BG high in morning?

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MaryB & Chester

MaryB & Chester

Member Since 2012
I feed Chester about four times a day - AM, lunch, PM and before bed. The other cats have dry food down, but we take it up so there's no food available overnight. Chester's AM BG numbers have still been really high (500-600). He's not getting into the bread box while we're sleeping, so why are his numbers going so high when there's no food around? We don't spot-check often, but when we do a check in the middle of his cycle (during the day) he's only dipping to 300-400. Could he really be dropping so low during the night that he "needs" to bounce by morning?

We did try an experiment this weekend. A friend's niece had a bag of Young Again 50/22 she didn't need for her cat so she gave it to us. It's not as perfect as the Zero Carb, but the carb range is still in line with the Friskies Chester has been eating. We left that down all day and all night on Friday, Saturday and Sunday nights. Saturday's numbers were good, Sunday's numbers were really good (for him) but this morning was right back up again. :?

I still want to pick up the YA Zero Carb for everybody and see how that works out. I KNOW that dry food is far from ideal but that's the solution I've got at the moment.
 
I doubt he's bouncing. He probably needs a higher dose - nadirs are way over 150. You've had 5 days at the 1.5 units and have collected nadirs for all of those days.

Per the Lantus forum Tight Regulation guidelines

""General" Guidelines:

Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit."

Looks like you may increase 0.5 units to a dose of 2.0 units.
 
SO...I may need to find a different vet...?
She only wants to do curves after two weeks at each new dose, then it seems to take her about a week to get back to me. She seems reasonably knowledgeable, but pretty laid back about treatment. I agree that he probably needs a higher dose...but I don't want to go against doctor's orders, either. My husband and I have already gotten into a couple of fights over everything we have to change and do, and the fact that I'm getting my "information" from a discussion board. He calls it voodoo - as in "do you want to trust your doctor or just rely on more voodoo"? I tell him that I'm not going to question how he takes care of his kids...but the truth is that he does most of the taking care of my cats while I'm off at work. I'm very grateful for his help, but he's more inclined to trust doctors than I am.

Have you ever raised a dose without consulting your vet? How did they take the news?

After doing some reading here, do you think his broken teeth might be affecting his BG ratings? We know he has a couple of broken teeth, but the vet hasn't said anything about getting those taken care of.
 
You can tell your husband that we are following guidelines from veterinary journal articles such as these:

AAHADiabetesGuidelines
Lantus/Levemir testing & dosing protocol Roomp & Rand
(Hey, we've actually learned to read!)

You might share these articles with your vet, too, and indicate you are willing to follow a stepped up time table to getting him regulated, since sustained high glucose levels put him at risk for diabetic ketoacidosis (DKA), which is very expensive to treat and often fatal if untreated. It also may cause damage to other organs such as the kidneys.

I'd encourage you to do urine ketone monitoring (see my signature link Secondary Monitoring Tools for some info), because the broken teeht could be a source of infection. That plus high glucose levels/insufficient insulin, and lack of appetite can trigger DKA.

PRovide a copy of your spreadsheet too, which documents the glucose levels and need for stepped up dosing. If you're testing at home, you don't need to take him in for a curve - you can do that and save money.
 
My husband was delighted when I went against the vet's advice and did all testing and curves at home - it saved $100s!
My cat hasn't had her bg checked at the vet since she was first dx in October - as I can do it at home whenever I want, why would I pay all that money for a less accurate (vet stress) reading?
My vet wasn't happy at first but I sent them the spreadsheet and the info and they came around to it. Sometimes, I think its a bit of bluster on their part but when they realise you're serious and can do the testing, they back down.

We change the dose frequently but follow the protocols in Tight Regulation guidelines that BJM listed. Testing is key!

Honey is now down to 1 drop and we're hoping for remission - cats are getting off insulin regularly by following this protocol. Although it doesn't happen for all, it does increase the chances of it happening.
It also means they are more likely to get into safer numbers.

Not sure about the broken teeth. I know tooth decay and gingivitis can affect bg.
 
As far as working with the vet...it depends on your vet, but I pretty much pushed mine out of the picture once Buster had a severe hypo event by just following her advice and shooting blind. And when I say severe hypo, I mean I came home to a limp, unresponsive cat face planted in the corner of the room. Nearly lost him. Basically all I do now is share our spreadsheet with our vet and she checks it once a month. I make my own dosing decisions by following the rules of Tight Regulation Protocol and I solicit advice from the wonderful, knowledgeable people on this forum. Once you start gathering data via hometesting and understand how your cat responds to the insulin, you will gain confidence in making the right decisions. You're definitely not alone! People here will stay up into the wee hours of the morning to help you should you need it!
 
It looks like my vet is actually following the AAHA guidelines to a T - including the two weeks between dose adjustment and curve and four-hour-spot curves. It just seems so laid-back compared to the way people here seem to do things.

I'll see if my vet would be willing to work on an accelerated time table. I don't want to rush things. I just think that, with Chester's high numbers, three weeks between dose adjustments is excessively long to wait.
 
MbMinx said:
... I just think that, with Chester's high numbers, three weeks between dose adjustments is excessively long to wait.
Click to expand...

Exactly why you should provide the Roomp and Rand article with the protocol we use here ... and which was developed with an internet forum, the Diabetes Katzen in Europe!
 
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