Lantus: BG is HIGH and LOW...with numbers getting lower

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J

Jo and Miga

Member Since 2012
Hello FDMB,

My name is Jo, and Miga (meega) is my 13 year old Cat diagnosed as diabetic - Nov 2012. She started getting insulin shots in Jan 2013, and I now do home testing using a ReliOn meter. I've read various posts about cat food, and eliminated most of the Dry Food she has had been eating (for 11 years) since adopting her. I've replaced Fancy Feast (grilled & marinated) flavors with Fancy Feast Kitten (low carb) flavors, and have added Friskies Pate flavors. Her BG numbers are getting lower, and I am giving her Zobaline (1 pill in AM food) for her Neuropathy symptoms. She is on Lantus, receiving insulin BID.

I'll peruse the FDMB forum when I have questions. Thanks everyone for your support and feedback.

Jo
 
Re: New Member: Lantus with HIGH and LOW readings

First thing first... have you tested again since you got the 42 this morning?

Carl
 
Re: New Member: Lantus with HIGH and LOW readings

Hi Jo,
And welcome to the FDMB!

Couple of questions:
How difficult do you think it would be to convince Miga to give up the dry food habit?

The dose adjustments suggested by your vet.... do you know the logic behind them? Looking at your spreadsheet, it looks like he's been adjusting based on the numbers you have been getting at "shot time"? If so, that's a basic misunderstanding of how Lantus works. First, the dose amount is based on the nadir (lowest BG reading) of a 12 hour cycle. And the other big thing is that Lantus works ideally when you hold the same dose for several days, collect the data, and then reevaluate the dose.
When you make dose adjustments, it's best to do so in small increments, usually .25u at a time. There are also "triggers" that call for an automatic reduction in dose. Whenever we see a kitty with a number below 50, that says "reduce the dose". That's why I asked about any tests after the 42 you saw today at +2 hours after the shot.

Carl
 
Re: New Member: Lantus with HIGH and LOW readings

Miga was sleeping, so I woke her up to get a current BG test. She again tests at 42 (+2,+6). I did give her some High Carb wet food a few hours ago, thinking it would raise her numbers. Plus, there is other Fancy Feast (low carb) food still available in her dish from this morning. I wasn't around to re-test earlier.

I just now gave her more Fancy Feast (gravy flavored) to eat. I'll test her again within a 1/2 hour. She seems alert and playful!

Are the ReliOn meters "accurate" with LOW numbers?

Jo :o
 
Re: New Member: Lantus with HIGH and LOW readings

Yes, most people have found the relion meters to be reliable at the low-number range.

You did exactly the right thing by feeding higher carb food on a number in the 40s, and you'll want to test every 30 minutes until the numbers come up. We call this the "lather, rinse, repeat" routine. High carb should bump her up, but the downside is that it doesn't seem to last long. Whenever you see a 40 that soon after the shot, it can mean an exciting day for the next few hours.
The other thing to be aware of is that because it might take several feedings to get her up to the 70-80 range and get her to stay there, you want to dish out the food in small amounts, like a teaspoon at a time. You want her to be hungry 30 minutes later in case you have to "repeat". Sometimes just a tsp of gravy will bump the numbers up and not fill their tummy.

I'll be here when you post your next number.

Carl
 
Re: New Member: Lantus with HIGH and LOW readings

Update: Miga is now at a BG level of 65, since her level of 42 - a half hour ago. She ate some Fancy Feast high carb food, and the number is rising!

We have a multi-cat household, so it won't be easy to completely remove DRY FOOD. I'll ask my roommate to keep the DRY FOOD in her cat's feeding area, since her cat needs the HC (high carbs). Miga might go looking for it (late at night), but hopefully she will eat more wet food - and not be as hungry!
 
Re: New Member: Lantus with HIGH and LOW readings

rhiannon and shadow said:
Hello.
Welcome. I am wondering where she is now too.
Click to expand...


