Help! Duffy's numbers all over the place

LisaZT

LisaZT

Member Since 2018
Duffy, 10yr old acro cat. Radiation last year. Seemed to help. Last Weds he had to go to emergency, severe hemolytic anemia. He had to have a transfusion. His bg over the last 3 months has crept up to the high 500's and would go down to 300's after 5.5 units lantus. He had an ongoing mouth infection I did not pick up on.

He got stabilized and put on cyclosporine to depress his immune system, clavamox and veraflox. Friday thru Sat his bg climbed even higher to over 650. Bumped him up to 6 Lantus. Still high Sunday. Monday he drops to 96. At this point he's also slightly impacted (megacolon). When he gets impacted his bg goes into the 100's and nobody knows why. Did not give any insulin Monday because of lows. Unstoppered, BG goes to 335 by Tues morning, gave him 3.5 lantus and sub-q, evening reading 98- no insulin. This morning it's 125, no insulin, this evening 600+, gave 5.5, 6 hours later still 600+. The specialist that saw him last week is on vacation and his regular vet is not returning emails. I'm not sure what I'm doing is correct. Any input?
 
First, hello and welcome to you and Duffy. My acrokitty girl also had radiation, specifically SRT.

We can help with dosing, but we are very data driven here and keep our blood glucose tests in a spreadsheet to help see blood sugar patterns. If you can do the same, we can help you better. Here is a post on the spreadsheet http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/ Without seeing the data, I cannot tell if the dose is too high or too low. What was Duffy’s dose before radiation?

If you haven’t already, read the yellow starred sticky notes too.
 
Wendy&Neko said:
First, hello and welcome to you and Duffy. My acrokitty girl also had radiation, specifically SRT.

We can help with dosing, but we are very data driven here and keep our blood glucose tests in a spreadsheet to help see blood sugar patterns. If you can do the same, we can help you better. Here is a post on the spreadsheet http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/ Without seeing the data, I cannot tell if the dose is too high or too low. What was Duffy’s dose before radiation?

If you haven’t already, read the yellow starred sticky notes too.
Click to expand...

2 units before radiation. The radiation was really to improve airflow and organ function.
Crista & Ming said:
It's quite late here and the acro cat experts are probably all asleep right now. In the mean time, it would be helpful if you could fill out a spreadsheet. It would help us get a clearer picture of what's going on with Duffy's number. Here are the instructions: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

For now, how is Duffy's appetite? Has he been DKA before? Are you able to test for ketones?
Click to expand...

Appetite is in the toilet, sometimes feeding him via syringe. No DKA, was tested at ER.
 
Antibiotics can kill tummy flora, making them feel unwell. Have you tried giving him probiotics? You have to do it two hours apart from the antibiotics.

Ketones can be tested at home with ketostix, available at most human pharmacies. It’s good to test daily for ketones when they are in high numbers. Ketones can develop quickly.
 
No probiotics. For some reason vet is resistant. His numbers are still all over the place.

Last evening he was 543, gave him 3.5 Lantus, he had 100ml sub q, this morning his bg was 46. My heart stopped. Gave him a teaspoon of a vitamin gel, first ingredient is corn syrup, got him up to 136. 4 hours later he's 225. Are the sub q's driving down his bg? Nobody knows.
 
I suspect 3.5 units is too much Lantus. Did you get any mid cycle tests? With the spreadsheet, we can help you with dosingninstead if relying on the vet.

You don't need your vet’s permission to try probiotics. I use them occasionally on myself without consulting my doctor, and gave them to my cat to help with gut issues.
 
I was being cautious. I think I may have a better handle now. It's a combo of sub-q's and insulin that's doing radical shifts. So now if under 250, sub-q only, over 250-under 400, 2units, half a sub-q, over 400- 3+ units, full sub-q. It's a dance.
 
Are you giving subq in a different spot from the insulin. When I gave fluids (scruff), shot was in the flank. I also tried to separate the times and tried to do subq after nadir, when Neko’s numbers would be rising anyway. Note that not all cats go lower with fluids, it’s very much ECID.

I don’t know what insulin dosing method you are using, sounds more like you are deciding to shoot based on preshot numbers. Here we use methods based on nadirs and find that tends to smooth out the numbers because the depot can get established. You might want to read over the dosing methods sticky note. I used Tight Regulation with my acrogirl,
 
Any chance you can test even 3-4 hours after the shot, maybe just before bed. Or somewhere mid cycle on weekends, We determine how to change the Lantus dose based on how low it is taking the kitty. Typically the preshots are the highest point of the cycle. We test then to make sure it’s safe to shoot, but it’s the other tests that tell us how to change the dose.
 
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