Help? +250 jump in 3 hours?

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pevsfreedom

pevsfreedom

Member Since 2015
Hi, Luna was 220 at +9 and I tested her at +12 an she's 464 and 471 (tested twice to confirm) after eating dinner (3/4 can 10% carb wet food like always). What's going on? She's never, ever been this high? We gave her 2.5 units Lantus right now.

5 minutes later she's at 422???
 
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How long has she been on insulin? Have you just started to home test? Did you skip the shot last night or why do you have an X in the dose cell?

Just a general note, we don't usually go up in half unit doses.....only .25, but without knowing how you got to the 2U dose or how long she's been on it, it's hard to give you too much in the way of ideas right now
 
She's been on insulin on and off for at least a year. She went into remission, and a month ago she came back out after being in remission for a few moths. I just started home testing about a week ago as you can tell from my sheet. I didn't test last night because I shot into her fur accidentally in the morning as you can tell from the lack of sugar levels dropping., but we did dose her last night. It was odd if you look because though we dosed her at night (the X was for pre-test sugar check, not dose) she was still >300 at +9 which should have been much lower.

I went from 1 to 2 because 1 unit wasn't getting her below 300 (which is what we've been giving her the last few weeks, we were relying on Vet to help us and I learned to do home testing instead). The 2->2.5 jump was for still being over 200 after the 2 days, I should have waited an extra day per the protocol in that regard but I'm just concerned how it is possible to jump from 220 to 470 in 3 hours?

Is this the Somagyi effect from bumping from 1->2 units? I don't think so because she never went low before going high.
 
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OK...when you first start on Lantus, there's a formula based on weight that should dictate the starting dose. How much does she weigh and is that a good weight for her?

Once the starting dose is figured, you have to hold that dose for at least 5-7 days to let the depot build and settle. You re-started her a month ago? At what dose?

It's also VERY important to get some tests in on the PM cycle....most cats go lower at night, and if she is, she can bounce back to high by morning and you end up thinking she needs more insulin when she could actually need less

With the furshot you gave yesterday, that's probably the reason for the higher numbers tonight.....any time you skip a dose or have a furshot, it takes 6 cycles at that same dose to determine what the next advice we'd give will be
 
She's been on Lantus for a long time, despite the break during remission. Her dose 'last time' (before remission) was between 2 and 3 units.

She weighs 11 lbs which is a good weight for her size. She lost about 3-4 lbs in the last year though she was obese and is now at a better weight.

Per the formula she should be receiving 1.25 units as a starter dose. The 1 unit wasn't bringing her under 350, so I figured going back to 2 would be a good start. I'm home all day to watch her for symptoms.

We re-started her at 1 unit for the last 30 days or so. I bumped her to 2 units three days ago, and 2.5 today because her nadir wasn't under 200, I thought that was correct per the tight protocol?

So I shouldn't panic right this minute? We gave her 2.5 units tonight, and I plan on testing at +1 and +2 and then again in the morning. Should I give her 2 or 2.5 in the AM, assuming she's 350 like usual pre-shot?

I've just never seen her level's this high, nor does her history from the shelter ever see her being above 400. She dropped from 470 to 422 in 5 minutes which was odd.
 
Well first, if you jumped from 1U to 2U, that was too much, too fast....After 5-7 days at the "starting dose", you'd only go up to 1.25 and then hold that dose for 3 days (6 cycles) before increasing to 1.5.....then 1.75.......then 2U BUT since you weren't testing all that time, it kind of throws a screw in the works. If she were my cat, I'd probably take her back down to 1.5 and then get as many tests as you can in for the next 3 days and then ask for help again...At least a Pre-shot test before shooting any insulin, a test somewhere mid-cycle during the AM cycle (like between 5-7 hours after the morning shot) ...then another Pre-test for the PM cycle and AT LEAST a "before bed" test ....just in case it shows that you need to find a way to get up and get more tests in to make sure she's safe

Lantus craves consistency, so it's important that we go slowly up in dose, let it settle for a few days and then re-evaluate how she's doing
 
Ok. I think I tried too much too soon. I am worried because she has ketones present (16.5mg/dl from an hour ago) but is showing no symptoms despite the high BG level's, so maybe I got overzealous trying to 'fix' that. I'm sure she's had this amount of ketones present for the last month or so since her BG's have been so high.

I plan on testing every 3 hours until I get her semi-regulated (except at night). I wasn't aware about the importance of consistency. Wouldn't 1.5 be too low with nadir's around 220 for 3 days now (besides yesterday which I furshot)? I guess that's what's throwing me off here.

As far as the 'before bed' test, is that looking for hypo #'s for the most part rather than hyper? I've noticed there's not much you can do for hyper levels?
 
The "before bed" test is just to get a test right before you go to bed so IF the number is lower than you expect it to be, you can plan on setting some alarms and getting more tests in

The reason I suggested going down to 1.5 and holding it for 3 days is because you skipped the 1.25, 1.5, 1.75 doses when you went straight to 2U so we have no way to know if any of those doses might have been a "best dose" for YOUR cat.

