Chip’s BG #s are all over the place

[Hotchachonia]

Hi everyone! First time posting. Chip is almost 13 and was dx’d last September. I still have not been able to get him anywhere near regulated. He doesn’t show much in the way of clinical signs - he’s playful and curious, decent appetite, doesn’t seem to drink excessive water, and isn’t leaving huge clumps in the litterbox anymore. But his numbers are all over the place.

He eats low carb-moderate protein, both wet (he’s turned up his nose at prescription foods, so I give him a variety from the wet foods list) and dry (Young Again LID Zero Mature), and treats are freeze-dried meats, roast chicken, and the occasional Churu. He used to weigh over 17 lbs, but has maintained around 15 lbs for months. (He’s a big cat.)

His vet is a cat doctor and she is very open and knowledgeable about diabetes and very willing to work with me. I share Chip’s spreadsheet with her and have told her about this forum, and she is impressed.

Could someone take a look at his spreadsheet and give me any advice or insight? His labs are entered there, too.

Many thanks!

 

[FrostD]

I understand you're trying to weigh vet advice vs what we do here but I really think the whole unit increase was too much. We don't really know how low he's going on the days without tests, or at night. I suspect he went low last night and was starting a bounce, then today's dose cut through the bounce a bit - then the insulin wore off and in came the bounce. Trouble with that is, if he wasn't going to bounce he would likely have gone hypo.

If he doesn't have any ketones, I would go down to 2.25U-2.5U and see how he does there, and do your best to get nighttime tests at least twice a week.

Are you doing anything for the CKD at the moment?

 

[Hotchachonia]

Thanks, FrostD. Chip’s AMPS today was 500, but I just gave him 2.5U, and will see how it goes. I’ll do a couple checks around his typical nadir. I think the reason his dose was upped a full unit was because, after edging up by quarter units and then many (around 21) cycles of 2U, we saw consistently increased numbers, and our vet thought that justified a full unit jump. So, maybe I’m waiting too long between dose changes and that’s throwing something off? At what point do I move up (or down)? This sugar journey is sure a complicated one!

You asked about any treatment for CKD: his urine protein-creatinine level ratio has been elevated for a couple tests now, so he has started on Telmisartan, with another retest in a couple weeks. He is also on Renal-K+ for low potassium, which is now corrected. I pick his foods from a list suggested for diabetes and CKD. He currently stays well-hydrated without additional fluids. Chip acts like a happy and engaged 13-yr-old. He’s pretty unbothered by what’s going on with him.

We also have two 17-yr-old kitties, both treated for high blood pressure (amlodipine) and arthritis (Dasuquin & Onsior for one, Adequan SQ & gabapentin for the other). One also has a heart murmur with managed hypertrophic cardiomyopathy (atenolol). He was also just dx’d with GI small cell lymphoma and will be starting his chemo-steroid-vit B treatment tomorrow. The other kitty has early stage CKD and we give her SQ fluids, Azodyl, and pay attention to her diet. All kitties are on low phos foods from the food lists, as they all are a hard no with the prescription foods. So we got a lot going on around here.

 

[FrostD]

Ah ok. Lot going on!

I had asked about treatments primarily to make sure you were aware of low carb + low phos food, but also because depending on when and where you give fluids it can effectively "dilute" the insulin. But glad he doesn't need fluids yet! CKD itself can make things harder to regulate as well.

Typically you want to hold each dose no more than a week. If nadirs are not below 120-150, you'd increase by 0.25U. Remember cats are very small, so a whole unit increase can easily overshoot a good dose. The more often you can test, the more quickly you can increase - so if you could get one additional test each cycle, you could increase every 4-5 days in the numbers he's seeing. You are also seeing short duration, which is mostly due to him bouncing. As he bounces less you should theoretically see duration improve.

 

[Hotchachonia]

I just did a +4 test and it’s 157. His nadir is typically +4 to +6, so I’ll do another at +6.

Makes sense about not holding the dose for longer than a week before adjusting. So, I’ll hold him at 2.5U for 5-7 days, and see where he is then. I had a feeling when we jumped from 2 to 3 after doing the 0.25U adjustments for the past couple months that we were moving too fast. Patience!

Thanks so much for your thoughts. I’ll update as we go.