68/14 Alice AMPS 317, PMPS 605- Wrong insulin??

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Julie and Alice

Julie and Alice

Member Since 2014
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Hi,
I have reduced Alice's dose of Lantus which I admit was probably the right thing to do. The problem is she is STILL heading for hypo with only the tiniest amount of insulin. I'd appreciate if you could have another look at her SS for me please confused_cat

It's so upsetting this evening to find the BG the highest I have ever recorded it at and yet she needed glucose earlier in the day to keep her up (using Alphatrak2).

Do you think it is time for a change of insulin to Bovine PZI (in UK) :?:

Many thanks

Julie
 
ok, well, first off, what is dear Alice eating? How much? As I see she is newly diagnosed, I also want to just check when you are testing her?

We test first, feed and then shoot insulin The test tells you if its safe to shoot at all, then you need to know they have a good meal onboard, and then you give the insulin. All of this to happen in fairly quick succession (10-20 mins). And those shots of Lantus need to be as close to 12 hours apart as you can manage.

Next, your spreadsheet has a lot of information, but frankly its quite confusing. I have a feeling that you have been trying to steer her numbers by adjusting insulin dosing daily, and maybe even giving some in between the 12 hour shot times? Lantus is a long acting depot insulin. It builds up in the system over several days (we call that the depot). Once a shot is given, you can't un-give it, and so you steer with food if they drop too fast. But there is a key point here... dont over correct either. I would not give High carb/glucose for the numbers you have seen so far. A teaspoon or two of a medium carb food (something like a gravy lovers food) is all that would have been neccessary, in my opinion.

Any adjustments in dosing are made based on the nadir, or lowest point in the cycle. Most cats nadir on Lantus at around 5-7 hours post shot, but some nadir later. (every cat is different) Alice is barely recieving any insulin at all, according to your spreadsheet, so there is not much room to move here anyway.

The high numbers you are seeing are definately a bounce. Her liver is panicking and releasing glucose when she gets those low numbers midcycle. Those numbers are not too low... she is not in danger at those levels. If she were mine, I would feed her 4 times a day, (AM preshot, midcycle, PMpreshot and midcycle again, if possible). I freeze tiny cans of food and put the frozen "puck" out for the cat to nibble on overnight as it thaws if I am at all concerned about her getting too low.

What are you feeding her? Changing food could be all the change you need to get this cat off the juice. If she is not getting a good low carb diet, or is getting into food she shouldnt have, correcting that might put her into remission.
 
Hi Linda,

Thankyou for your thoughtful response. Alice is on low CHO diet now but she wasn't before diagnosis. She has a problem with being sensitive to most foods & may have inflammatory bowel condition (& pancreatitis). She had some dried food introduced before diagnosis which I think was the problem alonside her high CHO sensitive Chicken & rice food (Royal Canin). I only use a little of that now if she goes low. She now eats Catzfine lamb & buffalo only which I believe is low carb. I test Alice's BG then give insulin. If she is high she wont eat for a little while anyway but mostly she does. She always eats around 230 to 280 gms in 24 hours. I let her free feed although she takes most in the first 4 hours or so, both after AM & PM shots. I used to control her food more but found that when I checked her BG it showed that she knew when to eat as she was getting low. Perhaps I should look at that again.

I have given her insulin a early on a couple of occasions when she was extremely high as I thought she had run out of insulin and I wasn't happy leaving her for a few more hours like that at the time. I am trying to be consistent but she seems to need less insulin at night than in the day. I do admit though that I have tried to adjust her insulin too frequently. I'm only just learning! I think it was partly because of going low in the night. She only ever used to go low in the night but now its in the day too! The vet had advised a later shot in the day & lower dose at night recently. l am now trying to shoot 12 hourly but don't seem to be able to get the correct dose.

I tend to give her a little high carb food if she is dropping very quickly early in her cycle & around 90 & heading down still. Perhaps I gave her too much Glucogel today. I am wondering if another insulin has more room for manouvre. It is such a tiny difference in the syringe between too much and not enough. I suspect that she may always have had too much insulin and the bounces made me and the vet think she wasn't having enough. I don't understand how she can need so little insulin but not be able to control her BG better. Alice often doesn't have a nadir but that might be because she was having too much insulin & so just going down & into the next cycle.

I just had a look at your SS & it looks great - brilliant that you are OTJ!
Thanks again Linda,

Juliex
 
Another issue to make sure we are understanding correctly. You are using an AlphaTrak meter. They measure differently than human meters ... here is some info cut and pasted to help you analyse your data correctly:

Comparing a human glucometer to a pet-specific glucometer is like reading temperature in Celsius vs Fahrenheit. Both are correct. You just need to know the reference ranges to interpret what the numbers mean.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]
 
Quite erratic there, what with the dose changes and exaggerated response to insulin. With the possible IBD and pancreatitis, it could be difficult to regulate on Lantus, as it does best with very consistent dosing. When I had Spitzer, I wound up using short acting insulin boluses when he'd be high, because I couldn't reliably increase the Lantus and hold it.

