Bouncing vs. legit need for 3 units of Lantus??

Hi. I'm new to the board, and I've been over at Feline Health for the past couple of days trying to get a handle on all of this.

I really need some help before 9 a.m. in the morning. -- some advice from someone who is very familiar with bouncing. Does anyone know someone on this board who knows a lot about it, and if so, could you tell him/her about my post?

Max's dose was increased from 2u to 3u on Thursday, March 8th, and I used a brand new pen just in case my donated pen was no good. He seemed to be doing well with the 3u dose from the morning of March 9th . He had a BG reading of 209 at 6.5 hours after the dose and a reading of 264 at 11.75 hours after the dose. I thought that 264 right before the next dose was due was really good news. However, someone cautioned me that 3u for a 9.8 pound cat is an awful lot, and so is an intial dose upon diagnosis of 2u, in general. Also, an increase of one full unit is quite a bit at one time. The concern is that the high BG readings I got on March 7 were the result of bouncing from the initial 2u dose being too high.

The history is that on March 7th, in the evening, the reading was up at 600 plus pre-shot (6 p.m.)!!!!!! This was after he had had no insulin since 11 p.m. the night before. I gave him 2u of Lantus (from a donated pen), and the BG value dropped to around 450 at about 4 hours after the shot. This could have been due to bouncing from having an initial dose that was too high. However, the readings after the increase to 3u were so good.

The evening of March 9th, I had accidentally loaded the syringe with only 2u after the 264 reading, and my husband gave that to Max at 9 p.m. while I was with the baby. When I realized the mistake we decided to leave it alone and see what happened. At 6.5 hours after the shot Max's BG was 559 and the re-test showed 500. How does the fact that he had such good readings on 3 units during the day of March 8th, and very high BG readings after only 2u that evening play into the analysis? Was he bouncing? Was he in legitimate need of 3u?

If I stick with 2u, and increase incrementally in .25 amounts every 3-7 days that means leaving him at these very high kidney, nerve and blood vessel damaging levels for who knows how long. He has had kidney problems in the past. I can't take him to a specialist or to the UC Davis clinic. I don't want to drive him to the UC Davis clinic in San Diego because he gets sick in the car if we go too far. I think the stress on him would be worse than the advantage.

Background: Max's BG upon diagnosis was 508 on Feb 2nd and 475 on Feb 3rd with UG over 1000. He had CRF diagnosed in Sept of 2011, and had a BG at that time within the normal range. His CRF was fully controlled on Feb 3. He eats about one to one and a quarter cans of Hills m/d wet per day. I'm using a ReliOn Confirm meter that I tested at the vet's (with vein blood). He will be 16 in May; he eats about one to one and a quarter cans of Hills m/d wet each day, He takes solidago, Standard Process Renal Support and Rehmannia Eight for kidney support. He has a water fountain, and I do have ketone sticks and Karo syrup on hand.
Does this information help to clarify anyone's opinion on whether he simply needs 3 units or whether he is bouncing? I am feeling so bad for him having such a high BG right now, but I'll have to let it go until 9 a.m.

 

Good Morning,

I probably have or should say did have the Queen of the Bounce in Musette. That said it is really hard to tell right now if Max is bouncing right now or not with the limited data. But since he is eating Hill's MD which is 14% carbs (too high in carbs for a diabetic ideally needs to be below 10% and most try for under 7%) there is a good chance that he is going to take more insulin than a cat on a lower carb diet. So yes, he could very well need that 3u of insulin at least while he is on that particular diet.

The thing with Lantus is that it takes a couple of days to truly know how a dose change is going to work, it needs to "settle" and often after a dose reduction you will see higher numbers at first.

So you kind of have several choice right now you can either raise him back up to 3u and keep testing to see if you are getting any ultra-lows or steep drops as they can also bounce when they take huge plunges. Or you can hold the 2u for 3-5 days to let it settle and run a curve to see where he is at and base a dosing decision on that or, start him all over at 1u b.i.d. let that settle and see if you get lower numbers after any bouncing clear.

However, with that said the biggest thing that will help bring his numbers down now that you are testing at home would be to find a food that he likes that is under 10% carbs that also works for his CRF which I have no experience with, but I believe that at least Friskies Special diet meets those requirements. Not sure if anyone over on health have given you this link or not, but this is the chart that most of us use to pick our cat's food. Binky's List

Mel, Maxwell, Musette & The Fur Gang

 

Morning!

Definitely switching to a lower carb food will help, because otherwise you will be balancing those carbs with higher insulin. I don't have experience either with kidney problems but I'm sure there's lots of people that can offer advice. I have read numerous condos about low carb food for kitties with CRF, so you can do a search as well if you have time as well (which I know is really limited with a little one at home).

