Hi Alphatrak2 readings

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MyFred

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Hi all..... my cat Fred has become diabetic again after being in remission. My vet & I believe that he became diabetic initially as a result of pancreatitis. Historically, he would get 3 units of Lantus twice a day. Diet is W/D kibble available all the time plus W/D wet for dinner and some 15 minutes before insulin shots to promote insulin uptake of sugar. I can't get his BG to stabilize - he currently is on 5 units of Lantus, twice a day. Doing a BG curve today and it reads 498- Hi (no number displayed, just the word). Have I started a vicious cycle by increasing his insulin causing him to eat more causing his numbers to increase etc? Thanks.
 
MyFred said:
...Diet is W/D kibble available all the time plus W/D wet for dinner and some 15 minutes before insulin shots to promote insulin uptake of sugar...
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The diet may be part of the problem. You want a food which has less than 10% of the calories from carbohydrates and W/D isn't it. Pop over to Cat Info for a detailed food chart which indicates the percent of calories from protein, fat, and carbohydrate, plus phosphorus levels. There's also explanation of why to feed a canned or raw diet.

With Lantus, you don't have to wait to give food. Lantus generally doesn't start kicking in until about 2 or more hours after the shot. Waiting just lets the glucose go higher for longer with a food spike.

MyFred said:
I can't get his BG to stabilize - he currently is on 5 units of Lantus, twice a day. Doing a BG curve today and it reads 498- Hi (no number displayed, just the word).
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Its great that you are home testing!
Just checking
Do you test before you give insulin?
You're doing a curve - every 2 hours or every 3 hours (mini-curve)?
What meter?

MyFred said:
Have I started a vicious cycle by increasing his insulin causing him to eat more causing his numbers to increase etc? Thanks.
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No. He'll eat more because he isn't regulated and can't use all of what he eats.
 
BJM - thanks for the quick response! W/D is what my vet recommends, so will ask her about other options after reading food posting to which you refer. Didn't know about the 2 hour delay for Lantus to become effective. I have wondered if he could have developed antibodies to the Lantus causing it to be blocked and thus not effective. Have you (or anyone else) ever heard of such a thing?
I do all BG testing before giving insulin. Have AlphaTrak monitor which my vet loaned me, using AlphaTrak2 strips which are acceptable. Have called the Abbott Animal Health line to ask about the 'Hi' reading. Being a Sunday, I expect to hear back on Monday.
BG curve is every 2 hours. And being an Excel spreadsheet lover, I'm graphing the data points plus when insulin shots are given. If I notice Fred eating kibble, that get's noted also. Before today, the BG's have been between 200-'Hi", so in other words, all over the place.
 
Switched my foster cat Wink from that very high carb Hill's W/D to low carb Fancy Feast pate style and his numbers dropped dramatically.

Took 3 weeks to transition him from the dry to the wet. Used most of these transitioning tips by vet, Dr. Lisa Pierson.

Look at his SS in my signature.
 
BJM wrote: The diet may be part of the problem. You want a food which has less than 10% of the calories from carbohydrates and W/D isn't it.
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Note: Fred has pancreatitis and I gather that a food low in carbs is not a first choice in these cases. Thanks for the thought....
 
You might want to read this primer on pancreatitis It's a synopsis of many of the links at the end of the post.

Diet Selection
There are no studies to support dietary choices for cats with pancreatitis. High-fat foods are not implicated in causing pancreatitis in cats; however, some internists avoid feeding high-fat diets when treating these cats.
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Recommendations for feeding cats with pancreatitis are based upon opinion.
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He still has pancreatitis? That's not helping at all. Plus I am surprised he went into remission with eating dry food, he must have had some luck and some residual pancreatic function at that point. Stopping dry will be very important in getting him back into remission

Do you want to convert your sheet into our format? It would help us advise you a lot more. Here is our setup link..http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Wendy
 
Thanks for the link to the pancreatitis article. Yes, Fred's specific fpl was just above high normal when he became diabetic again. It had been in the 30's when he was first diagnosed earlier this year which is way, way high! With the current bout, we think the pancreas is inflamed just enough to affect insulin production. I've boosted his Lantus dose to 6.5 u twice a day to see if that will decrease his BG levels. And, 150 mL subq of fluids continues. Discontinued the BG curve as the readings continued to be 'Hi', which told me nothing. Will keep you posted. Thanks for all the postings.
 
I would still like to see his readings to make sure he isnt bouncing - would you set the spreadsheet up? We have looked at hundreds of cats and may be able to advise better when we see the numbers over time.
 
What is bouncing?
And if Fred's 'hi' BG level is due to too much insulin, how do I know that's the problem instead of needing a higher dose?
If I reduce the amount of insulin say from 6.5 to 4 units, would I see the readings come to below a 'hi' reading relatively soon? I wouldn't want to deprive him of insulin if that's what he needs?
I know, I know....so many questions.....thanks.
 
Never too many questions - better to ask than do something to endanger your cat!

bounces...
When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.
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So thats where the spreadsheet comes into play - we can watch his number, and advise on tests, so we can see if thats what going on..
 
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