Barsa. Insulin dose advice needed

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Vintry

Vintry

Member Since 2014
Hi,

Could you please give me some advice. I am a little bit confused about insulin dose. I know that I should be doing something..increasing or decreasing. 3units (Levemir) was definitely too much but on 2.75 units Barsa has mixed numbers so far, both low and high. As a rule whenever her bg falls below 50 I give her 1-2tsp of high-carb food to bring it up (it's not always mentioned on the spreadsheet). Nadir at higher doses was at about +7 but on 2.75units it varies.. My target is green-blue numbers but nothing below 50. Your opinion is much appreciated!
 
She's had some very, very low numbers on that dose - down to 22 at one point and under 50 on 4 separate cycles. I think she might be going low and bouncing which is why you're seeing a mix of fairly high and very low numbers. It looks as though she's earned a reduction several times now - if it was me I think I'd reduce to 2.5 and see how she gets on with that but please get other opinions too.
 
Thank you. The reason I did not reduce there is because it was only her 3rd cycle on 2.75units so I thought that the low numbers were still from the effect of 3units. Actually I don't know..once reduced do we see the effect immediately or does it take time like it does with dose increase?
 
It does take a few days for the depot to reduce, but sometimes when they really want the second reduction you have to give it if they keep going low - I had to give Rosa 2 reduction in 3 days at one point too because I just couldn't keep her numbers above 50 no matter how hard I tried. And once she went under 40 and was really pushing for the second reduction, I gave it. I do notice that Barsa has been on insulin for over a year, but even based on that she's been under 40 twice which would be reason for a reduction and under 50 4 times. If you reduce and her numbers start going back up and staying there, you can always increase her again. :)
 
I agree with April, I'd reduce to 2.5U. A number under 30 calls for an immediate reduction. The depot can influence 4-6 cycles, depending on the size of the dose, but it's always better if you get that low to reduce the dose and subsequently drain the depot a bit. You can always go back up if she doesn't get back into green.

Here is the section from the TR protocol document:

If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
  • Please do not let yourself become complacent or blasé about drops into the 20s or 30s. Please ask for advice immediately.
  • If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are very few exceptions given for caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
  • Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more.
  • If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction.

    Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding a dose in-between the dose that dropped kitty too low and the reduced dose.
 
Ok, so I decreased, shot 2.5units this morning. Bg was 200 @ +5 last night and this morning it's very high - 400. So it's either she's gone very low in the night and had a bounce or the opposite. It might be that she has pancreatitis because she doesn't seem to be happy in the last couple of days, a bit down and doesn't want to eat. So it will be hard to figure out if the dose is right because pancreatitis (from what I've heard) can elevate numbers. Will have to wait and see.
 
What you're seeing is a bounce. A bounce can take a cycle to gather the upward momentum -- it isn't necessarily immediate. Try to look for a trend. For example, Barsa went from blues to mid-greens yesterday AM. Then, spend the early part of the PM cycle in the yellows. My guess is that after you stopped testing, numbers continued upward. Give this a few days to level out so you can evaluate the dose.

While pancreatitis is a possibility to keep an eye out for, sometimes, these swings in numbers make a kitty feel lousy. I was talking with a colleague yesterday whose a Type 2 diabetic and he noted that when his BG is high, he feels agitated/anxious. We likened it to being on a sugar high all the time.
 
Thanks, @Sienne and Gabby. Interesting. I noticed my cat does not particularly feel great on low numbers (under 6). It's like she's used to high numbers..? I sometimes get confused by her behaviour. It's so good that I think she must be in low numbers so I test just to find out that she's in the high ones. Basically as long as she's under 20s she will behave as if she's a healthy cat. Well, I have too many problems with Barsa right now. She spent all her 11 years roaming in the garden/s, home is for eating and sleeping I guess. Now we found out she goes and eats neighbours' food and I don't know how many gardens she visits. People have cat flaps, they have dogs, they have cats. And our fence is very low. It's a hopeless situation :( At home she hardly sleeps because she's such an active cat, she tried everything: meowing all day long, digging around french doors, escaped once through the window onto the kitchen extension roof, then jumped in the garden, she tried all other windows in the house after that, climbed onto loft when the ladder was down but of course there's nothing interesting there, she wants to go outside. So yesterday was one if the rare days when she won, we all felt so sorry for her that decided to let her out, straight away she jumped over the fence and went God knows where. So high numbers today could be 1) pancreatitis 2) bounce 3) insulin dose too low. She also just had diarrhoea and vomited food, same thing as the last time she went outside and ate something. But I'm not very sure it's that because with pancreatitis cats vomit too.
 
What you're describing isn't unusual. Barsa got used to being in higher numbers and she treats it as her new "normal." As she spends more time in lower ranges, her body will readjust.

Had you thought of maybe building her a cat enclosure? She could go out but not roam around.
 
Umm..I'm not sure I know what it is exactly but I get the idea. Just googled images of it. Cat enclosure will take a lot of space and then I get a feeling it will be the same, she will want to escape from it too :)

This is my garden

IMG_20140621_160738.jpg

IMG_20140621_170954.jpg
 
What a lovely garden! I don't blame Barsa for wanting to get out lol. Barsa is just such an adorable kitty by the way!
 
Here are some more ideas for cat enclosures. They don't have to take up a huge amount of space. We've had a number of kitties here go roaming for high carb dry food. :rolleyes:
 
I was thinking that maybe she's out sampling food from all the neighbor cats and dogs food bowls! Dry crunchies, too, no doubt. I think that could very well explain her sometimes higher numbers.

We have deer around here that want to get in our yard and eat all the plants. We have an ordinary fence, and then we also added another 6 feet of deer netting above the fence. It looks ridiculous and would never win any awards for attractiveness, but it does keep the deer out. That way we eat the food in our garden, not the deer! I'm not sure if you could rig up something that would keep her in your yard, but it might be worth exploring.

So glad to see that the ketones are gone for now. Good job!
 
Deer :) how adorable, but yes, of course not so much when they eat your plants.

My brother was going to build the wooden brackets to attach them high on to the fence + netting. This would look ugly but could be effective. Now turns out won't be able to attach them because the concrete fence poles are too thin to drill into them :( I will have to think about cat enclosure as there are not many options left. It's just sad that she's inside looking through french doors and seeing all this traffic of neighbours' cats over our garden. She used to be the boss of the area not just our garden, no cat would dare tresspass, now she can't even step outside. Now my other cat is a complete opposite, we try to make her go out for a walk in the garden more often because she's just so lazy, but she's a 100% indoor cat. We 'kick her out' the door outside, after about 5mins she hangs onto the doors with her paws so you can only see her head through the glass (so funny), we just have to let her back in after that ;)
 
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