11-14 Increased doses but BGs aren’t moving

[Howiesmom]

I’ve been following TR for Howie since he is an IAA kittie and is on higher doses. However, his BGs don’t seem to really be affected by these higher doses. I started him on 10 units this AM. He hasn’t seen multiple blues since he was at 8.5 units and I’m really confused. No food, treat, or medicine changes (besides using s boulardii for diarrhea/soft stool). The only thing I can think of is that I moved his mini meal times. He was getting them at +2.5, +4, and +5.5. I moved his times last week to +3, +5, and +7 so he was getting food later in the cycles. Would these time changes affect his BGs that much? Should I go back to his old times? I know I haven’t been testing him in the PM cycle besides +3 when I go to bed. Should I be concerned or does this seem normal with IAA kitties?

 

[Vyktors Mum]

With IAA you just have to keep increasing like you are until it breaks, and it will break. The feed at +7 may not be helping though, it’s possibly a bit late in the cycle and contributing to some slightly higher preshot numbers - barring yesterday morning of course

 

[Howiesmom]

With IAA you just have to keep increasing like you are until it breaks, and it will break. The feed at +7 may not be helping though, it’s possibly a bit late in the cycle and contributing to some slightly higher preshot numbers - barring yesterday morning of course

Thanks! I’ll readjust his times so his last one is at +6 and see how that does.

 

[Vyktors Mum]

@Howiesmom it occurs to me that now you’ve hit 10U it might be time to start increasing in full units too but let’s get @Wendy&Neko view on that too.

 

[Wendy&Neko]

I agree with Serryn, you can move to 1.0 unit increases when you go to 10 units. Think of the increases as a percentage of total dose.

The +7 feed should not be a problem, provided Howie's nadir is after that. Since he's a Levemir kitty, chances are his nadir is after +7 and ideally you want to feed before nadir when the insulin is stronger.

As for the +3 test being the last one of night, it's a little hard to tell if that's a useful one yet. When Howie is still stuck in his yellows, it's hard to tell when his onset is. Once he stops his affection for yellow, it should become more obvious. Ideally you'd like a before bed test at or after onset, so you can see if it's going to be an active cycle. Neko's Lev onset was +5, and I seldom was up that late, so I had to learn other patterns to tell me when I had to set an alarm for a later test.

I know you said his test for acromegaly was negative, can you remind me again what the IGF-1 number was?

 

[Howiesmom]

I agree with Serryn, you can move to 1.0 unit increases when you go to 10 units. Think of the increases as a percentage of total dose.

The +7 feed should not be a problem, provided Howie's nadir is after that. Since he's a Levemir kitty, chances are his nadir is after +7 and ideally you want to feed before nadir when the insulin is stronger.

As for the +3 test being the last one of night, it's a little hard to tell if that's a useful one yet. When Howie is still stuck in his yellows, it's hard to tell when his onset is. Once he stops his affection for yellow, it should become more obvious. Ideally you'd like a before bed test at or after onset, so you can see if it's going to be an active cycle. Neko's Lev onset was +5, and I seldom was up that late, so I had to learn other patterns to tell me when I had to set an alarm for a later test.

I know you said his test for acromegaly was negative, can you remind me again what the IGF-1 number was?

His IGF-1was 62. What sort of things/patterns do you look for to know if you had to do a later test? His +3 is my bedtime! I adjusted his feeding and insulin already so I could get a test that late. Thanks!!

 

[Wendy&Neko]

The patterns that appear are particular to the cat and can occur over more than one cycle. What I did try to do is get a +4 fairly frequently during the day, as that was my before bed test time. And if she had an active day time cycle, tried to figure out if that +4 during the day might have told me anything. I also fed the same times in the AM and PM, so that was consistent. Another test that I found helped me was the +9. Neko often did a nadir at preshot and sometimes even later. So if she was going down into preshot, then at at PM+4, it meant something different than if she was still going down at PM+4. I was often able to catch at PM+9, cause I'd be up for a workout several days a week. However, until you start seeing number in lower blues, those patterns will be hard to see.

For now, if I saw a big drop between your PMPS and before bed test, I'd drink a large glass of water and if you have to get up, grab a test then. If you see the PM of 11/03, there was a big drop before bed, then you woke up to blue. I expect he spent most of the night in blues.

 

[Howiesmom]

The patterns that appear are particular to the cat and can occur over more than one cycle. What I did try to do is get a +4 fairly frequently during the day, as that was my before bed test time. And if she had an active day time cycle, tried to figure out if that +4 during the day might have told me anything. I also fed the same times in the AM and PM, so that was consistent. Another test that I found helped me was the +9. Neko often did a nadir at preshot and sometimes even later. So if she was going down into preshot, then at at PM+4, it meant something different than if she was still going down at PM+4. I was often able to catch at PM+9, cause I'd be up for a workout several days a week. However, until you start seeing number in lower blues, those patterns will be hard to see.

For now, if I saw a big drop between your PMPS and before bed test, I'd drink a large glass of water and if you have to get up, grab a test then. If you see the PM of 11/03, there was a big drop before bed, then you woke up to blue. I expect he spent most of the night in blues.

Thanks so much! This is helpful! Yes, those readings on 11/3 were bizarre! I guess I’m “happy” with flatter curves and he’s not all over the place like some kitties. I’m bummed I got some erroneous advice when he was at 8.5 units when he was in blues as this might be a different story. At what point do I know when I should hold a dose and not move him to a higher dosage?

 

[Wendy&Neko]

A good goal for now it to get him to a dose where he's spending most of his time in greens and blues. That'll mean he's mostly under renal threshold. If he keeps up flat, that should be easier to do.