? Niki PMPS = 591 just so discouraged

N

nikkiaz

Member Since 2010
Hello all -

It’s just Niki and I again.

His BG keeps staying high. Occasionally we might get a 200 or rarely a 100-ish. He’s been on 1.25 units since 1/14/2022.

He’s still on antibiotics (doxy and ethro?) since about July when he was in the ICU. This is expected to be a long-term thing since his wounds are still healing. We have not seen a correlation between his antibiotics and his BG levels in a long time. His ultrasound showed nothing remarkable. His recent blood work (this month) was normal (for him) with the exception of an elevated ALT level, for which he is supposed to get Sam-e/milk thistle compound but he has gotten 2 doses in 3 weeks because he can’t swallow it - too dense and it can’t be diluted because it is oil based.

We are still frustrated (as is our vet). He is eating fine and acting fine. But all of this high BG can’t be good for him.

any suggestions or thoughts would be welcomed. I appreciate any input, even if it continuing to increase the dose.

Nancy and Niki the cat
 
Hi there,
Couple of thoughts:
Can you do a curve any time soon?

Are you only feeding twice a day?

What I think is happening is he dives pretty early and then bounces, so shifting some meals/strategically feeding different carb % may help flatten him out. You may also be dealing with some glucose toxicity and need to increase insulin, BUT its hard to do that with the way he dives/not enough test data. So the strategic food would help flatten things and make it safe to increase the dose
 
FrostD said:
Hi there,
Couple of thoughts:
Can you do a curve any time soon?

Are you only feeding twice a day?

What I think is happening is he dives pretty early and then bounces, so shifting some meals/strategically feeding different carb % may help flatten him out. You may also be dealing with some glucose toxicity and need to increase insulin, BUT its hard to do that with the way he dives/not enough test data. So the strategic food would help flatten things and make it safe to increase the dose
Click to expand...

Thank you for your reply!

I can definitely get a curve done this weekend (right now I am out of state so Scott is taking care of Niki).

Right now he gets 2 meals a day. He used to get snacks at 10am, 2pm and 10pm when we started this whole journey. Maybe he needs to go back to that? I think our vet told us that 2x/day was sufficient.

but it seems as his cycles are so long… like 1-2 weeks!

thank you very much. We will do a curve this weekend and post it for more assistance in case we need to increase his dose.

have a great night.

nancy and niki
 
Are you following one of our dosing protocols? Your SS says TR, but you are holding doses too long for TR and you need to get more tests for TR.
Without enough tests, you don't know if the high numbers you are seeing are due to him bouncing from going too low.

Feeding only twice a day is old school and more relevant for short-acting, in-and-out insulins where you need a good amount of food on board when the insulin onsets. Feeding smaller meals through the day is easier on the pancreas, keeps the cat happier (diabetic cats cannot process their food and are always hungry) and also helps "flatten" the curve which can reduce bouncing.
 
Nancy, you've got TR in your SS, so if that's the case, then it's important to make sure you continue to get midcycle tests each day, regardless of what the preshot numbers are.

From what I see, I think you've been holding the dose too long, which has resulted in some glucose toxicity. Getting those mid cycle tests are so important, since you don't want to hold doses too long, with TR depending on the nadirs, you can increase every 6 cycles. Midcycle tests help to determine that an increase in dose is needed, since we base dose decisions on nadirs with only some consideration to preshots. Are you able to test during the day, even if you work, say getting an out the door test?
 
nikkiaz said:
Thank you for your reply!

I can definitely get a curve done this weekend (right now I am out of state so Scott is taking care of Niki).

Right now he gets 2 meals a day. He used to get snacks at 10am, 2pm and 10pm when we started this whole journey. Maybe he needs to go back to that? I think our vet told us that 2x/day was sufficient.

but it seems as his cycles are so long… like 1-2 weeks!

thank you very much. We will do a curve this weekend and post it for more assistance in case we need to increase his dose.

have a great night.

nancy and niki
Click to expand...
Bhooma, Diane, and Christie all covered what I would have said in my reply ;) the key really is to not hold doses for too long, you should be evaluating doses weekly at a maximum (TR allows for every 3-5 days). But the key to doing that safely is the extra tests they mentioned.
 
Christie & Maverick said:
Nancy, you've got TR in your SS, so if that's the case, then it's important to make sure you continue to get midcycle tests each day, regardless of what the preshot numbers are.

From what I see, I think you've been holding the dose too long, which has resulted in some glucose toxicity. Getting those mid cycle tests are so important, since you don't want to hold doses too long, with TR depending on the nadirs, you can increase every 6 cycles. Midcycle tests help to determine that an increase in dose is needed, since we base dose decisions on nadirs with only some consideration to preshots. Are you able to test during the day, even if you work, say getting an out the door test?
Click to expand...


I thought that we needed to hold it a little longer because his cycles don’t seem normal to us.
I guess we need to change it to SLGS from TR?
We will get a curve done this weekend, and add in extra feedings.

We can also try to get an out the door test in the AM (it would be maybe +2 at the max). Unfortunately, we moved to a rural area so our commutes are 1.25 hours and 45 minutes each way now so mid-cycle tests can only be done on the weekends. We are consistent with getting a +3 or +4 at night though.

it looks like we will be increasing the dose also.

I appreciate you all taking the time (again) to help us.

Nancy and Niki
 
I don't see anything too out of the ordinary looking at his numbers. Those lower than usual AMPS you see are your clue he is going lower overnight, the thing is we need to know how low. It's unfortunate they always "choose" to do it at night! Then he bounces from those lows it would seem.

The SLGS vs TR is really your call. But with not being home during the day I am hesitant to recommend TR, since you can't be home to intervene with food if needed. I personally prefer the safety cushion of SLGS in these instances, but some people are ok with TR...they just leave out MC or such if the out the door test shows potential action
 
even with SLGS you've held the dose too long. On a particular dose, you would want to run a curve after a week and assess. Good job getting the night time tests that does help to fill in some of the missing pieces.
 
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