Lantus does take a couple of cycles to settle before you see the true numbers of that dose. It works on a shed, so you have to fill the shed first and after that, the remaining amount will go to do its work. If you start switching doses, then the shed will either have to drain or keep filling before it has effect, so in either case, it takes a couple of cycles.

Is there any way that you would be able to create a spreadsheet? If you go in the Tech Support Forum (I would post the link but I'm on my cell at the moment so it becomes quite complicated), all the info on how to do it is there, step by step. If you need help, just let me know and I'll go on the actual computer to get the links, etc. It makes inputting numbers a lot easier and its colour coded so its easy to see trends, etc. Plus you can attach it to your signature so anyone can have see it and give advice on what they see kinda thing.

In all cases, I really don't think that a jump from 2.0 to 3.0U is a good idea because that's too much of a jump. Generally, its best to do increases by 0.25U, just because a small change could make a big difference. Organ damage, etc does not occur so quickly. That's with sustained high numbers over an increases period of time. I would instead focus on finding that perfect dose, and that comes with gradual increases. But, that's my opinion and what I found worked for Kitten. I did increase 0.50U (from 1.0 to 1.50) the first time, and from then increased by 0.25 (to 1.75) Had I jumped 1.0U from the beginning, I would probably have had a hypo because it wouldve been way too high. And Kit is a big guy - weighing 25lbs before dx, and probably now around 18-ish.

I did just take a peek on the Health Forum and see that other eyes will be coming soon too. But you holding the dose for 3-6 days is a good idea. Then if you can do a curve (testing every 2 hours), or mini-curve (every 3) so that you can see how the dose is working throughout the day would be great. So then you can make a decision on whether to increase or decrease. Remember that Lantus is dosed based on nadirs (lowest point in the cycle).

Please let us know what you decide to do and keep us updated!

 

It's early and I am trying to figure out what's up with the numbers by your post and not a ss.... having a ss makes a quick glance tell you what's going on and what needs to be done.
I think this link is the most recent for making a google ss:
Create your Spreadsheet updated Dec2011

OK food needs to be low carb and wet if at all possible, but if not possible, you WILL need more insulin to balance the extra carbs like the others have said.
Here's where I say that dose has nothing to do with the weight of a cat, except maybe in the beginning when you want to err on the side of caution and start really low. You give what's needed. There was one cat who was getting 20u of insulin but dropped down to 1u after changing the diet from dry to low carb wet. Food is where you need to look first when you are thinking dose calculations. I can't comment first hand on all the vet food that is pushed on owners, but most cats don't like it, the carbs are high, and the ingredients are nothing to write home about. There was only one vet food that I saw help my Oliver when he was terribly sick and that was A/D which he actually ate after not eating for a couple days.
For food, look to raw or just some of the foods under 10%carbs on Binky's list.

Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition
List of Low Carb Healthy Treats

OK to the dose. Full unit increases are not good, unless you are at a dose like 15u and go to 16u. .... it's too big of a jump to give that big of a % of an increase. Going from 2u to 3u is a 50%increase, and that's too much. Oh sure, you may be OK with 3u, but with the shed, you are going to see a big jump in the numbers on the first few shots because the shed needs to fill. It's better to increase in .25u or .5u amounts.
The pen you are using, you are extracting insulin with a syringe, yes? Or are you using those like needles that attach to the pen and then dialing the dose?

Here's what I sort of see from your post; even with being relaxed, it's impossible to say much, but will give it a try.
Feb2 - 508
Feb3 - 475
Wed Mar7 - 2u
pmps/6pm 600+ gave 2u shot
+4 - 450
Thu Mar8 - 3u (up 1u)

Fri Mar9 - 3u
ps - ?
+6.5 - 209
+11.75 - 264
pmps/9pm - 2u shot
+6.5 - 559 / 500

Some questions:
When did you first give insulin shot, what was the dose.
Are you keeping with shot times 12hrs apart as is needed for Lantus.
Are you feeding any other foods or just the M/D
Are you using syringes with the 1/2 unit markings.

One thing that's bad for good numbers with Lantus is jumping around with the dose. You muck up with the shed and you are going to see numbers bouncing all over the place.
Changing shot times is not good either; and you mentioned shots at 6pm and then another one day at 9pm. When you delay a shot, you will see high numbers, and if you shoot late and with a decreased dose, you are really going to see higher numbers!

I think you have a good start going; you are using a nice meter, able to get numbers ok, and feeding wet food. Now you just need to get your numbers into the sheet so that lots of people can help you at a glance. I don't even know if I read your info correct, but if on a sheet, there would be no misunderstandings and then wrong advice/suggestions.

