? Glucose spike to 600+

Discussion in 'Lantus / Levemir / Biosimilars' started by Really Riley (GA), Dec 21, 2017.

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  1. Really Riley (GA)

    Really Riley (GA) Member

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    Oct 12, 2017
    Performed a 24-hour glucose curve at 2 units on December 16/17. Since overall readings were higher than they should be I increased the dose to 2.5. Riley's been at 2.5 before but this time his glucose spiked and isn't coming down. How long do I need to hold this dose before seeing a drop? Thanks for any advice anyone can find time to give at this busy season!
     
  2. Tracey&Jones (GA)

    Tracey&Jones (GA) Well-Known Member

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    Hi,

    I am not a dose expert, but I can bump up your thread.

    Have you read the stickies in the forum on the two different methods for L&L - there are TR or SLGS? Both of these methods provide the basis for increasing/decreasing doses and when and hold. It is hard to answer your question without know what approach you are using.

    Can I ask, why you jumped from 2u on the 16th to 2.25u on the 17th to 2.5u on the 18th? Lantus is a depot insulin so it needs some consistency in order to work to the optimum level.
     
    Last edited: Dec 21, 2017
  3. Tracey&Jones (GA)

    Tracey&Jones (GA) Well-Known Member

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    Previous Thread

    Ok I found where it seems you went with SLGS is that correct?
     
  4. Juliet

    Juliet Guest

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    If you’re following SLGS then you hold the dose for seven days UNLESS he goes below 90 in which case he would earn an immediate 0.25 reduction. Only increase once a week AFTER doing a curve. The number at nadir will tell you if an increase or decrease is needed and then you hold that new dose a week and start all over again. It does work. But it does take patience holding that dose.
     
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  5. Really Riley (GA)

    Really Riley (GA) Member

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    Yes. I started at 1.5 in October and held for one week before increasing by .25 units. I continued increasing by .25 and holding for one week until I reached 3 units in November. November 25/26 I did a 24-hour curve. I was really worried about the high numbers in that curve and took the info to my vet. She said she always recommends holding for 2 weeks. She told me to go back to 2 units and hold that for 2 weeks and then do another curve. That curve didn't look a lot different than the 3-unit curve. I dropped the curve numbers at the vet's office and asked if she would call me. No response. Is there a possibility that 2 units was too much? Should I take him back to 1.5 units and hold that for 2 weeks?
     
  6. Juliet

    Juliet Guest

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    Honestly I would not be listening to the vet. I trust this forum far more than a vet’s limited knowledge on feline diabetes. Just increase and/or decrease as the SLGS describes. Others can chime in that know far more than me. I need their help too. I’ll tag a few so you can get some more eyes on it.

    @Sienne and Gabby (GA)
    @Chris & China
    @Wendy&Neko
    @Tracey&Jones
    @Jill & Alex (GA)
     
  7. Tracey&Jones (GA)

    Tracey&Jones (GA) Well-Known Member

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    There is not a lot of mid cycle tests. With Lantus the dose relates more to how low does the dose take Riley vs. the AMPS and PMPS numbers. That said, I heavily recommend not giving insulin without a test.

    You are now on cycle 7 of 2.5u. Is there any chance you can get some mid cycle tests tonight or tomorrow?
     
  8. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    First a question, do you have any data from November 30 to December 1th? That part of the spreadsheet is missing.
     
  9. Really Riley (GA)

    Really Riley (GA) Member

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    Oct 12, 2017
    There aren't any glucose readings on the spreadsheet from November 29 to December 16 because the vet said to drop to 2 units and hold for two weeks - she said at that time there'd be no sense in testing because 2 units wouldn't take him too low - and I should give him a break from testing.
     
  10. Really Riley (GA)

    Really Riley (GA) Member

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    I thought I'd answered but I can't see my reply. I could get a test in tonight. Do you think it would be better than the 576 from this afternoon? I can get a test approx. 3 hours after injection tomorrow morning. After that time we will be out. If those two tests are in the 500-600 range, any thoughts on dropping him back to 1.5 units maybe?
     
