Unregulated cat. Two different insulin doses?

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Shonna and Neko

Shonna and Neko

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We are still in the process of getting our Neko regulated. The vet started her on 1 unit of Lantus, twice a day, and over the past month he has increased it each week. We are now at 3 units, twice a day.

On our last vet visit (Friday October 3rd), Neko's BG was in the high 90's. The vet mentioned that the 3 units didn't seem quite right, and suggested we might need to be on 1 unit for the AM dose and 3 units for the PM dose. Is this normal to have two different standard doses in a day?

Recent tests suggest that Neko's levels are low in the morning (below 100), so no insulin, but by the PM dose they are back up to the high 300's, so give the 3 units, which seems like what the vet is suggesting would be Neko's "normal." Except that the last vet visit took place around 5pm...

We are worried that this is doing more harm than good. It seems like the cycle is still too extreme, from high to low, and therefore, a bit harsh on her little body. When Neko was at 2.5 units her numbers were still high, but she appeared more energetic and like herself, whereas on this (sometimes) 3 unit schedule, she seems a little depressed and sleepier (not lethargic, we're watching for that, just less like her normal self).

We've only just started our home home testing, so we're still collecting data. We're also still trying to test for ketones, given Neko's history with ketoacidosis, but we haven't had much luck yet (she's a very private litter box user). I know it'll be hard to for people to give any definitive responses without more info/data, but I wonder if anyone has any insight into the insulin dosage suggested by our vet.
 
Hi Shonna,

Going from 1 in the AM to 3 in the PM sounds like a big swing. Both of my kitties have similar numbers on both cycles. I have heard that exercise may affect the numbers. More exercise, lower numbers.

Food will also play a big role in the differences. More food, higher numbers. I have kept their diet very strict with regards to portions and feeding times. Outside of the occasional Freeze Dried Treat for being good during testing.

Is there anything in diet or exercise that you can think of that would possibly account for the large differences?

The Technician at my Vet's office has a sugar kitty and she said she gives .5 AM and 1.0 in the PM. I never asked why but I will ask her and let you know the answer. Now you have got me wondering..

My vet's orders have always been the same for AM and PM but then again, there has been no evidence that either kitty's numbers are that different between AM and PM Cycles.

What you could be encountering is the Bounce effect. Without more data at +4 and +6 at a minimum ( a +8 would be nice), it is going to be tough for anyone to try to figure out why and if you have the correct dosage.

You have the spreadsheet up which is great. Now all you have to do is fill in the numbers a little more so that "Experience Eyes" can look at it to evaluate and make recommendations.

Please realize that if the test at the vet (5 PM) was used, it could have been higher than what it would be without the stress of being at the Vet. Only diligent home testing is going to help solve the mystery.

All the best!
Kevin
 
In order to for a twice-a-day insulin like Lantus to be effective, the morning and evening doses must be the same. That's just the way depot insulins like Lantus work. If a cat gets two different doses everyday, its body will never be able to adjust properly and blood glucose readings will be unpredictable and difficult to control.

Jenks & I started out the very same way, and we ended up wasting valuable treatment time and money as a result. It was only after I started giving him the same dose each cycle that we began to see progress.
 
You want to be able to give the same dose, evey 12 hours with Lantus.

The glucose levels should remain above 50 mg/dL on a human glucometer at nadir, the lowest glucose level between shots.

The nadir for Lantus is usually between +5 to +7 hours post-shot; it can vary, so test at slightly different times when possible.

New users should not give insulin if the cat tests below 200 mg/dL on a human glucometer at pre-shot test. This number may be gradually lowered to 150 mg/dL as you get more mid-cycle data.

If the cat tests too low to shoot, stall 30 minutes without feeding and re-test. If rising and above 200 mg/dL, shoot. If not above 200 mg/dl, but rising, and you have data showing it would be safe because the nadir is well above 50 mg/dL on that dose, shoot. If uncertain, post and ask.
 
In some cases a small difference in doses with the depot insulin like Lantus and Levemir is justified but not a 1/3 unit dosing.
What BG history is leading to 1/3 unit conclusion?
Yu spreadsheet does not have such BGs
Note the BG taken at the vet can be raised by stress 100 points or more.
 
Hi Shonna,

Here's the link to your first post here in case anyone wants to go back and look at what has been discussed previously: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=125032. I'll also go back and put the link to this new post in your old post so that anyone who might be looking for you will know where you "moved" to! :-D)

Great job getting the spreadsheet set up and getting that test in today at +6. Although it's still early in terms of home testing, it's always possible that you're getting some crazy numbers because of "bouncing." Has anyone explained bouncing to you before? If not, here's a link to more information about bouncing: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=46012. Bouncing is talked about towards the end of the second post in that thread.

Let us know what questions you have!
Shelly
 
Thanks for the replies everyone. it sounds to me like a 1/3 split insulin dose is not usual.

I've had to go out of town on business multiple times over the past 3 weeks, so my husband has had to take on the cat duties by himself. I just now updated the SS with recent numbers. It is still quite sparse. We are going to do a curve next weekend, to get as much data as we can, as I will be back in town (my husband is having a difficult time doing the BG tests solo).

Although Neko is new to the diabetes world, we suspected that she may have been bouncing, because truly her numbers weren't making sense. Our vet originally said we absolutely should test at home, that it would save a lot of money in the long run, but he didn't think we should do so for the first couple of weeks while trying to get her regulated. He thought that was best done using the vet readings only. We naively followed that, but as we learned more we realized that he was basing all of Neko's dosing adjustments on a once-a-week BG test at the vet. He eventually raised her to 3 units of Lantus, and then the following visit, when her numbers were too low to give a dose, he recommended the 1 unit/3 unit split, saying this might be her regular cycle. It seemed like a prescribed dose in that manner would guarantee an unregulated cat, rather than regulation. That said to us that maybe he wasn't as knowledgeable about FD as he originally lead us to believe. Testing once a week at the vet, and basing everything on that reading seems really, well dumb, to me.

So, my husband and I decided to get started on the home testing, even though the vet didn't think it necessary yet, and now we're just trying to get Neko back to a basic cycle. We started seeing more issues when we went up to 3 units, so, using her BG numbers as a guide, we've dropped her down to 2 units. This may still be the wrong dose, as her numbers still don't quite make sense, but they've stabilized a bit more (her vet visit numbers were regularly in the 400 range). We're hoping the curve next week will help us see what's really going on. In the meantime, we're going to try to get as many in-between readings as our schedules allow.

Neko does NOT care for the BG testing. We've followed the tips and tricks suggested on this forum, and they have really helped with getting a better, quicker blood draw. But we haven't had as much success with the cooperation side of things (i.e. we haven't found anything to bribe her with yet). She doesn't like store-bought treats at all (tried tons of different kinds), so my last hope is the boiled chicken idea suggested in numerous posts. I'll be trying that tomorrow.
 
Does Neko like brushing, a toy, catnip? Those can be used as positive reinforcements, too. (aka "bribes")
 
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