09/24 Sue and Ruben BG#'s-please advise

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Sue and Ruben

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hi, i posted a few weeks ago and wanted to ask again ...my cat's #'s were doing great about a month ago.
all blues and greens. a great ride, the lowest ever in 2 years. then for some unknown reason, the numbers started to rise from the double digits to now into the 300's. this morning i got a 400 reading. i have steadily increased his dose but wonder what would cause him to bounce so much in a month? food is the same, he doesn't need a dental, he is acting the same, etc. i need more readings between shots but just thought i would ask in case anyone has experienced a similar problem. very upsetting and confusing. thanks in advance for any feedback.
 
Hi Sue & Ruben,
I'm having a similar problem with Rusty's numbers. I also don't know what could be the cause: in every other aspect he is fine. I have given what I know were fur shots and some that I think must have been fur shots, but that is also not new! Interesting that Ruben hasn't responded to the increases in dose. I'll be reading your condo to see if you get any good feedback.

Good luck to us all!

Ella & Rusty
 
I think some full day curves would come in handy. Who knows...maybe going so low at a later time... +6, 7 or 8 that it may be a bounce??? Hopefully an 'expert' will answer your question...good luck!
 
can you get a bunch of mid-cycle tests this weekend (both AM and PM)? I'm concerned about all the dose increases without nadir checks. Without them, there is no way to know whether the increases were really needed or not. If you can get some data over the next few days, we can help you interpret the data.

The importance of nadirs in dose adjustments
 
You recognize that it's difficult to tell whether this is bounce related because of the data....I think anything is a guess at this point ....here are just a few things that pop off the tip of my head that you could check:

How old is your Lantus - any chance it's gone bad?
Have you been shooting in the same spot - this can form scar tissue which affects absorption
Any chance there's a UTI - they can sometimes be asymptomatic - may be worth a trip to the vet for a urinalysis...you could get blood work too which wouldn't hurt and could help to rule out or identify any other issues.

I know it's not much and I get it must be frustrating with the lovely numbers you've had. Do you have the ability to get any mid cycle numbers or to run a curve on the weekend? It would be so helpful and I know everyone wants nothing more than to help you!! :smile: :smile:
 
I agree with Libby. You've increased the dose by more than the usual 0.25u. (Based on the protocol, 0.5u increases are indicated only if the nadir is over 300 or the cat is on a large dose of insulin and neither apply to Ruben.) Too much insulin can produce high numbers just like too little. More spot checks should help to figure this out.

Also, when was the last time Ruben has his annual lab work done?
 
thanks to all. i willl do a curve and get more #'s this weekend.
good question about the lantus. i just started a new vial. it is not cloudy and the xpiration date is still a ways off.
 
when you say open, i am not sure what you mean. i have the cartridges that come 5 to a package. i have used this one only about a month or so.
 
Hi Sue,

We are suggesting that perhaps that pen that you are using is "bad". It can happen regardless of the expiration date. We were asking when you began using the "new" pen to see if there was a correlation with the number change.
 
the other thing that can make the lantus go bad - with a pen nothing should get shot back into the lantus, not air, not withdrawing the lantus into the syringe and then shooting back into the pen to adjust the dose. the syringes have a lubricant in them and it will contaminate the lantus if you see-saw the lantus back and forth from the syringe to the pen.

one option is to open a new pen and change to it. hang onto the one you're using now, because if you don't see a change in numbers perhaps it's not the pen. if the numbers come down, then that particular pen might've been bad.

what i think you're saying is that his numbers were under pretty good control til a month ago. and you've been using this pen about a month. could be a connection.

if you switch to the new pen to see if it's the lantus that was bad, make sure you do it when you are watching him. if he gets a larger dose of stronger lantus you don't want him to plummet without you being around to catch him.
 
ok. i will try switching the pen. you are right sometimes i do put the dose back in if i pulled in too much to the syringe. that could be it. the only thing is that when i started the new pen, his numbers started to go Down not Up.
 
if his numbers started to go down on the same dose, that would suggest the new lantus was stronger than the lantus in the old pen. it might mean that you're trying to use the lantus pen too long and the lantus has pooped out.

apparently lantus doesn't like to have anything else in it! the recommendation is to withdraw a little more than you need into the syringe, then squeeze out the excess into the air or i just let it run out of the needle.
 
a very good point. i started a new pen 3 days ago but the #'s are still high. I will post mid-day numbers. Nadir was about 136 at +6.
 
if it's not the lantus, is there any chance he needs a dental - diabetic cats are notorious for their mouths because all that excess sugar can cause tooth problems - or any chance he has some other kind of infection going on?

i'm really not sure what to suggest. perhaps others have ideas.
 
Let me ask the dental question a bit differently. Has Ruben ever had a dental and if so, how long ago?

It's very hard to get a good idea about a cat's dental health if the cat is awake.
 
well, i am sure he has had a dental over the years. not sure when the last one was. the vet did a bit of a scraping the last time i was in but at age 13, i don't want him to go under anesthesia if it is not necessary.
 
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