How do I know if the dose it too high

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We have been trying to get our girl regulated for awhile and she has a lot of underlying stuff going on and is on metronidazole and prednisolone 2x daily and probiotics 1 x daily. We are currently on 5 units 2 x day which was just moved up this week. We had our best "curve" at 4 units but the nadir was 250 so the vet wanted to increase to 5 - we weren't comfortable with the unit jump so we did a week at 4.5 and she did a reverse curve AMPS then her numbers climbed through the curve then started going down PMPS. After seeing this the vet said she didn't know what caused it and to increase to 5 units. We have been spot checking and the numbers are still off. Last night she had a PMPS of 243 then +2.5 it was 258 and +5 it was 270 then AMPS was 331. Since we have increased above 4 units we havent seen the drop after the injection so now I am worried she is being overdosed. We are doing another curve this weekend but I want to make sure we aren't hurting her if she is getting too much. Are these numbers consistent with overdosing?

Thanks
Kristina
 
It is hard to tell if the dose is too high. Sometimes the curve is inverse, with higher numbers at nadir than at preshots. She has some cycles that look like that. It is also scary to decrease the dose if there is an infection present. (What are the meds for? Is there an infection or skin condition or?) DKA is a combination of an infection, too little insulin and not eating well. You don't want to set up that scenerio.

If I was just looking at the numbers, I would say that yes, the vet started with a higher than recommended dose and then increased too fast. But with the meds, they are skewing the picture. Are they temporary or a permanent part of the picture?

Do you do regular ketone tests? I definitely would as they will help you catch DKA if it is present, even a trace. Tell us some more about her condition requiring meds.

Here is a protocol we put together for ProZinc:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=109077 it may give some ideas.
 
She 16 and has IBD, liver/heart and kidney disease. She had a bout of retaining fluid in the abdomen which the vet was FIP but we have since kind of ruled that out since that was about a month and a half ago and the fluid is gone and not accumulated again - vet is now thinking it may have been pancreatitis. Since then her health has overall improved and she has gained weight and has had increased activity levels. She eats well but we have seen a bit of a decline in the amount of food as the numbers have came down but I think we should see that? She is still eating about 4 3oz cans/day so she is eating. I have noticed her sleeping a lot and soundly over the last couple of days but she jumps right up when we come near her. The meds will be permanent and we haven't been testing for the ketones since the numbers have been coming down and she hasn't had and signs of DKA -
 
So she has several complicating factors which make the insulin dose picture much harder. With her, it isn't a matter of giving this amount and getting this result. There are so many other things impacting those numbers.

Does your vet think it might be too much insulin? Would he consider that as a possibility? I hesitate suggesting lowering the dose, even if I think that might be a good idea, with all the other things going on. I'm not a vet; I'm just someone who has been around several years advising people who use ProZinc and think I have picked up some ideas on patterns and how the insulin might work. Reducing the dose is a little bit of a scary proposition with a healthy cat. We always advise careful monitoring of ketones if reducing and only keeping the dose lower for a few cycles, monitoring the numbers carefully. If the bean sees an immediate change downward in the numbers, then we were right.

I don't know, Kristine. If she were mine, I might ask the vet if he thought it might be a good idea to try. If you want to try it without him, be sure to monitor carefully for both blood glucose levels and ketones and don't stay there too long if you don't see improvement.

The best example you could give him is Sev and kitty. Here is his spreadsheet. You can see the cat was clearly getting too much and went into remission when the dose was reduced. (be aware Sev was really a tester, much more than we suggest, but he loved data)

https://docs.google.com/spreadsheet/lv?key=0AopnX-7vlQSUdExMQmUtalV1ckJFNEREWjRsNDdBaHc
 
Thank you - I think her vet doesn't know what to do - I will see what the next curve shows and maybe suggest it to her and see if she thinks it is a possibility. We were told to have her put to sleep a month and a half ago so this turn around has her vet confused. We were told we would never get her regulated with her underlying stuff and meds so we are thankful to be getting her down from 750+ to in the 200's but we just want to make sure we aren't overdosing her and could cause potential harm by doing that. We test before each shot - although I don't record into the spreadsheet but her preshot numbers have been higher for the most part since we went up to 5 units. We really don't make any changes without the vets okay but I lost a little confidence after the last curve and the vet admitted she had no idea why she would be doing that and also diagnosed her with a terminal illness that also seems to be incorrect. Guess you never want to hear the vet has doesn't know - lol. Thanks for your help - I know she is a tricky one.
 
Do you ever get nadirs on a non curve day? If you could grab those some it might help. Granted, I am no expert but I found them really helpful in my fight. I'm with Sue about lowering dose...it might help but it's still not something I would do unless you are home to monitorBG and ketones.
 
