? Lantus dosing advice needed please

Hello,

I posted in a different thread recently...it was recommended that I re-post here. I would greatly appreciate any advice.

My cat, Booboo, was originally diagnosed with diabetes a few years ago and after two weeks of Lantus and a switch to a strict low carb diet, she went into remission. About a year later, she relapsed. Since then, the last couple of years, I've been giving her 1 unit of Lantus every 12 hours, while checking her blood sugar, of course. Until very recently, her blood sugar was well-regulated, reading usually around 80-100. However, about a couple of months ago, it's been creeping around 200 or more. In the last couple of weeks, she's experienced some scary lows (30's). She wasn't exhibiting any symptoms, but certainly made it clear to me that something was wrong...by her meows and seriously begging for food. I treated her with food and she's alright, but we're still dealing with highs and lows. I've lowered her insulin dose to about 1/2 dose in the last few days, which has seemed to alleviate the lows but not the highs.

As I mentioned in the other thread, I have to be out of town for work fairly regularly. I have a good, trusted pet-sitter who checks her sugar before administering her shot. I hate leaving her as it is, but her unstable blood sugar lately has me especially concerned. I should make sure to point out...I hadn't traveled much in the last 2 months, though, until just a couple of days ago - so the differences as of late are not due to the pet-sitter or Boo's possible stress in response to my absence.

Any thoughts on what may have changed concerning her pancreas, insulin sensitivity, etc? Could this be a sign of some other underlying issue?

I have attached a spreadsheet with her latest blood sugar numbers below my signature, to give an idea of what I'm struggling with. Any advice on dosing?

It's just me and Boo and I want to give her the best care I possibly can.

Thank you!

 

Hi Amek!

I can help you with a couple of things. First when you got the 28 on 6/27 with the 1.0u dose, that was a signal that the dose is too high. In the future, if you get any test less than 50, you really want to reduce the dose. Not just with the following shot, but I'd stay with that reduced dose unless you see her numbers trending up.

Looks to me like after you reduced, the 0.5u might not be quite enough, I can't tell for certain. Lantus dosing is based upon how LOW the dose can cause the cat to go. The 1.0u can cause her to go into the 20's. The 0.5u might or might not be quite enough. I think if I were you, I'd stick with the 0.5u just a few more cycles (a cycle is the 12 hour time in between 2 shots) and try to get a test before you go to bed. Many cats go lower at night. It's possible there are some lower numbers in there. So getting a few more tests will help you know for sure what to do with her dose.

There are good ideas on the first yellow post labeled "sticky" about taking care of a cat while you work full time, following the Tight Regulation Protocol. Regardless of what dosing method you're using, either Tight Regulation Protocol or Start Low Go Slow, it has great ideas for you. I gave you the reduction point (50) for Tight Regulation above, the other choice is the SLGS and the reduction point for it is 90. Either way, you'd want to reduce the dose for certain if any cat goes into the 20's and 30's.

For the future, hopefully she won't get that low again, but if you catch a test less than 50, don't let it go more than 20-30 minutes without retesting again, just to make sure she's not going lower.

Take a look at those 2 dosing methods described above and see which one is a better fit for you. Also, if you want help, often people who are traveling will post here a day or so before they leave and ask for help figuring out a safe vacation dose for while they're gone.

I don't see anything that suggests a problem. It may be that her pancreas is healing and is sputtering out some insulin, so the 1.0u that was ok before is now too great. Having to adjust the dose is a normal situation and doesn't indicate that something's wrong.

Does that help? Ask questions and then more questions, so you understand.

 

Hello and welcome Amek and Booboo. From your other thread, it looks like the values in your spreadsheet are from just the times you were home lately. I agree with the advice others gave in your intro thread.
Those low numbers are scary and earn a reduction in dose. We normally reduce the dose by .25 units. There are no syringes with .25U markings - you have to use the ones with .5U markings and eyeball the difference. The New to the Group has some pictures. Here is one of .75U:


Reducing by too much can cause higher numbers. As can bouncing. The second post here describes what a bounce is - it can last up to 6 cycles. But as Julie says, let's give the .5U some time to see how it does, you may have to increase back up to .75U if .5U is not quite enough.

Cat's blood sugar needs can change for a bunch of reasons, sometimes even just with the seasons. Some cats eat a little less in hotter weather, there are seasonal allergens, and sometimes the pancreas just gets tired or gets back on the job. Has Boboo been to the vet lately for a checkup and recent bloodwork?

 

Please see my post in your previous thread in the intro forum

 

Hi everyone. I've posted the last week of Boo's BG in the spreadsheet. I continued with the 0.5 unit, but that was obviously not working. So, I switched to 0.75 and she experienced a low late last night (43). This time I was better prepared (as I will continue to be) with higher carb food and treats to treat the hypoglycemia. Maybe it was bit more than 0.75? Thank you so much Wendy&Neko for the picture of the syringe. I wish there were syringes with 0.25 markings...especially for the pet-sitter.

I'm frustrated...I hate seeing her blood sugar in the 200's, but I'm scared of the lows, especially when I'm not home. I haven't taken her to the vet, but I'm planning on it - I'm looking for a different one.

Any other thoughts on her latest BG numbers? I'll be out of town for work quite a bit in the next few months (up to 5 days sometimes) and I'm really worried about leaving her.

 

If you are planning on following the Tight Regulation Protocol, when BG values drop below 50, for a cat within a year of diagnosis, a dose reduction is warranted. If you are planning on following the Start Low Go Slow approach, values below 90 warrant a reduction.

