Introducing Tara...seeking advice

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catlover0908

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I’ve been lurking on this wonderful board since my sugar kitty’s diagnosis a year ago, digesting all the info I can. The time has come to introduce myself because I need advice. (Sorry if this is long).

Tara was diagnosed last July after 2 bad UTIs. (She is 12 years old; 19 pounds right now…her vet says she could lose a little weight but she is a big cat all over.) Her BG at that time was around 500. Her vet put her on Lantus; over a period of months we started at 2 units twice a day, then 2 ½, then 3, finally settling at 5 units twice a day in late August. That amount got her lowest BG at 200 during her curve. I also got her right on the Binky food chart; a diet she adjusted to very well.

All went well through the fall until over the holidays I noticed her drinking and peeing increasing. In late Dec I brought her in for a curve and her BG stayed in the 400s all day. The vet thought I may have gotten a bad bottle of Lantus or it had frozen at some time, so I got a new bottle.

At this time I also started home testing Tara (Walgreens meter). Over the next 6 months her BG was always in the 150-200 range on my meter (I usually tested her about 5-6 hours after her 5 unit insulin dose), so I felt she was doing very well.

Then last Thursday night out of the clear blue sky the UTI symptoms started. I took her to the emergency vet. Her BG was over 500; urine had a lot of sugar (no ketones); very bad infection and inflammation. They put her on Clavamox. The next afternoon I took her BG at home…152!

On Tuesday I spoke with her regular vet, and he was concerned about her high sugar level and wanted to do another curve. This was done Wednesday, along with complete blood work, all of which was normal. I brought in my home meter so they could check her with both. His lab work showed 448 at 9am, 414 at noon, and 425 at 4pm. My meter at the exact same times showed 223, 178, and 228! So it looked like all this time my meter has been way off. He contemplated the Symogi effect but didn’t think so. He suggested I get a new meter and increase her insulin to 8 units twice a day until today (Friday). I questioned if that was wise, but he said with BG at over 400 all day it was ok. So Wednesday night I gave her the 8 units and watched her like a hawk for symptoms of hypo, yesterday morning as well.

Last night before her insulin I checked her with the new meter…156. Tried the old meter…same exact number!!! Assuming it was still higher than that, I gave her 6 units, not daring the 8. 4 hours later I checked her…it was HIGHER!!! 168!!! This morning I checked her before her breakfast and insulin…159.

I’m calling her vet today with an update, but I am completely frustrated. The numbers the vet is getting, over 400 all day during 2 different curves, is leading me to think it is the Symogi effect. But why on earth are my meter readings so much lower when taken at the exact same time? And if it is Symogi, would the excess glucose be spilling into her urine as well? I would be so grateful for any thoughts you have…
 
I don't use your insulin but others who do will be along with advice. One question they will ask is if you have any midcycle numbers at home. Those are the important ones to base your dose on.

What meter are you using? Unfortunately we have found that meters with True in the name tend to read much lower than other meters. But regarding the 168 and the 156. All meters have a 20% variance - even for the same spot of blood they can read 20% higher or lower. Your two numbers fall easily into that variance. It is not an issue in determining dose as we are looking for a range. We would shoot the same dose at both of those numbers.

It is a large amount of insulin, particularly as you are feeding wet low carb. There are several conditions that cats have that can require large doses. You might consider if these symptoms ring a bell with your cat: http://www.felinediabetes.com/FDMB/viewtopic.php?f=12&t=375 Or it could be rebound cycle after cycle. Lantus users will be able to give you ideas about that.

Glad you decided to stop lurking and start posting. I know we can help you figure this out.
 
Hello-
I can't help you with dosing, but can tell you I was relying on a TrueResults (Same manufacturer) as the True2Go meter and Truetest test strips and discovered the numbers I was getting were 100+ off compared to the ReliOn and Vet. There was another thread recently discussing it. Here's the link
Hope this helps some.
 
Cats in general are prone to high blood sugar, typically during times of stress, where glucose levels may reach 300-400mg. This is often a temporary increase in blood sugar, and happens to cats that even don't have diabetes. So curves at the vet's office are not only a waste of money, they are dangerous because they give falsely high numbers. Vets that try to base dosing decisions off these numbers tend to chronically overdose cats, which is not only unproductive, it's potentially deadly for your cat. Chronic overdosing actually causes higher overall numbers because the cat's liver will dump glucose into its bloodstream to counteract the hypoglycemia. I suspect that your vet started out on too high a dose to begin with--so the insulin never even had the chance to work to lower your cat's blood glucose. Bandit is 13.5 lbs and the most insulin he ever needed was 1.25u.

