My 15 year old cat, Simon, was diagnosed 3 weeks ago. He was placed on Vetsulin 2x a day, 2.5 units each and canned cat food. I feed him friskees classic pate 2/3 a can 2x a day with his shot. He was fine at 2.5 units for the first week. Behavior was returning to normal. Initial bg was around 280 in am and 230 in pm. Then one day a few hours after pm shot I noticed he was acting off so I tested his bg again and it was 63. I gave him some pancake syrup and he seemed better. The next morning bg was back at 276. So I continued on schedule and again at night he started acting strange. I tested and his bg was 50. Pancake syrup. Better. Then his am and pm levels both start getting lower. Good right? Except he has started drinking alot of water again, is peeing outside of his box again, always seems confused, sometimes walks along the wall, sometimes circles, follows me around, constantly under my feet but doesn't want me to hold him, no longer sleeps with me, and will only eat second half of his food if I hand feed him. Yuck! But his bgs are the best they've been since I starting testing on 12/17. Am is 164. Pm is 206. All numbers are preshot, prefood. I am testing with a relion. I dropped his insulin to 1.5 on 12/31 because his bg levels were so much lower. This has been doing well except he still has all the behaviors of high bgs. What gives? BTW his vet is completely unhelpful. He didn't even suggest testing his bgs. How am I supposed to regulate his diabeties without testing?
Decent BGs but bad behaviors
- Thread starter Jena
- Start date
- Status
Kris & Teasel
Member Since 2016
Some insulins simply don't agree with a kitty. They might lower BG but the cat doesn't feel well or act normal while on that particular insulin. However, from what you describe it seems that your kitty might be dropping into very low numbers. Do you routinely test in the middle of a cycle to see how low the insulin dose is taking your kitty? It's not clear from what you've written. You've only mentioned checking BG after a shot twice in your description. If not, your kitty might be dropping very low at nadir and that could explain some of the weird behaviours. Others cats on here have shown the symptom of extreme thirst when they were at hypo levels. Confusion, walking strangely (along walls, circling), peeing outside of the litter box are all possible hypo behaviours.
The only way to sort out what's happening is to set up a testing routine that includes some testing in the middle part of a cycle during the day or into the evening in addition to what you do already. If you're willing to set up the spreadsheet we use here it's viewable by other members who can help you.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
The only way to sort out what's happening is to set up a testing routine that includes some testing in the middle part of a cycle during the day or into the evening in addition to what you do already. If you're willing to set up the spreadsheet we use here it's viewable by other members who can help you.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
Nan & Amber (GA)
Member Since 2016
Hi Jena--
Congrats on getting going on the testing, despite a lack of encouragement from your vet! You're right, it's very very difficult to regulate your cat's diabetes without doing that-- I think vets don't suggest it because they assume most pet owners won't do it. Good for you for going with your gut!
As for the behaviors: I agree with Kris, the patterns you describe, and the low numbers that you have been getting, suggest that maybe Simon is regularly going too low after his shots. The only way to know for sure is to get more mid-cycle tests in, although as Kris suggests, if you could get a spreadsheet going with all the numbers you already have, then some of our resident experts could maybe say more about what is going on from what you have already measured.
I want to emphasize something you probably already know, but "too low" on blood glucose is not something to be at all casual about. When insulin is in the mix, things can quickly spiral out of control, and hypos can be fatal. From this site, see:
http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/
You've done great so far treating the low numbers you've seen, but I think you're right that at this point you need to go beyond your vet's limited advice if you are going to keep Simon safe-- the behavior you describe is disturbing, and I am disturbed that your vet is so casual about numbers as low as 50 when treating with Vetsulin.
Congrats on getting going on the testing, despite a lack of encouragement from your vet! You're right, it's very very difficult to regulate your cat's diabetes without doing that-- I think vets don't suggest it because they assume most pet owners won't do it. Good for you for going with your gut!
As for the behaviors: I agree with Kris, the patterns you describe, and the low numbers that you have been getting, suggest that maybe Simon is regularly going too low after his shots. The only way to know for sure is to get more mid-cycle tests in, although as Kris suggests, if you could get a spreadsheet going with all the numbers you already have, then some of our resident experts could maybe say more about what is going on from what you have already measured.
I want to emphasize something you probably already know, but "too low" on blood glucose is not something to be at all casual about. When insulin is in the mix, things can quickly spiral out of control, and hypos can be fatal. From this site, see:
http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/
You've done great so far treating the low numbers you've seen, but I think you're right that at this point you need to go beyond your vet's limited advice if you are going to keep Simon safe-- the behavior you describe is disturbing, and I am disturbed that your vet is so casual about numbers as low as 50 when treating with Vetsulin.
Critter Mom
Member Since 2014
Hi Jena,
What you're describing sounds like insulin overdose.
If BG goes too low the body's defences work to raise blood glucose levels and this can lead to a condition called rebound hyperglycaemia - hence the return to peeing etc. The spaced out behaviour is really worrying and sounds like Simon is going hypoglycaemic at times. The wild swings in BG could also be making him feel absolutely lousy and that might be behind some of the other odd behaviours you describe.
The general recommendation on FDMB for cats with little or no data is not to give insulin if the preshot BG is 200 or less on a human meter.
If it were my cat I would not give a 1.5IU dose again. I would actually be extremely worried about giving a 1.0 unit dose - even more so if eating is unpredictable.
For information, because of the hard, fast way that Vetsulin can drop BG levels the FDMB Vetsulin/Caninsulin guide recommends that the cat not be let go below 100 at nadir (human meter) when being treated with this insulin so as to provide an adequate safety buffer and reduce risk of hypos.
As already mentioned above you need to do mid-cycle tests as well as preshot tests. Thank goodness you are home testing and that you already caught 2 lows, but now you need to check for nadir regularly.
I suggest:
- reducing the dose to a maximum of 1.0IU. (If it were my cat I would definitely not give it 1.5IU again.)
- talking to your vet about dropping the dose down to 0.50IU BID.
- do not give insulin if preshot less than or equal to 200mg/dL (human meter).
- leave 30 minutes between preshot meal and giving a Vetsulin dose.
- AS SOON AS POSSIBLE start getting tests after each dose at +1, +2 and +3 hours after giving the injection to see if numbers are heading low in the early part of the cycle. Get Simon to eat something if numbers start getting into double figures and post here for help. If he goes below 70 I suggest you give him some higher carb food (e.g. food with gravy) to slow the drop. If he does get into double digits then keep monitoring him and intervene with food/honey as appropriate to keep him in safe numbers.
