8/07 - Astrophe - AMPS 427 after increasing dose

[Sunny17]

Hello All!

Astrophe - our male, neutered 18lbs senior cat - was diagnosed eleven days ago with a 382 blood sugar before starting on insulin.

- He was started by the vet on 1U Lantus twice a day. Numbers never went below the 300s.
- After 5 days the vet had us increase the dose to 2U in the AM, and stay at 1U in the PM - we saw only a slight improvement in numbers
- After another 5 days - yesterday - the vet had us increase the dose to 2U in the AM and 2U in the PM. 5 hours after the PM shot, I did a spot check and saw the first low BG number at 174 and we were happy.

But this morning the AMPS went *up* to 427 - which is higher than before we had even started on insulin!
Is this a Somogyi effect? What should we do?!

Please help. We love our furball and are at our wits end. Home testing has been very hard for us, as he hates being pricked, so my apologies for the sparse data in the spreadsheet

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Some other background about Astrophe:

- Has a history of bladder issues. Had to have a stone removed. Eventually had to have a PU surgery.
- Was on a low dose of prednisone (once a week) for arthritis, which we have tapered off and discontinued after the diabetes diagnosis.
- Has been drinking a lot and peeing/leaking indoors and that has not yet resolved. Vet thinks this is due to the diabetes.
- Was a dry food addict. We have switched him to wet food only fancy feast, which he will tolerate, but he won't (yet) eat the low carb versions. Working on it. He still gets dry treats
- Due to work arrival departure hours our dosage isn't every 12 hours. He gets a dose at 7AM and then 5PM. We are working on figuring out how we can get it to exactly 12 hours by adjusting schedules.

 

[Sue and Luci]

Hello and welcome to the forum! So glad you're here - lots to learn but it's clear that you love your kittie and you're already to help him get better. And this is the place to do just that!

Have you read this stickie? http://www.felinediabetes.com/FDMB/threads/the-basics-new-to-the-group-start-here.18139/

As soon as you're done reading that - you'll find that vets often get the dosing incorrect - yes, as unbelievable as that sounds, your vet (and mine too) do not understand insulin dosing in cats as well as the folks on this group do.

First bit of advice - don't change the dosage amount from one time of day to the next - usually cats here start at .25 units and work their way up (you'll read all that in the Stickie at the top of the forum) in the yellow highlighted tabs.

Home testing is always a bear when you first start - we had many hours of agonizing attempts, hurt feelings and downright exhaustion. Luci was far more tolerant of it than I was. I was sure I was hurting her and she was going to either bite me or claw my eyes out...she did neither...mostly just tried to wiggle away. DH held her for me...and I'd do the poking...I remember the first time I think I had to poke her FIVE times before I got a drop of blood.

Use a sock filled with rice to make a little ball and warm it in the microwave - prop his ear up with that - it warms the ear and you won't get poked with the lancet (watch the video on here for more advice on how to do that).

Yes, diabetic cats will do that - drink and pee...it'll improve with better BG numbers...first decide on a dose and stick with it for several days (or whichever number based on the protocol you choose to follow - either TR or SLGS)...look at the stickies for that info too...

You have a lot of homework to do...don't worry about the Somogyi effect right now...you've got lots more important things to figure out over the next few days than that...

Best to you and Astrophe!

 

[Wendy&Neko]

Good job starting to do testing for your kitty. It's that data that tells us how to change the dose. Kitties on high carb food here are started on a 1.0 unit dose, so the vet got that part right. Since your kitty is still eating higher carb food, he may end up having to go to a higher dose until you get him switched. Since you are still giving high carb food, take a look at the Start Low Go Slow Method sticky note, it'll describe one of the two ways we decide on dose here, the other method (Tight Regulation) requires all low carb wet or raw food.

If you look at the New to the Group Sticky Note that Sue linked, you'll see a description of the typical Lantus curve. It's usually higher at the end points (preshots) and lower or nadir somewhere in the middle. We determine how to dose a cat based on how low the dose is taking the cat. Hence the importance of getting tests, when you can, somewhere in the middle. As Astrophe showed you, many cats go lower at night, so good job getting that test in last night that showed you the blue. Today he is "bouncing" - it's not Symogyi. Bouncing is extremely common, especially for recently diagnosed kitties. Nothing you can do but wait it out, his numbers will come down. Again, the description of bouncing from the New to the Group Sticky Note:

• 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).