Question about regulation with higher dose

[Terwilliger1]

My cat was pretty well regulated in January and February, and then went off insulin for about a week after a dental cleaning and extractions. After needing to go back on insulin, it is taking a higher dose to try to keep her BG numbers normal than it did before. She was being regulated on about 1.2 units of Lantus, and now I’m up to 2.0 units for the past couple of days. I know I need to give the new dose a few more days, but I’m wondering about the trend I’m seeing. I’ve been using a new Lantus pen for about a month, so I wouldn’t think the insulin is going bad. It looks clear and I’m handling it properly. There has been no diet change (Fancy Feast low carb canned), and I know she’s not sneaking any other food (unless she’s developed magic powers and can drive herself to the grocery store in the middle of the night). Her numbers aren’t crazy all over the place, they are just higher than they were before. She doesn’t have another checkup for two months. She’s has two blood panels in the last four months that didn’t show anything too wonky other than the diabetes (which I know doesn’t mean that there isn’t something going on now). She hasn’t really been drinking a lot more or urinating more, and she’s acting pretty normal for a cat that’s almost 18. Her peak insulin time tends to be around +7-9 hours. I know I need to be patient, but I was just wondering if anyone had any thoughts?

 

[Blue]

My cat was pretty well regulated in January and February, and then went off insulin for about a week after a dental cleaning and extractions. After needing to go back on insulin, it is taking a higher dose to try to keep her BG numbers normal than it did before. She was being regulated on about 1.2 units of Lantus, and now I’m up to 2.0 units for the past couple of days. I know I need to give the new dose a few more days, but I’m wondering about the trend I’m seeing. I’ve been using a new Lantus pen for about a month, so I wouldn’t think the insulin is going bad. It looks clear and I’m handling it properly. There has been no diet change (Fancy Feast low carb canned), and I know she’s not sneaking any other food (unless she’s developed magic powers and can drive herself to the grocery store in the middle of the night). Her numbers aren’t crazy all over the place, they are just higher than they were before. She doesn’t have another checkup for two months. She’s has two blood panels in the last four months that didn’t show anything too wonky other than the diabetes (which I know doesn’t mean that there isn’t something going on now). She hasn’t really been drinking a lot more or urinating more, and she’s acting pretty normal for a cat that’s almost 18. Her peak insulin time tends to be around +7-9 hours. I know I need to be patient, but I was just wondering if anyone had any thoughts?

Well, many cats who were on insulin, go off, but then relapse and it could be for a number of reasons. It has been said that when they relapse, they have a tougher time getting regulated and the chances of going off insulin decrease... that's not so say it can't happen though.

If you think about the reason that cats need insulin, it's often to 'help' the pancreas. By giving insulin, you lessen the workload of the pancreas and give it time to heal. It could be that maybe Timmy's pancreas needs a bit more help this time around.

The dosing you are using looks more like the PZI style when I see doses like 1.2 and 1.7, plus around mid-March, there was a bit of dose juggling which is also known to upset the Lantus shed... Lantus likes things nice and steady with few ripples.

When you decreased from 1.5 to 1u on 3/17, you would have had some shed dumping on that pm cycle, and then when you raised the am dose back to 1.5u, you would have needed to fill the shed again and that's why you saw the 254, but that pm, you raised the dose to 1.7, which would mean you had to top up the shed even more. The next morn you decreased to 1.6u and that pm, up again to 1.7. Lantus needs slow changes.

Now, Lantus dose changes are usually based on the lowest point in a cycle, if you look at her ss, she was doing pretty well on the 1.5u till the 95 which is still a great number, but you dropped the dose.
Also, alot of cats go lower at nite, but you can't tell what she is doing with no test numbers in the pm cycles, so it's tough to really know what the insulin is doing. It could be that she is going lower at nite and then being higher at his amps, but that's just one guess of many possibilities. Would it be possible for you to get one before bed test number in the pm cycles? It may help to know what she's doing and may explain her morning yellows.

It could just be that she needs a bit more help and when she is feeling better she may need a bit less, but you want to be watching what's she doing in mid cycle range to know how any dose is working.

