Why are Sam's numbers rising?

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It almost looks like the insulin is not working at all. Just about all those numbers could be accounted for by meter variance or food spikes.

You've increased in 0.5U doses. Maybe bypassed the good dose?

What food are you feeding? Low carb? Try lower carb?

What is his weight? Overweight? Obesity in diabetic cats can cause insulin resistance.

Bad batch of insulin? Are you using the vial or the solostar pen?

Any way you can get a different vial/pen for even a shot or two to test against the vial you are using.

Storage of the insulin is being done how?

Has the vet checked your injection technique?

High dose condition like IAAA or acromegaly?

Haven't reached the right dose yet?

Trying to suggest everything I could think of and trying to be a good detective with all my questions.
 
Storage of the insulin is being done how?
In the fridge.
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Where in the fridge? Not the door where it would get shaken every time you open the door, on a middle shelf protected so it does not get jostled is best.

No rolling of the lantus vial prior to drawing the insulin?

Look at the vial of insulin closely under really good light. Are there any floating particles in it or has it turned cloudy? Lantus should be perfectly clear.

Please check both vials you have.

Do you switch back and forth on the vials you have? Or always use the same one for each shot?
 
There is no need to roll the lantus insulin. It is not a suspension like the cloudy insulins, like PZI or Novolin. My understanding was for best keeping quality, to not roll, to not store in the door.

Here is a sticky from over in the lantus TR ISG on handling procedures. http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=151

Detective Deb is out of ideas. Someone elses turn.
 
I have some ideas!

1. does she get out at all? is there any way she is getting contraband from somewhere else?
2. Is she on steroids or any medication? Does she have bad teeth? ear infection? UTI?
3. I have a note from way back asking you to get more tests because i was looking for bounces where she dropped low. But even if she is doing that you'd think you would see some occasional evidence of a low even though there arent many tests. So I start to wonder about high dose conditions like IAA or acromegaly too, however before you spend a ton on tests and worry etc I would very very strongly recommend more tests to see whats going on to rule bouncing out entirely.

My idea for the next 3 days do the following
1. AMPS (morning preshot test)
2 mid cycle test - somewhere between +4 and + 7. vary it by day. if you are out at work then do #4b below instead.
3. PMPS (evening preshot test)
4. before bed test or 4b. Mid cycle nighttime test - somewhere between +4 and + 7. vary it by night.

If we dont catch a low in that time we can rule out bouncing. Now I must say that bouncing is different from Somogyi and can last up to 72 hours so a one day curve will not catch it. Hence why I am asking for tests for the next 3 days.

Wendy
 
Just call me no Sxxx sherlock ;)

UTI treatment should have brought the BG down if that was the issue. .. but any other infection could cause the issue.

The 24 tests are great but if he is mid bounce you could miss them since a bounce can last a few days before they come down. Lets do more tests and see.

Hows his breathing? I hate to say it but breathing issues are a sign of acromegaly. Has he put on weight recently? Look back at photos from a year ago, do you see signs of growth esp in the face? What about his teeth? Take a peek at his canines, they should kinda overlap top and bottom. If they are wider ie the bottom is further than the top and they wouldnt touch then it could acromegaly.

Wendy
 
Debbie, you are onto something: I now have to follow up with my vet because she told me to:
1. Roll the insulin cartridge. Not with Lantus or Levimir. Only need to do this for the suspension insulins, the cloudy ones like humulin, Novolin, PZI or Prozinc. Rolling Lantus or Levimir simply damages the molecules and shortens the shelf life.
2. Inject the amount of air into it equivalent to the insulin I'm drawing. Yes, if you ae using the vial, you should inject an equal amount of air into the vial. This equalizes the pressure within the vial and minimizes air bubbles. I do not believe you want to do that with the pen cartridges though.
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We also do not advise, drawing the insulin out into the syringe and then squirting the excess back into the vial or pen cartridge. The insulin syringes have a silicone lubricant in them. Squirting excess insulin back into the vial can contaminate the insulin, shortening the shelf life. That Lantus and Levimir are expensive, so what ever we can do to store them properly and prevent detioration we try to do to save some money.

With careful handling a vial of Lantus of Levimir can last 4 to 6 months and maintain effectiveness.
 
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