We need eyes on ss

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Charlotte & Prop

Charlotte & Prop

Member Since 2011
Hi everybody

Bølles numbers are still getting skyhigh after the change to levemir. He is pretty stable for a few days and the he goes from 180 at +5 to 550 at amps. He was at 0,5 unit during last week and this weekend we changed his dose to 0,6 u because his numbers were getting higher and since he wasnt in the green numbers at all.

When he was on caninsulin he had the same high number, just a lot more.

Can you help os with what is going on, is it rebound or is the dose to low/high? Any other suggestions?

Please take a look:


Thanks
 

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CharlotteDenmark said:
Hi everybody

Bølles numbers are still getting skyhigh after the change to levemir. He is pretty stable for a few days and the he goes from 180 at +5 to 550 at amps. He was at 0,5 unit during last week and this weekend we changed his dose to 0,6 u because his numbers were getting higher and since he wasnt in the green numbers at all.

When he was on caninsulin he had the same high number, just a lot more.

Can you help os with what is going on, is it rebound or is the dose to low/high? Any other suggestions?

Please take a look:


Thanks
Click to expand...

I don't know Charlotte but it looks like maybe Bolle went low on the 10th then bounced in the morn, so you upped the dose and now maybe Bolle's going even lower when not catching a test, resulting in another bounce and getting the black amps.

I think the .5u looks better, and maybe the .6 is too much
 
Charlotte if I am reading the spreadsheet correctly he was on as much as 4U of Levemir a month ago? Or was that Caninsulin?

With spotty spreadsheets (meaning few mid-cycle tests) it is difficult to tell why they have high BGs at preshot.
However, with the few 100s and even greens they have gotten I agree with Gayle that he is probably getting a little too much insulin.

Unfortunately there have been too many dose changes to know what might be the best dose. HIs body is clearly not used to those lower numbers, so picking a dose and staying with it for a longer period than 3 or 4 days might help in that regard. We have seen that some cats just take longer to settle on a particular dose. You cannot rush Levemir, especially when it shows so much promise with Bolle. Sorry I can't spell his name right.

Sometimes in cases like these we recommend lowering the dose even further and staying with that dose for at least 5 days. That period of time should allow the rebounds to clear and give a better example of the curve after the 5 days on that dose, to help you know whether he needs more insulin or less. If they are willing, I suggest .25U.

I hope that helps. Bless you for helping yet another family with their diabetic kitty!
 
Thank you so much both of you. Bøllr has only been on levemir for a few weeks. The 4 units was before the family contacted me and it was with caninsulin. The vet told the family to give 4 unit because he was in the 600, but it is clearly rebound.

Is it possible to rebound when Bølles numbers not are green? the midcycle numbers are at +5 during the evening at weeksnights and then in the weekend there are more midcycle numbers.

Vicky what do you mean when saying that levemir shows so much promise with Bølle?

If we lower the dose to 0,25 u and his numbers stays above 400, should we still keep on doing it for 5 days?

Thanks once again :)
 
CharlotteDenmark said:
Thank you so much both of you. Bøllr has only been on levemir for a few weeks. The 4 units was before the family contacted me and it was with caninsulin. The vet told the family to give 4 unit because he was in the 600, but it is clearly rebound.

Is it possible to rebound when Bølles numbers not are green? the midcycle numbers are at +5 during the evening at weeksnights and then in the weekend there are more midcycle numbers.

Vicky what do you mean when saying that levemir shows so much promise with Bølle?
Click to expand...

Because he has had green numbers on very little insulin. The more important numbers are the green ones, because they prove the insulin is working. They are infrequent because of all the rebound hormones causing so much havoc in his body.

CharlotteDenmark said:
If we lower the dose to 0,25 u and his numbers stays above 400, should we still keep on doing it for 5 days?

Thanks once again :)
Click to expand...

I am going to answer yes because you need a basis from which to increase the dose and they can suddenly respond after 4 days, 3 may not be enough. Is he eating a good low carbohydrate diet? If he is eating any dry food, that may also explain some of the high BGs. I also recommend testing for ketones every day if possible, especially if he is not eating well, has lost weight or been treated or suspected of having any type of infection.

Insulin management is sometimes counter-intuitive. You see high BGs and because we tend to think more of anything is better, you want to give more insulin. It is sometimes very difficult to help new feline diabetic owners to understand that. I know you are understanding more about how Levemir works now since helping Pelle. Sheila may be along tonight, she understands very well how Levemir acts when the dose is too high. Her cat Beau was on Vetsulin (US version of Caninuslin) for 2 years and he went OTJ on Levemir in 3 months because she saw that although he got high numbers, he was also getting low numbers and she went against that tendency to think more of something works better.

