? Flat curve and very high numbers-- please help

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Christin & Mimi

Christin & Mimi

Member Since 2018
Hi everyone. My cat, Mimi, was diagnosed with diabetes about 3 years ago. I've educated myself extensively on feline diabetes. I home test and she eats FF pate exclusively. She has been well regulated for quite a while, but recently, she started displaying a pattern of higher numbers. I initially assumed it was caused by her Lantus insulin pen reaching the end of its shelf life (it was the last pen in the box of 5), so I quickly ordered a new pen. She's been on the new pen for over 2 weeks now and I still can't get her numbers under control.

Her most recent curve is very confusing to me--it's nearly flat. Yesterday morning she was HI and then 484 at the usual nadir. She was then HI again at PMPS. I am really struggling to figure out if she's bouncing or immediately needs a higher dose.

I'm suspicious about the possibility of bouncing for two reasons. 1) The last time I raised her dose by .25 units for her AM shot, her numbers shot up by 200 points when I did the PM test. 2) I had her well regulated on a very low dose (.5 units) in the past. The increase back up to 1.25 has been very gradual (with increases of only .25 at a time) over the past couple of months following all of the guidelines.

However, I don't want to risk serious issues. She isn't prone to ketones or DKA, but she's acting sluggish lately, and I'm getting really worried. If she needs a higher dose, I want to increase her right away. I should note that she recently had a full check-up and the vet said she seemed to be doing great--no concerns noted, and her numbers were fine during that visit. Since then, though, this new pattern has emerged and I can't seem to break the cycle.

Two of my immediate family members have been dealing with health crises over the past several weeks and things have been very hectic, so I don't have an up-to-date spreadsheet (I know I should) but I'm hoping for any possible insight based on her curve:

She is currently on 1.25 units BID of Lantus:

+0 549
+2 524
+4 489
+6 439
+8 464
+10 475
+12 499

Any idea what could be going on here? I'm overwhelmed at this point and appreciate any guidance.
 
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Hi Christin!

What were her numbers like when she was well regulated? When was the vet visit and what were her numbers then?

Unfortunately, we cannot tell whether the dose is too low or too high based on the number of 1 or 2 cycles - or even 1 or 2 days. Like you said, it's possible that the higher numbers in a cycle could be on account of her bouncing from lows in a previous cycle.

If you have been increasing her dose gradually by 0.25U, with tests to see how low she is going at every dose, its unlikely that you have bypassed a good dose and she probably just needs more insulin. How is she doing otherwise? Any other health issues that could have pushed her numbers higher? Any infections, dental issues etc?

I am sorry you have been dealing with multiple health crises on the home front, but would it possible to update just a week's figures in her spreadsheet? If you don't already have a spreadsheet, I can set one up very quickly for you to input the numbers in.

I hope you are testing her regularly for ketones.

Link to your previous post - https://www.felinediabetes.com/FDMB/threads/dosing-advice.225877/
 
Thanks so much for the reply! I've put together a spreadsheet covering the past couple of weeks.

I was able to get in a few midway-point tests yesterday, and what's confusing to me is that she dropped quite dramatically--from HI down to the 200s at +6. If she drops 300-400 points on 1.25 units, would it be a dangerous dose to give if she's in the 300s or lower pre-shot? I'm just so stuck on whether or not I need to be increasing or decreasing the dose.

Her health overall has been quite good. The vet was impressed, actually, with how good she looked at her visit 3 months ago. She mentioned that her weight now is ideal and she seemed to have no apparent health issues other than the diabetes and chronic constipation (which we treat with Miralax and/or canned plain pumpkin). Her numbers were in the 300s after the appointment, but I think that is to be expected given the stress of the ordeal.

When she's well-regulated, she's usually in the 200s or very low 300s pre-shot. This is not the first time that she's suddenly fallen off the well-regulated wagon, but it's always very distressing to me when her numbers shoot up.

Here's my spreadsheet:

https://docs.google.com/spreadsheet...A56H5XU6ISkHes2lcHZ8UfgQ9r2QLCfK39n64/pubhtml

Any thoughts?
 
