1/17/10 - HELP - Yo-yo'ing BG numbers - dosing advice?

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cjtalbot

cjtalbot

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My cat Buddy was diagnosed with diabetes over the holidays 2009. I've been giving him his insulin & switched him to a completely canned food diet. He sometimes throws a fit & won't eat his canned food (usually the ones that are "better" for him like EVO or Merrick or even sometimes the Wellness stuff) - but usually will eat any of the Sophisticat / 9Lives / Special Kitty foods for the most part. He still begs for dry every morning, but hasn't had any for almost 3 weeks.

At first, his numbers were still high, but now they're yo-yo'ing. He goes from some of his lowest numbers to some of his highest numbers on the same day 12 hrs apart (mid-100s to mid-500s). I can only give him his insulin at 8am & 8pm (Lantus) each day, but even that is sometimes problematic due to my work & school schedule. I check his numbers in the morning & they're "normal" numbers (in the < 200 range), so can't give him his insulin. But when I get home, he's hitting 500+.

It seems he is good for 2-3 days, then does this super-low, super-high numbers, then goes back again. I've tried to compensate with a little more / a little less insulin based on his numbers, but not sure if that's the right thing to do.

Today is another example of him hitting low numbers, but I've watched him eat every hour or two at least so far today...

Check his spreadsheet for full details - even includes what he's been given to eat each day & whether he ate much or not.

ANY ideas / suggestions would be GREATLY appreciated!!!

Thank you.

CJT
 
Hi CJ,

I am not one of the more experienced people here. I'm rather new myself, since I joined in mid-to-late December. I am sure someone with much more experience will be along soon to help you out.

In the meantime, I CAN say that I have learned the great importance of consistency since I joined here. I knwo there is a tendency to look at a BG number and want to make a change based on that. But, especially when there are big swings, there can be other things going on than the obvious. A very high number, for example, can be a reaction to a very low one earlier. So when we see the high number and want to adjust dose upward based on it, we are inadvertently making the problem worse instead of better.

I think you have done the right thing in changing to all canned and that will go a long way toward helping your Buddy get better. Hang in and wait. Someone will be along shortly, I'm sure!
 
Hi Welcome to LL. Have you read all the stickies at the top of the page? Did your vet start Buddy on 2u? We usually do not start cats on 2u. You are also dose hopping according to your spread sheet. You cannot do that with Lantus. Read all the stickies, I'm sure someone will be along with more suggestions shortly. IMHO his numbers reflect the inconsistent use of lantus. The cat foods you mentions are they low carb. There is a list Janet & Binky's food chart with all the varieties of LC. Do you have any more questions? Does Buddy have any other problems?
 
Please do not give him any insullin. Try and feed him small meals to get his numbers to rise a little. Do you have any high carb food? Not dry. Also get another test and post the number.
 
Hi there,

welcome back, I've linked the thread when u were last here in Lantus Land. For others to view back.

viewtopic.php?f=9&t=1028&p=8544#p8544

I have to agree here with the others, how important it is to remain consistent when dosing lantus.

Please, take some time to read the information stickies again up above.
Here in the lantus forum we follow the Tilly Protocol, start low, go slow.

PLEASE READ:
viewtopic.php?f=9&t=2963
viewtopic.php?f=9&t=1581

We also have some very experienced members who often offer their knowledge and support on staying consistent and following the protocol.

Please ask if you don't understand anything, we will be happy to help you.
 
I've read all the notes on here about dosing, but haven't read anything about what to do about this yo-yo'ing.

All the foods I'm feeding him are 4% carbs or less per the site listed for canned foods.

I just tested again & it's still "normal" bg's -- but usually when the morning #s are low (8am) & I don't give him insulin, then when I get home at 8pm they're sky-high.

My vet had me start at 2u / 2x a day.

I've been watching him & he IS eating about every hour or so all day today, so his normal BG's aren't because he's not eating.

I'm trying to figure out what the "right* way to handle this kind of shift in BG #s that's occuring every 2-3 days or so... Am I seeing it because he shouldn't be getting any insulin anymore, and therefore should just let the 500+ numbers ride themselves out without insulin? Should I be looking at lower numbers? The 2u / 2x a day wasn't bringing his numbers below mid-300s, so I had looked to up his dose to 2.5 & now I'm getting these swings.

