4/13/25, Nina (New member), AMPS 478 - persistent hyperglycemia

[Nina & Cosmina]

Hello!
My Nina is 18 YO, has Asthma, Arthritis, and other conditions (Gastrointestinal issues).
She's been on Glargine (administered once a day) since December 3rd, 2024. She is taking no inhalers for Asthma treatment given their interference with the Glucose levels.
She was started on 1U in the ER following a breathing crisis, overtime we increased to 1.5U, then to 2U / once a day.
We repeated her bloodwork last week. Her Glucose sits at 354 (was 360 in November) and the Fructosamine level is at 546 (was 489 in Nov.). I've been researching quite a bit, and I'm not surprised to see her Fructosamine that high as her numbers in March (after we increased insulin to 2U) have been rising.
She had a relatively good BGC after the 2U increase but a couple of days after her numbers spiked and remained high and seem to go even higher.

The vet recommends that I increase the insulin dosage to 2.5U / once a day.
I am concerned about an increase as I've noticed a persistent spike in her numbers ever since we increased from 1.5 to 2U. Her walking deteriorated as well since we increased the insulin.
I've started an anemic SS. I do not test her that much as I am only administering insulin once a day and I know she wakes up with higher numbers. I do not want to inflict more stress on her given her age as well as her other conditions.
Overall, she seems fine, except her walking. Her weight has not changed much, there is no vomiting or other symptoms associated with "not enough insulin". She rather exhibits signs of too much insulin (slight increase in drinking and appetite, plantigrade stance).

Note on feeding: Nina is on a wet food diet (FF pates, RC Glycobalance). She hasn't had one kibble since December.

I would so very much appreciate any thoughts, recommendations.
What would you do if Nina was your cat?

Thank you all!

 

[Tim & Pookey]

Can you edit the access so everyone can view on your spreadsheet? Right now we can’t see welcome to the board!

 

[Bron and Sheba (GA)]

I’m going to ask @Wendy&Neko to transfer this thread over to the main health page.

 

[Bron and Sheba (GA)]

Hi and welcome to the forum.
I’ve asked the moderators to transfer your thread over to the main health page as we like new members to post over there first so we can get you set up and sorted before transferring you to the Lantus page.
As Tim mentioned above, we can’t see your spreadsheet at the moment. You need to give us permission to access. Thanks!
Do you have some blood glucose data you could add to the spreadsheet for us to see. Even the last few weeks would be helpful, thanks.
Did you note any low BGs when you were testing?
How was her walking deteriorating? Was it staggered? Or did it look like neuropathy? Was it all the time or just a few hours after the dose of insulin?
Insulin needs to be given twice a day not once a day. Cats have a much faster metabolism than humans.
If you are only giving the insulin once a day Nina is being left in high numbers for 12 hours a day.
Can you tell me the current dose you are giving? It is much better to divide the current dose in half and give it twice a day. But first we need to establish Nina is not getting too much insulin.
Looking forward to hearing back from you.
Bron

 

[Wendy&Neko]

Hello and welcome to FDMB. I've moved your post to your Feline Health forum where we ask new people to introduce themselves and get set up. Part of that set up includes a bit more information in your signature, details here:
New? How You Can Help Us Help You!

Once we can see that spreadsheet, we'll be able to help more.

 

[Nina & Cosmina]

Can you edit the access so everyone can view on your spreadsheet? Right now we can’t see welcome to the board!

Thank you. Done! Sorry about that.

