12/15 Munchie- still high, need support

[ewest]

Hi All, Some of you have probably read my other posts on Munchie. I tried reducing her to 1 unit but that hasn't resulted in good numbers for her and I just upped her to 1.25 because getting scared by so much time in 500 and 400's (tested again just now and no ketones). When she was on 1.5, she at least got down to 200's and 100's off and on. Mainly needing encouraging words and any thoughts/suggestions. I've read others talking about more reductions- she was on .5 unit (that's the wbu 1) for a good while to start with (back in July) and that didn't seem to get her well regulated. Maybe she needed even lower??? Seen other posts about some cats not doing well on Lantus and maybe needing Levemir. Is Levemir a gentle insulin too? Little nervous because she's had 5 readings in 30's or below since July...so she tends to dive. Any words of support would be great. Am trying to not blame myself as I've been trying to stay on top of things and figure out how to help her but am sad having just lost my other cat and knowing she's struggling with it all. She does have other medical conditions that are complicating matters (pancreatitis and some liver condition they think). My vet's doing a consult with an endocrinologist on her (hopefully tomorrow).

Thanks.

 

[BJM]

...she was on .5 unit (that's the wbu 1) for a good while to start with (back in July) and that didn't seem to get her well regulated. ...

It does look like she was lower on the 0.5 unit dose, but there aren't a lot of data points there.

One important note: if she is over 50 and a 2nd test 15 minutes later without food show she is rising, you may not need to give Karo. Values of 50 to 120 are in the normal range.

You are testing for ketones; has she ever had ketoacidosis? or just pancreatitis?

With the higher doses, she has gone down to green levels, then swiftly gone up. To me, that suggests there may be too much insulin (dropped her too fast and the liver compensated)

Do you have syringes with half unit markings? It makes measuring small amounts less difficult.

If you back off to 0.5 units, be sure to give it a good 3-5 days to see how it shakes out for her. And be sure to test for ketones.

 

[ewest]

Hi. Yes, I use half unit marking syringes. The "dka" on my signature is diabetic ketoacidosis...so, yeah, that's how she got diagnosed unfortunately. I posted on the tight regulation board this morning but looking for more information on reduction or switching to Levemir. When I look at her time on the 1wbu (.5) I still see her bouncing from low numbers-- don't really see change in that. So that leads me think did she need .25...or change insulin type?

 

[BJM]

Disclaimer: I am by no means an expert.

You might go post on the Lev forum and ask them what they think. They are very willing to consult. And Lev does have a really long carry over effect.

You're not getting ketones and she seems to go higher mid-day at times, which could suggest too much insulin.

Or maybe it suggests food spikes? Have you checked what happens an hour after eating a few times (any meals during day)? Spitzer does huge food spikes - 200 points in 1 hour - and sometimes I will give him up to 0.5 units of R to compensate for that (in him, 0.5 will bring him down 150-200 points, so I have to be VERY careful!!!).

Another possibility is she has very erratic pancreatic/digestive function. If that were the case, ProZinc or PZI, which may be dose adjusted on the fly, could be a more flexible option for you - you could shoot what you see when you test.

 

[ewest]

Yes, I've checked her after meals which would basically be her +1 or +2 (she eats raw and grazes over 30 minutes usually). But as of 11/7 (i'm pretty sure that was the date) started leaving her food out during day and evening (some evenings in beginning i may not have, but now do) to make sure she had something if got low when I wasn't home (or was asleep). I did post on Levemir site as suggested. She's had a number of times where her nadir has been at the end of her cycle or near that. It sounds like folks are saying if a cat goes up more than 200 points within a cycle that can be a sign of too much insulin? I guess how do you tell too much from bouncing, because they can bounce with good dose too, right?

On a good note, she saw yellow today---got at least to the 200's. Now want to figure her next dose adjustment to get her going in better direction.

 

[Blue]

nothing wrong with trying Lev as my Shadoe does better on Lev than she did on Lantus.

for the pancreatitis issues, our vet had me give her B12 shots and she has not had more than maybe 1 or 2 mild issues.
I used to give her pepcid BID and had bupe on hand for pain plus fluids; I am thinking you are needing to do the same?

Ask your vet about trying B12 for the pancreas inflammation; it's worked for Shadoe.

For dosing, have you tried .75u?

 

[mybuddybinks]

some of the Lantus cats that have switched to Levemir are doing really well...

Ann & Tess, Marjorie & Gracie, lisa & Do Lou, and Ella & Rusty come to mind.

celi & binks