8u is a dangerously high dose of insulin, and I would drastically lower the dose. Continuing to give this much insulin could kill your cat. 2u is also a high starting dose--it's the maximum for cats, and should only be given to cats that are naturally very large and supposed to weight around 18lbs. The starting dose should be based on IDEAL weight if the cat is normal or overweight, and ACTUAL weight if the cat is underweight. Most cats on a low carb, canned diet do not need much more than 1u of insulin. I would recommend starting over on the dosing scale at 1u twice a day with daily hometesting and reach your cat's ideal dose safely and properly. If you're feeding dry food, I would also recommend switching to a low carb canned diet at the same time you're lowering the dose to 1u. High carb food will cause high numbers, so it's safer to eliminate it before you move up on the dosing scale--otherwise when you remove it later on and your cat's overall blood sugar levels drop drastically, a dangerous hypoglycemic incident can occur. About 25% of cats no longer need insulin at all from the diet change alone.

Here is some information for you to print and give to your vet on how to properly dose Lantus and treat feline diabetes. They explain the statements I've made and outline two basic points your vet does not appear to understand--1. Adjusting dose by home testing daily is the only way to safely and accurately administer insulin, 2. Diabetic cats need to be on a low carb, canned diet of less than 10% carbs (but preferably below 8%).

American Animal Hospital Association diabetes guidelines: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf (See p. 217-219)

Lantus dosing protocol: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf

Article explaining the safety and efficacy of the Lantus dosing protocol--newly diagnosed cats have an 84% remission rate if followed, with a 64% remission rate in cats overall. The sooner you start treatment as outlined in this article, the greater your chances of remission. Bandit's is diet-controlled on a low carb, canned diet and has not need insulin for nearly 2 years.
 

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Great responses, thank you. You have confirmed everything my gut has been telling me.

I am getting a Bayer Contour meter this weekend and am going to talk my vet into starting over from scratch, with me doing frequent curves.
 
Another thing to note--Urinary Tract problems are usually caused by chronic dehydration caused by dry diets. So this is the second reason you need to get your cat on a 100% canned diet. A properly hydrated cat will not have these issues. See this article for more information: http://catinfo.org/?link=urinarytracthealth. Many vets will try to tell you that the cat's pH needs to be maintained by a prescription diet at a certain level, but that is only treating the symptom, not the actual problem causing the bad pH, which is chronic dehydration.

UT infection can also cause temporary high blood sugar. It's very important that insulin is used sparingly with these cats (staying below 1u until the infection has time to clear), because most of the time their blood sugar will go back down to normal levels once the infection clears and the diet is changed. Obviously, your vet did not do this, which is another reason why I'm pretty certain your cat has been chronically overdosed and put in a dangerous situation.

It's fantastic you're hometesting now! The Relion meter from Walmart is very popular here because it's a good meter that has inexpensive test strips. It's very important that you are able to budget for at least 4 strips a day, and ideally more than that. With Lantus, you need to test a minimum of 3 times a day--once before each shot to make sure it's safe to give insulin, and a mid-cycle check to see how much the insulin is lowering her blood glucose. However, the more you test, the more data you will have the better you'll be able to adjust the insulin dose. When Bandit was on insulin, I was working two jobs and going to graduate school, so I could only test minimally during the week (4 times a day), but I made up for it on the weekend by doing a curve at least once a week until he was well regulated.
 
OK Walmart it is...I just want something accurate. I've felt like I was doing the right thing and this has been SO discouraging.

And Tara is on 100% wet food :)
 
Starting over, down to 1u, when you have been giving Tara 6u, is dangerous. The BG numbers you have mentioned are not dangerously low and somogyi has never been proven. To start over at 1u, you best be checking for ketones every chance you get because you will see Tara's BG go higher than ever.

If you can say the names of the meters you have been using, and which numbers were from which meter, plus where the numbers were taken, at home or at the vet office, it will be helpful. Avoid the meters with TRUE in the name and also avoid the FreeStyle meters as the butterfly strips technology gives wrong BG readings - none are over 299. So many poor cats have been suffering in much higher numbers in the 300s and up to 500s because of the FreeStyle meters poor readings. Relion meters are fine, but my favorite has always been any of the Bayer Contour meters, and for backup meters, I like the OneTouch meters.

Home testing will give you numbers that tell you how the insulin is working. If you could do a curve at home, testing every 2 hours, you will see the actual curve for the dose you are giving. If possible, a spreadsheet with Tara's BG numbers will be most helpful as others will be able to let you know what they see. A cat's nadir could be anywhere along a cycle; my Shadoe was around +5, but my Oliver was around +10 or +11, so depending on Tara's nadir, a lowish number around ps could be a late nadir or a need for dose adjustment.

