Having trouble with numbers confused need help

Kyas been on 2 units of Nph in the morning for a month now and I thought was doing good. Took back to vet for a curve and vet upped it to 3 units. When I gave 3 units the other morning her b g dropped low enough to have me worried as you can see on her spreadsheet. I backed it down to 2.5 and vet has even told me she doesn’t need evening dose because her blood sugar continues to drop all day. I am becoming very sceptical of this vet especially because she tells me I should not have to worry about home testing. I keep seeing her numbers drop and then climb back up. I’m confused and wondering if I should get a second opinion. Yesterday she didn’t eat much lunch or dinner which I know if her numbers are good they are not ravenous. This morning she didn’t finish her can of food so I gave her 2 units. I am confused if I am doing things ok. Need help. I am using relion prime machine.

 

Novolin is an intermediate insulin generally will last 8-12 hours in a kitty's system. It is not intended to only be dosed once a day in kitties. The current dose is dropping Kya's glucose too fast and too low which in turn triggers a natural reaction within the body which causes stored glucose to be released, since the body perceives the big drops and low numbers as an emergency. This will cause readings to 'bounce' up much higher as the cycle ends. Without the second dose of insulin the numbers stay high or even climb higher. So for 12 out of 24 hours your kitty is without insulin.

No disrespect, but your vet does not seem to understand FD. A kitty's metabolism is much higher than a person, or any other animal. The suggested starting dose is usually 1 unit TWICE a day at about 12 hour intervals. You are home testing, which is excellent. You might want to consider dropping the dose to 1 unit and giving it twice a day at 12 hour intervals. Continue testing before each shot allowing about 2 hours with no food before the preshot test. Doing a curve...testing at prehot and then every 2 hours will give a good picture of when the onset...when insulin starts working and when the nadir (lowest number) happens. Using this information dose adjustment can be made, preferably doing changes of 1/4 unit at a time.


The link below has some good information on how novolin works:


http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-novolin-humulin-nph.186097/

 

Today she did not eat all the breakfast so I dosed her with 2 units. On her spreadsheet, at 1030 it went down to 42. Now she won’t really eat and I have given corn syrup. She has had some temptations treats and a couple kibbles and a little bit of tuna. I’m stating to question the vet. Now should I not dose at all tomorrow even if numbers are high or should I start tomorrow out with 1 unit in morning and 1 unit in evening? I also gave anti nausea in case it’s her tummy as well

 

It is best if Kya has a good meal before the shot. Novolin can start acting in as little as 1 hour ( depending on the kitty) so having a good meal on board before the shot will help make sure the numbers don't drop too rapidly. With novolin it is suggested that you test...feed the meal...and give the shot 30 minutes later.

Temptation treats are higher carb and can cause glucose numbers to rise, so using something like a bit of plain chicken or a little bit of tuna as a treat are better.

Since you are doing a good amount of hometesting you could start with the 1 unit dose TWICE a day at the next shot time.


The information below is from the link I posted above and has some good information on starting doses and reviewing the dosing. My thought is that once you start on a lower dose given twice a day you should see less big swings in the glucose levels.

"
STARTING DOSE - N/NPH

Usually it’s best to start with no more than 1 unit of insulin, twice a day. Post on the forum for advice specific to your own situation.

Generally speaking, for newcomers to N/NPH it’s recommended that no insulin is given if the BG is below 250 [13.8] on a human glucose meter. And you may wish to use a slightly higher ‘no shoot’ number such as 300 mg/dL [16.6 mmol/L] in certain circumstances. (See ‘Blood Glucose Reference Information’ further down the page).

If you’re using a pet meter, such as Alphatrak 2, be aware that these usually give slightly higher readings than human meters, so you may wish to have a slightly higher ‘no shoot’ number.
There is no general formula for converting human meter numbers into pet meter numbers (or vice versa). You are therefore encouraged to perform your own side-by-side comparisons with a human glucose meter, and/or to consult your vet for information about the specifics of your particular meter.

Note: Because the ‘no shoot’ threshold levels are often slightly higher for N/NPH insulin than for other insulins, it is particularly important that you monitor your cat’s urine for ketones. See ‘Testing For Ketones’ section further down the page.

