Insulin dose increase

Ok so we just got done at the vet for a glucose curve. They said dose needs to be increased from 1 unit twice a day to 2 units twice a day. I have read here to do it slower. Can someone help me know how to do it slower? I am really new at this and scared of messing things up. Also from here on out I will be able to do curves at home and got fluids in case she needs them at home as well.

 

Rather starting out with 2 units start at Half unit increments or even smaller Hold on for more replies . I am not an expert.

UGH I didnt explain that properly. start at 11/2 units hold that for so many days and see how that works. I think some raise by a quarter unit each time they change.

Like I said hold on for more replies. I just wanted to bump this to the top.

 

We increase by 0.25 units at a time, usually after a week on a dose that's proving to not be enough.

Could you give me a background on Bitsy? What's the reason for her being dehydrated?

I would not increase yet. She looks like she's bouncing (a phenomenon where BG drops low and the body dumps extra sugar in the blood to compensate, causing very high BG). What were her numbers at the curve today?

I recommend getting some mid-cycle tests in every day so we can actually see where the dose is taking Bitsy. Could you get tests such as +2, +4, +6 one day and +3, +5, +7 another day? Just to fill in the gaps on her spreadsheet.

 

She was in a home where they did not care for her. She was skin and bones and severely dehydrated and malnourished when we brought her home. It was when we took her to the vet and they ran tests to make sure we were doing everything we could that they found she was diabetic. In the short time we had her she had to get subcutaneous fluids 3 times and so now the vet said we could administer fluids at home should she need them. Which is saving us another emergency vet bill. I can run a curve here at home and see where her numbers are. I am not sure of her numbers today as that was one question I forgot to ask. From what was said to me was that her numbers stayed in the 400’s and 500’s all day. Which would be consistent with home testing. Not sure what bouncing is but her blood glucose has never been below 300’s.

 

Poor baby! So glad she's found you, and you've found us!

Here is Bouncing 101 for you

Bouncing is a phenomenon that occurs when the body experiences (or at least thinks it does) hypoglycemia. Luckily the body uses bouncing as a defense mechanism against this where it attempts to compensate the low blood sugar by dumping excess glucose provided by the liver in an attempt to raise blood sugar back to “normal” numbers. Unfortunately, “normal” is a relative term according to the body. For a diabetic whose body has been untreated for so long that it considered very high numbers to be the new normal, lower numbers can often make the body overreact in attempt to save itself, even if it’s not in danger.

A cat who has been suffering from diabetes for some time may at the point of diagnosis have a new “normal” of 400. When insulin is introduced and brings it down, even to 200 (still diabetic levels), the body thinks it is in danger, dumps excess glucose, and thus the blood sugar skyrockets up to the 400-600s. After enough time has passed, the body will eventually realize that 200 isn’t such a bad number, and bouncing will happen less often. Note some cats are extremely bounce-prone and a switch to Lantus/Levemir is needed.

There are three main causes of bouncing: when blood sugar drops too low (hypoglycemia), drops lower than the body is used too, or by dropping too much too quickly. Typically if a cat drops more than 50% of their blood sugar a bounce is likely to happen, or if they drop 100 points within an hour.

While bouncing can be considered as a safety net in the instances of hypoglycemia, it can look very confusing on paper.
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That said, Bitsy's numbers are in no way unusual for a new diabetic. For one, Bitsy sounds like she's been poorly for quite some time and so these high numbers she's having are her new "normal" - as stated above. It will take some time for her numbers to go down, just don't rush it ... like your vet is trying to do. It's very possible (and likely) that Bitsy is dropping from the insulin and her body is reacting to the lowered glucose by spilling more glucose in (again as stated above). If you don't "catch" the lower numbers, it just looks like a bunch of high 400-500s.

There's a lot to take in and learn but let's stick with the basics right now:

• Test before giving insulin every time - you never know when they're too low for insulin! Right now too low is anything below 200.
• Mid-cycle tests are important for seeing how low the amount of insulin you're giving is taking Bitsy. On Prozinc getting tests between 2 and 7 hours after insulin is most helpful.
• Remember that bouncing - those high numbers - can take up to 3 days to clear the system. Don't get discouraged by them, it's normal!
• Small meals throughout the day - a good guideline would be to give a snack 2, 4, and 6 hours after giving insulin. Once we find out how Bitsy reacts to the insulin, we can adjust this later if needed.
• Reduce the dose by .25 units if Bitsy drops below 90 at any time.
• New diabetics need twice as much food as a regular cat. If Bitsy is underweight, give her even more if she wants it. The hunger will wane once she's better regulated.
• Feed at night!! Get an autofeeder (Petsafe 5 is popular). Cats drop lower at night. For all we know she's dropping late in the night and then all we're seeing are those high numbers in the morning.
• We are always here to help.

1 unit is a good starting dose. Bitsy does not "earn" an increase until one week has passed and her numbers INDICATE the dose isn't going low enough. Ideally we want her nadirs (lowest point in the cycle, usually around 5-7 hours after Prozinc insulin) to be below 150. You are correct to think that jumping to 2u is too much. Some vets think cats are dogs!

If you can (schedule permitting) start getting in tests during the day (+2, +4, +6 one day, +1, +3, +5, +7 another - rough example, doesn't have to be exact) we can see once the bouncing clears how well the dose is doing for Bitsy.

 

I remember you and Bitsy. A curve at home may reveal better numbers not affected by stress. As Panic said, we recommend increases at .25 units. It would be helpful to get 1/2 unit marked syringes if you don’t already have them. Although for prozync I think you’d have to look for U40 ones unless you covert the dose to U100

Here is a 101 on bouncing from Panic:

Bouncing is a phenomenon that occurs when the body experiences (or at least thinks it does) hypoglycemia. Luckily the body uses bouncing as a defense mechanism against this where it attempts to compensate the low blood sugar by dumping excess glucose provided by the liver in an attempt to raise blood sugar back to “normal” numbers. Unfortunately, “normal” is a relative term according to the body. For a diabetic whose body has been untreated for so long that it considered very high numbers to be the new normal, lower numbers can often make the body overreact in attempt to save itself, even if it’s not in danger.


A cat who has been suffering from diabetes for some time may at the point of diagnosis have a new “normal” of 400. When insulin is introduced and brings it down, even to 200 (still diabetic levels), the body thinks it is in danger, dumps excess glucose, and thus the blood sugar skyrockets up to the 400-600s. After enough time has passed, the body will eventually realize that 200 isn’t such a bad number, and bouncing will happen less often. Note some cats are extremely bounce-prone and a switch to Lantus/Levemir is needed.


There are three main causes of bouncing: when blood sugar drops too low (hypoglycemia), drops lower than the body is used too, or by dropping too much too quickly. Typically if a cat drops more than 50% of their blood sugar a bounce is likely to happen, or if they drop 100 points within an hour.


While bouncing can be considered as a safety net in the instances of hypoglycemia, it can look very confusing on paper.

 

Btw, giving fluids at home is very easy. I’m glad they showed you how!

 

Awwww Bitsy I hope she gets to feeling better real soon . Poor baby.

 

I beat you to it!!

 

By a fraction of a second. I think we were literally typing at the same time ha!

 

So now my diabetic mom is arguing with me because I said I am not going to give her 2 units twice a day just yet. I gave her 1.25 units last night and her sugars went down in the 200 range at one point. So I am glad I did not give her 2 units as that would have dropped her too low.

 

Looks like that bounce is starting to clear. Keep an eye on her today!