Inslin stacking

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AndreaM

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Hi everyone. Wish i dint have to be back here, but after a year of remission, Schroeder's diabetis is back with a vengeance. i caught itfast this time, but he's not responding as well to insulin treatment as he did the first go round. It's been 3 weeks since i started injections. started at 1u Caninsulin. I have him up to 5u now and finally seem to be getting into some decent nadir numbers. Im aware af the Symoigie (sp?) effect, but am fairly confdent that's not whatwe're experiencing. Have done 2 curves. The last one was yesterday based on 4u.

The insulin response is not lasting 12 hours. Nadir is around hour 6/7, but then rises fairly rapidly. Schroeder's AMPS and PMPS are usually greater than 594 with the testing meter reading HI, cuz it's off the charts.

So, question to you out there. Does anyone have experience with Insulin stacking (i.e. overlapping doses) with a lente insulin, or can you point me to some articles on this practice? I understand extreme caution is called for, but I've yet to get Schroeder's BG into the normal range (below 180), so I feel i have room to manouver.

Thanks!
 
Hi Andrea,
Sorry to hear that Schroeder has gone back on the juice. I'm not sure if anyone here stacks doses. I know that I've seen a few people in the Lantus or Lev forums that use supplemental doses of R? to deal with really high numbers. I was wondering if you could or have considered switching to an insulin better suited for cats than caninsulin? Are you in Canada? Can you get PZI there? Or even better, Prozinc which lasts a little bit longer. I just did a quick read on wikea on caninsulin, which is porcine in part, and PZI being bovine is a closer match to feline natural insulin. Is caninsulin what you used the first time when Schroeder went OTJ?
From looking at your SS and the timing of shots, it looks like you are familiar with the concept of shooting less than 12 hours apart but I'm just not sure how many people here have experience doing that. Hoping someone who has chips in soon!

Carl
 
AndreaM said:
Hi everyone. Wish i dint have to be back here, but after a year of remission, Schroeder's diabetis is back with a vengeance. i caught itfast this time, but he's not responding as well to insulin treatment as he did the first go round. It's been 3 weeks since i started injections. started at 1u Caninsulin. I have him up to 5u now and finally seem to be getting into some decent nadir numbers. Im aware af the Symoigie (sp?) effect, but am fairly confdent that's not whatwe're experiencing. Have done 2 curves. The last one was yesterday based on 4u.

The insulin response is not lasting 12 hours. Nadir is around hour 6/7, but then rises fairly rapidly. Schroeder's AMPS and PMPS are usually greater than 594 with the testing meter reading HI, cuz it's off the charts.

So, question to you out there. Does anyone have experience with Insulin stacking (i.e. overlapping doses) with a lente insulin, or can you point me to some articles on this practice? I understand extreme caution is called for, but I've yet to get Schroeder's BG into the normal range (below 180), so I feel i have room to manouver.

Thanks!

Why don't you try a longer lasting insulin like Lantus or Levemir? I started my cat on Caninsulin and had lousy results, but much better with Lantus and finally settled with Levemir as it's more gentle and longer lasting. I don't know that many people have the time for stacking / dosing TID, so it's simpler to switch to an insulin where you won't have the ups and downs when the caninsulin runs out after 9hrs.... too hard on the animal.
 
I can understand your sentiments for getting the regulation in order. And there are people here doing it.

I have had to do Once a day, Twice a day, Three a day and Four a day, even on Lantus too over the past soon 6 years on insulin. I am going through all years and days now, and starts to see a pattern where Simba becomes impossible to regulate on twice a day, and every time after having been off insulin for a while and then it seems as a severe pancreatitis have been sneaking up. It has, according to my wonky numbers notes, taken a while for this pancreatitis to manifest itself palpation wise and visually. And after each pancreatitis his numbers been all crazy and totally wacky wonky and have taken several weeks to get in order again. But ECID, and your wonkyness might be due to something else.


All you can do is at least try - but start low then and go slow (as you know)
 
Not surprised - Caninsulin doesn't ever last 12 hours. With enough data, there are a few people who shoot TID with the shorter acting insulins (every 8 hours). Unfortunately, that doesn't leave you with much of a social life, sleep time, etc.!

You are raising the dose rather quickly, though - up to 5u in only 3 weeks- so I wouldn't rule out Somogyi yet. Especially with the rapid rise after nadir.

And, as others have suggested, switching to a longer lasting insulin may be the solution.
 
Not wanting to pile on but supporting what the others said. There are way better tools now than caninsulin, plus that dose has been raised way too quickly in my opinion for you to be able to comfortably rule out somogi. Honestly, given what I know of caninsulin, I'd switch to levemir.
 
If you are stuck with caninsulin and can't get anything else, going to 3 doses per day (TID, 1/3 of the daily total at each dose) or using a split dosing method where you give half, wait and hour or two and give the other half (both AM and PM, ex 7am & 9am, 7pm & 9pm) may be the best options to get reasonable control of the diabetes. These take more monitoring and supplies, plus a lot of dedication.


Edited to add: the other posts make it clear you may be able to get a different insulin, so I'd strongly encourage you to do so. Lantus and Levemir both have gentle onsets and long duration, giving much better control over the diabetes.
 
And depending on the action of the insulin in your particular cat, they may or may not feel like they are on a rollercoaster :sad:
 
Andrea,
You are in BC, right? You can use any insulin you like, so why don't you just go to Shopper's Drug Mart and get a package of 5 cartridges of Levemir. Be sure to pick up some U100 syringes while you are there and ones with 1/2 unit markings on them.
Use your Optimum points card too.... getting your insulin and supplies there will get you some free money later on. I watch for the special deals where they say "Spend $50 and get a $10 card to use later" and that's when you go and stock up on test strips and stuff.

That caninsulin is horrible so get yourself a longer lasting insulin to give your cat a chance to go OTJ again if possible.
 
Yes, Caninsulin was the insulin I used to get Schroeder into remission last year. I know that people have some opinions about it, but i've historically had no problems with it. Thatsaid' Im open to trying another type if i can't get him stabliized fairly quickly. I will talk to my vet and do soe research on Levemir. Great idea to start using a rewards card. All the supplies are tres expensive!

I overlapped doses last nite, giving 3 and 3 units 6 hours apart. This yielded better numbers this morning (398) with no symptoms of hypo in the night.
 
So three weeks in, you are now going to be giving 12 units a day? and dosing TID with caninsulin no less. Ok, you may be on the right track, but my gut instinct is saying that you are proceeding way too fast, and that there are way better insulins to be using. It isn't just about the numbers, it is about the whole cat, and I can't see how this is better for your cat than trying a gentler insulin, starting at 0.5 to 1.0 units twice a day, working up at 0.5 unit increments at approximately 1 week intervals. Going slower or faster in some cases. Things have changed in the last few years.....
 
Good info everyone. I sure appreciate it! I wentto the Levemir thead and read up. Very convincing research and excellent dosing guidelines. I will likely pursue this.
 
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