Huge swings in Bella’s daily blood glucose

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DianefromDallaa

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My 16.5 year old DSH kitty has had diabetes for 4-5 years. She initially was diagnosed but went into remission for a year. Since then, I wasn’t able to get her back into remission.
About a year ago, we began seeing a decline in her kidneys. She was a stage 2 chronic kidney cat until last month when we saw a dramatic increase in her kidney values.
Bella is currently on Lantus insulin, .75-1 unit in the am and pm.
She was taken off renal food due to crazy facial tissues which was attributed to low protein in her food AND very low phosphorus. After a lot of consideration, I am letting her eat Fancy Feast pate. She has gained 2 pounds and is up to 9 pounds!

Here is the issue.
No matter what I do, Bella has H- U- G- E swings in her blood glucose. The vet initially thought she had the somogyi effect but after LOTS of tracking, we ruled it out. We used a Freestyle Libre for 2 months and the vet was stumped about the swings.
I got to the point of not giving insulin unless I test Bella. So as of today, I test my kitty every morning and night before giving insulin. (I am spending a fortune on test strips!) I was initially using Alphatrak2 but now using Advocate Pettest.

Bella’s glucose will swing from over 600 to 60 in one afternoon. For example, I gave 1 unit of Lantus this morning at 0830. At 430pm, Bella’s glucose was 60. She started eating like crazy to self regulate. By 8pm , her glucose was over 600.
If I increase her insulin, she will crash. It has happened at least 6 times. That requires, corn syrup and honey to get her stabilized.

Bella is allowed to free feed. She gets nauseated if she tries to eat a lot three times a day. I’ve tried. She tends to graze more at night. Overall, she eats about 2 small cans of Fancy feast a day.
Because of her CKD, she is getting 125-150ml lactated ringers solution.

Bottom line, how do I manage when the glucose swings from 600 to 60 to 600 in 12 hours??
 
Hello Diane,
Do you have a spreadsheet and signature we can look at.?
It is hard to give advice without those two things
Here is the link to how to set up a SS and signature. If you need help I will Ask @Bandit's Mom to help you.
HELP US HELP YOU

From what you are saying, it sounds very much to me like Bella is bouncing. You do not need to increase the dose. Bella needs to get used to being in normal numbers again and that takes time... At the moment she thinks the high numbers are normal. If we could see her data I know we could help you a lot.
I had exactly the same problem with Sheba when she fell out of remission after 2 and a 1/2 years. She bounced a lot and went from high to low and back again. My vet didn’t know what was happening. It was only when I joined this forum that I was able to learn how to manage it.
Here is an explanation on bouncing
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
I would let her eat whenever she wants except for the 2 hours before the present because we don’t want that BG food influenced.
 
DianefromDallaa said:
My 16.5 year old DSH kitty has had diabetes for 4-5 years. She initially was diagnosed but went into remission for a year. Since then, I wasn’t able to get her back into remission.
About a year ago, we began seeing a decline in her kidneys. She was a stage 2 chronic kidney cat until last month when we saw a dramatic increase in her kidney values.
Bella is currently on Lantus insulin, .75-1 unit in the am and pm.
She was taken off renal food due to crazy facial tissues which was attributed to low protein in her food AND very low phosphorus. After a lot of consideration, I am letting her eat Fancy Feast pate. She has gained 2 pounds and is up to 9 pounds!

Here is the issue.
No matter what I do, Bella has H- U- G- E swings in her blood glucose. The vet initially thought she had the somogyi effect but after LOTS of tracking, we ruled it out. We used a Freestyle Libre for 2 months and the vet was stumped about the swings.
I got to the point of not giving insulin unless I test Bella. So as of today, I test my kitty every morning and night before giving insulin. (I am spending a fortune on test strips!) I was initially using Alphatrak2 but now using Advocate Pettest.

Bella’s glucose will swing from over 600 to 60 in one afternoon. For example, I gave 1 unit of Lantus this morning at 0830. At 430pm, Bella’s glucose was 60. She started eating like crazy to self regulate. By 8pm , her glucose was over 600.
If I increase her insulin, she will crash. It has happened at least 6 times. That requires, corn syrup and honey to get her stabilized.

Bella is allowed to free feed. She gets nauseated if she tries to eat a lot three times a day. I’ve tried. She tends to graze more at night. Overall, she eats about 2 small cans of Fancy feast a day.
Because of her CKD, she is getting 125-150ml lactated ringers solution.

Bottom line, how do I manage when the glucose swings from 600 to 60 to 600 in 12 hours??
Click to expand...

