On Lantus since 6.27.13 still very high BG

Status
Not open for further replies.
LucyCat

LucyCat

Member Since 2013
We are new to this but have already done introductions through the Feline Health board. I just took Lucy's preshot and it was 451. She started 2 units of Lantus on Thursday evening. That means over the past 48 hours I have observed BG readings around 400. Everything I have read, especially about cats with a history of Ketones, suggests that I should increase her dose by 0.5 units withing 24-48 hours if her BG curves are still high and flat. Because I only started home testing her BG yesterday afternoon, I am thinking that I will increase her evening dose to 2.5 units.

What do you guys think about that?

Thanks,
Becky and Lucy

(You can check out our limited information on the spreadsheet in my signature)
 
Hi, Becky and welcome to Lantus Land.

Here's the link to your post on Health: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=98670&p=1055026#p1055026

Having read through your post on Health, there is a ton of information there some of which is conflicting. I know it's really hard to sort out what information to pay the most attention to. I want to underscore that the Information that Jill/Alex provided is information that I would trust. Jill is a very experienced Lantus user and has helped literally hundreds of cats here since she joined in 2006.

One of the most important pieces of information that you provided is that Lucy is a recent DKA survivor. We pay very close attention to those kitties who may be prone to developing ketones. Ordinarily, the Tight Regulation Protocol would stipulate that you hold the initial dose of Lantus for 5 - 7 days in order to allow the insulin depot to form. It may be prudent to raise Lucy's dose sooner BUT there are a couple of stipulations:
  • Have you been able to test for ketones and if so, what are the results?
  • With Lantus, dosing is based on the nadir, not on pre-shot numbers. It's important to do your best to get at least one test during both the AM an PM cycles in addition to your pre-shot tests. Can you start to routinely get at least a "before bed" test every night?
  • Please monitor Lucy's BG carefully if you are going to be removing dry food starting today. As several people noted in your Health thread, the dry food may be propping up Lucy's numbers.
  • If Lucy's numbers drop today due to your removing the dry food, please post. We can help to walk you through how to manage the numbers.
If you don't mind responding to the above points, we can figure out when to raise Lucy's dose.

Switching from Prozinc, you're going to need to shift how you think about dosing. Lantus is very different than Prozinc. While Prozinc does have a longer duration than many other types of insulin, Lantus is a long acting insulin due to it having a "depot." This allows for a cumulative effect. It also means that doses need a few days to settle -- the depot needs to catch up with the dose. You assess the effectiveness of the dose and base dose changes on the nadir (lowest point in the cycle) an not on the pre-shot numbers.

There is a huge amount of information in the starred, sticky notes at the top of this Board. Please let us know if you have questions. The people here are very generous with their time and information. We're here to help you get Lucy into better numbers. I hope you'll post often!
 
Thank you so much for the info. I just tested Lucy at +6 and received the lowest score I've seen thus far...297. This is most likely lower due to the fact that I have removed dry food.

Here are the answers to your questions: Your questions are in BLUE and my responses are in GREEN...I don't know how to quote on here yet...

Have you been able to test for ketones and if so, what are the results?

*I JUST got a Ketone test and I am SUPER excited to report that it came back negative!!

With Lantus, dosing is based on the nadir, not on pre-shot numbers. It's important to do your best to get at least one test during both the AM an PM cycles in addition to your pre-shot tests. Can you start to routinely get at least a "before bed" test every night?

*Yes, I can get a before bed test. My understanding was that the nadir is at +6 in the cycle...is that incorrect?

Please monitor Lucy's BG carefully if you are going to be removing dry food starting today. As several people noted in your Health thread, the dry food may be propping up Lucy's numbers.

*I am monitoring her BG and behavior very closely today. She has gobbled up all the wet food I've been giving her every 3 hours and have tested her BG every 3 hours too. I am adding her BG levels to her SS in my signature. Last test was 297 at 1:00 (+6)

If Lucy's numbers drop today due to your removing the dry food, please post. We can help to walk you through how to manage the numbers.

