Mary dose question

[Lisa & Mary]

I've been fostering Mary and her sister Rhoda for DCIN since the end of May and have been home testing Mary's blood glucose for the last 2 weeks. Her previous vet had her on primarily dry (Royal Canin DM) and had been continually increasing her insulin but wasn't able to get her blood sugars under control - I included her vet blood glucose readings/fructosamine results on ther spreadsheet so you can see the history since she was diagnosed in Oct 2010. Her owner was diligently following the vets advice despite serious health issues of her own but unfortunately the vet didn't appear to know what they were doing and from the numbers I think they could have got her into remission if they'd switched her to wet food back in Nov 2010. Grrrr...... I'm not sure what effect the long term large amounts of insulin would have had on how her body reacts to insulin now?

Mary loves wet (Fancy Feast Classics) and has been eating exclusively that since a couple of days after I got her. She gets 2 cans in the morning and she eats about half quickly and nibbles the rest through the day. She's usually eaten it all and has fasted for 2-3 hours before her PM test. It's the same in the evening but because I'm there I usually give her one can with her PM test/shot and the second one 2-3 hours later. It's gone by the time I get up.

We did a big dose drop when I got her from 4.5u BID to 0.5u BID which immediately improved her control into the mid/high 200's where she stayed for about 2 weeks. About a week ago she went into the 3-400's and I suspected somogyi effect so I dropped her dose to 2.5u BID and she's returned to the mid/high 200's. I've been able to do quite a few mid point/+9 readings and as far as I can see she's staying flat through the cycle.

So I'm trying to figure out what to do next. I think I should leave her at 0.25u for at least one more day but my gut feel is that if she stays where she is I should stop her insulin for a few days and see where she stabilises on her own. Then I'll have more info re where to restart her again. I suspect she is producing enough insulin herself to avoid going really high but I'll monitor her blood sugars carefully to make sure.

So wanted to get advice on if this approach makes sense of if anyone has any other suggestions.

Thanks
Lisa & Mary (who sends smoochies and purrs to everyone!)

 

[Marje and Gracie]

Hi Lisa

I think Mary needs more insulin and I would raise her dose to .5u in the morning but you are missing more than half your data by not having any PM tests. I would not stop her insulin and let her "settle". The longer you allow her to be at these high numbers, the more she could become insulin resistant and develop glucose toxicity. Here is some great info on the subject: Glucose Toxicity.

Somogyi has not been documented as occurring in cats that follow a tight regulation protocol and I do not think that is what you are seeing. I think her numbers are from not enough insulin.

I would take her up in dose according to the protocol. With these numbers, I would raise her dose to .5u tomorrow and increase per the TR protocol until you get to a breakthrough dose. But you need some PM cycle tests. If you can get at least a before bed test, that would help.

Please let me know if you have questions.

 

[Lisa & Mary]

Can you explain a bit more about what you mean by the PM testing? I'd have thought her +3, +6 etc would show a similar profile whether it was during the day or night

The reason I thought the 0.5u dose was too high was that when I reduced it to 0.25 her glucose levels came down.

 

[Vyktors Mum]

My internet connection is suffering from a storm tonight and is crashing when I try and go to Mary's ss (and every ten minutes anyway :evil: ) but I will say that night and day can be different. It is always recommended to at least get one test before you go to bed.

Mary is sooooo pretty :smile:

 

[Sienne and Gabby (GA)]

I agree with Marje and I've said the same thing in Mary's previous condos. You haven't any idea what's going on at night. What you are calling "Somogyi" could easily have been a bounce off of low numbers during the PM cycle. There's just not enough data to really have a solid grasp on what Mary's patterns may be. In order to safely follow a tight regulation approach, you need to have at least one test during BOTH the AM and PM cycles in addition to your pre-shot tests.

I'd encourage you to look at some other spreadsheets. I think you'll find that the AM and PM cycles are not mirror images. Until a cat is tightly regulated, it's unlikely that the cycles will be similar. Even in the case of tight regulation, a cat can still drop into low numbers. Safety is always our primary concern and without some way of knowing the direction numbers are heading, you are potentially putting your cat at risk.

I also want to underscore that there is absolutely no evidence for the existence of chronic Somogyi rebound in cats that are using a long-acting insulin. In fact, if you look at the research literature, the existence of Somogyi in humans is controversial, at best.

 

[Patty & Champ]

I can confirm how true it is that a cat can have very different AM cycles compared to their PM cycles. My cat is a very good example of that. On Champ's spreadsheet, on 6/16, he had been in the mid 200's all day. His PMPS was 281. I checked him at +6 that night (which is 1 a.m. for me) and he was at 48!!! He's done this many times, as have a lot of other kitties. Champ isn't alone in dipping low at night. PM checks are so important. I ALWAYS check Champ's BG right before I go to bed, usually at +4 (11 p.m. for me) and my daughter checks him when she goes to bed, usually at +6. On 5/11, Champ had a PMPS of 274. I checked him before I went to bed at +4.5 and he was at 139. My daughter checked him at +6.5 and he had dropped to 79!! On 5/12, his PMPS was 295. I checked him before bed at +4 and he was at 153. My daughter checked him at +7.5 (she had gone out that night and didn't get home until after 2 a.m.) and he was at 45!!! Not everyone has a someone to share the testing responsibilities with them at night. I thank God I have my daughter to help me out. If she wasn't here, though, I'd have to set an alarm to get myself up about 1 or 2 a.m. because my cat just LOVES to drop at night. Maybe you could do some testing, like a +2, +4, and +6, on the weekend nights so you can see if Mary is a nighttime "dropper." If she isn't, one test before you hit the sack would be all that's required every night. If she is, at least you're armed with the knowledge so you can make informed decisions as to how you want to test. It's something to think about. Good luck!!!

 

[Lisa & Mary]

OK Thanks. I'll start doing bedtime tests and nighttime tests at the weekend to see what is going on. I did a +4/bedtime test last night and she was 281 so pretty flat with her PMPS of 261 but I haven't done any night time testing at all yet so there could be something going on in the middle of the night.