Jordan has entered the building! Hard time getting regulated

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L

LabTroll

Member Since 2014
Hi. Jordan is 9, female maine coon, and was diagnosed diabetic November 2012. Due to family disagreement tried diet modification that first year but late 2013 realized she had dropped several pounds and was toooo thin. I took over all medical care and she is now on insulin. Started with PZI but discontinued after 5 months, doses over 8U BID and additional weight loss. Currently trying out Levemir but having a hard time - her preshot levels are in the low 300's but this evening's PMPS was 489! Will create a spreadsheet tomorrow so you can see. Scared me so I finally decided to join instead of just reading as a guest.

Query: I looked at another member's SS for Lev and saw that the dose was being increased every 4 doses - I thought the dose needed to be stable for 3-5 days to give kitty's body a chance to adjust. Was the purpose of the swift increases an attempt to break through insulin resistance?

I have to go (it's late) but thought perhaps you kind folks would give this a peek and maybe drop me a line. My vet has no experience with Levemir and is considering us a test case. Feeling a little adrift here... :?
 
Re: Jordan has entered the building! Hard time getting regul

Update: In for an interupted night - I checked Jordan's sugar before feeding her (she eats 4 times a day) and at +4.5 it's 562! :shock: Usually the Lev drops her BG by ~100 pts by the 5 hr mark... Going to bed but will be up in a few hours to test again.
 
Re: Jordan has entered the building! Hard time getting regul

i'm heading for bed but wanted to say a couple of things.

one is that high numbers don't always mean you need more insulin. cats can "bounce" if they are getting low - and that low can cause high numbers. the Second Post Here explains bouncing.

You also asked about increasing every 4 cycles. Yes, in certain cases we do advise that. That's a case-by-case decision, though, not for every cat.

That'd be great for you to get a spreadsheet up and include any data you have. We read numbers here! they tell us what's going on in the cat's body - one number doesn't tell much, but looking at the numbers on a spreadsheet, where we can see what time in the cycle the numbers are, and how they relate to each other, tells us a lot.

Just add another reply here with your spreadsheet. If you have spreadsheet woes, just holler. there are people who will help you get it going.

Glad you've registered - now you can get help for Jordan. :YMHUG:
 
Re: Jordan has entered the building! Hard time getting regul

Hello to you and Jordan, and a very warm welcome to FDMB!

May I ask you some questions:
How long has Jordan been on Levemir?
What dose did she start on, and what increases (if any) have been made?
What are you feeding Jordan at the moment? (And have there been any recent changes to her diet?)
Does Jordan have any other health issues that you know of?

Yes, it would be great if you can get a spreadsheet set up. And there are some techy people here who can help you with that (but I'm not one of them! :lol: ) We definitely need to see more data to get a clear picture of what's going on.

Some cats do need high doses. But as Julie said, high blood glucose levels can also be caused by giving too much insulin. And without more data it's not possible to tell whether Jordan is getting too little or too much.

'Rebound' or 'bouncing' can happen when a cat's blood glucose level drops too low or too fast (or both). "Too low" doesn't necessarily mean dangerously low (ie hypo low), it can also happen if the blood glucose drops lower than the cat's current comfort level.
The body can respond to this threat by putting more glucose out into the system. It can also release counter-regulatory hormones, the purpose of which is to keep the blood glucose high (causing temporary insulin resistance).
Sometimes tests catch only the high blood glucose numbers and miss the low numbers in between. This is why it would be good to see more data.

Thank you for registering: It's nice to 'meet you'!
And I'm really hoping we help you to feel less "adrift".

Eliz
 
Re: Jordan has entered the building! Hard time getting regul

Hi and welcome to FDMB.

I agree with what has already been said, your insulin dose may be too high and that is why you are receiving the high numbers. In order to protect itself from becoming hypoglycemic if too much insulin is give, a cat's body may increase it's glucose levels. That is why you keep receiving higher numbers.

One suggestion is to start over at 1 unit twice a day. Stay on this dose for at least one week before determining if you need to increase it. If an increase is needed, only increase it by 1/4 to 1/2 unit. Again, wait at least one more week before determining if you need to increase it again. By going low & slow, you will be able to find the dose that works best. Most cats only need 1 - 2 units per dose.
 
Re: Jordan has entered the building! Hard time getting regul

Before restarting with a low dose, getting more history will be very helpful. As Elizabeth/Bertie inquired, knowing what dose you started at with Lev, how increases were made and how Jordan has responded is important in order to get the big picture. When switching from another insulin to Lantus or Lev, the dose of the previous insulin needs to be taken into consideration. That Jordan was up to 8.0u on PZI could suggest that Jordan may be a high dose cat as much as it could indicate that PZI wasn't a good insuiin for your kitty. If you can fill in some of the blanks, we'll be able to help you puzzle through the dosing issues.

