BG 103 at +4--help please

MindyC

MindyC

Active Member
At AM+10, Max's BG was 300, which is low-ish compared to where he's been at that point. I wasn't home at normal shot time (5pm), and my husband fed him without testing, and no shot. At 5:30 I tested him and he was at 340, so I didn't shoot--didn't seem like enough of a rise, especially with food. At 6:30 tested again, and he was at 431. Fed him (usual 2nd dinner) and gave him 2.5U, knowing it was later than his usual shot time. Probably should have only given 2U, but we're new with this insulin.

At +4 (10:30pm), of course when I'm hoping to go to bed, he's at 103. I gave him a snack, and will recheck in a minute to see if he's rising. If he is, can I go to bed (I'm exhausted...it's definitely been a Monday)? It appears his nadir is around +5, though I don't have enough data to be concrete in that thought.

And in the morning...what do I do if he's kinda low again? 2U? 1U? Skip the shot? I have to leave for work around 2 hours after normal feed/shoot time, and will be gone for at least 6 hours.
 
I'm sorry no one was around last night or earlier this AM to assist. You handled last night just fine and I see you gave Max 2u this AM which I think was a good decision.

It looks to me like the 3u dose may be a bit too much insulin and may very well be playing into all those black highs he's been getting. As long as your pre-shot tests are high enough (over at least 250 to 300 right now) I'd continue with the 2u dose for a few cycles to see if that flattens out the cycles at all. Looks like Max is getting large enough drops in his BG that he is bouncing way up at pre-shot. Last night Max dropped to the lowest levels we recommend with Novolin. Many of his cycles he has dropped over 400 points which is huge and definitely will set off bouncing. It may be that Max needs something between 2 and 3 units but keeping the dose a bit lower for a few cycles should help lessen the bouncing and that will make future dosing decisions a little easier.
 
Thank you for the reply, Linda. I am definitely noticing the bounce with this insulin (we used Lantus the first time), though not sure where he's going to settle or if he'll (dare I say it?) go into remission again. A second remission wasn't ever an expectation (which was why we didn't start Lantus this time). Since his numbers were all over the map that first week, the vet said to increase. And at first that seemed to be okay. We'll stick with the 2U's for now and see what happens.

The main thing making me nervous at this point is we're leaving for vacation on the 29th. My mom and another petsitter will be feeding and giving shots, but they'll be shooting blind--neither is interested/willing to learn to test. And it would probably be traumatic for all involved. He does well enough with the tests for me, but I don't know that he'll be that good for someone not used to handling him because he gets cradled in my lap when I do them. I hope we can get him somewhat regulated by then, since we'll be gone for 10 days. Otherwise he'll probably just end up getting a tiny dose that may not be all that effective while we're gone.

In terms of overall behavior, he's getting better than where he was 2 weeks ago, despite the bouncing numbers. His coat has improved, and his skin seems less dry/flaky. He's moving around more too, and exploring more of the main floor than he has in quite a while. He may have neuropathy, and someone on another thread suggested Zobaline for him. Any opinions on that? It's listed for diabetic cats, so I'm guessing there isn't any sugar in it, but I don't know if adding that in right now would be helpful with the sugar numbers? We're having litter box issues with him, and I'm stumped as to what is causing it, though his back legs do appear to be weak.

P.S. Your profile pic looks a lot like Max. :-)
 
Novolin-N tends to go into action very early in the cycle and pushes BG down quickly so it often causes the bouncing to be more pronounced than with a longer lasting insulin like Lantus. And the bouncing can muddy the picture when it comes to finding the right dose.

Vacations can be a source of anxiety but with proper planning ahead of time, Max will be fine. As you've mentioned, deciding on a reduced dose to give while you are away will help. While it would be optimal to have pre-shot testing done, many folks find they don't have a sitter who can or will do it so you are certainly not alone in that regard.

I'd suggest you post for assistance about a week before you leave for some help to determine a safe dose to give Max in your absence. Many folks start the new "vacation" dose a few days in advance just to make sure it is sufficient but not high enough to cause any concerns. Max may or may not eat the same amount of food while you are gone and obviously activity level may be a bit different too so all of that needs to be taken into consideration. I think all of us, leave copious notes for our sitters about making sure kitty is eating before giving insulin, what to do if he isn't eating, how to deal with any odd behaviour.

The litter box issues could be a product of the neuropathy. It might be making getting into the litter box problematic for Max or it could be that he doesn't have the same control he used to have and is getting caught short. The other thing to consider is a UTI (urinary tract infection). Our diabetics are prone to bladder infections due to the sugar they excrete in their urine when unregulated. Have you taken Max to the vet to check into that possibility? If not I would strongly suggest you do so ASAP as infections can also cause elevated BG. If there is an infection, antibiotics will take care of it and BG will likely come down and less insulin will be needed. Better to deal with that sooner than later as I'm sure you don't want your Mom and pet sitter having to medicate Max or deal with a decreasing need for insulin in your absence.

Zobaline has been anecdotally shown to help with the neuropathy. No need to wait till Max gets better regulated..... it will help despite the elevated BG.
 
Thank you!

We just finished a round of antibiotics last Wednesday (infection that triggered the visit to the vet and the new diabetes dx), so I don't think it is a urinary tract infection, though we'll keep an eye on him over the next day or so. When he went in the bathtub, the urine was not dark, and in fact, had I not been looking for it, I wouldn't have noticed it (other than the smell, but even that wasn't' very strong).

I just ordered some Zobaline, but it won't be here for at least a week, so I also ordered a different capsule one (found the rec on another page talking about neuropathy, it's the methylcobalamin form, no sugar or flavors) that I can get by Thursday. That way we can get him started on it sooner than later.
 
I wouldn't expect urine to be dark from a UTI nor would it necessarily have an odour from the infection. Sugar in the urine however can produce a sweet scent. With CKF, I'd assume Max's urine is less concentrated than normal and that too would lighten colour and lessen any "urine" odour.
Assuming that the urinary tract infection has been dealt with it seems reasonable to think neuropathy is causing any ongoing inappropriate elimination although it is possible the antibiotic didn't kill off all the bacteria or wasn't the right antibiotic against the offending bacteria. Did they do a urine culture?
 
No urine culture. We went in for bloody vomit and diarrhea. Going to the vet is rather traumatic at this point for him, causing vomiting, urination, and defecation in the cat carrier. He was already a mess before we went that day, but then with all of that he needed a bath. He lived in the extra dog crate (attached to the litter box) for a few days after we got home. We were honestly not sure he was going to survive at that point, and he was pretty miserable. He appears to be feeling so much better now, though, which is why I'm confused about what's going on. I'll take him to the vet if this doesn't stop in the next day or so, tho. He's got a history of going where he shouldn't when he's mad about something, tho he's purring most of the time when I snuggle him and test him these days, so I just don't know. The purring is a big deal--I don't think I've noticed him purring much in the last few months.
 
The lack of purring could just be a sign of him not feeling well with all the ups and downs of his BG. That can make them feel pretty punky. It's quite possible that he's got a UTI. Antibiotics deal with specific bacteria. Those causing diarrhea are not necessarily the same as those causing UTIs so there could have been a UTI brewing that wasn't addressed or perhaps there was a cross infection caused by the mess of the diarrhea. All speculation but something to keep in mind.
 
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