So confused, need help: Glucose even higher after Lantus?

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Confused

Member Since 2013
Our kitty was recently diagnosed with diabetes. His blood glucose was around 350 when he was diagnosed. We initially started him on Glucobay for a while because we were about to go on a trip. His blood glucose slowly dropped and was stable around 280 for three weeks.

We then switch to insulin shortly thereafter. Our vet techs said we wouldn't need to monitor much with Lantus, especially in the beginning. We started on 2 units, which kept him around the 280-400 range for the first four weeks. After that he got sick, very lethargic and not eating. We figured it had to do with his blood glucose, so we upped his dosage from 2 to 3 units. He felt better. A week or two later, the same happened, and over the next 10 days we slowly upped it from 3 to 5 units. That seemed to be working well. We weren't measuring his blood glucose because he's been difficult to draw blood from. Even with applying warmth, light rubbing, squeezing a bit, we have yet to get blood out of the edge of either of his ears. He also finds it very stressful, and because he is currently very ill with a serious heart condition, he cannot have any stress, as it may stop his heart. So a few attempts off and on was all we got, and never enough/any blood, even trying large gauge needles.

So yesterday he seems very lethargic and isn't eating. We figure it's his blood glucose. We spend a while testing, he gets stressed, we wait, and try again only this time in his paw pad. It works! Here's what followed:

11pm: 'High' the meter reads so high we don't even get a value. We inject 7 instead of 5 units of insulin, since 5 is clearly nowhere near enough, despite the fact that his diabetes was mild just a few weeks ago and he was doing great on glucobay.

7am: 43 (!!) We decided to see what it is now, since we've figured out a method that works. DIsturbingly low. We give him three treats hoping it will help a little.

11am: Having trouble drawing blood from him, and he was super low at 43, so we don't dare give more right now.

4.30pm: Manage to get blood: 580! Wow, how did that go up so high from 43, when just a few weeks ago he was doing well on just glucobay? We immediately give him 5 units of Lantus (7 seemed too much because he dropped all the way down to 43, and he's less high right now than he was yesterday.

10.30pm: Manage to get blood again: 'High'!!

We don't understand. Just last month he was doing well for three weeks on Glucobay, now suddenly his units are up a dose every week, and he's still dangerously high constantly. Upping it by 2 units to a total of 7 nearly gets him below the dangerous number of 40, so that doesn't work. And now we've given him 5, and six hours later he's even WORSE instead of better?

How does 7 units yesterday make him drop from 'High' to '43' in 8 hours, and today 5 units makes him go from 580 to unreadably high? What gives? What do we do now?
 
Re: So confused, need help: Glucose even higher after Lantus

10.30pm he read 'High' even after being on 5 units (+6 hours), so we added two units to try to help bring him down

3am he STILL read 'High', and by then the 5 units had worn out probably (+10.5). We added another three units, hoping we'll finally get him below 'High'

I guess in the morning we'll see. If he's lower we give him his regular dose of 5, if still 'High' we give him 7? I just don't know anymore. 7 yesterday took him from High to a dangerously low 43. Today 7 units doesn't even get him out of High. In fact, it got him from 580 into High.
 
Re: So confused, need help: Glucose even higher after Lantus

Lantus insulin does not work that way. That's the way you might dose a shorter acting insulin, but not Lantus. If that's the way your vet told you to dose, then your vet is used to the shorter acting insulins and is not very familiar with Lantus.

You cat's BGs went way too high because his liver poured out glucogen sp? to try to "save" him. There are people better at explaining this than me. But we call it a bounce. When a cat's BGs go lower than the cat is used to, his liver has stored glucose like substance that it can spill out to try to raise the BGs, and they (a lot of cat's livers) tend to overreact.

If my cat had 43, I would be testing every 20 minutes and feeding high carb food until he stabilized.

You can ignore the bounce, as it is a natural and normal process, and can take up to 3 days (72 hours) to clear.

Without home testing you may have been giving way to high of a dose. A cat can go from 300 or 400 or whatever at shot time to 35 or less at nadir (the lowest point of the cycle) and then back up to well over 300 or 400 at his next shot.
Also, when you only get BG tests at the vet, he could have vet stress, he could have just eaten, or he could be in a bounce when he was tested. A BG test at a vet is just a moment in time and does not tell you how his BGs were for hours before that or in the middle the night the night before or yesterday or the day before.

I highly encourage you to start to home test. What is he currently eating?

I would not be giving that high of a dose of insulin and not testing regularly especially, if he just measured a 43. For all you know he was in the 20s an hour before that, and that is life threatening. Scary nailbite_smile

Please keep posting during the day and the weekend, so that others can help you.
 
