Cat not responding to Glargine Insulin

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But then he will not have anything to eat all night long unless I set the alarm and ruin my sleep every night and get up at 1AM to feed him. I can't leave the wet food out as the other two cats eat it up before he does, and it costs a FORTUNE, the Royal Canin Diabetic Wet. If he has the tumors, I think I will just let them take their course. I simply don't have the money nor the resources here in Ecuador to address this type of surgery.
 
But if I remove the Diabetic dry food at night, he will have nothing to eat at all for several hours. I can't leave the wet food out as the other two cats will eat it before he does. The only other option is for me to ruin my sleep every night and get up at 1-2AM to feed him. If he has tumors, I will have to let the disease run it's course... as I have neither the resources nor the funds to opt for surgery here in Ecuador. He is already 17 years old. He probably would not survive the surgery even if I was able to do it.
 
Overnight are you able to separate him from the other cats? If you can, then you can put him in the bedroom with you, with food left out (you can do the freeze and thaw method) and this way you can be sure that only he gets it.
 
I have posted this text twice now but it keeps disappearing off the thread. Not sure what is going on.. so forgive if they all suddenly show up. I will consolidate as needed. If I don't feed him the Diabetic Royal Canin dry at night, then he will have nothing at all. The other two cats (plus the neighbors cat that visits at night), will eat any wet food I put down before he does, and the diabetic wet food is very expensive. I will have to get up at 1 or 2 AM and feed him then. If he has tumors, and getting it diagnosed here in Ecuador will be difficult if not impossible, and surgery is an option, I will opt NOT. He is 17 years old, and I doubt he would survive it. So I will be educating myself on the signs of organ failure for him, so if that happens I will say goodbye to him. It says that if the cat does not get stabilized after 4 months of insulin, it is probably the tumors.
 
It's showing up, maybe you are just having an internet delay.

It seems that there is some missing information... Is your cat outside the house or inside the house only? When you say the neighbor's cat shows up, I assume this cat is showing up outside the house and going to the feeding station you set up. which is why I am now asking where you keep your cat in or out of the house?

Which I then will repost this:

Overnight are you able to separate him from the other cats? If you can, then you can put him in the bedroom with you, with food left out (you can do the freeze and thaw method) and this way you can be sure that only he gets it.

That is the only way I can see to solve the problem of other cats eating his food.
 
heidi, i didn't remember that you were giving dry food. the dry food would change my suggestion about testing for a high dose condition. at least at this time. even a few kibbles of dry food can raise blood sugar and keep it there, so if Blackie is getting dry food daily, even literally 5 pieces of crunchies, that would create the condition where you'd be needing more insulin. We've had members do experiments with the dry food and it's amazing how it can affect a carb-sensitive cat.

it also explains high numbers, and erratic numbers. another likely scenario is that Blackie is sometimes getting lower numbers but bouncing from them. Bouncing is the cat's body's way of preventing a perceived hypoglycemic episode, even when the BGs aren't low enough to truly be a danger. Here's a post about that and about New Dose Wonkiness, which is the unexplainable phenomenon of increased blood sugar following a dose increase.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=46012

Here is Linda/Scooter's spreadsheet. Linda has 13 cats and was pretty sure that Scooter wasn't eating any of the dry food around because he didn't seem to be interested in it at all. But it turned out that when the dry food was completely removed from the house, Scooter went from 5.5u per dose to off of insulin in 2 very long days. Look at February 18 - the comment on the far right says that this is the day the whole house went off of kibble. Feb 19th was the last day that Scooter got insulin and he's been diet-controlled ever since. Dry food is powerful stuff. Going off of insulin doesn't happen to every cat, but we've seen it more than a few times when the dry food disappears. https://docs.google.com/spreadsheet/pub?key=0AqyJS-ud54lgdHU2S2FwczByM3YwU2JjRFduOWJLUHc&output=html

Don't despair. We do this all the time, and I think with a little more information & coaching we could help you change what is going on with Blackie. Your husband's +3 test will really help us be able to see what's going on.

i'll just add that i almost never look at the Main Health board unless someone posts over in the Tight Reg group and asks for help, or sends me a pm asking me to look at someone. I see your post because it comes up in my list because i've posted in your thread before. Hillary is great about checking Main Health and helping people. If you're really serious about getting Blackie regulated, it can be done. You'll need to get those night cycle tests sometimes, get rid of the dry food entirely (but be prepared to reduce the dose when you do), and be open to learning a little more about how this all works.

I'm glad you've hung in there this long. It gets easier as you learn more and understand why you're seeing high numbers and how to get rid of them. knowledge is power. Truly. And even if Blackie doesn't go off of insulin, you can learn what needs to be done to keep his blood sugar low enough (tightly regulated) to prevent organ damage from high blood sugar. It's possible. Hang in there! :YMHUG:
 
What do I do if Blackies BG before the night shot tests between 80 and 120? We have encountered this 4 times in the last week. I went ahead and gave him a lower iu insulin shot, but what ended up happening is we had to give him emergency "high carb" food and honey at +3 because he was going way to low (which pushes his bg reading at 6am into the 2 or 300's. Last night he hit 51 and scared the holy crap out of me. So tonight, actually in 1 hour, if he is in the normal range, I am thinking I won't give him any night shot. Instead, I'll check him again before bed... if he is above 120 at that time, I will give him a SMALL dose - like maybe 3 units? This is the hard time when he is finally responding really well to the insulin, to keep him in a satisfactory dose, but not go too low. I am happy if he is even stabilized in the low 100's eventually. He is always a bit high in the morning... but with the morning shot it comes right down by noon. We have had some roller coaster reactions the last few days so don't judge it by his recent numbers... I think we can start lowering the insulin dosage now.. this morning I only gave him 5.5. I suspect it will he will be in the low 100's at 6, but if he is between 80 and 120 - I dare not give him any as last night, he went to 50.
 
