Insulin increase and Diet

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What do you mean you can't tell the vet what you are doing? Is he against testing at home? If so, relax. What you do at home is your business. If he gives you a hard time just ask him if he'd give a baby insulin without making sure it was safe to do so because Ninja is the same as a small baby. If you weren't testing you wouldn't know he is running high which is important information. And if he tries to tell you that is stress from testing, point out Ninja wasn't exactly unstressed when in the vets for days either.

ETA not getting alerts properly right now. Just noticed vet is not in favour of home testing. in previous message.
 
Ninja & Baby said:
I am very frustrated. I have no idea what to do since I can't tell the vet what I'm doing. Any ideas?
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Here's a thought: the 2 u dose might be too high and he's bounced up to high numbers. You jumped from 1 u to 2 u with nothing in between. There's concern about dosing high enough because of the DKA but maybe the good dose is somewhere between 1 u and 2 u and you've zipped right past it. You could try 1.5 u tonight to see what happens. Another thing that people do after DKA is to feed higher carb food to be able to give higher insulin doses to keep ketones at bay. Maybe the 2u dose is too high for the low carb Fancy Feast and he's bouncing because of that.

So maybe try:
  1. dropping the dose to 1.5 u OR
  2. keep the dose at 2 u but feed higher carb food for a few cycles - maybe FF with gravy.
 
I think he may very well be bouncing but I hate to think he bounced hard enough to stay HI all day. He was eating EVO dry until this morning which while not high carb does have tapioca which caused Paula to question if that was the problem. If he is already running high, giving more carbs is not a good idea IMHO. I do however wonder if dropping the dose to 1.5u might be in order.

Is the insulin cloudier looking than usual? If so it may be that the insulin has started to go bad. 30 minutes unrefrigerated shouldn't make it go bad but you never know if it might have been left out before you got it.
 
MrWorfMen's Mom said:
I think he may very well be bouncing but I hate to think he bounced hard enough to stay HI all day. He was eating EVO dry until this morning which while not high carb does have tapioca which caused Paula to question if that was the problem. If he is already running high, giving more carbs is not a good idea IMHO. I do however wonder if dropping the dose to 1.5u might be in order.

Is the insulin cloudier looking than usual? If so it may be that the insulin has started to go bad. 30 minutes unrefrigerated shouldn't make it go bad but you never know if it might have been left out before you got it.
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I don't know if it is cloudier than usual. I have nothing to compare it to.
 
Ninja & Baby said:
I think he was getting 2 units at the vets office, and it sounded like he was responding to it. He was responding at home somewhat before he went to the hospital
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If he was responding to 2u at the vet's and possibly eating higher carb food there too then the highs you're getting now make no sense. Maybe you could call them and ask for his BG numbers while he was there and what he was eating. Do you have a spare battery for your meter that you could put in to see if that's the problem? We can't rule out an insulin issue either.
 
Kris, I think Paula did a test on herself and got a reasonable number, so unless she got really really unlucky, it doesn't seem like a monitor problem. Although, if you've got a spare battery then yeah, why not try it! This is really puzzling....
 
Nan & Amber said:
Kris, I think Paula did a test on herself and got a reasonable number, so unless she got really really unlucky, it doesn't seem like a monitor problem. Although, if you've got a spare battery then yeah, why not try it! This is really puzzling....
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Yes, I tried it twice on myself. I do have a "new" battery...meaning I have no idea how long I've had it and I see no expiration date on the package. Ninja has gone upstairs to bed. I'm not going to check him again tonight unless he comes downstairs before I go to bed.
 
This is indeed puzzling and concerning. Did you check your meter manual for any other trouble shooting suggestions although with it testing properly on you, I doubt that is going to help.

Please try to get another test in tonight. If Ninja remains HI by tomorrow morning I think a call to the vet is in order. And if the vet gives you a hard time, just point out you think it's better to know now that his BG is not moving and is very high than to risk another bout of DKA. If the vet argues with a sound argument like that, it might be time to find a vet who does support home testing.
 
What jumps out at me when I look at Ninja's SS is that the numbers increased when the dose was increased.
So, I don't think we can rule out the possiblity that the dose is too high.

Here's my thinking:
Previously, on a preshot of 382 Ninja was given one unit of insulin. 12 hours later his blood glucose was 139.
Subsequently, on a preshot of 340 Ninja was given two units of insulin. The numbers the following day were 'Hi'.

There is no depot with Vetsulin. The insulin is 'in and out' (and often 'in and out' within 8 - 10 hours), so there is usually a good reason for there being a low number - like that 139 - at preshot.
Sometimes a low number at preshot means that the pancreas is working a bit, and is maybe able to extend the cycle once the blood glucose has dropped sufficiently low.
Sometimes, though, a low number at preshot means that the dose is too high. And it may well be that there was a lower number earlier in the cycle.