Re: So confused, need help: Glucose even higher after Lantus

Thank you for the advice, that helps a lot! We'll keep reporting back. What do you suggest doing about his next morning dose? A higher one to bring him down? Same as usual? Even lower than usual because he may have regularly been going too low and then bouncing up? We're testing him every couple hours and keeping an eye on him nonstop, but he keeps testing 'High', so we're seeing no change.

His 4.00pm dose is gone now, his additional 2 that we stacked will be gone by 8.30am or so, and then there's the additional 3 we stacked on the 2 after his 4pm dose ended, so he'll essentially be on 5 units until 5.30am.
 
Re: So confused, need help: Glucose even higher after Lantus

Oh, and as for the food, he's on Fancy Feast Cod/Sole/Shrimp which has 3% carbs (% of dry matter), and on Indigo Moon dry food which I think ha around 30% carbs (% of dry matter). The Fancy Feast is about 70% of his diet, the Indigo Moon about 30%.
 
Re: So confused, need help: Glucose even higher after Lantus

Confused said:
11pm: 'High' the meter reads so high we don't even get a value. We inject 7 instead of 5 units of insulin, since 5 is clearly nowhere near enough, despite the fact that his diabetes was mild just a few weeks ago and he was doing great on glucobay.
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Anything over 2 units is a very high dose for cats. Most cats only need 1-2 units. Most likely you have missed your optimal dose and experiencing Somogyi rebound. What happens is that when too much insulin is given, your cat's body tries to protect itself from becoming hypoglycemic and produces extra glucose. That is why you got the high readings. Eventually your cat will become hypoglycemic and that could be deadly.

I would suggest that you drop your dose all the way back to 1 unit twice a day. You will need to stay at this dose for at least 1 week before considering an increase. It takes that long for a cat's body to adjust to a dose change. If an increase is needed, then only increase by 1/4 to 1/2 unit. Again, you must wait at least a week before determining if another increase is needed. Only increase by 1/4 to 1/2 unit. It only takes a tiny amount to have a big influence on BG levels.
 
Re: So confused, need help: Glucose even higher after Lantus

Well, this is the problem, with 2 units he was clearly getting very high BG levels. I'm with him all day, I see him change and I see the patterns in his behavior and eating. After we went from 2 units, with which we never got a low reading (he was in and out of the vet because of congestive heart failure), to 3 units he suddenly became perkier, started eating again, clearly felt better.

Then after staying steady at 3 for a while, he lapsed back to behavior that was clear evidence of very high BG levels. This was fixed by slowly going up to 5 over a period of 10 days. That I was correctly estimating that behavior is clear from what we've seen with every test, especially the last two days. Every time he exhibits that same behavior, the test comes back 'High', when he doesn't, the reading comes back lower, so even without readings in between (last three weeks), it seems clear to me when he was low or in the middle, and when he was suddenly very high (started two days ago).

Best I can think of is that he was doing fine on 4 or 5, but then two days ago perhaps didn't eat enough or something (his heart has been more problematic in the last three days so he's been eating less), got a low, and has been bouncing since then? That would explain why it's been so extremely high suddenly.

Unfortunately it's difficult to get more carbs out of his diet, and his cardiologist specifically recommended allowing more carbs in exchange for getting as much fat as possible out of his diet. We're aiming for about 10% fat, but it's hard to achieve while balancing that with his diabetes, and lowering his salt intake which is very high in ultra high protein foods (which is why he gets dry food as a supplement to the Fancy Feast). And then he needs to gain as much weight as possible too, so we're putting that in the balance as well.
 
Re: So confused, need help: Glucose even higher after Lantus

Part of what is also keeping your cat's numbers high is the food. A dry food that is 30% carbs will skyrocket numbers. Also, dry food takes an exceptionally long time to work it's way out of a cat's system. In other words, it can keep blood glucose (BG) high in some cases, for well over a day. So, the combination of a very high carb (HC) food plus a bounce may be what your seeing. (In addition, it can take roughly 72 hours for a bounce to clear.)

Among the problems you may be seeing is that what you are describing (e.g., lethargy, not eating) may be due to his BG being in very low numbers. He may have been hypoglycemic. Without test data, there's no way to know if numbers were low or high. Dramatically increasing the dose of Lantus is not the best way to correct the problem. Lantus doses are typically increased by 0.25u and the dose change is based on the lowest point in the cycle -- not the pre-shot or highest numbers you're seeing.

Numbers below 50 indicate that a dose reduction is needed.