 

[Nina & Cosmina]

Hi and welcome to the forum.
I’ve asked the moderators to transfer your thread over to the main health page as we like new members to post over there first so we can get you set up and sorted before transferring you to the Lantus page.
As Tim mentioned above, we can’t see your spreadsheet at the moment. You need to give us permission to access. Thanks!
Do you have some blood glucose data you could add to the spreadsheet for us to see. Even the last few weeks would be helpful, thanks.
Did you note any low BGs when you were testing?
How was her walking deteriorating? Was it staggered? Or did it look like neuropathy? Was it all the time or just a few hours after the dose of insulin?
Insulin needs to be given twice a day not once a day. Cats have a much faster metabolism than humans.
If you are only giving the insulin once a day Nina is being left in high numbers for 12 hours a day.
Can you tell me the current dose you are giving? It is much better to divide the current dose in half and give it twice a day. But first we need to establish Nina is not getting too much insulin.
Looking forward to hearing back from you.
Bron

Thank you Bron. Just modified the settings on the SS.
Yes, there were some instances of lower BGs, noted on the SS. The lowest Nadir recorded was on Feb 16th (101). March has been mostly high, but did get some lower #s on April 7th (145) for instance.
Please let me know if you can now see the SS.
Yes, I do administer once a day at the recommendation of the vet. I've never dealt with diabetes before, especially in a cat, so I took that into account.
She is on 2U currently. Yes, I was alo thinking the same thing that it may be better to divide the dose in 2 (am and pm).
Her walking changed first when she came out of the ER, which coincides with her 1st Insulin shot. I do not know how much she was given when she was there but when she was released the ER doc recommended 1U once a day.
Nina's walking deteriorated even more after the 2U increase. It's more like neuropathy and not staggering. She's never had dizziness issues.

 

[Wendy&Neko]

I can now see the spreadsheet. I think trying 1 unit AM and 1 unit PM would be a good start. Provided the vet didn't say anything about ketones present? If there are ketones, that may change what we suggest. But I still wouldn't go to 2.5 units once a day, or anything once per day.

Are you home testing for ketones? You can do that with sticks you stick in the pee stream or a blood meter. Tips to catch and test a urine sample

On Nina's bloodwork, how was her potassium number? Low potassium is another cause of walking problems. The other is diabetic neuropathy, more here: Feline Diabetic Neuropathy

FYI, the Glycobalance is not a good choice for diabetic cats. It is too high in carbs. Even the wet food is 14% carb, which we consider medium carbs, almost high carb food. But for now, don't change her diet. Let's see how she does on the new insulin dosing scheme, then we can work on getting her onto a better diet.

 

[Bron and Sheba (GA)]

I agree with Wendy. I would try 1 unit twice a day.
The routine is to test, feed and then give the insulin. Are you giving snacks of food during the day?
I think you will see an improvement in the BGs once you are giving the insulin twice a day.

 

[Nina & Cosmina]

I can now see the spreadsheet. I think trying 1 unit AM and 1 unit PM would be a good start. Provided the vet didn't say anything about ketones present? If there are ketones, that may change what we suggest. But I still wouldn't go to 2.5 units once a day, or anything once per day.

Are you home testing for ketones? You can do that with sticks you stick in the pee stream or a blood meter. Tips to catch and test a urine sample

On Nina's bloodwork, how was her potassium number? Low potassium is another cause of walking problems. The other is diabetic neuropathy, more here: Feline Diabetic Neuropathy

FYI, the Glycobalance is not a good for diabetic cats. It is too high in carbs. Even the wet food is 14% carb, which we consider medium carbs, almost high carb food. But for now, don't change her diet. Let's see how she does on the new insulin dosing scheme, then we can work on getting her onto a better diet.

 

[Nina & Cosmina]

The bloodwork came back negative for ketones. I am not home testing but I've done it in the past so will do again.
Her potassium sits at 4.8, but the Chloride is a bit on the low side: 108.
Generally, her bloodwork looks ok, nothing notable except the glucose and fructosamine levels.

Regarding Glycobalance, it was administered by the vet back in December, but I do not feed her that on a regular basis. Once in a blue moon as she does not really like it.
I had no idea is high in carbs...
She mostly eats Fancy Feast chicken and liver pate.

A bit of a concern regarding administering insulin twice a day. I am working and out of the house for 9 hours a day, 3 days during the week and cannot do any testing during that time. The other 2 days I work from home so testing during those days will be doable.
The vet recommended shooting once a day as she said some cats respond very well to one shot per day.
Clearly not the case at least not at this dose.
Would it make any sense for me to lower her current dose to 1.75 U / once a day and see how she'll respond?