To add to Bron’s great advice, it’s important to dose the same amount twice a day. If she’s got that much variation, you aren’t using the insulin right and she’s going low and then bouncing back up. We see it quite often here. While we give consideration to the preshot, we don’t dose on it but what we think the low point (nadir) will be.

I wouldn’t suggest increasing the dose right now and would also suggest you shoot 0.75u every 12 hours. If you test her at some point and she’s below 90 on your Advocate Pettest, you will need to reduce her dose by 0.25u every 12 hours. Once you have a spreadsheet, we can look at the BG and see if the 0.75u is working or if we need to suggest a dose change.

The spreadsheet will help you and us immensely to get her under control.

BTW, 125-150 mls is alot of fluid at one time especially for a 9 lb cat. How often are you doing that? It’s better to give less more often (every day as opposed to every other day or whatever your schedule is) so the body can absorb it and it doesn’t overwhelm the heart. My last CKD cat weighed 12 lbs and he only got 100 mls every day.

Welcome to FDMB!
 
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Marje and Gracie said:
To add to Bron’s great advice, it’s important to dose the same amount twice a day. If she’s got that much variation, you aren’t using the insulin right and she’s going low and then bouncing back up. We see it quite often here. While we give consideration to the preshot, we don’t dose on it but what we think the low point (nadir) will be.

I wouldn’t suggest increasing the dose right now and would also suggest you shoot 0.75u every 12 hours. If you test her at some point and she’s below 90 on your Advocate Pettest, you will need to reduce her dose by 0.25u every 12 hours. Once you have a spreadsheet, we can look at the BG and see if the 0.75u is working or if we need to suggest a dose change.

The spreadsheet will help you and us immensely to get her under control.

BTW, 125-150 mls is alot of fluid at one time especially for a 9 lb cat. How often are you doing that? It’s better to give less more often (every day as opposed to every other day or whatever your schedule is) so the body can absorb it and it doesn’t overwhelm the heart. My last CKD cat weighed 12 lbs and he only got 100 mls every day.

Welcome to FDMB!
Click to expand...
Welcome to the Forum, one of the things I can help you with is so you can test more often and not spend so much on strips, is the Human ReliOn Premier meter and strips, you can get it at Walmart for less the $12.00 for the meter and the strips are $9.00 for 50 and $17.88 for 100, if you still use the Libre, please know that they do not read accurately, especially on low BGs, and the sensors are not only expensive but most of the stop working way before the 14 days, so is good you are hand testing, and especially during AMPS/PMPS( before shooting ), you are in the right hands the sooner you create your signature and spreadsheet as Bron posted above the quicker we can get you the best advise. Have a Blessed Thanksgiving Day:bighug::cat::cat:
 
I will get the spreadsheet done. Lately I’ve been testing every few hours to avoid her crashing.
I may not be describing the situation well and perhaps this is bouncing - something I haven’t heard of before.

today, Bella’s glucose was low until about 2pm! If I had just given a dose in the morning, she would have crashed. Her BG was 100 when it is normally much higher. Tonight at 10 pm she was under 200. Two separate vets have said not to dose unless she was 275+.
Well, I waited 90 minutes and she shot to 512!

as for fluids- I am doing 75ml twice daily. 150ml daily. She has bloodwork monthly and in October her creatinine was 2.6. One month later she’s at 3.8. Hats a huge jump in 30 days. I had been struggling with her diabetes and we don’t know if that further damaged her kidneys. Even with 150ml, she seems to be drinking more water. The fluids do get absorbed very quickly on her. Up until a month ago she was getting 50/75ml daily. Even with all the fluids, I’m not sure her kidney value are better. It’s been 2 weeks on this subq fluid volume.
We were going to give iv fluids for 2 days but I feel I’m drowning her at this point.
My vet said much of her issue will be due to her diabetes since it is SOOOO inconsistent. You’ll see the numbers. It’s a lot.
 
Bron and Sheba (GA) said:
Looking forward to seeing the spreadsheet :)
Click to expand...

I am sitting here crying and am sooooo frustrated. I purchased a connection cable to download the data from my glucometer. I have HUNDREDS (over 300 ) measures. I am doing several measures a day and have 200 just in November. The data isn't easily moved to this template.

I am DESPARATE to get the data out to this group. I have a spreadsheet that lists the values. I can't even seem to download the template and i've followed ALL the instructions.
 
DianefromDallaa said:
I am sitting here crying and am sooooo frustrated. I purchased a connection cable to download the data from my glucometer. I have HUNDREDS (over 300 ) measures. I am doing several measures a day and have 200 just in November. The data isn't easily moved to this template.

