Lucy's BG is 177...

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kalyv

kalyv

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Hi,

The vet and I have been playing around with her insulin levels and she is now getting 4units of Lantus every 12 hours.

Her levels have been going up and down like mad since we started on the 4 units last week. Yesterday they stayed over 20 all day. But this afternoon she was 9.3 and this evening she is at 9.8 or 177.

I have not given her evening shot yet but I am a bit worried about giving her the full 4 units with her BG being so low. Does anyone have any advice? Should I skip the evening shot or give her a smaller dose?
 
Kaly
Hold off for a little bit. I'm going to try to get some lantus-user to help out with this....

carl
 
Although I don't have background on Lucy, "playing around" with doses is not advised on Lantus. If you are uncomfortable giving that much insulin (good for you if you are) then go down to at least 2U. If you've never had her on as low of a dose as 1U, that's where she should have been started at and it's never too late to go down to 1U.

If we can get a quick history or at least a link to previous posts, that would help illuminate how you arrived at 4U.
 
Lucy was very sick when we took her to the vet so he immediately put her on 2 units every 12 hours.

We stayed that way for about three weeks and after I sent him a blood curve which showed that her BG was often over 20 and never went below 16, he said we should try 4 units twice a day.

During the time she was still on the 2 units, I took her off dry food and ran out of the DM prescription so switched her to the lower-carb Friskies pates. But it didn't seem to make much of a difference to her BG levels.

Anyway, after the first shot of 4 units her BG went down to 14 and then bounced between 16 and 18.

But then, a couple of days ago, she got into the other cat's dry food and when I checked he BG, the glucometer just said "hi." So I called the vet he said give her 4 units immediately (about 5 hours after her first shot.) Then check he BG again at the regular time and if she was still high, then give her her regular shot.

She was still over 20, so I gave her shot and then yesterday, she was still just over 20 so I gave her the usual 2 shots of 4. But after the dry food incident, I went and bought some more canned DM and that's all she got yesterday and today. Anyway, as I said, this morning before her shot she was at 9.3 and then again this evening at 9.8.

I am wondering if the DM was what made the difference.

So that is her history so far, if that helps.

ETA Dyana, thanks for adding the link to my intro post.
 
Logically, the DM should not have made a huge difference. It is listed on the charts at 7% carbs. Most of the Friskees pates are that or lower.

I think it had more to do with a build-up of the lantus, and the disappearance of the carb-boost from eating the dry. The 2 shots of lantus in 5 hours would have left her with a lot of insulin still on board. I am not certain, but I would think she's still got a good bit in the "shed" if I understand that concept correctly. I'd have to defer to someone with lots more lantus experience than I have however.

Carl
 
Hi there from Toronto!

I can't advise on dosing but I can tell you that there is a lot of additional Information in the lantus section. I would suggest going there to start and read the stickies (info at top of page).
 
It sounds like she may have had ketones in the beginning? Is that correct? There is another thread on Health right now where the kitty had ketones at diagnosis. http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=54214 There may be some info there to help you make sense of things. Kitty named Blue is also on Lantus. It's an excellent insulin, but takes some understanding to manage to best effect. The Tilly protocol could help you understand how it works. http://www.tillydiabetes.net/en_6_protocol2.htm
 
the dry food clearing her system could be playing a big part along with the overdosing with insulin. i'm sorry but your vet's advice to give another 4 units of lantus ONLY 5 hours after the last shot, was dangerous and potentially deadly. thank god it wasn't. in all honesty, the dry food that day was most likely a blessing.

also, doubling the dose from 2 to 4 with lantus is poor advice also. soooooooo, i think there needs to be some backpeddling and get some understanding of how lantus works and how it is properly dosed. by chance is this the first time your vet has prescribed lantus do you know? i'm wondering because it seems to be based on the advice given so far so maybe we can help him/her learn more about it too

for starters, no, i would not give her 4 units on that glucose level and possibly not again real soon. but, in all honesty, i will defer to others when it comes to what and when to shoot any more insulin because i'm still at work and highly distracted :-)
 
This is what I started to write before you posted your last post:
I read through your other condo, and I don't know how you increased in dose and how much at a time you increased it.
We usually suggest increasing in .25 unit increments, so you don't accidently pass the ideal dose. And each increase is held (the same dose every 12 hours) for 3 days.
I don't know if you went from 2 units right up to 4 units or went from 2 units right up to 3 units. Vet are known to tell their patients to do that. Many of the cats in the Lantus forum are on 1.5 units, or 1.75 units or 2.25 or 0.10 units and such.
If you increase the dose too quickly, the kitty may be in a state of rebound. I am not very good at explaining this. I am sorry.

