Symba: AMPS 31.6 mmol +6 3.6 mmol

kimouette

kimouette

Member Since 2012
Hi guys,

See spreadsheet here : https://docs.google.com/spreadsheets/d/1loYGjI3lkWVY8MLuXNFjmQL8Pcl-0hRfSMqbEh2SzHs/edit?usp=sharing

I am currently helping my cousin's friend with her newly diagnosed cat. He has been on Lantus for 2 weeks but she never tested the cat until the last 3 days. While she wasnt testing the cat, he was rushed back to the vet for a hypoglycemic episode, was given glucose and sent home and unfortunately got right back to his diabetes.

Now that "I'm in charge" I made sure the cat was switched to a low carb high quality food and the owner started testing her cat as often as she could. For the past 3 days I've been really depressed to see how the numbers are unstable, unpredictable and SUPER HIGH. Now the cat just dropped to 3.6mmol and I am no longer confident in telling her to maintain the dosage at 1U (I was actually going to ask her to increase the dosage before I saw that huge drop!!).

So what should we do about the upcoming injection? I have seen many cases of highs and lows in the past, but honestly never that radical in such a short period of time. So should we ignore the latest nadir and risk low numbers later in the night or should decrease the dose and risk to get right back to those ugly black values??

Any help would be greatly appreciated!
Thanks
Kim
:)
 
Sorry no one got back to you earlier. What dose was the kitty getting when he was rushed to the vet with a hypo? Do you have any blood sugar numbers from the hypo incident? Or description of symptoms. If he had a hypo, the dose should be reduced.

When was the food switch? What was he eating before that?
 
Hi Wendy, Thanks a lot for the reply!
Wendy&Neko said:
Sorry no one got back to you earlier. What dose was the kitty getting when he was rushed to the vet with a hypo? Do you have any blood sugar numbers from the hypo incident? Or description of symptoms. If he had a hypo, the dose should be reduced.
When was the food switch? What was he eating before that?
Click to expand...
The cat was receiving 1U when the hypo occured. I dont have any numbers from the hypo unfortunately. I've been told that the cat was shaking a lot when she rushed him back to the vet. After the vet gave him glucose, he asked that the owner stopped giving insuline cuz he thought he was cured. It took a little less than 2 weeks before the cat started to drink a lot of water again and this is when I started to ask her to switch the food and start testing (which happened 4 days ago, exactly when she started entering the values in the spreadsheet). We know that while he was eating high carb dry food he already had very high numbers (above 30 from what the vet said), but still managed to get a hypo. Maybe at that point he really was OTJ but simply needed to be put on a low carb food RIGHT AWAY, which didnt happen until recently.
I have updated the spreadsheet and as you can see the cat still isnt stable in any range. But we did decide to go ahead and stay with 1U yesterday night and now that i see the results, I'm glad we did!

I'm afraid we will have to take some risks with that kitty cuz letting him stay in those super high values is painful to watch (the cat is starving and wont stop meowing the entire day). Even is he gets close to a hypo he wont stay there for more than a few minutes and gets right back to very high numbers.

I hope the roller coaster effect will end soon. I wouldnt mind if he was always in high values cuz i would feel confortable increasing the dosage, but those highs and lows within a super short period are very hard to manage.
 
With that 3.9 I would say that kitty earned a reduction to .75u units. He may be very bouncy since having a hypo incident and his body super sensitive to lower than normal numbers. I hope someone with more experience comes along to help out with dosage.

With the switch to low carb wet, insulin needs can change quickly and he may go OTJ very quickly.

I would also let kitty feed several times a day to help with the hunger pains and it may help with keeping his numbers more consistent.
 
Has kitty been back on insulin for only four days? Just trying to figure out if the depot is established yet. If she was giving insulin but not testing, it would be helpful to put 1u in the preshots cells of the spreadsheet for those days, so we know he was getting insulin. Similarly, include a comment in the remarks on the day the food transition started. Timing of major changes is important.

And last question, how was kitty diagnosed? Was there a fructosamine? What was the blood sugar at the vet at the beginning?
 
Yes Symba has been back on insuline only since the 18th (and started to eat low carb food on that exact same day). Prior to that he was eating high carb kibbles.
The owner doesn't have ANY numbers from the vet's office. He did run a fructosamine test and kept the cat for a day to do a curve, but all she knows is that his numbers were high and that the vet already mentioned how the numbers were very "bouncy".

Does it change anything if I tell you guys that we are talking about a Sphynx cat? I'm pretty sure it doesn't, but just though I should ask...

Tracey, thanks for the suggestion. Starting today Symba will be fed multiple small meals instead of 2 big meals. Fingers crossed that this is going to help.

But honestly, now that I look at it, even though Symba managed to have 2 green numbers, I dont see how lowering the dose could be the right thing to do... He spends WAY too much time in these dangerous black values.
We'll see if the small meals help, and if not, I guess I'll be back for more advise!
Thanks a lot for your help!
Kim
 
Sometimes too much insulin looks like too little insulin. Which is why I was hoping someone with more experience would come along and help with reading the numbers!
 
kimouette said:
Yes Symba has been back on insuline only since the 18th (and started to eat low carb food on that exact same day)
...
But honestly, now that I look at it, even though Symba managed to have 2 green numbers, I dont see how lowering the dose could be the right thing to do... He spends WAY too much time in these dangerous black values.
Click to expand...

We usually dont recommend abruptly changing to low carb diet at the same time as starting insulin- but it does help that you/she is testing. Which meter is being used?

A lower dose may be a good idea when bouncing so severely. Remember that hypo can kill much easier than high glucose. That said, have ketones been checked at home? It would be a good idea to check with those high numbers, especially if the cat has been ever hospitalized for dka.
 
Hi guys, I have updated the copy of Symbas spreadsheet.
Each time we lower the dosage he gets those very high values and spends way too much time in those dangerous values. But then, if we increase the dosage we get slightly better values but he surely gets a hypo after couple of cycles.
When under low dosage he becomes aggressive and has dilated pupils so the owner is telling me that she’s willing to risk a hypo to avoid this situation.
I’ve never seen such a case of roller coaster at each cycle with Lantus.
Now I’m thinking that if Lantus is not acting as a slow/long lasting insulin on this cat, maybe we should switch to a fast acting insulin but maybe give 3 or 4 shots a day?
What would you guys do?
 
For the moment, I would hold the 0.5 unit dose until the bounce clear bounce, then reevaluate the dose. Any chance this caregiver can get tests after PM +2. Like last night when there was a huge drop to +2, which is a sign of an active cycle and worth getting a later test. I am worried some important data is being missed, for example, the PMPS test a couple nights ago.

Also, what is the normal feeding schedule and type of food being fed?

Worst case and Lantus doesn’t work, I would not go to a short acting insulin. This cat is already getting poor duration. I would keep trying Lantus for a bit, then maybe Levemir.
 
She feeds him a small meal after each test (so this is as “regulated” as it gets with this cat since she stopped feeding him only twice a day.. which made th bounces even worse!).

For the pm cycles... I know... I told her she couldn’t let these big drops happen without at least another test during the night, but she won’t hear it.

By the way when I said I was thinking about a short acting insulin, it was not to get the short action twice a day! I meant to maybe use Caninsulin like 3 or 4 times a day to get a continuous effect. I know for sure that two shots a day would be useless!

We’ll maintain the dose at 0.5 for another day or two but she is already pressuring me cuz the cat is aggressive when he’s having high red or black numbers... 0.75 was a little better but for some reason it triggers those huge drops and bouncy cycles
 
You must log in or register to reply here.
Back
Top