UK Possible rebound? Not yet regulated..

[soapachu]

Hi there -

Wicket was diagnosed about a month ago, and we've been adjusting his insulin dose slowly and performing a glucose curve once a week before making any further changes. Numbers were high to start with (30mmol/540mg/dl dropping to 25mmol/450mg/dl at nadir and then back up) and started to improve until last week, when we had a curve starting at 23mmol/414 and bottoming out at 9mmol/162. We weren't able to test that weekend, so didn't make any adjustment.

At next curve, the opening reading was 8.5mmol/153, which was way low for first thing in the morning, so I called the vet who said to halve the insulin dose (from 4units to 2units), the numbers just kept on rising, right up beyond what the meter will read (max 33mmol/594) and only started dropping after the evening insulin shot.
A few days on half dose and his numbers, whilst back on the high side, are starting to curve in the right way again. Is this likely to be Somogyi rebound? I should add that he seemed in perfect health/temperament all throughout the week prior and the funny numbers.

Have taken a few measures this evening and they're high (pretty much the same as they were last time he was on this unit dosage), but he seems grumpy, growly and a bit out of sorts. How long does it take to recover from this so we can get back to aiming for a regulated curve?

Edit - just checked his pre-meal reading this evening and it's off the scale again (higher than 33mmol/594mg/dl) and he's pretty grumpy again. Have administered the 2 units again, plan to do a full curve tomorrow to see if I can understand what's actually happening.

Bit worried, so any and all advice appreciated!

Thank you.

 

[Sue and Oliver (GA)]

Re: Possible rebound? Not yet regulated..

Welcome! Can you give us some more information? What kind of insulin, what dose did you start with and what dose is he on now? what food?

 

[soapachu]

Re: Possible rebound? Not yet regulated..

Welcome! Can you give us some more information? What kind of insulin, what dose did you start with and what dose is he on now? what food?

He started out on 1.5 units of Caninsulin twice daily (there are no other approved options in the UK, I know it's not the best) , and moved up on half-unit increments to 4 units twice daily, which gave us the lowest numbers, but I suspect (given what's happening) was too much, or at least causing the steep drop which might have triggered rebound.

He's a big cat (7kgs/15lbs) and is on the MD dry food. I intend to change this as soon as possible, but trying to wean him onto wet food - he really really hates it - as well as trying to regulate him seems like a bit much all at once.

 

[Sue and Oliver (GA)]

Re: Possible rebound? Not yet regulated..

Canninsulin is not the easiest insulin to use but you do not have many options in the UK. Some people have been able to get their vets to switch over. You might add UK to your subject line to get their attention (Go back to the first post and edit it and resubmit)

It is probably the dry food that is helping to keep the glucose levels high for that large dose. (The average dose on the forum is probably one unit, with some cats getting .25 units and some getting 2 or so) There are some conditions that cause high insulin doses, but the dry food is more likely the culprit.

A vet has great ideas for transitioning from dry to wet here: www.catinfo.org I would suggest starting with small amounts of wet mixed with the dry and gradually increasing. This way you can keep track of the numbers and adjust the insulin accordingly. (Our Oliver went down 100 points overnight when we suddenly switched. It can make a big difference)

We use US numbers on the forum so multiply yours by 18 to help us out. We have a spreadsheet http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 Not only is it easier for you and for us to figure out what is going on (it's color coded so easy to see patterns at a glance) but it converts from metric to US. If you have trouble getting it to work, just ask for help.

As far as your numbers. The 8.5(155) was low for a morning preshot number. Canninsulin doesn't last for the whole 12 hours in many cats so the long cycle and low number certainly indicates the dose was too high (you test before feeding, right?) It sounds like your kitty takes a while to adjust to a dose (in the beginning and now after you have halved the dose) The best way we can help you is for you to set up the spreadsheet, fill in your numbers and let us see the big picture.

 

[soapachu]

Re: Possible rebound? Not yet regulated..

You might add UK to your subject line to get their attention (Go back to the first post and edit it and resubmit)

Done.

A vet has great ideas for transitioning from dry to wet here: www.catinfo.org

Have read that and ordered some of the wet food recommended on a link I saw elsewhere here.

We use US numbers on the forum so multiply yours by 18 to help us out.

Done.

As far as your numbers. The 8.5(155) was low for a morning preshot number. Canninsulin doesn't last for the whole 12 hours in many cats so the long cycle and low number certainly indicates the dose was too high (you test before feeding, right?) It sounds like your kitty takes a while to adjust to a dose (in the beginning and now after you have halved the dose) The best way we can help you is for you to set up the spreadsheet, fill in your numbers and let us see the big picture.

Yes, I test right before feeding. I'm wondering whether, as you say, he's been taking a while to adjust and we increased the dosage too quickly, resulting effectively in an overdose. I read elsewhere that it can take two weeks to properly see the effects of reducing insulin after a rebound - I've just been worried about him spending loads of time with such elevated bg.

The Caninsulin has been lasting about 6 hours (that's when the nadir has been) when we've had 'normal' looking curves.

His pre-meal reading this evening was off the scale again (higher than 33mmol/594mg/dl) and he's pretty grumpy again. Have administered the 2 units again, plan to do a full curve tomorrow to see if I can understand what's actually happening. Will keep you posted. Am terrified of ketoacidosis again (how we found out he was diabetic in the first place) hence worrying so much. Plus he's my baby...

Thanks

L

 

[soapachu]

Re: Possible rebound? Not yet regulated..

[quote="Sue and Oliver (GA)"
It is probably the dry food that is helping to keep the glucose levels high for that large dose. (The average dose on the forum is probably one unit, with some cats getting .25 units and some getting 2 or so) There are some conditions that cause high insulin doses, but the dry food is more likely the culprit.

A vet has great ideas for transitioning from dry to wet here: www.catinfo.org I would suggest starting with small amounts of wet mixed with the dry and gradually increasing. This way you can keep track of the numbers and adjust the insulin accordingly. (Our Oliver went down 100 points overnight when we suddenly switched. It can make a big difference)[/quote]

Just thought I'd update - we have started transitioning to wet food this weekend with some good success initially and his numbers seem improved on last week so fingers crossed!

Thanks for the help.

Lyssa & Wicket

 

[Sue and Oliver (GA)]

This is good news! It's amazing how the diet change helps most kitties.

The other thing that will help you and us (especially when you are looking for dose advice) is the color coded spreadsheet.

Here are the instructions:


http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

It's a little tricky, so if you need help, just ask.

When you put it in your signature, please add the wet low carb diet and insulin type. Then we won't have to bug you each time with questions.