Sugar levels all over the place!

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Jennifer & Splunk

Jennifer & Splunk

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Hi everyone,

Well, I'm pretty confused about how I should be proceeding with Splunk, so I thought I'd post here and see if anyone can provide some wisdom from experience.

You can see from my SS that Splunk's sugar levels are all over the place.

There are a few influencing factors here:

1) A few nights ago, he was at the emerg for what we now think is a lung infection. He was given oxygen, salbutamol, and sent home with doxycycline, which has since given him diarrhea. I dropped his insulin from 1.0 to 0.5u while he was sick.

2) He ate poorly for a few days, but is now eating well again.

3) Yesterday his sugar dropped from 22 to 6 (ish) by +4... a huge drop for him. This was the first time since he'd been sick that I'd given him his regular 1.0u in the morning. I had to go out in the afternoon, and I know the usual nadir is around +7, so I gave him some extra food to prop up his sugar before I left. By the time the evening rolled around his sugar was 32 (gack).

4) Despite the fact that his sugar was so high last night, I gave him only 0.5u, since he seems to be very sensitive to the insulin right now. This morning his sugar was 12.1.

5) I've finally weaned him off dry food (that was an ordeal!), so that might have something to do with this as well.

I wrote my vet last night asking for advice, and she replied immediately, saying that although it was right to decrease his insulin dose while he was sick, normally "it's vitally important to be regular in the amount and the timing with insulin."

So I think she would have recommended giving him his usual 1.0u dose this morning, but I just couldn't do it, with a sugar of 12.1. I was tempted to give him an even lower dose, actually, but stuck with 0.5 (well, a skinny 0.5) because I'm trying to heed her warning about being consistent. (I'm used to dealing with diabetes in humans, where the insulin dose is a direct reflection of the sugar level, and my vet says this isn't the best way to do things in cats, though I'm not sure why.)

Anyway, I don't know if I should keep him at 0.5 for a while, regardless of his sugar levels, or go back to 1.0, or what.

If anyone has any wisdom to share, it would be much appreciated!
 
I'm not very wise when it comes to dosing...but I like your .5 this morning. Looks like your home most days to get some tests in, so I think you're good.
One thing I'll add, even though I'm guilty of freaking out and doing it, is unless Splunk gets towards dangerous hypo numbers, don't freak out and give him food to increase his sugar. That's counteractive to the insulin you give. (Um...yeah, I did this at like a 90BG, and probably will again, so...;)) I was like "yes! We're green!! Let's stay that way" while also being like "crap! We're green! Let's go back up to yellow!"
 
Wow! Splunk has given you a fun few days. I think what you're seeing from yesterday is some bouncing. I wouldn't have given 1 unit on that number this morning either. With Lantus and Levemir, keeping the dosing consistent is more important due to the depot. With ProZinc, there's more flexibility, and you have to adjust dosing based on what you see. I honestly think if it was me, I'd stick with 0.5 for now and get some tests in if you can...it looks like 1 is really too much at the moment. Can you get any tests in today just to see where he goes?

I'm glad Splunk is feeling better!
 
Haha, I'm glad I'm not the only one with the love/hate relationship with the lower numbers! :) I'm totally guilty of freaking out yesterday. If I was going to be home, I think I would have just left it, but I was terrified about going out and finding him dead when I got back. I'm sure as his numbers trend lower, I'll get more used to where I need to freak out, and where he's ok.
 
The 121 was a very safe number, but the drop from 403 to 121 would have caused bouncing pretty much no matter what you did at that point. Earlier in your data, the .5u was looking like too low of a dose, but you've gone through a food change, and clearing an infection, so I'm inclined to agree with Rachel about holding at .5 for a few more cycles.
 
Rachel said:
Wow! Splunk has given you a fun few days. I think what you're seeing from yesterday is some bouncing. I wouldn't have given 1 unit on that number this morning either. With Lantus and Levemir, keeping the dosing consistent is more important due to the depot. With ProZinc, there's more flexibility, and you have to adjust dosing based on what you see. I honestly think if it was me, I'd stick with 0.5 for now and get some tests in if you can...it looks like 1 is really too much at the moment. Can you get any tests in today just to see where he goes?