- get a 'before bed' test in EVERY NIGHT to see if Simon will be safe for the rest of the cycle. (A lot of cats run lower at night).
- Run a full curve at the very earliest opportunity to better see what is happening throughout the insulin cycle.
- Make sure you have urine ketone test strips (e.g. Keto-diastix). As an important safety precaution you need to test daily for ketones (much greater risk of ketones if appetite is a bit off and also when dose is being reduced - even more important if Simon has a history of throwing ketones):
Testing your kitty for ketones
Tips for catching and testing urine samples
- Watch for signs of nausea and address them immediately with your vet.
Nausea symptoms and treatments
Here is an article on rebound hyperglycaemia. It explains how too high a dose of insulin may lead to the sort of observations you're making.
http://petdiabetes.wikia.com/wiki/Somogyi_rebound
Important safety info:
How to treat hypos
Hypo toolkit
Always, always post for help here whenever you need it. And make sure you always have plenty of test strips at home (especially at the moment when it sounds possible that the insulin could be taking Simon too low).
Mogs
.
What you're describing sounds like insulin overdose.
If BG goes too low the body's defences work to raise blood glucose levels and this can lead to a condition called rebound hyperglycaemia - hence the return to peeing etc. The spaced out behaviour is really worrying and sounds like Simon is going hypoglycaemic at times. The wild swings in BG could also be making him feel absolutely lousy and that might be behind some of the other odd behaviours you describe.
The general recommendation on FDMB for cats with little or no data is not to give insulin if the preshot BG is 200 or less on a human meter.
If it were my cat I would not give a 1.5IU dose again. I would actually be extremely worried about giving a 1.0 unit dose - even more so if eating is unpredictable.
For information, because of the hard, fast way that Vetsulin can drop BG levels the FDMB Vetsulin/Caninsulin guide recommends that the cat not be let go below 100 at nadir (human meter) when being treated with this insulin so as to provide an adequate safety buffer and reduce risk of hypos.
As already mentioned above you need to do mid-cycle tests as well as preshot tests. Thank goodness you are home testing and that you already caught 2 lows, but now you need to check for nadir regularly.
I suggest:
- reducing the dose to a maximum of 1.0IU. (If it were my cat I would definitely not give it 1.5IU again.)
- talking to your vet about dropping the dose down to 0.50IU BID.
- do not give insulin if preshot less than or equal to 200mg/dL (human meter).
- leave 30 minutes between preshot meal and giving a Vetsulin dose.
- AS SOON AS POSSIBLE start getting tests after each dose at +1, +2 and +3 hours after giving the injection to see if numbers are heading low in the early part of the cycle. Get Simon to eat something if numbers start getting into double figures and post here for help. If he goes below 70 I suggest you give him some higher carb food (e.g. food with gravy) to slow the drop. If he does get into double digits then keep monitoring him and intervene with food/honey as appropriate to keep him in safe numbers.
- get a 'before bed' test in EVERY NIGHT to see if Simon will be safe for the rest of the cycle. (A lot of cats run lower at night).
- Run a full curve at the very earliest opportunity to better see what is happening throughout the insulin cycle.
- Make sure you have urine ketone test strips (e.g. Keto-diastix). As an important safety precaution you need to test daily for ketones (much greater risk of ketones if appetite is a bit off and also when dose is being reduced - even more important if Simon has a history of throwing ketones):
Testing your kitty for ketones
Tips for catching and testing urine samples
- Watch for signs of nausea and address them immediately with your vet.
Nausea symptoms and treatments
Here is an article on rebound hyperglycaemia. It explains how too high a dose of insulin may lead to the sort of observations you're making.
http://petdiabetes.wikia.com/wiki/Somogyi_rebound
Important safety info:
How to treat hypos
Hypo toolkit
Always, always post for help here whenever you need it. And make sure you always have plenty of test strips at home (especially at the moment when it sounds possible that the insulin could be taking Simon too low).
Mogs
.
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Squalliesmom
Member Since 2015
I agree with everything Kris, Nan and Mogs have told you. I am very concerned that Simon is getting too much insulin, a situation that can have tragic results. I would definitely reduce his dose and try to get some more mid-cycle tests in. Also, it's great that you know to give syrup if numbers drop too low, but you do need to keep checking because the syrup only has a short duration, 20 minutes or so. Try using some of the "carb-y" gravy from one of the gravy foods; it raises their bg without filling them up, in case you need to get them to eat again, later. You can also mix a little syrup into the gravy if necessary. 
We have a spreadsheet we use to track our kitties' bg readings; it's an incredibly helpful tool for determining how insulin is affecting your baby, and can be a huge help in determining dosage. Don't be daunted by it, it is easier to use than it may seem at first! If you need help setting it up just sing out and someone with tech skills will come help you.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/
We have a spreadsheet we use to track our kitties' bg readings; it's an incredibly helpful tool for determining how insulin is affecting your baby, and can be a huge help in determining dosage. Don't be daunted by it, it is easier to use than it may seem at first! If you need help setting it up just sing out and someone with tech skills will come help you.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/
Thanx guys. Too much insulin is kinda what I suspected but I couldn't find info to support that. Rather than gravy cat food can I use those gravy sauce things that you add to a dogs food? Then I can freeze the leftovers so I don't have to throw out a can every time he gets low. I have been testing before bed but it's only 4 hours post injection. That's where I have caught his low bgs. Lately it's been around mid to high 70s. I haven't done a curve yet because I just learned about it. I plan on doing one tomorrow. I work all week and sometimes Saturday too. I have considered lowering his insulin to 1 unit but I was afraid because he had 2 days where it did go back into the 200s. This morning I didn't give him anything because he didn't finish his food. Usually I can coax him to eat but I woke up late and needed to leave early because of the snow. I just bought ketone testing strips and I will start testing tonight if I can get some pee. Should I do a curve before I try to lower his insulin or do both tomorrow? His highest bg is always the morning one. I am so fustrated with my vet. How can there be so much info out here and he didn't suggest any of it?
Nan & Amber (GA)
Member Since 2016
Well, don't be too hard on your vet-- unless they are specialists they need to know about a lot of different conditions for a lot of very different animals and don't get much training in feline diabetes specifically. They often don't have time to keep up on all the research on something that they may not see a lot of in their practice. Whereas we here have lots of time to research anything and everything known about FD 
.