I would reduce the dose to maybe 5 or 6 units. You are getting too much of a drop on the AM shot which results in a very low PM PS.
 
[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

Glucose Reference​



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Examples of using the chart:

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)
 
hi heidi!

i'd really, strongly encourage you to not leave him unattended when you catch a number in the 50's at +3. It's very likely he spent a significant amount of time under 50 on the night of August 2nd and could very well have become hypoglycemic. I can't tell when Blackie's typical nadir (low point) in the cycle is, but it's very common for cats to continue to drop until about 6 hrs after their shots.

You want to continue to test until he has had at least an hour of rising numbers after you've stopped giving him carbs.

When he goes below 50, test every 20 or so minutes, and if he's below 50 give him a teaspoon of gravy from high carb food or a couple of drops of corn syrup or honey.

or you can post here and someone would help you through it. Yes it will mess up your sleep and take a lot of strips, but it will keep him safe. Hypos are nothing to mess around with and we see cats die from them - i don't want that to happen to you.

Lantus builds up in the body in a depot and sort of slow-releases. That depot size is related to the size of the dose. So his 6 unit shot this morning is still affecting him tonight, even though you gave 4u tonight. It can take as many as 6 cycles (3 days) for the larger dose's depot to reduce and equalize to a lower dose. My point is that he could still go in low numbers even after you give a reduced dose and i want to make sure you're aware of that.
 
The raw recipe looks good except that you don't balance the meat with bone - I also have Michelle Bernard's book and the recipe we use most for a raw diet was derived initially from her book as well, although I don't remember the raw butter and olive oil.

One of the most crucial matters about raw feeding is making sure that your cat has a proper bone to meat ratio. You have a good grinder but maybe you could use a plate with smaller holes. My cats don't even see the bone in the ground meat. I grind the chunks separately through a plate with bigger holes. I believe it is unhealthy to feed raw meat without bone or bone meal due to the imbalance. Dr. Pierson at catinfo.org discusses this here: Catinfo.org

My kitties are less hungry on raw food. I took all dry food up and threw it out for all my kitties in one day. They went cold-turkey off dry and survived. This meant, though that I had to give a before-bed meal which was at about 11:15pm. Their overnight hunger calmed down soon after and even with them being active at night, they don't seem to be bothered.

My heart breaks for you over your missing ragdoll. What a beautiful cat. Blackie is in good hands - you are here and we are here to help. We can hold hands, let you vent, let you cry and share in your successes!!!
 
Hi Heidi,

I hope you are still reading your post and I hope Blackie is doing well or even better than well.

I do have a small concern and I don't think it was picked up by anyone yet. If someone has I apologize. I'm still a newbie myself.

How are you 'warming up' your insulin? I noticed that you said you warm it up prior to shooting. In my limited knowledge warming it could impact the quality of Lantus if you are doing it in the vial. If it is after you draw into the syringe and you're handwarming, no harm done - I believe, someone correct me if I am wrong. I was just curious and I only saw your post today so I thought I might ask.

I keep my Lantus in the refrigerator at all times, draw it cold, and shoot cold. Simmie, who use to be a big bully at 22 lbs. doesn't care at all about the temperature, or even the shot, at all.

Just a thought.

:YMHUG: :YMHUG:
 
Well, am I the only one that almost killed their cat with a mistaken reading? This morning I read "502" - being very sleepy - but the meter was upside down... it was 205. I proceeded to overdose Blackie and didn't realize it. I had to go out at noon so I checked him early at 11:20 and his bg was 51. I quickly gave him some "high carb" canned cat food. His bg is now only 94 several hours later. I am NOT giving him a shot tonight if he is in the normal range. He is beginning to respond very quickly to the insulin, so we are slowly reducing the dose amount. Maybe this means good news in the long run. It is so hard to regulate him and when you do things like I did this morning, it seems like we will never get it right. Poor guy. We don't want to "chase" the numbers so if it is high, we just stick with the dose. We were doing good starting to lower it and then I did what I did this morning. If I had read it properly, I would have given him only 4 units this morning.

So what do we do when there is a normal reading (BG between 80 and 120)? I am going to wait and check him again at 10 or so, and if he is a little above normal... like 150 or so, I will give him only 2 units for the night, no more than 3 at this point. I am feeding him only the diabetic dry food at night. I think this will be fine for him as on a normal run of days, he is showing up ever lower in the morning. Low 200's now ... so he is going to be ok I think at night. If I could just get him down to the 100's in the morning reading, that would be good enough for me at this point.

I can't isolate him and I can't not feed him anything at all all night long.. a higher reading in the morning is better than him not eating all night. He is very active at night and so needs something. But like I said before, I think that as he levels out the Royal Canin diabetic dry food will be ok for him.

It is good to see that he is responding faster and faster now... is this normally what happens if we are lucky? Maybe this means eventually, in spite of his age and the fact that I suspect he has been sick for a long time, he may go into remission. Worst case scenario, hopefully I will be able to keep him in the normal or 100's range.

