Getting Regulated (on Lantus)

[ToddyTiger]

This is my first time posting here, but I have been posting on the feline health forum here for a while. Here is my post about what has been going on with Todd: viewtopic.php?f=28&t=31817

But here is my question, that I also posted this in Feline Health.

So Todd has been home for a couple of days now. So far, he seems to be doing pretty well. His walking is way, WAY better and he is eating more (been letting him free feed for now) I don't know what his kidneys are doing right now though, but they will be rechecked, along with his blood pressure, next week. For now we're doing 150ml of Sub-Q a day to maintain him.

My question is, how long does it generally take to get a cat regulated? Our vet upped his Lantus from 1.5 twice a day, to 2.0 twice a day. After that is when things really started looking much better on him, so I believe that had a lot to do with how he was feeling for the last couple of weeks. But his BG numbers seem to be all over the place, and I wonder if this is normal when regulating. He has been a diabetic for a few years, but I just started doing home testing recently. We always just had the vet do his curves and such. So I don't have a clue as to what his numbers were like say, 4+ months ago.

(Also, because it might be important. For the last year and a half, he was taking 2.5 units of Lantus twice a day. When he got sick in July with Pancreatitis and then his kidney values jumped up, he went almost a month without insulin, then was only given half a unit for a while, then went to 1.5 units for the last two months. I was trying to do what the vet and internal med. specialist thought was right, though I felt he should be back at his higher dose.


For example, I'll give you the last few days of his BG numbers. I was checking at 9am, 3pm and 9pm. He receives his insulin at 9am and 9pm. The first and last number each day is BEFORE insulin.

12/14: 500+, 570, 457
12/15: 348, 334, 431
12/16: 273, 129, 600
12/17: 466

Over the weekend his numbers at the vet were usually 500+. Their meter only goes to 500, so anything higher and it just says "HIGH".

Tuesday was when the vet decided to up his insulin dose. She said keep an eye on his numbers, and we'll talk in a couple of days. She said we should give it about a week for him to get used to the new dose. Is that how it works?.. you kind of give it a few days for it to start working? I was really happy yesterday (12/16) because his numbers were low in the morning and just about normal in the afternoon. But the 600 last night came out of no where. As I said though, he seems to be acting A LOT better and moving around a lot better.

Not asking about how Lantus works really, because I am aware of that. Just curious about the daily jumps in the numbers and how long it can take to get them where they need to be.

OH, and because it might be playing a role here, he eats Hill's k/d for his kidneys. Before getting sick in July, he was eating m/d

Thanks!
Sarah

 

[Sienne and Gabby (GA)]

Hi Sarah.

It sounds like and Todd have had quite the time of it.

There's not a quick and easy answer to your question. Lantus numbers can look like they are all over the place. However, you don't have a lot of data yet to be able to really look at trends. Most of us test prior to each shot and get at the bare minimum, one additional test in the morning and evening cycle. This gives you a sense of where the high numbers are (usually at pre-shot times) and where the lower points in the cycle are (at around the mid-point). Many cats have variability in their numbers after a dose change since that change effects the insulin depot and it takes some time for the depot to catch up with the dose change. Usually, you want to wait a few days for a dose change to stabilize.

Part of the "all over the place" is due to bouncing. The 600 is probably due to a bounce -- when a cat's numbers drop into lower ranges - like the 129, often the liver reacts by dumping stored glucose and counterregulatory hormones into the bloodstream. This causes numbers to spike. Over time, and as Todd spends more time with his numbers in those lower ranges, the bounciness will begin to slow down.

I believe the K/D is fairly high in carbs. If Todd needs to be on a higher carb food due to his kidney issues, it's quite likely that more insulin will be needed. Since you're home testing, you'll be better able to gauge his insulin needs. To get a feel for how our kitties respond to Lantus, you might want to take a look at our spreadsheets. They are linked in our signatures. Some cats are fairly easy to regulate, others are quite the opposite. Like I said, there isn't an easy answer and given some of the medical and related food issues you've been grappling with, you will probably need to work the insulin around Todd's health issues.

I would encourage you to test for ketones. It sounds like Todd has enough going on that an ounce of prevention would be wise. You can purchase Ketostix at any pharmacy.

You might also want to take a look at the starred sticky notes at the top of the Board. You indicated that you are familiar with Lantus so some of the information in those notes may not be new.

Please let us know how we can help.