New Here & Plateau?

Hi everyone,

My 15 year old cat, Cheyenne, was diagnosed with diabetes on 1/30/21. At the vet, her BG was 480, though it has not been that high since (assuming it was the anxiety of being there). She also tested negative for ketones.

Since then, I have changed her diet to wet food only (Fancy Feast pate). We started Lantus (0.5 units 2x/day) on 2/7/21 and I noticed a change pretty quickly in her numbers, but also in her drinking and urinating (went back to "normal" habits).

Now, the numbers seem to not be moving as much and I am noticing that she is drinking and using the litter box more - and the "sticky" urine is coming back. I am supposed to send a curve to the vet within the next few days. He had originally told me to start at 2 units of Lantus twice a day, but after reading through posts here and the Facebook group, I decided to start very conservatively in case she went hypo (which, as you can see in the spreadsheet, she started to dip low a few times).

Is this typically how it goes with a dosage increase? Meaning, it seems to be improving and then sort of plateaus? I am linking the spreadsheet and any insight that anyone has would be much appreciated! You will see that there was a day when I ran out of the AlphaTrak strips and had to use a Relion for a day - those low numbers are likely quite higher, as the Relion seems to read much lower than the Alpha when I compare. There was also one night when she had a lower number and I was not going to be able to monitor her over night, so I got nervous and gave her 0.25 units instead.

https://docs.google.com/spreadsheets/d/1GXGIKuNPkuSTo02Mm7ciAEuoRen6n2XRGmyTxIUOfgg/edit?usp=sharing

Rachel

 

Hi Rachel,

As you correctly observe, on two occasions the 0.5IU dose has taken Cheyenne too low:

11 Feb AM cycle: 41 on human meter (below 50 is too low).

13 Feb AM cycle: 55 on Alphatrak (below 68 is too low).

The higher numbers you've seen today look like a bounce (a temporary rebound to higher numbers caused by the body's defence mechanisms), although underlying conditions may also cause an upward trend in numbers (e.g. an infection). At the moment, all you have work with are the data in the spreadsheet. For safety, action is needed based on the too-low readings.

Without PM mid-cycle tests it's not possible to know for certain but it is possible that Cheyenne might be going low on the night time cycle.

You've changed to a lower carb food and Cheyenne is likely benefitting from the new diet. Some some cats can see improvements in BG range over the following days to weeks after the transition completes because there's less strain on the pancreas from the lighter carb load and, as numbers improve, the lower BG levels create an environment where beta cells may start to recover function.

Whatever about the speculation above, your BG readings show that the 0.5IU dose is too high. According to the Lantus dosing methods used at FDMB the dose should be reduced to 0.25IU immediately. (Note: If a reduction doesn't hold the dose can always be increased again after the reduced dose has been held long enough to determine its safety and efficacy.)

NB: It can take up to six 12-hour cycles for a bounce to clear and BG levels to drop back again, so you might not see an improvement in numbers straight away.

It would help you greatly to get some BG readings during the PM cycle because it would give you better insight into how Cheyenne is responding overall. Many cats tend to run lower at night too. If you could at least get a PM+2 reading each evening that would help a fair bit because the +2 gives some sense of how the rest of the cycle might play out and whether you might need to set an alarm to test later so as to make sure Cheyenne doesn't get too low - and you can always post for advice and help with interpreting the BG readings.


Mogs
.

 

PS: Are you testing for ketones at home? If not, I'd suggest testing daily for the time being as a general safety precaution. You can get the urine test strips at Walmart or any pharmacy.

Tips for collecting urine samples

And good call being cautious with the insulin (meant to say that above!).


Mogs
.

 

Thank you so much. I will change to 0.25 tonight and get some PM cycle readings.