Help! BG out of control

Hi all,

Start from this month Monkey's Lantus gradually increase from 3.0 U to 5.0 U, but the BG is still very high around 300 to 500 ml, as if the increase of Lantus had no effect.

What can I do? I am so helpless and extremely worried.

Brief history of Monkey, he dignosised since last April and I took very close care to him and his BG become stable and his health greatly improved within 3 months. However, because of my work my Mom individually took take of him since Sept 2020, and seem to make a big mistake of shooting insulin 2 hours AFTER a big meal. I guess this is the main reason that Monkey's BG become so unstable now. I have started to take close care of him again start from Feb 2021.

Behaviorially he is being quite well, he still actively socialize with people, explore environment and play with toys. He eats a lot, significantly more than my other cats. He is often hungry so I feed him 2-4 times per day. His meal is doctor Lisa's half raw chicken meat recipe Also, he gain 4 pounds of weight, from 10 pound to 14 pound. He drinks a lot of water and look slight bloated but I think he bodyshape look fine and not obese. To prevent obesity I played with him twice per day, 10 mins per session.

@Bron and Sheba (GA) @Nan & Amber (GA) @jt and trouble (GA)

 

Hi Peter, good to hear from you.
Looking at the SS I’m wondering if Monkey could be dropping lower and bouncing and you are missing catching the lower numbers later in the cycles. Just over a week ago he dropped to 90 at PMPS. You rarely test after +2 at night and we know cats often drop lower at night.
So I would try and get some tests in later in both the am and the pm cycles to see if you can catch any lower BGs. Is that possible for you to do that.?

I would not increase the dose until you have definitely established that he is not dropping low and bouncing.

 

Hi Peter!

Glad to hear that Monkey is feeling well, now if only his numbers were better! I assume that the vet hasn't found any other health issues that could be influencing his numbers?

I agree with Bron that he may be dipping low when you can't see it. I don't think that your Mom's shooting schedule would have caused the patterns you're seeing, sometimes this just happens when insulin needs change.

I'd definitely try to get a few tests at some other times before increasing again. You are increasing on a tight regulation schedule, and although you do technically test enough for TR, I get nervous when you are almost always getting the same tests during each cycle. You may be missing some important patterns that way.

Last thought: how old is the insulin pen/vial?

These things can be so tough to figure out, it is frustrating! Again, it's very good that he seems to be feeling well still, that is a good sign!

 

Hi @Bron and Sheba (GA) @Nan & Amber (GA),

Sorry for the late reply, luckily Monkey has a lower BG today.

My Mom is currently testing +4 or +5 at the PM cycle, hope this can help.

I have not taken him to the vet for a body check, I should do that right? Do you know what usually can affect Monkey's BG.

The insulin pen is quite new, we buy them last month.

I can do more tests in AM cycle too, but except +4 to +5 , what time should a take a test that is useful?

 

Hi Peter
Could Monkey be getting into anyone else’s food?
Also... who gives the insulin? You or your Mom? I was wondering if he could be getting some fur shots?

 

Hi Bron,

Monkey is not able to get in anyone's food except we occasionally give cooked shrimps and chicken as treat. I am sure Monkey does not eat any food that has carbs in it.

My Mom gives the insulin. I trust that she does not give a fur shot, and I reminded her strongly already.

 

Hi Peter,
I would continue to get the extra tests in for a bit longer to see if we can see anything. Also can you get any tests in later in the am or the pm cycles?

 

Hi all,
Monkey's BG is going high again, should I increase the dose?
Also, although Monkey behaves fine and still explores the environment, plays with toys and interacts with a human, he looks less energetic and agile than other cats, what should I do? Should I take him to body check?

@Bron and Sheba (GA) @Nan & Amber (GA)

 

Hi Peter--

I think I would take him in to get checked out, yes. He might just need more insulin, but it's a sudden change in the last week after a week of nice blues so you want to make sure it's not something like pain/discomfort due to something else. When you say that he isn't as agile, it makes me think that he might be feeling some arthritis or something like that? Or it could be something else, like pancreatitis, that is making him uncomfortable, even if he is otherwise behaving well. Cats are very good at hiding that kind of thing, but they can't hide BG numbers.

If the vet can't find anything else going on, it might just be that he needs another dose increase. He did get a green number a couple weeks ago, but in general from the recent data I don't think he looks like the problem is that he's going low and bouncing.

If he does need to start going up in dose again, he's starting to get to a high dose, and it's possible he has a so-called "high dose condition" like acromegaly or insulin antibodies (high dose isn't required for these conditions, but once a cat gets to a high dose they become much more likely). If that starts to look like what is going on, there are blood tests for these conditions. It wouldn't change much about how you are treating Monkey's diabetes, just help to understand and interpret his BG patterns. So not an urgent thing right now, just something to think about, I don't remember if we've ever discussed these conditions before.

Glad he seems to be feeling well otherwise!

 

Hi Nan, let me take him to the vet and I will update you later

 

I'll be curious what the vet says.

I do think you've been holding on to the 5.0u dose for too long, especially if you are still following TR. Remember, you adjust the dose after 3 days/6 cycles if the dose isn't putting Monkey in the desired range. He's been at this dose since the end of March.

 

thanks, let me start to increase the dose gradually by 0.25

 

@Nan & Amber (GA) and everyone, should I increase the dose by 0.25 to 5.5 U next cycle?

 

Can you get a +2 test this evening?

 

You mean in addition to PM+4, I should also get a +2?

 

luckily, Monkey's bloodwork result is good, except he may have kidney disease stage 1, but the vet said it is not a problem yet. I guess there is nothing much i can do. Monkey is behaving well. Also, his BG is more stable.now and sometimes lower than 50, i am reducing the dose now.