? Perry: 6/6 AMPS 218, +4 107 | 6/5 AMPS 396 (Alpha Trak 2)

[Perry & Jenn]

Hi everyone, I'm reposting my intro post here in the Lantus forum because Perry's 1. on Lantus now and 2. has been on a wild ride this week. Sharon kindly replied quickly there that constipation can increase BG, which solved the mystery, but I thought I'd repost over here to see whether anyone had extra thoughts about this swing. Thanks all!

Repost:
I've been mining the forums for information since late February, when Perry was diagnosed. Now that we're finally on Lantus, I needed a spreadsheet, so I had to join the forum!
Perry was already eating some low-carb wet food when he was diagnosed, so we got him off the kibble quickly and then waited to see whether he'd go into remission. He was up and down: a few urine test strips registering trace to +500, then a few clear, then a few at +250. Perry's a picky guy, so we do change his food up but always keep it below 5% carbs. (Dr. Lisa's list and the posts here about getting a picky cat to eat have been invaluable, thank you, everyone.)

I noticed Perry drinking more again the week before he went on Lantus. Our vet, who is fantastic by the way, decided to put him on one unit once a day to start. Four days later, he went in at +4 for a BG test and he was at 283. Vet decided to go to 1 unit of Lantus twice daily. That was two weeks ago.

I ordered an Alpha Trak 2 and started home testing last week, but not consistently, since I was still getting the hang of it. (Again, info here on the forum was invaluable.) Perry's thirst has been up for weeks at this point, and we were due for another check-in with the vet. Sunday night, I got my first successful drop from his ear just before his p.m. shot: 419. Yikes! The next morning, I didn't get a pre-insulin BG, but I did get one at +4: 311.

Then yesterday (Wednesday) morning, our sweet boy was very cranky. He didn't wake us up for food at 4:30 like he usually does, and he didn't want to eat breakfast. I got a BG: 396. After opening three cans, he finally decided to eat, so we gave him his 1u of Lantus ... and our very nice cat growled and then went and hid under the couch. We haven't had a DKA episode, thankfully, but I was pretty concerned at this point and ran him to the vet (after my husband lifted the couch so I could grab the kitty).

His usual vet wasn't in, but No. 2 vet immediately said, this cat is really constipated! We have two, so it can be hard to tell who's going, and we think they've both had some issues now that everyone is on the low-carb diet. The doc was like, hey it's not going to be pretty, but this cat needs an enema. He had trace ketones, but the vet was like, he is backed up enough to make him cranky, for sure.

Poor Perry came home smelling kind of poopy and with seriously ruffled feathers on his backside. He wouldn't let me help clean him up much--he was clearly hurting back there. Our vet called when she got in and recommended bumping Perry to 2u in the morning, still 1u of Lantus in p.m. With the high numbers and trace ketones, it made sense.

But then, this morning--once again, Perry didn't get us up to eat, but he was hungry at 5:45 when I got up--Perry's AMPS was 218. What?!? I decided to keep him at 1u for today. Is that because he hadn't eaten since 10 p.m.? Is that because the stress of being so constipated was finally off, and he was relaxing? Are we getting Lantus overlap? I don't know, but I'll test him this morning at 4+. Once again, I'm really glad I work at home so I can keep an eye on this guy.

(I just started the spreadsheet, and I'm still filling it out, so apologies for the lack of info there if you check it in my signature. I'm working on it.)

xo

 

[AmandaE]

I think that constipation could definitely have been a culprit in the high BG levels, but also keep in mind that Lantus is a depot style insulin and it takes about a week for the depot to build so that Perry can use it efficiently. I have a feeling that your AMPS of 218 happened because Perry has finally built his 1u depot, if I'm right this is great! you can finally get a feeling for how he is reacting to the insulin dosage and start dosing accordingly .

On the 2u dose in the am / 1u dose in the pm: I'm not at all an expert but it usually isn't recommended here to vary your dose amount through the day. You should stick with just one dose unless Perry qualifies for a dose increase or decrease (see below point a on dosing protocols). Right now it seems like Perry is reacting to 1u so I don't think that you need to bump to 2u in the am. If you change your dose, it often messes with the depot. You can read more about the depot HERE. It is also important to note that we usually increase or decrease by 0.25u at a time, this is so that we don't miss the ideal dose for our kitties!

A couple things that might be helpful for you to know is that:

a) There are two protocols that you can choose from when using lantus, they are Tight Regulation (TR) and Start Low Go Slow (SLGS). You should read the stickies on them at the top of the forum and decide which one is right for you. These protocols will help you determine when Perry needs a dose increase or decrease. Once you choose one you can add it to your signature so that members on the forum will know what kind of advice to give you when you ask questions

b) It is very important to get a BG reading before you head to bed (btw: good job testing already!). This is because cats often dip lower at night time, you want to make sure that Perry isn't at risk of falling too low which could trigger a hypoglycemic event. Usually a +2 after the PMPS will give you an idea of how the PM cycle will go, if it is the same or higher than your PMPS you should have a pretty uneventful night, if it is much lower than the PMPS you might have to stay up and monitor for a while. You can read information on how to prevent / handle Hypo events at the top of the forum.

c) Ask a lot of questions if you want to, everyone here is supportive, non judgmental, and has been in your shoes. There is a lot of information to go through on this forum and it can be overwhelming... don't be shy! there is a lot of experience here, and if someone knows the answer to your question they will share it with you!​

Welcome to the Lantus community, Good luck with everything and I will see you around the board

PS: ALSO - Go you for setting up the spreadsheet! it will really help everyone here offer advice if you need it as well as help you and your vet pick out Perry's BG vs dose patterns

 

[Ti-Mousse (GA) Pepe (GA)]

Welcome Jenn and Perry to the Lantus forum! You did OK reposting your Intro, that way we have a good idea of where you are now!
I don't have much to add to what Amanda just said! Testing is the key; always before shooting to make sure Perry is safe and a couple during cycles, depending on which protocol you will decide to follow! It's great that you're setting up your SS!
If you want dosing advice, you can just change your title and say "dosing advice please-new to Lantus" and leave your ?, that way dosing experts will look it up!
Don't be afraid to ask questions and keep posting so we'll be able to follow you and your little Perry's progress!

 

[Perry & Jenn]

Update: PMPS 297. So the wild ride continues.
Thank you so much, everyone. It's so reassuring to know that not only am I not alone in this, but there's this amazing community with a wealth of knowledge here. I'm incredibly grateful!
I think we are probably on a Start Low, Go Slow plan here. And I should have mentioned this sooner (and put it in my signature just now), but we're using the Lantus pen.