His ears are sometimes so dehydrated that I can't get any blood .... especially at the 6AM check. It's horrible to stick him so many times ....
 
Yes, I did that with ProZinc.

Maybe put a strip of brightly colored tape on the 'top' of the meter to visually cue you which way you need to read it.
 
It's horrible to stick him so many times
Click to expand...

Are you heating his ear before you stick it? It can really make a big difference. You can take a sock and put a little rice in it, tie it off and microwave for about 15-20 seconds, hold it to his ear for a little while before sticking. Another trick is to take a small pill bottle or film canister and fill it with warm water and use that to warm the ear. Test on your wrist like you would a baby bottle to make sure it's not too hot. The pill bottle also gives you something hard to poke against.
 
Hi Heidi!

It sounds like you are doing all the right things and this 'mishap' that you experienced in reading the glucometer is probably just one in a few mishaps you'll/we'll experience along the way. In my early days of testing I got so caught up in the test/feed/shoot (TFS for me) that I forgot the last step! I was so excited/obsessed to get the testing in I actually would on rare occasion, forget to shoot! HORRIBLE. Now I keep a chart up on a cabinet where I keep Simmie's 'pharmacy' inventory so I never forget his insulin again. Especially since his vial is out of sight.

Which brings me back to the question about the storage and management of your insulin vials. Would you let me know how you store the vial and how you handle it before and after you shoot? Just to be on the cautious side.

Some of us are very strong in all aspects of managing our furbabies' diabetes and some have a learning curve that requires us to provide some cues or reminders every day for ourselves to manage all the steps and scenarios we might run into. For me, it was the elation of getting a test done then remembering to shoot (I know that sounds really dumb) but for others there are so many issues along the way which needs some kind of 'poke' to remember!

You are truly fantastic. Love from me and Simmie to you and Blackie!
 
Suddenly in the past few days, Blackie is responding drastically to the insulin. Is this common? It is good (if I don't kill him first), as I try to find the "sweet spot" in the dosing. Maybe it is a sign that he will take himself into remission, even though he is old and has probably been sick for a long time?

When it is time to shoot at 6PM, If his BG reads normal or just above normal range, I have been NOT giving him any the last couple nights until later, and giving much less later. It seems we are now in the "dangerous" time where we could easily overdose him. I am erring on the high side as of yesterday, as if you look at my chart you will see I have almost killed him several times these past few days. Am I the only one struggling with this new stage? All the places I read say DO NOT GIVE INSULIN if the cat is in the normal range. And I have given before I read that, and almost killed him. This has become a chasing cycle now and makes it really tough to keep him regulated at any number.

I only gave him 2.5 units this morning even though he was high, as he literally PLUMMETS now after the morning shot... gotta be SUPER careful. He eats the Royal Canin Diabetic Dry food around 4:30- 5AM so when I take the BG at 6, he is higher because of that. Gotta take that into account for the dosage. I have been WAY WAY WAY overdosing him lately. Since he is now responding in big number drops quickly, better to err on the low unit and watch how he is around noon for a few days. I don't want to see him going from 51 to high 300's every 24 hours. I'd rather keep it in the 100's to 300's. I am not going to remove the dry food at night... he seems to be turning up lower and lower bgs in the am as he adjusts so I think once I get him regulated (or some semblance thereof) it won't spike him so much.

I can't afford to check him more often, as test strips down here cost a fortune. I am doing the best I can.

Again, the questions: Is it common for the cat to suddenly begin responding drastically to the insulin? What do I do if his BG is in NORMAL range, 80 - 120 or very close to that? As I said b4, I can't give him any insulin if he is normal or close to normal now, as his body sends him plummeting into death numbers.
 
All of a sudden all your replies came in and my old post was suddenly there. Good grief. Thanks for your answers and I am glad I'm not the only one to mess up so badly. I don't have a microwave but I will try to massage his ears more... I am afraid to as I am sure they are sore!

I keep the insulin in the fridge. I test Blackie now 15 mins prior to the time to shoot so I can decide on how much to draw. I take the insulin out of the fridge, draw, put it back in the fridge. The insulin in the syringe warms up to room temp by 15 mins, and I give him the dose.

I won't EVER EVER make the same mistake of reading the meter upside down again!
 
What do others do when the PMPS in the evening is normal?

Here are some answers for some of you:

Hillary & Julie - our cats are indoor/outdoor cats. They have access to the outside 24/7. We have a tall chain link w/barbed wire fence entirely around the property to discourage intruders. The neighbors cat still finds a way in... and I suppose when our 7 month old gets a bit older and before we neuter him, he might try to get out to have a look around the area... but I firmly believe that cats, if at ALL possible, should have access to the outside. We don't even have a door to any room in the house except those to the outside, so isolating Black Bear at night is impossible.

