? 10/31 Zuko AMPS 345 +2 285 +4 247 +6 230 +8 252 PMPS 361 +2 344 +4 356

[Zuko's Dad]

Hi everyone,

Our 8 year old boy named Zuko has been diagnosed as a diabetic for a year and a couple months. He has been on Lantus for the last year and we have not achieved consistent regulation. Recently he has had AMPS/PMPS numbers closer to the 400s and his nadirs (which used to be around 100 - 200 when on 2.5U - 3.0U) are much higher too. He is showing signs of diabetic neuropathy in his hind legs and we are trying to stabilize him as quickly as possible. He is on Zobaline.

We are working with our vet to determine what is going on. I have extensively read about the Somogyi effect and I am not confident that is the mechanism at play here. We test every day AMPS and PMPS with frequent nadir spot checks around +6 to +8.

Zuko is currently on 3.5U and we have been following the TR protocol. Zuko is 7.3kg and not overweight (confirmed by multiple vets), he is just a larger cat.

My question (which I am sure relies on a spreadsheet being filled out to properly answer): With a consistent climb in his nadir, AMPS and PMPS when we have previously had lower numbers at a lower dose (2.5U to 3.0U) is it appropriate to continue increasing his Lantus dose? I am starting to think that he may not respond to Lantus well and it might be more worthwhile to switch to Prozinc. Obviously that is a larger conversation, but quite frankly I am exhausted with being worried 24/7. Thank you for your help.

 

[Wendy&Neko]

Hello and welcome. I moved your post to the Feline Health forum, as we ask people to have their spreadsheet set up before posting there. To make it easier for you, start with the last couple of weeks worth of data. That's the most important to us. Then add prior data when you have time.

When you say Zuko is eating wet food and hard food, can you tell me specifically which brands? Following TR requires feeding just low carb wet or raw food.

The Somogyi effect has been proven to be not a thing, but it was something that vets of a certain age were trained on. Somogyi is a 100 year old theory based on studies of humans and fast acting insulin, in a study that didn't even get peer reviewed. A different phenomenon we see all the time is something we call bouncing:

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).

With a consistent climb in his nadir, AMPS and PMPS when we have previously had lower numbers at a lower dose (2.5U to 3.0U) is it appropriate to continue increasing his Lantus dose? I am starting to think that he may not respond to Lantus well and it might be more worthwhile to switch to Prozinc.

As you said, once we see the data we'll be able to help you more on the dose. There are many reasons that nadirs can rise. Switching to Prozinc from Lantus is a lot less common than the other way around.

 

[Zuko's Dad]

Hi Wendy,

Thank you for your reply and for moving the post. I have followed FDMB for a long time, but I am a first time poster so I appreciate the grace.

Zuko eats one can of Fancy Feast wet food and a portion of Sheba pate in the morning and 44g of Ziwi Peak Chicken & Whole Mackerel hard food with a single portion of pate in the evening if he is so desires. His daily caloric need is calculated to be around 330 - 360kcal. Thanks verifying that Somogyi is BS.

I will fill out my sheet ASAP so it is easier to see what is going on with him. Roughly 6 weeks ago he was responding very well with nadirs in the 100s and AMPS/PMPS were both around 300 or a little lower. There has been a sudden shift and almost flattening of the curve.

 

[Diane Tyler's Mom GA]

Hi Timothy
Just wanted to add if you are feeding any dry food at all you have to follow the SLGS method. Can you please add what Insulin you are using to your signature
@Zuko's Dad

 

[Sienne and Gabby (GA)]

One other question in addition to the information that Wendy provided -- how are Zuko's teeth? One of the issues we often see is that even in cats that are in remission or very tightly regulated is that if they need dental work, either a cleaning or for other reasons, it can cause their blood glucose numbers to rise. It's a common cause for a cat to fall out of remission.

 

[Zuko's Dad]

Hi Timothy
Just wanted to add if you are feeding any dry food at all you have to follow the SLGS method. Can you please add what Insulin you are using to your signature
@Zuko's Dad

Hi Diane! I updated my signature, thank you for the heads up. I understand that TR typically requires full raw/canned food, but up until the last 6 weeks he had responded rather well to the regimen we established. I have an important update today though!

It turns out our newest vial of Lantus may have been compromised in transit to our Costco's pharmacy. I had the idea to try one of his older vials and he had a nadir of 131 today! We contacted the pharmacy to let them know and we are getting a new vial from a new lot on Monday. I will use this older vial until we get the new one.

I will still fill out our most recent data in the spreadsheet and continue to monitor. I think that if he has been chronically under-dosed due to reduced potency in the last 6 weeks that the insulin depot must not be at the correct concentration either. We are anticipating needing to titrate down .25U or more as we build up that depot again and we are checking +3, +6 and +9 for the next few days.

 

[Zuko's Dad]

One other question in addition to the information that Wendy provided -- how are Zuko's teeth? One of the issues we often see is that even in cats that are in remission or very tightly regulated is that if they need dental work, either a cleaning or for other reasons, it can cause their blood glucose numbers to rise. It's a common cause for a cat to fall out of remission.

Hi Sienne and Gabby! Zuko's teeth are very healthy. He has routine yearly cleanings and has never needed to have any teeth pulled. You make a very good point though!