Gandalf made progress, what happened?

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Helena and Gandalf

Helena and Gandalf

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Hi all!

We have had a really exciting 1,5 months with great BG values! We managed to slice the dose in half over a few weeks. But when he started to get high numbers again we had a really hard time settling in on a good dose.

We managed a pretty blue again and thought we were back on track, but he had some loose poops the morning after and was a bit reluctant to eat. He ate and we shot but since then he has had nothing but high values. I have heard that UTIs can cause the BG values to rise very high, does that apply to all infections?

Could the bad values be due to him being sick or is it the dosing that is wrong? He just tested over 20 mmol/l this morning so I made the desicion to slice the dose back to 1.2 U just to make sure he is not getting to much insulin, since we were seeing good numbers on that dose earlier.

I could really use some input on how we handled the dosing when he got good numbers, did we lower to quickly?

Sorry, many questions but I was so happy and now I am so frustrated. :(
 
Hi Helena :)
Any sort of infection can cause BG numbers to rise but I don't think your high numbers are high enough to indicate an infection. His numbers might be a little higher because it's not enough insulin. You seem to have had some ideal cycles (yellow PS with blues and high green nadir) on the 1.4U / 1.6U. May I ask what made you reduce the dose?
Some of our veteran members should be on soon, still early in U.S. ;)

P.S. Gandalf is a cutie :cat:
 
I think his dose is too low. We want him to spend time under 120 (but over 50) so his pancreas can rest and heal.

My suggestion would be (provided you can spot test to steer when needed)
150-175 1
175-200 1.4
200-250 1.8
250-300 2.2
300+ 2.6
 
Hi Helena. Any infection can cause a BG raise. Did you have a UTI on board recently?

I do think some of your dose reductions may have been jumping the gun. Generally, you want to reduce when you hit a hypo one cycle (like on 3/12) or when you're hitting an unshootable preshot. Since around 3/17 it looks like you've been decreasing fairly regularly, but you weren't really getting those low numbers. Were you trying to see if his insulin dose was too much?

I think around 2 units was a good dose for you. I would have raised the dose a bit every 6 cycles or so when you were lowering it, honestly, and seen if that got you more blue/green nadirs and yellow preshots.
 
I agree with everyone else. You saw some good cycles, but I think at that point it would have been better to stay at those doses to try to get more of those good cycles instead of reducing. They need to sort of live in those greens for awhile to have time to heal. That being said, how would y'all recommend she increase at this point? Still go slow with the .25u increases?

I see Janet recommended a sliding scale. Some cats do benefit from that, and certainly if a pre-shot is dramatically lower than normal you might need to temporarily reduce the dose, but in general, I think many cats benefit from using the prozinc protocol and staying at a dose for several cycles before changing. Two different approaches that are both acceptable, it's just a matter of figuring out what works best for your cat.
 
Nice to see you back here! I agree with the others that your doses now are probably too low. The only time a reduction was needed was when you got that lime green 2.2 (40) on March 12/17. The other dark greens are really good numbers. A dose in the range of 2 u seems to be good. I suggest you begin increasing today in 0.2 u increments. It looks like you're dosing with U100 syringes. Is that correct?

Re sliding scale dosing: it can work really well to fine tune once you're in a good dose range. I like methodical small increases and dose consistency AM and PM until you get there. Gandalf bounces but his are not extreme. That's good.
 
Thanks for all the responses!

He has never had an UTI, and he seem healthy in general. But since he had an episode of diarrhea and at the same time got a high BG value I was wondering if it could be the same cause.

Thanks for all the feedback! I reduced the dose this morning to be absolutely sure that it was not to much insulin since it felt ike he got higher BG values everytime we increased the dose. I think we will stay with the protocol for now and not go with the sliding scale.

We are indeed using the U100 syringes, so we will then try and raise by 0.2 u until we reach a dose that gives good values again. He had 17.6 now at PMPS so we will raise to 1.4 and keep the dose for a couple of cycles before raising again.

Thanks again!
 
Helena and Gandalf said:
Thanks for all the responses!

He has never had an UTI, and he seem healthy in general. But since he had an episode of diarrhea and at the same time got a high BG value I was wondering if it could be the same cause.

Thanks for all the feedback! I reduced the dose this morning to be absolutely sure that it was not to much insulin since it felt ike he got higher BG values everytime we increased the dose. I think we will stay with the protocol for now and not go with the sliding scale.

We are indeed using the U100 syringes, so we will then try and raise by 0.2 u until we reach a dose that gives good values again. He had 17.6 now at PMPS so we will raise to 1.4 and keep the dose for a couple of cycles before raising again.

Thanks again!
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It's possible that the discomfort of diarrhea raised the BG. It would be a type of physical stress.
 
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