New Curve

[nepenthe]

My cat has been on prednisolone at the request of my vet, since he had a bad bout of pancreatitis in Jan 2011. She also suspected that he has IBD, although never confirmed. He had 10 teeth pulled this year, a couple of which were infected, and immediately some other issues he had got better, such as a recurring chin acne and his coat is much better. (I actually suspect that a long-term infected tooth could have cause symptoms like IBD and maybe even pancreatitis. Its hard to measure if the pred is actually doing anything, as he hasn't vomited since he was on it)

The bigger issue is that ever since the pred, he has needed more insulin and has huge spikes in his highs and lows, thus making regulation difficult. He gets Lantus and canned-only diet.

This past week I did a curve and my vet responded by asking me to reduce his dose from 2 units BID to 1.5 BID and then run another curve in 10 days. She is resistant to address the most likely reason of his spiked insulin levels - the pred and doesn't want to take him off because it might have "big consequences".

the numbers from the last curve are:

BG was 21.2 mmol/L (381.98mg/dL) - gave 2 unit glargine 11:00am (fed him, and let him graze throught day, as usual - canned only - fancy feast salmon)
BG was 19.4 mmol/L (349.55 mg/dL) 1:00pm
BG was 15.8 mmol/L (284.68 mg/dL) 3:00pm
BG was 13.7 mmol/L (246.85 mg/dL) 5:00pm
BG was 11.3 mmol/L (203.6 mg/dL) 7:00pm
BG was 10.7 mmol/L (192.79 mg/dL)) 9:00pm
BG was 11.1 mmol/L (200 mg/dL) 11:00pm

Today, he was at 23.4 mmol/L (421.62 mg/dL) am pre-shot (so, looks like he needs more).

What would such a belated peak time (10 hrs) mean?

* Note: these numbers are taken on the Alpha Trak 2 meter, which has been typically 4-5 points higher than the Freestyle Lite I used until a month ago.

 

[Phoebe_TiggyGA_NortonGA]

Late peaks are fairly common with Lantus / Levemir.

When you reach the right dose, the curve can become quite flat as the overlap helps bring blood sugar down.

I disagree with your vet's advice to lower your dose based on this curve. Looks to me like you need to increase to 2.5u BID.

 

[nepenthe]

That's what I thought too, that he would need more, not less. But I think she is worried because he gets these really odd lows, so, if I wouldn't have tested him, and gave him another 2.5 when he went down to a 200 mg/dL 12 hrs later, it could have made him hypo.

The thing I am facing is a struggle with her agreeing that its the prednisolone that is making him hard to regulate, even though its a low dose (5 mg EOD)