4/20 Hunter, AMPS 256, +2 249, +4 276, +6 410, +10 376

[Brittanv]

Hi everyone,
Just joined the message board, still trying to figure this out...

TL;DR:
Hunter was diagnosed a month ago, the vet started him on 2 units of Lantus twice a day. We haven't seen normal urine glucose numbers yet. I performed my first blood glucose curve today to rule out the Somogyi effect. His curve was wonky, despite only getting food at his AMPS. Any thoughts? Vet wants to continue increasing insulin.

Long story:
Hunter was diagnosed with FLUTD about six months ago- was having trouble urinating and was peeing outside of the box and was generally uncomfortable. We went through a series of treatment options until we finally hit a sweet spot putting him on Amitriptyline (which I am now in the process of tapering him off of, since I read that it can cause insulin resistance) and the prescription Science Diet c/d. He packed on the weight until finally we noticed him spending a lot of time at the water fountain and peeing a ton. Brought him to the vet and he was diagnosed with diabetes mellitus. Vet put him on 2 units Lantus twice a day and suggested a prescription diet. I didn't bat an eye at 2 units- figured this was standard and it was because Hunter is a big boy (19lbs).

I was unsure of the prescription diet, having been burned before by the Science Diet c/d. I found some low carb foods and changed his food to Tiki Cat and FF pates only, plus the insulin. His polyuria and polydipsia improved greatly but he was still very hungry and urine glucose numbers were around 1,000. Vet increased to 3 units. Finally got his urine glucose numbers to around 500. Vet wants to increase to 4 units.

In my continued research on diabetes, I found you guys and learned that it is nutty to start a cat out on 2 units of Lantus immediately! I was concerned he might be exhibiting the Somogyi effect and that increasing his insulin would only make the issue worse. To rule that out, I researched and then performed a blood glucose curve today. His numbers make no sense to me!

Is it possible I missed a drop between AMPS and +2 and he really is reacting poorly to too much insulin?

or

Is he not on enough insulin? Is he insulin resistant from the months of Amitriptyline?

I don't know what I'm doing, here!

https://docs.google.com/spreadsheet..._qkaShatAZnbPxXt4PvOhlXEnSkP2aeRPshQo/pubhtml

 

[Sue and Luci]

First - WELCOME to the LB&L forum!

None of us knew what we were doing on Day 1 - so don't feel alone!

Be sure to read this first:

https://www.felinediabetes.com/FDMB/threads/posting-guidelines-please-read.231511/

and

https://www.felinediabetes.com/FDMB/threads/the-basics-new-to-the-group-start-here.18139/

Those two will really help you get your footing here. Excellent job with your first title! So all you need to do is create your signature and you can embed your SS link in that - don't worry if you don't get it right away - I didn't - it takes time to sort out all the details of posting, etc.

And forget about that Somogyi effect stuff....it's not relevant...

Also, it's time to be sure to depend on your blood glucose readings and not on urine glucose as far as making decisions on increasing/decreasing.

You're just getting started with Lantus - which is a depot insulin - it's a hormone and takes time to build up in the 'depot'. You'll hear that term used around here a lot...

We usually recommend that folks select a dosing method - SLGS or TR (find out more info in the linked materials above about that). Decide which method you wish to follow and then make your decisions about increasing in .25 increments initially. If you increase too fast you might pass a good dose and not hit that sweet spot dose...

So anyway...keep posting, ask lots of questions and look around at other condos and Spreadsheets - it helps enormously to look around

Have a great evening and welcome again!!

 

[Katherine&Ruby]

Hi Brittanv, and welcome to the Lantus forum. I know how overwhelmed and freaked out you must feel right now but you've definitely come to the right place. I was very emotional, felt like I was stumbling in the dark, listening to vets who were not as well versed in kitty diabetes as the moderators and senior members here. Once I started following this forum, reading all of the sticky notes and looking at the spreadsheets of other cats, only then could I calm down and trust that everything would be all right.

That being said, you've only got one day of data, so it's hard for anyone to have a crystal ball as to what is going on with your cat. The only thing I'd have to add to what Sue said is if he's getting too much insulin, he would be giving you very low numbers below 100. So far, you haven't tested enough to know whether or not Hunter is going low, and the possibility of him dropping really low between AMPS and +2 is highly unlikely as kitties on Lantus often experience a rise in numbers from food (I am assuming you are feeding him when you give him his shot). Lantus usually kicks in somewhere between +2 and +3 hours after a shot, and then reaches its nadir or lowest point somewhere around +6, but this is not a hard and fast rule and until a kitty gets regulated, the nadir can move around a lot, which makes testing important. Seems like you've got that down though, so bravo to you!

I'd suggest that you get your signature up, read about choosing a dosing method, asking tons of questions about them before you make a decision, and we will help you each step of the way if you need.