Help. please? Lantus, rebound? I need help with dosage.

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gremlinthekitty

gremlinthekitty

Member Since 2014
Hi, I'm Heather, my cat is Gremlin. He's 14 years old, eating only Fancy Feast Classic, and was diagnosed in 2010. He's been OTJ a few times, but is back to using insulin now, following a tooth infection, and possible dry food ingestion in Dec.
I was told on the message board on Facebook that his chart looked like a possible rebound, so I've been lowering the dose. As you can see from the chart, he's been on Lantus on and off since 2010. I've never had this problem before, though. In the past, he has always had lower and lower numbers/dosages until he goes OTJ.
After talking to someone on FB, I decided to go back up to 1.5 units last night, but it made his numbers go back up...
I don't have any experience with rebound, and I don't really know what to look for. I need help regulating his dose.
Here is his chart, like I said, the chart starts in 2010, so be mindful of dates.
https://docs.google.com/spreadsheet/pub ... utput=html
 
Re: Lantus, possible rebound? I need help with dosage.

HI Welcome to LL! What you could be seeing today could be NDW (New Dose Wonkiness) as we call it here. Often when the dose is increased the BGs will rise as the shed rebalances itself. We usually wait 6 cycles (3 days) and voila! Things settle down.

What jumps out at me from your SS is that one lone green a few nights ago. You seldom get night time tests and Gremlin could be going low at night and bouncing by the next morning as the liver goes into gear. This isn't the same thing as rebound which is consistently high numbers on too high a dose.

My advice is to get in a few night time tests to see what is happening then (cats typically go lower at night). Second, you just have to wait out the cycles for the shed to balance w/ these long lasting insulins. We recommed getting a pair of "Patience Pants" ;-) , all the beans here have worn out more than a few pair!

One last thing, could you change the "ccc" in your SS link to "pub"? It takes a really long time for the "ccc" version to load for those who want to look and give advice.
 
Re: Lantus, possible rebound? I need help with dosage.

Hi,I can't advise you on dosage,but it might help if you posted again,leaving out Lantus and put "please help advise needed" when the experts log in they first check for people who need help,this hopefully will bring you a quick response.Good luck.
 
Re: Lantus, possible rebound? I need help with dosage.

Hi Heather and Gremlin and welcome to Lantus Land,

I'm not sure I understand what you mean by "rebound". I think it may be one of those old concepts that has been discredited. In looking at Gremlin's spreadsheet I notice that you do not seem to give each new dose much time to settle in and that you seem to be frequently going up and down in dose, sometimes by large amounts. I suggest that you read the TR protocol in the "Stickies" (informational posts at the top of the Lantus Forum). Also read the "new to the group" sticky. Lantus dosing is based on the nadir (the lowest point in the cycle--when the cat's blood glucose number is the lowest), usually around the mid-point of the 12-hour cycle. It is not based on the pre-shot number. This is why it is essential to get blood-glucose tests at times other than AMPS and PMPS. If work prohibits you from getting home in the middle of the cycle to test, try to get that information on weekends or in the evenings. Many of your pre-shot numbers, especially those except the most recent ones, are below 100. This suggests that Gremlin's nadirs may have been very low--even too low--for comfort. Please don't make any changes in dose when you do not know what his nadirs are. All changes in dose should typically be by .25 of a unit (not by full units, as you have done on occasion). All changes in dose need time to settle in--at least 6 cycles (3 days) and often 10 cycles. If nadirs are high (see the Sticky on the TR Protocol), you need to raise the dose, not lower it.

I am experienced, but not one of the dosing "experts" here. One or more of them will be along later with lots of help. Several things about Gremlin's spreadsheet jump out at me however: the inconsistencies and jumping around in dosing; the fact that you are using the FreeStyle Lite meter. This meter does not seem to work for cats and has caused many of the people here much grief. It tends to read much lower than the actual number. So many of us were lulled into thinking that our cats were doing well, when in fact they had much higher blood-glucose numbers than we thought. I would suggest changing to a different meter (many of us use the Walmart Relion meters).

I'm glad that you and Gremlin are here and hope that you will get the help you need.

Ella & Rusty
 
Re: Lantus, possible rebound? I need help with dosage.

Supposedly rebound is when you are shooting too high, and it makes the numbers go higher? Am I wrong on this?

Anyway, obviously I have been changing doses too frequently. I've been trying to stay more consistent lately, but I've also been following advice from another forum.
I didn't change by an entire unit, though, until someone on FB forum told me about rebound, and they said I should go down from 3 units to 2 units. Then from 2 to 1.
I usually only increase or decrease by .25 or .5. I thought it was OK to do after 2 days of testing.

Are freestyle lite strips really a problem? Because I just bought another 300 today... sigh... I have solo strips (you can see the reading they give me in the notes) They test much higher than the freestyle. and I've used novamax, which tests lower than freestyle. Wave sense seems to test about the same as freestyle. Also, his behavior seems to coincide with the freestyle being accurate. He gets hungrier when his number hit about 70 or below. I don't want to have to go out and buy a whole new testing system and strips unless it is necessary.
 
Ella is right about Symogi Rebound, it is a theory, but never proven and now tends to be discounted. Many people confuse rebound w/ bouncing, which is real. Bouncing is when the BG drops too low and the liver produces glucagon and counter regulatory hormones to prevent hypo.