  11. Tracey&Jones (GA)

    Tracey&Jones (GA) Well-Known Member

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    That will help fill in some of the blanks. Not to sound like a broken record - Lantus is about how low they go, which can be anytime from +2 onset to +13/+14. That is why testing is so important. At least 4 a day. Preshot night and morning. And a +1 or +2 out the door in the morning and a +2 to +4 before going to bed. Then do a curve on the weekend, which helps fill in the missing blanks.

    The reason I am stuck on the testing is that without that data it is hard to say what dose is a good dose.

    As stated earlier, I am not a dose expert. With being 7 cycles in (8 counting tonight), being on SLGS - the theory would be to hold for another couple of days at the 2.5u.

    I was hoping some of the people tagged above would respond by now. Hopefully by me answering we can bump this thread up.

    A side note: IMHO I think your vet is not very well versed in handling FD.
     
    Last edited: Dec 21, 2017
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  12. Tracey&Jones (GA)

    Tracey&Jones (GA) Well-Known Member

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    @Marje and Gracie

    I see you are on tonight...can you help with the dose question?
     
  13. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Yes....let me read the condo and look at the SS. Thanks @Tracey&Jones.
     
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  14. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    I have to agree that your vet is not well versed in FD. Next time she tells you it is ok to shoot insulin without testing, ask her politely if she would do the same with her child.

    There’s been a lot of dose hopping over time although I see you’ve been trying to do better since 12/17.

    I would suggest that you never miss a preshot test. Some of those black numbers “could” be from bouncing but it would be helpful to have more data.

    I don’t like to see kitties at these high numbers because it equally looks like he needs more insulin. If he were mine, because he’s so high, I’d depart from the SLGS guidelines and do a curve as soon as I could. If there is any way at all that you can get “out the door” and “in the door” tests as well as a +2 and before bed test at night, it will help us immensely.

    If we can figure out if he’s just high and needs more insulin, we can fast track him but it’s possible you missed a good dose for him by jumping up by 0.5u in a short time.
     
  15. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    First, a curve can be a test every two hours for twelve hours or every three hours for 18. The 24 hour curve must have been exhausting. Much better to get less data per day, but tests each and every day. It will give a much better picture about how Riley is doing on a dose.

    If you can get a few more days worth of tests on this same dose, including preshots each time and then a curve when you can, it'll help us say where to go next with the dose. Any other tests you can get in the cycles will be a bonus.
     
  16. Really Riley (GA)

    Really Riley (GA) Member

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    I'd like to post a reply to all of you at the same time. (I need more experience with message boards so if I've messed this up, I'm sorry.) Thank you so much for reaching out. I need the moral support right now since obviously I can't turn to a vet for answers. I'm sorry that I did not read your replies until this morning. I give Riley his evening insulin around 8:30 pm. At that time I did test and when I saw the glucometer reading of HI! I panicked and reduced his dose. In the past whenever his readings have been high, reducing the dose seemed to help. Whenever Riley's readings are high over several cycles, I think about the first vet he saw for his diabetes, plying him with insulin trying to bring the glucose down while it kept rising in response to the insulin increases. The "cure" at that time was to get him back home with no insulin and zero carb food. I realize that was then and this is now, but I keep thinking Riley is a low dose guy. Unfortunately I don't test enough. There are too many days that DH and I leave the house after the morning injection and don't get back home until shortly before the evening injection. I have got to test more on those days I am home and try to talk DH into getting up at night to test during that time frame. If I had tested more when trying to bring him up from 1.5 to 3 I would probably have seen where he should be. All that being said and my feeling like an idiot, what if I keep his dose at 1.5 and test more before the next increase? Can I check back in a week? What's the best way to reach out to you?
     
  17. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Thank you for your information. We appreciate it.

