LOUIE

[terijordan1]

I am new to this website and not sure how it all works but I have a male cat (Louie) that was diagnosed with diabetes March 2013. He is taking glargine insulin 2x/day and has been all over the map as far as the dosages. He is on a high protein wet diet (WeRuVa). I have been working with the same vet since the onset and we have been unsuccessful in regulating him to date. He went non-diabetic for approximately 1 month 3-4 months into the first year but then back to high numbers. He is a very good in receiving all the shots and blood glucose testing. I quickly learned how to do both at home. Before the diabetes, Louie weighed in at 20 lbs. and the vets encouraged my putting him on a diet and we were successful balancing him at 16.5, then he was diagnosed with diabetes. He lost a lot of weight (approx. 6 lbs in 3 months, but we are back up to a nice weight (12.4). Lately he has tested very low in the AM (100s) but climbs back up by the evening (400s) so I am currently working with the parameters of glucose levels under 200, no insulin is given; 200-300, 2 units of insulin; over 300, 3 units of insulin. I would really like to get him regulated and not have to test 2x day. I am confused by this chronic illness and wish I could get a handle on it for my boy!

 

[BJM]

...glucose levels under 200, no insulin is given; 200-300, 2 units of insulin; over 300, 3 units of insulin. ...

There's your problem right there. You're treating Lantus like its over and done with by the next shot ... and it isn't. Lantus has carryover effects and works best when dosed the same amount both morning and night, as close to 12 hours apart as you can get.

Read over the Lantus Tight Regulation protocol here to see a protocol for using Lantus which can help get him stabilized, regulated, and maybe, just maybe, off insulin in the future.

 

[Wendy&Tiggy(GA)]

Hello and welcome to the board

Part of the reason you are seeing odd numbers is your sliding scale dosing. Lantus is a depot insulin which means it takes a few days for dose change to settle and build up in the cats system - or to drain out if you reduce the dose. This means it only works well when dosed consistently. Which means you give the same dose AM and PM - no matter what the numbers are*. And you give that same dose a few days to settle before changing it if it isn't working.

* The only caveat is that as a newbie we advise you don't shoot under 200 until you have data to understand his trends - means you need a spreadsheet? That will help us advise better too.
http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

I am glad to hear you are home testing. You said he has been in the 100s in the morning? That makes me suspect he is going low at night - many cats do. Because its unlikely that the number you get in the morning is the lowest he went. So I would try and get some checks middle of the night to see if you can catch the low. Not easy so set the alarm but it will allow you to really know whats going on! Do it for 2-3 days in a row as he may be bouncing (bouncing is when he goes too low and then the body overreacts and stays high blood glucose for a few days in a row before coming back down) .

I know you don't want to do more tests but its critical at this point to work out the issue and keep him safe. let us know if you need help with the spreadsheet.

Wendy

 

[Deb & Wink]

Hello to sugarkitty Louie and your caregiver and welcome to the message board. Would you please tell us your first name?

Lantus insulin dose changes are made based on the lowest point or nadir in the 12 hour cycle, not the pre-shot BG (blood glucose) readings.
Most cats on Lantus nadir around +5 to +7 hours after the shot. ECID (Every Cat is Different) so you need to do some testing in the middle of the cycle to see when Louie hits his lowest BG level.

Some cats nadir earlier, like my diabetic boy Wink, around +3 to +4. Other cats nadir later, around +8 to +10. A few more random BG test numbers in the middle of the cycle would be helpful.

Here is a link to the sticky from over in the ISG for Lantus Tight Regulation forum on the depot and how it works.

 

[Deb & Wink]

How is Louie doing? Haven't heard anything from you for some time now. We miss you and would like to see you post again.

 

[terijordan1]

Thanks for your responses on my guy, Louie. FYI, my screen name is ZIPPY.

Interesting that you brought up the nadir. My vet is thinking Louie's nadir is 14-16 hrs and we are talking about changing his insulin to ProZinc. I will check out the website on Lantus right away - thanks so much.

Yes, I agree that consistency is a key with Lantus, but we have been consistent with his dosages for long periods of time (months) and only started spot checking his glucose levels at home a few months ago because he had high numbers in 2 glucose curve tests (300+ over a 3 month period) and then swung down to 58. Is it unusual to take over 1 year to regulate a diabetic cat? My vet is thinking we area having trouble regulating him because of his nadir running 14 hrs and it isn't reasonable that I give him insulin in the wee hours of the AM.

Odd thing though, he is very alert, active and mobile most days (chasing his sister) so it's real hard to see that he is having any problem dealing with those high numbers.

Zippy + Louie

 

[BJM]

We would find it very helpful to see some numbers recorded in a viewable grid.
Instructions for our standard are here

After you publish it to the web, you can share it as read-only, so we can take a look at it, but not change it.

To see examples, look for the wors spreadsheet or ss in folks signature.

 

[Wendy&Tiggy(GA)]

If you are doing that weird mixed dosing then in theory you may never see good regulation.

A late nadir can be because of bouncing - which means in fact his dose is too high. What happens is the cat drops low ( sometimes dangerously) and then the body overreacts and makes the blood sugar sit high for a few days Then the blood sugar goes back down again - and may again drop low. And it has no correlation to the insulin time. A good way to check for that is to get tests at various points of the day for 2-3 days in a row and look for him to sit high for a few days and then drop down.

Wendy