Lantus Advice needed - Is this Somogyi or remission?

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Wendy&Tiggy(GA)

Wendy&Tiggy(GA)

Member Since 2011
I am getting weird BG levels and wonder if anyone can advise. Our cat is showing sugar in his urine at high levels and clinical signs such as drinking a lot etc. We have tried raising his insulin level gradually and we are thinking its making things worse!! Here are the details...

At 1IU BID he had pre shot of 200 but his peak was only around 175 and he showed clinical signs so we thought that 1IU wasn't high enough.

We tried raising it to 2IU and saw that his pre shot number was higher, nearer 250. His peak maybe was only 50 less than that, plus he still showed clinical signs. However at 2IU he occasionally got lower pre shot numbers to around 150 then back to 250 for a few readings.

We tried raising to 3 IU but got the same kind of results. Pre shot was higher still nearer 275 and above. Still the occasional sudden drop in pre shot numbers, now to around 100 this time but it wouldnt last and he would be back to 275 12 hours later. Still showing high urine glucose.

Just for reference, he is 16lb cat. We know the insulin is ok because we have another diabetic cat that uses it and he is responding normally.

Any ideas? If we take him to 1Iu it seems to be too low, but his numbers are acting weird on higher levels. No matter what we do we cant seem to get his sugar low enough that he isnt spilling a ton into his urine, plus he has neuropathy. I am almost ready to take him off entirely and see where he is without it for a week or so. He has been in remission before (although he didn't behave like this) and I wonder if this is an odd somogyi?
Any ideas?
Wendy
 
Re: Is this Somogyi or remission? what is going on!!?

Wendy, do you have a spreadsheet of history (BG test results, insulin dose, insulin being used, food being fed, etc.) that you can share with everyone?

It's going to be really difficult for anyone to give input without seeing the above history. You can start a spreadsheet by following this information.

Hopefully, once you supply more info, people here will be able to help you deal with the kitty in question. :)

But you did come to the right place! The people here are very helpful and very knowledgeable about diabetic kittys!

Suze
 
Re: Is this Somogyi or remission? what is going on!!?

Hi.
I agree you need a spreadsheet so those with the most experience can look at the numbers and help you with
what's going on.

You do know about the b-12 for the neuropathy, don't you?
this is the product. If you hunt for it elsewhere, make sure it is methylcobalmin. Not all b12
are the same.

Vitacost Vitamin B-12 Methylcobalamin -- 5000 mcg - 60 Capsules
http://www.vitacost.com/vitacost-vitami ... 0-capsules

A commonly given dose here is 3 mg -5 mg.
B vitamins are water soluble and any excess is excreted in the urine.


the bottle above is 5000mcg which is the same as 5 mg. You can empty the whole capsule and mix in with the canned food or use part of it if you prefer the 3 mg dose.
Click to expand...
 
Re: Is this Somogyi or remission? what is going on!!?

Yes we have been giving him 3mg a day so we are hoping that will at least keep him stable.
 
Re: Is this Somogyi or remission? what is going on!!?

Ok here are his numbers for the last few weeks since the weirdness began. He is a free feeder (canned wet food) so he eats all day so that doesnt show on here. the chart on the bottom is a trendline for the whole time. Let me know what you think!!
 

Attachments

Re: Is this Somogyi or remission? what is going on!!?

I will request some eyes to come give you input .

I have no idea if they will like this different format.
They will tell you.
 
Re: Is this Somogyi or remission? what is going on!!?

I could download your ss the first time, but not the second link. We all use this google document: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 It can be shared without downloading; few people are willing to download a document on their computer. It also has a World version which converts between metric and US. If you want to use it and have trouble, send me a private message. (PM button in the bottom LH side of my post.)

But for now, how about giving the last few days of numbers like this:

amps BG number and amount of insulin given in the am, before food.
+6 (the BG number 6 hours after the insulin was given or whatever mid cycle numbers you have)
pmps BG number and amount of insulin given at night, before food

I think you are using Lantus? I would add Lantus to the subject line to get those eyes on your post. I don't use your insulin, but one thing that stands out for me is that you increased by a whole unit. We generally suggest increasing by .25 units so we don't go over an ideal dose.
 
Re: Is this Somogyi or remission? what is going on!!?

Hello
Ok yes he is on Lantus. I think I managed to attach his sheet to my signature.. what do you think?
 
There aren't a whole lot of Lantus users who hang out in Health. Now that you have the spreadsheet working, you could post on Lantus too to see if you can get more eyes.

Lantus forum

While you are there, read the starred topics at the top of the page. They have great info on how to dose etc.