I bet you need to settle down the shed, so I would go down to 2u and hold that dose, for 3 days / 6 shots and all shots 12hrs apart. Be sure to test before every shot, and then if you can get other tests in, great! The best is if you can do a few curves, just to see if the numbers are going very low mid cycle or if they are staying pretty flat.
If the numbers are staying flat at the 2u, you can move up to 2.5u maybe or even 2.25u.

Here are some links to help:
Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed

The below is a portion of the protocol followed on the TR forum, and it's a pretty good guideline to follow when it comes to adjusting your doses. I know that in the TR forum, they expect lots of testing and have other criteria, but here is not as rigid. You may well go along with no spreadsheet, and that's fine, but it's important to know that getting help will take a bit longer if your valuable data is not in one location.
People will ask you the same things over and over and over and over, but if you put stuff like meds and other issues like foods into a spreadsheet, along with the test numbers, people take a look and can give you suggestions in minutes.
"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.

For you, right now, look to the first part.... hold a dose, where you are now, will fill the shed and let it settle. After about 6shots, you will see how that particular dose is working, and based on your tests mid cycle, your +6.5 ones are great, you can say OK I need to go up, or stay put or go down. Your 6.5 test numbers are the most important ones.

if you stick with the 2u for a few days, get some data, some tests at shot times and during the cycles, you will have some good data for making decisions.

 

Thank you all! You are wonderful. I'm going to stick wth 2 units for now. I need to get him tested and dosed now. I'll update later when I can.

 

Thank you all for checking my post and responding. Max's shot at 9 am of 2 units resulted in a +5.5 reading of 487, a 6.5 reading of 443 and a reading 8 hours after the shot of 377. He finally peed in the BB gun pellets, and he is negative for ketones (double checked). If you have any thoughts on why his value would be dropping eight hours after the shot, I'd love to hear them, but I'll check the board to see if anyone else has ever posted on that subject before. I know the active period of the insulin can vary with the cat, but it will be interesting to see when it goes back up.

I suppose we all endure the annoyed, slightly confused, and eventually utterly dismissive look of a cat at times. Nevertheless, when he was trying to scratch a place to pee in those BB gun pellets after I had stabbed him in the ear 5 times in last day and given him subcutaneous fluids recently, while treating him to little bits of lard, he appeared to have concluded that I had finally gone off the deep end!

viewtopic.php?f=28&t=65674 (ORIGINAL THREAD)

 

Hi Dale-
I posted this in your original thread on health:

There could be many reasons that Max is still dropping. I understand there has possibly been inconsistency with shot times, there was a large increase (but now decrease), and did you maybe switch his food to LC today???

Please try to get a +11 and post if he is still going down.

 

Hi there,
I wanted to confirm that you are giving shots 12 hrs apart, yes? Be sure you stick to 9am and 9pm now, and if you need to change it, please post and get some help how to go about moving the shot time.

OK now to answer about the BG numbers.

You shot 2u Lantus at 9am.... what was Max's BG at shot time? It's very important to know what THAT number was or we can't say much about the next number, the 487 at +5.5. If I don't know what it was, I can't say if the 487 is good or horrible.

As for the 377 at +8, that's not a problem at all because some cats have very LATE nadirs, one of my cats has nadir at +10!

9am - BG ?........if you have this BG number can you post it? I think your meter should have a history, you can look at past #s
230pm - BG 487
330pm - BG 443
500pm - BG 377

Now, what is his BG at 9pm? If his BG at 9pm is even lower, don't shoot 2u Lantus.... it could be that your recent food change has resulted in Max needing less insulin, but you need to see where he is at 9pm, his next shot time.

if you can post what his test number is before the shot, someone can help you to decide if you give less insulin, the same dose or maybe even skip the shot.

 

Gayle and Carolyn,
You are both so kind. Max is doing fine for now - eating, peeing, and wanting to go outside for short periods. I'll post more a little after 9 am new time regarding his values, and see what we can do about the time change. I will really appreciate your help with that.

I hope your baby-kitties are all doing okay.

 

I am glad to hear your Max is doing fine! Remember to just think in 12hrs more than the clock.... if the shot's a bit earlier, it will be like a small dose increase, and shooting later is like a dose increase because you are using some of your spare tank of insulin.

Big pats for Max!

 

Hi. I'm too late to give the insulin an hour early anyway, but I was uncomfortable with that. Here are his numbers:
At 8:45 pm last night 386, at +7 262 and retest: 275, at 9:15 (new time which is +11.25) 331. I think it's safe to give it now, but I'll wait until 10:00 new time and try again to move the dose tomorrow.

Something strange happened yesterday, and I am wondering if his values are falling too fast: March 9 went like this:
9am HI (over 600)
+5.5 487
+6.5 443
+8 377
+11.75 368

Isn't it abnormal to still be fallilng at +11.75? Does this mean he's falling too fast, and is there some issue with that? Now that he went back up to 331 after being at 262 in the middle of the night, I guess he's all right for now.

