Rebound insulin drop information

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Renegaderem+Dainty

Renegaderem+Dainty

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I've got a rebounding kitty. I need to know how to lower her dose. Does anyone know how to take them down in insulin? Do I just drop it back down to 1u (we worked our way up to 1.7u) or do I stagger it down slowly?
 
Curious as to why you think he is rebounding
Do you have a spreadsheet?
If it is a true rebound I would back down to 1 unit and start over
Do you have any numbers you could give us or more information
 
My tracking is in excel so I'll give my best summary. A couple weeks ago Dainty was getting 1.7u with an average of 130ish +3hrs after shot. Then getting really low +6hrs after shot. Like I think the lowest she went was 29 (this is on a relion walmart meter so its with adding 30 or 40). I was worried that this was too much for her so I backed it down to 1.5u which she responded to by leveling off in the 350-400 range for the full 12hr period, this happened repeatedly for a couple days so I thought, okay 1.6u then. Her numbers are still erratic like 372 +6hrs two nights ago. 417 +3hrs last night and 372 +5hrs tonight.
I went to this site and what I read sounds very similar to my situation http://petdiabetes.wikia.com/wiki/Rebound
 
Thanks for the details. One thing we will need to fix you up with is a Spreadsheet we can all see. I think Sue is due back from her trip today (fingers, toes and eyes crossed that happens!), and she should be able to guide you with taking your excel data and attaching it to your profile to make it viewable to us.

With the numbers you just gave us, here is what I think happened.
The 1.7 was too high, and it pushed her pretty close to "hypo" numbers. The 30 point difference between the Relion and reality? That happens to us all, human meters are not quite as accurate on kitties, and my vet told me the same thing, 30 points. BUT, it seems to be as much as 30 at higher BG readings, but not maybe that much difference when you see low numbers. Like maybe it is more a percentage variance instead of 30 points all the time. Anyway, when you were getting 29's? That was too low. You know from reading that when the BG goes really low, the liver "panics" and dumps sugar into the system as an instinctive "life preserver".
There isn't any regulation to that, it just dumps glucose to raise the BG up. And what we usually see is what you saw.... higher numbers and flatter cycles for a couple of days. Rebound, sometimes what we call "bounce".
The numbers you got on 1.5? that wasn't because the dose was too low. It was because the dose had been to high at 1.7, and kitty's body was still recovering from that. I am guessing the 1.5 was still too high. Then going up to 1.6 (all these are really tiny adjustments), it's still too much insulin, which is why you are seeing pretty high and erratic numbers.

Are the numbers at the pre-shot tests as high as the numbers you are getting at the +6 tests?

You were getting what seemed like good curves on 1.7, but they were really too extreme, and caused this "spiral" effect.
What Denise said seems right. And given the specifics, I agree even more so.

I would drop all the way down to 1u every 12 hours. That should put a "smiley" shape back on the curves.
It takes 2-3 days, sometimes longer, for a kitty to adjust to a dose adjustment. You will probably see odd looking numbers for the next couple of days, then things should start to make more sense.

If you would like, post the numbers as you get them like this:
AMPS 350 (1u)
+6 225
PMPS 325 (1u)
+6 200

Short of a spreadsheet, that format is easy for all of us to understand, and when the numbers are laid out that way, it is easy to "see" what is going on on a daily basis. You can test at any time (always test at shot time), and the "+hrs" would be how many hours the test was taken after that pre-shot test in the AM and PM.

Carl
 
I will be back at my home computer Thursday morning. If you would send me a pm (button on the lower left hand side of my post) I would be happy to set up a spreadsheet for you.
 
The 1.7 was too high, and it pushed her pretty close to "hypo" numbers. The 30 point difference between the Relion and reality? That happens to us all, human meters are not quite as accurate on kitties, and my vet told me the same thing, 30 points. BUT, it seems to be as much as 30 at higher BG readings, but not maybe that much difference when you see low numbers. Like maybe it is more a percentage variance instead of 30 points all the time. Anyway, when you were getting 29's? That was too low. You know from reading that when the BG goes really low, the liver "panics" and dumps sugar into the system as an instinctive "life preserver".
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Oh dear, I don't like that idea at all. That would mean that she really was going low low low. Checking her meter her 3 lowest readings were
+6 29 (1.5u)
+6 30(1. 5u)
+6 44 (1.6u)
these were all taken between 10/27/11 and 11/10/11

Are the numbers at the pre-shot tests as high as the numbers you are getting at the +6 tests?
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I wasn't attempting to do amps and pmps until recently, in fact I think it was you who kicked started me on reading of their importance. Since then I have been trying to test Dainty Pre shots but for some reason she just won't bleed before eating so our success rate is low. My sister theorizes that it's a hydration issue because anytime after I get blood (not lots, just enough to do a test). I can't even begin to guess what's going on with that, all I know is that it's like trying to draw water from a dry well.
When you reduce to 1u I recommend you test for ketones.to be safe.
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No worries on that front. She's been clear so far. I will watch out for them though.
Well I am home 9 hours after shot and she does look gosh darned goopy. I gave her 1u this morning, I'll keep her on that for a couple of days and see where we go. Hopefully in the smiley curve direction!
 
