Help with Maddie

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Sarah Beers

Sarah Beers

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Long story short, Maddie isn't a usual case. She was officially diagnosed in February but I am sure it has been much longer than that. I had her tested multiple times over the years but her BG was always normal. She always drank nonstop and was overweight and had a horrible coat. I swear she goes in diabetic cycles...if that is possible. The drinking has stopped since going insulin and her coat is much nicer. Since being diagnosed we have been unable to find good dose for her. Some days her BG is 400, others it's 100. She was off insulin for a few weeks about a month or so ago. Then this past monday I gave her 2 units, which we have been doing fine on for a few weeks. Her BG starting dropping quickly. It was 238 before insulin and rapidly dropped down to 90 within 2 hours. The vet said stop insulin for a few days and see what happens. We thought maybe she didn't need it anymore because she seems to go in cycles.

Basically I just feel like we are missing something. My vet is great. She thought maybe she had something else going on that was causing these cycles but she covered all bases. She reached out to a vet (I think in Florida but I could be wrong) that specializes in feline diabetes. He was stumped. I'm just terrifed to give her insulin again because of what happened monday. Yesterday her BG was 357 in the AM and then in the evening it was 148 and she had no insulin. This morning it was 400. I feel like she needs it but I'm worried something will happen and I won't be here. I called off work on monday to be with her. I do have an automatic feeder so she gets lunch while I'm at work. My gut tells me to start over at a half unit but the vet wants me to call her with her readings over the past few days before we start insulin again. I will update her spread sheet with the numbers from this month. I don't have April's numbers anymore.
 
Wow, she is all over the place! Is there any way to get some mid cycle tests? Maybe on your day off run a curve also get a test at night before you go to bed. These numbers will help to see what's going on. Maybe a sliding scale would work for her. Sue, Rachel or Robin can help with that.
 
Sharon14 said:
Wow, she is all over the place! Is there any way to get some mid cycle tests? Maybe on your day off run a curve also get a test at night before you go to bed. These numbers will help to see what's going on. Maybe a sliding scale would work for her. Sue, Rachel or Robin can help with that.
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I can do that on Saturday when I am off! She is such a complicated girl. Do I test every 2 hours? Should I start giving her insulin or do it without insulin?
 
Sharon14 said:
Wow, she is all over the place! Is there any way to get some mid cycle tests? Maybe on your day off run a curve also get a test at night before you go to bed. These numbers will help to see what's going on. Maybe a sliding scale would work for her. Sue, Rachel or Robin can help with that.
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Her being all over the place is why I think she has been diabetic for such a long time without us knowing. I feel like the days I got her checked were the days she was fine. The only reason we caught it in feb is because she got a bladder infection and they detected glucose in her urine so they retested.
 
You do have an unusual case for sure. If you could update her SS that would be really helpful so we can see what is going on with the dose that you gave in each cycle. What was the last dose you gave her and how much? Are you at work right now? At 400 BGs she should be on insulin for sure.
 
Whether or not to give insulin will depend on her PS number. That's where Sue, Robin or Rachel can help. She was in the 300's yesterday and you did not give insulin and she was 160 @PM so shes an odd one.
 
Hi Sarah! Well, looking at the numbers you have, it's hard to say what is going on. My GUESS is that the amount you are giving is too high. Then she drops down and doesn't rise quickly enough for a PM shot. Unfortunately, without the mid cycle tests, we can't be sure. The curve Sharon suggested would really help...usually we do that every 2 hours. It does need to be done on insulin. The reason is the curve tells us what the dose does to her. It catches a lot of data in one day so we can see how quickly she drops, how low she goes, how fast she rises, etc. It's a great tool.

Until Saturday, can you grab some data whenever? I don't know if you have to leave for work pretty fast after you shoot...but if not, you can grab an on the way out the door number. Also, a before bed number. Like if you shoot at 6 PM, grab a test at 8 or 9 (whenever you are headed to bed) so we can just see where she is headed. Then run the full curve Saturday. Basically, getting data whenever you can will help, even if it isn't a nadir number. .Make sense?

I can tell you that I think she needs insulin. You wouldn't be getting high numbers like that if she didn't. But 2 units is bringing her too low to shoot at night, which doesn't help, since then she is super high in the AM. Are you wanting to shoot today?
 
If you run a curve you would give her insulin shot and just test every 2 hours for 12, or every 3 hours for 18 :)
 
Ok I will give her insulin tomorrow morning at 6 and check her at 8:45 before I leave for work and then do a full curve on Saturday. Should I back her down to a half unit or should I do 1 unit?
 
I already fed her this morning at 6 so I probably wouldn't be able to get her to eat enough to give her insulin now. I will check her tonight when i get home though and depending what that reading is I can give her insulin tonight. This morning I have a dentist appt so I have to leave shortly so I really don't think I could get her to eat in the next 20 minutes.
 
Okay, sounds good. I'll try to check in on you tonight. What time (and time zone) do you check at night?

As for dose, let's see what she is at tonight and/or tomorrow before deciding.
 
I like the idea of some more data. I wonder if the one unit on a yellow is giving her a low number at nadir. She may be a kitty who doesn't bounce for the next preshot test but has a higher cycle the next day.. It's possible that 0.5 for the 150+ range is too much also.

The only thing I can think of that would explain her lowering on her own is that her pancreas is working intermittently. It usually doesn't start working and stay working. It helps out for awhile and then "rests". Dosing during this time is particularly challenging.

If she were mine, I'd get those numbers midcycle to see if some of the higher preshots numbers are bouncing. Are you using a pet meter? Our hypo range for those start at 68 so I'd watch for that. You might also get some U100 needles and use our conversion chart. Lots of people here use them because it lets you shoot doses like 0.2 and 0.4 accurately. The chart is here:

http://www.felinediabetes.com/insulin-conversions.htm
 
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For my information only to understand prozinc. Is it common to not give a dose based on number instead of decreasing and give steady doses?
 
Did your vet do any imaging of the abdominal area?
There is a condition which may result in very erratic glucose levels; it is an insulinoma, a tumor of insulin-secreting cells. they are small and hard to detect on imaging. if one is detectable, it might be possible to remove it..
 
BJM said:
Did your vet do any imaging of the abdominal area?
There is a condition which may result in very erratic glucose levels; it is an insulinoma, a tumor of insulin-secreting cells. they are small and hard to detect on imaging. if one is detectable, it might be possible to remove it..
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No she checked her pancreas though
 
This is what I found but to me it sounds like she would have low BG if she had this.

Insulinomas are malignant neoplasms — fast growing cancerous tissue — of the beta cells in the pancreas. The beta cells primarily make and secrete insulin, which has a variety of effects in the body, the primary one being to regulate glucose throughout the body's cells. Because insulinomas secrete excessive insulin, the blood stream becomes low in glucose (hypoglycemia), which causes weakness and/or neurological problems. This disease does not effect cats as much as it does.
 
Are you able to monitor tonight? I think I might do 0.5. It may not be enough but I'm nervous to suggest more without more data and with her getting such odd numbers.
 
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