She is up to a BG level of 65! I'll make sure she gets more of the high carb food - this next hour! - Jo
 
Re: New Member: Lantus with HIGH and LOW readings

I'd give her a little bit more food and test again in 30? You can try low carb and see if that keeps her numbers steady.

Carl
 
Re: New Member: Lantus with HIGH and LOW readings

Carl & Bob said:
Hi Jo,
And welcome to the FDMB!

Couple of questions:
How difficult do you think it would be to convince Miga to give up the dry food habit?

The dose adjustments suggested by your vet.... do you know the logic behind them? Looking at your spreadsheet, it looks like he's been adjusting based on the numbers you have been getting at "shot time"? If so, that's a basic misunderstanding of how Lantus works. First, the dose amount is based on the nadir (lowest BG reading) of a 12 hour cycle. And the other big thing is that Lantus works ideally when you hold the same dose for several days, collect the data, and then reevaluate the dose.
When you make dose adjustments, it's best to do so in small increments, usually .25u at a time. There are also "triggers" that call for an automatic reduction in dose. Whenever we see a kitty with a number below 50, that says "reduce the dose". That's why I asked about any tests after the 42 you saw today at +2 hours after the shot.

Carl
Click to expand...


Yes, I believe the "insulin dosage amounts" have been based on "shot time" readings. The 2 Vets (same office) advised me to do ".5u-1u" changes, but obviously I don't yet understand how to properly determine dosage changes. Hopefully, some of you here @ FDMB can help clarify, based on what you see on the BG spreadsheet. I really want to get this figured out, so all help is appreciated. Thanks...
 
Re: New Member: Lantus with HIGH and LOW readings

Jo,
I just posted on the Lantus Tight Regulation forum to try to get some input from the great people there. They are very experienced with Lantus, and I'm sure they'll help with how to go forward from here, especially about dosage. My gut says "less insulin" with the 40's today, but just not sure how much less.

Carl
 
Re: New Member: Lantus with HIGH and LOW readings

Lantus works best with consistancy, both in the dosage amount and the 12 hour timing of the shots.

And like has been said the dose adjustments are done based upon the lowest point in the 12 hour cycle.

You definitely need to reduce the dose because of the 42 numbers you tested today.

We usually do dose adjustments in .25 unit increments.
However, I think you might want to start over again with 1 unit or maybe even 0.50 units. The main thing is to be consistant by giving the same dose each shot, unless a dose adjustment is called for. To find that out, you will need to get those mid-cycle tests.

Please print out the hypo instructions from this link and always keep a supply of test strips and high carb food handy for just in case.
How To Handle Low Numbers

If you post here often, we can help you a lot in helping your cat.

The sometimes getting into dry food may pose a problem. Why does your roommate's cat need dry food?
 
New Member: Lantus with HIGH and LOW readings

Hello FDMB!

So, I am perplexed now. Miga has eaten 1+ cans of Fancy Feast HIGH CARB - since her BG level of 42 this morning.

She is alert and playful, but her BG numbers have barely risen today. She did lick some syrup too!
AMPS 210
42 +3
65 +7
63 +9.5
53 +10
54 +11

I plan to keep testing her BG, and probably won't give her any insulin this evening! From what I am understanding here @ FDMB, I will need to go back to "1u" given 12/12 - and start over with gradual dosage increases, depending on the numbers. Is this correct?

Jo :o
 
Re: New Member: Lantus with HIGH and LOW readings

Yes, please skip tonight's shot. I will try to get some more eyes over here, as it's my bed time soon.
 
Re: New Member: Lantus with HIGH and LOW readings

Dyana said:
Yes, please skip tonight's shot. I will try to get some more eyes over here, as it's my bed time soon.
Click to expand...

Thanks! I'll keep adding numbers to the SS!
 
New Member: Lantus with HIGH and LOW numbers = BG 83 (+11)

UPDATE: Miga's BG is 83 (+11) and 130 (+12)

I'm glad to see her numbers rising, and now she wants to go outside to play in the freshly fallen snow.

