This is my first post to the FDMB, and I'll have to get back later with more details and history, but I wanted to throw out a quick question. In a nutshell, Snowy's (19+ lbs) been on Lantus BID as high as 4 units and we haven't got him regulated yet. We did have a couple of hypo episodes and most recently had him back down to 2.5 IU BID. We've been doing home bg testing for several weeks now and even though the data didn't necessarily show it, I was fearing that maybe we missed the lows and he was rebounding; perhaps showing his high numbers due to persistent overswing. (Note, my fears stem from having lost a previous cat due to not catching this.) So, we've brought him back down to 1.0 IU BID to check--which is where we've been at for 2.5 days now. We've only tested yesterday and today pre-eating, pre-insulin (I forget your acronym) at 474 and 353, plus I got a +6.5 today at 440. My question is at 1.0 IU, should/could I still fear overswing or is that low enough that I shouldn't worry about it? Anyone experienced overswing at 1 unit? I'm hoping to test tomorrow pre-eating, +3 and +6. Thanks.
overswing possible at 1 unit?
- Thread starter carrieao
- Start date
- Status
atajev
Member Since 2014
Well, obviously in the absence of any specific information I can't possibly even guess whether or not this applies in your specific case, but any cat on insulin could be showing a bounce from getting into a range that his/her body isn't used to. And any cat on insulin could also be brought down low enough to become hypoglycemic, whether they're getting 10 units or .01 units if that amount is more than is needed to make up the difference between the excess sugar in their blood and the insulin already in or produced by their body.
So, always a possibility in theory, though the actual numbers from your cat will help indicate whether it's likely for your own cat on any given dose.
Do you have a spreadsheet with your numbers yet? That's the best way to share them with everyone and get advice on your own cat's situation.
So, always a possibility in theory, though the actual numbers from your cat will help indicate whether it's likely for your own cat on any given dose.
Do you have a spreadsheet with your numbers yet? That's the best way to share them with everyone and get advice on your own cat's situation.
OK, so here's the whole story for Snowy (~19.5 lbs) ...
May 24, 2014: On a hunch, I tested Snowy's urine with an expired Keto-Diastix and it showed glucose in the urine. Same with next couple of days.
May 27: I changed him over to a canned food diet (Fancy Feast Classics).
May 29: Vet visit for a checkup. Bloodwork/urinalysis showed a trace of glucose in the urine but a normal BG at 169 (also Total Protein high at 9.2 and Globulin high at 5.5). So we did a urine culture which came back negative. We continued with the high protein/low carb diet (also added in some Evo and Instinct since he "needs" his kibbles too!, but mostly canned), except for a couple of vacation weekends where they free-fed. I also have three civies, one of which who would not eat anything but her Iams (have recently gotten her to eat Evo!). Urine strips are consistently showing glucose thru June. Kind of looks like I caught him at his pre-diabetic stage.
July 3: Fructosamine test and some subcue fluids for a little dehydration. Fructosamine was high at 627.
July 7: BG curve at vet (vet uses AlphaTrak):
AMPS (after eating): 436
9:20am: 2 IU Humulin N
+1: 519
+3: 445
+5: 348
+7: 350
So we kept him on 2 IU BID for a week.
July 14: BG curve at vet
8:18am: 2 IU N
+1: 457
+2: 429
+3: 333
+4: 320
+6: 367
+8: 525
Upped insulin dosage to 3 IU BID of Humulin N.
July 22: BG curve at vet
724am: 3 IU N
+.5: 520
+1.5: 495
+2.5: 431
+3.5: 326
+4.5: 330
+6.5: 352
Upped insulin dosage to 4 IU BID of Humulin N, but needed to decide if I wanted to switch to PZI or Lantus. We started on Lantus at 3 IU BID on July 25.
Here's where I admit my wrong-doings. It seemed as if Snowy was still not feeling better, plus I was consistently getting glucose in the urine, and my vet had wanted to start at 4 IU but didn't because of my insecurities, and he had said that it would take 3-4 days for any dose to "kick in", so I took it upon myself to up Snowy's dose to 3.5 IU BID on July 31, and then to 4 IU BID on Aug 3.
