Confused by the different readings

Hey,

We started insulin treatment on George 10 days ago. Initially, his blood sugar was around 29 mmol/l and stayed within the range of 20 - 29 mmol/l for the first 7 days. (2 units of insulin twice a day). Our vet told us to increase the dose to 3 units which we started yesterday morning. When we checked his blood in the evening it was 11 mmol/l so we decided to play safe and not give insulin. This morning we checked again and his blood sugar was 8.3. so again we didn't give insulin. (Obviously, we got a bit ahead of ourselves and thought we were experiencing some kind of cat miracle).

However, we checked again an hour ago and it was back to 29 mmol/l.

Can anyone explain what is going on and what this means? Is it normal to have such wide fluctuations?

This is all so new & is causing us constant anxiety. We really want to get it right but keep feeling we are making mistakes.

Thanks in advance!

 

Sounds like his pancreas is sputtering... Working a little on his own. It will be really important for you to always check the preshot, get a mid cycle test when you can, and I would lower to 1 unit twice a day when the preshots are high enough. You can always raise the dose of it proves to not be enough. 3 units is a high dose for a newly diagnosed cat!!!!!! The recommended starting dose is 1 unit twice a day.

 

First of all kudos for home testing George!

I can see why those numbers would confuse you and the easy answer is yes wide fluctuations can happen but it's hard to give you a definitive answer as to why based on what we currently know.

The first thing I notice is that the insulin was started at 2u which is higher than we would usually recommend. Normally a cat would start out on a dose of no more than 1u. Then we would recommend increases of 0.25u at a time and definitely not more than 0.5u to ensure you don't miss the optimal dose.
The problem with insulin is that it is a hormone, not medicine so it doesn't behave the way medicine does. Sometimes too much insulin can look exactly the same as too little (I know.....totally counter intuitive) so it's important to make dose increases slowly and methodically.

As Janet has pointed out, it's also important to check BG before all shots to ensure it's safe to give insulin which you are apparently already doing. Getting tests during the cycle will then tell you how low the insulin is taking George's BG and those tests are critical to figuring out when to increase or decrease the dose of insulin.

From what you've told us, my best guess would be that the 3u dose is too high causing it to last longer than the 12 hour cycle and dropping the BG down significantly which has now caused the high 29mmol reading you took recently. We call that a bounce and it is a normal biological occurrence that happens with most diabetics when BG either drops to levels the body has become unaccustomed to as a result of the diabetes, drops quickly or drops significantly. In this case the drop was obviously significant and to a level George is probably no longer comfortable with. Whether it dropped even lower than 8.3 mmol is an unknown but is possible.

I agree with Janet that a decrease is in order however, I am a little hesitant to say drop to 1u without a bit more info. Has George ever had ketones or DKA? Have you changed his diet since starting insulin and if so was dry food involved before and suddenly taken away? Have you taken any readings mid cycle at any time other than today and if so what was the lowest reading?

It would be very helpful if you would set up a signature (the light grey text below our messages) with some pertinent information so we don't keep asking the same questions over and over. In the signature, you can include information like cat's name, sex, date of diagnosis, insulin you are giving, glucometer you use, diet, any other health issues, and your general location in case you need any supply information.

To set up your signature, hover your mouse over your user name in upper right of the screen. Select Signature from the left side menu which will open up a text box where you can type in this information. When you are finished, scroll down and click on the Save Changes button. Voila!

 

Hi Stephen,

I agree with the previous comments that it is highly possible that the insulin dose is too high.
A dose that is too high can make the blood glucose drop too low or too fast (or both) for the cat's comfort. If that happens the cat's body can release its own stored glycogen to raise the blood glucose level. It can also release counter-regulatory hormones that cause temporary insulin resistance. And what one might see in this instance is high numbers interspersed by low ones, then high again.
A dose that is too high can also sometimes extend the insulin's typical 'duration' - the time that the insulin would typically last in the cat's system - and 'carryover' beyond 12 hours.

Another possibility is, as Janet says in the first comment, that your cat is producing some insulin of his own. When this happens the cat's own insulin can extend the cycle (rather like 'picking up the ball and running with it'), and this could contribute to the lower numbers you've seen. This is certainly a possibility and especially so if you're using Caninsulin. That's because Caninsulin 'often' lasts less than 12 hours in the system. Therefore lower numbers more than 12 hours after a Caninsulin shot would 'usually' indicate that the pancreas may well be producing 'some' insulin of its own. ...But when the pancreas starts to heal it can produce insulin intermittently and then get tired and so can't keep the numbers low.

We really need to see more blood test data to flesh out the picture and see what's going on. And it's great that you have learned to hometest so early on in this process. That really is the best way to help George. He's lucky to have you!

Can you tell us what insulin you're using?
And what you're feeding George at the moment?
And whether you've changed his diet since he started on insulin (switched to lower carb diet for example)?
And which glucose meter are you using? Human meter or pet meter?

Eliz

 

Hey all. Thanks for all your responses. It's very much appreciated.

I'll fill in my signature in soon but for now:

George is on Lantus. (We spoke with an animal diabetes specialist today who said 2u was definitely ok and said the low readings were basically due to an after glow from the 3 being a bit too high).

We feed him Royal Canin Urinary S/O (wet food) as he's had Struvite a couple of times in the past. I don't think we'll change this as it's worked wonders for him.

He also takes Seroquin & some sort of fish oil to help his joints. Just ordered Dr Bests b12 tablets.

We are using a Wellion meter. Readings are below:

11.01.19 evening: 21.1
12.01.19 evening: 25.6
13.01.19 evening: 26.7
14.01.19 evening: 21.5
15.01.19 evening: 20.6
15.01.19 evening: (Additional check - 1.5hrs after insulin & food) 24.3
16.01.19 evening: 15.4
17.01.19 evening: 17.3
18.01.19 evening: 29 (Dose increase to 3u)
19.01.19 evening: 11.3 (No insulin)
20.01.19 Morning: 8.3 (No insulin)
20.01.19 Evening: 26.7
21.01.19 Morning: 17.3
21.01.19 Evening: 15.3

All in all, he's doing well and seems a lot better in himself from a couple of weeks ago. I'm sure we'll get the balance right eventually!

Thanks again for all your support.

 

Just an ask.....when you do your signature, can you please designate whether the meter is a human meter or a pet meter. Wellion makes both and the scale of readings is different on a human vs. pet meter so we need to be clear which you are using to understand the readings you are taking.

 

Sure! (It's for cats)

 

Are you using Alphatrak, Stephen?

 

Eliz, Stephen is using a Wellion pet meter. Haven't seen anyone else using that one here but I don't think it's available in NA so with majority of members being American, that's to be expected. I would think the reference ranges would be pretty much the same as for the AT2.

 

Okey doke, thanks, Linda.