Very Confused... Lantus dosing advice

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Renae & Skye

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I will give a little back ground first. I have a 10 (she will be 11 in Oct) year old cat named Skye. She was diagnosed with diabetes 4 1/2 years ago (December of 2006). She was on Lantus insulin for around a year before she started to honeymoon. She did not need insulin until about 1 1/2 months ago. When she started showing signs of beind diabetic once again. I checked her BG levels and it was around 360 (before eating) and 450 (after eating).

I brought her into the vet and got another prescription for Lantus insulin. She has been on it since 6/22/11. I have been taking care of the insulin and making sure it isn't stored in the door - basically doing everything I can to make it last as long as possible.

What has me confused is how she seems to be reacting to the insulin. She is currently up to 3 units twice daily. Since Skye has started taking it her pre-shot levels have risen to be in the 500's. When she hits her peak it is anywhere around 280 - 380. She was started on 1.5 units and when she was started on 2.5 units her BG dropped to 96 (at her peak). however, it only remained like that for a couple of days before rising back up to being btwn 280-380 at her peak. And it is usually at the higher end of that level. It only seems to be working at a dosage for a couple of days before rising to what I consider unacceptable levels and she is still drinking water and peeing like crazy. And her being on 3 units hasn't seemed to make any progress - but she was just started on that dose.

Then we have last night. I usually give her her shot around 7 am and 7 pm. However last night I had birthday dinner to attend for a friend and did not get home until 11pm. I decided to give her a partial dose and then give her a full dose in the morning. However, when I checked her BG level it was only at 290 - this is 16 hours after her last dose. I decided to only give her 1 unit. then when I checked her BG level before her dose this morning it was 456 (this was before eating).

I am very confused to what is happening here. It does seem as if the insulin is working because her BG does get lower at her peak times. But it doesn't seem as if her peak times are lasting very long - it appears as if her peak is btwn 4 - 7 hours after a shot. and her pre-shot numbers are higher now then when she was started on insulin. You add into that the fact that it was only at 290 when she had not had a shot in 16 hours and this makes me very very confused.
 
Re: Very Confused...

Welcome back, but sorry you have to be here. :sad:

I don't use your insulin so can't offer dose advice. You might put Lantus in your subject line to attract eyes. The other place you can post is on the Lantus forum. Be sure to put Need Dosing Advice in your subject line. Everyone there uses your insulin and should have ideas to help: viewforum.php?f=9
 
Sometimes giving too much insulin can cause high BGs -- via "rebound" where the liver dumps extra sugar to soak up the excess insulin.

What do you feed? low carb canned food?

Do you have more BG data that we could look at -- like over the last month? (a spreadsheet)

Did you start at 1 unit twice per day? How long did you stay at that dose?

Do you have any curve data? (testing BG every 2 hours for a 12 hour cycle)
 
She is on low-carb canned food which i feed her twice daily. However, I have a roommate with a cat on dry food and Skye is extremely guilty of stealing her food.

Unfortunately all of my data is at home (except for the curve I did on 1.5 units twice daily). I am at work right now.

I am thinking that she may be rebounding and that I should go back to a lower dose. She started on 1.5 units and was only on that for 7 days. But it seems as if she will be good on a dose for just a couple of days and then her peak time will be between 280-380. I do have the data for 1.5 units posted below.

845 am - Before eating - 403
910 am - Right after eating 1/2 can of canned cat food and insulin shot - 441

She was not fed at all after this point

1110 am - 337
130 pm - 228
320 pm - 202
523 pm - 329
710 pm - 417

930 pm - after 1/2 can of canned cat food and insulin shot - 412

Based off these numbers the vet suggested waiting a week and increasing it to 2 units (for 7 days) depending on her BG. I do not have the data on the curve I did for 2 units but it was similar to the 1.5 units (in fact it was higher probably because she is a food theif - her peak level was in the higher 200's). It seemed as if the 2.5 units may have been too much. I got a peak level of 96 with that - which is a little lower then I care for but a good number. however it was at this time that her BG started getting very high in her pre-shot numbers. and then it started to get high with her peak numbers as well after only a couple of days on this dose.

I have been reading about rebounding and am thinking that may be what is going on. She was probably increased too quickly (I was going off the advice of my vet). It seems like she may have the most effact around 2 to 2.25 units twice daily....
 
Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed

Your dose of 3u BID was good till you were 4hrs late (+16) so you shot only 1u, 4hrs late.
Then in the morning, (at 7am?) she was up to 456. What dose did you give her at that time?

With Lantus & Lev, there's a shed that plays into the picture, so your being late was sort of OK because there was the shed on which to draw, but then the next day, it would need to be filled. Maybe that's why the high amps?

You also mentioned dry food, and those carbs could also be a factor - if your cat is very carb sensitive, all it would take is a half dozen pieces of dry food to drive up the BG. Also, if it's possible, feeding more frequently in smaller meals may help to keep the BG numbers more level and with less highs and lows. Many people use auto feeders to spread out meals and snacks while away at work, so you could try something like that as well.

It could be that this time around, you may need a bit of a higher dose.

As Phoebe mentioned, a spreadsheet listing the BG numbers for that last while would be useful in helping to give some good advice and suggestions. If you could provide them, it would be great.
 
That little spread was for when she was on 1.5 units not her current 3 units. At 3 units her lowest BG reading is btwn 280 & 380. Which i think is still very high considering. I will put together a spread sheet when I get home tonight.

Yeah, I only gave her 1 unit last night because her bg was only 290 - I was worried about giving her more. I gave her her 3 units this morning. I am definitely thinking she was increased too fast - about every 7 days - and that she may be rebounding now.
 
Following the protocol in the link I provided:


"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.

Holding a dose for 7 days is longer than needed to see if the dose is too little, too much or just right. Holding for 3 days, or 6 shots should be good enough.

Also, Lantus prefers stability in the dosing, so a late shot and then an early shot, plus two different doses, may be confusing to the system and you may need to let the dose stay put for a few more cycles. I don't know about the rebounding as people would need to see more data on the BG numbers
 
My cat Oscar was doing the same thing with the consistently high blood sugars with a high dose of Lantus and eating dry Purina DM.

I've dropped him back down to just 2 units every 12 hours and only wet food and he seems to be doing a little better with lower numbers.

I know what you mean though, this is sooooo confusing!!! I understand the principles of it, it's just getting the food and the insulin to balance each other out!
 
if she's stealing dry, i wonder if tht is an issue....not sure how you can combat that tho.
At times, my schedule w/work didn't always work with my 6am/6pm dosing schedule and on the weekends I adjusted it a little, but only by 1/2 to 1 hr, and I did it over time. So if I knew I had to be to work on Saturday at 6am & cedric would get the insulin at 5 instead of 6, the 2 days prior I would slowly change the shoot time. My weekday work schedule is always the same, but p/t job at disney is not.

good luck and i hope you get this fixed quick!
 
Sorry, I have not gotten back to anyone. I got home the other night and found out my niece was in the hospital. She ended up having to undergo a 4.5 hour surgery on her small intestines. They were sucked up into her large intestines when she was baby and kind of exploded. She almost died and was on various stages of life support for 6 weeks and in the hospital for months. She turns 8 this Sunday though! However, it sounds like she will be spending it in the hospital. She has been having some serious problems with the scar tissue. Poor girl has to go to the ER everytime she has stomach ache!! She is doing a lot better though and seems to be recovering well.

Basically putting together a spread sheet has not been a priority. I do have every intention of putting one together because they seem to be very helpful. I ended up putting her on a dose of around 2.25 units and that seems to be working great. Her numbers are extremely better with that and no longer through the roof. I think 3 units was too much and that she may need to be increased in smaller increments then 0.5 units at a time. I will hopefully have spreadsheet(s) put together in a few days to compare. I want to put something together for every curve I have done and the strengths of each.

I have talked to my roommate about switching her cat to a food that has lower carbs and higher protein. Her cat has a sensitive stomach but she is willing to try it out. She is currently on Friskies indoor cat food (it isn't on binkies chart so I am unsure of the carb content but I am sure it is high). I was given a bag of the purina dm dry cat food for free last time was into the vets office. I am also going to try giving Skye a little bit of that after feeding her the canned food and see if it helps cut back on her stealing. I doubt it will though - that cat has always loved her food! I have been battling her weight since she was 1.

Everyone - thank you for all of your suggestions it is greatly appreciated!!
 
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