? High numbers after it seemed like I had Billy semi-regulated? Help please

[Kiara]

Hey guys...
I would feel stupid telling my friends or family this but I know you will understand. I'm in tears right now. I've been working so hard to make sure Billy is on the path to wellness and this feels like such a setback. I know it's nothing I have done, but it still feels that way.

The past few days, his numbers have crept back up. I don't know what has happened. Here's the gist of it.

-I had him basically between the high 50s and 175ish for about a month

-All of a sudden we got a few days of 300s and now we're in the 200s. The insulin doesn't even really seem to bring him down. Midcycle tests are just a bit lower than pre-shot

-he was squinting a bit in one eye, with a little mucous. This was Friday. I gave him some antibiotic eyedrops just in case.

-he had a hairball yesterday. He has only vomited a few times in his life and never had hairballs. He vomited up hair in the morning.
Here's a video of him hacking (luckily this only went on for a couple minutes).

I would have rushed him to the vet but my mum said it was probably more fur he was trying to cough up, which is good because I'm just about to finish paying off my credit card from when he was diagnosed in September... God, I want to cry again. I went to the store and got some pumpkin and petroleum jelly. I put a little jelly on his nose and a teaspoon of pumpkin stirred in to his food (he managed to kind of eat around the pumpkin so I'm not sure how much he swallowed).

I thought his Lantus might be bad from a little bubble floating in it, so I pitched it today and started a new vial, exp is the same, Sept 2017, and it's always been in the door of my fridge.

Does anyone know what could be causing my poor little guy to have higher numbers? Behaviour is fine. He is active and exploring the house.

I budget about $500 each for the cat and the dog per year for the vet and that is clearly not enough for Billy. I spent almost $2000 on the cat getting misdiagnosed for diabetes and then the vet guessing at some allergies. I can't bear the financial stress again, but I also can't live with him not being well. I don't want to miss something and have this get worse.

As always, your suggestions are SO appreciated. So much love to everyone. I hope I don't seem like I'm overreacting. Last Christmas he was down from 18lbs to 9lbs and not eating, and the vet told me to put him down at age 9. don't want to see him sick ever again.

 

[Kiara]

I keep going through other poster's charts, wondering if I am overreacting a bit, and I think I am... do higher numbers just happen sometimes?

With how fragile his health was at one point, I want to make sure this isn't the start of something bad.

 

[Chris & China (GA)]

The thing I see first is that you keep changing his dose...Lantus works best when it's given at the same dose both AM and PM

Each time you change the dose, the depot is "disturbed" and so you start to see wonky numbers.

Remember, Lantus dosing is based on the nadir, not the PS, so you don't want to change the dose only based on PS numbers.

Today's higher numbers are probably a bit of a "bounce" from that 54 last night. I would have strongly suggested you get another test in after that since he could have gone even lower on that cycle

I'd probably go back to the 1.75U dose and hold it for at least 3 days (6 cycles) unless he drops below 50 and then see how he's doing.

 

[Kiara]

@Chris & China Thank you for the response. My plan was to hold steady at 1.75 but I can't seem to bring myself to shoot that when he's around 100-110, which he often is at PMPS.

What would you suggest I shoot for those kinds of days? When should I actually reduce a dose?

 

[Kiara]

@Chris & China I missed an update, he went from 3.0 mmol at +3 to 3.9 mmo/l at +4, but I have found his cycle is weird and has two dips, one at +3 and one at +6 or +7...

 

[Chris & China (GA)]

What would you suggest I shoot for those kinds of days? When should I actually reduce a dose?

One of the sayings around here is "Shoot low to stay low"....that means learning to shoot those lower PS numbers!! As long as you have plenty of supplies (HC food, Karo/honey or syrup, and plenty of strips) and can test as long as you need to overnight, it's really best to go ahead and shoot the "scheduled" dose

If he's below 150, we'll suggest you stall, don't feed and post for help....the first few times you shoot a lower number, we like to have someone with experience watching over you....gradually you will learn how Billy responds and then maybe next time you'll shoot when he's at 125....then 100....until you're comfortable enough with shooting anything over 50!

If he drops below 50, that will earn him a reduction in dose. Each time you reduce by .25

 

[Melanie and Smokey]

As Chris & China said, you really do need to get a more steady dose. There is no way to get steady numbers on Lantus without getting a steady dose. The 0.75 and then a chain of the 1.75 could have depleted your depot enough that you are seeing the effects now in higher numbers.

With symptoms of illness you describe, I think a vet visit might be in order to rule out infection. Infections that pop those BGs into higher numbers out of the blue very easily. Getting the infection cleared up as quickly as possible would help get the BGs straightened out.