No shot if he didn't get a full meal is a probably a good move, especially if you'll be at work today and unable to monitor. I haven't used Vetsulin myself, but from what I understand, 4 hours post-shot (that's "+4" in the notation we use here) is close to when you would expect to see the lowest numbers (the "nadir"), but the lowest point could also be a bit earlier or later. Because Vetsulin tends to be pretty dramatic in its actions, the recommendation is to try to dose such that the nadir is above 100 (leaving a safety buffer), so if he's in the 70's a further reduction is definitely in order, along the lines of Mogs' suggestions above. I would think that you would want to reduce first (for safety) even before the curve, but follow the guidance of the experts here who have more experience with Vetsulin/Caninsulin for specific recommendations. Given the no-shot this morning, the recommendation may depend on what number Simon gives you for the pre-shot this evening-- did you get a number this morning, by the way?
.No shot if he didn't get a full meal is a probably a good move, especially if you'll be at work today and unable to monitor. I haven't used Vetsulin myself, but from what I understand, 4 hours post-shot (that's "+4" in the notation we use here) is close to when you would expect to see the lowest numbers (the "nadir"), but the lowest point could also be a bit earlier or later. Because Vetsulin tends to be pretty dramatic in its actions, the recommendation is to try to dose such that the nadir is above 100 (leaving a safety buffer), so if he's in the 70's a further reduction is definitely in order, along the lines of Mogs' suggestions above. I would think that you would want to reduce first (for safety) even before the curve, but follow the guidance of the experts here who have more experience with Vetsulin/Caninsulin for specific recommendations. Given the no-shot this morning, the recommendation may depend on what number Simon gives you for the pre-shot this evening-- did you get a number this morning, by the way?
Critter Mom
Member Since 2014
Hi Jena,
If Simon's going into the 70s at +4 then if it were me I would lower the dose straight away. The BG readings up in the 200s are possibly due to Simon's BG levels bouncing upwards after the earlier low in response to the body's defence mechanisms kicking in. That said, Caninsulin curves do tend to be cup-shaped and there may be quite a difference between preshot and nadir BG levels. With a lower dose it might even Simon's levels out somewhat.
It would be great if you could get a spreadsheet up and running so that we can get a better picture of what has been going on with Simon's dose and BG levels up till now. (See Squallie's Mom's post above for the links to setup instructions and also the sticky which explains the column headings, '+' time notation, etc. - shout if you need help or further explanations.) Members will be able to give you better help and suggestions when they can see Simon's data. If you'd like assistance with the setup just shout and we'll find someone to help you with it.
Mogs
.
If Simon's going into the 70s at +4 then if it were me I would lower the dose straight away. The BG readings up in the 200s are possibly due to Simon's BG levels bouncing upwards after the earlier low in response to the body's defence mechanisms kicking in. That said, Caninsulin curves do tend to be cup-shaped and there may be quite a difference between preshot and nadir BG levels. With a lower dose it might even Simon's levels out somewhat.
It would be great if you could get a spreadsheet up and running so that we can get a better picture of what has been going on with Simon's dose and BG levels up till now. (See Squallie's Mom's post above for the links to setup instructions and also the sticky which explains the column headings, '+' time notation, etc. - shout if you need help or further explanations.) Members will be able to give you better help and suggestions when they can see Simon's data. If you'd like assistance with the setup just shout and we'll find someone to help you with it.
Mogs
.
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Critter Mom
Member Since 2014
At the moment I think Simon's more at risk from the 1.5IU dose than a 1.0IU dose. High BGs, while undesirable, represent far less risk to Simon than a hypo; better too high for a day than too low for a minute, as is the saying here. Also a BG in the 200s is not excessively high for a feline diabetic in the early stages of becoming regulated.
FYI, 194 is not very high as a preshot, all things considered (human meter). The normal recommendation on FDMB for all newly diagnosed cats with very little data is not to give any insulin if the preshot BG is less than 200 (human meter); doubly so with Caninsulin because it typically tends to drop BG very hard and fast at the beginning of a cycle.
WRT test timing - especially in a situation where too high a Caninsulin dose is suspected - testing at +1.5 hours after dose administration (+2 at the latest) is very helpful because:
1. It may give you an idea of where the cycle might be heading and provide an early warning that you may need to monitor more closely/intervene with food.
2. It can catch fast, early drops in BG which testing at 'typical' nadir time might miss (and also the later reading might be affected by rebound; a common reason why doses end up too high).
Here's a graph illustrating a typical Caninsulin cycle for an effective, safe dose (blue line shows how strongly the insulin is working at each point in time):
As you can see from the graph above, Caninsulin (aka Vetsulin) typically exerts a very powerful effect very early in the cycle. Often if a dose is too high the curve may be shaped like a tick mark instead of a cup. A high, 'flat' curve may also be indicative of rebound.
Running full curves can fill in a lot of blanks as to what is happening throughout the course of a cycle. Preshots and mid-cycle checks on other days flesh out the picture and are hugely important for safety (especially when too high a dose is suspected).
If you're reducing the dose it's important to test regularly for ketones as an added precaution.
If Simon's acting OK and any of his diabetes symptoms seem to be improving you could run a curve with a 1.0IU dose to see whether it is taking Simon too low for a Caninsulin kitty (<100mg/dL on a human meter). If Simon is bouncing from a previous low it might take several days worth of tests to establish how well the dose is working.
If you run a curve at 0.5IU dose, you could also see whether that dose will take him into better and safer numbers overall but again the caveat about bouncing applies (and it's even more important that he's negative for ketones if adopting this approach). Another thing to bear in mind is that it can take several cycles for a dose adjustment to 'settle' before being able to assess how effective and safe it is.
I'm sorry not to be able to give you more solid suggestions; without being able to see Simon's recent BG data it's difficult.
Be sure to post for the help and support that you need over the weekend.
Mogs
.
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Critter Mom
Member Since 2014
I've heard tell of a member here who once had to use ice cream to raise her kitty's numbers when she was stuck for something carb-y in a bit of a crisis.
Mogs
.
Well I didn't give Simon any insulin tonight either because his bg is 160. That's with no insulin this morning either. He finally ate dinner but not without coaxing. Turns out I won't be able to do a curve tomorrow because now I have to work. I'll shoot for Sunday but it will be tough now that I will have to make up for no Saturday. Ya know, with the chores. He's still not acting normal. And he hasn't beat up the dogs in 2 weeks but don't worry they are still scared of him. He has started resisting ear pricks. I even bought some freeze dried chicken. He likes it but not when I am trying to stick him. I don't know if o could keep ice cream in the house. It's my kryptonite. Lol
Noah & me (GA)
Member Since 2016
Hi Jena, welcome to a world of knowledge I never knew existed. Some of the people who replied to you are what I would call "The village elders" or "Oh wise one" and that is truly meant as a compliment. They know more than some vets I've had the misfortune to meet. There's more to come (not from me) so keep a pen and paper handy. This might sound condescending but I find using Notepad on Microsoft really handy, not as clunky as Word. Just highlight, copy and paste and you'll have your own textbook in no time. Strength in numbers, we all wish you the best.