*Her numbers lowered but are still high...so at this point I'm not concerned about a possible hypo situation.

*Should I hold off on increasing the Lantus dose from 2 units to 2.5 units tonight since she dipped a tiny bit below 300? Or is 297 so close that I should increase it?? Please let me know. Her PM shot will be at 7:00 central time.

Thanks!!

Becky
 
No dose advice from me, but I just wanted to stop by and welcome you to Lantus Land! As far as the Nadir, it is often around +6 but every cat is different (ECID). Also, it can change over time. The best thing to do is keep getting tests/numbers so you can see what little Lucy nestles decides to do. You're off to a great start - Lucy is in good hands for sure!
 
Yay!! for the negative ketone test. I'd try to test as often as you can to make sure that's exactly where ketones stay.

With regard to nadir, in theory, nadir "should" be at +6. I think if you look at lots of spreadsheets (SS), the one thing that will stand out is that nadir is a moving target. Some cats read the rule book and have their nadir at +6 -- sometimes. Nadirs can shift around from cycle to cycle or day to day -- or not. My cat, for example, usually has an early nadir at around +3 or +4 except when she doesn't. Just a few days ago, her nadir was at +2 and other times it's been at +6 or later. Our kitties do not like to be predictable!

Getting a curve every so often will help you to get a sense of when Lantus onset and nadir fall. Those are important times to be aware of. However, curves can have limited utility. It's probably best to get random tests. If you test before you leave the house, when you get home, before bed, as well as before each shot, you'll begin to fill in the white spots on your SS an begin to learn Lucy's patterns.

Based on the data you have, I'd get some tests tonight and we can think about raising the dose either at AMPS or PMPS tomorrow. I'm leaning toward PMPS. The reason for holding off on the increase isn't because Lucy dipped into yellow. It's because you haven't had the time yet to get test data. Increasing the dose with limited data can be a bad habit to get into -- it can put your kitty in danger. The Tight Regulation Protocol is aggressive with respect to dose increases. You don't want to be overly aggressive and potentially miss a good dose.
 
Thanks so much. I will hold off on the increase until I have more data/...till tomorrow. I will try to get daily ketone tests accomplished if I can.

Lucy has been having MASSIVE feces. The vet said this is related to her colon and diabetes etc. He suggested giving her some pure pumpkin to help with moving things along. I looked at the can and the carbs are less than 3%...so I assume this is fine...plus the vet suggested it so I assume he knows what he is talking about. She didn't really like it so it's just sitting there but I was wondering if anyone else has used pumpkin for helping their diabetic cat with pooping issues. She also doesn't cover them when she goes...so that's been fun to deal with! :roll:
 
I wouldn't try to get Lucy to eat pumpkin all by itself. Most people who add pumpkin to their cat's diet mix about a teaspoon it into their food. You may want to try squash baby food. It is also high in fiber.

There has been only one other person whose cat was having large poops and this seemed to pre-date the diabetes. Given the content of the dry food you were giving your cat, are you sure the poop issues aren't related to the dry food? I'll be curious if this self-corrects once your cat is on an exclusively canned food diet.
 
Welcome to LantusLand, the greatest place you never wanted to be. :-D Yay for yellow! On to blue, right, Lucy?
Liz, Zener's other mom
 
Thanks for the welcome!

We will see if the wet food fixes her pooh issues...I"ll keep you posted.

Yes, very happy about the yellow reading at 4:00 central time. Hoping we continue to see lower and lower numbers...but not too low!

I will try mixing the pumpkin into the food...great suggestion!

I think the large poops are related to the diabetes because she has been on dry kibble for 7 years with totally normal poops. My other cats poops are tiny compared to hers. The vet said it's sometimes caused by a back up in the colon that all of a sudden gets released...or something like that.
 
Status
Not open for further replies.
Back
Top