Noodle shows no clinical signs but BG won't budge. Thoughts?

[Christianna]

Noodle has been on Lantus for approx. 2 weeks with increases from .50 to .75 to 1.0 all twice a day. He has almost no "clinical signs". No overdrinking, overpeeing or overeating. He has put on a half-pound in the past 10 days, regaining some of the weight he lost when he was diagnosed and also after the hepatic lipidosis nightmare. I am running a curve today and his BGs are always very close in range, even at the supposed nadir time. Can anyone explain how he can have no visible signs (except moderate sugar in his urine) yet still have no drop in his numbers. (I've checked the numbers with 2 different meters and they are always very close.) Has anyone had an experience like this? Thanks to everyone.

Christi

 

[Larry and Kitties]

Re: Noodle shows no clinical signs but BG won't budge. Thoug

Three choices:
- Reduce dose. I would try no insulin for a day or so and see what happens
- Keep increasing dose.
- Change type of insulin. I would go to either ProZinc or Levemir.

 

[Christianna]

Re: Noodle shows no clinical signs but BG won't budge. Thoug

Thanks, Larry. That's what I'm not sure about--whether to increase or decrease. The day before Noodle was put on Lantus (after being taken off BCP PZI because of his protamine-salmon allergy) he tested in the 280s all day with no insulin. It's almost like he's worse the more insulin he gets. Weird. I think I will try no insulin tomorrow and see what happens before I talk to the vet on Monday. Thanks so much, I appreciate your answering me.

Christi

 

[Wendy&Neko]

Re: Noodle shows no clinical signs but BG won't budge. Thoug

Since your cat had trace ketones according to your spreadsheet, I'd be hesitant to stop insulin. If you do try that, make sure you test for ketones regularly. I think a better option is to give Lantus a chance, Noodles is still on a relatively low dose. I don't know if you've looked at the protocol that most people on Lantus/Levemir are using, but according to it, you'd continue to hold the 1.0U dose for a total of 6 cycles before increasing.

Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Lantus is a depot insulin and it can take 6 cycles before you see the full effect of what the dose can do. According to the protocol, you keep increasing every 6 cycles by .25 units until you start seeing numbers under 200, then you slow down the increases. Have patience, Noodles will get there.

 

[tibbs5]

Re: Noodle shows no clinical signs but BG won't budge. Thoug

hi christi
i am new also and my kitty has been on lantus for 3 weeks. it really does take time before everything adjusts so i would just be patient. after 3 weeks on lantus Tibbs is finally showing some decrease in his numbers. he is also playing and behaving just like his old self but his numbers have just now gotten to the low 300's (most of the time). it just takes time and alot of patience. hang in there. you're doing a great job.

 

[tibbs5]

Re: Noodle shows no clinical signs but BG won't budge. Thoug

and yes please look at the protocol for lantus as suggested. i would not stop giving insulin. it needs time to work.

 

[Christianna]

Re: Noodle shows no clinical signs but BG won't budge. Thoug

Hi Wendy and Neko,
Thanks so much for your advice and for including those instructions on when and how to increase. Noodle doesn't seem to have a clear nadir, or maybe I'm using that term wrong. He doesn't seem to drop at any point where I can conclude that that is his nadir. It's the fact that his numbers are stagnant that has me confused. But I'm also starting to finally get it that Lantus takes time, so will follow the advice to increase slowly and keep the same dose for at least 6 cycles. Noodle hasn't had any ketones for 3 days now but still shows moderate sugar in his urine. I'm nervous enough about the ketones that I test every day, twice a day if he'll cooperate. Poor kitty--I'm always coming at him with either a needle or a Dixie cup :shock:
Thanks so much for your help and for taking time to answer my post. I really appreciate it!

Christi