1/2 Kokkinoulis AMPS 501, +2 394, +4 360, +6 419 PMPS 483, +2 375 still high BG and blood issue

[Kokkinoulis]

Previous post:
https://felinediabetes.com/FDMB/thr...-curve-and-still-high-bg.285079/#post-3137877

Dear administrators,
@Wendy&Neko , @Sienne and Gabby (GA), @Bandit's Mom, @Chris & China (GA) , @tiffmaxee , @Suzanne & Darcy , @Diane Tyler's Mom , @Bron and Sheba (GA), @Ale & Bobo & Minnie (GA)

My cat has high BG numbers (above 300 mg/dl) and I increased the dose before 5 cycles from 3.25 to 3.5 units. After that during the 2nd new cycle the BG numbers temporary dropped to yellow colors but then increased again to high BG numbers.
Is this a bounce? What is your opinion?
Why the BG numbers are still high although the high insulin dose of 3.5 unit for a cat with weight 6.7 kg?
In the previous days it seems that a New Dose Wonkiness or NDW occured after the increase of the dose from 2.75 to 3.25 units.
Moreover, in the last 2-3 cycles I have a problem with the measurements of the BG.
When I tried to check the BG the blood coagulates and dries very quickly and I don't have time to put it on the strip of the blood glucose meter. I tried at least 5 times for the measurment at the PM cycle + 6 without success and Ι finally gave up as I was bothering my cat, the sugar levels are still high and there is no hypoglycemia issue.
Has anyone else had the same problem or heard of it and how did you deal with it?

Thank you in advance.

Best regards,

 

[Bandit's Mom]

Hi Gabriella, with nadirs over 300, you can increase by 0.5U when following TR. That will enable you to get him to a good dose faster. The reason he is still high is that he hasn't gotten to his breakthrough dose yet. Just keep doing what you're doing. He will get there.

After that during the 2nd new cycle the BG numbers temporary dropped to yellow colors but then increased again to high BG numbers.
Is this a bounce? What is your opinion?

Yes, the 500+ numbers you saw could have been him him bouncing from the 200s which his body is not used to.

Moreover, in the last 2-3 cycles I have a problem with the measurements of the BG.
When I tried to check the BG the blood coagulates and dries very quickly and I don't have time to put it on the strip of the blood glucose meter. I tried at least 5 times for the measurment at the PM cycle + 6 without success and Ι finally gave up as I was bothering my cat, the sugar levels are still high and there is no hypoglycemia issue.
Has anyone else had the same problem or heard of it and how did you deal with it?

I've not heard of this but maybe others have had this problem. You could try applying a thin layer of vaseline/petroleum jelly on his ear where you want to poke - before you poke him - this will help the blood bead into a drop and not spread into the hair etc.

He is due for another increase tomorrow after 6 cycles on this dose.

 

[Kokkinoulis]

Hi Gabriella, with nadirs over 300, you can increase by 0.5U when following TR. That will enable you to get him to a good dose faster. The reason he is still high is that he hasn't gotten to his breakthrough dose yet. Just keep doing what you're doing. He will get there.


Yes, the 500+ numbers you saw could have been him him bouncing from the 200s which his body is not used to.


I've not heard of this but maybe others have had this problem. You could try applying a thin layer of vaseline/petroleum jelly on his ear where you want to poke - before you poke him - this will help the blood bead into a drop and not spread into the hair etc.

He is due for another increase tomorrow after 6 cycles on this dose.

Dear Bhooma,

Thanks for the prompt reply. I will follow your advise with vaseline.
Can I increase the dose at 8th cycle instead of the 7th cycle i.e. in the morning on 04Jan2024 as I prefer to do it during the day as it is easier for me to check his BG numbers with the BG meter more times?
Moreover, althought according to the TR protocol and take into consideration his BG numbers I have to increase the dose by 0.5 unit is it acceptable to increase it by 0.25 unit as the total dose of 4 unit will be high and these high doses need to be carefully monitored for hypoglycaemia?

 

[Kokkinoulis]

Dear Bhooma,

Thanks for the prompt reply. I will follow your advise with vaseline.
Can I increase the dose at 8th cycle instead of tth cycle i.e. in the morning on 04Jan2024 as I prefer to do it during the day as it is easier for me to check his BG numbers with the BG meter more times?
Moreover, althought according to the TR protocol and take into consideration his BG numbers I have to increase the dose by 0.5 unit is it acceptable to increase it by 0.25 unit as the total dose of 4 unit will be high and these high doses need to be carefully monitored for hypoglycaemia?

Additionaly, as the BG numbers are still high it is difficult to find the nadirs, or at which time exactly are occured. According to his spreadsheet what is your opinion? When should I test him in order to find his nadir? At + 4 and +6 or other time?

 

[Bandit's Mom]

Can I increase the dose at 8th cycle instead of tth cycle i.e. in the morning on 04Jan2024 as I prefer to do it during the day as it is easier for me to check his BG numbers with the BG meter more times?

