Kitty higher on insulin than without, I feel so lost

I really need some input and some encouragement. I'm starting to feel like I can't fix this

Without insulin, Kitty is around 300-340, but with insulin she is 340-410. She was on .25 units of levemir, but kept going higher. Took her off insulin for 5 days and she went down to 300-340 again. Started her up again on .1 and now the same is happening.

So higher insulin makes her push more sugar into the blood, but she is high without also.
Damned if I do, damned if I don't. I don't feel like the protocols support cases like this.

I did not feel this lost last time around. She actually responded to insulin then.

Any advice or experiences? I dont think I've felt this useless before.

 

Hi Carina! Correct me if I’m wrong, but did you post this on FB as well? I remember your SS and saying I do see action when you’re giving insulin.

The issue is that Kitty is bouncing from the lower numbers she’s having. And lower doesn’t necessarily mean green or lime. It’s anything kitty isn’t used to. So yellows can be considered low until she gets more and more of these numbers and gets used to it again.

Coming out of remission is also harder to regulate. You may need to be more aggressive with dosing, more consistent with dosing, and give the Levemir time to build up its depot.

I’m not sure about dosing as 0.1 is considered a smaller dose. Another more experienced member may weigh in on the starting dose.

 

I posted on Facebook a week or two ago yeah is it that reading in the lower yellow, you think she is bouncing from? Is it a good idea with more aggressive dosing if she is already bouncing? If that is what it is.

 

She could've seen a lower number in the cycles that you weren't able to get a test in between like today's AM cycle. And of course, we understand when caregivers can't always get tests but they are important!

And maybe the dose just isn't enough. So yes, we increase despite bounces because depot insulins (lantus and levemir) are dosed based on how low it brings kitty. The lowest we are seeing so far with 0.1u is 202. That's not near what we want to see which is green (50-120). An increase might be needed but that's also dependent on the method you choose to follow (TR or SLGS). I would wait for more people to weigh in on the dose before you decide to change it.

 

I agree with Crista. I think you're interpreting the numbers incorrectly.

First and foremost, Kitty needs insulin. Her base numbers are in the 300s. The dose you are giving is tiny. I would not expect to see much of a response to so small of a dose. However, you do need to start somewhere and it's important to get the depot established. It takes 5 - 7 days for the insulin depot to form before you would expect to see a response. Having stopped insulin for several days, the depot was emptied. At this point, the depot has not yet been fully established.

Bounces occur for several reasons:

• Numbers drop low. This typically implies that numbers have dropped into dose reduction range.
• Numbers drop into a range that your cat is no longer used to. Thus, if Kitty is used to numbers that are in the 300s, a drop into the lower 200s or less may trigger a bounce.
• Numbers drop fast.

A bounce involves the liver and pancreas releasing a stored form of glucose along with counterregulatory hormones all of which serve to cause numbers to spike back up into higher ranges. It can take 3 days/6 cycles for a bounce to clear.

So, all of that said, you have at least one day before the depot is doing what it should. I would suggest that either tomorrow or Tuesday, you increase the dose to 0.25u unless there is some compelling reason to not increase the dose. Since you're following TR, you will then need to evaluate the dose every 3 days/6 cycles if numbers are above 200.

 

Thank you so much for your input! It gives a sense of relief to get a specific advice, when feeling so helpless. I will do this