Curve done today. Looking for opinions, please.

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Red'sMomHeather

Red'sMomHeather

Member Since 2015
I'm going to call the vet tomorrow to give her the numbers from the curve I did today but I would love some feedback from anyone/everyone on here. The link to Red's SS is in my signature.

Some info:

He has yet to be regulated.
9 yr old male. Weight - 16.5lbs (Down from 23.5 @ end December 2014.) Weight has been holding steady for 2 months.
No previous health problems, but his blood work showed elevated liver values that according to the vet are due to the high blood sugar. For this he is on Zentonil and hepato support every day.
Eats well. Wet Friskies pate. 2/3 can each @ 10:30 am. 5 pm, and 10:30 pm.
Currently receiving 10 U caninsulin @ 11am and 9 U @ 11pm.
Normal activity level (which for him = mostly lazy anyway :p )
It doesn't seem like he drinks excessive amounts BUT he shows no signs of dehydration while having larger than normal amounts of urine.
Poops are well formed. Not too hard or soft, medium brown in colour but often VERY stinky.

When I originally switched him from the prescription diabetic food to the Friskies I saw an avg. of low to mid-20's for the AMPS and PMPS and high teens before feeding him his dinner at 5pm, but now they're back up to mid-30's.

The point on the SS that I find the strangest is the lower numbers the day after he received only 4U in the am and none at night.

Thanks in advance everyone for your help!
 
What dose did Red start on? And how did he get to the 8 units of insulin? I see he's on 10 units now and that's quite a high dose. Neko has two high dose conditions and was seeing blues on 5 units of Caninsulin. It could be possible that Red is getting too much insulin - and his body is compensating by sending out sugars. Too much insulin can look like too little. I'd also try getting a test at night, maybe before bed. Often cats go lower at night than during the day.
 
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The un-useable glucose is causing fat breakdown for calories. This fat goes to the liver for processing. Too much makes the liver swell, reducing its ability to function in digestion. Thus, the need for liver support.

One or more of these things is true: you have a high dose situation (possibilities include infection, acromegaly, IAA, or Cushings), you need a different insulin, the dose isn't correct yet. I second the post before mine - how did you get to that high of a dose? Have you any historical data you can add at the top, maybe from the vet?

Really important - dose adjustments should be made on the nadir, the lowest glucose post-shot. If adjustments were made on the pre-shot glucose, the dose may be too high. I noticed the morning he had 4 units, he was red, not black in his numbers. And after skipping a dose, he came DOWN to the high 300s.

Given that you are seeing ketones, I would suggest getting a blood ketone meter, which detects ketones on an average of 5 days before they'll show up in the urine.

 
yikes. those are awful numbers today.

We're still faced with the same dilemma - is he a high dose cat that needs more insulin or is he overdosed, which is making his blood sugar stay high?

Are you committed to staying with the Caninsulin? It's really not recommended for cats - I just looked it up yesterday for someone.

@Wendy&Neko, here's the link to a discussion on that very topic in her last post.
 
Given this may be a high dose cat, I would suggest Levemir, as Lantus may sting at higher doses.
 
My story (I know someone mentioned before about putting this in a google doc to attach to signature?? A link on how to set that up would be much appreciated!)

When I first brought Red in he hadn't been eating, was lethargic, not grooming. Vet showed me he was jaundiced and dehydrated. Blood tests showed both high glucose and elevated liver values on his blood work.
He went from 1 to 3 units insulin while in hospital over 4 days. Dose stayed at 3 units as I brought him in bi-weekly for bs tests. He was always at the low end of the acceptable range for these tests which would have been roughly 6+ after shot. He ended up going hypo so we stopped insulin. His numbers stayed in the correct range. This all happened within two and a half weeks. His blood sugar stayed fine, liver values returned to normal.
At that point (maybe 5 weeks after original vet visit) vet said to just re-check his blood in about 6 months but, a couple months later, the exact same thing ended up happening, just caught earlier the second time around since I had seen this before. He showed the same signs that he did originally in January - lethargy, not eating well, not grooming - so I brought him in to find out his bs was again high as were his liver values.
He was in hospital for a couple of days on fluids and they increased the dose while he was there, starting at 1U 2x/day and I believe up to 3U 2x/day. I brought him in for bi-weekly bs tests. Again these would have happened mostly at around 6+ after shot so those numbers were the ones used for adjustments.
Again, if I'm remembering correctly, the dose was increased pretty much every time I went in. It would go from 3U am and 3U pm to 4U am and 3U pm, to 4U am and 4U pm, etc etc up to the current 10U am and 9U pm.
What ended up happening when I got the glucometer for home testing was that I would check the number but not record it. After a month I went back through writing down all the numbers stored in the glucometer, but somehow the time and dates were wrong so I found it all very confusing. I could try making a SS with those numbers but I don't feel like they're very accurate. If it'll help I can get as much info from the vet about the bs readings they did as well as his lab reports.

