Any experience with extreme insulin sensitivity?

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KarenRamboConan

KarenRamboConan

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Grace is the MOST insulin sensitive cat I have ever worked with. She will drop 200 points on a skinny 0.1u. Her BGs were going too low on a skinny 0.1 so we tried a couple of cycles OTJ ... she stays very stable without insulin, virtually no fluctuation at all, but the BGs are too high. Pop her on 0.1 and she goes too low- peaks in about 2 hours, too, which is fast for Lev. And then goes into nasty rollercoaster highs and lows- way too much.

Then we tried 0.1u SID, and that didn't work.

So now we are trying a fat 0u. After a few cycles, it seemed to work, but I think Hollis shot an empty tonight.

OTJ is not enough. A skinny 0.1u causes rebound.

HELP!!!

SS : https://spreadsheets.google.com/ccc?key ... VWkE&hl=en

22nd
PM PS 11.4 (205)
no shot
+3 15.6 (281)


23rd
AM PS 16.6 (299)
no shot
+2.5 19.4 (249)
+8 17.7 (319)
PM PS 16.9 (304)
+3 18.5 (331)
+10 16.4 (295)


24th
AM PS 19.9 (358) fat 0
+2 16.1 (290)
+5 12.6 (227)
+7 10.6 (191)
+10 16.6 (299)

25th
AM PS 21.7 ( 391) fat 0
+2 16.1 (290)
+5 11.6 (209)
+8 15.6 (281)
+11 15.0 (270)


26th
AM PS 16.4 (295) fat 0
+2.5 12.2 (220)
+4 14.9 (268)
+10 18.6 (335)


27th
AM PS 19.3 (347) fat 0
+4 6.3 (113)
+ 6 7.1 (128)
+ 9 8.3 (149)
PMPS 12.4 (223)
+2.5 15.7 (283)
+4 17.5 (315)
 
Your dialog reminds me of Riggs (June and Riggs). If Riggs was even shown a bottle of lantus, he could drop a few hundred points.
 
Honestly! I said to Hollis that our next step was to just open the vial of Lev and wave it beneath Grace's nose! :lol:
 
Karen, you have me playing with needles in the middle of the night! :)

I have the Walmart Relion syringe, 3/10 with the half unit markings. When I draw to the 0 line, there is still room to go down a bit and still get insulin out.

So, if the fat 0 is still too much (I'm going with plunger sitting on top of the zero line for fat), then try a flat 0 (I would measure plunger mid-mark) - and know that someone might have this laid out in logical order for you somewhere on this site.

Anyway, it seems there is still room for insulin at the zero mark as well as below the zero mark. I can clearly see a mid-point between the 0 and the bottom of the syringe.

Are you using short or long needles? This is a case where the length might make a difference.

Good luck!

Pam & Layla
.5 is not enough, .5 is too much...
:)
 
Thanks, Pam. I'm pretty sure she is using the short needles. I've seen the pics - I think Steve may have posted them, and I will try to print them off and mail them to her.

Oh, and *head slap*, I think it may be because of the fact that she was diagnosed with HyperT (something I forgot to mention! Oooops!) 3 weeks ago and the meds may be changing her metabolism... Does that sound logical?
 
I do think that the hypert meds will slow the metabolism down and therefore change the dose of insulin that is required. How long has the kitty been FD? Is the insulin sensitivity new since starting the tapazole (assuming that's the hypert med)?

Adding to Pam's thought on needle size, I've found with my cats when they were on PZI that if I wanted a slower absorption shooting in the scruff would do the trick. Misty(GA) got her shots on her flank, but if her PS was a little lower than what I wanted, I shot scruff to slow the PZI. I don't know if the same holds true for the Lev, but I'm assuming it would. Do you know where Grace gets her shots?
 
I forget who, but someone bought a child's syringe (re-usable) that holds 1/10 cc or 10u max. to help with microdosing.

Also -- going to PZI, you can get U40 and measure in U100 syringes (0.5u mark = 0.2u insulin)
 
You're (and probably others) going to cringe, but another option would be feeding the insulin with just a tad more carbohydrate so the 2 are balanced out.
 
One of my kitties did this. Used Lantus which made him drop like a rock no matter how little I gave him and it was always within the first 3 hours after dosage. I switched to some BCP I had left and was able to give him .25 which didn't cause that fast drop of Lantus. He eventually went OTJ.
 
this would be good post for the micro dosers to possibly help out with. in my experience with levemir changing to an area that is not usually used could make the insulin that much more effective which i think is not what yu want to see. i have noticed a significant effect in bgs when using a shot site area not normally used,which i use due to the advantage it has. what insulin is this? im sorry i didnt notice.maybe a shout out to the isg that is being used with a special shout out to those micro dosing beans out there ? just a thought
 
Adding to Pam's thought on needle size, I've found with my cats when they were on PZI that if I wanted a slower absorption shooting in the scruff would do the trick. Misty(GA) got her shots on her flank, but if her PS was a little lower than what I wanted, I shot scruff to slow the PZI. I don't know if the same holds true for the Lev, but I'm assuming it would. Do you know where Grace gets her shots?[/quote]



jenn i use lev and i have found this to be true :)
 
Maggie would also drop like a rock on Lev - but only sometimes. The drop would be from 300s to 30 in 2 hrs. It drove me nuts! But I did notice it happened more often after her HCM diagnosis. I figured that sometimes she felt bad, and sometimes she felt good and her numbers would fluctuate accordingly. So the hyperT dx may be the contributing factor here.
 
