Tiggy - weird BG numbers - flat and increasing with insulin

Status
Not open for further replies.
Wendy&Tiggy(GA)

Wendy&Tiggy(GA)

Member Since 2011
Hi
Marjorie and Gracie suggested I posted on here as I am having issues with my cat Tiggys BG. You can see the thread on the other forum viewtopic.php?f=28&t=76144 but to summarize:

I am getting weird BG levels and wonder if anyone can advise. Our cat is showing sugar in his urine at high levels and clinical signs such as drinking a lot etc. We have tried raising his insulin level gradually and we are thinking its making things worse!! Here are the details and the numbers are in my SS in my signature.

At 1IU BID he had pre shot of 200 but his peak was only around 175 and he showed clinical signs so we thought that 1IU wasn't high enough.

We tried raising it to 2IU and saw that his pre shot number was higher, nearer 250. His peak maybe was only 50 less than that, plus he still showed clinical signs. However at 2IU he occasionally got lower pre shot numbers to around 150 then back to 250 for a few readings.

We tried raising to 3 IU but got the same kind of results. Pre shot was higher still nearer 275 and above. Still the occasional sudden drop in pre shot numbers, now to around 100 this time but it wouldnt last and he would be back to 275 12 hours later. Still showing high urine glucose.

(Just for reference, he is 16lb cat. We know the insulin is ok because we have another diabetic cat that uses it and he is responding normally. we are using a Freestyle Freedom Lite meter that was calibrated by our vet and works great on the other cat. He is a free feeder and eats solely low carb canned food)

Any ideas? If we take him to 1Iu it seems to be too low, but his numbers are acting weird on higher levels. No matter what we do we cant seem to get his sugar low enough that he isnt spilling a ton into his urine, plus he has neuropathy. I am almost ready to take him off entirely and see where he is without it for a week or so.

thanks!

Wendy
 
Re: Tiggy - weird BG numbers - flat and increasing with insu

Hi, Wendy! Welcome to Lantus Land.

I have two thoughts regarding Tiggy's numbers. First, the insulin dose may have been raised in too large of an increment. With Lantus and Levemir, the dosing protocol that we use specifies that with a cat whose nadir is below 300, the dose is raised by 0.25u. You've been increasing your dose by 1.0u -- four times the amount by which we typically increase. It's easy to miss what could be an effective dose if your increasing by such large amounts.

The other possibility is you've just not gotten to what is Tiggy's "good" dose. More insulin may, in fact, be necessary.

One other consideration is that you really need to get at least one spot check during the PM cycle. Many cats experience lower numbers at night. You don't want to miss those. Also, if you aren't testing at night, you're missing half of your data. Not having that information can make decisions regarding dose changes next to impossible.
 
Re: Tiggy - weird BG numbers - flat and increasing with insu

Ok so I think I have a strategy. I am going to take a few readings at night for a few days. Then what do you think.... Start again at 0 and work back up at 1/2 increments? How long should I hold the dose for before increasing?
 
Re: Tiggy - weird BG numbers - flat and increasing with insu

Hi Wendy from another Wendy.

Have you thought about getting another meter and seeing if you get the same results? I started out with the Freestyle Freedom Lite and on the advice of others (who also had problems) I got a different meter. If you look at Neko's spreadsheet, see how it completely changes after March 12th when I filed the Freestyle into the back of the cupboard. I've now got both the Relion Confirm and the Bayer Contour. Both produce similar numbers and way different than what I was getting on the Freestyle. The issue I was told is that the Freestyle (the one with the butterfly strips) seldom reads over 300 for cats so you don't get a real picture of what is happening.
 
Re: Tiggy - weird BG numbers - flat and increasing with insu

Sienne and I are, as usual, on the same page.

There are two ways to go
1. Take him down to a better starting dose and bring him up slowly in accordance with the TR protocol: you will need to test for ketones every day; it can be tough to wait out high numbers and you could lose ground

2. Continue up slowly per the TR protocol until you hit a breakthrough dose that brings him down.

If you start over, you'll be dealing with possibly high numbers...higher than you see now. If you continue until you see a breakthrough dose, you might have to spend a long day or night controlling numbers but we can help you with that.

