please look at pony's numbers

Hi, I just set up a spread sheet and want to make sure that you all are able to view it. pretty sure i did it correctly, but i've been wrong before. for some reason the really high numbers that should be showing up as black are just staying white. these are the only numbers i have for pony. she just switched off of 8 units of vetsulin and i just started home testing. as you will be able to see from the ss, i have already made 2 dose increases, and rather quickly. my vet advised me to do so. can someone please look over the numbers and just tell me what you are noticing? am i making a big mistake with these increases? it looks like it is bringing the numbers down a little. i am now using humulin n. pony is 12 and she has not been clinically doing well with the switch. i made the switch from 8 units of vetsulin to 3 units of humulin n on 05/10/10. she has been losing her appetite, excessively drinking and urinating, tired, and bloated since the switch. i want to try and regulate her on the humulin n, but will switch to another insulin if i can't. she does not have ketones. many people on this board tried to help me several days ago when i was freaking out the day i started home testing and first saw the really high numbers. i was really, really new to this board at that time and a lot of the help was just confusing me mostly because of the jargon. i have calmed down now and have been able to get the ss up, so i am hoping to maybe reconnect here and make use of everyone's combined experiences. please help me continue on my journey with pony by checking out the ss(see, jargon, and now i am using it!). thanks(that is short for "thank you").

 

Thanks for getting your spreadsheet up and running.

It does look to me as if Pony needs more insulin.

You are getting a normal looking curve - Pony is responding to the Humulin N -- just not enough insulin. I used Humulin N for about 18 months with Norton.

How long has Pony been diabetic and what is she eating? (sorry, I missed your earlier posts)

It is rare for cats to need more the 5 units of insulin but not unheard of.

Has anyone mentioned the "High Dose" conditions? (Acromegaly, IAA insulin auto-immune antibodies, and Cushings)

My first diabetic cat, Norton, was up to 13 units BID at one point -- on dry food. After coming to FDMB, we learned about home testing, low carb canned food and the High Dose conditions. We had the IGF-1 test done and confirmed that Norton had Acromegaly.

 

pony eats canned wellness food of the chicken variety. she has been diabetic for, i think, 3 years or so. she started on lantus and gradually increased to what i believe was 12 units. a very high dose, i know. at one point we cut her dose way down and the vet did a a curve and at that point it was decided that lantus was not working for her and we tried vetsulin. based mostly on clinical signs but also on occasional fructosamine testing we eventually settled her in at 8 vetsulin units twice a day. she was doing well on the vetsulin clinically. her lantus fructosamine tests always showed poor regulation and with vetsulin we did eventually get her to fair regulation. not great numbers, but clinically pretty good. it has been discussed with me that she may have an underlying health condition that may be making her difficult to regulate. the options that were presented to me by a specialist for looking into the underlying health condition were extremely costly, and i was told that it would be very likely that one test would just lead to another and another and that it was likely that whatever would be discovered would not be anything that we could do anything about. i can't recall if the igf-1 test was mentioned at that time. please tell me about it, what it can determine, and an approximate cost if you know.

with all that being said, i realize that there are many "gaps" in what i just described. my goal right now is to try to regulate on the humulin n. i can see now just how valuable home testing is. i am hoping that with the supposrt of this message board i will be able to accomplish this goal. however, if humulin n won't work for pony i will eventually decide between levemir and prozinc. leviimir would be my first choice based on what i have read, but it apparently acts like lantus which didn't work for pony. hence, i may choose prozinc based on that it is more similar to the vetsulin which did work for pony.

but for now i am trying humulin n. i appreciate you looking at the ss and am glad that it looks to you as if raising the insulin dose is appropriate.

 

Perhaps she needs TID dosing instead of increasing the amount of insulin given BID?
Would you be able to give her a shot every 8 hours around the clock?

~M

 

i can't do 3 times a day. are you suggesting that because she peaks quickly? that is what i thought i noticed, as well. but do i need more data first? i might need a longer acting insulin. i'm wondering if i keep raising the dose if the high values will stay high and the peak values will keep dropping, or if it is possible for the whole curve to lower? does that question even make sense?

 

Dang!!!

I know this is frustrating for you and for me now!!

At the moment I don't see high dosing/Acromegaly because you got some initial movement (alot).The following high red could be one of two things-insulin 'petered' out and/or body responded to what it saw as a low number 272. Especially if you were used to having pony in the 300's for example.

I would have held the 3u for at least 2 more doses and watched numbers.
When increasing, I would have done a maximum of .5u increase.
My reasoning- because Pony has been on very high insulin doses for a long time, you have no way of knowing if she has been in some form of chronic rebound. In 'normal' circumstances this can take at least a week to 'clear through'.

My concern is not having first hand experience of this insulin.
I shall try and raise Sweetgrass who is a moderator for the humulin/Vetsulin isg and see if she can offer her thoughts.
My view is don't increase again at present until we get some more eyes on Pony's ss.

Nice to see your using the jargon :mrgreen:

 

thanks kate. pony just is not feeling well at all, as i am sure you can imagine. it really is sad to see her like this but i think she knows i am trying to help her. she has not pushed me away even though i am doing so many ear pricks. i have been taking time off work to get some of these numbers, which could cause its own sort of financial "rebound" for me if i don't figure this out soon. i know it can't all become figured out in a snap, but i just want to feel like i have some course of action and that i know that my moves are based on something rather than just tinkering. also, i have time in the next 3 days to take a lot of numbers and then for a few days i won't be able to get so many. my vet told me to raise the units after she saw the numbers. she said as long as i can see the numbers making a curve and not flatlining or jumping all around, and as long as she is never dropping low, to keep raising the dose and doing curves. i realize that that is just one approach but it is the one i am using until someone can give me a reason to do something else. and i am looking for that reason on this message board. thank you for keeping an eye on pony's numbers for me, i really need the help.

