Sudden jumps in BG readings? - Need Help

Hello all,

Today is approx Day #10 for Pearl on Lantus (newly diagnosed diabetic on 12/21, 4 days in hospital some of which was on IV insulin).

Until today, her readings have been pretty stable/predictable. Then, all of a sudden today they JUMPED. Now they are in the 400s (which of course scares me b/c she is prone to the high numbers, she was diagnosed at 500 with stumbling, not eating and drinking, significant dehydration - this is why she was hospitalized on 12/21). Nothing has changed diet-wise or stress in the house since she returned from the hospital on 12/25.

Is this normal? What could this be from? Is it normal for things to change like this with Lantus? She is on 1 unit twice daily. Tomorrow is her first curve.

What do I do if her sugars get really high in the middle of the night?

Her BG chart link is in signature. My vet asked me to try to NOT take as many readings for now (as you will see) since Pearl is prone to internalizing stress and getting a lot of anxiety.

Thank you!
Margaret and Pearl

 

Hi Margaret,
Have you looked at the two dosing methods we have?
They are at the top of this Lantus page.
Tight Regulation and Start Slow Go Slow.
If you are feeding only a wet diet you can do the TR but you will need to do more testing.
For example it is really important that you get at least one test in during the PM cycle to see if the BG is dropping overnight. A lot of cats drop lower at night. Make a habit of getting at least a before bed test in and if it is the same or lower than the preshot I would set the alarm and test again so see Pearl is safe.
When you have decided on a dosing method could you add it to your signature please?

Did Pearl have ketones when she was in hospital?
Are you checking the urine for ketones with Ketostix. I would recommend you do this daily while Pearl is unregulated.

There is nothing you can do if the BG rising higher during the night. Just make sure there is water available for her to drink.
It is possible Pearl is dropping lower at night and bouncing up higher during the day.

Are you feeding snacks during both cycles as well as the preshot meal?

I would try and get three tests in during the pm cycle tonight to see what she is doing. It looks as if she needs an increase in dose, but we need to see some night time tests first to see she isn’t dropping lower and bouncing in the morning.
Do you think you could get those extra tests in ?

 

Hi Bron,

Thanks for your message. I am doing the SLGS method. I can't test as much as is needed for TR and I don't know how well Pearl would handle it (and I am honestly scared b/c I don't think my vet would approve but I will get her thoughts).

We are doing only wet food, yes. I will try to start adding in before bed tests, that is not much to add for now. So how many tests per day? Part of the problem is that Pearl has a host of other medical issues that all get triggered by stress so my vet wanted me to test LESS b/c of her stress problem (she internalizes stress and then gets sick somehow). Right now I am doing 2 tests per day. I am happy to add more, but if I can only add 1-2 right now, when should they be? I really don't want to stress her out, that will throw everything off.

Pearl did not have ketones - but I suspect she was on the edge of developing them. I do not have a way to test for Ketones here - we went to the vet last Saturday and she was still negative for ketones. Is Pearl unregulated, is that what her numbers mean?

I don't honestly know what to do about the food - I try to divide her canned food (Wellness Core pate, 5% carbs) into quarters and feed her every 6 hours. At night I leave down whatever is remaining in the can for the day. She is still hungry, so in between times I give her a bit of fish when she asks me for it. Is this bad or ok? I had read it's ok to feed throughout the day?

Tomorrow I will curve her, and on Tuesday the vet will adjust her dose. What I do not understand is why the sudden jump today (and drop middle of the day - she usually does not drop that much historically) - are there reasons for why that would happen on Day 10 of Lantus? Shouldn't her responses be kind of typical at this point? (This is my first bout with a diabetic, so I have no clue how these things work).

Thanks, Bron!!

 

Margaret
First of all...every cat is different (ECID) so what is right for one cat, isn’t for another. The same with the BGs. There is no
“typical” response. But when they become regulated, they should look like this...this is Henry who was unregulated but is now beautifully regulated
https://docs.google.com/spreadsheet...PldCL2zOzzolQR8CnLKrz4CthDU9g8CG6OC7/pubhtml#

Unregulated cats will be hungry because they can’t absorb all the nutrients in the food, so if Pearl is not overweight, I would let her eat when she is hungry. I would also give her most of the food in the first half of the cycle as that is when the insulin is strongest. You could feed her preshot, then a snack at +3 and +5 or +6 both cycles. Don’t feed for the 2 hours preshot so the BG is not food influenced.
I would also use the remarks column to document when you fed and other information such as results of ketone tests, how she is....alert, lethargic etc..

You can test for ketones by buying some Ketostix from a pharmacy or Walmart and collect a urine specimen from Pearl. Dip the test strip into the urine and read the result exactly 15 seconds later against the colours on the side of the bottle.

If you can get the before bed test in every night and one test in during the day (vary the times between +3 and +7) as the nadir can move around and it is all useful data, that would be great. If you are doing SLGS you need to do a curve on day 7 to see if you need to increase.
Try not to leave her any longer than 7 days without increasing the dose, if the numbers are telling you an increase is needed, as glucose toxicity can set in and then it’s harder to get the numbers down.

It will take time to get her regulated. It doesn’t happen overnight so patience is needed.
We recommend only increasing in 1/4 unit (0.25 units) increments as it is much safer for the cat and you won’t go past the best dose.
A lot of vets like to increase in 1 unit increments which is too much.
Keep asking questions, we are happy to help
Bron

 

Thanks, Bron. I am so worried, it's been 10-11 days at the same dose (first time ever on insulin). It will be day 12 before the vet adjusts dose, is it possible she has glucose toxicity already? I am sure the vet will put her another unit. If I am adjusting things myself, there is no way I can do 1/4U with the needles I have - do you know of needles with 1/4 markers? I only have 1U markers on my needles! I may be able to eyeball 1/2 unit.

