05/01 Simon - Blood Glucose Steady in 400s despite dose increase

[salmonlover]

Hi! I'm looking for help in getting my cat's blood glucose levels lower. My cat was diagnosed with diabetes and hyperthyroidism over 2 months ago. The thyroid medicine was successful and that level is now stable. His diabetes is not stabilizing however. He's been on Lantus and started at 1 unit, then 1.5, and now has been on 2 units for a little over 2 weeks. This entire time his blood glucose has remained steady around 400 and has only dipped into the high 300s on a rare occasion. There is no curve. He has never had any levels remotely close to hypoglycemia. I have him on a Freestyle Libre continuous glucose monitor, which I understand isn't the most accurate, but it's the best option for us at this moment.

For the past 7 or 8 years he's been on a diet of mostly Feline Natural Freeze Dried Raw rehydrated, and has been on a raw food diet since he was 1 (he's 11.5 now). For treats he has Whole Life Just One Ingredient either turkey, salmon, tuna, etc. He takes Ferrapet Cardiac Supplement and Zylkene. In the past we've dabbled with fish oil, mushrooms, some other supplements, but I've pulled those back since the diagnosis. I know that the recommendation is low carb wet food, but his food is already "wet" and low carb and I'm not sure if that would make the difference. He's picky and hasn't liked wet foods in the past when I've tried.

I know that some cats can have acromegaly which causes insulin resistance, but that requires up to 7 units of insulin to test for -- is that correct? I would like to get his level until control to destress his kidneys this way he can be a candidate for permanent thyroid treatment. I'm willing to try anything! From the experience on this board, should his dose be increased to 2.5? I see some people with cats that needed 3 or even 5 units before responding. Do you think it is worthwhile for me to switch his food? I would really appreciate any and all advice. Thank you!

 

[Mary & Jude]

Hi! I'm looking for help in getting my cat's blood glucose levels lower. My cat was diagnosed with diabetes and hyperthyroidism over 2 months ago. The thyroid medicine was successful and that level is now stable. His diabetes is not stabilizing however. He's been on Lantus and started at 1 unit, then 1.5, and now has been on 2 units for a little over 2 weeks. This entire time his blood glucose has remained steady around 400 and has only dipped into the high 300s on a rare occasion. There is no curve. He has never had any levels remotely close to hypoglycemia. I have him on a Freestyle Libre continuous glucose monitor, which I understand isn't the most accurate, but it's the best option for us at this moment.

For the past 7 or 8 years he's been on a diet of mostly Feline Natural Freeze Dried Raw rehydrated, and has been on a raw food diet since he was 1 (he's 11.5 now). For treats he has Whole Life Just One Ingredient either turkey, salmon, tuna, etc. He takes Ferrapet Cardiac Supplement and Zylkene. In the past we've dabbled with fish oil, mushrooms, some other supplements, but I've pulled those back since the diagnosis. I know that the recommendation is low carb wet food, but his food is already "wet" and low carb and I'm not sure if that would make the difference. He's picky and hasn't liked wet foods in the past when I've tried.

I know that some cats can have acromegaly which causes insulin resistance, but that requires up to 7 units of insulin to test for -- is that correct? I would like to get his level until control to destress his kidneys this way he can be a candidate for permanent thyroid treatment. I'm willing to try anything! From the experience on this board, should his dose be increased to 2.5? I see some people with cats that needed 3 or even 5 units before responding. Do you think it is worthwhile for me to switch his food? I would really appreciate any and all advice. Thank you!

Hi Salmonlover! Do you have a spreadsheet you are using to track Simon's numbers? I can tell you that folks over here like to look at a cat's data, meaning a track of Simon's blood glucose numbers before they can weigh in with advice. Let me know if you need a link to directions for setting up our spreadsheet.

 

[Mary & Jude]

Also, when posting on this forum, each day you post, please link your previous day's posts so that people can track what has been happening with Simon. Here are your previous two posts:

Seeking shirt recommendation for FreeStyle Libre
Lancing Device Help

 

[salmonlover]

Also, when posting on this forum, each day you post, please link your previous day's posts so that people can track what has been happening with Simon. Here are your previous two posts:

Seeking shirt recommendation for FreeStyle Libre
Lancing Device Help

Will do! Thank you! Looking at the spreadsheet, I wasn't sure how to fill it out because the glucose meter gives me a max and min reading for each hour. Should I be using the max or the min? See example:

 

[Mary & Jude]

It would help if we had a more expansive snapshot of Simon's numbers (not just a couple of days), and I'm not sure if you're able to offer that with what you have. Let me give you the link to our spreadsheet: Sticky - New? How You Can Help Us Help You! AND I'm not sure which number to use--the max or min. Let's see if we can get some advice on this: @Bandit's Mom

 

[salmonlover]

It would help if we had a more expansive snapshot of Simon's numbers (not just a couple of days), and I'm not sure if you're able to offer that with what you have. Let me give you the link to our spreadsheet: Sticky - New? How You Can Help Us Help You! AND I'm not sure which number to use--the max or min. Let's see if we can get some advice on this: @Bandit's Mom

I have data from April 8th forward. I filled out the spreadsheet with minimums, since the highest daily maximum is always 400. I added the link to my signature. He switched sensors in between the month and is due to switch again this week. It's often always around 400 which I find... strange, right?