I am DESPARATE to get the data out to this group. I have a spreadsheet that lists the values. I can't even seem to download the template and i've followed ALL the instructions.
Click to expand...
@Wendy&Neko
could you help her with the SS??
 
I’ll tag @Bandit's Mom to see if she can assist you.
Even if you can just give us a couple of weeks data with maybe 6 or 8 reading from the day with the preshot BGs and then a few from during the am and Pm cycles. That would be helpful.
 
The "Upload a File" function does not work. You would either have to drag and drop the file/photo or save the file on a cloud/drive and share the link here. A bit painful, I know!

I can very quickly set up the SS for you. Like Bron said, we don't need all the data for dosing advise. Even the data for the last week or two is enough for starters. If you'd like, you could email me the spreadsheet you have and I can enter that data in the FDMB SS for you.
 
DianefromDallaa said:
tried attaching and it wouldn't allow so here is the dropbox file.
Click to expand...
A few things need tweaking. Maybe @Bandit's Mom can help you
I can see the SS is upside down and you have put each entry on a separate line instead of the whole day on one line. Never mind we can get that fixed. And the whole SS is a lime green which needs to be white.:)
 
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DianefromDallaa said:
oh and she is now at about .33 units twice daily. It's very hard to manage between .25-.5 units which is why my vet wants to switch to PZI
Click to expand...
I would not switch to another insulin until we have had a good look at all the numbers. I can see Bella is bouncing because of the high numbers and then the drops. But I really need to be able to see a spreadsheet that is set up properly to really help you.
So hang in there and we will get the SS set up properly first.
Is she still just getting about 2 cans of fancy feast a day? Are you feeding her the 2 main meals before the insulin and then giving her snacks during the cycles? It is important that diabetic cats eat well.
And confirming she is still getting Lantus insulin.
Here is an explanation on bouncing.
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
 
I read about bouncing but I don't think that's what is happening.

In the best scenario, she is getting .75 units of insulin when she was high but the result would be her dropping too low. When we reduced the insulin to .25 or .5, she would go high and only last 8-9 hours.

She is on Lantus

She free feeds. I try to get her to eat something before insulin but she seemed to ALWAYS be high in the morning and at night so I would give insulin at those times. She free feeds all day/night long. She has had LOTS of bouts with infections. Been on and off antibiotics. I recently had a week of no infections and no antibiotics and her numbers were still erratic.

I am exhausted. I am up all hours checking on her. I am doing fluids 2x/day and her kidneys are starting to decline. The uncontrolled glucose is impacting her. Ive had 2 vets working with her and they have just thrown up their hands. I had her hospitalized to see what was happening and that was a DISASTER as the stress kept her >600 for 2 days at the hospital.

I am beyond myself trying to figure this out. Ive had freestyle libres installed and they showed all the chaos.
My former vet said - just give .5 units and stop measuring. I did that and she almost died because she crashed. (he said it was impossible on .5 units. Since then he changed his tune.)
 
Also, since April she has been getting monthly and sometimes biweekly labs run.

Sometimes her sodium is high, sometimes her calcium is high, now her sodium and potassium are low (maybe too much fluids?). She was getting anemic so we put her on carafate and that helped (bleeding ulcer?).

She was doing fairly well in early summer but now her kidneys are really starting to decline.

Lots of things happening at the same time so we don't know cause and effect. We need to get diabetes under control quickly if we have a shot at stabilizing the kidneys. She seems to be losing weigh and muscle mass in the last few weeks.
 
I certainly don’t agree with just giving 0.5 units, not testing and hoping for the best.
We do not advocate that.
We believe in hometesting to keep our kitties safe.
We have a lot of cats arrive here where the CG is completely stressed out and the vet does not know what to do.

I could see from a few of the BG numbers on your SS that the dose was too high at some point. And the BG drops too low, then it shoots up high. That is bouncing. As I explained above, bouncing can be caused by numbers dropping too low, numbers dropping too fast or numbers dropping lower than what your kitty is used to. All those scenarios can cause bouncing. A lot of diabetic cats bounce. There is nothing you can do about it. You just need to let your kitty get used to the lower numbers. If she is dropping too fast you can feed the curve and that can slow down the drop and hopefully stop the bounces. But first we need to see the SS and then we can help you more.

