Poopers

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rbrumbaugh82

Just so you all know, I woke up to a cat with a 507 glucose and you were all worried he'd plummet to dangerous levels. Somehow I wasn't afraid of that happening or else I wouldn't have done what I did. My cat isn't like your guy's cats or any example of your cats. He is very stubborn and has a stubborn body. So the higher dose is probably what he needs as the low dose doesn't do much to budge him. Anyways, I am staying with the 5.5 units for over a week to see what it does then with the new shipment of cat food I'm getting. I won't go up from the 5.5 units.
 
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Hmmm, well this must be the case for over a week then because all the time of keeping him on 5 units he remained that way. A few times he dipped to below 200 but rebounded after the low point.
 
If you look at the spreadsheet and zoom out, his numbers started going up as you started increasing the dose from about 1 unit or so.
 
May or may not be rebound. I am not convinced it is rebound
Me either. Rebound is just one of several explanations for the high preshot number this morning. A little consistency and restraint might yield more information... just sayin.

Anyways, I am staying with the 5.5 units for over a week to see what it does then with the new shipment of cat food I'm getting. I won't go up from the 5.5 units.
That's a good start. I seem to recall a similar suggestion three days ago:
Have to start over with Lantus and any help with usused Lantus Pens?

Good luck!
 
If you look at the spreadsheet and zoom out, his numbers started going up as you started increasing the dose from about 1 unit or so.
BJM, that was because I was on a completely different insulin and he may have not been fully diabetic then. That was back in Dec/Jan and he was on N. That probably does work for my boy but it does not last.
 
I'm not an idiot and I know his dosing yesterday was vastly close to each other. However, he got a total of 6.5 units of insulin which is not much more than the 5 units he was getting for several days before. So I can see potential problems if I was giving him like 3 units for several weeks and then suddenly see he isn't doing better so I go from 3 units to like 6 units all of a sudden. However, he was on 5 units for a while. My problem is I may need new insulin and a fresh batch of it. These pens were prescribed back in Aug and despite me keeping them in the refrigerator since I received them they may have lost their potency during the time spent unrefrigerated. I don't know but while this does work its not sticking around. I was suggested to try either Levemir or PZI. Those are 2 insulins that I have not tried yet. I did try to BCP PZI insulin but it kept his numbers in the 300s all the time with the 3-4 units he was on. Trust me, do you honestly think I am clueless and want to hurt my boy? Do you think I want to jump around from dose to dose because I'm not an idiot and I know the harm that does to anyone using insulin. I'm just trying to find the right dosing for him and stick with it. As I can see from experimenting, the lower dose keeps his numbers up since he is starting high to begin with in the mornings. Yes, he was low once with the lower dosing but that was because he was on N and most of you said that is a cheap insulin and not good for cats. It did drop his numbers like a rocket but it only lasted 4-6 hours before wearing off and then he was without insulin until it was time for his next shot. I don't want him to be on that kind of insulin as I want to see him on something that lasts in his system all day until evening. I'm probably going to have to get a fresh batch of insulin but affordability wise I'm not sure what route to go and given that I sent out a message asking if anyone had any leftover pens and not getting any response I'll probably have to order it myself from somewhere. That is okay because I know not everyone can help out and I completely understand. My next step is whether or not to keep Lantus or go to PZI even though I'm worried about that not working due to the BCP insulin not working and that insulin is a cat insulin. Although at the time Pooper's had dental problems when he was taking the BCP insulin so not sure if since his mouth has cleared up if that insulin could work now if given a higher dosage from the 3 units he was getting on it?
 
