Frustration with Frodo's BG readings/insulin dosage. Help!

[Ruth Ann and Frodo]

We’ve been trying to get Frodo regulated, and it just seems like we’re getting nowhere. The first couple of adjustments were done under the vet’s direction, and were based just on one or two 6-hour readings. Since then I’ve been trying to make some adjustments on my own, with more testing. None of his 6-hour readings appeared to be particularly low, so I increased the dosage a couple of times. But at 4 u bid he still was high a lot of the time. We didn’t have any middle-of-night readings, so decided to cut back to 2u bid and check some night readings in case of “rebound”. Result: nothing particularly low that would lead to a “bounce”.
Currently at 2.5u bid and got a good “curve” yesterday - it seemed to be pretty flat. Had meant to get a +6 hour at night, but I goofed and gave a pm “fur shot”, so no point in getting up overnight. Waited 3 hours and he was going up, not down, so I gave him 1.5u at 3 hours after regular shot time.
We just don’t seem to be getting anywhere in getting his BG down to a more reasonable range, and I hate to see him sitting in the 400s and 500s most of the time. I’d love some opinions/comments on what his spreadsheet shows, or what to do about dosage.
A couple other details: Frodo was never obese or substantially overweight. He’s lost enough weight that I now pretty much feed him whenever he seems to be willing to eat, which is not all the time. Prior to diagnosis he got some amount of Orijen dry (Now only the other cats get some), and canned and a fair amount of raw meat. I’ve cut out all canned with wheat or wheat gluten, although some canned he gets has rice. Only time he got mostly dry was 12 days last summer when we were out-of-town. He gets some Fancy Feast, some Friskies paté, and all the raw (fresh pork, chicken, and some beef) that he wants - we free-feed the raw on ice.
Thanks for any comments or advice - Ruth Ann

 

[Stacym20]

Could there maybe be an infection going on? Teeth? UTI? That would make a curve high and flat.

 

[Ruth Ann and Frodo]

Could there maybe be an infection going on? Teeth? UTI? That would make a curve high and flat.

White count normal at the beginning of January (diagnosis). Not tested since. He was and is hitting the litter box a lot. No apparent changes since diagnosis and start of insulin. Have call in and spreadsheet printed and brought to vet. We'll see what she says.

 

[Sue and Oliver (GA)]

It is a strange spreadsheet. The only day you saw a nice drop was 3/5. Usually when you drop or raise, you see more movement, one way or the other. I know how frustrating it is when you see nothing happening. He is early to the sugar dance, but I would think you would see something.

Just checking some of the basics:

You are using U40 insulin and U40 needles. You roll the insulin before injecting and it's been refrigerated. It has no chunks of stuff in it. Was it from the vet and not repackaged?

I think Rachel's thoughts about an infection is certainly a possibility.

It might be worth backing off the food that has the rice. Sometimes it takes only a few carbs. No chance he can sneak some of the other cat's dry? That would definitely explain high and flat wit the one yellow (didn't get into it that day)

If you have explored all these possibilities, I think I'd slowly start raising the dose again. If you get above 4 units with no change, it's definitely time to look at high dose conditions and/or another insulin.

I would be sure to check ketones regularly while he is running so high.

 

[BJM]

A normal white count is not the same as no infection. If an infection is localized to a specific area, there may not be a systemic response.
Pop into the Acro/high dose forum and read over the characteristics of these conditions, then consider if any of them resemble your cat.
Actually look at the teeth and gums. Is there tartar? Is there redness around the gums (gingivitis)?

Had a thought: wondering if there might be a duration issue. Maybe see if you can snag some numbers in the +9 to +11 period to see when/if it starts rising some. Pick different times on different days, or do all 3 at a time that works for you. If that is the case, dosing TID (about every 8 hours), or switching to a depot insulin may be needed (and with the current dose level, I'd suggest Levemir as Lantus may sting at higher doses).

 

[Ruth Ann and Frodo]

It is a strange spreadsheet. The only day you saw a nice drop was 3/5. Usually when you drop or raise, you see more movement, one way or the other. I know how frustrating it is when you see nothing happening. He is early to the sugar dance, but I would think you would see something.