My Shadoe always tested much higher at the vet office; Oliver often tested lower. Both can be chalked up to stress because I tested them at home before leaving for the vet and then again when we got back home. Within 30min of getting home, their BG returned to their own 'normal' numbers.

Before dropping back to 1u, I would do a few curves to see where Tara's numbers are right now, at the current dose. I started over with Oliver when I was advised his dose of 4u was way too high, and I witnessed a horrid jump in his BG and for days, he just laid around and suffered for that starting over.

If you choose to start over, be sure you have a fresh container of KETOSTIX and will be around to hometest/monitor the changes from such a drastic drop in dose.
 
Gayle Shadoe & Oliver said:
Starting over, down to 1u, when you have been giving Tara 6u, is dangerous. The BG numbers you have mentioned are not dangerously low and somogyi has never been proven. To start over at 1u, you best be checking for ketones every chance you get because you will see Tara's BG go higher than ever.

If you choose to start over, be sure you have a fresh container of KETOSTIX and will be around to hometest/monitor the changes from such a drastic drop in dose.
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I disagree. The dose was not reached properly to begin with (started too high and raised in 1-2u increments while treating a UT infection) and it's far more common for overdosing to cause these sorts of problems than high dose conditions that would actually require that much insulin. I think the danger of hypoglycemia of an overdose outweighs the danger of hyperglycemia while an accurate dose is reached. Without data that shows either way if the dose is warranted, it makes more sense to make a decision based on the insulin need for the majority of cats. I understand that the dose reduction did not work for Oliver, but if I remember correctly, he had a high dose condition. Without actually getting a test for a high dose condition, the only way to determine whether or not the dose is too much is to start over on the dosing scale. I do very much agree that testing for ketones is very important any time you drastically reduce the dose.

What kind of canned food is Tara eating? Some canned foods are too high in carbs for diabetics, and that could be effecting insulin need, especially if it's a prescription food.

Here is the link that shows you how to set up a spreadsheet and post it in your signature: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207. If you could fill it in as best you can so that we can see what her BG has been like from the data you have, it could be very helpful in determining what sort of decrease is warranted.
 
The testing I've been doing at home since January has been completely inaccurate because of the Walgreens True2Go meter I've been using...so I don't trust ANY of my data. And I haven't done any curves at home...that is going to change.

The last 2 curves done at my vet's office, with her insulin dose at 5 units twice a day, has shown BG in the 400s all day.

She eats primarily FF and Friskies Classic; a little Natural Balance and Pro Plan (pate). Her favorite treats are grain free and she ADORES freeze dried chicken :)
 
I'm sorry that it's confusing that there is a difference of opinion here...hopefully some other Lantus users will be along to give you some more advice on what route you should take. In my opinion, I think that considering Tara started started out on too high a dose, had the dose raised too much too quickly, and that there is infrequent and questionable data that may or may not indicate a high dose condition, it is better to take the more likely scenario and start over on the dosing scale. Unless you plan specifically testing for high dose conditions at the vet, the only way to confirm that she does indeed need that much insulin to get back up to that dose properly, which would mean you need to start over anyway.

The food is great--a nice low carb diet. :smile:
 
Are you testing Tara's urine for ketones? If not, please get a container of KETOSTIX at the pharmacy when you pick up your meter, Relion is good and economical, but I do love the Bayer contour ones, and start testing, especially if you are going to drop the dose down to 1u.

I was a Lantus user with both of my cats, and I switched to Levemir when they reached higher doses because Lantus stings at higher doses, and that statement is from human diabetics.

Too often, people are advised that their dose is too high; start over, but with no mention of preparations for that drastic change. I experienced first hand with my Oliver what can happen from dropping a dose from just 4u down to 1u; he suffered, and I am sharing my experience just in case you see a step backwards in how Tara starts acting by a dose reduction.

I would suggest you do a couple curves this weekend if possible to see what numbers Tara has now, and only then will you have data to compare on any dose reduction. Without a before picture, your after picture says little.

some info on somogyi:

http://www.tillydiabetes.net/en_6_protocol2.htm

Be aware that experimental studies in human diabetics over the last 15-20 years have rejected the existence of the Somogyi effect (sometimes also called rebound). In cats, no studies have ever been done which properly demonstrate that such a phenomenon exists. Therefore, adjust the dose as described above, focusing on the nadir: don't do so-called rebound checks, as they only lead to unnecessary (and unhealthy!) hyperglycemia.

Info from the old FDMB board:
What is the Somogyi Effect?

Glucagon and insulin are released by the pancreas. Glucagon and insulin have opposite effects: insulin makes the blood sugar go down and glucagon causes blood sugar to go up. They work together to balance blood glucose levels. Glucagon can increase blood glucose levels by causing the liver to release its stored glucose to the blood stream. Insulin lowers blood glucose by allowing tissues to use or store glucose.

