High 500 BG won't come down even with insulin, No Appetite, Need Help!

Hello
My cat Pumpkin was diagnosed with diabetes when he was 8 years old. He's now 15, and his Insulin became uneffective which we didn't realize until it was too late, and he had to be hospitalized for 3 days with over 600 on his glucose.
He is on a Raw low carb food diet with snacks of cooked chicken and raw hamburger.
We've since found the FDMB and have begun doing Glucose tests. For the past 5 days, we've had him on 2 U, and the previous 3 days he was on 1.5 U. Pumpkin has always had very high BG, and we didn't know that regulating him was an option until we found here.

At the Vet he had a full check up with all vital signs good, no ketones and even his potassium was good! The only thing the blood test showed, was very high BG and that he was anemic.

Since we got him home he has been stable, and eating very well with his BG between 260 and 370 although, just yesterday he refused to eat and we tested him. He was 425 so we gave him the 2 U anyway and let him be, +5 he was 370 then +9 he was 490 still with no food. We gave his Lantus insulin early at +10, 2.5 U. +2 he was 401, we were able to get him to eat half a teaspoon of food, +4 450.
We read the forums here and thought it might be a bounce, so we decided to wait until the morning and reduce his dose to 1.25 U. At 9 AM, His AMPS was 471 +2 497 and now at +3 he is showing over 500, he has only eaten a little this morning, we are unsure as to what we should do next.

Any help would be very much appreciated, as we're very concerned about him. Do we need to take him to the vet again?

P.S.
He has been home only 8 days and is on Clavamox since he returned from the vet.

P.P.S.
He also just got a new bottle of Lantus Insulin on 11/19/18.

 

It's very difficult to know what's going on because there are so many reasons for high BG numbers: too low an insulin dose, too much dose changing, another infection or area of inflammation, etc. You've come to the right place to get help though! The essential tool to get moving forward is testing Pumpkin's BG at home and you're there now - and you're using a good insulin. Congratulations!

I suggest the following:
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Choose a reasonable dose like 2 u and stick to it for several days while you gather BG data in a systematic fashion. Don't change the dose unless he drops very low (50 or below on a human meter, 68 or below on a pet meter). Here's a basic testing routine to start with:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

This is useful: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
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Set up the spreadsheet we use here to log BG data. If you need help getting it done please ask. There are members who will do it for you. We rely heavily on the spreadsheet patterns to assess any dosing regimen.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
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Go to the Lantus forum and introduce yourself. There's a ton of expertise there and very well documented dosing methodology. Read the yellow information stickies at the top of that forum's thread list:
http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/
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OK - now that I've pointed you in the right direction please take the red 911 of your thread's title. It's used in an emergency or when a member arrives in a panic and hasn't yet received a response.

 

Thank you so much for the reply, I just tested him now and he is still above 500 and now he can't stand up, I know you can't give lantus sooner than every 12 hours. Should I take him to the vet to get fast acting insulin? Or should I just wait it out? @Kris & Teasel

 

Has he shown leg weakness in the past? Could he have neuropathy form prolonged time in high BGs? If it's neuropathy, a B12 supplement or injections can help along with getting his BG down a lot into a better range. FYI - some vets think that no kitty will need more that 2 - 3 units of Lantus per dose. Not so - there are many who need significantly higher doses, some very high because of other conditions.

If he's not looking extremely ill, I wouldn't ask for fast acting insulin right now. Post your question on the Lantus forum to see what they say. I'd also wait until his normal shot time.

 

He hasn't really shown leg weakness in the past, we do have the right kind of B12 on hand, should we give that to him now? Also should we try to feed him even though his BG is so high? He has barely eaten for almost 24 hours. I'll go post on the lantus forum now, thank you so much again! So, waiting would be the best course? He does get very streesed when brought to the vet so we don't want to bring him unless it's needed.

 

Are you testing his urine for ketones? If his BG is high, he isn't eating and there's some infection going on, that's a perfect storm for ketone development. When you say he's weak is it like "limp dish rag" weak and a lot of lethargy? If so, then DO CALL your vet ASAP. I'd be worried about the onset of diabetic ketoacidosis (DKA).

 

We don't have Ketone strips on hand, we'll go get them now and test

 

Here are some testing tips:

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

If you do take him to your vet, ask specifically that they test for urine ketones.

 

Any ketone test results to report?

 

If he won’t eat on his own you should feed him with a feeding syringe at this point. No insulin and no food he could easily develop ketones or fatty liver.

 

In the USA the faster acting insulins like R and N are available without a script. R is very fast acting while N is a little slower. I myself would try N to see if you can get a good drop. Walmart has the best price.