? Minnie’s Stubborn High BG #s

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Aleluia Grugru & Minnie, Jul 11, 2020.

  1. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Dec 21, 2019
    Hello all,

    I thought it was time for a new thread about Miss Minnie, but also I want to double check my thinking and see if y’all agree with me.

    I got a very low 75 the first day after we stopped her antibiotics and so I decreased her dose by .25. I’m still getting very big peaks and valleys. She can go from 400 down to 100 by midday and back up to 400 or higher at pmps. The good news is I’ve seen some 100’s at her midday tests lately. What I’m inferring from the data is that her body is considering these 100’s as lower than what’s used to now and so she bounces the next day or two. I changed the time I give her the budesonide to pm +2 because I’m hoping that if it’s affecting her BG it will do so overnight when cats tend to go lower anyway. I got a high just 2 days ago which freaked me out and I had given her the budesonide about 3 hours before that test so I decided to try changing the time to see what happens. My questions are:

    1. should I increase her back to 3.25 or wait till her checkup this Tuesday to see if she’s going to be done with the furosemide and if that lowers her BG?

    2. am I interpreting the numbers in her ss correctly? Is she bouncing from those lower 100 numbers?

    Thank you so much to all of you who asked me how she’s doing all the time. Here’s a pic she wanted me to share with her online aunties :kiss:

    2C19E113-A740-43FD-8E65-B1388168486A.jpeg
     
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  2. Dusty & Roe

    Dusty & Roe Member

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    Look at my Beautiful Happy Niece Minnie
     
  3. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Hi Ale, I hope you get some feed back on your questions. Ya just gotta love this pic of Minnie. What a great life right lol :bighug::cat:
     
  4. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Dec 21, 2019
    This is the “look how cute I’m being, don’t you want to come over and brush me under the scorching sun?” position :D:joyful::D
     
  5. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Dec 21, 2019
    I’ll tell her auntie Roe said so! :bighug:
     
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  6. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    No rush. I fell I’m on the right track, but as we all know, it does take a village!
     
  7. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    I can't understand how they can lay in the hot sun. My cats lay in their cat nappers that are attached to the window sills in the sun, I'll feel their fur and its so hot.
    But I guess they love it or they would move.:cat:
     
  8. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    Hi. I would think the issue is a failed reduction and time to go back to 3.25 except for two things. One is no curve. Second is no +3 or before bed or a+5-7 at night so I can’t tell if she’s bouncing from dropping low at night. Max and many others are known to drop lower at night and then bounce. Just my two cents fwiw.
     
  9. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    I think you're holding the dose for too long and it's likely that glucose toxicity has developed. Minnie has gotten used to those higher numbers. With SLGS, you need to evaluate the dose every week and run a curve. At this point, since Minnie isn't experiencing mostly good nadirs, you need to consider raising the dose.
     
  10. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Dec 21, 2019
    I’m sorry and not sure why I didn’t get any alerts for your replies :(

    Changing the time of the budesonide is working to keep her numbers below 400. Her +2 is her before bed test at 10pm. I’ve been reluctant to change the dose too much because I’m not sure how much is still being influenced by the cardiomyopathy or the meds she’s still on and I wanted to wait till she’s off the furosimide, hopefully today, given the drastic drop to 75 on her first day off the antibiotics.

    I’ll go back up to 3.25 then @Nan & Amber (GA) would love to get your thoughts too!

    Thanks!
     
  11. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Dec 21, 2019
    Just to explain why I haven’t done curves in a while, we went from the feeding tube to this schedule and we were on till about 2 weeks ago:

    7:30am - test, feed, insulin
    8am - doxycycline
    9am - furosimide
    12pm - Veraflox
    1:30 or 2:30 - midday test
    3:30pm - furosimide
    4 pm - budesonide, probiotics, potassium paste
    7:30pm - test, feed, insulin
    8pm - doxycycline
    9:30pm - furosimide
    10pm - clopidogrel

    I needed to give her and me a break because it was quite insane with all these liquid meds I have to force down her throat. I’ll be doing one either later this week or next week.

    Thanks again :cat:
     
  12. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Ale asked me in a PM for a simple explanation of glucose toxicity. So here it is.
    Glucose toxicity means a decrease in the production of insulin, by the body.

    When there is chronic hyperglycemia, that can lead to insulin resistance. So the insulin does not work as well. So you need to increase the dose.