I am in complete agreement with what Dyana posted. What I would suggest is to drop the dose back -- way back to 2.0u and get rid of the 30% carb food. We consider a low carb (LC) food to be less than 10% carbs and most of us feed substantially lower than the 10%. The Fancy Feast is fine (although you may not want your cat on a steady diet of fish). By eliminating the HC food, it will lower your cat's BG numbers. You do not want to be shooting such a large amount of insulin if you are lowering the carbs otherwise, there is a very real risk for hypoglycemia.

You may find it helpful to put your test data into the spreadsheet that we all use. This will allow you to keep track of the numbers and it will allow us to offer better informed assistance. You can look at my cat's spreadsheet -- it's in a link in my signature.

There is a great deal of information about Lantus and it's use, dosing, etc. in the starred sticky notes at the top of the Lantus board. Below is a description and links to those posts. This information will help you to learn more about how to best use Lantus and to understand how it works.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
 
Re: So confused, need help: Glucose even higher after Lantus

We've been keeping a spreadsheet, though not quite in the same form. As I explained in the message I posted around the same time as yours though, we have sort of limited choice for his diet. No choice at all really. And 30% of dry matter is pretty much the lowest carb dry food on the market. So not sure what to do with that. No other wet food is suitable, and we need something to offset the sodium. We could try going back to supplementing with raw food, which worked for a while, but then he stopped eating that. And as I mentioned before, he can't afford to lose weight. We were advised to give him whatever he's willing to eat as long as we meet the fat requirements (under 10% fat) and don't get sodium too high, and then to compensate by giving more insulin if needed.

We'll definitely go for the lower dose in the morning though. Should we just ignore his BG reading as 'high' though? For two days?
 
Re: So confused, need help: Glucose even higher after Lantus

Oh, btw, I was reading another thread where I saw some foods recommended as having 10% or less calories from carbs. Those foods have the same composition as ours.

I think you were confusing 30% of dry matter with 30% of carbs. If Wellness Core and Evo Cat and Kitten have about 10% carbs as a percentage of calories, then the cat food we're feeding Lucky does too, since their nutritional composition is about the same. Doesn't get any lower for dry food.
 
Re: So confused, need help: Glucose even higher after Lantus

Good news, down to 401 as of 7am. Following your recommendations and cutting his dose back to 1.5. Will measure again at +3 and +6 or so, which will hopefully give us a better idea of what his low point is on a small amount of insulin! We've also taken away any dry food for the time being, maybe we can sub it with raw food again to bring carbs and sodium down. Thank you all for the advice, will update later.
 
Re: So confused, need help: Glucose even higher after Lantus

The bottom line is that we highly recommend NOT feeding dry food at all. For the detailed list of reasons, please visit www.catinfo.org. Dr. Lisa Pierson explains it best.

So, that leads to the question, do you really need to feed your cat dry food? What are the reasons you need to feed dry food? If you could share this with us, we may be able to help you with alternatives and solutions.

One immediate alternative to dry food (one of my cats loves it and misses not eating it), is feeding a freeze dried raw food product. The one I use is from Stella & Chewy's and I buy it online here:
http://www.petfood.com/item/stella-and- ... od/498360/

It comes in several flavors and while it is dry in texture, it is actually a raw food product that is meant to have water added to it. My cats only eat it dry, so it's the compromise I made to keep them happy, yet not feeding them kibbles. They get this in addition to wet food.

Help us to understand what your issues are, so that we can help you with solutions.
 
Re: So confused, need help: Glucose even higher after Lantus

Too much insulin can result in high BG numbers as can too little insulin.
 
Re: So confused, need help: Glucose even higher after Lantus

From petwiki on use of oral medications to control diabetes in cats.

Oral Medications. Use in cats

Unfortunately for cats, diabetes is a condition with many vicious circles, and these medications, in the ~80% of feline cases where they don't work, tend to make diabetes worse instead. Worse, vet literature often says that 6 to 8 weeks of oral med treatment should be tried before giving up, and it's quite possible for an untreated diabetic (or one on an ineffective treatment) to die of starvation, dehydration, or ketoacidosis within that time. The odds of oral medication leading to a successful regulation of your cat are poor, and the odds of things getting much worse during the treatment are more likely.
Click to expand...
http://petdiabetes.wikia.com/wiki/Oral_medication

Cats are unique in that they can regenerate the damaged beta cells in their pancreas. The oral medications cause the pancreas to work harder, preventing the healing from taking place and destroying more beta cells. This often results in permanent damage to the pancreas and you lose all possibility of remission. We hope this is not the case with your cat.

When your cat was on the oral diabetes meds, the pancreas was continuing to deteriorate. So now that he is off those meds, you are seeing a relapse.
 
