Diagnosed last November

Hello everyone!

I am new here but I have been following since November when my kitty was diagnosed. His name is Jasper and is about 9 years old. He is currently using Lantus and was getting 1 unit in the morning and the evening. When I took him for his check up on the 19th (January) the vet said his numbers were still not low enough (always in the 300's) so she wanted to up his insulin to two units in the morning and one at night. Now his numbers are everywhere and wanted to get some more input on this.
It seems that every other day when I do his mid-day glucose check his numbers will be in the 200's and the other days it will be 300+. When he was getting the 1 unit twice a day I hardly saw him in the 400's but now I am seeing it more often. When I checked him this morning at 0700 he was 354 and now at 230 he is 434...granted he did have a little hard food but shouldn't his numbers still be going down? I have switched both my cat's diet (mostly) to an all wet diet using Nature's Variety but still had some hard food left that I let them eat every once in a while.
Jasper is currently 13 lbs and I feed him half a can of the Nature's Variety in the morning and the other half at night.

Does anyone know what might be going on here? I find myself a little lost at how to proceed if I need to get him back into the vet or not.

Thank you!

Sarah

 

Welcome to FDMB, Sarah.

Have you read over Cat Info and downloaded the food chart for shopping reference?

Lantus works best when given as the same dose every 12 hours; it'd be better to give 1.5 units twice a day. The numbers may smooth out some if you do that.

Can we get you started using our grid to record your glucose tests? It will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.

 

Hi and welcome

We actually have a lantus forum and you might like to ask your question over there

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

But as BJM said lantus likes consistency. So keeping to the same dose at the same time each morning and big is much better and allows the lantus to build up in the system so the numbers smooth out. We tend to only increase by 0.25 unit each time. I don't want to advise on dose as I am quite inexperienced myself.

 

If you set up a spreadsheet (SS) and link it into your signature, we'll have a better idea of what is going on and think of what changes you may make to get those BG levels looking better.

Directions for that setup are here.

Which of the Nature's Variety canned foods are you feeding? The Instinct grain-free (ok for a diabetic kitty) or the Prairie with grains?

 

Thank you everyone for your responses!

BJM-I had read over the Cat Info and the Food Chart when he was first diagnosed and completely changed his diet from hard food to wet. I rarely give them hard food and when I did that day both of my kitties didn't eat their canned food and I realized the next day that they just didn't like that flavor of the Nature's Variety that I bought (Rabbit).

I have been keeping my own record of glucose tests-one in the morning, afternoon, and evening but I will get started at filling this sheet out.

phlika29- I didn't realize that there was a Lantus forum, but I assumed that since I was new that I needed to post in here first. Thank you for the heads up. =)

Deb & Wink-Currently they are eating Chicken and Pork (cutting out the Rabbit since they seem to not like that one). All are Instinct Grain Free.

 

Yes, starting out in the Feline Health (the Main Forum) is good for new members until they get their feet on the ground and their heads wrapped around some of this info.

Glad to hear the Nature's Variety are the Instinct Grain Free ones. Those are good for our diabetic kitties.

 

Good job on the food change; that can be tough with some cats.

 

Sorry for being a little late on getting this done, but here it is. He's been really high these last two days that he didn't even register on the meter so my husband had recommended given him 2 units. =/

 

Hi again

Some thing isn't working for you but I don't know what that is. I think I will ask for members over on lantus board to pop over here and offer some advice.

Can I just check how old your lantus is, how you are storing it? Do you inject the excess back into the vial?

 

Hi Sarah!

I wish I could help you but my computer doesn't have Office on it so I can't open the spreadsheet you're using. Could you please use the spreadsheet that the rest of us use here so we can help you no matter what programs we have (or don't have in this case)?

Here's "How to create and link your spreadsheet" instructions that will really make it much easier for others to follow along and help you. If you have problems with getting it started, let us know! We have people who can set it up for you and show you how to use it!

