Bounce, not enough insulin, something else?

Can you guys please look over Peanut's spreadsheet and see what you think. I am trying to slowly increase to a dose that keeps him regulated. I can't seem to get him there.

Do you think I'm giving him too much insulin? Not enough? Is he bouncing? I don't think he drops low enough to bounce. Would a change of insulin help?

I just increased him to 2.4 units tonight, 309 at PMPS, 326 at +2. He has had 2 pee accidents today, chugging water, and is lethargic. This can't go on forever. What would you do with a spreadsheet like Peanut's?

He has a vet appointment tomorrow morning too, so if he needs a different insulin I can do that.

 

Hi Kait. I usually live in the Lantus or the Acro subforum. But I did help write the Prozinc FAQ.

Peanut is not regulated. Peanut is not achieving nadirs (+6) in the 100-150 range on a regular basis. Each 12 hour range should see him dip into that range. Since he is not regulated, his kidneys are filtering out the excess glucose from his bloodstream. It takes water to do that. The water gets excreted in urine.

I would keep raising the dosage until that occurs. For Lantus and Levemir, we increase by 0.25. We generally like to adjust dosage based on the nadir achieved.

The one concern I have is the low nadirs at the lower doses.
June 4 - 150
June 9 - 166
then
July 11 - 127

Was Peanut not getting enough food then? Or has there been carb food involved?

Overall, nice job with the spreadsheet. If you are home during nadirs, please start taking tests and recording them. It is the only way to know if the dose is effective.

 

Good morning Kait. Jeff didn't just help write the Prozinc stickies...it was his idea to redo them in the first place! They used to be pretty old and out of date and he came in one day and pointed that out and suggested we redo them. He pretty much got the whole thing rolling so we can all thank him for them being up to date and for having the advanced technique sticky up there.

I agree that Peanut needs more insulin. You're getting a reaction, but not enough of one...the nadirs aren't even close to low enough. I'd keep doing those 0.2 increases (looks like you're using u100s right?) every 6 cycles until you can get those nadirs lower. I think the problem may have been holding the dose too long before when you weren't getting the action you need. He's not on a super high dose of insulin or anything yet, so I'd keep the increases up for now.

 

Great advice from Jeff and Rachel!

 

I don't understand the low numbers either. That's what makes me uncomfortable about dose increases. The vet did not permit dose increases for a while, and I just recently was allowed to increase up to 2.5, but that 127 caught me off guard.

He changed food recently to fancy feast classic pate. He eats 6oz for breakfast and 6oz for dinner. I've been giving him tiki cat food for a snack at +6. He throws up from hunger if he only gets 2 meals a day.

I use u-100 syringes. So 6 cycles per .2 unit increase and if he does see nadirs of 100-150 then another .2 increase?

 

The nadir never went to a dangerous level...most of those days you had 100 points or more to drop so really they’re not at all dangerous. What those blues showed was you were getting some good action from the insulin but not enough.

Yes I’d do 6 cycles (so 3 days) at a dose and then if nadirs aren’t going down into greens I’d increase again. Waiting too long for increases can cause them to get stuck up in higher numbers which makes it harder to break through and get them back down.

 

Thanks Rachel.

We can still be proud of that accomplishment. I think it was 2 years ago. We should probably have a committee review all the stickies, and at least update the links.

@Kait & Peanut - more good advice from others. In general, Peanut will need more insulin so that he can shed some of these diabetic side effects like drinking and peeing. If Peanut is at a good weight, or slightly under, consider feeding him more. I like to get a little fat on my kittehs to take them through the lean-eating spells.

Another side effect for unregulated kittehs is lots of eating. That's because they are not absorbing all the calories. Once Peanut is regulated, those hunger urges slow down. Now that Leo (my cat) is regulated, I free feed him. And he doesn't over eat.

 

Happy 3rd Diabetes Anniversary - Leo <<--- link

Thank you Kris, Rachel, and FDMB members and helpers. Thank you FDMB moderators.