I admire you Robin, for your dedication to your furry ones. We get up at 5:30 to prepare for his morning shot. If we stayed up until 11pm to feed everyone (so we could pull the dry food away) we would get seriously sleep deprived and then everyone suffers. Not an option for us. Black Bear only gets access to the DIABETIC ROYAL CANIN dry food at night... I at least went as far as getting him expensive prescription diabetic dry food for the night times. I put a mixture of Royal Canin Fit 32 and a small amount of other kinds of dry food for the others, on a high table at night - which he absolutely CANNOT access. He has bad hips and can hardly jump up to our bed, much less a high table - so we're safe on that count. All the cats love the Diabetic dry food and seem to prefer it over the stuff on the table. I like to give them some variety, instead of the same old meat food day after day. In the wild, of course they wouldn't have that choice as much, but since they are domestic, I try to find a medium balance. Which leads me in to a bit more on the bone and bone marrow... Aagonus Vonderplanitz, in his controversial book "We want to live, the Primal Diet", addresses that all the toxins in the body of an animal goes in to the bone and bone marrow.... so feeding them bone and bone marrow is not so great as once thought. Our 4 year old Ragdoll, LuLu, can only eat 3 to 5 licks of wet food (especially meat) in a sitting. If she eats more than that, she literally throws up her guts every time. The only food she can keep down is dry. So what do I do about that? I can't cold turkey her... I have tried. She went 4 days with about 15 licks of wet food each day and was crying pitifully with hunger ... I couldn't stand it. We have a complicated household and have had to make the tough decision to feed both dry and wet.

We will just have to live with higher numbers in the mornings for Black Bear for now as I try to figure out what is the best approach for us and him during the night. Yes, it is much harder to try to regulate him, and I know that the yo yo is not good for him, but neither would leaving him completely untreated and in 5 and 6 hundreds every day. So at least we are treating him, at least we are keeping him MOSTLY in the 200's on average. Sometimes even 100's. In the best of worlds, I would get up at 2am and feed him wet food so that his morning reading would be lower. But I am not willing to go that far for him for years. If it was for just a couple months, I would consider it.

Again, I ask, what do you all do when the PMPS numbers are in the normal range???
 
I totally understand... I get up at 5:30 am as well to test, shoot, and feed all my monsters. Then I rush around during the last half hour to get showered, dressed and out the door at 7am for an hour commute. It is difficult to stay up late - I often have to wake myself up from the recliner for that 11pm feeding and then go to bed. So I totally understand but I would not make it through the night if they didn't have something in their bellies and it sure isn't going to ever be dry food.

So my idea of feeding through the low part of the cycle wouldn't work for you. I hope you can find a solution.
 
Have you considered using (in the US, anyway) Young Again 0 Carb dry food?

How about a timed feeder? The Pet Safe 5 seems to work well for folks here and is available through our shopping partner Amazon (use the shopping button at top of screen. Purchases made that way will belp support the message board)
 
Help! Today from the morning shot to +6, instead of going down at ALL it went UP. What in tarnation is going on? This is the first shot from a new lantus pen. Could the insulin be bad? Any other reason? As you can see from his chart, this has never happened before! (Inserting update - I gave him 1.5 units at noon and by 3 it had gone down quite a bit).

Thanks for the steer to Young Again Zero Carb. I will order some and luckily my husband is going stateside mid-sept so he can bring it back. I wish I had known about it b4 as I spent a fortune on Royal Canine Diabetic food and shlepped it all down here a couple months ago. It doesn't seem to keep his BG low anyway in the am. But maybe it would be in the 4 and 500's if he was eating the regular dry at night.
 
Hi Heidi!

The high this morning is due to "bouncing"....he dropped from 236 to 87 in 3 hours last night and that's a big drop. I would have strongly suggested setting an alarm and getting more tests in last night because he could have continued to drop and even gone too low. When they drop fast like that, it's best to check a little later and make sure they're not continuing to drop.

Lantus needs to be giving at a consistent dose. We don't base the dose on the Pre-shot numbers. They are based on the nadir...How low it's taking them. Since you have kept changing his dose lately, he's not having a chance to "settle into" a dose and really show you what he can do on that dose.

While I understand you're choosing to continue to feed the dry, you're right that it's going to make regulating him harder and he will need more insulin than a cat on a low carb diet, but going up by whole units can easily bypass the "best dose" for Black Bear. We never increase in whole unit increments so we don't pass that "best dose" without knowing it. He seemed to be getting some good numbers at 6 units and 7 units but since you weren't testing on the PM cycle until just lately, there's no way to know if those would be good starting points at this point or not. My first thought (since he's starting to show some signs of green and blue numbers) is to try shooting 5 units every 12 hours and get those PM tests in and lets see where he's at in a few days time.

If you're getting a PMPS that's too low to shoot, it means you're giving too much insulin. We need to find a dose that you can give every 12 hours. When they are lower than normal, but still above 50, that's a good opportunity to learn to "shoot low to stay low" (shoot a lower number to keep them in lower numbers) Most of us will shoot anything above a 50 once we have the data to know how our cats respond. Shooting lower numbers does require keeping an eye on them though...for however long it takes to make sure they're safe overnight.

I know it seems like there's a lot of "Rules", but the protocol we use is proven to work. Now that he is getting some better numbers, I'd really suggest shooting the same dose AM and PM unless the Pre-shot is below 50 and testing as much as necessary to keep him safe...that may mean the dreaded alarm clock though sometimes.
 
Thank you for your input Chris. It seems to me trying to keep the numbers between 50 and 100 is playing Russian Roulette as it could easily go too low. Unfortunately for me, it costs $40 for just one container of 50 test strips. I am spending $100 a month just on test strips and we are on a fixed retirement income and were barely making it financially before. I wish companies weren't so greedy but that is just the way it is. I have ordered 6 months worth of test strips from India for a fraction of the cost here, but I won't get my hands on them until the last week of September. So testing more frequently to find the "nadir" is really costing us right now and he is so all over the map that it seems an impossible task to do this.

