BG still high, should I increase dose?

[Squalliesmom]

Squallie's BG numbers seem to have been fairly consistently higher the past couple of days. Is it time for a dosage increase? He's at 2 units now, I wondered about 2.5, or even 3. I don't know why his numbers went up like that, either, nothing has changed, food-wise or stress-wise, or anything like that. He's also been sleeping almost all day for the past couple of days, not being very active at all. I mean, I know he's old and he's also lazy, but this is beyond his usual lack of activity. Any ideas? Could this be related to the higher numbers?

 

[Sue and Oliver (GA)]

Hi Lucy,

Not sure why he is inactive. I would think you could raise. My preference would be to 2.25 but 2.5 would be okay too, as long as you can monitor, as you always do.

 

[Squalliesmom]

Hi Lucy,

Not sure why he is inactive. I would think you could raise. My preference would be to 2.25 but 2.5 would be okay too, as long as you can monitor, as you always do.

Thanks. I went ahead and gave him 2.5 units, and will monitor. Could he have some type of diabetic neuropathy that would make him less active?

Also (don't think this applies to Squallie) I was just curious to know - has anyone had their kitty's ear(s) become infected through repeated testing?

 

[BJM]

Sometimes a cat will not do well on an insulin, not because of glucose levels, but because of effects on behavior. When did the lassitude start - before or after starting Vetsulin?

If you can get a test in the +10 or +11 time, you may see when the insulin is wearing off. Vetsulin may last only 10 hours in some cats and I'm wondering if that is happening. If you find that is what is happening, a switch to ProZinc or BCP PZI may work better. ProZinc, in particular, was developed for cats. Both are non-depot insulins, so what your vet understands about insulin dosing will be similar and not require a bunch of extra study on the vet's part.

 

[Squalliesmom]

Sometimes a cat will not do well on an insulin, not because of glucose levels, but because of effects on behavior. When did the lassitude start - before or after starting Vetsulin?

If you can get a test in the +10 or +11 time, you may see when the insulin is wearing off. Vetsulin may last only 10 hours in some cats and I'm wondering if that is happening. If you find that is what is happening, a switch to ProZinc or BCP PZI may work better. ProZinc, in particular, was developed for cats. Both are non-depot insulins, so what your vet understands about insulin dosing will be similar and not require a bunch of extra study on the vet's part.

This has only started in the last two or three days, before that he was fine. Lassitude is a very good description, too, he's not full-blown lethargic but definitely not active, either. I will try to test him at +10 or +11. Looking at his spreadsheet, it looks to me like his BG starts to rise around +7 or +8. Would this be normal for Vetsulin?

 

[BJM]

It can be. Vetsulin is a mix of 2 insulins - one shorter acting, the other longer acting. When it starts to wear off depends on the individual cat. If you see a sudden rise by +10 or so, you'll have data supporting its lack of control in your cat, and justification for switching to a different insulin.

Also see my signature link Secondary Monitoring Tools. These may be helpful in evaluating Squallie, too.

 

[Squalliesmom]

It can be. Vetsulin is a mix of 2 insulins - one shorter acting, the other longer acting. When it starts to wear off depends on the individual cat. If you see a sudden rise by +10 or so, you'll have data supporting its lack of control in your cat, and justification for switching to a different insulin.

Also see my signature link Secondary Monitoring Tools. These may be helpful in evaluating Squallie, too.

Okay, thanks!

 

[Critter Mom]

it looks to me like his BG starts to rise around +7 or +8. Would this be normal for Vetsulin?

Yep. Squallie has been unusual in that he was getting a longer period of effect from the Vetsulin.

As BJ says above, the manufacturers of Vetsulin advise that the crystalline fraction of Vetsulin reaches its peak effect between +7 and +10 but it does not have as strong an effect as the amorphous fraction which kicks in during the early part of the cycle and does most of the work to lower BG in each cycle.


Mogs
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[Squalliesmom]

Yep. Squallie has been unusual in that he was getting a longer period of effect from the Vetsulin.

