REALLY NEED HELP

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kkoka1

kkoka1

Member Since 2013
Hi,

Jinglebells mom here. Jinglebells is notorious for not doing well on insulin. Her specialist put her on .5 of Lantus. She's been on this for a month--no reactions, but her numbers are still high. Usually in the high 300's after eating. My other computer crashed (hard drive) and it has her spreadsheet on it, but honestly...235 up to high 300's usually. Based on the test shots we've done at home, her specialist just moved her to .5 at night, too. He asked us to test her am BG's PRIOR to feeding. After the 1st night time injection, her prefood BG in the am was 435--the highest I think she has ever had on or off insulin. We hung in there and did a second injection last night. Her BG this am is 603!!!! It has NEVER been this high on or off insulin. Of course his office is closed (weekend) and we don't know whether to give her the pm insulin shot tonight or not. Note: It has been because of us that we didn't start the pm dose of insulin sooner. My daughter had to have surgery and we've been dealing with that for the last month--24/7 nursing.

PLEASE...can anyone tell us what is going on??? :shock: I'm going to post here and on the main page cuz I am just really worried.

Thank you.
 
Can you list the doses, BGs and times the best you can in terms of:
preshot( PMPS and AMPS)
Does
+X then BG.
It is hard to tell what is happening from your description of the BGs
 
I will try to see if my daughter has a copy of the spreadsheet that died with my hard drive 2 days ago, but for now, all I can give you is the last 2 readings. I am hoping I am correct that AMPS AND PMPS means "am preshot" and "pm preshot." Note: Our specialist has asked us to do this BG BEFORE I feed her at 6 am.

7/25/14
amps = 435

7/26/14
amps = 635

From memory, she has always been:
amps = 350's
pmps (note we never gave her insulin in the pm until 7/25/14--this is from our spotchecks) = 395ish
* Spot checks + full curves always yielded 195's to 250's (if we were lucky), but more than not in the low 300's for all +2, +4, +6, + 8, etc. She'd start at 350's curve down to mid 250's then climb back up to the 350's or a bit higher.

I'm thinking this is rebound, but I don't understand all the types of rebound (3 kinds, right?). We are super conscientious about meal feedings/times. She always gets fed at 6 am with .5 of the insulin at 6:30 am. These outlandish numbers started the day we did the 2nd shot of .5 at 6:30 pm. I also don't understand the "shed" concept and how that figures in if anyone can explain it to me. All I know is that Lantus builds up, right?

Note: She seems fine--alert and responding which is good. When she was on PZI, she was comatose and twitching, so Lantus is a huge improvement. I am worried these high BGs are hurting her body/organs. nailbite_smile

Thanks for any help and I will post her numbers when my daughter can access them. -Kristi
 
Hi. She is not getting enough insulin most likely. Hop over to the insulin support forum and read the stickies on lantus. It is dosed based upon the nadir, low point, which is usually but not always between +5-+7 after insulin. You can set up a spreadsheet via google chrome to keep track of all your tests. With lantus you want to try and get your cat into the BG of a non-diabetic cat for good health and a chance to go OTJ, off insulin.
 
We understand that she wasn't getting enough insulin, but because we almost lost her twice on PZI, we were going slow and easy with her on Lantus. This is all a result of trying to GIVE her more insulin.

What we weren't prepared for are the dramatic increases we've seen in the am.

Glad to know about the nadir basing Lantus rather than the BG's, but geesh...I'd rather have her NOT on insulin in the pm and maintain a BG of low 300's than be on insulin in the pm and have BG's in the 600's.

I was hoping someone here would be able to tell me if this was something that is experienced when introducing more Lantus, with the hope that the shed will readjust and level out. Does anyone know?
 
There is something called new dose wonkiness. Lantus is meant to be dosed every 12 hours. If you could read the stickies on Lantus it will become clearer and then you can ask questions that will let us know how to help you.
 
It sounds like you were only giving her .5u once a day. With Lantus, if you're not giving it twice a day, it's basically ineffectual because the depot never gets properly filled as the skipped shots keep enough insulin from getting into her system. If you want to start slow, you can do .25 to .5u twice a day and hold the dose initially for 5-7 days so the Lantus depot can be properly built up. If the numbers are still high, then increase by .25u for a minimum of 3 days/6 cycles before re-evaluating if another increase is needed.
 
hi. i didn't understand the lantus shed either but mel gave me a great explanation of it. i copied and pasted it here for you. it really helped me to understand

from mel ......
Think of a funnel...now without corking the little end you are trying to fill up that funnel so the water stays even with the top while its still running out of the bottom. If you pour too much or too fast it overflows (hypo) if you don't pour fast enough or enough the level at the top sinks. (High BGs). The water only remains level if the right amount at the right rate goes in the top at the same rate it goes out the bottom. The top of the funnel is Tibbs BGs, the water in the funnel is the insulin and the funnel itself is the shed. So when you increase the dose you've have raised the top of the funnel to make a bigger funnel but it's still running out of the bottom at the same rate it was. However this funnel magically adjusts the hole at the bottom to match the top hole. But while it remolds itself his BGs either stay high or go even a little higher. A phenomena we affectionately call New Dose Wonkiness. Once the top and bottom of the funnel magically adjusts then the BGs stabilize again. 

Regardless the insulin you just shot into Tibbs' funnel isn't what is running out the bottom. That is what was already in the funnel. Each shot builds on the previous until the rate going in the top matches the rate out the bottom. 

Because of the type of insulin Lantus is when you inject it, very little is in a useable form for Tibbs to use right away. Lantus forms little crystals under the skin that

Mel and The Fur Gang

Autumn's SS CUSTOM DOSING DO NOT COPY
Cassanova's SS CUSTOM DOSING DO NOT COPY 
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MommaOfMuse 10621 Wed May 26, 2010 7:52 pm Hastings, Nebraska May 26th, 2010
 
If you have been giving insulin only once a day, you should give it in the evening also. Lantus needs to be given twice a day. I suggest you keep the same dose right now, just add the PM shot.

BG readings are normally taken before food and insulin. Food can significantly increase the BG readings, that is why you test before feeding to get an accurate reading. After a week of twice a day dosing, we can use the BG readings to help you determine if you need to increase the dose.
 
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