Everyone keeps saying that I am not putting him on a low carb diet, but diabetic dry food IS low carb. And during the day all he gets is my homemade raw chicken and vitamins food. I am going to order a couple 25 pound bags of Young Again also, but won't get that either until last week of September. I can then see if that will bring Blackie to a lower number in the morning.

We are slowly bringing him back in to the 2 or 3 unit doses right now. We had a couple of days where Blackie ran out into the orchard and we couldn't find him for the night shot. And a few other challenges too. So all of this will take time. At least he is mostly in the 1 and 200's now so we have made some progress. This morning he was playing like a kitten which I have rarely seen in him. So he must be feeling better at some level. His BG will get wonky on us just out of the blue sometimes too, with no rhyme or reason.

We couldn't have even done this without all of you so I thank you from the bottom of my heart.
 
It depends on which brand of diabetic cat food you have. The dry food may be higher in carbohydrate than you think. Check the food table at Cat Info. See if it is < 10% calories from carbohydrate, which is what is recommended.
 
Hi. Blackie's bg is shooting up to high 200s even low 300's lately. We have increased his Lantus doses up again to 3 2x a day. He doesn't seem to be responding. The only other kind of insulin we can get is Humulin which I read on here is not good for cats. I read that he could have a dental problem and that that can cause a prolonged spike... not sure what to do. Should I try Humulin for a week or two? Hate to buy it as we already have an extra unopened Glargine in the fridge. Blackie was down to 1 unit 1x a day for quite awhile. Then out of nowhere, started spiking. He is ABSOLOUTELY NOT getting in to any high carb dry food at night.
 
Hi Heidi!

I think it will help you tremendously to understand about how Lantus works. You've got a different dose at pretty much every shot. Lantus dosing is based upon how low the dose takes him. I get all your problems with strips and the other cats, but the low point of a Lantus curve is somewhere in the middle of the cycle most of the time, and at this point, you have no idea how low he's getting. That's essential information for making dosing decisions!

Here is a great post on The Insulin Depot that will help you.

Lantus is also a depot insulin, meaning that it builds up in the body and slow releases. When you change the dose, there is some immediate change, but there is also a delay to the change. People here give the example of the contrast between a speed boat and a barge. When you're steering a speed boat, you move the steering wheel this way and that and the direction changes nearly immediately. That is like a non-depot insulin.

Depot insulins are like steering barges. You make a little change (0.25u - NOT 1u or even 0.5u for most situations) and then you wait to see what the dose change does. With a different dose every morning and evening, you're not going to see consistency in his blood sugar.

I'd encourage you to post over in the Relaxed Lantus Insulin Support Group. They use Lantus and can help you learn a little more about how to help your sweet Black Bear. They also can suggest some things to help you since you can't test very often. I don't think your problem is the Lantus, I think it's in how you're using it. Understanding how to use it will help you get better results for BB.
 
Blackie started going up for no good reason 3 weeks ago. This morning was the highest reading yet since the beginning of June... 504! We don't know what to do. I tried a round of broad spectrum antibiotics... that didn't help. He is high in the morning, so we pound it down with higher doses and then at 6pm he is almost normal.. so the night dose is super low. I wonder if his body is just starting to shut down? Or he just got all wonky for no reason? I am now using the Young Again no Carb dry food at night..so it isn't that he is eating too much at night... in fact he is eating less then ever at night now as the Young Again is very filling. I hate to see his numbers so high. What are the signs that he might be dying now - ie. organs shutting down? He doesn't seem to be in pain.
 
Okay you're still using Glargine (Lantus) right? If so here is the problem Lantus is a depot insulin you need to give the same dose both morning and night. You can't pound down the high numbers with more insulin in one shot because it causes exactly the problem you are seeing wide swings. Because the shot you give in the morning isn't what they are using during that cycle to bring down the numbers. If he responds immediately to a dose change and it is dropping him too low to shoot at night then it's too high.

Mel and The Fur Gang
 
I'm still catching up on your thread but one thing that stuck out and I haven't seen anyone address it yet. But Lantus is an U100 insulin so on a U100 syringe you don't convert. 1u is 1u The conversion is only done when using a U40 insulin with a U100 syringe to microdose easier. That 1u on the U100 syringe is the same regardless if it is going into a human, a cat or a ferret. So if I haven't just missed it and some has addressed it and you've corrected your thinking and what you are calling your doses this might change the dosage listed on his spreadsheet.

Mel and The Fur Gang
 
Heidi, I'm just wondering if you're reading the responses you're getting. It's really helpful if you can read what people have written and respond to their comments and questions. That can help us help you move forward and help your kitty.

I'm quoting and repeating my last post below. From the spreadsheet, it looks like you might have missed this information, and I think that you're not understanding how Lantus works. As Mel said, you can't use Lantus to beat down high numbers. It simply doesn't work that way. You have to make SMALL increases, 0.25u at a time and give the dose change a chance to settle.

You also need to give the same dose shot am and pm.

In order to keep him safe, you really have to get some mid-cycle tests in. It is dangerous if you see a green number and you don't follow up with more testing to make sure he isn't going into low numbers. Insulin can kill - you can't be casual with it.

julie & punkin (ga) said:
Hi Heidi!

I think it will help you tremendously to understand about how Lantus works. You've got a different dose at pretty much every shot. Lantus dosing is based upon how low the dose takes him. I get all your problems with strips and the other cats, but the low point of a Lantus curve is somewhere in the middle of the cycle most of the time, and at this point, you have no idea how low he's getting. That's essential information for making dosing decisions!

Here is a great post on The Insulin Depot that will help you.

