Too much insulin?

[Christina Marie]

We haven't been able to get Shadow regulated since his diagnosis in April. Just bumped him to 5.25 units 2x a day and his +6 is higher than his AMPS. I just don't get it. What am I doing wrong? Is his dose too high and that's why it's going up mid cycle or would that mean we still aren't high enough on his dosing?

 

[tiffmaxee]

https://felinediabetes.com/FDMB/threads/shadow-pmps-308-2-338-4-408-6-470.238539/#post-2680591

Here’s your previous post. We link them for continuity. I know it was suggested that you get mid cycle tests. Some cats reach nadir earlier than +6 and some later. I’d add a +2 when you can because if it’s lower than the pretest it’s likely going to be an active cycle. Experiment with one more test between +4-9 changing the time to see if you can find the nadir. Today’s preshot was lower than you are used to so it looks like you are seeing response to the increase. Many cats drop at night so a before bed test is a good idea and if it’s lower than the preshot setting an alarm for later is a good idea.

 

[Gill & George]

hello and welcome, I haven't visited with you and shadow before.

Here is the link to the previous post on this forumhttps://www.felinediabetes.com/FDMB/threads/shadow-pmps-308-2-338-4-408-6-470.238539/

Just bumped him to 5.25 units 2x a day and his +6 is higher than his AMPS.

Not all cats have their nadir (lowest number) at +6 especially cats that are not regulated.
George could (and did) nadir at any time between +1 and +12, though his more usual nadir was around +5/+6

He may not have reached a good dose
Though there is quite a few gaps in the data so it is possible that you are missing some lower numbers.

Have you had a look at the different dosing methods we use? SLGS and TR? have you decided which you would like to follow.
You are perhaps holding on to doses that are allowing Shadow's BG to run a little on the high side.
Link to TRand SLGS sticky explaining both methods
https://www.felinediabetes.com/FDMB/threads/dosing-methods-start-low-go-slow-slgs-tight-regulation-tr.210110/


For instance on TR we would re assess the dose every 6 cycles, taking the dose up if nadirs do not fall within a certain range

With SLGS which is a slower method, we hold onto the dose for a week, then we run a curve and make a decision on a dose.

Holding onto a dose that is not getting your cat into a healthy range is counter productive as it often leads to glucose toxicity. This then makes it harder to bring the BG down, requiring more insulin to achieve a drop in BG
Link to glucose toxicity https://www.felinediabetes.com/FDMB...-what-is-it-what-should-i-do-about-it.144381/

In the meantime the next couple of cycles could you/ are you able to get a couple of midcycle tests in each cycle?

Any more questions just fire away.
Once we know what method suit you best we can advise you with the dosing to suit your situation.
We did TR so of course we are a big fan of TR, I liked that I could change the dose quickly but safely, which meant I didn't have to sit around watching George hang in high numbers without being able to take some action. On the downside it does require a little more testing.

 

[Christina Marie]

hello and welcome, I haven't visited with you and shadow before.

Here is the link to the previous post on this forumhttps://www.felinediabetes.com/FDMB/threads/shadow-pmps-308-2-338-4-408-6-470.238539/


Not all cats have their nadir (lowest number) at +6 especially cats that are not regulated.
George could (and did) nadir at any time between +1 and +12, though his more usual nadir was around +5/+6

He may not have reached a good dose
Though there is quite a few gaps in the data so it is possible that you are missing some lower numbers.

Have you had a look at the different dosing methods we use? SLGS and TR? have you decided which you would like to follow.
You are perhaps holding on to doses that are allowing Shadow's BG to run a little on the high side.
Link to TRand SLGS sticky explaining both methods
https://www.felinediabetes.com/FDMB/threads/dosing-methods-start-low-go-slow-slgs-tight-regulation-tr.210110/


For instance on TR we would re assess the dose every 6 cycles, taking the dose up if nadirs do not fall within a certain range

With SLGS which is a slower method, we hold onto the dose for a week, then we run a curve and make a decision on a dose.

Holding onto a dose that is not getting your cat into a healthy range is counter productive as it often leads to glucose toxicity. This then makes it harder to bring the BG down, requiring more insulin to achieve a drop in BG
Link to glucose toxicity https://www.felinediabetes.com/FDMB...-what-is-it-what-should-i-do-about-it.144381/

In the meantime the next couple of cycles could you/ are you able to get a couple of midcycle tests in each cycle?

Any more questions just fire away.
Once we know what method suit you best we can advise you with the dosing to suit your situation.
We did TR so of course we are a big fan of TR, I liked that I could change the dose quickly but safely, which meant I didn't have to sit around watching George hang in high numbers without being able to take some action. On the downside it does require a little more testing.

Shadow had been at 5 units since at least September and that was per his vet. I only increased his dose recently because I didn't have enough information on his numbers on my last post to get any dosing advice and I'm just trying to do ANYTHING to get him where he needs to be.

When I am home, I am able to do testing at any point, but the issue is I work 10-13 hour shifts, so I am not always able to test him at any point during his cycle, so there will always be empty information on his spreadsheet.