So, what is the dosing history? Have you converted Lucy to all wet food, yet? or does she still get some dry food?
Has she every had ketones? How are her teeth and does she have any other medical problems?

You might want to start over again with 2 units, and hold that dose for 6 cycles (3 days) and let us know how that goes by posting her numbers. We can then advise if she needs a small increase or decrease.

These are just my thoughts. Let's see what others have to say.

I can't believe your vet told you to shoot another 4 units 5 hours after you originally gave her insulin and then give her her regular shot at her normal time after that. Your vet does not seem to know about insulins like Lantus. OMG ohmygod_smile

I'm glad you have her eating wet food now. The dry food incident did spike her BGs and dry food can make them stay high for quite a while.

Come over to the Lantus forum and read the stickies at the top of the page, when you get a chance to.
Have you shot yet tonight? If not, would you feel comfortable giving a 2 unit dose, and testing her a few times to make sure she doesn't go lower? Do you have high carb food and lots of test strips, just in case, and will you be home to monitor her? When you give her her shot, if you've stalled, you'll need to stay on a 12 hour schedule, meaning, if you shoot at 9:30pm tonight, you'll need to shoot at 9:30am tomorrow morning and 9:30pm tomorrow night. Is that doable?

These are all questions that need to be asked and considered.

I need to hit the hay in about 10 minutes. I hope I have helped you a little.
 
I am not sure if she had ketones when I took her in. I can't recall if the vet mentioned it. She had lost weight rapidly and started eating ravenously, drinking and peeing like crazy which is when I finally clued in that there was something seriously wrong. Because I was in the midst of moving and had boxes everywhere for several weeks, I kind of just put her loss of weight down to stress. So dumb.

The problem is that I cannot test her for ketones now because of the other cat since they both use the same boxes. So the vet said, just watch her BG closely for now.

I don't really know my vet's background. I saw him for the first time when I took Lucy in. We just moved to a new neighbourhood and he was close by.

But he initially thought she had a thyroid problem and a bladder infection and actually didn't clue into the diabetes until the very end of the exam after he had tested her blood for other things.

Anyway, he said we should try the 4 units for three weeks and then to another BG curve.
 
Sorry Dyana, I was typing the other post while you asked your questions.

I am working from home tomorrow so monitoring her is not a problem.

So I think I will check her BG again and give her 2 units tonight and check her a few times. And I still have all that dry food so if she drops too far, I can always give that to her.

ETA so I just checked her BG and she is back up to 19. Guh! This stuff is confusing.
 
Sounds like a plan. Except the dry food. Do you have any higher carb wet food you can give her, instead, I mean just in case you should need it, which you probably won't. Dry food just takes longer to raise the BGs and stays in the system a lot longer..like possibly more than a day. High carb wet foods like the Fancy Feast varieties with gravy are much better. They are about 18% carbs, and will raise the BG level much quicker, which is what you would need to steer the numbers higher, should she go down to say the 30s or 40s, which again, she probably won't. If you see that she is dropping too much or fas for your comfort level, try giving her a little low carb food first, and see if that helps to raise her BGs. And only give her a little bit (like a teaspoon) at a time. You don't want her so full she throws up, or doesn't want to eat anymore.

I think she'll be fine, and you'll do fine :-D

Much luck to you, tonight. I must go to bed.
 
Oops, cross-posted again. I just checked and now she is back up to 19. But I think I will just give her the 2 units for tonight and see how it goes.

Thanks for the advice and I will definitely do some reading up so that I can ask the vet some proper questions.
 
I would post your BG number this morning before shooting and ask for advice.
Your kitty may have gone into a bounce from the 177.
Have a good day.
 
Damn I just saw this but I think it was OK.

She woke me up at about 5 a.m. this morning (which is early even for Lucy these days) and when I checked her BG she was at 8.1. So I fed her some turkey and cheese in gravy Friskies and checked her BG again right before her shot at 9:50 and it was 22.6 so I gave her 2 units. At about 3 p.m. this afternoon she was at 10.6 and seems fine.

Is it normal for her to have such drastic ups and downs or is that a result of the messed up dosages?

It seems best to keep her on the 2 units for now. What do you guys think?
 
My kitty J.D. is a bouncer. When his blood sugar is less than he is used to, he tends to bounce.
If your kitty did not have ketones previously, then staying with the 2 units every cycle for at least 3 days (6 cycles) seems like a good move. Please keep letting us know how she's doing.
When you get a spreadsheet up and running, then I would advise you to start posting over in the Lantus forum.
Have you read through the stickies over there? Do you have any questions we can help you with?
 