 

[Bandit's Mom]

I know that some cats can have acromegaly which causes insulin resistance, but that requires up to 7 units of insulin to test for -- is that correct?

Yes. We test for Acromegaly, IAA etc once the cat crosses a dose of 6U.

I have data from April 8th forward. I filled out the spreadsheet with minimums, since the highest daily maximum is always 400

Yes, we would need to see the minimums since dosing is based on how low a dose takes a cat.

How old is the pen/vial of Lantus? Is it stored in the fridge? Do you see any floaties or cloudiness in it? Just trying to rule out the possibility that the insulin has gone bad.

Since he is on a raw diet, you could follow the TR dosing method. You don't need to hold doses so long when his numbers are so flat and high. With TR, you can increase the dose by 0.5U every 3 days if his numbers remain over 300. I would take him up to 2.5U and then re-evaluate in 3 days.

 

[salmonlover]

Yes. We test for Acromegaly, IAA etc once the cat crosses a dose of 6U.


Yes, we would need to see the minimums since dosing is based on how low a dose takes a cat.

How old is the pen/vial of Lantus? Is it stored in the fridge? Do you see any floaties or cloudiness in it? Just trying to rule out the possibility that the insulin has gone bad.

Since he is on a raw diet, you could follow the TR dosing method. You don't need to hold doses so long when his numbers are so flat and high. With TR, you can increase the dose by 0.5U every 3 days if his numbers remain over 300. I would take him up to 2.5U and then re-evaluate in 3 days.

The Lantus was bought in mid-late February, and it is in the fridge. It's not cloudy. I think it's still good. Thank you! I will try that and report back in a few days.

 

[Wendy&Neko]

You do not have to wait until he hits six units to test for acromegaly and IAA (insulin auto antibodies). We have seen cats with one or other of those conditions on lower than six units. The 2015 study from the Royal Vet Clinic that found one in four diabetic cats has acromegaly, found some on as low as 1 unit. If you think you see other signs of acromegaly, go ahead with the tests. IAA doesn't really have any symptoms, other than extreme insulin resistance. It can go hand it hand with acromegaly, as it did for my Neko. It will save you money to test for both conditions at once, as the blood for both tests goes to Michigan State University.

However, if a cat is on an all low carb diet, and doesn't need a dental, and has gotten to six units, then we suggest the testing. Because at that point, it is much more likely one or the other of those conditions is present.

Raw food, as long as it's low carb, is fine to feed and follow TR. At one point Honest Kitchen had a lot of potato in it and wasn't low carb.

As suggested above, following the more aggressive dosing Tight Regulation will really help. Right now he's probably seeing some glucose toxicity, where his body is getting used to higher numbers. TR allows increases every 3 days as long as you aren't seeing anything under 300 for nadirs.

 

[Staci & Ivy]

I agree with all the above. Looks like he needs an increase.
Hope that will help with his numbers.
He should feel much better and pee and drink much less too

 

[Bandit's Mom]

Hi @salmonlover, I see that he's been flat and high with nadirs over 300 for the last 3 days at 2.5U. You can take him up to 3U tomorrow morning (5/5)

 

[salmonlover]

Hi @salmonlover, I see that he's been flat and high with nadirs over 300 for the last 3 days at 2.5U. You can take him up to 3U tomorrow morning (5/5)

Thank you so much for your help! I tried 3U this morning and he was at 400 until 12 when he dropped down to 374 and currently is holding around the mid 370s almost 2 hours later. Yay! This is the most progress I've seen in a while. I'll report back in 3 days.

 

[salmonlover]

I agree with all the above. Looks like he needs an increase.
Hope that will help with his numbers.
He should feel much better and pee and drink much less too

Thank you so much!

 

[salmonlover]

You do not have to wait until he hits six units to test for acromegaly and IAA (insulin auto antibodies). We have seen cats with one or other of those conditions on lower than six units. The 2015 study from the Royal Vet Clinic that found one in four diabetic cats has acromegaly, found some on as low as 1 unit. If you think you see other signs of acromegaly, go ahead with the tests. IAA doesn't really have any symptoms, other than extreme insulin resistance. It can go hand it hand with acromegaly, as it did for my Neko. It will save you money to test for both conditions at once, as the blood for both tests goes to Michigan State University.

However, if a cat is on an all low carb diet, and doesn't need a dental, and has gotten to six units, then we suggest the testing. Because at that point, it is much more likely one or the other of those conditions is present.

Raw food, as long as it's low carb, is fine to feed and follow TR. At one point Honest Kitchen had a lot of potato in it and wasn't low carb.

As suggested above, following the more aggressive dosing Tight Regulation will really help. Right now he's probably seeing some glucose toxicity, where his body is getting used to higher numbers. TR allows increases every 3 days as long as you aren't seeing anything under 300 for nadirs.

Thank you so much for this information and your help! This is really interesting to learn.

 

[Bandit's Mom]

@salmonlover Looks like he's good for another increase to 3.5U from tomorrow (5/8). Unless he sees numbers below 300 tonight.

 

[Marje and Gracie]

Thank you so much for this information and your help! This is really interesting to learn.

Please start a new condo today. Also, I’d like to know if you are doing TR or SLGS which should be added to his SS and your signature block.

In the new condo, I’d like to discuss with you fast tracking his dose up. He shouldn’t be staying at these high numbers for so long. Hope to see you in a new condo today.