If, if, IF the 1 unit was too much at that preshot 382, then wouldn't it follow that the 2 units would be way too much at a preshot of 340 (assuming the same food is being fed, etc)...? ...And couldn't it be the case that the blood glucose dropped low enough to cause significant, lasting rebound....?

Just my 10 cents....

Linda, Kris, Nan, what do you think?
@MrWorfMen's Mom , @Kris & Teasel , @Nan & Amber
 
Elizabeth and Bertie said:
What jumps out at me when I look at Ninja's SS is that the numbers increased when the dose was increased.
So, I don't think we can rule out the possiblity that the dose is too high.

Here's my thinking:
Previously, on a preshot of 382 Ninja was given one unit of insulin. 12 hours later his blood glucose was 139.
Subsequently, on a preshot of 340 Ninja was given two units of insulin. The numbers the following day were 'Hi'.

There is no depot with Vetsulin. The insulin is 'in and out' (and often 'in and out' within 8 - 10 hours), so there is usually a good reason for there being a low number - like that 139 - at preshot.
Sometimes a low number at preshot means that the pancreas is working a bit, and is maybe able to extend the cycle once the blood glucose has dropped sufficiently low.
Sometimes, though, a low number at preshot means that the dose is too high. And it may well be that there was a lower number earlier in the cycle.

If, if, IF the 1 unit was too much at that preshot 382, then wouldn't it follow that the 2 units would be way too much at a preshot of 340 (assuming the same food is being fed, etc)...? ...And couldn't it be the case that the blood glucose dropped low enough to cause significant, lasting rebound....?

Just my 10 cents....

Linda, Kris, Nan, what do you think?
@MrWorfMen's Mom , @Kris & Teasel , @Nan & Amber
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You've got me. It make sense, but what do I do? I do not want to cause harm, and I have no idea where to start or stop. Do I need to worry that this is causing lasting damage during this short time period? Is it OK to let this going on for a little while longer to see what happens as long as there are no ketones and he is eating?

Update: AMPS +1.5=582 Yay!!!! Ha ha. Kinda dumb to celebrate 582. At least it has dropped to a readable level.
 
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@Elizabeth and Bertie I agree with you that it might be that the dose is too high. I sort of alluded to the possibility that he was HI yesterday possibly from going to low the night before and we all angsted a bit about the dose the first night home. There is so much muddling/complicating the picture here. And the DKA only serves to further complicate the picture. I think we can assume Ninja was stressed at the vet and yet he got to a nadir of 200 at the vets on 2 units but he was eating higher carb food there which may have helped to balance things out.

I think dropping the dose to 1.5 units tonight might be a good idea to see if that brings his numbers down more and get Ninja back on track. Your thoughts?
 
Paula, I see Ninja was still high this morning but had dropped some to 582 by +2? (can't tell exactly when that test was taken) which isn't much but definitely better. Can you test again at +3 or +4 to see if he has dropped further. We really need to get a handle on things to help you keep Ninja safe and healthy.
 
Elizabeth and Bertie said:
What jumps out at me when I look at Ninja's SS is that the numbers increased when the dose was increased.
So, I don't think we can rule out the possiblity that the dose is too high.

Here's my thinking:
Previously, on a preshot of 382 Ninja was given one unit of insulin. 12 hours later his blood glucose was 139.
Subsequently, on a preshot of 340 Ninja was given two units of insulin. The numbers the following day were 'Hi'.

There is no depot with Vetsulin. The insulin is 'in and out' (and often 'in and out' within 8 - 10 hours), so there is usually a good reason for there being a low number - like that 139 - at preshot.
Sometimes a low number at preshot means that the pancreas is working a bit, and is maybe able to extend the cycle once the blood glucose has dropped sufficiently low.
Sometimes, though, a low number at preshot means that the dose is too high. And it may well be that there was a lower number earlier in the cycle.

If, if, IF the 1 unit was too much at that preshot 382, then wouldn't it follow that the 2 units would be way too much at a preshot of 340 (assuming the same food is being fed, etc)...? ...And couldn't it be the case that the blood glucose dropped low enough to cause significant, lasting rebound....?

Just my 10 cents....

Linda, Kris, Nan, what do you think?
@MrWorfMen's Mom , @Kris & Teasel , @Nan & Amber
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I was thinking that the dose might well be too high as well. However, there's concern about Ninja being post DKA and needing insulin at a high enough dose. Because Vetsulin is so amenable to dose changes because there's no depot, a trial at 1.5 u might be helpful.
 
I see that small drop but I'm not sure it's significant enough to call it a lowering due to insulin. Might be more a meter variance thing. Here's my thinking: being stuck in high numbers isn't a good thing post-DKA, whether the numbers are high due to too low a dose or high due to bouncing. We've wracked our brains trying to figure this out and I think a trial of 1.5 u this evening is the only thing left to do.
 
