Nadir too low but pre-shot high

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nursjuju

nursjuju

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My sugar bug Sophie has been diagnosed and on Lantus for a year. I was able to get BG down quickly and I thought she would go into remission last June (about 6 mos after diagnosis) as I had her down to .25-.5u Q12-36hrs depending on BG. Then she had a dental cleaning and since her BG has been up & down. At least it seems to have happened after that. Initially, I thought it was from inflammation from procedure (even though her teeth did not have a lot of tartar), then I thought it was the Lantus going bad so I have replaced that twice since then (cost over $300/vial!!!). I have been feeding the same food twice daily of Purina Pro Plan True Nature Classic flavors Chicken/Liver or Chicken/Turkey which are both between 1-2% carbs per Purina Vet Resource Dept with occasionally Young Again Mature Zero Carb dry, but not even that in the past month. I can't leave it out because she will overeat for whatever reason even still now.

Her preshot reading will be 250-300 (Relion Confirm), will give .25u & feed, and her nadir will drop to 30's & even 20 twice! There was even a point for a couple days where she definitely had the somogyi effect & rebounded to 400s. That was immediately after I was out of town for 2 days & son was giving insulin that I pre-measured so attributed it to that he didn't give shots at same times. I can't go any lower than .25u & even that is very difficult to measure. If I give no insulin her BG continually rises. I have had all labs checked, urine, & nothing indicating any other infections or issues. Of course the vet suggested feeding Purina DM canned at twice the cost. I did try it for a week & there was really not any change. The only real noticeable difference in ingredients is the DM has oat fiber.

I am very diligent about checking glucose at least twice but usually 4x day, and many days even more. The nadir is very variable on when it happens. I'm really not sure what to do. The Lantus vial is 3 mos old & has been stored in back of fridge since opened.

If anyone has any ideas I would love to hear input.
 
For one thing, the Lantus pen cartridges might be better because you'll use up the contents (3 mL) before it loses it's strength, an issue with the large 10 mL vial. Some people have been able to buy a single cartridge from the 5-pack be calling around to different pharmacies and asking if they'll sell a single.

Sounds like you have things under control in the food department and it's great that you're home testing. One thing I noticed is that you said you sometimes dose Q-36 h depending on BG. It's better to give Lantus twice a day at 12 hour intervals even if the doses are tiny. Changing the timing can interrupt the depot in such a way as to act like a higher or lower dose. Consistency is key. Some people dose minute amounts (0.1 u or "a drop") BID as the kitty heads toward remission.

Would you consider setting up the spreadsheet we use here? It's viewable by all members and is the first thing we look at to see what's going on with your kitty before offering advice.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
There are many experienced people on the Lantus forum who can help you sort this out.
 
I have used the pen which I can only get from an online pharmacy for $125 inc shipping as the local pharmacies will only sell the 5 pack, and the same issues have happened even with the pen as far as variation in BG. There has been no differences between vial, pen, new or old. I used the first vial of Lantus without any issues for over 6 mos & only bought a new one (which was the pen) after the dental when the BG became erratic thinking maybe that was the cause.

Also I should clarify that I have been dosing Q12 since last August. I was looking at the spreadsheet but have not been able to set it up yet. Here are some readings to look at.
PS - 251 - Fed/.25u
+2 - 195
+4 - 62
+ 6 - 32 - Fed
+ 8 - 67
+ 10 - 60
+12 - 172

PS - 196 - Fed/.25u
+4 - 34 - Fed
+6 - 68
+9 - 219
+12 - 308

PS - 320 - Fed/.5u
+2 - 292
+4 - 223
+7 - 114
+9.5 - 59
+12 - 39
 
nursjuju said:
I have used the pen which I can only get from an online pharmacy for $125 inc shipping as the local pharmacies will only sell the 5 pack, and the same issues have happened even with the pen as far as variation in BG. There has been no differences between vial, pen, new or old. I used the first vial of Lantus without any issues for over 6 mos & only bought a new one (which was the pen) after the dental when the BG became erratic thinking maybe that was the cause.

Also I should clarify that I have been dosing Q12 since last August. I was looking at the spreadsheet but have not been able to set it up yet. Here are some readings to look at.
PS - 251 - Fed/.25u
+2 - 195
+4 - 62
+ 6 - 32 - Fed
+ 8 - 67
+ 10 - 60
+12 - 172

PS - 196 - Fed/.25u
+4 - 34 - Fed
+6 - 68
+9 - 219
+12 - 308

PS - 320 - Fed/.5u
+2 - 292
+4 - 223
+7 - 114
+9.5 - 59
+12 - 39
Click to expand...
Diving like that usually warrants a dose decrease. The high PSs could be rebound from the lows mid cycle. What fractions does the pen permit? It looks like he needs a decrease from 0.25 u.

Your best bet right now is to get some of the "pros" on the Lantus forum looking at this data.

@Wendy&Neko
@Doodles & Karen
@Bobbie And Bubba
@Marje and Gracie
@Jill & Alex (GA)
 
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