Tight Regulation is the more aggressive approach. Regardless of which approach you follow, you've seen numbers (e.g., in the 20s) that indicate you needed to reduce Boo's dose. With TR, unless a dose reduction is indicated, you hold the dose for 3 days/6 cycles. Lantus is a depot-type of insulin. It takes several days for the depot to adjust to any change in dose. Lantus dosing is also based on the lowest point in the cycle (nadir) not on the pre-shot number.

I know this is all a lot to take in. There is a ton of information in the sticky notes at the top of the board. I'd strongly encourage you to read them and ask questions. You may also want to make sure your pet sitter has access to this board in case she can't quickly reach you. There's usually someone here pretty close to 24/7.

 

One thing you can do is to make a sample syringe with the 0.75u, then use that to compare your dose to. Some people mark the sample syringe with masking tape.

Syringe markings themselves are pretty inconsistent - if you look at 10 of your syringes and compare the stamped unit markings, you'll probably notice that they aren't all at the same spot.

 

I took Boo to the vet on Tuesday. They drew blood (which was an awful experience for her) and the vet called me yesterday with the results. She said that everything looks really good, especially for her being 16 y.o. and diabetic. The vet doesn't understand her BG numbers as of late.

Boo does have a high eosinophil count though. She doesn't have any symptoms of asthma. So, I need to take a stool sample for examination of parasites - although in the last couple of days, she's had diarrhea and has been very lethargic. This morning she didn't get up when I went into the kitchen for our morning routine of checking BG, food and shot. She just laid there, which is very unusual.

Her BG has remained high most of this week. Initially I thought it was also due to stress from the vet visit and the blood draw, but I'm wondering if she picked something up from being there. Any thoughts or experiences with high eosinophils in diabetic cats?

 

Elevated eosinophils is often related to an allergy. Have you changed your cat's food or are you feeding a different variety (e.g., you started feeding beef). Cats often have an allergy to beef and fish. They can also have environmental allergies so if she's scratching or licking more than usual that may be an indication of allergy.

 

When I look at the past week, I wouldn't interpret things quite as you have. I wouldn't say her BG has remained high most of this week.

I think those yellow numbers on 7/16 are just ordinary bounce numbers. I wouldn't worry about them. This dose is consistently getting her into mid-green numbers, so it's pretty good. It's just that she's bouncing from them. On the 15th, she spent at least 7 hours in green numbers, which is what caused the bounce the next day. The longer she spends in normal numbers, the more her body will accept them as normal. When she's in green numbers, you might try doling out a teaspoon or two of his regular low carb food every hour or so - for some cats that will help them "surf" along in green.

So what it looks like to me, is that she's having a day of great test numbers, then a bounce day of higher numbers, then the bounce clears and she's back into green numbers again. At the moment it's an every-other-day pattern. That's pretty normal. If you want to fatten her dose just a little bit, that might help bring down some of the higher numbers and shorten the bounce (because it may extend the time she spends in lower green numbers), but if you do that just know that she may be more likely to go below 50 on a higher dose.

edited to add: here's more info on bouncing in the second post in this thread.

 

Boo has not been well since I took her to the vet last week. She had some diarrhea and hardly ate for a couple of days (which is highly unusual for her), so I took her to an emergency vet. They did an abdominal ultra sound - everything looked fine; urinalysis was fine. She hasn't eaten or had much water in a few days. She's extremely lethargic. I haven't given her insulin because she won't eat. I've tried different types of food...nothing. We have another appointment today with an internal medicine specialist.

I don't know what happened to her since I took her to the vet. I could understand if it stressed her out, but it's been a week now and all of the tests so far show that she's otherwise very healthy for her age and as a diabetic. Has anyone experienced this sort of thing and have any idea what may be going on with her?

 

What are you feeding her? Diarrhea can be food allergy (it happens any time Gabby has eaten beef) or irritable/inflammatory bowel problems, or a GI bug. I would start with food and possibly switch to a novel protein or even a raw diet.

 

I'm feeding her the food I usually do - turkey and giblets wet food. I did give her a beef flavor twice a few weeks ago, but it's been a while and I can't imagine that at this point that's what's causing her to avoid food and water. I haven't tried a raw diet, but I've tried other brands/types of food (not beef) in the last few days. She is completely disinterested in food and is not herself - very slow and definitely showing signs that she doesn't feel well.

 

Could you put something like Skip or NS (no shot) in the units column where you haven't given insulin. It just helps us to know what happened that cycle. It's also helpful to put something in the Remarks column about when she started going off her food.

Kitties need to eat - anything more than two days off food is a concern. Hepatic Lipidosis (fatty liver disease) becomes a real concern when they stop eating. Here are some tips on getting kitty to eat. I hope the visit with the IM vet provides some answers. She may need an anti nausea drug.

 

It sounds like you might be describing pancreatitis - it can have far-reaching effects in the body and is very common in diabetic kitties.

Here's the "Primer on Pancreatitis" - see if it describes what you are seeing. If so, there are meds suggested in there that can be very helpful.

edited to add - if you aren't giving insulin, you really need to be checking for ketones at least twice a day. Ketones can quickly become a crisis. I would think you might want to reduce the dose even further just to get some insulin in.

There is info on ketones, diabetic ketoacidosis in the New to the Group sticky, in the single topic links at the bottom.