? Increased the dosage but BG is higher

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Sass

Sass

Member Since 2017
Hello! My cat was diagnosed a week ago, on the 15th. We started with Lantus immediatly and two days later also changed his diet - eating only raw now. At the vet's we were given the Lantus SoloStar pen. We injected 1 unit twice a day (nr 1 in the little window - is it 1 unit?) for a week, then we were told to change to 2 units twice a day. So since Friday we have injected him 2 units twice a day. We have also checked his BG levels, usually before injection but today in every 3 hours. Since we increased the dosage, his BG has gone higher! Today, his AMPS was 24,1, +3 was 20,3 and now, +6 was 18. What should we do? Should we give him another injection? Increase the dosage that we give him twice a day? What could be the reason his BG has gone even higher? Last week, before increasing the dosage, his AMPS was usually under 23. He's also overweight (7,1 kg) and had/has an infection (got an antibiotics injection on the 15th, so it should be improving).
Thank you for any kind of advice - the whole thing is still completely overwhelming for us...
 
It's very likely that the 2 unit dose is too high and is causing a rebound reaction that raises the blood glucose to high numbers. We call it bouncing. The Lantus pens only allow dose changes in 1 unit increments I believe and we recommend much smaller increases of 0.25 units at a time. That's only possible using an insulin syringe and drawing insulin directly from the cartridge inside the pen. The cartridge acts like a mini vial.

Treating feline diabetes is very overwhelming because there's a lot to learn, new skills to acquire and adaptations needed to your own schedule. We can help you with all of this. Ask all your questions and the experienced people here will get you on track. :)
 
Thank you so much for a reply! At the moment, it all does feel like rocket science to me...

Yes, Lantus pen allows dose changes in 1 unit increments only. I'm not sure, though, that I'd be able to use a "normal" syringe on my cat - tried it two years ago when he was ill and it was quite impossible. The pen is much easier to use. But I have to learn, I guess :) So your guess is to inject 1.25 units now?
 
Please be careful with this. I know how overwhelming it all is. I'm a 3 year veteran and am still baffled by many things!

Firstly, increasing from 1 unit to 2 is a lot and it may be too high a dose for him. He may need 1.5 for instance. I would suggest returning him back to 1 unit every 12 hours, and if possible test him at AMPS time, 4 hours later, 7 hours later and then PMPS time. Then 3-4 hours later and another test as late as possible before bed. Keep doing this for 3 days. If numbers are still high and the lowest numbers each day and night are not going down very much, then increase if you can to 1.25 or at least 1.5. Try that same routine for another 3 days.

He may also be bouncing, meaning the higher insulin dose may be dropping his blood glucose down lower than his body is used to so his liver produces a heap of extra glucose to compensate and stop him from going too low / hypoglycemic. This may mean the 2 units are too much for him or that his body just is reacting to being lower than it's used to.

DO NOT EVER give any extra injections except for one every 12 hours. NO more. Ever.

Your spreadsheet doesn't have any info from when he was on just the 1 unit. I really wanted to know those numbers. Especially what his lowest point (nadir) in each cycle (12 hours period) is.

From the one day of results in your spreadsheet I can see, it seems at least the 2 units is bringing his blood glucose down slightly and the number at +6 hours may be his low point, but it may not. It is not a very good lowest number if it is though. Still quite high.

I also really want to see any readings for his PM cycle to see how low or high he's going at night.

Also be careful with any dose increases, as his improving infection may cause his blood glucose to go down too by itself. Infections often cause high blood glucose.

7.1kg isn't too bad depending on his breed, age and natural weight, but if he can lose a little weight gradually and slowly on a low carb wet food diet, this will hopefully help a lot of things.

Good luck and good for you for being committed to your fur child!
 
A couple of things...

Welcome to the Board!!

Can you check on your spreadsheet and see if widening the columns on the US tab will allow for the values to transfer over to mg/dL? Most of us are in the US and to understand Sass' numbers, we would have to multiply everything out. It's also possible there's a glitch on your spreadsheet that's preventing the numbers from transferring automatically. I'm tagging @Marje and Gracie in case you need help with your spreadsheet. Sass' numbers for today, so far are:
  • AMPS = 434 (24.1)
  • +3 = 365 (20.3)
  • +6 = 324 (18)
If Sass' usual AMPS was under 23, it depends on how much under they've been to determine if these numbers are that much different. An AMPS that's 23 vs 24.1 is normal variation. There's a 20% variation in any number that is attributable to the inherent error in a meter. Also, the starting dose of Lantus (if following the Tight Regulation Protocol) is based on weight: initial dose = cat's ideal weight in kg x 0.25. Based on Sass' current weight, the starting dose would have been a bit low (dose would have been 1.75u). Using that formula, most cats at ideal weight have an initial dose of around 1.0u.

I'd strongly encourage you to read over the sticky notes that discuss the two methods of dosing we use here. There is the Tight Regulation Protocol and the Start Low Go Slow method. These will help you understand when to change a dose. Typically, we change doses in 0.25u increments. This is why using the pen needle is not advised. Cats generally do not need large doses of insulin the way humans do so increasing in 1.0u amounts could easily overdose your kitty. You will need U-100 3/10cc syringes with half unit markings and most of us use a 30 or 31 gauge needle.

Before we encourage you to do anything with the dose, does Sass have any medical issues? When your cat was diagnosed, was he having problems with ketones? You mentioned you've been giving antibiotics for an infection. What kind of infection? Just as an FYI, any infection or inflammation can cause blood glucose (BG) numbers to be elevated. Once the antibiotic (AB) begins to do its job, the numbers could start to drop -- sometimes rapidly -- so it's great that you're testing. It sounds like your vet gave Sass an antibiotic injection. I'm going to assume this was Convenia. It's an antibiotic that is generally not used by many vets. If it was Convenia, it lasts upwards of 2 weeks. If your cat should be allergic to it, a long lasting AB means there's very little you can do once the med is in your cat's system. Also, its only recommended for skin infections. Many vets will use it so caregivers don't have to pill their cat despite it not being an appropriate medication for something like a UTI.