Re: So confused, need help: Glucose even higher after Lantus

Confused said:
Good news, down to 401 as of 7am. Following your recommendations and cutting his dose back to 1.5. Will measure again at +3 and +6 or so, which will hopefully give us a better idea of what his low point is on a small amount of insulin! We've also taken away any dry food for the time being, maybe we can sub it with raw food again to bring carbs and sodium down. Thank you all for the advice, will update later.
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That is good. You should see a significant improvement in the BG levels. Dry food, even a small amount, can keep BG levels high. Because of the high dose you were giving him, that may have been the main thing keeping him from becoming hypoglycemic.

Remember, that you will need to stay at this dose for at least one week. It can take that long for the cat's body to adjust to the dose level so you can accurately determine if you need to change it. The only exception is if you see the BG levels drop too low, then you definitely want to decrease the insulin.
 
Re: So confused, need help: Glucose even higher after Lantus

Confused said:
Oh, and as for the food, he's on Fancy Feast Cod/Sole/Shrimp which has 3% carbs (% of dry matter), and on Indigo Moon dry food which I think ha around 30% carbs (% of dry matter). The Fancy Feast is about 70% of his diet, the Indigo Moon about 30%.
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I used this carb calculator
http://www.scheyderweb.com/cats/catfood.html

And got 19% carbs for that Indigo Moon dry cat food.

First 5 ingredients are Chicken Meal, Potatoes, Canola Oil, Chicken, Pea Protein. So, you are going to have good amounts of carbs from the potatoes and pea protein. Plus whatever all those other fruits and vegetables add to the carb content.

Some cats are very carb sensitive. With diabetic cats, the percentage of carbs can make a huge difference in the BG (blood glucose) readings.

With my diabetic cat, under 6% carbs is good, too much of 8-10 % carb foods raises his BG numbers.

If you change the carb content of the food, you need to adjust the insulin dose downward.
 
Re: So confused, need help: Glucose even higher after Lantus

welcome to FDMB!

I have a very important question that I don't think anyone has asked. I'm skimming quickly while at work, so if this has been addressed please forgive me and go on about your day. :smile:

It looks like you have given a total of 11.5 units of Lantus in the past 14 hours, is that correct? At intervals of roughly 4-6 hours between each shot? And his usual dose was 5 units?

Am I understanding this correctly?

4:30pm (about 16 hours after previous 5u shot) - 580 - 5 units
10:30pm (6 hours after last shot) - HI - 2 units
3:00am (4.5 hours after last shot) - HI - 3 units
7:00am (4 hours after last shot) - 401 - 1.5 units
 
Re: So confused, need help: Glucose even higher after Lantus

I think you're offline, so I'm going to post my followup now, and hope you will see it.

Please test your cat today, A LOT. And please put the dry food back down for today. If you see the numbers dropping much, take the cat to the vet ASAP.

Lantus works on a cumulative basis. There is a thing we call "overlap" that means that one shot hasn't worn all the way off before we give the next shot after 12 hours. If you shoot too early, you can get too much overlap. If I'm reading your posts correctly, you will have an awful lot of overlap by now. He was already dropping rapidly at the time you gave your last shot, and there is a chance that the drop will pick up speed and get out of your control.

Usually the cat's body will catch the fast drop and respond by dumping extra counterregulatory hormones into the system to save them, but that can only help up to a point. Be safe, not sorry.

I'll come back later to explain the "whys," but let's get through the potentially urgent part first.
 
Re: So confused, need help: Glucose even higher after Lantus

Thank you all for your replies and suggestions, we greatly appreciate them! Let me see if I can reply specifically to each of your questions here:

I used this carb calculator
http://www.scheyderweb.com/cats/catfood.html

And got 19% carbs for that Indigo Moon dry cat food.
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Youre using guaranteed minimum, not typical analysis (see Lisa Pierson and Tanya's list), which is why the carb numbers come out higher. That calculator gives 23% carbs for Wellness Core (tan and gold), which is recommended on this forum as the lowest carb. So Indigo Moon is a better, lower carb choice.

The bottom line is that we highly recommend NOT feeding dry food at all. For the detailed list of reasons, please visit www.catinfo.org. Dr. Lisa Pierson explains it best.
Click to expand...

Trust me, we've spent literally dozens of hours pouring over that site, going through the chart over and over, making calculations trying her raw food diet (not one of our 7 cats would touch it even though plain ground turkey was popular with them). We tried DOZENS of canned cat foods, going through varying restrictions as we were working on diagnostics, and figuring out which he will or won't eat (he won't eat chunks in gravy at all, not from any brand). We eventually settled on Fancy Feast Cod, Sole, and Shrimp because it was a pate with by far the lowest fat and carb content. The downside is that it's a little high on the sodium side, though not extremely so. To compensate for the sodium, we're supposed to feed him something else that is low sodium, and still low in fat and carbs, with low fat being a priority. That doesn't leave many options I'm afraid. Supplementing with raw food is better, but he stopped eating that. He will also go into boarding (at our vet) for 12 days starting next week because we'll be out of the country, so raw food is not an option there, they'd have to go buy it fresh. He also needs food available 24/7 because we urgently need him to gain weight. Can't leave raw food sitting out.

