Sparta, Lantus Insulin, high BG readings

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Sabby

Sabby

Member Since 2016
A month ago, we took Sparta into the vet, and he's been on Lantus, they have increased his dosage several times, the first few days it was 1 unit morning and night, then it was 2 morning and 1 night, then 2 morening and 2 night, then 3 morning and 2 night and now its 3 morning and 3 night. He seems to be getting worse and worse with each increase. He's acting lethargic, doesn't want to eat (we had to spoon feed him last night) and wants to drink, but doesn't have the energy, he just puts his head in the bowl.

I have about two thousand already at the vet to this point (in a little over a month), and they suggested maybe its DKA (but he has no ketones in his urine) and that I should hospitalize him, but I don't have the money to do that. (In Toronto its about $1500 per day to put him in hospital.)

I am at a loss of what to do, I worry that they increased his insulin too much too fast? Or maybe it's not enough, but I don't know how to know which it is or what to do about it?

His BG levels last night were around 440 at +4 hours after his insulin, I haven't been checking on a schedule as I only just bought the meter yesterday and I am still learning how to do all of this. ;(
 
Hi Sabby and welcome to FDMB. Sorry you have found yourself here and that Sparta is not doing well. I am in Toronto too so I well understand the high costs of vet care.
Did you check his urine for ketones or was this done previously at the vet's office?
Since you just started testing, it's hard to say whether the dose of insulin is too high or too little. If dose increases have been based on vet office readings, there is a good chance the dose is too high and this is a very common problem.
What kind of meter are you using? Human or pet?
Lantus usually peaks (lowest readings aka nadir) around +5 to +7/8 hours post shot so those are the readings that you need to aim for mid cycle to figure out dosing. We also test before each shot to make sure it's safe to give the insulin.
 
The meter I bought is human. It shows reading in mmol, so I've been using a chart to convert the numbers. The increases were after vet readings.

The ketone test was done at the vet, and I've done it as well at home and it shows none.
 
How do I 'start over' with him? Is it possible? Since his dosage is 3&3... would it be detrimental to lower it back to a 'normal' starting range?
 
It's Ok.:) I speak mmol or US because I use mmols too but am old enough to remember when we too used the US measurement. LOL! There is a spreadsheet available here which keeps your readings consolidated, converts then automatically, is colour coded to give you a good visual of what's going on with Sparta, and is kept on Google docs so anyone on the board with the link can view it and assist you with benefit of seeing the history as you collect more readings. HERE are the instructions for setting that up. If you need any assistance just holler and help will be along.

If the ketones have been checked recently, chances are good that's not the problem although ketones can take a couple of days to show up in urine. I'd keep checking them daily for now. You can start over but on the off chance that there are ketones developing, you will need to monitor him closely because not enough insulin would make ketones worse.

I take it you've been reading and noticed we recommend increasing doses by .25 or 0.5u at the most. I also notice your vet had you giving a different dose for each cycle at times. Lantus works best with consistent doses.

I strongly suggest you get the spreadsheet set up and post on the Lantus board to get benefit of more eyes and opinions on how best to figure this out. And make sure you check his BG before his shot as well as mid cycle. :)
 
@Misterbeesmom Love your true confessions! Unfortunately, this is a problem many folks have faced because of either vet advice based on vet readings or our own angst to get kitty down into acceptable numbers. Figuring out if high numbers are due to too little or too much insulin is sometimes difficult. Regulating a cat is definitely a marathon...not a sprint. Only with time and data do we all become more attuned to our own cat's idiosyncrasies and every cat is definitely different in one aspect or another.

It's easier to start low and make small increases as data dictates than to turn around and start over. I have a high dose cat and ended up starting over with her because I wondered if she was on too much insulin. That wasn't the case, and I lost a lot of time. If I had known then what I know now, I would have identified the signs that she has a somewhat rare condition that makes her unable to use insulin efficiently. But hindsight is always 20/20.

@Sabby The other thing that crops to mind is whether Sparta could have pancreatitis. A simple SNAP fPL test at the vet would rule that in or out. Pancreatitis can make kitty lethargic and lose their appetite and it's unfortunately relatively common in diabetics. High BGs can put cats off their food but the fact that he's not drinking makes me wonder if something else is going on. Is Sparta still peeing more than normal amounts?
 
Well, I didn't mention this, but earlier today my daughter and I decided to not give him his insulin at all because he wasn't eating hardly at all for the last 2 days... and now +6 from when his shot WOULD have been his BG levels are 270mg range / 15.1 mmol -- AND this is the best part. He got up and went to drink and eat too on his own. Is it okay that I did this? Can I keep him off it for a day or two, then try and start over with low dosage like the guides say?

His last Lantus was at 9pm last night 3 units.
 
