? .5U Too Low; 3U Too High...What’s Just Right?

Soleil has been on Novalin N for a week today. In the beginning, because I wasn’t knowledgeable with the syringes I received, she was only getting half units vs what was prescribed by her vet that diagnosed her. When I learned that I was using the wrong measurement, she started getting 2U. When we visited her new vet for the first time, I was advised to move up to 3U.

Her numbers still ran high on half units. They were a little lower with 2U but not low enough to be out of the danger zone. 3U took her way too low yesterday evening. Now I’m not sure what to give her this morning (as of 12:30 am EST she came in at 301).

I’ve read through the sticky note about this particular insulin twice and I plan to print it out so I can highlight what I need to retain. Currently, though, I’m lost on where I should be dosage wise. I don’t want to leave her too high, and I definitely don’t want her going too low. Clearly 3U is too much, so she’s definitely not getting that.

Any guidance for this is greatly appreciated. While I consulted the vet when I initially tested her yesterday afternoon and she came in at mid-200’s, by the time we got to the vet her numbers increased to mid-400’s and she still advised the 3U. After last nights steep dip in numbers, I don’t plan on going that high again anytime soon.

It would probably help to add that Soleil is a diabetic that isn’t obese. She currently weighs 9lbs, but used to be at least 12lbs. I’m not sure if this information helps.

 

A couple of things:

• we always recommend dose changes in tiny fractions of 0.25 u because a whole unit is far too large a change (syringes with half unit marks are useful but eyeballing is needed even with those)
• Novolin is a strong acting insulin with the ability to drop BG quickly and low setting the stage for a rebound phenomenon we call "bouncing" (more below)
• it's essential to know how low a dose takes her BG in order to properly assess it - the pre shot tests are done to know if the planned dose is safe to give (ie., PS is high enough to support it) but aren't reliable in assessing the dose (rebound inflated quite often)
• middle of cycle tests in the +3 to +7 range are important on days you can manage them but evening tests are also useful
• you can try dropping back to 2 u for a few days, getting more tests this weekend and then increasing to 2.25 u if BG levels warrant that.

Here's the basic testing routine we recommend:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

Here's an explanation of bouncing:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.

I hope this helps.

 

What you experienced yesterday is not an uncommon problem. Our kitties find vet visits very stressful and that causes their BG to elevate often 100 or more points. Looks like Soleil was not a happy camper going to the vet given that huge increase in her BG at the vet. This commonly causes vets to prescribe too much insulin because there is no way for the vet to know if the readings they take are true or stress elevated and if stress elevated, by how much. This is why we advocate home testing that gives you the ability to take a more hands on approach to dosing.

Your instincts are serving you well.....the 3u dose is too high and should be lowered given the low reading of 64 yesterday. Looks like you may have skipped the shot this morning despite that higher pre-shot reading. It would be helpful if you would indicate "skip" in the dose column (if that's what you did) for future reference.

Kris has given you a great explanation of bouncing and I think Soleil has definitely been bouncing a fair bit.
I like Kris' suggestion of reducing the dose to 2u for a few days to see how that works for Soleil.