High BG Levels, Confused Newbie, Please Help!

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Luckyducky

Luckyducky

Member Since 2012
Hello everybody, my kitty Lucky and I are newbies to FDMB. We recently posted an intro and some questions in the main FDMB forum here and here. The help, knowledge and encouragement we've gained so far has been invaluable, thank you all so very much! Right now I'm worried because Lucky's been getting consistently high numbers, and I was advised to come post in this forum. I was hoping someone may have advice to help our situation.

I posted all of Lucky's glucose readings so far in his SS below. Our vet had Lucky started out on Lantus (Solostar pen) at 2u twice daily, and after trying that for a week we found his glucose readings turned up some dangerously low numbers (35 at lowest), so the vet had his dosage cut back to 1u twice daily. We tried that for a week, but his numbers were still really low (48 at lowest), so we cut back to just 1u once daily. We tried that for a week, but his numbers still dipped quite low (56 at lowest), so after talking with the vet the dosage was split to 0.5u twice daily. Ever since then, however, Lucky's numbers seem to be climbing unexpectedly higher each week (425 at highest). I don't really understand it, since Lucky was still effectively getting 1 whole unit of insulin each day. The vet recommended increasing his dosage for his evening shot, such that now he's getting 0.5u in the morning and 1u in the evening... but now his numbers still continue to climb steadily and consistently into the danger zone (usually the high 200's-low 300's, 439 at highest).

I don't really understand what's happening, and I've been trying to figure out what could be causing this unexpected BG increase. Around the time his numbers started climbing, the Lantus pen expired and I changed to a new one, so maybe the new Lantus pen is bad? I also increased his food servings around that time (he went from approx. 1 3/4 can to 2 1/3 cans daily, and now he's on 3 cans daily), is it possible that increasing his food amount could be affecting his numbers? I'm so confused and new to this, I don't know what I should do, and any help or guidance would be greatly appreciated. Thank you all so much!
 
Question: Is the canned food you're feeding and any treats Lucky is given low carb?

Your vet definitely started Lucky way too high and doesn't seem to understand how lantus works. Lantus likes consistency with shot time and dose. It is not recommended to give different doses in the AM v PM except under very rare circumstances. In your ss I don't see any reason for doing that. I see no evidence that Lucky's numbers are any higher at night (in fact I see the opposite, it has been at night that Lucky has hit the blue zone), at any rate Lantus operates in such a way that the effects of what you shoot this cycle aren't necessarily felt until the cycle/s following.

What is happening with Lucky is that he is hitting lower numbers than he's used to (the blue numbers) and then he's bouncing because his body isn't used to those lower numbers any more and his liver reacts by releasing a form of stored glucose and hormones that flood the system and cause those high numbers. Bounces can last up to 72 hours.
For example on the PM cycle of 3/24 Lucky hit the blue floor and then bounced up to red, the same thing occured on the 3/27 PM cycle and it is most likely this would have happened irrespective of the increase to 1U in that cycle because of the way that lantus operates. Chances are that Lucky hit the blue numbers again on the AM cycle of 3/29 but you have not caught that number - again a bounce to red follows.

As Lucky's body gets used to being in low numbers again and his liver realises that lower numbers like that are not an emergency the bouncing will reduce and the cycle become flatter. Patience is required in using lantus.

We do not increase the dose during a bounce because of the possibility of overdosing the cat when the bounce finishes. I do not think it was the right move to increase the PM dose to 1U. I would revert to the 0.5U AM and PM for a little longer, it may be that Lucky will require a little more juice but I don't think the timing was right to increase. If/when it is time to increase we would recommend an increase of only 0.25U at a time in both cycles concurrently. If you start posting your numbers here regularly (most post daily) then we will get to know you and Lucky and be able to help you with all your dosing questions (you can still ask questions ad lib of course but I think you get the best advice when people get to know your cat better). Based on the actions of your vet to date I do not recommend that you trust them with the dosing recommendations for Lucky.

