My Cats BG isn't going down

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silenze

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Hi, about a month ago our cat was diagnosed with diabetes. We started him on wet food for a week with no change. Then 3-4 weeks at 2 units LANTUS (GLARGINE) twice a day.
Last week when we took him back to the vet his numbers were very high about 600 (probably stress). They changed his insulin to 2.5 every 12hrs. He is fed and gets a shot at 4:30am and pm
We just started testing his BG at home at night. his BG never seems to go down very much.
He is always hungry and is still loosing weight. he is now at 11.5 lbs and very skinny.
I just don't think the insulin is having any effect. His numbers are always between 300 and 400. we are using the walmart relion meter
Wondering what to do. Thanks for your advice!

19-Oct 445pm Hi (600)
19-Oct 600pm 553
19-Oct 8pm 389
20-Oct 430pm 407
21-Oct 415pm 332
24-Oct 430pm 387
24-Oct 6pm 368
25-Oct 430pm 446
25-Oct 715pm 378
 
Now that you are home testing, please test before each shot, and try to get a mid cycle (about 6 hours after the shot) every cycle if you can. If you have to be away from home during the weekdays, like I do, then please get mid cycle tests during the weekend (and a curve (every 2 or 3 hours) would be great), and the days that you are not home set an alarm and do a middle of the night test.
You may have to increase the dose, but we recommend only increasing by 0.25 at a time. I would get the mid cycle tests first, and let us know what they are.
 
Ok thanks. I didn't know when to test. I figured that 1 or 2 hours later the BG would drop.
I can only test when my wife is home so I may have to wait until the weekend. Right now we test before the shot at night. and 1-2 hours later before she goes to bed.
His diet is 1 can of Purina DM every 12 hours. He wolfs it down like a monster!
 
Have you read the stickies on the Lantus board to understand how Lantus works? http://felinediabetes.com/FDMB/viewforum.php?f=9

silenze said:
Ok thanks. I didn't know when to test. I figured that 1 or 2 hours later the BG would drop.
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Lantus doesn't work that fast :smile:

Lantus typically works like this:

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.



His diet is 1 can of Purina DM every 12 hours. He wolfs it down like a monster!
Click to expand...

Great that your cat is eating canned food but you really don't need to feed the DM. The DM has pretty junky ingredients and it's expensive and many cats get bored of eating the one flavor available. You can return the DM to the vet for a refund.

There are lots of commercial canned foods that you can feed to your cat: Fancy Feast, Wellness, Friskies, Merrick, Innova EVO, etc.

Here's Binky's canned food charts: http://binkyspage.tripod.com/canfood.html

A newer canned food chart that is more up to date.

Look for foods that have a number 10 or less in the carb column on the charts.

Also, new diabetics are always hungry. 1 can of food a day isn't enough. Most people give their diabetics several small meals throughout the day. A programmable timed feeder works great if you are not home during the day.
 
In order to see how Lantus is working in your cat, you should get at least three tests a day--once before each shot, and then one about 6 hours after either shot to determine what the lowest number of the cycle is. This number is what dose adjustments are made from. Many cats "bounce" when they first start insulin, meaning that their bodies aren't used to normal numbers so they'll react by raising glucose from anywhere between 12 and 72 hours. That's why it's important to get these numbers daily, because you don't know if the high number you're getting is really a high number or a bounce.

Also, cats that are on too high a dose will also remain in high numbers, for the exact same reason. However, this situation is more dangerous because the cat could be dropping into hypoglycemic numbers. I think it's possible your cat is on too high a dose. Most cats on a low carb canned diet do not need much more than 1u of insulin. This is the typical starting dose. 2u is on the high side for a starting dose, and usually only given to very, very large cats. Also, numbers obtained at the vets office are often inflated because of stress and do not reveal any sort of daily trends, so dosing adjustments are often made in too large increments too quickly.

I would urge you to check out the stickies in the Lantus forum to understand how the insulin works and should be dosed. Here's a link to the dosing protocol that has been proven to bring the large majority newly diagnosed cats into remission: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Also, I wanted to second that while DM canned is the only prescription food good for a diabetic cat, it is definitely a waste of money. If you read the ingredients on the can, it's pretty much the same thing as the cheaper low carb canned commerical foods, like Friskies or Sophistacat, so you're paying an 80% markup for JUST the label. You can get a higher quality low carb food for less. Fancy Feast is a good mid-grade food, is easy to find and has many grain free, low carb options: http://felinediabetes.com/glutenfree.htm
 
I am very hesitant to give you any advice, because I am very new here, and just trying to get through this myself, but here goes.

