Newcomer concerned about Jasmine's numbers

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Toni M

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Hello,

Hello,
I am a newcomer and this is my first post here and I would really love some help with my kitty Jasmine. Jasmine is a kitty that wasn't getted adopted at the shelter (black and diabetic). I brought her home and got her regulated on 3 units of PZI. She had a rough time at the shelter, lost her kittens, was not eating, was on steroids, etc. but she was doing wonderfully after we brought her home. Unfortunately, one Sunday morning my husband and I both dosed her. She spent 3 days in the ER but then went into remission for three years. I've home tested all along and her numbers went up again a couple months ago. She is now on 3 units of Lantus 2X/day but I am concerned about her numbers. Her home curve numbers before we started insulin varied from mid 200's to mid 300's. After we started her on Lantus (starting at 1 unit 2X/day for two weeks, then doing a curve, then moving on to 2 units 2X/day then a curve after two weeks at that dose, then on to 3 units 2X/day and a curve two weeks later) her first curve after 2 weeks at 1 unit was consistently (pre and all post shots) in the low to high 300's.
Then after two weeks at 2 units 2X/day her curve numbers ranged from over 300 (pre-shot) to the high 200's (mostly 2 and 4 hours after Lantus). Now after 2 weeks at 3 units 2x/day her curve numbers were 288 pre-shot (first shot in the morning) to mid 200's 2 and 4 hours after the shot to high 300's just pre-shot again.
Three units of Lantus seems like a lot to me and it seems like she is not responding enough to the insulin, but I am far from an expert at this. Should I give it more time? Go down in units? Hang in at 3 units for awhile and do another curve.
She is on a diet of 75% wet food and 25% dry (Instinct, raw, Acana, Origen, Weruva...)

Thank you

Jazzy and Mom
 
Look for known causes of increased glucose OTHER than diabetes - if you find and treat those, you may get control again.

When was the last time she had a dental cleaning? Dental infections often raise glucose levels.

Is there any evidence of sneezing or ocular discharge, suggesting a kitty cold?

Is she urinating more frequently, but in small amounts? or with blood? Urinary tract infections are very common in diabetics. A cystocentesis and culture will identify if this is a problem and if so, what antibiotic to use.

Is she having any vomiting or diarrhea?

Is she 'meatloafing'? ie resting in a crouched position much of the time? This could suggest pancreatitis.

Are you testing for ketones with urine strips or a special glucometer (ex NovaMax)? Uncontrolled blood glucose may result in ketoacidosis, a medical emergency. If not, pick up some Ketodiastix from the pharmacy asap and check.
 
Lantus definitely works differently than the pzi did. It is a great insulin for cats, but just works differently. I am sure lots of lantus users will be by soon to help, but one thing that may be messing you up is the large incremental increases. Most people here increase in .25 unit increments, and follow a proven protocol. It could very well be that you could have "skipped over" the best dose when you increased. This is not a huge problem and can be fixed if needed. I am sure some qualified lantus people will reply soon, so don't worry.
welcome to the board!
Carl
 
Toni M said:
Hello,

Hello,
I am a newcomer and this is my first post here and I would really love some help with my kitty Jasmine. Jasmine is a kitty that wasn't getted adopted at the shelter (black and diabetic). I brought her home and got her regulated on 3 units of PZI. She had a rough time at the shelter, lost her kittens, was not eating, was on steroids, etc. but she was doing wonderfully after we brought her home. Unfortunately, one Sunday morning my husband and I both dosed her. She spent 3 days in the ER but then went into remission for three years. I've home tested all along and her numbers went up again a couple months ago. She is now on 3 units of Lantus 2X/day but I am concerned about her numbers. Her home curve numbers before we started insulin varied from mid 200's to mid 300's. After we started her on Lantus (starting at 1 unit 2X/day for two weeks, then doing a curve, then moving on to 2 units 2X/day then a curve after two weeks at that dose, then on to 3 units 2X/day and a curve two weeks later) her first curve after 2 weeks at 1 unit was consistently (pre and all post shots) in the low to high 300's.
Then after two weeks at 2 units 2X/day her curve numbers ranged from over 300 (pre-shot) to the high 200's (mostly 2 and 4 hours after Lantus). Now after 2 weeks at 3 units 2x/day her curve numbers were 288 pre-shot (first shot in the morning) to mid 200's 2 and 4 hours after the shot to high 300's just pre-shot again.
Three units of Lantus seems like a lot to me and it seems like she is not responding enough to the insulin, but I am far from an expert at this. Should I give it more time? Go down in units? Hang in at 3 units for awhile and do another curve.
She is on a diet of 75% wet food and 25% dry (Instinct, raw, Acana, Origen, Weruva...)

Thank you

Jazzy and Mom
Click to expand...

Welcome to the site to both of you.

The first thing I noticed was dry food. Any dry food is going to be high carb and contribute to higher insulin needs. Since you are testing, you will see a difference in the numbers when you remove the dry.
Here are some food links; take a look at the food listed on Binky's list that are under 10% carb and the less carbs the better.
Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition

The most important numbers when comes to dosing is the nadir or the lowest number in a cycle, with the preshot numbers important to let you know it's safe to shoot.
Here are some links to the lantus info to help you have a good understand of this insulin.
Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed
Lantus & Levemir – Data Ready to Shoot Low Numbers
Lantus & Levemir: Info, Proper Handling & Storage has picture of syringe and insulin pens.

Now, most people here keep track of their BG test numbers in a spreadsheet so that they can see how you are doing and help you decisions on safe dosing.
I can't find a link to the setup but someone will have it for you.

Dosing is usually done more gradually and not in full units, so you will have better luck if you can pick up some U100 syringes with 1/2 unit markings on them.... it's pretty tough to measure out something like a 2.75unit dose, and there ARE many cats who are on fractional doses.... some who are almost off insulin may be on a dose like .25units and even .1 unit!

While a dose of 3units BID(twice a day) may seem high, it's not for some cats.
You need to keep in mind that Jasmine's dose may go much lower when you remove the dry food.
One of my cats is extremely carb sensitive and if she ever snuck just a mouthful of a few pieces of dry food, yup, her numbers would jump up to the 400s. Some cats are more sensitive than others, so it's best to remove the dry.

In the protocol followed by many around here, in the Tight Regulation forum, they have some general guidelines that will help you to know which way to go with dose.
hopefully, the below notes and the above points will help you to get started with Jasmine's treatment.

"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 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 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 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 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 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. 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.

--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.
 
Here is the link to help you set up a spreadsheet
http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130

Increasing by 1 unit at a time is way too much and it may be that you have missed the right dose and are giving too much insulin. It is impossible to know without seeing the data.

If you have been feeding high carb food and change that I would suggest you reduce the insulin at the same time. Insulin needs can drop dramatically with a change in diet and for some kitties the change in diet alone is enough to put them in remission. If you don't reduce the insulin when you cahnge the diet you could end up with a hypo. Just in case that ever happens please make sure you print the hypo sticky at the top of this page and stick it on your fridge so you know what to do.

I can't get syringes with half units marked in Australia but I don't have any problem measuring 0.25 and 0.75 doses. If your eyesight's not great you can use a magnifying glass to help.
 
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