Advice please on Baileys rising bg numbers

[BaileyUK]

Bailey had been doing well of late,the vet was delighted with his fructosamine test taken on 9th Feb which came back as excellent control at 345. Two weeks ago his bg levels started to rise,we even went into the red ,and red is a colour we haven't seen for over 2 years! he has been on anti biotics for a trauma at tip of his tail (we think he goes looking for contraband in cat neighbours houses,and someone I am so very has possible shut the door on his tail!) the vet doesn't think the a/b is the cause of his elevated bg as he has been on same a/b before and looking back it made no difference to his numbers.I asked the vet if he thought these high numbers were rebound and that he was on too much insulin,but he said there was no evidence looking at his ss.so I upped his insulin by .25. Today was the 5th cycle of the increased dose and we are not seeing any improvement.I am so very worried and stressed,could experienced eyes please take a look at his ss and tell me if I should up again to 5 units. Thanking you in advance. Diane
Just to add that his demenour has not changed,he is eating well & all 5 p's in place!

 

[Marje and Gracie]

I probably would not have raised his dose without getting in some night time tests to see how low he might be going. As an example, on 2/20/15, he started out at 230 at PMPS and was at 124 at AMPS and went straight up from there all the way to 313. That makes me wonder if he got a little lower the night of 2/20.

It's likely the higher numbers you were initially seeing were new dose wonkiness. If it were me, I'd leave the dose alone but start getting those nighttime tests again and see where he goes. Unless the vet is giving an a/b that has sugar in it (you said it's the same as before but is it the same formula as before....in other words, if it was pills before, is it pills now?), the a/b shouldn't be affecting the BG. The other thing is if the a/b is the same but it has sugar and you didn't see a change to numbers before, perhaps he was on more insulin which was able to counter the increased sugar. Hard to say.

 

[BaileyUK]

Thank you for your reply,formula of the a/ b is the same as given before,he is also on the same dose of insulin.
Sorry to appear dense! but the reference to the 313 you made was that on 2/25? If he did go low on the night of 2/20 would this reflect on this high reading 4 days later?

 

[phlika29]

Sorry to hear bailey has been in the wars. Remi used to sneak into our neighbours house. One time I caught him trying to sneak up their stairs when I went round looking for him. My neighbour had no idea he was even in the house.

I hope you get better glucose readings soon.

 

[Vyktors Mum]

I think @Marje and Gracie is suggesting that he may have been going lower on other ocassions too, and she just used the night of 2/20 as an example because it provided quite a clear illustration and also that she accidentally crossed it with 2/22 which also illustrates a similar thing.

 

[Marje and Gracie]

Sorry...evidently, I got my eyes crossed. On 2/20, I was just trying to illustrate that he might have come down that night because he went straight up on 2/21. He has cycles, like 2/27, where he started high, came down, ended high. So Serryn is correct that what I was trying to say (and sorry my mind was moving faster than my fingers) was he could be coming down at night lower than you think.

 

[BaileyUK]

Thanks Marje & Gracie & Serryn,I can see now what you mean.I had already increased the dose so will hold that for now and see where that takes him.if his numbers don't drop I will test through the night. For how many nights,and at what intervals do you think I would need to do the night testing for to show the full picture?

 

[julie & punkin (ga)]

Poor little guy. I'm sorry you guys are having a hard time - his ss does look different in the past couple of weeks.

For how many nights,and at what intervals do you think I would need to do the night testing for to show the full picture?

Usually just one test around +3 or so, or whenever you're going to bed, is enough to fill in the picture in the night cycle.

I was also wondering about whether or not he's getting into dry food at the neighbor's place? I found out one of our cats was helping himself - the neighbor was leaving her garage door open a few inches and feeding her cat in the garage. Fortunately he wasn't our diabetic guy, but he was obese and we were limiting his food trying to get him to lose some weight.

Since he's had pancreatitis, there's always the possibility he's having a flare-up and that can increase BGs, but you said his demeanor is the same, so maybe not. I'm just mentioning it as something to watch for.

 

[BaileyUK]

Hello Julie,thanks for your reply.No he can't be getting into contraband food as the weather here has not been good over the past month and being an old boy now he hasn't been going out much.I am so stressed about his rising numbers,I didn't appreciate how lucky I has been with him over the past year.The vet looked at his ss on Thursday and said he didn't think it was too much insulin as there were no low numbers but it's such a contradictory illness! so,this morning after 6 cycles of 4.75 and with no improvement I upped him to 5 units.I worry that there maybe some underlying issue but he had a full blood screening done approx. 2 months ago and all (for his age) is ok.Asked vet if arthritis could be causing bg to raise so he is looking into similar injectables to your Adequan.I have taken some before bed tests and on those he doesn't seem to be dropping. Nice to catch up with you again,hope all is well with you and your family. Diane

 

[julie & punkin (ga)]

Nice to see you too!

I can completely understand why you are concerned - he's been stable for a long time. I'd be focused on his tail incident because his numbers went up around then. Is it completely healed now, or could there still be an infection? if you touch it, is it painful to Bailey?

The other possibility is that if Bailey has acromegaly, which is the most common reason for needing a bigger than typical dose, the pituitary tumor that causes it can wax and wane with its hormone production. Cats with acro can even go OTJ if the tumor shuts down production of the hormones. We don't usually suggest cats get tested for high dose conditions until they pass 6u per shot, but at 5u he's basically there. If you want to read more about insulin resistance conditions, go to the "New to the Group?" sticky and slide down to the single topic posts at the bottom of the post. There are several on acro. It's by far the most common, although we also see insulin auto antibodies (iaa) which sometimes doesn't even get mentioned in the official literature. We also see Cushing's, although that is far less common.

My point in mentioning this is that if a cat has acromegaly, you don't need any other reason for the dosing needing to be increased. the hormone production ramps up at will and you have to increase the dose.

There are resources in the UK for getting tested for these high dose conditions if you want to do that. It can be a relief to know why a cat needs more insulin, and it can also guide dosing decisions as well.

 

[BaileyUK]

His tail is healing,just scabby now,the vet gave it I good looking over on Thu,and up to press he has stopped licking it,don't want to examine it as may start him nibbling it again! He was tested for Acro last year and that came back ok.