High glucose (morning/evening) and nadir despite increased insulin dose

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Michaela (George's Mom)

Michaela (George's Mom)

Member Since 2021
Good morning,

first time poster, so bare with me :). And thanks for any help you can provide; I have no idea if what we're experiencing is perfectly normal for a freshly diagnosed diabetic cat or if there's something else going on with our purrminator.

Our kitty George (15 year old male) was recently diagnosed with diabetes. We started him on ProZinc twice daily and switched him to Purina DM (combination of wet and dry). The initial dose was 3 units (twice daily), which led to several hypoglycemic events (very scary!).

Our vet then reduced him to just 0.5 units twice daily and that seemed to work pretty well for a couple weeks with morning/evening glucose values of around 300 mg/dl and nadirs of around 100 mg/dl.
Unfortunately, over the course of a few more weeks George's morning/evening spot checks crept up to 400 - 500 mg/dl. Our vet suspects that his pancreas was still "sputtering" a little initially, which made the low dose seem to work, but that since then it has given out completely - therefore the increase in glucose and the need for a higher insulin dose.

Since then, we've continued to increase his insulin dose by 0.5 units, waited about a week, and took a glucose curve. I also did spot checks at around the time I expected his nadir to be.

Initially he seems to react quite well to the increased dose (the morning/evening spot checks and his nadirs often come down somewhat, but typically never below 450 mg/dl for the spot checks and 300 mg/dl for the nadir). But over the course of the week or so he "regulates" himself back to his old high values of by now 500+ mg/dl in the mornings/evenings and nadirs of around 350 mg/dl.

We're currently up to 3.5 units twice daily. At 3 units we briefly broke through the 300 mg/dl nadir and reached mid 200s a few days in a row, but currently at 3.5 he remains stubbornly above 300 mg/dl.

Has anyone else experienced something like this? Is this part of the normal adjustment period? Is his insulin dose still too low? Or could there be something else going on? I am pretty certain that I'm handling and administering the insulin correctly (I have a science background and am used to working with syringes). I also always sniff his fur and never smelled insulin, and by now I know how it should feel when I'm injecting it subcutaneously.

Thanks for any thoughts and advise you may have!

Michaela
 
Welcome Michaela and George.
I can tag some Prozinc users for you but meantime can you set up what we call our signature I will give you the link further down
It's information about our kitties at the end of everyone's post in gray

If you can also set up a spreadsheet and enter Georges BG numbers so we can see how the insulin is working for him and how low he is dropping
We then can give you advice on what to do

@JanetNJ

@Panic

I asked her to set up her signature and SS
 
For your signature

Go all the way up top to you name tap on it and a drop box will appear , you will see the word signature, tap that and just add all your information about baby girl and hit save.
If you are still having trouble setting things up we can have someone help you just ask
Take a look at my signature all about Tyler all signatures are at the end of everyone's posts in gray

Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
 
Thanks Diane, will do! I have all my data in Google Colab, but will transfer it over to a spreadsheet later this evening. Stay tuned :). As a sneak peek - here are his curves from 0.5 units twice daily to 2.5 units twice daily.

upload_2021-8-31_9-1-50.png
 

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My cat, Magic, is currently on Vetsulin but kind of did the same thing until we finally hit 4u and then we could at least break 300 barrier. From then things started to fall more in line until we had issues with how he was metabolizing it. Maybe you’re not yet at whatever that dose is for George?

You can look at my spreadsheet and see… similar behavior.

I got really hung up and discouraged by that initially myself and folks here encouraged me to be patient and it did finally happen. As one member said, he didn’t become diabetic overnight and it’s not going to drop overnight.
 
Denver said:
My cat, Magic, is currently on Vetsulin but kind of did the same thing until we finally hit 4u and then we could at least break 300 barrier. From then things started to fall more in line until we had issues with how he was metabolizing it. Maybe you’re not yet at whatever that dose is for George?

You can look at my spreadsheet and see… similar behavior.

I got really hung up and discouraged by that initially myself and folks here encouraged me to be patient and it did finally happen. As one member said, he didn’t become diabetic overnight and it’s not going to drop overnight.
Click to expand...


Thank you! This is so encouraging to hear. I'm OK being a bit more patient; just knowing that we might really be on the right track is very comforting :cat:. It's just hard seeing George not feeling his best (and still losing weight - he's gotten so skinny :( ).
 
