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Discussion in 'Feline Health - (Welcome & Main Forum)' started by Kate & Toby, Oct 8, 2019.

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  1. Kate & Toby

    Kate & Toby Member

    Joined:
    Aug 23, 2019
    Hi All,
    I would really appreciate some opinions on Toby's spreadsheet, his BG has been all over the place, I sent it to his endocrine specialist and she has suggested I drop his dose for 10 days to see if we can even out the highs and lows.
    This is what she said:

    I’ve looked at his chart with a colleague, for the two heads being better than one approach. We feel that he could be suffering from Somoygi overswing, at least in the last few days when he is repeatedly very high. Overall, his control looks the best when he was on 1.5 units twice daily and we shouldn’t overlook the fact that previously, when he was getting 2.25 units, his glucose went into the green (3mmol/l level).

    So I think that you should go back to 1.5u twice daily and try really hard to not measure too many BG’s (perhaps do a couple around the nadir time if you feel reassured by doing that) for about 10 days but then perform a couple of days of curves This dose reduction should eliminate the risk of Somoygi overswing.

    The longer acting insulin I would consider would be Glargine. He is doing so well clinically at the moment that I am loathe to change him but that would probably be my next step if we feel we are not winning with the PZI.


    Most cats that become ketotic do so because they have another disease that leads to a big change in insulin requirement. It seems most likely to me that Toby developed pancreatitis which lead to his recent DKA. We can’t prevent him getting pancreatitis in the future unfortunately and if the disease is grumbling it may lead to variability in his insulin need. I think it is wise to screen for it but bear in mind if he develops it, it is more likely due to another disease rather than due to the wrong dose of insulin alone.

    Tagging Linda @MrWorfMen's Mom as she has kindly been helping me with Toby for a few weeks.
     
  2. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Kate, I don't see what your vets are seeing at all. While I agree that Toby did see a few more blues when at the 1.5u dose initially, you already experimented dropping the dose from 2u to 1.75u and then down to 1.5 again with virtually no change in numbers. Other than the green (some of which were admittedly too low) on the 12Sept. he hasn't maintained any run of even high blue readings. Ideally the goal would be to get Toby running in the 90s or even a wee tad lower at least some of the time and the rest of the time in low blue range. Your vets goals may not be quite so aggressive opting for blue/low yellow only.

    There is a debate about the existence of Somogyi existing in cats and it generally refers to humans waking up with high BG after taking insulin the night before. Toby is high in the evening as well as the morning. If you were seeing bouncing or rebound hyperglycemia, I'd expect there would be more lower readings in the mix.

    While 2.25u might have been too high before, insulin needs can change over time and for various reasons. I agree with the vet that there generally is an underlying cause for DKA such as a UTI, URI, pancreatitis, dental issue or any other condition that causes an upset to the body's equilibrium and if Toby has chronic pancreatitis, that alone can make his BG harder to control.

    If the vet is so sure this is "somogyi" or rebound hyperglycemia, then the case to switch to Glargine would be stronger not weaker. Glargine is a gentler insulin than ProZinc and would be less likely to promote the rebound effect your vets seem to think is happening. I frankly wonder if ProZinc isn't long lasting enough for Toby and that too would be helped with a switch to Glargine.

    I'd really love to see if we can get @Djamila to peak at Toby's SS and provide an opinion. She has lots of experience with ProZinc and I value her input. She hasn't been on the board at all lately but did pop in yesterday so I'd like to tag her and see what she thinks.
     
    Kate & Toby and CandyH & Catcat like this.
  3. Kate & Toby

    Kate & Toby Member

    Joined:
    Aug 23, 2019
    I had Toby weighed today, he has put on 345 grams in 1 month, this makes me a very happy cat mummy tonight...... note Mr Chilled curled up on the scales
     

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  4. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    If it fits, I sits! He is so elegant.
     
    Kate & Toby likes this.
  5. Kate & Toby

    Kate & Toby Member

    Joined:
    Aug 23, 2019
    @Idjit's mom he's way too chilled at the vets, it's not normal!
     
  6. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    How adorable is Toby, he's such a beautiful color. Happy he gained some weight
     
    Kate & Toby likes this.
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