    The reason why neither of us wanted to see you reduce the dose is because I’m seeing him have normal cycles which I can’t attribute to a bounce. For example, on curve days of 11/25 and 12/16, both cycles look very normal.....he onset, was fairly flat, and then came up at the end of the cycle (more than we like but he did come up). The same thing happened that night. He onset, came down and had a nadir, and then went back up. If he was bouncing from low numbers, you’d see a different pattern.

    Unless it is very obvious to us that the high numbers are solely from bouncing, we don’t recommend doing a rebound check which means you lower the dose, as you have done, to see if you missed a good one. The reason we don’t recommend that is because that has the potential to leave them very high and flat all of the time and it takes longer to get to a good dose.

    I’d hate to see your husband get up to test and that’s why I suggested a +2 and a before bed test so that you don’t have to get up when he’s still so high. Even that info gives us more to go on. Any time at all you are able to sneak in extra tests, it’s helpful.

    Keep in mind that the depot from a higher dose can affect up to six cycles after you reduce. So it doesn’t surprise me that you might see better numbers at first. For example, on 11/12, you shot a reduced dose because he had a lower PS than you felt comfortable shooting (and that’s fine). But instead of going back up in dose to 3u, you went down. His BG went up and you had to increase the dose. What I see is every time you reduced the dose as you indicated, he did better for a couple of cycles (which is the depot), and then he did worse.

    If he were mine, I’d hold the dose, now that you’ve decreased it, and get as many tests in as you are able. If, within a few cycles of possibly having some extra tests, we can see he’s high and flat (which is what looks to me is happening), we can fast track him even under SLGS until he starts looking better. Please take a look at Chloe’s SS (click on the dark blue for the link). You can see she was high and flat and Pennie was doing SLGS. We started fast tracking her on the p.m. cycle of 9/8. This gives you an example of what this looks like. You can also see how similar her SS looks to Riley’s.

    The best way to reach out to us is tag us by typing “@“ in front of our names such as @Marje and Gracie or @Wendy&Neko. As you start typing the user name, you’ll get a list to select from. The more often you can post, the more we can see what is happening with him and make suggestions sooner to you than a week. Most of our members post daily. I know you are busy so the more you can post, the better. There are times that we see something in the numbers that you might not think is important. If you are posting and have a thread (condo) going, it’s easy for us to reach out to you.

    :bighug:
     
  18. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    You are in the position that many of us were with our vets when we started. I loved my vet for other things, but it soon became clear that handling the diabetes was going to be under my control. She started on the insulin she knew (Caninsulin) and wasn't familiar with Lantus - which a locum vet had got us onto. BTW, he also pointed me to FDMB. :cool: My vet also knew nothing about high dose conditions, until Neko and I taught her. One of the reasons I like her is that she was willing to learn.

    As for testing, we have many members who can't test during the day due to work or other circumstances. We've also had members who can't test at night for medical reasons. That's OK - we'll help you with what testing you can do. If you can get even a +2 or +3 at night some nights, all preshots, plus the weekly curves, we'll help you help Riley to a better dose.

    Is Riley going with you while you are gone over the holidays? Any chance you'll be able to get a few mid cycle tests over that time? I see you did get one today and it looks like Riley's numbers are coming down but still pretty high. If you can get those tests I mention above, and start a new post here when you are back, we'll help you figure out where to go next with Riley's dose. I do want to stress one thing, please keep giving the same dose, unless he goes under 90, in which case you'd go down to 1.25 units. Don't react to the preshot values, as we dose based on how LOW a dose takes a cat, and that's typically somewhere in the middle of the cycle. Changing the dose all the time upsets the depot, then we can't figure out how well that dose is doing.

    It's really hard to tell right now whether Riley needs less or more insulin. Sometimes a Hi means too much insulin, or it could mean too little insulin, or as it was with my Neko, it meant she was finally seeing some better numbers. Riley has been in high numbers for quite a while, he'll like bounce high even if he saw blues at this point. Keep gathering data, we'll help you figure it out.
     
