New to this forum - need help!

I am new to this forum, so I don't know the proper coding, but my cat is on Lantus insulin three units twice a day right now. I have a log of her blood sugars and a glucose curve from yesterday attached below. The dose was increased from two units twice a day around a month ago by her vet and she was previously barely responding to the insulin. Her response has increased dramatically, and now her evening numbers are always a lot lower than they were previously (high 200s to low 300s).


6/13/18 7:41 AM (preshot) - 251
**Given 2 units Lantus

6/13/18 7:07 PM - 195
**Given 1 unit Lantus

6/14/18 7:07 AM (preshot) - 338
**Given 3 units Lantus at 7:20 AM

6/14/18 7:25 PM - 92
**Dose held for the evening

6/15/18 11:17 AM (preshot) - 441
**Given 3 units Lantus at 11:20 AM

6/15/18 10:34 PM (preshot) - 122
**Fed her, then gave her Lantus 1 unit at 11:15 PM

6/16/18 glucose curve:
10:51 AM (pre-shot) - 454

1:34 PM - 302

4:02 PM - 130

5:03 PM - 97

6:07 PM - 91

7:32 PM - 103

9:46 PM - 161

10:53 PM - 159

 

Welcome to the group!

The first thing I would recommend to help you get oriented is to read through the "sticky" notes at the top of the Board. There is an overwhelming amount of information in them which really does get easier. One of the first things you will want to do is to create a spreadsheet for Sunkist. Having all of the numbers in one place, in our compulsively color coded format, will allow you to see your kitty's progress (and not have to keep typing all of those numbers in your posts). Here is the link to the instructions for setting up a spreadsheet and linking it to your signature. (You'll see our SS link in our signatures if you want to take a look.)

The strategies we use for Lantus dosing involves a couple of basics. First, the dose is based on the lowest number in a cycle (i.e., the nadir). Because Lantus is a depot-type of insulin, you need to hold the dose for at least 3 days before increasing. The depot is what gives Lantus it's duration but it needs time to "catch up" whenever you change a dose. Thus, making back to back changes in dose typically results in weird numbers. Lantus does not do well when you see a high pre-shot number (like when you skip a dose) and try to "shoot down" the numbers with a one time increase in dose. Long acting insulin, like Lantus, are not meant to be used quite that way. Also, we make dose changes (both increases and decreases) in 0.25u amounts. By increasing the dose in larger amounts, it's very easy to miss what could be a very effective dose for your cat. Much of what I'm outlining is in the stickies which discuss the two dosing methods we use: Tight Regulation Protocol or the Start Low Go Slow method.

What it looks like to me is that Sunkist is bouncing. A bounce happens when numbers drop quickly, drop a lot (like from 454 to 91) or drop low. Your cat's liver and pancreas react to the change in numbers by dumping a stored form of glucose along with counterregulatory hormones into the bloodstream. These cause numbers to spike upward. It can take up to 3 days for the bounce to clear -- although some cats turn the bounce around rather quickly. This is a normal, albeit annoying phenomenon.

Please let us know if you have questions. The people here are very generous with their time and knowledge. We're here to help.

 

The "bounce" has been happening for three weeks now. This is the general pattern of her response to her insulin over the past three weeks. The last time the dose was changed was three weeks ago. It was increased from two units twice a day to three units twice a day. Prior to the change, she generally measured 300 to 350 before shots and had a response down to 250 nadir. so I really have no idea why her pattern has changed so much or whether I should give an evening dose when her pre-shot number is lower.

 

Welcome to Lantus and Lev Land!
There's a lot of info on this site! And tons of experience!
Can you tell us a bit about Sunkist The Cat (Love the name by the way)? When was she diagnosed? What was the starting dose? What foods does she eat and is that any different from what she used to eat? How old is she? Any other medical issues? Are you able to test throughout the day? lol sorry about all the questions but it will help all of us help you and Sunkist.

 

Yes! Sunkist is 8 years old and she was 100% in normal health back on her labs in January (no diabetes, nothing). She got a steroid shot for skin allergies in late January, and in mid-March I found her unresponsive on the couch when I got home one day. She was diagnosed with severe pancreatitis and diabetes, and ended up hospitalized for 14 days at a specialty group. Her pancreatitis was so severe that she needed a feeding tube for 7 weeks which got taken out around mid-May.

