Having trouble with insulin dosage, really need some imput

[Michele M]

HI
Crushy was diagnosed last month with Diabetes. The vet started him out with 2 units twice a day and his #s were still in the 300s, we tried 3 units for a while, and we spent some time chasing his numbers around with different doses. HIs BG #s just seemed to be all over the place. I decided to hold at 1 unit twice a day to see if he would level out. Its been almost 2 weeks on that dose and his # still keep going up and down. All the BG tests Ive done are in his SS in my signature (as well as the link for basic info on him.

He's been raw fed for the last 10 years so there was a lot of surprise when he turned up diabetic.

I was going to try to do a curve today. Hopefully that will shed some light.

I just dont know if this is normal, abnormal, an indication that something else might be wrong, or that something needs to be changed! Im very new to this. My vet wants higher doses (and he was the one who suggested chasing his BG #s with different doses) but his #s have hit some low points. And from what Ive gathered on this list its better to start low and go slow. I was waiting for his #s to level out but they are just NOT doing that!

I did just start giving his shot in the side and not the scruff of the neck in the last 2 days....not sure how much of a difference that actually makes, but his BGs #s shot into the 400s

I got an automatic feeder to try to give him smaller meals throughout the day but Im not using it for meals because he hasnt figured it out yet (it doesnt make any noise when it opens) Ive put treats in it but every time I try to show him that it opened he thinks it was me that just gave him a treat. He'll figure it out...Im just not ready to put his main food in there till he does.

any thoughts welcome

Michele

 

[BJM]

Re: Having trouble with insulin dosage, really need some imp

You've been on the same dose for over a week; with those nadirs, you may increase 0.25 units.

Some of the fluctuation might be a set pattern of meal types. I'm wondering if doing some of each at each meal time would smooth out things somewhat.

 

[PeterDevonMocha]

Re: Having trouble with insulin dosage, really need some imp

Hi guys .. I don't have a lot of advice for you but I do know with lantus, it is best used consistently .. meaning the same time 12 hours apart every day and the same dose should be held for awhile as well ..I'll message in the lantus forum that you could use some help and hopefully get some eyes over here for you ..

 

[Michele M]

Re: Having trouble with insulin dosage, really need some inp

You've been on the same dose for over a week; with those nadirs, you may increase 0.25 units.

Some of the fluctuation might be a set pattern of meal types. I'm wondering if doing some of each at each meal time would smooth out things somewhat.

Ill try mixing his food up a bit, that sounds like a good idea, thanks. about the .25 unit increase though....Its such a teeny weenie marking for the .5 unit, if your shooting for 1.25 units how do you not give a slightly different dosage each time? Have you guys worked out a good way to do that? (I searched around but couldnt find anything on that)

I'll message in the lantus forum that you could use some help and hopefully get some eyes over here for you ..

Thanks, Ill try posting over there too if I dont get more input

Michele

 

[Dyana]

Re: Having trouble with insulin dosage, really need some imp

I use calipers to get the closest to a consistant dose as I can.
These are the ones I and some of us use: http://www.harborfreight.com/4-inch-digital-caliper-47256.html
Otherwise, I just try to memorize how much light I see between the plunger and the line on the syringe, and try to be as consistant as I can.
Would you be able to set an alarm to get some more mid-cycle tests in at night time? A lot of kitties will go lower at night.

 

[Michele M]

Re: Having trouble with insulin dosage, really need some imp

Would you be able to set an alarm to get some more mid-cycle tests in at night time? A lot of kitties will go lower at night.

I could probably do that. He is somewhat more patient with the tests at night for some reason. Thanks for the link on the caliper

Michele

 

[Sienne and Gabby (GA)]

Re: Having trouble with insulin dosage, really need some imp

I think some of what you are seeing with respect to the variability in Crushy's numbers are bounces. When a cat drops into lower numbers than s/he's used to, even if those are normal BG numbers, the cat's liver and pancreas may overreact. As a result, glucagon and counterregulatory hormones are released which cause BG numbers to spike upward. A bounce can last roughly 72 hours.

I'd encourage you to look over the starred, sticky notes at the top of the Lantus board:

• Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM in one of the top vet journals.
• New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
• Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
• Lantus depot: This is an important concept for understanding how Lantus works.
• Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.

 

[Wendy&Tiggy(GA)]

Re: Having trouble with insulin dosage, really need some imp

It would be great to get some tests to fill in the blanks. We dont know for example what he does after +2 at night .. does he drop low? Many cats drop lower at night and it would be useful to know how low if he does.

Wendy

 

[Michele M]

Re: Having trouble with insulin dosage, really need some imp

I think some of what you are seeing with respect to the variability in Crushy's numbers are bounces. When a cat drops into lower numbers than s/he's used to, even if those are normal BG numbers, the cat's liver and pancreas may overreact. As a result, glucagon and counterregulatory hormones are released which cause BG numbers to spike upward. A bounce can last roughly 72 hours.

I'd encourage you to look over the starred, sticky notes at the top of the Lantus board:

Ive read the sticky notes at the top of the Lantus board (Including the tight regulation protocol.) What I dont understand is do you go ahead and move the dose up even if there are still what appears to be bounces after 13 days on the same dose? Do you look only at the nadir position, do you take into account that he may still be bouncing after 13 days on the same dose? Is it normal to still be bouncing after 13 days on the same dose?

It would be great to get some tests to fill in the blanks. We dont know for example what he does after +2 at night .. does he drop low? Many cats drop lower at night and it would be useful to know how low if he does.

Im going to work on that, thanks

Michele