It's up to you...you hold the syringe.

You might want to first see what kind of numbers you are getting at night, mid cycle. It won't hurt to leave him here a few more days until you can see how those mid cycle tests look.
 
Re: Tiggy - weird BG numbers - flat and increasing with insu

Hey there - so I got up at last night and took some readings, Plus I have been using both meters. Check out the SS. Here is what I am seeing though...

1. the new Contour meter is showing the same flat numbers as the old Freestyle so far (the contour seems to be almost consistently 60 higher at these levels)
2. Overnight behaviour seems the same as during the day - which makes sense since he is a free feeder

However now I am seeing one of those weird drops I mentioned before.. look at his numbers from last night versus this morning - it showed on both meters but here is the numbers from the new meter :
PMPS 322
+3 310 (dropping)
+5 286 (lower)
+9 295 (going back up)
AMPS/+12 274 (wtf?) I gave him 3.5IU for now.
I am going to do a curve today to see what happens now. I am suspecting the flat numbers are in fact somogyi and that with his most recent dose he will drop low and shoot back up again and go flat. Thats what I am looking for anyway.. thoughts?
 
Re: Tiggy - weird BG numbers - flat and increasing with insu

First, flat numbers are not Somogyi. Rebound is characterized by big swings in numbers. Also, there is no evidence in the research literature to document the presence of Somogyi with Lantus or Levemir.

The numbers you're seeing are attributable to meter variance. I've calculated 20% around each of the blood tests you've gotten.
PMPS 322 (range = 258 - 386)
+3 310 (248 - 372)
+5 286 (230 - 340)
+9 295 (237 - 383)
AMPS/+12 274 (220 -328)
You can see how the numbers all overlap.

If you're referring to the drop at AMPS, this may be a "double dip." Some cats will have a drop in numbers right before shot time.
 
Re: Tiggy - weird BG numbers - flat and increasing with insu

Good morning

Could you tell us your name please? Also, we'd love it if you can post daily as many of us do so we can offer you the best help. Each day we open a new "condo" or thread and everything goes in that same condo for the entire day. So one condo per cat per day. We also link the previous day's condo so those helping can go back and review what happened. It's quick for us especially if we need to go back several days. In order to link the previous day's condo:

1. go to previous day's condo and copy link in browser
2. open a "new topic" and put your cursor in the big text box
3. click on the URL box above the text box
4. paste your link in between the boxes so it looks like this: Paste Link Here

If you want to make it fancy, do this:
1. remove the second bracket and put in an =
2. put the second bracket at the end of your link
3. in between the second and third bracket, put whatever title you like....some are like the one above, others are "Yesterday", whatever you like so we know it is the condo from the day before
4. highlight it all and then click on the B in the line above the text box to bold your title. So it looks like this: 7/17 Condo (note: I didn't add the "b" or else it will just bold it and you won't see them anyway) starts working.

In the subject line, we put the test results by hour so those of us helping you can keep track of how Tiggy is doing and if we see a number of concern, can post in your condo. The format is:

date cat name AMPS other tests. So it might look like this to start the day: 8/4 Tiggy AMPS 320

then as you test during the day, you add the tests so at the end of the cycle, it might look like this: 8/4 Tiggy AMPS 320 +2 288 +4 256 +6 200 +10 255

When you do your PMPS, then you take out all the AM info and add the PM info so it might look like this: 8/4 Tiggy PMPS 267 (and then add your PM tests as you get them).

In order to edit the subject line, at any time, open the condo, go back to the FIRST post of the day, select "edit" and then edit the subject line and if you need to click on a question button, etc, do that, and then hit "submit". Then to add your post, click on "post reply" so it adds it to the bottom of the condo so posts are sequential by time. If you need help, but it's not an emergency, just put it in your subject line or click on the "?" button above the subject line (again on the first post of the day even if you have 20 posts after it in that condo).