    That's all you probably want to know about glucose toxicity. But just in case, here's more.

    "Glucose toxicity means a decrease in insulin secretion and an increase in insulin resistance due to chronic hyperglycemia. It is now generally accepted that glucose toxicity is involved in the worsening of diabetes by affecting the secretion of β-cells.Sep 7, 2009" from this link. If you want to read more. It's talking about humans, but the concept is the same for cats. The β-cells are the cells in the pancreas that produce insulin.
    Problems associated with glucose toxicity: Role of ... - NCBI

    Wink was on 4 different medications, for his cardiomyopathy. They did not affect his BG levels. No numbers on the SS for 2017 when he was on the heart medications, since he was OTJ for 4 years before that. I stopped recording the data at that point. But the data is still in the memory of my meter. EDIT I just added the 2017 SS data.

    "Glucose toxicity is an important point to consider especially in diabetic cats. It is defined as a decreased secretion of insulin by pancreatic β cells following a prolonged hyperglycemia. Initially, this inhibition is functional and reversible." quoted from the following article, since some people like to read the original references.

    Canine and Feline Diabetes Mellitus - WSAVA 2003 Congress ...


    p.s. I'd wait until the Tuesday vet visit, to see what the vet says about Minnie.
     
  13. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    Here is a post on glucose toxicity.

    Neko was on four heart meds, plus budesonide and potassium, though I used powder, not paste. None of them impacted her blood sugar more that a couple days after she started them. I know that because she was fairly well regulated at the time, and I could see any changes. With the data you have, and higher numbers, it is harder to say what the meds are doing to Minnie. I do agree with Sienne that you need to increase.
     
  14. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Dec 21, 2019
    I do think the budesonide at the time I was giving to her was increasing her pmps numbers. They have since then gone below 400 so yay!

    I’ll increase to 3.25 in the am. The vet wants to increase by a full unit, surprise surprise. I trust her on everything excerpt the diabetes ;)

    she’s still going the be on the furosemide with a gradual decrease instead of going cold turkey so I won’t really see much difference there I don’t think. she’s peeing so much she’s lost some weight so I have to keep an eye on that and give her about 5% more food while this is going on.

    Thank you FD village! :kiss:
     
  15. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Dec 21, 2019
    Oh and I can’t find anywhere the ingredients in RenaPlus. Not on the bottle or on their site. It has to have something in it that makes it taste good. Minnie licks it off my finger and I wouldn’t be surprise if there’s some type of sugar or starch in it :nailbiting:
     
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  16. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    You could try calling the manufacturer. Neogen at 800-525-2022

    I found this on the distributors website. https://mwi.compassites.com/product/basic/view?c=5241015

    MSDS (Materials Safety Data Sheet) for the gel says it contains:
    3.2Mixtures
    This product is a mixture of the substances listed below with the addition of non-hazardous materials
    Chemical Concentration CAS No. H-Statements Symbols
    Glycerin 99% 20-25% 56-81-5 None None
    Potassium gluconate 20-25% 299-27-4 None None
    Vanilla flavor <0.5% n/a None None
    Ingredients not precisely identified are proprietary or non-hazardous. Values are not product specifications.

    So still can't tell you if there are any sugary or carbohydrate containing components. Either way, she needs the gel for the potassium.
     
  17. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    You can get RenalK in pill form and crush it and put in food. I used to put it in some baby food.
     
  18. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Dec 21, 2019
    Well, she was at 308pmps which is the lowest she’s been at pmps in weeks. With the stress of the vet visit, peeing all over herself in the carrier, being rinsed in the kitchen sink and food past +6 :banghead::banghead::banghead:

    I’ll stick with increasing in the am unless I get an amps lower than 300
     
  19. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    hey Ale? :bighug::bighug::bighug: for Minnie:bighug::bighug::bighug:
     
  20. Deb & Wink

    Deb & Wink Well-Known Member

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    Pass it on.
     
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  21. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Minnie was at 122 this am at amps. Going up to 3.25 was not the right call and I’ll be bringing her back down to 3. Her furosemide has been lowered to twice a day only and clearly that makes a difference. I know in some cats these meds may not, but I know with Minnie it does. I’m just not always sure which one is doing what. I’ve been noting all the meds she’s on and the changes and dosage on the Notes column since Deb asked me a few weeks ago. I got scared of glucose toxicity and went against my instincts to not increase :(
     
  22. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Boy you are braver than I! Then I dont think I could get use to shooting lantus lol
    Sending love and tummy scritches to our Minnie and CHOCOLATE to you!
     
