Need Help Getting Miracle Regulated

NotTheMamma

NotTheMamma

New Member
Hi Everyone, first time positing, we've been having trouble getting our cat Miracle's BG levels regulated, we've tried all sorts of things, and have been working with or vet but still to no avail. So we thought we would post here in the hopes that someone might have some advice for us. Miracle was diagnosed last year after having been on prednisone for a skin allergy, which seems to have triggered it. We took him off that pretty quickly but since then we have been struggling to get his BG under control, we are strictly controlling diet, and are on our second type of insulin, we've tried lots of different doses, but his numbers remain high. Also want to add that we have really appreciated all the helpful information on this site and just hearing about other's journeys and not feeling so lost. So thanks in advance to everyone.

An overview of our situation:
Insulin
We originally started him on Lantis, which we tried for a while without results, and are now using PZ at the advice of our vet, we are currently at 3 units every 12 hours which we have been building up to slowly.

Testing
We are using an alphatrak 2 at the moment, see our spreadsheet
More recently we have been trying to do BG curves by testing every hour, since we noticed that he seems to jump around a lot. but in general he has been in the 400s or 500s pretty for a while now.

Diet
We are feeding him Hills prescription Glucose Support MD wet food primarily with a bit of ID food to help with digestion. We give him just plain cooked chicken for treats. We strictly control what he eats and when, right now we give him about 130 cal every 12 hours. He is typically super hungry when we feed him, and eats it all right away, this can also make it hard to get his BG around meal time.
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So Obviously he is not responding to insulin in a normal way, we are wondering if we are starting to break through at this does since he has been going a bit lower sporadically. I wonder if you all would recommend we keep raising the dose?

Thanks so much!
 
Welcome!

Glad to see youve got the testing and a spreadsheet going. Couple more housekeeping items:
  • Do you have a hypo kit?
  • Are you testing for ketones?
  • The MD is 13% carbs, we consider that medium carb. The ID is 23%, we consider that very high carb. Ideally you want something around 5%. There is no need to feed prescription foods, majority of us feed regular old Friskies and Fancy Feast Pates. Here's a food list for you. Do not change food yet, if/when you are ready ask us for advice. It can have a very significant effect on BG and be dangerous if dose isn't adjusted properly beforehand. Good news is you can keep your existing foods for the hypo box
  • Did you determine what the skin allergy was to? Are you sure it's not a side effect of food?
  • What is his ideal weight? What's current weight? Unregulated diabetics often need more calories to maintain/gain weight.
  • A spaced out meal schedule with smaller snacks is actually better for them, easier on the pancreas. You want the larger meals to be at shot time, then a few smaller snacks around +2 and +4 each cycle. Many of us use autofeeders
  • Is there a reason there's no preshot tests? Yet so many other tests? The preshot test should be fasting for 2 hrs beforehand so you have consistent data to base decisions on.
  • With ProZinc you test/feed/shoot,.you can do it all in succession. Many people prefer to make sure they eat at least a tbsp or so before giving the shot, but some people give the shot as they're eating
I suspect the bulk of your issue is the carb content of his food.
 
Hi! Thanks so much for your response.
  • We do have parts of the hypo kit, including maple syrup which our vet warned us we should have, but not everything in one place, we need to do this
  • We are testing for Ketones occasionally so far we haven't had any sign of them
  • The skin allergy is called eosinophilic dermatitis, we don't know exactly what he is allergic to, but we have managed to reduce the outbreaks with antihistamines (we have been giving him 2mg of Chlorpheniramine Maleate twice a day with his meals) we have taken him to our vet and a veterinary dermatologist who both say they don't think its food related at this point
  • Before he developed diabetes he was around 15 lbs, now he is around 12lbs, we don't know what his ideal weight is, but the vet would occasionally say he was a bit overweight before.
  • We have been testing a lot during the day to try to get curves with varying doses (this is something the vet has asked us to do)
  • We usually can't get him to cooperate enough to do a test when its close to meal time, he gets so hungry and anxious that he won't let us do it, (another reason we try to test during the day when he's sleeping) His BG has been so high on a regular basis we didn't think he would be too low, but maybe we can get him to do it if we start giving him more small meals and he isn't so hungry
It sounds like a good first step would be changing his food, we would like to try some other wet food with a lower carb content, we are thinking WELLNESS - Complete Health Beef & Chicken which is 5% (what he used to eat before) what do you recommend in terms of lowering the Insulin dose?
 
