Glucose Curve: 400 to 70 BGL

[Steve and Blue]

Greetings.

My 13 y/o male cat has been recently diagnosed with Diabetic Ketoacidosis. He was in the ICU for 5 days and is now home. He has been put on PZI @ 4 units twice/day. He has not had Ketones in his urine for 5 days (since he's been home).After much research, I have taken him off of all dry foods and am feeding him hi protein/low carb canned foods exclusively. Clinically he is well but does lack some energy.

Yesterday he had an initial exam by the local vet who found the BGL to be in the high 70's six hours after his morning insulin shot. We were concerned that this may be a bit low considering the amount of PZI and today we had his glucose curve. I realize this is a bit early, but the vet recommended it. Well, I brought the cat in at 8:00AM and his BGL was in the low 400's. After his shot, his BGL declined slowly and leveled out at 78 almost 9 hours later when it began to rise. I did not get to 'finish' this Glucose Curve as the vet closes at 6:00pm and I have yet to home test him.(I do have the urine test strips, but of course this tells me nothing as to how low his BGL acutally is. I have the blood test kit, but the vet has it as they want to see if there is any difference between there kits and mine.)

Obviously, this a a wide swing and I am very concerned to say the least. The cat has been on the PZI only one week though - so hopefully things even out. I do feel that 4 unit dosage with a BGL that low is somewhat dangerous considering he has a low nadir. The cat is eating well and hopefully the research I've done on high protein diets is beneficial and not hurtful in this case.

I think I'm looking for some reassurance here? :? Are these numbers typical so early in the game? Is it true that a cat on a high protein diet is much less likely to go hypoglycemic? Is it wise to keep the cat on such a high dose of PZI considering the low numbers? Any advice appreciated. Also, the vet I am using was talking about putting the cat on human insulin (it's all they use). They say that the cat would most likely not get such a wide swing in BGL if a switch was made in a few weeks. What I have researched does not seem to agree with this opinion, but his numbers are very worrisome. Thanks for any and all advice!

 

[Sheila & Beau GA & Jeddie GA]

You have a couple of immediate issues here because he has had ketones. You do not want to risk more ketones. Another is that it sounds like you just changed the diet to low carb? That can lower insulin needs. Another issue is that cats generally test higher at the vet because of stress - so that 70 at the vet could become a dangerous low number at home where he is not stressed.

Get your meter back tomorrow regardless of it being tested by vet or not. The vet needs to test capillary blood with your meter and *may* need to test venous blood with his meter if it is a special vet meter. Home meters are not designed to test venous blood and the result will not be accurate. Also, all meters have variance up to 20%. They are tools to monitor trends and not absolutes. Generally, the results of up to 20% difference (80-120 for a "true" BG of 100) doesn't change the treatment protocol.

Anyway, you need to find out how low he is going at home. He may be getting too much insulin and the low numbers are causing rebound, but you can't tell without the numbers. Was the 400 tested at the vet? That could have been elevated from stress too.

There pretty much is no such thing as "typical" numbers. Supposedly, levemir (one of the 'human' insulins) needs time to build up in their system, but my cat Beau dropped to the 80s on the first shot and the 30s by the third shot - so I lowered the dose. 4u is a large dose and not a typical starting dose, which would be 1u twice a day. I would not drop to 1u just now because of the ketones, but 4u does seem like a awful lot of insulin. And if it is causing very low numbers and rebound into high numbers, that will make your cat feel pretty terrible (on top of feeling terrible from the ketones).

You probably should be leaving food out for him all the time in case he starts to drop too low.

 

[Steve and Blue]

Thanks for responding so quickly.

Yes, the 400 and 78 were both tested at the vet, and I switched him to low carb. I am letting him eat as much as possible - and he is eating two cans of Fancy Feast at the moment. :smile: The vet recommended 2 1/2 5.5oz cans per day - which I agree with. I should also mention he is about a 16-17lb cat at his ideal weight.

I am very tempted to drop his morning dose to 3 or 3.5 and then take your advice and get the meter back. I think this would be a good compromise until I can get some numbers from home as you suggested. I don't think lowering the dosage .5 or 1 unit would do too much harm? Thank you!

 

[Venita]

I agree with Sheila's points, and support your inclination to drop the dose. If it were me, I would go to the 3U. And, yes, get your meter back today and start testing your sugar kitty at home.

Besides Levemir, there is another human insulin that is used alot and with great success. Lantus (glargine). We generally recommend against the human insulin, Humulin N, because its drops can be even steeper than what you are seeing with the PZI. Also, if I were going to switch insulins, I would do it now. I see no reason to wait a few weeks. When my cats were on a PZI insulin, they didn't experience these drops. Therefore, I can't really advise whether the curve will "smooth out" if given a few weeks.

