Lisa dvm » Mon Jan 16, 2012 9:15 pm
carlinsc wrote:
Something that Dr. Lisa said several weeks ago keeps tugging at my brain.
Given that there are MANY things going on in the body that influence the BG level, it is my opinion that we all get too caught up in thinking that the dosage we give is so critical down to the 0.1 or 0.2 unit….and that the *only* reason a hypo occurs is because of an overdose. Exogenous insulin is only one piece of the puzzle. This is why there is always going to be a risk of hypo because what if the pancreas just decides to wake up that day and join the party…adding to the exogenous insulin? What if some infection/inflammation subsided….or stress was reduced….or the patient lost some body fat…..any of which would render the patient more insulin sensitive?
I have been so busy lately and have not been following Copper's saga but I want to reiterate the above because I often see folks on this board getting so caught up in the insulin dosage (down to overdone minutia....driving themselves crazy....) as if that is the only issue...and as if 0.1 (not even measurable...) or 0.2 units (highly doubtful that this level is accurately measured...) is the end all...be all...'deal breaker' for the cat's situation when it simply is only one TINY (at that level of change) piece of a very complicated puzzle.
Believe me, I completely 'get' the frustration involved with managing any diabetic cat - especially one like Copper - but I just hate to see people ripping their hair out over the dosage of insulin....down to impossible-to-accurately-measure increments of 0.1 or 0.2 units when there are SO many other factors involved in the glucose curve making that level of dosage change pretty darn moot. Yes, it would be great if we really had *that* much control over the disease process but we don't.
(Lori - I am hoping that the last statement will take pressure off of you - not add to it. Copper's body is in charge and we are just along for the ride...doing the best that we can with the ability to affect only a few pieces of the puzzle....ie....diet, insulin, constipation, body weight - in the case of an overweight cat.)
Serum glucose, at any single time point during the glucose curve, represents the sum effects in the *rate* and *amount* and *timing* of:
*Exogenous insulin absorption
*Endogenous insulin production
*Intracellular uptake of exogenous and endogenous insulin
*Insulin degradation and elimination - different for exogenous vs endogenous
*Intestinal glucose absorption
*Endogenous glucose production
*Tissue glucose uptake and utilization
and then throw in the amount of exogenous insulin....excess body fat....inflammation....subclinical infection....etc...etc....
....and then add in Copper's recent bouts with constipation (stress => increased BG) which prompted an email to Lori to get Miralax (or generic PEG 3350) into him asap before he ended up needing an enema at her vet's office...which is not easy for her to get to and I hated the thought of Copper having to go through all of this. (Dosage Rx was to start with 1/8-1/4 tsp AM and PM - mixed into food - and dose upwards to effect.)
When you consider all of the above, to me, at least, I can't get caught up in agonizing over minute dosage changes...so dear Lori....please stop driving yourself nuts over such small dosage increments.
