High bg 400-600 on day 5 of lantus

I am new to FDMB and desparately need help. I have a 17 yr old male kitty diagnosed 3 months ago. Was on Novulin N with bgs in 300 to 700 range. Came down to 200 but insulin didn't last long enough so vet switched to Lantus pen 5 days ago. Started at 2 units BID. Day 1 and 2 in 500's, day 3 down to 300, day 4 and 5 back up to 500-600. Checked bg at pre, 3 hrs, 6 hrs, pre again and staying fairly even but still high. Petey weighs 6.8 lbs. Eating only Fancy Feast and cooked chicken breast. Should I degree dose or increase dose. Going on vacation in 10 days please help!

 

Welcome to FDMB! I am sorry to hear about your fur baby. I don't have any experience with Lantus but there is a whole crew over at the Lantus forum. Here's the link http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/. I also put a message on there for someone to come here to see your post, but more people will be on that board to help you. Welcome again,

 

I'm responding to the SOS that Mum of 2 felines put out on the Lantus/Lev group for you.

What kind of doses were you giving with the Novolin that was getting him into the 200's?

Does your sweet boy have any history of DKA (diabetic ketoacidosis) or ketones? DKA is a crisis and he would've stayed at the vet if so.

We can help you with the dose, and can help you figure out a vacation dose as well. We ask people to start recording all the numbers they have in a spreadsheet. There are directions here and if you have any trouble someone can help you.

Lantus dosing is based upon how low the dose can take the cat. It's common to start on a dose and then adjust it. Before I can tell what to do with the dose, it would really help to see things laid out on the spreadsheet.

Can you try to get a spreadsheet going and let us see what's up? I'll watch for your replies and give you a hand.

 

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.

 

Thank you so much for responding! And thank you for posting on the lantus board. I am new to the site and don't know how to reach anyonen for help.

 

That's why we're all here! We all just work together and help out to the best of our abilities! The spreadsheet is the best way for members to help you. My piece of advice is to follow all the steps...I didn't and it took me awhile to figure it out, but I am so glad I did. The spreadsheet saved both my fur babies lives!

 

Petey was on 1.5 units of Novulin starting Jan. 22 until 5 days ago. His bg would range from a preshot of 700 or higher than come down to the mid 200's to low 300's in 3 hours and stay there until 6 hours then back up to 600-700 at preshot again. He has some mild kidney damage but vet says normal for his age, getting hydration to help since numbers were so high. Vet specialist suggested changing to lantus to keep bg down longer. I have a handwritten spreadsheet but will fill out the one you have all suggested and post it for you to see. He has had not ketones (I test daily) and is maintaining his weight at 6.8 lbs (was 8 lbs when diagnosed). He has a good appetite, but I'm not sure if I should feed him only twice a day with shot or let him eat for the first few hours since he is underweight.

 

I don't know about Lantus, but if you go to their board and post the questions someone will help you When you start your thread over there, click on the no prefix and choose the ? To get members attention. I know it looks confusing over there, but they are a wonderful bunch!

 

It sounds like you've got a Lantus dose in the ballpark, then. If 1.5u Novolin was getting him as low as the 200's, then 2u of Lantus might be ok. Usually cats stay on the starting dose of Lantus for the first week, then assess if it needs to be changed. However, if you haven't had any tests under 300 in these first days, that might suggest he needs a dose change sooner.

You're doing a lot of things right - Lantus is a good insulin and when a cat gets to the right dose, it can provide excellent control of blood sugar. You're checking ketones daily, which is great. He's getting fluids to help with hydration & kidneys, per the vet's direction. It seems you've also mastered home testing. You've gotten him on low carb canned food (I assume you're only giving pates that are low carb?) and plain chicken. Those are all good steps.

Fancy Feast is very high in phosphorus, which isn't good for cats that have compromised kidneys. I had punkin on it until his kidneys started to go, then switched him to low phosphorus/low carb foods. You don't have to deal with that this week, however. Let's look at the rest of it first and revisit the food question in a couple of days.

I think what I would do at this point is to get the spreadsheet going with the info you have written down. As soon as you have a spreadsheet, I'd encourage you to go here to the Lantus/Levemir Insulin Support group and post. You'll find many very experienced Lantus users there. Don't be intimidated by the lingo or appearance of the posts. I waited 2 months after discovering FDMB before posting because of the lingo . . . but it makes sense once you're there. The color references are to the spreadsheet colors.