  23. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    I gave her my version of a chicken dose which is actually high as opposed to low because I get scared she’ll go high if I give her too low a dose. So after 2.5 she went up to 181 @+4 and 333 @+5 :banghead::banghead::banghead:
     
  24. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Wow that really shows just how Lantus WORKS. Interesting
     
  25. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    I can’t say it’s Lantus. A better statement might be, that really shows just how Minnie WORKS :D

    She’s been having these dramatic highs and lows since this whole ordeal started so it’s just hard to predict but I have to go back to 3 units obviously 3.25 is too much for her right now
     
  26. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    :D:bighug::D
     
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  27. Deb & Wink

    Deb & Wink Well-Known Member

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    Remember that insulin "depot" with Lantus. It takes 3 cycles usually to fill that depot, and to see any effects from the dose increase.

    Big chicken shot you say? Well, I say you hold the needle, know Minnie better than we ever will, are there to monitor her and SEE how she acts. So you get to make the choices on dose.

    What ever we say are suggestions, based on what we think. We're not always right. But sometimes we are.
     
  28. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Dec 21, 2019
    So you don’t think the low amps was because of the .25 increase?

    Pmps should be interesting :nailbiting:
     
  29. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Dec 21, 2019
    My gut feeling is there’s one maybe more of these meds affecting her levels. The fact she dropped to 75 the first day off the antibiotics and this low amps number today after the furosemide dose got reduced. So I’m reluctant to treat her like I would another diabetic cat that doesn’t have all these other things going on. Upping her to 3.25 seemed like the right idea on paper, but didn’t feel right to me when I got that 308pmps. I guess I just have to listen to my inner voice and stop second guessing myself
     
  30. Deb & Wink

    Deb & Wink Well-Known Member

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    No, no I don't think the low at AMPS today, 7/16/20 was because of the 0.25U increase. It's always possible, but it usually takes longer than that to see an effect from an increase. More than 1 cycle.

    Listen to your gut, Ale. Intuition or something else may be guiding you.
     
  31. Lalkabee

    Lalkabee Member

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    May 1, 2020
    Hey Ale <3 You could maybe ask your vet if changing insulin could help? Prozinc seem to be very stable for Bee.
     
  32. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Ale, not too many times your guy has been wrong. Listening here is important because it opens your "gut" to info. Its almost like fine tuning. I think you and Minnie are doing a beautiful "dance". KEEP UP THE GOOD WORK!
    Tummy scritches for Minnie please. :p:bighug:
     
  33. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    I spoke with the vet yesterday and she was finally able to discuss Minnie’s X-rays with the radiologist and the pneumonia is coming back. She has no behavioral symptoms, other than she sneezed once last week, but she has to go back on one of the antibiotics. Heart is less enlarged and muscles look better too. It doesn’t help me interpreting her ss because I’m always unsure how much of it is due to ALL of this :( but I did put on my big girl pants and went up again to 3.25 and she again went way down to 57 & 61 which earns her a reduction, so back to 3 and bouncing it seems like the last 2 days. 2 days ago she was actually higher at +6 then at her amps.

    Question of the day is: I’m not following TR and I’ve been decreasing when she goes below 90, but should I ignore the drops and stick to 3.25 unless she goes below 50?

    PS - also need to increase the budesonide because of some vomiting and her not wanting to eat at all last night. I gave her an ondansetron and still all she would eat was baby food until I caved and gave her the apetite stimulant. Then within 2 hours, midnight by this point, she finally ate 1 of the 6 foods I had out and was ravenous the rest of the night ((big sigh))
     
    Last edited: Jul 24, 2020
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  34. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    (((((Ale)))))n I'm so sorry about the DX again, Lets hope Minnie can shake this off quickly. sigh

    You know I'm no expert but my gut is inclined to go with this decision. Just be prepared (I KNOW you are) for the consequences.

    I also know you are going to get better advice than I can ever give.