Thank you.

 

[Wendy&Neko]

The only times (all two of them), where I've seen a cat do better on one shot a day was when they were on practically no insulin. I'm talking drop sized doses. The rest of the cats on one dose per day go lower the one cycle, then higher when no insulin is given, like Nina is doing. So no, lowering the dose you are giving once a day won't do much to get her regulated.

We have quite a few people here who work during the day. Getting tests before each shot, and a before bed test if it's 2-3 hours after the PM shot, then mid cycle tests the rest of the days when you can, will tell us a lot about what is happening. For some people, they arrange their schedule so they can get up and test, feed, shoot right away, then get another test 2 hours later as they head out the door. That +2 test can tell us a lot about what the cycle will look like. And whether you need to leave out higher carb food to keep her safe. For others, a test as they get in the door two hours before the PM shot works.

 

[Nina & Cosmina]

OK. Thank you for your inputs, everyone! I do understand, however the problem that persists in my mind is that even the 2 units in the am do not make a difference in numbers for the 1st cycle. So, my reasoning for lowering the dose to 1.75 once a day is to see how she'll react to it for the 1st part of the day. I do realize that it will only cover the needs for 12 hours or so. But I'd like to determine if there will be a difference in the high numbers that she currently displays at 2U.
I do hope it makes sense. Thanks again!

 

[Wendy&Neko]

Lantus is a depot style insulin. One cycle builds on the other. It's this cumulative action (one shot 12 hours after the other) that will help bring numbers down. More information here: What is the Insulin Depot? By only shooting one cycle a day, you are interrupting the building of the depot. Lowering the dose to 1.75 units only once a day will not tell you much. It'll just make her day numbers worse.

It's entirely possible she may need more than 1 unit per AM and PM cycle, but we'd rather start with a lower dose and work your way up safely.

The other factor to consider is that she is doing what we call bouncing. Here is the definition:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
The way to reduce the amount of bouncing is for her body to spend more time in normal blood sugar numbers. Shooting once a day won't help that process. Right now she's bouncing whenever she sees anything under 200.

 

[squeem3]

[QUOTE="Wendy&Neko, post: 3264495, member: 5773"
We have quite a few people here who work during the day. Getting tests before each shot, and a before bed test if it's 2-3 hours after the PM shot, then mid cycle tests the rest of the days when you can, will tell us a lot about what is happening. For some people, they arrange their schedule so they can get up and test, feed, shoot right away, then get another test 2 hours later as they head out the door. That +2 test can tell us a lot about what the cycle will look like. And whether you need to leave out higher carb food to keep her safe. For others, a test as they get in the door two hours before the PM shot works.[/QUOTE]


Don't feel bad if you can't test as often as Wendy suggested above. Fit in testing at whatever times works for your schedule. I'm at 4:30am and out the door by 6:15am. There is no way I'm getting up any earlier to get a AM +2 test before I leave for work. I don't get home until at least 4pm which is basically PMPS time. I don't usually get PM checks done only because I know my cat and the fact he's on a steroid that keeps his blood glucose levels high (not all diabetic cats have the same response to the steroid).

The walking on hocks is called diabetic neuropathy. It is treated with methylcobalamin. LifeLink Zobaline is one brand but pricey. Here's an alternative:

the Vitacost brand another member told me about
Vitamin B-12 Methylcobalamin -- 5000 mcg - 100 Capsules

Same as Zobaline , but the Zobaline is so expensive as you know
This is the same thing
The only difference is the Zobaline has 200 mcgs of folic acid
So I bought the folic acid at the supermarket and crush it up and added it to the Vitacost brand
If you can't find the 200 mcg get the 400 mcg and cut it in half and crush it up and add it, some members didn't even add the folic acid and the neuropathy improved
The Vitacost brand is a capsule so just open it and pour the powder on the wet food
Has no taste, no need to crush it up, I still give it to Tyler every now and then and he has never tasted it in his food , I always add water to his food and just stir up the methyl B-12 good
I switched to the vitacost brand because the zobaline was too expensive,
Even though the vitacost brand is 5000 mcgs and the zobaline is 3000 mcgs
What they don't need they will pee out because it's water soluble.