Last, people often allow themselves to get caught up in the numbers and forget about the cat.
How is she acting? What changes are you see in her? How's her coat, her appetite? Is she eating well now with all her teeth extractions healed? Are the gums looking good? Sometimes just a small splinter from a tooth can cause some higher numbers, or maybe she is just feeling a bit under the weather.

See if you can stick to a dose for at least 4 or 6 cycles to be sure how it's working.
If you can get some mid cycle test and bedtime test, I bet you will feel better and know that she is doing OK.

 

[Terwilliger1]

Thanks for the reply and giving me some things to think about. The real doses I was trying for were 1.5, then up to 1.75, and now up to 2.0. The 1.6 and 1.7 doses are just my estimation based on whether or not I couldn’t get an air bubble out of the syringe while I’m trying to eyeball the middle spot between the half-unit markings. Sometimes it’s hard to be exact at 4:45am. I dropped the dose to 1.0 unit after 95 the one time because I had to shoot an hour early due to a family emergency (I should have commented on the spreadsheet). I always wonder how consistent the .25 increments can be on the U100 syringes with half-unit markings. A stubborn air bubble could throw off the dose by .1 unit, I would think.

Anyway, I might try to get an evening mid-cycle number if I can wake up in the middle of the night. Before bed would only be +3.5 or +4 and might not help much. Overall, Timmy is doing pretty well, so there isn’t anything specific I’m worried about. I guess I just always wonder if I can be doing a better job.

 

[Blue]

Anyway, I might try to get an evening mid-cycle number if I can wake up in the middle of the night. Before bed would only be +3.5 or +4 and might not help much. Overall, Timmy is doing pretty well, so there isn’t anything specific I’m worried about. I guess I just always wonder if I can be doing a better job.

Ah but that +3 or +4 is exactly what you want to see! That's when you will see the Lantus starting to work, and what if you saw a green number at around +3.5? I bet you may want to give her a wee little snack, yes, just to slow her dropping too low overnite, and that's about the only reason to get that 'lights out' test.

If you were not doing fine, I am positive that you would see a very sick kitty, but you are not!
She's doing great!

I always wonder how consistent the .25 increments can be on the U100 syringes with half-unit markings. A stubborn air bubble could throw off the dose by .1 unit, I would think.

I bet you will feel better if you can practise some microdosing..... take a used syringe and fill to the .5u marking. Now, hold the syringe with the needle up, and twist the plunger so that you get one drop on the end of the needle. Flick it off. Keep getting a drop and flicking off until there is nothing left in the syringe.
What you are trying to do is see how many drops can you get out of that .5u..... I was pretty good at getting about 4 drops, and I am sure you can do just as well or even better!

Instead of doing the eyeball thing, fill to the line and then you can twist out a drop or two... you will then know that you are getting a consistent dose! And it will be good practise for the time when she is ready to go off insulin.... you will be able to measure her dose smaller than the 0.5u.

Sometimes it’s hard to be exact at 4:45am. I dropped the dose to 1.0 unit after 95 the one time because I had to shoot an hour early due to a family emergency (I should have commented on the spreadsheet).

I had to smile about measuring doses at 445am... alot of us have been there! And don't forget the testing at that time and reading the meter!
As for early shots and emergencies, they happen to everyone, so you were correct to go lower and shoot early, and noting in the comments will be great to help others be able to help YOU and her better.

Now that I know that shot was 1hr early, my next question is what time did you give the am shot? Was it 12hrs after the early shot OR did you shoot at the normal time which would have made that shot much later and it would explain the high am ps!
if you shot at 4pm with 1u and then the next shot at 5am, that would have been +13 and naturally, her number would have been higher.
I know it's hard in the beginning to use the comments, and I was very bad at it, BUT it will help you and others a great deal for the misc stuff that may just turn out to be important stuff later on.

 

[Terwilliger1]

Excellent advice about the microdosing! I feel so much better when I have a plan and guidelines. I nearly always test before the 5am and 5pm shots, and you are right about the one shot that was an hour early causing a 13 hour period until the next shot, resulting in a higher number. I think I’m starting to look at these numbers in a different way now. I can think of one other number that might have been higher because I overslept by 20 minutes

Timmy always gets a bed-time snack, so I’ll try to add in a few more tests before bed each week. I really appreciate all of your comments, especially the microdosing. I think I’ll be able to be much more consistent now. Thanks again!