When you do the ear poke, are you using the device that the meter came with, or are you "free handing" the lancet? If you know, what size are the lancets themselves? I think most of the time the meter comes with 33g lancets, which are really tiny. I had a problem getting blood at first too. I went out and bought bigger lancets and was able to get blood easier that way.

They come in various sizes, 26, 28, 30, 33. The higher the number, the smaller the "needle" as backwards as that might sound. I had great success with the 28's. Eventually I got good with the 33s, but at first, not so much.

You might try a lower gauge to see if that helps.

Carl
 
And just to be sure, if you've never seen this, here is a picture of the "sweet spot" you need to poke at:
 

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When you do the ear poke, are you using the device that the meter came with, or are you "free handing" the lancet? If you know, what size are the lancets themselves? I think most of the time the meter comes with 33g lancets, which are really tiny. I had a problem getting blood at first too. I went out and bought bigger lancets and was able to get blood easier that way.

They come in various sizes, 26, 28, 30, 33. The higher the number, the smaller the "needle" as backwards as that might sound. I had great success with the 28's. Eventually I got good with the 33s, but at first, not so much.

You might try a lower gauge to see if that helps.
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We're using the clicking pen thing. We tried with just the lancet with no luck. I have a bag of various lancets I think they are pretty tiny. The thing is that I can get blood from her after she's eaten just fine with our normal routine. But when she is ready for breakfast or dinner its almost a lost cause (though tonight we had success on the second try!)
 
Not sure if anyone has already given you the "tips" on getting the ears to cooperate....

You can warm the ear before hand just by rubbing it for a bit.
Or you can take an old sock, fill the end of it with rice, and nuke it in the microwave for just a few seconds and use it like a mini heating pad on one side of the ear while you poke the other side.
An old pill bottle filled with hot water works like that too.
A flashlight shining thru the ear helps you to see that sweet spot better. Aim between the vein and the edge of the ear....
Carl
 
It's hard to tell because the avatar picture is a close-up, but are his ears dark colored? I know with black cats, it's hard to see the vein at all, and many people poke the inner surface of the ear instead of the backside because it's easier to see.

Carl
 
Dainty's lovely ears are black lined in tan on the outside and a creamy pink on the inside. It is for this very reason that we aim for the inside rather than the out. We'd never get anywhere hunting for blood on the outside.
 
It's been three days now on the 1u dose, her numbers are really about the same if not a little lower as when she was getting 1.5->7 units. Unfortunately my strips ran out Monday night and didn't arrive until this morning after shot times...
On Monday (1st day of 1u dose change over. Her AMPS were 325 and her PMPS were 261)
As for today, here are her numbers
PMPS 341 (1U)
+3 256
+6 262
So, is she doing well at 1u and I should continue that or should I lower/up her dose? This is all very confusing any insight is appreciated since I'm in the dark about what to do next if anything. (Oh I also tested for ketones Tuesday which came back negative thankfully.)
 
This is one of the hard questions to figure out. It could be that you need to lower a little or raise a little. Sometimes the only way to tell is to try one or the other for a few cycles.

You might try one more day at 1 unit, getting some mid cycle numbers. That would help us see whether she is high and flat or inverse through the cycle (likely to mean lowering is best) or just in general 200-300 numbers with a normal smile curve. That would suggest raising the dose to 1.25

Maybe we can get your spreadsheet done today. That will make it much easier for you and us to decide on the next dose.
 
Whelp, Dainty isn't having the greatest day.
Amps 302 (1u)
+6 372
then we got really hungry at 5:30 (an hour before the time we got fed this morning) and we puked up some of our breakfast.
So what are your thoughts?
 
Here is some more information from the day to give some more information
Pmps (unable to collect because she ran and hid when she heard the meter turn on) (.8u)
-Decided to barely lower her dose to what I am guessing is .8 to see what happened, its really hard to measure this on a u40 syringe but I gave it my best effort, it was at least a tiny bit under the first line.
+3 314
+5 208

Does this mean that Dainty really was experiencing a rebound on the higher dose (1.5->7), even at 1u? Or could this totally be a fluke? Should I try lowering it even more still---keep it at .8 for a couple of days? Can that ((.2)) little amount of insulin change even be making a difference. Dainty's been DX as diabetic for almost exactly a year and this is the first time that I feel I am beginning to understand this even slightly but there is still so much more to learn, thank you all for taking the time to help me over the learning curve. Dainty and I both really appreciate it!

https://docs.google.com/spreadsheet...wc3lCQWtDbFpzT1RnbXdRYTJENWc&authkey=CPuDnpIJ
Also! Here is her spreadsheet finally put into an accessible form!
 
When starting a new dose, you should stick with it for at least 3 days; it takes time for the.body to adjust. And yes, .2u can make a difference-that's actually the full dose I give Casd and it.s atarting to look like it may be too much.

Lookin' pretty good on .8, though. If you keep with small doses, you may want to coonsider switching to u100 needles w/ the conversion chart (I think it's in the pzi sticky). Gives mote precision for.smaller.doses.
 
Yes, in some cats, even .2 units can make a difference. If it is easier to shoot .5, I don't think that would hurt. Just be sure to get that daily ketone test in and keep an eye on her numbers. I like your numbers on the lower dose better.

If you are going to need to mini dose, it would be worth it to get some U100 needles and use the conversion chart: http://felinediabetes.com/insulin-conversions.htm

Great job on the spreadsheet!
 
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