fluctuating BG levels

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6happycats

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Bobby Joe was recently diagnosed with diabetes Oct. 31st. Switched to wet EVO and started her on Lantus. After finding Dr. Hodgkins website and finding that her BG levels were uncontrollable, we started the tight regulation protocol.. and now have her on the bovine insulin. We are into a week and a half and have seen a vast improvement in her BG levels. That being said, it seems that just as we see that the numbers and amount of insulin are trending downwards for a couple of days her BG will spike again. My question is....is this typical as the pancreas is trying to heal itself? She actually, was in the hosp. the first week in Nov. for 4 days with ketoacidosis and BG's in the 700's. She's come down now to low to mid range numbers in the past 6 weeks. Thanks for your comments.
Lisa
 
er ... need a bit more info from you, please.

What made you determine the glucose was "uncontrollable" on Lantus?

Which bovine insulin are you on now - PZI? or something else?

It would be helpful to see a columnar list of date, time, and glucose readings, with insulin doses listed too. We use a template on Google docs that color codes the glucose levels so the color patterns clue you in to how well you are doing. Mine is a modified example.

If you can put your data in a plain spreadsheet, it will be easier for us to review (it keeps the columns lined up), though not mandatory.
 
Is that the YDC (Your Diabetic Cat) website? And the insulin would be PZI, correct?
I know there are people here who use or have used (me) PZI to treat their sugarcats, but I don't know if anyone around has done the Hodgkin's TR protocol. My kitty, Bob, is also a DKA survivor.

What sort of dose have you been giving, how far apart, and what sort of numbers are you getting?

The more we know, the more help we can provide.
Carl
 
Date Time Glucose Level Meal Insulin Dose
Nov 25, 2011 7:15 a.m. 429 Yes 1 unit Lantis insulin
2:30 p.m. 424
5:45 p.m. 374 Yes 1 unit
10:30 p.m. 512
Nov 26, 2011 7:05 a.m. 361 Yes 1 unit
12:09 p.m. 358
6:00 p.m. 321 Yes 1 unit
10:30 p.m. 365
Nov 27, 2011 7:15 a.m. 424 Yes 1 unit
6:00 p.m. 526 Yes 1 unit
10:35 p.m. 175
Nov 28, 2011 7:18 a.m. 89 Yes 1 unit
6:10 p.m. 87 Yes 1 unit
Nov 29, 2011 7:15 a.m. 386 Yes 1 unit
1:00 p.m. 239
6:00 p.m. Yes 1 unit
Nov 30, 2011 7:15 a.m. 354 Yes 1 unit
6:00 p.m. Yes 1 unit
Dec 1, 2011 7:00 a.m. Yes 1 unit
6:00 p.m. Yes 1 unit
Dec 2, 2011 7:15 a.m. Yes 1 unit
6:00 p.m. Yes 1 unit
Dec 3, 2011 7:00 a.m. 416 Yes 4 units Start bovine inuslin
2:00 p.m. 296 (-120) 3.5 units
6:00 p.m. Yes
10:00 p.m. 47 (-149) -0-
Dec 4, 2011 7:00 a.m. 46 (-1) Yes -0-
2:20 p.m. 39 (-7) Small-0-
6:00 p.m. Yes
10:00 p.m. 76 (+37) -0-
Dec 5, 2011 7:15 a.m. 95 (+19) Yes -0-
1:20 p.m. 109 (+14) -0-
6:00 p.m. Yes
10:00 p.m. 366 (+257) 4 units
Dec 6, 2011 7:15 a.m. 93 (-273) Yes -0-
6:00 p.m. Yes
10:00 p.m. 116 (+23) -0-
Dec 7, 2011 7:15 a.m. 190 (+74) Yes 1.5 units
6:00 p.m. Yes
10:00 p.m. 92 (-98) -0-
Dec 8, 2011 7:00 a.m. 152 (+60) Yes .5 units
3:00 p.m. 273 (+121) 3 units
6:00 p.m. Yes
Dec 9, 2011 7:15 a.m. 219 (-54) Yes 2 units
3:10 p.m. 70 (-149) -0-
6:00 p.m. Yes
10:30 p.m. 116 (+46) -0-
Dec 10, 2011 7:00 a.m. 153 (+37) Yes .5 units
2:10 p.m. 172 (+19) 1 unit
6:00 p.m. Yes
10:00 p.m. 53 (-119) -0-
Dec 11, 2011 7:15 a.m. 49 (-4) Yes -0-
2:50 p.m. 84 (+35) -0-
6:00 p.m. Yes
10:17 p.m. 83 (-1) -0-
Dec 12, 2011 7:10a.m. 160 (+77) Yes .5 units
3:00 p.m. 80 (-80) -0-
6:00 p.m. Yes
10:00 p.m. 139 (+59) -0-
Dec 13, 2011 7:00 a.m. 133 (-6) Yes -0-
3:15 p.m. 215 (+82) 2 units
6:00 p.m. Yes

