How long does it take to regulate bg?

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My cat Frankie, was diagnosed with diabetes around October 20th. I was a bad mom and did not recognize the symptoms fast enough and he developed DKA and was in the hospital for 6 days. He has been home since Oct 30th. Frankie is nine years old. Frankie's bg is still not under control. This pm it was once again Hi, which means it was over 600. My vet has said to start giving him 4 units each time no matter what his bg is unless it is under 100. It seems to me that it should be coming down by now.

He eats well, DM canned and dry food. Plus fancy feast canned food. He really does not eat much of the dry food. He has lost some weight but has been stable at 14 pounds for the last month. I checked his keystones and they are negative. He does have pancreatitis and receives a pill a day for it. I have a feeling the pancreatitis is the key to Frankie's bg problems.

My question is how long did it take for your cats to get their bg under control?
 
It varied with the cat.

Spitzer was never regulated.
Dusty went off in about 6 weeks with only weekly visits to his owner's home.
Gracie is looking like a maintenance diabetic who will be on insulin for life.
 
Every cat is different. But there are many things you can do to help you get his BG under control.

It looks like you may be already hometesting. If so, are you keeping a spreadsheet and can you post it? That information can help us guide you.

One thing that I see in your post that concerns me is your dose. 4 units is a lot of insulin for a diabetic cat. Most cats only need 1-2 units. What may be happening is that you have increased the dose too frequently and may have missed your optimal dose. This can cause a condition called Somogyi rebound. What happens is that if the dose is too high, in order to protect itself from becoming hypoglycemic, a cat's body produces extra glucose. So instead of seeing the BG levels go down or level out, it increases. Eventually though, your cat could become hypoglycemic and that could be dangerous or deadly.

What insulin are you using and what was your starting dose? How often was it increased and by how much?

Another thing that is also contributing to the high levels is the dry food. Even though he may not be eating much of it, any dry food can cause BG levels to jump considerably. Almost all dry foods are high in carbs, including prescription foods. However, do not stop feeding the dry food until you reduce your insulin dose. Right now, the dry food may be preventing hypoglycemia because of your high dose.
 
I do have a spreadsheet. I have attached it. I am using Lantus insulin. We started around 1.5 units. I sent my spreadsheet to my regular vet on Thursdays and she recommends changes based on what she sees. Tomorrow we go to the specialized vet for a re-check.

Frankie is not eating much of the dry food. He really, really likes the canned food. I have another cat, Jonnie, who prefers the dry food. So that is why I have both. When I run out of the DM dry I will try to feed just canned food.
 

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Your spreadsheet concerns me a little bit. Are those all preshot tests? I only see a few nadir tests on the spreadsheet at the very beginning. So your vet is adjusting the dose of Lantus without having any idea how low you cat is getting on it? Lantus is dosed based on nadirs-the low point in the curve. Doesn't look like you've gotten one of those tests since 2U twice a day and now you are at 4U twice a day. Most cats only need to get up to 2-3 units. You very well could have passed the good dose and had some too low numbers creating high preshot numbers and now are just stuck high because the pancreas and liver are in panic mode.
 
Since it appears that the Lantus insulin is not working so the vet has changed Frankie to Levemir, one unit every 12 hours. Frankie does not like this, only eating twice a day, before he gets a shot. I am to do this dosage for a week and then do a curve and see how he is doing.

I really hope this helps regulate his bg!!!!

Update - the dose is every 12 hours not every four hours. A typo that I missed.
 
Whoa!

I have two cats that are on Levemir and its is actually a longer lasting insulin than Lantus in most cats. And you definitely do NOT dose it every 4 hours. Levemir is a depot insulin so each dose builds on the next one. Levemir at the very least should be given every 12 hours apart and 4 units is an extremely high dose for a cat.

What you are probably seeing in those high numbers is over-lapping nadirs (lowest points) which is causing his body to go into self-protect mode and throwing him back into the high numbers again.

Also the dry DM isn't helping matters either at this point, although it maybe the only thing keeping him alive on that high dose.

Personally if he was mine I would cut the dose down to 2u twice a day, remove the dry altogether, keep testing for ketones, feed small frequent meals (mine eat 4 times a day) and try to get as many blood sugar tests as possible for several days (3-5 days at the same dose). You need to find where he is going the lowest, as that is how Levemir dose adjustments are made. Normally a cat on Levemir will be there lowest around 6-10 hours after injection. That is what you want to base dosing changes on, not the preshot values and then if you need to go up in dose you do so at .25u -.5u at a time.

The problem is that too much insulin and too little can look just a like. I have a little guy here that when I adopted him already diabetic he was on 11u of Levemir, I cut his dose back to 1u, took him off dry, put him on Fancy Feast Classics and Friskies Pate Style canned food, watched him like a hawk for ketones, and within 8 months not only was he regulated he was in remission and off insulin completely. My other Lev cat is on .1u every 16 hours

Mel and The Fur Gang
 
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