Is this possible? BG levels higher with insulin?

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Theresa6

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There is a whole history here, but here is the readers digest version:

I started my cat Stella on lantus in December, on 2u and after 3ish weeks up to 2.5. It did nothing for her BG levels. Zero... they didn't change at all in the entire time she was getting the insulin. Together with our vet, we decided to get her off the insulin totally since it was doing nothing. She was diagnosed with hyperthyroidism at the same time as FD, so we decided to switch her to canned and off the prescription dry she was on, and at the same time give her thyroid meds some time to work. She was off insulin and on wet for over a month and her levels drastically dropped (really within 24 hours of the diet change) from mid to upper 400's to steady around 250. We went back, got her thyroid levels checked, and when they were fine decided to start her on lantus again. And thats where we are today, day 3 of her being back on lantus.

I decided to go with the SLGS and start her at .5u. In the last 3 days her BG levels are HIGHER than they were when she was off the insulin all together. Last night PMPS I got a 400, which I have not seen since she was on dry food.

What is going on? Its as if the insulin is having the opposite effect! Something about my cat and insulin just don't seem to work together. Any ideas on what could possibly be going on?
 
Well, that is frustrating, isn't it? She clearly needs insulin with numbers in the mid-upper 200s without insulin. Those are about the numbers I got with Beau when I stopped insulin for a few days out of pure frustration about 8 months after his diagnosis.

So, there are several possibilities. My first question is: what insulin syringes are you using? They should be u100 insulin syringes, 3/10cc with half unit markings. Sometimes people inadvertently use u40 syringes and 1u on those syringes = 2.5u of u100 insulin - just want to get that out of the way first.

She may need less insulin. How about dropping to .25u and see if that helps.

She might just need a lot of time to settle on the dose. She is definitely bouncing a bit right now and that could just be her body over-responding to any drop in her BG right now.

Get more spot checks in like you used to so you can see what her BG does throughout the cycle. Where was she yesterday between the amPS of 203 and the evening PS of 400? Could she have been a lot lower between - like low 100s? That could "spook" her liver into a rebound response.

She may need more insulin, but I think trying less and slowly increasing might be the trick with her. some kitties are very sensitive to dose changes and that would include actually starting them on insulin. Also, with these lower doses, make dose changes that are .2u or smaller. Smaller is like, .1u and that takes practice drawing that amount. There is a good post on the lev ISG with photos and instructions. Stop over there if you want help with that. Thinking in terms of percentages, a change from .25u to .5u is a 100% increase.

Hang in there. You'll get this figured out.

PS - you might want to change this morning's dose. I don't think you shot 5u, right?
 
I am not an expert by any means, but I think with Lantus that you wouldn't be seeing an effect one way or the other for 3-5 days. So I don't think the rise in BG could be related to the insulin. I agree that either way, you should probably give it some more time to see what is going on. I am sorry this is so frustrating.
 
Nor am I a Lantus expert, but I have definitely read that cats bounce around for awhile before they settle, with that insulin. Starting low is good, and now you wait.
In case you haven't already found them,
Here is a link for the Lantus "relaxed regulation" group
viewforum.php?f=32
 
thanks everyone :)

I just checked my syringes and they say u100, so thankfully I am using the right size! I honestly don't think I could do dose changes less than .5u. It is hard enough to measure half a unit on those syringes without markings and the lines so close togther. How am I supposed to go up or down by less than that?
 
Theresa6 said:
There is a whole history here, but here is the readers digest version:

I started my cat Stella on lantus in December, on 2u and after 3ish weeks up to 2.5. It did nothing for her BG levels. Zero... they didn't change at all in the entire time she was getting the insulin. Together with our vet, we decided to get her off the insulin totally since it was doing nothing. She was diagnosed with hyperthyroidism at the same time as FD, so we decided to switch her to canned and off the prescription dry she was on, and at the same time give her thyroid meds some time to work. She was off insulin and on wet for over a month and her levels drastically dropped (really within 24 hours of the diet change) from mid to upper 400's to steady around 250. We went back, got her thyroid levels checked, and when they were fine decided to start her on lantus again. And thats where we are today, day 3 of her being back on lantus.

