? Roxi PMBG 54, stalled +0.5 49. Carbs or not?

Hi all

Pretty much as the title says. We've been working Roxi's dose up gradually and she got to 6.5 u Lantus starting this morning. She's had her first proper good day for numbers. Her PMPS was 54, so I stalled with her shot and tested half an hour later...and got a 49. Clearly I'm skipping tonight's shot and taking her back down to 6 u tomorrow morning. But, as the Lantus should now be wearing off, do I need to carb or should I just give her usual meal and test again in another half an hour?

We're pretty sure Roxi became insulin resistant both before getting to us and during her first couple of months with us. Initially, we were unable to test because we could barely look at her without her lashing out at us. And our vet had us take her off insulin temporarily for safety as they measured her at 165 mid-cycle and weren't comfortable with us dosing when we couldn't test often or reliably. We put her back on a very low dose not long afterwards because the tests we were able to get were in the upper 200s and 300s. Once we were able to test her frequently enough, we started increasing her dose following the TR protocol, though dose increases seemed to only reduce her average numbers slightly. It seems as though we might finally have hit on her breakthrough dose with the 6.5 u.

 

In theory at the end of the cycle, just her normal food would probably bring the BG up as the previous shot wears off, since she's staying level, and you have decided to skip I think you would be OK to give the normal food, and check in 30min, since the last shot will wear off and when it does you will likely see the numbers shoot up, so you probably don't want to add to that with HC.

 

Thank you @Gill & George - usually I know what to do, but it's not often I see a cat drop beyond +12 like that. And because she's been insulin resistant, I haven't attempted shooting a number in the 50s for her just yet (probably just as well or she'd have got the full 6.5 u on that 54 as I usually shoot anything over 50 once I have enough data ). I did go with my gut instinct and just let it ride as she wasn't under 40 or symptomatic. And at +1.25 she's up to 68. I think I'm still skipping tonight though - we're too far off schedule at this point and I'm sure any sort of shot is just going to send her right back down again in a couple of hours.

 

I could see your reasoning, especially with 6.5u/full depot and possible insulin resistance deciding to break, a skip today may have been a good choice, and it is the first low green she's really had since way back.
It will be interesting to see when she starts to shoot up, I wonder if it will be before she usually onsets?
I'm glad she's finally letting you test her more must be a relief.

 

It certainly is. After doing TR all the way through with Rosa, it was so nerve-wracking knowing we had to give some sort of shot, but might not be able to get a test on her at all. Unfortunately, it did leave her under-dosed for months as we couldn't risk having her drop too low when we might well not be able to test to make sure she was coming back up. I'll be getting a couple more tests on her tonight just the same...just to see, as you say, what happens with her numbers over the next few hours. The last time she was in the 50s, she was actually having an allergic reaction to Advantage 2 - and since then she's only hit green 2 or 3 times before going right back up to the 200s and staying there. Hopefully, if this is the resistance breaking, she'll start seeing good numbers more of the time now.

 

Paws crossed, it's the beginning of more time spent in green.

Think Green Roxi

 

She must have heard me talking about taking her to be acro tested next week if her numbers didn't improve. Maybe I should have told her about it earlier!

 

I would get tests done for both acromegaly (IGF-1) and IAA. The latest research shows one in four diabetic cats has acromegaly and that particular study found acros with doses as low as 1 unit. I haven't seen a cat make it over 6 and not test positive for one of the high dose conditions.

I never found that Neko's insulin resistance (she had both IAA and acromegaly) made a difference as far as shooting low. Course, I never shot below 51. She gave me lots of 40's for preshots - I would just wait 15-20 minutes and she'd usually be on her way up so I would shoot. Don't blame you for not shooting though. Typical cat - first green preshot and it's low 50's.

 

Good to know, thank you Wendy. I'll go ahead and book the tests anyway then. She's still at just 64 at +2.5, so at the moment I'm happy with the decision to skip her shot, though I might not be quite so happy about it when I see her number in the morning!