As BJ says above, the manufacturers of Vetsulin advise that the crystalline fraction of Vetsulin reaches its peak effect between +7 and +10 but it does not have as strong an effect as the amorphous fraction which kicks in during the early part of the cycle and does most of the work to lower BG in each cycle.


Mogs
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Squallie's numbers seem odd to me today. He's already rising again at a little under +5 hrs. He has gotten up and moved around a bit but fell asleep so deeply, afterwards, that he didn't hear the Bengal kitten squawking at him or feel it when she started to lick his ear. When I went over and woke him up he seemed a little shaky, i.e., he tried to scratch his cheek with his hind leg and kept not connecting, and his head seemed shaky or trembly. I immediately tested him and his BG was 274, up about 50 points from his last test at +3 hrs. He is purring, though, so I don't know what's going on or whether or not I should be overly worried.

 

[Sue and Oliver (GA)]

Can you get a ketone test?

 

[Squalliesmom]

Can you get a ketone test?

Did one late last night, it was negative. Haven't caught him in the LB yet today.

 

[Critter Mom]

Have you noticed any other odd behaviour or clinical signs, Lucy? Is Squallie more lethargic/grouchy/withdrawn again?

.

 

[Squalliesmom]

Have you noticed any other odd behaviour or clinical signs, Lucy? Is Squallie more lethargic/grouchy/withdrawn again?

.

I can't really say he was grouchy or withdrawn, just sleepy. Right now he's being a little social butterfly! I had to do his PMPS test with the Alphatrak, I was out of Relion test strips, and his BG is way high, it's as high now as it was when he was first diagnosed. I'm sure part of the problem is his dry food; I was led to believe it was 8% carbohydrates but in fact, it's 17%. This is the dry he's been eating since his numbers started to go up again, so I'm pretty sure it's the culprit.

 

[Critter Mom]

I'm sure part of the problem is his dry food; I was led to believe it was 8% carbohydrates but in fact, it's 17%. This is the dry he's been eating since his numbers started to go up again, so I'm pretty sure it's the culprit.

(Emphasis mine)


Er ... yeah.

It would really help you - and us - if you could record the food you're serving in the Remarks column of Squallie's spreadsheet, Lucy. Food and insulin are very intimate sugardance partners. Through monitoring both it will help you spot patterns that might not otherwise be apparent.

Watch it with the dose if you start to move away from the 17% carbs food to a lower one. Always post for advice on anything you're not sure about, Lucy.


Mogs
.

 

[Squalliesmom]

(Emphasis mine)


Er ... yeah.

It would really help you - and us - if you could record the food you're serving in the Remarks column of Squallie's spreadsheet, Lucy. Food and insulin are very intimate sugardance partners. Through monitoring both it will help you spot patterns that might not otherwise be apparent.

Watch it with the dose if you start to move away from the 17% carbs food to a lower one. Always post for advice on anything you're not sure about, Lucy.


Mogs
.

I will try to remember to record his food. His BG has been going up the past couple of days and I couldn't figure out why - until I realized the dry food was higher in carbs than the last formula I bought. He got no dry food tonight and won't get any more of this particular formula!

I will definitely reduce his dose if he starts dropping too low! Thanks, Mogs!

 

[Critter Mom]

Be very vigilant on the first few cycles after changing the food, Lucy.

 

[Squalliesmom]

Be very vigilant on the first few cycles after changing the food, Lucy.

I've dropped that particular dry food from his diet and I'm checking him every 2 hours. I think his AMPS number was due to a bounce. I figure he probably went lower last night than the 125 I saw at +6 hrs. After I get a feel today for where his #s are headed I may reduce his dose to 2 units again.

 

[Critter Mom]

I had a look at Squallie's spreadsheet earlier, Lucy. I still think you're getting Vetsulin carryover from one cycle into the next - I think that may have contributed to the 125. Be careful.

 

[Cat Ma]

Lucy, you've been working really hard at getting this under control with Vetsulin. I admire your patience. Are you considering a swtich to another insulin? From looking at the SS, you've still got a lot of high readings/red #'s in the AM slots for Squallie.

