I need help with Lantus. It just does not seem to work like it should!

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MOS

Member Since 2014
My girl has never had a hypo event. They had her up to 4 units at one time and her BGs just went up with the dose! More insulin equaled higher BGs. That's when I knew something was wrong. We started low again and she did better but never nothing like tight regulation. She does best below 1 unit, but still not great. I have worn the less than 1 unit values out trying to get her better #s but nothing works. Especially the nightly dose! Her am #s are always high. A dose adjustment will seem like it's going to work better but that only lasts about a day, then we go back to high 200s. We were doing the best ever for a while at .8 am shot and .3ish dose at night early in December but that stopped abruptly on 12/27 for no apparent reason. Nothing had changed. A similar event happened the previous month as well. One unit will seem to work good for a day, but it doesn't last. If I try to hold around 1 unit for a while, the BGs start creeping up and the pees start getting bigger. I'm so confused. I would appreciate any suggestions. I think I should just start over again at .5 units and try to hold that for 5 days. I don't know what else to do? Should I try a different insulin? I'm trying to attach spreadsheet.....
 
Brainstorming here. I notice that you mention that there was a monthly element to the differences. Some cats are very sensitive to moon phases. Maybe you could look to see if there's any correlation between a particular moon phase and the pattern of BG values?
 
Thank you! Well, it's so weird.... I can't get it back this time. Does my spreadsheet link work? I couldn't name it... :|
 
Good! I wanted to try to hurry and get it up there in case you guys had any ideas. As you guys can see last night...more lantus than night before increased her am BG. I tried less tonight because her pees were also heavier today. :(
 
I'm too inexperienced to give you any dosing advice, but if you go over to the Lantus and Levemir forum, there are a several sticks there with good information that will really help you understand how Lantus works and what the protocols are for dosing it. Be sure to read the one that explains that Lantus is a depot insulin. That info is priceless!
 
Marycatmom said:
if you go over to the Lantus and Levemir forum, there are a several sticks there with good information that will really help you understand how Lantus works and what the protocols are for dosing it. Be sure to read the one that explains that Lantus is a depot insulin. That info is priceless!
Click to expand...

MOS, the advice given above by Marycatmom is well worth looking into. Sorry, but I am also not experienced in giving dosing advice. My little sugar girl is on ProZinc and I am still struggling with dosing that particular insulin. Hopefully, someone with good experience and additional advice will be along soon to help you out. Best wishes to you and your sweet girl.
 
What's that thing called the Somogyi effect? Could that be happening here?

Is it the same thing as the blood sugar "bounce" that happens when the cat's body is used to having high BG numbers so reacts in the opposite to expected way to the insulin as the BG lowers?
 
Let's see if we can get you back on track and get Moody's BG levels under better control.

I see a couple of things.

1. Lantus, being a depot insulin, is best dosed consistently both AM and PM cycles. To help you understand this a bit more, I think one of the better STICKIES for you to read right now, is the one on the Insulin Depot which can be found in the ISG for Lantus (glargine)/Lemimir(detimir) forum. Here is a link to that article.
LANTUS & LEVEMIR - WHAT IS THE INSULIN DEPOT?

You need to try to give the same dose both AM and PM.

2. It appears to me that you have been basing the dose on the pre-shot BG readings. Is that what you have been doing?

Lantus dose changes are based on the nadirs or lows in the 12 hour cycle. We don't know what your daily schedule is like, but if you can try to get some mid-cycle tests in the +4 to +8 hour time frame, that would help to give us some clues to what is going on. That may only be possible for you on days off, or by setting an alarm at night to get some tests.

3. What food are you feeding? Be as specific as you can, brand, flavors, style of food (dry or wet; pate, grilled, sliced). Do you know the carb content of the food you are feeding?

4. When do you feed?

5. When do you test in relation to when food is given? For example, are those pre-shot tests taken before or after you feed? Is food taken up at least 2 hours prior to those pre-shot tests?

We do need some more clues, to help us determine what changes may be appropriate for Moody.
 
I used to think that maybe it was Somogyi, but I've never seen a low sugar number. It seems to me like it's a constant battle with the "bounce." Could she still be in bounce mode after 5 months!? If so, what's the best way to battle it!? So far it has not ever been possible to get her sugar to drop very much. More lantus just raises it. The tiny dosages help the most, but they are unpredictable and I worry they don't help enough. Especially lately, we can't seem to depart from the high 200s. :( One unit seems to work best if her sugar is right at 300. If it's less to begin with, then 1u doesn't help as much. Then there seems like there should be a better dose somewhere around there, but I can't find it. I feel like I should leave it alone and let the depot settle. But, she starts feeling bad or peeing more after about 3 days. Should I start over at .5 for 5?
 
