When, oh when, will the BG go down? - UPDATE with SPREADSHEET

I did the spreadsheet - spoiler alert, it's a sea of black and red.

Hugo is 8, had him for 3 years. He was 20lbs. I noticed he was losing weight and drinking a lot, so I brought him to the vet. Bingo, diabetes. (He is now 14lbs.)

Years ago we had Grumman, who was also diabetic. He lived a long happy life, and we found his care to be easy and routine. So I didn't worry too much about Hugo.

But here I am 6 weeks in and I can't get a decent BG to save my life. We started with Novolin, vet moved to Lantus after a month of no results. All dose amounts have been recommended by my vet. We are in email communication.

Also, a few weeks in I changed from dry food to Fancy Feast. He loves it, eats 4-5 cans a day.

 

My first thought is that you’re increasing and decreasing by full units and we recommend doing that by 1/4 units so .25 that way you don’t accidentally skip right through the ideal dose. Most vets do the full unit adjustments and don’t think twice about it, but here we don’t. I also know it’s tricky, but 6 weeks is not all that long and feline diabetes is a marathon not a sprint as I’m sure you know! Lantus is a better insulin so I’d just try to be a bit more patient - I know easier said than done - especially since you just go him off dry food

 

I’d also try to get a few more pm tests in. Can you do a +2 pm?

 

I agree with Aleluia, do you have syringes with half unit markings. You should try to get some PM tests also
I'm going to tag @Deb & Wink to take a look at your Hugo's SS
Thanks in advance Deb

 

Here is Liz king's previous thread
https://www.felinediabetes.com/FDMB/threads/when-oh-when-will-the-bg-go-down.233194/

 

Since Hugo is on Lantus, one of the lantus users is a better choice for suggestions for Hugo.

Thoughts.
1. Hugo could be a high dose kitty. Acromegaly, IAA.
2. Dose is being raised too frequently, by too much. Not giving the insulin depot time to fill before the next dose change is done.
3. Hugo is dropping lower in the PM cycle, but there is no test data, so we can't tell if that is what is happening.
4. You only switched to Lantus on 7/28/20. It takes time to fill the insulin depot. A minimum of 3-6 cycles usually. Often a bit longer.
5. You weren't seeing good results, meaning BG levels in the yellow or lower range, until you got up to 6 units of Novolin. It may take that much lantus to get Hugo into better numbers. But let's take it slower with the dose increases, to be sure he needs that much lantus insulin. We don't want to overdose him
6. Insulin resistance. Built up while he was on the Novolin. Since the Novolin only lasts 6-8 hours duration in most cats, he was high for much of the cycle so insulin resistance built up. Takes time to break through that resistance.

Which of the Fancy Feast foods is Hugo eating? If you could please make a note on the SS, in the Remarks column over on the right, that would be helpful for us to see. Which style and flavors is helpful to see. Sorry to ask for more work from you, but it would help us.

Thanks for getting the SS setup. We rely on that data to tell us what is going on.

How are Hugo's symptoms? The 5 P's? (purring, preening, playing, peeing, pooping)

Hugo is really showing you what ECID means. Every Cat is Different, and Hugo is certainly different that Grumman.

 

Thank you Deb for your thoughtful response. I read up on the insulin depot, as that is new info for me. So I am going to try to be patient.
I did a full curve every 2 hours yesterday, and it was flat, which is great, but it was flat in the 400s! Not so great!
Hugo's 5 ps are good. He's doing them all. But in general, he is lethargic and tired.
His FF is the classic Pates, seafood variety box and beef/chicken variety box.
This morning that dart cat was 600+ again. I just don't know what to do. I'll be patient and not change anything, but it's very frustrating

 

what is Acromegaly, IAA?

 

Acromegaly and Other High Dose Conditions: What We Know

 

Could someone please glance at Hugos SS and see if recent history constitutes progress? Yesterday I got 136 at 6+ and I almost fainted with delight...

 

Sorry I cant help but wanted to tell you how beautiful Hugo is. This must be his "Regal" pose.

 

136 is great congrats!!

I still don’t see any pm tests. Can you get some +2 tests done as Deb suggested? I feel you’ve been on 5 units for a while and may merit an increase to 5.25. Did you post on the Lantus forum as well?

 

The drops into the. blues and pinks were a welcome change!

Just to clarify, when starting Lantus, it takes about a week for the depot to stabilize. You may not see much of an effect until the depot has formed. Given that you saw some lower tests over the past 2 days, there's a good chance that Hugo's numbers may have dropped during the PM cycle. Many cats do experience lower numbers at night so getting a "before bed" test every night is very important. In addition, without any PM tests, you're missing half of your data.

I'd also encourage you to read the sticky notes at the top of the Lantus board. There's an overwhelming amount of information in those posts that will help you with understanding how Lantus works (it's very different than Novolin) and how to dose. You may want to consider posting there since many of the members don't come back over to Health to post.