Nadirs have been high. What does that mean?

[Raina]

Typically her Nadir around +6 is 140-270. With morning preshots of 270-370 and dinner preshots of 180-280. We’ve had multiple days this month where at +5-8 she is similar to or above her evening preshot. Is this cause for concern? We follow a strict daily schedule with very little carbs and lots of play time

We use alpha trak and although she was diagnosed 3 years ago, we’ve only been home monitoring for 5ish months.

She is a sphynx so I’m assuming her genetic abnormalities may make it harder to control her glucose or generally complicate things

 

[FrostD]

What is her diet? Any other health issues? Teeth, thyroid, IBD, etc

Do you have any sort of BG spreadsheet or log?

 

[Raina]

She eats raw duck or turkey patties with very small amounts of low carb dry food and freeze dried meat as her treats. Being a sphynx (ie high metabolism) she eats close to double what a "normal" cat does but that has always been true for her. She does have asthma and uses an inhaler but does great with that!

We haven't seen her glucose with such a low range of change from preshot to nadir before

 

[Raina]

She eats raw duck or turkey patties with very small amounts of low carb dry food and freeze dried meat as her treats. Being a sphynx (ie high metabolism) she eats close to double what a "normal" cat does but that has always been true for her. She does have asthma and uses an inhaler but does great with that!

We haven't seen her glucose with such a low range of change from preshot to nadir before

Actually the duck is a newer addition so we’ll remove that and see if maybe there is an allergy to the duck that is causing it! Thanks for getting me thinking!

 

[FrostD]

I was more thinking in terms of carb % lol I wouldn't think allergy unless she's having skin issues, diarrhea/constipation, or vomiting.

Honestly, it's probably the insulin itself. Very few cats do well on Vetsulin/Caninsulin, it sounds like she's having pretty uneven cycles (you want a flat-ish curve). Are you giving the same dose AM and PM? 12 hours apart?

 

[Raina]

I was more thinking in terms of carb % lol I wouldn't think allergy unless she's having skin issues, diarrhea/constipation, or vomiting.

Honestly, it's probably the insulin itself. Very few cats do well on Vetsulin/Caninsulin, it sounds like she's having pretty uneven cycles (you want a flat-ish curve). Are you giving the same dose AM and PM? 12 hours apart?

She’s been on vetsulin the whole time but I have heard that. Today she only had a difference of 60 throughout the day

405 6:30am
361 +4
342 +6
347 6pm
All of today’s numbers are higher than normal for her

Yes she has 4.0 u around 6 am and 6pm

She is going in for a check up this week though!

 

[FrostD]

Ok. I suspect today is a bounce - when they drop lower and/or faster than they're used to, their liver "panics" and releases stored glycogen and hormones which can keep the BG higher and flatter up to 6 cycles (though Vetsulin usually clears it more quickly).

Are you sure you aren't missing any lower numbers under the 140 you mentioned? Nadirs can move around, and can be as early as +3 with Vetsulin. If she's at a good dose and lowest truly is 140 you can increase to 4.25U and see how she does. But if she's been swinging like this for 5 months I suspect (a) it's possible you're missing lows/dose may be too high OR (b) Vetsulin just isn't a good insulin for her and she'll do better if you switch to ProZinc or Lantus (I prefer Lantus/semglee, it tends to be more gentle - not sure where you're located, but most of us buy from Canada where cost is about the same as ProZinc)

 

[Raina]

Ok. I suspect today is a bounce - when they drop lower and/or faster than they're used to, their liver "panics" and releases stored glycogen and hormones which can keep the BG higher and flatter up to 6 cycles (though Vetsulin usually clears it more quickly).

Are you sure you aren't missing any lower numbers under the 140 you mentioned? Nadirs can move around, and can be as early as +3 with Vetsulin. If she's at a good dose and lowest truly is 140 you can increase to 4.25U and see how she does. But if she's been swinging like this for 5 months I suspect (a) it's possible you're missing lows/dose may be too high OR (b) Vetsulin just isn't a good insulin for her and she'll do better if you switch to ProZinc or Lantus (I prefer Lantus/semglee, it tends to be more gentle - not sure where you're located, but most of us buy from Canada where cost is about the same as ProZinc)

Still having high nadirs. In the last two weeks, she's only had two total readings of under 200mg at any given time (that I was able to catch) Just now at +4 was 401 while her preshot was 345. She just started a new vial so we know that isn't the problem and got a clean bill of health from the vet

How do I know if the dose is too high or low? Or is it just trial and error to see? I appreciate the help we've received from this page so much!

 

[FrostD]

Still having high nadirs. In the last two weeks, she's only had two total readings of under 200mg at any given time (that I was able to catch) Just now at +4 was 401 while her preshot was 345. She just started a new vial so we know that isn't the problem and got a clean bill of health from the vet

How do I know if the dose is too high or low? Or is it just trial and error to see? I appreciate the help we've received from this page so much!

The tests over a span of a few days would tell you without a spreadsheet I wont be able to tell you what she might be doing.

For example - sometimes based on tests you can infer a cat went low. If she started a day at 300, but ended around 150. Or if she started 200 and ended 400, could indicate a bounce from lows.

If you have been testing every cycle and are petty sure she isn't going below 200, then the dose I too low and you could increase by 0.25U. Hold new dose for a week unless reduction earned, then re evaluate