I thnk it is at the higher ranges that the Freestyle lite has had odd reading for a number of members. I'd certainly use up the strips you have , but consider getting a different meter. You can save a lot of money by going w/ one of the meters below, the cost is really in the strips, not the meter itself.

Some have had problems w/ the Relion Prime as well. The Relion meters most here use are the Confirm or the Mini which use the same strips. The Confirm/Mini strips are made by Arkray whose Glucocard 01 uses the same strips as the Relion Confirm/Mini. Do you buy retail or online? You can basically get a meter free from ADW and you will save a ton of money on strips as well. Here is the ADW link, the Glucocard 01 has the dark blue box.

I really like the Agamatrix Presto. It has a top rating from Consumer Reports and the strips are even cheaper. In a pinch you can get the strips from Target for their Up & Up meter which is made by Agamatrix and is the same as the Presto, just rebranded like the Relion Confirm is for Walmart.

All that said, once you decide on a meter stick with it. All readings are relative (meters only have a +/- 20% accuracy) and you will just give yourself a headache trying to compare too often.
 
Thanks, I'll look into those links. [Edit, never mind, figured out how to publish, changing it now -What did you mean about changing the ccc on the link earlier? Not sure how to do that.]
I actually started out using the agamatix. But I ran out of strips and couldn't find a deal. It was a re-branded wavesense, but same machine.
Ann & Tess said:
Ella is right about Symogi Rebound, it is a theory, but never proven and now tends to be discounted. Many people confuse rebound w/ bouncing, which is real. Bouncing is when the BG drops too low and the liver produces glucagon and counter regulatory hormones to prevent hypo.

I thnk it is at the higher ranges that the Freestyle lite has had odd reading for a number of members. I'd certainly use up the strips you have , but consider getting a different meter. You can save a lot of money by going w/ one of the meters below, the cost is really in the strips, not the meter itself.

Some have had problems w/ the Relion Prime as well. The Relion meters most here use are the Confirm or the Mini which use the same strips. The Confirm/Mini strips are made by Arkray whose Glucocard 01 uses the same strips as the Relion Confirm/Mini. Do you buy retail or online? You can basically get a meter free from ADW and you will save a ton of money on strips as well. Here is the ADW link, the Glucocard 01 has the dark blue box.

I really like the Agamatrix Presto. It has a top rating from Consumer Reports and the strips are even cheaper. In a pinch you can get the strips from Target for their Up & Up meter which is made by Agamatrix and is the same as the Presto, just rebranded like the Relion Confirm is for Walmart.

All that said, once you decide on a meter stick with it. All readings are relative (meters only have a +/- 20% accuracy) and you will just give yourself a headache trying to compare too often.
Click to expand...
 
Yeah, I think the full name is the Agamatrix Wavesense Presto. I actually have the Target version, but buy strips online from ADW. I like the Target version because it's RED and I can find it easily. Plus it's cool looking! ;-)

Looks like you figured the SS link out because now it says "pub" not 'ccc". You have to have the ccc link in order to get into the SS to edit it. Since we don't need to do that, a "public" (pub) link is all that is needed. It's kind of like a pdf version and much quicker to load. We also usually add them to our signatures on the bottom of each pst, so it is right there and doesn't need to be searched for when someone needs to look at it. To create a signature click on User Control Panel on the left in the light blue bar on top of the page, click on the Profile tab and select Edit Signature from the list on the left. Type in whatever you want to show at the bottom of your posts such as : date diagnosed, age of cat, meter used, food ………and a link to you SS. You need to use the BBCode [URL}paste your SS link here[/URL} and make sure that it reads w/ the pub in the middle.

For example:
  • here is the link I use to get to Tess's SS to edit it:
    • https://docs.google.com/spreadsheet/ccc?key=0AuZ-0a5jXFjAdFZyU3FpUDg0cldMdW5aRUg1M21xOWc#gid=26
    when placed in my signature it looks like this:
    • https://docs.google.com/spreadsheet/pub?key=0AuZ-0a5jXFjAdFZyU3FpUDg0cldMdW5aRUg1M21xOWc#gid=26

You can also name the link so the whole string of code doesn't show, but this is enough for now.
 
What great picture and a really nice intro too! You might want to add a link to that when you get your signature set up too.
 
Welcome to Lantus Land.

I would strongly encourage you to read over the Tight Regulation Protocol sticky. There are a few guidelines that most of us do our best to adhere to -- dose changes are usually made in 0.25u increments. This will allow you to make sure you don't increase past what may be a good dose for Gremlin. Likewise, we try to give each dose at least 3 days (6 cycles) to settle.

For now, how about sticking with the 1.5u dose. I suspect it's not enough insulin but it will let you get the basics in place. You want to do your best to get at least one test, in addition to your pre-shot test, every cycle. Some cats experience lower numbers at night so getting some PM tests will be important to make sure that Gremlin isn't bouncing.

Generally, you don't want to decrease a dose because your cat's numbers bounce. We differentiate between chronic Somogyi rebounce vs. bouncing. As other noted, the former has never been proven with long-acting, depot -type insulin like Lantus. However, bounces do happen when numbers drop low or drop fast. It's a protective mechanism of the liver and pancreas whereby they release a stored form of glucose and counterregulatory hormones. It's annoying but not dangerous.

Please let us know if you have questions. We're all here to help.
 
Alright, thanks, guys.
His numbers were looking a little better this morning. He's been high for a long time now, which worries me, I've never allowed him to be high for this long before. But I should wait the full 6 shots before I increase, right? When I increase, it should be .25 unit?
 
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