Yes, Linda, I'm going to check again probably around +4. His reading this morning of 582 was at +1.5. That is the reason I put it in the middle of the Unit 1 and Unit 2 cells. That helps me to be able to keep up with the time better since there's no 1.5. Is there an easier way to note 1.5? All this is so confusing.

I am thinking this Hi has lasted so long we can probably rule out Evo causing a problem???
 
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Elizabeth and Bertie said:
What jumps out at me when I look at Ninja's SS is that the numbers increased when the dose was increased.
So, I don't think we can rule out the possiblity that the dose is too high.
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You are absolutely right!! When the dose increased, so did Ninja's BG!!! When he was at 1 unit, the numbers were running lower. I think by the time he got started on insulin he was already dehydrated and headed into DKA. So the dosage may have been right, but it was too little too late to undo the damage????
 
Ninja & Baby said:
Yes, Linda, I'm going to check again probably around +4. His reading this morning of 582 was at +1.5. That is the reason I put it in the middle of the Unit 1 and Unit 2 cells. That helps me to be able to keep up with the time better since there's no 1.5. Is there an easier way to note 1.5? All this is so confusing.

I am thinking this Hi has lasted so long we can probably rule out Evo causing a problem???
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Hi Paula,
You can enter those in between times right in the cell where the BG goes. Example: 548 at +1.5. You then have to go up to the little paint can icon in the tool bar to properly colour in the cell and reverse the text to white using the text colour tool if needed.

Ninja & Baby said:
So the dosage may have been right, but it was too little too late to undo the damage????
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The dosage might have been fine but the other factors - dehydration, not eating, etc. - tipped him into DKA. Are you game to try 1.5 u tonight?
 
Update: AMPS +5=Hi

I got my nerve up and sent the spreadsheet to my vet. The nurse said he was currently in surgery and she would have him look at it and call me back.
 
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Ok Paula.I think we are all agreed that the dose is in all likelihood too high. Tonight's number permitting (and it doesn't look like that will be a problem), reduce the dose to 1.5u and then test him at +1.5 and again at +3. By then you should be seeing a drop in his numbers if the dose was too high. Right now you need to view testing Ninja the same way you would giving him medicine. Even if Ninja decides it's bedtime, testing has to be done. It's really the only way you are going to figure out what is going on and how to get Ninja back on track.
 
:( Ninja is back at the vet's office. He is in surgery today so he will see Ninja when he has a chance and will call this afternoon.
 
He was doing ok, but he was drinking and peeing a lot. I sent the spreadsheet to the vet and he wanted me to bring him in so he could figure out what is causing his high numbers.
 
OK, I think it is good to rule out some additional underlying issue, esp. with the threat of ketones looming. Just the high numbers alone probably explain the drinking and peeing.
 
I'm so sorry to hear he's back at the vets but I would make sure you ask the vet specifically if it's possible that the dose of insulin is too high. Unfortunately some vets do not accept that cats get what is called Somogyi effect (rebound hyperglycemia/bouncing) and will simply suggest increasing the insulin more which if the dose is too high simply makes matters worse. I would also make sure he knows Ninja was eating lower carb diet at home than at the vets. As Eliz said earlier, when you look at the numbers, bouncing because the dose is too high seems a very likely explanation. Even the 1u may have been too high because he never did get a good drop in his numbers. Some cats need very little insulin and a starting dose of 0.5u may have been more appropriate for Ninja. Please keep us posted.
 
My vet seems to know about the Somogyi effect because he was telling me about it. That makes me feel a little better. I think all of you are right. Everything was going pretty well at the vet. The minute his dose was doubled, his BG spiked. I kind of wish I had not taken him and just lowered his dose tonight, but when it gets close to the weekend I start to panic because I know I will be out of luck unless I go to an emergency vet.....and they won't know his history.
 
Totally hear you on the emergency vet thing-- I've definitely jumped the gun a few times just because I didn't want to be in the position of having to take my cat in to the ER if I waited a couple days. Worth it for the peace of mind, too. Glad Ninja is doing well!
 
I think you made the right decision. When DKA has been in the picture, better to jump the gun than risk having to take him to the ER. :bighug:
 
MrWorfMen's Mom said:
I think you made the right decision. When DKA has been in the picture, better to jump the gun than risk having to take him to the ER. :bighug:
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Thanks to all of you for the emotional support. I am pretty low right now. My poor little Ninja is away from home again, and I feel so bad. I keep hoping the vet will call soon, but it's looking unlikely.
 
Waiting for news is always so hard but you know he's being cared for! Snuggle with Baby tonight. We're all sending healing thoughts to Ninja! And for you and Baby.......
graphics-hugs-061298.jpg
 
Thank you, Linda!! Waiting is hell!!! If only they would call, text, or email and give me a few words of information. . . . . .

Your hugs are greatly appreciated!!! :bighug:
 
The attached clip sounds like Ninja.....like most of you have already stated.

The Vet's office called last night and obviously they haven't even looked at him. They are to assess him this morning. . . . . .
 

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