Thanks for any replies I get. Ciao.

 

No, it's not abnormal to be falling around shot time; my Oliver is frequently lowest at his ps times, as that's his nadir.
I would not worry at this point about shooting early as he's got pretty high BG numbers and you want to get them under 250 all the time. Actually you are aiming for numbers under 100, so you have plenty of space to come down.

 

Thanks, Gayle,

I am so pleased to see that Max is close to 300 at shot time. What a relief! I hope this holds, but you are right, I will have to watch very carefully when he starts eating low carb food all day.

One thing is that I can't change his food all at once. When he was about, gosh, 10 years old, my roommate bought him a different food all of a sudden. I didn't think anything of it, but he became very sick. I found out that cats are so sensitive in that regard. I had to shove pills down his throat 2x a day for two weeks! So, I always mix an 1/8 of a can of new with old for day, then a quarter the next day, and so on. It seems to work.

By the way, if anyone doesn't know this, I discovered that a good coffee grinder will pulverize just about any pill you want to put in the cat's food.


Dale - Max and Emma's Mommie

 

No problem at all to go slow with the food change, but if you give Max a choice, you may find that he takes to the wet quickly. If he does, then no need to leave any dry out anymore, and if not, then just keep leaving less and less dry out.

For the pills, be sure to ask if it is allowed to grind the pills as some need to be given whole. Also, lots of meds are BITTER, so whatever you mix the meds with, Max could end up hating that item because it tastes like the ground pill... better to pop that pill back whole and he will not have the taste of it in his mouth.

Keep in mind that the dose you are giving builds up to fill the shed, and then the numbers should level off when the shed is full. Stick to the current dose for at least 6 shots, just to see how it's working and you just need to watch for much lower numbers.

 

Hi everyone,

Thanks, Gayle, for pointing that out. We always have to check with the vet before pulverizing pills.

I would think he should have the shed built by now. He's had 2u twice a day since early February. He never went more than 13 hours without a shot until March 6 in the morning when I did not give him a shot. Then I gave him 2u that evening, 2u the next morning, 3u that next evening per the vet, and 2u every 12 hours since then. How's that reasoning for shed building analysis? Do you, or anyone, think that there is any unspoken assumption in there that is not correct?

Right now, his +6 reading is 127 -- down from his pre-shot reading of 331. If he continues to drop, as he did on March 9th, all the way up until the 11th hour, we are in trouble. I hope he will do "the curve" as he did last night when he went back up by the 11th hour. I'm going to have to keep an eye on him this afternoon, and I'm going to feed him right now. Wish me luck!

By the way, he's been eating wet food since Sept of 2011 when he was diagnosed with CRF, but it was Hills k/d. It might as well have been dry food or it may have been even worse than dry.

Dale

 

Well that 127 was a good number to catch! A +11 is always helpful so if you get a lower than usual number at shot time you know if it is rising or falling. It will help you understand if you should shoot the regular dose, partial dose, or skip.

I have some time tonight...if you like I could use it to put a ss together for Max. It will be really helpful to have this so you (and everyone else) can see if /when an increase may be needed.

 

Hi Dale,
The shed adjusts every time to change the dose, and not all cats settle as quickly. Sure Max's dose should be well established so you can assume from any low numbers now that the food change is making a difference or the shed is too full for what he needs.

One of my cats has her shed settled from changes maybe in 3 or 4 shots, but my other always took his sweet time. There were times when we had been at a dose for 6 shots and I was about to increase on the next, but he'd come down lower in time for the 7th shot.

From a preshot of 331, to drop to 127 at mid cycle is great. I would think the dose is fine to have those numbers.

 

Hey All,

When I tested him at +6.25, I got 125 and on retest 127 - the SAME number as at +5. Sounds pretty good! Now, we will see what the food switch does.

Thank you, Carolyn, for offering to create the spread sheet. Let me take a look here right now and see if I have any problem with the logistics. If I do, I may take you up on that offer.

Tomorrow, I'm going to a funeral 500 miles away, and I won't be back until Wednesday. My husband will take care of Max alone while Emma and IgonZZZZZZEZZZZ (That was Emma.), Emma and I are gone. If he has any questions, I'll let him ask them, but hopefully all will go very well.

 

Carolyn and Everyone,

I did the spreadsheet, but thank you for offering to help. Now, Max's value went down to its lowest for the cycle that began at 10 a.m.: 111 at +9. I understand that at 70 I have to be vigilant for hypoglycemia, and that his value should not go anywhere near 40 on a human meter.

 

FYI, Whew! His BG bottomed out at 111, and now he's at 160 for +10.25. Looks like he's gonna be okay. (Big cheer)

Goodnight all. I'll check in with you on Wednesday. Good thought going out to all your SugarCats and your other babies, too.