How can you tell if too much/little insulin?

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bookw0rm

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I'm trying to figure out what's going on with my boy Cassie (see spreadsheet below). How can I tell the difference between too much insulin and too little insulin? I'm walking a tightrope since I have no data before he went DKA. He's only been back home since Friday night (spreadsheet starts Sat. am) and I'm feeling my way to the "right" dose. I'm worried about how high he is pre-shot. I can't always get in between numbers but it looks like he's dipping into the mid 200's at min. and mid 50's at max. I can't tell if the big dips are too much or too little. I'm afraid too little will cause ketone problems. I haven't seen any, but I didn't manage a test last night.

Some history if you've not been following: Cassie was dx 8/1, sent home on 1 u ProZinc sid. He was home for about a week, then landed at the vet hosp. for 8 days for DKA. He crashed at the vet 2-3 in this process, but also wasn't eating so everything is screwy. He came home at 1.5 u bid. The first day I pulled a furshot, 6 hours later we gave 1 u, as per advice from the board. He then crashed royally for 3 hours. I've been keeping him at a low dose (.5 u bid), but I don't like how high he's running either. No ketones Sun. or Mon. Spreadsheet is up to date.
 
Generally if you are seeing a nice U-curve - PSs are higher and nadir mid-cycle is lower, then back up to the next PS, you don't have too much insulin in play, unless either the numbers are too low (nadirs below 50 or PSs under 150), or you are getting rebound from steep drops.

You do have a potential steep drop the night of 8/22 (red PS down to green nadir), but then the next PS is blue, so it doesn't look like that drop triggered rebound.

If you look at the AM cycle on 8/23, that gradual slope up to higher numbers suggests too little insulin.

I got a little confused on the timing after the fur shot bit - the response to the 1u there looks good, but possibly a little too much insulin as he is below 50 - might be ok, but a little low for comfort when he is so new to insulin. I presume it was because of the DKA that people advised you to shoot at the +6? Typically after a fur shot you wait it out, as you don't know if possibly some went in. So it could be that the 1u was really more than 1u, no way to know 100%.

I would try to get a nadir test on the 0.5. I doubt it is too much insulin, but it's possible that it is too little and you might want to get closer to 0.75, maybe something like 0.6 or 0.65. Good to get a midcycle test in though if you can - could be he is getting green nadirs and then you don't want to raise the dose, or could be the nadir is a lot higher than green, and then you would want to get pretty close to 0.75 I would think.
 
I apologize if I am confusing you with another...but did you mention you are still using at least partial amounts of dry kibble?
If no, forget I even asked.
If yes,,,,,well it will mess with your numbers at different times...inconsistant as the feedings.
Lori
 
He's still free-feeding dry, high-carb. I'm going to talk to the vet on Saturday about options since he won't eat the wet food, and part of the problem with the DKA was that he wouldn't eat at the vet until they gave him dry food. They said make sure he eats, even if all he'll eat is his regular food. I'm going to at least try for a low-carb dry like Evo or Hlls prescription (I can't find the Evo around here and I hate to order it if they won't eat it).

I'm starting to suspect too little. I got some mid-cycle tests last night. He has exhibited a pattern where he nadirs late, so he may have dropped lower than what I saw, but this is at least some indication of what's going on. I'm probably going to hold off changing things until I talk to the vet, but she's probably going to go for too high a dose.

PMPS 396
+3 186
+6 183
AMPS 477
 
Hi Lisa,

I've had a chance to look at your ss and still feel that the .5 unit is a good dose. The 1 unit was a little too much (nadirs a little low), the .75 unit gave you a questionable/unshootable AMPS.

For some kitties it takes awhile for them to get used to the dose and how their bodies respond to it. I would give it a few days.

Breeathhhhh.
 
Rob & Harley said:
Breeathhhhh.

I'm trying, I promise. Between the start of a new semester at school (I'm a college math professor), a new girl scout year, and Cassie getting sick, I'm flying in a million directions all at once. I actually go to the vet this weekend. I'm going to ask a bunch of questions she probably can't answer. Then I'll come back and get some more solid advice. :)

I've already decided to stay at .5 at least through Saturday. I don't want him to crash while I'm at work. Thanks for the advice, however.
 
Yes, eating is definitely top importance. My kitty took months before I could get him to eat canned food, so don't give up trying. Don't take the dry away though, but you can still try experiments to tempt them with the canned. For my guy, ultimately I had to literally stick the canned food in his mouth to get him to try it, and then.... he decided it tasted way better than dry, and decided to switch! So go figure.... never give up hope I guess.

You might call the company that makes EVO and ask if they can send you a sample. Also they probably have a money back guarantee if you order the food, you could check with the supplier what their policy is. It made my cats sick ohmygod_smile but I think others have used it successfully. If you have to go dry, it's better than most of the other choices.

On the dose, I would probably go with a fat 0.5, just a hair over the 0.5. The curve is pretty good though, but it would be nice to see the numbers a little lower, and whenever they have a ketone history it makes me edgy keeping the dose on the lower side of the spectrum. What's amazing is that he is on a really low dose and getting a good drop, so that is a really good sign. If you can get the carbs a little lower, I think he may do really well. It's tough with the high carbs though, it's like a person living on M&Ms (yeah, I know, sounds good doesn't it?!? ;-) )
 
You're more likely to find evo at a small owner "specialty" shop. The one nearest me, has small sample packets for free, so I'm sure the company would send you some. My kitties were hard to transition - 2 used to small the wet and back away. They love it if it is soupy - equal amount water and canned food - go figure!
Another way to tempt is to add water from canned tuna to any of the seafood varieties.
Hope that helps some. I agree to stay with the low dose.
 
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