Diet is an issue - she currently eats 75% Blue Buffalo wilderness dry food. Yes, I know dry food isn't the best for cats, but it is the ONLY thing she will eat regularly. Because of the pancreatitis, the vet says I should feed her anything she'll eat regularly and that doesn't seem to cause the pancreatitis. She does eat 25% of the blue buffalo wet food every day. I give her a little as a "topper" with each meal and she does eat it. She also will eat salmon filet treats occasionally. I am scared to change her diet because that's what caused the pancreatitis last time (sudden diet change), and she almost died from it.

Starting dose on discharge was Lantus 1 unit BID. In the hospital she was running up to 500s. We increased it to Lantus 2 units BID in late April, and then to 3 units BID at our last visit 3-4 weeks ago. I am totally puzzled because 3-4 weeks ago, her curve ran between 250-350 on the 3 units, and now she has the curve above. >_< I am thinking maybe her pancreas is starting to heal and I need to drop the dose back down.

 

Pictures of kitty

 

Hi Sunkist and Momma What a fun name for a beautiful kitty ! You are in the perfect place for wisdom and advice , all guided by experience . While I am mostly an encourager you have been given awesome advice/direction by two of the “ pros” on Board in Sienne and Judy . They know what they are talking ab and their insight is invaluable !! So again, welcome to you and beautiful Sunkist

 

I am so appreciative of the help! I have sent an email to her vet as well but haven't gotten reply yet, thank you guys for welcoming us!

 

Also forgot to add that I work during the day, so I don't want her sugars to drop too low because I wouldn't be able to be there to notice it.

 

It could very well be that Sunkist's pancreas is beginning to kick in. I would encourage you to see if you can transition her over to a canned food diet. FWIW, Blue Buffalo has been subject to a number of recalls.

If you're not already familiar with this website, Lisa Pierson, DVM has a great site that discusses feline nutrition. She has a section on transitioning a cat to canned food. The food you're using (and yes, your cat has to eat!) is very high in carbohydrates which is not the best thing for a diabetic.

 

Totally agree with what you said - I've been trying to transition her to healthier food (cooked salmon filets for cats, cooked tuna, etc and the BB wet food), but issue is the pancreatitis has made her a really picky eater. Maybe a vet could weigh in on this, but my vet also says that any diet too low in carbs is going to put too much strain on her pancreas and potentially cause another episode. She seems to have been safe on this diet so far and I am terrified of another pancreatitis episode since she came VERY close to death with the first one - spent 2 weeks in the kitty intensive care unit in an oxygen chamber

 

Because of your inability to test mid cycle, I would suggest reading and following the SLGS protocol which generally keeps the kitty at higher numbers.
Lantus works best if it is dosed consistently 12 hours apart with the same dose. We also increase/decrease in .25u increments (and sometimes smaller when we're trying to tweak a dose); the 1 unit changes are way too much and could cause you to miss the best dose.

If you do decide to follow the SLGS protocol, Sunkist came very close to earning a .25 reduction (which happens when you get a BG of 90 at any time). I see that you shot 1u at PMPS on the 15th, I'm assuming you shot 3 units yesterday morning, evening, and today?
@Sienne and Gabby (GA) you certainly have a lot more experience with this than I do! Do you think that the dose should be reduced?

 

Just to clarify, over the past few days the cat has only been getting her morning dose of insulin because her evening numbers are so much lower than her morning numbers. It looks like the Lantis drops her blood sugar by 300 points, and I am concerned she will get hypoglycemic if I give three units at night as well. I am wondering if I should be giving the evening dose, even though the blood sugar is lower, or if I should lower the dose and give twice a day. This is a new problem, and has only been happening for the few weeks or so, So it appears her response to insulin is changing.

 

Twice a day is definitely best but I believe that 3 units is too much. Hoping Sienne will pop in again!

 

In general, lowering the dose so you can give the same amount at AM and PM is preferable. However, the caveat is whether Sunkist was having problems with ketones or especially diabetic ketoacidosis (DKA). If ketones aren't in the picture, how would you feel about shooting 2.0u?

