Struggling with Lantus and Hypoglycemia

[Mazi's Mom]

Hello!

Overwhelmed and Need Advice.

My cat Mazi was diagnosed with diabetes last month and was initially put on 1 unit of Lantus to manage/regulate his diabetes.

Things were going great for the first 3 weeks of treatment. However, due to some episodes of hypoglycemia in the morning and afternoon, my vetinarian reduced his dose to 0.5 units two times a day.

After the first 5 days of the new dose building up in his system, he started experiencing episodes of hypoglycemia again about 2 hours after his morning insulin shot.

Today was the second episode. The first was yesterday. I called my vetinarian yesterday and he said he didn't want to make any changes due to 1 episode of hypoglycemia, however since it happened again I think he's going to want to make some changes. He mentioned yesterday that Mazi was on the lowest dose of Lantus and that it would be difficult to reduce his dose to 0.25 units of Lantus. After I got his blood sugar back into a normal range after his hypoglycemic episode today, I called the vet and they told me to go ahead and give him his evening dose and to call in the morning to report his PM glucose reading and Mazi's AM pre meal glucose reading and that we would talk about things.

I use an alphatrak meter to monitor his blood sugars before meals, 4 to 6 hours after his shot, and 12 after his shot (pre meal PM). At night Mazi can always maintain a normal acceptable range (110 to 130's). Morning Pre meal readings have been in the 130 to 147. I feed Mazi 3/4 of a can of friskies pate and give him his 0.5 units of Lantus after eating all his breakfast. However, when I checked him 5 hrs into his morning dose yesterday he dropped down to 64, I gave Karo Syrup till he was 110 and called the vet. This morning he was 147, I fed him his normal 3/4 can and even added half a pouch of friskies gravy bc I was predicting he might drop low again this afternoon. I decided to check him 2 hours into his morning dose and he had gone from pre meal 147 to 74. Again I gave Karo syrup until he was in normal range again. Due to this happening two days in a row this is a pattern and a dosing problem.

My question is why is he only dropping low after his morning dose and why is it happening so fast? Is it due to the insulin doses over lapping? Has anyone ever had this happen to them? What worked for you? What are my options since my vet said its impossible to get an accurate 0.25 dose, he said it would be based off guessing due to syringes not being offered with 0.25 markings. Im already using U100s with half unit markings so I know my doses are accurate when administering them to Mazi.

I really don't want to get off the long acting Lantus bc its the safest and switch to a faster acting insulin or intermediate acting.

Any advice? This is becoming overwhelming for both me and my sugar baby Mr. Mazi.

 

[Wendy&Neko]

64 means the dose is too high. You need to try 0.25 units. We even dose 0.1 units here. Some people use digital calipers to measure a consistent dose, but also lots of people just eyeball it. You can load a used syringe with coloured liquid (tea, pop, juice) to 0.25 units and use that to compare to. Or use calipers: Dosing with calipers

Here are pictures of those small doses

.

It sounds like your kitty is doing what we call bouncing:

Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

We might be able to help you more if we see your blood testing data in a spreadsheet. Information on that and other useful thing for new people in this post:
New? How You Can Help Us Help You!

 

[Bron and Sheba (GA)]

Hi and welcome to the forum.
I was just starting to type when Wendy’s post popped up. I agree with Wendy. If you could set up the spreadsheet we should be able to help you.
Dropping under 68 on an alphatrak meter is an automatic reduction in dose.
Lots of people here give 0.25 unit doses or smaller so don’t be afraid of the smaller doses. It means your kitty is making good progress.

 

[Red & Rover (GA)]

My cat Mazi was diagnosed with diabetes last month

How was your cat diagnosed?

 

[Mazi's Mom]

64 means the dose is too high. You need to try 0.25 units. We even dose 0.1 units here. Some people use digital calipers to measure a consistent dose, but also lots of people just eyeball it. You can load a used syringe with coloured liquid (tea, pop, juice) to 0.25 units and use that to compare to. Or use calipers: Dosing with calipers

Here are pictures of those small doses

.View attachment 69907 View attachment 69908

It sounds like your kitty is doing what we call bouncing:


We might be able to help you more if we see your blood testing data in a spreadsheet. Information on that and other useful thing for new people in this post:
New? How You Can Help Us Help You!

Thank you for your feedback. I will definitely try your suggestions.

I will be talking to my Vet tomorrow when I report Mazi's pre meal blood sugars for tonight and his pre meal blood sugar tomorrow morning.

These past couple of days I've been reading alot of other peoples experiences and the advice they have been getting. I'm willing to try the dosing with caliper method. I do not want to give up on Lantus because its the best and the safest because its Long/Slow acting. I will read more into it tonight and I will talk it over with my vet tomorrow. So far he's been a pretty good vetinarian, he takes his time and explains things to me, he gives his advice, he listens to my concerns, and ultimately he let's me take the lead in the decision making.

I agree I think he is bouncing because his liver is getting panicked and releasing stored glucose to compensate for the low blood sugars. However, I must admit, I also get panicky as well when my little guy drops, and I think I might be doing too many interventions when he decreases and also stressing him out.

For example, when he dropped to 64 I gave 3ml of Karo syrup and 1/2 a can of his friskies pate. I will fill out the spreadsheet soon so you can see his patterns, trends, and changes because I can't remember off the top of my head what he bounced up to two days ago, I believe it was 110. I have been logging the past 2 weeks so that won't be a problem.

