HELP - dosing advice for Simon needed!

Thanks everyone - you've all been such a help for me re my cat Simon.

Just to recap. He was the cat who developed diabetes secondary from being put on Budesonide for his IBD in January (his BGs then were ok). Last month, he developed significant wt loss along with polydipsia/polyuria, resulting in a diagnosis of diabetes Mar 22. BGs about 20 (360 mg/dL).

Started on Toujeo insulin by vet. Major issues with trying to get BS under control. No way of titrating as pen used to administer that kind of insulin only does full units. He had been getting 1 or 2 units of this bid - BS all over the place!

Changed to Lantus yesterday morning, in large part due to the advice received here - thanks everyone!
Decided to start him on 1.5 U of the Lantus in view of the fact that he seemed to need somewhere in between 1-2 units of the Toujeo and the dosing should be similar. This was started yesterday morning.

However his BGs have dropped steadily and IMHO very rapidly. I am wondering if he has finally started to clear the effects of the steroids and his BGs are dropping on their own, in conjunction with the Lantus insulin which then is muddying the waters.

These are his results:

Yesterday, first day getting the Lantus
BS pre shot 21.4 (385)
1.5 U Lantus given
2 hrs later 19.6 (352)
4.5 hrs later 18.8 (338)
8 hrs later 18.1 (325)
pre PM shot 18.4 (331)
1.5 U Lantus
2 hrs later 16.9 (304)

This morning preshot 18.4 (331)
1.5 U lantus given
4 hrs after 11.2 (201)
Now, 8 hrs post shot 8.9 (160)

Given this very fast rapid drop, I am really worried about how much to give him tonight. I figured I'd be better off posting this now and asking for advice, as I think that if I wait till I do his pre PM BS check, it will be too late for most of you (who I suspect live in the east), so thought I would be proactive and do now.

IMHO this is too fast, and now I am worried about bottoming him out tonight if I give him 1.5 or even 1. Argh!

Given the rapid drop in his BS, I am wondering if this is due to the effects of the steroids wearing off now so this is really confusing the issue.

Frankly, am really unsure about what to do!

I have updated his SS so it is more easily visualized there.

Help! (and thanks in advance!!!)

 

Here's the link to your last post, so people have some context: https://felinediabetes.com/FDMB/threads/simon-update-re-toujeo-advice-please.245590/

The drop from +4 to +8 is not very much, approximately 10 points per hour. Although cats don't drop at a consistent rate, it does tell you he's not dropping really fast now. If you are really worried about what you might have at preshot time, you could get a +11 test and see if he's started to rise yet. Which would make the dosing decision easier.

Given that we don't have much/if any experience with Toujeo here, it's hard to say if you are still seeing some BG lowering effects from the Toujeo depot. Or just from the Lantus depot building.

When did he last get any budesonide? And what was the dose?

 

Just checked him now - up to 17.7 (319). This is SO frustrating!

He last got the Budesonide Mar 21. He was getting 1 mg per day. The vet stopped it cold turkey the following day when I brought him into the clinic.

 

Budesonide should be out of his system quite a while ago. Usually it's tapered off, so surprised on the immediate stop.

Looks like you'll be fine for full dose tonight of Lantus. By the way, these swings are not uncommon for newly diagnosed diabetics, but very frustrating!

 

Thanks! These fluctuations are so scary to be dealing with.

 

Ugh. Now his prePM BS is 24.8 (446). What a roller coaster.

I gave him his 1.5 U of Lantus.

 

His body is reacting to the blues, he's not used to them. There's a term we call bouncing, it will pass:
Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

 

So how does one get past this? Just keep holding the course? Or does one lower the dose of insulin a bit so that there isn't such a precipitous drop, and then gradually start increasing it again?

 

Hold the course. The way to stop the bouncing is for the cat to spend more time in normal or safe lower numbers, so their body gets used to them. It means short term bouncing for long term gain. Lowering the dose just means they won't see those nice numbers and will stay high and flat. If you get the chance, try to find some other new people with cats on Lantus, and look at their spreadsheets. You'll see a lot of similarities.

 

BG 25.1 (452) this morning

Wendy, thanks for the tip re looking at other spreadsheets. I have been opening up some of them, but haven't seen one yet, with a newly diagnosed cat with similarities. Will keep looking.

 

Pop on over the Lantus/Basaglar/Levemir forum, you'll see more there.

 

And go back in the spreadsheets. I started Lev this January. Was a month on it in April last year too.
You can see how long it took Mauer to build a depot. But when it was there, it worked like a charm!