If you choose to work with a different insulin, the Hypurion PZI would be a good candidate. If you do that, come over to the ProZinc forum where we deal with PzI type insulins. An advantage of the PZI, is that you can 'shoot what you see' - when you know how low various doses take him, you develop a sliding scale to use that info.
 
I am hoping someone else will chime in on this one, so I am bumping this up to the top of the index.
 
I have been doing a lot of thinking about your Alice, and I am going to suggest you take her off insulin altogether. Give her a chance to reset, so to speak, and show you what she can do.

You will control her diabetes by diet only, so it is very important that you feed only low carb food, including treats. Nothing is to be given to this cat that might elevate her BG.

If it turns out that she needs insulin support for a little longer, I have a suggestion on how to literally give her just a drop of insulin. But the other issue you are having is that you are over correcting when she gets low on you, and having a cat that zooms up on the sugar. I can help you navigate those low moments, if you ever have them again.

So, take a breath, and take her off insulin for at least 3 days. Let her system settle down.
 
LindaMS said:
I have been doing a lot of thinking about your Alice, and I am going to suggest you take her off insulin altogether. Give her a chance to reset, so to speak, and show you what she can do.
Click to expand...

Hi Linda,

I've also been thinking about Alice and have also wondered how she'd do with no insulin. She had ketoacidosis at dx though, so - because of that -I've wondered if it would be risky to leave her with no insulin at all...?

Eliz
 
Thanks Linda & Eliz,

Just noticed your responses. I had wondered also about what she would do with now insulin. Its really nice to know you are thinking of us and trying to help. I haven't had a chance to update her SS recently for one reason and another. I am hoping to do that asap now. Please give me a mo & have another look. I have cut her back to a 'fat zero', she has had some rotten highs though. Its really hard to understand why so little would cause such a huge drop in blood sugar & why a hairline less on the syringe may not be enough! Anyway, I am trying to stick with the fat zero for a short time as yes she did have serious ketoacidosis and was in vets Hopital on a drip for a couple of days, it took several weeks to see a real improvement. She has gone backwards though this last week with the sugar being so high. She also developed loose stools a couple of days ago which she hasn't had for a while, I'm wondering if the high carb Royal Canin Chicken and Rice 'Sensitive' caused ther IBD to flair up. She also occasionally has vomited just fluid back (as not eaten) when her sugar is particularly high.

I'm not sure if I am posting this in the correct place now??

I look forward to any response you might have, thanks.

BTW I tested for ketones this morning & from time to time & she is always clear.

Juliex
 
The highs are a direct result of her going too low. Its a defensive mechanism that the body uses to save the cat from low blood sugar, and possible death.


and why are you giving that glucogon? please dont use that, its too much sugar, and pops her up way to high. Try giving her a nice treat of a couple of teaspoons of gravy lover's food. ... We want to use a Minimally Effective Response, .... like a little bandage, not an industrial staple gun!

Seriously, if she were mine, I would stop insulin right now. Dont freak about the numbers for at least 2 days, give her a chance.

If she has to go back on a drop, I can teach you a very easy way to do that, consistantly
 
LindaMS said:
and why are you giving that glucogon? please dont use that, its too much sugar, and pops her up way to high. Try giving her a nice treat of a couple of teaspoons of gravy lover's food. ... We want to use a Minimally Effective Response,
Click to expand...

Hi Linda,

Julie and Alice are in the UK and don't have access to 'gravy lover's food'.

I understand that Julie has been using glucagon and/or a little higher carb food when Alice's numbers have been low.
And in fact in my own cat I've found that glucose alone, used judiciously, gives less of a high BG headache than higher carb food. My experience has been that the glucose is in and out of the system quickly but the carbs in the food seemed to hang around for longer and elevated the BG levels over time. I start out with a couple of drops of glucose in low carb food, and have found that this can stave off low numbers without creating high numbers later on.
But this is just my experience in my cat (who is also prone to very steep drops at times). And 'every cat is different' for sure...

I absolutely agree about wanting to get a "Minimally Effective Response" to Alice's dropping numbers. That may take a little experimentation, I think.
There are other medium/high carb foods that could be tried if necessary, but Alice has very sensitive digestion, so that itself may be something of an experiment.
 
Like everyone else I've been thinking a lot about dear sweet Alice. I have to concur with both Linda and Eliz. I think I would try her off insulin for a few days while testing for Ketones religiously.