As was suggested above, we encourage everyone to get at least a "before bed" test every PM cycle. Lantus dosing is based on the lowest point in the cycle (i.e., the nadir). If you don't test at night, you're missing half of your data. By testing, it will let you know if it's safe for you to go to sleep or if you need to monitor for a bit longer. Right now, since you're still figuring all of this out, it's important to begin to get a feel for how Sass responds to insulin. Having data will help to build your confidence which is particularly important given how overwhelming this all is at the beginning.

Please ask questions! The people here are very generous with their time and knowledge. We're here to help.



 
I learned to use the spreadsheet only today. I now also inserted the earlier measurements on the spreadsheet, as much I have them, but they don't occur on the in the US sheet?!?

When we were diagnosed on the 15th, we were just sent home with the Lantus pen and an instruction to inject him 1 unit twice a day and come back a week later (and a bag of Hill's kibbles and recommendation to feed him only with these kibbles :mad:). Not a word about measuring his BG or monitoring him in any way. So now we're trying to educate us, based mainly on this page. We got the (human) glucometer on Monday night and have tried to measure twice a day, but it didn't work out every day. We'll try to do better now! On Friday morning we went back to the vet's, his BG was 18 (animal glucometer, no shot for 13h) and the vet told us to increase the dosage to 2 units twice a day and to come back in a week. Since the recommendation to feed Sass only with Hill's kibbles, I do lack trust in our vet, but haven't been able to find anyone specialized in cats / cats diabetes (we live in Estonia).
 
Thank you! This community is a wonderful thing, I'd be completely lost without it (well, I'm still lost but at least with hope :) )

Sass has a genital infection. He has been licking himself a lot and the skin was (and is, but less) red under his tail. Unfortunately I don't know what sort of antibiotics were given to him, but yes, it was an injection and yes, it was told to last up to 15 days. His kidneys were fine, we were told. We don't know his age. We've had him for two years, when he was found in the streets, badly hurt. We took him in. We think he's rather old than young - he has always been very calm and not overly eager to play. But then again, he was very, very ill back then when we got him and even though we managed to cure him from those injuries, who knows how long he has had diabetes? (At the end of Oct, 2015 he was fine). He's also overweight, we are trying to get the weight down now, too.

Otherwise I'd hope that the increased BG is due to infection, but just few weeks before that I started to notice that he was drinking more (not much, but still) and he is overweight, so therefore at risk.
 
Having a look at the SS, that first day on 2 units his AMPS was 18 and then later on 13, the lowest number yet. Then the next days' AMPS were higher than ever. I suspect the night of that first 2 unit dose he went lower than 13 and then bounced those following mornings / days.

Hopefully once the infection is all gone, he can stabilise more.

Is it a urinary infection? Diabetic cats can be prone to them due to the high sugar content of the urine irritating the urethra.
 
Sass said:
On Friday morning we went back to the vet's, his BG was 18 (animal glucometer, no shot for 13h) and the vet told us to increase the dosage to 2 units twice a day and to come back in a week. Since the recommendation to feed Sass only with Hill's kibbles, I do lack trust in our vet, but haven't been able to find anyone specialized in cats / cats diabetes (we live in Estonia).
Click to expand...
This is the routine many of us were started on with our vets. I did this for several months with my cat (although the dose changes were only 0.5 u at a time) but got nowhere with either understanding his BG patterns or how to make them better. I was doing BG curves at home but they told me nothing. I came to FDMB in August last year, started a daily testing routine, set up the spreadsheet we use here and learned SO MUCH about my cat's responses to insulin. My vet is very willing to let me manage his diabetes myself and I am very glad of that.

The people here have taken on their kitty's diabetes treatment themselves with help from the FDMB members. It's almost impossible to find a vet that is very experienced with FD. If you can buy some U100 insulin syringes with half unit marks at a human pharmacy, you can use them with the cartridge inside the Lantus pen. We can help you with getting to a good dose range.
 
Hi
Hang in there, a lot of the way this dance works is completely counter-intuitive until you have danced the steps a few times. You will have Ah-Ha! moments with it I promise!
One thing that really helped me start to understand it was when someone pointed out for me that insulin is not a DRUG. It is a HORMONE. The two work very differently. A drug hits the system and boom, effect..and out. A hormone however acts completely differently and interacts with a whole slew of systems. Add to that that Lantus is a depot insulin, (meaning that in each dose some is stored and some is used when you increase a dose until that depot is filled, and the reverse as you lower a dose) and it makes a lot of the body reactions a bit baffling until you learn the ups and downs so to speak of this dance.
The threads with yellow stickies help, I read, reread, and read them ..and then read them again! But also reading other condo threads really helped me too. I was able to see the protocol in action in real time so to speak as others worked it and that helped me to understand it better when Gussie’s body did the wild SugarDance tango.
The folks here will help explain it, the key is to ask, ask, ask!
Hope that helps a bit..
Les
 
Hey, just wanted to say Welcome! You have all ready received lots of good info. Please keep asking questions as that is how we all learned..
 
Welcome! You've come to the right place with a wonderful community who always wants to help.

If you'd like me to check your SS and see if it is working right, I'd be happy to do it. I can already see there appears to be one formatting issue. I developed the current SSs and can easily check it but I'll need editing rights from you.

I'll send you a private message. Just click on "inbox" in the upper right corner and you'll see my message in a few.
 
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