If you could also do a Profile for TIggy, it will help us help you because important info we need to know about her is quickly accessed by us.

There is a lot of important information regarding lantus that is available for you to read. We suggest you print it, put it in a folder or binder, and then you have it handy if you need it quickly. The info is found at the top of the Lantus TR forum that you are in....they are called "stickys". Here are quick links to them:

New to the Group-provides great, basic information ....a must read first :-D
Tight Regulation Protocol - more on this below
Proper Handling and Storage of Lantus/Levemir - very important as we store our insulin in the frig, do not shake, roll, warm, prefill syringes, etc.
Insulin Depot - discussion on how lantus/levemir work
Dealing with Low Preshots - very important to have on hand
How to Handle Low Numbers - also very important to have on hand

The vast majority of the members of this Insulin Support Group are using a dosing protocol that is based in clinical research and that has been published in leading veterinary journals. It is referred to as the Tight Regulation (TR) Protocol (or by other names as well, the Tilly Protocol or the Rand/University of Queensland Protocol). They are all the same. A modified version of the protocol and links to the formal versions is available in the Tight Regulation sticky. This approach will give your cat the best chance of going into remission or keeping his/her blood glucose numbers in a range that will prevent organ damage.

It is not mandatory that you follow this approach. However, you should be aware that most of us do and it is how we approach dosing decisions. As a result, we are very numbers oriented.

This protocol was developed by lay people who are members of the German Diabetes-Katzen Forum and It has since been published in the Journal of Feline Medicine and Surgery. In other words, there is research to support the use of this dosing protocol. The majority of cats do very well on this protocol; some cats do not. Every cat is different (ECID). Also, results do not occur overnight. Lantus will teach you patience. It is more time-consuming than most other protocols but still definitely doable if you work a regular full-time job. Many people here have challenging schedules.

Some important notes that are "requisites" to following a TR protocol:
• Kitty should be monitored closely the first three days when starting Lantus or Levemir. Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9. More monitoring may be needed.
• Learn the signs of and How to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
• Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA). Be aware that ketones don't typically occur once a cat is (and remains) properly regulated. Most of us buy ketostix at the pharmacy and test urine...it's easy and quick.
• Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
• Feed a high quality low carb canned or raw food diet.
• Feed small meals throughout the day. Some kitties adapt well to free feeding.

There is a steep learning curve but we are here to help you. All you have to do is ask....people here are very warm and generous with their time.
 
Re: Tiggy - weird BG numbers - flat and increasing with insu

Thank you, this is all great information! My name is Wendy Thomson and I have two diabetic cats, Tiggy and bailey. Tiggy is the one I am worried about. I will start the condos and move him to 2iu tomorrow which is the starting dose you recommend on the tight regulation based on his ideal weight. Also I have done a profile and out it into my signature as suggested! Am looking forward to trying this. I really want to get him settled, it worry since he is losing weight again and spilling into his urine.

Bailey is a completely different story... Here it is if you are interested
Bailey is 11 and used to belong to my husbands sister. She had two cats, and suddenly one lost a lot of weight. She went to the vet who did a curve overnight and recommended a dose. Even with this dose, The cat died suddenly within a week. the second cat had lost weight too and she thought it was just because the first cat had eaten all the food. But then he starts peeing everywhere and i persuaded her to take him to the vet too, however she couldn't afford and didn't trust the vet whenhe said the second cat also diabetic. So I took him off her having had some success (at that point Tiggy was in remission). Bailey had gone to being a seriously obese cat to skinny, when we got him he could barely walk. He was skinny and dirty and spent his whole time going from water bowl, to food bowl, to litter tray and back. The vet put him on 1/2 iu bid. And we took him off dry food entirely, His numbers were wacky for months but the vet expected that since he was in such a bad way. But the insulin worked and now he has a ton of energy, has put weight on and is clean and happy. All on 1/2iu bid. Now his numbers over the last months have dropped to 50-125 preshot. We tried to give him less, and take him off but his numbers just shoot up again into 300+ but we know why..... He really desarately needs dental surgery to remove easily five teeth but the vet wouldn't do that till he was strong enough. Now that he is , we operate next month, and we and the vet expect to take him off insulin entirely at that point! I wish Tiggy was as easy!
 
