would like some discussion on glucose toxicity

Someone responded to my last post in the Tight Reg. Lantus forum with a mention of the "well-known" glucose toxicity, as my cat seems to be having persistent high numbers. My vet even suggested that maybe Terra isn't responsive to Lantus, but my suspicion was that we haven't given it a proper try yet. The term Glucose Toxicity was new to me and I looked online to learn more. This Pet Wikia article was most helpful. http://petdiabetes.wikia.com/wiki/Glucose_toxicityI wonder if this wouldn't be helpful to other newbies to have some perspective on a slow to respond cat. I am in the learning phase now: that article contains links to some old, archived discussions on FDMB about glucose toxicity. I'd love to hear this addressed by some more experienced caretakers, even see some info on this as a sticky.

 

I am not sure what you mean by not responding to Lantus.... Terra's ss looks more like dose jumping all over the place and at the moment, just not enough insulin..... lots of cats need more that 2u BID, one cat on the board was up around 6u BID I think and then went OTJ. If you look at some of the other ss, you will see doses higher than 2u.

I would suggest you follow the guidelines below for a week or so, basing your dose adjustments on the nadir, and I bet you will find that you need to give a bit more insulin.
"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.


Stick with the 2.5u for another 4 cycles and if you don't see an improvement, increase the dose according to the above. Alternatively, you can always try to stick with the 2u dose.... the high numbers you see today are likely part of the dry food. One of my cats will get high numbers in the 400s if she gets just a couple pieces of dry food as she is very carb sensitive. If you need help to get your cat to eat, try some fortiflora or some other method to get eating. It could be that it's a bit of nausea and just a 1/4 of pepcid will help with appetite. I was giving my cat 1/4tab pepcid (2.5mg) BID for her upset stomach and it got her to eat.

Don't worry about it all .... fur shots happen, and bounces happen as well. Stick to a dose because that's what works best for Lantus....

 

Thanks. I feel glued to the computer as the replies and info on this site are so helpful; it's becoming a bit obsessive! ;-)

I did order some fortiflora yesterday in hopes she'd eat the canned food exclusively. I've not heard of pepcid but will look it up. Mostly what Terra does is push the food around on the plate so she looks like she's eating but really just dispersing it, and maybe that's stomach upset.

I do intend to keep working with the protocol for Lantus and will keep her on this dose to 6 cycles and evaluate w/help on the Lantus forum. Slow but steady...Thanks for the encouragement.

 

Hi
if you do a search and chose the pzi forum specifically for "glucose toxicity", you can find lots of input from Dr. Lisa on the the topic. She refers to it as the "crux" of feline diabetes, and her comments got me to do a whole lot of reading up on it. The threads date back to around Thanksgiving, i think.
If you don't have any luck searching, let me know...
Carl

 

Hi Karen,
Welcome to FDMB. This is a great place to get help for Terra,

I am going out on a limb in assuming that Gayle meant my Max when she mentioned to you that there was a kitty
that went OTJ after being up to 6u of Lantus. (OTJ is off the juice)

Have a look at Max's ss in my signature and you will see how we went up to 6u and then just came crashing down.
I sometimes wondered the same thing about glucose toxicity.

This sugar dabce takes time and patience and sometimes our kitties just need more insulin.

 

I mentioned earlier that in PZI, Dr. Lisa has posted about "glucose toxicity"....well since I knew what I was looking for, I did the search and here are three threads that she has posted in within the past 3 months. Lots in them about glucose toxicity, and also good information about "bounces", dose adjustments, all sort of great and useful information. They are listed in the order they happened over a few weeks, with the last one containing the best information about glucose toxicity specifically.
Great reading for everyone!
http://felinediabetes.com/FDMB/viewtopic.php?f=24&t=57769&p=627507&
http://felinediabetes.com/FDMB/viewtopic.php?f=24&t=58009&p=630767&
http://felinediabetes.com/FDMB/viewtopic.php?f=24&t=58953&p=642503&
Here are a couple of excerpts:

Although this case involved PZI/prozinc, I think that Dr. Lisa's "usual" insulin is Lantus, so that might help you out as well.

Carl

 

A lot to think about in all this lot. Thanks for digging up these links Carl.
We need a head-scratching Icon.
Nat