Tested tonight at 2+ and got 36.0. Also tested for ketones - negative.
 
Though I realize that if this is the case I need to get a new vet, I'm wondering if she can supply the levemir? I don't want her telling me to stick with caninsulin because it's the one type she has.

Is a blood ketone meter available at a Wal-Mart type store?
 
Red'sMomHeather said:
(I know someone mentioned before about putting this in a google doc to attach to signature?? A link on how to set that up would be much appreciated!)
Click to expand...

You have the spreadsheet already in your signature...it's titled "Red's SS"

Lantus or Levemir (the better insulins for cats) are human insulins that you can get at any pharmacy. Your vet just needs to write the prescription. They are expensive though. I'm not sure where you live, but in the US a box of 5 pens can run close to $500

The last post in the Insulin from Canadian Pharmacies thread has info on where you can get it for a lot cheaper and a lot of us are using Marks Marine in Canada
 
I
Chris & China said:
You have the spreadsheet already in your signature...it's titled "Red's SS"

Lantus or Levemir (the better insulins for cats) are human insulins that you can get at any pharmacy. Your vet just needs to write the prescription. They are expensive though. I'm not sure where you live, but in the US a box of 5 pens can run close to $500

The last post in the Insulin from Canadian Pharmacies thread has info on where you can get it for a lot cheaper and a lot of us are using Marks Marine in Canada
Click to expand...

Oh, sorry, I meant the whole "story." Is there a way to put that with the SS?

The link for the Marks Marine...you wrote I think $169.00. This is for one "pen"? I'm afraid I'm not sure what that means. :/
 
No, the $169 price is for a 5 pack of the Levemir Touch pens. Each pen holds 3ml (300 units) and you use a regular insulin syringe to pull the insulin out of the pen the same as a vial. You end up with 5 pens with 300 units in each one for that price
 
Since you live in Canada like I do, you just walk up to the counter of a people pharmacy and ask for a 5 pack of Levemir cartridges. Should run you around $130, cheaper than Marks Marine. You'll also need U-100 syringes, which in Canada, since they have a monopoly, means the BD Ultrafine II (purple and yellow box). I get my best prices in BC at a Safeway, your mileage may vary in Ontario. You may wish to discuss with your vet first that you'd like to change insulins. Neko started out on Caninsulin, in spite of me keeping on saying "is this the right insulin for cats?". A locum vet got me on Lantus and pointed me here for dosing advice. I did the switch to Levemir later, but I just did it without asking the vet.
 
Note, you cannot use your "regular syringes" that you use for Caninsulin, you need the U-100, orange cap ones. Caninsulin syringes are U-40 syringes and likely have a red cap. My vet bought back my extra unused unopened packages of U-40 syringes, but I had to donate the Caninsulin (barely opened) to a charity that dealt with older dogs.

You do NOT need a prescription for Levemir.
 
Thanks for the great advice everyone!

I'm seeing the vet Monday so I'll see what she says about his numbers and the caninsulin dose, ask her if she thinks he might do better on a different insulin. Hopefully she'll listen to my concerns.
 
Fyi, the dosing guides that BJM gave you are also used for Levemir.

All of those high numbers are concerning. The more I see, the more I think you may need to increase the dose. Some cats have high dose conditions and they need more insulin. What was the vet's advice about adjusting the dose? What are your thoughts about that?

Even though you aren't completely confident about the glucometer, I'd put the data in anyway.

If you will be able to test, I'd encourage you to increase his insulin.
 
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