Need Dosing Advice for Baxter -- wild BG swings

[SusanBaxterJesse]

Hi everyone,

My Baxter has unfortunately just come out of remission, so I started him on Lantus about two weeks ago. He has a history of severe hypoglycemia in which he almost died from two years ago. Because of this, to protect his health and my sanity, I started him very low -- .25. His BG has been all over the place in wild swings. With just that little amount, his BG plumets 200, 250 or even more points -- which makes me afraid to shoot anything under 300. But of course, then if I skip a dose then his next BG reading is sky high. But I'm really afraid for him to go hypo again when I'm at work, and it's so hard for me to predict how low he'll go. I've just asked my vet to prescribe Levemir, on the recommendation of many others on the facebook feline diabetes group. I'm thinking that because that insulin produces flatter curves and less variability it may be much better for him. Nutrition-wise, Baxter eats canned food only -- Wild Calling and Weruva.

Any guidance that you have is very much appreciated -- I'm pulling my hair out trying to regular my sweetheart while also balancing my PTSD of hypoglycemia. I'm especially interested in dosing advice, and whether switching to Levemir would be a good idea. Also, if I switch -- how do I best make the switch from Lantus?

Here is Baxter's spreadsheet:https://docs.google.com/spreadsheet/ccc?key=0AroBYUCR5FovdHc0d1VIdnI0aGRjNFpOeFdEWVpKWnc&usp=sharing

Many thanks for your help!

Susan and Baxter

 

[Dyana]

I would get as many tests as you can during the evenings and weekends, so you can see how he does on a dose.
You want to keep the dose as consistent as possible. I see you raised his dose last night and he got a 98 at +5. I probably would have tried to get a +6 or +7 after that, just to see where he went. Eventually with enough tests, you'll feel more comfortable with his BG numbers. Dose increases often take a couple days to fill up the depot to the new dose.
If you do switch to Levemir, I believe the Levemir dose is 70% of the Lantus dose.

 

[Chris/China (GA)/Garfield]

Hi Susan!

Just a suggestion.....If you'll "edit" your subject line and add the ? icon (where it says "No Prefix" there is a drop down menu that includes the ?, the 911 for emergencies and the GA for our kitties that have "gone ahead") it will help to get you more attention. We watch for those ? in the posts to know who's posts include questions

I think that part of what's going on is that you're changing dose too often. Lantus requires a consistent dose, and some cycle you gave .25, some .13 and some cycles zero, so it's impossible for his depot to "settle"

Can you get at least 1 test during the AM cycle every day or do you work?

At this point, I think it's premature to talk about switching to Levemir since you haven't given Lantus the chance to work. Levemir isn't going to be any better if you can't give it consistently either

If you can post here daily and let us work with you and Baxter, we may be able to get him into better numbers! As well as keeping him safe! I totally understand your fear of hypo's, but that's why we home test. If you are home testing, you can almost always intervene in time to prevent anything serious from happening.

 

[Amy&TrixieCat]

I can't believe it's been 2 years since Baxter hypo-ed....I remember it like it was yesterday. You're dedication to him is so inspiring. How is he doing in general these days?

When you got that 98 last night, did you retest? It's definitely possible that he responded that intensely to the increase, but when we get a number that seems out of place (either high or low), retesting right away is a good idea, just to make sure it wasn't a wonky test. Getting a follow-up test after such a big drop is also a good idea, for safety-sake. Unfortunately nadirs aren't consistent in timing - it can change at any given moment. Some cats nadir early, some hit the mid-cycle with their nadir, others nadir late, and most decide to change when they nadir just to keep us on our toes and make us beans crazy!

I agree with Chris about trying to get a daytime test if possible, too - even if it's a +1 or +2 "out the door" kind of test, so you can see what Baxter might have in mind for the day. The curves are helpful, but daily random spot checks (one per cycle) can really help fill in the data gaps, too, since thing can change day-to-day and cycle-to-cycle.

I totally understand your circumstances are different that most L&LL kitties, given Baxter's health and experience, so keep posting and we'll do our best to work out a plan that works best for you the two of you!

 

[Sienne and Gabby (GA)]

Susan:

Maybe I missed something but has Baxter been checked by your vet? Any kind of health issue, even a dental issue like tartar or gingivitis, can throw a diabetic cat out of remission. If he's not already had a vet visit complete with blood work and a good look at his teeth, I'd encourage you to have him see

 

[SusanC]

Thanks so much everyone! My laptop is on the fritz and my responses are too long to type out on my phone. More later from my work laptop tomorrow!