Getting frustrated, levels not dropping

[sjewell]

We increased Salem's dose from 1.5 to 2units last week and it seems that the levels are not dropping, sometimes they even go up? I don't understand. The vet we've been seeing isn't even checking up on him so I need to find someone else. Salem has been on Lantus for about 3.5weeks. We switched him from dry to FF right away and also got Young Again zero carb food because I felt he was really missing dry food (we have another cat who is not diabetic who also grew up on the dry). I haven't started a spreadsheet, we just write down his numbers w/the date & time and I'm guilty of not doing it every day. Just to give you an idea, one day his level will be 338, the next 380, the next 422. (his levels when diagnosed from blood labs was 512). Salem is acting fine, not sick or lethargic, like himself. He does have dental issues and has had that his whole life so I'm wondering if an underlying issue is causing the levels not to drop. Should we increase his dose to 2.25 next week? I may schedule apptmt with a new vet for next week and see if I can get some help. Salem is 14.5 and was diagnosed early Jan. He had a shot of depo for a sore on his lip and the vet believes that this shot caused him to develop diabetes. The sore on his lip is still there. She didn't want to continue with steroids til diabetes was under control. Any advice would be appreciated. Thanks.

 

[BJM]

We adjust the insulin based on the lowest glucose post-shot, ie the nadir. this is usually around +5 to +7 hours after the shot.

With Lantus, you need to keep the same dose for a minimum of 3-5 full days for the dose to stabilize its effects.

If the glucose goes below 50 mg/dL on a human glucometer, a dose reduction of 0.25 units is earned on the Tight Regulation protocol.
OR
If the glucose goes below 90 mg/dL on a human glucometer, a dose reduction of 0.25 units is earned on the Start Low, Go Slow protocol.


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[phlika29]

Hi @sjewell

I'm afraid there is no easy way to get the blood Glucose where you want it to be. You have to monitor daily and to really see what is going on you have to put it into a form that both you and others can easily see.

Lantus dose is not adjusted on the pre shot number but the nadir and so you need to be getting at least one other test per cycle, even if it is a +2 or +3. If over thecourse of the next week you can get some more readings during each cycle you will build up a better picture. At the moment you have no way of knowing if Salem is dropping low in each cycle and then bouncing back up or sometimes high levels can indicate too high a dose. If you can put the work in now it should become easier.

When you increase you really want to go up by 0.25 unit at a time and really you want to follow one of the protocols suggested. Either the start low go slow or the tight regulation. They have helped many cats get regulated.

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol.1581/

If you could set up that spreadsheet it really would help us comment more.

 

[Lisa and Witn (GA)]

It is possible that you have already missed the optimal dose and you could be experiencing Somogyi effect. When a cat's body is getting too much insulin, the body produces extra glucose to try to prevent hypoglycemia.

Can you answer some questions for us? You may need start over at a lower dose and gradually increase it to find your optimal one.

1) What was your initial dose when you started insulin?

2) When did you change Salem's diet? What was his insulin dose at the time you changed it?

3) When did you begin hometesting?

A change in diet can significantly decrease the BG levels. However, if your dose was too high, you may not notice it since Salem may be producing extra glucose to counteract the insulin. One suggestion is to start back over at 1 unit twice a day. Test before every shot and also if possible, about at the +5 - +6 hour. Keep a record of all of the readings. Then after a week at 1 unit, we can help you determine if you need to increase the dose. If you do need to increase it, only by 1/4 to 1/2 unit and repeat the testing process again for another week, before increasing it again. The goal is to find the best dose to keep Salem's BG readings regulated.

 

[sjewell]

It is possible that you have already missed the optimal dose and you could be experiencing Somogyi effect. When a cat's body is getting too much insulin, the body produces extra glucose to try to prevent hypoglycemia.

Can you answer some questions for us? You may need start over at a lower dose and gradually increase it to find your optimal one.

1) What was your initial dose when you started insulin?

2) When did you change Salem's diet? What was his insulin dose at the time you changed it?

3) When did you begin hometesting?

A change in diet can significantly decrease the BG levels. However, if your dose was too high, you may not notice it since Salem may be producing extra glucose to counteract the insulin. One suggestion is to start back over at 1 unit twice a day. Test before every shot and also if possible, about at the +5 - +6 hour. Keep a record of all of the readings. Then after a week at 1 unit, we can help you determine if you need to increase the dose. If you do need to increase it, only by 1/4 to 1/2 unit and repeat the testing process again for another week, before increasing it again. The goal is to find the best dose to keep Salem's BG readings regulated.

I'll answer ur questions:
1. Initial dose was 1unit Lantus 2xday
2. We switched diet from science diet mature dry & friskies canned pate/bits/gravy to just Ff & eliminated dry. (Ordered Young Again zero carb as I felt he needed the dry). He's been on that abt a mth. Waiting for new bag to arrive. He hasn't had dry for 3days. He was at 1unit for first 2weeks then becz his readings were staying from 350-460
We increased to 1.75 then 2units. Still had high #s last wk so we brought up to 2.5. At this dosage we now are starting to see lower levels. Thurs day was 460 for example. Fri morn was 180 yest was 70. We cut dwn to 1unit as I got scared. We are testing more also & will do a curve today. Last nite preshot was 230.
3. We've been home testing since he's been on lantus but more frequently now since the level is dropping.