? Constant hyper numbers, curve today & potential dosage change?

Today, I am doing a curve on Rambo. He has been having very high numbers and a couple of accidents outside of the litter box. I am giving him B12 methyl to help with his neuropathy issues in his hind legs since they seem to be wasting more because of his hyper high numbers/insulin. I am currently giving him 1.25 units of Lantus but am debating about increasing to 1.50 units. The last time I had him on 1.50 units he had hypo issues. How do I make his numbers stay in a normal range?

Also, when he tests over 500 what should I do? At 12:45 pm (CT, Minnesota, 4 hours after am insulin dose) today he is at 650 (using AlphaTrak2). Is there anything I need to do to help lower these numbers when he is in hyper glucose levels?

Past thread: https://felinediabetes.com/FDMB/thr...i-still-give-him-insulin.253849/#post-2861873

 

@tiffmaxee
@Wendy & Neko (GA)
@Sienne and Gabby (GA)

Let's see if we can get your pretty boy some help, Karrie. I think he definitely needs an increase but wait to see what the experts say. Hope you got over the COVID with no lingering problems.

 

Hi, Karrie! Sorry to hear about Rambo.

I don't think there's much you can do when the numbers are that high to bring them down. The good news is that HYPERglycemia is not as urgent a condition as HYPOglycemia. It's not great, but usually doesn't land a cat in the ER. On your previous thread, it was suggested that you test for ketones. Is this something you're able to do? Before my cat got into healthy numbers, I was advised to check her urine for ketones once a day to make sure nothing was developing. That *is* a problem that can develop from numbers that are too high and can be quite serious. If checking the urine is problematic, they do make blood monitors that check both glucose and ketones.

When you got that low number, did you double-check to make sure it wasn't a bad strip or not enough blood? When you get a shockingly low number, it's always good to confirm it with another test just to be certain. And if it was actually that low, that doesn't mean that 1.5 might not be a good dose for him now. I am also not a dosing advisor, but he probably needs more. Insulin is a hormone, not a medication, so how the dose works can vary from day to day depending on whatever else is going on inside your cat's body. Once we find a good dose and he starts spending more time in healthy BG ranges, then you'll start to see the numbers that you want and see improvements in his neuropathy.

 

Hi Karrie,

It does look like Rambo needs more insulin. You can take him up to 1.5U.

Have you decided to follow the SLGS dosing method? Since you are feeding only LC wet, you can follow TR since it is a more aggressive protocol and can get Rambo to a good dose sooner. However, it requires more testing than SLGS. Do you think you would be able to get at least one more test per cycle in addition to the preshot tests?

A cat's insulin needs can and do change - just because 1.5U was too much for him a month ago (assuming that strip was not a bad one like Alex pointed out), does not mean it will be too much now.

His neuropathy will resolve once he starts seeing better numbers. Hang in there!

Btw, you may want to switch to a human meter. Cheaper strips and the AT reads much higher at higher numbers.

 

Thanks everyone for your advice. I plan to increase Rambo's insulin dose to 1.5U. I know he was stressed on Sunday so maybe doing a curve on Monday wasn't the best day to do one. I will try and test him some more throughout today to see what his numbers look like. Is it normal to give 1.50 units in the am and 1.25 units in the pm? Should I try that?

I am not sure how to test for ketones and where to get supplies for that. I will have to do some research on it to learn more. I will also look up what SLGS and TR differences are again. I have been doing the slow and steady type of routine.

When I had low numbers I retested a few times to make sure it was legit. I also make sure I have a large enough blood drop each time when I test him. Where do you buy human meters from for a pet? I use the AlphaTrak2 one because that is what my vet uses.

 

Generally with Lantus, you give the same dose AM and PM. Each dose builds on each other to keep the depot full, so consistency with dose and with timing is important to success with this kind of insulin.

You test for ketones using ketostix - they are strips you hold in the stream of urine (or collect using a cup or a ladle) and the color that shows up after 15 seconds will tell you if there are ketones. You can pick them up over-the-counter without a prescription. I think my bottle was, like, $8 for 50 strips. It's the same stuff people on the keto diet use to test their urine for ketones.

If you are in the US, a lot of us use the ReliOn Prime from WalMart. The meter is about $10, and you can get 100 strips for $18. It needs a little bit more blood than the AlphaTrak, but still not a lot. There are plenty of others, available at most pharmacies and you don't need a prescription for them. The numbers will generally read lower than the AT because of the blood composition, but as long as you know what numbers to look out for (and the resources here have those guidelines), you will have a good idea when your cat is getting healthier. I also started on the AlphaTrak and switched to a human meter. I keep the AT as a backup or if I need to give the number to a vet who is insistent on using a pet meter.

 

There are a couple of additional items I want to stress.

I'm going to assume that you're following Start Low Go Slow versus Tight Regulation. You'll want to make that note in your signature (since I just happened to notice it on your spreadsheet.) With SLGS, you need to evaluate the dose every week and do a curve. It looks like yesterday was the first time in a while that you've done a curve. The reason for evaluating the dose is to determine if Rambo is due for a dose increase. You've been holding on to the 1.25u dose for a bit longer than necessary.

It's also very important to get at least one test in addition to your PMPS every PM cycle. I suspect that Rambo may be seeing lower numbers at night and bouncing into high numbers during the AM cycle. Lantus dosing is predicated on the lowest number in the cycle. You may have missed a dose reduction by not getting PM tests.

 

Can you send me a picture of what you buy at Walmart for the ketostix? Also, does it have to be a pet only one or do human ones work the same? Or is there a certain one on amazon that works good to indicate this?

I will look into the ReliOn Prime meter and read through the resources to learn how to use it for Rambo. The AlphaTrak2 has worked nice for me but man oh man the test strips are at least $50 a bottle for only 50 strips.

 

I will try and test him before I go to bed at night to get an after PMPS reading. So far I have not noticed any change in his blood glucose readings after upping his dose to 1.5U's. He does seem happier though since giving him more insulin. More snuggly and so far (knock on wood) no accidents outside of the litter box.

 

The Relion functions pretty similarly to the AlphaTrak. The strip collects blood on a slightly different part of the strip, and the numbers will read lower. But otherwise, they're pretty similar. And you don't have to enter a special code either.

If you go to WalMart, these are the ketostix: https://www.walmart.com/search?q=ketostix There are not pet specific ones - they work the same for both. You'll see the gradient on the box of the ReliOn brand - that should also be on the bottle of any brand. After you collect the sample, wait 15 seconds and hold the strip up to the bottle. The color of the strip at 15 seconds is your reading. It will keep getting darker, so that's what that counter is important (I just count, not set a timer or anything).

 

Good to know! Thank you for all of your help.