I do try to get some data at the +5/+6 mark but I never know if it is the lowest without the curve. We haven't been curving long enough to nail down when to expect the lowest reading. All of her curves have been different and her last one didn't drop at all and her +5 last night and those that we did when she was on 4.5 units were still rising at +5/+6 . Do you recommend a specific time to test to assume it is probably the nadir. We really haven't seen a post shot drop since she was on 4 units 2x day? We monitor BG pretty frequently and test before every injection to make sure she isn't too low.

Thanks
Kristina
 
The nadir can vary, so testing in the +5 to +7 range, with some variation day to day, will help you hone in on it.
 
Odd turn of events today = we were going to do the 5 unit curve today and Lil was not having the shot and jumped and we missed some of the dose - we are figuring 2-3 units went in so we decided to just see what happed
So far:
AMPS 366
+2 298
+4 239 - lowest reading we have ever had

We still have a ways to go and have the next reading at 1 but I have a call into the vet to discuss the possibility we were overdosing and trying to figure out where to go next. This is the first post shot drop we have seen in atleast two weeks. Problem is we have no way to know exactly what she got and I don't know if some of the five unit doses over the last week could have some effect on the numbers we are getting today. The sugar dance never ends lol. Any advise would be greatly appreciated.

Thank you
 
What a lucky turn of events! It does seem like she is getting too much insulin. What a lovely possibility. The general consensus is that ProZinc is an in and out insulin so the doses from the days before most likely shouldn't be influencing todays' numbers.

I'd see how the day plays out and then most likely reduce the dose. My suggestion for dosage will depend on where she goes today and what the pmps looks like. I'll try to check back in later today.
 
It is probably a bounce. When their body preceives a level that is lower than it is used to, it releases extra glucose which causes the level to jump up. If she hasn't been in the 200s for awhile, that could be it.

I'd just keep getting numbers and see how the day ends up. And remember to breathe. You got some good news this morning. The trick is to figure out how best to use it.
 
Actually I just went back and looked at some of her other curves and that is a typical pattern - low at +4 then up at +6 and down a tad at +8 - so we will see. It is good to get good news for a change. After the bad prognosis on Lil then losing her brother Phil out of the blue a couple of weeks ago we need some good stuff for a change. Although Lil has made a huge improvement in her health - we are actually at a point where we feel comfortable stocking up on stuff. We were day to day for a couple of weeks with the poor baby. Thank goodness we decided to help her fight instead of following the advice of the vet. Thank you so much for all your help -
 
+8 448 so she is definitely climbing = probably going to be really high by time for next dose. Vet says keep her at 5 units - not sure if I agree with that - her numbers were consistently higher on the 5 units with no post shot drop. Husband says he thinks she realistically got maybe 2 units this morning - I think we are going to do 3.5 or 4 and see how it goes? What do you think? At 4.5 units we started with the reverse curve with not post shot drop so we are thinking she should be below that?
 
If she were mine, I think I'd try lower - 3.5 or even 3. The first cycle on a new dose can be a little wonky; it can take them a while to adjust. Then maybe hold that dose for 3 cycles before adjusting up or down. I would get some ketone strips and do a ketone test every other day or so, just to be safe.
 
If she shows ketones at what point do we worry - she had them once coming back from a day at the vet where she had held her pee all day but it never developed into anything. At the time she was retaining fluid so the vet had told us they really couldn't do anything anyway. She was running in the 600+ range for weeks and thankfully didn't have an issue. I really don't know how to use the data from those? lol We are thinking about consulting another vet but I have no idea where to go.
 
Anything more than a trace needs a vet trip. They can push fluids. It will help if she likes warm water added to her wet food; that helps with hydration.

If you want, post on Health with your city and state and ask if anyone knows a Fd friendly vet. There is also a thread around with questions to ask when interviewing a possible new vet.
 
See my signature link Vet Interview Topics for questions you might ask.

To locate candidate vets, do a Google Maps search for
Veterinarian near my address
And fill in your address where it is highlighted above in blue.
 
Thank you - We are having a consult with someone on Tuesday - they say they treat many diabetic cats so we will see - they may say the same thing as our current vet but we need to check it out just to make sure. We aren't getting the attention we need from our current vet to really look into her curves and see what is going on. She is a terrific person but has a lot of patients and her first response is to increase the dose and we are starting to think that may not be the correct response. I'll let you know how it goes. For now we are going to try 3.5 units and see how that goes and just monitor her levels. Thanks for all your help and I will be taking the questions with me.
 
Baby girl topped out at 550 last night for her PMPS gave 3.5 and she was 405 this morning so that was a little better. Gave her 3.5 this morning - hoping she doesn't bounce through the roof again tonight/ 405 wasn't as bad as I figured, we had been seeing AMPS in the mid 350's on 5 units. This sugar thing is really tough to get right. Since she is on the prednisolone should realisitically expect to see numbers in the 100's?
 
