? Glucose rises despite insulin increase. need advises

Snowflakes was first diagnosed with diabetic back in Jan 18 2018. Ketones was like more than 4. Her glucose was close to 400 b4 admission to a 24 hours hospital. she was hospitalised & they started her with only 0.5 unit u100 BD insulin Glargine. Please see the chart . She stopped eating again back in March and realised her glucose isn' doing well so started to read up and bought a human glucosometer. Took her to a nearby vet and recheck and started the glucose curve but been already more than a month and the glucose kept rising . She has checked no.thyroid or any other illness eg uti etc. Is already 3 months but i see ni improvement in glucose numbers would appreciate any one can share with me
Here is my Google spreadsheet https://docs.google.com/spreadsheet.../edit?usp=drivesdk&ouid=110028842665718653248

When to increase insulin dose etc?
Anyone has the same experience?
How to overcome this glucose increase ?

 

Hello and welcome. Make sure to read the yellow starred Sticky Notes on the top of this forum. Lots of good information in there. Included are two dosing methods, the Tight Regulation protocol and thrnStart Low Go Slow Method. People here use one of these two methods to determine how and when to change the dose. Read them over and see which will suit you best. For both of those methods,we determine how to change the dose based on the nadir, or low point of the cycle. The low point typically is in the middle of the cycle, or time between the shots. Most of your tests seem to be in the morning or evening. Can you get mid day tests? Or at night before bed? That might provide a better picture what the lows look like.

Have you been on 1 unit the entire time? Sorry, your spreadsheet is quite different from the format we use here, so I am having a hard time finding the information I need to answer your questions,

 

I did many glucose test per day for a few days.
Is from 0.5 once per day to 1 once per day to 1 twice per day to 1.5 twice per day . U can refer to the link to see all the numbers. Please scroll to the 1st row and freeze it so u can see the rest and understand what each column means.

 

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

You are still at a relatively low dose. Your cat is probably about insulin resistant to the dose you're giving. The info at the top of the link above will explain the SLGS and TR protocols. Please read them and decide which is a better fit for you.

 

Hi and Welcome to Lantus and Levemir forum. Would you be willing to set up a spreadsheet ( SS) like the one we use here so we can better help you? I am having trouble understanding yours. The directions on how to do it are Here Then you could set up a signature and link the SS to your signature like we have at the end of our post in grey letters. The directions are below.

Setting up Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback. You are limited to 2 hard returns, so separate pieces by | or -.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as
your name | cat's name | date of Dx (diagnosis) | insulin | meter
general location (city and state/province)
any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.
Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.

Those two things will help us help you. If you have any trouble setting up the SS just yell and some one will help you.

 

If I read your sheet correctly at first you were only giving insulin once a day and it looked like every other day. Now your doing twice a day which is correct. As far as increases, they are increased every 5 or 7 days depending on which method you follow. There is no one dose fits all. You keep testing and adjust accordingly following the method of choice. Keep in mind the longer their levels stay high, kitties get use to it and it takes longer and more insulin to overcome the higher readings.

 

That 911 is a little scary.

 

Haha yes. We usually reserve 911 for scary hypo emergencies.

 

@JanetNJ

I'm reading SSheets trying to understand better the increases in insulin.

What method do you follow? I've never so many changes in dose before? I thought we were supposed to stick to the dose for at least 5 days until we make a change?

 

Take a look at the stickies. If you're following TR then increases are every three days. If following SLGS then every seven days.

 

Grateful that you took the time to read & understand & make the caring effort to reply. Forgot to mentioned that she is a rescued previously abused abandoned cats with Felv. Not sure felv plays a part in the glucose or not. Anyone had any experience with felv diabetic cat?

 

@JanetNJ is suing a different insulin (Vetsulin) and the dosing method is also different.

 

@Kris & Teasel

Thanks for explaining. It still all gets confusing.

 

Vetsulin is a totally different type of insulin from lantus.... Look at the spreadsheets of other lantus users.

 

Seems like the blood glucose isn't dropping with the increase in insulin after reading the spreadsheet u shared. Thanks for sharing the info. Good to know

 

Thank you for taking the time to reply with such useful info. Grateful to your help in sharing

 

I didn't share a spreadsheet?

 

OK will try to.find the time as I held 3 jobs working 365 days to support all the rescues under my care. And currently also taking care of many kidney failure kitties which were previously abused abandoned etc.

Grateful that u took the time to share such useful tips. Thank you for your reply

 

Yes u did is the link that follow your every reply.