When too much insulin is given the blood glucose drops rapidly and hypoglycemia (low blood sugar) results. This can trigger the body to release glucagon (and other hormones) and the result is that glucose is dumped into the blood. This can lead to hyperglycemia (high blood sugar). So, you have hyperglycemia induced by hypoglycemia, or the Somogyi effect. (Somogyi was a scientist who did research on glucose production by liver during times of stress.)

The method of determining if Somogyi effect is occurring is to do a blood glucose curve. Your cat will have a specific pattern of hyperglycemia if the Somogyi effect is occurring. Although at first it seems odd, the treatment for this type of hyperglycemia is to DEcrease the insulin dose. This prevents the hypoglycemia from occurring and triggering the Somogyi effect.

What caught my eye was the trigger of being low in order to go high. That makes sense to me. It does not look like there were any studies done with cats, only the one on some humans and that study was rejected.

If a cat were getting too much insulin, I would expect to see very quick improvement in numbers when the dose is dropped.
If the numbers remained high, I would think there is no sort of rebound involved at all and would increase the dose again.
If the numbers went even higher, I would be positive that the previous dose and likely a higher dose was needed.

Take precautions when dropping dose drastically and be sure you are around to to test and record the changes in numbers from such a drop.
 
I have a question...

I understand that the existence of a "high dose condition" like IAA or Acro requires a special test to confirm or rule out. I don't think we can argue that 6u or 8u is an extremely high dose unless they have a high dose condition. Whether "smogyii" exists or not is probably a good "Think Tank" topic, but people have been arguing about it for 80 some years since the guy invented the term, so it doesn't really matter at this point in time.

My question : is there any indicator in a "normal" panel of blood work that would lead a vet to conclude that a test for high dose conditions makes sense? Or is it just a matter of getting to a certain seemingly high dose and saying "hey, we need to check for IAA/Acro"? I think last week a blood test was done, and everything was "normal" other than high blood sugar?

Is Tara still on the clavomox for the UTI? If there is an infection present, then you should be testing for ketones if you aren't already doing that. And reducing the dose with an infection present makes that even more important I think. I can't help with dose advice, I don't use Lantus, other than to say that 6u is abnormally high compared to most Lantus kitties I've seen who never require more than 1u-2u.

Carl
 
I completely agree about testing for ketones--I should have included it in my initial advice and I did not mean to omit that information.


Gayle Shadoe & Oliver said:
I would suggest you do a couple curves this weekend if possible to see what numbers Tara has now, and only then will you have data to compare on any dose reduction. Without a before picture, your after picture says little.
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The problem with this suggestion is that even two curves might not be revealing of a rebound/chronic overdose situation. BG can stay inflated for up to 72 hours from glucagon, it can take several weeks of regular testing to detect it. There are even some cases where a low number is never detected because the hyperglycemia creates insulin resistance--it's not until the dosing scale is started over and the numbers drop that the data shows high dose was the problem. In the meantime, you're shooting a dangerously high dose of insulin, and all it takes is for one missed meal or for the pancreas to get too burned out to produce glucagon anymore to cause a serious hypoglycemic incident. Furthermore, if numbers are high because of chronic overdose, the cat is just as much at risk for diabetic ketoacidosis as if the insulin is reduced too much. Yes, if the cat has a high dose condition and you drop the dose too much, but the cat will also suffer if stays hyperglycemic because the dose is inappropriately high, or if it has a hypoglycemic incident. Given that chronic overdose is by far more common than high dose conditions, it does not make sense to me to assume that is what is going on here.

Please note p. 218 of the AAHA guidelines, where it states:

Be aware that chronic insulin overdose may not only result in clinical hypoglycemia (seizures,coma),but also the development of sustained hyperglycemia and insulin ineffectiveness following secretion of insulin antagonists(catecholamines,glucagon,cortisol,growth hormone)that combat hypoglycemia.
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As well as this article: http://www.ncbi.nlm.nih.gov/pubmed/3528096
 
There have been cats at higher doses who have gone off insulin; Randi and her Max is a good example. One day, Max's dose, around 6u or 6.75 or something, just started to kick in and down he came. Max is still OTJ to this day. My Shadoe and Max were going up in dose at the same time. Max dropped and went OTJ; Shadoe continued upward and I finally tested her at 9u. Max had no tests done, but there is nothing to prove or disprove whether Max was IAA and beat it back, acro and in remission, or just a regular feline diabetic whose pancreas healed / now diet controlled.