I'm glad Splunk is feeling better!
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Thank you!! Those are really helpful comments. I wondered about bouncing yesterday. I'm happier with 0.5 for now too, I think. I'll test a bit throughout the day, but he just had a fight with one of the other cats... SIGH... so he's stressed out now, and I'm going to let him be for a bit before I go poking him any more.
 
Djamila said:
The 121 was a very safe number, but the drop from 403 to 121 would have caused bouncing pretty much no matter what you did at that point. Earlier in your data, the .5u was looking like too low of a dose, but you've gone through a food change, and clearing an infection, so I'm inclined to agree with Rachel about holding at .5 for a few more cycles.
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Awesome... THANK YOU! :)
 
I'm with the others for now, sticking with 0.5U. When his bounce settles we'll take a look again to re-evaluate next dose ;). And seeing how he's influenced by what Djamila said, cleared infection, diet change :)
 
Jennifer & Splunk said:
Haha, I'm glad I'm not the only one with the love/hate relationship with the lower numbers! :) I'm totally guilty of freaking out yesterday. If I was going to be home, I think I would have just left it, but I was terrified about going out and finding him dead when I got back. I'm sure as his numbers trend lower, I'll get more used to where I need to freak out, and where he's ok.
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I'll keep freaking out....I can't even pretend I won't.
 
I like 0.5 u given the switch to wet food and clearing infection. If you have some time, I suggest you read the ProZinc stickies to learn more about dosing. Also, I saw your note about the FSL strips being unreliable. If you put them in your AT meter, you should do a few same blood drop comparisons with an AT strip every time you start a new vial of FSL strips. Leave the AT meter set on whatever the cat code is for your AT strips. Most of the time the difference in readings is less than 10% with the FSL usually reading a bit higher.
 
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Kris & Teasel said:
I like 0.5 u given the switch to wet food and clearing infection. If you have some time, I suggest you read the ProZinc sickies to learn more about dosing. Also, I saw your note about the FSL strips being unreliable. If you put them in your AT meter, you should do a few same blood drop comparisons with an AT strip every time you start a new vial of FSL strips. Leave the AT meter set on whatever the cat code is for your AT strips. Most of the time the difference in readings is less than 10% with the FSL usually reading a bit higher.
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Thanks for the advice on the FSL strips. I've been doing that, and sometimes it's ok, but yesterday I had a 7 point difference between the AT2 and the FSL strips. Ugh.
 
Djamila said:
Ugh...I just saw your note over on the world page - I was just looking at the US page. Makes perfect sense now!
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Hi! Weird that the PS and date didn't carry over into the US version. I'll try to fix it later. I'm not sure I did the right thing, dropping his dose to 0.25 (my vet would almost certainly say I did not), but I know the rule of thumb around here is not to give insulin at 11 or below, so with his BGL so close to 11, I thought I'd hedge a bit. Still, I'm not sure that's the right move. Do you think I should stay at 0.5?
 
Jennifer & Splunk said:
Hi! Weird that the PS and date didn't carry over into the US version. I'll try to fix it later. I'm not sure I did the right thing, dropping his dose to 0.25 (my vet would almost certainly say I did not), but I know the rule of thumb around here is not to give insulin at 11 or below, so with his BGL so close to 11, I thought I'd hedge a bit. Still, I'm not sure that's the right move. Do you think I should stay at 0.5?
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I think the 0.5 u dose looks good right now. Don't worry about the drop today to 0.25 u. You can go back to 0.5 u tomorrow assuming the AMPS permits it. You have to look at the PS (pre shot) numbers as well as the nadir numbers to judge a dose. So far your blue mid cycle numbers say the 0.5 u is a safe dose. Your task for the next couple of cycles is to gather data. Then you have to learn how to interpret it.
 
