BG readings higher with increased insulin dose

Heather and Gizmo

Heather and Gizmo

Member
I increased Gizmo's insulin dose to 2 units 5 cycles ago and the numbers are higher than they were at the 1.75 units. At the 1.75 units I was seeing some blues and yellows. The increased dose is showing pinks with the occasional yellow. I would normally increase his dose by .25 units at this time, but I am wondering if I should continue to go up or go back down. Can someone help me figure out what his next dose should be? I hate seeing his numbers going back up.
 
Has anything changed with Gizmo? Any possibility of higher carb food or any illness?

You were getting some blues, but they were pretty high...and you were getting more reds with the lower dose too. I think I'd probably bump the dose up to 2.25 and see what happens there. You want to help get Gizmo out of those higher numbers and it's possible that he's just a little stuck in higher numbers right now.
 
I'd continue the careful increases. Those high blues and low yellows aren't really that far apart when you factor in meter variance. It's also fairly common to see these erratic patterns when you haven't yet reached Gizmo's good dose range. :)
 
Thank you Rachel and Kris. Gizmo has not had any illnesses. The clinical signs are still at bay and have been since I took him off dry food 12/22/18. I just can't get his BG readings regulated. I did finally get a blue number this afternoon, even though it was high I was glad to see it. I did increase his dosage to 2.25 u this evening. I am praying for the color green to show up on his spreadsheet. I would be happy with lower blues at this point. At least it would be heading in the right direction. Thanks again for your quick responses. All of you are such a blessing.
 
Looks like you might get your wish tonight! That's a pretty fast steep drop. If he seems extra hungry right now, that's normal. It might help to give him a little snack of regular, low-carb wet food. If he isn't asking for food though, don't worry about it. Just keep an eye on him and maybe grab a +4 if you can.
 
I did get my wish and he was extra hungry, but his numbers have gone back up. Is that normal? Then tonight I ended up with a partial fur shot, so I don't know how much he ended up getting. I really hope this doesn't through his numbers off to much. I used to love roller coasters, I am not liking them so much anymore.
 
Heather and Gizmo said:
I used to love roller coasters, I am not liking them so much anymore.
Click to expand...
:joyful::smuggrin::D

Unfortunately yes, going back up and getting stuck up there for a cycle or two is totally normal.

And fur shots stink. I'm so sorry. Don't worry about it though. They happen. I used to do them soooo often because my cat will not sit still. Gizmo may be a little higher for a cycle or two, but he'll catch back up.
 
Thank you Djamila. Do you think he could be bouncing? I know his numbers have not gone as long as we would like, but he seems normal in the yellow range. He has no clinical signs of excessive hunger, thirst, urination, etc. The only sign of his diabetes is his high BG readings.
 
A little bit, but not much. He's still staying in pretty consistent ranges. Today's higher flatter cycle shows a hint of it, but he had two good cycles in a row yesterday. So far he's not bouncing nearly as much as some of our kitties do. But as you close in on a more effective dose for him, you'll likely start to see more of that.
 
How can you tell when they are bouncing? I have been pleasantly surprised by Gizmo's last two BG readings since I was expecting higher numbers due to the partial fur shot. It looks like he is flipping on me. He was giving me low number in the a.m. and higher in the p.m. Now it is the opposite. I have read on some posts that some people are increasing in .10 increments. How is this done with a U40 syringe. I am eyeballing the .25 u increases.
 
If i switch to a human meter (Relion), do I start a new spreadsheet? The test strips are cheaper and more accesible than the ones for the Alphatrak so I was thinking about going this weekend to get one.
 
It would be helpful to us if you add in your signature - that pale grey text you see under our posts. Here's how:
  • click on your name in the upper right corner of this page
  • click on "signature" in the men that drops down
  • type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.
 
Yes, most people start a new spreadsheet, and then keep both linked in the signature. I'm a big fan of using a human meter over the AT2. The AT2 is helpful when you need to communicate current numbers to the vet, but the human meter matches our dosing approach here, and as you said, much cheaper and easier to get supplies.

As for the 0.1u dose changes - many of us use u100 syringes instead of u40 syringes, and then we use this conversion chart: http://www.felinediabetes.com/insulin-conversions.htm Right now though, Gizmo can still handle the larger increases, so you can keep using the u40's and then switch when you get towards the "fine tuning" phase. Or you can switch now, of course, if you just want to. :)

Why did you decrease the dose this morning?
 
Thank you Kris and Djamila. I have updated my signature to include all the requested information. I decreased the dose this morning since I was not sure how much he received last night since it was a partial fur shot. I was not sure if it was the right thing to do or not, but I was not able to get on this forum to ask for advice. I figured it was safer to decrease than give him the 2.25 u.
 
I just checked his BG reading at +3 and it was 320, so obviously I made the wrong decision. How long did it take all of you to figure this all out? I feel like I should know his BG patterns by now to try and make a good decision if I am not able to get on her to ask for advice.