Michaela Kleinert said:
Thank you! This is so encouraging to hear. I'm OK being a bit more patient; just knowing that we might really be on the right track is very comforting :cat:. It's just hard seeing George not feeling his best (and still losing weight - he's gotten so skinny :( ).
Click to expand...

Totally get that…. Magic went from 18.2lbs to 12.5lbs. Thursday at his appointment he finally gained .2lbs and is now up to 12.7.

Patience isn’t really one of my virtues. I honestly though, ok he’s getting insulin now the numbers should be lower in the morning - not.

Here was my thread and it should sound familiar:
https://felinediabetes.com/FDMB/threads/vetsulin-first-decent-number-was-short-lived.251391/
 
Denver said:
Totally get that…. Magic went from 18.2lbs to 12.5lbs. Thursday at his appointment he finally gained .2lbs and is now up to 12.7.

Patience isn’t really one of my virtues. I honestly though, ok he’s getting insulin now the numbers should be lower in the morning - not.

Here was my thread and it should sound familiar:
https://felinediabetes.com/FDMB/threads/vetsulin-first-decent-number-was-short-lived.251391/
Click to expand...

It does sound very familiar! I'll bring this up next time I talk to George's vet. Not sure how much higher we can go safely - I found 0.8 units per kg as the "typical" upper range, which would be close to 4.0 units for George -, but there is hope that we are on the right track!
 
Michaela Kleinert said:
It does sound very familiar! I'll bring this up next time I talk to George's vet. Not sure how much higher we can go safely - I found 0.8 units per kg as the "typical" upper range, which would be close to 4.0 units for George -, but there is hope that we are on the right track!
Click to expand...

Don’t get hung up on the whole typical thing. One thing I’ve learned from this experience is - surprise - cats aren’t typical and there is no crystal ball, ouija board, or voodoo that’s going to change that. He’ll need what he needs.

Magic is going to be transitioning to ProZinc tomorrow - barring Shipment delays due to weather -and our new adventure starts.

Don’t get discouraged…

We saw our breakthrough with Magic at 4u. And, if you look at his numbers for the short time he was on 5u you can see a dramatic change. He was basically almost normal for an entire day. Unfortunately the insulin he’s on just didn’t do what we needed it to do consistently. ProZinc is not supposed to have those deficiencies so you’re already starting from a much better place than we did.
 
Good to hear. I am so glad I found this page - you have been wonderful and welcoming, and hearing that there's at least one other kitty out there who had similar issues is just so assuring!

I noticed that you adjusted Magic's dose way faster than I am adjusting George's. Our vet advised us to give it 5-10 days after each adjustment, and then take another full glucose curve. Do you think adjusting the dose a bit more quickly and somewhat on the fly, based on the am/pm PS, is the way to go to get them out of this state?

Good luck transitioning Magic to ProZinc!
 
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Michaela (George's Mom) said:
Good to hear. I am so gad I found this page - you have been wonderful and welcoming, and hearing that there's at least one other kitty out there who had similar issues is just so assuring!

I noticed that you adjusted Magic's dose way faster than I am adjusting George's. Our vet advised us to give it 5-10 days after each adjustment, and then take another full glucose curve. Do you think adjusting the dose a bit more quickly and somewhat on the fly, based on the am/pm PS, is the way to go to get them out of this state?

Good luck transitioning Magic to ProZinc!
Click to expand...

NO!... Absolutely NOT! All cats are different and respond differently... (Keep in mind that Magic is currently on Vetsulin which behaves differently.)

It takes insulin several days to show it's full effect and behavior. If you don't allow for that process you're essentially trying to treat a moving target which is never a good idea. I'd STRONGLY recommend following the dosing advice of YOUR vet for George and to work in partnership with them on a treatment plan. The guidance here of SLGS is an excellent approach.

Magic's dosing is currently being managed and monitored closely by his vet due to the shape he was in when this adventure began. Magic went into this with numbers higher than whatever the maximum is that the reference lab could read. They've been aggressively treating him to try and get his numbers down. He has a vet visit every Thursday afternoon and has since he was diagnosed.

Once we get into better numbers, I'll be taking a more active (SLGS) role with the doctors supervision and guidance using the methods and advice here to assist.

Don't try and rush the process.... Having a fur baby crash is not fun for anyone. Slow is WAAAAAY better.

@JanetNJ has experience with ProZinc and may be able to give you some first-hand suggestions to help George.
 