 

You are welcome, let us know how we can help you.

 

Thank you for taking your time to sent me all these useful information. Grateful to your help

 

We have all been new at one time, we remember how overwhelming and frustrating it can be at first. Keep asking questions, we love to help.

 

Oh ok. You mean in my signature. It's a good idea for you to set one up as well.

 

I saw many high glucose numbers getting loads of fluctuations & getting higher despite the change in glargine insulin doses in many of the charts in this forum. I also read success cases which is good.

Overall Seems like the focus is more on numbers then the cat clinical signs, important things to know apart from the glucose number are like measuring the amount of water & food intake + weight, are the cats on prescription MD diet , any vomit or diarrhea, eating on its own or had to be handfed, is it alert? dehydrate? The fur coat is it healthy and not dull? her urine output volume...etc Even though Snowflakes is in need of dental very badly but she is not a suitable candidate to go for dental as diabetic cat wounds are hard to heal and the scaling with GA will do more harm unless her numbers are on the range of 8 to 10 with 0 ketone. One should measure the blood ketone using a home human device which is very very useful for cats especially those that are not eating or vomiting dehydration etc. Subcutaneous drip is crucial to balance its electrolyte numbers & hydration mode when needed. This is my own humble experience . Must give time for the cat body to adjust the doses b4 changng the dose to avoid the Somogyi effect . My snowflake needs at least 6 days to see the body adjusting to her new dose and another 3 days to see whether doses need to be increase. Still trying to figure out how to find the correct dose for her to go into remission. I guess I jus had to figure out

Really appreciate to those who care enough and take the time to reply with useful info for reference.

 

Well you're a little off re the dental info. My vet is doing Silver's dental in 10 days and he has higher numbers and ketones. He doesn't seem to be worried. The Somogyi effect has long since been debunked. Holding dose longer than seven days isn't recommended or you run the risk of glucose toxicity. There is a reason the two methods were written - they work. I'd pick one and follow it.

Sub q fluids shouldn't be needed if you add water to the food. I took Silver off sub q in three days after I started adding water to food. Vet saw her yesterday and said he is well hydrated.

 

Dental issues can prevent regulation. You should consider getting that done sooner rather than later.

 

Saw your CC spreadsheet. u sent your cat to dental on July 21 2017 when your cat glucose was having normal glucose range. After the dental saw that your cat blood glucose number start to rise again 3 weeks later & shot up to the high range. That' why I didn't sent mine as I had many sent to dental before not only had such outcome but many followed with kidney failure after the dental 1 year later . Normally I run a very complete bloodtest to check on the cat and I have visited 3 vets (all don't recommend dental especially when the cat is like snowflake with such out of normal range glucose number).

I am also very impressed with CC number back in Aug 2016 where u did great in managing CC back to normal range prior to your dental visit in July2017. Thank you for your feedback and taking your time to share your thoughts.

 

The kidney failure a year later was unlikely related to the dental. If the cat's teeth are bad and you said Snowflake's are - then a dental is needed. If you don't then gingivitis will develop and likely infections which will prevent regulation. And she'll have a sore mouth.

 

Understood silver is in emergency hospital now. May silver be blessed with speedy recovery. Understood that silver is schedule to go for dental despite her Diabetic ketoacidosis condition in April 25.

I am also very impressed with silver number back in Dec 2014 to Sep 2017 where u did great in managing silver back to normal.

Snowflake was seen by 3 vets and I was initially like u very eager and even schedule Dental to be done while she was hospitalised with Diabetic ketoacidosis. But they told me the big "No" to go for dental including the vet specialised in dental as the risk of losing her life is greater than the benefit of the dental. I didn't sent Snowflakes to dental as I had many sent to dental before not only had such outcome but many followed with kidney failure after the dental 1 year later . Normally I run a very complete bloodtest to check on the cat and I have visited 3 vets (all don't recommend dental especially when the cat is like snowflake with such out of normal range glucose number).

Thank you for your feedback and taking your time to share your thoughts.

 

Agreed with u. Thanks a lot.
The risk is far greater than the benefit after 19 years of experience caring for many and worked with many vets to find the best solution for them in this case for snowflake isn't suitable for dental at this moment due to her abnormal glucose numbers and her diabetic ketoacidosis back in Jan. May your Silver blessed with speedy recovery

 

Many a cat here has been prevented from going into regulation by bad teeth. Since you like looking at spreadsheets, Rufus is a recent example. Check out what happened after the dental mid February. Dental specialists may be more comfortable doing a dental with a diabetic, though Neko's vet did her first when she was unregulated.

