higher dose= higher BG rebound anyone????

Ok so my cat sam was fairly recently diagnosed with fd about 2 mos now His bg was 350-600++++ (my meter only reads that high) first we had him on 1 unit then two then three twice daily of pro Z on the 3 units his low was about 300 and high only was getting up into the 400's for two weeks before the vet had us up it again to 4 units..my concern is after he gets the shot his bg goes down to around 250 (which is much better) but everytime it gets anywhere near the 12 hr mark 9-12 hrs his BG are always reading over 600 I don't understand why the 3 units did not give him so high of a spike??? Do they really swing that much? We really need to get his Bg to get lower and stay there as he is still having probs with hydration due to the high blood sugar. It is better because we are only using sub Q once daily though. I am almost scared to up it again as we have no idea how high it is going and you can tell he gets really hungry and glassy eyed or wont eat at all. Can some of you please share any opinion, experience whatever to better help me understand this? Thank you -jen and Sammy

 

The insulin only lasts about 12 hours. Some a little more, some a little less depending on the cat. So, you could be just seeing the end of the cycle happening sooner than 12 hours. When Podo was on Vetsulin and I started home testing, I saw the same thing, where at around +10 she would start heading back up. You might check in the PZI group to see what kind of duration most of them are seeing.

 

You seem to be getting a good drop in BG so it does not look like you are overdosing. I would increase dose by 1/2 unit and see if that helps.

 

Thanks i will look into the pzi group did not realize there was one.. I just don't nderstand why I am seeing higher numbers at the end of the 12 hr cycle than I was on 3 units? thanks -Jen and sam

 

Hi Jen! I'm sorry Sam isn't feeling good, you have come to the right place for help though! Mr Tinkles started on ProZinc, we used it for 3 months before switching to Lantus.

It could be rebound, and I would not suggest increasing until we get more information. You said that he had lows of 300 and highs of over 400 on 3 units....when were those tests taken in relation to the shots? Can you give us some of his test results in this format:

AMPS 400 3u (test before morning shot of 3 units)
+2 360 (test 2 hours after shot)
+4 300 (test 4 hours after shot)
etc.

Please also give us test results on the 4u dose in the same format, then we can get an idea of what is going on. If his preshot numbers are higher on the higher dose, it could be rebound especially if you are not testing at or close to his nadir. ProZinc generally has a duration of 10-14 hours, with a nadir around +4-+7, but every cat is different, so you need to see how long it is lasting for him, and when his nadir is.

When you increase by 1 unit at a time, it is very easy to overshoot your mark. ProZinc often gives you big effects with small dose adjustments, so I advise adjusting by no more than 0.25 units at a time. I used to adjust by 0.05-0.1u and see a big difference in response.

There is a PZI insulin support group, you can crosspost a thread over there also.

 

here are some numbers from just before we switched to 4 units

On 3 units pro z

am before eating or pro z 396
3 hrs after 296
Before dinner and pro z at 11 hrs 450
2 hrs later 352

am before eating and pro z 386
2 hrs later 301
before dinner and pro z at 11 hrs 498
2 hrs later 370

On 4 units pr z started in evening when home to better watch

Before eating and Proz 384
3 hrs later 249

Am before eating and Pro Z 573 (no food overnight locked in bedroom with me)
about 4 hrs later 369
Before dinner and pro z at 11 hrs reads HI over 600
2 hrs later 587

Am Before eating and pro z HI over 600
2 hrs later 406
pm before eating and pro z 432
fell asleep no test

Am before eating 462
2 hrs later 299
Pm before eating 500
2 hrs later 367

This am before eating 448

Yesterday seemed a little better no HI readings we just uped the dose 3 days ago I just didn't like seeing thos "hi" over 600 because we had not seen those since 1-2 units Sam is fed 3-4 times a day but we don't feed within 2 hrs of pro z time. He is still underweight and I can't get him to eat enough in one sitting. He is eating Fancy Feast patte style no gravy ones----he hates the Dm and he has to eat so after researching on here tried Fancy feast and he likes it especially the beef and shrimp flavors. He is eating betweek 2 -3 cans of FF a day I figure at 3 oz thats like one and a half reg cans and that is what the vet said he should be eating is one and half cans per day. (I have caught him eating a little dry food here and there (leftover spillage on the floor from when we pick up the other cats bowls to lock themm away) but I instantly feed him FF figuring he must me hungry. Thanks guys
jen and sammy

 

Thanks for the numbers, that helps a lot.

