Advice on Dak's BG chart

[Jeremy & Kate]

A few weeks ago (April 12, 2024), Dak had knocked down a sealed container of dog treats and ate a majority of them (alongside our two dogs). As a result, his numbers shot up into the 300's. We started him on vetsulin again (he was on it for the first time in October 2023, then we think we got him into remission), starting at 1 unit, once a day (vet recommendation) and then changed to twice a day shortly after. We are currently doing a curve, since we saw that a week on 1 unit was not reducing his numbers, with Dak on 1.5 units twice a day. His numbers are currently very confusing and concerning for us with the curve and previous days. It seems that the vetsulin is not putting a dent into Dak's numbers, and his numbers have actually increased during the curve so far. Any advice is much appreciated, as we are unsure what to do next, besides bring Dak in for a head to tail screening at the vet.

 

[Wendy&Neko]

A checkup by the vet is an excellent idea. One of the more common reasons cats fall out of remission is needing a dental, so that should be part of the checkup. A full blood panel, including checking the thyroid, can tell you if there is something else causing insulin resistance.

Cats coming out of remission often need to go higher than their breakthrough dose the first time, it could also be Dak will need a bit more insulin. Just follow the Vetsulin dosing method and see what he needs.

Are you 100% sure the dog treats are now on lockdown?

 

[Sienne and Gabby (GA)]

For many cats that fall out of remission, the second time around is not the same as their first course of insulin that got them into remission. It may be a matter of Dak needing more insulin. If it's been a while since Dak saw your vet, getting him checked out isn't a bad idea. There may be another reason (e.g., he needs a dental) that are contributing to his higher numbers.

I'm not recalling if you were following our dosing guidelines for Vetsulin. I'm linking it just in case you were looking for it. I would stick to the guidelines and increase Dak's dose by 0.25u every week if his numbers aren't where you want them to be.

 

[Jeremy & Kate]

Yes, we are 100% sure that the dog treats are on lockdown (stored high up in a cabinet that Dak can't reach). It seems that he had an inverted BG curve today when increasing his insulin to 1.5 units (from 1.0 units). What would you all recommend, should we stay at 1.5 units or decrease/increase the amount of units? Yeah, we have been sticking with the guidelines (stayed with the 1.0 units of insulin for a week before adjusting the dosage), except we did go ahead and jump to 1.5 units instead of 1.25 units since he had a better reaction to the 1.5 units in the past and the current 1.0 unit regiment was doing little to nothing for his BG levels.

 

[Sienne and Gabby (GA)]

What I see is a flat curve. There is very little variation in the numbers. There's approximately +/- 20% allowable variation in any test due to inherent measurement error. Dak's numbers were ranged from 302 - 350. That's negligible.

Given that you've already increased Dak's dose to 1.5u and you're experienced diabetes cat caregivers, I'd stick with that especially given that nadirs have generally been above 300. However, going forward, please get tests closer to nadir. Vetsulin can drop numbers hard and fast. Your PM cycle test at +3 may give you a "heads up" if numbers are dropping. Vetsulin does not have a 12-hour duration so you are unlikely to see the lowest point in the cycle at +6. I would increase only by 0.25u especially if you are seeing more movement in Dak's numbers with this recent increase.