High glucose,on 5U Lantus

Status
Not open for further replies.
R

Riley and me

Member Since 2014
Hi, My sweet boy Riley and I are new to this but I am just beside myself today. I really could use some help and support. We've been at this since before Christmas
and thought we had settled at a dose of 5U, followed by possible rebound, followed by cutting back to 4U, followed by regression. Increase to 4.5U showed some stability but the numbers post dose were between 11-15 with predose values being in the 20-21 range. These values are in mmol/L as we are in Canada. I believe the conversion is to multiply by 18 to get mg/dl. This morning Riley's glucose was 26.6 and his value at 6 hours post dose was 22.1 which did not move very much at all. He is lethargic, poor appetite, he's not even interested in water, which is unusual at these high glucose levels. Anybody out there that can relate and better
still can give me advice.
 
You are testing; good.

If he's too high, you need to get him down. Sustained high levels may be associated with diabetic ketoacidosis (DKA) and death.

Can you take him to a emergency vet now? He may be in DKA now.
 
Thank you for replying so quickly. He is not in DKA as he shows no ketones in his urine. I just measured his predose and he was at 19.4 so I gave him his evening dose. I know we're close to the right dose but I want to know if people have experienced this yo yo between 0.5 of a dose where it seems 4.5 is not enough and 5 is possibly too much.
 
It can happen. It is more likely if something else is going on that alters appetite, or causes vomiting, or diarrhea or if you're using an inappropriate insulin for a cat.

What are you feeding, how much, and how often?

What meter are you using?

What insulin and how old is it?
 
Riley gets about 4.5 oz of wet food and about 1/3 of a cup of Evo dry food. The wet food is either Whiskas or Fancy Feast chicken which according to the wet food tables have about 5% carb content. The EVO has 7% carb content. He is currently drinking about 10 oz of water a day, which is down from a few weeks ago. He gets
wet food 1.5 oz 3 times a day and free feeds on the dry.
 
I have an Alpha Trak 2 meter for cats and dogs. The Lantus is in the fridge, show no crystals or cloudiness and is about 2 months old. I understand it can last up to 6 months if kept refridgerated.
 
Are you using the Cat Info tables? Dr Pierson of Cat Info has a wonderful list of most North American canned foods with the percent calories from carbohydrates, fat, and protein. Ideally, staying below 10 % calories from carbohydrates may smooth out glucose curves. The Evo is about 7-8%.

The Alphatrak is a good, albeit expensive meter.

Lantus is a good insulin. Are you using pen needles, or a syringe? We find a syringe allows more specific dosing, even eyeballing quarter unit increments.

And, you could have a high dose kitty with a intermittent problem.
 
How are his teeth?

Is he having any trouble urinating? Urinating a lot?

He may be ill from something unrelated to the diabetes.

I really, really, would take him to the vet.
He is lethargic, poor appetite, he's not even interested in water, which is unusual at these high glucose levels.
Click to expand...
 
Teeth are okay, no nitrites or blood in urine. I spoke with the vet yesterday with the run down on everything.He suggested an evening dose of 4U and a day dose of 5U. I followed this advice and was suprised at the high predose this am. It's a long weekend in Canada so he's not available til next week. I am using the cat info tables for nutrition info.His blood work did not show any thyroid or pancreatitis or UTI, but I will investigate these things again next week.
 
We often eyeball dose adjustments of 0.25 units; some folks even use calipers for consistency.

Lantus works best with consistent am and pm dosing, as close to 12 hours apart as possible. We've got a Tight Regulation protocol, based on a research study, that has had good success getting kitties stable and in some cases, off insulin.

What glucose levels are you aiming to reach? What is your no shot number where you don't give a shot?
 
Hello and welcome from a fellow Canadian. What Lantus dose did Riley start on and how did the vet decide to take his dose up to 5U? Also, how much does Riley weigh? We have a weight based formula we use for determining the starting dose, then we increment by either .25 or .5U increments, depending on the nadirs the cat is seeing. Just wondering if there's a change he is overdose, which can sometimes also cause high numbers.

Also, Lantus likes consistency as it's a depot insulin. Using a different dose at night from the daytime is a strategy for short lasting insulins like Caninsulin, which is what is often what vets suggest for cats, but is old school. We started on Caninsulin but switched to Lantus.

BTW: great job on doing the home testing!
 
That's still a good amount of water. My cats drink zero water on wet food. When I was feeding them Evo they starting drinking a good bit. How you do feel about cutting his dry food further, at some point even none? That could help even though Evo is pretty low carb for being dry.
 
Riley started out at 1U twice a day and went up 0.5 U every 3-4 days until he reached 5U. At 5U I saw his first value below the 20 mmol/L. All previous values were anywhere from 21-29 mmol/l. I did a glucose curve at 5U and his nadir was 4.6mmol/L which was scary although he did not display any symptoms of hypoglycemia.
Within 1/2 an hour of this reading he went up to 5.8 and continued on his way up for the rest of the curve. This is when the vet suggested cutting back to 4U. At 4U his numbers began to climb again and the thirst increased again along with the output. We then went to 4.5 and the curve at 4.5 showed numbers in the 11-15
range with the predose going back to 20. My vet then suggested 5U in am and 4U in pm as he eats far less during the night and he wanted to see better predose numbers. I have to say that I believe the magic number is 5U just by what I saw when he was on 5U. His appetite was normal, he was more energetic and his output was more regular. I think we shied away from that dose too quickly.
 
I know that wet food is the best but I do work shifts and when I'm gone I feel better leaving that for him as I know that once that wet food dries out he doesn't touch it. That's why I give him 1.5 oz at a time and he eats it up. Any more than that it will jsut sit there and get thrown out. Also, Riley was fed Whiskas dry for 12 years prior with no wet food, so his diet is much improved since his diagnosis. He is 13 years old, a very spry 13 until December 2013.
 
I have read the tight regulation protocol before and I found that it may difficult for me as I do work shifts. For the most part I am able to stick to the 12 hr dosing but there are times I have to shoot early or late depending on my upcoming shift.
 
Good, it sounds like your vet started at a good dose and increased systematically, although we'll increase by .25U increments if nadirs are below 16.7 (300). We don't want to bypass a good dose. We find a number of new people where the vet started the kitty out on way too high a dose. It could be that your kitty needs a dose somewhere between 4.5 and 5.0 units, but a nadir of 4.6 (83) is not too low. The TR protocol we use here does not suggest a reduction unless kitty goes below 2.8 (50). But vet are often nervous having cats lower than 5.6 (100) because so few if any of their clients do home blood testing. Getting the cat to spend as much time in normal numbers is the way to heal the pancreas and gives the best chance for remission.

Many people here add water to the wet food to make it soupier. As well as getting them to drink more water, the food will be fresher longer. Another trick is to add a bit of water to food and freeze it, making cat foodsicles that will thaw out over time. Or you can get an automated feeder with or without a cooling pack that can be set to go off during the day.

How early or late would you have to shoot based on your shifts?
 
Well Riley is a very spoiled cat. He likes his wet food with water added and then warmed up. If it cools off he's no longer interested.
If I am working days I am pretty consistent with 7:30 am and 7:30 pm dosing. When I have a 3-11 shift coming up and am off the weekend, i start giving the dose
an hour later each day so that by Monday, when I know his evening dose is going to be at 11:30 pm, I give the dose around 11 am. I know it's not ideal but it's just me so I can only do what I can do.
 
Status
Not open for further replies.
Back
Top