NotTheMamma said:
Hi! Thanks so much for your response.
  • We do have parts of the hypo kit, including maple syrup which our vet warned us we should have, but not everything in one place, we need to do this
  • We are testing for Ketones occasionally so far we haven't had any sign of them
  • The skin allergy is called eosinophilic dermatitis, we don't know exactly what he is allergic to, but we have managed to reduce the outbreaks with antihistamines (we have been giving him 2mg of Chlorpheniramine Maleate twice a day with his meals) we have taken him to our vet and a veterinary dermatologist who both say they don't think its food related at this point
  • Before he developed diabetes he was around 15 lbs, now he is around 12lbs, we don't know what his ideal weight is, but the vet would occasionally say he was a bit overweight before.
  • We have been testing a lot during the day to try to get curves with varying doses (this is something the vet has asked us to do)
  • We usually can't get him to cooperate enough to do a test when its close to meal time, he gets so hungry and anxious that he won't let us do it, (another reason we try to test during the day when he's sleeping) His BG has been so high on a regular basis we didn't think he would be too low, but maybe we can get him to do it if we start giving him more small meals and he isn't so hungry
It sounds like a good first step would be changing his food, we would like to try some other wet food with a lower carb content, we are thinking WELLNESS - Complete Health Beef & Chicken which is 5% (what he used to eat before) what do you recommend in terms of lowering the Insulin dose?
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Ok thanks!

I'm going to tag @Wendy&Neko for her opinion because his current food mix is so high carb.

Wait to start any transition until there's a day you can be home - ideally a few days in a row - and have hypo kit all together. I would start with 1/4 new low carb food, 3/4 old (mix it all together though so the carbs are the same throughout the days and do it that way for 2-3 days). Im thinking lower the dose to around 2-2.5U.

Also would be a big help if you can get signature set up for us: https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
 
OK, great.
So we have proceeded according to your advice, we lowered Miracle's dose to 2 units, and started to transition him over to Wellness - Complete Health Beef & Chicken over the weekend. We've also started feeding him 4 hours before the dose so that its easier to get his BG pre-shot, which does seem to be helping, we will keep and eye on his BG as we continue to transition his food and then re-evaluate his insulin dose once he's fully transitioned.

thanks again for all your help!
 
Ok good luck! Slow and steady. If you get any blues or lower let me know so I can take a look and make sure he's safe
 
Hi Again,
We wanted to start with an update since its been a while. First of all Miracle has been doing much better since we transitioned him back to low carb wet food at your suggestion, he has been way less hungry and crazy trying to eat everything, he started responding to insulin and has been getting into lower BG numbers, he has regained weight and is a healthy weight now, and generally seems much healthier, thank you so much for your help, its made a huge difference!

The reason we are writing is because while Miracle is responding to insulin often and getting into very good numbers, he has had really inconsistent BG levels. Some days his nadir is close to 80 and other days he stays in the 400s all day. Our current situation is this:
  • We have been adjusting his insulin dose to try to get him properly regulated, we went down after he started responding to the insulin and have come back up slowly (0.25 units at a time), we landed at 2 units and have been there for a few weeks. When he does respond to the insulin and get into lower numbers it seems perfect, he gets around 100 at the low and then comes back up to 200 or 300, we have not seen him get too low yet on this dose.
  • Occasionally when he does get into lower BG numbers, we have had to delay giving him his shot because his BG was below 225 at meal time, so we fed him his meal and then his shot after an hour or so once his BG levels were high enough.
  • We have been feeding him two snacks per day (about 30 grams of food each) 4 hours before his main meal (85 grams of food) and insulin shot every 12 hours.
  • When we do insulin injections we have been trying to rotate the injection site to avoid build up of scare tissue, we do his haunch most often and the nape of his neck occasionally.
So we were wondering if you had any suggestions for getting him to respond to insulin on a more consistent basis? perhaps changing up his feeding schedule to more small meals? doing something different with his injections? Something else? any help is appreciated, Thank you!
 
