High Glucose Curve Readings, Help! :(

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Luckyducky

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Hi everyone, my cat's name is Lucky and he's on Lantus (using Solostar Pens and 31 gauge needles purchased at the Walmart pharmacy). I posted an introduction in the Health forum here (not sure if anyone remembers, but I'd like to say again that I'm so thankful for all your help). Well, after going through a few expensive trips to the vet for glucose curves, I recently started taking glucose curves at home using the Walmart ReliOn glucometers and testing strips. I'm encountering some worrisome values on a recent curve though, and was hoping you all might be able to help give some advice. It's much appreciated!

During Lucky's first week of home-testing (last week on Wednesday), I was administering 1 unit once a day in the morning (I rotate between injecting behind his left forearm, between his shoulders near the scruff, and behind his right forearm). He generally ate 1/4 can of wet food (Fancy Feast Classics) after every test. His 24-hour curve that week was the following:

6:40a.m. - 299 (1 unit insulin shot administered after test)
9:40a.m. - 208
12:40p.m. - 70
3:40p.m. - 45
6:40p.m. - 117
9:30p.m. - 165
1:00a.m. - 270
3:40a.m. - 266

I spoke with his vet, and because we were concerned about how low his numbers dipped from just the 1 unit, we decided to put Lucky on 0.5 units twice daily. Since he seemed to still be hungry after eating, we also decided to increase his food intake to 1/3 can of wet food (Fancy Feast Classics) after every test, which seemed to fill him up fairly well. After a week of putting Lucky on 0.5 units twice daily, I did another 24-hour glucose curve yesterday (a week after the first 24-hour curve), and the results were the following:

6:30a.m. - 284 (0.5 unit insulin shot administered after test)
9:30a.m. - 225
12:30p.m. - 187
3:35p.m. - 187
6:30p.m. - 347 (0.5 unit insulin shot administered after test)
9:35p.m. - 351
12:25a.m. - 353
3:30a.m. - 336
6:39a.m. - 333

I'm really confused about these numbers, and very worried that they're so high (and I can't understand why the second shot doesn't seem to have had any effect whatsoever). Worse yet, I just took a reading a few moments ago (6:30pm), and his BG number was 398. I have no idea what's going on. Could it be that the 0.5 unit dosage is insufficient? Could increasing his food intake from 1/4 to 1/3 of a can have caused such a dramatic change? Could his insulin have gone bad? Could he be experiencing the Somogyi effect? I have no clue what's wrong, or what to do in this situation.

Lucky does seem to have urinated more than usual yesterday, and he's been more restful than usual (previously, he was always energetically craving food). His vet was unfortunately out today and I won't be able to get in touch with her until tomorrow. Also, I just administered another 0.5 unit dose of insulin at 7:30 p.m. Central Time, using a new solostar pen just in case. Any help would be greatly appreciated, thank you all so much!

P.S. - I was thinking of posting this in the Lantus forum, but I haven't figured out all the terminology just yet.
 
first, let me clarify something, you shot one shot tonight at 7:30? or did you shoot one at 6:30 and then another one at 7:30? just want to make sure you did the first option, not the second as it kinda reads in a way that sounded like to me you gave 2 shots tonight.

next, how long has he been on the 1/2 unit twice a day?

and to be honest, those numbers aren't that high really for only being diagnosed a few weeks ago sooooo, be patient and let's see what others think about what's been done and what should be done going forward
 
Hi,

First I want to say how proud I am of you for getting all those BG checks!! That is awesome. One thing that will help is if you write them out regarding how many hours each check is after the shot.

So your first set would be
AMPS (AM preshot) 299
+3 208
+6 70
+9 45
+12 117
+15 165
+18.5 270
+21 266

We rarely do SID (one shot per day) 24 hour shot cycles, so normally you would have your second shot of the day in there and it would be called PMPS - PM preshot.

But that way you don't have to worry so much what time it is and concentrate on how much past the shot it is, as that's important to know.

That was excellent to lower to .5U and give shot twice daily.

After the first day's results on 1U, I would have expected the BGs to be lower today even though it's .5U so let's look at some possibilities.

Food can increase their BGs for sure, but going from 1/4 to 1/3 of a can is not much different.

He was on the 1U once a day for a week, is that correct? He may have had several days like the curve he had at the vet's and it may have caused a few BG raising hormones to be circulating in his body. There is a safety mechanism acting between the pancreas and liver which reacts to either low BG or rapidly falling BGs. Hormones are released to increase the BG and keep them from becoming hypoglycemic. The hormones are very strong and the effect can last 2 to 3 days, which can make it look like the insulin dose is not high enough.

Did you get the Lantus pens from a pharmacy? The Lantus is most likely fine. If kept in the refrigerator, it can last for several months.

The best thing to do at this point is remain at .5U for another day and see how he does tomorrow. He may need more insulin, but just because you are seeing 300s does not definitively mean he needs a higher dose.

Since it takes a few days for Lantus to show what it can do on a particular dose, it is best not to change the dose for at least 3 to 5 days.

