+) a bunch.

We went to the vet this Monday and I got the lab values today. His kidneys are steady, despite no subQ fluids cuz of the heart disease (he had cardiac heart failure in Jan after fluids, so I stopped). BUN (92 now, 89 in March), CREAT (5.1 now, 4.8 in March); Phosphorus was HIGH, now normal—he’s on Phos binders in food; He is slightly anemic HCt 25 and his B12 is low 236 (and low range is 276+ apparently)

Fred has been on Lantus for 4 years and 9 months. He's been a little erratic but overall pretty well regulated. He will be 20 years old next week and has kidney disease (on Pepsid, no subQ fluids) and heart disease ('mild' HCM on Plavix) as well. He had a case of heat stroke almost a month ago (my fault, I posted about it at the time). But he miraculously pulled thru and seems to be ok from it. The emergency vet was shocked. He didn't even have to stay overnight, he was back to normal in less than one hour after I rushed him in.

I have tried two new vials of insulin and so it’s him, not the juice.

So here are his past 2 months of numbers. I only recently started doing extensive curves...and now, having typed it all out, it’s looking like maybe I should drop him.

Just to explain my units system—I notice that even a drop seems to be powerful so I have very subtle gradations in doses and in the past have changed the dose ever so slightly acc to PS numbers.

.5< this means the dose is on the bottom part of the black line
.5 the dose is right in the middle of the black line
.5> the dose is on the upper part of the black line
>5(+) the dose is barely past the black line
.5+ the dose is just above the black line
.5++ the dose is a bit above the black line (so this might equate to, say, .75
1- the dose is below the black line (maybe .8ish)
and same system 1<, 1, 1>, 1(+), 1+, 1++, 1.5-, 1.5<, 1.5, 1.5>, 1.5(+), 1.5+