Lantus dosing is based on the nadir (midcycle number) so I know they will be urging you to get more midcycle numbers.
 
I will certainly get more mid cycle numbers but from what I have seen the nadir is around 200.... which is a big part of the problem!
 
What are you feeding (specifically)? Does your cat have access to any dry food? Is your cat free feeding? Also, is this your first vial of Lantus? I am asking because it doesn't seem to be having any effect..and am wondering if the vial is bad? I had an experience with a bad vial (at least that was my assessment) and when I changed it out, I started to see lower readings -- though it's a tough decision to throw away $130 bottle of Lantus (for sure). Just trying to think of reasons why the numbers do not appear to be affected by the Lantus (it's like you are giving water).

IF you do want to try changing out the vial... PLEASE consider going back to 1 unit (or less) just for a day or so.... because if the Lantus is bad, a 3 unit dose of "good stuff" will likely send your cat into hypo. Others will advise.
 
A few things off the top of my head.

1. We mostly increase in .25u increments. Jumping straight from 1u to 2u to 3u can very easily miss the "sweet" dose. 1u to 2u is double the amount of insulin. This might cause chronic bouncing/rebound/flat numbers. Some cats do get up to higher doses, but we do it slowly so we don't miss the right dose. The highest my Scooter got was 2.75u.

2. If you are feeding any kind of high carb dry food or treats, this could cause the high flat numbers too. You need to eliminate ALL high carb food from the diet. Even a few crunchy treats can send some kitties sky high.

3. If the vial of Lantus you are using was damaged, repackaged, frozen, left out in room temperature, etc. it may be bad. Like Melanie said, please be careful when starting a new vial... if this one is pooped out, you are already up to 3.5u, and that is a high dose that could severely harm your cat when you use an active insulin. Here is the handling/storing Lantus thread: viewtopic.php?f=9&t=151
 
Ok..sorry I missed the note about the other cat. Maybe others can speak to their experience with insuslin resistance (if they think that could be a possibility here). I know nothing about it myself, but here is an article I found, if it is helpful: http://www.google.com/url?sa=t&rct=j&q= ... wbz9vGuiaw

Basically it says that some cats are resistant to insulin due to a number of factors including underlying conditions, infections or other reasons -- of which there can be many. Alternately, maybe Lantus is just not the right insulin for this particular cat. I believe several of the members here have switched insulin as well, as their cats were not responding well to one particular type -- so for example, if Lantus is not showing effect, maybe Levemir or PZI may work better. Wish I had more to offer.
 
he gets no dry food at all, he gets Core Wellness canned wet and the low carb Janet Binky recommended fancy feast. I will try dropping him back to 1.5IU and see what happens. thanks!
 
I'm sorry to just get to this now. I was asked by Rhiannon to come over from the Lantus TR ISG to look at Tiggy's SS.

Actually, I don't think his numbers look wonky. I do think the increases were done in too high of an increment. But I'm seeing pretty flat numbers regardless of the dose. He is coming down some into the 100s.

One thing that concerns me is the lack of testing at night. It's pretty hard to tell what's going on without some nighttime, mid cycle tests. If you are able to get up at night and do one test around mid-cycle, it would really help.

I don't think this is Somogyi or remission either one. Normally, if a caregiver has been following the tight regulation protocol with small, incremental increases, Somogyi can't happen and so lowering the dose to do a rebound check doesn't get you anywhere.

It would be nice to be able to see what he's done in the last day or so if you lowered his dose.

Quite often, cats that go low at night and spring back up the next day, see more variation. You'd be seeing numbers over 300, most likely. If I saw a cat's SS that looked like this who had been taken up per the protocol, I would think he's still not gotten to his fitting dose. However, without more data, I wouldn't recommend a dose increase. Once you are able to test a few cycles at night, then we could help put this puzzle together a little better.

You might want to post on the Lantus TR ISG so we could watch a little more closely as to what he's doing at night or if you decreased the dose.
 
Just curious, maybe I missed it, but what BG meter are you using for testing your cats?
 
thanks Marge for looking at this. I didnt lower his dose yet as I thought I might let him settle longer on this current dose of 3.5IU. Since I read different people saying 3 days before increase, and then others say a week. I have updated my SS. I will take some night readings (I am off next week on vacation = makes it easier!) and see. I will let you know!
 
I've read over and over on these boards people advising us to stay away from meters with "free" in the name due to accuracy problems. You might want to do a search here for "FreeStyle" and see what people have said about them.

