Need help understanding BG # and Lantus dosing

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by NyCatMom, Oct 28, 2020.

  1. NyCatMom

    NyCatMom New Member

    Joined:
    Oct 11, 2020
    Good Morning All,

    I have created a spreadsheet for my cat, Honey. Here's a bit of background on what's going on with her.
    • Diagnosed Sept 12, 2020 - acute pancreatitis, IBD. Lost 3 lbs in one month; hospitalized with feeding tube
    • Released from ER vet w Feline i/d wet diet (high carb but only thing she could eat) & 2 units Lantus 2x day
    • Stayed on above protocol until Oct 8. Then started on low carb FF classics diet.
    • Directed by vet - no insulin if she was below 250.
    • Numbers start to climb and she is put on 1 unit , then 1.5 if she is over 300. Sometimes directed to give 2 units by another vet at the same practice.
    • Numbers started to climb when IBD flares ; started giving Budesonide on Oct 14. Wondering if this might be causing the increase in BG.
    Any insights or suggestions from group members would be appreciated. She is scheduled for Fructosamine and B12 blood testing next week.
     
  2. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Welcome. Your vet’s dosing advice does not seem to be based on how Lantus works. It’s a depot drug and builds up in the cat. Dosing is based upon how LOW a dose takes your cat and not the preshot numbers. It’s impossible to know this after looking at your spreadsheet because you only have preshot numbers. The only reason fir the preshot tests are to see if it’s safe to shoot. The lowest point in the cycle is typically between +5 and +7 but can be earlier or even for some cats later. This can change from cycle to cycle. The onset, when Lantus starts working, is around +2.
    I suggest you read the yellow stickies at the top of this forum on depot drugs and our dosing methods. I’m asking you to take a leap of faith and try letting us help you learn how to work with Lantus to get your cat into normal numbers. Our methods really do work.
     
  3. NyCatMom

    NyCatMom New Member

    Joined:
    Oct 11, 2020
    Thank you. I will read the forum information this evening (WFH now). One of the reasons I joined the group was to achieve better regulation for my cat. Our vet texts back dosing info but I can't help but feel like they are distracted. The pandemic and curbside pet pick up hasn't really helped the situation. I will start getting nadir readings and add them to the spreadsheet.
     
  4. thebigfuzz

    thebigfuzz Well-Known Member

    Joined:
    Mar 9, 2012
    Good Morning, and Welcome :bighug:

    You have found a great place for resources, information and help! The members here are amazing people. There is a lot of information and reading material in the stickies, when you have a moment, feel free to start checking some of them out. I refer back to the stickies all the time and learn something new each time :)

    Testing: First, good job on getting at least a preshot blood glucose test in at am and pm shot time. That is great!!! How has that been going? Let us know if you are having any difficulty...we have all been there :cool: I see you have a pet meter. Many of us use human meters and reference numbers on the site are human meter numbers, so it’s totally ok to use a pet meter, just know you will have to convert some things. It is advisable to also get at least one mid cycle test On both am and pm cycles to see how low the dose of insulin is taking Honey. “Typically”, the lowest point of the cycle (called nadir) is around +6, but can differ for each cat. So, on am cycle, you could get a test somewhere between +5 to +7. On the pm cycle, many of us will get a +2 test to see whether kitty might be having an active cycle and to make any decisions on setting an alarm for overnight monitoring. Many cats can go lower at night, so the +2 can help you to know. (More info later on this)

    Dosing: a lantus is a depot insulin, so it takes some time for the cup to fill, so to speak. I know many vets base the dose on preshot, but lantus doesn’t work best this way. It is dosed on how low the dose takes your cat - which usually happens mid cycle. Another reason for the mid cycle tests.

    Methods we use: On this forum, we use 2 dosing methods: TR (tight regulation) and SLGS (start low go slow). Here is the sticky on the methods that are recommended you choose between. You are not married for life to either and can change your mind at any time.
    https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

    The 400 you saw today is likely what we call a bounce - or the livers reaction to numbers Honey might not be used to. On this thread, is a great explanation from @Sue and Luci on the relationship between pancreas and mr. liver.
    https://felinediabetes.com/FDMB/thr...1-1-295-2-281-8-346-increased-tonight.234063/

    I think I’ll leave it at that for now, please ask lots of questions...there is so much to read and learn :) Again, welcome :bighug:

    You’ll want to set up a signature when you have a moment, that is usually the first place members look when helping. And a pic of lovely Honey...I’ll bet she is a beauty!
     
    Sue and Luci likes this.
  5. NyCatMom

    NyCatMom New Member

    Joined:
    Oct 11, 2020

    Thank you for the warm welcome. It's comforting in stressful times. :)
    She is actually quite easy to test and after I found the sweet spot to test, it has been a breeze. We have another diabetic cat (in remission) in the house that belongs to my 98 yr old mother (who also lives with me). I got the Alpha Trak back then and kept it even though she is in remission. In comparison, she was a breeze. She was on Lantus for a couple of months but as soon as we got her on low carb food she got off the juice. I was hoping that Honey would respond the same way but the IBD makes finding a food that works for her more difficult.

    I took a nadir reading today (+7) and it was 249. I'm starting to wonder if the budesonide is the culprit.

    I'll set up and my profile in more detail tonight and continue nadir readings to get a better idea of how the Lantus is working for her.
     
    thebigfuzz and tiffmaxee like this.
  6. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    Welcome to the best place you never wanted to be! Sounds like you've got some experience in dealing with FD kitties - all good! However your vet probably has less experience dealing with FD than they care to admit.

    I have to wonder sometimes where they get those 'no shoot numbers'...if no one here ever shot a cat lower than 250 there would never be any cats going into remission...amazing...

    And it looks like you've been through a rough time with the pancreatitis too! :(

    You and @Butters & Lyla will have a lot to talk about in that regard. Poor Butters is in recovery from a recent bout of pancreatitis too...

    I'm glad to hear that you're going to read up and that @thebigfuzz was able to give you lots of tips today on things to consider - avatar, signature, etc.

    It's a bunch of stuff...but just take them one at a time. Can't wait to see your kitty's pic :)

    Have a look around at other condos and their spreadsheets - I found that to be so helpful - I felt like I was 'spying' on other people but as it turned out it was extraordinarily informative and helpful to read how they handled situations...and believe me we get them all...the ups, the downs, the highs the lows and everything in between :)

    Have a great evening :)
     
    Butters & Lyla likes this.
  7. NyCatMom

    NyCatMom New Member

    Joined:
    Oct 11, 2020
    I am feeling very discouraged. She is back on Royal Canin novel protein rabbit which has curbed her constant diarrhea but her blood glucose numbers continue to rise. I know part of the increase is due to the higher carb food, but her nadirs have been in the 300s recently with her pre shot numbers rising steadily through the 400s (spreadsheet in profile). Our vet has moved her dosing to 3 units twice daily.

    Have any of you experienced an increase like this? It would make me feel better to know you can work through this. Thanks
     
    Last edited: Nov 3, 2020

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