Poopers Glucose is stressing me out!

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rbrumbaugh82

I just do not understand a cat's pancreas when it comes to being diabetic. As you all know my cat has been doing fairly well although not in the low 100s like most people's cats are before they go OTJ. Today has been a sorrow day with his glucose and not understanding why his stupid pancreas is not kicking in more. This morning when I woke up I took his AMPS at 830 and it was 295 which is the highest its been in a long while. So I give him .075 units of insulin and +3 hours later it was 143. IF it went down any after that it wouldn't have been much given +2 hours after that his BG was 170. From that point on its done nothing but go up and I have made him eat each time his number was up. So at 3:30pm today his PMPS was 187. I gave him 0.5 units of insulin. The reason why I didn't give him 1 unit each time is because in the past when I did that his BG dropped to under 100 even when his BG was above 200 it dropped below 100 so I wanted to be safe. However, +2 hours after his PMPS it only went to 164. +2 hours after that which is 7pm now it went back up to 191. Why is that? He was even eating during these intervals too. I just don't understand how the past week or so he has been doing fairly well with staying in the mid 100s which probably to most of you isn't all that great given how I've checked some of your cats spreadsheets and most that are OTJ have had numbers below 100. I get excited when Poopers is like 140 but I know that isn't that great. I just WISH and PRAY that his pancreas will stay awake and make his glucose go down whenever he eats Fancy Feast classics!
 
The goal while on insulin is between 50 - 130 mg/dL at nadir, not pre-shot, on a human glucometer.
It may be time to set up a sliding scale that takes into account his pre-shot and how much he tends to drop on a given dose of Novalin (you still have that in your signature; is that correct?)
Just a draft here, for you to test out and see how it works for you. Initially, check around the nadirs several times in a range to see if you need to adjust the ranges, or the dose for the ranges:
If pre-shot glucose between 250-300 give 1.00 units
If pre-shot glucose between 200-250 give 0.75 units
If pre-shot glucose between 150-200 give 0.50 units
If pre-shot glucose between 130-150 give 0.25 units if you can be home to monitor the nadir
 
Can you refresh me on the NADIR and how I go about doing that properly? His insulin is def not between 50-130mg/dL before preshot. I already gave him 2 shots today of insulin and do not want to think about even doing another one without it being dangerous. I just thought by giving him the insulin today it would have dropped his numbers to atleast 100 or close to it.
 
Okay I will adjust his insulin accordingly to that scale! Thank you! I do believe aside from the morning insulin I have given him the correct dosage. Maybe the insulin is going bad? I got it back at the end of October but the expiration date doesn't expire until 2016.
 
The nadir is the lowest glucose post-shot; for Novolin, that can be as early as +3 to +4 hours after injection.

At pre-shot, if he is in the middle 200s, give or take, he's doing pretty well. It'd help him the most if the nadir also gets between the 50-130 mg/dL.

And that set of ranges for you is a draft, OK? It is a rough estimate of what might work. Trying it out and getting tests will help you decide if it needs to be tweaked and how.
 
Well seems like most of the mornings his pre shot numbers are usually below 250. Just these last 2 days they were between 250-300. That is also why I check his BG +3 after shot because of what you guys have told me about N and that it peaks in that time frame. I just would love to see him after shot be down around 100
 
Around 240 mg/dL is the renal threshold, when glucose spills in the urine because it is too high in the blood. The occasional urine ketone and glucose test with KetoDiaStix may be helpful to see what has happened since the previous void.
 
I just gave him 0.75 or so unit of insulin. Took his glucose and it was 220. It has been rising all evening and going up even after eating wet food. Errr.
 
I think he has developed a pretty typical N pattern, dropping to a low point at +3/4 and then starting back up. There is no way to counteract this by increasing the dose. That generally just results in a possible dangerously low nadir and a big bounce for the next preshot. With the in and out insulins, sometimes dosing 3 times daily helps, but it is exhausting and takes a lot of careful monitoring. You'd cut your current dose into three doses, dosing every 8 hours. The trick is that you have to monitor enough to be sure he is rising at +8 each time, so you have to have previous numbers or do the stalling thing before shooting each time(test, wait 20 minutes w/o feeding and retest). This technique works with insulin that have a fast onset and don't last 12 hours. As you can see, it is tiring in terms of watching the numbers very carefully.

I'd suggest another insulin. Lantus and Levemir are popular and have good success rates. They are fairly expensive but there are ways to cut costs. ProZinc is also a milder, longer lasting insulin that can be bought for less if your vet will order the BCP PZI version (which is a compounded version). Any of those should give you longer, calmer cycles.

I don't know why his pattern has changed. Looks like his pancreas did work for awhile but quit. I don't know why. It's just one of the many mysteries of this disease.
 
Yeah a disease that stinks! Today has been fairing a bit better if you look at the chart. I guess probably its safe to say that you guys would not believe that being on N my Poopers will not become OTJ unless he goes on another insulin.
 
I'd say your chances for remission for him are much better with a milder, longer lasting insulin. He could be the one that surprises us (We see very few cats who do well on N) and it did look promising for a while, but not so much now.
 
The NPH insulin is simply not lasting long enough. You want 12 hours duration, and a nadir more in the 6-8 hour timeframe after the insulin shot.