• If, after at least a week, and having reviewed your cat’s BG levels, the dose doesn’t seem sufficient, dose increases may be considered in very small increments. Increasing doses of N/NPH needs to be done with great care. DO post on the forum for advice if you are considering dose increases for your cat. And if in doubt consult your vet.
• If you have reason to be concerned about hypoglycemia, or if your cat won't eat, decrease the dose immediately and contact your vet.
• Don’t ever inject insulin twice! Sometimes we may not be sure if we’ve given an insulin shot correctly. Perhaps we notice that the fur seems wet where we’ve injected (a 'fur shot'). If this happens, never repeat the shot/ injection. You may give too much insulin and your cat’s BG may drop too low. We have a saying regarding BG levels: “Better too high for a day than too low for a minute.” Safety first!

UNDERSTANDING 'ONSET, PEAK / NADIR and DURATION'

N/NPH can start to have an effect soon after it’s been injected. It may start to drop BG well within 60 minutes. The point at which the insulin starts to have an effect is called onset. After onset, BG will continue to drop for a time, and the process may speed up. Be aware that N/NPH typically drops the BG fast, but this is not the case in all cats. ‘Home testing’ will help you to determine how the insulin works in your cat.

The lowest BG level of the cycle is referred to either as peak (peak insulin activity) or nadir (lowest BG). Experience of N/NPH on this forum has shown that the time of the peak can be quite variable, and, depending on your cat’s own response to the insulin, you may see this anytime between 2 - 6 hours after the insulin shot; though in most cats it will be between 3 - 5 hours after the shot. With N/NPH it is particularly important to know when the peak/nadir of the cycle typically occurs in your cat.

The length of time that insulin remains active (lowers BG) in your cat’s system is called the duration. N/NPH typically has a shorter duration than other insulins, with some cats only getting around eight hours. But your cat may get a longer duration.

‘Home testing’ will help you to determine when onset, peak /nadir, and duration typically occur on a given dose of insulin. Knowing these patterns can be extremely useful, and will help you to keep your cat safe.
"

http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-novolin-humulin-nph.186097/

 

Corn syrup will wear off pretty quickly so I'd test again if it's been an hour or more just to make sure Kya is not dropping again. I see the last reading of 82 on the spreadsheet but am uncertain how long ago that was.

 

I just took at reading at 3pm and it was 110. My concern is she may be dehydrated and is not eating much. I did go to Walmart a bit ago and got a jar of turkey baby food which she did eat some but that is about all she had besides the little bit of tuna, 5 dry kibbles and a couple of treats. She ate most of her breakfast. I’m using a Relion Prime meter.

 

You can check to see if she is dehydrated by pinching her scruff and letting go. If the skin settles almost immediately, she is probably fine but if it takes a few seconds to settle, she may be dehydrated. You can also check her gums to see if they are wet (normal) or tacky (dehydrated). You can add some water to her food to get more fluids into her if she will eat. When did the lack of appetite start? I see you gave her anti-nausea med today. When and what was that prescribed for? Is she behaving normally otherwise?

I'm also wondering if you are checking for ketones. You can get Ketostix at any local pharmacy or Walmart and test her urine. Some folks can hold a long handled spoon under kitty's bottom and get a sample (if you do this label the spoon ). Others put plastic wrap in the litter box to grab a small sample.

She may be a little more sensitive to the insulin right now given that low today. I'd definitely lower the dose and give it twice daily instead of once daily going forward as the effect of one shot a day may be making Kya feel poorly. Tonight, I'd withhold insulin completely unless her PMPS is above 200 and she is willing to eat a reasonable amount before her shot.

 

I’ve been doing syringe fulls of water if tolerated.
She has had some more baby food. But that’s all. She is not getting any more insulin today. I will start tomorrow with 1 unit in morning and 1 in evening if she eats well for morning.

 

Sounds like a good plan. I would also seriously suggest if her appetite doesn't pick up by tomorrow morning that you test for ketones. They can cause inappetence and can get serious very quickly especially if there is dehydration and an infection or inflammation of some sort going on.