I woke up to a cat with a 507 glucose and you were all worried he'd plummet to dangerous levels.
Then you were lucky. There was zero guarantee of that happening.
Somehow I wasn't afraid of that happening or else I wouldn't have done what I did
And there is the problem - you SHOULD be scared that his numbers could drop. Hypo is not something you play with or ignore the possibility of. We've all had nights where we got little to no sleep and that was with our cats on consistent doses where we knew where the numbers would be likely to go. And that, if you want Poopers regulated and in good numbers, is something you're going to have to deal with too. You can't just decide that you think he's OK because you're tired and leave him alone for the night.
My cat isn't like your guy's cats or any example of your cats.
He's a cat, he's subject to the rules of biology just like every other living creature. At the rate you're going, you'll never know whether or not there's a dose he does respond to because you'll never let him have any dose long enough to find out. On this site there are low dose cats, high dose cats, cats that go into remission, cats that do well for years on the same dose, cats that need dose adjustments now and then for years. The one thing most of these cats have in common is that their owners treat their diabetes consistently and within safety guidelines. Not you - you seem to think you know better than the whole veterinary profession and everyone who's been through this before.
So the higher dose is probably what he needs as the low dose doesn't do much to budge him.
Not in one shot it won't - not with Lantus. We've all explained this over and over and it will never work the way you seem to expect it to. You're treating it as though it's one of the fast acting in and out human insulins and it just isn't - you're never going to get the results you want this way.
He is very stubborn and has a stubborn body.
No, he's not. He's a cat. He's not doing this to spite you or anyone else. He's just not getting the chance for his body to learn to deal with a consistent dose of insulin.
Anyways, I am staying with the 5.5 units for over a week to see what it does then with the new shipment of cat food I'm getting. I won't go up from the 5.5 units.
I sincerely hope you mean it this time for Poopers sake. But you've said this before and gone ahead and changed the dose anyway after 2 or 3 cycles when you don't see the numbers you want to see and I expect nothing different from you this time around. To be honest, I'm pretty much done caring what you think (and it takes a long time and a lot of someone else's refusal to listen to anything anyone else says to make me that way about anything) - we've all tried and tried and you don't want to hear what we have to say. I have been trying to help you for many weeks and you don't want to listen. Even this morning I'm getting the impression of "look guys, I was right" and you could easily not have been. This condition is NOT a game.
May or may not be rebound. I am not convinced it is rebound
Might be, might well not be - remember he ended up with an unshootable number last night after the way he dosed yesterday. So it could be rebound, a bounce from the 190 of the effects of a skipped shot especially when the cat has no solid depot to work on when a shot is skipped.
If you look at the spreadsheet and zoom out, his numbers started going up as you started increasing the dose from about 1 unit or so.
Yes, and he even had better numbers than he's getting now when he got no insulin for about a week. FWIW I'm wondering if at this point, as well as the fact that Poopers clearly didn't need a particularly high dose to begin with, we're looking at insulin resistance and/or glucose toxicity from the way the dosing's been played about with - increased, decreased, stopped and started altogether when it probably didn't need to be early on. In which case, consistency and working up the doses gradually to find the one that breaks that is going to be even more important because when he hits a breakthrough and starts to come back down it's going to be fast.
BJM, that was because I was on a completely different insulin and he may have not been fully diabetic then.
If he was on insulin then he was "fully diabetic" whatever you think that means at that point. And even before you switched insulins for the first time you were losing control of the numbers - AFTER increasing the dose. BJM is right - his numbers were better on a lower dose.
I'm not an idiot and I know his dosing yesterday was vastly close to each other. However, he got a total of 6.5 units of insulin which is not much more than the 5 units he was getting for several days before. So I can see potential problems if I was giving him like 3 units for several weeks and then suddenly see he isn't doing better so I go from 3 units to like 6 units all of a sudden. However, he was on 5 units for a while. My problem is I may need new insulin and a fresh batch of it. These pens were prescribed back in Aug and despite me keeping them in the refrigerator since I received them they may have lost their potency during the time spent unrefrigerated. I don't know but while this does work its not sticking around. I was suggested to try either Levemir or PZI. Those are 2 insulins that I have not tried yet. I did try to BCP PZI insulin but it kept his numbers in the 300s all the time with the 3-4 units he was on. Trust me, do you honestly think I am clueless and want to hurt my boy? Do you think I want to jump around from dose to dose because I'm not an idiot and I know the harm that does to anyone using insulin. I'm just trying to find the right dosing for him and stick with it. As I can see from experimenting, the lower dose keeps his numbers up since he is starting high to begin with in the mornings. Yes, he was low once with the lower dosing but that was because he was on N and most of you said that is a cheap insulin and not good for cats. It did drop his numbers like a rocket but it only lasted 4-6 hours before wearing off and then he was without insulin until it was time for his next shot. I don't want him to be on that kind of insulin as I want to see him on something that lasts in his system all day until evening. I'm probably going to have to get a fresh batch of insulin but affordability wise I'm not sure what route to go and given that I sent out a message asking if anyone had any leftover pens and not getting any response I'll probably have to order it myself from somewhere. That is okay because I know not everyone can help out and I completely understand. My next step is whether or not to keep Lantus or go to PZI even though I'm worried about that not working due to the BCP insulin not working and that insulin is a cat insulin. Although at the time Pooper's had dental problems when he was taking the BCP insulin so not sure if since his mouth has cleared up if that insulin could work now if given a higher dosage from the 3 units he was getting on it?
Again, there's your problem. You don't understand what you're doing with Lantus and whether you want to believe it or not, that was a HUGE dose increase - plus the fur shot you think you gave in the morning which he might very well have got some of. Even cats that finish up being high dose (and we're talking 20 or more units twice a day) don't increase that fast at 5 units BECAUSE IT ISN'T SAFE. The Lantus is working - if it wasn't he wouldn't have got to 193. No, we know you don't want to hurt your boy, but you are in fact either clueless or unwilling to learn and listen to sense. If you're not going to dose consistently, safely and properly then it isn't going to matter a damn what insulin you use - it isn't going to do what you want it to do. And what exactly makes you think that jumping around from dose to dose is going to suddenly let you land on the 'magic' dose when that method doesn't work for anyone else? Because, please, if you have some miraculous answer to how to decide the perfect dose without any method at all, share it with the rest of the world and make everyone's lives easier. Oh, that's right you DON'T have that answer or Poopers would have been regulated from day one. Or in fact that you haven't hit the 'magic' dose already but were too impatient to see it work so moved on to something else before you saw results? You say you know it does damage but you're doing it anyway - what sort of reasoning is that? Especially when we've all told you that not only might it cause harm but it isn't going to help you get him regulated. We've heard a lot about what you want for Poopers and his numbers over the months, but wanting something without working with a method to make it happen doesn't do anything to get you to where you want. You're looking for the food that works, the insulin that works and then at the same time not keeping anything consistent enough for anything at all to work.

