? Has anyone experienced this?

I'm baffled, frustrated and dispirited. Big Hoss has been on Lantus since his diagnosis on 10/5. He started at 2U BID and now he's up to 4.25U BID. Basically every single time we increase his dose (which I'm doing in .25 unit increments because .5 unit increments made him swing too much), he gets really good results and good, pretty flat curves in the blues for about 24-36 hours. Then he goes right back up to the upper 300's & 400's. He's just done it AGAIN, and we're getting ready to increase him to 4.5U BID tomorrow because I'll be home Friday-Sunday and can monitor closely and do curves. Has anyone experienced this with their cat? Where dosages just don't "stick"? I'm not sure if we just haven't gotten to the right dose yet or if there's something else going on? We're two months into treatment and the mid-100's is the best we've ever done and they never last more than one cycle.

 

In a word - yes. Take a look at Neko's first year on insulin. Ignore the first three weeks with a bad meter. With Neko, she had a couple of other conditions that caused insulin resistance, IAA (insulin auto antibodies) and acromegaly. How is Big Hoss feeling in general? He acting OK? Peeing/pooing/preening/purring/playing? We call those the 5 P's and getting a general sense of how the cat is doing can help us.

What dosing method are you using? People here use one of Tight Regulation (TR) or Start Low Go Slow (SLGS). If you are using one or the other, could you put TR or SLGS in the spreadsheet? With both of those dosing methods, we only increase by 0.25 units if kitty is seeing blue, as long as their total dose is under 5 units. Over 5 units, we make larger changes. Think of the change as a percent of the total dose. Your 0.5 units increase at 2.5 units was too much of an increase at that point in time. However, I wouldn't go backwards now. Pick one of the dosing methodologies, follow it, and you will find a dose that gets Big Hoss into better numbers. Try to worry less about the size of the dose than the blood sugar numbers. The dosing methods will help you increase safely. A couple of your increases have been done without sufficient mid cycle data.

Can I ask why the 0 unit doses on November 2-4 in the AM? Here we find it best to give consistent doses.

Here is the link to your last post here for continuity.

 

I am going to tag @Chris & China for you... My (pretty) confident response is that he is bouncing, you are not letting the juice even out before you are raising him again. If Chris is available she'll be a good one to look at this, for you

 

All great advice here! I thought I'd show Ming as an example of bouncing: look at his last night's cycle which was nice and green. This morning, he is bouncing again. Mine is a bouncer and one day, hopefully, his body will get used to it and understand that being low = good.

 

I'm not specifically using either dosing method but we probably follow the SLGS method more closely than TR because he does still eat some low carb dry food (Dr Elsey's Clean Protein: 4.7% carbs) and I'm raising his insulin in .25 unit increments. I realized that .5 increment increases were causing him to have wild swings, so I started going with .25 unit increases and he's staying much, much flatter.

There were a couple of days that my vet wanted to try him on just one dose per day. It was experimental only because obviously the vast majority of cats on Lantus should have twice daily dosing. However, Hoss is a bit unusual in his reactions and my vet has actually had one previous patient who did better (and whose cycles stayed much flatter) on only one dose of Lantus per day. So we did just a couple days of one dose only to see how he would do and it obviously wasn't enough. So we started over at a lower dose and slowly moved up by quarter units every few days as needed. Because of glucose toxicity and because he clearly feels like garbage when he's staying in the high 300's & 400's I haven't wanted him to stay at a dose that obviously wasn't bringing him down far enough for more than a few days to a week at the most. When he gets down into the 200's and 100's he feels much, much better. He drinks/pees/eats less and is more active.

I just didn't know if anyone else has had a cat who seems to initially respond to a dose increase and then within 24-36 hours goes back up to where they were before and stays there. Even though he's never even come close to a hypo, it's like his body "panics" when he starts to get anywhere near a more normal BG. Maybe he's just going to be one of those cats that needs a quite high dose to initially get his BG under control and allow his pancreas to settle down.

As far as not having enough mid-cycle tests, my work schedule does not allow me to test any more often than what I am. I'm gone from 5:30 AM to 5:15 PM Mon-Thurs and some Fridays. And since I have to get up at 3:15 in the morning for work and I'm already only getting 5-6 hrs of sleep a night, routinely getting up in the middle of the night to test him is something I'm just not able to do unless he's having an unusually low cycle (like a couple nights ago when he was in the mid-100's) and I will most certainly do it then if needed. I do curves on him every day I'm home. I was off all last week and I tested him dozens of times in the 9 days I was off.

 

Body panicking at lower BG's than they are used to is a great way to describe a bounce. From the New to the Group Sticky Note:
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).

I understand you have to work and can't get mid cycle tests all the time, but you shouldn't be increasing as fast as you have, ie. every 6 cycles when you can't get tests. With dry food in the picture, you should be following SLGS which means holding each dose 7 days. Hoss is still a recently diagnosed diabetic. You will get to a good dose, but need to have patience so you don't increase past a good dose.

