glucose curve

My cat Ginger was diagnosed with Diabetes a few months ago, then they told me they misdiagnosed her and she was not diabetic after all.
She had new blood work done and ultrasounds done of her liver, pancreas and heart.
They found nothing wrong.

After she was brought home, I checked her glucose myself 3 times that week. It was normal each time.
She was still tho not acting herself and was lathargic. She then seemed a little better, tho still not herself.

Recently she started urinating on the carpet, so we took her to a new vet.
She IS diabetic.

I have had her on Humulin N 2x a day for the last 2 weeks. Her glucose readings have still been pretty high.
So I started her on the Humulin N 3x a day. Breakfast, dinner and bedtime.

The vet asked me to do a glucose curve today.
These were her readings:

7am (481) gave 3 units of insulin.
10am (110)
12pm (230)
2pm (387)
3pm (419) gave 3 units of insulin.
5pm (265)
7pm (184)
9pm (388)
10:30pm (451) gave 3 units of insulin.

She is on Humulin N, weighs about 18lbs and is 11 yrs old.
I feel these readings are pretty high.
Any suggestions are welcomed.

 

I'm sorry that nobody has replied to you yet -- this board tends to be a pretty quiet, since Vetsulin is being slowly phased out, and I think that Humulin is being used less and less (from what I can tell). It seems that the two most popular insulins in use here are Lantus and Levemir, and PZI-type insulins coming in third.

I can't really give you any Humulin-specific information, since I've never used it, but you may want to post this on the main health board where more eyes are likely to see it -- including people who have some prior experience with Humulin.

Having said that, I would agree that it looks like Ginger's numbers are a little high. That 10AM reading of 110 looks pretty good, but it appears that the nadir (lowest glucose level after the shot) is hitting at around the 3-4 hour mark, so the insulin seems to be getting used up fairly quickly.

I would wait until you hear from people with more experience with Humulin, though, before you chance the dose amounts or anything else. It could be that Ginger's body needs to get used to the insulin for a several more days -- or it could be that you may need to switch to a longer-lasting insulin (people seem to really love how Lantus & Levemir work on their cats, but you have to be able to give shots exactly every 12 hours, which is why I haven't switched to one of those).

I realize that I haven't really given you any practical/useful information here (sorry about that!) but I don't want you to think that you're being ignored, either!!!

 

hello.

It is good to see you cross posting on health etc and asking for thoughts where there are more frequent eyes.
I am posting this in both places...I also agree with the idea of testing for acromegaly.
Weight gain and need for higher than most doses ( as seen by how she is using the insulin now ) are good first indicators that this is a possiblilty.

For those reading.. I giving the following thoughts based on the apparent need for higher doses , the fact that N runs out of steam so quickly and the evidence of TID dosing in the past being successful for other kitties to create a shallower curve if needing to use this insulin along with the fact that heart issues have been indicated in the past.

That curve you posted has a couple of things that stand out to me.

1- the drop from 7am 481 shot to 10am 110 is very steep and fast.
This can cause kitty's body to feel really awful with the potential to cause the body to try and protect itself from going too low by dumping glucose into its system. This can then be seen as a higher preshot and a big drop once more following the original fast drop.

A too fast and steep drop can set up rebound the same way a blood glucose level that level that goes too low into hypo territory can.
This can be evidenced by high preshots 400s and drops to the 100s in the first 4 hours as nadirs....I believe you may be seeing this here. A big rollercoaster looking curve. This is really hard on kitty's body and one of the reaosns why we encourage switching to the longer lasting insulins. However you are not seeing a drop to hypo territory therefore I would not suggest dropping the dose back much here.

One thing you could do to try and create a slightly shallower curve would be to cut back your dose just a bit and continue with the three times a day shooting.
I would consider 2.5 units as a thought and try that.
A whole jump from 2 units to 3 units may have missed a good dose. Are you also ketone testing?

2- feeding
I am curious as to what the feeding schedule looks like and what you are currently feeding.
Would you mind adding that info along with the curve? I have added examples to the curve below.
A smal low carb snack about 1 hour after shot will help slow down the drop also, and allow for a shallower curve.
Food can really help with this insulin.

3-How is her heart these days? I know there was discussion early on here about cardio issues?
What other medications has she been given recently? These can all have an impact on the curve.

I am linking some info for you about humulin N and about rebound.
viewtopic.php?f=19&t=303
http://petdiabetes.wikia.com/wiki/Somogyi_rebound

The fact that you had normal readings and then diabetic readings over the last several months has me wondering if the diabetes could be a result of
meds given to help the heart at some point and the fatc that acromegaly could be suspect?
Just thinking outloud here.

I also support the using N more than twice a day...to get any kind of shallow curve and enough insulin coverage for 12 hours...shooting more often with this insulin will let you have a little more control.
However, I am concerned that 3 units is too much and would love to see more of you curves from previous doses if you don't mind sharing?
a snack about 1 hour after shot, a slightly lower dose and keeping an eye on where the nadir is and ensuring it has passed and Ginger is truly rising again before giving next shot, are all keys to shooting a TID schedule.

It would be remiss of me not to mention the longer lasting insulins as an option here...they really do make all this a lot easier, but I understand why you have stuck with Humulin N so far so am trying to help address those needs here.

One more thought...shooting a little earlier and thinking more " as needed" instead of a strict 3 time a day schedule....
You need to know peak/nadir has happened and you need to be sure the blood glucose levels are rising... I have put in what a possible as needed schedule may have looked like with this curve....

*********I would only change one thing at a time though..

*I would consider dropping the dose to 2.5 for a few days and seeing how that helps before trying anything more. Do a curve once more and share here.

Meanwhile ask questions and read up on as needed dosing......and come back here with any questions. I will keep my eyes open for you here.

7am (481) gave 3 units of insulin. add feeding example- ( fed 2/3 of a cup a fancy feast chicken grill )
10am (110) ------ lowest point is quite a drop from that preshot and hard on Ginger's body
12pm (230)
2pm (387)---if you had shot 2 units here instead of waiting you may be able to bring the curve down with less of a drop. A slightly lower dose on lower prehot levels on this rising lelve, but that is not too high yet would really help
3pm (419) gave 3 units of insulin.
5pm (265)
7pm (184)---lowest point is 4 hours after shot once.
9pm (388)---level is rising....a possible shot here...again a lower dose as a lower preshot

Hang in there.....I know this forum is slow, but a few of us are kicking around

Kimmee