Thanks.
 
welcome CJ!

The first thing to do, since you're getting preshot readings that are lower than you are comfortable shooting, is to reduce the dose a little bit. That should bring those lower numbers up a little bit and leave Buddy shootable every 12 hours.

The reason he is going high afterwards is that whenever Buddy hits lower numbers (green or maybe even low blue), his liver thinks "oh no, danger!" and dumps extra glucose into his blood to try to prevent hypo. He is not in danger of hypo at these numbers, but his body is so used to living in high numbers that it *thinks* these numbers are dangerous and reacts anyway. It is normal, we call it "Liver Training School" because the best way to make this stop happening is to train the liver by showing him lower numbers over and over again until his body gets used to it.

I would suggest lowering the dose to 1.5 units to see if it levels him out a bit. He might end up needing more than that, but that should bring the numbers up a little until you can collect some data and get used to shooting low. Soon you won't worry about shooting in the 100's, but I agree that right now you don't have the data to do it.
 
Seeing how your cat is responding to Lantus is done by spot checks thru each cycle.
If you work during the day, that's fine, an out the door spot check is recommended....
we suggest spot checks on days off, weekends,
plus you also have the evenings to squeeze in a couple of spot checks,
a before bedtime check is always recommended.

From the stickie : New to the Group:
Learn how YOUR kitty is responding to insulin:
Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
Peak/Nadir - the lowest point in the cycle
Duration - when the insulin is strongest or works the hardest
How to do a Curve

Example of a typical curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
 
Yes, that was my initial reaction when I read the subject line...inconsistent dosing causing the yo-yo effect. I think you will see the two numbers becoming closer together once you stop skipping shots and the way to stop skipping is to get the BG to a number you consider shootable....by decreasing the dose...Libby knows what she's talkin' about! :thumbup
 
In addition to what the others have pointed out, I think you will better understand your cat's numbers if you are able to get more spot checks. I wrote this in another condo yesterday:

Sienne & Gabby said:
With respect to spot checks, the more data you have, the more confident you will be about making decisions about both dosing and shooting. It will also make it easier for the experienced members of the Board to help you make those decisions. The more data there is, the more evident your cat's unique pattern of insulin needs and use will be.

So, what does that mean and why is it important? Right now, your numbers are high. That could be for a couple of reasons. One reason is that your cat may not be getting enough insulin and his dose needs to be raised. That's the obvious explanation. The completely counter intuitive explanation is that he could be getting too much insulin. When this happens, numbers drop low at mid-cycle and then bounce up to high levels at pre-shot times. If you don't have spot checks, all you see are the AMPS and PMPS numbers and you then raise the dose and the cycle repeats. The only way you can know about whether a dose is effective and how it is working is to get spot checks.
Click to expand...

Getting more spot checks will give you greater insight into how the dose is working.
 
Thanks guys - this is helping a lot.

It's hard for me to get all-day cycles, even though I know it makes sense to do & helps with these decisions. I've tried to catch them today & it looks like he's not spiking today at all... Staying pretty constant, despite eating all day every hour or two. If he's under 200, I'm not going to give him any insulin, but if he spikes again before bed or in the AM, I'll look at reduced numbers.

Thank you again for the feedback - it has been very helpful with understanding my cat's current situation.

CJT
 
I understand I need to be consistent, but when his BG has been <127 all day even without his morning insulin AND he's been eating all day, I'm worried he'll drop too low - especially since I've read 40/60-120 is "normal" for most non-diabetic cats. What if he's at the point where he doesn't need it & I've just been making things worse by giving him any insulin at all at the spikes? I know only testing will help answer this, which is why I've tried to do that today as much as possible...

Thanks.
 
I thought Libby posted some suggestions for you. What time do you have to shoot? I just don't think skipping shots is helping him. Too much insulin, not enough? Maybe they will suggest you start over and go from there. Good luck. Keep us posted please. I know working is difficult trying to get spot checks. A lot of us have that problem but you will be able to figure out something to get the checks. Before bed is also very important.
 
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