BG at 168 - do I dose.

First I haven’t set up my spreadsheet yet. Will do so today. Also am planning on doing a curve today.
Precious was diagnosed July 29, 2019. He’s on vetsulin 3 units twice daily.
Last week I got him switched to all wet food and freeze dried chicken for treats. Friskies pate.
I test morning and evening before eating. Here is the last 7 days beginning Oct 6.
354/301; 309/334; 349/284; 337/195; 320/295; 189/314/ 324/270 (am/pm).
This morning it was168.
I’ve never not dosed him before but don’t know if I should this morning. The way his bg fluctuates so much, though, I just don’t know what to do. My vet isn’t available on weekends.
Please help.

 

Just tested, 1 hour after eating. Bg is 268. I am going to dose.
Spreadsheet is done and posted.

 

Sorry you didn't get a response sooner. I see you asked if you should dose or not but that's obviously been missed. For the future if you need help right away using HELP NEEDED and "?" prefix would stick out more and grab faster attention.

What you did today giving a reduced dose this AM after seeing the BG rising is fine but you normally would not give insulin on a food influenced reading. That said, given the cycle you are seeing today and what the spreadsheet shows, I have to honestly think you've been seeing high pre-shots because of too much rather than too little insulin. Vetsulin starts acting quickly and usually peaks in action between +3 and +6 hours post shot so I'd keep an eye on things today to see how Precious does on the 1u dose. That may be a better dose for her.

Getting random mid cycle tests in the +3 to +6 post shot timeframe will tell you how low BG is going on a particular dose of insulin and that information is crucial to finding the best dose for Precious. Also grabbing some tests during the night cycle with a before bed test every night helps to fill in the picture as many cats go lower at night than they do during the day.

There is a phenomenon known as bouncing that occurs when BG drop quickly, drops a lot or down to levels kitty has become unfamiliar with. It's possible Precious has been dropping lower than you are aware and some of those high pre-shots are from bouncing.

I'd stick to the 1u dose for a few days and see if her numbers improve. Then if it appears she needs more insulin, we'd recommend raising the dose by 0.25u and repeat holding the dose to see how she responds while getting mid cycle tests. Dose increases of a full unit often result in skipping over the best dose and lead to unnecessary dose increases that can eventually become dangerous.

 

Thank you for your response. I’m trying to understand it all, but I think I know what you are saying.
First, I probably shouldn’t have given him a dose when his bg went from 168 to 258. If it continued to rise (without a shot) then what.
The high pre-shot levels...I don’t quite understand how that could be from too much insulin. I thought insulin made bg lower, not higher. Are you saying that after his shot, his bg drops so low that it reacts by bouncing high to try to even it out? And since I wasn’t testing on those days mid-cycle, I wasn’t aware of the drop.
As I said, I’m just trying to understand the information you gave me. Feline diabetes is new to me...it’s been a lot to absorb. But.
, thank you very much for seeing my post and responding.

 

I'm kind of butting in here, but I am not sure when Linda (MrWorfmen's Mom) will be back on the board. She is Canadian and it's Thanksgiving Day in Canada today.

This is from my collection of files:
Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high: (possibly contributing to your kitty's high BG at the high dose he's on)
BG goes low OR lower than usual OR drops too quickly.
Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
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.
These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
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.
*********

You are testing and that's good. And every day that you can get some mid-cycle tests in, (even a before bed test, or if you get up in the night to use the bathroom grab a test if you can) is going to tell you how low that insulin is taking the BG. That information is very important.

 

Thank you so much for the explanation! That makes perfect sense.
I will be talking to my vet tomorrow about the possibility he is on too high a dose. If she doesn’t agree, do you think I should just go ahead and lower his dose myself? I’ve Ben very concerned with the way his readings have been up and down. I know that can’t be good for him.

 

I don't feel comfortable advising you about dosing. All I know is what I read here and that is many many times vets do prescribe a higher starting dose than recommended here, or raising the dose by whole units too quickly. This does often result in "bouncing" and sometimes worse, on rarer occasions, in hypo events. I would say: educate yourself, read everything you can here, be cautious and keep Precious safe. You can always test, record, see where a dose takes him over a recommended period of time, and if necessary, adjust the dose. You can increase or decrease in smaller increments, when needed. I have read many times: it's better to be high for a day than too low for a minute.

Linda is very experienced with feline diabetes and if it was Idjit, I would heed the advice given. I trust her experience and wisdom.

 

Ok. I just did before eating test. It’s 269. Normally I would dose 3units after eating. I’m kind of reluctant to do that though since he did so well on 1unit today. I’m thinking 1 1/2 or 1.25?

 

@JanetNJ
@MrWorfMen's Mom

Tagging for dosing help.

You may want to just keep it at the one unit if someone doesn't tell you differently, and see what this dose does for a few days. Give it time to work and give him time to get used to it?

 

It's entirely up to you if you want to give 1.25u or 1.5u tonight. It may be that Precious will need slightly more than 1u but I definitely wouldn't go back to 3u given the lovely cycle she had today. If you feel better giving a slightly higher dose, that is fine. Just don't be swayed by the pre-shot number alone. The important information is how low the dose took BG and today may not have demonstrated the full ability of that 1u dose given Precious' BG went up when the Vetsulin would have been starting to act and then fell later. I can't help but wonder if you got that low pre-shot this AM because of a lower BG at some point the night before.

 

If it were my cat I might do 1 unit for a couple more cycles then decide if you need to raise it. Kind of like the idea of starting over with dosing since it was raised in whole units before.

 

Ok. I have a friend who is a vet and she said 1unit tonight would be good.
I have a really stupid question regarding the spreadsheet. The +1, +2, etc, is that post eating? That's how I was recording it, but just wanted to make sure.

 

The +1,+2 etc is the number of hours post shot. Your routine should be to check Precious' BG (AMPS & PMPS), feed her and wait 20 to 30 minutes and then give insulin. Any readings you take after that are put on the spreadsheet in the corresponding number of hours after you gave the shot.

 

His bg is277 this morning before eating. I don’t want to give him 3unuts but am wondering if 1 is enough. Suggestions?

*edit. I gave him 2units. Will test again before I leave for work.

 

As I mentioned earlier, don't be swayed by pre-shot numbers. Reacting to every single number individually never works. While sliding scale dosing can work for some cats once they are relatively stable and regulated, consistent dosing generally works better for most cats and particularly until regulation is achieved. I'd still recommend 1u for a few days or at most 1.5u to see how that works.

 

Thanks