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Gotcha. That was my gut feeling (slower is better) - we had some crazy scary nights the first few weeks when George dropped too low, so I'm not keen on repeating that! Since we started the SLGS approach everything has felt a lot more controlled. I was just curious as to why you're adjusting Magic more quickly. And yes, we're working very closely with our vet who is fantastic and extremely patient (and probably at this point quite sick of all my email updates - LOL).
 
Michaela (George's Mom) said:
Gotcha. That was my gut feeling (slower is better) - we had some crazy scary nights the first few weeks when George dropped too low, so I'm not keen on repeating that! Since we started the SLGS approach everything has felt a lot more controlled. I was just curious as to why you're adjusting Magic more quickly. And yes, we're working very closely with our vet who is fantastic and extremely patient (and probably at this point quite sick of all my email updates - LOL).
Click to expand...

Trust me, I'm not crazy about the large changes the vet makes but I do understand his urgency. With the switch to ProZinc the plan is to slowly and gradually adjust the dosage since we kind of know where the 'wall' is now.

I ended up giving my vet direct access to my Google Spreadsheet to reduce the number of emails and he now checks it when he comes in. It works better for him and let's him have the full picture all in one place rather than having to go back and forth through his inbox.
 
Hi Micheala and George!

So first thing I recommend is read over the Prozing Dosing Methods. I'd recommend starting with Start Low, Go Slow (SLGS) method before moving on to MPM which is another great method, just a little more strict.

With SLGS, there are guidelines you follow to help you dose. Get a couple midday tests in each cycle (during the day and night - most people get a test in before bed to make sure kitty will be fine) and you will start to see a pattern develop. With Prozinc I'd recommend getting a +2 as it's a good indication of how the cycle will go. A noticeable drop will let you know to keep your eyes peeled for a more active cycle. Feed a few mini meals (use their regular food, just give food preferably around +2 and then a couple more times before nadir, which is usually around +5 to +7.). Cats do better with multiple, small meals than smaller, big ones. It's easier on the pancreas.

We increase in 0.25u doses - cats are tiny, they don't need much to make a difference. So try to keep to quarter increases from now on, UNLESS someone here suggests otherwise. There are exceptions. :)
With SLGS, you maintain a dose for 7 days. If BG drops below 90 at any time, you decrease by 0.25 units and that is the new dose from now on, 7 day count starts over. If nadir consistently stays above 150, we recommend raising by 0.25 units.

There are much better, lower carb food options available. Purina DM Dry especially is too high in carbs, get rid of it and switch to lower carb wet-only food and you'll see a difference. Make sure you are testing closely though, because lower carb food (ESPECIALLY when you're using high carb dry, which Purina DM is considered) will lower the insulin need, so you may have to lower the dose quickly to accommodate. We normally recommend Fancy Feast Classics or Friskies Pate but there are tons of options out there! Anything on this list under 10% carbs (but ideally under 5%) is acceptable for diabetics.

I'd also recommend ditching the Alphatrak and picking up a human meter, ReliOn Prime from Walmart is very cheap and strips are only $9 for 100. You'll find here that all the BG numbers we talk about on this website are designed for human meters, not Alphatrak. Alphatrak does run higher numbers so for example, the "take action" number on a human meter is 50, but the take-action number for Alphatrak is 68. Do keep that in mind if you continue to use Alphatrak! There is no comparison between the two either.

As far as dose at this moment, I want to see what @JanetNJ recommends.
 
Panic said:
Hi Micheala and George!

So first thing I recommend is read over the Prozing Dosing Methods. I'd recommend starting with Start Low, Go Slow (SLGS) method before moving on to MPM which is another great method, just a little more strict.

With SLGS, there are guidelines you follow to help you dose. Get a couple midday tests in each cycle (during the day and night - most people get a test in before bed to make sure kitty will be fine) and you will start to see a pattern develop. With Prozinc I'd recommend getting a +2 as it's a good indication of how the cycle will go. A noticeable drop will let you know to keep your eyes peeled for a more active cycle. Feed a few mini meals (use their regular food, just give food preferably around +2 and then a couple more times before nadir, which is usually around +5 to +7.). Cats do better with multiple, small meals than smaller, big ones. It's easier on the pancreas.

We increase in 0.25u doses - cats are tiny, they don't need much to make a difference. So try to keep to quarter increases from now on, UNLESS someone here suggests otherwise. There are exceptions. :)
With SLGS, you maintain a dose for 7 days. If BG drops below 90 at any time, you decrease by 0.25 units and that is the new dose from now on, 7 day count starts over. If nadir consistently stays above 150, we recommend raising by 0.25 units.