DianefromDallaa said:
Also, since April she has been getting monthly and sometimes biweekly labs run.
Sometimes her sodium is high, sometimes her calcium is high, now her sodium and potassium are low (maybe too much fluids?). She was getting anemic so we put her on carafate and that helped (bleeding ulcer?).
Click to expand...
I am concerned you might be giving too many subQ fluids. Marje mentioned above in post 3 she was concerned about the amount of subQ fluids given daily. If the sodium and potassium is too low, this could be the reason. I will tag @Marje and Gracie to address this issue with you.

Fancy Feast is not the best food to be feeding a CKD kitty. It is high in phosphorus.
You would be better looking for foods that are lower on phosphorus.
Have a look at THIS FOOD CHARTand look for foods that are 200mg phosphorus/100kcals or less. There are plenty of of low carb to choose from. Weruva brand has several.

Do you have any lab results you can share with us? If the vet has them you can ask him to email them to you. They are yours as you paid for them. You could then copy and paste them into this page for us to see.

Do you check for ketones in the urine? I would recommend you do that is she is getting lots of infections and is unregulated.
To do this you need to buy a bottle of Ketostix from a pharmacy, collect a urine sample and then test as per the instructions on the side of the bottle.
 
I attached Bella's labs and recent test results. Her kidneys have gotten worse in a month!

To respond to a few questions...
Subq - she is currently getting 125 ml split in 2 sessions. My vet wants to give more and believes some of her values are associated with dehydration. I don't want to do too much so I've stayed at 125. She is drinking a lot but her sugar is up a lot so that can be the cause.

I get her urine checked weekly at the vet for infection and ketones. Luckily no ketones so far.

Her sodium and potassium are very low which is concerning.

Today vet and I spoke and she thinks Bella now has neuropathy based on the loss of muscle and the way she is standing. This is very concerning.

About 6 months ago i took Bella off of renal food. She flourished! She gained 2 pounds and her "twitching" stopped. Her phosphorus stayed good - until recently. Then she went into a phase where she wouldn't eat (about 2 months ago) so I gave Fancy Feast. It was suppose to be used as a topper but she wouldn't eat the Science diet I previously gave her. I know it isn't ideal and want to change but she doesn't like Weruva. I will try going back to Science Diet.

She has had infections on and off for 12 months. Clindamyacin caused MASSIVE diarrhea that was HARD to control. it almost killed her. Shes on Zeniquin now for a week. She tolerates Zeniquin which is why we go to that first. Tomorrow we do a recheck for the infection.

I hope that answers everything.

Thanks for your help

Recent labs -

https://www.dropbox.com/scl/fi/9mxy...ey=r2z3ey0v2szc5e0cgpxf0djlw&st=p6sys2bn&dl=0

https://www.dropbox.com/scl/fi/v5oa...ey=ipn4rm2mmms9uhhevtljeectk&st=etsjb6iv&dl=0

https://www.dropbox.com/scl/fi/ve5o...ey=hffk243vxic0436mb66q7p4q0&st=db7jozl3&dl=0
 
DianefromDallaa said:
I attached Bella's labs and recent test results. Her kidneys have gotten worse in a month!

To respond to a few questions...
Subq - she is currently getting 125 ml split in 2 sessions. My vet wants to give more and believes some of her values are associated with dehydration. I don't want to do too much so I've stayed at 125. She is drinking a lot but her sugar is up a lot so that can be the cause.

I get her urine checked weekly at the vet for infection and ketones. Luckily no ketones so far.

Her sodium and potassium are very low which is concerning.

Today vet and I spoke and she thinks Bella now has neuropathy based on the loss of muscle and the way she is standing. This is very concerning.

About 6 months ago i took Bella off of renal food. She flourished! She gained 2 pounds and her "twitching" stopped. Her phosphorus stayed good - until recently. Then she went into a phase where she wouldn't eat (about 2 months ago) so I gave Fancy Feast. It was suppose to be used as a topper but she wouldn't eat the Science diet I previously gave her. I know it isn't ideal and want to change but she doesn't like Weruva. I will try going back to Science Diet.

She has had infections on and off for 12 months. Clindamyacin caused MASSIVE diarrhea that was HARD to control. it almost killed her. Shes on Zeniquin now for a week. She tolerates Zeniquin which is why we go to that first. Tomorrow we do a recheck for the infection.

I hope that answers everything.

Thanks for your help

Recent labs -

https://www.dropbox.com/scl/fi/9mxy...ey=r2z3ey0v2szc5e0cgpxf0djlw&st=p6sys2bn&dl=0

https://www.dropbox.com/scl/fi/v5oa...ey=ipn4rm2mmms9uhhevtljeectk&st=etsjb6iv&dl=0

https://www.dropbox.com/scl/fi/ve5o...ey=hffk243vxic0436mb66q7p4q0&st=db7jozl3&dl=0
Click to expand...
There is no way this kitty should be getting all that fluid and I certainly would not give IV fluids for a cat whose creatinine is 3.7. It’s standard to not even start fluids until the creatinine is above 3.5-4.0 consistently and then you start with a small amount like 50 mls once a day. Your vets are endangering your cat’s heart with this much fluid. You can overwhelm the kidneys with that much fluid.