I understand that the existence of a "high dose condition" like IAA or Acro requires a special test to confirm or rule out. I don't think we can argue that 6u or 8u is an extremely high dose unless they have a high dose condition. Whether "smogyii" exists or not is probably a good "Think Tank" topic, but people have been arguing about it for 80 some years since the guy invented the term, so it doesn't really matter at this point in time.
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There seems to be some opinion that IAA is a high dose condition, but it is more of a resistance and uncontrollable condition. Even acros can be a lower dose, as my Shadoe dropped to 2.5u after her dental and did not go all that high for most times. It's more in the pattern of the BG numbers, along with the dose.

To say that 6 or 8u are extremely high unless they have a HD condition is jumping the gun a bit; we know that illness, and diet, and even some meds will contribute to dose size. You want to eliminate all those items first, and be sure you have a healthy cat that just happens to be needing alot more insulin than other diabetic cats. Even before then, a spreadsheet with BG numbers can be very telling - the diff between acro and IAA numbers on a spreadsheet are very noticeable.

I am not sure why somogyi / rebound needs to be pushed off to the Think Tank when the 'effect' is mentioned so often in many threads. If one mentions somogyi / rebound, I think it's important to give the OP all the info to be found that support or dispute the effect. With the only studies known having been with humans and also been rejected, and no studies done on cats, I would hesitate in suspecting rebound based on a higher dose and a few BG numbers taken at the vet office.

My question : is there any indicator in a "normal" panel of blood work that would lead a vet to conclude that a test for high dose conditions makes sense? Or is it just a matter of getting to a certain seemingly high dose and saying "hey, we need to check for IAA/Acro"? I think last week a blood test was done, and everything was "normal" other than high blood sugar?
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If there were a value on normal blood work to indicate acro or IAA, you would be seeing a bucketful of more HD kitties! I believe that many are going undetected. Just like with pancreatitis, there's a test but it's separate and costs extra.
Until the IGF-1 and IAA are included in the normal panel, owners will have to ask for the additional test, and possibly have to force their vet to have the tests done as many vets resist the 2 tests.

Is Tara still on the clavomox for the UTI? If there is an infection present, then you should be testing for ketones if you aren't already doing that. And reducing the dose with an infection present makes that even more important I think. I can't help with dose advice, I don't use Lantus, other than to say that 6u is abnormally high compared to most Lantus kitties I've seen who never require more than 1u-2u.
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With Tara seeming to be prone to infections, it would be a good idea to recheck with the vet after clavamox is done, just to be sure the infection is gone. Infection + high BG are 2 contributors to ketones, so be sure you are testing, even before lowering the dose. Ketones can occur at low BG numbers, so until you know if your cat is ketone prone, it's good to test when you can.

As for Lantus cats, there are a fair number on doses above 2u, so I would not say most never need more.

It's great that you will have a reliable meter and strips, and some KETOSTIX so you can test Tara tonite/Saturday at this dose, then maybe lower the dose on Sunday and do another curve, to see how Tara is reacting. It may take a day or so for the Lantus shed to drain and for you to see how Tara is doing on the lesser dose.

I would not drop the dose until you have the all clear from your vet that there is no infection still.
 
Gayle Shadoe & Oliver said:
As for Lantus cats, there are a fair number on doses above 2u, so I would not say most never need more.
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While there may be a number of cats on doses above 2u, this does not change the fact that most cats do not need more than 1u of insulin. The reason why there is a large number of cats on this web site on higher doses is because people with cats in remission generally don't continue to post on the website. Cats that end up here for a longer amount of time generally need larger doses.

In my experience, the longer a cat has been in sustained hyperglycemia from too low or too high a dose, the further up they need to go on the dosing scale. Many people end up coming to this site after they have pursued their vet's recommendations and found them unsuccessful.

I'm not sure if you're arguing that rebound doesn't exist, and/or that high dose conditions are more common than sustained hyperglycemia due to chronic overdose, but if so there are studies that support rebound, and there is no evidence that high dose conditions are more common than rebound--in fact, the evidence overwhelmingly points in the opposite direction.

Gayle Shadoe & Oliver said:
I would not drop the dose until you have the all clear from your vet that there is no infection still.
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I think this is exactly the reason why the dose needs to be dropped. If high BG from infection is causing a greater insulin need, then once the infection clears and BG drops, you could be shooting a potentially deadly dose of insulin.

If no ketones are present, the risk of hypoglycemia is greater than the risk of ketoacidosis. Which is why testing for ketones is very important. If there are ketones present, then I think the argument can be made to hold off lowering the dose.
 
I'm not sure if you're arguing that rebound doesn't exist, and/or that high dose conditions are more common than sustained hyperglycemia due to chronic overdose, but if so there are studies that support rebound, and there is no evidence that high dose conditions are more common than rebound--in fact, the evidence overwhelmingly points in the opposite direction.
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Can you quote the studies/ provide the links? Too often, I see statements as above - evidence overwhelmingly points in the opposite direction - if cats are not tested for high dose conditions, you have no evidence, and the same goes for the studies - if you cannot quote the studies, you have no evidence.