We did our first home BG test (ReliOn Confirm) on Aug 5.
8:47am: 4 IU Lantus
+8: 377
Our second home "poke" was Aug 7, but taken at +1 after giving 4 IU and he was at 95! All of our home BG testing from here on is in my spreadsheet.
We lowered him to 3.5 IU (and I was yelled at by my vet for upping him as I did). We sent him hypo again a few days later. Before Aug 10, our pre-shot bg tests were after eating; since then we've started doing pre-eating (fasting) BGs (much to the chagrin of all my kitties!). My vet requested AMPS and +6 BGs and didn't really want a curve until we were on a consistent dose for a week.
We don't have an explanation for the hypos or for any days that are lower. He seems to run pretty high much of the time and pretty inconsistent. A little voice in my head was screaming that we could be in Somogyi rebound. What if he's gone into remission and we've missed the lows and his highs are from overswing? What if he's in persistent overswing? (Note, my voices stem from having lost a previous cat due to missing overswing and continually upping her dose until she was beyond help.)
So after my curve at 2.5 IU on Aug 19, I listened to my vet and upped Snowy to 3.0 IU without overtly wondering about overswing. A day or two later, he said if I want to make sure, go ahead an lower dosage to 1.0 IU and we can see. This is pretty much where we're at now. I find it interesting that at day 3 his AMPS was lower and that his numbers are mostly the same as when he was at higher doses. I feel better with my overswing fear, but have to admit that I still have it a little bit.
At this point, my vet suggests that if his AMPS is 360+ and his nadir is 180+, then up the dose by 0.5 IU and stay on a dose for a week.
Note, currently Snowy gets about 1/3 of a 3 oz can of Fancy Feast Classics in the morning, followed by ~1/8 cup of kibble (Evo or Instinct) at shot time and then somewhat grazes through the day (4-6 small meals). Usually canned again mid-afternoon and late evening. Sometimes 9-lives canned Tuna and Egg as a treat. A small amount of kibbles a few other times. So his eating schedule is pretty inconsistent, but this is what works for us (and my vet is fine with, for now). Snowy was found sick, injured and starving a few years ago and has been used to free-feeding at my house (on not-so-low-carb food, I guess). He's a big cat, but that's how he got fat. (His frame shape looks like he was probably fat in his past too.) He likes food!
Note, he also has a grade 3 heart murmur. We have not had an ecg (or whatever) done at this point.
I would love for you experienced people out there to take a look at my story and data and tell me what you think. Work my way back up on insulin dosage? Can you quell my overswing insecurities?
If I've done things correctly, here's my spreadsheet: https://docs.google.com/spreadsheets/d/ ... 4s/pubhtml
Thank you!
May 24, 2014: On a hunch, I tested Snowy's urine with an expired Keto-Diastix and it showed glucose in the urine. Same with next couple of days.
May 27: I changed him over to a canned food diet (Fancy Feast Classics).
May 29: Vet visit for a checkup. Bloodwork/urinalysis showed a trace of glucose in the urine but a normal BG at 169 (also Total Protein high at 9.2 and Globulin high at 5.5). So we did a urine culture which came back negative. We continued with the high protein/low carb diet (also added in some Evo and Instinct since he "needs" his kibbles too!, but mostly canned), except for a couple of vacation weekends where they free-fed. I also have three civies, one of which who would not eat anything but her Iams (have recently gotten her to eat Evo!). Urine strips are consistently showing glucose thru June. Kind of looks like I caught him at his pre-diabetic stage.
July 3: Fructosamine test and some subcue fluids for a little dehydration. Fructosamine was high at 627.
July 7: BG curve at vet (vet uses AlphaTrak):
AMPS (after eating): 436
9:20am: 2 IU Humulin N
+1: 519
+3: 445
+5: 348
+7: 350
So we kept him on 2 IU BID for a week.
July 14: BG curve at vet
8:18am: 2 IU N
+1: 457
+2: 429
+3: 333
+4: 320
+6: 367
+8: 525
Upped insulin dosage to 3 IU BID of Humulin N.