Jo :smile:
 
Re: New Member: Lantus with HIGH and LOW readings

Hi, Jo and welcome to FDMB.

When you say you fed Miga HC, what exactly did you feed? A can of FF in a HC variety should bring Miga's numbers up a bit higher than what you're seeing.

When you say your roommate's cat need HC food, to be honest, I doubt it. Most dry food contains grain, vegetable matter, and all sorts of animal by-products. Cats are carnivores. They don't need carbs. Think about what a lion eats. The only plant matter that a feline gets is in the GI track of prey where it's partially digested. Cats can't process carbs. You may want to take a look at this website on feline nutrition that's written by a vet. I have a non-diabetic cat in my home. Both cats eat the same canned food.

As for dose, Miga's dose has not been worked up in a systematic manner. The starting dose of Lantus can be determined by a formula:
initial dose = 0.25 x ideal weight in kilograms​
Usually this calculates out to around 1.0u. I'd suggest you start over using the formula or at 1.0u and we can help you to adjust the dose, based on the nadir values, in a safe way. I'd also suggest that you routinely get a test every night before you go to sleep. Many cats experience lower numbers at night so it's important to get tests during the PM cycle.

There is a great deal of information about Lantus in the starred sticky notes at the top of the Lantus board. Below are links to those posts and a brief description of the content.

  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
 
Re: New Member: Lantus with HIGH and LOW readings

Sienne and Gabby said:
Hi, Jo and welcome to FDMB.

When you say you fed Miga HC, what exactly did you feed? A can of FF in a HC variety should bring Miga's numbers up a bit higher than what you're seeing.

When you say your roommate's cat need HC food, to be honest, I doubt it. Most dry food contains grain, vegetable matter, and all sorts of animal by-products. Cats are carnivores. They don't need carbs. Think about what a lion eats. The only plant matter that a feline gets is in the GI track of prey where it's partially digested. Cats can't process carbs. You may want to take a look at this website on feline nutrition that's written by a vet. I have a non-diabetic cat in my home. Both cats eat the same canned food.

As for dose, Miga's dose has not been worked up in a systematic manner. The starting dose of Lantus can be determined by a formula:
initial dose = 0.25 x ideal weight in kilograms​
Usually this calculates out to around 1.0u. I'd suggest you start over using the formula or at 1.0u and we can help you to adjust the dose, based on the nadir values, in a safe way. I'd also suggest that you routinely get a test every night before you go to sleep. Many cats experience lower numbers at night so it's important to get tests during the PM cycle.

There is a great deal of information about Lantus in the starred sticky notes at the top of the Lantus board. Below are links to those posts and a brief description of the content.

  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
Click to expand...

Thanks! I will discuss the DRY FOOD issue with my roommate, and will take some time to read more about Lantus and BG curves. - Jo
 
Re: UPDATE: Lantus with HIGH and LOW readings - BG 130 (+12)

Hi there

It looks like you are having some fun with Migas numbers. I would like to suggest you come over to the lantus tight regulation board and we can discuss dosing etc with you http://felinediabetes.com/FDMB/viewforum.php?f=9

Specifically we need to discuss consistent dosing and the Lantus depot. Lantus takes a few days for a dose to settle in so if you keep going up and down in doses and dont let it settle in you wont know what the best dose is.

Plus if you start to post there regularly the members can hand hold you through shooting low and the best way to deal.. what do you think?

Wendy
 
Re: UPDATE: Lantus with HIGH and LOW readings - BG 130 (+12)

For the roommate, perhaps you might get her/him to change the dry s/he feeds to one that won't encourage diabetes so much, such as Wellness Core, or Evo Cat & Kitten. Ask her/him if they'd want to be managing a diabetic cat too! Its much cheaper to feed 'em right, than spend oodles on diabetic supplies, or renal disease supplies, etc.
 
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