Not sure which dose to give anymore

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Betsyboo

Betsyboo

Member Since 2020
Hi everyone, hope you’re all ok in these crazy times!
I’m at a loss with Betsy’s dosing now. I thought I had found the right dose at 0.75 but I caught her going low on a night with that and some mornings looked like she was bouncing. I’ve put her down to a fat 0.5 but I don’t know if that is enough for her. I thought it would help to get some more eyes on her!
 
Betsyboo said:
Hi everyone, hope you’re all ok in these crazy times!
I’m at a loss with Betsy’s dosing now. I thought I had found the right dose at 0.75 but I caught her going low on a night with that and some mornings looked like she was bouncing. I’ve put her down to a fat 0.5 but I don’t know if that is enough for her. I thought it would help to get some more eyes on her!
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I'm not seeing that the current F0.5U dose is bringing Betsy's BG levels too low. She's staying up in the high blues for nadir.

The lowest she has been, is the high "tree green" levels. BG of 5.3 and 5.1 were not particularly low. The nadirs have increased, since you have done those reductions.

I think you should be back to the 0.75U dose.
 
Yes, Betsy needs a touch more insulin, an increase back to the 1U of Caninsulin.
She isn't getting below the mid-range blue colors 7 - 9.5 mmol/L ( 130-170 mg/dL) and needs to get down to the lower blues, < 6.5 mmol/L (120 mg/dL).

I can't emphasize how important it is to always get that pre-shot test done.
Without that test, you don't know if Betsy is really low before you give her the insulin.
You are testing at pre-shot, to assure yourself that her BG level is high enough to give her insulin in the first place, for that particular 12 hour cycle.

Plus, without those pre-shot tests, you do not know how many points this particular dose dropped Betsy's BG levels. The nadirs or lows need to be put into context, and for that you need to have both the pre-shot test and the nadir test.

Only a 0.5U dose for this evening, 5/8/20? Would you explain why?
 
Thanks Deb. I was also asking on a Facebook group for advice and someone thought because the 0.5 dose dropped her quite low and faster than 5 mmol per hour on 31/3 that she could be on too high a dose and be bouncing. They thought she needed to be on a lower dose and to try it for 3 days.
 
Betsyboo said:
Thanks Deb. I was also asking on a Facebook group for advice and someone thought because the 0.5 dose dropped her quite low and faster than 5 mmol per hour on 31/3 that she could be on too high a dose and be bouncing. They thought she needed to be on a lower dose and to try it for 3 days.
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Thanks for that explanation Bev, because Betsy's test numbers certainly did not indicate a need for a reduction.

I see you are giving that advice from that FB person a go. Hope it works.

But here is an explanation of bouncing and why it happens.
"Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles)."

Well Bev, you are going to get conflicting advice from different FB groups. The message board here FDMB, is only affiliated with one facebook group. This one, Feline Diabetes. I'm a member in 4 different FB feline diabetes groups. Which ones are you in?

There are ways to slow down the "bouncing", by "feeding the curve". That is, giving your cat small meals at different times to slow down the drops in BG levels.
 
Well I tried the experiment of giving her less, it wasn’t enough for her. I was just worried about giving her 1u when it had made her go too low before. However Betsy has been on 1u for a week now and some days it seems enough, others it doesn’t? I was thinking of giving her 1.25 tomorrow so I can monitor her more tomorrow? Maybe a fat 1.0u?
 
14 mmol isn't really too low. (254 mg/dL)
I do see you made the choice to give Betsy a 0.75U dose this evening.

At some point, Betsy may need a bit more insulin. You can try the 1.25U dose, if you are able to monitor a bit more. Probably not a good time to increase the dose during a night time cycle, unless you like to stay up and test.

p.s. The Sheba Fine Flakes in the Signature was a tipoff. That's a food available in the UK and other European countries.
Plus the SS link takes you to the US version first and you have to look to the right to see that there is a World spreadsheet. Another way you can tell that someone is outside of the US.
 
The thing is, without a pre-shot test, you have no idea how low Betsy was before you gave her the insulin.
So there is no context for that nadir number of 4.6 mmol/L (83 mg/dL).
We like to keep kitties safe, so recommend ALWAYS testing at pre-shot. That is to make sure your cat's BG level is high enough to give insulin in the first place.

Imagine that Betsy was at 4.6 (83) at pre-shot. She then could have dropped really, really low and had a symptomatic hypo. It's a good thing you were home to test, and give Betsy some food at +4, after that low today.

If you feel that the fat 1U works better for Betsy, certainly it's ok to continue to give her that dose.
But please, please, please test before every insulin shot.
 
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