CONSTANT, VERY HIGH BG's - Need Advice from EXPERTS

[TheBowHuntress]

Hi,
Every since my cat was diagnosed, he has had some very high numbers (see Gobbles' SS please). When looking at his SS, please be aware that testing from 11/24-11/26 I was using a ReliOn with outdated test strips. On 11/27, I started using a TrueResult. On 1/7, I had the TrueResult tested at the vet's office vs. his AlphaTrak--the TrueResult was reading much lower (and I had my new ReliOn with me, but dropped the darn test strip in the parking lot, thereby wasn't able to test it vs. AlphaTrak. On 1/8 I had my ReliOn tested vs. AlphaTrak which resulted in a 10 point difference! I know this complicates matters, but if you are interpreting his SS, please be aware.

I believe that his BG has been high for some time. On 1/7 the vet did a fructosamine test which came back at 543!

I have a few questions and would appreciate any answers, opinions, recommendations, from experts:

1. What may be causing the numerous high BG's? 2. Other than push water on Gobbles, add water to each can of food, offer water/chicken juice and test frequently for ketones, what else can I do? He is peeing in very large quantities most of the time--that's good (in lieu of his high BG's); correct? 3. I don't quite understand the "shed" thing, but there was a reduction in dosage on 1/17/13; I am grateful to the experts who suggested the decrease, I just don't understand the dynamics of it 4. I read that some cats can do well at a higher threshold, but at his numbers....!!! BTW, he actually "ran" up the basement steps this morning, which he has not done for over a month--was walking/taking breaks previously

 

[Sienne and Gabby (GA)]

First, a fructosamine number is not the same as a BG reading. They use a different scale. Fructosamine levels, at least the reference range that my vet uses, can be interpreted as follows: 300 - 350 Excellent, 350 - 400 Good, 400 - 450 Fair, >450 Poor, <250 Prolonged hypo. Let me point out that for a fructosamine in the <250 range, your cat could have an average BG in the 90s. That's not "Prolonged hypo." I'd encourage you to ask for the reference ranges whenever you get a lab test so you and your vet are on the same page. (Different labs may also have different reference ranges for tests.)

1. What may be causing the numerous high BG's?

I believe several people have pointed this out on the Lantus board: Gobbles is bouncing. He does not have "constant, very high BG" numbers. He drops into blues and greens and then has a very normal response for a cat that has likely been diabetic for a while. A cat's body becomes used to being in high numbers. When numbers drop into lower ranges than the cat is used to or if there's a fast drop, the cat's liver and pancreas react by dumping a stored form of glucose along with counterregulatory hormones into the bloodstream and numbers spike. This sort of bounce can take up to 72 hours to clear.

2. Other than push water on Gobbles, add water to each can of food, offer water/chicken juice and test frequently for ketones, what else can I do? He is peeing in very large quantities most of the time--that's good (in lieu of his high BG's); correct?

If you are feeding a canned food diet and adding water to that food, you really don't need to keep pushing water. It doesn't effect BG numbers. It can help with ketones but Gobbles doesn't have ketones.

3. I don't quite understand the "shed" thing, but there was a reduction in dosage on 1/17/13; I am grateful to the experts who suggested the decrease, I just don't understand the dynamics of it

The "shed" is outdated Lantus lingo for the insulin depot. Please let us know if you still have trouble understanding the depot after you've had a chance to read the sticky note that I linked. It can be a difficult concept to wrap your head around.

The reason that the dose reduction was recommended has nothing to do with the depot. If your read over the Tight Regulation Protocol, a dose reduction occurs when a newly diagnosed cat's BG numbers drop below 50.

4. I read that some cats can do well at a higher threshold, but at his numbers....!!!

I don't understand your question. What threshold?

 

[Carl & Polly & Bob (GA)]

I'm personally not a big fan of the word "experts", nor do I consider myself one. I think it puts too much pressure on people. So consider this advice, from someone who has never even seen a syringe of Lantus, as "non-expert".

First thing I'd do.... disregard any data that came from your Trueresult meter testing days. If you've verified that it read much lower than the AT or than your Relion, it isn't worth much. Yes, you can still see patterns in the data from back then, but the specific numbers are not very useful. Besides, Gobbles isn't the same cat he was then.

I believe that his BG has been high for some time. On 1/7 the vet did a fructosamine test which came back at 543!

The 543 result from a fruct test does not mean that was his average BG during the time period the test covered. I think you take that 543, and use some chart to "translate it" to a BG value. I think that 543, per this chart, converts to an average BG around 350, which is still high, but common to newly diagnosed cats.
http://www.sugarcats.com/articles/Fructosamine-test-conversion-charts/. Fructosamine tests can be used to determine or verify a diabetes diagnosis, but their value beyond that is minimal. That's why we usually tell people not to waste the money on the tests. Your spreadsheet is a lot more accurate in terms of what Gobble's BG is, and what the insulin is doing for him.