Another example, is today, when he dropped to 74, I panicked again, even thou I know he was not dangerously low, but I'm an anxious person at my baseline, so when a complication occurs my fight or flight response makes me react like I'm in a major crisis. Haha. I'm working on that. Anyways when he dropped to 74, I gave him 1.5 ml of karo and encouraged him to eat a 1/2 a can of wet food to boost him, but he only took a few bites and wasn't interested. I rechecked his blood sugar 15 mins later and he was only 76. So naturally, I panicked. I had thought because he was only +2 into his shot, I was fighting the most concentrated/powerful phase of the 12 hour cycle and it was going to take alot to boost him. That said, I gave him an additional 1ml of Karo and offerd him some Temptation treats (I only buy those for emergencies like this, when he's not interested in pate. I can usually bribe him with treats) and he ate quite a few. Then I rechecked him 15 mins later and his blood sugars were not budging. I finally calmed myself down, and reminded my self not to over do it and push him because he will go moderately or severely hyperglycemic. It took a good hour 1+ of interventions and recheckes, before he finally bounced up to 130 and I stopped intervening with syrup/food.

I know I need to calm down, me being stressed is just going to stress him out and alter his blood sugar readings.

My vetinarian considers normal blood sugar levels to be 80 - 120. He ultimately doesn't want Mazi to drop lower than 90 and doesn't want him to go above 250 bc thats when ketones can start spilling into the blood and urine.

 

[Mazi's Mom]

Hi and welcome to the forum.
I was just starting to type when Wendy’s post popped up. I agree with Wendy. If you could set up the spreadsheet we should be able to help you.
Dropping under 68 on an alphatrak meter is an automatic reduction in dose.
Lots of people here give 0.25 unit doses or smaller so don’t be afraid of the smaller doses. It means your kitty is making good progress.

Thank you so much for your reassurance. I needed to hear that!!

I have to call my vetinarian tomorrow to report tonight's premeal blood sugars and tomorrow mornings premeal blood sugar. I will definitely bring up the 0.25 dosing again, even thou he might feel like it will be difficult to achieve, I'll remind him that it can't hurt to try because right now he's going to slow, death can happen quickly with insulin. I'm sure he will be on board to atleast trying.

 

[Mazi's Mom]

How was your cat diagnosed?

I had noticed shinny/sticky dried up urine on the floor next to his litter box a little while back. And then last month he suddenly became lethargic, increased urine, thirst, hunger, weight loss, and vomiting. Also, acetone/sweet breath.

I took him to the VCA animal (I also didn't have a primary vet for him till now and henis at a facility closer to my home) and he was diagnosed with DKA, they discharged him less than 24 hours of being admitted and said he was eating well. I never had a chance to order a glucose meter, which made me very uncomfortable. I think they discharged him too soon..

So that evening when I brought him home we was eating a little more than half of his 3/4 can of pate and then I delivered a dose. That night he still appeared lethargic, but I figured it was to be expected because who knows how long his sugar was high before his symptoms became extreme enough for me to finally pick up on them. Again because he had been burning fat for energy and had alot of sugar in his blood instead of his cells I figured that was to be expected for him to feel that way for a few days after the DKA diagnosis.

When 1st brought in, his sugars were in the 600's and his urine was positive for ketones. Potassium was low and he was dehydrated.No UTI.. Normal kidney and liver function. Heart and lungs sounded normal. He does have a history of 1 episode of pancreatitis that we know of. I say that because cats are great at hiding their symptoms. And he does have periodontal disease. He was some teeth, but most were extracted years ago.

Then that morning he ate, and I gave him his morning dose. Soon after I noticed he was still lethargic, wobbly legs, staring into the distance, salivation, and when he jumped off my bad and struggled to land on his feet I was able to realize something was wrong with his sugar levels and he was probably low because his symptoms suggest his body was slowing down. I called the vet told them the symptoms and said I was on the way. During that time mazi had collapsed in his litter box. I scooped him up and put him in his taxi (carrier) On the way to the to the hospital he started panting and it made me so scared that his lungs were shutting down and I was going to lose him or he was going to seize before we got there. Well then we got there they were prepped and waiting for us. The vet took him into a run and scanned his blood sugar, and it was 23! This is why I wasn't comfortable without a meter, I almost killed my sugar baby! They shot him with Dextrose, inserted an NG tube, IV, and an insulin drip. Doctor said he was just beginning to seize when I handed over mazi and the carrier, but he came to pretty fast after the large dose of dextrose. That resulted in 4 days in the ICU NFL a huge bill.

 

[Bron and Sheba (GA)]

With a history of DKA we often do things differently so I’m glad you mentioned it.
Can you create a signature please and put DKA in it as it’s important for the people helping you to know this. You can find out how to create the signature in the link Wendy sent you above.
Are you checking for ketones in the urine? If not please get a bottle of Ketostix from Walmart or a pharmacy and check daily for the moment.
Also it’s very important he is eating very well. So offer him lots of snacks inbetween his 2 main meals.
We base dosing advice on the nadir or lowest point in the cycle nit the Preshot BG as the nadir tells us how low the dose is taking the kitty.