P.S. I am not sure what I did wrong to add the information Kris requested. I entered it all but I don't see it showing up below. It doesn't help that I am not real great with technology.
 
Heather and Gizmo said:
I just checked his BG reading at +3 and it was 320, so obviously I made the wrong decision. How long did it take all of you to figure this all out? I feel like I should know his BG patterns by now to try and make a good decision if I am not able to get on her to ask for advice.

P.S. I am not sure what I did wrong to add the information Kris requested. I entered it all but I don't see it showing up below. It doesn't help that I am not real great with technology.
Click to expand...
I can see the signature here, Heather. Thanks for doing that.
 
Heather and Gizmo said:
How long did it take all of you to figure this all out? I feel like I should know his BG patterns by now to try and make a good decision if I am not able to get on her to ask for advice.
Click to expand...
I'm still trying to figure out Teasel after three years! :confused:;) Seriously, it takes quite a lot of time to get familiar with your kitty's responses to insulin and to learn what dose adjustments to make. And just when you think you're getting a handle on it they change - cats! They're notoriously difficult to figure out with very few exceptions.

Oops! I just tried to check your SS and I can't see it because you need to make it "public" on the forum. Go to your SS and click on the green "share" box in the upper right corner. In the drop down menu choose "anyone with link can view" and then click on "done". That should fix it.
 
Heather, you're doing just fine! As Kris said, it takes a lot of time. You've only been testing for less than a month! Make sure you've read the stickies at the top of the Prozinc forum. I also spent a lot of time when I first got here (and still do) studying spreadsheets for other cats and thinking through the dose changes and the responses. One important thing to learn is that it's not just one cycle that matters. You have to look at a couple of cycles back to start to make sense of things. Sometimes a dose will change and the cat will react right away. Other times you won't see a response until the second cycle, or the third cycle. And things like the fur shot will impact the next cycle or two, as will the dose change this morning. So all that to say: it's complicated. It's going to take some time to figure out, and even then there will be plenty of cycles when you're going to have to kind of guess. But for now, ask lots and lots of questions. Read other people's threads. Ask more questions....

And don't worry when you guess wrong. We all do it, no matter how long we've been here. Hindsight is the best sight we have.

One thing about the fur shot: What made you think it was a fur shot? It looks like he had a really good cycle and dropped more than 50%. You're talking about the cycle that started with the 402, right? That seems on par with the cycles where he got the full dose which makes me wonder if you didn't get it all (or at least nearly all) of it in?
 
Thank you Djamila. I am talking about the cycle that started with the 402. I have a tendency to have my finger on or near the plunger to where the injection starts before I poke him. His fur was wet, so I know some of it didn't make it. That is why a guessed the morning dose at 1.75 u, because I figured it was around that much that made it in him. It was a bad guess. How long do you think I should keep him at the 2.25 u? Does that all depend on the next couple of cycles? I did read the sticky for changing the dose before I decided on the 1.75 u this morning to try and make an educated guess. I read that if the cate is in the 250+ range or higher and drops below 50% at nadir that bouncing is a possibility and if bouncing is suspected to make small increases and monitor carefully. Since I knew he didn't get all of the insulin in last nights cycle, I was worried about putting him at the 2.25 dose again since he met the criteria of the possible bouncing. Am I understanding this correctly?
 
One thing with fur shots is that afterwards, you just go back to the regular dose. No need to try to guess how much went in. Just keep on with the regular plan as if the fur shot never happened.

Usually you would hold a dose for 3-4 cycle (depending on if you prefer to increase in the morning or evening - whenever you can monitor best). He really doesn't look like he's bouncing to me. If you look at his nadirs (or at least what we can see) for the past three cycles, you have a 173, 221, and 222. Those are all really close to each other, and that despite the dose changes. That's pretty steady. Because of the dose changes, if your schedule allows, I might keep the 2.25u tonight and then do the increase tomorrow morning. But if you're feeling itchy I think it would be okay to do it tonight. You monitor enough that if he decides to over-react to something you'll catch it and can give him some extra food to keep him safe.
 
Thank you for taking the time to explain to me how a bounce is identified and to let me know what to do after a fur shot. This is so confusing but I am trying to figure it out. I would be lost without this forum. I am going to keep the 2.25 u tonight and increase tomorrow morning. This way I will have two cycles to monitor him at the 2.5 u dose. Do you think he is responding well to the insulin? Should I have him checked for some underlying reason for his high numbers? The blood work that was done to identify the diabetes was all within normal range except for his blood glucose. He does seem to get hard stools now that he is on Prozinc. Is this normal? I have started to add 100% pure pumpkin to one is his meals each day. It seems to help some..
 
I am going to post this in a new thread as well since I am not sure if any of you will be on here before I am due to give Gizmo his next insulin shot. I gave him the 2.25 u shot this morning. His BG reading started at 437. By +6 he was at 135, at +9 he is at 158. I am wondering if I should give him the 2.25 u this evening if his numbers are still on the low side. The difference from his AMPS and the +6 is 302. If his number is only in the mid 300's, will this put him at risk for hypo?
 