 

[Squalliesmom]

I had a look at Squallie's spreadsheet earlier, Lucy. I still think you're getting Vetsulin carryover from one cycle into the next - I think that may have contributed to the 125. Be careful.

Thanks! I 'm not really sure I understand carryover - you mean, the dose from the first shot not having worn off by the time he gets his second shot?

 

[Squalliesmom]

Lucy, you've been working really hard at getting this under control with Vetsulin. I admire your patience. Are you considering a swtich to another insulin? From looking at the SS, you've still got a lot of high readings/red #'s in the AM slots for Squallie.

Thank you! I know, and I'd love to talk to my vet about it but I don't think she's ever used any other type of insulin so she probably won't know anything about it. She's resistant to using human meters, I can't imagine how she would react if I said I wanted to switch to a human insulin!

 

[Critter Mom]

Thanks! I 'm not really sure I understand carryover - you mean, the dose from the first shot not having worn off by the time he gets his second shot?

That's exactly right, Lucy. The carryover is residual effectiveness from the previous dose.

 

[Squalliesmom]

That's exactly right, Lucy. The carryover is residual effectiveness from the previous dose.

But if that's what is happening here, why are his AMPS numbers so high? Wouldn't they be lower? There's still so much about this disease that I don't understand, it gets so frustrating sometimes!!! I just want to do what's best for poor Squallie but it's like trying to play a game when you don't know all the rules! :-(

 

[Squalliesmom]

Squallie's AMPS was 455. I don't understand why his AMPS numbers have been so high the past few days! Is this likely a bounce? But why only his AMPS, not his PMPS as well? Can he have carryover and bounce at the same time? It looks to me like his daytime numbers are not going particularly low, nighttime either, really. I'm so frustrated, and I don't know what to do!

 

[Critter Mom]

But if that's what is happening here, why are his AMPS numbers so high? Wouldn't they be lower? There's still so much about this disease that I don't understand, it gets so frustrating sometimes!!! I just want to do what's best for poor Squallie but it's like trying to play a game when you don't know all the rules! :-(

It is possible - and I'm speculating here - that Squallie is a cat that tends to run lower at night. Any carryover from the AM dose into the PM cycle could possibly be taking Squallie lower at night. That could be triggering bounces. As I mentioned before, some cats tend to have a pattern of higher AMPS numbers. Higher AMPS numbers may also be linked to a similar process to the the 'dawn phenomenon' experienced by human diabetics.

... it's like trying to play a game when you don't know all the rules!

That's very true. Only our little ones know the steps to their individual sugar dances. We mere humans have to resort to detective work to try to fathom them out. That's why it's so important to record both food and insulin information in their spreadsheets.

Talking of food, when are you feeding Squallie during the PM cycle? Is there any difference between the amounts and timings of feeds between the AM and PM cycles?


Mogs
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[Sue and Oliver (GA)]

I agree with Mogs. I think you have said before that he doesn't eat and isn't active overnight. That is a different pattern during the day. The interesting thing to me is that sometimes it seems like a bounce in the am (when you get a low overnight) but sometimes the insulin just doesn't seem to last as long. And yes, having a pattern that isn't a pattern makes everything complicated.

Someone once called this sugar dance a dance where the cat leads AND he is the only one who can hear the music. Your job at this point is to follow his lead, keep him in safe ranges and try to minimize the high ranges. And considering that you are using Vetsulin which is usually very hard to do either of those things with, you are doing a fantastic job.

 

[Squalliesmom]

I agree with Mogs. I think you have said before that he doesn't eat and isn't active overnight. That is a different pattern during the day. The interesting thing to me is that sometimes it seems like a bounce in the am (when you get a low overnight) but sometimes the insulin just doesn't seem to last as long. And yes, having a pattern that isn't a pattern makes everything complicated.

Someone once called this sugar dance a dance where the cat leads AND he is the only one who can hear the music. Your job at this point is to follow his lead, keep him in safe ranges and try to minimize the high ranges. And considering that you are using Vetsulin which is usually very hard to do either of those things with, you are doing a fantastic job.

