Need Help with Wide Swings in Glucose

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sulile

Member Since 2012
This is a post I copied from the Main Forum.

Facts: Buddy - 16 year old male
Diabetic for 5+ years
Meds: Vetsulin for 2-3 years until discontinued; well controlled
Humulin for 2+ years - well controlled on 5 units 2X a day until a hypo event in November 2012
Lantus since 11-26-2012

Other Medical Conditions: HCE (hypertrophic cardiomyopathy)
Crisis: Hypo event where BG went to 20 on November 11, 2012; vet switched to Lantus
Current dose Lantus: 2.5-3.0 Units twice a day

First, I am totally stressed out as I cannot seem to get any kind of consistent curve for Buddy.
My first attempt at a spread sheet is attached.

I am very concerned since yesterday he had a BG=60 at +10 hours, the lowest it's ever been since switching to Lantus (that is, the lowest I know of). I did the check at +10 and +11 after reading one of the stickies that suggested this is a good idea. I was shocked when I saw the 60.

I've been trying since last November 2012 to get something that works. But as you can see from the spreadsheet, he is all over the place.

We intially started Buddy out with 1, then 1.5, then 2, 2.5 etc. Units of Lantus. He stayed in the mid 300-s to 500's through November and most of December, so we increased it to 3 units.

He had a dental cleaning yesterday as he had some gingivitis and the vet wondered if this could be keeping him high. Plus he has had an upper respiratory infection through all of December. Seems to be improving.

Please help...I am a basket case.
 
Welcome to LantusLand! You are in the right place to get help with Buddy. Here is the post in Health so could you delete all the text in your first message to minimize the scrolling? I'll let one of the dosing experts weigh in. You are doing a great job with giving shots and testing, that is a huge step. :-D :-D
Liz, Zener's other mom (I sign my posts and Anne doesn't)
 
First, Welcome to Lantus Land!

Second, breathe! Dental issues and a URI can all have contributed to high numbers. If both are over and done with, you're starting with a cleaned slate.

As others have mentioned, Lantus does best if you are consistent both in terms of shot time and dose. You want to give the same dose at AM and PM times unless there is a good reason (e.g., you get an unexpectedly low pre-shot number). If you do get a low pre-shot, post and we'll help to walk you through the options.

What Buddy's SS suggests to me is that there a good bit of bouncing going on. While the highs and lows can be scary, it's not entirely unexpected. When Buddy's numbers drop into lower ranges, his body overreacts and dumps a stored form of glucose along with counterregulatory hormones into his system and the numbers spike up. You very clearly see this on 1/9 when you delayed his shot and he was in the 500s by +3. I suspect you're not catching some of the low numbers.

As Marje noted previously, we don't change doses in as large of an increment as your adjusting Buddy's dose. The typical dose change is in 0.25u increments. Dose changes are made very systematically and the dose is given at least 3 days to settle. If you look over the Tight Regulation Protocol sticky, you'll see on what basis we raise and lower doses.

I'd also encourage you to take a look at Lisa Pierson, DVM's site on feline nutrition. She has a section on her site on how to transition even the most stubborn cat from dry to canned food. Even thought you're feeding a lower carb dry food, the dry stuff still has a negative impact on BG levels.

(If you could edit your post and eliminate all of the replies to your Health thread, the post here will be much easier to read. Liz provided the link to the post on Health so people will be able to easily go back and get the information that you and others provided.)
 
Welcome! Once you understand how Lantus works you will be able to get a better understanding of things. Lots of great advice on here. Bouncing is typical in the begining. Take care and put your patient pants on lol. Hope things improve soon!
 
Buddy is eating EVO Ancestral Diet dry food ~ 7% carbs. (I know all about how wet is better...read all the stickys, etc.).
He will not eat the moist food, so for now I have him on EVO.

Should I be on the Lantus Relaxed protocol forum? Where are the regulations for the Relaxed Protocol? I just read the Tight Regulation Protocol requires the cat be on a soft food diet, low carb.
 
You can follow the Start Low and Go Slow approach and post here. It's not a problem in the least. The Relaxed board is not very active and your questions can go unanswered for a while. You are welcome to hang out with us here.
 
Here's the link for Start Low Go Slow approach. Please let us know if you have questions. We are happy to help you with this approach, too, as Sienne said. And you will get faster responses in this forum.
 
Re: Need Help with Wide Swings in Glucose-Is it time to incr

Hi,

After ging back to 2 Units Lantus, I've been testing Buddy a lot this weekend and have updated his spreadsheet.
Is it time to increase the dose from 2.0 to 2.5 units?

I'll try to get 2 more readings tonight before going to bed.

Thanks for any help.

Susan & Buddy
 
Susan:

I feel terrible saying this but I really can't make any suggestions without at least one test during the PM cycle every night. You're missing half of your data.

You might want to take a look at this post on increasing the dose.
 
Susan

We start a new condo or thread every day to keep them from getting too long.

My concern is you are missing half your data by not getting any tests at night. A +2 or before bed test and then, if possible, a +10 or +11 test would give us a good idea what Buddy is doing at night. I've seen cats go from 300s at AMPS to 40 at mid cycle and back to 300 by PMPS. Without a mid cycle test, the caregiver would have thought the cat was just high and increased the dose when they should have decreased it.
 
Thanks...still getting the hang of this. I'll start a new thread in a second.
Just wanted to let you know I got som PM numbers last night and this morning which are in SS now.

Susan
 
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