The gold standard for treating CKD cats is Tanya’s. I would suggest you read the section on subq fluids and discuss it with your vets. Even when my CKD boy had a creatinine of 4.5 and he weighed 12 lbs, he got 100 mls/day. He lived well over 7 years with stable CKD and passed from another condition.

Her phosphorus level concerns me more than the sodium and potassium which are normal on IDEXX. There is no way a cat with CKD can go from 6.3 one month to 3.7 two weeks later. Especially eating Fancy Feast. It would be hard to get that kind of drop that fast even using a phosphorus binder. Something is weird with those labs. The one in Nov looks like an in- house lab and I don’t put a lot of credence to those. I’d trust IDEXX more.

CKD cats are often anemic as the disease progresses and her hematocrit (HCT)is still very good. Vets also need to be cautious about checking labs too often; if her HCT were lower, the last thing you want is to be taking blood so often.

Honestly, I’ve seen much, much, much worse labs for a CKD cat. I am most concerned about her calcium level. You can read about calcium here. I would have an IDEXX test on the calcium done and an ionized calcium test run.

I would urge you to start reading Tanya’s. There is also a group like this one and they are very knowledgeable about CKD. I belong to it.

Insofar as the FD, that looks like our SS but the background shouldn’t be green and the dates should start with the oldest at the top and the most recent at the bottom. You say you are shooting twice a day but it isn’t shown and without more data to see what BG you are shooting at night, it’s hard to guess a good dose. It’s hard to tell your shot times. You should be shooting every 12 hours with very little (minutes for now) difference in time. All the tests for one day should be on one line.

She is definitely bouncing. If you can get us more data, it would be helpful. If it were me, I’d go back to 0.25u twice a day and collect data: always a preshot, +2, +6, +9 for the a.m. and a preshot, +2 and +4 at night. I’d also buy a cheap human meter and strips like a ReliOn.

You can address neuropathy by giving B12 like Zobaline.

I would be checking her ketones every day. When you say she hasn’t moved….is she eating and responsive? If not, do you have urine ketone strips to check her ketones? They can develop quickly.
 
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Thank you so much for the review.

Here are a few responses...

Fluids - I have been posting on Tanya's about the fluids - type and amount. I did see an improvement in Bella when I did fluids and her creatinine dropped when we increased fluids.
I'll revisit with the vet and Tanya. I'll do anything for 7 years!!!!

Phosphorus - she actually jumped from 3.7 to 6.3. That's a HUGE issue. I know I have o get her off Fancy Feast and am looking for options. I have the food lists. I may use aluminum hydroxide until I can get her onto another food.

Anemia - Bella was anemic in the past. She had a bleeding ulcer which is so much better. We do blood when I see odd behavior.

Calcium - yes, definitely a concern. You will see it bounced around a bit. I'll ask vet about ionized calcium test.

Tanya's site - It has been my bible and their forum is awesome.

Spreadsheet - I am trying to do every 12 hours - but if Bella is too low (under 250) I wait because she will crash if I give insulin. Lately her numbers have been so high
and she seems to peak after 9 hours.
What do I do if I test and she's low? I am really afraid to give insulin as she will crash.
I can restart a spreadsheet. I have sooooo much data as you saw, i only gave you a small snapshot.
>>What do you do for measuring overnight?

"neuropathy" - i got the Jackson Galaxy Methyl B12 Liquid and I just put in her mouth. She's easier to pill so I will order Zobaline.

Ketones - we are doing another urinalysis tomorrow to check for bacteria and ketones. I ordered strips that should be here tomorrow. I want vet to check her heart too as neuropathy can impact heart and lungs.



Thanks a MILLION. Shes not doing well today. Seems very weak.
 
DianefromDallaa said:
Phosphorus - she actually jumped from 3.7 to 6.3. That's a HUGE issue. I know I have o get her off Fancy Feast and am looking for options. I have the food lists. I may use aluminum hydroxide until I can get her onto another food.
Click to expand...
I’m sorry. I thought the 3.6 was Dec. My bad. :confused: But the latest one was in-house and it would be good to compare apples to apples. Binders should be started at around 6 so I’d do that, change foods, or go back to the renal diet but I don’t know the carbs on that.