A test I like to get is the +2.....we've found that a lot of times, you can almost use this as a "crystal ball" test.....If the +2 is lower than the Pre-shot, those are the cycles you want to get more tests in because kitty may be making a move down during that cycle and you need to find out how far down they do.

If the +2 is about the same as the Pre-test, that usually means a more normal Lantus cycle that gradually goes down to nadir and then gradually goes back up to the next shot time.

If the +2 is higher than the PS, that can signal the beginnings of a bounce...and on those nights, it's safer to take a pokey break and catch up on your sleep!

Lantus dosing is based on how LOW it takes them, not the pre-shot numbers, so getting those tests in will really help to figure out what's going on
 
Is the +2 thing because Lantus takes a few hours to 'kick in'?

Semi-related question:
I saw you feed your cat fancy feast at ~4% carbs. Do you know if it's bad to feed a cat only a sea-food type variety of food? Costco sells fancy feast cheap but I think it's the seafood variety box and I seem to remember that sea-food ONLY diets can be bad for cats?

Do you know if that's true or not? I'm feeding her Friskies Pate which is 9-11% which I read in another thread is 'too high'?

Thanks for all your help.
 
The Friskies Mixed Grill is more than 10% calories from carbohydrates; all the other standard pates from Friskies are fine. I mainly feed Turkey and Giblet, and Poultry Platter.
 
Back to (normal) 311 this morning pre-shot.

After 5 days of home testing she hears the microwave (for the rice sock) and she meows and jumps up on the table, and lays down patiently and waits to be tested. I'm really lucky with how well she handles all of this. Does the same thing when she sees me open the insulin drawer. It's kind of weird actually.
 
To remind everyone, Luna had moderate ketones a few days ago. This might change the speed at which increases should be done. Please, if your blood sugars are still high at the nadir, don't reduce insulin!

Increases per protocol should be 0.5U every 3 days.
 
Meya14 said:
To remind everyone, Luna had moderate ketones a few days ago. This might change the speed at which increases should be done. Please, if your blood sugars are still high at the nadir, don't reduce insulin!

Increases per protocol should be 0.5U every 3 days.
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That's kind of why I jumped to 2.5 because I tested for ketones the previous day, though I am still inexperienced. She's at 2.0 units now and I plan on adjusting after 6 cycles. I know from her previous medical history that her 'magic dose' was 2.0 so I'm trying to go off that because 1.0 wasn't getting her under 300 and I know she's been too high, too long.

Question: How do pre-shot numbers go down to healthy levels? Say I find her 'magic dose' for now is 2.5, which gets her to say 100 at nadir, but her pre-shot numbers remain 300+. How do you get a more 'flat' set of numbers, or is that kind of impossible? Does the insulin start lowering these pre-shot numbers after more cycles? (If that makes sense). Just curious.
 
Yeah, there are some thoughts that increasing doses can increase bloodsugars (anecdotally), but it's questionable. In the case of ketones, they develop due to not enough insulin. Backtracking a dose could put the cat at risk for DKA. Keep doing the 0.5U increases every 6 cycles until readings start to improve. Then go to 0.25U increases. You could probably bump back up to 2.5U now instead of waiting the 6 cycles.

Here's what the protocol says about increases. For >300mg/dl at nadir, you increase by 0.5U. This could be a lower with the ketones and if you are able to test often.

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
 
Well her nadir's were around 230 at +9, though obviously still high. You think an increase to 2.5 will be warranted tomorrow morning (2 cycles early) because of present ketones? Thanks. Her ketones went down as well since I've been giving her more insulin (she went from ~20 to 16mg/dl in 2 days).
 
I would restart the 2.5U at the next shot, hold for 6 cycles, then increase by the 0.25U per protocol if the nadirs are still around 230. If the ketones don't decrease with the first 0.25U increase, then go to the 0.5U increases even if the sugar is 200-300 range.
 
pevsfreedom said:
Question: How do pre-shot numbers go down to healthy levels? Say I find her 'magic dose' for now is 2.5, which gets her to say 100 at nadir, but her pre-shot numbers remain 300+. How do you get a more 'flat' set of numbers, or is that kind of impossible? Does the insulin start lowering these pre-shot numbers after more cycles? (If that makes sense). Just curious.
Click to expand...


Every cat is different. You might begin by seeing some occasional blues and greens, and then suddenly at the next increase all the numbers are better. Sometimes, It's not a gradual change, but rather, like a breakthrough, and numbers are better. This is how my cat was.

Some cats slowly come down a little more with each dose increase. Some cats bounce up and down until the dose is high enough. Once you start seeing pre-shot numbers <200, the lantus is able to control the sugars much better and things get flatter. For new cats, that's the cutoff line for skipping a dose, but really, lantus works the best when you can shoot on numbers in the normal range.
 
Good - there are many very experienced Lantus users there who will give you good feedback.
 
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