 

I wold not count on rebounding with N looking high and flat...more like steep peaks and valleys. I would also be very hesitant to do TID with N considering its typical action. I cannot see your spreadsheet as I am on my blackberry but pls consider these comments

 

Jen

Jen,

can you explain your comments again. Not clear to me.

Are you saying it is unlikely to be rebound if your getting generally high numbers with some times a shallow valley curve? and more likely rebound if the numbers are high and flat regardless of the dose?

The first part is what I see. Acro has been muted.

If you have experience of Humulin N could you offer more thoughts at a convenioent time later. We seem to be in short supply of such beans! Thanks

 

Hi Elise and welcome to the board.
I am not familiar with Humilin at all as we were Lantus users.
I juts wanted to answer you question about your ss.

Everything looks fine. Many people think that tha numbers over 500 are supposed to look black but in fact they don't. If you want to show the black then you can manually change ths background of those cells and change the font to white.

Good luck with Pony. You are in a great place here to get the help you both need.
Great job with the testing!!!

 

I'm not a numbers person and my short experience was with Humulin L, but in the past when we've seen cats rebounding on N we would often see steep drops and then a steep rise. Perhaps there are those who've had high flat numbers on N from rebound but I've not noticed it.

 

so since it does not sound like rebound, does it seem wise to raise the dose?

 

hm - sorry for no reply yesterday --

yes, an increase of 1u BID would probably be a good idea.

If you get late cycle BG numbers, you should see when the Humulin N drops out. In most cats, N only lasts 8 to 10 hours. That is why it is "ok" to go to TID dosing (every 8 hours) for many cats (if your schedule allows). (divide the total daily insulin by 3 -- so if your dose is 8 units BID, the daily total is 16 units -- divide by 3 shots instead of two -- and dose would be 5 units TID (total 15).

Lantus, Levemir and Prozinc have the benefit of staying in the body a longer period of time (also varying for each cat)

so -- the second injection is given while the kitty still has some insulin working and the BG is still lower.

For example:
Humulin N curve
AMPS BG 458 gave X units
+2 BG 330
+4 BG 280
+6 BG 345
+8 BG 400
+10 BG 430
PMPS BG 460 .....

Lantus, Lev or Prozinc curve
AMPS BG 458 gave X units (we'll start at the same place for the example)
+2 BG 430
+4 BG 400
+6 BG 350
+8 BG 280
+10 BG 300
PMPS BG 320
...

so - lets say that X units of L,Lev or PZ gives a drop of 180
when you now take advantage of the "Overlap" in the insulin shots---
now from 320, the BG goes down to 140 at "peak" in my example.

Lantus and Levemir are strictly 12 hour schedule insulins because of the "storage shed" that is built up.

ProZinc can be dosed more flexibly. I used the compounded PZI from BCP, which may be different from the NEW Prozinc insulin.

[NOTE: the sliding scale should NOT be used with Lantus/Levemir]

When I used PZI with my high dose acrocat, I was using a Sliding Scale and adjusting each shot by what Norton's blood sugar was at test/shot time. PZI could be injected as early as +6 if the blood sugar was rising (an increase of at least 20 points)

The beans in the High Dose Insulin Support Group can help with developing a sliding scale if you want to try it --- the sliding scale is customized especially for your cat based on previous response to insulin (your spreadsheet)

Also -- many high dose beans give a "bolus" of a very fast acting insulin "R" to initially reduce the blood sugar before the more gentle insulin kicks in.

An example of an "R" curve (usually lasts about 4 hours in cats)
AMPS BG 458 gave 0.5 unit R
+1 BG 400
+2 BG 280
+3 BG 300
+4 BG 450

So --- by injecting R PLUS a gentle insulin like Lantus or Levemir, may result in a curve like this:

AMPS BG 458 gave 0.5u R, gave 3u Levemir
+1 BG 380 (most of the benefit is from R)
+2 BG 240
+3 BG 230 (R is now wearing off)
+4 BG 215
+6 BG 170
+8 BG 120
+10 BG 140
PMPS BG 160 No R needed, gave 3u Lev

Keep in mind... when your kitty has been high for so long, the "normal" range of blood sugar is uncomfortable at the beginning and some rebound may occur (for example, after reaching BG 120 for the first time in a year, the next test might at +10 might be 380 due to rebound).

Sorry this is such a long post -- hopefully you will find it helpful and give you some ideas on what to try next.

Usually "R" insulin is only used by vets for emergencies like diabetic ketoacidosis (DKA).

Quite a few people in "Lantus Land" and High Dose (insulin support groups) do use it routinely to help get the blood sugars under control. It is available in most human pharmacies without a prescription.

 

Phoebe, question...how many cats do you know who've been on Humulin N using TID dosing?

 

phoebe thanks for such a thorough response. everything you say makes sense to me. i am going to increase and keep looking at the numbers. the humulin n does seem to peak fast and hard and then wear off too quickly. my work schedule won't permit me doing TID, so i will probably be switching insulins again. i am thinking of switching to the new prozinc. i am hoping to hear from my vet later in the day. she wanted me to stick it out at the 5 units for at least 5 days. i gave her the link to my spread sheet so i am hoping that she will share her reasoning for waiting a full five days when things are looking so poor for a full 3 days.

anyhow, thanks for the feedback and the insulin lesson. i like that you used numbers in your examples, it really helps me visualize things. if you have the time and interest i would be ever so grateful if you'd keep your eyes on pony's ss.