Thanx
Critter Mom
Member Since 2014
Try crumbling up some of the freeze-dried chicken treats and using them as a topper for Simon's normal food; it might tempt him to eat a bit better for you.
Given that he's out of sorts and his appetite is off I'd recommend you make sure he's ketone-free by testing his urine (especially when you're needing to skip doses) and also ask the vet to test for pancreatitis (often present in diabetic cats). Ketones are a real priority as they can build up quickly and, if present, need to be treated as a medical emergency.
Even though you've not given any insulin for this PM cycle, any BG tests you can manage to get in will be really valuable to you as you build up a picture of what's happening with Simon's BG levels.
Mogs
.
Can I express his pee? I used to have a paralyzed dog that needed her bladder expressed. I tried the chicken treats on top of his dinner tonight. That didn't work either. He did eat but he ended up wanting the flavor he snubbed 2 days ago and my company. I can almost always get him to finish but often that means hand feeding him. The vet tested him from ketone in the hospital the first night and said he didn't have them. I have also started collecting a bg right before I go to bed. Which actually is now. Lol
Kris & Teasel
Member Since 2016
There are several ways we get urine for a ketone test:
- put the strip in the stream as kitty is peeing;
- put a shallow spoon or similar under the backside to catch a bitof urine (doesn't take much);
- put a double layer of kitchen plastic wrap over the litter in the favourite pee spot and push it into the litter to make depressions that will catch urine.
Kris & Teasel
Member Since 2016
That's a great number! It would help us a lot if you could at least put all his recent BG data down in a list:
Date:
AM BG =
Fed:
AM dose =
BG at __________ time (use +1, +2, etc. to denote hours since insulin dose)
Today?4:15 Am BG 194
FED: 1/2 can of friskees classic pate ( he's supposed to eat 2/3)
AM dose skipped ( no full meal, semi low bg)
4:48 Pm BG 164
Fed: 2/3 can of friskees classic pate
Pm dose skipped ( too low for shot)
8:42pm BG 90
YESTERDAY
4:27 AM BG 223
Fed: 2/3 can classic pate
Am dose 1.5 IU
4:06PM BG 168
Fed: 2/3 can classic pate
PM dose 1.5
8:10 BG 77
Is this enough or do you need more? I plan on filling out that shareable spread sheet tomorrow at work.
Kris & Teasel
Member Since 2016
My three share one large box as well. I know that my guy will generally go there after a meal so I keep an eye on him then. Once I see him go in, I quietly follow and slip a long handled shallow spoon under his backside. I try to be very casual and relaxed about it.
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I actually don't know when he goes. Their boxes are downstairs and they have a kitty door. I may try the plastic wrap. I have been thinking of putting one box in the bathroom cabinet and closing him in there when I go to work. At the very least it will make clean up easier if he pees outside the box. How fresh does the pee have to be?
Kris & Teasel
Member Since 2016
I think fresh is best.
Kris & Teasel
Member Since 2016
I'm glad you'll be doing the SS. I notice from this info that yesterday you gave 1.5 u when PM BG was 168 and 4 hours later he was at 77. Today you gave no insulin at all and his latest BG was 90. I'm quite sure that 1.5 u is too much but it's hard to know whether he needs 1.0 u or less. As Critter Mom said above. you have to do a curve at one of these doses to see the full picture over a 12 hour cycle.
Squalliesmom
Member Since 2015
Lol,I try to act very natural about it, but it's very difficult to act like stalking my cat around the house and then sticking something under his butt while he's peeing is "normal"!
Squalliesmom
Member Since 2015
If I am reading this correctly, Simon dropped almost 125 points in the first four hours after his insulin? I would definitely try reducing his dose and seeing how he does from there. Better to be a bit higher, and safe, than lower and in a perilous position. You can always raise it again if needed.
Critter Mom
Member Since 2014
I agree with Janet that Simon is showing definite signs of diabetic remission.
I've FDMB-ified your info from yesterday:
5 January 2017
AMPS: 223 (4:27 am) - FED: 2/3 can classic pate - DOSE: 1.5 IU Vetsulin.
PMPS: 168 (4:06 pm - AM+11.5) - FED: 2/3 can classic pate - DOSE: 1.5IU Vetsulin.
PM+4: 77 (8:10 pm)
6 January 2017
AMPS: BG 194 (4:15 pm) - FED: 1/2 can of friskees classic pate - DOSE: Skipped ( no full meal, semi low bg)
PMPS: 164 (4:48 pm) - FED: 2/3 can of friskees classic pate - DOSE: Skipped (too low for shot)
PM+4: 90 (8:42 pm) <----- Much lower BG after eating - Simon's pancreas produced a significant pulse of insulin in response to incoming food.
If Simon's next AMPS is in normal numbers (50-120 mg/dL on a human meter) then a remission trial is indicated. (Withhold insulin, continue testing, and if BG stays in normal range for 14 days - preferably under 100 on a human meter - then cat is deemed a diet-controlled diabetic.)
If Simon's next AMPS is higher after fasting since last night's feed he may have impaired fasting blood glucose levels (pancreas pulses sufficient bolus insulin at mealtimes to keep BG in normal range but does not secrete enough basal insulin between meals to balance release of stored glucose from the liver and BG drifts outside normal range after a long interval between meals).