My concern for Tara is that a big drop in dose, when health has not been confirmed, and with no at-home BG numbers, and no tests for ketones, you could be inviting problems. Once home testing is started and urine testing for ketones is also being done, plus Tara's vet says the infections are cleared, it will be safe to reduce the dose, but not before.
 
Could you ladies take this discussion to the Think Tank? You are highjacking a thread from a new member who is "seeking advice".

Tara's Mom, it seems clear that there is a difference of opinion about whether it is wise to start over or to reduce the dose. I am sorry that your first post to the board resulted in this discussion that is probably of very little help to you in your advice seeking.
 
I don't think the discussion has gotten out of hand, but do agree that we don't want dosing advice to get lost amongst the long posts. Perhaps a compromise -- like 3U -- is in order, provided that frequent BG testing and ketone checks can be done at home.

I am assuming the curves done at the vet were with Alpha Trak -- correct?

MJ
 
Gayle Shadoe & Oliver said:
I'm not sure if you're arguing that rebound doesn't exist, and/or that high dose conditions are more common than sustained hyperglycemia due to chronic overdose, but if so there are studies that support rebound, and there is no evidence that high dose conditions are more common than rebound--in fact, the evidence overwhelmingly points in the opposite direction.
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Can you quote the studies/ provide the links? Too often, I see statements as above - evidence overwhelmingly points in the opposite direction - if cats are not tested for high dose conditions, you have no evidence, and the same goes for the studies - if you cannot quote the studies, you have no evidence.

My concern for Tara is that a big drop in dose, when health has not been confirmed, and with no at-home BG numbers, and no tests for ketones, you could be inviting problems. Once home testing is started and urine testing for ketones is also being done, plus Tara's vet says the infections are cleared, it will be safe to reduce the dose, but not before.
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We both agree she needs to test for ketones and BG at home. But given the risk of hypoglycemia vs hyperglycemia, I disagree that it is safer to continue giving a high dose without data to support the dose is appropriate. Testing without restarting the dosing scale my not be revealing for some time, if at all, even if the chronic overdosing is the problem.

Studies on rebound hyperglycemia:

Specifically for cats: http://www.ncbi.nlm.nih.gov/pubmed/3528096

In humans: http://www.nejm.org/doi/pdf/10.1056/NEJM198411083111904

http://care.diabetesjournals.org/content/28/12/2948.full

There are no studies that have adequately captured the frequency of either condition in cats to compare incidence rates, but if you were to analyze the incidence rate on these boards you would find that cats on high doses reached inappropriately more often were found to be chronically overdosed than diagnosed with a high dose condition.

It is not my intention to hijack the thread, but since there is a difference of opinion I think that it is necessary to explain the reasoning behind our opinions, so that she can make an educated decision on what to do. Tara's mom, I am very sorry if this discussion is overwhelming. Whatever you decide, as long as you are testing for ketones and BG at home, Tara should be ok.
 
Studies on rebound hyperglycemia:

Specifically for cats: http://www.ncbi.nlm.nih.gov/pubmed/3528096
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J Am Vet Med Assoc. 1986 Jun 15;188(12):1426-31.
Rebound hyperglycemia following overdosing of insulin in cats with diabetes mellitus.
McMillan FD, Feldman EC.
Abstract
Posthypoglycemic hyperglycemia (rebound hyperglycemia) after overdosing of insulin was diagnosed in 6 cats with diabetes mellitus. Administration of excessive insulin induced hypoglycemia within 4 to 8 hours, followed by rebound hyperglycemia. Diagnosis was made by serial blood glucose determinations during a 20- to 24-hour period after insulin administration. Four cats had a history of difficulty in regulating the diabetic state. In 2 cats, rebound hyperglycemia was diagnosed on routine serial blood glucose determinations. All of the cats were hyperglycemic for most of the day. Rebound hyperglycemia was observed with both intermediate (neutral protamine hagedorn) and long-acting (protamine zinc iletin) insulins, and the range of insulin doses at which the disorder developed overlapped previously determined therapeutic doses for these insulins in the cat. Urine glucose and single afternoon blood glucose determinations were inadequate and potentially misleading in monitoring diabetic cats receiving excessive amounts of insulin.

You are quoting a very old study 1986 that involves 2 insulins, NPH and PZI.... Total different ball game when Tara is using Lantus.

The other 2 links also take one to old info from 1984 and relating to humans.
We already know that humans and cats are very different.

