Can't get insulin regulated - Help please

Last weekend I took my cat Walker to the vet because I could not get his bg numbers down. The vet did blood work, checked his teeth, his thyroid, etc and could find nothing wrong with him. He felt like the only issue could be food. I feed Walker 1/2 can of Fancy Feast pate and 1/2 can of Merrick chicken pate. It had worked to keep his numbers down until recently. I checked other threads and these are listed as some of the lowest carb pet foods. I don't know what to do and I am really concerned. If I up his insulin dose, his bg actually goes up. I have no idea what to do. I would be so grateful for your suggestions. Thanks so much!!

 

We've also been struggling with getting regulated...it's a tough road....I wish I could help or give good advice, just know you're not alone in your struggle

 

Is this a new problem or have you been struggling with this right from the beginning? 6 units of Vetsulin is a hefty dose and if this has been an ongoing problem, it could indicate Walker has a coinciding high dose condition. When you increase Walker's dose, does it seem to improve his numbers for that day and maybe the day after and then he goes back up to his previous or higher numbers? If this is a more recent problem, it could also be that the dose of insulin is actually too high because sometimes too much insulin and too little can look very similar. There are any number of things that could be causing the issue.

It's difficult to give you a lot of assistance without seeing exactly what Walker's cycles look like. We have a wonderful spreadsheet for tracking readings here and it would be very helpful if you could set one up and plot in some readings that demonstrate the increased readings with dose increases. HERE are instructions for setting up a spreadsheet and if you have any problems doing so, we can help you set it up. Just holler if you need assistance. And THIS is a guide to help you understand the spreadsheet as we don't use clock times because our members are all over the world.

 

As MrWorfMen's Mom said, without knowing what is happening to BG between before shot and at about two hour intervals after the shot we really can't help you.

This may indicate that the insulin dose is too high

 

Hi @Walker's Mom ,

Yes, indeed.
Both too little insulin and too much insulin can produce higher numbers.
An increase in blood glucose numbers following an increase in dose certainly raises the possiblity that the dose is too high..
If the dose is too high and the blood glucose drops too low and/or too fast because of that, this can trigger the body to release stored glycogen to raise the blood glucose level; hence the higher numbers.

Are you managing to get some mid-cycle tests?
It would be great to have more data so that we can see exactly what's going on.


Eliz

 

Thank you, Becky!

 

Hi Mr. Worfman's Mom,

I am sorry. His dose has changed and I forgot to update my profile. Walker is actually down to 3 units of Vetsulin. He has been on this amount for awhile. It wasn't until recently that it started getting wonky. A month or so ago it was because he had 2 abscessed teeth. When that got resolved, he went back to normal for a short while and then started to go up again. If I give him 3 units he is in the 300s+. If I give him 4 units he bounces and goes even higher. This is a new issue. In the past increasing his dose was usually the solution. My vet suggested giving him 3 doses a day which would mean breaking up the morning dose into 2 doses and giving one in the morning and another at lunch. I was hoping there was another way as this is not always feasible. I hope the new details help. I sincerely appreciate your help!!

 

Hi Larry and Kitties,

I plan on testing him every few hours this weekend to see what is happening. I will be glad to post the results once I have them. I forgot to change my dosage in my profile. Walker's dosage is actually at 3 units. He is above 300 at 3 units and bounces even higher if I give him 4. Thank you so much for your help.

 

Thank you Eliz! This weekend I am going to test him every couple of hours and will post the results. I so appreciate your help and input!!

 

Curves help to find the nadir but even that can move from day to day. One day of testing doesn't necessarily show exactly what is happening. BG fluctuates continually and one day's readings/nadir may be higher or lower than average. It's the pattern over time that is most helpful in determining dose and identifying potential issues. I notice you indicate you have been using the AT2 meter since Aug 22nd. Is that when you started home testing or were you using a different meter previously? If you could plot your test results since 22Aug on the spreadsheet, that would give us some data to look at and hopefully shed some light on what might be happening. Vetsulin is a fast short acting insulin so it does sometimes require dosing 3 times daily to get 24 hour coverage however as you mentioned, dosing 3 times a day isn't usually practical. If the problem is because the insulin is wearing off too quickly, you could consider changing to a longer acting insulin like ProZinc, Lantus or Levemir all of which are excellent options.

A couple of things come to mind. As Eliz mentioned asked above, have you been testing mid-cycle? Those are the readings that are critical to determining what might be going on with Walker. It's possible the 3u is too much insulin. The other thing I wonder about is his dental issues. I assume he had some extractions done and was likely on antibiotics following the procedure. Were x-rays taken after the extractions to make sure no roots were left behind? Sometimes a piece of tooth gets left behind and causes another round of issues. Infections definitely have an adverse effect on the BG.

