Bouncing or something else?

[jayrosen1576]

In mid-October, Humphrey was getting some decent #'s but it appeared that after a good day he would be high again for several days after regardless of the dose. He had a bit of a cold a few weeks ago but now that has cleared up and he is back to the same pattern: low one day then high for 3-4 days after that with a steady dose. It seems that the insulin is ineffective for a few days after he has a low nadir (80 - 150 range). Everything else is the same and he is showing no adverse signs of the high numbers. His water intake and urine output is normal and he seems perfectly normal all day. Any idea what's going on? My vet is clueless as to what to do.

 

[Sue and Oliver (GA)]

That is a strange looking spreadsheet. No difference between the high and low days - is the food all low carb and always the same? He doesn't get outside and could get into something high carb every couple of days. Don't I remember that you feed the other cats dry food - is it possible that he gets into it?

I guess he could be having a 2 day bounce after a lower cycle but it sure isn't a normal pattern. If his numbers were consistently bad, I'd suspect the insulin but it does work some cycles.

How about doing a curve some day soon- every 2 hours and see what it looks like? And if there is dry around, make sure for a couple days that he couldn't possibly have access to it and see if the numbers look better?

 

[BJM]

I'm wondering about 2 possibilities:
- Insulin resistance of some sort - High numbers with a drop on a new dose could indicate insulin resistance.
OR
- too much insulin - High numbers with a sudden drop could indicate too much insulin. The stored glucose (glycogen) is used up and the level drops.

What is the lowest insulin dose he has ever been on? Have you got any test data from then? Were the initial dose increase done based on curves at the vet?

To test if he is on too much insulin, you have to take a risk by lowering the dose substantially. To do this, you must get urine ketone test strips or a blood ketone meter and strips and monitor for ketone development daily as it indicates not enough insulin. And then you drop the insulin dose down to where you might have started - 1.0 unit.

 

[jayrosen1576]

Both cats are on the same diet - wet food only. They get a mix of FF Chunky chicken or turkey and Ziwi Peak Venison & Fish or beef. both are low carb. He doesn't have IAA (test was neg), cushings or acro so I don't suspect a condition is causing the high #'s. I also notice that even on good days, the insulin only seems to last about 6 hours or so. I am going to try TID with a sliding scale starting today to see how that works. When I tried it in September for 2 weeks he was bouncing a bit but his pre-shot #'s were mostly in the low 200s with a few blues sprinkled in every so often. I went back to BID with consistent dosing on the advice of my vet but the results are less satisfactory. He did start out on 1u BID originally but that dose was ineffective so I gradually moved him up to 5u. If it is his liver dumping glucose, am I correct in thinking that the net effect is the same as if i didn't give him any insulin at all? Meaning, does the glucose dumping adversely effect the kidneys & pancreas the same as the glucose levels derived from food?

 

[BJM]

So you started low enough, ruled out high dose conditions (though those can change), and he bounces a fair bit, maybe has a duration issue with PZI? Does that seem right?

Did they check for hyperthyroidism? Those symptoms overlap with diabetes symptoms - high thirst, high hunger, high urination, weight loss. Sometimes the cat is a bit jittery or nervous, not always. If he is eating a lot to compensate for that, it would require more insulin to process the food. (just brainstorming here)

When the liver releases stored glucose and it elevates the level above normal, the same consequences are likely - organ damage over time. The other thing to consider is that the reserves can become depleted, which could make that safety feature unavailable if the glucose gets too low.

 

[jayrosen1576]

Ok so since I switched back to TID and drastically lowered the dose I've observed two things:

1) He can still get into the blues from 300+ with only 1.75u of insulin. This tells me his dose was way high. What I don't understand is even with such a high dose, he only went into the greens once and usually never dropped too far below 200. How can a better result be achieved with almost 1/3 of the previous dose? I've done a few curves and never saw low numbers.

2) With TID it seems that (other than the bounce yesterday) I am getting a better overlap between doses so his pre-shot numbers are not as high. It is only day 2 of the TID trial so time will tell but it does look promising. I think I need to stick with it for the rest of the month before making a final judgement.

Also, I suspect yesterday was a bounce, but unlike the recent bounces, it seems to have lasted about 24 hours as opposed to 48+ which is acceptable in my opinion.

 

[BJM]

It may be a duration problem. Spitzer ran through ProZinc in 10 hours and then his glucose would zoom up. By doing TID, you've got overlap, so it can't go so high.

 

[nckitties3]

My Lucian had a major issue with duration of PZI at the beginning and was TID and still is occasionally. He would do fine for 7 hrs, then shoot up 2-300 pts in the 8th hr. That's when I started 'chasing numbers'. Takes more testing, I would have to start testing at +8 and test every 1/2-1 hr until he got to 200, then shoot. Over time, he has stretched out his cycles, most are +10-+12. Until last week when he freaked me out with crazy high numbers and short cycles again. Now he seems to be back to where he was a week ago, lower preshots and longer cycles again. No clue why or what caused it. But then, Lucian marches to his own drummer! :lol:

I'm fortunate that I don't work any more, so I can be here to shoot whenever it's needed, usually. I realize that isn't an option to most care givers. Not only is his schedule NOT a schedule, but his dose is on a sliding scale, which has worked best for him. He's a crazy cat that refuses to read the book on how an FD kitty is supposed to act. :lol: Whatever works!