Thank you, everyone!

And no cringing here, BJM- I have also considered upping the carb amount. My Conan did better with a few more carbs, as did Anne's French Fry.

She is on Lev, and gets her shots in the scruff with short needles. (And yes, this was crossposted on her usual ISG, where she is a regular. Just looking for some new eyes.)

No PZI is available here. Besides, she was OTJ for a year when using the Lev before. I am assuming that the HyperT is what is throwing the monkey wrench into things now. She's been on Tapazole for the past 3 weeks ... pretty much the same amount of time that her BGs and dosing have been acting wild.

I upped the dose today to 0.1u based on the last few days' nadir, and she had her usual drop, but spent most of the day at good numbers.

Thanks again, everyone!

Karen
 
Grace seems to be having some similar numbers to Beau after about 10 weeks on lev. This was right after he was diagnosed with hyper-T also. This would be Aug/Sep of '09 on his SS.

I had finally figured out he was rebounding on even .4u and began decreasing the dose in .1u amounts. I got him down to .1u bid decreasing the dose every time he dropped below 40-50 and when he dropped low (30s) on that after a week or so, I dropped him to .05u bid. When he dropped low on that I tried skipping shots, but he climbed back up again. As he went into remission I set a "do not shoot below" number of 130. I arrived at it by trial and error. I shot his microdose of .05 and got spot checks. I discovered that below 140 he could drop into the 30s, so I would skip that shot. Often at the next PS he was above 140 and I gave him his insulin.

There was a period of about a week when he got no shot because I was out of town and he was doing these unpredictable drops to low numbers. I set a higher do not shoot number and he ranged from 92-223 on his own. After that, it was back to, basically, as needed. Sometimes he would get two shots a day, sometimes only one. He did go 72 hrs between shots and that was his last one (until a brief period 3 months later when he got into dinner rolls).

I definitely think that Grace needs some insulin above mid 100s and .05u might work well so that you can shoot the numbers above 140-150 and not leave her without the little bit of assistance she needs.

Microdoses need to be as accurate, or at least consistent, as you can make them, otherwise the dose could be fluctuating by 50% or more. I always arrived at .1u by starting at .5u and beading off drops down to .1u - same for .05: bead off 4 drops and then a half sized drop. On my syringes (GNP from Hocks) the width of the syringe stopper top edge (flange) and the printed lines is about .16u, so having the top edge of stopper on the bottom of the zero line = .16u (I just call it .15u).

Here is how I arrive at my microdose amounts:
I practiced with a used syringe and water or expired insulin at first. Draw up 1u, then twist the barrel (clockwise if the needle is pointed away from you) slightly until a drop forms on the end of the needle. It will be about the size of the end of a straight pin. Flick it off and twist to form another one. Practice until you get 10 drops that size from one unit and 5 drops that size from a half unit. Those would be .1u drops, so you can dose fairly easily in any increment of .1u. If you want to perfect that, try for a drop HALF that size. Those would be .05u drops. Loads of fun to draw! I have to take off my glasses to see to do that.

Hope that helps.

ETA: With these micro doses it is very important to be aware of misprinted lines on the syringes. I have 1 in 3 or 4 misprinted, some with the zero line off by as much as .2u (that much "extra" insulin). When this happens, I draw to zero (top of stopper flange on top of zero line (needle pointing up), twist the plunger to form drops and count/estimate how much is there. Then I redraw and make my dose.
 
That's interesting, Sheila - so the HyperT seems to be the commonality. It's amazing, isn't it, how 0u can be not enough, but you can get 200+ point drops and rebound on 0.05u

I'm hoping- and trusting- that her dosing is as consistent as possible, but our communication is via telephone only. I haven't actually seen Grace in about a year.

Thanks!
 
I think the hyper-T has an effect on BG regulation/insulin dose, but I could not find very much information on it when Beau was going though his issues. From what I read, it seemed like it should increase insulin needs, but with him it seemed to decrease his insulin needs.

Actually, now that I think about it, he had two incidences of hypo-thyroid from the hyper-T meds and his methimazole dose needed to be reduced. I think the first one coincided with him going into remission. Maybe the insulin dose effects the methimazole dose and not the other way around?

Its definitely a balancing act, that's for sure!
 
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