? 10/16 Zephie AMPS >500 +1 >500 +2 >500 +3 476 +4 381 +5 417 - advice on dosing/what to do?

Stacey - Zephie's Mom

Stacey - Zephie's Mom

Member
Link to prior thread
https://felinediabetes.com/FDMB/thr...04-ss-interp-help-needed.294808/#post-3213301

Hello again,
We're still on the struggle bus here trying to get Zephie's numbers into a better place. I upped his lantus to 1 unit q12h on 10/12 per advice of @Bandit's Mom . He had one good day (10/13) and then it's been crap ever since. Last night was terrible -- all above 500 as though I didn't give him his insulin at all. I am sure it wasn't a fur shot as I have been checking for any signs of wetness and also checking for any of the lantus smell where I injected. This morning, his #'s are barely budging. I just don't know what's going on. This seems like a long time to chalk up to a bounce from his good day on 10/13?

On the plus side, other than massive PU/PD, his weight is stable for the past few days for the first time since his dx 3 wks ago, he is purring, chatty, and moving around. I'm checking his urine at least 2x/day for ketones, negative so far (knocking wood).
Any thoughts on what to do? I am at a loss. His internist is still on vacation. She is due back tomorrow but I doubt I will be able to get a hold of her unless Zephie goes into emergency mode as she will have a mountain of work after being gone for 10 days.
Thank you all.
Stacey
 
Bounces can last six cycles. Today is cycle 6 since those low blues. So hopefully he'll ditch this bounce tonight. At which point you can get a better idea of how low this dose is taking him.

When following SLGS, you hold a dose for 7 days, then decide if you need to make a change. Tonight is the end of day 5 on this dose. The saying is that Lantus teaches patience. ;)

But, the fact that Zephie is feeling better is great! Cats are so much more than their numbers, which is why we like to hear about how they are doing, as that's the part we cannot see.
 
Thank you for your reply, @Wendy&Neko . In your experience with diabetic cats on lantus, is this fairly typical for a newly diagnosed kitty? Does it usually take this long to get them stabilized? I feel like we are many weeks -- hopefully not months? -- away from getting him into better #'s on a regular basis. Can you help me set reasonable expectations? I've been looking at the spreadsheets of other kitties, but with my being so new to diabetes, I don't see any patterns or don't yet have a sense of what might be within the realm of "typical" so don't know if I should be more or less worried?
 
It has been not quite 3 weeks since he got diagnosed? That is very early days. Having said that, the response of cats varies a lot. Zephie is not unusual. We have a saying ECID or every cat is different. Some of the factors that impact who long it takes is what caused the diabetes (steroid shot, other medical condition, weight, family history are some examples). Inflammation/infection like pancreatitis or IBD or needing a dental can make it harder. Also, how long was he diabetic before he was diagnosed so how long did he spend in higher numbers and get used to them? Choice of insulin also a factor, Lantus is one of the best. Diet is another factor, and unfortunately he's on some higher carb foods which will make it more complicated to get him regulated. Not impossible, just might take longer. Plus you have to follow SLGS for dosing, which means slower increases for safety's sake.

My girl was on the complicated side of the spectrum. She had a couple secondary endocrine conditions, one of which caused the diabetes (acromegaly) and the other that complicated it (IAA or insulin auto antibodies). It took her about 1.5 years to become well regulated and she never went off of insulin. Her "good dose" changed around a lot. But I've also seen cats get regulated and off on insulin within a couple months.
 
Thanks again, @Wendy&Neko -- you have been so helpful. Yes, he was diagnosed 3 wks ago and he was not diabetic for more than a few weeks prior to that. Because he was on budesonide (at a *very* low dose of 0.5 mg twice a week), I was monitoring his urine at home every week or two. Two weeks before he was diagnosed, he was still showing as "negative" for glucose on urine testing at home. Plus, no PU/PD and weight completely stable until a few days prior to my getting the positive urine test. We stopped his budesonide in hopes he would revert, but he did not.

We have always been worried he might become diabetic because of his history with chronic pancreatitis and that he has been sensitive to steroids when given them in the past. So, while he wasn't officially diabetic until 3 -4 wks ago, his numbers were on the higher end of normal for some time. His fructosamine tests ran in the mid 200s (we ran that test as part of his quarterly labwork). I know of a sibling of his (same mom and dad, different litter) who also got diabetes so I think he could have some genetic predisposition.

I realize his diet is an issue, but I feel quite stuck about that, at least for now. Because of his IBD, pancreatitis, and CKD, we have limited choices for food. And the last two times we had to make a diet change due to the pet food company eliminating their food he ended up with a terrible pancreatitis flare up, the last of which nearly killed him. So, I'm trying to see if we can get him into better territory without risking a diet change because the last thing we need is a pancreatitis attack on top of everything else.

It sure sounds like your Neko was a very lucky kitty to have you as her mom and caregiver. I've had many complicated cats over the years, and it really does take a commitment to sort out the best treatment plan and get them to the best place possible.
 
It's great you were so good at monitoring him on budesonide and caught his diabetes early. That should help because his body wasn't stuck in high numbers for a long time.

The diet is what it is, I was just pointing out that it's a factor in how easy it is to regulate a kitty. I have an IBD cat myself, on prednisolone, and can't get her off of it. I tried tapering, but her body said "no" at a certain point. In cases where kitty is taking a medication or food that is otherwise medically necessary but impacts the BG, we work the insulin dosing around it.
 
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