There are much better, lower carb food options available. Purina DM Dry especially is too high in carbs, get rid of it and switch to lower carb wet-only food and you'll see a difference. Make sure you are testing closely though, because lower carb food (ESPECIALLY when you're using high carb dry, which Purina DM is considered) will lower the insulin need, so you may have to lower the dose quickly to accommodate. We normally recommend Fancy Feast Classics or Friskies Pate but there are tons of options out there! Anything on this list under 10% carbs (but ideally under 5%) is acceptable for diabetics.

I'd also recommend ditching the Alphatrak and picking up a human meter, ReliOn Prime from Walmart is very cheap and strips are only $9 for 100. You'll find here that all the BG numbers we talk about on this website are designed for human meters, not Alphatrak. Alphatrak does run higher numbers so for example, the "take action" number on a human meter is 50, but the take-action number for Alphatrak is 68. Do keep that in mind if you continue to use Alphatrak! There is no comparison between the two either.

As far as dose at this moment, I want to see what @JanetNJ recommends.
Click to expand...

Thanks! We've been doing this (mostly) for the last two months (sorry that my spreadsheet is not yet up to date - I have all his data in a different program, so copy/pasting it over is a bit of a lengthy process), except that we increased him by 0.5 units instead of 0.25 units. I did notice that he overshoots/undershoots a bit with that, so especially with the higher doses (2.5 units and up) I increased him by 0.25 units, say, in the evenings, then went back to the previous dose in the morning, and from there went up to the new higher dose. That worked pretty well for George!

With Purina dry, while the % of carbs is higher, because it's pretty calorie dense, at what we feed he ended up with just 1-2 extra grams of carbs per day (compared to an all-wet diet). I didn't think that was significant enough. Plus, getting enough wet food into him is challenging - it's just so much volume. I'll look into the food alternatives a bit more closely this weekend, so thanks for the links!!
 
Michaela (George's Mom) said:
Thanks! We've been doing this (mostly) for the last two months (sorry that my spreadsheet is not yet up to date - I have all his data in a different program, so copy/pasting it over is a bit of a lengthy process), except that we increased him by 0.5 units instead of 0.25 units. I did notice that he overshoots/undershoots a bit with that, so especially with the higher doses (2.5 units and up) I increased him by 0.25 units, say, in the evenings, then went back to the previous dose in the morning, and from there went up to the new higher dose. That worked pretty well for George!

With Purina dry, while the % of carbs is higher, because it's pretty calorie dense, at what we feed he ended up with just 1-2 extra grams of carbs per day (compared to an all-wet diet). I didn't think that was significant enough. Plus, getting enough wet food into him is challenging - it's just so much volume. I'll look into the food alternatives a bit more closely this weekend, so thanks for the links!!
Click to expand...

Welcome George’s mom. The people on this forum have been a blessing. I’ll let them address the dosing. I’ll tell you that we were looking really good until we got into the DM and MD foods. That was about 4 weeks ago and we’ve still not landed on a dosage that works for Shasta when we were so close. We had better luck with some Sheba and his Iams than any of the prescription foods. We’ve since scrapped all of them and now are on a Fancy Feast Classic diet. Originally we had to spoon feed the last of a half can in the AM and PM. Now we have to tell him he cannot have more until +3. I’ve been told to be patient, it’s a marathon and not a sprint. Your patience should serve you well!
 
Michaela (George's Mom) said:
With Purina dry, while the % of carbs is higher, because it's pretty calorie dense, at what we feed he ended up with just 1-2 extra grams of carbs per day (compared to an all-wet diet). I didn't think that was significant enough. Plus, getting enough wet food into him is challenging - it's just so much volume. I'll look into the food alternatives a bit more closely this weekend, so thanks for the links!!
Click to expand...
It makes a huge difference honestly! Purina DM Dry is 18% carbs. To put it in perspective, we use food 16% + in carbs in emergency hypo kits to raise the BG up quickly. That's how big of a difference it makes. :)

How well does George eat? Is he at a normal weight? If you're struggling to get him to eat enough you can look into Dr. Elsey's Clean Protein or Young Again dry food, they are the only two dry foods available that are low enough carbs for a diabetic.

Another thing about Purina DM wet is they tend to get tired of it quickly (it's mostly liver).
 
With no lows under the 190’s I’d go to 4 units. Once you start seeing more blues increase in 0.25 increments.
 
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