Need help understanding Elmo's numbers...

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Beth 73

Beth 73

Member Since 2016
Hello to all ! Have so many questions even tho have been at this since late July 2016... not sure where to start so will begin with my boy Elmo's spreadsheet numbers...need experienced help knowing what they mean . I am willing to do WHATEVER to help my guy. We r also dealing with hyperthyroid (2013) controlled by hills y/d til diabetes diagnosis ....SO glad to be off prescription foods ! But now on low dose (1.5 mg) methmazole for last 7 weeks. I keep a daily journal so have info there that I can refer to. Thank you, thank you, thank you in advance!
 
I'm not an expert in dosing, but had my Callie on Vetsulin for several months. With all those greens in the morning, it looks like the dose is a little high. Could you eyeball the dose to give him a tiny bit less? Somewhere between 1 and .75 units.
 
Thanks Donnalea! Have wondered about that. Makes me get a bit edgy changing thingsafter experiencing DKA one week in back in July. Want to be very careful. What would be better nadir/+4 BG to aim toward? Also can u explain regulation to me. Asked my vet and his eyes glazed over, mumbled something and never got straight answer ! I always ask lots of questions . Also I posted his last 2 blood works ...first one is from Sept 8 and second from Oct 25. Many thanks !
 
I think these numbers are very good. Yes, Elmo's nadir is early-ish but consistent with what I know of Vetsulin. You had several slightly uncomfortable lows a while ago but mostly you have similar AM/PMPSs that are well below renal threshold. Ideally, the nadir should be around 50% of what the PSs are. Yours are a little lower than ideal from that perspective. Some people who are inclined to tinker with doses might try lowering to 0.75 u - it can be eyeballed on a U40 syringe if it has half unit marks. If Elmo was my cat I'd have a very hard time deciding if I should change anything. How is he feeling?
 
Thank you, Kris ! He seems to be feeling fine. Has been adjustment to go on thyroid meds and am grateful it has taken a low dose to lower his T4. (1.2 mg 2x day). He consistently eats about 1.5-2 oz of food.2x a day....never has been a big eater. In evenings he tends to get rowdy with our other two tabbies, playfully jumps them. They r very good natured with him. Eyes clear, fur flat and not scruffy.Sleeps most of day but is alert when awake. Would love a simple explanation of what "regulation" is and means?​
 
Regulation means that a diabetic cat is on an insulin dose that keeps the BG numbers in a good range most of the day every day. The same dose gives close to the same results day in and day out. There will always be slight ups and downs because physiology is complex. Generally, people on FDMB are told to aim for preshot BG values in the low to mid 200s and a nadir that occurs roughly mid-way through the 12 hour cycle and gives BGs in the high double digits to low 100s range. If a given dose accomplishes this consistently over time, that's regulation. I'd say you're close.

The range of BG values over a cycle can depend on which insulin you're using. Lantus and Levemir are depot insulins and can give a narrow BG range in some cats (almost a flat line curve) whereas the in-and-out insulins like Vetsulin and ProZinc usually give a "smile"-shaped curve with a wider BG range. The timing of the nadir can also vary with the insulin. Vetsulin can give a nadir closer to +4 to +5 in some cats while the other longer-acting insulins can give a nadir around +5 to +6. These are generalities only.

Now, getting to regulation is a challenge for some/many cats because they're very unpredictable in their response to insulin and can overreact to the BG lowering effect of the insulin by throwing out high numbers. We call it "bouncing" and it's caused by a regulatory response involving the cat's liver, etc. that results in glucose being produced in the body to compensate for a perceived lack or too rapid a drop in BG. Some hard to regulate cats will bounce for months as the owner tries to find a good dose. Some will go into high BG numbers and stay stuck there because they develop insulin resistance. And on it goes ... and I'm not even mentioning other health issues that can affect insulin response. My cat's SS is a perfect example of hard to regulate. :)

Hope that helps.
 
Mercy !! Thanks for making the complex understandable ! This is quite a journey we r all on and such a blessing to be going on it with the wonderful pet parents of FDMB !
 
Beth 73 said:
Mercy !! Thanks for making the complex understandable ! This is quite a journey we r all on and such a blessing to be going on it with the wonderful pet parents of FDMB !
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I'm glad to help. Others may want to add to what I said but I think you have the gist of it.
 
I think your spreadsheet is a very good example of how it is possible to get a cat regulated on Vetsulin. Kris has basically said it all!
 
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