So yeah, this morning I for one am mad at you. Yesterday I wasn't, I was trying to help keep Poopers safe. But this morning when you're still refusing to listen and thinking you know better - yeah I'm mad. You know why I'm mad? Because Poopers is going to finish up paying the price for this and that MAKES me mad when if you'd just listen you could get all the help and support you'd need to keep him safe and instead you choose to go on taking risks with his safety and possibly his life.
 
Lantus is a depot insulin. In other words, it has a cumulative effect... each dose builds upon the next. You're not going to see the numbers you'd like to see until you get close to a good dose or what some of us call a "break through dose". The typical scenario is to continue with dose increases in small increments (usually 0.25 unit) with not much happening until bam!... you've reached a break through dose and things start happening. BUT... don't get too excited. Kitty's numbers may go up again. Don't get discouraged. One has to have patience and continue to chip away at the BG numbers.

To shift the focus back toward moving forward...

There are a lot of threads going on here and it's hard to keep track of what is where, but I wanted to pull this one bit of information out of one of Jill's posts and see if I can illustrate it for you. I imagine you are one who won't believe me until you see it in your own cat, but maybe this will help somebody else who is reading these threads thinking this sounds familiar.

Take a look at my spreadsheet for Lucy: Lucy's spreadsheet

First, she started on N (there are no numbers on the spreadsheet because I tested only rarely). I switched to PZI in mid-October, still testing not so much. I had no idea what I was doing and for a while I was ok with that. After a while, her numbers got worse. I had a wake-up moment when I realized that Lucy had fought hard to survive her DKA and I needed to give in and ask for help so I wouldn't be the one to kill her. About that time, the PZI I was using was discontinued and I felt really lost. I had a new vet, who said "well, I like Lantus for cats." So I bought the Lantus and gave in and came here to post for advice. I'm not a social person, had never posted on an internet board before, and I'm not someone who likes to admit that I need help, so that was HARD for me but I had to do it for Lucy.

We started Lantus on 4/15/08. From there, you can see what Jill is talking about above. At first her numbers were pretty flat and were the same no matter what dose. I increased the dose, the numbers stayed the same. Dose after dose after dose. Other people's cats were having breakthroughs at 1 unit, or 2, or 3. I was sure she wasn't going to respond ever. People here (especially Jill) said "trust me" and I really had nobody else to depend on, so I tried to believe them. When she got to 4 units I remember saying "please can't I go ahead and increase by 0.5 units at a time? Obviously she is nowhere near a good dose yet." I expected her numbers to at least be going down a little bit if her dose was getting closer to correct, but the numbers were still pretty much the same on 4u as they had been on 1u. I was told "no, trust the protocol, do the increase by 0.25. It it's not enough you'll be able to increase again in a few days but you never know which will be the right dose and you don't want to miss it."

Sure enough, I increased to 4.25u and the next day her whole spreadsheet changed. Green everywhere and she never looked back. (notice I said the NEXT day her spreadsheet changed, not the same day. That's important). Then she started earning dose reductions like crazy. Now that I have been here for so long, I've seen that pattern a zillion times and I know the sudden breakthrough is a normal pattern for Lantus cats. At the time of course it was brand new for me and I thought Lucy was different. The breakthrough dose might be 0.5 units for some cats, 5 units for some, 50 units for some, but there will be one.