Lantus is also a depot insulin, meaning that it builds up in the body and slow releases. When you change the dose, there is some immediate change, but there is also a delay to the change. People here give the example of the contrast between a speed boat and a barge. When you're steering a speed boat, you move the steering wheel this way and that and the direction changes nearly immediately. That is like a non-depot insulin.

Depot insulins are like steering barges. You make a little change (0.25u - NOT 1u or even 0.5u for most situations) and then you wait to see what the dose change does. With a different dose every morning and evening, you're not going to see consistency in his blood sugar.

I'd encourage you to post over in the Relaxed Lantus Insulin Support Group. They use Lantus and can help you learn a little more about how to help your sweet Black Bear. They also can suggest some things to help you since you can't test very often. I don't think your problem is the Lantus, I think it's in how you're using it. Understanding how to use it will help you get better results for BB.
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Thank you one and all for great support and information. Ok, so I have been really messing it up. We are trying to give him less in the morning so that he will be high enough in the evening to give him some. We are also trying to give the same dose each time... until we can inch it lower and lower the same. Hopefully we can get him back on the right track in a couple of weeks.
 
Don't beat yourself up too much Heidi! It really takes a good understanding of how Lantus works to figure it out.

I PROMISE you if you'll post every day and let us help you, we can help you get Blackie under better control!!

Since you gave 3 units tonight, let's just STAY at 3 units for at least 3 days, OK?...Unless he were to drop below 50

It's also very important for you to get at least one mid-cycle test in each cycle....maybe somewhere between +5 and +8 during the morning cycle and one test "before bed" at night

If you absolutely can't get a mid-cycle test sometime during the day, then you'll want to hold the dose even longer than 3 days, but it's even more important for you to get at least one test in on that PM cycle...and maybe on weekends do more testing during that AM cycle. We really need to see where the dose is taking him

Filling in those gaps as well as holding the same dose will really help us to help you....and Blackie may very well start showing some better and more consistent numbers instead of bouncing from too high to low and back up again.

Again...please don't change his dose without asking for help. Just stay at 3 units unless he drops below 50 and keep posting
 
But he went up to 557 this morning. That's death zone. We gave him 3.5 today... I know you say not to raise it, but it just keeps climbing. He was down to 1 or 1.25 from mid Sept until Nov 25 - when on the eve of the 25th of November he started to skyrocket for no reason whatsoever. Now he just keeps rising and rising. Since all you good people steered me back in the right direction, we started to give him less in the morning, so that at night we could also give him some. We tried to stick close to the same dose morning and evening the past couple of days... but when he shot up to 557 this morning, I couldn't just give him 3 - we upped it .5. Something else is wrong with him, as he was doing so well for sooo long, and now his numbers have gone sky high for no apparent reason. How can I just stand by and dose him low and watch him die because I didn't give him enough to keep him from dying on the high side? WHY is his sugar going so high all of a sudden without any reason? I have already run him a course of broad-spectrum antibiotic shots and that didn't help. He seems to hurt today when I pet him... he usually LOVES to be touched.. not today... he gently pushed my hand away from him. We'll check him mid-day and see what his sugar is... it seems such a waste of suffering for him and his poor ears to check him any more than that as after the mid-point between shots, he will start climbing anyway. There are absolutely NO VETS anywhere close to me that would even have the slightest clue how to proceed to help him at this point. So I guess if he goes higher and higher it just means he is dying and there is nothing I can do but sit there? Just keep the dose the same? Please understand, he was doing great for several months... he was not perfect, but we were happy to keep him under 200 most of the time. Even closer to 100 actually. So now he suddenly goes sky high for not reason... I just DO NOT get it. So if his BG is even higher tonight, I should keep it at 3.5? I am afraid he will die. He has gone down to 50 before a few times and seemed OK. But I don't know about the high numbers.

To answer you question am I reading your posts? When I go to the main page and check to see if there are any new messages it always says (O new messages) like below- so I figured nobody was responding to me when I posted early this month. When I finally went in to make another post, it was THEN that I saw all your posts. So now I just ignore the (0 new messages) and go all the way in to see if there are any posts.
User Control Panel (0 new messages) • View your posts
 
Without any BG reading between shots we do not know what is happening. Can you take some?
Cats tolerate high BGs with out problems for extended periods of time. My Badger throws BG PS' in the 400's regularly and infrequently in the 500's
 
It eases my panic a bit to know that other cats get up into the 500's too... but don't understand why. I'll take his reading at noon now... which is halfway between the dosing. We all know our darling friends will die one day, it is inevitable, (so will we) but I would like to prolong his life, comfortably, for as long as I can. His BG at noon now is 378. Hardly down enough for mid point - as it will probably go right back up to over 500 by 6pm.
 
Heidi, there are 2 things that are really really really important for you to understand.

1. High numbers do NOT always mean that a cat needs more insulin.

2. Lantus is NOT an insulin that can "beat down" high numbers. It simply doesn't work that way.

Sometimes high numbers are CAUSED BY low numbers. Sometimes high numbers are caused by increasing the dose. Please read through this post http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=46012 for information about this.

I can't say that you need to stay at 3.0 units. It's impossible to know what to suggest because of the erratic dosing. Think of this situation as rocking the boat. Everytime you change the dose you increase the rocking. That's at least one reason why you're seeing crazy highs and lows. I suspect the dose is too high and that likely Blackie is going low and then rocketing high from hitting low numbers. Every time you change the dose, especially when you're giving a fairly large dose at one time (3-4units) and then dropping to a small dose the next time - it's like you've set up a crazy dance on the boat.

