Screwup here, too?

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dosgatos

dosgatos

Member Since 2010
I increased his dose from 0.2 to 0.3 skinny last night and he stayed high all night and even higher this AM.
I did not think it as the high after the dose increase because it seemed too high to me so I decreased it to
.15 again after 2 cycles. Yes, maybe I did wrong again in terms of consistency...
What do you think AM's flattish numbers above 350 on 19th are? Normal response after the dose increase?
Why could he do quite well with .15 at the beginning ? Was it the effect of the previous dose?
Why can he throw a similar curve with different dose like .15 and .3 skinny ?
Is he experiencing glucose toxicity? Is consistency the most important thing with Lev? Lots of :?: :? :?:
Akane seems OK.
 
I took a peek at your SS...I am wondering if the higher BG's are more related to the current illness than the insulin dose.

I've seen it written here on FDMB many times where kitty being ill causes higher BG's.

If the higher BG's ARE due to the illness, I am not sure if you would give more insulin to combat the higher BG's....it seems logical that you would, however the illness could relieve and cause lower BG's as quickly as the high ones, so you would want to monitor more closely during this time, I would think. And be sure there is food available when you are not there to test.

I remember you mentioning about the Lysine....were you able to find it? Have you started it yet? I don't see it noted on the SS...

Also, are teeth okay? For my sugarkitty, his BG's get high without explanation when he needs his teeth cleaned.

Watching for updates- hang in there! (((hugs)))
 
Thank you, Melissa! Yes, I was convinced his high BG's on Sunday must have been due to his condition but he got gradually better it seems and now I see no sneeze, no dullness and still eating well so I ruled out that thought …but there may be something different brewing or… I don't know.. he just drinks and pees a lot but he does 5 Ps. Lysine has not arrived yet but I am expecting it soon.. And teeth. When I took him to the vet in Oct ?, I forgot, but she said it was OK..

I think my no.1 question at the moment is why he was able to drop and make a quite nice curve on (with?) .15, the curves which are similar to .3 skinny and after increased from .3 skinny :?:

I tested him +3 and it was 363. If he ends with lower BG than the pre shot 360, I will try .15 again.
 
With illness you can't really trust the numbers you get. Very frustrating, but until that resolves you're going to have a very hard time determining a good dose. I would not consider it resolved until you get the Lysine and he's had it for a week.

Since you've raised it, you might as well leave it at .3U. I can't answer your question because the illness could be the reason for those discrepancies. Sorry.
 
hmm....about the dental. I think diabetic cat teeth harbor more issues thant he average kitty....

Do you have any follow appointments scheduled soon that the vet might take another look- a closer look.

Bacterias seems to double up and multiply in the diabetic...in a short time things to go from worse to down right nasty.

Teeth may not be the issue at all, but since there doesn't seem to be any other explanation, that is usually a good go to starting point.

Also, as Vicky points out, giving the Kysine time to work might be helpful.

And of course, in case you are feeling secure at all ;-) I wanted to remind you that cats are super villans at hiding their illnesses....usually by the time you see an actual symptom, the illness has manifested greatly.

Just unexplained numbers on a dose that was recently doing fine makes me wonder.

Does all that make sense?
 
Did some checking on interferon, seems it may mess with glucose levels - causing them to be less controlled (meaning higher?). See this link to an abstract on humans where type 2 diabetics given interferon had to change from oral meds to insulin...
http://www.ejinme.com/article/S0953-6205(00)00080-7/abstract
We know cats don't always respond as humans do, but it is worth noting. Maybe the interferon is taking affect and he needs more insulin to counteract it?

I didn't find anything about acyclovir that indicated it raised BG levels. I just did a quick search though.

Anyway, it would seem to indicate that he needs more insulin right now, until things settle down. I would go back to .3u and let that settle for 2-3 days - of course if any "extreme" numbers show up, that would have to be reassessed.
 
Sheila & Beau & Jeddie said:
Did some checking on interferon, seems it may mess with glucose levels - causing them to be less controlled (meaning higher?). See this link to an abstract on humans where type 2 diabetics given interferon had to change from oral meds to insulin...
http://www.ejinme.com/article/S0953-6205(00)00080-7/abstract
We know cats don't always respond as humans do, but it is worth noting. Maybe the interferon is taking affect and he needs more insulin to counteract it?

I didn't find anything about acyclovir that indicated it raised BG levels. I just did a quick search though.

Anyway, it would seem to indicate that he needs more insulin right now, until things settle down. I would go back to .3u and let that settle for 2-3 days - of course if any "extreme" numbers show up, that would have to be reassessed.
Click to expand...

Good job on finding that Link Sheila. I did a google search the other day on that and couldn't find anything related to interferon and diabetes.