    I wonder if this rise in numbers isnt due to, the onset of the pneumonia coming back.:confused:
     
  35. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Thank you JT

    since I got no replies, I’ll try the Lantus forum today
     
  36. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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  37. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Hmmm.... I hate to say it, but I think I would go back to 3.25, I agree with both these statements:

    I think you should definitely consider going to TR and its more strict criterion for reductions. Minnie just doesn't seem to hold reductions taken at the 90 point, and she really does look like she needs more insulin-- she's spending way too much time in high numbers. And under SLGS, every time she gets on a dose that so much as lets her dip a toe into better (healing) numbers, she has to go right back down again-- it's like she's running in place.

    It's also possible that she needs more insulin because of the pneumonia, but it doesn't really matter why, if she needs more insulin, she needs more insulin. Dose around the other problems until the other problems are resolved!

    I also agree that it might be good to spend some time on the Lantus forum. It's a bit intense over there, but it does help the process of getting used to seeing green numbers-- there are cats over there who spend almost all their time there! Eventually it will get much less scary to see those numbers in Minnie. They really are good for her!
     
  38. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Okay I was leaning this way anyway so I’ll have to read up on TR because that’s all I know about it the decrease threshold.

    I guess overnight scares me the most because I can control and check her well in the day. But she’s not budging so I need to get over my fears and increase. Will do in the am. I’m also trying to transition her to a new food that’s more IBD friendly like ziwkipeak so will have to watch that carefully too.

    Thanks Nan! :kiss:
     
  39. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Of course you're scared; this stuff is scary! Especially so with a cat prone to big swings in BG, because no matter how confident you are in her patterns, there's the knowledge that she is capable of just about anything!!!! That definitely makes the nighttime stressful.

    Let's see how this increase goes. It may be that being more diligent about increases on SLGS (doing that weekly curve) will do the trick. If not, another thing about TR is that it not only makes it a little harder to go down the dosing ladder, it goes up quicker (potentially every three days rather than, at best, weekly). So if glucose toxicity has set in, it'll take less time to get to the dose that breaks it.
     
  40. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Dec 21, 2019
    Exactly! When she goes from 400 down to 75 or 300 down to 57 tells me that I just don’t know anything ha!

    Started her on 3.25 today. Fingers crossed. Thanks again Nan :bighug::bighug::bighug:
     
  41. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Dec 21, 2019
    We’re up to 3.75 and finally I got a midday nadir of 131!!! I’m hoping it sticks! :bighug::bighug::bighug:

    no behavioral signs of the pneumonia, like sneezing or runny noise, and she seems like herself even when she’s bossing me around with a very stern meow because I’m taking too long getting her food ready :p but I had to increase the budesonide back up to .2mls because she had a few vomiting issues in the last 2 weeks. When she throws up all the food after I gave her the insulin and the other meds, I get scared so playing it safe with the dosage and I have her on the metoclopramide twice a day now too
     
  42. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    YAY GO MINNIE GOOOOO!!!
     
  43. Dusty & Roe

    Dusty & Roe Member

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    Mi
    Minnie try not to make your Mom worry with throwing up ok We all Love you and your Mom and Brother Good job with your BG Minnie
     
  44. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    Great seeing that blue nadir Ale, I hope the new dose does it.
    Ale you better move quicker getting Minnie's food ready lol
    I'm glad there are no signs of pneumonia.
    Have a good night Ale :bighug::cat:
     
  45. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Dec 21, 2019
    I swear sometimes I’m walking over to her and she still does it like I’m suppose to be running not waking LOL we are having a heat wave this weekend and today I almost melted under the sun combing the little princess. Sweat pouring down my face and I didn’t budge :D:D:D
     
  46. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    Dec 21, 2019
    she says I love you too auntie Roe :kiss::kiss::kiss:
    D3E772B9-AD72-4F80-A212-D0AB176F07B3.jpeg
     
  47. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    HaHahahahaha another Penthouse pose!
    :bighug:
     
  48. Deb & Wink

    Deb & Wink Well-Known Member

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    Blood, sweat and tears. All being poured into caring for your princess.;)
     
  49. Dusty & Roe

    Dusty & Roe Member

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    That is an I’m a happy loved kitty pose lol
     
  50. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

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    The blood comes from her and the sweat and tears from me hahaha! :D:D:D
     
  51. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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  52. Deb & Wink

    Deb & Wink Well-Known Member

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    New thread please? Pretty please? With sugar on top?
     

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