? Somogyi Maybe

I put all of the following on the intro page (sorry), but got replies (thank you!) saying to put it here and include brand of insulin, brand of glucometer and type of food. I'm using Lantus SoloStar glargine, TRUEtrack monitor from RiteAid, and Riley eats whatever food I find on Dr. Pierson's chart with a 0-1% carb level - Fancy Feast fish flavors, most Tiki, and Hounds & Gatos lamb/chicken/salmon. I have Young Again Zero Carb Adult dry food available to him in case I'm away for hours and worried about his intake.

"I'm very glad to have found FDMB and hope for Riley's sake that I can find the help he needs here. He was diagnosed with diabetes August 2016 and 3 units of Lantus once a day was prescribed by the vet. After about a month I was unable to give him his insulin for a couple of days due to my being in the hospital. When I returned home, Riley was showing signs of high blood sugar (I wasn't checking his glucose at home then) so I took him to the vet who said to leave him for a couple of days to get "stabilized". After that couple of days the vet told me that he was going to euthanize Riley because nothing was working. I raced to the vet's office and brought Riley back home. He was emaciated, dehydrated and could barely stand up on his own. I felt that I'd probably done the wrong thing at that point and was wondering where to take him to end his suffering. But after being back home for 24 hours he seemed to show improvement. I threw out the Lantus and Friskies canned food, and changed his diet to nothing but zero carb food. He learned to like Tiki chicken, salmon, tuna, chicken and salmon, chicken and tuna, chicken and egg. I took Riley for a checkup at another vet in December 2016 and his glucose was near 200 but the vet said it was probably due to being in a vet's office. Otherwise he looked great. His weight was normal, the muscle along his spine had returned, and his coat was thick and shiny. On to April 2017. I went on vacation for a couple of days and left him with someone to monitor his food. Unfortunately Riley got into a bag of dry cat food (the kind based on corn meal) and ate quite a bit of it before anyone knew. When he started to show insatiable thirst and soaked the litter box, I took him back to vet #2 and his glucose was near 400. The vet sold me a bottle of insulin which she said was the type you should dose every 12 hours. I was to dose him 4 units a day, either 2 twice a day (preferred) or 4 once a day. I bought a glucometer in June to monitor his glucose because of the fear of overdosing him. I started a spreadsheet at that time. The vet said Riley had a few bad teeth and that once these were removed he might not need the insulin. The vet removed all of his teeth (I'm not sure why) at the beginning of July and that was the end of any active involvement on the vet's part. I tried to talk the vet into doing a glucose curve, but she said I needed to do that on my own at home after giving Riley 3 units twice a day for a week. I gave him 2 units twice a day because I didn't want to go over 4 total per day. I had not been in the habit of checking the point in time that should have been his nadir, but for some reason I did so midway between injections on the 3rd day and found him at 110. 6 hours later he was at 316, 12 hours after that he was at 416 and leveled off and stayed near 400. I talked to the vet about this and she said that I couldn't do a curve at this point in time because of the spike. I've taken more midway readings since then and have found that this happens quite often. I've taken him off insulin for a day or two, started over at a lower dose and the drop in glucose followed by a sudden increase happens again on the third day. Where do I go from here to get his glucose numbers to stay within a "healthy" range? Thank you for any advice you can offer."

 

It's called "bouncing" and is normal in an unregulated diabetic cat. As their body gets used to being in lower numbers, the bouncing will slowly decrease.

From: http://www.felinediabetes.com/FDMB/...the-basics-new-to-the-group-start-here.18139/

• 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).

Lantus is an insulin that craves consistency. It should be dosed every 12 hours. To do that, you start low and work your way up the dosing scale using one of two methods by 0.25 units until you find a dose that works.

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol-tr.1581/

When you have a chance, you can also set up a spreadsheet. The information on the spreadsheet will help us help you. There are spreadsheet gurus on the board who are most willing to help set up the spreadsheet if you run into difficulty.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

I've already overwhelmed you with information. As you have found out on your own, feline diabetes is a steep learning curve; and it is a marathon, not a sprint. Kudos to you for doing so much already.

