We're back, unfortunately - and a question re: dose

[Vidya & Boo]

So, here we are again. A couple of months ago, Boo suddenly stopped eating and, after much testing, was diagnosed with pancreatitis, fatty liver disease, and inflammatory bowel disease. After a course of antibiotics because of infection issues with his new feeding tube, his IBD flared up and he would not stop vomiting EVERYTHING. After trying absolutely everything else we could think of, we had to put him on prednisone, because he was so terribly sick that there's no other way he would have made it.

So, of course, now the diabetes is back. Even with a reduced dose of the prednisone (he was started on 10mg/day; at this point he's down to 2.5mg every other day) and an increased dose of Lantus (he was on 1.0u for a week; we raised this to 1.5u a few days ago) his sugar is still climbing, slowly but steadily by about one (Canadian) point a day with only a very small dip mid-cycle. (He may have reached a plateau over the last couple of days; we're still watching the pattern -- he's been in the 22-24 range lately).

The problem is, because of all his other problems, Boo's under the care of a veterinary internist who doesn't know as much about diabetes as he thinks he does, IMHO. Now he's unhappy with the Lantus dose increase we've given, because he claims that the climbing numbers might mean that Boo actually needs a lower insulin dose and could "crash" on a higher dose. All our experience is with dose decreases, not increases, but this sounds like BS to me, especially since his BG levels are so very stable, he has a history of ultra-flat curves, and he has never, ever had a hypo episode. Does this make sense to anyone else here? Dealing with this vet and his patronizing tone is making me increasingly upset, and yet we don't have a choice at this point. And after months of round-the-clock cat-care in addition to work and school, I'm just too tired to think straight.

(I'm sorry that the BG data on Boo's spreadsheet is somewhat incomplete; I can't afford too many test strips after all these vet expenses, plus I have to manage the actual testing mostly on my own. I also can't post daily condos on the Lantus board anymore, as I just don't have time -- I've almost failed out of school because of all this. :cry: )

Thanks.

 

[BJM]

You might send him the Roomp and Rand article, or any of the other Lantus use articles to educate him.

Lantus/Levemir testing & dosing protocol Roomp & Rand

 

[Ida and Charlie (GA)]

It's not BS and I have seen it happen in my Charlie (GA).It's something called Somogyi effect and when it happens it happens subsequent
to a rapid drop in blood glucose rather than how low the glucose goes. It's less common with a longer acting insulin like Lantus,but it does happen.

Here's a link that explains what to watch for in terms of glucose levels to determine if that increase is probably or possibly due to the Somogyi effect rather than something else.

http://gorbzilla.com/somogyi_rebound_minifaq.htm

 

[Vidya & Boo]

I thought I'd read on these boards that the Somogyi Rebound was now considered to be a myth, though? Or am I confusing it with something else?

 

[Blue]

I thought I'd read on these boards that the Somogyi Rebound was now considered to be a myth, though? Or am I confusing it with something else?

You are correct; people can say what they like but with Lantus and Levemir, you are not going to see this rebound that keeps getting mentioned.
The current dose you are giving is not high, and with his health issues and meds, you can expect to see higher BG.

continue following the protocol, with your increases and don't stress over lots of testing .... what matters most is the test before EACH shot and aim to get a before bed test done so you know what BG before you go to sleep.

Do a curve on a weekend cycle, maybe every 3hrs so that's just a few extra strips and you don't need to do that very often.