 

I did take a quick look at your ss. You are holding the dose too long but also don't have daytime mid cycle tests. I assume this is due to being at work. What about weekends or on your days that you don't work? When you do increase if not getting nadirs under 100, we usually increase by .25 of a unit. Do you have syringes with 1/2 unit markings? That makes these increases much easier to measure.

 

Have you heard of the concept of bouncing? See the second post here. It can cause a kitties numbers to go high as a reaction to blood sugar numbers lower than they are used to. This action can make it tricky to figure out if a cat has high numbers because they are not getting enough insulin, or whether they are getting too much insulin causing the blood sugar to go low and subsequently bounce high. From the spreadsheet, I noticed that here are no tests at night. Cats can often go lower at night. Getting the odd test at night, say before you go to bed, really helps fill in the picture of what is happening.

We also determine how a Lantus dose is doing by looking at the nadir, or low point of the cycle. That is where those mid cycle tests come in handy. Try to ignore the high preshot values for now.

 

Ok I think I got it now, the file is showing a ton of pages but it has the information there. =)

https://drive.google.com/file/d/0B9tvTLg3aFUfWXJObkJTNTc0THc/view?usp=sharing

 

I got the Lantus..it should have been in December of last year and I keep it in the fridge. Yes, I inject the excess back into the vial, is that bad? When I was shown how to give him his shot this was never mentioned too me if I shouldn't do it. =(

 

A specific date would be good; do you mean December 2014?

Lantus wanes in effectiveness by 6 months. We suggest getting an Rx for the insulin pens or cartridges. If you are in the US, it can be less expensive to order from Canada when you have time to do so.

 

Yea I've been pretty busy, the vet wasn't too happy that I hadn't done many of the mid-day checks but I am trying to get better at it. Yes my syringes do have a 1/2 unit marking =) Thank you for the tip!

 

I have never heard of bouncing, it could make sense...for the first month or so I gave him 1 unit in the morning and 1 at night and his numbers although still high were normally about the same but once the vet had me increase it his numbers just went everywhere. The vet had only asked me to get a morning preshot test, mid-afternoon, and night preshot test. I had no idea that I should do a nightly test. I will be sure to get them done before I go to bed now, thank you!

 

Yes, sorry last year 2014 =) I have been getting both my insulin and syringes from the vet, I'm currently living in Japan so it is a bit easier buying from them (thankfully the exchange rate is in my favor). I will keep in mind ordering from Canada when we move back in a few months. I wonder if he is going through this 'bouncing' thing that Wendy&Neko mentioned? I am a little curious since his numbers didn't go all crazy until I started his increased dosage. I hope his numbers start to smooth out here soon. I am wondering, if his numbers are really high in the morning if I should go ahead and give him 2 units or 1.5 so it is even with the evening shot? I had never seen him with such I numbers so they make me a little nervous when I do.

 

I notice that you are sometimes giving different doses morning and night. Lantus likes consistency, so we usually dose the same dose morning and night, for at least 3 days. And we also determine how to dose by the nadir, or how low a dose will take the cat. We typically increase by either .25 unit or .5 units at a time, not whole units as you can bypass a good dose if you increase too quickly. We have two protocols for Lantus. You might want to look over them and see if one of them would work for you.

Tight Regulation
or
Start Low Go Slow

We don't change doses based on the preshot values. You could try 1.5 units and stick with it for at least 6 cycles. Unless he goes under 50, in which case you'd go to 1.25 units.

 

You are t meant to push any insulin back into the vial.

Read through this link on handling and storage

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-info-proper-handling-storage.151/

 

Ok, I have been sticking out with the 1.5 units morning and night and his numbers are looking much better! I am also trying to be better at getting his shot at the 12 hours instead of a little too early or a little too late. My kitty also learned he can wake me up in the morning to feed him, haha.

I'll take a look at the storage information, thank you philka29! I know my vet had never mentioned that I shouldn't be doing that.