I haven't a clue what your vet is referring to with regard to carbs and pancreatitis. Old school thinking was that cats need to be on a low fat or low residue diet if they had pancreatitis. That thinking has changed. You might want to take a look at this Primer on Pancreatitis that one of the members here put together.

 

I'll take a look at that! I am cautious about changing the diet since a change to a "healthier" diet from her old diet was what caused the episode (within a week after changing diet she went haywire), so if any changes are made I want to be extremely cautious, doing it at most 10% a week at a time. But, I am slowly starting to top her food with healthy wet food and she seems to be taking more interest lately. She has not had any ketones on any checks so far. Since the vet hadn't replied this AM, I tried giving her 2.5 units instead of 3 units - the morning BG was 370, so we'll see how she looks on tonight's check and whether it's more consistent. I will let you guys know what vet says when she replies.
.

 

So this is just a tip from when I switched my non diabetic cat pumpkin, the pickiest eater in the world, from dry to wet. I know you said you top her food off with wet, but what if you put wet on the bottom and sprinkled the dry kibbles on top? That seemed to work for my pumpkin princess. I did it slowly, first with just a tablespoon of the wet, then 2, etc. I think once she started eating the dry food and got a taste of the wet by accident with it, she realized it wasn’t so bad. Now she LOVES the wet food and actually eats it better than she used to eat dry. Best of luck, and your kitty is ADORABLE!

 

Thank you! I will try that out! She is the PICKIEST eater, it's crazy. She doesn't even like cat treats, except for recently taking an interest in those salmon filet cat treats I mentioned (and only will eat a little bit). I want her on the healthiest diet possible but she doesn't make it easy >_<

 

Welcome. How are you treating the pancreatitis? I treated with ondansetron or cerenia for nausea, sometimes cyproheptadine to jumpstart his appetite if the nausea medication didn’t do it and sometimes buprenex for pain. Your cat is beautiful. What skin condition does she have? One of my young ones has eosinophilic granuloma. So far I’m hoping a new protein will help. I don’t want to use prednisolone and neither does my vet.

As others have said it’s likely 3 units is too much. Is your vet increasing by full units? We usually do .25 increases so as not to miss a good dose.

 

She takes Zofran as needed and Cerenia Mon-Fri. She also has a medication called Entyse to help with appetite but hasn't needed it for a while. Vet thinks she has eczema problems which is why she got the steroid shot which unfortunately I think caused the diabetes

 

It would be really helpful if you would create the signature and put the pertinent information such as insulin type, dosage, other conditions, medications etc so it's all there for each responding member to see. Just select your username at the upper right corner of the page, then select signature. Take a look at other members' signatures to get an idea of things you want and need us to know about your kitteh. Things like age, weight, diagnosis date, insulin type, dosage, meter type, food type, other medical conditions and medications.
You won't have to repeat the information and responding members won't have to search previous posts for that information.

 

How is Sunkist doing today?

 

I decreased the dose like you guys suggested to 2 units BID. She seems to be improving, with the pre-shot BGs more consistent now, between 130-200 on both checks. I think maybe the dose she was on was too high. I am also having some success transitioning her to wet food! She eats around 1 can (needs 3 cans daily wet food) and 2/3 dry food now with a little salmon treats on top. Gonna do another BG curve this coming Saturday or Sunday and we'll see how she looks on the 2 units.

 

Thank you, I'll work on that and see if I can add one! I definitely need this community, diabetes has been such a rollercoaster and so anxiety provoking for me ever since she was diagnosed constantly live in fear of DKA or hypoglycemic episode.

 

Wonderful to hear!

This forum is awesome! My Boomer has been diabetic for over 4 years (in remission 3 times) and I'm sure I wouldn't still have him had I not joined this forum!
For the best, most helpful, experience most of us try to post each day, with a new condo each day. At the top of each day's condo you can place a link to the previous day's condo so that it's easy for us to look back. Even if you have nothing to say except (i.e.) AMPS 120 shooting 2u, as long as you post in the body of the condo and not just in the title it gets bumped up to the top and members will see it and be checking in to see how Sunkist is doing!

 

Just an update - the vet (who is an internal medicine specialist) says she thinks Sunkist is starting to go into remission. She actually said to give her only 1 unit once a day and re-curve in 2 weeks. That seems like a pretty big dose decrease, has this happened for anyone else's kitty?