Rusty first red zone on Lantus

E

emilyrose

Member
Hi all
After starting Lantus, Rusty has been in the 2-300s, which isn't bad. I have not done a curve yet. I'll admit, it has been a challenge drawing up such a teeny tiny amount of insulin.
This evening he had his first almost 500 reading since starting. Nothing changed today, no new food, treats, or the like.

He has been on Clavamox 62.5mg 1 tab 2x daily since 1-8-24. Despite his UA being clean, he did have some sniffles and eye gunk so vet wanted to make sure we got ahead of anything he may have going on (as he has had 3-4 incidences prior to being Dx diabetic of his face swelling for what was assumed to be dental infection).

How will I know when Lantus is working? Why would he have such a high spike? I really don't understand diabetes.
His chart is up to date.
 
You need to start getting some mid cycle tests. We determine how Lantus is doing, and whether the dose needs to be changed, by the nadirs or how low the dose is taking the cat. Nadirs vary, but are typically in the +4 to +6 range. I'd strongly suggest grabbing a middle of the day test when you are home, and every night get a test just before you go to bed.

The red you saw for PMPS tells me one of two things. Either he went lower than he's used to and bounced, or 0.5 units is not enough insulin. Any infection/inflammation will raise the blood sugar numbers. Meaning, we don't have enough data to make a decision if you should lower, increase, or keep the dose as is.
 
Hi all.

Rusty is just a dose away from finishing his antibiotics. For the last 2 days, his feet have begun being a major issue again. I'm also seeing his numbers trending back up into the pink more and more.
He's getting the following:
(Have omitted SQ fluids since dilution was a suspect cause of low K+)
0.5u Lantus 2x daily w/food after test
1 capsule WonderLabs PET factor B-12 daily (methylcobalamin)
2-3 scoops or capsules of Vetoquinol Renal K+ powder (1 scoop = 2.2mEq potassium glauconite)
Liqui-Tinic 4X 1mL 2-3x daily (also has B-12 according to vet)
Yesterday gave 0.1mL gabapentin (250mg/5mL) but had no effect or improvement

I'll be calling in the morning to see if she wants to repeat electrolyte check. Today his feet were noticably bad, as he was eating his wet food, he would slide backwards as if he can't grip with his toes at all, and he has gone back to only being able to go a couple feet down a hall before getting tired and sitting down. He truly acts like he can't feel or use his toes, but I know he can, because when I try to feel or rub them, he pulls the foot away.
His front feet are also effected; his wrists sometimes wobble when he's trying to lean over to eat.

Gums look fine. Temp in one ear is 100.1 while the other read 99.2. He ate an entire can of Friskies meaty bits by himself.

I don't know what the heck else I could be doing. My income is limited and I just started a new job, so I can't do a $160 full comprehensive or $85 fructosamine test every 2 weeks, the magnesium test is $116 just by itself, not counting the $60 it will cost for electrolyte panel.

No, he is not on the 100% best food for his diabetic and CKD conditions, mostly due to the fact a $25 set of weruva cans will only last him a few days, and unless I lock him in a room all by himself, I cannot fully prevent him from eating the Iams available to everyone else when he's hungry.

Is it the food? Is this all my failing? Do I need to just fully isolate him from his family for his feet to get better? Do I need to just focus solely on the magnesium test everyone on the CKD forums wants me to get? Is it my fault he's like this because I don't have the money to test him so frequently, or to hire an internal specialist?

I'm just so lost. I want his numbers to come down, and I want him to walk unencumbered again. I'm afraid to leave the house because what if he falls?
 
I wouldn't bother with a fructosamine test at the vet if you are home testing. Which you are. Speaking of which, he had a big drop to +2 tonight. Any chance of a later test? I'm worried you are missing some low numbers. Now I think those pinks are bounces from going lower mid cycle.

The vet only needs to check his potassium, that doesn't require a full blood panel, just the chem panel. Why is the magnesium being tested?
 
Wendy&Neko said:
I wouldn't bother with a fructosamine test at the vet if you are home testing. Which you are. Speaking of which, he had a big drop to +2 tonight. Any chance of a later test? I'm worried you are missing some low numbers. Now I think those pinks are bounces from going lower mid cycle.

The vet only needs to check his potassium, that doesn't require a full blood panel, just the chem panel. Why is the magnesium being tested?
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The CKD forums suggested magnesium testing due to his feet and chronic low potassium, which was the first suspect of his foot problems, not neuropathy (I don't think there's a way to verify neuropathy?) The vet did say she would consider it if he still couldn't keep up his own potassium, after multiple bouts of adding potassium to his SQ LR.

I'm going to test him again in about a half hour, which is +4 for the evening dose. I'm recording every test I take without exception. Only other thing I can do is test him every single hour for 24 hours.
 
+4 should be enough to say if he's going low this cycle. You don't need to test every hour. But if you can, and you see a big drop from preshot to +2, it's good to get a later test as that can be an indicator of a very active cycle with Lantus.
 
Wendy&Neko said:
+4 should be enough to say if he's going low this cycle. You don't need to test every hour. But if you can, and you see a big drop from preshot to +2, it's good to get a later test as that can be an indicator of a very active cycle with Lantus.
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What kind of a drop should I consider alarming? With both insulins, he had significant drops
 
Looks like Rusty likes to nadir early with those big drops. He's safe now. Unfortunately those big drops can also cause bounces. You might want to try feeding him a couple tsps of his low carb food at +1, to see if you can slow those drops. What determines a significant drop does vary by cat. With mine, a 20% drop would be significant. I think with Rusty we need to see a few cycles with tests early in the cycle to see what is significant for. him.
 