I will definitely let you all know how it goes. Thanks so much for your advice. This place is literally a life-saver.

I skimmed a couple of the articles on the Lantos sight last night but haven't had time today to do more. I had a big work project due today and was too distracted last night to finish it so it was down to the wire today but I got it in on time so it's all good.

I will also check out the spreadsheets and try to get one started this weekend.

I will see how Lucy does on the weekend and then talk to the vet about her dosage.

Just one question Dyana - what do you mean when you say your kitty bounces? Is that the big jump in BG like Lucy's?
 
I would take what your vet says about dosing with a grain of salt. Most vets get about 1/2 day or less instruction on diabetes in school, and that's to cover all species. And they just don't have the experience in specializing in one decease, like we do here. And, unfortunately most vets (like my vet) are used to prescribing PZI or another insulin and do not know that much about the longer acting and shed building insulins like Lantus and Levemir. When I asked my vet for a prescription for Levemir, he asked me how to spell Levemir. I was and probably still am his only client using one of the L insulins.
When you said your vet told you to shoot another 4 units of insulin after you had given 4 units 5 hours before that, I knew he did not know squat much about Lantus. He could have overdosed your cat so easily that day. And, to top it off, by then telling you to give him his regular 4 unit dose again at his regular shot time :-x You might be able to do that with the other insulins that are in and out of the system quickly, but Lantus builds up a shed (a held depository? of insulin), and your cat could have easily ended up in the ER or worse that day or that night.


Bouncing: I'll try to explain, but then again, I'm not that good at explaining medical terminology. When the kitty's BG goes lower than what he's used to, his liver sometimes thinks it is too low, and then over reacts by spilling a glucose like hormone into his system to get his BGs back up to high numbers like he is used to. Bounces often can take up to 3 days (72 hours) to clear. So, if say Lucy had a BG of 60 one day (which is actually a safe and nondiabetic number), and she is not used to being in that low of numbers, her liver may try to "save" her and spill a bunch of this stored up "life saving" glucose hormone. If the next tests are sky rocketing upwards and she has high BGs for a day or two or three after that 60, then she is just bouncing from the low number, and you should just wait it out, for the 3 or so days, before considering giving a dose increase. If you freak become extra concerned when you see those higher numbers, and then give her a dose increase because of that concern, without waiting for the bounce to clear from her system, then when the bounce does finally clear, she might go even lower the next time because of the increased dose. If you did do that, and when she cleared the bounce, she went to 40 the next time, she may bounce even higher than the first time. It's just a way the body helps itself.
I know a little lot about bouncing because J.D. is the King Of Bouncing. I just don't know all the technical jargon.
I hope that helps. I'm sure you can find some more info on it over in the Lantus forum stickies, when you have a chance to read them (which I highly recommend you do, even if just a little bit each day).


One thing we do on the Lantus forum is recommend attaching a link to your last condo, into the first post of your new condo. That way the person posting has to go looking for their last condo (and read the unread replies, hopefully) in order to do the copy and paste of the URL address, AND, the people reading your post can easily click that link to see what happened and what was advised the day before.

Let us know if you have more questions. Maybe someone else can explain the bouncing part better than me ;-)

Hope you have a good weekend :-D
 
Thanks for the explanation on bouncing. It made perfect sense. Also thanks again for all the support and advice.
 
Dyana gave you a great explanation on "bouncing". The only thing I can add to it is this-

It doesn't just happen with low (normal non-diabetic 50s and 60s) numbers like she mentioned. If kitty is used to living in the reds and high pinks, and might go 250 on a normal "nadir", then one day for some reason, the nadir drops to 150 or 175, the same thing can happen. "Liver panic" is what some people call it. The liver does its thing, dumps "glucose" to ward off what kitty's body feels is "too low", and boing, here comes the bounce. Numbers go up to reds, usually higher reds than "normal". Same theory holds, however. Don't "shoot the bounce" thinking you need more insulin. Just let it clear. Many people find that very hard to do.
Ideally, the liver will "learn" (referred to as liver training by some) that what it thinks is low really isn't that low, and it will quit doing this. It seems to happen a lot when kitty starts seeing greens or yellows the first few times they happen.

Carl
 
Thanks for the further explanation Carl. Man this stuff is complicated.

I kept Lucy on 2 units for now but her numbers never dropped below 20 for three cycles in a row.
 
The bounce can last for as long as 6 cycles. We learn patience doing this sugardance.
 
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