HELP! glucose levels going up??

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Tucker'sMom-Jen

Member Since 2014
I could seriously use some help here!

Tucker has been on ProZinc since 8/31, starting at .5 u bid and increasing in .5 u increments. He had been starting out pink and staying pink, sometimes his +6 would be yellow and so I kept titrating up. Two weeks ago his amps was yellow for the first time and I was thrilled to see blue for +4 and +6, but he had a bounce back to pink for his pmps so at the advice of folks here on FDMB I decreased his AM dose down .5. I have been titrating up ever since, back to the pink amps, yellow +6 and pink pmps.

Until today. Since his amps has been stubbornly stuck in the low 300s I increased him to 3.5 units from 3 units at 7am today. For the past 3 days he had been getting 3 units AM and 3.5 PM. Since I made a dose increase I checked him every 2 hours, but his glucose went UP :(. His pmps was the highest it has ever been at 396 (that was the second test- the first test was 402 and I thought it was an error).

I know he got his insulin this morning. As a nurse I know what to feel for when giving an injection and have been very careful to double-check each injection site to make sure there were no inadvertent misses. Other than infection, what should I be looking for?? Does he just need another type of insulin? He is on chronic daily steroids... My SS is in my signature (I hope) and I welcome any advice.

BTW - I gave him his 3.5 unit PM dose without increasing it.

thanks!
Jen and Tucker
 
I'd increase, the next shot you can monitor, to 4 units. He is still pretty flat and high. With the 20% variance, today's numbers are still relatively flat. If he is on steroids, regulation will likely take more insulin. You just have to work around the steroids and give enough insulin to balance it.
 
Hi Jen, we have a diabetic CH kitty too! Our Zener is on Lantus, and we don't know anything about prozinc so can't offer any help there. Zener is also on prednisolone for intestinal bowel disease, 1.25 mg BID. We just about doubled his insulin when he started on steroids, which is unfortunate, but the pred has really helped his appetite. Let us know if we can help.
Liz, Zener's other mom
 
388 at +2 so hopefully trending down. Will have to see what tomorrow brings. I just wish I could rely on my vet for advice... So glad for this board!!!
 
Update: Tucker's amps was 355 and I gave him 4 units of prozinc. At +2 he was 315 and I realized I forgot to give him his pred so he got 2.5 mg of that. +4 was 343 (pred prolly!) and at +6 just now he is 250!

What a roller coaster!!
 
I did some research this morning on insulin resistance in cats and found that those on steroids typically require larger doses of insulin. Pretty much described Tucker, since the only thing keeping his anemia at bay is the prednisolone.

Any thoughts on possibly needing a higher dose in the PM since his PM pred dose is higher? He also eats more during the night (prolly from the pred).

I am going to increase his PM to 4u and see what happens over the next day or so.

Stupid question - when (if) he gets more regulated, should I use a sliding scale or would I continue to use whatever dose of insulin we are on at the time?

Thanks for your help, BTW!
 
I don't know. Right now the same dose looks pretty good for both pre shots (which are generally in the same range) If things change and one is higher than the other, yes, you definitely can give a different dose am and pm.

Not a stupid question - the only stupid questions are the ones you wonder about but don't ask. :mrgreen: I think I'd wait and see how things look and what the doses look like when he is more regulated. (We generally consider a cat regulated when they are in the mid to lower 200s at preshot and double digits at nadir, but not below 40. He is headed in the right direction!)
 
I am honestly not sure what Tucker's count is. As long as his nose and gums are pink, I am happy! I am to the point with my vet that I only bring him in if there are signs of trouble - pale nose/ears/gums. These days his anemia is the least of my worries! At least that is stable...
 
Yikes! Now that I have increased his prozinc today to 4u/4u we are seeing some action!

His pmps was 349 and I gave 4 units. His pred was given at +1 to get back on schedule tomorrow...but his +3 is 135!!!

I am hoping the pred kicks in and he doesn't drop any lower. He did eat, thankfully, but I am planning to try and stay awake for a retest at +4. If that # is higher I think I can safely go to bed.

Fingers crossed.
 
Sounds like a good plan, Jen. Very nice to see an early blue, but you don't want it dropping into the 50s. I'm with you, the steroid and food will probably bring him up.
 
If he'd go down to the 50s, you can give him a tablespoon of the gravy off a high carb food. But I am going to hope he stays up in those blues.

You may get a bounce in the am because he hasn't seen a blue in awhile, but I'd still stay with 4 units.
 
Update 9/25:

Better today so far. I was expecting a big increase after last night's blues but surprisingly not. Gave 4u again for amps 368 and +2 was 351 so no quick drop. I am curious how low we go for nadir but time will tell. So glad that I work from home and can keep an eye on Tucker!

Thanks again for the advice and support last night, Sue :smile:
 
As expected after the blues last night... He bounced. PMPS was his highest yet = 407. I gave him the 4 u dose we are currently testing out and I guess things will settle after a few days? I am hoping he doesn't drop into the scary blue range again tonight...
 
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