Very high glucose levels in the morning -why??

[Nepthaphis]

Hi

We're working with our Vet on getting Largos diabetes under control, and after increasing the dose of Vetsulin to 4 units twice a day (as of monday afternoon), it seems we're finally getting some results. He is now also eating all wet food - Bozita and BARF. He's drinking much less but still peeing more than usual - although not as much as when he was first diagnosed. We're bringing the Vet a urin sample to tomorrow. He's also starting to gain some weight back. (He dropped half a kilo the first week after diagnosis)

I measured his blood sugar every 2 hours yesterday for a full insulin cycle - from 6 AM to 6 PM:


(Sorry I've not started using the spreadsheets yet - I've only got my own excel tracking for now)

It seems his nadir is around 8 hours after injection.

What baffles us, is that the dose of insulin seems to be working fine for the 12-hour day cycle (6 AM to 6 PM) but something happens during the night cycle (6 PM to 6 AM) that causes his glucose level to spike seriously! Yesterday morning pre-insulin his blood sugar was 27,9 mmol/L (European). At nadir (around 2 PM) it was 5 mmol/L and then before his evening insulin shot at 6 PM it was 13 mmol/L.

Our cats usually get a small lunch around noon when we are home (weekends and vacations) and they get supper at around 10-11 PM in the evening. When I measured Largos blood sugar last night at 10:30 PM (before supper) it was an acceptable 8,1 mmol/L. Then, this morning pre-insulin at 6 PM it was as high as 25,6 mmol/L! I really don't understand why this happens!

Our kitties are free to roam outdoors during the day, but at night they're kept indoors. There is no food available to them after supper until breakfast the next day. Comparing the blood sugar levels last night at 10:30 PM to the levels at 10:15 AM the same day, the PM levels were lower than the AM ones! (10,5 mmol/L AM against 8,1 PM). After supper in the evening, all the kitties do is cuddling and sleeping?

Has anyone else had similar experiences? From what I can read online, for humans if blood sugar is too high in the morning one should test agan at 3 AM. If the blood sugar is low at that point, one might need a smaller dose of intermediate insulin or long-lasting insulin in the evening.

I don't know if the same thing applies to cats, but what baffles me is that Vetsulin seems to be long-enough acting during the day...

Any input or advise will be welcome! I've asked our Vet to try and think of a solution too but I figure the collective experiences of this amazing forum runs a better chance of having seem something similar

 

[dirtybirdsoaps]

When I asked this question Jen&eddie told me "Have you read about the Dawn Phenomenon? In human diabetics, BG is often higher in the morning, and it seems some of our kitties are as well."

Hidey had the same problem, I'd feed him RIGHT before I went to sleep but his highest bg was first thing in the morning. I had to start feeding him during the night. I bought a petsafe 5 feeder and Hidey eats about every 5 hrs to keep his bg diet controlled now. He eats at 7 am, 12 PM, 5 PM, 10 PM, and at 3 am. Since I started feeding him during the night his numbers have been a lot better. They also offer a 2 meal feeder if you do not need the 5.

 

[Nepthaphis]

Hi Dirtybirdsoaps, and thanks for responding!

Problem is that we have two cats, and unless I keep Largo confined to one room, I have no way of knowing which kitty will actually eat the food in a timed feeder (We've tried before)
Our kitties are indoor/outdoor cats - they have a cat flap and are allowed to come and go as they wish during the day but are kept indoors at night.

I really don't want to make Largo stressed out by taking some of his freedom away At least no more than strictly necessary

 

[JenM]

I just want to point out that by allowing your diabetic kitty outside, you may have difficulties in getting him regulated. Assuming you have neighbors... you have NO WAY of knowing what he's eating when he's outside - lots of people feed kitties on their front porch and it's almost undoubtedly high carb kibble.

I know MY sugardude would clean the dishes on every front porch on my street if given the chance.

If you dont have neighbors, it might not be that big of a deal - I would assume mice/birds are zero carb :lol: - but I'd definitely be concerned about my guy scavenging kibble.

 

[Nepthaphis]

Hi Jen

I absolutely agree with you and we've thought about the risks for sure! But Largo really don't stray far from the house (he's 13 years old and perfers lounging around in the little forest in our back yard). He so much loves being outdoors and since we live in a cat-safe suburban neighbourhood (no passing traffic or major roads) we are loath to keep him confined indoors. He's been allowed outside for the 7 years he's been with us since we adopted him (he's a humane society rescue).

Luckily he's a major foodie, so he always comes home for dinner and his evening insulin shot.(otherwise we'd obviously have to keep him indoors)

As an extra precaution he also now wears an 'I have diabetes' tag on his collar.

Thank you so much for your concern!

 

[dirtybirdsoaps]

You could always get 2 auto feeders, one for each cat or even fill their bowls up extra before bed in hopes they'll eat but leave some for later.

 

[BJM]

Partitioing off sections of the room with a dog kennel run might work and let you be sure he gets his night snack. Some of them have tool-less assembly and if neither jump, no cover or roof is needed, otherwise chicken wire works.

An outdoor cat-a-tat (Big Cat Rescue's term) or catio would protect him against other critters and people with ill intent.

 

[Nepthaphis]

Thank you both for your concern!

We've tried two separate timed feeders before - one for each cat - but invariably Largo would finish both meals as My (our non-diabetic cat) is not as interested in food and prefers to snack at irregular times..