Yes, she is on pzi and we're using the sliding insulin dosing chart suggested by Hodgkins. Hopefully these numbers won't shift when I submit this as I've had to re-tab the columns. Hope this helps. Thanks!
 
I can see that all my data shifted so I'll try and re-do it on a google spreadsheet. So don't worry about trying to decipher it all until I re-submit it.
Thanks!!
 
Lisa
I took all those numbers and put them into our normal SS format. If you click on the link in my sig, you can see what it looks like....
Overall, I'd say her numbers look terrific!
The dose you are shooting will most likely look "high" to most people who look at it, but I can see how you are following the scale you have.

Is the "no shot" line at 150?
Is the 200-250 dose 2u, and then 251-300 2.75u?
And over 300 you are shooting 3u?

ok, if you are going to keep with the TR, you just test her at specific times (looks like around 7am, 3pm and 10 pm?) and if the number is high enough, you dose her, if not you skip till next test?

I noticed that since switching to PZI, you do something at 6pm every night, but what does the "yes" mean?

I have never used your TR protocol...but here's my thinking.... can you lower the threshold below 150, say to 125 and give a dose of maybe .25?

Last night at 10pm, and again this morning, you were close to that line, but skipped. I'm wondering if you had given a dose of .25 at those times, if that would have lowered the 215 this afternoon at 3pm?
It looks to me like she's really close to going off insulin. What is the line in the sand for that? At what point would you not give a shot? As long as she's below 150 or is it another value?

Another thing, I am not sure what her feeding schedule is, but do you feed 2 meals a day? If you can spread her meals into 4 or 5 small meals throughout the day, that may spread the BG boosts from eating over the course of the day and keep her more level BG-wise.

What do you think?

Carl in SC

edit...sorry, I kept referring to "her" as "he"!
 
Carl

The "yes" before the insulin dose refers to a meal, based on the column heading at the top.
 
I put it in a Google docs spreadsheet for you

6 Happy Cats

I think you can make a copy into your own Google Docs account - File, Make A Copy.
 
Thank-you all for your comments! I'll try to answer all the questions. We feed BJ at 7am and 6pm. The sliding scale is as follows. 151-170 give .5U, 171-185 give 1U,
186-200 give 1.5U, 201-220 give 2U, 221-250 give 2.5U, 251-290 give 3U, 291-350 give 3.5U, 351-410 give 4U. We strictly follow the dosing chart. The "yes" means that a meal was given. One of you had already clarified that. It is possible that giving an extra meal in the middle of the day would help in stabilizing her numbers. We'll have to give that some thought. I am not sure at what BG level she'd be able to come off of the insulin. That is a good question. I guess if she's consistently below 150 day after day, she could be considered insulin free although I'd rather see her numbers in the 50-80 range. This is all so new to us. Thank-you, for putting all of her numbers in a spreadsheet for me, that was so kind, although I didn't understand how to access the chart. I am so un-tech savvy. can you instruct me again? Again, thanks for all of your kindness in helping us to navigate through this unchartered territory. It is soooooo appreciated!!
Lisa
 
I think you're seeing improvement because the PZI is a much better fit for your schedule. Lantus works best if shot on a 12/12 schedule, and needs to build a "shed" before the insulin starts working on lowering blood glucose, so consistent doses need to be held for 3-7 days.

PZI has much more wiggle room with shot times.

You seem to be doing all right on PZI right now, but if you do decide to give Lantus another chance down the road, here is the link to the dosing protocol for that insulin: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581
 
Thanks everyone, we've had a great last 3 days without having to give BJ any insulin with numbers from the 40's-104 and very gradual increases. So we are encouraged. Thanks for the link to the Lantus dosing protocol.
I appreciate all of your input!!!
 
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