To repeat my related concerns:
My concern for Tara is that a big drop in dose, when health has not been confirmed, and with no at-home BG numbers, and no tests for ketones, you could be inviting problems. Once home testing is started and urine testing for ketones is also being done, plus Tara's vet says the infections are cleared, it will be safe to reduce the dose, but not before.
 
What information contained in that article is outdated? It may have used different insulins, but the basic concept is the same. There is absolutely NO evidence that a long acting insulin inhibits the release of counterregulatory hormones. Quite the contrary, as rebound is seen in the Lantus forum all the time.

And studies on humans are relevant in cases where the effect of counterregulatory hormones has been proven to be similar, as with humans and cats. You're also criticizing my evidence, but so far you have provided none to support your statements. If you'd like to continue this discussion via PM or in Think Tank, I am willing, but I think we should not continue this discussion in Tara's thread, as I think it's passed the point of being helpful.
 
I can't tell you how much I appreciate all of your input and concern.

I just talked to my vet about all of my concerns. He agrees that it is wise to get a more accurate meter and start more home testing. So this weekend I'm going to get the Walmart meter and start home curves. That's the only way I can find out exactly what is going on. I will report my findings and seek more advice then. :).
 
That sounds like a good plan. Here is a shopping list for meter supplies:
A human glucometer. Any one that sips and takes a tiny sample is fine. The meters are often free at drug stores; it’s the strips that are expensive. You can, however, buy them on ebay at less than half the price of stores. Lots of people here also like the ReliOn from Walmart. It is an inexpensive meter and its strips are the cheapest around. Try the meter out on yourself or someone else before you try it on your cat. You want to be familiar with it before you poke the cat.

Lancets and a lancet device. Usually, until the ears “learn” to bleed, a 26-28 gauge is good. Any brand will work as long as the lancets match your device.

Ketone strips. (Ketostix) Just like human diabetics use. You will sometimes need to test urine if the numbers are high.

Rice sack. Make this out of thinnish sock, filled with raw rice or oatmeal and then knotted. You heat this in the microwave until very warm but not hot. Then heat the ears before poking.

Also nice to have. Flashlight: so you can look at the ears and find the little capillaries that come off the vein running down the ear. Vaseline: Put a tiny smear where you want to poke. It will help the blood bead up.

And some lo carb treats to give your kitty, successful test or not Lo carb treats
 
Welcome catlover!

I'll tell you about Sneakers and you can see if there is anything Tara might do that is like it...

We started on Humulin 3u BID right off the gate that got increased to 4u when she had high numbers. Back then (in the old, old ages where there was no electricity and I did whatever the vet said to do- aka last November) I didn't question. I did question the insulin because the first thing i did was find out about FD online and what the best insulin for cats would be and the food she needed to eat. I changed her food to canned and made some chicken and told the vet I wanted PZI for the next bottle. Home testing wasn't mentioned other than "It's a bother, you don't need to do it."

Fast forward to January when we got the new bottle, I was told to drop the dose for a week then raise it back to 4u... By that time I had learned more about FD- she hadn't improved much on humulin and I got onto the board and found the food she really needed to be eating and that plain chicken wasn't enough for her and that home testing was necessary for her safety. Got online to ADW and ordered the TrueRead. It wouldn't even WORK! went through 25 strips and got E-6, E-7, E-2 for the majority of it. The only good thing at that time was Sneakers ears learned to bleed :? . I know, kind of the happy/sad masks you see. Now we use Relion Micro and are very happy with it. I test her about 7 times a day- mostly at night when I wake up, along with her shot times.

I realized that Sneakers really hadn't had a curve done, he just tested her at food times and that was it, plus she was at the vet! It was going to be high anyway :roll: . So I dropped her from 3u to 1u overnight and her body didn't like that too much. She started throwing off ketones, always trace to small but they were there. So my lesson learned was don't drop a cat that is used to a high dose like that- I cut it into thirds and gave her the lesser part. You can see on my ss (second page) I had quite the worry time for about a month until I finally built her dose back up again and the ketones steadied into trace.

So, when it came time to switch insulins, yet again, instead of starting at .5u as advised in the protocol, I actually started at 2u. It was between 50-75% of her previous dose and it took three days for her shed to build up (and so did the ketones nailbite_smile ) until her shed filled then the ketones started to lower and they haven't been back in weeks. I only check every other day now rather than every day.

So when you start with Tara- I would check the ketones while you are testing her on a reliable meter to get her basieline. If she has even a trace I wouldn't start back down to 1u at all but do a percentage that you are comfortable with- 6u times 50% is 3u and times 25% is 4.5u (8u is 4 @50% and 6 @25%). You could even move her down just 1u at a time, just make sure to give her 6 cycles (depending on ketones) to get used to it. Once you have checked out that dose, if her numbers are still high, drop it again, the same 50% or 25% again until she starts leveling out.