Others will be along to share their views :smile:
 
Good morning and welcome again!

You are definitely in the right place for assistance! :-D :-D The first question I have is, what syringes are you using? I see that you got your insulin from Walmart... are you using their Relion syringes as well? In particular, I am wondering if you're using syringes with 1/2 unit markings, as I suspect that you will be dosing in quarter units or even drops of insulin in the near future (you'd be shocked at how much difference even a single, small drop of Lantus can make in our kitties' BG #s!). Also, are you using a human glucometer or the AlphaTrak that is designed for pets?

I suspect that part of the problem that you're seeing is that you are shooting different doses for morning/evening. Lantus works optimally when it has consistency. It works by building up a depot or "shed" of insulin under the skin... think about it as every time you give Lucky a shot, he takes his insulin out to store it in a shed in the backyard where he then continuously gets what he needs throughout the day. If the shed is too full, you get numbers that are too low, if the shed doesn't have enough, you get numbers that are too high. I think the numbers on your spreadsheet suggest that Lucky's needed dose is likely less than 1u twice daily (BID) but is more than 0.5u BID. Unfortunately, trying to split the difference as you are is making it hard for Lucky to get to that place of stable consistency because Lantus has a cumulative effect, so you don't see the results of changes in the dose right away... it can take a few cycles.

I recommend talking to your vet about splitting the difference and shooting 0.75u BID. You will need syringes that have half-unit markings in order to do this. If yours are marked only in full units, the Relion syringes from Walmart will work for you. 31 gauge, 3/10cc, 5/16" needle are the ones you need. There are two ways to go about measuring such a dose... the easy (and potentially less precise way) it to get the mark halfway between the 0.5u and 1u lines. The other way takes some practice and measuring. Fill the syringe to 0.5u, and then gently twist the plunger as you very slowly push up. Count the drops of insulin in 0.5u (making sure the drops you are counting are uniform in size). If you count 4 drops, then to measure 0.75u, you would fill the syringe to 1u and then dial back two drops. I would go with option B, because I do suspect you will be making dose changes in drops in the near future anyway. One key to getting Lucky's dosing to a consistent place will be making sure that you don't have any air bubbles in the syringe... when you're dealing with such a small amount of insulin, even a small air bubble can mean a large variance in dose from shot to shot. Fill your syringe with 2u or so of insulin. With the needle pointing upward, tap the barrel of the syringe to get all the air up by the needle. Then draw in a bit of air so that the bubbles and the air all join together. Then slowly twist the plunger until you've expelled the air and arrive at the desired dose.

Others should be along soon with their thoughts as well. Please continue to ask questions... and know that you're doing a great job!
 
Welcome! I think we met on the Health board as well! No dosing advice from me, but I think you'll find if you settle on a consistent dose you will start to see improvement. I think most kitties start at 1u twice a day, and Serryn is right--we usually use the same dose twice a day. I've found that even though my vet got us started out on the right track and is actually a really good vet, some of the people here in Lantus Land know way more! My vet has been really concerned with Simon's numbers being below 60, but 60 is actually a good blood glucose (my non diabetic cat tests in the 60s every time). The protocol we use has 50 as the trigger for a dose reduction for a newly diagnosed cat like yours.

From what I understand, most vets use equipment that runs higher, often 30 points, and this can cause them to think our home readings are too low. Just last week my vet told me to take Simon off insulin, but I really don't think he's ready. This was based on a "good" fructosamine of 197, but his BG is s till too high at most of his AMPS checks. So we soldier on!

If you look at this paper, you can see a footnote on p. 271 that mentions adding 30 points to the targets if using a veterinary meter. Maybe that will help vet understand the discrepancy--but don't be afraid to take the advice here because I think people are very careful and very knowledgeable!


And the same thing presented in another format (this one has two separate charts with the protocol for vet/human meters)
Queensland protocol
 

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Welcome to Lantus Land!!

