Sam (diabetes/IBD)- BG bouncing between 100s - 600s

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Katarina

Katarina

Member Since 2022
Hi, my name is Katarina (Kat) and I need help with insulin - Lantus dosage for my 5 year old kitty Sam.
History: My sweet Sam was diagnosed with diabetes and DKA in January of this year and IBD in March. He is a complicated case and still not regulated. According to GI test and low folic acid levels, he was also diagnosed with inflammation of the first 1/3 of his small intestine.
Medications: Sam is on Lantus 2 units, 1 mg Budesonide 1x a day, 8mg Cerenia, 200mg Folic Acid, Pure Saccharomyces 10B.
My vet is putting him also on chlorambucil (starting next week) - due to the inflammation of the small intestine.
Food: After diagnosis, I started to feed Sam with Primal freeze dry diet but after I've learned to calculate carbs, I saw that was not good either and switched him to RAWZ rabbit pate. Because of his IBD, we are also limited to rabbit, duck, venison, lamb. Since RAWZ had only one type of protein and he was not excited by it, I slowly switched him to small batch raw food and he is doing really well on it.
Current problem: These few days, his glucose levels have been completely crazy. As soon as he goes below 200, his body reacts and BG shoots to 600s! I am really concerned. My vet said it could be Somogyi effect.
Sam is on Lantus 2 units - could you please advise if I should try to lower the dosage to 1.75 so his body would not react this drastically? THANK YOU!
Otherwise, he is doing well - gaining weight, he is playful, eating, etc. No ketons according to the test from last week Friday.
Here is a link to Sam's spreadsheet.
https://docs.google.com/spreadsheets/d/1tIRpgKglBlNGXFFoKodQuoZFzRnIlenp9_FMFfXBW7k/edit?usp=sharing
 
I really wonder if you're giving too much. His numbers looked better earlier and you missed taking a lot of reductions that you should have.

How about trying 1.5 and holding that dose for at least 3 days (Unless he drops below 68 since you're using a pet meter) and get as many tests sprinkled around at different points as you can.

Hi from FB too...I'm Chris R.

ETA...IF he were to have a Pre-shot under 150, you should Stall, DON'T feed and test again in 20-30 minutes. Use that time to post here with a clear subject line like "STALLING! NEED HELP!" until you get somebody's attention. Once you have help, you can go back and "edit" your subject line to something else.
 
Thank you, Chris! I will give him a shot now and see how he does with 1.5 units. I see I have a lot to learn. Your help is truly appreciated!!!
 
Great job on your Signature too!!

Now that you have all the basics down, I'm going to invite you to the Lantus/Levemir/Biosimilars forum. The people there all use the same type of insulin as you are using so you'll get the most experienced eyes watching out for you.

It's also totally fine if you want to continue posting here for now. I know we've thrown a lot of new information at you very quickly, but the Lantus forum also has some good information in the "Sticky's" that you should take a look at.

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Hi Katrina I see on your SS up top where it says Diagnosed you have DKA 1-27-2022 I would add that to your signature also
Tap on your name above then tap on signature add DKA 1-2022 then tap Save
 
Welcome, Katerina!

I have a slightly different spin on Sam's numbers. I suspect you were holding on to your doses longer than we suggest. Even with the Start Low Go Slow method, you want to evaluate how well the dose is working after a week. It's 3 days if you're following Tight Regulation. If you hold the dose overly long and the numbers aren't in the range you're looking for, you're cat's body may start treating the higher levels like his new "normal." (This is called glucose toxicity.)

In addition, if your kitty isn't accustomed to spending time in normal range numbers, when the numbers do drop into that range, there's a good likelihood that you'll see what we call a bounce. In other words, the liver and pancreas panic and dump a stored form of glucose and counterregulatory hormones into your cat's bloodstream and the numbers spike upward. It can take several days for the bounce to clear.

As for Somogyi -- here's where I give a heavy sigh. Chronic Somogyi rebound was coined in 1938 by a St. Louis MD, Michael Somogyi, who was using a small sample of humans on which to base his observations. The original research has never been replicated in humans let alone in cats. Further, the only insulin that was available certainly wasn't Lantus. In recent times, Roomp & Rand attempted to determine if they could document Somogyi in diabetic cats prescribed Lantus. They couldn't. The bottom line is that Somogyi has about as much credibility as an urban legend. I really wish the authors of vet textbooks would do their homework!
 
Thank you so much! This was very helpful information. I made definitely made a major mistake and Sam's body created ist own new normal. I am not working this week, so I will do my homework and make notes about everything and monitor him more closely. Also, I've learn a lesson as I should post here to ask for an advice to review his numbers with this group so we can make some progress. The more I learn I realize I know so little
THANK YOU SO MUCH!
Kat & Sam
 
Sienne and Gabby (GA) said:
It's 3 days if you're following Tight Regulation.
Click to expand...