Thanks. Lol, I don't feel like I'm doing a good job at all, more like floundering in the middle of the ocean without a life jacket!

 

[Critter Mom]

@Sue and Oliver (GA) - I always find it very reassuring when you review my contributions to make sure I haven't missed anything, Sue. Thank you.

.

 

[Squalliesmom]

It is possible - and I'm speculating here - that Squallie is a cat that tends to run lower at night. Any carryover from the AM dose into the PM cycle could possibly be taking Squallie lower at night. That could be triggering bounces. As I mentioned before, some cats tend to have a pattern of higher AMPS numbers. Higher AMPS numbers may also be linked to a similar process to the the 'dawn phenomenon' experienced by human diabetics.


That's very true. Only our little ones know the steps to their individual sugar dances. We mere humans have to resort to detective work to try to fathom them out. That's why it's so important to record both food and insulin information in their spreadsheets.

Talking of food, when are you feeding Squallie during the PM cycle? Is there any difference between the amounts and timings of feeds between the AM and PM cycles?


Mogs
.

Squallie eats 1/2 can of FF Classic both AMPS and PMPS. I can't get him to eat wet food during the day but he will nibble on dry throughout the day (right now I have the complete WRONG dry so he can't have it, trying to supplement with Tiki Cat canned but he's not convinced he likes that - ordered Young Again, should be here today). I make sure he doesn't eat anything two hours prior to his PMPS test, then feed the canned. He usually doesn't snack after his PM shot, but he did get into the "bad" dry food last night and helped himself to probably around 1/4 cup, he really prefers the dry to the canned, especially the high-carb stuff, poor guy.

 

[Squalliesmom]

Someone once called this sugar dance a dance where the cat leads AND he is the only one who can hear the music.

What a perfect description!

 

[Critter Mom]

Lucy, can you record your food information over a typical 24-hour period and post it for us to have a look at, please? We need food brand/variety and carb %, plus meal/snack size.

It needs to be in a format similar to this:

Food Log (Example)

AMPS - main meal - 80g Sheba Fine Flakes Chicken Flavour (1.6% kcals from carbs)
AM+3.0 - mini meal - 50g Sheba (1.6%)
AM+6.0 - mini meal - 20g Sheba (1.6%)
AM+9.0 - snack - 10g Sheba (1.6%)

PMPS - main meal - 50g Smilla Kitten Food with Chicken (0.7% kcals from carbs)
AM+3.0 - mini meal - 25g Smilla (0.7%)
AM+6.0 - mini meal - 15g Smilla (0.7%)
AM+9.0 - snack - 10g Smilla (0.7%)

(NB - this is not a feeding guideline - the example is based on two foods Saoirse eats but which have different calorie densities: Smilla Kitten food is more 'fattening' - hence smaller quantities! )

.

 

[Critter Mom]

he did get into the "bad" dry food last night and helped himself to probably around 1/4 cup,

This is the sort of info you really need to record in the Remarks section of your spreadsheet, Lucy. Detective work - can't do it with a blindfold!

.

 

[Squalliesmom]

Lucy, can you record your food information over a typical 24-hour period and post it for us to have a look at, please? We need food brand/variety and carb %, plus meal/snack size.

It needs to be in a format similar to this:

Food Log (Example)

AMPS - main meal - 80g Sheba Fine Flakes Chicken Flavour (1.6% kcals from carbs)
AM+3.0 - mini meal - 50g Sheba (1.6%)
AM+6.0 - mini meal - 20g Sheba (1.6%)
AM+9.0 - snack - 10g Sheba (1.6%)

PMPS - main meal - 50g Smilla Kitten Food with Chicken (0.7% kcals from carbs)
AM+3.0 - mini meal - 25g Smilla (0.7%)
AM+6.0 - mini meal - 15g Smilla (0.7%)
AM+9.0 - snack - 10g Smilla (0.7%)

(NB - this is not a feeding guideline - the example is based on two foods Saoirse eats but which have different calorie densities: Smilla Kitten food is more 'fattening' - hence smaller quantities! )

.

Okay.