Hope that answers some questions and helps you feel more at ease. You're doing great and I'm sorry you're not seeing immediate results. It takes quite a bit of patience, but you'll get him there.
 
Thanks so much for the replies Cindy+Mousie and Vicky&Gandalf, it's so relieving to hear from someone. Your encouragement in these difficult times really does help so much, thanks! :)

Cindy + Mousie said:
first, let me clarify something, you shot one shot tonight at 7:30? or did you shoot one at 6:30 and then another one at 7:30? just want to make sure you did the first option, not the second as it kinda reads in a way that sounded like to me you gave 2 shots tonight.

Sorry about the confusion, he got a 0.5 unit shot this morning at 6:30AM and another tonight at 7:30PM.

Cindy + Mousie said:
next, how long has he been on the 1/2 unit twice a day?

The dosage was changed last Thursday, so it's been about a week already that he's been getting insulin at this dosage. The BG curve was done yesterday.

Cindy + Mousie said:
and to be honest, those numbers aren't that high really for only being diagnosed a few weeks ago sooooo, be patient and let's see what others think about what's been done and what should be done going forward

I really hope it isn't as bad as I think! :( I heard that crossing 400 is entering the Danger Zone, so his BG levels crawling upwards to 398 gives me a chill, especially since it's climbing despite having received insulin. I'll definitely try to be patient, though, thanks.

Vicky & Gandalf (GA) said:
Did you get the Lantus pens from a pharmacy? The Lantus is most likely fine. If kept in the refrigerator, it can last for several months.

Yes, we got the Lantus from the local Walmart and have been keeping them in the fridge at the recommended temperature.

Vicky & Gandalf (GA) said:
The best thing to do at this point is remain at .5U for another day and see how he does tomorrow. He may need more insulin, but just because you are seeing 300s does not definitively mean he needs a higher dose.

Since it takes a few days for Lantus to show what it can do on a particular dose, it is best not to change the dose for at least 3 to 5 days.

I'm sorry that I missed mentioning in the original post, but Lucky's been on the .5U dosage already for a week (every time the dosage changes I wait about a week before doing another BG curve to reassess the dosage amounts with the vet). I'm thinking he should have adjusted to the .5U dosage by now... which is why the results of yesterday's glucose curve trouble me so much.

Thank you guys so much for sharing your insight and experience, it definitely helps to cast some light on this situation. I've updated the original post accordingly to avoid further confusions, if you have any other ideas about what might be happening please let me know. Thanks so much!
 
I hadn't heard of injecting into the forearm before. Question for the peanut gallery: does anyone else inject into forearms? I always injected Scout into a skin tent on her back.

Where did you inject for the curve that was all 330s?

Overall the numbers aren't terrible but you've got some work ahead of you. I'm not going to give dosing advice because I'm not familiar with Lantus. You mentioned that Lucky's been more restful. Is he playing, grooming, doing his normal routine? Can you get him to play if you initiate it? Sometimes how they feel is as important as the numbers.

Good luck and keep up the awesome work testing and taking care of your lucky kitty.

Lori
 
Lori&Scout said:
I hadn't heard of injecting into the forearm before. Question for the peanut gallery: does anyone else inject into forearms? I always injected Scout into a skin tent on her back.

I'm sorry for the confusion, actually, I'm not injecting into the forearm itself, but behind the forearm, on the side of the chest near the scruff. I was generally going by this injection site diagram that shows locations that are supposedly good for the injection (mainly, where it says "Side of Chest" and "Scruff"). I read somewhere that it's a good idea to rotate the injection locations, so at each shot I change the location (so I go from behind the left forearm, then at the next shot later in the day the scruff area near the shoulders, and then the next shot behind the right forearm, then the next starting all over again behind the left forearm).

I initially tried injections on Lucky's flank since I read somewhere that the absorption rate was better in that area, but he unfortunately seems very sensitive there and really disliked it, so I've tried to keep his shots close to the scruff since he doesn't seem to notice them nearly as much. Prior to the previously mentioned two curves I had gone through 3 separate curves at the veterinary hospital, and they based their curves off of insulin shots I had given at home. The results from those curves made sense though, so I'm thinking that the injection site likely isn't the culprit.

Lori&Scout said:
Where did you inject for the curve that was all 330s?

I injected behind the left forearm on the side of the chest near the scruff. Though now that I think about it, he has been sitting a bit awkwardly when eating recently, with his forearms bent and his body leaning in (I had started using bigger food bowls a week or so ago I think is why), so it's been a little more difficult to grab the tent than usual (maybe that has something to do with it?)
 
The numbers you got in the PM cycle could well be a bounce from lower numbers. It's great that you're getting curves but you also need to get pre-shot numbers before every shot and a mid cycle test. Then the lantus experts will then be able to help you out in respect of the dose and understanding what is happening. Here is the link to help you set up a spreadsheet to help us to help you: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130 I suggest you post in the tight regulation forum even if you're not following it as this has the most traffic (someone is there nearly all the time), just put in your subject line that you are a newbie and people will be along to help you out.
 
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