Yes, that's perfectly fine.

I have to increase the dose by 0.5 unit is it acceptable to increase it by 0.25 unit as the total dose of 4 unit will be high and these high doses need to be carefully monitored for hypoglycaemia?

The increase by 0.5U is only if nadirs stay over 300. The reason that TR suggests more aggressive increases is to get the cat to a good dose sooner and to break through any glucose toxicity that the cat might be seeing. The faster you can get a cat to a good dose after diagnosis, the better chances of the cat getting regulated and even going into remission.

Also, the size of the dose does not matter if it isn't a good dose for a cat - 3.5U might be too less for one cat (that is seeing flat and high numbers like Kokkinoulis is seeing) while a dose of 0.5U might be too much for another cat. A cat needs as much insulin as it needs. You are testing enough to keep him safe and thus far there is no indication that he is dropping low. In fact, he is largely staying over 300.

 

[Bandit's Mom]

Additionaly, as the BG numbers are still high it is difficult to find the nadirs, or at which time exactly are occured? According to his spreadsheet what is your opinion? When should I test him in order to find his nadir? At + 4 and +6 or other time?

He is staying flat and high so you aren't really missing any important data as of now. Once he has starts seeing better numbers, you might be able to get a better sense of his patterns. But yes, you could probably try different times on different days. Do +2 and +4 on one day and +3 and +5 on another.

On Jan 1st, he seems to have nadired at the end of the AM cycle. There are some cats who do this in cycles where they are clearing bounces.

 

[Kokkinoulis]

Yes, that's perfectly fine.


The increase by 0.5U is only if nadirs stay over 300. The reason that TR suggests more aggressive increases is to get the cat to a good dose sooner and to break through any glucose toxicity that the cat might be seeing. The faster you can get a cat to a good dose after diagnosis, the better chances of the cat getting regulated and even going into remission.

Also, the size of the dose does not matter if it isn't a good dose for a cat - 3.5U might be too less for one cat (that is seeing flat and high numbers like Kokkinoulis is seeing) while a dose of 0.5U might be too much for another cat. A cat needs as much insulin as it needs. You are testing enough to keep him safe and thus far there is no indication that he is dropping low. In fact, he is largely staying over 300.

Dear Bhooma,
Your answer calms me down because I was worried that his lack of response to this large dose may indicate some other condition such as acromegaly. I am also afraid of what I will do in case I have reduced preshot BG numbers near to blue colors and the dose is too high. In that case I will need the forum's help!

 

[Bandit's Mom]

Your answer calms me down because I was worried that his lack of response to this large dose may indicate some other condition such as acromegaly.

We ask caregivers to test for acromegaly etc when a cat reaches 6U, so Kokki has a way to go to get there

I am also afraid of what I will do in case I have reduced preshot BG numbers near to blue colors and the dose is too high. In that case I will need the forum's help!

We are here to help. All of us have hesitated to shoot the first time we encounter a lower preshot. But with time you will realize that you get flat cycles when you shoot low. The size of the dose does not affect the decision to shoot as long as it is a good dose for the cat.

 

[tiffmaxee]

When you have a question or need help add the question mark prefix. We don’t always get tags.

 

[Kokkinoulis]

Hi Elise, I remove the question mark prefix after the 1st answer by Bhooma. Is this correct? So, there is no need to tag the names of most of the administrators inside only the question mark prefix. Sorry, I am new to this forum.

 

[Wendy&Neko]

There isn't really a correlation between size of cat and size of dose. And size of dose can change over time. I've seen tiny cats on large doses and large cats on small doses. My girl weighed about 6.5 kg at her maximum, and her dose went up to 8.75 units, gradually down to 0.75 units, back up to 7 units, then back down to 0.25 units. She did have IAA and acromegaly, and treatment for it which did cause some changes in dose needed. But I've also seen other cats without these conditions get to much higher doses than Kokkinoulis before hitting their breakthrough dose, and go back down again. And sometimes they too had to go back up in dose, then down again. Moral of this story, the important numbers are not the size of insulin dose, but rather the blood sugar numbers.

I am also afraid of what I will do in case I have reduced preshot BG numbers near to blue colors and the dose is too high. In that case I will need the forum's help!

Definitely post for help if unsure what to do with a preshot lower than you are used to. Even with higher doses, I learned to shoot Neko with preshots below 100.

If you follow the dosing methods, and test to know how low the dose is taking him, you will not have to worry about the dose being too high. Unless of course something has changed in him (such as pancreas healing), which causes him to need less insulin.

 

[tiffmaxee]

Hi Elise, I remove the question mark prefix after the 1st answer by Bhooma. Is this correct? So, there is no need to tag the names of most of the administrators inside only the question mark prefix. Sorry, I am new to this forum.

That’s perfect. You can tag too but sometimes when you tag lots of people we dint get the tags. Other times we do so hit and miss. So question mark and tag is fine.