? No Depot? AMPS 450, +4 450, +12 450, PMPS 460

Steve & Merlin

Steve & Merlin

Member Since 2019
It has been awhile since I have posted as Merlin has been reasonably well controlled until recently. Since my last post he has developed CKD and a slight anemia. But he eats, drinks, and seems happy. I also give him SubQ fluids everyday to help support his kidneys with extra fluid. My question is this: Over the last 18 months his weight has dropped from 15lbs to 9.75 lbs despite frequent feedings. I try and feed him every 4 hours or so. Because of his dramatic weight loss, he has very very little SubQ fat to inject into or for a depot to form in. I have noticed that my best control of his BG is when I inject at the first sign of BG rise, even if the PS value is relatively low (90 or higher). If I wait, he can zoom up >100 points in an hour. So it turns out that a shot lasts for about 10 hours and not 12. His 10 hour curve was good, just inconvienient. He really acts like he has zero depot buffer. My vet agrees and said to follow what ever works to keep his BG below 250. Is it possible he no longer supports a Lantus depot, or is there another possible explanation?

I currently have another issue. Two days ago his BG zoomed up like he had a bounce, which is possible as he sometimes would go into the mid 40s if I don't intervene with some MC food. But these rarely happen, and if they do, it's usually at midcycle. They seem to happen when he eats less. If I try to reduce his dose by even 1/10, his BG goes into the 300s. His current 1.0 units of Lantus seems to be where he wants to be. So two days ago his PMPS was 220 and then his +6 was 488. I was shocked. I have continued to give him his regular dose, but now coming into 5 cycles, his BG really hasn't budged and it's really taking a toll on him. It will not budge from 450 +- 10. I am at a loss as to what is happening or what to do. Should I raise his dose? He has been VERY sensitive to dose raising with going up to 1.1 units making his BG fall too far/fast. He has never acted this way before. Do I hang in there and stay with 1 unit, or what?!?

I don't have a current spreadsheet for him as we live in the mountains of MT and have very very low bandwidth. It can take the spreadsheet 5 minutes to load up and forever to update. So I keep one by paper and pencil. I do not inject the Lantus anywhere near where I give the SubQ fluids (scruff of neck). Fur shots are somewhat possible as he is skin and bones and the needle can pass out the backside of the tent, but I usually can smell it if it happens. If I inject accidentally into muscle, it's almost like giving no shot. The response is very anemic BG-wise. I doubt I have given 5 successive fur/muscle shots. He also is on Cerenia 1/2 pill once a day. I give him 3000u/day of B12 Methylcobolamine to counteract any nerve issues due to the high BG. Ketone tests show 0.4, so at least I don't have to deal with a ketone issue.

With his CKD and low weight this high flat BG of 450 he has is taking a terrible toll on him, but he is still eating. His BG right now acts like I am not giving any insulin at all. Everything was OK until 2 days ago. Help!
 
Hi Steve--

Has a vet examined Merlin recently? It really seems like there may be a major issue, either the CKD or something new, going on, and the BG results are downstream of that.

I'm afraid I can't really answer most of your questions-- Merlin seems like a pretty complicated case and out of my league. Without the spreadsheet data, I can't even offer a guess on the FD part of the story, the only part I have any real experience.

My guess is that Merlin's loss of BG control has more to do with his other health issues than with lantus no longer forming a depot, but one thing you could try might be a switch to levemir to see if it agrees with him better. In many cats (not all, of course!) it has a later onset and action than lantus, so you might see a better duration.

I hope you can get some more useful suggestions about the CKD, weight loss, and other issues. In the meantime, could you replace the '911' with a '?' in your post title? We try to reserve the '911' for immediate, life-threatening emergencies, and while Merlin's issues do seem to require some urgent attention, they don't seem quite there right now.

Also tagging @Wendy&Neko for help.
 
I plan on taking him to the vet today.
Sorry about the spreadsheet. He usually was ~100 nadir and 220 PS. So this recent change is dramatic from what he was before. Other than the slow progressive weight loss, he was doing pretty good.
 
OK, that's good. The thing about these BG responses is, it could be relatively minor (we've seen cats spike when they get a little constipated or have a hairball), but when you see a change like that, it definitely should be checked out. Something's bugging him.

Good luck at the vet, paws crossed for something simple!
 
Did your vet examine Merlin's heart before fluids were started? Just asking because cats with heart conditions cannot take fluids. Heart stress can cause BG numbers to rise. I found out the hard way with Neko. :( Heart conditions are also good at hiding.

Do you give the fluids the same times as the insulin shot? Or time apart? I found it helped to give fluids a couple hours before the insulin, when blood sugarbwas starting to rise.

As far as duration, if the dose is too low, you'll also lose duration. Without a spreadsheet though, I have no way of telling if that is an issue, or even answering any other of your questions. Does sound like he's bouncing though. Even the last two weeks of data would be helpful to us.
 
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