The Zobaline is expensive for 60 pills, 30.00 some other places want 33.00
I used to use the Zobaline when I joined, then a member told me about the Vitacost brand .

It took about 2 months for Tyler to get back to walking normal, jumping on to the couch, running around
But every few weeks I did see a slight improvement
Some members didn't even add the folic acid to the vitacost brand and it still helped and the neuropathy was gone

https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6

14.49 for 100 capsules

 

[Larry and Kitties]

Th curve on 4/7 was good with a good drop on 2 units. However, the curve on 4/14, also on 2 units, showed little drop. Is there anything to explain the difference? Without getting consistent BGs it is really impossible to get good BG control. What specific GI does she have?

 

[Nina & Cosmina]

Lantus is a depot style insulin. One cycle builds on the other. It's this cumulative action (one shot 12 hours after the other) that will help bring numbers down. More information here: What is the Insulin Depot? By only shooting one cycle a day, you are interrupting the building of the depot. Lowering the dose to 1.75 units only once a day will not tell you much. It'll just make her day numbers worse.

It's entirely possible she may need more than 1 unit per AM and PM cycle, but we'd rather start with a lower dose and work your way up safely.

The other factor to consider is that she is doing what we call bouncing. Here is the definition:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
The way to reduce the amount of bouncing is for her body to spend more time in normal blood sugar numbers. Shooting once a day won't help that process. Right now she's bouncing whenever she sees anything under 200.

Thank you Wendy! Yes, it all makes sense. And yes, I did read up about the depot on this site as well as the bouncing effect. One of the reasons why increasing to 2.5U once a day as the vet recommends does not make sense. I do have a good relationship with her (or as good as it can be) and have a follow up with her this Friday. I do need her to see Nina as she hasn't seen her in a while. This morning I discovered Nina developed a bit of a rush around the injection site. I do rotate sites and try to not shoot in the same place. I will discuss with the vet and also develop a better plan (1U/AM and PM) for the Insulin administration. For some reason that I do not know she is quite adamant about shooting only once a day.
It's just so frustrating, to say the least, as I've been following up on the recommendations all this time, since December, and her Glucose has not changed at all (354 back then, 354 last week). And she is 18 (19 coming up next month) and I do not want to inflict more pain/discomfort than I have to, given all the other conditions she is dealing with. It's a lot for me, how much more for the poor cat!
My Nina was born in Toronto btw but BC will always be a winner from my end lol
Thanks again!

 

[Nina & Cosmina]

[QUOTE="Wendy&Neko, post: 3264495, member: 5773"
We have quite a few people here who work during the day. Getting tests before each shot, and a before bed test if it's 2-3 hours after the PM shot, then mid cycle tests the rest of the days when you can, will tell us a lot about what is happening. For some people, they arrange their schedule so they can get up and test, feed, shoot right away, then get another test 2 hours later as they head out the door. That +2 test can tell us a lot about what the cycle will look like. And whether you need to leave out higher carb food to keep her safe. For others, a test as they get in the door two hours before the PM shot works.

Don't feel bad if you can't test as often as Wendy suggested above. Fit in testing at whatever times works for your schedule. I'm at 4:30am and out the door by 6:15am. There is no way I'm getting up any earlier to get a AM +2 test before I leave for work. I don't get home until at least 4pm which is basically PMPS time. I don't usually get PM checks done only because I know my cat and the fact he's on a steroid that keeps his blood glucose levels high (not all diabetic cats have the same response to the steroid).

The walking on hocks is called diabetic neuropathy. It is treated with methylcobalamin. LifeLink Zobaline is one brand but pricey. Here's an alternative:[/QUOTE]

Thank you. Yes, I found out about Zobaline from this forum. I gave it to Nina for about a month but did not see any difference. Assumed it was due to her uncontrolled diabetes. But I will try again. Hopefully I can get better BG numbers. I don't like the blues, but I would be happy to see Nina there Green feels out of reach but never lose hope.