Also, when we went to the vet last (June 24th) he had an ultra sound to see if there was anything else going on... and all his blood work and things came back mostly normal, and slightly improving over his previous visits.

He has gone from us thinking he was going to need to be put down last night / this morning to now walking around the house and drinking and eating a little. His urine seems normal, I will check for ketones again tonight.
 
Sabby said:
Well, I didn't mention this, but earlier today my daughter and I decided to not give him his insulin at all because he wasn't eating hardly at all for the last 2 days... and now +6 from when his shot WOULD have been his BG levels are 270mg range / 15.1 mmol -- AND this is the best part. He got up and went to drink and eat too on his own. Is it okay that I did this? Can I keep him off it for a day or two, then try and start over with low dosage like the guides say?

His last Lantus was at 9pm last night 3 units.
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that just reinforces how i felt about it possibly being too much insulin too fast.

i'm glad he is feeling better!
 
No worries about holding the dose this morning, and good to know an ultrasound etc. have all come back without any concerns and that he is feeling and acting better today.

I don't think you need to stop giving insulin totally but given what you have witnessed by withholding this morning, it seems your intuition about the possibility of too much insulin may be serving you well. Lantus is a depot insulin which means it accumulates and it takes a few cycles to "drain" the depot, so that 15.1mmol is still being influenced by the Lantus he has already received and that BG is still higher than it should be. Rather than withholding completely, I'd be inclined to half the dose and give him 1.5u to see how that works. It's up to you how much you want to reduce so if you don't feel comfortable with that, you could give him 1u. Withhold food for 2 hours before his shot, then test him at shot time to see what his pre-shot reading is without any food influence, then feed him prior to giving the insulin. This way you will know if it is safe to give the insulin and have a baseline for the cycle. If you give insulin, test him again before bed to see whether his BG is coming down or has gone up. Usually a test about 3 hours post shot will give you an indication of whether kitty's going to have an active cycle or not.
 
Lol, thank you. He wore those doll glasses for a while, lol... he didn't mind them one bit so we took a lot of photos. :) Thank you for the advice, we're going to check him again in the morning and see how he is and then start with 1 unit. Right now his BG is 17 (though we gave him wet food with gravy because he was refusing to eat anything and we figured something was better than nothing) -- back to the plain 'ole pate tomorrow morning now that he's eating on his own again.
 
It seems that the lower BG was a fluke, cause now it's labeled 'HI' before eating this morning. Which means it's too high for my meter to read, so I'd guess over 600. He is still moving around and eating and drinking. but I am now wondering if the 3 & 3 units were finally 'starting' to work... can I go back to 3 units today with his shot or do I need to go back down to 1 and work my way back up? :((
 
i wish i could be more helpful, but 1. i dont know your recent dosing and 2. i'm still trying to understand my own cat! LOL

i'm sticking with my notion that sparta was getting too much insulin too fast (that many increases of whole units within one month is super fast), but its worn off now. he's up and about, not lethargic like before, and with a HI reading. my instinct would be to give him insulin. how much of a dose i really cant say. i can tell you my experience. what my vet did after we realized we increased too quickly by too much, was to decrease the units over a few days. we went from 5u to 3u rather quickly, which i dont think is viewed as ideal, but we had to do it. he felt much better as a result for a couple weeks, then started showing signs of needing an increase again, which is fine and is happening more slowly, with lots of regular BG testing at home.

hope that helps in some way.
 
Not good at all, his BG has read 'HI' all day, taking him to the vet in the morning. He's totally lethargic, he had a day (the day with no insulin) of being much better acting, eating, peeing (no ketones) and drinking and walking around and purring, and then back to this again today. ;/ We gave him 2 units this morning and 2 units tonight (cause that was what he was on for a week or so before the DR raised it again) but its not lowering his BG at all. I checked at +4, +8 and both times it just said HI
 
Sabby said:
Not good at all, his BG has read 'HI' all day, taking him to the vet in the morning. He's totally lethargic, he had a day (the day with no insulin) of being much better acting, eating, peeing (no ketones) and drinking and walking around and purring, and then back to this again today. ;/ We gave him 2 units this morning and 2 units tonight (cause that was what he was on for a week or so before the DR raised it again) but its not lowering his BG at all. I checked at +4, +8 and both times it just said HI
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I'm really sorry to hear that!
Was there any point during this month/in his early treatment when he was acting and feeling better?

What are you feeding sparta? Maybe if its a high carb food its adding to the problem. Especially if its dry food.

I hope your vet can figure out whats going on. Keep us posted if you can please.
 
He's eating wet Friskies pate food, its on the list of approved low carb foods. (Well he's not eating it, cause he won't eat unless I pry his mouth open and spoon feed him.)

