Biscuits...more questions than answers

[Karen & Biscuits]

Hi everyone! I hope you've all been having a nice weekend. I'm dealing with a pile of sick cats and dogs and my Biscuits, who's blood sugar is all over the place. I have updated her spreadsheet so you can see what I mean. One day it's super high, next day it's super low and the day after that it's somewhere in the middle. I never know what I'm going to get when I test her sugar and there is no consistency, where it's staying at similar levels for any period of time. None at all.
Another thing - I don't know if it's the Levemir she's on, the methylcobalamin or something else, but this girl has severe muscle spasms to the point that it causes her to look like she's having seizures and it's happening all day long, whether she's awake or asleep. She's jerking like crazy then licks herself profusely, mostly on her back. She has tiny bumps all around her neck, like a rash of sorts, and I don't know if that's itchy and she's trying to scratch it or if it's dry skin or maybe needle pricks from the insulin but it's making her crazy. I can no longer pet her from her neck down her back - AT ALL! She goes into conniptions if I try, even if I'm holding her. This is not normal for her, she used to be very insensitive to being touched, she loved it and would beg for it but now, she will try to bite me or get away from me if I try to touch her there. The top of her head is the only safe place now. What is going on?????? I'm worried that she might be allergic to something, either the Levemir or the methyl-B12.
She is improving with her walking and ability to jump since she's been on the B-12 for several weeks. I am seeing a considerable improvement, which is a good thing but now we have this new problem.
She was actually annoying tonight, by repeatedly getting on my desk and knocking everything off in the process, and she was not taking no for an answer. She never used to do that. She would get on my desk but she has a mat that she would lay on and she would happily lay there for hours, but tonight she was determined to sit on the mouse, the keyboard, knock my drink off and mess up the carpet, knock anything and everything down in order to lay on the desk but not on her mat. I have no idea why. I let her "sleep" there awhile and kept my hand on her the whole time, and I could feel the spasms in her left shoulder, it just won't stop, it happens every few seconds. Maybe she was trying to tell me something tonight, I'm not sure. Eventually she settled down and now she's sleeping on a little plastic storage shelf that I have by my livingroom window - but her head is hanging off the edge of it at a 90 degree angle almost and she's spasming away over there.
I don't know what to do with this girl. She's just a hot mess of weird stuff and I can't afford to run to the vet right now to ask these questions. She needs to stay with them for at least a day so they can observe her doing all this and see what's going on but I already have a bill with them of almost $600 and I can't afford to make it higher.
Have any of you experienced similar issues with your cats? What did you do or what did your vet do to help?
I'm frustrated because I feel like if I don't straighten her out soon I'm going to lose her. She's just not herself at all anymore and it's scaring me. I have never had these issues with her brother, Skittles, who is also diabetic. He's been so easy to deal with from the beginning and responds well to Vetsulin, never had neuropathy in any capacity. He's just happy-go-lucky all the time. His sugar fluctuates a little but not like Biscuits does.
This is just so weird and it's really got me worried that maybe she's being affected neurologically by something. It's either her high sugar levels or the insulin or the methyl-B12 but something has changed my cat drastically and I don't know what.
I look forward to your feedback - maybe someone here has the answers?

 

[Sienne and Gabby (GA)]

I can't say that I've ever heard of the kind of spasming you're describing. I did a search and it appears that while rare, a skin rash can occur. I would stop the methyl-B12 and see if the symptoms disappear. Lev can also cause a rash and while side effects are rare, seizures are on the list. I'd also suggest taking a video and sending it to your vet or making a vet appointment.

As for the Levemir, I have a couple of observations.

• First, please get at least one test during the PM cycle. At this point, you're missing half of your data and you have no idea if Biscuit's numbers are dropping during the PM cycle. A "before bed" test every night would be helpful.
• Lev is different than Vetsulin. You can give insulin at lower numbers and it is still safe. Since you're no longer new to FD, if you can post and ask for help if your cat's numbers are lower than your comfort zone, that will help. Remember, Lev is a depot insulin so every time you adjust a dose, it has an effect on the depot. (If you need more information, please take a look at the sticky notes at the top of the Lantus, Lev and Biosimilar board.
• You're holding your dose for too long a period of time. If you're cat's BG numbers aren't in the range you want, it's important to increase the dose. Depending on the dosing method you're using, you change the dose either every 3 days (Tight Regulation) or weekly (SLGS). If you stick with a dose that's not having the desired effect, you can end up with your cat treating the higher numbers as the new "normal" (i.e., glucose toxicity).

The variability in numbers are likely due to bouncing. When Biscuits falls into lower numbers, her body isn't used to those numbers. As a result, her liver and pancreas release a stored form of glucose along with counterregulatory hormones that cause the numbers to spike back up. It can take roughly 3 days for the bounce to clear.