My kitty was diagnosed on 10/1/11, so we're pretty close to the same place. My kitty started out on 1 unit twice a day of Prozinc. I was taking him back to the vet every 2 or 3 days and he would test, and it would not have changed, and we would move up....slowly. We are up to three units, and have been for almost 2 weeks...and I'm just now seeing some reasonable numbers. Samson would still be at the "HI' reading...which, as you know, means it is at least 600. This week, it is finally going down to under 300 at times.

I'm hesitant to put a lot of faith in the readings at home at this early stage....I've bought 3 meters ....the Freestyle, the Relion and the iPet that my vet ordered for me. None of them come close to each other....and I had the vet check the iPet at the same time he did his reading using his Alphatrak....and the iPet was more than 100 higher than the vet's. But, I have new strips for the iPet, and it is being more resonable and it and the Relion are closer to each other. I will go to the vet next week for him to do another test, and will have the Relion and the iPet tested by him....I want to use the Relion because the strips are so much cheaper.

I have to say that trying to do these readings and keeping on getting those high numbers has been very stressful, and some days I would not even take a reading, because I couldn't stand the stress of those high readings, seeming like we were not getting anywhere, and the fact that the glucometers just were so off from each other.

I have read that it takes some time to get a kitty regulated on insulin.....my vet said he was not likely to be regulated before a month, and the Prozinc website information is looking more like 45 days. My vet knows I'm about to have a stroke, and he keeps telling me I just have to keep it up and be consistent and that we'll get it right.

There is encouragement for me, because Samson is improving....and just in the last few days. Not only in his numbers being better, but he's just feeling a lot better, and maybe putting on a little weight finally. He's still pretty boney, but until his body is properly using the insulin, I don't think I can expect him to start filling out, but hopefully that will happen soon.

A lot of the folks on this forum are very experienced in all this, but I sure need the crutch of close contact with my vet and doing what he says. My vet has 5 cats with diabetes that he is treating right now, one that is 18 years old and has had diabetes for 5 years, and I have a long experience with my vet, so I can be confident that he knows what he is doing. Which I don't think is always the case. Maybe further along, I will feel more confident to have an opinion on what I need to be doing for my kitty....but not yet. Certainly not while I can't feel good that I'm getting an accurate reading on any of the meters.

All that being said, I think I may have just completely freaked out this past month if I had not had posts to read on this forum....to give me hope.

Don't despair....you're not the only newbie who is going nuts, and who is trying to do everything right, but being quite bewildered and discouraged. You must keep hope alive that your kitty's body will start responding to the insulin soon. And, if not, that you have a vet that will move to a different insulin if necessary.
 
I just wanted to comment a little on the reliability of meters--I would not trust the ipet. I've never used it, but I've heard nothing but how unreliable it is. Also, a meter calibrated for a cat like the iPet or the Alphatrack is going to give you a higher reading than one calibrated for human use, by about 30 points. That is why the Lantus dosing protocol has two sets of number ranges--one for human meters and one for the Alphatrak.

As for human meters, you want to stick with one meter that you're testing regularly with. It's good to have a back up, but different meters will give you slightly different numbers. Human meters are allowed to have a +/-20% variation. So you may get two different numbers with different meters, but the difference should not be any more than 20% between the two. If it is, one of your meters is faulty. A good way to determine if a meter is faulty is to use the control solution, or to test your own blood as a control.

You should not worry too much about the exact number you're getting (unless of course it's low), but the trends over a period of time from daily testing. This is what will help control your cat's blood sugar. Learning how to test can be very stressful in the beginning--I remember breaking down in tears my first week because Bandit was fighting me and I could not get a drop of blood--but it is absolutely necessary. No matter how good you vet is (and badams, it sounds to me like you have a good vet because they are advocating home testing to begin with), vet numbers can never give you an accurate picture of how your cat is reacting to insulin. The numbers are gathered too infrequently, and are usually inaccurate due to vet stress.

Lantus also differs from PZI where dose adjustments are based off of the nadir, or the lowest number of the cycle. That's why it's necessary to get at least three daily tests with Lantus--once before each shot to make sure it's safe to give insulin, and the nadir so that we know how the insulin is working.

All I can say is that it DOES get easier. Not only that, once testing is routine and you have enough data, it gets easy. You're not freaking out about whether your cat will hypo because you know how low he's dropping, and you have enough data to where you can have confidence that your dose adjustments are correct and safe.
 
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