Very high pre-shot numbers - increase/decrease dose?

[Kot]

Bailey has been on Humulin N for short of a year now. He was well regulated up until recently. His numbers were between 100 and 160 pre-shot and I was giving him 0.5U of insulin twice a day (he is a 10 lbs cat). That was a very low dose and it worked beautifully. We had a summer vacation trips when he was given the same dosage of insulin but once a day by our cat-sitter for one of our trips and no insulin at all for three days for our second trip (end of August). His numbers have been very high since then and I can not get him regulated with 1.5U twice a day now. He also eats like crazy - we will be seeing a vet at the end of the week about that. I am not sure if I should up his dosage because we had lots of Somogyi Rebound issues last winter when I finally went against my vet's suggestions and was decreasing dosage from suggested 2-3 units twice a day to 1 unit and then to 0.5 units. Need to mention that his BG never drops that low for me to suspect rebound; may be because he cries and I feed him about 5 times a day (small meals). Any advice would be very appreciated.
Thank you.

 

[Robin&BB]

Noting Sue's comments (before you reposted here), I have to ask: Is it possible your bottle of insulin has expired? Or could it have been accidentally left out (if your brand needs refrigeration) or held at the wrong temperatures during some the the time you were away?

Given these high numbers you're seeing right now: If you're not already testing for ketones, you should do that.

We had a summer vacation trips when he was given the same dosage of insulin but once a day by our cat-sitter for one of our trips and no insulin at all for three days for our second trip (end of August). His numbers have been very high since then and I can not get him regulated with 1.5U twice a day now.

From the Humulin N "Primer" sticky: 10. BID (TWICE PER DAY) dosing: In all the years of being on and off the FD Boards (since 10/97) I have not come across a cat that got any more than 12 hours duration on N. It is NOT a single dose per day insulin by any stretch. Increasing dosage does not make the insulin last longer, it only makes the cat’s number see-saw more, dropping them lower which causes their glucose to go higher. If your vet wants SID (one dose per day) please explain this to him/her and if they refuse to listen, PLEASE INSIST that you do twice per day dosing.
Even on slower acting insulins like L and U, MOST cats need insulin twice per day.

I have never used Humulin N insulin for my own cat, so would be hesitant to give you dosing advice at this point. But have to wonder if perhaps the once-daily dosing while you were away, and then the lack of insulin for a few days at end of August, may have contributed to the trouble you're having in getting Bailey regulated now?

I am glad to know that you'll be seeing the vet by week's end, as you'll also want to have some blood work done to rule out any infections/ inflammation/ other conditions that may be helping his #s spike. Please keep us posted. Will be thinking good thoughts for you and Bailey in the meantime.

 

[Kot]

Saw the vet on Friday, did some bloodwork - we'll know results tomorrow, Monday.
I agree, the once-a-day shot and then not having any insulin for a few days would have thrown him in a loop. Previously, though, we did manage to be away for the same 3-4 days with Bailey not getting insulin shots and I was able to bring him back to "normal" (100-150 readings) within a week.
We also have lost his sister two weeks ago - I wonder if that is somehow intertwined here....

 

[Robin&BB]

Saw the vet on Friday, did some bloodwork - we'll know results tomorrow, Monday.
I agree, the once-a-day shot and then not having any insulin for a few days would have thrown him in a loop. Previously, though, we did manage to be away for the same 3-4 days with Bailey not getting insulin shots and I was able to bring him back to "normal" (100-150 readings) within a week.
We also have lost his sister two weeks ago - I wonder if that is somehow intertwined here....

Oh, my ... I'm so sorry for your loss! And it wouldn't surprise me if losing his sister is one of the factors that is throwing Bailey off-kilter lately. Poor little guy! I'll keep keep thinking good thoughts for him & you. And again, my sympathies for the loss of Bailey's sister.

 

[Cat Ma]

I am so sorry to hear about your loss. It is never easy and I am sure Bailey is missing his sister very much.

Hopefully nothing else is going wrong with Bailey. That is wise you did lab work to rule out other issues for Bailey.

As Robin&BB recommends, it is a good idea to test for ketones. You can purchase ketones strips anywhere diabetic supplies are sold and do this at home. If you need help with how to do this, please let us know. Ketones put a cat at risk for DKA, a very expensive and potentially life-threatening condition.

You mentioned Bailey's BG #'s spike after eating. What food are you feeding Bailey? You'll want to aim for low carbs (canned, wet or raw) under 10%. If you're feeding more than 10%, you'll want to transition Bailey to a low carb diet slowly. Chart of cat food; the third column "c" is for carbs: http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

CJ was on Novolin twice a day. She never got more than 6-8 hours of benefit on it with each dose. Novolin is a shorter-acting insulin and can be harsh on a cat.

Here's the guide Robin is referring to. Humulin is the same as Novolin, just a different manufacturer: http://www.felinediabetes.com/FDMB/threads/humulin-n-primer.303/

You mentioned you feed Bailey 1 hour to 1 1/2 hours before testing/giving insulin. Per the primer, 1 hour before is recommended.

Please keep us posted on Bailey's lab results.