? 3/31 Simon AMPS 460

I feel like I'm missing something with his dose or in general. He is drinking SO much more water the past week and peeing excessively too. Simon's dental is scheduled for 4/16 but there aren't any infected teeth that they saw from exam, just gingivitis buildup. So while I hope it will help his numbers stabilize, I'm not holding my breath. He also has asthma and is on the flovent inhaler, for the past 30 days and foreseeable future.

I just don't think everything is right. He is back to acting desperate for food (eats 4-6x/day), drinking and peeing constantly. I'm sure he doesn't feel good, and I feel horrible that I can't help him more. Ketosens was 0.3 last week, I will retest today, and I'm doing a curve again today.

Do you all see anything I could be missing? Is it possible the lantus pen is bad even though there are no floaties and it looks very clear? I can switch to another pen, from the same box... I pull from the pen with a syringe so it's not the pen dispensing incorrectly.

Simon's spreadsheet

I think this is your most recent previous post? Please always include a link, even if it's been awhile, so folks here can get a little context.

It certainly looks like he's due a dose increase. It's not surprising that you're seeing a lot of PU/PD with his numbers that high. Glad you're testing for ketones! It looks like you only test once a day most days, which makes it really hard to find patterns ... you don't know how low/deep his cycles go, which is really not ideal. I skimmed your older posts quickly, so I'm sorry if I missed something, but - are you able to test a little more often on a daily basis? It would be helpful to have more data.

Allie & Gen said:

I think this is your most recent previous post? Please always include a link, even if it's been awhile, so folks here can get a little context.

It certainly looks like he's due a dose increase. It's not surprising that you're seeing a lot of PU/PD with his numbers that high. Glad you're testing for ketones! It looks like you only test once a day most days, which makes it really hard to find patterns ... you don't know how low/deep his cycles go, which is really not ideal. I skimmed your older posts quickly, so I'm sorry if I missed something, but - are you able to test a little more often on a daily basis? It would be helpful to have more data.

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Yes, it has been awhile, sorry about that and thank you for adding the link. We just did a dose increase per his last curve on 3/24, and I'm doing another curve today. Do you think the lantus pen could randomly go bad without floaters or visible indicators?

I will do my best to get more random tests, I do test at least twice a day but I know that doesn't really help for patterns since it's the end of the previous cycle... I've been barely keeping my two kitties, horse, and myself going with everyone's health stuff lately (it's just me taking care of everyone), but I'm working on changes as best I can!

I use vials instead of pens, so I don't know if there's possible variation, but without visible indicators I don't think it's likely the insulin has gone bad, though its efficacy could wane if it's not being refrigerated or through some other random quirk.

Is Simon on any medications that could affect his glucose? (Also, I wouldn't count out the dental factor until it's done - it seems like procedures sometimes find things exams miss, for one thing.)

I don't mean to pressure you, believe me; I only have the one cat, but I know it's hard to be a solo caretaker and this is all a lot of work! It's great that you're doing another curve. Have you ever considered a continuous glucose monitor? They have their downsides, certainly, but it's been a godsend for me with my cat; I'm not sure how either of us would cope with multiple blood tests every day, and that's without taking into account the fact that I work full-time mostly away from home.

My experience is limited, especially when it comes to what seems to be your biggest overall issue (no middle ground; high numbers up to a certain point in dosage, and then big dives which force reductions). Hopefully someone more equipped can offer some insight. It's such a stressful thing to have to manage, and you're clearly working hard at taking care of Simon and your other critters, too.

I suspect the problem is that you are holding doses too long and glucose toxicity is developing. That’s where his body gets used to higher numbers. I suggest not holding the dose any longer than 7 days if he’s not seeing nadirs (plural) in the 90-149 range. You should also be doing a curve some in the last part of those 7 days. Another suggestion is to try to get a before bed test more often. Many cats go lower at night and we dose based on how low the dose is taking him. You are only getting half the data with just preshots tests and daytime data.

I doubt it’s the pen, I suspect it’s the cat not getting enough insulin. Good luck with the upcoming dental, it’s possible there is something below the gum line that only those dental x-rays can see. Happened a couple times with my Neko.

Wendy&Neko said:

I suspect the problem is that you are holding doses too long and glucose toxicity is developing. That’s where his body gets used to higher numbers. I suggest not holding the dose any longer than 7 days if he’s not seeing nadirs (plural) in the 90-149 range. You should also be doing a curve some in the last part of those 7 days. Another suggestion is to try to get a before bed test more often. Many cats go lower at night and we dose based on how low the dose is taking him. You are only getting half the data with just preshots tests and daytime data.

I doubt it’s the pen, I suspect it’s the cat not getting enough insulin. Good luck with the upcoming dental, it’s possible there is something below the gum line that only those dental x-rays can see. Happened a couple times with my Neko.

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How do you get them back from glucose toxicity? More testing, as you described, I'm guessing? I will be better about late night testing. His ketonsens was 1.3. I just got off the phone with the vet and she said if he's acting normal monitoring is ok, but if his behavior changes he needs to go to ER. He's acting totally fine. Playing, eating, drinking (more than normal), and generally seems himself aside from this crazy numbers. Simon means the world to me and I feel horribly anxious and like I'm not doing enough for him. Do you think we need to rush to the ER or do you agree with the vet analysis? He will be getting a dose increase today and I've set my calendar to do a curve in 6 days.

Hi Katrina, Glucose toxicity is managed by taking appropriate increases when the dosing guidelines (you're following SLGS) say to do so. The fact that you're increasing his dose today is great. Take a look again at Wendy's post--her guidance is key. You are doing a great job in managing Simon!! It's wonderful that he's feeling better now. Good luck with the dose increase!!

Mary & Jude said:

Hi Katrina, Glucose toxicity is managed by taking appropriate increases when the dosing guidelines (you're following SLGS) say to do so. The fact that you're increasing his dose today is great. Take a look again at Wendy's post--her guidance is key. You are doing a great job in managing Simon!! It's wonderful that he's feeling better now. Good luck with the dose increase!!

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Thank you for the encouragement! I have set more alarms daily and weekly alarm for a curve. I really appreciate this community, I'm so grateful for everyone here. It is the most supportive forum for animal care that I have ever seen. It's so clear that everyone really wants the best for all the kitties

Update for everyone: ketones at 0.5 BG at +4: 277. Still acting like his frisky little self! I've changed our routine and set weekly curve reminders (and daily PM/late as possible) so it can't slip my mind.

Thank you for the support!