Question about BG levels

Gizmo has been on insulin for about 5 weeks now. At first his numbers moved around a lot and we were not real consistent on dosing, but he had some blues and greens on relatively low doses. Then we took a step back and started with a consistent low and slow approach. Since then, he has remained in the pink even as we have slowly been increasing the dose.

Early on at 0.75 he was showing low numbers; now he's not showing not much lower than he was on 0.50. Why would this be? Nothing has changed in his diet (still on Fancy Feast) and we regular test for ketones (always negative). From the SS, it would appear time to up the dose to 1.0U, but we're really beginning to wonder if the insulin is still good or if his pancreas are getting worse or something else going on.

As an aside, I realize the BG tests are somewhat sparse. We haven't always gotten a pre-shot BG because he can be difficult to test and we can generally tell when he's on the high side.

One thing we've taken to doing lately in the morning is testing at -1, rather AMPS, because he is more cooperative for his shot when he's not hungry. So testing earlier and feeding make him more relaxed for his shot.

Could be one of two things

1. his insulin isnt high enough - so 0.5 or 0.75 isnt enough to make a difference

2. his insulin is too high - he is dropping down too low during the day or night and then bouncing to a high by the end of the day as the liver panics at the low. Happens a lot to cats.(bouncing explained below)

Only way to know for sure is to do a curve over a few days and/or get more tests in. If its #2 above I would be wary of increasing the dose.

What kind of fancy feast is it? Classic pates?

Wendy

Bounces - what are they and is my cat doing them?
When a cat isnt regulated, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.

Yes, classic pates. Turkey & Giblets, Chicken, Beef & Chicken, Liver & Chicken.

We did do a half cycle curve last weekend and he was relatively flat during the entire time, so it seemed unlikely it was #2, yet his PS numbers on 0.5 and 0.75 when we first started were much lower than they are now.

We will try and get another curve on him today. If he's still high at the mid point is it ok to stop the curve at that point (like we did earlier)? It is difficult to do the BG testing on him.

Yes it's okay to stop during a curve if he's not cooperating with the testing. The only time you need to force the issue is if you happen to see a number low enough to concern you. If you see a number that is too low for comfort, you just have to convince him that further tests are for his own good.

I don't know if you need a curve. It would be less tests in a short time, and more valuable data to just get 1-2 more tests every day in addition to your preshot ones...

- a spot check mid day ie 5-7 hours after morning shot but I would vary this time
- a before bed test 2-3 hours after evening shot

What's the problem with the testing? Maybe we can help advise tweaks to make it easier.

Wendy

He's doesn't like holding still and doesn't like having his ears handled. Our earlier cat had no problem with being tested or shot, but in Gizmo's case, I think it's his initial feral life that makes him that way. He's just plain ornery. He was ok with being shot and now he's starting to put up a fuss about that, too.

Does he like his feet being touched?

I would practice stroking ears and giving treats.. Get him used that, without any poking.

I'm going to pass along this Ear Testing Psychology article that member Kpass wrote up for her feral kitten Michaelangelo. You may find it helpful.

Thanks!