 

Thanks so much for sharing rgds Rufus. May Rufus have speedy recovery from not eating and vomiting after the dental. Am also glad to see Rufus glucose number drop . Again thank u so very much for your replies. Appreciate.

 

a dental couldn't cause kidney failure a year later.

And for cc I'm not convinced the dental caused her to come out of remission... Unless her recovery was painful (I wish they could talk). I think it was more arthritic pain.... She wasn't moving as much and gained 4 lbs in that year while in remission.

 

I would recommend the dental asap. Davidson was in remission for 4hrs, healthy and he’s had no issues others then his 3 month diabetic run in 2014. I continued to test and when his BG levels went high I took him to the vet. He developed a few infections in his teeth and had gingivitis- all unaware to me as no side effects, no smelly breath and no pain as he happily crunched on dried chicken treats daily. He had 4teeth extracted and now I’m trhing to get him regulated and “hopefully” back in remission sometime down the short road. IMO, the dental absolutely caused Davidson to come out of remission and had I not got it done his healthy would be at risk due to the infections and the return of diabetes

 

You are incorrect in much of this. Silver is not in hospital anymore and DKA has not been confirmed. Vet is testing for pancreatitis. You have to understand each cat is different and comparing spreadsheets is never a good idea as you don't know the circumstances of the cat. Silver was in remission due to the fact I took him off dry food - nothing I did to keep him in remission except remove the dry food.

As for his numbers rising now - that could be due to many reasons - highly likely one reason is due to the need for a dental so waiting until his numbers are low for that is an oxymoron. We also think the insulin may be old and if he does have pancreatitis that also raises BG. You cannot say BG keeps rising with insulin increases without looking at the whole picture. No vet would be irresponsible enough to put a cat through a GA and a dental if he thought it was unsafe and would put the cat at risk. We must put some trust in the vets even if they are not fully versed in FD. My vet happens to have two diabetic cats of his own so he knows more than most.

 

Thanks for this information - Silver also has gingivitis and I believe could be a cause of his numbers rising. As I was trying to tell @Snowflake you need to remove ALL possibilities of rising numbers first - check insulin is good; do any required dental; check ketones; pancreatitis - otherwise we will keep increasing and increasing insulin to no effect. Correct?

 

It may seem like the focus is on numbers here, however we do indeed consider the Whole Cat Report (WCR) very important and recommend every caregiver pay close attention daily to the ‘5 Ps ‘ (peeing, pooping, playing, preening, purring).

Regarding Somogyi, @Sienne and Gabby (GA) can provide the best information for you.

 

To continue (I’m always touching ‘post’ accidentally)...

Please get your ss into the format we use here- it’s designed as a common language, one we all understand and speak, so that we can quickly assess a situation. It is the foundation for all recommendations.

Lastly, for my FIV+, two time DKA survivor, IAA kitty, when all else was said and done it was addressing his dental health that put him on the path to a remission that lasted 6.5 years (which was the rest of his life).

 

I'm another person who would ask that you take the time to convert your spreadsheet to the format we use: Spreadsheet Instructions. It's very hard to see patterns or discern what you've been doing given the format you're using.

As for Somgyi, I will try to be brief since this is a soapbox issue for me. So, climbing up on said soapbox... The term was developed by Michael Somogyi in 1938 based on a handful of human subjects who were not using current generation insulin (i.e., long-acting, depot type of insulin). Even without benefit of modern insulin, the results of his experiment have never been replicated making his findings highly suspicious. In a more recent attempt to investigate chronic Somogyi rebound in cats, Roomp & Rand (the people who have done the groundbreaking research on managing feline diabetes with Lantus) found that it didn't exist in the sample of diabetic cats prescribed Lantus. So, from the standpoint of human biology, Somogyi is likely an urban myth and it is even less credible in cats. I haven't a clue why the term still exists and why it hasn't been purged from textbooks. (Climbing off of soapbox...)

 

Hey, both Davidson and myself have all the “5 Pees” intact! Just adding a little humour.

 

To everyone who has been so nice & helpful to offer your views & tips on Snowflakes. Thank you.