With that being said, I'm going to assume the SLGS would probably be my best option to follow since I am not always around and available to check his numbers. I will start testing him on some of his +odds as well to see where he is sitting during those times.

The last time I tried to do a curve on him, he found every way to mess it up..got into the dry dog food, someone's leftover ice cream they left in a bowl on the counter, his sister's canned food...pretty much anything to mess up his numbers and ruin a true curve.

 

[tiffmaxee]

Work makes things tough. If he messes up a curve then halt it. An auto feeder will allow you to shoot lower numbers once the breakthrough dose is found. Staying on a dose too long can lead to glucose toxicity.

I have to literally stand over my two cats when I feed them. One has skin allergies. If I turn for just a second she will go after her sister’s food. You might need to separate them for curves or be a police officer like I am. Lucky for me they eat fast.

 

[Gill & George]

When I am home, I am able to do testing at any point, but the issue is I work 10-13 hour shifts, so I am not always able to test him at any point during his cycle, so there will always be empty information on his spreadsheet.

That's tough with the shift work. Gathering the extra info on days you are home would be great. We have had members do TR with shift work, it just depends on whether you can gather enough info on your days at home to be able to follow TR. Another thought, is if you have some family members that you could enlist in helping you with her care, maybe if they could get the extra tests in on your work days? We've had Kitties here who have had a team of family members looking after them. My DH learnt to shoot and test so he could do that on days when I needed to be out, I did most of the testing but he helped out.



Like Elise we have multiple cats here, and dogs, so I am the food police at dinner time. One diabetic, another with heart/kidney issues, it sometimes feels like a full time job keeping them separate. They are sneaky little creatures especially when it comes to food. With his numbers running high he probably feels hungry all the time and will be really resourceful at getting into things, George got into the dog biscuits, outside cats kibble and my blueberry jam on toast.


Aim to run a curve on your next day off so you can see where he's at. (when do you think that will be?)
On SLGS 5 december will be a week on the dose, so you want to run at least one curve before then, and any tests you can grab whenever you're home will also be helpful. With that info on the 5 december we can look at the data and decide what you need to do with the dose.
Remember with SLGS if you find a number below 90 you would take the dose back to 5u, otherwise hold until 5th december and with the data you have gathered you can see if you need to take the dose up.

One other important note is that when we get to over 5u we make dose changes in 0.5u steps.

To answer your question, it doesn't look like Shadow is on too much insulin, but I can't be certain, with a little more data if you can manage that we should be able to tell. I'm sorry I can't give you a more definite answer.

Here's a link to a post on doing TR with a full time job, perhaps the tips and advice on their can give you some ideas on how to do TR in your situation. (if that is something that you want to do)

Is Tight Reuglation Possible on a full time Job? Yes

 

[Christina Marie]

Well I have added more to his spread sheet, have tried to get more tests throughout the days and time that I could. I ended up moving him to 5.25 units and he definitely had a response to it. Does it look like we should go ahead and move to the 5.5 units and see how he does with that?

 

[Christina Marie]

I

That's tough with the shift work. Gathering the extra info on days you are home would be great. We have had members do TR with shift work, it just depends on whether you can gather enough info on your days at home to be able to follow TR. Another thought, is if you have some family members that you could enlist in helping you with her care, maybe if they could get the extra tests in on your work days? We've had Kitties here who have had a team of family members looking after them. My DH learnt to shoot and test so he could do that on days when I needed to be out, I did most of the testing but he helped out.



Like Elise we have multiple cats here, and dogs, so I am the food police at dinner time. One diabetic, another with heart/kidney issues, it sometimes feels like a full time job keeping them separate. They are sneaky little creatures especially when it comes to food. With his numbers running high he probably feels hungry all the time and will be really resourceful at getting into things, George got into the dog biscuits, outside cats kibble and my blueberry jam on toast.


Aim to run a curve on your next day off so you can see where he's at. (when do you think that will be?)
On SLGS 5 december will be a week on the dose, so you want to run at least one curve before then, and any tests you can grab whenever you're home will also be helpful. With that info on the 5 december we can look at the data and decide what you need to do with the dose.
Remember with SLGS if you find a number below 90 you would take the dose back to 5u, otherwise hold until 5th december and with the data you have gathered you can see if you need to take the dose up.

One other important note is that when we get to over 5u we make dose changes in 0.5u steps.

To answer your question, it doesn't look like Shadow is on too much insulin, but I can't be certain, with a little more data if you can manage that we should be able to tell. I'm sorry I can't give you a more definite answer.

Here's a link to a post on doing TR with a full time job, perhaps the tips and advice on their can give you some ideas on how to do TR in your situation. (if that is something that you want to do)

Is Tight Reuglation Possible on a full time Job? Yes

I was not able to do a curve today (it's still my Saturday) because I had to work. I have family who is willing to help me give him his shots, but they aren't comfortable with testing him. They've told me they're leaving that aspect up to me, so that is why there are quite a bit of empty spaces and times. He receives his insulin at 3:30 AM and 3:30 PM, so after his AM shot, I'm usually going to sleep for the next day. I can work on getting a curve on him Sunday afternoon (12/6) and see from there?
I did not see your reply until I came on to ask my previous question tonight about moving him to 5.5 units.