Bouncing numbers? Confused.

A bit of history - Blu was in remission for about a year and a half, eats only FF classics, has normal blood panel results besides glucose, does need some teeth removed. Back on lantus 2 weeks ago.

So poor Blu is getting weird numbers. I started him on 2u of Lantus for the first week, bumped to 3u last few days. He's all over the place. I've only been checking pre shot/pre meal, and did one curve yesterday. The general pattern I'm getting is pretty high pre shot/pre meal numbers 260-350, then every 3 days or so I get a pre shot / pre meal low reading around 100. This results in a missed shot, as they seem to happen in the morning, and he is alone all day so I don't dare give him insulin with those readings. The curve I did yesterday was his second shot AFTER a missed shot due to low readings. These are the results:

9am - before food - 320
12pm - 306
2:15pm - 274
5pm - 303
7pm - 371
9pm - 370

Not great at all, just left a message for the vet, and I assume she will want to up his dose based on those readings. I'm scared because of his random low readings! Any insight as to what is going on or have you had a similar experience?

Thanks!
Tanya & Blu

 

That "every 3 days or so I get a pre shot / pre meal low reading around 100" comment suggests you could be observing the consequences of too high of a dose, which can look very much like too little of a dose. His body fights back with the bounce to keep him alive. It also could just be bouncing alone, in response to going lower than usual and/or dropping quickly and/or dropping too low.

And the dental issues may be at least partially responsible for the high numbers.


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, test)
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.

The nadir is the lowest glucose between shots. There is a general period when it will happen which is specific to the insulin being used and testing then helps make sure your cat doesn't go too low.

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

Also, when you have a moment, could you add a few tidbits to your signature? It, too, will help us give you feedback by providing some context for interpreting the numbers.

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback. You are limited to 2hard returns, so separate pieces by | or -.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as your name | cat's name | date of Dx (diagnosis) | insulin | meter general location (city and state/province) any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.

Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.

 

I don't know how much Blu weighs, but depending on what method you are using for dosing, we'd either start on 0.5U of Lantus per shot or use a weight based formula that usually starts around 1 unit for the average sized cat. And we typically increase by 0.25U at a time, in order not to bypass a good dose.

The pattern you mention of high numbers for three days followed by a low numbers suggests that he is bouncing after going low or at least lower than he is used to. Bounces (read second post here) can take three days to clear. Getting a few more random tests between 3 to 7 hours after the shot will help tell you if this is what is happening.

 

thank you for the responses. I will motivate to do the grid so I have records - I am terrible at these things but I see the usefulness. The bounce explanation link helped a lot - thank you! Blu is 14 pounds - usually 15, but lost a pound when his sugars were going back up. She calculated his insulin by weight when I brought him in. Lantus 3u BID. She did have me start on 2u the first week, then to 3u unless we saw any low numbers.

After calling in the curve yesterday, she called me. She said no increase for now, another home curve in 2 weeks. She said she feels like he is bouncing bc he misses a shot and things get wonky, so suggested 1/2-1 unit dosing on numbers 120-180, no shot below 120, unless I am going to be home, in which I can give him a 1/2 u or so if he is in the low 100's and I can watch him.

But now after reading these posts and the linked article, I'm wondering if his dose should be lowered?

 

The weight bases formula I mentioned above would have him starting at 1.5 units. But that's for a cat new to insulin. If Blu was on Lantus before and went into remission, we'd take his highest previous dose into consideration.

Missing a shot can lead to wonky numbers. But I wouldn't wait two weeks for a curve. If you can do some spot checks mid cycle, that may help determine how low the dose is taking Blu. We determine what dose to give based on the low points.

Lantus likes consistent dosing and you can also get wonky numbers if you are changing the dose due to his preshot numbers. We find it's better to lower the dose a bit so you can consistently shoot the same dose.

Teeth problems are one of the common reasons for kitties falling out of remission. The sooner you can get that taken care of, the better.

 

Because you are having to skip shots, you might back off by 0.5 units, so you can shoot every time. It takes 3-5 days for a Lantus dose change to stabilize.
Once you have your grid and signature set up, you can start posting in the Lantus forum here and get specific guidance from Lantus users.