Cats bounce until they don't. I think Cassie over in the Prozinc forum bounced for 2+ years.

To see if it is bouncing, you really need to get some tests in the middle of the cycle to see when the nadirs or lows are.

You need to consistently dose the same amount AM and PM cycle so you don't keep draining and refilling the depot.

Please see my previous response two posts up, with that link to the Sticky on the Insulin Depot.
 
She eats fancy feast classic pate; the low carb ones. She likes the chunky turkey and chicken. This all started with her being extremely hungry! Even before the diabetes showed up, she started acting like she was starving all the time and got overweight in a season! She still acts like shes starving, even with slightly better numbers. She wants to eat at least every two hours, and she acts like she's not seen a bite in days every time! It doesn't matter if I feed her a whole can, she still wants more in 2 hours. So, I take two ff cans - 6 ounces and spread it out over the course of a day. Sometimes we go over a little. She's a small framed cat and she has a round belly, she got up to almost 13lbs. But she's probably 11+ now. I even set the clock and feed her once at 1 or 2 in the morning. If I don't she can't rest, she bugs me till I get up and feed her. I worry so much about her, I hate that she feels so hungry all the time. As soon as she eats, I take her preshot. That stems from when this started, she was sick with pancreatitus and they wanted to be sure she ate before I gave a shot. But I do it as soon as she finishes. She hasn't had any food within 4 hours of the am preshot. But, the pm, its been within 2 hours.
 
You really need to test first, then feed.

Unless she gobbles her food down in <2 minutes like my civies Dancer and Monet, testing AFTER you have fed could be skewing those BG readings.

I checked Dr. Lisa Pierson's food chart. The Fancy Feast chunky foods are 5-7% carbs. Good for a diabetic cat, and under our suggested 10% carbs.
 
An even more basic question for you.

You list the pre-shots on your SS. But when is the actual shot given in relation to your taking those tests? Within 15 minutes? 1 hour later? 2 hours later? some other time frame?
 
Oh, she woofs it down in 2 minutes or less easy. It could not have time to show up! She eat, then I check and then I give her shot. One right after the other. No wait in between!
 
Ok, so it does sound like you feed, test, shoot all in a 10-15 minute time frame. That may be ok.

Still, when kitties here are trending too low, headed to hypoglycemia territory, and we need to bring the BG levels up quickly, we can easily have a food influence reflected in their BG levels in 10-15 minutes. It's why we recommend test, then feed, then shoot.

You say she is starving all the time, but is a bit on the chunky side. Usually, uncontrolled feline diabetics are losing weight, not gaining weight.

Have you had her thyroid levels checked recently?

Is she currently on medication for the Pancreatitis? When was her last pancreatitis episode? Is she showing any of those pancreatitis symptoms now?

When was her last dental? A hidden dental infection or inflammation can keep numbers higher.

Are you able to follow the Tight Regulation protocol?

Have you read that Sticky I pointed you to about the Insulin Depot?
 
She was diagnosed with pancreatitis when I first took her to the vet but she wasn't showing symptoms other than those related to diabetes. She was extremely thirsty and tired. She got sick and wouldn't eat for a couple of days back in September; they didn't know if that was related to the pancreatitis or not. They just treated it like it was with cerenia and fluids. Other than that her appetite has remained excessive. I tried the tight regulation at first but I can't get her sugar below the high 100s. It will only go so low, then the next increase in insulin will just cause higher BGs instead of lower. Sometimes her nadir seems like its around +3 and then sometimes it seems it's late like +11. She hasn't had a dental in a few years. But the vet looks at her teeth and gums every time we go in. Maybe that's not enough? She has never lost weight, only gained with the diabetes. She lost a little weight right before her diabetes diagnosis. I was working on cutting back on dry and introducing wet and counting ounces because her belly was getting so round. We were working on her loosing weight when the diabetes symptoms started. I read everything when she was first diagnosed. I'm re-reading all the Lantus information now. I guess I could test first just in case. I figured since I tested as soon as it hit the stomach, it wouldn't have time to affect the blood sugar but maybe it could? She's just always so hungry, if I don't feed her first, she won't hold still for the test. She'll lay still if the belly is fed. I'm working on her depot now. I'm being consistent with am and pm dose of 0.75 U. When I give that a few days to stabilize, I'll start doing curves and looking for the nadir again.
 
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Insulin type as well as insulin dose changes take days to level off...get stable. Don't change things too frequently or you will always be on a roller-coaster ride. Good luck from Jane and Stewey
 
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