1. What may be causing the numerous high BG's?

Most likely, "bounces". An infection of some sort could cause them, any kind of pain, from dental problems for instance, stress. But most likely the high numbers are due to bouncing.

2. Other than push water on Gobbles, add water to each can of food, offer water/chicken juice and test frequently for ketones, what else can I do? He is peeing in very large quantities most of the time--that's good (in lieu of his high BG's); correct?

He'll continue to pee in large quantities until his numbers are more regulated. Once that happens, he'll pee less, and you'll hardly see him drinking out of a water bowl. If he's getting a lot of fluids right now, well, it's got to go someplace, right? If you've seen ketones, then added fluids help to flush them out. If you are getting negative ketone tests, which you've noted in the SS comments yesterday, that's great news. If he doesn't seem dehydrated, you may not have to push as much water on him? A cat that is on a canned diet that is diet controlled and off insulin, like Bob is, rarely if ever touches his water bowl. There's enough fluid in his Fancy Feast to meet his needs for hydration.

3. I don't quite understand the "shed" thing, but there was a reduction in dosage on 1/17/13; I am grateful to the experts who suggested the decrease, I just don't understand the dynamics of it

A depot type of insulin will establish a certain level of insulin in Gobble's system. At some point, this depot becomes "more" insulin than he needs. You see a drop to a number under 50 like you did on the 17th. When that happens, per the dosing protocol for tight regulation, you reduce the dose. As you're adding less insulin each shot, the depot adjusts downward to a lower level. But it doesn't happen instantly, it takes a couple days or longer (ECID). Same logic applies to a dose increase. It doesn't show immediate results in most cases, but can take a few cycles to do so. And if you look at just about everyone's SS, you'll see where a cat will get reductions, and for whatever reason, they "fail", and then you have to do increases again based on the data you collect. To me, that's the "easy" part of Lantus treatment. The guidelines for increasing and decreasing are right there in black and white. They tell you how long to wait for results, and what to do based on those results. The hard parts are waiting for the results to make themselves known, living through the cycles of "bouncing", and hoping for (but at the same time being anxious about) the low numbers on the meter that tell you that you need to reduce the dose. To me, that's the stressful part for the caregivers. The dosing decisions are pretty simple.

4. I read that some cats can do well at a higher threshold, but at his numbers....!!! BTW, he actually "ran" up the basement steps this morning, which he has not done for over a month--was walking/taking breaks previously

I also have read where people say that kitty acts "better" at higher numbers, or seems to feel bad when the numbers are lower. But I think it's the swings from highs to lows that make that cat feel crummy. I don't imagine if feels too good for your BG to go from 350 to 100 and back up to 350 over a 12 hour period. I'm not a diabetic, but someone who is can probably tell you how that makes them feel. I would think that spending a day at 350 would feel a lot worse. What you want to see happen is for Gobbles to spend as much time over the course of a day below the "renal threshold" - the point were glucose spills over into the urinary system. That's the point where the extra glucose in the body causes problems overall, and where glucose toxicity becomes the issue.
The most encouraging thing I've read about Gobbles in the past few days is this:

he actually "ran" up the basement steps this morning, which he has not done for over a month--was walking/taking breaks previously

No matter what your glucometer says, that is an outward sign that he's doing better, and you should be very encouraged by it. Sometimes it's important to put down the meter and close the SS, and just watch him to see how he's "doing". People here call it the WCR (whole cat report). When they start acting like their old selves, then things are getting better, Kat.

Carl

 

[TheBowHuntress]

Hi Sienne, I will ask my vet for reference ranges when I take Gobbles to the vet on Wednesday. He mentioned another fruct. test, but I certainly am going pass on that as I actually do understand why at this point it is totally a waste of my money. Regarding the high BG's and myself thinking they are "constant"--Eureka! I finally do understand that concept and I suppose "constant, high BG's" would be something perhaps, like, Gobbles having pink numbers which were rarely any other color. With regard to pushing water, I thought that if I did that, it would help flush the sugar out of his kidneys when he's high (can you tell I'm super-paranoid that the high numbers are making Gobbles' feel physically terrible, damaging my little boy's organs and shortening his life?) Then, should I quit watering his food (I add enough water to make a "gravy")? I will quit with the chicken juice and forcing water on him! Between you & Carl, my eyes have been opened regarding shed/depot. By threshold I meant by [something I read elsewhere] as renal threshold to filter glucose at 200 or something... I will be studying the sticky links you gave me in your post (copy & paste & put into a Word Document & save it on my desktop

 

[Carl & Polly & Bob (GA)]

With regard to pushing water, I thought that if I did that, it would help flush the sugar out of his kidneys when he's high

Ah, okay. Well, it's the sugar in his blood that's the problem rather than his kidneys. You don't want excess glucose anywhere, of course, but it what is in his blood, and his body's reduced ability to absorb that glucose into his cells from his blood (just because he's diabetic). That's where the breakdown is happening, and because of that, the extra "sugar" continues on it's merry way, gets filtered by his kidneys and probably his liver, and ends up leaving as "waste".