 

OK, thanks very much. I missed that part of the sticky note when I read it, I guess. I thought bouncing only happened from a hypo or "near-hypo". I didn't realize it could be just from their body kind of fighting against the "set point" of the high BG they've probably had for months or longer. I'll slow his increases down to once a week at most and stay at .25 increments on those increases. I'm hoping we can get him regulated on a dose no higher than 5 units, but I guess time will tell. He's a big, big cat and an extremely stubborn one, so I guess it stands to reason his body would be just as stubborn as his personality is.

 

A cat needs however much insulin they need. We have seen small cats on doses over 10 units and large cats with doses less than a unit. ECID - each cat is different. Try not to worry about the size of dose. If he needs to go over 5 units, so be it.

As for bouncing, some newly diagnosed cats even bounce from seeing yellows. Over time, and as they see more lower numbers, it'll seem like the new normal and they'll bounce less.

 

I've got my fingers crossed for you! I'm feeling some similar frustration in not being able to quite figure out Sherlock's doses either, but I'm still new at this. I think we started insulin around the same time in early October and Sherlock still pretty much hovers up in the yellows and pinks most of the time.

Good luck to you and your big fella.

 

Thanks very much Wendy and LexaJoy. And good luck to Sherlock too! I'm an impatient person and a worrier by nature and I'm fighting, fighting, fighting against impatience and frustration with this. I'm trying SO HARD to "fix" this big boy and I just want it to be NOW. And I KNOW that's not realistic. But I can't help but want it. The other day when he had an awesome flat cycle in the mid-100's I was euphoric thinking maybe, just MAYBE we'd hit his "magic dose" and when he went back up to 400 - AGAIN - I literally sat down and cried. At least the 400's are much more rare now than they were in the first few weeks - so that's an improvement. And his cycles are typically much flatter now instead of the wild swings he was having for awhile. Those were concerning me and my vet. She's much happier to see him more flat, even if he's still too high. And she's also encouraged to see a few cycles now of flat mid-100's. Even though they've been few and far between, there have been a few. So I guess I'll just consider all those things small victories and TRY to have more patience and not worry so much. I think one of the reasons I've been more aggressive than I apparently should have been is that I've read quite a few articles stating that, to have the best shot at remission, it's better to be a bit over-aggressive at the beginning with the dosing of Lantus (as long as you're testing and watching for hypos) and to try to achieve regulation within the first 6 months. Obviously I took that sense of urgency too much to heart. Again, I really appreciate the advice and encouragement from everyone.

 

Big Hoss is certainly a looker.

 

He IS a beauty! Hope to see you around more...cats need what they need...look around at some of the other condos and their spreadsheets - you'll see cats on more, some on less...it's all over the board for dosages - once they respond they work their way down the dosing ladder...it's just looking for that 'sweet spot' that takes a bit of patience and effort...hang in there.

 

TR is already considered aggressive so if you can follow TR, then you're on the route to a higher chance of remission. Of course, ECID and schedules and other things get in the way.

One of the things that helped me a lot (and still does) when I'm in that headspace of WHY IS NOTHING WORKING?!?!? is to look at other member's SS and see how their journeys went. And also repeating the mantra that many will tell you on FDMB: this is a marathon, not a race!

Good luck with Big Hoss! I definitely think controlled doses is better than erratic dosages... take a look at my SS when Ming was at the vet and the vet was calling the shots on what doses he was getting... Wendy said I was initiated into Lantus BY FIRE and it sure felt like A LOT of fire the first 2 weeks I brought Ming home. I had so much anxiety: I couldn't focus on work, I felt like crying a lot, and so so so antsy and helpless. But I feel so much better even though Ming's numbers are still high. I at least feel more prepared and less crazy lol

 

Awww, thanks. We adopted Big Hoss and another Siamese named Spice 7 yrs ago from Rocky Mountain Siamese Rescue. I’d never had Siamese cats before and these two have been absolute love bugs. We adore them. How such sweet, gorgeous cats ever ended up in animal shelters as strays, I have no idea, but someone else’s loss was our gain!

 

Patience is the remedy. On the Board you will occasionally see someone being advised to "put on her/his patience pants". Sometimes it can take many months for a cat to stop bouncing. Some cats just bounce. As long as you follow the protocol and try not to panic, you will be on the right track. Remember that whichever protocol you decide to follow (TR or SLGS), don't raise the dose too early. Lantus needs time to settle in each time the dose is changed: the depot needs to reestablish itself. And it can take up to 72 hours to clear a bounce. So let Lantus settle in, let Big Hoss settle down, and settle down yourself!

Big Hoss is very handsome.

 

Welcome. Just want to make sure you add SLGS to your signature sinceyou are feeding dry food. TR is not used if any dry food is given.

 

Yes to needing a ton of patience! My cat could drive me nuts if I let him! Big Hoss is a gorgeous boy!

 

Tigger's brother is a flame point siamese and looks just like your boy but like half the size! Honestly, Big Hoss is magnificent!