One additional thought... If Jordan isn't responding to insulin in the way she typically has, there may be a health issue brewing. Any kind of infection or inflammation can raise blood glucose numbers. This includes a dental issue such as gingivitis or a urinary track infection. If Jordan hasn't seen the vet and this is a change, a vet visit may be prudent.
 
Re: Jordan has entered the building! Hard time getting regul

Thank all of you for replying!

Jordan eats Fancy Feast pates and Sheba pates and cuts. She is fed 4 times a day as a nod to her needing to gain weight.
Just prior to starting Levemir she had a massive UTI - took 2 rounds of antibiotics to clear up but she was done as we were starting anew. She has had a complete workup and nothing was out of whack except her sugar.
I am having problems with pre-shot consistancy - my parents keep forgetting I need to test and they get up for work long before I have to. I hadn't realized how spotty it was until I filled out the spreadsheet.
I admit to pulling a totally dumb move and trying to use a bumper dose to drive the peak a little lower - hence, I was the cause of the really high number the other night. :?

Please and thank you for the advice to follow.
She is peeking over the computer at me, she knows it's time to eat.
Hope the spreadsheet show up!
 
Re: Jordan has entered the building! Hard time getting regul

Great job on the spreadsheet and getting some spot-checks in. First things first, Levemir cannot be used as a "bolus" and it can really skew numbers if you try, as I'm sure you've figured out. ;-) Next, you want to make sure you dose as close to every 12 hours as possible and hold the dose a minimum of 6 cycles/3 days to give it enough time to see that it's working/not working.

Levemir usually has a much later nadir/peak than Lantus so your pre-shots will generally be lower than at other points in the cycle. From your pre-shots and mid-cycle tests, I'd say Jordan isn't getting too low and might even suggest an increase to 1.75u (you have to eyeball the quarter doses). If possible, try to get a few more tests in when you can. If you can't get that many tests in across each day, some people will do a curve on a day they have off to monitor. The more tests when you first start out, the more data we have to go off for suggestions. :thumbup

The reason I suggest a dose increase is because she looked like she was starting to come down a bit on the 2u (although it looks like even the 2u might not have been enough) but then you decreased the dose and her numbers went back up. Others might chime in with more advice or other opinions or see something I might have missed.
 
Re: Jordan has entered the building! Hard time getting regul

How do I add additional values to the SS? Can I only do it from the same computer I started it on? Not sure where the file is stored.

I went up by 1/2u at a time and watched the values but at 2.25 (only 1/4 u increase, I know) I didn't like that her numbers were staying over 300 so I though maybe it was too much...
I appreciate so much the advice and consideration of more experienced users. :smile:

She seems to have recovered from the dumb bolus move (thankfully) and I learned my lesson. Last night +5 292 and this morning AMPS 344. Think I'll go up to 1.75 like suggested.
 
Re: Jordan has entered the building! Hard time getting regul

The file is stored on the internet at http://drive.google.com

You must log in to Google Drive in order to make any edits as the link in your signature should be a read-only version we can see, but not touch.
 
Re: Jordan has entered the building! Hard time getting regul

Hi! just wondered how you and Jordan are doing today. The board has been slow and cranky, but for the moment it seems a bit better.

Did you go ahead and increase the dose? I don't see it on your spreadsheet. I wanted to let you know that it's important to get at least one test in the evening cycle. Many cats go lower at night than they do during the day, and you'd be surprised how many have high numbers during the day and dip down at night. Because Lev dosing is based upon how low a dose is getting a cat, we try to catch the low point of a cycle so we know when to increase. Often people will be reluctant to suggest increasing a dose if there aren't any evening cycle tests because so many cats go low then. You can just get a test before bed and that will help us help you with dosing.

There's a large learning curve in treating a diabetic cat, and in learning how the insulin works in their bodies. Don't beat yourself up for trying a creative approach to helping to bring Jordan's numbers down by giving those extra shots. Fortunately, no harm done. The best success with Lev is going to be to re-evaluate Jordan's dose about every 6 cycles (shots) and see if she needs more insulin or if her dose needs to be held.

Especially with the board being erratic, I want to suggest that you print out this link on Shooting and Handling Low Numbers. It's meant for people following the Tight Regulation Protocol, but the part that will apply to anyone is how to handle low numbers. If Jordan goes low, under 50, it will tell you how to bring up her blood sugar safely. I'd invite you to post over in the Lantus/Lev Tight Regulation Insulin Support Group and people will help you each day learn how to evaluate the dose and decide what to do. That support group is here.

Hope you guys are doing ok!
 
Re: Jordan has entered the building! Hard time getting regul

Thank you to each person who checked up on us and/or offered advice. I did increase to 1.75u, it's been a full 3 cycles, and will work on getting more night checks in. Thinking about going up to 2.0 Sunday.
As invited, I'm headed over to Lev/Lantus board(s) to look around.
Thanks again!
 
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