Lantus works best with consistency. It "likes" to have the doses held for at least 3 days before changing the dose. It works best when shot into lower ranges. It takes a while for it to bring down higher numbers. I think if you looked at other cat's spreadsheets, you would see that high numbers are common. It's not desirable but it's just part of it until a cat gets controlled.

If I were you, I'd drop to 1unit and stick with it for at least 3 days - regardless of how high he goes during that time. Don't let high numbers cause you to panic. LOW numbers are the numbers that are important - and you're not seeing them because of how you are testing and shooting. It can take 3 days for high numbers to clear out of the system if the cat is bouncing from having hit low numbers. That's the reason for waiting 3 days - to see what the dose is actually doing and to be confident about how low the dose is taking the cat. Only shoot less if he gets less than 50 on a human glucometer or 68 on a pet glucometer. Which one are you using?

Did you see my suggestion above that you might benefit from posting in the Relaxed Lantus Insulin Support Group? They could teach you how Lantus works and help you help Blackie.
 
Ok. So if the cat has been on a steady low dose for weeks and weeks doing fine, then suddenly goes way high, do you ignore the high and keep dosing the same anyway? That makes no sense to me. What we should have done at that time was to add in a night dose at that time, with the same dose as the am and ran that for a few days.

That's how this whole mess got started, yes, we were not doing it right.. we should have dropped his dose in the am to 1/2 and given the same dose at pm, instead of nothing. Way back in the beginning, when suddenly he was too low pm to dose, I asked and asked what do I do? No-one answered me, or maybe I didn't see it. So we proceeded to just dose him low in the am and since he consistently tested too low to dose at night, we skipped it. He went this way for 3 months. Then shot up on NOv 25th. I'm not blaming anyone, I'm just trying to explain how we got so off-road with all of this. When he went high Nov 25th, I left the next day to travel back to Portland, OR, to get 50 pounds of Young Again No Carb food for Blackie. I got viciously ill with the flu and ended up staying there for 2 weeks and only my husband was here to take care of him, and he knows very little about Lantus... my mistake. So what should we have done when he suddenly went high that night? Left the dose the same as the morning one I suspect... I so wish we had done that instead of going higher.

I will look at joining the support group.. thank you for the suggestion. You all must get so frustrated and want to reach through cyberspace and shake the crap out of us folks who don't do our due diligence with this illness, and then screw up, sometimes probably even killing our beloved animal friend. I hope I have a chance to recover Blackie from this. I still don't know what to do IF we can get him regulated on low dosage again, and then he starts to spike high again more than for just a day.

I will drop to 1 unit tonight, and 1 unit am and stick with it for several days. I have to try to get him back online again. I just hope it doesn't kill him. He is a tough old guy though, and has lots of reasons to stay with us, so let's hope for the best. Again, thank you for being patient with me.
 
HeidiBroward20 said:
Ok. So if the cat has been on a steady low dose for weeks and weeks doing fine, then suddenly goes way high, do you ignore the high and keep dosing the same anyway? That makes no sense to me.
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You aren't ignoring the high levels; you are interpreting within the context of how low he goes.
And what you are describing could well be a reaction to an unusual low number triggering compensatory, protective hormones which release stored glucose (glycogen) to bring the glucose up to a safe, survivable level.
Or, a sudden infection could have triggered higher than usual glucose levels. Or the insulin could have pooped out and become less effective.
This is why mid-cycle testing is key. If it is or has gone low, that sup.ports the first possibility. If it is never low, even after 3-4 days, it supports the 2nd possibilities
 
Heidi....When you look up where you've been seeing "0 new messages", this means you don't have any new PRIVATE messages

If you look directly to the right, you'll see "View your posts"...if you click there, you'll see your post and any new replies

If you can get at least 4 tests in per day (Pre-shot as well as 1 mid-cycle during the day and a "before bed" at night) you can start posting in either the Tight Regulation Group OR the Relaxed group

Both groups use Lantus! The Tight Regulation group is where I think most of us are because we are concentrating on keeping our kitties very tightly regulated (between 50-120 as much time as possible) but you can post in either group!

In the TR group, we make changes more frequently (but always holding the same dose for at least 3 days) where the Relaxed group generally doesn't change the dose for 7 days

What you've been trying to do is what we call "beat down" the numbers...think of it like a headache...You think "well my head hurts worse, so maybe I should take 3 aspirin instead of 2"...Lantus DOES NOT work like that!

When you give too much, it could be taking Blackie too low (since you haven't been testing, we can't know) and then his liver reacts to those low numbers by releasing even more sugar and hormones to bring him back up fast! It's a leftover survival mechanism to protect our kitties when they were in the wild and their blood glucose dropped too low. By releasing that stored sugar, it kept them alive long enough to hopefully get a meal!

Next....just because he was doing good months ago on 1 unit doesn't mean his insulin needs won't change....unfortunately, that's all part of this disease. By testing as much as you can and posting in one of the insulin support groups (either TR or Relaxed) those of us that have been using Lantus for awhile can help to tell you when you might need to increase...as well as when you might need to decrease!

Please just hold that 1 unit for 3 days and post daily in either forum and get those tests in.....We really do want to help you with Blackie, but you're going to have to trust us.

