Is it rebound?

[AlyMcF]

I'm just not sure what is going on. Sketch has gone into remission twice, but the last time (mid August) it only lasted 3 days and then he was suddenly back in the 400s again. So we started up again with Lantus, 2 units. You can see the spreadsheet in my sig. A month has past and he's always high, even after continually, slowly creeping the insulin dose upwards.

Today is a good example of the kinds of unexpected numbers I get on occasion...299 preshot, then up to 399 4.5 hours later, when I was expecting the number to drop. I was trying to figure out if this is rebound or Simogyi effect?

I use an AlphaTrak 2 monitor by the way. He eats Evo dry (12% carbs) and low carb wet food (BFF and Fance Feast classic).

Side question: Sketch has a vet appt on Tuesday to check his urine for a UTI. Is there anything else I should have the vet test for do you think?

 

[Melanie and Smokey]

Do you have any numbers prior to this round of insulin? Its hard to say what it looks like without more information.

Have you ever tried him without getting dry food? Some cats just run higher even if it is lower carb dry food.

The dose could be too high, it looks like you went from 2.0 to 2.5 without any testing after the first day to see how the 2.0 was doing. Most cats, if the dose is too high, you will see the depot spill and the numbers will break showing you too low of numbers. But since you don't do testing every day during the low points, you could miss that break and only see the effecting bounce.

It looks like you are testing a bit more these day. Hopefully a pattern will emerge. I do see yellows showing up more, less red. It might just be a case of needing more insulin. Cats coming out of remission often need more than they did the first time around.

 

[AlyMcF]

Do you have any numbers prior to this round of insulin? Its hard to say what it looks like without more information.

Have you ever tried him without getting dry food? Some cats just run higher even if it is lower carb dry food.

The dose could be too high, it looks like you went from 2.0 to 2.5 without any testing after the first day to see how the 2.0 was doing. Most cats, if the dose is too high, you will see the depot spill and the numbers will break showing you too low of numbers. But since you don't do testing every day during the low points, you could miss that break and only see the effecting bounce.

It looks like you are testing a bit more these day. Hopefully a pattern will emerge. I do see yellows showing up more, less red. It might just be a case of needing more insulin. Cats coming out of remission often need more than they did the first time around.

I wasn't really keeping track of numbers before. I naively thought this was going to be easy, but since the pancreatitis, Sketch as been impossible to regulate. When he originally was diagnosed diabetic in Nov 2014, we switched to low carb canned food exclusively and after 1 week of 1 unit of Lantus and 1 week of 1/2 unit of Lantus, he went into remission. That worked well until a few months later when his housemate Max started boycotting the food. We spent $750 trying to find a medical problem, and eventually realized Max was just being picky. Both of these cats have always preferred dry food, hands down. They won't touch raw food at all, and rarely finish the 3 oz can I put down for them twice a day. So I picked the two lowest carb dry foods I could find, Evo and Wellness Core. It soon was apparently that they preferred Evo without a doubt. Sketch was ok with this diet until June 2015 when the excessive drinking and peeing returned. I couldn't deal with it right away because I was heading to gallbladder surgery June 30, and thought he'd be ok for a few weeks as he'd showed diabetic symptoms for over a month before he was originally diagonosed. Alas, this was not to be the case. He got severe pancreatitis and went to the kitty hospital the night before my surgery. After using up two of his nine lives, he pulled out of it a couple weeks later and was on two units of insulin as I recall. I assumed that getting him regulated or into remission would be easy as it was before, but no. I admit it is very likely the dry food is to partly to blame (that and possibly a malfunctioning pancreas), but short of finding a new home for Max (who is 15 and starting the early, early stages of renal insufficiency), and hoping Sketch will accept the canned food only diet again, I just don't see any way to eliminate it.

Prior to what you see on the Spreadsheet, he had boarded with the vet for 5 days Aug 11-15. He was on insulin when he went in, but then on Aug 12 I think it was, they tested him in the morning and his BG was 50. So they did not give him insulin for the rest of his visit but continued to check him. His numbers we good until the morning he went home when suddenly he was back up to over 400 again. So we started over again with 2 units of insulin, I think that was on Aug 15. So he had been on 2 units for a week when we did the curve you see on Aug 23. Based on those high numbers we upped him to 2.5 units.

 

[Melanie and Smokey]

It sounds like, all things considered, Sketch is just going to need more insulin this time. Most of us are spreadsheet and numbers driven in our thought process so that was why I asked if there was info from when he was on insulin before, no judgement here A second time around often is harder to reach remission, often a higher dose is hit. Now that you've had pancreatitis added in, things could be even stickier. You just keep working your way up the dosing scale until you find the one that works for him.
Days like that 50 at the vets office is why we encourage testing before every shot. Cats can have off days like that and we don't want to be shooting insulin into a 50.
It does look like you are on the right path. It is frustrating I am sure that things aren't going the same way they did the first time around. You are right, the dry food and pancreatitis probably have something to do with why things are more difficult this time. You'll just need to adjust your treatment accordingly. That likely means Sketch will need more insulin support. Never rule out remission, but consider it the bonus not the expectation.

 

[AlyMcF]

It sounds like, all things considered, Sketch is just going to need more insulin this time. Most of us are spreadsheet and numbers driven in our thought process so that was why I asked if there was info from when he was on insulin before, no judgement here A second time around often is harder to reach remission, often a higher dose is hit. Now that you've had pancreatitis added in, things could be even stickier. You just keep working your way up the dosing scale until you find the one that works for him.
Days like that 50 at the vets office is why we encourage testing before every shot. Cats can have off days like that and we don't want to be shooting insulin into a 50.
It does look like you are on the right path. It is frustrating I am sure that things aren't going the same way they did the first time around. You are right, the dry food and pancreatitis probably have something to do with why things are more difficult this time. You'll just need to adjust your treatment accordingly. That likely means Sketch will need more insulin support. Never rule out remission, but consider it the bonus not the expectation.

Yeah the way I see it, my cats are both old and I'd like them to enjoy their final days/months/years as much as possible. I'm not even daring to hope for another remission. I just would like to see him get a little more stable. And if that's not possible, we will just work with what we've got.

 

[AlyMcF]

Ugh...tonight's preshot number was 546. I just don't get it at all. How can this cat fluctuate so much? Hoping we can get some answers after Tuesday's testing and vet visit.