Exactly what Kris said. I'll just add that the rule to not shoot under 11 is for people who are not home testing, are new to home testing, or for cycles when you can't monitor (get a mid-cycle test). Once you are comfortable testing, you can begin to move that number down a bit, although caution is still important, and whenever you're in doubt, ask for a second opinion. Even after being on here for awhile, I still like to ask others to chime in whenever the numbers aren't typical. You don't have a lot of data yet, so while I agree that the 0.5u would have been fine, I think you made the right decision to err on the side of caution.
 
Yong said:
Yesterday morning you gave 0.5U on a 12.1. Pretty much same number as 11.9 :). Can always look at your data ;).
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Yup, pretty much the same thing, but figured I had to draw the line somewhere. He's been so sick lately that I'm terrified of dropping him too low. I'll be able to watch him all day tomorrow, so I'll go to 0.5 in the morning, as long as he's above 11.
 
Djamila said:
Exactly what Kris said. I'll just add that the rule to not shoot under 11 is for people who are not home testing, are new to home testing, or for cycles when you can't monitor (get a mid-cycle test). Once you are comfortable testing, you can begin to move that number down a bit, although caution is still important, and whenever you're in doubt, ask for a second opinion. Even after being on here for awhile, I still like to ask others to chime in whenever the numbers aren't typical. You don't have a lot of data yet, so while I agree that the 0.5u would have been fine, I think you made the right decision to err on the side of caution.
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Ok, great... thanks! :)
 
Jennifer & Splunk said:
Yup, pretty much the same thing, but figured I had to draw the line somewhere. He's been so sick lately that I'm terrified of dropping him too low. I'll be able to watch him all day tomorrow, so I'll go to 0.5 in the morning, as long as he's above 11.
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This is a nerve-wracking undertaking at times! Data is key: a well-filled spreadsheet is the best resource to have.
 
Kris & Teasel said:
I think the 0.5 u dose looks good right now. Don't worry about the drop today to 0.25 u. You can go back to 0.5 u tomorrow assuming the AMPS permits it. You have to look at the PS (pre shot) numbers as well as the nadir numbers to judge a dose. So far your blue mid cycle numbers say the 0.5 u is a safe dose. Your task for the next couple of cycles is to gather data. Then you have to learn how to interpret it.
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Thanks, Kris! You guys are so helpful. I'm definitely paranoid about the poor guy right now, and am almost certainly erring too much on the side of caution.
 
Kris & Teasel said:
This is a nerve-wracking undertaking at times! Data is key: a well-filled spreadsheet is the best resource to have.
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Yes, I agree that data is key. It's just too bad a well-filled spreadsheet comes at the expense of the poor guy's ears. My vet cautioned me to "give him a break" on the testing, and I'm feeling a bit wary about burning him out on the procedure. I don't want him to start running away when he sees me reach for the kit. (Don't worry, I'm very gentle -- he's just very reactive.) I'll probably give him the weekend to (hopefully) start feeling a bit better in general, and then I'll do a full curve early next week.
 
Jennifer & Splunk said:
Yes, I agree that data is key. It's just too bad a well-filled spreadsheet comes at the expense of the poor guy's ears. My vet cautioned me to "give him a break" on the testing, and I'm feeling a bit wary about burning him out on the procedure. I don't want him to start running away when he sees me reach for the kit. (Don't worry, I'm very gentle -- he's just very reactive.) I'll probably give him the weekend to (hopefully) start feeling a bit better in general, and then I'll do a full curve early next week.
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Your poking skill will develop quickly and over time you'll learn to be strategic in planning test times between the mandatory AM and PM tests.
 
Most kitties get to the point where testing is just routine, and it doesn't bother them. We also get better at doing it, so less bruising and less stress all around. A few times my kitty has hopped up to the testing place and started pawing at the meter because he knows with a test comes a treat. And he was not a fan of testing when we first started out!
 
Also remember that you can do mid cycle tests at different times on different days. Sometimes, you could do like a +3 and +7 on one day and say a +4 and +8 on another day....that way it's not too many tests at once, but we're still getting a fairly good idea of what the curve would look like for your kitty.
 
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