And what does Tanya’s group think about all that fluid?

Actually, 250 is high and we have new members here shoot everything above 150 and then teach them to shoot lower. We need to get the SS sorted out and the data correct. You can post here for help shooting for a BG you feel is “low” but don’t feed her if you are stalling a shot. Best to test at +11 and post for help so you don’t have to stall.

What do you mean by “peaking” as it’s not a term we use. Do you mean she loses duration? If she is losing duration by +9, either the insulin is old, you are feeding too much after +6, or you are not getting the insulin into the subq layer.

For testing in the p.m. cycle, we get a preshot, a +2, and a before bed. If the +2 is similar to or lower than the preshot, it will likely be an active cycle so you might have to test a bit more depending on what her BG is?

Diabetic neuropathy in cats just affects the limbs, usually back limbs. I've been here 14 years and never seen a cat with neuropathy that affected the heart or lungs. Certainly diabetes itself can affect the heart.

But is she eating? If she’s weak and not eating, I’d be going to the ER if I couldn’t get urine ketone strips and test at home.
 
Bella is eating although is has slowed down maybe due to antibiotics.
I just did 1 hour reading and her BG went down which usually takes a few hours- so I have a bad feeling about tonight. This usually means she will drop very low which is tough to monitor in the middle of the night. She usually starts eating like crazy which is the sign for me to watch.

I’ll keep you posted.

Today, I gave her morning dose and she was VERY SLOW to drop. I would usually watch and test and then only when I saw her BG going up, would I be comfortable giving insulin.
Tonight I just gave it to her and her BG dropped by 100 on an hour.

my gut says she was still dropping from this mornings dose.
Let’s see.
 
We are just closing in on the end of day 1.

I thought I would share a little of the results.
I started last night and gave insulin at 10p. After the first hour, I was excited to see that her numbers dropped by 100. She had a little Fancy feast pate to eat. Not much. Within 3 hours, her BG INCREASED by 200! By early morning she was “HI” which means over 600.
Gave insulin this morning at 10am. During the day, the lowest reading was in the 400’s and within 8 hours she increased again to “HI”.
Thus is the reason we increased her dose in the past but when we did she would go so low.

I wanted to give insulin but am waiting and will dose the same time. Let’s see what happens.


Vet checked urine today and bacteria is gone. vet consulted with some specialists about what we are experiencing. She was told to change from Lantus to PZI. Their belief is that her body may not be responding to Lantus since she’s been on it so long.

We agreed to continue our plan over the next few days and revisit in the future.

fingers crossed we can get her out of this bounce!
 
I thought I’d give a quick recap since things aren’t going well.
I will put in spreadsheet but am on phone and wanted to get this out.
Sunday
10pm. 465bg administered .33 unit
+1. 380bg. She ate after this
+3. 566bg
+7. HI bg which means over 600

Monday
9am. HI bg administered .33 unit
+4. 532bg
+6. 486bg
+8. HI bg

9pm. HI bg. Administered .33 unit
+2. HI bg
+3. HI bg
+11. 452 bg
10am. 555bg. Administered .33 unit
+4. 574
+5. Vomited. Hasn’t really done that much
+7. HI bg

She is running too high. When she does, she starts to breathe heavy - vet said it’s a way to balance ph.

recently the .5 dose caused her to drop too low but I don’t know what else to do.
 
DianefromDallaa said:
I thought I’d give a quick recap since things aren’t going well.
I will put in spreadsheet but am on phone and wanted to get this out.
Sunday
10pm. 465bg administered .33 unit
+1. 380bg. She ate after this
+3. 566bg
+7. HI bg which means over 600

Monday
9am. HI bg administered .33 unit
+4. 532bg
+6. 486bg
+8. HI bg

9pm. HI bg. Administered .33 unit
+2. HI bg
+3. HI bg
+11. 452 bg
10am. 555bg. Administered .33 unit
+4. 574
+5. Vomited. Hasn’t really done that much
+7. HI bg

She is running too high. When she does, she starts to breathe heavy - vet said it’s a way to balance ph.

recently the .5 dose caused her to drop too low but I don’t know what else to do.
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@Marje and Gracie
 
Hi Diane, have you made any progress on setting up a spreadsheet in the format used here? If so, put that Google sheets link in your signature, along with some other basic information about Bella. Maybe look at mine or others signature for guidance. Folks are used to that and can better help you.

How has her eating been? Any improvement?
 
DianefromDallaa said:
@Marje and Gracie

any input?
Click to expand...
I’m sorry. I don’t always get the alerts & I’m not on the board most days.