One immediate alternative to dry food (one of my cats loves it and misses not eating it), is feeding a freeze dried raw food product. The one I use is from Stella & Chewy's and I buy it online here:
http://www.petfood.com/item/stella-and- ... od/498360/
Click to expand...

But that's higher in carbs (and fat) than the dry food we feed him! See http://www.scheyderweb.com/cats/catfood.html It's also even lower in moisture than our dry food, which doesn't help replenish his fluids, so you're actually feeding your cat food that is higher in carbs and lower in moisture than the top dry foods! I get that this food may have higher quality ingredients and that you feel it's safer than dry food from major manufacturers (I certainly understand that concern, with recent food scares), but going by the analysis you linked, it's actually less suitable for diabetic cats than dry Wellness Core or Indigo Moon, by quite a bit.

Remember, that you will need to stay at this dose for at least one week. It can take that long for the cat's body to adjust to the dose level so you can accurately determine if you need to change it. The only exception is if you see the BG levels drop too low, then you definitely want to decrease the insulin.
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Good advice, we'll keep him low for a while to see how things go!

With my diabetic cat, under 6% carbs is good, too much of 8-10 % carb foods raises his BG numbers.
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You're forgetting though that he gets 70% wet food that has only 1% or so carbs, so he's actually getting way less. On a 10% dry food, that would make his total 3.7%, even less than 6%.

It looks like you have given a total of 11.5 units of Lantus in the past 14 hours, is that correct? At intervals of roughly 4-6 hours between each shot? And his usual dose was 5 units?
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Correct, though assuming a 9-10 hour typical duration, the maximum he had at any one time would have been 7 at any given time:

5 units for 6 hours (still 'high'), then 7 units for 4 hours, then 2 units for half an hour (dropped to 400 or so), then 5 units for 4 hours (dropped to 30), then 6.5 units for 1.5 hours, then 4.5 units for 4.5 hours, and now he's on 1.5 units which will wear off completely in 2 hours or so.

And please put the dry food back down for today.
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Good advice, we actually did that at 7am when he was on a higher dose still. We're taking it away once he's stable on 1.5 units.

And finally, the update:

3am - High
7am - 401
10am - 380, so no longer dropping much despite having been on 5 units
1pm - 320
3pm - 259

I suspect it will start going up again from here with yesterday's doses being out of his system now, but we're monitoring him.
 
Re: So confused, need help: Glucose even higher after Lantus

Help us to understand what your issues are, so that we can help you with solutions.
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Sorry, I forgot to address your question, which is a very good one. I should've written this more clearly earlier.

His current need, in order of importance, is:

Essential:
Total fat about 10% of his diet (currently around 12)

Very important:
Weight Gain
Sodium 0.5-0.8% (currently 0.88%

Also important:
Carbs - as low as possible because of diabetes, but compromise on carbs and give more insulin if above goals aren't being met.
Fluids - maximize fluid intake
 
Re: So confused, need help: Glucose even higher after Lantus

I'm wondering if you could reply to Libby's question about when you're giving your cat his shots and how much insulin you're giving?
Libby & Lucy said:
Am I understanding this correctly?

4:30pm (about 16 hours after previous 5u shot) - 580 - 5 units
10:30pm (6 hours after last shot) - HI - 2 units
3:00am (4.5 hours after last shot) - HI - 3 units
7:00am (4 hours after last shot) - 401 - 1.5 units
Click to expand...
Did your vet inform you that Lantus is given twice a day? Lantus duration is 12 hours. If you give insulin in between the 12-hours, you end up with overlapping nadirs to the point where you can dramatically increase the risk for an overdose. Please, stick to a 12-hour dose schedule. If the above information is correct, you've dosed 11.5u of insulin in the past 14 hours.

I also wanted to repeat what I think you may have missed from Libby's second post:
I think you're offline, so I'm going to post my followup now, and hope you will see it.

Please test your cat today, A LOT. And please put the dry food back down for today. If you see the numbers dropping much, take the cat to the vet ASAP.

Lantus works on a cumulative basis. There is a thing we call "overlap" that means that one shot hasn't worn all the way off before we give the next shot after 12 hours. If you shoot too early, you can get too much overlap. If I'm reading your posts correctly, you will have an awful lot of overlap by now. He was already dropping rapidly at the time you gave your last shot, and there is a chance that the drop will pick up speed and get out of your control.

