3/31 Benny's numbers not going down; curve warranted?

[Ben&Squirrel]

Hi everyone,

Benny's new vet told me to wait 7 days, giving 2u of glargine 2x/day, then do a curve. His numbers are just not going down at all, though. I am using ketostix and he is showing no signs of DKA, thank god.

I have been doing spot testing based on what the doctor and some of you have asked, and there is no time of day when his values go down. Is it still possible that he is having a bounce somewhere, or can that not be known until the whole curve is done?

The curve should involve blood glucose tests every two hours for 12 hours, correct? If it is not really needed right now I would rather not do that. He is getting irritated and sometimes struggles with the lancet stick. I'd rather save the curve for a time when it can give us real information that is needed and right now...don't we know that this is not working?

(Edited to add that if someone can tell me how to edit a title or delete a post I will change this to be more consistent with the group's way of including dates in the titles.)

 

[Wendy&Neko]

What this is showing you is that you started on too low a dose of Lantus. We typically go with the same dose as with Prozinc unless it's getting some lower greens.

How much of the high carb kibble is he still getting per day?

The link to your previous post on Feline Health where you talked about switching insulins: https://felinediabetes.com/FDMB/threads/update-on-benny.261077/ For editting post titles, look at the top right of your first post of the thread. There is a drop down under Thread Tools that allows you to Edit thread.

 

[Ben&Squirrel]

Wendy, thanks for the pointer on editing titles! I'm not sure if I should be including links to my old posts in a new thread or not. Is there a rule of thumb? I still feel pretty clumsy on the website!

He is getting I would say a third of a cup of kibble a day; this is down probably by half.

It is just hard to see the numbers not changing. He did just show a better one, although still in the red!

 

[Wendy&Neko]

On this forum, we suggest that you post a link to your previous post here, so people can easily go back. I included the previous one on Feline Health, cause I thought the discussion might be relevant to anyone wanting to talk about today's topic.

How long do you think it's going to take to switch out the remaining 1/3 cup? Just trying to match that with a recommendation to up the dose. Just wondering if you should go up a full unit to get closer to the old Prozinc dose faster. Also side note, if you are changing things like food carbs/meds that might impact his dose, it's good to put comments in the Remarks column so we can see if there is a tie in to the change and what happens with the numbers.

 

[Ben&Squirrel]

I don't know how long it will take to totally get him off of the kibble; I'm a bit confused by that. He does not seem to be eating enough calories, although I can't be sure. Should I change that while his dose is changing, or wait? It is hard for me to know how aggressive to be with changing his food. He's eating the higher protein food, but I'm still trying different flavors and makers and it can be hit and miss with him. When he rejects the new food, he can always be counted on to have a bite of kibble.

The glargine dose actually is the same as the prozinc was; my old vet just told me to give him the 4 units of prozinc at once in the morning. The new vet wanted to start by splitting that dose. I communicated with hear earlier and she just wants to see the curve before raising his dose. I'll do that this weekend, although it feels like he's already not a fan of mine any more!

 

[FrostD]

Prioritize the food change, it is important for a number of health reasons. We normally try to do to over the course of 1-2 weeks, but some cats are more cooperative than others.

Wendy is just asking for a realistic target to give the best dose advice - we adjust the dose around the food change, it's intertwined. I would try to set something and stick with it - like every other day you're going to pull a tbsp of kibble from each feeding and replace it with the wet.

Edit: to answer the curve question, no I would not bother. The midcycle tests you're getting are enough to tell you he's just high. The additional benefit to completely getting rid of the dry is you can increase much more quickly, every 6 cycles (3 days) if you can continue to get the preshots + one additional test both AM and PM

 

[Wendy&Neko]

Are you weighing him periodically to see if he's gaining/losing weight? In those high numbers, it's going to be really hard to gain any weight. I hate to see you have to keep in such high numbers until after the weekend.

As for Prozinc/glargine doses, Prozinc is an in and out insulin, so we can see over 12 hours what the 4 units was doing. It was at least taking him down to the 300's. Lantus being a depot style insulin works differently. You need to build the depot first, 5-7 days, to see what the dose can do.

 

[Ben&Squirrel]

Prioritize the food change, it is important for a number of health reasons. We normally try to do to over the course of 1-2 weeks, but some cats are more cooperative than others.

Yes, he is definitely not cooperative about it! This morning he refused two different cans of food before eating. But I'll prioritize it.

Are you weighing him periodically to see if he's gaining/losing weight? In those high numbers, it's going to be really hard to gain any weight.

I had not even thought of it. He had gained a pound when we changed vets, but I'll start doing that too.

You need to build the depot first, 5-7 days, to see what the dose can do.

Thank you for the explanation. I had just heard that I had to wait 7 days and I did not know why.