 

Hi Mr. WorfMen's Mom,

Thank you for your input. I have been using the AT2 meter since August of 2015. It is the only meter I have ever used. This weekend I have been running his bg tests every few hours. I apologize that I do not have them plotted on the feline diabetes spreadsheet as I can't figure out how to work it. It opens up but won't let me edit. So here below are my crude data plottings for the weekend. I hope it makes sense. It was interesting to me that when I gave him 3 units his bg didn't really change a lot. When I gave him 4 it did move but then had a weird bounce. BTW, I fed him what I always feed him, 1/2 can of FF pate and 1/2 can of Merrick pate. I sincerely appreciate all of the help!!!!

Saturday Sept 24
AMPS - 301 at 7:58am
Gave him 3 units
12:09pm - 361
2:31pm - 365
5:03pm - 391
6:16pm - 471

PMPS - 379 at 9:07pm
Gave him 4 units
11:48pm - 148
1:12am - 122
5:46am - 481

Sunday Sept 25
AMPS 6:53am - 437
Gave him 4 units
10:09am - 207
12:49pm - 153
2:24pm - 208
5:26pm - 505

 

Hi Eliz,

Here is the glucose curve I did this weekend. I sincerely appreciate some wisdom. Sorry it is not in spreadsheet form. I can't figure out how to edit the Google glucose spreadsheet.

So here is what data I have collected over the past weekend checking his bg every few hours.


Saturday Sept 24

AMPS - 301 at 7:58am

Gave him 3 units

12:09pm - 361

2:31pm - 365

5:03pm - 391

6:16pm - 471

PMPS - 379 at 9:07pm

Gave him 4 units

11:48pm - 148

1:12am - 122

5:46am - 481


Sunday Sept 25

AMPS6:53am - 437

Gave him 4 units

10:09am - 207

12:49pm - 153

2:24pm - 208

5:26pm - 505


Food – ½ can of Fancy Feast pate and ½ can of Merrick pate.

Thank you, Eliz!
Mary

 

I'm technologically challenged so I'm not sure what to tell you about the SS, but bumping this up so maybe someone can help with that. It will be a lot easier to help when you get that set up. Another person that might be able to help you is @Sue and Oliver (GA)

 

When you set up the spreadsheet, did you save it under a new name like " Walker's Spreadsheet" or whatever you like? It could be that you can't add data because you are trying to use the original template. If that doesn't solve the problem, let us know and we'll ask our techie wizardess to help you out.

Those are interesting readings. The 3u cycle readings suggest the 3u might be too much but the 4u of Vetsulin caused a very sharp drop of over 200 points, which looks like it caused his liver to panic and pump out glucagon to get him back up to numbers his body has become accustomed to and more. Again those are only a couple of cycles which may or may not be indicative of what happens everyday. I'd be inclined to try a dose of 3.5u to see what that does. It might smooth out the cycle a bit and give Walker a chance to get re-familiarized with some lower numbers a little more gently. I'm still not sure if the dose is too high or not.
@Elizabeth and Bertie @Larry and Kitties can you have a peak at Walker's curve readings and offer your opinion as you both have hands on experience with Vetsulin which I do not. Thx.

 

Just noticed Marje is working some of her wizardry on the spreadsheet template so maybe it would be easier for you to follow the link in this post. The offer of assistance still stands if you need it though. The spreadsheet is a wonderous tool for tracking our readings and it makes it so much easier to see exactly what is going on with our extra sweet kitties.

 

Marje is till experimenting right now. She said "Please do not post in this thread or click on any links. Thank you.P

But Marje can certainly help with setting up a spreadsheet if you wish.

 

Marje put a link on that thread that I took to mean it could be used but not to use the ones in the Spreadsheet instructions. Admittedly, I may have misinterpreted the message. Will check with Marje directly.

@Marje and Gracie.. is the link in your post "SS Test" usable for those wanting to set up a spreadsheet while you work your magic? Thanks for your help.

 

@MrWorfMen's Mom Google is getting rid of all the custom template documents which means we would be losing the SS templates. I was developing a workaround and the test post linked above was just that...a test post and that link was not to be used. I have deleted the link in the test post.

The spreadsheet sticky has now been updated, tested, and is working.

@Walker's Mom Linda is correct....it sounds like you downloaded the template without making a copy so it won't let you add numbers. If you'd like me to do the SS for you, I'd be happy to. Please send me a private message by clicking on "Marje and Gracie" to the left and then "start a conversation".

Thank you

 

What???




Mogs
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@Marje and Gracie Thanks for the info and your assistance.

 

Yes, I know. I've been trying to figure out how we were going to address this for some time now. I don't know why they are doing that when so many people use the templates. They will still have templates but not any of the custom ones like ours.

That also means that no one outside of FDMB members will be able to access the spreadsheet templates.

 

You are very welcome!!!!

 

@Marje and Gracie Thanks for all your hard work!

 

You're welcome and thank you for acknowledging it!

 

Hear, hear!

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