3/6 Frankie Plateau/Rise

[Shelley7]

Hi. I haven’t posted in a while so can’t find my last post to put here. I’m looking for advice, problem solving and maybe just good old fashioned support because I’m feeling a bit burned out and like I’m spinning my wheels.

Frankie was on 3.25 and seemed to be trending about 110-140 with green nadirs. I went up to 3.5 thinking we were finally going to get mostly green and not only did that not happen, his sugars are now almost always in blue with no green readings and even the blue numbers are getting higher (140-180). I had tried a different food flavor so thought that was it but apparently not, because i stopped it after 2 days and it’s still happening. In addition to that change, he had these weird days where is fasting is 90, but then the sugars rise and stay high all cycle instead of a curve down. Even the +3 being higher doesn’t make sense because he often sleeps during that time and either just eats a little or doesn’t eat at all.

I know the testing has been sparse lately, but he’s sick of it and resisting more and I’m feeling discouraged because I don’t want to test just to test and I kind of know it’s going to be 120-180 and even when it’s 90 very occasionally, it only goes up.

Why is it rising and not lowering with increased doses? Could it just be insulin resistance from the Budesonide? Could the Lantus be going bad? (It looks fine but I’ve been using it for 63 days). He seems fine, no signs of infection. He doesn’t have any teeth left, so no chance of dental issues.

Should I try a different insulin? Should I just keep going with the Lantus? 3.75, 4, 4.25? I feel like that’s such a high dose and it’s so expensive. Maybe it’s not possible to get tight regulation when on Budesonide? Do I really need to do a curve before going up? I feel like it’s 8 pokes for nothing because his numbers are so flat and consistent within a range. Could the batteries be low on the machine? What would that look like? Would it give false readings?

Any ideas to explain the numbers and advice about what you’d do next would be appreciated. Thank you.

 

[FrostD]

So first, I think you are being too hard on yourself. His numbers are fantastic, those nadirs actually don't leave much room for improvement. He's very well regulated, I would be very happy with those numbers.

One thing to remember is that you have a slightly more complicated kitty than most here (oh hey, look at my signature too lol). So while you may be browsing and seeing very tightly regulated cats, it's not always possible for every cat.

Additionally, insulin needs change over time - it's a hormone, not a typical medication like an antibiotic. Same as how his budesonide needs may change depending on what the SCL/IBD is/isn't doing. It's not as if you hit a magic dose and boom, that's the dose for the rest of his life.

Budesonide does not usually affect BG, but I believe I've seen it once or twice here. I would not say that's the case for Frankie.

How long has it been since the I-131 treatment?

We test because you just don't know. As the budesonide does it's job, the inflammation will hopefully reduce and that may have an impact on BG. Or depending on how far post iodine treatment he is, you may see some effects from that.

 

[Shelley7]

So first, I think you are being too hard on yourself. His numbers are fantastic, those nadirs actually don't leave much room for improvement. He's very well regulated, I would be very happy with those numbers.

One thing to remember is that you have a slightly more complicated kitty than most here (oh hey, look at my signature too lol). So while you may be browsing and seeing very tightly regulated cats, it's not always possible for every cat.

Additionally, insulin needs change over time - it's a hormone, not a typical medication like an antibiotic. Same as how his budesonide needs may change depending on what the SCL/IBD is/isn't doing. It's not as if you hit a magic dose and boom, that's the dose for the rest of his life.

Budesonide does not usually affect BG, but I believe I've seen it once or twice here. I would not say that's the case for Frankie.

How long has it been since the I-131 treatment?

We test because you just don't know. As the budesonide does it's job, the inflammation will hopefully reduce and that may have an impact on BG. Or depending on how far post iodine treatment he is, you may see some effects from that.

Thanks for the encouragement. You’re right that I have to remember that he has a lot going on and we are both doing ok.

I doubt his bowel inflammation will lesson at this point because it was persistent even on pred and bude is not as strong (although thankfully he doesn’t have active symptoms).. I have the option of trying chlorambucil (bigger gun) but hesitate to do so with his advanced age and because it can cause them nausea and to not eat, which obviously would be a problem if on 4 units of insulin.

I was really hoping that moving to bude would mean much less insulin but I guess not. You don’t think it’s playing a role in keeping sugars up?

His I-131 was a long time ago. Can’t remember exactly but at least a year if not two or three.

Do you think I should go up to 3.75?

 

[FrostD]

I have the option of trying chlorambucil (bigger gun) but hesitate to do so with his advanced age and because it can cause them nausea and to not eat, which obviously would be a problem if on 4 units of insulin.

I certainly understand. Quality of life has to be considered too, I know. It is possible to balance dose with chlorambucil and inappetence, it's akin to dealing with pancreatitis.

I was really hoping that moving to bude would mean much less insulin but I guess not. You don’t think it’s playing a role in keeping sugars up?

On the contrary! Look how much his numbers came down within days of that last pred dose, at the same dose of insulin.

Well the I-131 certainly isn't affecting anything now lol

As for the increase, I would not. Because I'm not entirely sure how low he's going some of these cycles -4/2, don't know if he was lower before the 78. 4/4 with that AMPS and no overnight test no idea how low he went. On TR you hold at least 10 cycles after seeing green, so I'd wait a few more days and see where he's at.

 

[Shelley7]

I certainly understand. Quality of life has to be considered too, I know. It is possible to balance dose with chlorambucil and inappetence, it's akin to dealing with pancreatitis.


On the contrary! Look how much his numbers came down within days of that last pred dose, at the same dose of insulin.

Well the I-131 certainly isn't affecting anything now lol

As for the increase, I would not. Because I'm not entirely sure how low he's going some of these cycles -4/2, don't know if he was lower before the 78. 4/4 with that AMPS and no overnight test no idea how low he went. On TR you hold at least 10 cycles after seeing green, so I'd wait a few more days and see where he's at.

True that is numbers came down from pred wean but not really responding predictably to increases now. I know we can’t know for absolute sure how low his number went on 4/4 but I felt like there were quite a few prior days that showed the nadir wasn’t even in the green so can’t we reasonable conclude that a PMPS of 156 (when it had been 172 for an am nadir) would likely not be super low?