Never out of 300's-why

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katieroc

Member Since 2014
Took Rui to a new vet-all feline practice on 10-16. I liked her. I wanted to take him there, well, it's all feline. Had a test for pancreatitis done (came back negative) to see if this could be causing his continued high numbers. Also, his teeth need cleaning, but the vet would like his numbers better regulated before (previous vet also of that opinion). Vet gave him an antibiotic injection in the event he has an infection which may be a factor with his numbers. He's still testing high. He's now on 3.5 units twice a day (he's a big cat, 16+ lbs.). He's on low carb food--mixing Purina DM (3%) and Tiki Cat (0%)--can't get much lower on the carbs. 2 weeks ago had a fructosamine test (vet said number was "good") and also urine culture (negative). When I spot test him during the day, the number doesn't seem to fluctuate. Never lowers. Flat. Every time I test him, my heart sinks. The other day his number was 275 and I thought I was going to cry with joy, that maybe, just maybe he was starting to turn around. Back in the 300's in the evening. I know from reading here and online that regulating a cat can take time. If I saw any curve with the numbers I would be encouraged. I'm poking and sticking him. Stressing him with vet visits. I feel I'm failing this cat.
 
Was the antibiotic Convenia? Keep an eye on him, as if he has an adverse reaction to it, it can be difficult to manage.

And if you don't treat the dental infection, it will be d*mn difficult to regulate the glucose levels. Push your vet on this a lot.

If the mouth is painful, do not attempt brushing. If it is not painful, brushing may help.
 
Hi Susan!

I do not use Lantus and don't feel comfortable giving dosing advice but do have a general observation after looking at your ss. Is it possible you are giving too much insulin? It seemed like 1 unit was doing well for a while, but when you increased you didn't stay on 1.5 for long enough. Just a thought.

Hang in there. I am sure someone experienced with Lantus will be by to help. Have you read the stickies for Lantus? I believe there are two forums for Lantus.

If there is an infection the stress does increase glucose levels, but it looks like you are investigating that angle.

Jen
 
Hi Susan

As a newbie I don't know enough to advise but like the others it does appear that rui was doing quite well on the lower dose. Hopefully someone will be along to discuss it with you. You might also like to join one of the lantus forums there are two-relaxed and tight regulation.

Best wishes

Sarah
 
I am thinking too much insulin as well. If it were my cat I would drop him down. I cant tell you how much, but maybe someone else will have some suggestions soon.
 
Thank you all for your responses. Rui seems ok since the antibiotic injection. He tested 313 this am. Down a little from yesterday. He was very playful which I haven't seen too much of lately. Lifted my heart a little. The consensus seems to be reduce the dose. I understand lowering it is there was a Symogi (sp) response. His bg never lowers so he's not experiencing that. Can you explain why to lower it when he's just at a steady high bg level? Does the high dose cause a steady high bg level? I'm searching for info on that and can't find it. If I do reduce the dose, how do I go about it? How much do I lower it and at what duration? If the bg starts to go up if I lower the dose what do I do then? Thanks again for all the advice.
 
I am afraid I don't know enough to help. I would suggest you ask the question in the tight regulation lantus group as they are very experienced over there. I have seen a number or replies where they talk about missing the optimal dose and it resulting in high flat levels but not sure why this happens.
 
Hi Susan!
A cat getting too much insulin usually does stay high because the liver senses it and is releasing counter-regulatory hormones often. You should see more movement like a smile over the cycle. I ended up blowing right by Doc's dose twice - now that I started low and worked up again, we're now close.

HUGS!!
 
Thank you all. How would I go about lowering the dose now that he's up to 3.5 units now? Do I have to lower slowly over a certain duration? He's over 16lbs. Does that factor into the amount of insulin he needs? He tested at 326 tonight on the alphatrak (also tested on one touch-291).
 
I copied this for you from the protocol



Using a weight based formula for determining a starting dose of Lantus or Levemir when following the Tight Regulation Protocol:
the formula is 0.25 unit per kg of the cat's ideal weight
if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration

Here is a site for converting lbs to kg
http://www.manuelsweb.com/kg_lbs.htm

There are circumstances such as ketones present, an unusually low preshot number, a caregiver leaving the cat with a sitter, relatively high flat curves, loss of appetite, infection, a schedule change, ability to monitor, etc. which may call for adjustments to these guidelines.
"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.


