New member Priscilla here! Lantus struggle post dental

[PriscillaGia]

Hi all! I am so happy to be here! Priscilla my black beauty was diagnosed in November. She was on a kidney diet (very high carb, yikes!) that I suspect unmasked her latent diabetes. Since November I have switched her diet to zero carb homemade food with a completer, got a persistent UTI under control, and started her on Lantus...she is already back to her healthy weight! I am a member of a FB group that has been helpful but I am in need of more expertise. Early January is when things get interesting. The last piece of the puzzle was a dental, which she had never had. The week of the dental Priscilla had the most beautiful numbers, what would be considered WELL regulated. Dental went GREAT, one extraction, nothing concerning, she healed beautifully, but since then I have struggled to get her back to the beautiful numbers she had, her thirst is increasing more and more, and I am getting worried. ALSO her nadir changed from +2 +3 +4 to +6 +7 +8. I reduced her dose on the dental day and have been creeping it up ever since. It seems she is requiring more insulin than before the dental. The dose that gave her great numbers seems to low. It's been 1 month and a half and all that has changed is I blend her food now. (I realized she preferred her food in a puree by accident, she started finishing her bowl rather than leaving a little behind, AI says this could be a reason for the nadir change and insulin sensitivity change). I also realized her insulin vial was 4 months old, so I started her on a fresh Lantus pen last night at a reduced dose. I would love LOVE LOVE the experts here to take a look at my SS, after this post I will work to convert them over to this forum's format so I apologize in advance. You will clearly see pre-dental vs post-dental. I just lowered her dose 2 drops because she went hypo, but then 4 days on the reduced dose her numbers were flat and high. I am worried I am bouncing her around too much and under-dosing her. Maybe that hypo was a one off. Are we on the right track? Are these changes normal post dental, later nadir, needing more insulin? Was it a good idea to reduce with the new pen vial? How many days should I hold this reduced dose before increasing? Am I doing anything wrong? I could go on but I will try to not to overwhelm with too many questions!!!!! I should note she never had ketones, and was diagnosed with fructosamine test. She is doing GREAT except for the noticeable increase in thirst and peeing! Thank you in advance for taking the time and we are SO happy to be here! Priscilla's SS

 

[CORKY]

@Sienne and Gabby (GA)

 

[Sienne and Gabby (GA)]

Welcome to FDMB.

First, you can attach Pricilla's spreadsheet to your signature. The info on how to set up your signature is in this introduction post we refer to as helping us to help you. The signature also contains information about Pricilla so we don't bug you by asking the same questions repeatedly.

I'd also encourage you to read over the sticky notes that are at the top of the Lantus board. In particular, it may be helpful if you review the posts on dosing methods. Take a look at those posts and we can answer more questions based on which approach to dosing you decide to use.

The thing that stands out to me on Pricilla's spreadsheet is how long you've held her dose. To back up for a bit, there are 2 dosing methods we use -- the Tight Regulation (TR) protocol and Start Low Go Slow (SLGS). With these methods, the dose is held for a specific period of time (3 days with TR, a week with SLGS) and if the numbers are not in normal range and providing a dose reduction hasn't been indicated, the dose is increased. With TR, dose reductions occur if the numbers drop below 50. With SLGS, dose reductions are given if the numbers drop below 90. (FYI: these are numbers based on a human meter, not your AlphaTrack.) You've been holding Pricilla's dose substantially longer than either of these methods indicate. The headache with not increasing is that glucose toxicity can result. The term sounds a lot worse than what it is. Basically, glucose toxicity means your cat's body had become used to the higher numbers. It makes it harder to get the numbers into a better range.

While it's reasonable to withhold insulin on the day of a dental or other procedure, ordinarily, you bring the dose back to the original amount either at the next shot time or the next day. By dropping the dose and holding the reduced dose, it likely didn't help for Pricilla to get back on track. The other factor I suspect you didn't consider or the vet didn't think to explain is that when you skip a shot or make any dose change, it has an effect on the insulin depot. Lantus is a depot type of medication. If you make a change in dose, it can take up to 3 days for the depot to stabilize.

To answer your question, you don't reduce the dose if you are starting a new pen or new vial of insulin. The likelihood is high that the insulin was just fine. In fact, you had numbers in normal range on 2/16. Unless you saw "floats" in the insulin, it was probably fine.

This is also a pet peeve of mine so apologies in advance. When Pricilla's numbers dropped into the 50s, was she experiencing symptoms of hypoglycemia? If not, she was in low numbers. Unless a cat is symptomatic, it's not hypoglycemia. You do want to bump up the numbers so she's in a safe range but it helps to remember that normal blood glucose is 50 - 120 on a human meter.