Just checking some of the basics:

>You are using U40 insulin and U40 needles. You roll the insulin before injecting and it's been refrigerated. It has no chunks of stuff in it. Was it from the vet and not >repackaged?

U40 insulin (ProZinc) and syringes. Insulin refrigerated, was from the vet, can't remember if they had started the vial when they ran a curve in the office, but in its original package. My husband has been rolling and drawing evening and morning syringes each evening - insulin looks fine but we're nearing the end of the vial.

>I think Rachel's thoughts about an infection is certainly a possibility.
Will keep it in mind, but no obvious signs.

>It might be worth backing off the food that has the rice. Sometimes it takes only a few carbs. No chance he can sneak some of the other cat's dry? That would definitely >explain high and flat wit the one yellow (didn't get into it that day)
I usually stand over the other cats as they eat "crunchies", and cover any extra as soon as they're done. Frodo might get a crumb off the floor, or sometimes he will sneak in fast if I turn my back for an instant, but he can't be getting very much. The canned foods have rice pretty far down the ingredient list, and they're all under 10% carbs on Dr. Lisa Pierson's list.

>If you have explored all these possibilities, I think I'd slowly start raising the dose again. If you get above 4 units with no change, it's definitely time to look at high dose >conditions and/or another insulin.
Had a phone conversation 3/10 with vet - she thinks he's just taking a long time to start responding, and OKd going up to 3u bid. Then we had a strange day yesterday - he started high, really dropped at +6 , but back up for pm shot. Then this morning very high again, and he was very reluctant to eat (finally did around +2 but not a lot) - don't know what his BG is going to look like later.

 

[Ruth Ann and Frodo]

It is a strange spreadsheet. The only day you saw a nice drop was 3/5. Usually when you drop or raise, you see more movement, one way or the other. I know how frustrating it is when you see nothing happening. He is early to the sugar dance, but I would think you would see something.

Just checking some of the basics:

You are using U40 insulin and U40 needles. You roll the insulin before injecting and it's been refrigerated. It has no chunks of stuff in it. Was it from the vet and not repackaged?

I think Rachel's thoughts about an infection is certainly a possibility.

It might be worth backing off the food that has the rice. Sometimes it takes only a few carbs. No chance he can sneak some of the other cat's dry? That would definitely explain high and flat wit the one yellow (didn't get into it that day)

If you have explored all these possibilities, I think I'd slowly start raising the dose again. If you get above 4 units with no change, it's definitely time to look at high dose conditions and/or another insulin.

I would be sure to check ketones regularly while he is running so high.

It is a strange spreadsheet. The only day you saw a nice drop was 3/5. Usually when you drop or raise, you see more movement, one way or the other. I know how frustrating it is when you see nothing happening. He is early to the sugar dance, but I would think you would see something.

Just checking some of the basics:

You are using U40 insulin and U40 needles. You roll the insulin before injecting and it's been refrigerated. It has no chunks of stuff in it. Was it from the vet and not repackaged?

I think Rachel's thoughts about an infection is certainly a possibility.

It might be worth backing off the food that has the rice. Sometimes it takes only a few carbs. No chance he can sneak some of the other cat's dry? That would definitely explain high and flat wit the one yellow (didn't get into it that day)

If you have explored all these possibilities, I think I'd slowly start raising the dose again. If you get above 4 units with no change, it's definitely time to look at high dose conditions and/or another insulin.

I would be sure to check ketones regularly while he is running so high.

 

[Sue and Oliver (GA)]

I certainly think you could try dosing every eight hours - as long as you are checking to make sure he is rising then, not falling. It may be that the ProZinc doesn't last long enough.

It may also be that he is a high dose kitty. Have you seen this thread? Do any of the symptoms sound familiar?
http://www.felinediabetes.com/FDMB/forums/acromegaly-iaa-cushings-cats.12/
The thread is old and the High Dose Facebook page is more current, but it may give you some info.

If he is a higher dose kitty, and because your vial is running low., I think I would consider switching to Levemir. It and Lantus work a lot alike and are dosed similarly but people say Levemir stings less at higher doses and it tends to have a later nadir which seems like something Frodo might need.