10/13 Kitty Rabbit PMPS 294, +3 314 dosing question

[Christine & KR]

Hi, all. I'm wondering if someone can help me figure out what KR's doing with her insulin.

After a rather harrowing (for me) start to insulin injections (KR 10/5 Condo), KR was dropped to .25u. She sat at that dose for almost a full week, mostly because I couldn't be home to monitor her. I'd planned to increase the dose Friday morning, but moved that up a day when I saw Thursday's AMPS. KR's been receiving .5u BID since then.

For two full days I watched the increase have apparently little impact. I did some random reading on the board and decided to hope I was seeing New Dose Wonkiness. I ran a mini-curve today (without as many tests as I would've liked to get) which seemed to confirm the NDW was out of her system...until I hit +3 tonight:

AMPS - 226
+4 - 190
+7 - 139
+9 - 163
PMPS - 294
+3 - 314

My vet told me at initial diagnosis that "elderly kitties are really hard to regulate." Is KR trying to prove her right? I realize one day doesn't give a lot of data, but I really didn't expect that 314 after the nice mostly blue day we had.

Any thoughts?

Thanks,

Christine & Kitty Rabbit

(edited to make it clear I'm looking for help)

 

[rhiannon and shadow (GA)]

Re: 10/13 Kitty Rabbit PMPS 294, +3 314????

Evening..
I don't have dose advice , just popping in to say hello.
I haven't heard of age having anything to do with regulation.
Wow on Kitty Rabbit making it to 19. That's very impressive.
Someone will come , maybe if you put Dosing ??

The subject line right now looks like you are questioning the +3 going up....

 

[Christine & KR]

Re: 10/13 Kitty Rabbit PMPS 294, +3 314????

Thanks, Rhiannon. Someday I'm going to catch on to all the nuances of subject lines... I'll take your advice and edit this one.

KR and I have moved a lot. Every move results in a new vet, and invariably, since she was about 14, I've gotten the "there's no way that cat is that old!" reaction from the vets. Then they open her mouth and look at her teeth...and take it back. Yep, she's really that old.

Have a great night, and thanks again for the advice,

Christine

 

[Sienne and Gabby (GA)]

Re: 10/13 Kitty Rabbit PMPS 294, +3 314????

I think there are a couple of things that could be going on. First, it can take 5 - 7 days for the insulin depot to form. Some cats have a good initial response to insulin and then things level out and numbers rise. Usually, a dose increase is needed after the initial period. It looks like KR fits that pattern.

You raised the dose. It looks like your AMPS was already high the day you raised KR's dose. It can take up to 3 days for the depot to stabilize and for you to start seeing how the new dose is performing. And, in fact, that's exactly what you saw today on day 3 -- KR's numbers came down into the blues. So far, this is a very typical response to Lantus.

What is also not unexpected is that KR may bouncing. She hasn't spent much time in lower numbers. Her body treats higher numbers as "normal." As a result, when numbers come down into lower ranges, her body reacts. Her liver released a stored form of glucose along with counterregulatory hormones which act to raise BG numbers. Bounces can take up to 72 hours to clear.

I said that KR "may" be bouncing because I'm not sure if this is the case. You could be seeing a food spike. Given that there's a 20% variance in any test number that's attributable to the meter, your PMPS and +3 are essentially the same number. There often seems to be a big difference because they are color coded differently on your spreadsheet.

As far as the influence of age, I suspect the same rules apply to cats as humans. Drugs are metabolized differently in the young and the old compared to adults. My guess is that KR may metabolize drugs more slowly. Depending on whether there are kidney or liver issues, this may effect how well any drug is clears in your cat's system. Often, smaller doses are needed -- at least in older adult humans.