? Rom - numbers not improving

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Sue484

Sue484

Member Since 2015
Morning. Since Romulus's hypo numbers 7 days ago, he does not seem to be reacting to insulin at all. Am I increasing too quickly? Should I go back to 1 unit and trial him on that again? He was doing well until this point. When he runs out of insulin, I will be speaking to the vet about switching him to Lantus. I'm not holding out much hope though.
 
Hi Sue,

First up, the obvious question: did anything unusual happen with the Caninsulin vial in the last few days?

I am wondering whether after the hypo Romulus is more sensitive to insulin and the dose increases might be too much and making him high and flat? (Speculating here.)
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@Critter Mom Nothing out of the ordinary. It is fairly new, been open just over a week. I did reduce him to 1 unit but he was just rising. Maybe I should go back to basics and start at 0.5 units.
 
@Sue and Oliver (GA) might be able to give you a better steer on dosing, Sue. My own feeling if it were my cat would be that 0.5 units might be a step back too far.

Is Romulus showing any signs of being poorly at all? Also how are his teeth and gums? Any other possible source of inflammation?

The only other variable I can think of is food, but I'm assuming that you haven't been feeding him different food.

Sorry I can't be of more help to you, Sue. :(


Mogs
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Rom is very healthy, if overweight. The vet said he could probably benefit from a dental at some point, but not yet. He is nearly 13 after all!! His food is unchanged and he is eating well. Never see him drink and he doesn't pee excessively. It's all a puzzle.
 
Just to double-check, did you open the new vial of Caninsulin before or after the hypo?

Also, are you using a new pod of test strips?
 
How long does a dose of Caninsulin take to settle in? I know there's no depot, it's an in and out hormone, but how long should you give it to see what a dose can do?
 
Sue484 said:
How long does a dose of Caninsulin take to settle in? I know there's no depot, it's an in and out hormone, but how long should you give it to see what a dose can do?
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My vets told me that it can take a week for a dose to settle.

Reasoning this through,

* Romulus had a rather low hypo on 1.5 units. (Dose too high.)

* Romulus is high and flat on 2.0 units. (Higher than the dose that caused the hypo less than a week before.)

* You had a black pre-shot number for the first time in yonks. (Possibly effects of counter-regulatory systems reacting to higher dose?)

* Of the data you have, only one test has returned a result that isn't pink or higher in the past 3 days on 1.5 units or higher..

* When you reduced to 1.0 units after the hypo you only held that dose for 5 cycles before increasing again (and there is a possibility that Romulus may have had a bounce off that very low hypo of 2.4mmol/L.

If that were Saoirse and there was no change of food or signs of other illness, I would consider that there is a possibility that the dose of 2.0 units too high. (Too much insulin can look like too little data-wise.) Also if she had had a hypo that low on 1.5 units Caninsulin, I would not have gone back to 1.5 units at all. I would have held at 1.0 unit for a week to see what happened and then review the dose (unless another low cycle indicated another dose reduction was due). If the numbers stayed high on the lower dose after a few days, I'd touch base with our vets and maybe bring Saoirse in for them to check her over. I'd also monitor closely for ketones. If any subsequent dose increase were indicated, I would be inclined to only make conservative adjustments (e.g. increase from 1.0 to 1.25 units).

My two penn'orth. Other members may have a different take.


Mogs
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I'm with Mogs. I wonder if the problem was going from one unit to 1.5. That's when the numbers got a little wonky. The 500 to 178 seems to suggest 2 units is too high.

I think I'd try 1.25 on the higher preshot and when you get a yellow pre shot, lower it to one unit. You can use a sliding scale with Canninsulin, with a lower dose for lower pre shots. I also like the idea of a trip to the vet to make sure there are no infections and testing for ketones. I am assuming you are in the UK. Will your vet consider that he is too volatile on Canninsulin and change to a milder insulin? He seems to have been on it long enough to qualify under the cascading system. If he won't, maybe @Elizabeth and Bertie could help with this; she's done it.
 
@Sue and Oliver (GA) - I thought similar about whether 1.25 might have been a better dose or whether leaving the 1.0 unit to settle might have given better numbers.


@Sue484 - I'm with @Sue and Oliver (GA) ('Sue' Overload!) on asking the vet to consider an alternative insulin. If you got one with a gentler, longer action it could go a long way to evening out Romulus' BG. Do you share his spreadsheet with your vets, BTW?

FWIW, Saoirse was actually better regulated than Romulus is currently when I managed to make the case for her Lantus Rx. Guess it may depend on the vet. In addition to our vet being able to see Saoirse's data, some of her clinical signs were poor (e.g. lethargy and hiding when Caninsulin dose was active in her system; hiding at injection time). The combination of test data and clinical evidence swung it for Saoirse. I don't know whether there might be odd things about Romulus' response to Caninsulin that might help you meet the drug cascade criteria for permitting a different insulin Rx.


Mogs
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