Advice for controlling bouncing & glucose resistance?

Ramon's mom

Ramon's mom

Member
After steadily raising his dosage bit by bit to kick him out of insulin resistance, he now is in a situation where the high doses (3.8, 3.6 and now 3.4) cause PMPS BG readings to be too low to shoot. I've tried skipping or stalling then shooting half-doses but still it doesn't seem to bring us to shootable numbers for both AM and PM. I need some advice on whether my current approach of slowly lowering his AM dosage is the right thing to do. Thanks!
 
Looks to me like Ramon may be going lower at night than you are aware (many cats go lower at night than they do during the day) and that is causing the AMPS to be higher than your PMPS due to some bouncing from lower numbers he is not yet used to. It appears Ramon usually hits nadir around the middle of the cycle i.e. +5/6 or so and the only way to know what he's doing overnight would be to set an alarm and grab a test in the middle of the night cycle.
Switching up doses based on pre-shots works for a few kitties once you get a good handle on how well any given dose is working but it doesn't work for all. A better strategy is to find a dose you can shoot consistently both AM & PM.

I would be inclined to try 1.8u morning and night for a few cycles and see if that evens him out at all. Then you can adjust either up and down based on what the numbers look like with consistent dosing.
 
It looks like the insulin resistance is breaking. Hooray! So yes, you'll need to keep lowering the dose.

If you look at my spreadsheet at the end of 2018, you can see how it can look. Sam was on 4u on 12/10/18, and by early January he was down to 2u. Ramon hasn't been diagnosed as long, so he may drop even faster. It can get a little stressful trying to catch the slide. Remember to error on the side of caution when you're trying to decide on doses right now - it's better to lower a smidge too much and have to raise again, especially if you aren't going to be home.
 
Unfortunately his insulin resistance is not really breaking. It appears to have more to do with whether I skip his other meds or not. Atopica and budesonide seem to raise his numbers. When I skip he goes into the blues and greens. Darn! And now he has caught a cold so he may be going on another med soon if that goes as badly for him as it is for the cat he caught it from.
 
What is the clavamox for? If he has an infection, that will raise his BG some usually.
 
Try warming his food to make it stinkier or add some tuna water or parmesan cheese to add a more potent scent. Add some water to his food to keep him well hydrated. Meat baby food without any onions or garlic is easy for them to lap up with a stuffy nose and sometimes that helps to get them eating. Make sure he keeps eating as infections and higher BG can put kitty at risk for ketones. Are you testing for ketones? You can get Ketostix at the local pharmacy and check his urine. Anything over a trace of ketones, a call to the vet is in order.
 
MrWorfMen's Mom said:
Try warming his food to make it stinkier or add some tuna water or parmesan cheese to add a more potent scent. Add some water to his food to keep him well hydrated. Meat baby food without any onions or garlic is easy for them to lap up with a stuffy nose and sometimes that helps to get them eating. Make sure he keeps eating as infections and higher BG can put kitty at risk for ketones. Are you testing for ketones? You can get Ketostix at the local pharmacy and check his urine. Anything over a trace of ketones, a call to the vet is in order.
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Thanks for the reminder about checking ketones. I will do that today.
 
Haven't been able to check ketones since I haven't seen him urinate. But he is doing very poorly - not eating (I've had to forcefeed and give fluids). On new meds and his BG is skyrocketing. I don't know what to do for him.
 
Djamila said:
If you haven't been able to check for ketones, then I think you should take him in and have the vet check. They can do a quick blood test. When a cat goes off food, you don't want to mess with it - they need to see the vet.
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He has had a horrendous cold since Tuesday and can hardly breathe still. I took him to urgent care then and he is on clavamox and now entyce (an appetite stimulant). I stopped his other meds except insulin. I think I will need to take him in again today.
 
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