Re: Tiggy - weird BG numbers - flat and increasing with insu

Oh yes I forgot to say that I regularly test his urine using keto-diastix. Ketones are clear but his glucose is maxed out.
Also i feed nothing but canned low carb wet food... Free feeding. Canned core wellness, natural balance venison and green pea, fancy feast pate.. See my profile. I was giving him. Methycobalamin for the neuropathy but have stopped that recently due to the fact that there is some sugar in there and I wondered if that was impacting the results. I couldn't find a methylcobalamin without xylitol but also without sugar..
 
Re: Tiggy - weird BG numbers - flat and increasing with insu

Wendy

Thank you for the profile. He's so handsome.

The starting dose is for newly diagnosed cats just starting on insulin. He has been on the juice a while. I am out right now running errands but i would suggest you hold on the dose until I can get back and we can dis uss it.
 
Re: Tiggy - weird BG numbers - flat and increasing with insu

Ok will do. He has been on 3iu bid since he went back on insulin after his remission. And everything was fine for a while but a month ago he started spiking up and down.. Up over 300 and down below 60 preshot, so i tried reducing it a bit a few weeks ago which didn't help the spiking .. I took him down 1iu every 4 days or so. Eventually I took him off and he was way over 300 so I started him at 1iu which is where my spreadsheet actually begins.. Do you want me to update the sheet to show from day one after remission?
 
Re: Tiggy - weird BG numbers - flat and increasing with insu

Wendy --

I don't think Natural Balance is low carb. I can't find any list with the carb values but I may have calculated it at one point. If you ask on Health, someone may have that information.

If you are looking for methylcobalamin, there actually is a product formulated for diabetic cats -- Zobaline. I believe you can purchase it through Amazon.
 
Re: Tiggy - weird BG numbers - flat and increasing with insu

Omg omg omg. Natural balance venison and green pea isn't low carb!!! That explains EVeRyThing! I just looked up a few things and Let me explain

We got bailey (2nd diabetic cat) in January. Tiggy was in remission at that time. Both. Cats were being given core wellness and low carb fancy feast only. Then bailey started losing fur from his face and scratching all the time. The vet diagnosed him with an allergy to chicken so he suggested variety of foods including this natural balance. I questioned him at the time because I couldn't find it on Janet and binkys chart and he said no, here it is, it's 8%.

So we started feeding it, and now i worked out that literally two weeks later Tiggy came out of remission!! So now I look at Janet's and binkys charts again and sure enough natural balance venison and green pea isn't on there. There is a royal canin one but that's not the same.

Could it be this simple? Maybe the low numbers we occasionally get were times he ate less of the venison. Anyone know what % carb it actually is?

I am cutting them off natural balance immediately.We will worry about baileys allergy later...
 
Re: Tiggy - weird BG numbers - flat and increasing with insu

Let me look through a bunch of stuff I have on food and see if I can find that one. My guess is it's probably much higher %carbs than you realize.

Is it not affecting Bailey's BG?
 
Re: Tiggy - weird BG numbers - flat and increasing with insu

I couldn't find anything on it although I used to feed it to my cats before Gracie was dx with FD.

You are probably going to have to wait until Monday when you can call the company and get the as-feds. In the meantime, I'd feed him something else. The Wellness Core foods are all on the higher end of LC. The chicken, liver, turkey is 8%; the turkey duck is 11%; the fish one is 13%; the beef, venison one is 10%. Many of us just feed the Wellness 4% foods like the chicken, beef and chicken, and turkey.
 
Status
Not open for further replies.
Back
Top