What you're seeing is bouncing. When they drop lower and/or faster than they're used to (that definition varies by cat, but a 400 to 80 drop pretty much always qualifies!) their liver perceives it as life-threatening -whether or not it actually is - and dumps stored glycogen and counterregulatory hormones in order to spike BG back up. They can last up to 6 cycles. The good news is I see progress in that this week, he's clearing the bounces faster and spending more time in good numbers.

Technically per SLGS he earned a 0.25U reduction since he went below 90 that one time....but I am hesitant to say take the reduction because he's making good progress. Can you start making a +3 test a regular thing? That way if you see a big drop there you can feed him some slightly higher carb food to help slow the drop and avoid a reduction. So if his regular food is 5-7%, you'd try feeding something like 10-12% around +3/+4 to help slow him down.

Are you saying to feed at +8 and at shot time? If so we'll actually want to change that, as you want the majority of food/carbs before nadir while insulin effect is strongest. By feeding at +8 when insulin is wearing off, you're giving his BG a boost up.

Normally we say try to lower the BG at which you shoot a full dose, but I am uncomfortable advising that right now. His swings are pretty big at this dose, and so far you've been ok shooting the full dose in the 200s because he's started to bounce anyway. What we advise is stall without feeding for 20-30 mins and retest. If you need advice we're more than happy to help. Sometimes a partially reduced dose is better, but if the test indicate he's about to bounce (i.e. a rapid rise) full dose is usually best.
 
Ok, this makes a lot of sense with what we've been seeing. We decided to change a few things to try to reduce his Highs and lows and make him drop slower. It seemed to be working at first and then we've had a few bad days, we did just start a new vial of insulin that came in the mail from chewy so we are also questioning whether it got shaken up or too hot and is not effective.
  • We've changed when we are feeding him, instead of a snack at +8, now we feed him a meal with insulin and a snack at +3 to help slow the drop. We have just been giving him regular food at +3 nothing hi carb.
  • We lowered his insulin dose from 2.0 to 1.5 as we transitioned him to a new feeding schedule, and also to see if a lower dose and less of a drop would help reduce the bouncing, we just recently tried coming back up 1.75
  • at first we were on the same proportions as earlier (75% of his food with insulin and 25% at +3) for a few days
  • the last few cycles we've tried splitting the food (50% with insulin and 50% at +3), he did respond yesterday but we also switched back to what insulin we had left in the old vial to see if that makes a difference, we don't know if its a coincidence or not
We've been trying to test him at around +3 to see if he's dropping too fast and it didn't seem too extreme. It does seem like he is still bouncing (and possibly has some ineffective insulin?) we are wondering if you have any other advice for how to mitigate the bounces, or what you think about his new insulin. Would you continue bringing his insulin dose back up to 2?

Thank you for all your help!
 
Hmm. I would hold the 1.75U a few more days just to give the changes time to settle down. Typically we do want the meal at preshot to be the bigger one, so I personally would keep the 75/25 split. If after 6 cycles at 1.75U you don't see anything under 150, I would increase to 2U.