 

[Nina & Cosmina]

Th curve on 4/7 was good with a good drop on 2 units. However, the curve on 4/14, also on 2 units, showed little drop. Is there anything to explain the difference? Without getting consistent BGs it is really impossible to get good BG control. What specific GI does she have?

Yes, the BGCs on February 16th and April 7th were not bad. I was encouraged to see especially the 02.16 numbers (2U). I do not know what caused the spike in numbers especially after Feb 16. At some point I thought I got a bad insulin vial, bad needles, Nina became insulin resistant...you name it. But I continued to administer insulin and kept checking numbers once in a while. And then I started to see some response. I haven't changed anything in her feeding pattern, environment, or anything that can be considered a stressor. It's why I thought she was getting too much insulin and that was the cause in not only the spike in numbers but more or less the persistent high state.
Sadly, the ER could not determine exactly what's up with her GI. They've done more testing and X-rays that I probably had done on me. They suspected hyperechoic liver, hepatic lipidosis, pancreatitis, hyper echoic pancreas to name a few. They also suspected bronchopneumonia, chronic pulmonary fibrosis, or partial atelectasis. Nothing definitive though. I decided to take her out of the ER after a couple of days as she was kept in the oxygen tank all the time she was there, and they could not find a more definitive diagnosis. She was absolutely miserable and when I took her out she started to display the walking she still has today (full neuropathy). She did not have that when I took her in, 2 days prior. It was a lot going on back then. She was discharged with asthma and possible fluid accumulation around the lungs, as well as some issue with the pancreas which I am unclear about to this day, but she was prescribed RC Gastrointestinal wet food. Of course, DM and arthritis.
So given all that, I've been trying to do the best that I was able to and rely on recommendations from her regular vet.

 

[Nina & Cosmina]

BTW, Nina has a long history. When I took her in about 10 yrs ago from a friend of mine who rescued her from the streets, she was coming out of a surgery. I was told she had an "accident". I think a dog teared her apart. The surgery was only partially successful. The wound she had only closed halfway. This friend of mine wanted to take her to a shelter so I decided to take her in as the shelter would have most likely put her down with that wound.
I had 2 surgeries done on Nina, the 2nd one finally closed the wound. I was so grateful! And she was finally free of pain and discomfort.
And so given her history, I do not want to bring back into her mind her traumatic past. I want to be extra careful with how much poking I do, how many injections I administer especially because the ER doctor told me Nina had some "reaction" when she was given insulin the 1st time in the ER. Her numbers dropped dangerously low. I was not given more detail, and I was too overwhelmed myself to "demand" more answers.

 

[Wendy&Neko]

What gauge size are the needles on the syringes you are using? I started out with 29g (from the vet), but both Neko and I appreciated it when we went to the smaller 31g.

It can take Zobaline several months to help and will need better BG numbers too.

For some reason that I do not know she is quite adamant about shooting only once a day.

I wish she was an outlier, but unfortunately not. Humans take it once a day, cats have way faster metabolisms so need it twice. Maybe your vet needs to see this article, top of page 240:

• (2015) ISFM Consensus Guidelines on the Practical Management of Diabetes Mellitus in Cats

Here is the quote I'm referring to:

Panel recommends, whenever possible, the use of longer acting insulin preparations (eg, glargine, detemir or PZi), injected twice daily, for optimal diabetic control.

 

[Nina & Cosmina]

What gauge size are the needles on the syringes you are using? I started out with 29g (from the vet), but both Neko and I appreciated it when we went to the smaller 31g.

It can take Zobaline several months to help and will need better BG numbers too.

I wish she was an outlier, but unfortunately not. Humans take it once a day, cats have way faster metabolisms so need it twice. Maybe your vet needs to see this article, top of page 240:

• (2015) ISFM Consensus Guidelines on the Practical Management of Diabetes Mellitus in Cats

Here is the quote I'm referring to:

I've been using 31G. Thank you for providing the article. Very helpful!