I would urge a highly conservative approach to dosing. For safety reasons, I don't advocate sliding scale dosing based on preshot BG for Vetsulin, especially for a cat running in lower numbers: even a tiny dose of Vetsulin has the ability to yank a fairly high preshot BG straight back down into low numbers again. Because the effect of Vetsulin is so strong in the early stages of a cycle I think it is vital for safety to have a wide BG safety buffer in general (target nadir >=100 mg/dL on a human meter) - and doubly so when a cat's pancreas is showing clear signs of recovery. Here is a link to a recent post discussing the problem with a 'sliding scale' approach to Vetsulin dosing; it shows my own girl's data as an example of how Vetsulin (aka Caninsulin) has the capability to really tank BG levels with only a tiny dose, and it clearly illustrates that the relationship between Vetsulin dose and Vetsulin effect is non-linear:
http://www.felinediabetes.com/FDMB/threads/scooters-multiple-endocrine-issues.169703/#post-1849184
Also, here is a link to Elmo's spreadsheet where you can see the same non-linear relationship between dose and effect in his most recent Vetsulin data; a dose of less than 0.25IU pulled down preshot BGs of over 200 into a much lower range:
https://docs.google.com/spreadsheets/d/1ZAoPctvtyhkyKhyx_vJh8ffy8ZTl_Ac1AqiCovCd_70/pubhtml
(Note: While Elmo was on Vetsulin his BG was measured with an Alphatrak meter; his test results would have registered lower on a human meter.)
If this were my cat's data and preshot was over 200 I might consider giving a maximum dose of 0.25IU Vetsulin but certainly no more than that. Even with the 0.25IU dose I would want to monitor throughout the cycle to make sure that numbers did not go too low. Your data clearly shows that Simon's pancreas is doing some work so any insulin added to his system via injection could see him go too low - and his clinical signs point to his having already been in hypo territory on some occasions recently. If the dose proved safe and could stand an increase then you could adjust it (with monitoring, of course).
If an OTJ trial at this time should prove unsuccessful (i.e. Simon's numbers continue to show relatively frequent spikes or they start to trend upwards again) I would suggest switching him to a gentler insulin like Lantus or Levemir to allow his pancreas to rest a little longer and, hopefully, see him achieve a strong remission.
The L insulins typically don't produce the steep drops so characteristic of Vetsulin and therefore they make treatment of a cat ready to run in a lower range much more straightforward and also a good deal safer. Due to the way it works I consider it to be far too risky to try to keep a cat in lower numbers using Vetsulin - especially a cat whose pancreas is showing signs of recovery. L insulins are very good at keeping a well-regulated cat in lower numbers; Vetsulin is better at pulling down BG from higher ranges. Because Lantus and Levemir are basal-style, longer-acting insulins they can help keep a cat with impaired fasting BG problems from spiking between feeds.
If a switch to an L insulin isn't feasible and Vetsulin still needs to be used to provide support for a little longer I would suggest switching to using U100 0.3ml syringes with half-unit markings along with a conversion chart to facilitate easier measurement of microdoses of Vetsulin. I would also set a very high no-shoot limit and monitor BG very closely (checking for nadir BG in at least one cycle per day - probably PM in your case, Jena). I'd also regularly monitor urine for ketones (particularly when eating is a bit hit 'n' miss and Simon's still off colour).
Mogs
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I've FDMB-ified your info from yesterday:
5 January 2017
AMPS: 223 (4:27 am) - FED: 2/3 can classic pate - DOSE: 1.5 IU Vetsulin.
PMPS: 168 (4:06 pm - AM+11.5) - FED: 2/3 can classic pate - DOSE: 1.5IU Vetsulin.
PM+4: 77 (8:10 pm)
6 January 2017
AMPS: BG 194 (4:15 pm) - FED: 1/2 can of friskees classic pate - DOSE: Skipped ( no full meal, semi low bg)
PMPS: 164 (4:48 pm) - FED: 2/3 can of friskees classic pate - DOSE: Skipped (too low for shot)
PM+4: 90 (8:42 pm) <----- Much lower BG after eating - Simon's pancreas produced a significant pulse of insulin in response to incoming food.
If Simon's next AMPS is in normal numbers (50-120 mg/dL on a human meter) then a remission trial is indicated. (Withhold insulin, continue testing, and if BG stays in normal range for 14 days - preferably under 100 on a human meter - then cat is deemed a diet-controlled diabetic.)
If Simon's next AMPS is higher after fasting since last night's feed he may have impaired fasting blood glucose levels (pancreas pulses sufficient bolus insulin at mealtimes to keep BG in normal range but does not secrete enough basal insulin between meals to balance release of stored glucose from the liver and BG drifts outside normal range after a long interval between meals).
I would urge a highly conservative approach to dosing. For safety reasons, I don't advocate sliding scale dosing based on preshot BG for Vetsulin, especially for a cat running in lower numbers: even a tiny dose of Vetsulin has the ability to yank a fairly high preshot BG straight back down into low numbers again. Because the effect of Vetsulin is so strong in the early stages of a cycle I think it is vital for safety to have a wide BG safety buffer in general (target nadir >=100 mg/dL on a human meter) - and doubly so when a cat's pancreas is showing clear signs of recovery. Here is a link to a recent post discussing the problem with a 'sliding scale' approach to Vetsulin dosing; it shows my own girl's data as an example of how Vetsulin (aka Caninsulin) has the capability to really tank BG levels with only a tiny dose, and it clearly illustrates that the relationship between Vetsulin dose and Vetsulin effect is non-linear:
http://www.felinediabetes.com/FDMB/threads/scooters-multiple-endocrine-issues.169703/#post-1849184
Also, here is a link to Elmo's spreadsheet where you can see the same non-linear relationship between dose and effect in his most recent Vetsulin data; a dose of less than 0.25IU pulled down preshot BGs of over 200 into a much lower range:
https://docs.google.com/spreadsheets/d/1ZAoPctvtyhkyKhyx_vJh8ffy8ZTl_Ac1AqiCovCd_70/pubhtml
(Note: While Elmo was on Vetsulin his BG was measured with an Alphatrak meter; his test results would have registered lower on a human meter.)
If this were my cat's data and preshot was over 200 I might consider giving a maximum dose of 0.25IU Vetsulin but certainly no more than that. Even with the 0.25IU dose I would want to monitor throughout the cycle to make sure that numbers did not go too low. Your data clearly shows that Simon's pancreas is doing some work so any insulin added to his system via injection could see him go too low - and his clinical signs point to his having already been in hypo territory on some occasions recently. If the dose proved safe and could stand an increase then you could adjust it (with monitoring, of course).
If an OTJ trial at this time should prove unsuccessful (i.e. Simon's numbers continue to show relatively frequent spikes or they start to trend upwards again) I would suggest switching him to a gentler insulin like Lantus or Levemir to allow his pancreas to rest a little longer and, hopefully, see him achieve a strong remission.
