I was going to, based on his numbers from today so far, drop his dose tonight to 4.25 (unless of course he is less than 11 and I will not shoot) and stay up and do tests up to +6 or +7. Is 4.25 still too high do you think? Would you have a suggestion on what I should drop it to?
Hi Jemma, I'm guessing that you may be considering a 0.25 unit reduction because of info in the Caninsulin guide? ...Just copying the 'dose change' info for reference here:
"The general guidelines for making dose changes are:
- If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
- If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
- If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit"
...These are very general guidelines on dose reduction, probably based on a cat's blood glucose
just dipping below 5mmol, but they don't necessarily cover all situations. And there are certainly situations in which the dose should be reduced much more, for example, if a cat's blood glucose drops into hypo or near-hypo numbers on Caninsulin.
This morning, with your kitty, there were two main things playing into that situation. The first of those was the low pre-shot number. The second of those was the 4.5 unit insulin dose. Because the preshot number was so low the large dose of insulin was too high and dropped the blood glucose too low. And it was already dropping the blood glucose too low by +3, possibly a couple of hours before his typical peak of the cycle, so it could have actually continued to drop the blood glucose and get into a real hypo situation. Thankfully your wonderful testing skills were there to 'save the day'! And I also 'suspect' that Kyra's own body may have foreshortened the insulin cycle by releasing some of its stored glycogen.
Another thing to bear in mind is this morning's low preshot number. Because Caninsulin 'typically' has a short cycle it is unusual to see low numbers at the end/beginning of cycle, because when the insulin wears off the numbers come up.
So, low numbers at the end/beginning of a Caninsulin cycle need to have some additional 'cause'.
Sometimes, an insulin dose that is too high will cause low numbers at the end of a cycle, but this is 'less likely' with Caninsulin than with longer-acting insulins. 'More likely' with Caninsuln is that the numbers will drop hard and fast early on in the cycle (as happened this morning) and then bounce (assuming the body has enough glycogen reserves to release into the bloodstream).
A common reason for low numbers at the end/beginning of a Caninsulin cycle is that the pancreas is producing more insulin of its own. In this case you may see the insulin cycle being extended beyond the point where the Caninsulin will have usually worn off. This is often good news, and is a sign of pancreas healing. But a 'sputtering pancreas' can also be unpredictable, and it may mean that caution needs to be taken with the dosage.
...
If this were my kitty I would reduce the dose considerably at this point, maybe to something like 2 units, to see if the numbers settle out a bit more on that dose; and then reassess in a few days (unless it becomes apparent that the dose is still actually too high, in which case I'd reduce again). But this is just my opinion. Others may well have other suggestions.
Eliz
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