Flynn- PMPS 589- Help!

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Morgan & Flynn

Morgan & Flynn

Member Since 2020
Flynn had an abdominal ultrasound on Thursday to rule out any pancreatic tumors. We were instructed to not feed from midnight until he came home (which was around 5pm Thursday night) because he had to be sedated. We were told by his vet to give him half his insulin dose without food that morning. We fed and dosed him regularly that night. His blood sugar read HI (we use ReliOn prime and it will say HI if it’s above 600) for most of the night. The lowest it ended up being that night was in the height 300s. Since then we can’t get it back down though.. he has been in the 500s/400s since Thursday. Has anyone else had this experience? Will it just take a little time for his numbers to come back down? Is there anything I can do to help lower those numbers? I raised his dose from 2.5u to 3 today.
Thanks in advance!
 
here is your previous thread for continuity https://www.felinediabetes.com/FDMB...on-the-road-to-remission.249022/#post-2809472

I’m not sure why his numbers are high at the moment but there were no midcycle tests done for the three cycles before the high numbers, so it is possible that he dropped lower than he is used to lately and is bouncing. Bouncing can happen if the BG drops too low, too fast or lower than the cat is used to having lately. Bounces can last from 1 to 6 cycles. There is nothing you can do but wait them out.
Sometimes when the bounce is breaking, the BGs can drop faster and lower than normal so just be aware you are on the 6th cycle now so watch for the BG to see if they drop..The highs may not be a bounce but keep that in mind.

He did get a 1/2 dose on 24th before the ultrasound so that could be contributing to the higher numbers, although he did have a high BG before the 1/2 dose.
It ‘s not unusual to see cats in those high numbers and it won’t hurt them short term but we do want him to come down into lower numbers.

How is his appetite and demeanour?
Was the ultrasound normal?
Have you tested for ketones?
 
Thank you for looking into all of that! He is acting normal! He just ate and is napping now. We haven't received our ultrasound results yet though. And no I haven't tested for ketones, but I will try to tonight.
 
One thing that I noticed is you're holding the dose too long. On Tight Regulation, you should only hold the dose for 6 cycles if it's not getting him into green or blue numbers at nadir. By holding it so long, you give his body a chance to get used to it which can mean having to go a lot higher to break through.

I'm glad to see you starting to get some tests on the PM cycle (other than just the PMPS). Most cats go lower at night, so it's important to get at least 1 other test every cycle. A lot of us would drink a large glass of water in the evening so we "had to" get up in the middle of the night and as long as we were up, might as well test the cat!

Hopefully the new 3U dose will get his attention!
 
Morgan & Flynn said:
Thank you for looking into all of that! He is acting normal! He just ate and is napping now. We haven't received our ultrasound results yet though. And no I haven't tested for ketones, but I will try to tonight.
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Hi Bron! It kind of looks like his numbers are bouncing.. what causes that? He dropped from 594 to 493 in less than an hour..
 
Bounces are caused when numbers drop low, if they drop fast, or if they drop into a range your cat isn't used to. As a result of the drop, the pancreas and liver release a stored form of glucose along with counterregulatory hormones that cause BG numbers to spike. It's possible that Flynn dropped below the 394 last night and the HI this morning was a bounce. It's also possible that you're beginning to see the bounce breaking but you'll need to get a couple of tests this cycle to see if the numbers are continuing to come down.

Another FYI -- Lantus is fundamentally a gentle insulin. It isn't good a "squashing" numbers to drive them down. When numbers are high, it's harder for Lantus to grab on and bring the numbers into a better range. The numbers will come down, it just takes longer.

I suspect that you're seeing the results of a smaller dose along with the carry over of the stress from the ultrasound. In addition, I agree with Chris -- you've held the 2.5u dose for too long. It would be more than helpful to get at least one test each cycle in addition to your AMPS and PMPS. Without knowing how low the dose is bringing Flynn's numbers, your essentially shooting blind. Lantus dosing is based on the lowest number in the cycle (i.e., the nadir). In addition, the lack of PM tests means you're missing half of your data. Holding a dose that isn't bringing numbers into a desirable range allows glucose toxicity to develop. The term sounds worse than it is -- it means that your cat starts to treat the higher numbers as his new normal. The dosing methods we use with Lantus encourage you to evaluate the dose on a regular basis.
 
Sienne and Gabby (GA) said:
Bounces are caused when numbers drop low, if they drop fast, or if they drop into a range your cat isn't used to. As a result of the drop, the pancreas and liver release a stored form of glucose along with counterregulatory hormones that cause BG numbers to spike. It's possible that Flynn dropped below the 394 last night and the HI this morning was a bounce. It's also possible that you're beginning to see the bounce breaking but you'll need to get a couple of tests this cycle to see if the numbers are continuing to come down.

Another FYI -- Lantus is fundamentally a gentle insulin. It isn't good a "squashing" numbers to drive them down. When numbers are high, it's harder for Lantus to grab on and bring the numbers into a better range. The numbers will come down, it just takes longer.

I suspect that you're seeing the results of a smaller dose along with the carry over of the stress from the ultrasound. In addition, I agree with Chris -- you've held the 2.5u dose for too long. It would be more than helpful to get at least one test each cycle in addition to your AMPS and PMPS. Without knowing how low the dose is bringing Flynn's numbers, your essentially shooting blind. Lantus dosing is based on the lowest number in the cycle (i.e., the nadir). In addition, the lack of PM tests means you're missing half of your data. Holding a dose that isn't bringing numbers into a desirable range allows glucose toxicity to develop. The term sounds worse than it is -- it means that your cat starts to treat the higher numbers as his new normal. The dosing methods we use with Lantus encourage you to evaluate the dose on a regular basis.
Click to expand...
I just got done working for the summer so I have recently been able to start testing more during the day, I am aware that I need more mid cycle tests. I have been trying really hard the past almost 9 months to do what I can with the time I have. If you look at the past week or so, you’ll see that I’ve been getting multiple tests in per cycle. Im asking for help specific with the really high numbers that we have been seeing since Thursday. These aren’t anywhere near what his “normal” had been before. I guess I will just wait it out and keep testing.
 
I don't disagree -- the >400 numbers are totally out of sync with what you've been seeing. It looks like Flynn was stressed at the vet visit. While typically numbers come down once a kitty is home, that may to always be the case. If stress hormones were really high, it may take a couple of days for them to clear. Numbers are coming down a bit by mid-cycle today.

The best I can do is speculate. What I said above holds.
 
Just checked him and he’s down to 311! Hopefully we can keep them down :) it seems like this new dose of 3u might help him make some progress!
 
I would increase to 3.25 units tomorrow providing Flynn doesn’t drop lower tonight.
If you are doing TR you can increase after 6 cycles, not 6 days providing the BGs are telling you this.
I would also get some later in the pm cycle tests in if you can. Unless the PMPS is much lower than you are used to, I wouldn’t get a +1.
I would get a +3 or +4.
The + 1 usually has a food bump and the insulin doesn’t normally onset until +2 so a + 3 our 4 will give you an idea of how the cycle might go.
 
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