I decided to go with the SLGS and start her at .5u. In the last 3 days her BG levels are HIGHER than they were when she was off the insulin all together. Last night PMPS I got a 400, which I have not seen since she was on dry food.

What is going on? Its as if the insulin is having the opposite effect! Something about my cat and insulin just don't seem to work together. Any ideas on what could possibly be going on?

OK I think the best approach is to go through a checklist of things to eliminate that may be contributing to the problem.

First food. You changed the diet which is fantastic. Food plays such a big part in it all, and so many cats don't need insulin shots at all once they are on their wet low carb foods.
Just check on Binky's list to find the carb amount you are feeding, and if all is under the 10% level, we should be good in this area.
Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition

Second. Home testing. Another good thing to see is your testing before shot times .... what meter are you using? One big thing with Lantus is that unfortunately, the test before shots, ps number, is not the most important one. What you are most interested in seeing is what's happening in the middle of the cycle.
If you were to test every 2-3hrs and see mostly the high and flat numbers, you can make a few observations, like maybe the dose is just too high (like I thought for your start at 2u BID), or you need to give more insulin.
If your curve showed a HUGE dip low in the middle, and then bounce back up high by the next ps, people would all be saying too much! reduce the dose!
So the testing you were doing at the 2u dose was good; now you need to do a couple more curves at home on the .5u dose and see what is going in through the cycle.
Last on the testing ... see if you can get a before bed test because many cats go much lower at night.

Third. Drug interactions. I really don't have much experience in this area but it's important to know how your insulin and meds mix together, and you also need to know what non-medicinal ingredients are in your meds. If there are any in syrups, etc, check for sweeteners.
Two of my cats get a pain med regularly, gabapentin. My vet was mixing the contents of the capsules into a syrup and I could give their doses orally with a syringe. Well, after a week or so, I was noticing that both of their BG were creeping up higher, so I asked the vet to check on what's in the syrup. Sure enough, there was a sweetener, and so they got a SUGAR FREE syrup, and both my cats' numbers came down.
See if you can enter your meds and Lantus into this checker to see if there are any concerns. There may be none, but better to check and rule out a problem in this area.
Drug Interactions Checker

So, now, you have looked at food and dose and interaction.
The type of syringe was a very good point as well .. the U40 is for insulins like caninsulin/vetsulin and PZI, but for the Lantus and Levemir insulins, and even the humulin N and R insulins, you would need the U100 syringes.
Make sure that you have the syringes with 1/2 unit markings; you will need to be able to measure .5u doses, and when you are close to going off insulin, you may well be measuring .25u doses!

I have something gnawing at the back of my head about this kind of resistance, like a rebellion, but can't recall what it is. Maybe later on, after enough coffee, I'll remember.
I do have to agree that something seems strange.
Hopefully, with enough people here thinking it over, we can get you some answers.
 
Theresa6 said:
thanks everyone :)

I just checked my syringes and they say u100, so thankfully I am using the right size! I honestly don't think I could do dose changes less than .5u. It is hard enough to measure half a unit on those syringes without markings and the lines so close togther. How am I supposed to go up or down by less than that?
You should be able to easily get .25u doses with the right syringe. U100s come in a lot of varieties. You want 3/10cc ones with half unit markings. I get these from Hocks:
http://www.hocks.com/diabetic-suppl...edle-1-2-unit-markings-gnp-brand-100-box.html
I can get down to .1u doses with these - even .05u, but both of those take practice. I just think you may need a different syringe. You might have a 1/2cc so the barrel is wider and the lines are closer together.

Do you live in the US? I know some other countries have limited syringe availability.
 
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