Just FYI....I suggested 3 days not because I was thinking TR but because if the 1.5 held for 3 days didn't seem to make a difference, I didn't want her to hold it any longer because he may need more. I did see several tests that were lime green when she was on 2U earlier so was just thinking to stick with a slightly lower dose and see where he is after this current bounce clears.

@Katarina ....please be sure to get at least 1 other test on every PM cycle after the PMPS. Most cats go lower at night so it's important to know what's going on during that cycle too. You don't necessarily have to set an alarm...just get a "before bed" test (which, depending on what time you shoot, is usually at least a +2 or +3) If the +2/+3 is lower than the PMPS, you may need to set an alarm though to get another test later in the cycle.
 
Chris, I am monitoring today +2 and so far (93/215 (Pre-shoot), and then every 2 hours (415,334. lunch meal, 453,456). I will check before going to bed and will out alarms (1-2) on for the night to see how his BG is doing. Wish us luck!
 
Hello, I would like to share the BG numbers we had so far and see if someone can translate what this tread means.
I was very upset that Staurday night my alarm didn't go off so I have not tested anything until 5:30 AM, so no clue what was going on in between. Last night I did a test before going to bed at +3 hours. Then I did monitor every hour starting +6 until the morning shot. Today, I missed on what was going on in the afternoon as he went from 141 at lunch time to 687 in 4 hours. There are no changes in his feeding or anything else. He eats at 7 - 9 AM (it takes him a while), 12:30 PM - 2:00 PM and 7:30 PM - 9:00 PM. If that helps, he gets his Budesonide 1 mg after dinner ~ 9 PM.
My plan is to monitor tomorrow closely the time from lunch time until he gets high again.
Any advice on what else to do?
Thank you so much, Kat & Sam
 
Katarina said:
Chris, I am monitoring today +2 and so far (93/215 (Pre-shoot), and then every 2 hours (415,334. lunch meal, 453,456). I will check before going to bed and will out alarms (1-2) on for the night to see how his BG is doing. Wish us luck!
Click to expand...
Hi Chris or anyone else from the forum,
As suggested, I lowered Sam's doze of insulin from 2 units to 1.5. The results are mixed, and I do not know what to make of it. Please, see our spreadsheet for the details.
  • Day #1 07/02: Started day well, then it went down the hill. On the top of that, my alarm didn't go off, so I missed few important shots during the night. I was so upset!
  • Day #2 07/03: Day numbers were pretty much horrible but surprisingly, they were wonderful from 7+ to +11 hour (night) after evening shot.
  • Day #3: 07/04: Really bad numbers in the afternoon and evening. There was one strange experience I had... His BG went within 2 hours from 290 to 557! I couldn't believe it, so I took another strip and tested from the other ear within a minute - B was 480! Is that normal there would be such a difference??? I am questioning everything at this point. I did check the expiration date and I always make sure the code for cats matches on the meter and the testing strip container.
  • Day #4: 07/05 - we didn't start well with AMPS 485 :(
Just in a case this info could help:
- I am giving him Budesonide 1mg after his dinner ~ 9 PM. He eats usually slowly (7 PM - 9 PM)
- Breakfast 7-9 AM; Lunch 12:30 - 2PM; Dinner 7-9 PM
- Insulin shots 7:30 AM and PM
- Food Small Batch (raw) lamb, rabbit, duck and Vital cat raw treats (duck, rabbit) sprinkle when he doesn't feel like eating or asks for it. He gets also RAWZ rabbit pate 1/4 of can a day.
- He plays, eats, acts normally

Any suggestions are welcomed. I already wrote to my vet this morning, but I believe there is more experience with diabetes here in this forum. I have no idea what to do to help my baby.
Thank you so much, Kat & Sam
 
Hi Kat,

I’m going to tag some members for you - make sure to add @ when tagging - will help when trying to notify them.
@tiffmaxee
@Chris & China (GA)
@Bandit's Mom

I also think that you should move over to the Lantus group now that you have you signature all done up. Your title should look like this: 5/6 Sam AMPS # (followed by editing your title with every test, ie: 5/6 Sam AMPS #, +2 BG#, +4 BG PMPS # etc) . You can also change your title prefix to ‘?’ And that will notify anyone skimming the thread that you have a question.

When you post in the Lantus forum you’ll get experienced members using Glargine insulin, not that you wouldn’t have that here but it just helps filter out members into insulin appropriate forums
 
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