2/10 - AMPS 196, +9 260 — need advice

Autumn - Sunday’s mom

Autumn - Sunday’s mom

Member Since 2021
Hi all,

My cat, Sunday, has been getting .5 units of Lantus every 12 hours (has been at this dose for about 4 months). Her blood glucose levels usually always fall between 100-199. Within the last month and a half, she’s been very frequently testing at numbers between 190-260. I’m not sure what has changed to cause this increase in her BGLs. I haven’t changed anything.

I was wondering if anyone could check out her spreadsheet and advice what my plan of action should be moving forward. I’m thinking I may need to increase her dosage a little bit, but I’m not sure.

TIA!
 
Hi Autumn. Your spreadsheet says TR but it doesn’t look like you are following it. Your signature says SLGS so I assume that is the method you are following?
 
So - I have a couple of thoughts for you. I am glad you've managed to get some midcycle tests recently, since with Lantus you want to be able to see how low the dose is taking Sunday when making dose decisions, and unfortunately the preshot numbers just don't give you the right information.

One of the things we often find is that insulin needs do change, for a lot of reasons, which is why if you start to see numbers creeping up, it's time to consider bumping up the dose. Sometimes all it takes is a little nudge and the numbers start to fall back in line.

That said, I noted you have SLGS on your signature, but TR in your SS.

With SLGS in general, your goal is to achieve flat numbers that are greater than 90 mg/dL. You are also looking to see if nadirs are more than 150 mg/dl (8.3 mmol/L), before deciding to increase the dose by 0.25 unit, and in some cases, when there aren't enough midcycle tests available over a week's time frame, it would be a good idea to run a curve. You are getting some nadirs under 150, but if you want to try and achieve some flatter cycles, and can perhaps test a little more to watch how the increase is working, that might be worth doing.

With TR, as long as you are testing each midcycle (day and night), which you've done recently, you do have room to increase, since you haven't seen greens in a while, although with that PMPS of 129 on Feb 8th, I do wonder if maybe there was something earlier in the cycle and she was coming back up by preshot.
 
Christie & Maverick said:
So - I have a couple of thoughts for you. I am glad you've managed to get some midcycle tests recently, since with Lantus you want to be able to see how low the dose is taking Sunday when making dose decisions, and unfortunately the preshot numbers just don't give you the right information.

One of the things we often find is that insulin needs do change, for a lot of reasons, which is why if you start to see numbers creeping up, it's time to consider bumping up the dose. Sometimes all it takes is a little nudge and the numbers start to fall back in line.

That said, I noted you have SLGS on your signature, but TR in your SS.

With SLGS in general, your goal is to achieve flat numbers that are greater than 90 mg/dL. You are also looking to see if nadirs are more than 150 mg/dl (8.3 mmol/L), before deciding to increase the dose by 0.25 unit, and in some cases, when there aren't enough midcycle tests available over a week's time frame, it would be a good idea to run a curve. You are getting some nadirs under 150, but if you want to try and achieve some flatter cycles, and can perhaps test a little more to watch how the increase is working, that might be worth doing.

With TR, as long as you are testing each midcycle (day and night), which you've done recently, you do have room to increase, since you haven't seen greens in a while, although with that PMPS of 129 on Feb 8th, I do wonder if maybe there was something earlier in the cycle and she was coming back up by preshot.
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So should I maybe run a curve within the next few days and just work on getting more data overall before making a decision (within the next week maybe)?
 
I would - it is a bit of a toss up, since you are looking at nadirs (plural), and based on some more recent data over the last few days you are getting some nadirs under 150 and some over. And you are using AT2 which does read higher than human meters, which our dosing methods are based on.

How is she feeling? Everything good?

@tiffmaxee Elise, what do you think?
 
She seems like her normal self. Always a little sleepy in the evenings before her PM shot and dinner, but playful and follows me around all day. Appetite normal as well. Thanks for all of your input so far. I will wait for Tiffmaxee’s response as well.
 
You're welcome. I'm glad to hear she's doing well, since they are most definitely more than their numbers. :). Numbers aren't that bad overall, so it also depends on what your goals are for Sunday.

I had discovered for myself and Maverick, being at this for around 4.5 years, that ultimately he would be on insulin for life, so my goals shifted from trying to achieve remission to trying to keep him under renal threshold as much as possible, and being happy and healthy.
 
Christie & Maverick said:
You're welcome. I'm glad to hear she's doing well, since they are most definitely more than their numbers. :). Numbers aren't that bad overall, so it also depends on what your goals are for Sunday.

I had discovered for myself and Maverick, being at this for around 4.5 years, that ultimately he would be on insulin for life, so my goals shifted from trying to achieve remission to trying to keep him under renal threshold as much as possible, and being happy and healthy.
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As much as I’d love for Sunday to be in remission, I think we are at the same place. She was diagnosed in 2019, and unfortunately, we didn’t find this group until about 5 months ago. I just want her to live a long, happy, healthy life as well. I will do whatever I need to do to make that happen.

Thank you so much for sharing your advice and personal experience. I will do a curve and try to update everyone on a new post.
 
One last thought - if you are finding that her numbers really start to change significantly to the upside, it might be worth getting a regular health check for her with her vet. Sometimes when kitties who are very well-regulated lose that regulation, there may be some underlying cause (dental issues, infection, etc) that cause increased BG levels. If you haven't been to the vet's within the last year, might also be something to think about doing.
 
Christie & Maverick said:
One last thought - if you are finding that her numbers really start to change significantly to the upside, it might be worth getting a regular health check for her with her vet. Sometimes when kitties who are very well-regulated lose that regulation, there may be some underlying cause (dental issues, infection, etc) that cause increased BG levels. If you haven't been to the vet's within the last year, might also be something to think about doing.
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She just had a check up about a month ago, but they didn’t do any blood work. They checked teeth and said she may need to have some cleanings but mentioned she’d need to be put under which could mess with her BGs, so they said we would monitor.
 
BTW, you forgot to put Autumn’s name in your subject.

Autumn - Sunday’s mom said:
She just had a check up about a month ago, but they didn’t do any blood work. They checked teeth and said she may need to have some cleanings but mentioned she’d need to be put under which could mess with her BGs, so they said we would monitor.
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If she needs a cleaning that could be raising her bg. It would be better to do it sooner than later. I don’t know why vets are so hesitant. There are veterinary dentists but they are quite pricey.
 
tiffmaxee said:
BTW, you forgot to put Autumn’s name in your subject.



If she needs a cleaning that could be raising her bg. It would be better to do it sooner than later. I don’t know why vets are so hesitant. There are veterinary dentists but they are quite pricey.
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Thanks for the info. Do you have any experience with this? How does it mess with their BG?
 
We have cats go into remission after a needed dental. It’s also the first thing we ask when cats come out of remission.Autumn’s bg is pretty well controlled so I would think a dental would be a good idea. There’s a section in health issues on dentals. Let me find it for you.
 
tiffmaxee said:
We have cats go into remission after a needed dental. It’s also the first thing we ask when cats come out of remission.
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Wow very interesting. This could definitely be what’s going on then. The vet didn’t make it seem like it was urgent, but now I’m considering scheduling it anyway. Thanks
 
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