I know that it seems that most people do add water to the canned food. Some seem to do so because at first, when switching to canned food (after eating only dry food in the past), some cats just won't eat it. People add warm water, and I guess it makes it smell better, or makes the texture better? Not sure why, but it makes the cat want to eat it. Other people add water because they might have seen ketones, or because their cat is somewhat dehydrated? But from reading on the board, a lot of people do add water.

I never had to. When Bob was post-DKA, he was getting lots of sub-q fluids, so that rehydrated him when he needed hydration. He had been fed mostly dry, but also some canned food before diabetes. Canned food was more of a "treat", and I had no idea dry food was bad for him. It was so much easier to feed dry. No stink, no mess, you could just keep topping off the bowl.... maybe that's why he ballooned to 22 pounds? Anyway, when I switched him cold-turkey to low carb canned food, I think I was his favorite person EVER, like he'd been waiting for that moment for all his life! So I never had to add water to coax him to eat it. He's a "hoover". He'll eat a can of FF in 3 minutes or less. But I saw an immediate reduction in the amount of times he went to the water bowl, even though he was still on insulin. And he started peeing a lot less often, and much less per litter box visit. That improved even more as his numbers got better.

If Gobbles is staying hydrated, and not throwing ketones, and he'll eat the canned food without added water, you might be able to stop adding water. But leave a bowl of water available, and just see how often (or not) he goes to it everyday. If he isn't getting enough water, he'll "tell" you. Just keep testing for ketones as you are able, and add water if you see even trace ketones again.

Carl

 

[TheBowHuntress]

Ok...but I've never seen ketones--since the first time I tested him, it has always been negative dancing_cat

 

[Carl & Polly & Bob (GA)]

Knock wood.

Sorry, for some reason I thought you'd seen "trace" at one time...

Too many kitties for me to keep 'em straight

Carl

 

[TheBowHuntress]

Fingers crossed. BTW, Bob is ADORABLE

 

[Carl & Polly & Bob (GA)]

Lol, thanks
I'll try to find a pic of his "other end" and then his name will make more sense.
Carl

edit:
There you go...

 

[BJM]

Metaphor definition for depot:
Imagine a funnel.
Imagine pouring liquid into the funnel.
If you pour it in fast, the funnel can't let out the liquid as fast and it will overflow.
If you pour it in slowly, the funnel will allow the liquid to flow out as fast as it flows in.

If you're really careful, you can pour it in just a little bit fast at first, then at a steady rate, and have a little pool of fluid in the funnel. That pool is like your depot.

 

[Sienne and Gabby (GA)]

Kat --

I add water to Gabby's (and Gizmo's) food. Water won't hurt Gobbles. It is good for kidney health. The lack of water in dry food is one of the reasons it's such a bad idea for cats. In the wild, cats get most of their hydration from the prey they eat. Canned food has a high percentage of water and it's fine to give extra. The water you're "pushing" though, isn't really necessary. It's not going to really flush sugar out of the system. Glucose needs to get into the cells to provide nutrition and energy. Insulin is what transports glucose into the cells.

All of us have dealt with a cat that's got bouncy numbers. They are frustrating. The best thing you can do is wait for the bounce to clear and stick with the dosing protocol. The TR protocol is designed to be both safe and aggressive. It will get Gobbles into better numbers if you are patient.

 

[TheBowHuntress]

Lol, thanks
I'll try to find a pic of his "other end" and then his name will make more sense.
Carl

edit:
There you go...

How cute. I see they like the TP as well? Gobbles' thing is to (after he wakes me up by licking the wrinkles off my face) he follows me directly to the toilet, and gets the TP for me...although sometimes he gets a little OCD and takes ALL the TP off the roll. Your kids are both real cute cat_pet_icon

 

[nckitties3]

Hey! Could you send Gobbles over here? I have many wrinkles I'd gladly let him lick off MY face! :lol:

Debbie and Lucian

 

[Doug N Libby]

*Several of us add water to our kitties' food because we give them laxatives/meds that can cause dehydration.

Have a great weekend -

Libby (& Hershey, too!)