What you are likely seeing is the timing/strategy of the food change is doing more of what it's supposed to do mid-cycle. He isn't going as low because the food is slowing things down - it seems counterproductive, but the flatter cycles are better to help stop the bouncing. It will also give you room to increase the dose and bring the overall numbers down. More than likely you will end up at a higher dose than the 2U you "started" with but that is a good thing if he stops bouncing and slowly starts to come down. I'd hazard a guess you might make it up to 2.5U-3U before nadirs are 90-120 range.

Before all this shipping craziness I'd have said it's very unlikely to be the insulin, but now it's definitely a factor. It is still bringing BG down so it is at minimum somewhat effective, the truck will be determining if it's the food strategy change or the insulin changing the patterns.
 
Hi Again, So we've tried a few things, we got new insulin from our vet and its working. We have been changing his dose a bit here and there based on his pre-shot BG, and adjusting his snack time on a daily basis to try to prevent rapid drops and keep him from bouncing. Recently he has been staying pretty flat and high most of the day then dropping at the end of the 12 hour cycle right before his next dose. So much so that we have had to feed him and wait for his BG to come up before giving him insulin. Yesterday we started giving him all his food at meal/shot time in hopes that the nadir will happen earlier in the cycle, but hasn’t had any effect so far. Looking at his numbers do you think he is still bouncing? If so what should we do to stop it? Should we lower his dose again and slowly come back up? or should we increase his dose to get him into lower numbers and give him snacks if necessary? We are confused about what we are seeing and how bouncing works.

Thank you so much!
 
Which cycles (dates) were you waiting for him to come back up? The dropping at the end of the cycle is very characteristic of breaking a bounce, late nadirs are very common. From what I can see, his nadir after a bounce break tends to be in the normal window (+4 to +6; some cats keep a late nadir for a few cycles).

The trick is trying to guess if he'll bounce or not, but he doesn't really give you many clues to go from. Typically, we try to give full dose if over 200. If he bounces, that's a safe bet and helps hold the bounce.down. The trouble is if he doesn't bounce, you get lows...looking at SS, the few times.youve shot full dose in the low 200s + he didn't bounce, it's been ok (i.e. no hypo).

By new insulin, you mean new bottle of ProZinc correct?

Food typically won't change the nadir time itself, unless you happen to feed so much like an hour before that you effectively head it off and make the curve flat in the middle. The wet food tends to wear off within 1-2 hours, so if the insulin is still circulating and close to peak, he'd drop again.

For now you want nadirs between 90-120 on the non-bounce cycles, so that will determine dose. I see he bounced again today; when he clears this one, if you don't see (or estimate) a nadir of 90-120 I'd go ahead and increase.
 
Hi, wondering if you'd be willing to take a look at Miracle's numbers again and let us know what you think. In response to your last message the days we have waited to shoot after feeding were June 4,5,8,11,14,15 and July 7,8,10,11,16, and 17. We have considered increasing his dose but then he got down below 90 (7/11/22). Also yes, we meant that we got a new bottle of ProZinc.


Lately He's been high more often and it seems like responding less, he is less often in the 200 range or lower, and when he does get lower it tends to be at the very end of the cycle, when this happens we feed him and wait to give him insulin when BG is higher usually about 1.5 hours or so and then give a normal dose. We have also had him get really high mid cycle (7/16 and 7/17) which we have never seen before.


We've started giving him Denamarin 1 pill/12hrs (7/12/22) recommended by vet bc his liver numbers aren't looking so good, we were wondering if that could be affecting his BG?


any thoughts you have would be greatly appreciated.
 
The Denamarin shouldn't be affecting things, quite a few people here use it. Did you check the ingredients for any potential sugars? I know they have a few different forms.

As long as he is above 200 and BG is flat or rising at shot time, I would shoot. You do a great job testing, you'd catch any potential lows.

I think you are ok to try an increase. We say wait at least a week after seeing green, and his last string of low numbers were still mid-high blues. So some glucose toxicity settling in, and I suspect that also contributes to the higher than usual numbers. Looking at his SS as a whole, he kind of goes through these higher numbers as a dose "goes stale" so to speak.
 
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