Now it would be a good idea for you to get some urine ketone testing in while he's in those higher numbers. This is an extra layer of safety since if they are caught early, ketones can be treated easier...and a lot cheaper. Ketone strips are available at any pharmacy and you just dip them in his urine. We can give you tips on how to do that too.

Come on over to one of the insulin support groups and post...let us try to help you....and then watch that "View your posts" instead of the "0 new messages" above :-D
 
Thank you Chris, for all your good info and advice. We have been keeping the dose the same - at 1.5 actually, (I know, we said one) , but his number are still really high and not dropping much. Just checked midday ... 337 - down 103 points from this am. I guess we'll keep it at 1.5 for another day. I am wondering if maybe he was actually getting better when his number spiked last month? That would explain the spike reaction. Maybe we should stop all insulin for a few days and see what happens? It would rule out the over-reaction from the liver if that is what is happening. What do ya'll think?
 
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If his glucose in the +5 to +7 hours post-shot are elevated, I would continue with the dose, and begin following one of the Lantus protocols to adjust the dosing. Tight Regulation does dose adjustments more quickly than Start Low, Go Slow, so if you can test about 4 times a day - pre-shot, mid-cycle, and before bed- I would recommend it. It may help you get better control sooner.
 
I don't think TR is a good fit for Heidi, BJ. She's having a hard time getting midcycle or pm cycle tests, and they are really essential.

Heidi, I would definitely not stop the insulin. Most of the time, increasing slowly and methodically, which monitoring the blood sugar changes that happen while you're increasing, is the path that is needed to get control of blood sugar.

Good job holding the dose for 6 cycles. You're getting the hang of the dosing and we'll be able to tell more because the dose was steady! Lantus likes consistency. If you could just get one pm cycle test every evening, right before you go to bed, we would be able to have confidence in suggesting dosing changes. My gut feeling is that Blackie probably needs more insulin, but i can't suggest increasing without something in the night cycle to let us know how low the dose is taking him. I promise, we don't get a commission for getting people to get a pm cycle test. ;) In fact, everyone here is volunteers - not sure if you realize that. From experience, we know that is critical information to know for every cat because so many of them give all their lower numbers in the pm cycle.
 
Well, it seems even 1.75 isn't going to touch his high numbers. We upped it last night after 3 days, 6pm number - 427 3 hrs later it was down a WHOPPING 6 numbers to 421. This morning - 445. What still baffles me is that his BG steady and low for weeks and weeks with just ONE small dose a day... as the night readings were to high to dose. Then suddenly he starts to climb and climb. I so wish we had given half the morning dose at night in those days... maybe all this would have been avoided. So now we're stuck with 1.75 for 3 days while his numbers don't move hardly at all.
 
Looking at the nadirs you've been getting (above 300) and following the Tight Regulation protocol, it would be OK to increase from 1.5 units to 2.0 units, then hold it for a minimum of 3 days while checking the nadirs.

Initially, you changed the doses so quickly and used different doses based on pre-shots. That works fine with Caninsulin/Vetsulin. It works lousy with Lantus. Lantus is a depot insulin. When you inject it, it forms crystals under the skin. These slowly dissolve to release the insulin. We call these crystals the depot or shed. There are usually some undissolved crystals present when you give the next shot. This results in overlapping shot effects. Lantus works best with the same dose at all shot times, to keep that overlap consistent. Shooting early increase overlap and may act like a dose increase; shooting late decreases the overlap and may act like a dose decrease. Depending on the cat's sensitivity, you want any time adjustments to be no more than 15-30 minutes because of this.
 
I haven't seen anyone else suggest it, but have you considered a different insulin? Most people would be surprised I would say that because I am a very strong proponent of Lantus. But Lantus cannot, just can not be used to in-the-moment beat down high preshot numbers. You can't up the dose after a shot or two, skip, and just do a variation of doses and expect to get any results at all from Lantus. Its a depot insulin and that just won't work. It takes 3-7 days for a dose adjustment on Lantus to settle. If you never consistently dose it twice a day at the same dose for at least 3-5 days, you will never make any progress on Lantus (and you risk a hypo incident). Its like trying to sprint holding a cup of water and not spill any of it. The harder you run, the bigger the waves are in the water. There are non-depot insulins out there. They can work better with the type of dosing you are trying to do. Prozinc and PZI are non-depot insulin yet still longer lasting insulins. Maybe it is time to try one of those? Its so hard to hold the dose when the numbers are high, we all know that, but if you don't on Lantus you can start creating the high numbers instead of helping them.
 
Thanks Melanie. I have to stick with Lantus as it's the only one I can get here in Ecuador. For many months I did hold the dose, etc. It was just in the past month that things got squirrely. We are getting slowly back on track. I have searched the site but can't find any thing so asking what are the signs that a cat may be shutting down? Blackie is back to drinking a ton of water and his breath smells rotten - not normally this way since we started treating his illness in June. I am going to take him in for a tooth exam next week in a town quite a ways away, just in case it is an abscess tooth that started his numbers climbing in November. But in the meantime, is there anything I can do to see if he is actually in his last times? He is eating OK and peeing OK.
 
See my signature link Secondary Monitoring Tools for some other assessments you can make. These will help you evaluate how he may be doing.
Cat Info has a section on dental health - if his mouth is not painful, you could try brushing his teeth.
 
This thread has been quite helpful to me, also. Miles is having many of these same issues. We know how Lantus works but it just isn't cooperating. Good luck with your sweet Blackie, who looks like he enjoys the grass as much as Miles does! :cat:
 
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