The L insulins typically don't produce the steep drops so characteristic of Vetsulin and therefore they make treatment of a cat ready to run in a lower range much more straightforward and also a good deal safer. Due to the way it works I consider it to be far too risky to try to keep a cat in lower numbers using Vetsulin - especially a cat whose pancreas is showing signs of recovery. L insulins are very good at keeping a well-regulated cat in lower numbers; Vetsulin is better at pulling down BG from higher ranges. Because Lantus and Levemir are basal-style, longer-acting insulins they can help keep a cat with impaired fasting BG problems from spiking between feeds.
If a switch to an L insulin isn't feasible and Vetsulin still needs to be used to provide support for a little longer I would suggest switching to using U100 0.3ml syringes with half-unit markings along with a conversion chart to facilitate easier measurement of microdoses of Vetsulin. I would also set a very high no-shoot limit and monitor BG very closely (checking for nadir BG in at least one cycle per day - probably PM in your case, Jena). I'd also regularly monitor urine for ketones (particularly when eating is a bit hit 'n' miss and Simon's still off colour).
Mogs
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Critter Mom
Member Since 2014
By any chance did you also notice Simon starting to resist injections?
Was there any improvement in Simon's mood and behaviour yesterday while he was not receiving any Vetsulin?
Also, is he showing any signs of nausea when you're trying to coax him to eat?
Mogs
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Critter Mom
Member Since 2014
Many cats pee just before or after eating. It might be an idea to set up the litter box with the plastic food wrap ready to catch a urine sample and sequester Simon in a room by himself with the litter box around mealtimes until you can catch a sample.
With the off-ish behaviour, finnicky eating, and also the need to reduce insulin in response to Simon's better BG levels it's safest to do all you can manage to determine his ketone status.
If his off-ish behaviours don't resolve quickly (particularly if they persist when he's not receiving any insulin) I'd recommend getting Simon checked out by a vet - especially if he becomes more reluctant to eat or starts showing any signs of nausea.
Mogs
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Simon's BG this morning was 176 so I didn't give him a shot again. He ate 1/2 can of classic pate then walked away. I hand fed him almost all the rest. He developed diarrhea last night. He peed twice out of the box. One had a little puddle so I tried the ketone stick. It was negative but in all fairness my husband left them in his car overnight. We didn't know they have to stay above 60 degrees. I will pick up some more tomorrow. Snow storm today. I hope to fill out the spreadsheet tonight. I also think he's looking old. Maybe it's the weight loss. I'm not used to him looking so thin. If thinks don't look up by Monday I will bring him back to the vet.
Critter Mom
Member Since 2014
(((Simon)))
That doesn't sound hectic at all. Does he seem worse without any insulin?
If you can manage it try to test him a few hours from now to see whether the food brought him back down again or whether his BG has risen enough to give perhaps a small dose of insulin (with close monitoring through the cycle to make sure he doesn't go too low). You'd need to leave at least 2 hours after a meal to get a valid preshot BG not influenced by food.
Do you have any different foods/different batches of the same food that you might be able to leave out for him to see if he'll select what he can eat better? (Don't hold out much hope for this; it really sounds like something's going on to cause a problem with Simon's eating.)
I'm worried about whether pancreatitis might be the issue, in which case not having any insulin support at all might make Simon feel worse. The reluctance to eat, low mood and now diarrhoea are possible symptoms of pancreatitis (might be something else, just throwing out suggestions here). If Simon crouches in a sort of tense 'meatloaf' or withdraws somewhere after eating those could be indicators of discomfort/pain. Lethargy is also something to watch for.
Is Simon drinking at all? Could he be dehydrated? (Pull scruff of neck to see if it snaps back; check gums to see if they feel tacky.)
If pancreatitis were the problem the sooner treatment starts the quicker a flare can subside. If a kitty becomes completely inappetent it makes things much, much harder (and a number of conditions can cause inappetence). Also if Simon isn't eating enough, still in need of some insulin and has some other undiagnosed illness it increases the risk of ketones showing up - and there's more of a risk in kitties who are underweight. Ketones can cause nausea/GI distress.
It sounds like Simon is feeling really quite poorly. If he isn't picking up maybe you might consider getting an emergency appointment for a vet to examine him before Monday. I can't think of anything else to suggest that might help you and Simon. I think the vet consult is the best thing to do now. [ETA - there really seems to be some underlying condition you need to address for Simon; it doesn't seem to be a basic case of too high an insulin dose.]
Mogs
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That doesn't sound hectic at all. Does he seem worse without any insulin?
If you can manage it try to test him a few hours from now to see whether the food brought him back down again or whether his BG has risen enough to give perhaps a small dose of insulin (with close monitoring through the cycle to make sure he doesn't go too low). You'd need to leave at least 2 hours after a meal to get a valid preshot BG not influenced by food.
Do you have any different foods/different batches of the same food that you might be able to leave out for him to see if he'll select what he can eat better? (Don't hold out much hope for this; it really sounds like something's going on to cause a problem with Simon's eating.)
I'm worried about whether pancreatitis might be the issue, in which case not having any insulin support at all might make Simon feel worse. The reluctance to eat, low mood and now diarrhoea are possible symptoms of pancreatitis (might be something else, just throwing out suggestions here). If Simon crouches in a sort of tense 'meatloaf' or withdraws somewhere after eating those could be indicators of discomfort/pain. Lethargy is also something to watch for.
Is Simon drinking at all? Could he be dehydrated? (Pull scruff of neck to see if it snaps back; check gums to see if they feel tacky.)
If pancreatitis were the problem the sooner treatment starts the quicker a flare can subside. If a kitty becomes completely inappetent it makes things much, much harder (and a number of conditions can cause inappetence). Also if Simon isn't eating enough, still in need of some insulin and has some other undiagnosed illness it increases the risk of ketones showing up - and there's more of a risk in kitties who are underweight. Ketones can cause nausea/GI distress.
It sounds like Simon is feeling really quite poorly. If he isn't picking up maybe you might consider getting an emergency appointment for a vet to examine him before Monday. I can't think of anything else to suggest that might help you and Simon. I think the vet consult is the best thing to do now. [ETA - there really seems to be some underlying condition you need to address for Simon; it doesn't seem to be a basic case of too high an insulin dose.]
Mogs
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Noah & me (GA)
Member Since 2016
Jena, will make this quick. I may have said something nasty earlier about Emergency Clinics. That's just one guy and one clinic, ignore it. But you knew that already. Mogs=Knowledge
I have great news. Simon ate all his dinner with just me standing next to him. No spoon or finger feeding. Also he jumped up on the couch to be with me when I first came home from work. He seems less confused and he's purring alot. He hasn't really done that in days. His back legs are still weak but he seems much better. Also his BG was 186 so no shot. Or should I give him a little one? Also I checked my other cats BG as well and it was 70. Does anyone think my meter runs low? Or does my cat lol?
