hello.
It is good to see you cross posting on health etc and asking for thoughts where there are more frequent eyes.
I am posting this in both places...I also agree with the idea of testing for acromegaly.
Weight gain and need for higher than most doses ( as seen by how she is using the insulin now ) are good first indicators that this is a possiblilty.
For those reading.. I giving the following thoughts based on the apparent need for higher doses , the fact that N runs out of steam so quickly and the evidence of TID dosing in the past being successful for other kitties to create a shallower curve if needing to use this insulin along with the fact that heart issues have been indicated in the past.
That curve you posted has a couple of things that stand out to me.
1- the drop from 7am 481 shot to 10am 110 is very steep and fast.
This can cause kitty's body to feel really awful with the potential to cause the body to try and protect itself from going too low by dumping glucose into its system. This can then be seen as a higher preshot and a big drop once more following the original fast drop.
A too fast and steep drop can set up rebound the same way a blood glucose level that level that goes too low into hypo territory can.
This can be evidenced by high preshots 400s and drops to the 100s in the first 4 hours as nadirs....I believe you may be seeing this here. A big rollercoaster looking curve. This is really hard on kitty's body and one of the reaosns why we encourage switching to the longer lasting insulins. However you are not seeing a drop to hypo territory therefore I would not suggest dropping the dose back much here.
One thing you could do to try and create a slightly shallower curve would be to cut back your dose just a bit and continue with the three times a day shooting.
I would consider 2.5 units as a thought and try that.
A whole jump from 2 units to 3 units may have missed a good dose. Are you also ketone testing?
2- feeding
I am curious as to what the feeding schedule looks like and what you are currently feeding.
Would you mind adding that info along with the curve? I have added examples to the curve below.
A smal low carb snack about 1 hour after shot will help slow down the drop also, and allow for a shallower curve.
Food can really help with this insulin.
3-How is her heart these days? I know there was discussion early on here about cardio issues?
What other medications has she been given recently? These can all have an impact on the curve.
I am linking some info for you about humulin N and about rebound.
viewtopic.php?f=19&t=303
http://petdiabetes.wikia.com/wiki/Somogyi_rebound
The fact that you had normal readings and then diabetic readings over the last several months has me wondering if the diabetes could be a result of
meds given to help the heart at some point and the fatc that acromegaly could be suspect?
Just thinking outloud here.
I also support the using N more than twice a day...to get any kind of shallow curve and enough insulin coverage for 12 hours...shooting more often with this insulin will let you have a little more control.
However, I am concerned that 3 units is too much and would love to see more of you curves from previous doses if you don't mind sharing?
a snack about 1 hour after shot, a slightly lower dose and keeping an eye on where the nadir is and ensuring it has passed and Ginger is truly rising again before giving next shot, are all keys to shooting a TID schedule.
It would be remiss of me not to mention the longer lasting insulins as an option here...they really do make all this a lot easier, but I understand why you have stuck with Humulin N so far so am trying to help address those needs here.
One more thought...shooting a little earlier and thinking more " as needed" instead of a strict 3 time a day schedule....
You need to know peak/nadir has happened and you need to be sure the blood glucose levels are rising... I have put in what a possible as needed schedule may have looked like with this curve....
*********I would only change one thing at a time though..
*I would consider dropping the dose to 2.5 for a few days and seeing how that helps before trying anything more. Do a curve once more and share here.
Meanwhile ask questions and read up on as needed dosing......and come back here with any questions. I will keep my eyes open for you here.
7am (481) gave 3 units of insulin. add feeding example- ( fed 2/3 of a cup a fancy feast chicken grill )
10am (110) ------ lowest point is quite a drop from that preshot and hard on Ginger's body
12pm (230)
2pm (387)---if you had shot 2 units here instead of waiting you may be able to bring the curve down with less of a drop. A slightly lower dose on lower prehot levels on this rising lelve, but that is not too high yet would really help
3pm (419) gave 3 units of insulin.
5pm (265)
7pm (184)---lowest point is 4 hours after shot once.
9pm (388)---level is rising....a possible shot here...again a lower dose as a lower preshot
Hang in there.....I know this forum is slow, but a few of us are kicking around
Kimmee