30 May
+12 336 gave .5 unit PS
+11 522 gave .5+ unit PS

31 May
+13 500 gave .5+ unit PS
+9 HI
+12 566 gave .5 unit PS

01 June
+13 522, gave .5+ unti PS
+7.5 576
+11.5 576 gave .5++ unit PS

02 June
+11.25 241 gave .5 unit PS
+3.5 228
+9.5 322
+13 408 gave .5+ unit PS

03 June
+11.75 359, gave .5> unit PS
+13.5 438, gave .5+ unit PS

04 June
+11 277, gave .5 unit
+12 498, gave .5+ unit

05 June
+12.25 533, gave .5++ unit PS
+3.5 470
+12 469 .5+

06 June
+13.5 431 gave .5+ unit
+4.75 348
+11.5
381 gave .5>unit PS
+8.75 289

07 June
+11.25 329 gave .5> unit PS
+5.5 443
+11.25 535 gave .5+ unit PS
+10 384

08 June
+13 334, gave .5 kunit PS
+7 220
+11 295, gave .5 unit PS

09 June
+10 462 gave .5+ unit PS
+13.5 368, gave .5> unit PS

10 June
+12 368, gave .5> unit PS
didnot eat all day, pepsid issues
+12.5 209 no shot

11 June
+18 562 gave .5++ unit PS
+7.75 343
+13.75 448, gave .5+ unit PS

12 June
+15.25 549 gave .5++ unit PS
+11.25 360, gave .5> unit PS

13 June
+13 595 gave .5++ unit PS
+12.25 477 gave .5+ unit PS

14 June
+13.75 320, gave .5> unit PS
+11.25 500, gave .5++ PS

15 June
+14.25 474 gave .5++ unit PS
+6 418
+12 449 gave .5 unit PS

16 June
+14 HI, gave 1- unit PS
+11 HI gave .5+ unit PS
+8.25 454

17 June
+10.5 529 gave .5+
+3 439
+6.5 315
+12 HI, gave .5- unit PS

18 June
+8.5 HI, gave 1- unit PS
+5.5 515
+8.5 444
+14.75 454, gave .5++ unit PS


19 June
+12.5 489, gave .5++ unit PS
+8.75 495
+11.25 507, gave .5++ unit PS
+6 469

20 June
+13 523, gave 1 unit PS
+4 358
+9.5 318
+11.5 339, gave .5+ unit PS
+6 350
+9 310

21 June
+12.5 322, gave .5+ unit PS
+5.75 266
+12 231 gave .5 unit PS
+5.75 295

22 June
+10.75 443, gave .5++ unit PS
+7.5 469
+12.5 562, gave 1< unit PS


23 June
+11.5
324 gave .5+ unit PS
+12.75 294, gave .5++ unit PS

24 June
+11.75 80 NO SHOT PS
+15.5 133 no shot
+19.25 373 gave .5++ unit PS

25 June
+13.5 323 .5++ PS
+13 359 gave .5++ PS

26 June
+11 415, gave .5++ unit PS
+13 HI, gave 1? unit PS

27 June
+11.5 547, gave 1 unit PS
SUFFERED HEAT STROKE-EMERGENCY ROOM
+8.5 254
+14.25 HI, gave 1 unit PS

28 June
+12 472, gave .5++ PS
+12.25 560, gave 1 unit PS

29 June
+11.75 313, gave .5++ PS
+11 202
+12.5 461, gave .5++ PS

30 June
+11 416, gave 1< unit PS
+12.25 380, gave .5++ PS

01 July
+12 575, gave 1 unit PS
+12 585, gave 1< unit PS

2 July
+12.25 452, gave 1< unit PS
+11.75 506, gave 1< unit PS

3 July
+12.5 225, gave .5++ unit PS
+5 172
+7.75 168
+11.25 327 gave .5++ unit PS

4 July
+12 595 gave 1 unit
+11.75 411 gave 1< unit PS

5 July
+11.75 371 gave 1< unit PS
+11.75 439 gave 1 unit PS

6 July
+12.25 264, gave 1- unit PS
+12.25 HI, gave 1> unit PS
+3.25 548

7 July
+10 HI, gave 1> unit PS
+2 HI
+5.25 545
+8 555
+10.5 534 gave 1 unit, PS
+3.75 457

8 July
+13.75 485 gave 1 unit PS
+4.5 280
+7.75 364
+12 HI gave 1> PS
+3.75 494

9 July
+11.75 465, gave 1 unit PS
+5.25 306
+12 466 gave 1 unit PS

10 July
+11 372 gave 1 unit PS
+12.75 173
+14.25 333 gave 1> unit PS

11 July
+10.25 332 gave 1< unit PS
+10 277
+12.5 537 gave 1> unit PS

12 July
+12.75 468 1 unit PS
+7 295
+12.5 HI gave 1(+) PS

13 July
+11.5 436, gave 1 unit PS
+6 452
+11.5 517, gave 1(+) unit
+2.5 438

14 July
+13.75 433, gave 1(+) unit
+4 350
+8.75 573, gave 1(+) unit
+3.5 485
+9.75 402

15 July
+12.75 599, gave 1+ unit
+5.25 499
+10.75 426, gave 1 unit
+4 303
+8.5 514

16 July:
+12.25 HI, gave 1+ unit
+3.5 HI
+8.5 470
+11.75 523, gave 1+ unit

17July:
+13 413, gave 1> unit; PS
+6.5 390
+13 HI, gave 1+ unit PS

18 July:
+11.25 496, gave 1(+) unit PS
+6.25 473
+11.75 527 , gave 1++ unit PS
+3 527

19 July:
+11.75 405 gave 1.5> unit (fur shot?) PS
+3 394
+10.5 HI, gave 1.5< unit PS
+4.25 HI

20 July:
+12.5 528, gave 1.5< unit PS
+3 473
+7 371
+11.75 357, gave 1.5(-) PS
+5 341
+9.25 460

21 July:
+13 594 PS gave 1.5< unit
+3 575
+6.5 460
+9 478
+11.5 521 PS gave 1.5 unit
+3 455
+5.25 362
+7 307
+10.75 280, ate

22 July:
+13 381, gave 1.5< unit PS
+3 382
+7 310
+12.25 298 gave 1.5 units PS
+4.25 109 gave food
+6.75 95 gave food
+7.75 174

23 July
+11.5 596 gave 1.5 unit PS
+2.5 541
+6 498
+10 436
+12 393 (Fred has not eaten all afternoon since +6...just did shot...not sure if I should go lower with dose now or what...)

My vet only looked at the past week of numbers and listened on the phone as I told him about the last few day's curve. He thinks that Fred might need even more than 1.5--not withstanding the 101 and 95 I got yesterday....But he acknoledged there could be some somogyi going on and I'm not catching it--although things tend to be slow on Lantus no sudden dips...

anyway, please help!