In any case, it's the best place you never wanted to be and patient people will teach you what you need to know to use Lantus in Petey and help him get well. We've all been new and in your shoes, wanting desperately to help our cats. We get it.

 

Thank you so much for your response! I was able to download the spreadsheet and am going to fill in the numbers tonight an post it to the web. Petey does have some mild kidney issues and the vet said we might need to switch to a different type of food but didn't say what yet. Do you have one to recommend if he wants us to change the canned food?

 

If you post over on the Lantus board all the members there will be able to help you wit all your questions or will be able to tag the experts here. http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/. Put a ? Before your post title and the members will be helping in no time.

 

Petey, my experience is annecdotal, but with Sebastian, his blood glucose readings tend to lag behind his dose changes. I think my first reading was done a week after starting him on the Lantus. I do his blood curves at home (which my vet advised is usually more accurate as cat is less stressed), and his dose has gone up and down between 1 units and 3, most recently going as high as 4, but whether this latest high is related to diet, the Lantus starting to get older and less effective, or just Sebastian's natural tendency, in all cases, I noticed that the changes to his glucose do not follow immediately after a change to his insulin. I have actually learned to do his blood curve later than a week after making a change to allow him time to adjust. There are people with a lot more hard information on the Lantus discussion board, it sounds like, but it has taken me a while to get used to how much the readings vary even when the vet advises me they are now in the ideal range for Sebastian--i.e., we never get a flat reading of say 200 at every blood draw. Sebastian is especially tricky because he will vomit dry food if he eats it all at once, and he often refuses wet food completely, so I can't give him two single big meals timed to his insulin dosage (since vomiting and having an empty stomach is worse than gradually raising his blood sugar by spreading his breakfast out). Sebastian has actually been doing well for almost a year since his diagnosis, and it has taken me this long to get used to how to read his varied blood sugars and adjust his insulin appropriately. I have learned to tell from his behavior if we need to revisit his dosage, and that maybe for him there is not a "perfect, ideal" dosage that will stay the same forever. My vet has stressed many times that too much insulin is far more dangerous than too little, so I really keep an close eye on him and just expect that I may have to do a blood curve and make an adjustment every few months. Hope this helps!

 

There's a well-researched and highly-respected website that's an absolute goldmine of information for cats with renal issues. Here's a link for you:

Tanya's Site

There's a support group attached to the site (link in left-hand column on home page). Also there's a Yahoo feline CRF support group (link below).

https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info

There are some very experienced members in the support groups who will be happy to look at Petey's lab results and give you some recommendations on diets that work for both diabetes and CKD.


Mogs
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Petey: Sebastian (diabetic kitty starting to show a little bit of kidney symptoms) and Milou (cat with kidney disease) are sharing two of the Spot's Stew dry food flavors that are recommended in the chart on Tanya's site. For wet food (which Sebastian often rejects) they get Wellness brand cat food, which we buy on Amazon. I would test the flavors to see which ones he likes and then switch to the dog-food-can size, which is cheaper overall (but not cheap). Another great low-carb choice is Stella & Chewy's freeze dried but it is very expensive, so I only use it either to tempt Sebastian to eat if I need to get his insulin injection done and he doesn't want to eat or to reward him after an injection or the blood curve. Sebastian hates getting his ears pricked, poor baby!

I strongly recommend Rehmannia 8 Chinese meds for kidney disease. This was prescribed by Milou's former owner who is a vet, and continued by my own vet, who knows Chinese medicine as well as being a traditional vet. I was skeptical at first and not sure if I wanted to try it, but Milou's former owner made a strong case that Western medicine does not have a good answer for kidney disease yet. Milou was diagnosed about two years ago and is doing great, very active and full of beans, loves to eat though still a lot skinnier than when he was in his chunky prime, and more active than all my other cats. He regained weight on the Rehmannia 8. We buy it (with a prescription) from the online website Kan Herbs and get a glycerine formula that is concentrated and does not taste so bad so it is easy to mix in with food. For his meds, Milou gets a little bit of some premium Fancy Feast flavors or a little tuna, something with a strong flavor and a lot of juice.