? Too much insulin or too little?

Discussion in 'Lantus (Glargine) / Levemir (Detemir)' started by Bubby & Ash, Mar 4, 2018.

  1. Bubby & Ash

    Bubby & Ash New Member

    Joined:
    Mar 4, 2018
    Hello, I am new here. Here is a basic overview of the journey to this point. My cat, Bubby, was diagnosed in December 2017. We are currently on our second vet. The first started him on 4 units of Lantus, twice a day, and put him on Hill's MD dry food. After a week he suggested increasing to 5. Everything I read made 4 seem too high for a starting dose (I was extremely worried and anxious about this) so I consulted with another vet and took him there after that first week. We moved down to 2 units twice a day. We stayed with 2 units for a couple of months, just doing checks at the vet's office. I recently started home testing with a Relion Micro.

    A couple of weeks ago, the current vet wanted to move him up to 3 units but I talked her into 2.5. In our very first meeting she told me that if a vet ever suggested a full unit increase, "take your cat and run." So I was pretty distressed at the mixed messages. So here we are, 2 weeks after a half-unit increase, and Bubby's numbers are all over the place. I thought for awhile maybe his insulin had gone bad because he was staying so high all day long, but he's come down a few times since then. I am supposed to send the vet his latest AMPS numbers on Tuesday. I'm going to send her all of the numbers though. We had also talked about switching him to low carb canned food after he settles in to this dose.

    I am hoping that some experienced folks can take a look at his spreadsheet (hopefully I set it up right?) because I am afraid she will suggest another increase and I'm not sure what is even going on with him now. Is he bouncing continuously on this dose? Does that mean it's too high? Or does he really just need more? Or was a half unit just too big of a jump?

    Thank you for any insight you can give. I am feeling so discouraged and worried all the time because I don't feel full trust in my vet and there aren't any other options nearby.
     
  2. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Welcome to the group!

    FWIW, I would agree -- a 1.0u increase would have me out the door.

    At this point, there's not enough data on your spreadsheet (SS) to be able to give you solid information. We look at patterns vs what's going on in an isolated cycle. You also need to get at the very least, a routine before bed test every PM cycle. Many cat's experience lower numbers at night so if you don't have PM tests, you're missing half of your data. You can already see that Bubby sees more numbers in the 200s at night.

    What I would suspect is that Bubby isn't getting enough insulin. If you look over the two dosing methods we use (see the Tight Regulation and the Start Low Go Slow stickies at the top of the board), we evaluate how effective a dose is every 3 - 7 days, depending on which method you're using. If a kitty is on a dose of insulin that's not getting numbers into close to normal range, then you increase the dose. If you continue to hold the dose, glucose toxicity can develop. The terms sounds a whole lot worse than it is. What it means is that your cat's system begins to treat the higher numbers as the new "normal." This makes it a little tougher to get the numbers to get back into normal range. There's also a bit of bounciness going on.

    What are you feeding your cat? If you're still feeding Bubby the Hill's MD, it's very high in carbohydrates. You want to be feeding your cat a low carb, canned food diet. Rather than preach to the choir if you've already changed your cat's diet, please let us know what she's eating.
     
  3. Bubby & Ash

    Bubby & Ash New Member

    Joined:
    Mar 4, 2018
    Thank you!

    Ok, so if he needs more, should we just do 0.25 units or another 0.5 increase? It seems like 0.25 is what those protocols would suggest? It is tough having to push back on everything the vet says but I will if it's better for Bubby.

    He is still eating Hill's MD. I have been talking to the vet about switching. It's difficult because I am not his sole caretaker. He is technically my parents' cat. So I've been trying to get all parties convinced that we need to switch him to low carb canned. The plan was to let him get used to this dose and then make the switch. But his numbers aren't really settled on this dose at all. He was high (preshot values always in the 300s), but at least steady on 2 units. I am also terrified of the transition process. Do you preemptively decrease the insulin? How much do you reduce if he drops really low? I feel like I need solid guidelines because I get extremely anxious about this.
     
  4. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Welcome. You will get lots of guidance here. Since you are feeding dry you would follow SLGS so please read over that protocol. In my opinion it will be easier on the nerves if your parents decide to transition to canned food. Doing so on my opinion gives a stronger chance of becoming a food controlled diabetic and off insulin. If you are able to test as often as you have been he will be safe while transitioning off dry. I’m not sure what I would do about dosing if dry is stopped. See what others think.
     
  5. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    We don't preemptively reduce the insulin on a food switch. Rather, do the switch slowly. It'll be easier on his GI system to make slow changes with the food as well. And with a slow switch you shouldn't see a sudden drop in the amount of insulin needed. Remind your parents that low carb commercial wet food will be cheaper than dry food from the vet.
     
  6. Bubby & Ash

    Bubby & Ash New Member

    Joined:
    Mar 4, 2018
    Ok, thanks everyone. I really appreciate your help.

    So should we do the food switch before any further dose changes then? Or is it more important to deal with an inadequate dose now? Probably not a good idea to increase and change food concurrently I’d guess.
     
  7. Sean & Rufus

    Sean & Rufus Well-Known Member

    Joined:
    Jan 10, 2018
    I would change foods now and see how the dose works with the new food.
     
  8. Bubby & Ash

    Bubby & Ash New Member

    Joined:
    Mar 4, 2018
    Ok. So how do I know when he needs a decrease? SLGS says anything under 90, decrease by 0.25. Just follow that rule? Would you ever decrease by more than that? Or is there a certain pre-shot value I should decrease for as well?

    Thanks again!
     
  9. Sean & Rufus

    Sean & Rufus Well-Known Member

    Joined:
    Jan 10, 2018
    How often are you testing? Usually you would test at least 4 times a day: amps, 1 mid cycle, pmps, 1 kid cycle. Then weekly do a curve, which is every 2 hours for 12 hours or every 3 hours for 18 hours. Once you get some data collected, it's much easier to figure out which way to go dose wise. If amps or pmps is 90 or lower, don't shoot. I wouldn't mess with increasing or decreasing without asking for help here first. After a while you'll get the hang of it and can make judgement calls yourself. Always ask questions! :)
     
  10. Bubby & Ash

    Bubby & Ash New Member

    Joined:
    Mar 4, 2018
    I’ve been testing quite a lot lately, trying to figure out his weird numbers. There are a few days I can’t be home right in the middle of the day but most days I can.

    I’m actually getting pretty concerned by how much lower his night numbers are than day. What the heck! It was mentioned above that it’s a known phenomenon but I find that quite scary. He is used to having food available during the night because he never finishes it in one sitting. So when moving to wet food, how long can that sit out? I’d sleep better knowing he had something available when he’s potentially dropping lower. Or even when I’m not here during the day.

    I will for sure ask lots of questions. I just wanted some general guidelines in case I come across something and don’t get a reply right away. I panic easily, sorry to say :(. Can not wait to get to the other side of the food switch!

    Many thanks!
     
  11. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Many of us use automatic feeders with wet food, so we can make food available later when it's needed. My girl was a Hoover too. You can add water or an ice cube to the food to keep it cool and lasting longer. I liked the Petsafe 5 feeder.

    For now, you would decrease by 0.25 units if your cat goes below 90. We determine dose by how low it takes the cat, which doesn't happen as often at preshot if using Lantus.
     

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