Usually the cat's body will catch the fast drop and respond by dumping extra counterregulatory hormones into the system to save them, but that can only help up to a point. Be safe, not sorry.

I'll come back later to explain the "whys," but let's get through the potentially urgent part first.
Click to expand...

Libby is a highly experienced Lantus user. I would encourage you to pay a great deal of attention to her comments.
 
Re: So confused, need help: Glucose even higher after Lantus

Hello. Now that I'm home from work, and off tomorrow too, I can spend some more time to help you.
I agree with Sienne, in that I think you should start over again on 2 units every 12 hours.

Lantus works best if given every 12 hours, and it works best if given the same dose every 12 hours.

I think your cat is bouncing all over the place from the low numbers he got (maybe when you weren't testing, or) around the time he got that 43.

My cat bounces all the time, when his numbers go too low (for him or what he's used to) and/or when he goes down too fast. His liver responds and puts out a sugar like substance.

Please consider dosing the same dose every 12 hours and getting as many tests as you can. At least before every shot and if at all possibly in any way a mid-cycle test in every 12 hours.

If he goes into the 200s then I would test every 2 hours (unless he's dropping fast). If he goes into the 100s, then I would test every hour. If he goes below 70 then I would test every half hour until he is back up and stays back up to numbers over 70 again. If he goes below 40 I would feed high carb food or karo syrup or whatever syrup you have and test every 20 minutes as that is getting into dangerous territory.

Some of us have been on this FDMB board (and the old FDMB boards before this one) for a very long time. We have seen a lot. We have helped a lot of care givers and their cats. Those of us that know Lantus, know it better than most vets.

Please let us help you to help your cat.
 
Re: So confused, need help: Glucose even higher after Lantus

I'm wondering if you could reply to Libby's question about when you're giving your cat his shots and how much insulin you're giving?
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I think maybe your reply was posted before my response showed up for you? I addressed that extensively in the last post, as well as those numbers coming from my earlier posts.

Please test your cat today, A LOT. And please put the dry food back down for today. If you see the numbers dropping much, take the cat to the vet ASAP.
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Also addressed in the previous post.

I agree with Sienne, in that I think you should start over again on 2 units every 12 hours.
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We already did, starting this morning 1.5 units though instead of 2. If you think we should up it to 2 though, we'll do that starting this evening. He's due for his next dose at 7pm.

Lantus works best if given every 12 hours, and it works best if given the same dose every 12 hours.
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We know, but that's what we were doing for weeks, and he still had three episodes of hyperglycemia. We administered more over the last 24 hours because we just couldn't get it to even drop from 'High'. Only this morning did it drop. As you guys recommended, we're not taking him much lower, because a bounce can apparently happen not just from very low insulin, but simply from lower than he's been used to in recent months, so we're aiming for 200-300 for the time being to avoid bounces. My calculations, based on what we learned here about bounces and on typical Lantus curves for felines, were correct and our regime worked. He's finally been steady between 200 and 400 for the last 12 hours, testing regularly.

3am - High
7am - 401
10am - 380, so no longer dropping much despite having been on 5 units
1pm - 320
3pm - 259
5pm - 261
 
Re: So confused, need help: Glucose even higher after Lantus

Thank you for the spreadsheet recommendations btw, those are great, better than our own spreadsheet!
 
Re: So confused, need help: Glucose even higher after Lantus

BTW: Do you have recommendations for how to decide when to raise his insulin again if needed? How long should we take to easy into the 100-200 range, to avoid bounces? As you all suggested, Lucky is now back to a low dose (1.5/twice a day, but as per recommendations we'll go for 2 from now on). Hopefully he won't bounce around again if we go up slowly. I assume if we get him to the low 200s now at the lowest point, that would be a good place for him? Then how long do we wait to start aiming for 150-200 or so? And half a unit up at a time?

I should add that he already feels much better. As of this morning he's clearly in a better mood, and is eating more vigorously!
 
Re: So confused, need help: Glucose even higher after Lantus

There are aspects of using Lantus that I don't think you're fully appreciating. Shorter acting insulin (i.e., not Lantus or Levemir) act to grab numbers and yank them down. This is among the reasons that with the shorter acting insulins, it's imperative that your cat has eaten prior to your injecting. Lantus and Lev are very different. They are not as potent. Rather, they are gentle, long-acting, depot-type insulin and in their pharmacology, they are unique. Doses are cumulative. I don't think you were losing duration. I think your cat was bouncing. Successive early shots create multiple nadirs, extensive overlap, and dramatically raises the potential for a hypoglycemic episode. There are certainly cats that do not get the extended duration from any insulin. In addition, it's crucial to shoot the same dose at each shot. Otherwise, numbers look even worse. I would want to see the data before arriving at the conclusion that your cat is not getting adequate duration from twice a day dosing. It's likewise critical to see that a proven dosing protocol was followed before attempting a highly individualized approach.

