Skipped shot this AM as well. (UPDATED)

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Little One

Member Since 2012
Hello again.

We have been checking Little One's BG fairly regular (no curve yet), but he has never been lower that the 250 using 1 unit so last night we upped it to 2 units and was able to get a +2 (11pm) test @ 52. Checked on him a couple hours later (1am). He was acting fine, but could not test. This AM (+10 since last shot) we tested and his level was only up to 60. We did not want to give him any as we work all day and would not be able to monitor him.

What are your thoughts. His SS is up to date and he is currently on Humulin N per my signature.
 
Re: Skipped shot this AM as well. What do you guys think?

my only thought is this... to increase 1 whole unit seems like quite a jump when the bg is @ 250... to me that's not an alarmingly high number, but i don't know your cat like you do. also, i'm not sure now how all the different insulins measure out - could be different than when i had to use it. if it were me, i would have possibly tried to increase by .5 or.25 unit...

i was most comfortable with everyone's motto of start low, go slow...
 
Re: Skipped shot this AM as well. What do you guys think?

Little One dropped to 60 at a preshot on 1u of N, which is an indication 1u is too much insulin, so I don't know why you raised the dose to 2u! This is certainly too much insulin, so please drop the dose! If you recently changed the diet to low carb, canned food, then this will lower blood glucose levels by 100-300 points and possibly cause spontaneous remission.

I would lower the dose to .5u or stop insulin completely and test for 3-7 days to make sure he still needs insulin. A preshot of 60 on N is very unusual since the insulin is out of the cat's system 6-8 hours after the shot, so this is an indication he may no longer need insulin.

Remember that too much insulin will cause numbers just as high or even higher than too little insulin, because cats' livers will dump glucose into their bloodstream to counteract hypoglycemia. Cats do not show symptoms of hypoglycemia until it is severe, so they can be chronically overdosed and if you're only testing preshots, you might not realize the cat is going too low. Tests at +3 to +6 will tell you how low he is dropping on the insulin.

IF he still needs insulin, then I would get a prescription for Lantus or Levemir ASAP. Humulin N is dangerous to use with cats--it has a very high incidence of hypoglycemic episodes and offers very poor control over blood glucose. Lantus and Levemir have an 84% remission rate in newly diagnosed cats, vs. 25% with N, and most of those 25% would have gone into remission regardless of insulin because of the diet change.
 
Re: Skipped shot this AM as well. What do you guys think?

Julia & Bandit said:
Little One dropped to 60 at a preshot on 1u of N, which is an indication 1u is too much insulin, so I don't know why you raised the dose to 2u! This is certainly too much insulin, so please drop the dose! If you recently changed the diet to low carb, canned food, then this will lower blood glucose levels by 100-300 points and possibly cause spontaneous remission.

Julia & Bandit - Thanks for the input. At any given time since we have been testing his lowest PS number has been 253 using 1 unit. That is the main reason we increased the dosage from 1 unit to 2 units. We didn't increase from 1 unit to 2 after a BG of 60, even I know that wouldn't be a good idea and I don't know much. He was at 296 PS last nigh, we gave 2 units for the first time since our testing started and at +2 he was 52. This morning PS was 60 so we did not give a shot.

Because we work all day it is impossible for us to get good test data during the week, but the one test we were able to do (8/20) he was 328 PS and 298 @ +5. I would have expected him to be much lower than 298.

Is the N leading to such odd numbers? One day he is at 328 PS we give 1 unit and +5 he is still at 298. Another day he is 296 PS we give 2 units and he is 52 at +2?

I plan to test his as soon as we get home from work tonight and I bet he is back in the 300s.

This weekend we plan to get a +3, +6 and +9 test if he will cooperate.
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Re: Skipped shot this AM as well. What do you guys think?

I also forgot to mention that i tested twice this morning just to double check becase I was supprised his BG was still at 60.
 
Re: Skipped shot this AM as well. What do you guys think?

Increasing the dose on twice a day shots may send your cat into a hypo when he hits his nadir around 3 to 4 hours after the insulin injection.

Keep in mind that N insulin lasts roughly 6-8 hours in the cat, so when you test 12 hours later, of course the glucose level will have jumped up as the insulin will have worn off after the 8 hour point.

You may do better shooting every 8 hours spreading the dose so it works better for him without taking him too low. You can't get the insulin out once you've put it in!
 
Re: Skipped shot this AM as well. What do you guys think?

I see..for some reason i misread the the 60 as yesterday's preshot instead of today's. Sorry about that. That does change things a bit, but we surely know 2u is too much insulin.

Here are the dosing guidelines for N: http://www.uq.edu.au/ccah/docs/diabetesinfo/link2.pdf. However, I would really work on switching insulins as soon as possible. N just does not work well in cats, because it causes huge peaks and valleys. There is also a window on remission, so the sooner you begin one of the better insulins the more likely you'll get your cat off insulin. Given that the large majority of cats go into remission on the other insulins, this is more likely than not if you switch. Note in the document where it states "Lente is the 3rd insulin of choice and NPH the 4th of choice insulin for control of diabetes mellitus in cats behind glargine or detemir (1st choice) and PZI (2nd choice), Lente and NPH result in lower remission rates compared to longer acting insulins."

Regardless of insulin, it's still very important to get mid-cycle numbers so you know how much the insulin is lowering blood glucose. When Bandit was on insulin, I worked all day and had a 2 hour commute so I couldn't go home and test him on my lunch break, so I got mid-cycle tests at night. Sometimes that meant setting an alarm, testing, and going right back to sleep, but it was 100 times worth to get Bandit off insulin (we used Lantus).
 
Re: Skipped shot this AM as well.What do you guys think?(UPD

Tested tonight when we go home from work and he was at 110. So we haven't given insulin for 21 hours now.
 
Getting a test in somewhere between around +3 or +4 would be very helpful in telling you how much he's dropping from the insulin, and whether or not he needs it.
 
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