We need our google SS for her. We just use this because if everyone had a different one, we would be taking too much time deciphering it. Also, I can’t access the one you linked as I don’t have a Dropbox account. I’m going to send you a private message to get the info I need from you to do a SS for you.

What did your vet say to increase to and did you do it? If she’s got neuropathy, she isn’t getting enough insulin. I wonder if you are getting into her subq layer? Here is a post that includes shooting tips.

Are you testing for ketones every day with urine ketone strips? The vomiting and not wanting to eat concern me. Please check her ketones every day.

I don’t like giving dosing advice without a SS but the BGs you’ve listed are really high. When was the last time she was below 100 and how low was it? If she went very low, she could be bouncing really hard.

I would suggest increasing to 0.5u twice a day even though you said it took her too low. Be sure to get a test at +2 and if she’s starting to drop, post here. You can control the drop using high carb food so you can keep her from going too low until we figure this out.

I have to go out this morning but if you can get the info I ask for while I’m gone, I can do a SS and that will help us immensely.

Please check your inbox in a few minutes.
 
The spreadsheet was in the above message. labs are in previous messages.

My laptop has crashed repeatedly so I work on my phone. I haven’t figured out how to put in my signature line yet.

her eating has been a little lighter lately as I’m now using aluminum hydroxide and I think she detect something different. She’s on fancy feast and I have to wean her off that to a different food but haven’t found one she’ll tolerate.
 
DianefromDallaa said:
The spreadsheet was in the above message. labs are in previous messages.

My laptop has crashed repeatedly so I work on my phone. I haven’t figured out how to put in my signature line yet.

her eating has been a little lighter lately as I’m now using aluminum hydroxide and I think she detect something different. She’s on fancy feast and I have to wean her off that to a different food but haven’t found one she’ll tolerate.
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As we’ve all told you, we can’t use the SS as you’ve attached it. I sent you a PM and if you could just, please, provide the info, I can get you properly set up.
With the SS you have attached, you would have to keep attaching it every day and we’d have to search for it. Our SS goes in the signature block so it’s always attached and auto updates every time you post something on it so we can see data quickly.
 
Marje and Gracie said:
As we’ve all told you, we can’t use the SS as you’ve attached it. I sent you a PM and if you could just, please, provide the info, I can get you properly set up.
With the SS you have attached, you would have to keep attaching it every day and we’d have to search for it. Our SS goes in the signature block so it’s always attached and auto updates every time you post something on it so we can see data quickly.
Click to expand...
Beautiful video :bighug::bighug::bighug:;):cat::cat::rb_icon:
 
@DianefromDallaa

I’ve done the SS and linked it and sent you the instructions. I was going to put some more data into ours from the info you posted in this thread but, honestly, I can’t figure out from your data when you shot and when you tested as you have no PS BGs and you have multiple lines for each day. I set up the SS with rows to enter data from 11/15/24 as that should give us enough info to go off of.

Just from, in general, what I can decipher from that SS you linked in Dropbox, it looks like 0.75u was just a tiny bit much for her as she was dropping below 68 a bit at night (I think it was night) and then bouncing hard back up the next morning. We need to work her dose back up to at least 0.5u but, first, I’d really like to see the data in her SS if you can please make it a priority to fill in from 11/15 with what you have. I find it hard to tell but it looks like you might already be shooting 0.5u which would be great because we could see how she does on it. I think we can get her to a much better place in not that long of time if we can see the data.

Insofar as changing her insulin, we often say if one isn’t working after six months, it might be wise to consider a different insulin. However, I cannot tell that you’ve been using Lantus correctly and I’d like to give that a chance before you change insulins.

Thoughts or questions?
 
Thanks Marje for your help!

Hi All,
I’ve updated the spreadsheet and would appreciate your thoughts.
Bella has been a diabetic for many years and for the past few months I’ve just had a hard time getting her regulated (on Lantus).
Yes I test before giving any dose and yes the insulin is fresh- common questions I’ve seen.

Appreciate your input.
 
DianefromDallaa said:
Thanks Marje for your help!

Hi All,
I’ve updated the spreadsheet and would appreciate your thoughts.
Bella has been a diabetic for many years and for the past few months I’ve just had a hard time getting her regulated (on Lantus).
Yes I test before giving any dose and yes the insulin is fresh- common questions I’ve seen.

Appreciate your input.
Click to expand...
I just have a few moments tonight to make an observation but she was really bouncing due to fast drops and running lower. There are ways to slow down those drops so she doesn’t bounce so hard.

