How long to 'well regulated'

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strange1

Member Since 2014
My female cat was diagnosed 5 months ago. Her BG was 451.
WE've gone low & slow from 2.0 units twice a day to 4.0 units twice a day now.
Her BG is still between 200-500+, mostly 300+. We'll do a fructosamine test next week.
Help.
Tasmin
 
Can you post some BG with times they were taken? We really need to see the data that that said you should increase as well as current BGs.
I have been working on my Patches for over nine yeast and here preshot BGs still very between a little over 100 to over 400.
 
Got a few questions for you which will give us some context for answering you.

What insulin are you using?
How big have the dose increases been each time?
How often have they been?
Are you home testing?
What are you feeding?
Are there any other medical problems, such as asthma, dental tartar and gingivitis, respiratory infection, renal disease, urinary tract infection?

Becoming regulated depends on the specific cat.
I'd consider Gracie reasonably regulated. My first diabetic, Spitzer was never regulated due to several comorbid diseases which complicated treatment. Dusty, an adopted cat I helped, went off insulin in about 4 weeks with diet change and Lantus.
 
Hi Tasmin!

If you could please answer BJM's questions, we'd could get you some better answers.

What is your kitties name by the way?
 
My cat's name is Tasmin. I'm Deborah.
insulin : LANTUS 100U/ML insulin glargine, BD U100 syringes
Dose History in sequence (every 12 hours):
2 units for ~21 days, BG 305-507 ***2.5 units for ~ 9days, BG 265-507 *** 3.5 units for~16 days, BG 324-439*** 4.0 units for~20+ days, BG 86-482***3.5 units for ~30+, BG 350-550 (here we maybe had a hypoglycemic event, but the BG went right back up), back to 4.0 units for the last 17 days, BG370-441.
January 10 glucose curve
time glucose Insulin=4.0
6am 242 pre
9am 482
11am 368
1:30pm 370
3:30pm 312
5:30pm 371
time glucose Insulin=4.0
March 8 glucose curve
time glucose Insulin=4.0
6am 373 pre
10am 426
2pm 382
5pm 395
Both these curves show an increase in glucose AFTER her shot ? Shots given 6:30AM & 6:30PM.
I home test with a AlphaTrK2 glucosemeter.
I feed Fancy Feast Classic wet, Purina DM dry, I'm adding EVO wet & dry too.
No other medical issues, some vomitting, Whenshe had that hypoglycemic event, she had stopped eating.
My vet and I discuss Pancreatitis and somogly (sp?) effect. I' starting to suspect somogly (hypoglycemic induced hyperglycemia).
Thank you very much for your thoughts.
Deborah
 
Those BG typically indicate somogyi effect as you suggested and that is usually due to too high of a dose.
Did the curves on the lower does show the same type of curve?
Do y have the BG values for those?
 
I'd suggest the diet may be part of your problem. We feed wet low carb food, in the 8-10% range. Purina Dm dry is 13%. A vet explains why wet low carb is best here: www.catinfo.org. You might eliminate the dry and make sure your wet choices are in that lower range and see if that helps.

When we switched Oliver from dry to wet, his numbers dropped 100points, overnight. So be monitoring carefully.
 
I see a couple of things here. The first is that you don't have enough data (at least you are sharing with us). You don't seem to be getting any tests at night and many cats drop low then.

Plus - and this is key - with the phenomenon called "bouncing" and somogyi, what happens is the cat will drop low (like hypo or even just under 100) for a few hours and then bounce and sit high for up to 72 hours. That means you can easily miss the low if you aren't testing enough and assume the cat is high all the time and assume the dose is too low... when in fact the bouncing indicates the dose is too high!

Also Dry food like Sue said - a small amount like just a tablespoon can spike BG for over 24 hours

So I would take away the dry and try and get more tests in over a 3 days period to check for bouncing
I usually recommend 3-4 tests a day

- always before the shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe.
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low the cat’s blood sugar is going. The low point "nadir" is what you base dose changes on since you don't want the cat dropping too low (under 50).
- before bed (2-3hours after Pm shot) to get an idea of what the cat's overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.

Wendy
 
And when you drop the dry food, drop the insulin back down to maybe 2 units to reduce the risks of hypoglycemia.

Also, dose adjustments are based on the nadir, the lowest glucose level between 2 shots. This is roughly +5 to +7 hours after injection. Please try to get some tests in that time frame on a day off, or even by setting an alarm to get up in the middle of the night. If the glucose goes below 50 mg/dL, a dose reduction is earned.
 
Thank you !
I am very impressed with the quality and insight of your help. Below is additional data. I am meeting with my vet today. I’m thinking this is a somogyi effect and will ask to lower Tasmin’s insulin units. On 4.0 units her glucose stays high and flat, I read that is characteristic for somogyi. How much damage to organs does a long somogyi effect do? For the first 2 months I did spot glucose tests. My vet has not mentioned mid evening tests.
Re Diet: I have 2 other cats and one will not eat anything but dry. My diabetic Tasmin cat eats mostly wet FancyFeast classic. You are correct about the carbs in purina DM, one source said 18%. I am transitioning to EVO. EVO dry has 7.0% carbs, and EVO wet. Boy do these cats hate having their food changed. Thank you again for your advice, I don’t feel so alone and out of my depth.
Date time glucose units of Insulin
10/29/13 5pm 513 2.0 pre-evening injection
11/04/13 5pm 306 2.0 pre-evening injection
11/12/13 4pm 564 2.5
11/19/13 6am 265 2.5 pre-morning insulin
10am 202 2.5
11/21/13 7pm 488 3.0
12/05/13 4pm 324 3.5
12/17/13 8am 393 3.5
10am 378 3.5
12pm358 3.5
2pm 189 3.5
4pm 213 3.5
6pm 362 3.5
12/31/13 6am 258 4.0
10am 139 4.0
2pm 86 4.0
6pm 307 4.0
(01/10/14 at 4.0 data is in 1st response)
01/14/14 6am 134 3.5 pre-morning insulin
8am 277 3.5
11am 216 3.5
2pm 147 3.5
5pm 310 3.5
01/21/14 6am 336 3.5 pre-morning insulin
8am 372 3.5
10am 285 3.5
1pm 323 3.5
4pm 357 3.5
3/1/14 6am 441 4.0 pre-morning insulin
10am 379 4.0
Any more thoughts?
Deborah
 
Eventually, the body's ability to compensate for too much insulin is exhausted and the cat suffers a potentially fatal hypoglycemic episode.