Wendy&Neko said:
Looks like Rusty likes to nadir early with those big drops. He's safe now. Unfortunately those big drops can also cause bounces. You might want to try feeding him a couple tsps of his low carb food at +1, to see if you can slow those drops. What determines a significant drop does vary by cat. With mine, a 20% drop would be significant. I think with Rusty we need to see a few cycles with tests early in the cycle to see what is significant for. him.
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Early tests? So what frequency of tests would y'all (and the vet) need to adjust the dosage properly?
He often reaches his lowest at 3-4.5 when he was on Vetsulin.
 
So far today he went from 296 to 146 in two hours. I will test again at +4. I always thought the quick reduction in BG was a good thing, but I guess I don't understand insulin or diabetes at all. Is it possible he's not even diabetic? Just some malignant disease masking itself as diabetes?
 
It's also possible he's seeing a good reaction to insulin. Cats do have the ability to heal their pancreatic beta cells, unlike other species. When this happens, their insulin needs reduce, and for some lucky cats, they go into diabetic remission. However, that generally means going to just a low carb food.
 
So, after his feet continued to worsen to being hardly unable to walk at all and urinating on himself again, as well as a slightly low temp of 98 this AM, the vet saw Rusty and did a mini panel and electrolyte check.

Potassium is on the low end of normal at this time (3.5 today)
PCV is 23% today, up from 18% in December
Creatinine is 3.2, down from 3.6 last month
BUN "is worse" but "can be impacted by dehydration and other things besides kidney function".
Glucose at 11am (+4 hrs) was 134, and I think they use an AlphaTrak2.

She is for now going to assume the plantigrade stance is neuropathy. For this she would like me to get these for him, as she read this could POSSIBLY help:
https://www.chewy.com/vetriscience-cardio-strength-capsules/dp/54809

She added 1 vial of Potassium to a 1L bag of LR for potassium "maintenance", at 50-75mL/day, and I am to continue with his Vetrinoquel K+ capsules, Liqui-Tinic, Gabapentin, and stay the course with Lantus 0.5 2x/day.


Does anyone have any additional advice? If this is neuropathy, she doesn't think we can do much about it, and even if he becomes regulated on insulin, that it may never reverse.
 
Low potassium can also cause them to stumble when walking. Glad to hear that's getting supplemented. Hopefully you are going back for a recheck on the potassium levels in a couple weeks.

Besides getting him better regulated, you can also give B12. Details in this post: Feline Diabetic Neuropathy. Most people with cats with neuropathy see improvement when treated and getting them into blood sugar numbers.
 
Wendy&Neko said:
Low potassium can also cause them to stumble when walking. Glad to hear that's getting supplemented. Hopefully you are going back for a recheck on the potassium levels in a couple weeks.

Besides getting him better regulated, you can also give B12. Details in this post: Feline Diabetic Neuropathy. Most people with cats with neuropathy see improvement when treated and getting them into blood sugar numbers.
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I have been supplementing with methylcobalamin b-12 supplements for the past week or so, due to suggestions in a prior thread here. :'( It feels like the more I'm giving him med wise, the worse he is getting.

His potassium is technically on the low end of normal range, yet he's walking worse than he was when he had severely low potassium. He stepped over/on his own toes as if they weren't there.

When can I expect the Lantus to regulate him, or at least give us some hope of recovery of the feet and stability of BG for more than 4 hours? Does he need small doses of Lantus at more frequent intervals? I feel like if we were to give him 1u he would crash, but the insulin is not regulating him in good numbers past 4 hours, just like the Vetsulin.

I'm losing hope.
 
It can take months, not weeks for the B12 to help.
emilyrose said:
When can I expect the Lantus to regulate him,
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I hate to say this, but ECID (every cat is different) is very true. We can't predict how long it will take. It really does vary from cat to cat.
emilyrose said:
but the insulin is not regulating him in good numbers past 4 hours, just like the Vetsulin
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You have hardly any tests past +4, you have no way of knowing what his typical cycle looks like. When do you think you'll be able to do a curve?

No on the more frequent shots. You've barely had him on Lantus for a couple weeks. Insulin is a hormone, not a drug, it can take some time for them to settle in and properly use the insulin. The hardest thing for me when I switched to giving Lantus was patience. I know we all want our babies to heal as quickly as possible, but some things just take time.
 
Wendy&Neko said:
It can take months, not weeks for the B12 to help.

I hate to say this, but ECID (every cat is different) is very true. We can't predict how long it will take. It really does vary from cat to cat.

You have hardly any tests past +4, you have no way of knowing what his typical cycle looks like. When do you think you'll be able to do a curve?

No on the more frequent shots. You've barely had him on Lantus for a couple weeks. Insulin is a hormone, not a drug, it can take some time for them to settle in and properly use the insulin. The hardest thing for me when I switched to giving Lantus was patience. I know we all want our babies to heal as quickly as possible, but some things just take time.
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Yes, I plan on doing a curve tomorrow morning from AM to PM dose every 2 hours.

Yes, while I am not exactly on +4, I have tested at +3 and +5 and for +3 he's in the blue, and by +5 he's going back up.

I'm sorry if this is coming off as impatient, but like I said, it seems the more I'm supplementing him, the worse he's gotten. This morning he could barely make it 2 feet without having to sit down, but yet the 2 prior dx causes of his feet flaring up (mild anemia and very low potassium) are not present in the labs we were able to do in-house. I've even bought him a huge stack of fancy feast, 1% ish carb wet food, to make up his primary meals, until I can get him Weruva or BFF cans in from Amazon.

Right this moment, I am opting to help him to the food and water bowls, and to the litter box, because otherwise it'll take him so long and use up so much energy. This shouldn't be his life, and I just wanted some hope that it won't always be this way, or that there was anything else I could do.
 
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