Rebound on Lantus?

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jmalasiuk

Member Since 2014
Hi, new to posting here. My cat Tonka was diagnosed as diabetic a couple months ago (I myself have had type 1 diabetes for decades, however, so I'm only new to the feline side of thigs). We've been adjusting his dose very slowly, since I have to work out of town frequently, and my cat sitter was not comfortable doing blood glucose monitoring on Tonka.
After 2 months, he is up to 3 units of Lantus twice a day, roughly 12 hours apart, but his blood sugars are still quite consistently high. My worry is that he occasionally drops to normal or lower levels, followed by a spike: last week, he had a day with 23.2 before insulin to 5.9 four hours later, with a spike up to 32.4 by hour 11, after whch it fell slowly but never got below 15 on multiple tests over the next couple days. This week, we had a similar episode: he went from 20.5 before his morning shot, to 4.4 three hours later, then spiked ip to 16.9 another 3 hours later, and was up to 36.6 by hour 12 when he had his second shot for the day, after which his levels have fluctuated, but all been high (above 15, and as high as 31.
In a human, I'd suspect rebound, but I do not know how much this affects the cats, or how long it continues to affect them after the initial rebound. Could it be a couple days of high sugars after? I also can't see how he can drop so quickly (and he is eating the same amount each day, at the same time) on what is a very slow acting insulin in people. Are cats more sensitive to Lantus so that it can act that quickly? I figured he should have a more stable curve given consistent feeding... Also, since he's still on a rlatively low dose of insulin 6 units per day for a 14 pound cat - he's overweight but not grossly obese, just a big boy - I'm worried that he might need more insulin, but not sure how to avoid these sudden drops.
 
If the increases made were in whole units, or even half units, it is possible you missed the best dose for him and are giving too much insulin. Every so often, the stored glycogen is exhausted and he can drop like a rock.

Infection can also increase glucose - a common culprit is dental infection. Take a look in the mouth for signs of red gums or loose teeth.

Also, let's check something - what are you feeding?
If it isn't low carb canned or raw - under 10% calories from carbohydrates - that could be part of the highish dose. See Cat Info for discussion why, plus snag a copy of the food list to review what you've been feeding.
 
Thanks for the suggestions. We have been increasing him in full units, so it could be that he's getting too much and the chronic highs are a result of rebound. Now that I'm going to be home more regularly for a while, I intend to test him regularly for several days and see what turns up in his curves. Just have 2 days to go on so far, which isn't alot.
As for food, he's on the Purina DM dry and wet food, eating the amount that his vet figured was correct for his ideal weight. Even the dry is relatively low carb (13%), and only half his intake is from the dry right now, so I don't think that that should be causing such extreme and rapid spikes. Hard to know though, since we all metabolize slightly differently, eh?
 
When you keep the carbohydrates below 10% of the calories, that is closer to what a cat's diet would be like if eating wild caught prey.

And dry food is a water-depleted diet which can stress the renal system, can pack on pounds from calorie density, and does not help clean the teeth 9its a myth that dry food cleans the teeth).

I routinely leave the low cost, low carb, over the counter, Friskies pates out for the 14 cats in my home. They're all doing well, with terrific coats, and healthy weights.
 
That's good to know. I've been planning on experimenting with his food once we get his blood sugars stablized, so I can see better how his diet effects his levels. Problem is still figuring out whether it's too much insulin and he's rebounding, or not enough insulin for the carbs and he's just dropping randomly from time to time.
 
Can we get you started using our grid to record your glucose tests? It will help us give you better feedback.

Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
Once you get a spreadsheet up, folks will be able to review the pattern and interpret it.
 
Though some cats need to go higher, 2-3 units b.i.d. that often all the higher many cats need to go. My current foster ChrisFarley is 18.5lbs and only needed to go up to 1.5U b.i.d.. Our first foster, Cecil, came to us under 8, but settled around 13.5 and 2U was too much for him. If you look at his spreadsheet, you can see that when we brought Cecil home his BGs started to drop fast. The first night he went down 100pts - we didn't feed him the dry he'd usually gotten at the shelter. He bounced a few times, but went off of insulin relatively quickly after that. Not all cats may react the same, but Cecil shows how hard food can hinder a cat from getting to regulation and remission.

ChrisFarley had the tendency to drop really fast early in the cycle and then be higher at shot time. We moved his feedings around, more frequently and made sure to feed him later in the cycle, and late seemed to really help flatten him out an bring down the preshot numbers while keeping the drops from not being quite so steep. It was a bit tough until we got him an autofeeder set up. Now he sits by it when he gets hungry :lol: and will go running when he hears it turning.
 
Hi - managed to get his blood sugar curves from last week and the last couple days entered and supposed to have been added as a URL on my profile. If it doesn't show up with this post, I'll try again
 
The link to his curve seems to show up as the globe icon, vs. words. But it is there.
Just a note: I enter the data using the International tab. For some reason, the conversion to the US tab misses the first row of data.

BJM said:
ChrisFarley had the tendency to drop really fast early in the cycle and then be higher at shot time. We moved his feedings around, more frequently and made sure to feed him later in the cycle, and late seemed to really help flatten him out an bring down the preshot numbers while keeping the drops from not being quite so steep. It was a bit tough until we got him an autofeeder set up. Now he sits by it when he gets hungry and will go running when he hears it turning.

I'm in a bit of a bind for feeding. I have two cats, and both appear to be in a grazing (vs gobbling) phase right now, so it's hard to get them to eat all their own food without hitting the other's later. I'll be moving my older boy (Teeger) to the same diet, most likely, but he's of an age that kidney issues could be a problem, so I want to approach this carefully. I'm also at work all day with no-one else in the house to look in on the cats. I could use the auto feeder (I still have one from when I had only one cat, but Teeger would most likely just barrel poor Tonka out of the way on his way to the feeder when it clicks :) I'm hoping that if I can move them to an even lower carb diet, the feeding schedule won't be as critical, so they can both free feed.
 
BJM said:
ChrisFarley had the tendency to drop really fast early in the cycle and then be higher at shot time.

Was ChrisFarley also on Lantus, or another long-acting insulin? It really surprises me that they could drop so quickly on Lantus alone - it's more of a basal insulin, with very little peak in activity when used in humans.
 
Sorry - ChrisFarley wasn't me.

There's an enhanced search feature in the upper right, where you can enter the words/phrase and/or date and/or author to find all kinds of stuff. Chances are good, someone has had the question or condition or issue before.
And here's the post
 
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