So Mami how long did the vet want Akane on the interferon + acyclovir?
 
Thank you for your responses! I was just writing my post. He woke me up at 4:30 am so I tested and it was 316 +10. I did not test his nadir so no idea.. will see..

The interferon article was interesting, thank you. He only got one injection on Sunday and was prescribed acyclovir for 5 days (twice daily so 10 doses) but I only gave him 2 times on the first day.

So his condition or the medication could be the cause for those highs otherwise it is not really explained..? I thought what I wrote in my question often or occasionally happen with Levemir but no ??

I wish I can find another good vet I can trust who knows better about diabetes and everything. The current vet is a nice person but they (there are several there) think you do not need to control pets' BGs like human. They did not pay attention to his pancreatitis last year even though I took him several times for his continued inappetence, vomiting and weight loss and after they finally tested spec fpl because I asked hard, they did not really think it was a problem that needed to be treated but thought it was a due course for diabetic cats and said to me "no surprise". I was so ignorant at that time.

I phoned every veterinarian hospital in my city but had no luck to find a good one. There is one 1 - 1.5 hours away from here that has good reputation so I might visit there. The vet seems to be good at dental care, too, so I was thinking I would take the boys once some time. Can Rin the scaredy cat bear the long ride..? :shock: lol



ETA
He was 327 +12 and dosed him .15 again.. wanted to see..but possibility of a fur shot. May have screwed things up even more nailbite_smile
 
Just want to learn some general knowledge further ... Is the increase from .15 to .3 is OK? Up to how much is considered to be OK? :roll: To increase slowly by .1 increment seems to be the usual practice but it is OK in such odd case? Thanks!

ETA ..and again, about my question. Why the reduction to .15 could have similar curves as with .3 skinny. If anyone has any ideas in general term - not in Akane's case when his condition could be in play, could you share it with me? Or is it a new case and not explicable? :roll:
 
You can go to .3u in one step because he was on that just one day ago and you have data for that dose to show it is safe.

As for the similar curves on .15u and .3u, are you referring to the 14th and the 11th data? It's hard to say with limited data. It looked like he was starting to settle well on .15u, but then something happened - his health, the shot of interferon? Not sure. What I would say is that right now it is important to work the insulin around whatever else is happening - meaning, don't let him sit in high numbers. That's why I suggested going back to .3u for now. I think when he feels better you will have to "start over" maybe with the dose reductions. Have to wait and see of course.

Since he had pancreatitis last year, are you sure he isn't heading into a flare up right now? Beau had a couple of nearly fatal pancreatitis episodes when he was 3 years old, then just some minor episodes that I didn't even recognize for what they were until he became diabetic and I "looked back" at those short periods of eating less and being somewhat withdrawn. He had a bad fare up a couple of years ago, and a few mini ones after that, but nothing for the past year or more (knock on wood). Just make sure he is eating enough and getting extra fluids - I mix water into all the cats's food for extra moisture.
 
Thank you, Shiela, for your reply to my not clear questions. :oops: I am now prepared to dose .3 if he stays high again. Not enough datas, exactly.. I need to learn there are things that I cannot understand why..

He dropped to upper 100's but is now 407 +12. Gave him another .15.. to see if he could go down with .15 or needs more or needs less. And thank you for sharing your experience with Beau's pancreatitis! It is so good to know that he is fine now. We are very encouraged :smile: He tested spec fpl last month and it was 6mg/dl. Above normal range but better than 21mg/dl when he had it in 2009 (sorry it was already 2 years ago).
 
dosgatos said:
Thank you, Shiela, for your reply to my not clear questions. :oops: I am now prepared to dose .3 if he stays high again. Not enough datas, exactly.. I need to learn there are things that I cannot understand why..

He dropped to upper 100's but is now 407 +12. Gave him another .15.. to see if he could go down with .15 or needs more or needs less. And thank you for sharing your experience with Beau's pancreatitis! It is so good to know that he is fine now. We are very encouraged :smile: He tested spec fpl last month and it was 6mg/dl. Above normal range but better than 21mg/dl when he had it in 2009 (sorry it was already 2 years ago).
Click to expand...

Unless you remain at .15U dose for several days, you cannot tell whether he "needs more, needs less." It's a simple fact with Levemir - too many dose changes hurts its ability to do its job - which again is to maintain steady, level blood glucose. Thinking in terms of nadir all the time is inappropriate for this insulin. If user's goal is simply to achieve an acceptable nadir (below 150), they will never achieve a stable cycle.

Sorry if I sound harsh, but 4 dose changes over 6 days will get you no where, with or without an infection or physical stress.
 
Yes, Vicky, you sound a bit harsh! No.. Seriously, I welcome anyone's any advice but I do not want to get confused..

