? New Member Megan and Loki - need advice

So I will make a separate post with our backstory but right now I am kind of at a loss as to how to dose Loki's insulin. Long story short, his fructosamine level about a month ago was >700, and we had a really hard time getting his glucoses under control and his Lantus dose was as high as 4 units twice daily. Fast forward and now we are dealing with hypoglycemia (relatively, I know you can go lower in kitties). He has a Freestyle Libre on and it seems like his glucose peaks about 10-12 hours after eating. My worry is the onset of action of the Lantus is much faster so I am afraid to give him insulin when his glucoses are in the 50s and 60s. He usually eats at 6 am, 4 pm, and 9 or 10 pm (that is how he has been eating for years and we would like to avoid doing strict feedings 12 hours apart which is what our vet recommended. He receives Lantus around 6:30 am and 6:30 pm. We were giving him 4 units twice daily when it was placed and then we saw how low he was dropping so we right now are giving him 2 units twice daily but I am wondering if I should go down to 1.5 units or even 1 unit? I apologize if there is a specific format I am supposed to use, but here is the sensor data I have from his most recent sensor

 

Ok so now that I have posted what is going on now, here is the whole backstory. Loki is a rescue who was on the streets for an unknown amount of time and has had a number of upper respiratory infections. He would occasionally have events which we now know were essentially asthma attacks, but they happened very infrequently and his workup at the vet was largely unremarkable. Then about a month and a half ago, we noticed that he was having more respiratory symptoms and was acting more lethargic. So I took him to urgent care and they did an x-ray and determined that he had asthma and potentially bronchopneumonia. We were sent out on an antibiotic and a steroid taper. After a couple doses of both, he was vomiting more and not really eating. I kind of chalked it up to the antibiotic as previously he got really bad GI symptoms on Clavamox. So I called the vet and asked if we should switch to a different antibiotic. Thank goodness they had us bring him in as they found his liver enzymes were markedly elevated, and his glucose was mildly elevated. We thought that might be stress related because his glucose was normal when he had his checkup a couple months prior. We were given mirtazapine to try and enhance his appetite and instructed to take him to the pet ER if he didn't start eating in the next day. Spoiler alert, he did not eat so he was admitted for fluids and NG tube feeds and they found he had hepatic lipidosis, pancreatitis, and some bowel inflammation (triaditis). His glucose was also elevated so they checked a fructosamine and as mentioned earlier, it was >700. So we were obviously told to stop the steroids and just go with the Flovent inhaler. We had a Freestyle placed on him soon after discharge but had issues keeping it on as he is an active cat and our previous vet was not familiar with CGM application. So we brought him in for a couple glucose curves where his dose was increased from 1 unit BID to 2 units BID to 3 units BID to 4 units BID. I then discovered another vet who was familiar with CGM application and had a new one placed a few days ago and you can see the results. From previous sensors, his glucoses were largely >400 so he obviously needed the higher doses initially to bring his glucose into a better range. But now I am struggling as to how to dose him. I also think we get in a habit of overtreating him with food and then his glucose spiking. Any advice would be very much appreciated.

 

I am still very new to all of this so I really don't know how to manage some of these numbers. Loki has a Libre, and it looks like his glucoses peak around +10 to +12 and then rapidly drop. Given the onset of Lantus is much shorter, I am really struggling as to how to dose him. Currently on 2 units BID but I almost don't want to give him anything tonight.

 

Your previous post ( intro post)
https://felinediabetes.com/FDMB/threads/new-member-megan-and-loki.296037/#post-3223504

 

@Megan and Loki
Hi Megan I linked your introduction post so members can see what's been going on with Loki.
I'll tag some experienced members for you
On your signature after you have Freestyle can you add after that Libre

To draw attention to your post I would go back to your title and put a ? New Member Need Help in front of the date .
Tap on the word Thread Tools then tap on Edit Title and add what I suggested then tap save

Megan it would be better if you set up our spreadsheet. It would be much easier for the members here to give you advice .Here is the link
Your previous post ( intro post)
https://felinediabetes.com/FDMB/threads/new-member-megan-and-loki.296037/#post-3223504