She may be able to explain better than I am.
 
If his health is good and he is eating a low carb, wet food diet seeing numbers in the pinks, reds, and blacks usually indicates rebound. If his owners are willing to start over with .25u and hold that until they can do a curve on Saturday, you might see more stable numbers and can figure out from there where to go next.

One thing that is very hard to figure out from the numbers is the difference between a little too much insulin and a lot too much insulin. The first (a little too much) often shows high, flat numbers, but give a bit more and you see some nice green lows AND the higher numbers. That makes it look like the higher dose is better - until there is a sudden drop to a very low number.

He was clearly getting too much on 1u, but after you dropped from there, the dose wasn't held very long. For instance, I would have held the .75u for 3-5 days to see if he stabilized on that dose. It's so early on lev that there isn't a lot of data to see a pattern yet.

Beau was on about 1u of vetsulin (caninsulin) when I switched him and I started at .5u. He had an immediate response to it and on the 3rd shot dropped very low. He was never on more than .5u, but it took me a while to figure things before I started lowering his dose because on .4u his numbers looked worse. After I got him to .3u his numbers got better.
 
Thank you so much both of you.

Bølle is only eating low carb, around 4% of carbs. He is in good health. His weight has stopped dropping after the change to wetfood and lev. He is happy and playfull.

His pmps was 355 when he recieved his first low dose of lev. The family gave him 0,25 as you suggested or maybe it was 0.3 because it was easier to measure. His +5 was 263. Amps this morning is 450. The family will try to test for ketones.
 
Bølles pmps is 403 so that is 47 points lower than amps, but still high. I have to say since he so many times has jumped right above 500 i was a little surprised that it didnt happen now, so i really hope this lower dose will stable his numbers, and hopefully will begin to drop within a few days.
 
Something is definetly working for him. Pmps last night was 403, his +5 was 241 and amps today thursday morning is 227. So this lower dose is doing something for him. We keep expecting him to bounce skyhigh because he always has, but we keep our fingers crossed.
 
500 at pmps, so once again a big bounce. Could this low dose still be to high. He was 227 at amps and got 0,25 u and now skyhigh. Do we keep the dose since it has only been 2 days or should we lower it even more?
 
That's a shame about the 500 again. I wonder about the impact of the diet change alone in Bolle's case. Some cats can come right off insulin once the diet is changed. So yes, even .25U could be too much.

200s really aren't low enough and were not a large decrease from the previous preshot to cause a 500 rebound again at next preshot. That's why I wonder if there isn't some pancreatic activity here causing sudden lows which they aren't capturing with mid cycle BG tests.

Can you give us an idea of how much carbohydrate was in Bolle's previous diet compared to what he eats now? I would suggest doing a no insulin trial to see if he can bring his blood glucose down on his own, but that is risky.

If they can manage giving a couple drops of insulin via Sheila's drop method, that would be preferred to no insulin at all.
 
I would hold the dose. Will they be able to do a curve on the weekend? He will have been on the new dose for 4 days, right?

He might still even out more. His body doesn't know what to expect with insulin right now and may still be over-responding to it even a little drop in BG.

Can you get ketonstiks there? To test for ketones? Here you can get them at any pharmacy and are pretty easy to use if you can catch him in the act of peeing. Hold one under his urine stream or dip in the puddle immediately after he is done before it soaks in (you have to shoo him out of the box). It would be a good idea to use them once a day to test him for ketones, if you can, while he is giving you high numbers. It's just a precaution. He is getting to low 200s, which is good.
 
Yeah, I agree it's better to hold the .25U at this point than to take away insulin all together or even lower it further. Are there certain days of the week when they can check his BG more often, at least every 2-3 hours? I would really like to see a complete curve on .25U after he's been on it for at least 3 days.
 
I believe Bølle was eating dryfood with 46% of carbs before the change to wetfood. His food now contains between 3-5% of carbs. Nina bølles mom told me she got some ketosticks yesterday, but im not sure if the have been lucky to get him in the act yet :)

Today is day 2 on .25 u so saturday will be day 4 and i can ask if it would be possible to do a curve with test every two hours, so we can see if there is a pattern.

