Need advice for Tuck

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AbyResq

AbyResq

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I received Tuck as a foster cat in mid-February when he was diagnosed. Within a few weeks of an all wet FF diet and insulin it looked like he might be headed towards remission. He had stretches where a shot was lasting him 18+ hours. During that time I got used to adjusting his dose based on his blood sugar.

A few weeks ago he had a major dental and I haven't been able to regain control. I think I was treating high preshot numbers with too much insulin, causing bounces. Thursday night he definitely had too much insulin and had a 46 mid cycle. I stayed up testing and feeding him and understood the high numbers which resulted. I held his dose steady and didn't increase it based on the high number he got from bouncing.

This morning his number was 553 which I did not expect. I pretty religiously check to make sure I haven't given a fur shot. I think this is a bounce number too. I checked for ketones and he is negative.

What would you do at this point? I will be testing him at multiple points today. I almost feel like I need to go all the way back and start at .5U and adjust up as testing supports. Thoughts????

He is going to his new mom on 5/14 and I would love to see him better controlled than this. She is new to feline diabetes.
 
Hmmmm...it could be a bounce. There's really no way to tell for sure, but if he's been hitting low numbers mid cycle, I'd say it's likely.

A nice curve today will help (the multiple testing you mentioned). We'll be able to see what's going on today to see if he hits a low point or not. Do you happen to still have all your old numbers written down? That data would be helpful to us. Oh just saw the SS in your signature...sorry still getting coffee in my system!

What dose is he on now? It looks like he moved around a lot and never really went to a high dose (which is fine, it just sounded like you were on a high dose!)
 
Sorry, you are right he's never had a really high dose of insulin. Too high for him but not a truly high dose for most cats :)

I was thinking of holding him steady at 1 unit for a while. When he was in the low 200's at the prehot time last night I decided to shoot a little less. I think I should have been even more conservative. He had to have gone low last night after my bedtime test. He's seemed really sensitive to small amounts of insulin since he started. I really think he can go into remission if he's carefully guided there. I feel like he needs a sliding scale and I need help figuring out the right dose based on preshot testing.
 
I can't see your spreadsheet. It should show up in blue. Maybe go back to your original. Choose Share with Anyone with the link and then Publish to the web. Use the URL that comes up and paste into your signature.
 
He is definitely jumping all over. I think Your idea to lower the dose overall and see if that stops those bounces into the blacks is good. Maybe o.5 under 250, one unit for most ranges, maybe 1.2 over 400?
 
That sounds reasonable. I'm hoping a more conservative approach stops the jumping around. I don't have U100 syringes so when he's over 400 I will try just a hair over the 1 unit mark on the U40 syringe.

He's only here for 2 more weeks but I think I'll tell his new mom to get some U100 syringes. She's a very dedicated caretaker and will probably join here. She's a nurse and I want to make sure she doesn't overreact to the highs (like I think I was for the last few weeks).
 
He was down to 123 at +6 on 1 unit. I think 1 is the max I should ever give him.

AMPS 553
+2 - 430
+4 - 292
+6 - 123

1 can of Fancy Feast at AMPS and +6. He needs to have his food amount lowered but I'm letting his new mom do that once he's settled. When he first got here he needed to regain weight from being uncontrolled.

Based on this, I think 1 unit may be enough even when he's >400.
 
AMPS 553
+2 - 430
+4 - 292
+6 - 123
+8 - 196
+10 - 201

Thinking ahead....

He will have a long stressful day when he goes to his new owner. Then he will be in a new environment. AKA all of this will be stressful. Should his new mom hold his low doses really steady during that time? Or should she slightly increase his insulin if the blood sugar rises from stress? My gut says she should let him run high for a week to see if he naturally starts coming back down. Clearly my upward adjustment after the dental was too much for him.
 
This cycle is in safe enough numbers. She might start a little lower and increase once they get to know each other and she feels comfortable testing.
 
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