juvenile diabetes new dx cant regulate PLEASE HELP

[EllieKozak]

Hello all. I am having a horrible time getting my Charlie regulated. His numbers are so erratic and high and he is scaring me. Last weekend he was hospitalized with DKA. His symptoms are much better and hes eating well but I am so scared. I had to give his shot 2 hours early tonight because he was close to 500! Vet says to increase to 4 units bid instead of 3. He is only 2 years old and this came on hard and fast. All bloodwork was normal except glucose. Urinalysis was clean. Please help

 

[Elizabeth and Bertie]

Hi Ellie,
I replied to your other thread in the main health forum but am copying/pasting the main content of my reply here also:

It seems very possible to me that the reduced response to insulin you saw yesterday could have been caused by rebound or 'bouncing'.

Rebound/bouncing can happen when a cat's blood glucose drops too low or too fast (or both).
"Too low" doesn't necessarily mean 'dangerously low'. Bouncing can happen even when the blood glucose just drops lower than the cat has become accustomed to. The liver releases glucose to raise the blood glucose level, and can also release counter regulatory hormones the purpose of which is to keep the blood glucose high. This can look like temporary insulin resistance. The effect can take up to a couple of days to clear sometimes.

It's quite possible that the beautiful 103 Charlie got gave his body a bit of a fright and triggered a bounce.

Vet says to increase to 4 units bid instead of 3.

Ummm... If it is the case that the high/flat numbers were caused by bouncing then raising the dose would not be appropriate at this point. A dose should never be increased on the basis of high numbers caused by a bounce. As the counter regulatory hormones in the system clear the numbers should come back down.

Of course it may not be a bounce. Time will tell...
Is Charlie eating OK?
Are you testing his pee for ketones?

Edited to add: Ellie, are you able add your insulin type to your signature? (Prozinc?)

 

[EllieKozak]

Good morning. His amps was 507. Spoke to his dr last night and she suggested bumping him .50 so I gave him 3.5u this am. Tended to him before I got online and saw the post about not increasing. Should I get even more bg's today for better interpretation? Somebody please tell me that it is normal for them to be all over the board in the beginning because I'm close to a nervous breakdown

 

[Elizabeth and Bertie]

...Somebody please tell me that it is normal for them to be all over the board in the beginning because I'm close to a nervous breakdown

Ellie, yes! It is very common indeed for blood glucose levels "to be all over the board in the beginning"! Honestly!

Given that Charlie's numbers are still high it probably won't cause a problem that you've raised the dose. If the high numbers are caused by a bounce (which isn't certain) then you may see them drop into more typical numbers for him later on, so maybe just watch out for that.
(Edited to add for clarification: Re your having raised the dose, I meant that it may not be a problem on this occasion. I didn't mean that the dose should be raised ongoingly (in case these higher numbers are result of bounce).)

You're doing an absolutely brilliant job with Charlie. I know it's a cliche, but do try not to worry.

Big reassuring hug to you,

Eliz

 

[EllieKozak]

Thank you Eliz and everyone that has helped. You have set my mind at ease. This is all so new and scary for Charlie and I. Being SO young, this was the last thing I ever thought of would be the problem with my sweet little baby. Its so frustrating to see his numbers all over the place. Just updated his SS to show the morning AMPS. Will update throughout the day. Thank you all again, I don't know what I would do without this board. It really is so helpful and you guys are just amazing. I don't have any glucose/ketone strips. I haven't used them before, but I am willing to try and do anything, whatever my baby needs he will get. Can I get those at a human pharmacy?

 

[Rachel]

You can get ketone strips at any pharmacy. I think they're called ketodiastix? I found them right by the glucometer supplies. If you don't see them, just tell the pharmacist you need strips to test for ketones. They will know what you mean.

Don't beat yourself up or worry too much. It's hard but you are NOT alone. We are here for you. We'll help you get through this.

 

[BJM]

Quoted from my other post responding

You need to be patient when first starting insulin. The cat has become accustomed to higher numbers, so any dramatic drop or even a fast drop may trigger compensatory hormones to release glycogen from the liver. This gets broken down into glucose and shoots the levels high. It takes about 3 full days for the bounce to settle out.

When you gave 3 units, he dropped over 350 mg/dL the evening of 6/30. If anything, his dose is too high.

That HI on 7/1 was almost certainly a bounce from the 67 the previous night. I would NOT increase the dose any higher or you set yourself up for successive highs until all spare glycogen has been used and exhausted ... and then he may crash and hypo on you.

Think calmly and remember - better too high for a day than too low for a moment. The latter, hypoglycemia, kills quickly. Yes, the former can result in DKA, but that is a slower process and you have time to respond. Just not with a knee jerk increase in insulin.