Just checking here: You are giving insulin 2 times per day, 12 hours apart, correct? Not at every test.

It'll help us if you list it like this:
AMPS - ###, dose - morning pre-shot test , dose of insulin given
+5 - ### - any test taken 5 hours after shot
+7 - ### - any test taken 7 hours after shot
PMPS - ###, dose - evening pre-shot test, dose of insulin given

We use the + hours notation because we are in many different time zones and because decision making is based on where you are with respect to the insulin dose.
 
Thanks – Here’s some data in your format:
Her shots are given at 6:30am & 6:30PM (what does OTJ mean?)
12/17/13 AMPS - none, 3.5
+2 - 393
+4 - 378
+6 - 358
+8 - 189
+10- 213
PMPS – 362, 3.5

01/14/14 AMPS – 134, 3.5
+2 - 277
+5 - 216
+8 - 147
PMPS – 310, 3.5

1/21/14 AMPS – 336, 3.5
+2 - 372
+4 - 285
+7 - 323
PMPS – 357, 3.5

3/1/14 AMPS – 441, 4.0
+4 - 379
+7 - 349
PMPS – none,4.0

3/8/14 AMPS – 373, 4.0
+4 - 426
+8 - 382
PMPS – 395, 4.0
 
Looks like too much insulin to me. Yesterday you said you were meeting with your vet the same day. If yo did meed what did the vet say?
I myself would reduce the dose to 2 units and see what happens
 
OTJ means off-the-juice, insulin being the juice. It's another way of saying your cat is diet controlled or in remission and does not currently need any insulin.
 
Because the BG is either about constant over the day or it even goes up a little at +4 like
3/8/14 AMPS – 373, 4.0
+4 - 426
+8 - 382
PMPS – 395, 4
Frequently some increase might be noted at +2
Wendy&Tiggy said:
Larry - can you explain to her why you think its too much insulin?

Wendy
Click to expand...
 
Also, seeing low pre-shot tests and higher mid-day tests, sometimes called an 'inverse curve' because it is contrary to normal glucose curves - suggests too much insulin provoking compensatory hormones to release stored glucose (glycogen) to keep the animal alive. The body can do that for a limited amount of time until the reserves are depleted ... and the the cat may have a hypoglycemic attack and die.
 
Thanks again.
I did meet with my Vet for >1hr, studying the data. Tasmin's glucose has remained high and unchanged for 5 months, through 2.0 through 4.0 units. We discussed somogyi effect, I am very familiar with somogyi effect(rebound). My vet does not think this is somogyi, 3 reasons: Tasmin's gained weight back to her pre diagnoses weight, she's gone from ~10 lbs to 12 lbs 4 oz; also her urine output is half of what it was when we started, lastly stress during the test. Her appetite, attitude and hygiene are very good, she's playful. My vet prepared a fructosamine(sp?) test and we will get results very soon. We are in contact with 2 other diabetes specialists vets concerning Tasmin's care. And they say stay the course. I'll keep you posted. Thank you for your thoughts.
Deborah
 
It may be time to do some reading on High dose conditions, if you're sure it isn't diet or type of insulin. There are very specific tests that need to be run that cannot be done by most vet's offices.
 
Thank you. I have read about that disease.
My cat's frucosamine came back within 6% of 'well regulated'. Next week we are joining a University cat diabetes trial.
Your caring comments mean a lot to me thank you.
D
 
Which disease?
Acromegaly, found in lab tests for about 30% of diabetic cats (if I remember the lecture correctly)
Insulin autoantibodies (IAA)
Cushings
Insulinoma
 
@BJM, if a cat exhibits symptom similar to what you mention for too high a dose (i.e., an inverted curve), what would one typically see when the dose is gradually lowered? It seems like the curve characteristics could remain the same if the new dose was still too high, or the curve could flop around to the normal glucose curve, lower during early and mid-cycle. Is that what you would expect? When do you know you have the correct dosing when you're going back down?
 
An inverse curve can be a sign of two things: either the dose is too high or too low. I've experienced both types with Mikey. The safest method is to assume the dose is too high, so you drop the dose a bit and see if that helps. If you're on much too high a dose to start with, it might even be beneficial to do a "reboot" back to 1u, depending on the circumstances. If you have a "last know good dose," if you reach that again and the numbers still remain high or the curve is still inverted, then that means the inverse curve was probably due to the dose being too low, so you just increase back up again.
 
If you choose to try a re-boot, you will need to test for ketones, either with urine testing, or by purchasing a meter such as the Nova Max which test for blood ketones. ketones form as a by-product of fat breakdown for calories. Too many ketones may cause diabetic ketoacidosis, a potentially fatal, expensive to treat, complication of diabetes.
 
Thanks for the info KP and BJM. Our thinking is that even though Gizmo sometimes (but not always) has an inverted curve, he's probably still on too low a dose. I appreciate the info, though, and I'm sure many others here do, too.
 
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