New, Confused, and Need Help!

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pinkfirefly

Member Since 2010
My vet has switched my cat Alley from Vetsulin to Lantus. I have read the stickies here, but am still confused about Lantus as it appears to be SOOOOO different from Vetsulin. Her numbers have been so wild over the past couple of days, I feel overwhelmed and unsure of what to do. I gave her one unit twice daily for a week with poor results. Her numbers were from 300-400, so the vet had me up her dosage to two units twice daily. My cat looked well and acted better, but I had to rush her to the Vet after three days due to an early morning reading of 46 two hours post her AM shot. The vet encouraged me to keep the same dosage, which I did, but freaked out yesterday morning when I saw that her preshot number was 82. On Vetsulin I was told not to shoot her if her numbers were under 100, so I called the vet and she suggested I skip her morning dose and shoot her at 1.5 units that night. I watched her like a hawk, and these were her numbers yesterday.

4:57am- 104
7:41am-82 (she gets shot at 8:00am, so I skipped her shot because this number was so low)
8:49am-73
9:22am-110
10:49am-183
1:48pm-326
5:39pm-268
7:22pm-344 (Was given 1.5 units at 8:00pm)
9:09om-371
10:30pm-395
12:00am-419
12:52am-432
1:44am-473
2:16am-423

This morning
5:29am-418
7:00am-412(Was given 1.5 units at 8:00am)
8:52am-395
10:45am-263
2:42pm-69

This makes NO sense to me. Any help or input would be greatly appreciated.

Amanda
 
Hi Amanda and Alley! :mrgreen: First off, take a deep breath and try to relax.
You are home testing and that is totally great. You will be in control with your meter and the knowledge you gain from this website.
I was on Vetsulin with my two kitties in the first 6 weeks after their dx, so I understand where you are right now.

Here on this Lantus Forum, we post a condo (thread) each day and show our kitty's numbers, with a header that reads:
Date, Kitty;s Nam, AMPS+________ in the header.
We also link the previous day's condo to the first post of the day.

I am glad you read the starred stickies at the tops of the page. There is one thing that you will need...the spreadsheet to put all your data and link it to your signature so that we can monitor the numbers and see all your BG checks. You are welcome to click on either one of my two, Raja or Shadow at the bottom of my post to see what it looks like.

Here is the link to the post in the Tech Forum about how to create the spreadsheet and attach it to your signature:
viewtopic.php?f=6&t=18207

Can you tell me the date that Alley was diagnosed?
are there any other meds besides the Lantus, any other medical conditions?
 
I just wanted to know if you have done another test after the 2:42=69
Do you have any canned cat food in the house that has gravy?

What kind of food are you feeding Alley?
 
I just checked her again. 3:14pm and she's 61. Seriously people, I am at my wit's end. I've been feeding her Purina DM dry as per the vet's suggestion. Alley has been a diabetic for two years without issue on Vetsulin and Fancy Feast. I home tested her and never had a problem until 3 weeks ago when she developed a severe UTI, Kidney Infection, Pacreatitis, and DKA. She almost died. $2,000 dollars later she pulled through, but now the vet has her on this new food and Lantus and I'm ready to pull all of my hair out. I see no rhyme or reason to her numbers and feel so, so overwhelmed.
 
We understand that feeling.
Can you share her test results so we can get a better idea of what may be happening? Whatever bloodwork/urinalysis or whatever the vet did 3 weeks ago when she was hospitalized?
Might just need a dose adjustment - hopefully it is as simple as that. Vetsulin is so very different that you need to change how you think about and react to her BG test numbers. I used it on Donovan for ~6 months before switching to Levemir.

MJ&Donovan
 
Hi Amanda, you've found a great resource for using Lantus. You are not in dangerous numbers yet, but you don't want her going much lower. ... just saw you last post. you may want to give her a little higher carb food right now to boost her into more comfortable numbers. You were feeding FF? do you have anything w/ gravy? Just give a tsp. or less of the gravy, that's where the carbs are.

Lantus is a lot different than Vetsulin and takes some getting used to. It was good that you held the 1u. for a week, but we usually only increase by .25u at a time. Please read the stickie about the insulin shed or depot. Lantus build up in the system, with some held in reserve. The shed has to be slowly built until we see the full effect of a dose. When decreasing we also see a carry over until the excess in the shed is depleted. You may very well have jumped over the ideal dose for Alley. Pat and I are bumping you to the top of the list until a dosing advisor can help.

Oh good, MJ is here.
 
She dropped 8 points since the last test.

