Sander at too high insulin?

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ekoren

Member Since 2011
Hi feline diabetes experts,

I am hoping some of your experience can help me figure out what is going on with my cat Sander. I have two brother cats who started Lantus 3 weeks ago at 2 units twice a day each. I can only test glucose levels sporadically (yes, I KNOW it is better to test more, but I'm doing my best). After some feedback from this list last week, and low AM glucose numbers, I have dropped the cats' doses .5 units at a time so that now they are on 1 unit twice a day. Tree seems to be doing just fine at this level. Sander for a few days earlier this week is still having AM numbers of 49 and 60, even with evening shots of only 1 unit. His blood numbers seem to creep up to the 200's by evening, and then I give him 1 unit of insulin again. Does this suggest that Sander needs an even lower does? Do I drop the dose to .75 or .5 and see?

I understand that you determine doses by the BG numbers at the nadir, but I am a travelling performer and I have not been home to test him at the 6 hour mark during the day. I may have time this weekend to check at the 6 hour mark, but will be travelling for the next few days. What should my husband do for the interim while I am gone (he will not do blood tests)? What is the harm in just giving Sander 1.0 units of Lantus once a day? Or does it make sense to go down to .5 units twice a day while I am traveling?

Thanks for your help.

Elisa
 
hey elisa, you must have quite an interesting job!

i was just wondering if you've considered setting an alarm and getting up at night to test the kitties a few times. you just really need more information from testing, however it is that you can get it. in the meantime, without the info, you're basically shooting with your eyes closed. maybe you could test at +4 and +6 tonight . . . ?
 
elisa, do you feel like you understand the way lantus works?

my understanding is that it lasts around 12 hours with the peak effect on the body in the middle-ish of that time. then it begins to be less effective and is wearing off around +12. So when you are seeing a morning value of 49, 12 hours after having given sander a shot, that's AFTER the lantus has basically worn off. You know that number because you've tested and learned it.

The question then becomes, what is his blood glucose when the Lantus is at its peak?
 
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Hi again, Elisa,

here I am with more links.
I know you've read them already as you mentioned in your last Lantus Land thread in March.
But it does help to refresh.
I see it has been mentioned to you that we are a data driven forum.
It takes time and patience to get it, but you seem to be on your way. Keep at it, but I have to add, bedtime checks are really important, and basically whenever you can squeeze in a test for both kitties, it helps fill out your spreadsheet.

Protocol
Might the protocol be something you'd be interested in? It has worked well for many cats coming thru here. But does help with a bit more testing.


As I see in your health thread for today, it has been suggested for your DH to learn to test, (good idea!) reduce the dose (if you have to go with limited testing and especially if there is limited testing and shooting blind) Safety first is very important.

Are you working with your vet regarding the dosing?
Lantus works best on a 12/12 schedule, AMPS and PMPS.
It would be a good consideration to keep in mind, shooting BID(2x a day on a 12/12 schedule.

Lastly, you may want to print these handy links for easy reference especially in times when it is quiet around here, and even better - for your DH, if you can get him to help with testing.
Dealing With Low Preshotshttp://felinediabetes.com/FDMB/viewtopic.php?f=9&t=39309
and Handling Low Numbers


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Hi Elisa and welcome back.

Clearly, your schedule is challenging when it comes to managing your kitties diabetes. While Lantus is a once a day dose in humans, given the speed of a cat's metabolism, you really need to give Lantus twice a day. Otherwise, it's not surprising that you'll see higher numbers past the 12-hour point and, more importantly, you'll be draining the shed and never attaining the long duration that makes Lantus a gentle, long-acting insulin.

I am concerned that you are shooting blind on many evenings. The only way to keep either of your cats safe if this is necessary, is to reduce the dose. In addition, if Sander is giving you such low numbers, in order to give a shot twice a day, it's best to reduce Sander's dose.

I'm wondering if there may be a creative solution to getting more data. As Julie suggested, can you get tests during the PM cycle? It wasn't clear whether when you're traveling if you're gone in the evenings. Is there a compelling reason that your husband won't test? Is there a friend or neighbor who would be willing to learn to test so you can get at least a PMPS test?

To be frank, with the paucity of data, I am very uncomfortable making any dose suggestions other than to reduce the dose of insulin. I am very concerned about the safety of your cats. Tree has given you a 39 at AMPS -- there's no way to know whether his numbers were lower overnight. With Sander's numbers in the 40s at AMPS, the same issue presents itself.
 
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