Now for handling those lows...with both my Autumn and Cassanova (well actually all my sugars to date) I don't use any medium to high carb foods. I simply feed them up with their regular diet. Since cats unlike humans can convert everything they eat into carbs.. but again just my experience with my own cats and every cat is different. I also don't test and feed up every 15 minutes when I have a low. I feed a mini meal of about 1 oz give them an hour to digest and test again. As I find with my own cats they come up easily and seldom bounce sky high for the extra carbs.

Mel and The Fur Gang
 
Thanks folks!

I take the point on not using high carbs. I was up last night monitoring her as she looked like she may be heading low but was in fact ok. I did wonder how I would be able to get her to take her usual low carb food with glucose if necessary though as she relishes the high carb & may well turn her nose up at the same old food if she's not particularly hungry. I don't want to use the high carbs again though because I think that it upset her inflammatory bowel problem and as Eliz mentioned, it may be the cause of her going from a particularly low BG to then swing very high (2

I don't really feel happy stopping her insulin completely at this minute as I know in the past when she hasn't had any, or a fur shot her glucose has gone sky high. It might be different now but I would need to understand it a little better. Tonight her glucose has shot up well above her pre-shot number, only 3 hours after her insulin. I just don't understand this, it cant be a bounce at this point could it?

She has naturally been needing less and less insulin and yet she cant seem to control her blood glucose at all well. It seems a strange phenomena which I would really like to understand. The way it has gone I would predict that she would continue to wean herself off insulin by going lower and lower on the same dose as she has done all along. She's not seeming to do that at the moment though. I notice other cats that come off the insulin tend to be in the greens and blues for a while before they stop insulin.

I'm feeling quite worried at the moment to find that she is reading 26 (468) at only PM +3 tonight. That doesn't bode well for later in the night & tomorrow morning, she's already started to drink more water. She normally at least goes lower than her pre-shot number. All can think is the even the lower carb foods shoot up the BG.

I will certainly consider stopping the insulin but at the moment I just couldn't risk the high numbers, she is so lethargic and unwell when her sugar is high. I hope that isn't too disappointing as I do value your advice, I just need to understand the reasons better before I do that. She has been so sick when she's missed her shot.

I'd appreciate you having another glance at the latest figures on Alice's SS if you can & see if you can make any sense of it!

Thanks again,

Julie & Alice x
 
Hi Julie
Julie and Alice said:
..I did wonder how I would be able to get her to take her usual low carb food with glucose if necessary though as she relishes the high carb & may well turn her nose up at the same old food if she's not particularly hungry.
Click to expand...
I have the same issue with Bertie. Good low carb food is not his favourite thing! If I need him to eat more of it I crumble some freeze dried treats over the top. Does Alice like any of the Thrive freeze dried treats, Julie? (Is there liver in the high carb food? If it's that she likes then she may like the liver Thrive treats?) Or a little grated cheese?

Julie and Alice said:
..I don't really feel happy stopping her insulin completely at this minute as I know in the past when she hasn't had any, or a fur shot her glucose has gone sky high.
Click to expand...
Aha... If that has happened every time insulin was missed (and the subsequent high numbers couldn't have been caused by a bounce from the previous cycle) then stopping insulin may not be the thing to do.

Julie and Alice said:
.. Tonight her glucose has shot up well above her pre-shot number, only 3 hours after her insulin. I just don't understand this, it cant be a bounce at this point could it?
Click to expand...
Sometimes there is an obvious reason for higher BG levels. Sometimes we never know the reason. :roll:
It could be that the fat zero isn't enough when Alice's body isn't producing any insulin of it's own.

Julie and Alice said:
..She has naturally been needing less and less insulin and yet she cant seem to control her blood glucose at all well. It seems a strange phenomena which I would really like to understand.
Click to expand...
The numbers Alice has look very similar to the numbers Bertie had after he was first diagnosed (though he was on a much higher dose). I struggled to make any sense of the pattern. And I actually felt that we were such a hopeless case that I stopped posting on FDMB for a few years! It seemed to me that everyone else's cat was doing just fine (that wasn't true, of course), and mine was the only one that was 'out of control'.
In our case, things just changed over time (plus a couple of insulin changes along the way).
I guess what I'm saying is, don't lose hope. :YMHUG:

Julie and Alice said:
..I will certainly consider stopping the insulin but at the moment I just couldn't risk the high numbers...I hope that isn't too disappointing as I do value your advice...
Click to expand...
Sweetie, nobody is going to be disappointed! Honestly! People are here to offer up ideas, but you are Alice's best buddy and caregiver, and you decide what you do and don't want to do. :smile:

Big hug to you,

Eliz

PS. I've been wondering about transferring some of my new Hypurin PZI into my previous vial so that I could let you have some to try out. Am still working on that idea...
 
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