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  19. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Marje and I posted at the same time. ;) I really like her idea of fast tracking if he stays high. My suspicion is like hers, that he needs more not less insulin.
     
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  20. Really Riley (GA)

    Really Riley (GA) Member

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    @Marje and Gracie @Wendy&Neko Hope your holiday was all you had hoped for! Thank you both so much for the responses. Makes way more sense than what I'm hearing from the vet. I didn't get as many tests in as I should have over the weekend, but did find out that Riley has a yeast infection in his ear. I'm wondering (1) if the yeast infection is infecting more than just his ear and (2) if that's the reason for the high glucose readings. The vet did agree to the second 'if'. I moved him up to 1.75 - hope I went through enough cycles at 1.5. If he is having high glucose from an infection, what's the protocol there? More insulin to bring the glucose down? Or just wait it out? Thank you again.
     
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  21. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Infections and inflammation can definitely cause some insulin resistance, meaning the need for more insulin. Are you getting something to treat him?

    Yes, I think it's time to increase. I hope you can get a few mid cycle tests in. With something like an infection or other thing causing higher numbers, we just keep following the dosing method with increases, and wait for him to tell you with lower numbers if the dose has become too much. Riley's in really high numbers, and it's best to try to get him down into a healthier range. Good luck with the increase.
     
  22. Really Riley (GA)

    Really Riley (GA) Member

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    @Wendy&Neko The vet didn't give me anything to treat his ear infection at home. She syringed some medication into his ears and told me that would last for two weeks. I'm hoping so. I would have felt more comfortable if she had done some blood work to see if his white cell count was high, and whatever else might give more info about the infection. Since I just started 1.75, how much more should I increase?
     
  23. Really Riley (GA)

    Really Riley (GA) Member

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    Oct 12, 2017
    @Marje and Gracie @Wendy&Neko Sorry, should have answered to you both because I wanted to ask about Chloe's SS. I looks like the dose was held for only 4 cycles in some cases. Is that the way to go?
     
  24. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Sorry, stick to the 1.75 dose for now. Try to get another test somewhere else besides preshot, even if it's just a +2 or before bed at nigh for the next three cycles at least.I'd like to see how this dose is doing before suggesting any changes. We can't do that when you are missing those tests.
     
  25. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Sorry...my DH worked yesterday so today is our Christmas.

    Pennie increased like that with Chloe because she was testing enough that we could see numbers were just high and I was working directly with her (on the board, of course).

    As Wendy said, and we understand schedule issues, the more tests that you are able to get in, the better.

    When there is infection and numbers are high, we worry about kitty developing ketones. Are you testing his urine ketones with ketostix that’s you can get at the pharmacy? I’d test, ideally, twice a day but no less than once a day.
     
  26. Really Riley (GA)

    Really Riley (GA) Member

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    @Marje and Gracie Hope you had a good Christmas even if a little late. Just did a test and it was 496. This would be 5 hours after injection because we got off to an early start this morning. Should I try another before this evening's injection? I will get one after the PM - maybe 3 hours? We do have test strips that measure both ketones and glucose in urine. It's great when he makes a mistake and misses the box so I can place the stick in a puddle. He's kind of shy so some of the other methods mentioned wouldn't work so good. I am using clumping litter however, and he has peed in the same corner of the box a couple of times today, so I had some wet goo to place the stick in. I got a high reading on the glucose and nothing on the ketones. It may not be 100% accurate because of not having liquid to work with.
     
  27. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    That’s fine but you might want to get a +10 just for a bit of extra data so we can see what he’s doing before he goes into PMPS. A test at +3 after his PMPS is fine.

    Good job on the ketone test. It will be more accurate it if is in the liquid urine for exactly 15 seconds.

    BTW, we do one condo per day per cat. Here is the info on how to do it: How to Make the Most of your Lantus/Levemir ISG Experience

    By following that format, you help those of us helping others as we routinely scan the ISG and check the numbers in the subject line; we can tell a lot by those numbers and know if someone needs help and doesn’t know it :):)
     
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