When you add a high carb dry food into the equation, it may not be possible to know what's going on. If your cat needs to be on a food regimen for other health reasons, that's fine. The insulin dose can be adjusted to compensate. However, I would not encourage you to shoot more than twice a day until you have the benefit of the input of some of the members here who have extensive experience with Lantus and with helping people set up individualized dosing plans to assist you. There is an overwhelming amount of information that you need to assimilate about Lantus and it's use. There are experienced people here who will help you to get your kitty into better numbers using a safer strategy. Keeping your kitty safe is a priority.

Bouncing is a normal protective response. Dyana is very experienced and J.D. is a pro when it comes to bouncing. In other words, bounces are unavoidable. A bounce is the body's way of responding to what it thinks is a critical, low BG situation. If numbers drop low, if they drop lower than the cat is used to, or if the drop is fast a bounce may be triggered. The liver and pancreas release glucagon, a stored form of glucose, and counterregulatory hormones in order to raise BG out of what is being regarded as a dangerous situation. The more time your cat spends in lower ranges, the less bouncing should occur.

I would encourage you to read the Tight Regulation Protocol, as well as the other sticky notes at the top of the Lantus Board, that I linked in an earlier post. The post on the protocol, in particular, will answer your question about when to change the dose.
 
Re: So confused, need help: Glucose even higher after Lantus

Thank you for your help! I understand the way Lantus works, I've looked at curves and read relevant research studies. I get the effect of stacking, which seems to have worked in our case at least, as the outcome was exactly what I expected it to be. As you said though, it remains to be seen how he responds over the next few days.

I'll check out the protocol, and we'll keep him at a steady twice a day. Today was way better than the two previous days, and hopefully his numbers will remain stable!
 
Re: So confused, need help: Glucose even higher after Lantus

Ugh giving him 2 instead of the 1.5 I had reduced him to was not good advice. I had him beautifully stable all night and day with my own calculations which you all said were too high, and then tried to maintain with 1.5 which worked perfectly. Then I followed your advice however of giving him 2 units instead of 1.5 in the evening because you said 1.5 was too low, and he bounced again. Great.
 
Re: So confused, need help: Glucose even higher after Lantus

Confused said:
Ugh giving him 2 instead of the 1.5 I had reduced him to was not good advice. I had him beautifully stable all night and day with my own calculations which you all said were too high, and then tried to maintain with 1.5 which worked perfectly. Then I followed your advice however of giving him 2 units instead of 1.5 in the evening because you said 1.5 was too low, and he bounced again. Great.
Click to expand...
Relax and Breathe. Bouncing is normal and natural.
I am understanding your post to say that 2 units was too much and he bounced, and 1.5 units worked perfectly.
Stay with the 1.5 units then, for at least 3 days. Ignore the bounces and be patient.
Bounces all over the place can be from too much insulin, but sometimes cats just bounce because they have a strong liver or something. J.D. has bounces all the time. Most cats stop bouncing after awhile, once they are on a dose that doesn't freak out their liver.
 
Re: So confused, need help: Glucose even higher after Lantus

Panic reduced, he's doing better. We're now going with 1.5 doses, or 2 if he's high. So far that has kept him fairly stable between 200 and 500. When he's at the vet we'll have an all day glucose curve done as you recommended, and we're trying to test at home every two hours when we can (I'm out of town now, but my husband has a friend who works in a vet's office who's helping with some readings). We're hopeful that, on a dose of 1.5, there might even be a chance of remission, even with his other conditions that complicate his diet needs (and put him at greater risk of kidney issues). Thank you for the support!
 
Re: So confused, need help: Glucose even higher after Lantus

Well you've been through the ringer these past few days!

In addition to the blood glucose testing, particularly while you are working to get him stabilized and find his optimal dose, its a good idea to check for ketones, a by-product of fat breakdown for calories. Too many ketones may indicate diabetic ketoacidosis (DKA), a potentially fatal, expensive to treat complication of diabetes. My signature link Secondary Monitoring Tools has a few tactics for testing urine ketones, as well as some other assessments you may want to use to assess his diabetes, including behavior, intake, and outgo.

Note that KetoDiastix test both ketones and glucose in the urine, accumulated since the last void. Seeing glucose means the renal threshold was exceeded (from 180-280 mg/dL depending on the reference source) and glucose was too high during that period.
 