If she starts throwing out small to moderate ketones it may be too much for her right now and a smaller step might be needed. Negative to a trace would be her body getting used to it (or at least that is what I figured with Sneakers) but if she hits small to moderate I would test as frequently as you can because ketoacididosis is bad news and expensive to treat. And make sure she eats.

I know its long but I don't have any technical jargon to toss out there. Tara is your furbaby and you will do what you choose is best and one that will calm your nerves.

Good Luck! Heather
 
Thanks for not continuing the discussion.

At this point, from what it sounds like, Tara's dose is up to 8u based on the vet having tested and numbers being in the 400s. Home testing was yielding significantly lower numbers but on an unreliable meter.

There are a couple of considerations. If Tara is like many cats, she may be experiencing stress from traveling to the vet's office and from being at the vet's office. In other words, the stress may have inflated her numbers. In addition, the UTI is raising her numbers. (Any infection can raise BG numbers.)

8.0u is a whopping dose of insulin. I do agree with Julia in that the dose of Lantus was not worked up to the 8.0u level in a systematic way. Typically, if you are following the instructions in the Tight Regulation Protocol that's in the article that Julia linked, doses are usually raised by 0.25u so you don't end up giving more insulin than your cat needs. There's no way to know if this is an appropriate dose. Unfortunately, there are times when not enough insulin and too much insulin can produce the same results.

I'd be concerned about ketones developing if you started over by dropping the dose down to 1.0u. Is Tara eating? If she's not eating well and there is an infection present, the risk for ketones increases. If you are not already testing her urine with Ketostix, I'd encourage you to do so. When you make your trip to Walmart for a new meter, then get some Ketostix, as well.

I'm not entirely clear how Tara got to a dose of 8u. You mentioned that she was getting 5.0u back in August and that she was on that dose for some time. That may be a reasonable place to start for a dose but you will need to monitor closely. I'm suggesting frequent testing because the meter you were using was unreliable and because if the antibiotics kick in, Tara's numbers may drop. She will also be experiencing far less stress when you're testing at home vs. at the vet's office and you may not see the same high numbers as you did at the vet's office. I know you need a place to start but I also think you may need to be prepared to either systematically raise or lower the dose depending on what your tests tell you.
 
I just want to add my 2 cents and my experience.....my cat, Missy, is a high dose cat on Lantus. My vet started us out at 3 units, because she is a big girl. There were many discussions that she was started too high, so in December, I decided to back her dose down, to either prove or disprove that theory. In no time at all, she was throwing me ketones. So, obviously she was not started on too high a dose. We have just reached 10.25 units and it seems to be the 'right' dose, for now. For the first time in forever, she is back to consistent greens and blues. We have just tested for IAA/acro and not got the results yet, so no way to know if that is a contributing factor. So, while her dose is NOT typical for most cats, it is working for her. While all the controversy rages over the dose, just remember the mantra here "every cat is different'. Watch for ketones and just maybe your baby is a high dose kitty like mine. Good luck.
 
catlover0908 said:
I can't tell you how much I appreciate all of your input and concern.

I just talked to my vet about all of my concerns. He agrees that it is wise to get a more accurate meter and start more home testing. So this weekend I'm going to get the Walmart meter and start home curves. That's the only way I can find out exactly what is going on. I will report my findings and seek more advice then. :).
Click to expand...

Hi, just wondering if you were able to get the supplies and start home testing, and what sort of numbers you have gotten? Can we help you set up a spreadsheet?

Carl
 
Oh, Carl & Bob, help setting up a spreadsheet would be *so* appreciated!!! I'm ok with computers but that is something I've never done. I think if I had one set up I'd be able to input the #s.

I got a Relion meter on Monday afternoon. I tested Tara 6 hours after her normal 5 units and got a reading of 222; just before her nighttime shot she was 355.

Yesterday I did a curve...pre-breakfast & insulin she was at 372; 6 hours in she was at 168; 12 hours in she was at 340.

Today I tested her 5 hours after insulin...282 (she ate more this morning than yesterday morning).

So given these BG numbers that are changing as one would expect, I'm thinking I was wrong in suspecting a high dose leading to the Symogi effect. Since they are still on the high range, I'm thinking maybe a slight increase in insulin would be wise. She is off her antibiotics as of Monday.
 
Those numbers don't sound bad. I think it's likely that the infection was a large part of the higher numbers, and now that the ABs have seemed to have done the trick, the numbers may make more sense. Great job collecting all that data!
I have to leave for a couple hours, but I think Sue is going to contact you to help with the SS set-up.

I'll check back later,
Carl
 
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