Going OTJ

[Sandman]

My large tuxedo, Mr. Sluggo went out of remission about 3 weeks ago with some abscessed teeth, since pulled. Since that time, I've had him on a tight regulation sliding scale with prozinc insulin from yourdiabeticcat.com testing with a human meter (bayer breeze2). After a series of iterations his diet has settled on twice daily feedings of canned blue wilderness chicken pate (7% dry matter carbs per scheyder calculator) with free range feeding of young again zero carb (primarily left out for the other kitties). His insulin requirements have varied. For a while he was in a strange mode where he had a single high number first thing in the morning (200-210) treated per protocol with 2 units of insulin followed by absolutely normal numbers the remainder of the day (90-120 range testing at 6-8 hr intervals) with no coverage. Trying to get out of that mode, I've been treating numbers in the 130's at night and 140's in the morning with 0.5 unit. And that one seems to work. It's probably time to give him a trial going OTJ, but am wary of getting high numbers in the morning again. It was a very weird thing that made me think of Somogyi rebound, but vet said probably not. Any ideas?

 

[BJM]

Unless you were testing overnight, it is possible the high morning number was actually due to a very low middle of the night glucose. We call it bouncing. When the glucose drops quickly, or to an unfamiliar level, that triggers compensatory hormones which release stored glucose (glycogen).

Can we get you started using our grid to record your glucose tests? It will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.

 

[Sandman]

Thank you for those instructions... I have filled in a new spreadsheet with sluggo's data for the past few days, my dosing and my attempted transition from once daily (big dosing) back to twice daily dosing. As you can see this has required micro-dosing of some numbers that wouldn't ordinarily be dosed. What you call "bouncing" is referred to in humans as "somogyi effect" or "somogyi rebound", so indeed we were thinking of the same thing, but when I specifically asked my vet about that, she said that only happened in cats that were overdosed with insulin to numbers under 50 or so with rebound to numbers 500+ and those cats show typical signs of poor diabetic control (Polyuria, polydipisa, polyphagia, etc., etc). That ain't the picture here. Also, as you can see from my SS, if that were going on, that would be happening overnight in a cat that hadn't been dosed with Prozinc in 16+ hours. So that really didn't fit. As I say, the SS shows my attempt to adapt to the situation by giving half-unit doses even with some pretty normal numbers (in hopes of avoiding the pretty high one in the morning). What do you think? Any suggestions?

 

[BJM]

No, we're talking about different things. Somogyi is sustained overdosing of the insulin. Bouncing is a short term phenomenon. A sudden drop and/or an unfamiliar low (ex 100 when the glucose had been running in the 300s or dropping 300 mg/dL in 2 hours from 500 to 300).

He's looking pretty good with that 0.5 unit dose so far. Stick with for a couple of 12 hour cycles. to see how he does with it. If he goes below 50 mg/dL, he earns a 0.25 unit reduction (you have to eyeball it on the syringes).

 

[Sandman]

Thanks.