Lucky certainly was lucky to have decided that you were going to be his bean and thank you for deciding to take the leap of faith to care for his diabetes!

I suspect there may be a few explanations for his numbers.
  • It sounds like you and your vet recognized that Lucky's initial Lantus dose was too high. When this happens, it's almost like a "shock" to the system and numbers drop. For some cats, when numbers go into lower ranges like this, the blood glucose (BG) levels may stay in that blue and green range or you cat may have been very sensitive to the effect of insulin for a few cycles.
  • The doses were changed in relatively large amounts. If you've had a chance to look at the Tight Regulation Protocol sticky, you'll note that based on this protocol, in most cases, doses are changed in 0.25u increments. So, while Lucky may have been getting too much insulin initially, he's not getting enough insulin now.
  • The unequal dosing (0.5u in the AM and 1.0u in the PM) is likely contributing to the problem. Lantus is a long-acting, depot-type of medication. Lantus does best when doses are consistent -- the same amount twice a day. Because the insulin depot is most effective when there's a "steady state," if you give a different dose each time you shoot, the depot is in a constant state of flux. This can result in wonky numbers. Again, if you look at the protocol, you'll see that doses are allowed to stabilize for a 3 day period before the effect of the dose is evaluated (unless it's clearly too much insulin and numbers drop below 50 which would warrant a dose reduction).

What I would suggest is to give the same dose twice a day. Since you're giving a total of 1.5u per day, I would split that in half and give 0.75u twice a day.

Did anyone happen to mention ketone testing to you? This is something you can do at home and given that Lucky was diagnosed with DKA, it is a great precaution. You can purchase Ketostix at any pharmacy. These are a plastic strip with a test square at the end of the stick. You dip the end with the test square into Lucky's urine stream and then wait 15 sec. You then compare the color of the test square to the guide on the container. You want to make sure that ketones are "trace" or lower. Many of us have cats that have survived DKA and this is an inexpensive means of prevention that, as you experienced, can save you thousands of dollars.

I've linked a couple of the starred, sticky notes that are at the top of the Board, You may want to take a few minutes to review the information in all of the notes. Frankly, there's an overwhelming amount of information in those notes and the included links. It's evident that you've already done a lot of reading. Please let us know how we can help and what questions you may have. The people here are incredibly generous with their time and their information so let us know what we can do. I hope you'll continue to post on a regular basis.
ketostix
 
Hi!! Welcome to Lantus Land...Lantus is an insulin that works best when given twice daily at 12 hour intervals..The starting dose is usually figured by the cat's weight, but generally 1U is a beginner dose--
Your kitty has responded to this insulin, which is good-- A lot of fine tuning is needed to find the right dose--
You want your kitty to ultimately be between 60-120 bg which are normal numbers....
Sounds like he is sensitive to insulin, which is great, as maybe there will be a chance in the future for he/she to function without it!! But for now, Be Consistant, Be patient, be observant..
Home testing is the ultimate way we can manage our cat's numbers & by testing & recording, we see a pattern emerging!
The High numbers you are seeing are called a bounce, means when the cat's blood sugar gets too low, the cat's liver responds by spilling glucose into the bloodstream as a protective response to the low numbers--
It is Normal for this to occur, so dont be alarmed, most bounces clear within 72 hours...
Please start to be a member here-POst the date /cat's name, and the hour & number your cat tested at during the day--From this we can see the pattern of where he is going that day & evening...
Please Read the Stickys at the top of the page, they are filled with good info you need to know--
Ask questions, be vigilant, and your kitty will get better--Welcome AGAIN TO LANTUS--WE WILL HELP YOU=
Not to worry!
 
Welcome to Lantus Land!

Wow! You got some very excellent advice from very experienced people so I would definitely bookmark this page (I am doing that now for me!) so that you can refer to it over and over.

No new advice from me because what you have already is spot on!