 

It is a bit overwhelming, but I've got to get a grip on this and soon. Riley's glucose has been too high for too long. Anyway - - if you suspect a bounce has happened, do you remain at the same dose and wait for the glucose readings to come down? Or do you withhold insulin for a day or two and start again at a lower dose?

 

No, don’t withhold insulin. To know if he needs a reduction we need to see some mid cycle tests. If you get the spreadsheet going it will really help you, your vet and us to see what’s going on. If you need help setting it up let us know and someone will do it for you.

 

You do not withhold insulin. Lantus is a hormone and needs to build up a depot. Lantus needs consistency. You ride it out unless the nadir (roughly midpoint of the cycle) drops dangerously low, in which case you decrease the dose slightly. A bounce can take up to 3 days to clear.

For questions like these, a spreadsheet would be most beneficial.

 

I will work on setting up a spreadsheet. How many mid cycle tests does it take to know? What tends to happen after a bounce is that Riley's glucose levels remain at a higher level, no appreciative drop mid cycle. If I start now that he has just had a bounce, I may not see any mid cycle drops soon.

 

Number of tests depends somewhat on your schedule. Always get the preshot test (PS), then try to get at least one mid cycle, more if possible. If you read the yellow stickies in the Lantus forum Red & Rover linked above, then come back and ask any questions.

 

How is Spinney doing today?

 

Thanks for asking. I've really got to work on message board skills like image and presentation. I chose a user name based on my last name, not realizing it would appear under Riley's picture (which could be better). Should I change my user name? Riley is doing what he usually does during the day - sleeping. He is up all night (which is normal for a cat, right?). Night time is the time he eats the most, but last night he wasn't that hungry. Didn't even finish the baked chicken, which he always does.

 

If you want to change your user name, go up to the top of the page on the right and click on your name. Then click "personal details." Scroll down the list of the lefthand side to the bottom, click on change username.

 

How are his numbers and how much Lantus did you give?

(I'm out the door for an appointment, but others will be reading this thread.)

 

Unfortunately, I'm out the door also for a bit. I gave him 1.5 units this morning - have been since October 13. His glucose this morning was 350 - way better than yesterday morning at 586!

 

Thanks again for all the info. I read both the "start-low-go-slow" and "tight regulation" protocol. Since he has "bounced" so often, thought I'd try reducing the dose to 1.5 and hold for a week then increase week at a time to see if I could get Riley's glucose to drop slowly without any unwanted spikes. Can you point me to information regarding weak hindquarters? I believe I saw something about using B12 with a link to a brand sold on Amazon. Unfortunately, the ratings indicated that the manufacturer had changed formulation and it doesn't work very well any more.

 

I don't have any direct experience with diabetic neuropathy (which can cause weak legs), but I can point you in the right direction for information. One of my favorite pages on here is the Health Links/ FAQs about Feline Diabetes thread, located at http://www.felinediabetes.com/FDMB/forums/health-links-faqs-about-feline-diabetes.14/. It has information regarding a little bit of everything, including diabetic neuropathy, how to treat hypos, and glucose toxicity. I had actually been here quite a while before I found that page, so I wanted to share it with you so you have it in your arsenal of information. Hopefully someone will be along shortly to discuss their experience with B12.

 

Hi - My name's Cindy. Do you mind if I ask you a question about the Lantus "go low and go slow" method? I started around the middle of this month and thought I saw some progress until yesterday. I increased the dose from 1.75 to 2 units this morning after 5 days instead of waiting for one whole week to pass because of a 534 glucose reading. Riley had been on 2 units about a month ago and that was going well until he "bounced". I should have stuck with that dose at the time - now that I haven't could it be that I've pushed him into insulin resistance? By the way, should I start posting on the Lantus forum? Thanks for your help.

 

Now that you have your SS set up, you can post in the Lantus forum. They will be able to answer all your questions.