? Advice on Dosing

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JaiJai

JaiJai

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Hi Everyone, I have multiple things I'm looking for thoughts/opinions on.
1) Dealing with shifting Nadir: So recently Jai's nadir has shifted from 6 hours to 4 hours. She is still consistent in how much she goes down (ie ~150 for 1.25U), but she goes down much faster, hits nadir at 4 hours, slowly climbs for a few hours and then skyrockets by 8hr (to 350 or more). Then, despite being fed at 8 hours, she actually will go down anywhere from 50-100 points before her next preshot. Should I go up in her dosing? I'm worried she'll drop too much and still bounce back higher.
2) Preshot shifting down, then shoots up. Over 3-4 days, Jai's preshot number will get lower and lower each day, then she'll just shoot way up and start over again. I like that she's responding to insulin and getting lower, but should I adjust how much I give her when she's <250? I worry when she is <250 preshot, she'll nadir at <100 and that causes her body to bounce, thus I would be interested in adjusting her shot in hopes to hit ~100 and not much lower.
3) Sputtering Pancreas? Jai is just at ~8weeks of diagnosis, a prime time for her pancreas to start working. Could any of these dips/spikes/etc be due to sputtering pancreas? Would that make adjusting her dose relative to per-shot BG more relevant?
Any other thoughts or questions? Thank you in advance for taking the time to answer!
 
1. The nadir does move around. If you get mid-cycles a lot, you should start to see a "usually", but even that will move. My cat usually hits nadir around +3, but sometimes it's +2, or +4, or +5....you get the idea :)
2. A healthy, non-diabetic cat will spend most of their time between 50-80. You need her numbers to get below 100 if want her to heal. Bouncing happens. The more time she spends in healthy numbers, the less it happens (for most cats)
3. Huh? While there are some cats that go into remission quickly, there is nothing magical about eight weeks. Did you read that somewhere on here? Many cats take several months, or even years. I don't see evidence of her pancreas pulling the BG down much at this point. It looks to me like she needs a little dose increase. When there is a cycle or two you can monitor, I would recommend bringing her up to 1.5u
 
1. We've been consistent in dose time, feed time and food amount/type. Her Nadir timing had been super consistent (flank 4 hours, shoulders 6 hours - with us recently doing all shoulders to keep the effect going longer) and then she just shifted to 4 hours. I'm ok with it, it just means the insulin seems to wear off by +8 hours.
2. Right now, based on the bouncing after, she doesn't seem to be use to sub-100 numbers still. I would love to get her lower, but she responds well and quickly, so I am trying to be cautious and not over do it. I did do both treatments today at 1.5U (I agree she needed to go back up) and because her pre BG was so high pre shot she had plenty of space to drop. If she doesn't start going back to below 300 in the next two cycles I might even try 1.75.
3. There is a research article (https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1939-1676.2010.0598.x) that found the median time to remission is 48 days and between 41-84% of cats go into remission within weeks to months of starting insulin therapy. There are other things that factor into this (age, weight, other illnesses), as well as how said kitty is responding to insulin, but its not unreasonable. I was asking both what are the signs, and if those signs fit Jai's pattern (as I really don't know the signs).

The only other correlation I see is that her number went bonkers starting the first day it hit above 70 degrees here (and has been warm since). Can overheating affect BG?

Thanks for the advice!
 
Ah, so you were taking median to mean prime time for remission. As you said, there are many factors that play into that.

Yes, changes in weather can certainly impact their numbers. Once they adjust to the new season they settle back into regular patterns. It's usually just a day or two when the weather changes - at least for my cat. Every cat is different.

The signs of remission are reducing insulin needs and then consistently getting numbers greens. For most cats, they end up being sort of weaned off of the insulin: 0.75u....0.5u...0.25u...0.1u....drop....nothing. Other cats just jump off the cliff, so to speak. They go from 1u to nothing overnight.

Another sign is a disappearing food spike: for example on 5/9 PM cycle, you can see that the +1 is higher than the PMPS. That's because of the food. A cat with a functioning pancreas doesn't get that spike. The caveat on that is that early nadir cats like mine don't get a food spike anyway because they start using the insulin (onset) so quickly. And cats with good overlap don't get it as dramatically either. So that isn't an indicator for all cats, but it is for some.
 
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