 

[Sheila & Beau GA & Jeddie GA]

Oh, Venita, I didn't even think that the vet meant Humulin when they said "human" insulins. I thought they meant either lantus or levemir.

I would refuse Humulin, if that is what they meant. It's tough to get decent numbers from.

One thing (ok, two things) to add is that when you start testing, you want to watch for "better" numbers as you lower the dose. This means lower PS (preshot) numbers and less of an extreme drop (although 78 is an excellent number, he is probably dropping lower at home). If you see better numbers then you know less insulin is better. If you don't, well, post what you are getting and "we" can see if we can figure out what is going on.

Food: is he only eating 2 cans of FF per day, or was that what you were feeding "at that moment"? Try and encourage him to eat more by gently warming the food and/or try sprinkling tuna flakes on it. Cosmic Cat makes tuna flakes and I get mine at PetSmart. Once he is clear of the ketones he may eat a lot more until he is well regulated. Both of mine ate about 150% of what they needed for optimal weight, then slowed down to normal amounts.

 

[Steve and Blue]

Thanks to all for the advice. :thumbup

Blue cat is eating very well the last couple of days. He is eating lots of high protein canned food. Right now about 12-15oz/day. I gave him a 3.5 unit dose this morning
and will most likely give him a 3 unit dose tonight. He I will keep it there for at least a week or until his blood tests tell me otherwise. I have yet to get the Glucometer so I can't measure his levels, but will get it tomorrow. I'm waiting for him to pee so I can test for Ketones and his urine glucose level. He has not had any Ketones for a solid week. He looks great and doesn't act like he is having a problem... but as we know the numbers will tell the true story.

You guys have a great and informative site and I'm very glad I found it. I'll post again when I get some numbers.

Edit: I have just seen that PZI is no longer a bovine insulin, but human. I was under the impression that it was still from cows. I have a lot to learn. I think there is
a good possibility that this may be contributing to the problem. Back to the research...

 

[Steve and Blue]

Ok, I was finally able to get a home glucose curve on Blue Cat and here are the results from yesterday. Since I last posted, I had lowered his dose to 3 units
since he had some low reading the last few days. I attribute this to the Hi protein/low carb diet he is now on. Once again, he is on the ProZinc recombinant human insulin.

3-28-2010

amps 304 (3 units)
+3 233
+6 148
+9 96 :!: (first reading said 'low' and retested minutes later)
+12 pmps 150 (3 units, thought about decreasing units, but insulin seems to peak between 7-9 hours ...)
+15 59

3-29-2010 (was a bit nervous about the lows so monitored some extra)

-2 AMPS LOW :!:
amps 189 (Decided to drop to 2 units this morning, vet agreed that I did the right thing after the fact) ;-)

Would really appreciate some opinions on this! I'd like to think the diet is helping. So far every dosage decrease I've made
seemed to be 'helpful'. The cat shows no ill effects and is eating very well - about 12-oz a day. I'm going to do a new Glucose test
soon and will post. Once again - opinions appreciated!

Edit: Just tested:

+9 169

 

[Jen & Squeak]

I think that there is some long duration going on, and you need a day or two of hometesting to see where this is all going. I think that the 3 units at 150 was much too much for a beginner and that you need to be more cautious like you did today. Keeping the history of ketones in mind, perhaps 2 units for numbers under 200 is sufficient, but it is impossible for us to really know. There is a fine line between overdosing and underdosing and the ketones makes that tougher.

So my suggestion is stick to that lower dose, test frequently (a pain but will pay off) and also make sure that you are testing the urine for ketones and that your cat is eating well.

 

[Steve and Blue]

I think that there is some long duration going on, and you need a day or two of hometesting to see where this is all going. I think that the 3 units at 150 was much too much for a beginner and that you need to be more cautious like you did today. Keeping the history of ketones in mind, perhaps 2 units for numbers under 200 is sufficient, but it is impossible for us to really know. There is a fine line between overdosing and underdosing and the ketones makes that tougher.

So my suggestion is stick to that lower dose, test frequently (a pain but will pay off) and also make sure that you are testing the urine for ketones and that your cat is eating well.

.
thanks. He is definitely eating well. His numbers were 288 at tonight's pmps. I was hoping for a bit lower, but...

I think I'm going with a 2.5U dose for now and once again plan on keeping it there unless his numbers go way out of whack. If I see that his BGL hit's 300 I'll test for the Ketones. He is not urinating or drinking nearly as much, so it's hard to catch him in his box... I think that's a good thing.

Originally he was in the high 400's w/ Ketones when he was admitted to the hospital, and they had a hard time keeping him low. However, they were also feeding him lots of Purina DM dry food. :YMSIGH: I'm seeing improvement with the current diet and hopefully his numbers get more consistent after a few weeks. If not, I'm looking into Glargine or the BSI PZI bovine insulin as an alternative.