July 22: BG curve at vet
724am: 3 IU N
+.5: 520
+1.5: 495
+2.5: 431
+3.5: 326
+4.5: 330
+6.5: 352
Upped insulin dosage to 4 IU BID of Humulin N, but needed to decide if I wanted to switch to PZI or Lantus. We started on Lantus at 3 IU BID on July 25.
Here's where I admit my wrong-doings. It seemed as if Snowy was still not feeling better, plus I was consistently getting glucose in the urine, and my vet had wanted to start at 4 IU but didn't because of my insecurities, and he had said that it would take 3-4 days for any dose to "kick in", so I took it upon myself to up Snowy's dose to 3.5 IU BID on July 31, and then to 4 IU BID on Aug 3.
We did our first home BG test (ReliOn Confirm) on Aug 5.
8:47am: 4 IU Lantus
+8: 377
Our second home "poke" was Aug 7, but taken at +1 after giving 4 IU and he was at 95! All of our home BG testing from here on is in my spreadsheet.
We lowered him to 3.5 IU (and I was yelled at by my vet for upping him as I did). We sent him hypo again a few days later. Before Aug 10, our pre-shot bg tests were after eating; since then we've started doing pre-eating (fasting) BGs (much to the chagrin of all my kitties!). My vet requested AMPS and +6 BGs and didn't really want a curve until we were on a consistent dose for a week.
We don't have an explanation for the hypos or for any days that are lower. He seems to run pretty high much of the time and pretty inconsistent. A little voice in my head was screaming that we could be in Somogyi rebound. What if he's gone into remission and we've missed the lows and his highs are from overswing? What if he's in persistent overswing? (Note, my voices stem from having lost a previous cat due to missing overswing and continually upping her dose until she was beyond help.)
So after my curve at 2.5 IU on Aug 19, I listened to my vet and upped Snowy to 3.0 IU without overtly wondering about overswing. A day or two later, he said if I want to make sure, go ahead an lower dosage to 1.0 IU and we can see. This is pretty much where we're at now. I find it interesting that at day 3 his AMPS was lower and that his numbers are mostly the same as when he was at higher doses. I feel better with my overswing fear, but have to admit that I still have it a little bit.
At this point, my vet suggests that if his AMPS is 360+ and his nadir is 180+, then up the dose by 0.5 IU and stay on a dose for a week.
Note, currently Snowy gets about 1/3 of a 3 oz can of Fancy Feast Classics in the morning, followed by ~1/8 cup of kibble (Evo or Instinct) at shot time and then somewhat grazes through the day (4-6 small meals). Usually canned again mid-afternoon and late evening. Sometimes 9-lives canned Tuna and Egg as a treat. A small amount of kibbles a few other times. So his eating schedule is pretty inconsistent, but this is what works for us (and my vet is fine with, for now). Snowy was found sick, injured and starving a few years ago and has been used to free-feeding at my house (on not-so-low-carb food, I guess). He's a big cat, but that's how he got fat. (His frame shape looks like he was probably fat in his past too.) He likes food!
Note, he also has a grade 3 heart murmur. We have not had an ecg (or whatever) done at this point.
I would love for you experienced people out there to take a look at my story and data and tell me what you think. Work my way back up on insulin dosage? Can you quell my overswing insecurities?
If I've done things correctly, here's my spreadsheet: https://docs.google.com/spreadsheets/d/ ... 4s/pubhtml
Thank you!
Tara & Buster
Member Since 2012
I think you should ditch the dry all together. You are home testing and that's the best way to keep kitty safe. Be advised: if you eliminate all dry food it can drop the numbers significantly!! Be sure to be diligent with monitoring and post here if you need help.
Short of doing a whole curve, can anyone tell me what would be a good time for a spot bg check if I were going to catch a "fast drop"? One hour after insulin? Two hours? Three?
Today his expected nadir time (+6.5) was higher than his AMPS. Now he ate after AMPS but shouldn't the insulin help counter that? Or apparently not enough?
Today his expected nadir time (+6.5) was higher than his AMPS. Now he ate after AMPS but shouldn't the insulin help counter that? Or apparently not enough?
- Status