Perplexing BG swing....Can't figure it out

L

Linda Simpson

Member Since 2018
Hi Folks,
I just joined about a month ago (or so) and have to say I really enjoy the posts I've been reading and the discussion.
My Zoe has a host of issues which I listed in my introduction post (I don't want to bore you with it again) but now that I've updated her spreadsheet, I'd like to get input from anyone that is or has experienced the same thing. When I created her spreadsheet, I went back to the beginning of Sept but she's had diabetes for a year now, except for the slight remission between Oct-Jan.
Zoe's BG numbers are swinging. The recurring theme is that in the morning she's well within normal ranges and does not get any insulin. Then by the PM testing, she's quite high and needs insulin.
We used to have her on a very strict protocol where, even if she was within normal ranges, she was getting a wee bit of insulin. This was to try to get tight control on her BG when she was in the mid-20's. The protocol worked and with a slight reduction in pred and the protocol, we were able to bring her average numbers down.
I'm not using that protocol anymore because at least once a day, her BG is quite low and we don't want to risk hypoglycemia. We've reduced the pred about as far as we can - she stops eating without it. I can understand pred causing her BG to be raised but it shouldn't cause BG swings.
Lately she's become more and more finicky - I think her nausea from her severe IBD is getting worse and she's not eating well. A few days ago she stopped eating all food but she's liking poached chicken breast for now but I'm sure that will be short lived like everything else is.
Thanks in advance for all opinions and discussion.
 
Hi. Here’s what I see. She has a low preshot so you don’t shoot. Then when you do shoot instead of .75 you shoot 1.5. So she bounces around. I’d start over and shoot a dose you can shoot every 12 hours, either .5 or .75 and hold the dose for six cycles unless she drops under 50 if she were mine. The drugs she needs for IBD likely compound the issue. So maybe consider .50 consistently and see if she stops bouncing so much. Just my two cents FWIW.
 
tiffmaxee said:
Hi. Here’s what I see. She has a low preshot so you don’t shoot. Then when you do shoot instead of .75 you shoot 1.5. So she bounces around. I’d start over and shoot a dose you can shoot every 12 hours, either .5 or .75 and hold the dose for six cycles unless she drops under 50 if she were mine. The drugs she needs for IBD likely compound the issue. So maybe consider .50 consistently and see if she stops bouncing so much. Just my two cents FWIW.
Click to expand...
Thanks very much for that idea. It resonates with me.....Zoe is always getting a different dose to correspond with whatever her BG is but what would happen if instead of reacting to her BG, that I try and regulate it with a consistent dose of Insulin.
I'm going to try that. I'll check with the vet to see if we should try .5 or .75 (because I so much enjoy those fractions haha).
 
Linda --

Have you always used Lantus? One of the issues that may be complicating things is that even if you are dosing twice a day, if you shoot different amounts, the insulin depot never has a chance to stabilize. Elise's suggestion re. finding a dose you can comfortably shoot twice a day may help to flatten out the cycles.

It looks like you are using a sliding scale for your dosing. This approach is useful for shorter acting insulin. With Lantus, because it is a depot type of insulin and long lasting, generally a sliding scale is less effective. Every time you change a dose or skip a shot, it has an effect on the depot. Lantus is most effective if the depot is allowed to stabilize.
 
Sienne and Gabby (GA) said:
Linda --

Have you always used Lantus? One of the issues that may be complicating things is that even if you are dosing twice a day, if you shoot different amounts, the insulin depot never has a chance to stabilize. Elise's suggestion re. finding a dose you can comfortably shoot twice a day may help to flatten out the cycles.

It looks like you are using a sliding scale for your dosing. This approach is useful for shorter acting insulin. With Lantus, because it is a depot type of insulin and long lasting, generally a sliding scale is less effective. Every time you change a dose or skip a shot, it has an effect on the depot. Lantus is most effective if the depot is allowed to stabilize.
Click to expand...
Hi Sienne,
Zoe's always been on Lantus.
I had heard that Lantus was slow acting and could still be in the system 12 hours later. Elise's suggestion makes even more sense now. Come to think of it, when my vet had Zoe on that strict protocol, I was to take her BG only once daily, in the AM and use the same dose for both AM and PM. But we didn't extend it a few days. I'm definitely going to talk to her tomorrow.
I'd like to know more about this depot you are referring to. I think I saw a link to it somewhere. :)
 
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