Just wanted to say "Welcome to the group!" :mrgreen:
 
Hi guys .. so glad to see you here and that you've gotten so much advice already! It's a lot to take in so bookmarking this info is a really good idea .. I hope you find all the answers you are looking for here and make yourself at home with us! Have a great weekend!
 
hi - welcome from me & punkin too. you've gotten great information - and we all understand all of it can be overwhelming. good job learning the testing and getting a spreadsheet going.

in answer to your question about food - yes, absolutely, increasing the volume of food can make the BG numbers rise. there is a direct relationship between the food/carbs consumed and the amount of insulin needed. if you can settle in on the amount of food that you think is needed, then we can help you tinker with the dose to get it in a good balance.

you want lucky to eat enough that he is at a normal, healthy weight. many cats lose weight before their diagnosis is made when the diabetes is untreated. if he's too skinny, we'd want him to regain what he needs. if he's overweight, it will help him to lose weight, but it needs to be done very slowly. cats can't tolerate rapid weight loss. if he's healthy, you feed him enough to hold his weight still.

keep posting, keep asking questions, and you'll find that you'll get fairly quick responses here. we'll do all we can to help you!

eta - punkin is an orange maine coon too! he weighs about 13lbs and eats about 10-11oz of fancy feast classics each day.
 
Thank you all so very much for your replies, I can't begin to thank you all enough! It definitely gives me hope that Lucky can get back to more normal numbers soon.

Vyktors Mum said:
Question: Is the canned food you're feeding and any treats Lucky is given low carb?
Click to expand...
Right now Lucky is getting 3 cans daily of Fancy Feast Classics (low carb), and no treats.

Also, thank you so much for the thorough and detailed advice in your post! Our vet doesn't seem aware of all the recent advances in Lantus dosage information, and reading your thoughts and that of others really helps to shine light on our blind-spots. I suggested the Simogyi effect to our vet, but she wasn't so sure that was causing Lucky's strange numbers. Based on everyone's advice here I've changed the dosage to 0.75u twice daily to maintain consistency without going too low or too high. I will definitely try to be more patient as you suggested, and hopefully Lucky's numbers will start decreasing soon.

Christie & Willie said:
The first question I have is, what syringes are you using? I see that you got your insulin from Walmart... are you using their Relion syringes as well? In particular, I am wondering if you're using syringes with 1/2 unit markings, as I suspect that you will be dosing in quarter units or even drops of insulin in the near future (you'd be shocked at how much difference even a single, small drop of Lantus can make in our kitties' BG #s!). Also, are you using a human glucometer or the AlphaTrak that is designed for pets?
Click to expand...
I'm currently using ReliOn syringes, a ReliOn glucometer and ReliOn testing strips. The syringes are 31 gauge, 3/10cc, 5/16" needles.

Also, thank you so much for all the recommendations in your post, I am now following the approach you described for filling the syringe, and have also modified the dosage for consistency.

@kimandsimon - Thanks so much for the journal article, knowing the difference between veterinary and human-based glucometers is indispensable!

@SienneandGabby - Thank you for your insight, the informative links and dosage recommendation! :D I'm definitely thinking of buying Ketostix too, and will probably pass by Walgreens tomorrow to pick some up.

@RoniandMoore - Thanks for all the advice, guidance and information! Consistency, patience and observation especially sound like very sagely advice.

@julieandpunkin - Thank you so much for the diet info, it's very useful to know how food changes can affect a cats BG numbers. It's also a relief to hear the weight and feeding numbers for your maine coon Punkin are about the same as Lucky's. I'm also feeding Lucky the same brand of food in the same amount you are, so it's great to know Lucky's on a good diet.

Everyone, thank you all so much for your kindness, your encouragement and your considerateness! His numbers are still leaning high but I hope Lucky will get back on track soon enough, I'll start posting his numbers on this board soon like everyone else. Thanks again!
 
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