 

[Libby and Lucy]

on a quick glance, I agree with your vet that Fred needs 1.5 or maybe a bit more. The 95 yesterday was nice, and today he's bouncing from it but that is normal. I would hold 1.5 for now, be as consistent as possible with the dose (try not to add/subtract drops, just shoot 1.5), test as much as you can, and after a few days we can help evaluate whether he needs more or less.

It's hard for them to compensate for frequent dose changes, and as you have noticed, even a drop matters.

If Fred gets a lower preshot reading than you expect, you can post here for advice. You can definitely shoot anything over about 150. Lower than that, we can help walk you through the decision making the first few times.

 

[Jill & Alex (GA)]

My vet only looked at the past week of numbers and listened on the phone as I told him about the last few day's curve. He thinks that Fred might need even more than 1.5--not withstanding the 101 and 95 I got yesterday....

i happen to agree with your vet. i'd stick with 1.5u for now (101 and 95 are lovely numbers) and go from there. we've learned to adjust doses according to nadir with only slight consideration given to preshot numbers. post often and we'll help.

 

[Martica and Fred]

Before I saw you posts I just gave Fred .5

The thing that scares me is that the 101 last night was at 1:30 in themorning...I fed him half a can of Turducken (1.5 oz) and then tested him 1.5 hours later and he was 95...I fed him a 1/2 can of Wellness at 3am...then woke up again at 4:30am or whatever it was and he was now 174...and then super hi a few hours later at the next PS time...despite the 1.5 dose before.

but I am scared if I HAD NOT tested and seen the 101...nor the 95...nor fed hiim either time--I'd given him the 1.5 at 298 PS...so I'm wondering if he would have hypo'd had I not fed him twice in the middle of the night?

He free feeds..but the problem is, since he is so much less mobile (and is also wearing a diaper) I think he is less apt to get up and eat if he might need too...and particularly middle of the night, he doesn't get out of bed by himself anymore, he literally lites in the same position on the pillow the entire night--he might wake me up sometimes for water...with his paw on my cheek.

anyway, so I just maybe gave him too little...he's had sooo many 500+ numbers in the last 2 months, including after I started increasing the doses that I was thinking that maybe I should start very small before trying to increase...arrrghh!! Can't believe after almost 5 years of this I am back to square one... :sad:

 

[Ann & Tess GA]

Martica, stop, breathe! We all end up giving BCS ()big chicken sh*t) sshots once in awhile. Tomorrow you just go back to your regular shot and wait out the bounce which will probably come. No harm done in playing it safe. You are learning for next time

 

[Sienne and Gabby (GA)]

I suspect some of the bouncing is being accentuated by not shooting a consistent dose. Lantus likes consistency and every time you shift a dose, it has an effect on the shed. Lower numbers can be managed with high carb food, if necessary.

 

[Martica and Fred]

well last year for many months he was totally regulated on .5 so I hate to keep bumping it up. But I guess something has to give because poor Fred is not doing well on whatever we are doing now. In some of the shots I posted...if you notice there are times where he is fine, then suddenly shoots up like 2 hours before shot time up to 500+....which it was never like before, he often had 24 hours or longer than 12 hour cycles with the Lantus...I wonder if his pancreas has just given up suddenly---like before it was pumping out some insulin which complemented the shot--but now maybe nada and so his shot needs have increased. I wish there was some sort of test to gauge pancreas beta cell function...

OK, just checked him after the small dose

22 July:
+13 381, gave 1.5< unit PS
+3 382
+7 310
+12.25 298 gave 1.5 units PS
+4.25 109 gave food
+6.75 95 gave food
+7.75 174

23 July
+11.5 596 gave 1.5 unit PS
+2.5 541
+6 498
+10 436
+12 393 gave .5< unit
he ate some food
+2 336

so he is not rising yet, despite small dose, although could be carryover from earlier shot...I guess I'll see in the morning, not sure if I'm going to wake up every few hours all night again tonite to monitor him...

thank you for all the help

 

[Libby and Lucy]

I'm sure it's hard to have to increase his dose after all this time. Dosing needs change, though. There could be lots of reasons, or there could be no reason. It happens, though. I believe Ele/Blackie has gone through something similar, Blackie's dose has increased significantly after several years on insulin.