Great job on setting that SS up. Thank you! :-)

A cat's normal number are 50-100 on a human meter. 200-300 is also on the higher side. Looking at her numbers she definitely needs more insulin. I would take her up to 1.5U.

How are things on the home front? Will you be able to get a mid-cycle test in addition to the pre-shot test? Since she is on a LC canned diet, you can follow our TR protocol if you can get 4 tests a day - 2 pre-shot and 2 mid cycle. That will enable you to get her to a good dose quickly.

The other option is to follow our SLGS protocol where you hold the dose for a week and then do a curve and increase if needed.
Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

We encourage members to shoot any number over 150. If you get a number that you are uncomfortable shooting, stall without feeding and post here for advice.
 
One immediate thought is if the vet has checked your cat's teeth. The need for a dental is a frequent reason that cat's fall out of remission or regulation.

I realize that it's counterintuitive but the 1.25u dose at a start in the 400s generally will not plummet numbers down if the pre-shot is in the 200s. Often, you end up with a flatter curve.
 
Thanks for the replies! The vet did check over her teeth at her last appointment. She said that it wouldn't be a bad idea to schedule a dental, but that her teeth seemed okay overall. I still wonder if there may be issues with her teeth though that could be contributing to her falling out to regulation.

I did go ahead and increase her to 1.5 units. She dropped back down into the 300s last night pre-shot, so it seemed things were going in the right direction. However, I'm concerned she may have actually bounced today. She was 345 at AMPS, dropped to 256 at +6, and then shot up to 574 at +8, then HI at PMPS. I have updated the spreadsheet. I gave her another dose of 1.5 at PMPS, but I'm not sure if that was the right thing to do. Any thoughts? So stressful. :-/

https://docs.google.com/spreadsheet...A56H5XU6ISkHes2lcHZ8UfgQ9r2QLCfK39n64/pubhtml
 
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It's possible that she bounced from the 200s she saw today, but she is still in higher numbers and needs more insulin. A cat's normal numbers are between 50-120 on a human meter. You want to at least bring her below the renal threshold which could be anywhere between 200-280 (different for each cat). Ideally you want her largely below 200.

If you are feeding her 100% low carb canned food (no dry food) and can get at least one test per cycle in addition to the pre-shot ones, you can follow the TR protocol which allows dose increases every 3-5 days. With that we can fast-track the increase in her dose.

Christin & Mimi said:
Mimi's Spreadsheet - Google Sheets
Click to expand...
Btw, this link does not work. The one you shared in post #3, does though.
 
Thank you. I corrected the link to the spreadsheet. I'll keep her on the 1.5 U and see how she does. She does seem to be, for whatever reason, very sensitive to significant drops in her BG. Her numbers often seem to shoot way up after she drops several hundred points, even if she's not going too low. Do you recommend continuing to update the spreadsheet and sharing it in the Lantus forum for continued help getting her back on track?
 
Christin & Mimi said:
I'll keep her on the 1.5 U and see how she does.
Click to expand...
Please don't keep her on the dose too long. The longest we suggest is 1 week per the SLGS protocol. The 1.25U dose was held too long. She needs more insulin. Keeping her at higher numbers is not old hard on the kidneys, it also makes it harder for numbers to come down with insulin. When a cat stays in high numbers for too long, it's body gets used to higher numbers and treats them as normal. It then requires much more insulin to break through to lower numbers.

Christin & Mimi said:
Do you recommend continuing to update the spreadsheet and sharing it in the Lantus forum for continued help getting her back on track?
Click to expand...
Yes please! We will need you to pick a dosing protocol for us to be able to help you with dosing.

In addition to updating your Spreadsheet, it would be a big help to us if you can set-up your signature? It's basically a summary of the information we need about your cat to give you advice. The spreadsheet and signature are the things we look at when asked for advice. It saves us asking you the same questions again and again especially when the question is time critical like stalling or low numbers. It also saves you the effort of giving us the information every time you post!

Here's how you can set-up your Signature:
  • In the Menu, under your user name, click on Signature.
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
  • There is a limit of two lines. You may separate info with commas, dashes, | etc.
  • Be sure to click the 'Save Changes' button at the bottom.
 
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