OK - got curve, constant 300's - Vetsulin - increase dosage?

Well we are out of the 400's and into the 300's, trying to decide if I should stay a while at 2 unit shot of Vetsulin twice a day or increase it again. Its been (7) shots a 2 units so far and today was the first time in the 300's for a while.

Doing this curve have been Check Glucose, leave food out a 1/2 hour, take away food for 2 hours, then Check Glucose and repeat. (She has been eating Fancy Feast "Classic" and Friskies Pate')

I am going to talk to my vet and make a move to Basaglar insulin instead ASAP, but it will be 10-12 days before I get the order from Canada.

Thanks,

Bryan & Princess

 

On normal days do you 'leave food out 1/2 hour, take away food for 2 hours...and repeat'? When doing a curve, you are supposed to feed as normal; otherwise, you are not seeing the glucose levels as they would normally be. The only time you have to withhold food is two hours prior to the pre-insulin-shot glucose test... like normal.

It looks to me a little like she may be getting too much insulin. Notice on 6/20 after she went too low how she went high then stayed pretty flat in the 300s.. that looks like a bounce to me. With a bounce, when they go too low (or even just lower than they are used to) they then go high then stay pretty flat for awhile. That flat part can last as much as a few cycles, and you have to let it clear before you can judge the impact of the current dose, and you have to have mid-cycle tests to do that. There is only one mid-cycle test for the time she was on 1u after the drop following the hypo number. So, I am not sure what the next dose increase to 1.25 was based on. I am also not sure why it was a dose increase only for morning shots while keeping the 1u for evening shots.

To me, that curve looks like a flat cycle following a bounce. Mid-cycle data is very important (maybe especially so with a bouncy cat). When you have so many cycles without any, it is extremely difficult to know what the dose is doing, and if you keep increasing without really knowing, you run the risk of ending up on too high a dose which can look like too low if you only have pre-shot tests and a mid-cycle test every day or two.

 

I thought Food effected and made her results higher, this is why I am taking her food away for 2 hours before testing during the day? and this still confuses me, I thought food would RAISE her test numbers, not decrease them as if they go into hypoglycemia the first direction is to food them high carb food. She has always had food available all day previous to diabetes (she got can of friskies at dinner and had unlimited Purina One all day) and she has been polishing off the 3oz cans of Fancy Feast I gave her 3 times a day in 15 minutes, so now I am doing the 5.5oz Friskies twice a day and sometimes a 3oz Fancy Feast can once.

And I misread the "Bouncing" section

I took "bouncing can happen when the BG drops too fast and/or too low." as the test results numbers dropping too fast, which I thought was the problem on 6/20 and the 46 test result. I did not take it as being the HIGH test number result. So this whole giving her too much Insulin is not causing hypoglycemia (low numbers) but causing high numbers was confusing.

In the beginning it was hard to do a curve, my Princess hated the testing (still does) and I was fumbling through them, having trouble getting blood, getting a lot of testing error codes, forgetting to turn up the light so I could see, or not remembering my glasses so I could see, and just in general struggling. Now I get everything ready, grab her, prick her ear, give her a treat and its done in 30 seconds vs. 5 minutes most of the time.

I look at Mia's spreadsheet and surprised at the amount of overnight tests you do on top of your daily tests and not sure how you do it. Between caring for my failing dependent on me 88 year old mother, working my business at home (web design/hosting), dealing with my own health issues, and trying to help my 23 year old daughter who lives 4 hours away, and now my Princess is all taking a toll on me.

 

PS: So in your opinion I should go back to 1u shots? correct?

 

Yes, food usually raises BG. My point was that you should not change her feeding schedule on a day that you are doing a curve. You want things to be as normal as possible when you do a curve so that you are getting get results as they would normally occur. Normally (and on curve days) food should be withheld for two hours prior to the pre-insulin-shot test. The point of that is so that the results will not be food-impacted (inflated) so that you will know it is safe to give the planned insulin dose. Other than that, you can continue with your normal feeding on curve days. If what you described is your normal feeding schedule, then okay, but it sounded like you were handling it different for your curve.

Going too low is what triggers the bounce, like the 46 you got on 6/20. It's like a rubber ball hitting the ground - it then bounces UP. So, when they have gone too low or lower than they are used to, they then go up. Once they do that, they tend to stay pretty flat for a period of time. Mia was very bouncy for a long time, so I have seen this pattern myself. It can take a little while (even two or three cycles sometimes) for the bounce effects to clear and for you to then be able to see the impact of the dose. You normally do not want to make dosing decisions/changes before the bounce impact clears.

I set an alarm to get up at midnight and feed my girls. I always test then, so that is why there is always a PM +6. Sometimes, that is the only overnight test I get, but a lot of the time, I will set an alarm for another time, too. Or, in some cases, I may not have set one but I woke up anyway so decided to do it. Mia has proven to be a difficult one, so I try to get quite a bit of data to help me manage things.

It sounds like you have a lot going on. You just have to do the best you can. Please do not take my comments about needing mid-cycle data as a 'judgement' against you or anything. It is just very hard to know what to do with the dosing without that info. You have to figure out what works for you to strike a balance where you can get the data you need but still manage everything else and not kill yourself. This does take a toll..not only the things you do for their care but even the concern/stress from worrying about them. We used to travel a few times a year, but I have not been able to go anywhere since Mia's diagnosis and have no idea when I ever will be able to again. I have also not had a solid nights sleep in almost a year now. And, every time things start looking really good with Mia's BG, things start looking wacko again. So, there is really never much rest for the weary.

Be sure to give yourself credit for the fact that you are testing and giving her appropriate food (and trying to get her on a longer-lasting insulin) and celebrate the little victories like being able to test in 30 seconds instead of 5 minutes.

 

It looks like you already decided to do this. Have you ever posted on the Vetsulin forum? You may be able to get more specific dosing advice there from people who use that insulin.

Since you are now giving 1u, I would just say to hold that for several cycles, getting mid-cycle tests in, if possible, so that you can see the impact. You should then be able to tell whether it needs to go back up or not.

 

Thanks for the feedback, I am just getting frustrated as every time I feel like I am getting a handle on things, I am back to trying to figure it all out again (and this is for everything, just not Princess LOL)

I really do appreciate all your help and input!!!!!!!

I went back to giving her 1unit shots for now and will try to test more often. I am going to go get the Relion Prime meter, I have the Relion Confirm meter now but planned to eventually using the Prime meter as was told she would be producing larger samples as time goes on and I am seeing that now, The cost of Prime test strips is half so I can test more often and not panic as much over the cost of test strips on top of the added stress to my baby.

 

I use the Prime meter and have from the beginning. The drops do get larger the more you test. And the strips are about half the price. Very rarely do I get a drop too small to register.

 

So with the general consensus think the high scores were from Bouncing I went back to 1u shot twice a day, the PMP tonight was a high 584 tonight, it just feels wrong but I am guessing I should just stay the course for a bit and see if it redirects, through all this she has been ok for the most part, and maybe its in my mind, she does not look as good today, I will try another curve tomorrow and see how it goes (leaving food down all day except for preshot testing). I still feel the increasing of dosage was heading in the right direction, in part I feel maybe because the Vetsulin is losing potency.