Re: So confused, need help: Glucose even higher after Lantus

Confused said:
Panic reduced, he's doing better. We're now going with 1.5 doses, or 2 if he's high. So far that has kept him fairly stable between 200 and 500. When he's at the vet we'll have an all day glucose curve done as you recommended, and we're trying to test at home every two hours when we can (I'm out of town now, but my husband has a friend who works in a vet's office who's helping with some readings). We're hopeful that, on a dose of 1.5, there might even be a chance of remission, even with his other conditions that complicate his diet needs (and put him at greater risk of kidney issues). Thank you for the support!
Click to expand...

What alot of words and stuff in here! I am sure I missed some things with all the confusions.
I may ask what has been posted before, but I will just say what I think is important.

So, what a relief that you are home testing. With the high dose you were giving before and changing the dose all the time, it's a relief that your cat's still around! I am pretty sure that it was the high carbed dry food that saved him.

Diet is such an important part of regulating feline diabetes. Some cats are VERY carb sensitive, and my Shadoe could grab (steal) a mouthful of just 3 pieces of dry food, and her nice number in the 100s would end up in the 400s; she was such a carb addict. Now that you are down at a decent dose, the dry should be removed, gone, because all it does is create havoc with your cat's numbers and health. I am sure that someone has referred you to Dr. Lisa's site, and I hope to the writeup about Opie and what dry food can do to your male cat.... take a look and you will be yanking that dry food pronto!
Scroll down about half way on this page and read about all that Opie went through with his urinary tract... http://catinfo.org/?link=urinarytracthealth

You seemed to be worried about some other items in your cat's food, but the carbs are the most important, so look to the other issues as secondary. Refer to Dr. Lisa's list for wet foods under 10% carbs, then fiddle around with the rest from those foods.
http://catinfo.org/docs/FoodChartPublic9-22-12.pdf

There are vet insulins and it seems that the dosing can jump around with use of sliding scales, but that's not how the human insulins work best. Lantus and Levemir like things nice and even, with gradual dose changes up or down. By changing the dose based on a number you get when you test, it's like rocking in a row boat..... you can't do that without ending up in the water.
Lantus lasts 12-14hrs, so shots need to be as close to every 12hrs as possible. If you get a fur shot, oh well, don't give another shot. If you did not give enough and the numbers go up, oh well, wait till it's shot time and increase the dose.
I don't know if anyone's said alot about the protocol followed by may Lantus and Levemir users here, but the gist of it is like this:
"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.

Someone will come along and say it's not exactly like the above but you get the idea.....
Dose changes need to be given a chance to settle.... when another person gets in the rowboat, there's a bit of rocking so you need to 'wait' for everyone to be seated and the rocking stops.\
The same goes for Lantus... you change the dose, you need to give that change a good 4-6 shots to see the real results of the change. One of my cats took about 3-4 shots before I saw if it was good or not, but my other often took a good 6 shots before I saw results.

The people using PZI or Prozinc vet insulins will give a dose base on the test number at shot time, but they also give shots only twice a day.

If you have your numbers in an excel spreadsheet, you can just put them into the google spreadsheet template that others use. At the least, if you can transfer your excel sheet into a google sheet and share with others here, they can help you better. Google is free and many may not have excel, plus google sheets stay updated with your changes, plus more than 1 person can view with you at the same time. The template people use here is very good.

You mentioned being stable between 200 and 500, but stable to me is more like a 100 point range not 300. I am sure with the dry food out of the picture, and equal doses given every 12hrs, you should see some real stable numbers soon.

Gayle
 
Re: So confused, need help: Glucose even higher after Lantus

I would like to give a suggestion for canned food to try out--have you tried Merricks canned foods? There are several flavors that are high in protein, low in carbs, and low in fat, which will better meet your dietary concerns. My Bandit has mild IBD which flares when he has too much fat in his diet, and I struggled to find a good quality low carb, low fat food for some time. I've had him on Merrick's Cowboy Cookout, Grammy's Pot Pie, and Surf and Turf for several years now, and he is simply thriving on it. I would also pick up some Fortiflora probiotic to help with the transition--most cats like the taste of the Merrick's, but a probiotic is good to use when switching from dry food because it not only helps ease gastrointestinal upset from the change, it also has the same flavoring they put in dry food to get cats to eat it (which a lot of cats end up addicted to). Fortiflora helps wean them off that artificial flavoring while they learn to appreciate the different flavor of the canned.
 
Re: So confused, need help: Glucose even higher after Lantus

hey there

I am just following up to see how things are going since we haven't heard from you for a while.. hows things going.. Do you need help setting up the spreadsheet?

Wendy
 
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