You are testing before food and shots, that's perfect. It's also great that you are not feeding within 2 hours of test & shot time. Fancy Feast classic flavors are good, are you looking at Jan & Binky's list and choosing flavors under 10% carbs? Don't waste your money on the D/M, it's too high carb and junk. Dry food is very bad, try to eliminate it completely from Sam's diet. A little dry food can cause very high BG. You can feed him as much food as he wants right now, as long as it is low carb wet food. I was feeding Tinkles 13-15 oz a day when he was unregulated! Three to four times a day is fine, even free feeding anytime he wants is fine, you don't need to limit him to 2 meals a day.

For testing in between shots: 2 hours is when PZ starts to work, generally, so you are only seeing the very beginning of the effect. You need to test about 4 hours after, and try to get tests from 4, 5, 6, 7 hours after. You don't have to get them all on the same day if you can't do it, but you need to get some data on the middle of the cycle. I suspect that he is getting much lower than you realize, and the high numbers you are seeing are rebound numbers. The nadir (low point) is usually somewhere between 4 and 7 hours after the shot, but that varies also depending on the cat and how close the dose is to "good". If the dose is too high, you can get nadirs at or close to 10 hours after the shot. So, try to get some tests and see where he bottoms out, and starts to rise again.

Four units is a pretty high dose for PZ, I personally would go back to 3 units and get some data, especially since you changed his diet. What was he eating before you changed to Fancy Feast? Also, when did you change him to Fancy Feast?

 

We having been using Fancy feast for about two weeks before that he was getting all different bands friskies, 9 lives, etc I was trying to pick the patte or flaked kinds for bg's but if he absolutely refused I did have a beef and gravy on hand just because we were force feeding for a few weeks before that and he really needed to eat and put on weight....we are going to do a BG cuve this weekend we did it at 2 units and he was only on 3 units for a week before vet uped and we were crazy busy. Doing a curve this weekend and I will post results. I will start checking more at 4 hour vet recommended two hours but 4 works too! thanks

 

Ok, he has been eating it for a while then. If you have trouble getting him to eat, then you give him what you have to in order to make sure he eats. Not eating is worse than eating high carb!

If you can check at 4 hours and 6 hours during one day, then 5 hours and 7 hours another day, that would help you out a lot. You need to pin down when he is reaching the lowest point and see what his BG is at the lowest point compared to his BG before the shots. The full curve is the best, but the spot checks in the middle of the cycle can give you a good idea what is happening. Please do keep posting and let us know the test results!

When you get a chance, you should set up a spreadsheet for Sam's BG numbers. It's a great tool, and helps you and others see how the insulin is working. It's fine to keep posting your numbers like you did, but you will love the SS when you get it set up! Here are the instructions: viewtopic.php?f=6&t=18207&start=0

I know sometimes the vets seem to like to rush to raise the dose and try to regulate as quickly as possible, but raising too much too fast can backfire. Many vets adjust doses by full units, it is very common, and it often leads to people coming here with cats on very high doses...8u, 22u for example. Sometimes they end up having hypoglycemic episodes before we are able to help people get to a reasonable dose. Maybe some of them will chime in and share their experiences! The general advice here is to adjust by no more than 0.5u at a time. My vet wanted us to go from 2 units to 3 units, and I refused to do it because of the advice here. Tinkles ended up needing 2.2u, so I was glad I didn't agree. It's very easy to overshoot by increasing by too much at a time.

I forgot to ask you about ketones...are you testing his urine for ketones?

One other thing jumped out at me when I re-read your original post...you said that sometimes he gets really hungry and glassy eyed. Those can be signs of hypogylcemia. If he gets like that, please test his BG right away. When cats are really high or really low, they are often really hungry.