Levemir switch from Lantus - unstable diabetes

[al3xfree2all]

Hi all. My cat been on lantus for a month, after being on caninsulin which was given to him because he had ketoacidosis, jaundice and hepatic lipidosis. And before the illness he was also on lantus for 8 months but it probably didn't work anymore and that's why he got sick and worsened his diabetes. (He has been given 2 units of Lantus on these months and not monitored)

A month ago, after he recovered from all the above, definitely God helped us .
He was switched to lantus again because caninsulin didn't cover the 12 hours. I started with 1 unit of lantus every 12 hours and I'm currently on 8 units every 12 hours when the blood sugar is high, 300, 400 and 500. Now I'm strongly considering to switch him to levemir which is still slow but stronger.

It's possible that he also has a urinary tract infection and the insulin can't work properly.

We are using a pen currently(attached photo), but have been told that it might not be so effective and some small drops are not going through, which would mean an innacurate dosage.
So we want to use the U 100 0.3 ml and 31 and 32 gauge needles.

Is there any advice considering the above?
As the insuline is high for a while, we are definitely concerned not going to Keto acidosis again.

 

[squeem3]

The pen doesn't work well for cats. It only doses in whole units and you're not really getting the full dose because there's some insulin loss. You can use insulin syringes with the pen. You want the U100 3/10cc ones with half unit markings.

Do you keep track of your cat's blood glucose numbers? FDMB members can't really advise on what to do without seeing a history of your cat's daily blood glucose levels.

Diet can also impact blood glucose levels. What are you feeding? A high carb food will just keep blood glucose levels too high.

 

[Sienne and Gabby (GA)]

I am assuming you are located outside of the US. Please be aware that in some countries, Levemir is being discontinued. It has already been discontinued in the US.

From your note, it sounds like you were not advised to increase your cat's dose of Lantus during the 8 months prior to his episode of ketoacidosis. With any insulin, the dose may need to be changed. It's likely that the 2u dose was not enough insulin which contributed to the health issues.

What is the typical insulin dose for your cat? If I'm understanding your post, you increase the dose to 8.0u if his blood glucose is over 300. Unfortunately, that's not the way Lantus works best. Lantus dosing is based on how low the insulin brings your cat's blood glucose level. It's not good at "shooting down" high numbers. It is a longer acting, depot type of insulin and it sounds like you've been advised to use Lantus like a short acting insulin. If I've misunderstood and your cat is getting 8.0u at every shot, I would strongly encourage you to get your cat checked for a high dose condition -- either acromegaly or insulin resistance (insulin autoantibodies). If we see that a cat is on a steady dose of more than 6.0u, we suggest getting the cat tested.

It would help us if you set up a spreadsheet and your signature. The information on how to set these up is in this post.

 

[Bron and Sheba (GA)]

If you think you cat might have a UTI I would get it checked asap. If he recently had DKA you don’t want to have any ketones/infection in the picture.
Are you testing for ketones at all?

 

[al3xfree2all]

Thank you all for the answers, I will be back with spreadsheet and reply as soon as I can.

 

[al3xfree2all]

@squeem3
Yes, that's right, the pen has losses and that's why I switched to injecting with U100 and 0.1 ml syringes.
Of course, I have strict records thanks to the freestyle libre 3 blood sugar measurement sensor.
I feed Winnie only with food, without carbohydrates, cereals, starch. Ex. Venandi Animal brand, Mjamjam, Mac s Super food etc (the food I use is supplied from eastern EU where we live in).And I also supplement it with grilled chicken breast or grilled fish fillet. I rarely give him only as a small snack, 10 gr. of dry food Carnilove fresh chicken.

@Sienne and Gabby (GA)
Indeed, we live in Eastern Europe, I am not sure about the discontinuation or full status of Levemir here, but thank you very much for the notice.

Yes, that's right, I was not recommended to increase his dose of Lantus and most likely that's why he got sick and developed ketoacidosis, jaundice and hepatic lipidosis, but also because he eats quite a lot being overweight. Now after the episode of illness he lost weight and I try to keep him on less food and more strictly for diabetes.

I will also do these tests to rule out everything possible and also do a urine culture test as soon as possible. I gave him a dose of 8 units every 12 hours for 6 days and nothing happened. On the 7th day I gave him insulin with a syringe and at night towards the morning his glycemia dropped very suddenly from 480 to 120, in the morning I only gave him 6 units but throughout the day his glycemia was still very high, even over 500. In the evening I gave him 8 again and again his blood sugar dropped suddenly and he even had hypoglycemia with 75. I reduced the next dose again but to 7 and again his blood sugar increased a lot during the day. This has been happening for 4 days including today, I reduce the dose a little, nothing happens, I increase the dose again, that is, 8 units at night towards the morning it drops suddenly with a risk of hypoglycemia.

Of course I will send you the data with the spreadsheet and signature.

@Bron and Sheba (GA) Yes, I tested him for ketones but it was negative and I'm going to do a urine culture.

Fyi I am using google translate, as I do not know how to speak English very well directly, my son helps me sometimes with translation and he directed me on this forum, as well configuring all of these stuff around (signature, spreadsheet, etc).

My question for all of off you, who can help and guide me in this matter ?
I read that you assign a dedicated person to someone to help, this would be wonderful, because I need someone to guide me find a solution for this high glucose from Winnie.

Note: I will put as many labs results I have and I will update anytime I have new ones. Also my signature is done, all data + daily updated spreasheet, please check it.

 

[al3xfree2all]

For your info, Winnie's glycemic curve from today (8 PM -> 8 Units Lantus), can be seen that during nighttime to morning (8AM -> 6 Units Lantus) it goes v low and afterwards during the day it goes very high, even past 500, this happened so many times and varied so many times as well.

 

[Sienne and Gabby (GA)]

We do not assign one person to help. Most of our members are working or in school. I'm one of those people who has a full time job and when I'm able to log in to FDMB is not predictable. It's why there are so many people who can help.

Lantus works best if you do not make frequent, large changes in dose. A change from 8u to 6u may not look like much but it is a big change. Because it is a depot insulin, you need to give a dose a chance to stabilize. In addition, if you see a drop in numbers the way you described, there's a good chance the high numbers you saw afterward were a result of what we call a "bounce." If numbers drop lower than what your cat is used to, the liver and pancreas may react by releasing a stored form of glucose and counterregulatory hormones that cause numbers to spike.