That's a very nice insulin response today. How many hours until PMPS for you?

Heather and Gizmo said:
The difference from his AMPS and the +6 is 302. If his number is only in the mid 300's, will this put him at risk for hypo?
Click to expand...
Alas, insulin doesn't work like that. It would be nice if it did because then responses would be much more predictable! When a kitty is doing well, the nadirs will typically stay around the same level, even though the PS numbers might vary. Now of course some cats don't want to play nicely and will drop in some surprise numbers (that's why we test so much), but in general, if he's at 300 tonight, I would say to go with the regular dose.
 
Thanks for coming to my rescue Djamila! I was totally freaking out on what I was supposed to do. Should i check his numbers at the same times tonight to catch the lows or should i check them at different intervals, such as +7, and +10 or something like that?
 
Of course if he gives you something in the low yellows we'll have to rethink the dose anyway. ;) Are you about an hour out from PMPS right now?

Looking at the evening of 2/13 and 2/14, it looks like he has a tendency to drop early, so I think I'd get something around +3, and then go from there. If he's staying high, then you can probably sleep well and just grab one more later in the cycle (if you want to - sleep is important too!). If he does drop quickly you could then also grab a +5 and see if he's heading up, staying steady, or continuing to drop.
 
Thank you. I give his insulin at 7 pm. I take his food away at 4:30 and do his testing between 6:30 and 6:45 and then give him a few minutes to clean himself before I stick him with the needle. The first test i just did no him was 337 but i did it again because the blood drop didn't read the first try so i put the strip to it again. I tried it again with a new strip and i got a much higher number of 458. Could it be the stress of the second test that made him just this much from one drop to another in a matter of seconds? None of this makes sense to me. Ugh!! I feel so bad for him that I keep pricking his poor little ears so many times in a day. Should i test him less? His nadir changes from one cycle to the other, otherwise i would just test at the nadir.
 
My hunch is that the second test is more accurate since the first test strip was a little wonky. The only way to know for sure would do the best two-out-of-three, but that would require another poke, and it isn't really necessary. Both numbers are high enough to give the full dose, and that's really all you needed to know anyway.

As for how much to test, I think a lot of it depends on the kitty. My diabetic, Sam, hates being tested. He's a good sport and cooperates well enough now, but if I never tested him again he'd be very happy. My other cat however, doesn't feel it at all. I could stab him 100 times/day and he'd just lay there and keep purring. So if Gizmo is doing fine and you're just feeling bad, keep testing. If he's bothered by it though, I think you'd be fine to test a little less. How much less is really hard at the beginning to know. Based on the numbers you're seeing right now, I think if you tested once or twice in the cycle that would be enough. Just move around when you test. So one cycle you might try +4 and +6, another cycle +5 and +7, another cycle +3 and +????....And then if you have an unusual number (for example when you start shooting on yellows) then you might test more on those cycles.
 
A good thing to do after the poke is also to press on the ear for a few seconds. It helps stop the bleeding and also helps to prevent bruising I believe. I also used neosporin gel with pain relief before poking to help the blood bead up on the ear and to hopefully help with any pain the poke was causing. Others use a bit of vaseline to help the blood bead up...makes testing easier.
 
i have been using Vaseline tgo help the blood bead up. I like the idea of neosporin, since it might help with the pain. Thanks again for all of your guidance and advice. You don't know just how much i appreciate it.
 
I am worried about Gimzo. He has had a healthy appetite (not excessive), but today he has not had much of an appetite and he is just moping around. Could it just be the increase in his insulin dose this morning? He was like this before I started treating him with Prozinc, but then his appetite got better. When should I be concerned enough to take him to the vet? Anyone else experience this with increases in insulin doses? Any advice you can give would be great.
 
Heather and Gizmo said:
I am worried about Gimzo. He has had a healthy appetite (not excessive), but today he has not had much of an appetite and he is just moping around. Could it just be the increase in his insulin dose this morning? He was like this before I started treating him with Prozinc, but then his appetite got better. When should I be concerned enough to take him to the vet? Anyone else experience this with increases in insulin doses? Any advice you can give would be great.
Click to expand...
Is he drinking more water? Crouching in the "meatloaf" position? Has he seemed quite lethargic?

I'd do a urine ketone test. Do you have test strips for that at home? If not they're available at any human pharmacy. Here are some ways to get a sample:
  • put the end of the test strip right in his urine stream as he's peeing
  • slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
  • put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.
Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.
 
Has he eaten anything? Is he just refusing food? Is he hiding away at all?

I agree, I'd get a ketone test. They can develop extremely fast and the sooner you catch them the better the chances of treatment are. Do you have ketone strips?
 
You must log in or register to reply here.
Back
Top