Janet &Binky's food chart shows different brands of canned cat food. We suggest something under 10% carbs for meals and snacks....even less is better. Also, have on had all the time canned foods that are high in carbs...HC canned foods with gravy.
We use gravy at times when the kitties BGs go lower...and we give them the gravy from these cans to bring up their BGs.
http://binkyspage.tripod.com/canfood.html

That prescription food your vet recommended is not a really good choice as we have come to see.
Many people use the Fancy Feast varieties that are low carb.
For the high carb, I use the Friskies Chicken and Tuna dinner with gravy 19%
Please look over the list and see if you can get some of those low carb foods....


Can you try giving her some food right now and then retest in a half an hour and post that number for us?
 
Lantus is a very slow acting insulin and it's not at all unusual to see a reaction several hours after a shot (or a no shot, a change in dose).
You have found the right place now - and although I can't advise you about dosing, others here WILL be along to help you soon!.
Oh indeed! Look - there is a reply now. (While I was typing this).
 
I think the dosage that you have been giving her might be too much. We do not go up by one unit, but rather in .25u increments. That way, we go up carefully so we do not bypass the ideal dose. The lows are due to the insulin's action and the very high numbers represent what we call a Bounce. It is the effects of the hormones that are thrown out in the system in a reaction to the lower numbers.
The kitties have been used to such high numbers before dx, and the system is really out of sorts.
What you are seeing is the effects of too much insulin. So, take a deep breathe and tell me if yo have any karo syrup on hand. or honey...or something like that..pancake syrup?
 
I fed her some canned food with gravy, and she now shows a BG of 100. Is it safe to say the numbers will go up, or do I need to worry about them going low again?
 
Giving you another bump up.

One board convention we use is to give times in hours past the shot . We are all in different time zone and we don know where you are. So, for you:
Shot time = 8:00am shot 1.5u
+1 = 9:00am 395BG
+2:45 = 10:45am 263BG
+3 = 11:00am
+4 = 12:00pm
+5 = 1:00pm
+6:45 = 2:45pm 69BG
+7:14 = 3:14pm 61BG
+8 = 4:00pm

It helps us relate to where Alley is in the cycle, she should be past the nadir (lowest point in the cycle) now. Have you fed her again? .....

Just saw your last post. This is good, keep an eye on her and test again in half an hour. It is still possible for her to drop again if the rise was just food spiked.
 
How long ago was the increase to 2u BID? The shed could still be emptying from that.

I totally agree w/ Pat on the dry food, few of us feed any try of dry, not even the lower carb stuff.
 
That is good Amanda...the food with the gravy got her going up.
You may see a rise in the numbers later...that might be a bounce from the 69/61 today.

The idea is to get her on a dose that you can safely shoot twice a day. Lantus works best if it is given 12/12 with the same dose. It was good that you did not shoot that full dose when she was ow, but you see how the snowball effect started taking place. We are looking for steady numbers with a steady dose.

I do hope you will have time to get your Spreadsheet up and running so that we can help you further.
 
HI Amanda and Alley, It sounds like a lot of crises and a lot of changes all at once. Perhaps it would have been better to stabilize Alley after clearing up the infections and other health problems by continuing on Vetsulin for a while. However, since you have already made the switch to Lantus, there is not much point in going back! I am not a "dosing" expert, but there are a number of them on this board and I hope that they will be by soon to give you some advice. I do know that although Lantus is a relatively gentle insulin, it is important to work up gradually to a viable dose. The board usually suggests a "start low, go slow" policy, starting with an initial dose--usually 1 unit every 12 hours--and holding it for a few days before raising it by .25 of a unit, etc. etc. until, gradually you reach the optimal dose for the cat (see the description of the Tilly Protocol in the "Stickys"). If you raise the dose by a whole unit at a time, you run the risk of going beyond that optimal dose and getting into a vicious cycle of overdosing and crashing (it actually sounds like that's what is happening to Alley at present).
The issue of appropriate food is an important one, and I know that the people here will tell you to get Alley off DM dry food as quickly as possible. Dry food, even DM, is the worst thing possible for a diabetic cat. A diet of low carb, wet food (see Janet & Binky's food charts in the "Stickys") will do wonders for Alley.
I'll leave you in the capable hands of those more knowledgeable than I, but just want to say that Lantus is a great insulin that requires patience and consistency. You may very well see "wonky" numbers at first. Just don't panic. You have a wealth of information available to you here on this board, and many caring people who will help you every step of the way.
Welcome to Lantus Land!

Ella
p.s. This post crossed with a number of others, but I see that we are all giving you basically the same information. Do get a spreadsheet up for Alley so that people can see her numbers more easily and can more easily make recommendations.
 
