6/7, Aiden, AMPS- 300, PMPS- 368...just keep going up :(

[Elizabeth & Aiden]

Hey everyone! So I hope someone can take a look at my readings on Aiden's chart and tell me just what I'm doing wrong It seems like we just keep upping the dose and it isn't doing a darn thing. He's currently at 4 units of Lantus. We're approaching his year anniversary of being diagnosed (shy a month and a couple weeks). He's fed fancy feast and friskies (free-fed). No changes to his environment. I have noticed he's been gagging more (Like 2-3 times he'll act like he's throwing up but not actually throw up...he used to throw up a lot in our old house, but now it's just gagging. For a while he was only doing it when he had been out of food for a while, now he'll do it even when he has food :/). So any advice on that would be great as well. Thank you so much!

Just a couple notes...
- I do curves as often as I can between my own responsibilities and issues.
- I know I need to grab more nighttime numbers.

 

[tiffmaxee]

I wonder if he’s developing pancreatitis. It’s common in cars and very common with diabetes. How’s his appetite? Does he seem nauseous?
The next time you get a yellow pmps would you please set an alarm to get a test between +5-7. He might be bouncing from lower numbers hence the pinks and reds in the day cycles.

 

[Elizabeth & Aiden]

I wonder if he’s developing pancreatitis. It’s common in cars and very common with diabetes. How’s his appetite? Does he seem nauseous?
The next time you get a yellow pmps would you please set an alarm to get a test between +5-7. He might be bouncing from lower numbers hence the pinks and reds in the day cycles.

I hope that isn't the case I know I've read about cats developing insulin resistance...is that related or entirely separate? His appetite seems relatively the same as it has been since this whole journey began. Sometimes he eats relatively quick, sometimes he munches throughout the day. There have been maybe 2 or 3 days I can think of in the past months where it was like...come on Aiden, you have food, eat it! But he's never flat out /not/ ate.
I'll have to wait for the weekend to try and get a reading between +5-7 after pmps. Does it make any difference at all in the night that I leave out food for him? I know I keep reading cats go lower at night, but don't really understand why I'm afraid.

 

[Wendy&Neko]

There are quite a few causes of insulin resistance, pancreatitis is one of them. Other things like heart disease, kidney disease, hyperthyroidism and some secondary endocrine conditions like acromegaly, Cushings or insulin autoantibodies can cause insulin resistance. And there is something call glucose toxicity, where cats get really used to higher numbers.

I know I keep reading cats go lower at night, but don't really understand why I'm afraid.

We don't either, but it is something we've observed. How many hours after his PM shot do you go to bed? If you could get a before bed test more often, it'd help us determine what is happening at night. If you can get a +2 or +3 test and it's quite a bit lower than the PMPS, that's a good indicator he is getting lower numbers at night and you should think about setting an alarm for a later test, or making sure he has lots of food out to keep himself safe/

 

[tiffmaxee]

On a positive note it doesn’t sound like pancreatitis.

 

[Elizabeth & Aiden]

There are quite a few causes of insulin resistance, pancreatitis is one of them. Other things like heart disease, kidney disease, hyperthyroidism and some secondary endocrine conditions like acromegaly, Cushings or insulin autoantibodies can cause insulin resistance. And there is something call glucose toxicity, where cats get really used to higher numbers.

We don't either, but it is something we've observed. How many hours after his PM shot do you go to bed? If you could get a before bed test more often, it'd help us determine what is happening at night. If you can get a +2 or +3 test and it's quite a bit lower than the PMPS, that's a good indicator he is getting lower numbers at night and you should think about setting an alarm for a later test, or making sure he has lots of food out to keep himself safe/

Thank you for explaining! I go to bed about 3-4 hours after his PM shot (usually). How often should I try to get the before bed test? Just a few times a week? I'm able to stay up later on the weekends, so I can try to get those +5-7 times then Also, he always has plenty of food left out (and if he runs out, he tends to wake us up lol)

 

[Sienne and Gabby (GA)]

I typically suggest that caregivers get a before bed test every night Given that it looks like you're not home during the day, you don't really know what's going on in between shot times. Just as an example, with my cat, there were a handful of times when Gabby's AMPS was in the 400s. Her PMPS was in the same range. However, her nadir was in the 40s. If I didn't have those test data between her preshot numbers, I would have been increasing her dose when the numbers were dictating that her dose needed to be reduced. (See 11/2/09 on Gabby's spreadsheet -- and yes, I was a testaholic.) With SLGS, you want to do your best to get a test during both the AM and PM cycles in addition to your AMPS and PMPS so you have some idea of what's going on around the middle of the cycle. I do think there's a good chance that glucose toxicity is one of the factors operating in Alden's case. Earlier on, you were holding the dose for what is by our standards, a long time. Even with the 3.75u dose, you held that for 2 weeks. Alden may have gotten used to being in higher numbers.

Regarding why PM numbers be lower, it's part of the endocrine cycle. If you are old enough to remember when people talked about biorhythms, that was a popularized term to refer to our normal, biological rhythms. There is a part of that cycle called dawn phenomenon. This is due to your body beginning to ramp up for the stresses of the day. As a result, stress hormones (corticosteroids) are released. This is why AM numbers are often higher. Since there's a normal cycle, those hormones are less available at night and numbers may trend lower. Of course, some cats are very active at night and this may not alway apply. I'm sure you'll hear people comment that every cat is different (ECID).