Gus - Started testing finally, need help with what to do next

[ChristinaK]

Hello all,

Gus was diagnosed a little over a month ago. We finally started testing (albeit sporadically) with a ReliOn Prime meter. We've been increasing his dose units but still can't seem to get his numbers below 300. I've finally sat down to start a spreadsheet with the data we have so far and linked it in my signature. I apologize for the inconsistency (and probably doing things wrong). We had a tragic human death in the family during all this, so we're honestly just keeping our heads above water at the moment.

My questions are:

--We've gone from 2 units / twice a day (what vet prescribed) to 7 units and have barely gotten his numbers below 300.

--We haven't been able to test as regularly as I'd hoped. If we can only do it a few times, where should I focus my efforts?

--Gus is on Semglee. Do I post my questions on the Lantus forum?

I've been pouring through articles and other threads trying to understand if we are heading in the right direction. I'm honestly not sure. If you have any insight or could point me to further reading, I would greatly appreciate your effort.

Thank you!

 

[Bandit's Mom]

Hi Christina, sorry to hear you lost a family member.

It's great that you got his spreadsheet and your signature set up!

An increase from 2U to 7U in a month is way too much and too soon an increase. We increase in mulitples of 0.25-0.5U depending on the numbers.

Too much insulin can sometimes look like not enough insulin - when the dose is too high and the cat drops too low on that dose, the cat's body fights to stay alive. The liver and the pancreas will release stored hormones and sugars to bring it back up fast so too much insulin can actually look like it's not enough! This happens when a cat is started at too high a dose, or the dose is increased by too large amounts (so you bypass a good dose) and when you don't have enough tests to know how low the cat is going on a dose.

Can you let us know what your schedule is like and how much you will be able to test Gus in the coming days? Many cats go lower at night so we recommend getting a "before bed" test.

Link to your previous post:
https://www.felinediabetes.com/FDMB...en-will-gus-start-to-look-feel-better.250858/

I'm going to tag a few senior members to weigh-in on dosing
@Wendy&Neko
@Sienne and Gabby (GA)
@tiffmaxee

 

[Sienne and Gabby (GA)]

Semglee is a generic/biosimilar form of glargine so its fine to post in the Lantus/Basaglar/Levemir forum.

I agree with Bhooma, that's a very large dose in a very short time. By any chance are you dosing using the pen rather than a syringe? The pens only dispense in 1.0u amounts. In order to dose smaller quantities, you need a U100 insulin insulin syringe. The information about syringes is in one of the sticky notes at the top of the Lantus board. Also, was your vet suggesting these rapid increases? Regardless, you may want to look at the sticky note on dosing methods, as well.

 

[Wendy&Neko]

Hello and welcome.

I have some questions first before my comments. On the spreadsheet, the 25th thru 27th is blank. I presume you shot (what dose?) but things were too crazy for testing. Sorry about the death in the family. Lantus and it's biosimilars are depot insulins, meaning the effect is cumulative over several shots. It's good to know how long a particular dose has been held. Any dose skipped deliberately or fur shot (partial doses on the cat, it happens ), will interrupt the depot. So if you could either fill in the days in between with the dosing, or put a comment like you had done the previous week, it'll help us to help you.

Some cats need more insulin than others. There are secondary conditions some cats have that mean they need more insulin than most. My girl had two of those conditions. So it's possible Gus needs a higher dose, or not. We can't tell with the current data. Our job is to help you figure out where to go next on dosing. I do see some numbers under 300 on 7 units, so that is promising. If you can do it, I'd like to see 4 tests a day for the next couple days. Get one just before you give insulin. The order should be test him, feed, then shoot soon after. If he takes a while to eat, you can shoot while his head is in the bowl. My girl took less than a minute to eat her meal, so it was after. So that's two shots a day. The other two are sometime in the middle of the cycle. If you can get another one in the range of +4 to +7 during the day, and a test before bed, that would help. How long after the PM shot do you go to bed? If it's at least 2-3 hours later, that would be perfect. With that data of 4 tests per day, we'll be able to see what needs to happen next with the dose. Given how things are at home now, is this something you can do? If so, I'd suggest posting daily in the Lantus/Basaglar/Levemir forum.

Yet another question, sorry, are you testing Gus regularly for urinary ketones? When cats are in high numbers it's especially important to test regularly, daily if you can. Tips to catch and test a urine sample

Side question, how much does Gus weigh?

And lastly, it looks like Gus is doing what we call bouncing. It's perfectly normal for newly diagnosed cats, and some not so new. Here is the definition to help you understand what is happening:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

 

[ChristinaK]

Good morning - a sincere thank you to each of you!!! @Wendy&Neko @Sienne and Gabby (GA) @Bandit's Mom

Gus weighs 15 lbs now. He used to be 20 lbs but lost weight pretty rapidly prior to his diagnosis. I’ll try to weigh him today to double check how he’s doing.

We are using U100 insulin syringes (.5mL single unit scale) The lines for each unit are tiny, so five hash lines then the number 5, five hash lines then the number 10. The Semglee is in a vial (not the pens).

Our schedule has been: AM shot around 6am, eats whole can of FF Pate (we shoot when he’s eating), test when we can, PM shot around 6pm, eats whole can of FF Pate

He is crying for food constantly, so we’ve been feeding him another half a can here and there throughout the day. Is that bad? He’s literally pulling canisters of dry goods off the pantry shelves. My poor little guy is starving And I’m so afraid what I can feed him and what is just making it worse.

We have not been testing for ketones. I will read about that today. I do remember they tested him at the vet for his diagnosis and said he had none at the time.

I just updated his spreadsheet (that thing is amazing btw - whoever created it is a real crackerjack!) I just gave him 5 units this morning. His numbers are very high. I really don't see any change in his demeanor one way or the other. I so wish my baby could talk and tell me what he is feeling. It is hard to know what is working.

Thank you Thank you Thank you! I'll start posting tomorrow on the Lantus forum.

Christina

 

[Wendy&Neko]

Can I ask why the skipped doses yesterday?

As for feeding, you may find it helpful to feed him those smaller meals throughout the day. What really helped me was getting an automated pet feeder. I used the Petsafe 5 (and another I wouldn't recommend). Anyway, once Neko discovered that her autofeeder did the feeding, she stopped bugging me for food and stared at it. As for amount to feed, weighing weekly or so is a good way to find out if you are giving him the calories he needs. It sounds like he might need to gain back a bit?

 

[Chris & China (GA)]

We are using U100 insulin syringes (.5mL single unit scale) The lines for each unit are tiny, so five hash lines then the number 5, five hash lines then the number 10.

Those aren't the right syringes. You need 3/10ml, 30 or 31 gauge insulin syringes with half unit marks. The ones you have hold a max of 50 units...the 3/10ml syringes hold a max of 30 units. Since I know you have a WalMart nearby, you can get syringes from there for $12.58 for a box of 100. (although don't try asking them for syringes with half unit marks....most of them don't know they make them). These are the boxes you'd look for (different stores have different colored packaging but as long as it has the purple "stripe", it's the right syringe. You can get 31 or 30 gauge (that's just the thickness of the needle)