ALPHA TRAK- if kitty goes below 68 that is an automatic reduction


I cant tell you what to dose, I can suggest however, and if it were my cat I would drop him to at least 2units. When increasing, if he continues to rise, you raise in .25 increments.
 
Or more simply the starting dose for a depot insulin may be calculates as:
What is your cat's current weight?
What is your cat's ideal weight?
Take the lower weight.
Convert to kilograms if in pounds (pounds / 2.2)
Multiply by 0.25.
Round down to nearest 0.25.

To test dropping the dose, however, you might cut the current dose in half, and test for ketones frequently. If dose reduction is going to help, you may see improvement within 3 to 5 days.
 
Thank you and I appreciate your advice. If I lower/reduce by 1/2, is there danger he could crash? That's why I asked if lowering should be a gradual thing.
 
If, in fact, the dose is too high, he runs the risk of hypoglycemia (crash) if the reserves of glycogen are depleted and he is unable to eat enough to compensate. Therefore, testing his insulin needs by reducing and allowing the new dose to stabilize may protect him from hypo if it reduces demand for the reserves. You may see better numbers if dose reduction was the right choice.

If, however, he does need a higher dose of insulin, monitoring for ketones will alert you to fat being broken down for calories which happens in diabetes if there is insufficient insulin to use the food glucose. Note that fat may be broken down if insufficient food is being given, too, or if there are higher caloric demands (ex hyperthyroidism). More than trace ketones are a medical emergency.

So this is an experiment. You don't know which way it will turn out. The only way to know is to see what happens and be prepared for either outcome.
 
No gradual reduction necessary? Just cut dose by half. I realize I have a lot of questions. Just trying to do the right thing for him. Thank all of you for your help.
 
Correct no gradual to it. You should see pretty quickly if it is going to help or not.
 
I won't tell you this all doesn't scare the heck out of me. A mistake could be fatal and it terrifies me. I know the advisors on this board are experienced, but for a person like me, well. As far as checking keytones, the vet has done this thus far. Thankfully, he doesn't have any trace levels. I'm at work most of the day, so trying to get a urine sample is difficult and also, I have another cat. The vet tested him for a thyroid isssue, but that was OK. I may wait until the weekend to reduce the dose so I can be home and keep an eye on him. Frankly, I'm surprised he still comes near me. I'm always approaching him with a sharp object.
 
Are you offering your kitty treats at testing time? I have chicken flavored Pure Bites and my Tiger just loves them, they
re like a kitty potato chip! Now she sits on her cushion in the kitchen waiting for her test and shot.

The other thing, if kitty is in high numbers, it is best to test daily for ketones. The strips are inexpensive and a good way to make sure ketones are not present. I have litter boxes on both floors of my house, it's easy to catch Tiger at the litterbox that way.
 
Dusty's owner couldn't test. I went over on weekends. He went Off The Juice in between tests, so he spent several days getting insulin he didn't need. She always left dry Wellness Core food down for him and he was able to eat enough to compensate.
 
I have the strips to test for keytones, but I rarely see him go in the litterbox. I have another cat who uses the same box, too. Purina used to make "confetti" that you put in the box, but I see it's been discontinued. Do you know if anyone else has a similiar product? I can't find anything. I don't give treats, but I was going to get some of the freeze-dried kind (just chicken or shrimp). I'll see if he likes them. I do leave a little extra food before I leave in the morning. I'm not sure if he scarfs it down as soon as leave though or goes back to it during the day. I'm getting a new bottle of lantus tonight and tomorrow I'm going to reduce his dose. Say a prayer for me. nailbite_smile
 
Here are some urine catching tips you might find helpful. There is also a glucometer that checks for ketones, although the only one I can think of is the Nova Max (not sure if there are other options). Good luck with the dose reduction!
 
Well, I reduced the dose (new bottle of lantus today) to 1 u. I figured that was the dose he started with on 9-5, so I went with that. Tested bg up until +8. No fluctating, flat in low 300's. I wasn't going to stick him anymore. I don't know what I expected on day 1 of the dose reduction "tryout". Maybe a miracle. I think I'm desperate for one. I'll test again before his PMPS, but based on those numbers, it doesn't look like a miracle will happen today.
 
Hi Katie,
I don't have any advice as I'm too new, but wanted to send some warm thoughts your way. I understand your concern and worry for Rui-I'm right there with you!
 
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