I was using the Relion Micro until recently, because the test strips were more affordable than many other meters. ($.36 each if you purchased 100 at Walmart, and $.28 each if you purchased the equivalent Arkray test strips from American Diabetes Wholesale online). Then I purchased the Relion Prime at Walmart a few days ago, because those test strips are $9 for 50, or $.18 each. What a savings, especially if you test a lot. A lot of people here use the Relions with good results.

Hope that helps!

Suze
 
That might explain why the numbers not only don't make sense, but don't match the symptoms.

Supposedly the FreeStyle Lite meter does not register over 300 with felines so some of the yellow numbers may be way off.

Good thing you caught this early, but you really should retest with another meter right away, such as Bayer Contour or Relion.
 
The FreeStyle meters are inaccurate for cats. They are off by 100 points or so. Please return the meter and buy a different brand. Aviod any meter that has "True" or Tru" in the name. Wal Mart's Relion brand is what many people here use. Big name brands like AccuChek and OneTouch are good as well.
Click to expand...

This could definitely be affecting your numbers.
 
I have to agree on that meter. A lot of members use the Relion confirm. The Contour is an awesome meter but strips are expensive even on eBay.
 
That surprises me since the numbers are perfect on the other cat. However we had the meter calibrated with our vets blood testing and it was only out by a small amount 25 or so. So I dont think its the meter.
 
The meter may be fine for normal numbers. It's when you get high that it may be way off and give the impression the numbers aren't so bad.

Tiggy may be bouncing high but you need to test with another (feline accurate) human meter to find out for sure.
 
Excellent Wendy.

You can review this thread for more specifics of the problem. But it seems it's the yellow numbers which aren't always correct.

I know a cat Boo Radley who went DKA because of this problem of false readings from the Freestyle Lite.
 
thanks. I regularly check his urine for ketones so I am watching closely. I should say he has been diabetic since October last year. He went into remission in December and dropped out of remission in March this year after we got a new cat that he was fighting with constantly. And from March till June his numbers were fine.. behaving normally with the 3IU he was getting. Then a few weeks ago his numbers started to go wacky. Which oddly coincided with his no longer fighting with the new cat.....
 
You don't need a "feline accurate" meter. Trying the Contour is fine.

Just as a note, we had another member here who was using the same meter as you. Her cat was almost always in normal numbers. But she was still PU/PD. She discovered the issues with the meter. When she got a different meter, she realized that the cat's numbers had not been normal.
 
Marjorie and Gracie said:
You don't need a "feline accurate" meter. Trying the Contour is fine.
Click to expand...
What I meant was a "feline accurate" human meter, as opposed to "feline calibrated" such as AlphaTrack.

Or in this case anything but the FreeStyle Lite, or the Tru or True meters. Since the Freestyle is apparently accurate for humans for whatever reason. Relative accuracy of the meters when testing felines is paramount for insulin dosing. ;-)

The tip off for me was the neuropathy. Chip got neuropathy in a month from too much NPH. He was bouncing to red and black everyday. But fortunately he never developed ketones. Chip is now way higher than Tiggy's current SS and he has no trace of neuropathy presently. I'd guess Tiggy must be bouncing. But a few days with the Countour meter including some overnight spot checks should tell the whole story. Unless of course during that time period he actually stays under 250 or 300 for real.
 
Hey there - so I got up at last night and took some readings, Plus I have been using both meters. Check out the SS. Here are some conclusions though

1. the new Contour meter is showing the same flat numbers as the old Freestyle so far (the contour seems to be almost consistently 60 higher at these levels)
2. Overnight behaviour seems the same as during the day - which makes sense since he is a free feeder

However now I am seeing one of those weird drops I mentioned before.. look at his numbers from last night versus this morning - it showed on both meters but here is the numbers from the new meter :
PMPS 322
+3 310 (dropping)
+5 286 (lower)
+9 295 (going back up)
AMPS/+12 274 (wtf?)
I am going to do a curve today to see what happens now. I am suspecting the flat numbers are in fact somogyi and that with his most recent dose he will drop low and shoot back up again and go flat. Thats what I am looking for anyway.. thoughts?
 
Wendy,

Looks like you are getting a better picture of how bad that FreeStyle Lite meter is. If 241 may be off by 60 or 90 points, it shows you never know where he really is with that meter. That's way more than the 20% meter variance, and when it's always off in the same direction it just means you have (nearly useless) false readings. Even dangerous.

If there is any way possible I would get both cats on a better meter permanently.

Once you get some accurate readings you will be in a better position to determine the dosing for Tiggy. Those flat pink numbers are more in line with the symptoms you describe.

BTW I love those pictures in the profile. Best of luck getting him controlled. :smile:
 
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