New on Lantus

[RamaMoo22]

My cat, Rama, was diagnosed with diabetes on July 5th, 2017 after we noticed he was losing a lot of weight. He is 12 years old and has always been a big cat, not just weight wise but overall size, he's just a big boy. We noticed we could feel his spine and when we took him to the vet his glucose number was 379. Since then we started him on 1 unit of insulin, which we quickly upped to 1.5 units. We also switched both of our cats to Vital Cat freeze dried raw patties so they are on a low carb, species appropriate diet. The diet has been great for my cats' coats and their overall energy. He plays like he's a kitten again! Even with these changes, Rama's numbers were still getting up to 600 at night and in the morning and his glucose was not going below 400 midday. The vet told us he may need more insulin because he's such a big cat so he is now on 2-2.5 units every 12 hours. Unfortunately my husband and I both work full time jobs so our only time to test him midday is on the weekends or in the middle of the night. We saw one low number at 70 in the middle of the night, about 8 hours after his insulin shot, but overall his low numbers have been around 250-350. His normal for morning and night is 500-600. It is pretty rare we've seen it around 100, that was really at the beginning of us giving him 2.5 units (he's been on 2-2.5 units for a week today). We were thinking it was the somogyi effect, where he's getting too low and then it shows up as getting too high, but I'm really not sure because he seems very rarely low and even the low numbers seem high. I was giving him two big meals, 12 hours apart when I give him his insulin, but he was acting like he was starving (he used to graze) so now I give him the daily portion size but over four feedings- a whole pattie for breakfast at 5:45 am, 1/4 a pattie at 10 am, 1/4 a pattie at 2 pm, and then a whole pattie for dinner at 5:45 pm. The portion size says 2 patties for a 12 pound cat and he is 14 pounds. This schedule works out well for him because he seems more content. We just started this feeding schedule and got an automatic feeder so he can always have his midday meals. Unfortunately we are still getting high readingin the morning and at night, still 500-600. Midday has been more like 250. He is on lantus and I was just wondering why you may think his numbers are still getting so high, is the food schedule I have him on okay? Also, do you feel like it could be the somogyi effect where he is getting too low or does he need more insulin? Any advice is a big help to us, we're doing our best for him but we're newcomers. Thanks again!

Rama's mama,
Fran

 

[Kris & Teasel]

Welcome Fran and Rama! You're doing so many of the right things - a good insulin, low carb food, home testing. Many people have to test the way you do because of busy work schedules so it's possible to get a handle on your kitty's BG even with these constraints.

Here are the recommendations we'd make:

• increase the dose by no more than 0.25 u (eyeballed on a syringe with half unit marks) - you're already up to 2.5 u and the increases might have been done too quickly and by too much. You can miss a good dose that way.
• get a structured testing routine set up so you know before you inject that a dose is safe and you gather data to assess how low he's going (see below)
• set up the spreadsheet we use here to log all your BG data. It's viewable by all members and is the first thing we look at before offering advice.

It's actually quite common for too high a dose to look like too little insulin due to the overreaction it can cause. The term Somogyi is used to describe a high that can come after a very low number. You've seen some evidence of that. In FDMB world we use the term "bouncing" to describe a wider array of causes: a) BG dropping too low; b) BG dropping to lower than usual number but not that low; c) BG dropping quickly even if the numbers are still high. I believe this is what's happening with your kitty.

How about setting up the spreadsheet and entering all the data you have first?
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Insulin Testing Routine

Here's how to approach finding the good dose range:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your SS, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

And here's something I wrote about bouncing:

Here's how it works:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
7. Many vets have little/no understanding of the bouncing phenomenon.