And yes, her numbers did go back up again later and she did have to work back up to 4.25 again to get another breakthrough, but that one stuck and she eventually went off insulin.

Getting back to Poopers: for what it's worth, I think the higher dose is probably a good choice for Poopers right now. I did not see any reasons on his spreadsheet for you to reduce to 2 or 3 units, but it seemed important to you to back down and start over. Just be consistent and careful with how you increase from here. Don't let the high/flat numbers make you complacent because you could catch a green number out of nowhere at any time, just like I did on 6/14/08. Never saw that coming, especially with a preshot of 390 that morning!

Good luck to you. I hope you can figure things out soon.
 
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I'm not an idiot and I know his dosing yesterday was vastly close to each other. However, he got a total of 6.5 units of insulin which is not much more than the 5 units he was getting for several days before. So I can see potential problems if I was giving him like 3 units for several weeks and then suddenly see he isn't doing better so I go from 3 units to like 6 units all of a sudden. However, he was on 5 units for a while.
You know, if I didn't understand "how lantus works" I would read your comments above and think, "Yeah, he's right. That's not so bad. What's the big deal?"

Here's the big deal in a nutshell:
  • You administered 3 shots in approximately 4 hours
    • 2u @ AMPS (fur shot) - The thing with a fur shot is there's no way of knowing how much insulin "got in there". For that reason alone, re-shooting after a fur shot is not recommended. We've seen fur shots drop a kitty when not expected over and over again for two reasons: the insulin depot (which is already in place) plus the addition of whatever insulin "got in there". I should mention there's actually another possibility. With Lantus you'll typically see "waves of action". These "waves" usually last about 3 days until one gets closer to regulation. If this scenario should happen on a day kitty is breaking a bounce kitty may plummet anyway even on a partial dose.
    • you reshot 1.5u because of the fur shot - see above.
    • about 4 hours later you shot 5 units
  • Each of those three shots you gave had a separate onset, nadir, and duration. They not only effected the cycle... they interacted or you could say "played off of each other. The result will not be what you would expect the cycle to look like. Let's be honest here... at this point you don't have the knowledge of what is to be expected nor do you know what's not to be expected. Click on those links in blue. Start learning about the insulin you're using before drawing conclusions which have no basis of fact.
One could quickly find themselves in trouble when not knowing/recognizing how the insulin they're using works. That's why most of us who do understand the long-acting insulins gasped when we saw what you had done. BTW, Lantus is a long-acting insulin with the potential of long hypoglycemic episodes. We've seen Lantus hypos last as long as 16-17 hours when inadvertently overdosed. Some vets have seen them last longer despite putting kitty on a glucose drip. Again, not something you've seen or been exposed to, but we have... on this very board.

Trust me, do you honestly think I am clueless and want to hurt my boy? Do you think I want to jump around from dose to dose because I'm not an idiot and I know the harm that does to anyone using insulin.
You know what I see? I see an accident waiting to happen because you think you know what you're doing... and don't.

My next step is whether or not to keep Lantus or go to PZI even though I'm worried about that not working due to the BCP insulin not working and that insulin is a cat insulin.
If you decide to switch to one of the P insulins, your choice would be Prozinc if you've already tried BCP. PZI has been discontinued. Although, you'll run into the same thing no matter what insulin you might switch to. You'll have to learn about whatever insulin you choose... or you'll run into the same problems you've been encountering all along.



I see Libby and Lucy posted while I've been typing. She offered an excellent example and explanation.
Thank you, Libby!
 
FWIW I'm wondering if at this point, as well as the fact that Poopers clearly didn't need a particularly high dose to begin with, we're looking at insulin resistance and/or glucose toxicity from the way the dosing's been played about with - increased, decreased, stopped and started altogether when it probably didn't need to be early on. In which case, consistency and working up the doses gradually to find the one that breaks that is going to be even more important because when he hits a breakthrough and starts to come back down it's going to be fast.
Exactly!
 
FWIW I'm wondering if at this point, as well as the fact that Poopers clearly didn't need a particularly high dose to begin with, we're looking at insulin resistance and/or glucose toxicity from the way the dosing's been played about with - increased, decreased, stopped and started altogether when it probably didn't need to be early on. In which case, consistency and working up the doses gradually to find the one that breaks that is going to be even more important because when he hits a breakthrough and starts to come back down it's going to be fast.
Yep!
 
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