It will also explain how to use it. If you need help setting it up just ask

Take a look at this members spreadsheet to give you an idea what it looks like


https://felinediabetes.com/FDMB/threads/11-26-pookey-amps-248-7-180-pmps-245.296023/#post-3223488

Go to the top of the post and then tap on where it says Pookey's spreadsheet

 

@Wendy&Neko
@Bron and Sheba (GA)
@Suzanne & Darcy

Here is Megan's introduction post

https://felinediabetes.com/FDMB/threads/new-member-megan-and-loki.296037/#post-3223504

 

Megan, I have a huge favour to ask of you. You will notice that most of us have a spreadsheet in our signatures, and we all use the same format of spreadsheet. I'm afraid that most of us are dependent on looking at this type of spreadsheet to give you help on dosing. The majority of us do not use the Libre, which is a relatively new thing on cats. If you could put together a spreadsheet, that would be a great help. Some posts on how to do that are here:

• How to Create a Spreadsheet
• How to Use the Spreadsheet

If you have technical problems, let us know. We have people who can help. The other Libre users here also use the spreadsheet.

In general, if your kitty is going below 90 on a human BG meter (and on a dry food diet), then you need to reduce the dose by 0.25 units.

 

Thanks so much for your responses. I ended up not giving insulin last night and only giving 1 unit this morning. I think we have a habit of overreacting and then over treating with food but any advice would be fabulous.

 

Thank you for getting Loki's spreadsheet set up. Looking at Loki's spreadsheet, I think you were wise to drop the dose. If it were me, I'd keep Loki at the 1.0u dose for the time being. Lantus is a unique type of insulin in that it forms a depot. What that means is that a small amount of insulin forms microcrystals that are deposited in the fat tissue and gradually dissolve. This gives Lantus its long duration but it also means that there's a small amount that sticks around past the 12-hour cycle. It can take the depot roughly 3 days/6 cycles to stabilize at a new dose. As a result, even those cycles where you've dropped or skipped the dose (e.g.., 11/26 and 11/27), you can still see lower than expected numbers because the depot is at work.

I'm linking information on the dosing methods for Lantus. Because you're feeding Loki a dry food diet, you need to look at the instructions for the Start Low Go Slow (SLGS) method. Basically, any time numbers drop below 90, a dose reduction of 0.25u is indicated as Wendy noted. The post will give you some guidelines for how we approach dosing.

I'm also linking a post on how to handle low numbers. It may be what you're already doing but I wanted to be sure you had instructions so you're not over doing it with the high carb intervention.

Please let us know how we can help.

 

Thank you for the advice! I ended up only giving 0.5 units this morning. I'm at work so I'll have to see what his BG trend was today with that dose. I also included some more numbers from last month when we were only able to keep a sensor on him for like a day or two at a time so you can kind of see how drastically his number have changed.

 

One other point... Lantus likes consistency. If you can decide on a dose, you want to be sure you can give that same dose twice a day. Giving different amounts of Lantus at AM and PM shot times will result in wonky numbers. Again, it's a depot issue.

And that is a dramatic difference in Loki's numbers. It's possible that the high numbers are due to too much insulin. I also wonder if those high numbers were due to inflammation/infection and once the infection cleared, there was a big drop in numbers. That is not an uncommon response to an infection being treated. (Any infection or inflammation can cause a rise in blood glucose numbers.)

 

Yeah I totally agree; I know his wonky numbers are in large part by the up and down dosing I've been doing. I guess the past few days I've been so concerned about hypos and getting worried about him going too low.

Also I was wondering the same thing about the inflammation tbh. He did get pretty sick right before being diagnosed; he needed tube feeding for a couple days for the triaditis and his liver enzymes and electrolytes were not great at all.

 

@Sienne and Gabby (GA) Hi Sienne linking some recent discussions over on LLB.

https://www.felinediabetes.com/FDMB/threads/11-27-24-loki-amps-165-1-57-5-48-11-57-no-shot.296063/