If she stays in high numbers above 200 through tonight, she will have been ten cycles at this dose and I would suggest you increase to 0.75u in the morning if you are there to monitor her.

A couple things:
—you are shooting the same time am and pm, 12 hours apart every day, right? That means like a 7 am/7 pm or 9 am/9 pm shot time?

—please try to always get a +2 test and if it’s similar to or the same as the preshot, it’s likely to be an active cycle, so post here and so one can help you slow it down.
 
Last edited:
So today was a good example of my frightening days….
I gave Bella .5 units of insulin at 10am. She was only 238bg and I would normally would have waited but I was heeding advice to stay on a set schedule. At 1pm she was 250. At 3pm she was 262. I needed to run errands and left the house at 4. I thought she would be ok.
I got home and tested at 6:30pm. She was 59!!!!
She had food out and normally would eat to self regulate. That didn’t happen. I have no idea how low she fell.
I ended up giving morsels of Fancy feast dry as that gets her BG up faster than corn syrup. But now she’ll spike.
This is so frightening. I didn’t dose at .75 units because I had appts and wanted to be home - but when is it safe? I felt that she was staying at the +200 range after 5 hours so I never expected this type of drop.
I’m afraid now to leave the house because even in 2 hours she can drop like this!
 
DianefromDallaa said:
So today was a good example of my frightening days….
I gave Bella .5 units of insulin at 10am. She was only 238bg and I would normally would have waited but I was heeding advice to stay on a set schedule. At 1pm she was 250. At 3pm she was 262. I needed to run errands and left the house at 4. I thought she would be ok.
I got home and tested at 6:30pm. She was 59!!!!
She had food out and normally would eat to self regulate. That didn’t happen. I have no idea how low she fell.
I ended up giving morsels of Fancy feast dry as that gets her BG up faster than corn syrup. But now she’ll spike.
This is so frightening. I didn’t dose at .75 units because I had appts and wanted to be home - but when is it safe? I felt that she was staying at the +200 range after 5 hours so I never expected this type of drop.
I’m afraid now to leave the house because even in 2 hours she can drop like this!
Click to expand...
Without complete data on the SS so I can look at times, I am hesitant to advise. We live by the SSs and you will find members will be reticent to advise without current data. With the SS, we can see patterns and trends. You can’t look at one cycle in a vacuum.

We are all on separate time zones and so we speak in terms of number of hours since the last shot so a test two hours after a shot is +2.

Finally, I asked a couple questions in post 46. I also strongly suggested you get a +2. There are reasons why we ask questions or ask you to do something, if you are home. We can best help if you are responsive and keep the SS up-to-date.
 
I updated the spreadsheet.

To answer your questions -
- yes I try and dose at the same time each day and 12 hours apart
- yes I also try and do a +2 or +3 measure - although doing overnight measures are getting more and more difficult. I was at a doctor appt this morning and came home at 2 hours 38 minutes so I logged as+3.
 
DianefromDallaa said:
I updated the spreadsheet.

To answer your questions -
- yes I try and dose at the same time each day and 12 hours apart
- yes I also try and do a +2 or +3 measure - although doing overnight measures are getting more and more difficult. I was at a doctor appt this morning and came home at 2 hours 38 minutes so I logged as+3.
Click to expand...
I’d really like to help you but if you can’t keep the SS updated (add a new BG as soon as you take the test unless she’s really low & you need to feed), it’s difficult.

For instance, after the 59 yesterday, she did what? Is she bouncing today, what dose did you shoot, etc. As a note, usually when we see a test that doesn’t seem to fit, we retest. I’m not saying the 59 is not valid because my Gracie did the same thing to me early on Lantus when I didn’t realize how bounces broke and wasn’t managing the curve with food.

What is the % calories from carbs is she currently eating and when do you feed her? We have found most diabetic cats do best with foods that are 6-10% calories from carbs and they often require several mini- meals to work with the action of the insulin.

It looks to me like she was clearing a bounce and when that happens, the BG progressively gets lower so the nadir is late in a cycle. She was likely bounding from the 100s on am cycle 12/14. The 320 on pm cycle 12/15 could have been the high before the break.

Because insulin is a hormone and not a medication, you aren’t always going to get the same response and a lot of things influence it. You not only have to test at appropriate times but also feed at appropriate times. You’ve done a pretty good job of testing and so it’s important we figure out the feeding part of it.

But, again, I will tell you Bella’s patterns are not uncommon. We just need to teach you how to work with the insulin to get a better outcome. You can help us by keeping her SS very up-to-date and posting every day.
 
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