The 3 vets I took Snowflakes to see are all from different clinics. I have known them for years. They graduate from top vet schools from Europe, Usa & Australia. They have the expertise, the skills and worked in many worldwide emergency veterinary hospitals & have dealt with countless cases on diabetic patients . They done miracle to many of my rescues which most other vets would advice to be put to sleep. All those rescues since then are rehomed & having a good life with loving families. They all told me NOT to proceed With dental & have explained to me why(which i already highlighted earlier) Obviously I trust my vets' views & would never put Snowflakes in any life threatening situation jus to get the dental done. So if your vet says can do dental and you are comfortable with the dental because your cat is a suitable candidate. Definitely is good news to u and your cat.

As for the somogyi effect, these was informed to me by multiple experienced vets. (More than 20vets as my rescues i need a list of vets that can help my cases) Whether this effect will apply to the cats or not, it all depends on many factors & the cat itself. I am not a vet so I would not comment any further but i do trust my vets information.

As for the spreadsheet. Thanks for the info. With 3 jobs and so many rescues to care for, can only have time to do the ones that is link to multiple vets in my list to view. If u were to read my SS. It has all the 5ps and more details info that my vets has requested.

I am grateful to all your concerns to Snowflake and felt touched to see so many of u who took the time to share your views. Thank you.

From this point onwards, I will read but will not responds any further as I respect everyone views and their experience dealing with such cases. I trust my vets too jus like everyone here! so to me this is a wonderful forum to share views and helping each other and supporting each other. Thank you all once again for enlightening me with many information regards to dealing with diabetic felines. Have a great week ahead.

 

If you're not prepared to learn from the forum and you're just telling us how your vets are correct and we are wrong - why are you here? Your vets are NOT correct in much of what you have been told but if you're happy with their opinion and don't want the opinion of the forum. Fine. And to correct you - most of us here do NOT trust our vets. They get minimal instruction regarding diabetes and most of that is on dogs. Listening to vet instruction almost killed my cat and several others' have similar experiences.

 

Careful with your tone. We don't want anyone to feel alienated, or feel like they can't ask a question or share a different opinion. Everyone here is coming to the forum with different experiences and comfort levels.

 

Thanks your valuable advice. Have increase the dose yesterday morning. SLGS protocol .

 

Regarding Somogyi, I'm attaching a research paper for your review as well as to share with your vets if you see fit.

 

I might add, we are all like our cars different. Some have more, some less experiences and we also have our personal opinion of our cats. I don’t think anyone in here tells anyone what to do, and I admit I was very overwhelmed when Davidson was diagnosed. I had no clue about any feline diseases, as H&D have been the perfect animal we dream of having. Then all he’ll broke loose when Davidson got his DX on Nov 5/13 when I took him in for teeth cleaning. His BG was 475, and i was leaving for holidays. Upon my return Jan 7th the vet’s curve showed BGs as high as 545. DANGER!!!

My vet, like many on here experienced just put him on insulin and that was it, twice a day shots and the odd test. In the 8 hrs he was at the vet in the first day they did a curve. Who knew what that was at that time. However, during those 8 hrs I found this amazing site and read everything I could, posted questions and decided to heed the advise and suggestions I receive here. I picked up Davidson, didn’t buy the high carb vet special food, and put him on FF and donated the dry food. His levels immediately droppped in half just by changing food. Did the vet say to do that? No, they had no idea about high carb food, just the food they sold (ahhh advertising and kick backs from the Mfg). Davidson only got the 3 units insulting the vet provided that day....then he was without insulting for another week. So in total he went from Nov to Jan with no insulin (other then vet induced 3u) and things progressed from there.

I changed vets, and now they are not only open to reading the pages and pages I provided them on the TR, but they send me all their clients who have been given the DX, so that they can learn and perhaps one day get their cats into remission.

There is no right or wrong here, merely suggestions that may save our cats and nobody is telling anyone to do this or that. Like our cats we all have varied ages, financial responsibilities and work requirements. This is not easy and if any of us can get just one bit of useful information - then this site has done its job.

I have no idea who put all this together, but knowing how much work my company was when I started, and over the 23 yrs of working, I PERONALLY HAVE THE UTMOST RESPECT AND ADMIRATION TO THESE WONDERFUL STRANGERS WHO DEDICATED THEIR TIME TO HELPING OTHERS. I don’t always agree with what suggestions are on here, but together with them andmyself I always find that for the most part they were right!!

Do as you wish, but always take in consideration that Dr’s and Vet’s of all sorts are not holding a crystal ball and unless they are specialists in a specific field, then it’s guesswork or following the procedure they were taught in school.

Good luck with the choices you make, I’m sure all our hearts are with our cats and we only seek the best for them.