Xuxu 1/8/13 AMPS >750 Diluting works!

I was pondering whether to raise Xuxu's dose from 2.25 to 2.50. If you look at 12/24/12, a daily curve at 2/50 was good in the morning, but he started crashing in the afternoon and I had to give emergency glucose. So I dropped to 2.5 for a week and on 1/1/13, a daily curve when down into the 400s, all day. But it also looked like there wasn't any carryover into the 2nd 12 hours. So it looked like 2.5 was too high, and 2.25 was too low. A modification might be to do the 2.5 in the morning and 2.25 in the 2nd half. This has all been with my protocol of "diluting" the Lantus.

But then came today. I injected the Lantus, and while reaching for the 2nd syringe with the sodium chloride solution, Xuxu moved and the insulin syringe came out of his skin. I still had hold of the skin fold, with the hair separate so I knew within a couple of mm of where I'd injected. So I could do two things, inject the NaCl near the same place, or just not inject it at all. I decided to doublecheck my previous results and not to inject anymore and see how effective the Lantus was without diluting. If you look at the Health Discussion link in my signature, I outline all my problems with high levels and how I cam to decide to dilute the Lantus.

So what happened. I decided to do a curve and have reposted the spreadsheet. Xuxu's BG stayed above 750 (the high level for AlphaTrak2) nearly the whole first 12 hr. AT 6 hrs when there was no sign of the Lantus being absorbed, I gave him a brisk massage on his side and played with him a bit to get him moving. This was a recommendation to get his circulation moving and get the insulin into the blood stream. It dipped his level to 720 but went right back up to 750 until his PMPS. I could definitely tell a difference in his personality. He was less active, drank far more water, ate less, didn't purr or want to be petted, and just acted like he didn't feel well.

At his PM shot, the same thing happened, he moved, the syringe came out of his skin. But this time, I went ahead and injected the NaCL as close to the injection site as possible. I'll let you know what happens tomorrow, although I won't be able to take a many readings through the night.

This was happening as I was looking up Levemir as someone has suggested I consider it. It sounds like it can be much more stable for unregulated cats. So I'm talking to my vet tomorrow about that possibililty.

 

Here is Gilor's work on Levemir to pass on to your vet.
1_Gilor_Chen.pdf

 

How is Xuxu doing?

 

I checked Xuxu's spreadsheet and I see you've started Levemir. Ooops - we didn't think to tell you to back off a bit on the dose when changing over! That 26 was probably scarey!

Be cautious with dose changes as it takes a bit longer for Levemir to stabilize at new levels.

 

I didn't see you post. Lantus and Lev functionally work the same. The same dosing protocol applies to both types of insulin. They are pharmacologically somewhat different but both are long-acting, depot type insulin. Looking at your SS, I see no differenct in Xuxu's response to Lev vs. Lantus.

 

This person is posting over in the Lev forum now, so I guess this thread is no longer going to be updated?

 

Yes, I've switched to Levimir and am posting there now. Still having problems with getting him regulated.

 

You switched insulins only a week ago, so you need to give the cat time to adjust to this insulin.

Regulation can take months with some cats, so you need to do what you can and the cat will decide on the important stuff like regulation.