Part of the problem is that yes, Pearl is overweight. She started her diabetes journey at 11.8 pounds 2 weeks ago (should weigh between 8-9). Her weight gain came from medications - prednisolone to treat her asthma and IBD, and Cyphroheptadine to deal with her asthmatic allergies. She is eating 215 calories daily now. I just don't know what to do about giving her additional food beyond that 1 can, and she eats it so fast, that there is then NOTHING down for her overnight, that is why I leave some fish down when I go to bed. I don't want her BG to plummet, but at the same time I am supposed to be having her lose weight. I do think she has lost some weight, maybe she is 10.5 now.

Thank you for your encouraging message. I will add in those 2 extra readings daily.

 

You're doing a great job with Pearl. One aspect of testing to keep in mind. If you're feeling stressed about testing Pearl, she will respond to your being anxious. The more relaxed you are about the process,, the less anxious Pearl will be. So, take a few deep breaths and remember that testing is the best way to keep Peal safe. As weird as it sounds, she will begin to understand that the testing results in her feeling better. Well, that and you should give her treats (any freeze dried proteins, some chicken, etc. -- anything she likes) as a reward.

A typical curve looks like a smile. The numbers are higher at pre-shot times and dip in the middle. In principle, the lowest point in the cycle (the nadir) is at +6. However, not all cats follow the rule book and can have an early or late nadir. Nadirs can and do move around. Once a cat is well regulated, the typical Lantus curve flattens out.

Lantus dosing is also based on the nadir, not on the pre-shot values. This is why it's important to get enough information to know when Lantus starts working (i.e., onset) and the nadir fall. With either TR or SLGS, the minimum number of tests you want to get is 4 -- your pre-shot tests and at least one additional test per cycle. I would also keep in mind that it's up to you how much you want to test. It's not up to your vet.

If Pearl also has IBD, are you feeding her novel proteins? I'm asking since fish is often one of the more common allergens for cats. Often proteins that are not in most cat foods are recommended -- proteins such as venison, rabbit, or lamb.

If you want to make sure Pearl is getting food overnight, there are a couple of options. You could get a timed feeder. Another option is to mix some of her usual low carb food with water and freeze the food in an ice tray. You can leave a "catsickle" out for her overnight.

 

'Im sure she will be fine. it is very early days. I am telling you this for moving forward.

Just tell the vet you are not comfortable increase the dose 100% (1 unit to 2 unit is 100%). Say you want to increase in 1/4 unit increments. My vet used to find it amusing that I tested so much and increased in 1/4 unit increments but he often said I knew more about feline diabetes than he did.
At the end of the day...you are Pearls advocate and you must do what you think is right for her.

You can buy 1/2 unit syringes at Walmart or pharmacies. I've heard people say that the 1/2 unit syringes are under the counter at Walmart and a lot of the shop assistants don't know they are there. You shouldn't have any trouble at all getting the 1/2 unit syringes in the US. Make sure they are the U-100 3/10 30 or 31 gauge, 6 or 8 mm syringes 1/2 unit.

Have you tried adding some warm water to the food to fill her up a bit. You don't want her to lose the weight too quickly or that will bring other problems. It is hard when they are constantly asking for food and you need to limit the supply.
Could she have chicken broth with her IBD. If so you could make up some using chicken bones and cooking them in water....nothing else... for several hours...then cooling and skimming off the fat and freezing in ice cube trays for use later. I used to do that for Sheba and she loved it.

 

Thanks Sienne. Yes, she is on Duck and Turkey as her canned food - problem is that she is PICKY, and typically other novel protein treats she will not eat. I am on the fence about whether she tolerates fish or not - I'd like to get her off that completely (no fish snacks), but I haven't yet found another snacky type food with zero carbs that is novel protein. I have to do some work on that.

Catsickle is a great idea, I will work on that, too. Thanks for the helpful information.

 

Thanks Bron for the ideas - I will go to Walmart and check on the syringes, fingers crossed I won't need a script. And thanks for the idea about the warm water to help fill her up with the food.

I will keep your suggestions for when I talk to my vet on Tuesday. I am more confident in adjusting by small doses (that way I am not as much afraid for great drops).

 

You are doing a great job looking after Pearl. She's a lucky girl to have you in her corner.
It is hard when you have the added IBD in the picture.

 

Maryland doesn't require a script for syringes although you may have to sign a register (and some pharmacists will require one even if the state doesn't but in the case of WalMart, they change pharmacists more often than I change my socks so if one's being a pain, try again the next day....LOL)

These are the ones you want. (they are the same, just different packaging)

 

There are tons of them around! Orijen has wild boar and lamb. Here are the Hare Kitty Kitty freeze dried rabbit treats. Vital Essentials also makes rabbit treats. Purebites makes duck treats (dog and cat size). Just do some searching for freeze dried treats with the name of the meat, and you'll find some. I'm in Canada and have some different options - just go to a pet food store that sells raw food and you'll find a good novel protein snack section. I can get kangaroo, water buffalo, camel, goat, etc. I have occasionally bought some freeze dried raw food and crumbled those pieces as treat toppers.

Have you invested in an autofeeder? Set the autofeeder for smaller meals later in the night when you don't want to get up to feed her. My Neko inhaled her food, took less than a minutes to finish it off. I just gave a bit less at a time and spread the meals out.

In case anyone is interested, there was a related post in Feline Health.