Critter Mom
Member Since 2014
Oh, Jena, I'm so happy to hear your good news!
I've read reports here of kitties coming off insulin having GI upsets. My Saoirse experienced nausea when she went into remission and came off insulin but chronic pancreatitis influenced that so not a good example.
In these circumstances I don't know what to suggest to you about insulin; Simon's clinical signs sound so much better this evening. I'm concerned about the hind leg weakness you're seeing. Diabetic neuropathy can be a cause of such weakness but so can low potassium - and insulin can increase uptake of potassium by cells. Low potassium levels can be dangerous.
All I can suggest to you in the current situation is to get Simon checked over by a vet ASAP for safety - especially because of the back leg weakness and just in case it's a potassium issue. You've got some BG data now to show how low he has been going and a good ER vet might be able to sort out the question of whether both the Vetsulin and the dose could be part of what has been causing Simon to be so 'off' or whether another underlying issue may be the problem.
Another thing that you might want to discuss with a vet is whether Simon might be a brittle diabetic. Here is the text of a post by member Meya14 on the subject:
I wonder whether this might be relevant to Simon? (Again, brainstorming.)
If Simon's BG hasn't gone down after his food this time then his pancreas may possibly be 'sputtering' and that can make BG levels a bit unpredictable. If he's not able to stay in the normal range then he'll need to continue insulin treatment but again I suggest you ask your vet about switching to a gentler-acting insulin like Lantus if further treatment is necessary; (Vetsulin can be too blunt an instrument at lower numbers.)
BTW was Simon's recent diarrhoea a bit runny? When did Simon poop before that? Is there any chance he might actually be constipated? (Sometimes liquidy faeces can 'leak' around a stuck stool.) Constipation can cause nausea and appetite issues (and it can also be caused by low potassium levels).
Again, I'm sorry I can't offer any concrete suggestions other than a speedy visit to see a vet.
Mogs
Side Note:
There was discussion earlier in this thread about some insulins disagreeing with cats. From my own experience and from the experiences of others shared here about Vetsulin any ill effects seemed to subside and the kitties brightened up in the last few hours of each cycle as the dose was wearing off; the ill effects tended to wax and wane in line with the insulin doses; it didn't linger on for several cycles without any Vetsulin doses. There is an active thread on Feline Health at the moment where a kitty started treatment on Prozinc a few days ago and it seemed to really disagree with her in general, not just when the dose was active (thread title is 'Poorly Puss'). Could it be that something similar might be happening with Simon and Vetsulin? (More brainstorming here.)
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I've read reports here of kitties coming off insulin having GI upsets. My Saoirse experienced nausea when she went into remission and came off insulin but chronic pancreatitis influenced that so not a good example.
In these circumstances I don't know what to suggest to you about insulin; Simon's clinical signs sound so much better this evening. I'm concerned about the hind leg weakness you're seeing. Diabetic neuropathy can be a cause of such weakness but so can low potassium - and insulin can increase uptake of potassium by cells. Low potassium levels can be dangerous.
All I can suggest to you in the current situation is to get Simon checked over by a vet ASAP for safety - especially because of the back leg weakness and just in case it's a potassium issue. You've got some BG data now to show how low he has been going and a good ER vet might be able to sort out the question of whether both the Vetsulin and the dose could be part of what has been causing Simon to be so 'off' or whether another underlying issue may be the problem.
Another thing that you might want to discuss with a vet is whether Simon might be a brittle diabetic. Here is the text of a post by member Meya14 on the subject:
I wonder whether this might be relevant to Simon? (Again, brainstorming.)
If Simon's BG hasn't gone down after his food this time then his pancreas may possibly be 'sputtering' and that can make BG levels a bit unpredictable. If he's not able to stay in the normal range then he'll need to continue insulin treatment but again I suggest you ask your vet about switching to a gentler-acting insulin like Lantus if further treatment is necessary; (Vetsulin can be too blunt an instrument at lower numbers.)
BTW was Simon's recent diarrhoea a bit runny? When did Simon poop before that? Is there any chance he might actually be constipated? (Sometimes liquidy faeces can 'leak' around a stuck stool.) Constipation can cause nausea and appetite issues (and it can also be caused by low potassium levels).
Again, I'm sorry I can't offer any concrete suggestions other than a speedy visit to see a vet.
Mogs
Side Note:
There was discussion earlier in this thread about some insulins disagreeing with cats. From my own experience and from the experiences of others shared here about Vetsulin any ill effects seemed to subside and the kitties brightened up in the last few hours of each cycle as the dose was wearing off; the ill effects tended to wax and wane in line with the insulin doses; it didn't linger on for several cycles without any Vetsulin doses. There is an active thread on Feline Health at the moment where a kitty started treatment on Prozinc a few days ago and it seemed to really disagree with her in general, not just when the dose was active (thread title is 'Poorly Puss'). Could it be that something similar might be happening with Simon and Vetsulin? (More brainstorming here.)
.
He's really doing so much better today. Even pushing the dogs around. I will call his vet on Monday to see if he suggests a visit or is there anything I should be doing here at home. The ER vet is extremely expensive and we've already put a grand on the credit card. Ouch. Add that to the 1200 we spent last year trying to save our cat with the blood cancer, 1000 the year before on the dog in liver failure and the year before that 500 on a dog with a brain tumor. Ouch. At home we have now 2 dogs 18 and 14, 2 cats,Simon,15 and Jessie,16, and 2 turtles. By the way the day after I got Simon hone from the hospital, one turtle attacked the other turtle. That was 185 at the exotics vet. Now I have to rehome the attacker. They are separated. It's been busy.
Critter Mom
Member Since 2014
Just a tad!
We're very lucky over here; a great number of vets run their own out of hours service and the costs are far less than on your side of the pond. When you're speaking with the vet I suggest you ask about the hind leg weakness and possibly getting a blood test done to check his potassium levels. (BTW should neuropathy is the issue then better regulation and oral supplementation with B12 methylcobalamin can help a great deal with that.)
I'm so pleased to hear that Simon's acting more like himself and keeping the canines in check!
Have you managed to do a spot check of Simon's BG at all? It would be invaluable to you to have information on how he is doing after skipping another dose. I hope the weather will be OK for you to pop out to get the ketone strips tomorrow.