Also, check your eyedrops and make sure they are ones that don't include a steroid.

 

[Critter Mom]

Aw ... poor wee thing ... ((((((Billy)))))) And he's such a dotey little fella.

Here are some for you, Kiara. Caring for diabetic kitties can be a bit of a roller coaster ride at times. Many of us here have done our fair share of blubbing while caring for our little ones.

All sorts of things can send BG numbers awry. Infections are a common offender.

Do you have ketone test strips at home? (You can get ketostix/keto-diastix urine test strips at pharmacies.). With a potential infection in the mix it is even more important to keep an eye on ketone status. With Christmas only a couple of days away, I would very much recommend that you contact your vets (maybe a phone call?) to let them know how Billy's doing.



Mogs
.

 

[Kiara]

@Chris & China I've twice looked for help around 6pm EST but it seems like it's a really busy time on the boards and I don't usually get a reply until a couple hours later. Lots of folks looking for dosing help at the same time I was

With that being said, if he is below 150, do I adjust the dose or give the same? And at what point would you suggest I actually lower the dose? 120-ish? I know ECID and we need more data on Billy. I'm thinking the first few times, I approach more cautiously and test lots, but I suppose in the past I've been TOO cautious changing doses too often and causing bounces.

 

[Kiara]

@Critter Mom I do have ketostix. I test whenever he is over 250, and so far have never had a positive. I don't know how I worked myself in to such a tizzy last night, but I was so terrified of something going wrong. I woke up today with much more sunshine in my heart, and Billy is throwing me blues again so, of course, that helps. Thanks for writing

 

[Julia & Bandit (GA)]

@Chris & China I've twice looked for help around 6pm EST but it seems like it's a really busy time on the boards and I don't usually get a reply until a couple hours later. Lots of folks looking for dosing help at the same time I was

With that being said, if he is below 150, do I adjust the dose or give the same? And at what point would you suggest I actually lower the dose? 120-ish? I know ECID and we need more data on Billy. I'm thinking the first few times, I approach more cautiously and test lots, but I suppose in the past I've been TOO cautious changing doses too often and causing bounces.

Hello Kiara!

If he's below 150, keep giving the same dose unless he drops below 50 at any point in the cycles. Lantus works best with consistency, so the longer you can hold a dose steady, the better.

You would lower the dose by .25u if he drops below 50 at any point in the cycles, or if all of his numbers in both cycles stay within a normal range (50-120) for 7 or more days.

If you get a preshot that is less than 100, I would post to the Lantus forum for advice. There are a few options in that situation, and you may also reduce the dose at that time depending on how his numbers look after you are able to test him again.

 

[Critter Mom]

Hi Kiara,

I think tizzes go with the territory! I'm glad things are brighter today.

For future reference, if there's any possibility of a kitty having an infection it's no harm to test for ketones to be on the safe side. Ketones can occur at lower numbers, too.


Mogs
.

 

[Chris & China (GA)]

I've twice looked for help around 6pm EST but it seems like it's a really busy time on the boards and I don't usually get a reply until a couple hours later. Lots of folks looking for dosing help at the same time I was

The vast majority of the time we're going to tell you that if you have plenty of supplies and can test as much as necessary, to go ahead and shoot the scheduled dose.....then to get a +1 and +2 so if you need to intervene, you can do it early

The only way to gain the confidence to shoot those lower numbers is to start doing it and then seeing how Billy responds! The one thing to remember is that as long as you're home testing, YOU are in charge of his blood glucose!! If he drops too low (under 50) you just get out the high carb food or Karo/honey/syrup and bring him up!!

Next time you get a Pre-shot you're not sure about, go ahead and post (don't feed!!) Make sure your subject line is very clear that you're looking for help....something like "STALLING...NEED HELP!!" will usually catch someone's eye

You can also use the 911 prefix if you're concerned he's dropping too low! We all watch for those! Then when someone is helping you, you can remove the 911!

I agree you should start posting over on the Lantus forum....you'll get the most experienced Lantus users watching out for you there and it's a pretty active forum. You'll also learn a lot just by reading other people's posts and seeing how well their cats do when they shoot low!

 

[BJM]

There are 2 sets of guidelines we have for using Lantus - Start Low, Go Slow and Tight Regulation. These are described at the top of the Lantus forum in the sticky posts.
With both of them, you use a steady dose as it can take 5-7 days for the initial dose to stabilize and 3-5 days after that. They have different criteria fow when you reduce a dose, based on how much testing you can do, plus whether or not you are able to feed low carb canned food. (If not, you use the Start Low, Go Slow method).