It'll be interesting to see where she goes today. Will you be able to get some mid cycle numbers to see how low she drops? That will help you see if this dose works well.

I have no experience with pred though some others do. I think it'll make it more difficult to get low but I couldn't tell you for sure.
 
Update - +4 364 +6 378 - didn't drop much from the pre-shot of 405 but I think we will give it a couple of days and see how it does - she spikes at the end and always seems to be higher at night so maybe she needs 4 in the am and 3.5 in the evening? We probably won't test again till PMPS so I will post that data when I get it.
 
Just did PMPS and got the lowest number of the day????
AMPS 405
+4 364
+6 378
PMPS 352

She does not make this guessing game any easier - lol. She is eating now then we are going to give her 3.5 units again and see what the day holds tomorrow. We have church tomorrow so testing will be a little off but we will get what we can. Any suggestions will be gladly accepted. Thank you
 
I'd just keep muttering "data gathering, data gathering" to each other. The picture will become clearer. Today was pretty flat. There is a 20% variance with any meter; all her numbers today fall within that variance so are basically the same. So she surfed along in the 360ish range, which is better than spiking and bouncing or in the 450+ range. I'd give her another cycle at this dose and seem what tomorrow brings. If still in the pinks and flat, then the question is up or down?
 
Will do - thank you - Ill post tomorrow afternoon what we get. I was really glad she didn't spike up because she is prone to jumping way up at the end so we will see what tomorrow brings.

Thanks
 
The more data you get the better we can figure things out!! I'll check back tomorrow to see how you are both doing!
 
Number so far on Lil:
AMPS 417
+3.5 329
+7 394

We had church is morning so our times are a bit off from our usual test times. She we get more data before PMPS? Also, we are using the AlphaTrak monitor which I know reads a little higher than the human ones so I don't know if that matters but wanted to let you know in case it does. Also any suggestions on how to get them to eat Pate? She has started turning her nose up even if I mix it with some grilled? I know the grilled isn't helping the numbers but what do I do if she won't eat? We also give her the white meat chicken appetizers and I boil chicken but she is totally snobbing the food she needs to eat.

Thanks
Kristina
 
Couldn't hurt to get a +9 or 10 just to see where she's headed.

Have you tried mixing the food with warm water? Heating it up to make it stinky? Crumbling treats in it? The treats work for mine when they get picky and I always add water. I've also heard forti flora works amazingly though I never tried it.
 
Just got the +10 - she is 448 - I will try the treats tomorrow - she is a stubborn old girl. Should I stick with the 3.5 tonight? Today is the second full day at the 3.5.

Thanks
Kristina
 
I might change the dose tonight. Honestly you could go up or down. Maybe try 3 and see what that does? If you do, make sure you monitor and test for ketones... Especially if she isn't eating. Has she eaten today?
 
She is eating just not what she is supposed to - lol she has 4 to 5 3oz cans a days just not pate. We are just worried that the numbers are running a little higher - if she is getting too much will that make her numbers higher? PMPS was 449 so she didn't to up much higher - I think we are going to try 3 units and see what kind of numbers we get. Let me know which way you would go.

Thanks
 
Honestly, higher numbers could mean too much or too little insulin. I just recall the day you gave a smaller amount and the numbers were lower. If it was me I might lower to 3 for 2 or 3 cycles. I'd be careful to test for ketones. That way, we can see if the numbers go down or up. Might help determine what we need to do in the future. I'd go down because it did seem to work once before. What do you think?
 
That is the way we went - we gave her 3 tonight and I will try to test tomorrow. Unfortunately I have to work but I am hoping to get some during the day over the next day or two to see what is going on. Thanks for all your help and I will post what I get tomorrow.
 
So we gave her 3 last night and 3 this morning numbers are:
AMPS 399
+4 383
+6 424

Did we go the wrong way? Help!! Lol

If you look at her curves the 4 units had the lowest drop but had the huge jump at the end - I would assume this is a bounce from the low number - will bounces eventually stop happening? Is it possible she should be on a different kind of insulin?
 
It's hard to know. Let's see if the high number is the top of the curve, which would make it inverse and would indicate too much insulin. Yes, some of your best numbers were at 4 units but they included the bounce. Some cats bounce a long time before they settle in. Regardless of insulin. If she were mine, unless you have an inverse curve today, I'd stick with ProZinc awhile , go up to 4 units and see what it looks like.

Remember that the meds make this a difficult picture. She may never be in the really low numbers like cats not on predisone. The goal may need to be getting her consistently below the renal threshold, which is 250-270.
 
Another thing could be duration issues - when you're not at the optimal dose OR depending on the cat, both PZI and ProZinc may not last a full 12 hours. You're just starting out, so another week or so may clarify what your cat's pattern is and what dose works most optimally before trying to evaluate if the insulin isn't lasting long enough..
 
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