Glucose Spike - dose help?!

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Jezzie

Jezzie

Member Since 2020
Hey Everyone
For those who've seen my previous post...Selene was recently diagnosed with IBD/Lymphoma and we commenced prednisone 2 and a bit weeks ago.

We've been watching the glucose levels and despite sitting high the vet has been reluctant to make changes, frankly its starting to worry me!! We made our own dose adjustment on wed morn (1.0 to 1.25 glargine) and then again on thu (1.25 to 1.5).
Despite having eating issues over the last few days she'd been drinking like mad and her glucose has varied between 16.5 and 22.5.

This morning we spiked to 29 :(
I immediately called our specialist and they advised no dose change (wtf :mad:)

So this morning she has eaten a double serve of boiled chicken (she was very hungry and then proceeded to drink heaps straight after). I checked her glucose before she had breakfast (9am) and that was when I got 29. Her previous meal was at 9pm the night before (chicken) and then she had approx a tablespoon of z/d at 11:30pm.
She had 1.5 units of glarine at 9am today

I've updated our spreadsheet and I'm hoping I've done it right.

I'm at a loss, I'm certain she needs more insulin but I keep being told to not change her dose and that its common for a spike with prednisone which I do understand but here we are 2 weeks later...we can see shes sitting high so why not increase!?

I'd really appreciate some feedback on what you think her dose should be.

NB: when looking at her spreadsheet you'll notice another spike on monday 20/4, this was due to her escaping outside and missing her morning insulin (a first for us!!) we did finally get that to drop back down to 17.4 but I still feel this is too high.

EDIT to add no ketones phew
 
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Jess the first thing I notice is that you are not doing many tests during the cycles at all.
Lantus (Glargine) dosing is based on how low the dose takes the BG so the nadir or lowest point in the cycles is important.
If there are no tests there is no way of knowing how low Selene is going. She could start off at 23 and drop down to 5 during the cycle and go back up to 23 by the end of the cycle.... And you would have no idea this is happening ..That is common.
Heat no ketones!

it is very possible she is dropping down and bouncing back up again, and to increase the dose with no data from during the cycles would be risky.

I can also see you increased the dose to 1.25 for 3 doses and then increased to 1.5 units.
It is great you are only increasing by 0.25 units at a time.
With Glargine you need to hold the dose for at least 6 cycles (3 days) when you increase the dose, to let the depot fill otherwise you can get wonky numbers. The same happens if you chop and change the dose....Glargine likes consistency

What I would do is to get some tests in during the cycles so you can see what is happening.
If you can get one or two in during the day cycle say at +3 and + 5 one day and the next day +4 and +6. That will help give an idea of what’s happening. Then in the pm cycle it is a really good idea to always get a before bed test in. That will tell you if Selene is likely to drop lower at Night. If the before bed test is lower than the preshot BG then she is likely to drop lower and you might want to get up later and check the BG.
It is possible she will need more insulin, but to do if safely, you need to get tests in during the cycle.
Is she getting prednisone or prednisolone?
I know it’s frustrating but hang in there, keep posting and we can help you get Selene sorted.
 
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Thanks for your reply @Bron and Sheba (GA)
She’s on Prednisolone, didn’t click on the slight difference there.

Happy to do further tests it’s just her poor ears are a mess of bruises. We were mainly doing the BG checks before eating and injecting to ensure we weren’t getting crazy levels though I know for actual curves additional tests are needed.
I suppose I didn’t think of it like we’re doing a curve as we typically do those with the free libre sensor so it’s less invasive.

Thanks for the info re holding the dose as well.
 
Jezzie said:
Thanks for your reply @Bron and Sheba (GA)
She’s on Prednisolone, didn’t click on the slight difference there.

Happy to do further tests it’s just her poor ears are a mess of bruises. We were mainly doing the BG checks before eating and injecting to ensure we weren’t getting crazy levels though I know for actual curves additional tests are needed.
I suppose I didn’t think of it like we’re doing a curve as we typically do those with the free libre sensor so it’s less invasive.

Thanks for the info re holding the dose as well.
Click to expand...
Glad it is the prednisolone!
Great you are checking before all doses given. That is so important!
Are you holding a cotton ball over the prick after you get the blood. That will help stop bruising.
You don’t need to do curves all the time, just a couple in the first half of most of the am cycles would be great Data and the before bed test.

There is an ointment called Neosporin pain relief ointment that is good for cats ears.
We can’t get it here but I bought some from the US. Here is a link
https://www.amazon.com/Neosporin-Pain-Relief-Action-Ointment/dp/B000NQ10FK?tag=felinediabetesfdmb-20
 
Bron and Sheba (GA) said:
Glad it is the prednisolone!
Great you are checking before all doses given. That is so important!
Are you holding a cotton ball over the prick after you get the blood. That will help stop bruising.
You don’t need to do curves all the time, just a couple in the first half of most of the am cycles would be great Data and the before bed test.

There is an ointment called Neosporin pain relief ointment that is good for cats ears.
We can’t get it here but I bought some from the US. Here is a link
https://www.amazon.com/Neosporin-Pain-Relief-Action-Ointment/dp/B000NQ10FK?tag=felinediabetesfdmb-20
Click to expand...


I hold as long as she'll let me haha! She's usually pretty keen to get to her food cos she knows the pattern of 'come over for a test and stay still and then you get your food'
I've heard of neosporin for humans before, I'll order some and give that a go :)

She's all for throwing me for a six atm ... just did pre dinner test and she's coming in at 13.8 ... mamma mia this girl will be the death of me!!!!!
 
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