Vet appointment in an hour. It's really not looking good. He has been declining slowly ever since we started the Insulin regimen (Late June), it just got worse and worse as his blood sugar got higher and higher no matter how much they increased it. Now it's just seems like maybe he is a high dosage cat, but we won't know because he doesn't seem like he'll last long enough for us to get his dosage right.
 
I'm sorry! At risk of sounding like a broken record, your vet increased lantus very quickly in very large units. It seems counterintuitive but too much insulin can give high BG#'s as well. I have been there! The cat's system thinks its going hypo, and the liver starts dumping stored glucos into the system.

Please hang in there. Its very hard, i know. Perhaps get another vet's opinion on this. For us, it took 6 months before we got from 2u to 4u. When i increased to 5u too quickly, my cat got lethargic and dopey, lost his appetite and wasnt thirsty.
 
It's not a matter of us hanging in there. He's literally starving to death and dehydrating. We have been giving him water and food with syringe/spoon, but he's not going to bathroom or food on his own at all. He just isn't moving, laying in same spot all day. We will see what the vet suggests today and go from there, but his quality of life is so bad at the moment I can't see her suggesting we continue him this way. This is how it was too before his 'good' day on Monday as well. He will have 2 days like this, then a good day, then 2 days like this. It's heart wrenching. ;/
 
Sabby said:
It's not a matter of us hanging in there. He's literally starving to death and dehydrating. We have been giving him water and food with syringe/spoon, but he's not going to bathroom or food on his own at all. He just isn't moving, laying in same spot all day. We will see what the vet suggests today and go from there, but his quality of life is so bad at the moment I can't see her suggesting we continue him this way. This is how it was too before his 'good' day on Monday as well. He will have 2 days like this, then a good day, then 2 days like this. It's heart wrenching. ;/
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That sounds awful.

How was he before lantus? We dont know your history here. Was he like this before insulin was started?
 
Before the Lantus he wasn't lethargic, just drinking a ton and losing a lot of weight very fast.
 
Sabby said:
Before the Lantus he wasn't lethargic, just drinking a ton and losing a lot of weight very fast.
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Yup, that pre-lantus situation sounds like diabetes. What he's got now sounds like too much insulin too fast.

I wish some other members would pipe in. Sorry you're having such a hard time. I know all you want is answers and for sparta to feel better.

If he's horribly dehydrated, giving intravenous fluids will perk him back up. It did for my cat. He started eating just fine after lowering his lantus considerably, quickly.
 
You still home? How much did sparta weigh when the vet first gave him insulin?

My cat weighed 14 pounds when started insulin. We started 2u am, and 2u pm, and stayed with that dose for 2 months.
 
Maybe I missed it somewhere but have you checked for ketones lately? I assume the vet will do so today but you have been seeing "symptoms" for awhile apparently so I'm wondering about any past or recent checks.

ETA Sorry, just went back to the beginning of this thread and see there were no ketones in his urine when last checked. Ketones take a few days to show up in the urine so that still could be a possibility.
 
MrWorfMen's Mom said:
Maybe I missed it somewhere but have you checked for ketones lately? I assume the vet will do so today but you have been seeing "symptoms" for awhile apparently so I'm wondering about any past or recent checks.
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They said no ketones.
I think they've probably left for the vets by now. I'm hoping everything goes ok.
 
The vet told us he needed to be put down and that he wasn't likely to come back from this without hospitalisation and even then they weren't sure. ;( My daughter chose to put him down vs making him continue being as he was. ;(

Thank you all for listening and for the help. :(
 
Sabby said:
The vet told us he needed to be put down and that he wasn't likely to come back from this without hospitalisation and even then they weren't sure. ;( My daughter chose to put him down vs making him continue being as he was. ;(

Thank you all for listening and for the help. :(
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I'm reallly so very sorry :(
 
This has been an all around bad month, my other furbaby had to be put down June 11th (he was 18 yrs old) because he had multiple strokes and was losing mobility and lost his sight. Then a couple weeks later this with Sparta. :( Hard month for our family. I do appreciate your help.
 
Sabby said:
This has been an all around bad month, my other furbaby had to be put down June 11th (he was 18 yrs old) because he had multiple strokes and was losing mobility and lost his sight. Then a couple weeks later this with Sparta. :( Hard month for our family. I do appreciate your help.
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Oh thats just awful. I'm so sorry! Its so hard losing a furbaby, nevermind two, and so close together. Really sorry. I know that pain.
 
I am so very sorry to hear Sparta has departed to Rainbow Bridge:rb_icon:. Your daughter and you are good pet parents for putting Sparta's well being ahead of your own feelings. You have indeed had a hard month. I know how hard it is to lose one never mind two in such a short period of time. :bighug::bighug::bighug: for you and your daughter. Fly free Sparta on your new wings.cat_wings>o
 
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