Remission rates with the lente insulins are low. The NPH insulins like Novolin and Humulin N are lente insulins. From this University of Queensland slide show.
Remission rates:
 Lente = 2 of 8 (25%)
 PZI = 3 (4) of 8 (37-50%)
 Glargine = 8 of 8 (100%)
Most remissions within 4-6 wks

Treatment of newly diagnosed diabetic cats with glargine insulin improves glycaemic control and results in higher probability of remission than protamine zinc and lente insulins
http://www.sciencedirect.com/science/article/pii/S1098612X09001508
 
Yeah, I may just have to switch over. What would you guys recommend I check into? Lantus, Prozinc?
 
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Hi Ryan,
I recommend Prozinc

That's what I switched Hank to from being on the Novolin.

It worked great for Hank.

Kimmie
 
If I check into Lantus since it seems to be the most effective way to get a cat into remission, how long can I expect a vial to last? I am reading that it lasts only 28 days so am I going to have to spend over $100 every month just to buy a new vial of Lantus?
 
Lantus, Levimir and Prozinc are all good choices for a diabetic cat. ECID - Every Cat is Different so they will respond differently to the various insulins. All 3 of these insulins are use by many members on this message board.

Lantus and Levimir are depot type insulins where the effects can overlap from cycle to cycle and it takes time to see the effects of a dose change. Prozinc is an in and out insulin. Once the cycle is done, the insulin is used up and little to no overlap occurs from cycle to cycle.

Perhaps your choice will be influenced by what your goals are for Pooper and what your lifestyle is like.

With any of these insulins, it takes a bit of testing to determine how the insulin is working for YOUR cat.

Yes, the 10ml vial of Lantus is labeled and tested in humans for 28 days of use. Many of us here have used a vial for 3-6 months, keeping it refrigerated to help prolong it's life.

If you are thinking of Lantus or Levimir, you might want to consider the pen. It's like mini vial, 3ml, and can usually be used to the last drop. You'll want to use insulin syringes to withdraw from the pens, not the pen needle tips. That's because the pens only dose in 1 unit increments, and we like to make changes in 0.25U or 0.5U increments so we don't bypass the good dose.

Lantus and Levimir are more costly, but many people order from Canada.
 
You don't have to buy new insulin each month. With proper handling and care, insulin can last much longer than the labels say.
 
Yea I always keep my insulin in the box it came in and stored in fridge.
 
May have to try Prozinc or whichever works the best as far as giving his shot and then seeing his pancreas kick in to keep his BG down to around 100 or slightly below for like 12 hours. This N stuff stinks because most days it works well but like yesterday I would give him his shots but his numbers weren't going down all that much even with eating. Like today, his numbers have been great and I haven't had to give him any insulin.
 
Okay everyone, I hope you can answer before I decide to go to bed. I just got done testing his BG again and +2 hours from his last BG reading it went from 137 to 181. I don't want to fear that it will keep going up through the night even though he is sleeping now and usually does all night. I don't want to wake up to a 250+ BG either. I don't plan to be up +3 or +4 hours from now to check his glucose if I were to give him a .5 unit shot. So I give him a shot at all or just let it go and test it in the morning?
 
He ate a bit about 30-40 mins ago. I took his BG at 8:30pm which then it was 137. +2 hours later and he ate during that time and it was 181.
 
We have a saying here, well actually, we have a lot of little sayings. :p

"Better too high for a day, than too low for a moment."

With the N insulin you are using, you know it can quickly drop the BG levels low. The higher BG you are seeing at +2 looks like a food influenced BG spike to me.

If you can't stay up to monitor, it's safer to skip the shot and deal with the high number in the morning. I know that higher BG is not what you want to see, but sometimes we have to take care of ourselves in order to take care of our kitties properly.

Personally, if Pooper were my cat, I'd skip the shot.

ETA: I took a look at your SS. On those cycles where you have not given Pooper a shot, would you please enter 0 (zero) in the units column
 
Okay well I was thinking that too because I didn't want to give him a shot and then go to bed and worry that it drops like 100 and find out he has been like at 50-60 through the night. I will just pray for the best that when I wake up and test his BG that it will be under 200! Thanks to BJM for the chart above, I can go off of what to give him if the need arises. However, I have been using gut feelings towards not giving him any insulin even if he is at 200 or slightly above because I want to see if the food helps to bring it back down. IF it doesn't then I'll give off of what his number is.
 
Is it a good sign though if I can take him through some days where he doesn't need any insulin due to being in the mid 100s about all day?
 
Mid 100's are good, under renal threshold, so yes I'd say there is some progress. I just don't feel safe having anyone shoot the NPH type insulins when the numbers are so low. Sure, we like to see Pooper in the normal range, but I don't think that is going to happen safely with the use of the N insulin.

Hey, we do pajama parties around here. Stay up all night, helping someone through those lows and helping them keep their kitty safe.
 
I agree with you. I was hoping I could be the special case and see this stuff get his glucose to normal levels and stay that way. On the positive side of things, his glucose is much lower than what most people's cats were at. He hasn't ever been above 300 and from my SS his numbers have been mostly in the 100s or the blue color. Well, I guess I will head to bed then and hope he stays below 200.
 
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