While Donovan reacted rather quickly to the insulin change, for other cats it may take longer. It sounds like you went from a dose of 1 unit to 2 units after a week of seeing little action, and then things went haywire. You may very well have passed the ideal dose for her at the moment. Since she has dropped rather low now, it's probably a good idea to go back to a lesser dose, assuming ketones are not an issue. You didn't see a reaction to the 1.5U after the skipped shot until the next cycle, which is one of the major differences between Vetsulin and Lantus/Levemir. Vetsulin gets in, does its job (or not :roll:), and then it's done. Lantus/Levemir builds up a "reservoir" first, and now you're seeing some major action from it. The good news is it's working. Now we just have to find the right dosage for Alley.

Keep posting whatever numbers you get.

MJ&Donovan
 
Welcome Amanda and Alley, you're in the right place!

The numbers may go back down as the food spike wears off, you need to keep testing.

I would be very careful about changing her diet to LC canned without lowering the Lantus dose. It looks like this dose *may* be a little too high already, and if you cut out the dry food, her insulin requirement will go down....so she will need a lower dose to compensate. I would wait until you get the spreadsheet set up and the folks here can see what's going on before you change her diet. JMHO
 
We're all confused in the beginning, but there are lots of people to help here. do you have another test result? And let us know how close to the test the last food was.
 
Amanda

I'm so glad you came over to LL...I looked for you earlier today...see...I told you that you'd have lots of help and you've got some of our best
looking at Alley's numbers. Good job!!! You did a great job bringing her up and as you start to feel more comfortable with the Lantus and
doing the spreadsheet (btw...let me know if you need help with that), then you will learn what foods she responds to. Some cats, like Mannie,
need higher carbs to control his drops. My Gracie and also Ann's Tess are very carb sensitive so we tend to use lower % carbs than 18 or 19 to
steer them. Home testing is your friend and will help you steer Alley away from low numbers. So welcome to Lantus Land and please stick
with us...you'll learn quickly!!
 
Welcome to Lantus Land, Amanda.

I know we're throwing a lot of questions at you and this can be overwhelming. First, the dosing strategy with Vetsulin is very different than with Lantus. No doubt, this is adding to your confusion. Lantus dosing is not based on the pre-shot number. Rather, it's based on the nadir. We get pre-shot tests to make sure it's safe to shoot. As you collect more data on how Alley responds to Lantus, you will be able to shoot lower numbers. You might want to take a look at the starred sticky note on becoming data ready.

I don't think you mentioned what dose of Vetsulin Alley was on at the time you switched. The initial Lantus dose can be based on a weight-related formula (initial dose = 0.25 x ideal weight in kilograms) but if switching from another insulin, that dose can be taken into account.

It also doesn't sound like your vet mentioned that Lantus is a depot-type drug. This means it forms a pool or what we refer to as a "shed," under the skin. This is why Lantus has a cumulative effect. You weren't seeing that much of a response initially and as the shed was building, you were seeing more and more of a response. Further, once you got a low number, Alley's liver responded by dumping glucose and counterregulatory hormones into her system and blood glucose levels spiked.

Please let us know how we can help. This is a wonderful community of people who are more than willing to share their experiences and knowledge and help you get more comfortable with using Lantus.
 
Okay, so Alley has steadily climbed since the BG of 61 at 3:14pm. She was 230 at 7:00pm.

I just want to thank everyone here so much. I had no idea that Lantus was a slow-building insulin and that it would be SOOOOOO different from Vetsulin. (Alley was taking 2.5 units every twelve hours prior to her hospitalization and DKA incident.) I will try to create a spreadsheet as soon as possible so that my numbers make more sense.

So, should I stay at the 1.5 every twelve hours, or reduce her down to 1.25?
 
no advice here, just want to say welcome and assure you that you have found the best place for the best help...these folks are amazing. take a deep breath, and they'll guide you through it!

celi & binks
 
Here's the difficulty. Because you've had a recent episode of DKA, that is a critical factor. You've GOT to test for ketones religiously, especially if you reduce Alley's dose. Ordinarily with a cat that's been diabetic for more than one year, their numbers need to drop below 40 to earn a dose reduction. However, Alley dropped to a 46 at AMPS +2 which suggests that she really meant business and if you hadn't intervened, her numbers would have, in all likelihood, dropped lower. I think it may make sense to reduce her dose to 1.25u, but please, please, please test for ketones at least once a day. I've been through DKA with Gabby and it's very scary. The goal is to keep Alley safe and healthy!

Another question for clarification. You mentioned that when you were using Vetsulin, you were feeding Fancy Feast. What exactly were you feeding -- canned or dry? And if canned, do you know what percent carb? You mentioned you changed food. I may have missed this, but what are you feeding now? If you are using a lower carb food, it is also going to effect Alley's BG numbers. Often as people change over from higher to lower carb foods, insulin needs drop dramatically so it's wonderful that you're home testing.
 
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