? Need opinions please, Cole's BG is out of control

hi, i'm new to this forum. I'm desperately looking for some guidance, if you can I would greatly appreciate it! Cole means the world to me but try as I might, I cant regulate him Cole was recently diagnosed in Dec'16. He's a little over weight, suffers anxiety and had UTI/crystals over the summer. I've worked with the VET to increase Lantus as needed and I have changed up his food from hard/wet "Royal C Calm/Urinary" for anxiety and crystals to Glycobalance hard/wet for diabetes/urinary to now just Glycobalance wet food and grilled chicken, no hard food anymore During the day he seems ok but I only recently started checking his evening glucose. A few times he came down in 100-200 range but mainy spikes high over night. After a blood curve, the vet increased him to 2.5 U lantus but his levels went way up for a few days, hitting 680 for his evening shot. I wonder if he has to much insulin or not enough, or was on the wrong food all this time or maybe not enough food or somogyi, etc etc. I started today to give him more wet food, 2 cans for dinner and he came down from high 500 to high 300 so far. if you have a minute, can you please review his spreadsheet and see if anything is glaringly obvious? We both thank you!

 

I think he is bouncing over night on the 2.5 units. His AM preshot is lower when you lowered the pm dose to 2 units. I do not use Lantus so I can't say what a good dose is or not. Does he only eat every 12 hours? Does he have access to any other food? My cat usually starts begging around +9 to +10 for his next meal if he doesn't get a snack somewhere in between and then sometimes he could have 4 snacks and still yell at me early for his next meal! The grilled chicken could be a good snack in the middle of the cycle because it's zero carb. I was feeding my cat 2 5.5 cans a day to help him gain weight. I don't think 1 or 1 1/2 cans is too much for one meal. Royal Canin's website recommends 4 3/4 cans a day for a 15.4 pound cat so 2 cans per meal is within their recommendation. That would only be 244 kcals a day. Do you weigh him at home? With more wet food you might need more insulin but Lantus users could clear that up with you since I'm not familiar with it.

 

Hi,
You could also try posting in the Lantus forum, there is a pretty good crowd of folks there who can help out.

 

The Glycobalance food is still higher in carbs than ideal....we want them eating less than 10% carbs and even the wet is higher than that (I think it's about 12%)

I also see that you keep changing his dose.....Lantus works best when given at a consistent dose that's based on how low it takes them, not on how high the Pre-shot test is

You've also only recently started getting some tests in between the Pre-shot tests....Again, lantus is dosed based on how low it takes them, so it's really important to get mid-cycle tests on each cycle (if at all possible) .....but if you work full time and absolutely can't get mid-cycle tests on the AM cycle, it's even more important that you get at least a "before bed" test on the PM cycle.....Most cats go lower at night so it's important to keep him safe as well as possibly figuring out what's going on

He's also probably bouncing.....Bounces happen when they 1. drop too low...2. drop too quickly ....3. drop lower than their body is used to being at (or any combination of the 3).....the liver releases stored hormones and sugars to bring them back up from what it considers a dangerous number

If Cole was my cat, I'd probably try the 2.5U dose every cycle for at least 6 cycles and get those mid-cycle tests in so we can really see what he's doing on that dose and post daily in the Lantus Forum so the people who have lots of experience with Lantus can help guide you

 

^^^Lantus pro at work here!^^^
You're in good hands!

 

Do you think, may be, it is better to do 2U for 6 cycles and monitor for mid-cycle drops? Seems as 2.5U is a bit high judging from the spreadsheet. I am just thinking, if Cole stays on 2.5U and it IS too high a dose there will be a lot of bouncing and nothing conclusive?

 

She did get 8 cycles in at 2.5 and although there aren't a lot of tests, there are a few on the PM cycles and I don't see any reason to drop back to 2U now

If 2.5 IS too much we should see it soon enough if she can get a few more tests in

We don't want to drop back too much and then have to work our way back up again because it just gives the body more time to get used to living at higher numbers and can end up taking even more insulin later on to get them back on track

 

At this point, I think the most important thing is to start giving a consistent dose and get those tests in

 

Thank you for the feedback! When I took the hard food away last week I wasn't sure how much wet to give, so thanks for that! I never thought to look at RC website. I upped his wet food to 1.5 cans and he leaves a little behind. I give him 2 snacks of chicken treats during the day. I did out his dose back in pm to 2.5 because I really think the hard food was the culprit and I wasn't feeding him enough. I do weigh him, he's been holding at 16lbs so I still need to get him down a few more. His am shot today was 224! So happy, hoping it stays.

 

Thank you everyone for your help!!! I took your advice and will keep it at 2.5. I've been able to be home (I broke my ankle) so I can test midday. And I'll test again before bed. I didn't update the s/s yet but his numbers weren't as bad as usual yesterday and this morning was 224!! Thanks again!!

 

Hi Lori and welcome !!! You are in great hands here and will find all the help and support u could ever imagine !!! Chris helped me greatly, especially early on in our diabetes adventure .....she is a life saver and a peace giver not to mention full of knowledge and experience . So rest assured, you and Cole are in the right place for help and sorting all of this out

 

thank you! I can't tell you how comforting it's been to me to find this forum a few days ago and all of the help so far. It's been so overwhelming and each time his number spikes, I felt like I was failing him. I feel optimistic now that I can get him under control soon.

 

I can't give lantus advice so I'll leave that one to the experts, but I can tell you that two months into treatment my cat was still hitting numbers in the 400's... It takes a while to find that breakthrough dose sometimes.

Also wanted to give you a shout out from NJ TOO! Haha. Hey north Jersey neighbor! I'm by the Meadowlands.

 

You are right down the road from me, off the Parkway LOL
Thank you for the encouragement! I'm trying to be patient.

 

Yep! 153! Lol