? Need Advice on Lantus dosing ~ High AM/PM's but good Nadir

Hello all! My name is Jessica and I have an approximately 10-12 year old diabetic cat named Luna that has been on Lantus since September 2017. I'm home testing using a Relion Confirm Meter and she eats FF Classic 3x a day. When I first started her on Lantus I thought we were making progress, but her numbers have skyrocketed in the past month or so. The problem is that she is nearly always in the high 300's for AM/PM shots but her nadir is in the 100's or lower. I am trying to follow SLGS method and have slowly decreased her dose from 2 units to 1 unit after a few scary numbers under 50. According to SLGS it just seems like I should be holding her dose but I really wish I could get her regulated so she isn't in the 300's for so many hours a day.

When she gets her insulin she drops fast and I don't know if that is causing her to bounce. I have tried very hard to understand bouncing and I'm really not sure if that is what is happening becuase she has a normal looking curve every day, she just doesn't get that nice flat curve that I thought Lantus was supposed to achieve. In her case it doesn't seem like Lantus is affecting her in the way it is supposed to. I don't see any slow release or long lasting effects! She frequently bottoms out in hour 4-5 and climbs back up into the high 200's and 300's fast. I am really at a loss for what to change. Her spreadsheet is here:
https://docs.google.com/spreadsheets/d/1PPw380QLOq7oJ0dOcLl1oyRnIebSUg_y5KPanIxmqS8/edit?usp=sharing

Any advice is much appreciated. I have learned a lot on these forums.

 

Hello and welcome Jessica. I can't help much plus we are on TR but if I remember setting Titan up we shoot based on nadir. So it looks like you are close. Other more experienced folks should chime in. It would help you if you go back and edit you thread and put the question mark as a prefix, that gets more attention. Good luck! Ed n Paula.

 

I had to request permission to see the spreadsheet so you should get that request.

 

Sorry, here is a shareable link. I will update it in the original post as well:
https://docs.google.com/spreadsheets/d/1PPw380QLOq7oJ0dOcLl1oyRnIebSUg_y5KPanIxmqS8/edit?usp=sharing

 

okay....
i see it now.

There is a pattern there....
When Luna has a green number, her body is dumping counter-regulatory hormones because it's not used to those nice normal greens anymore.
So what you are seeing is indeed a bounce, and why she will go up to high pinks or even a red.
It is possible that she is even having a hard time adjusting to the mid-blue numbers.... but not to worry about it, she will eventually get used to those numbers again and will
stop the hormone dump .

Since you haven't seen a low green now since you made it down to 1 unit.....

I'm going to tell you that it's time for a slight increase. She needs a little more insulin but I think she was getting too much when she started.
This is to be methodical with either protocol.

I hope you have the syringes with the half unit marks so that you can give 1.25 u...

if you haven't seen it, there is a picture of 0.25 u on this page
this should give you an idea ... of what it will look like on your syringe.
your dose doesn't have to be perfectly on 1.25u , just try to make sure you know where your guesstimate is so you can give that dose more than once....
you want it to be as consistent as you can.

 

Thank you so much! I do have the syringes with half units. I am confused as to why she was doing so well up until mid January on 1.5-2 units with hardly any pink numbers. Nadirs were in the green and blue often and she wasn’t rebounding.

This disease is like one big puzzle and drives me crazy because I’m a fixer and problem solver and I can’t fix her. At least she seems happy and is acting like herself again. I guess I worry about the long term effects of the high numbers though. I see so many other spreadsheets with mostly green and blue and I feel envious. I want my baby to have those kind of numbers too. Hope she settles down soon!

 

I’ve also been reading about other types of insulin like Levemir. Anyone else have a bouncy hard to regulate cat that had better luck on another insulin? She’s been on Lantus 6 months with nadir in greens and blues but is spending most of her time in yellow, pink and even red sometimes (yikes!!)

https://docs.google.com/spreadsheets/d/1PPw380QLOq7oJ0dOcLl1oyRnIebSUg_y5KPanIxmqS8/edit?usp=sharing

 

I hear that. If I'm lucky enough to get my kitty down to the yellow zone right now I'm excited, but I know we have more progress to make to get lower. It's a long road, for sure. They don't call it "Start low, go slow" for nothing!

 

What times of day are you feeding your kitty? It's better to spread the food out a little rather than all at once. Typically we'll do a decent amount of food at shot time, then spread the rest out later in the cycle. You don't want to feed carbs after nadir, as that can slow the duration (imsulin action) and give you higher preshot numbers. And it's easier on the healing pancreas not to have to deal with a large amount of food at once.

Getting a few more night times tests, maybe before bed, will help give a better picture of what is happening. Many cats go lower at night. You want to catch the lows, since we determine the dose based on those lows, or the nadir.

Neko was much bouncier to start - even got to blacks. Some cats are just bouncier than others and take their own sweet time to get used to lower numbers.

 

She is being fed FF Classics 3-4x a day. She has 3oz in the morning during AM shot, 1.5 oz in the afternoon around +5 and then another 3oz at night with her PM shot. Some days she has a "hungry day" so I give her an extra 1.5oz snack of FF classics but never after nadir because then she won't eat her full dinner. She very rarely gets some Purina DM dry food as a special snack (maybe 1-2x a week and just a spoonful). I can't leave food out for her overnight because I have three other cats that will steal her food. One of them has IBD and can't have her food because he is on a strict limited ingredient diet.

I feel bad that she eats better during the day but then goes almost 12 hours without food at night. Her PM shot is at 9:30pm and I usually get a +3 reading at 12:30am right before I go to bed. I will try to stay up and get some more night time numbers though! She's been on Lantus almost 6 months and was doing fine (in the 200's before AM/PM shots) up until mid-January. Wish I knew what was causing this because it seems like she is getting worse on it, not better!

 

Can you divide her PM food so she gets a bit of it at +2-3 right before you go to bed? A little fresh carbs before onset may help even her out a bit. She's doing some really big drops at the beginning of the cycle. Those big drops can cause bounces.

ETA: There are some low carb unique protein wet foods, that maybe all can eat over night.

 

She does drop fast and I think that is what is causing her to bounce because she isn't going THAT low. I work from home and she likes to be downstairs in my office with me so I am able to put up her food when she is done eating and then offer her the rest an hour later. Sometimes she wants to eat her entire portion at once and sometimes she is done after eating 1/2 - 3/4 of it. So I take it off the floor so "the pigs" don't get it and then I give it back to her an hour or so later and she almost always wants it and finishes it. So there are many times she is still eating a little bit at +2/3 but it is just her low carb wet food. I can definitely try to feed her more carbs at +2/3 to try to slow the drop. I have some slightly higher carb Buffalo Blue dry food so I will give her some to see if that makes any difference. Thank you!

 

I would stay away from dry food, just feed regular low carb food. I didn't mean to feed higher carbs, just some carbs (ie. some food).