We really don't want to confine the cats or take away their outdoor lives, but will see what the Vet comes up with after cultivating the urine sample I handed in this morning. She doesn't really like that Largo goes as low as 5 mmol/L at Nadir and he's still too high pre-shot. But he's only been on 4 Iu since Monday night, so it might take a bit of time for the real results to show. The Vet is also considering trying another type of insulin - a longer acting one.

On the bright side she was very impressed that we keep such close tab on Largo and measure his blood sugar as fastidiously as we do She said we were a dream-case in that respect! So at least we're doing something right - if only Largo would soon be regulated... :/

I got up at 3 AM this morning to test (with reference to the human diabetes high blood sugar in the morning information I found yesterday). At 11: PM he was at 4,8 mmol/L (a bit too low for our Vet's comfort). Then at 3 AM he was at 16,2 mmol/L and at 6 AM pre-insulin he was as high as 27,7 mmol/L! And this spiking only happens at night! The Vet says we might have to skip his late night supper for a couple of days to see how that affects the morning readings, but she would get back to me once she's had the time to go through our latest numbers.

Also she told me that she'd just been to a Vet seminary concerning cats, and one of the topics had been the definite benefits of feeding only wet food! YAY!! She said that will for sure be what she will recommend for cat owners in the future. So that's at least a victory for the cats using our clinic!

I need small positive gems like this to keep my mood up. These have been tense weeks with little sleep and much worry!

 

[JenM]

While removing that last meal would make SENSE... I found the opposite to be needed with Tink. He also had very high numbers in the morning and I found that by throwing in the latest meal possible, it actually resulted in a lower AMPS. To this day I dont understand why, but it works for him. By splitting his meals into 4 servings (he used to eat twice/day) and feeding the last one as late at night as possible, we got him diet regulated. That is over now and we're back on insulin... but still... it seems the later I feed him, the better his AMPS is. I am seriously considering adding a 5th meal around 2am - but like you,the logistics of being a multi-cat household make that a challenge. He does get one meal via timed feeder, at noon, that I'm reasonably sure the other cats aren't getting (he's kind of the boss) - so perhaps a mid-night meal could work for us too.

 

[BJM]

Perhaps getting too hungry is a stressor and that is why it raises the glucose.


I have a dog kennel made of 5 feet tall panels which are then connected together w/ screws. You can add on and make them quite large, so not terribly confining. And I've seen cat trails made of mesh tubes which allow the cat outside, while protecting against hawks, opossums, raccons, etc.

 

[Nepthaphis]

Hi JenM and thanks for your input!

Incidentally, Largo didn't have any lunch today (he was outside sleeping through lunch-hour for once) and when I tested him pre-shot at 6 PM today his blood sugar was 11 mmol/L! Too low for me to be comfortable giving him his insulin as he's not yet stabilized, so I have called the Vet's office to ask what they recommend. 'Our' Vet had left for the day, but they are contacting her and I'm waiting for them to get back to me.

BJM - that too might be the case! Why does getting a kitty regulated have to be so difficoult? Where's the Vet-equivalent of Doctor House when you need him? *sigh*

As for potential harmful predators, here in Norway we have very few of them - at least where we live. There's the occational fox meandering past at night (which is why the cats are indoors during the nighttime) Other than that, there are precious few things that can threaten our massive 16 plus pund kitty

 

[Nepthaphis]

Heard back from the Vet - they've asked me to test again at 10 PM and give insulin then if readings are high (above 15 mmol/L). I tested at 7.30 PM and he was then at 16,5 mmol/L, but they still told me to wait. And even if I end up giving insulin tonight at 10 PM, they told me I can still give at 6 AM in the morning if he's high.

That sounds kind of scary to me - since it'll only be 8 hours? (I asked but they said it should be okay) I'm thinking maybe I can give a smaller dose tomorrow morning, or should I give the 4 units? (We're on Vetsulin).

Any thoughts would be welcome!

 

[BJM]

Vetsulin is an in and out insulin normally. If you shoot sooner than when it mostly has worn off, there can be some overlap. This can be OK if you are fighting high numbers and shortened duration. Just be sure to check around the time he normally nadirs or hits his lowest level.

 

[Nepthaphis]

Thanks again BJM for being there for me! I honestly don't know what I would do without this forum!!

We tested again at 7 AM this morning (from what we've seen that's just around nadir). He was then at 14,5 so we didn't give any insulin.
Since he was so low yesterday when he didn't get any lunch, we figure if he can skip lunch today we might be fine until next shot at 6 PM - we'll see!

 

[BJM]

Just in case you haven't seen this, glucose reference numbers by meter reading types.

[false assumptions removed by moderator]

Comparing a human glucometer to a pet-specific glucometer is like reading temperature in Celsius vs Fahrenheit. Both are correct. You just need to know the reference ranges to interpret what the numbers mean.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

* * * * * * * * * * * * * * *​

Examples of using the chart:

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)

 

[Nepthaphis]

Thanks again!!

I found this overview a few weeks ago and has taped it to the inside of my journal where I write down Largo's readings, insulin dosages and weight I use it for reference daily and it's invaluable!!

Aslo, my Vet advised that going forwards now we should try 3 units of Vetsulin in the morning and 4 units at night, since he seems to get much higher during the night. We'll start that tomorrow morning and test every 3 hours through Sunday.