So you think it was better to keep (or I should have kept) .3 skinny even though he was able to come down with .15? I changed it because I thought those numbers above 350 might have been from too much insulin so I wanted to do reduction. And I mean to go with .15 for at least 6 cycles to see if it is less or too much..

I want to add a bit more because I do not want to get misunderstood. If you pointed it reading my comment "I am ready to go .3", it simply meant I now understand that the dose change from .15 to .3 is OK. And I am not just looking at nadir numbers. I think I mentioned in my earlier post that I pay attention to a dose that brings him flattish gentle curves with lower numbers at the end of the cycle than the pre shot numbers.

Would be happy if you could tell me with more words :smile:
 
"Would be happy if you could tell me with more words" :smile:

You asked for it :lol: And I do not want to confuse you, so I will use an analogy that perhaps will make sense.

A mistake almost all of us have made at one point or another was being impatient and because we weren't seeing the results we expected or wanted, we made a change in dose. Whether that change was up or down is irrelevant. The very change itself causes the BG to alter, but sometimes in a manner which is illogical - you give more, they go up, you give less they go down!

That happens because we are trying to move an ocean liner - it needs a wide berth in order to turn and you turn and turn and turn the wheel and if you are not patient, you turn too much because the ship is so large and takes so long to move that you don't realize the turn you made 3 turns before has suddenly caused the ship to arrive at its desired position! So the turns you made after that turn have caused your ship to continue turning further than you expected!

Where is Illka when we need him?! (Illka posted here occasionally and the ocean liner was his analogy, which I probably did not explain very well)

Akane may currently have a physical stress of illness which effects his BG, so it is impossible to tell why his BG went down on less insulin. It could be that his illness has resolved, but it's difficult to say.

If you plan to remain at .15U for several days, that is a good plan at this time, unless you continue to see red levels and he continues to act ill. Then I would recommend returning to .3U.

Hope that was enough words :-D
 
Ooohh, hang on... it was almost going to be more than enough words - or enough "turn", noun and verb - for my tiny head :lol: but I think I got it. Thanks for that explanation. So the most important thing was consistency.

What I did not really understand were #1 why everyone suggested to go to .3. To me .3 was the dose you told me it was too much for him when I first joined here. I did not understand to go back to the dose that was once too much for him even if he was not doing well due to illness. And I thought he was receiving too much insulin with .3 skinny after seeing those numbers above 350. I was thinking BGs above 350 are somewhat an index for too much insulin. But that seems to be wrong, too... Then #2 when you consider he is receiving too much insulin? :?:

Then I would recommend returning to .3U.
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Go back to .3 from .15 directly after minimum of 6 cycles on .15, right ?


The good news is lysine has arrived. I think he is already better but will give him for a few days. The bad news is the syringes I order from US (half-unit markings) have been stopped at the customs and I may not be able to receive them.


ETA
..unless you continue to see red levels and he continues to act ill. Then I would recommend returning to .3U.
Click to expand...
Sorry, in that case after how many cycles ??
 
Vicky thanks for that explanantion of his ocean liner analogy ---very clear and helpful,
esp.to me at this moment with Buddy.
 
Mami, this is a management process with ever shifting variables - meaning, a dose that was good in one set of conditions may not be if conditions change. Having another health issue, from an upper respiratory, urinary track infections, or being diagnosed with hyperthyroid (as a few examples) will effect the blood sugar levels and the dose. In the case of infections, usually the BG will rise and the dose needs to be increase. Pancreatitis can cause lower BGs because they are not eating enough - which brings a whole other set of problems for cats, especially diabetics.

When you first joined, yes, the .3u seemed like too much with the drop to 25, but now he has an upper respiratory infection and higher numbers, so the dose needs to be increased so he isn't sitting in the 300s.

As for how many cycles, the general 3-5 days is not adhered to if there are high numbers, no numbers under 200-250 and the cat is ill with something else.

Infections, high numbers, dehydration (even slight) and inappetance can cause DKA (diabetic ketoacidosis) which can be life threatening. You don't want to risk that. Here is a link to detailed information about it: http://petdiabetes.wikia.com/wiki/Ketoacidosis
 
Thank you so much, Sheila! I understand now about .3.

I am sorry for asking similar (or the same?) questions again and again. I just wanted to understand well so that I could be prepared for different situations when no one is around.. but slow in learning.. and easy to get confused...

Hope I am getting it gradually. Thanks all for your help.
 
Do not feel bad for asking questions or clarification of our answers. I know there is a language issue, but only because you have mentioned it. Your English in your posts is very good, but I can understand it is a complicated issue in any language. So ask as often as you need to. :-D
 
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