Thank you so much both of you, your help means a lot to us :)
 
Hi all you helpful souls
I am Bølle's mom and so grateful Charlotte helps me managing him and now all you guys. Bølle was diagnosed January the 5. numbers 403 and started Caninsulin and I followed the vet's instructions about diet. The vet prescribed Hill's Prescription Diet M/D wet and W/D dry despite I expressed my doubts about the carb percentage in the dry formula, but the vet said, that it was the correct diet for a diabetic cat. His numbers stayed constantly high. I changed the diet after having found Charlotte's homepage. Bølle has been on low carb diet (max. 5%) since the middle of February.
He had terrible numbers on Caninsulin, I was really worried and changed him to Levemir March 2. pmps.
Sorry, I am not able to do a curve until saturday because of work.
Bølle is feeling all right as far as I can tell.
I have brought home some Ketostix and will do my best to test him.
I have been practicing drops using a pin as measurement and trying to do my best to aim for .25u. I am using BD microfine with half-unit marking.
 
Nice to meet you, Nina, welcome! Saturday is a good day for a curve. Don't worry about it till then.

The old food carb percentage was very high! Even the Hill's brand M/D is higher than we recommend, so I'm glad you quit using it too. Diet is very important to feline diabetes management and you are doing the right thing.

I'm not sure what types/brands of syringes are available in Europe, but the American BD brand has been found by a study done here on the board to be of poor quality. Here are the comparisons:

http://www.felinediabetes.com/phorum5/read.php?22,1462377

I used BD syringes for a short time. I had to leave Gandalf at a University clinic for Hyper-Thyroid testing and gave them those syringes to use. The vet on his case used them to give his insulin and recognized that the bubble they often get at the top, mentioned in the study above, displaces the insulin and with such small doses really causes problems.

I don't know if the BD brand syringes you have are like that or not, but they might be making it more difficult to maintain consistent doses. The drop method may actually help you more even with these syringes, so it's good you are doing that.

I'm very happy that we are helping Bølle. I learned how to spell his name :-D
 
Thanks Vicky - very nice to meet you too.
I have checked the syringes. It looks like they are manufactured in France and maybe not quite similar to those in US?
I am very aware of bubbles (I am a nurse myself) and checking every time to get the dose as accurate as possible, but it is tiny.
I don't think there are other brands of syringes available in Europe. Have not been able to find some.
Pmps 497 - just checked +5: 335
Now it's bedtime in Denmark, we will see what numbers he is displaying tomorrow.
I think, there's some sort of pattern. His numbers fall nicely, and as soon as he is between 150 - 185, he is bouncing up again.
Well I hope for the best. Bølle is really my best buddy :-)
 
Welcome Nina and Bolle!

Another thing to check with the syringes is that the zero line is at zero. With such tiny doses any space above it can really effect the dose. And tiny doses DO have an effect. I had Beau on .1u and even .05u at the end before he went into remission.

It may turn out that he needs more insulin, but he has been swinging between high and low, and you want to stop that first. He was on such a high dose of caninsulin that it may just take time to get him sorted out. Beau was up to 7u of caninsulin at one time! But also eating dry food at the time.
 
This morning amps 430.
I've checked the syringes ,and I think the zero line is at at zero. If I press very hard, I can make a tiny drop, but at this point the rubber stamp is really pressed flat. I would never press so much when injecting human beings.
I have just given him .25u and there was nothing left in the syringe, so I hope it was accurate.
I know I must be patient, Bølle has only been on Levemir for 14 days, and you are quite right, he was on a large dose of Caninsulin, because the vet raised the dose every time I mailed the numbers.
Nevertheless Bølle seems to be in better shape. His fur looks better than in January and February, he is happy have a normal behavior.
 
Yes, I meant to say he looked so cute in his photo! Gotta love those orange boys!

On the zero line, I always check each one before I draw a dose. In a batch of 100 syringes I might have 25% with the lines printed "off" - this means some have the zero line overlapping the barrel end (so up to .1u less insulin) or below the barrel end with up to .25u extra insulin. I just always check and adjust the draw to compensate. I use a different brand than you and it might be the brand. If you find that after several weeks there are no "off" lines, then maybe you don't need to check like I did. Just wanted you to be aware of it with these tiny doses.
 
yes I do love the oranges boys. Actually he has an orange stripe crossing his white belly - always looks so cute.
I've checked the syringe - it looks like it's ok at zero line, but I will keep an eye on it for sure.
Pmps 430 - maybe he's leveling out now - we will see tomorrow, when I do the curve.
Thanks again for all your help and support
 
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