Mogs
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The weakness is better than when he first got sick 3 weeks ago. Just took his 3rd BG for the day it was 92. Yay! This will make day 2 no insulin. He is still drinking water or laying in front of the water bowl but it's not constant anymore. He did jump on the couch today and the armchair yesterday so at least he is confident enough to jump 2-3 feet high. No bed yet. And no jumping down. Do you think I should still do a curve tomorrow even if he's not on insulin? Should I still wake up at 4:30am to check his BG and feed him or do you think he could handle an extra hour or two without? I could use the sleep. I really couldn't figure out the spreadsheet today but maybe tomorrow.
Critter Mom
Member Since 2014
For this, two things: check Simon for ketones ASAP and also check the link about nausea symptoms I posted earlier in the thread. Also be sure to mention this behaviour to the vet when you speak on Monday (plus the diarrhoea, finnicky appetite and any other potential nausea symptoms you may observe). If Simon were my cat I'd ask my vet to test for pancreatitis, B12/folate levels and also to check electrolytes (inc. potassium) plus any other tests he might consider appropriate (kidney problems, for example, as they can also cause nausea and excessive thirst).
If you don't give insulin tomorrow then spot checks during the day before and after meals would be more helpful than a formal curve. Re the fluctuations in BG keep a log of the time you feed and note the number of hours after a meal when you test Simon's BG. If it's lower shortly after a meal then that shows the pancreas pulsing insulin. If it goes higher after several hours without food it could indicate a problem with impaired fasting BG.
If you need the extra sleep then I think you should take it: Simon and the rest of the crew need you to take care of yourself so that you can look after them.
Again I can't really suggest what to do about insulin dosing in this situation for the reasons I gave earlier.
I really am glad to hear that Simon's clinical signs are improving.
Mogs
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JanetNJ
Member Since 2016
I hear ya. Now that two of my cats are seniors and 7 cats all together, I automatically budget $500 per month for the vet... Just in case. If I don't need it I put the mony in an emergency fund. For the past few months I've needed at least $200 of it each month though. In 16 months I spent About 5 k
Critter Mom
Member Since 2014
Hi Jena,
How's Simon doing today?
Mogs
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How's Simon doing today?
Mogs
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Fantastic! I found out the diarrhea was never his to begin with, it was the dog's. His BGs were good throughout the weekend with only 1 semi high #. Sunday morning it was 223 but in his defense u usually feed him between 4 and 4:30 am and on Sunday I slept til almost 6. I checked 2 hours after he ate and it was 100. Guess not eating stresses him out lol. Me too. Hahaha. He is still not going downstairs to use the box but is peeing less frequently. He has not reverted to the adorable way of licking water from his paw that he used to though. I miss that sigh. I tested his ketone again from the puddle he left me on the floor and it was negative. I tested with strips from the new bottle I just bought and the one that got left in the car overnight. They were identical. He has been jumping up, purring, and picking on the dogs(poor dogs). I really hoped that would go away once he felt better. I was hoping it was a symptom of the diabeties but it turns out he is just a jerk to the dogs and my daughter. He is a love to everyone else. My Pit mix used to chase him all the time and he was a perfect cat but she died 3 years ago and Simon has become increasingly bold with the remaining dogs. He doesn't mess with the other cat though. He wears a calming collar and it does help some. I have been thinking about trying one of those thunder shirts for cats.
Critter Mom
Member Since 2014
Hi Jena,
Delighted to hear that Simon's feeling better - even if he is being a bit of a thug to the canines. Good news about the negative ketone check, too.
I noticed similar in my Saoirse and I asked my vet whether such spikes could be stress-related because she was hungry (especially in the days when she was still unregulated and still somewhat polyphagic). Through tracking her BG and her behaviours I found that it was protracted fasting itself and not agitation that seemed to be spiking her levels. It took me a while digging around the web but eventually I found the following info which explained what I empirically proved to be happening with Saoirse:
How blood glucose control works - and how it goes wrong
It's a very helpful, plain English article. Have a look in particular at the section on 'impaired fasting glucose with normal post-meal control'.
If this should prove to be the issue with Simon then dispensing wet, low carb food at regular intervals from a timed feeder could improve his overall BG levels, though he may still have the problem where his pancreas does not secrete enough basal insulin between meals to match output of stored glucose from the liver and over time his BG control may deteriorate. It's something you might want to discuss with your vet to see whether s/he can recommend a treatment strategy. It may be that a short period of treatment with a very small dose of a longer-acting, gentler insulin like Lantus or Levemir might allow Simon's pancreatic beta cells to rest and help him to achieve a more solid remission (much greater statistical chance of this if treatment starts as soon as possible after initial Dx).
Mogs
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Delighted to hear that Simon's feeling better - even if he is being a bit of a thug to the canines.
Good news about the negative ketone check, too.I noticed similar in my Saoirse and I asked my vet whether such spikes could be stress-related because she was hungry (especially in the days when she was still unregulated and still somewhat polyphagic). Through tracking her BG and her behaviours I found that it was protracted fasting itself and not agitation that seemed to be spiking her levels. It took me a while digging around the web but eventually I found the following info which explained what I empirically proved to be happening with Saoirse:
How blood glucose control works - and how it goes wrong
It's a very helpful, plain English article. Have a look in particular at the section on 'impaired fasting glucose with normal post-meal control'.
If this should prove to be the issue with Simon then dispensing wet, low carb food at regular intervals from a timed feeder could improve his overall BG levels, though he may still have the problem where his pancreas does not secrete enough basal insulin between meals to match output of stored glucose from the liver and over time his BG control may deteriorate. It's something you might want to discuss with your vet to see whether s/he can recommend a treatment strategy. It may be that a short period of treatment with a very small dose of a longer-acting, gentler insulin like Lantus or Levemir might allow Simon's pancreatic beta cells to rest and help him to achieve a more solid remission (much greater statistical chance of this if treatment starts as soon as possible after initial Dx).
Mogs
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Well I took Simon back to the vet today because he's been circling the last 2 days and last night and this morning wouldn't eat. The vet tested him and found him to be neurologically deficient all down the left side. It is his determination that Simon has had a stroke. He believes that Simon has cancer which probably also caused his diabeties. I took Simon home with me today because my dad died Sunday night and I couldn't handle Simon too. I will bring him back Saturday. A few more days with my "fat boy". Man sometimes life just sucks doesn't it?
Nan & Amber (GA)
Member Since 2016
Oh, wow. That is just awful-- I am so, so, sorry... 
Kris & Teasel
Member Since 2016
I'm so sorry that you're having such a difficult time.
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