? Pre-Shot Numbers Higher than Usual?

So I know it's not too unusual for Victor's preshot numbers to be in the red, but it's been pretty consistent over the last couple of days and I was just wondering why that could be and if we should be concerned?

 

I suspect that the 4 u dose is finally getting him into much better mid cycle numbers but he's rebounding (bouncing) to higher PSs. Bouncing will happen if:

• BG drops too low
• it drops to lower than usual levels (even if not too low)
  
• it drops too fast.

Humulin N has a strong effect on BG and can yank down BG fairly quickly. That's likely what's going on. This bouncing effect can be pronounced when you're at a more effective dose that's getting Victor into better mid cycle numbers. He then bounces high at PS. Two things can be happening to promote bouncing: rapid drop in BG and also lower than ususal BG (although he's not going too low).

This very deep curve is typical of insulins like Humulin. The depot insulins like Lantus and Levemir can help reduce this effect but they're much more expensive. If you qualify for help from DCIN they might be able to assist in this department.

 

I was kind of wondering if it could be due to bouncing. Is it anything to be concerned about?

 

There's really nothing you can do about bouncing. Some kitties are more bouncy than others. You have to focus on the lowest numbers you get at a dose to assess its effectiveness. The PSs are almost always artificially inflated from bouncing so don't assess the dose based on them.

 

@H.M. Victor

I'm experiencing some of the same frustrations with high preshot numbers as you are. You've been at 4 units for a good week, although I do see where you lowered some doses and skipped some altogether for the PM shots due to poor appetite. Are you just feeding two meals per day plus treats? If so, you may want to divide his meals into 3 or 4 mini meals. I feed Bama a 3 oz. can after his preshot test, just before his shots both am and pm, allowing about 20 - 30 minutes for mealtime. If he hasn't finished eating at shot time, he gets his shot and I continue to encourage him to eat the rest of his meal, adding water as necessary. [He seems to be feeling his thirst kick in as his BG is usually above renal threshold by this time.] Then @ +4 hours in the am, I feed another half 3 oz can. In the pm, I feed half 3 oz. can @ +2 hours because I head to bed right after. If I'm taking a BG reading at any of these meals, I test first then feed but I don't worry too much about whether he's eaten within 2 hours. When I'm doing a curve and testing every 2 hours, he's mostly likely eaten within the 2 hour pretest window at some point anyway.

I'm doing a curve today and it looks like I'll be increasing Bama's dosage to 3.5 units for his pm dose. He has been as high as 7 units in the 4 years he's been diabetic. On the same insulin the whole time. Novolin N which is similar to Humulin N but cheaper. In my state it's available behind the pharmacy counter at Walmart. No prescription required.

 

@Bama Kitty Mom (AL) Thanks for the info in your response. Victor does get just two meals a day plus treats after tests/shots. I'd like to change him to 3 or 4 mini-meals, but I know how much we feed him needs to be based on calories per pound of ideal weight and I'm absolutely terrible at math.

Our pharmacy actually just told us about Novolin N and the cheaper price would help us, but we weren't sure if it would be a good idea to switch him to it without consulting our vet. How has your experience been with it?

 

@H.M. Victor

I've been able to get up to about 4 months worth of insulin from 1 vial. There are different recommendations for replacing a vial at specific time frames [i.e. after 30 days, etc.] but as long as it seems to be working, I keep using the same vial. So, if you are considering Novolin N, I would wait to switch until you are nearly out of your current vial of Humulin N.

My experience: Bama was diagnosed September 2014 and I was sent home from the vet with a bag of Hills Prescription Diet W/D. After about a month trying to regulate with diet only, vet prescribed Novolin N, 4 units twice per day, and said come back in a week to check BG. At the one week check-up, vet said increase to 5 units & come back in a week. Week later, he increased to 6, said, "This cat is regulated. Come back in a month." Over time doses were lowered to 3, then 2. No curves. While vet said it was possible for me to self test at home, he didn't really encourage it. I think he was just glad I was willing to give the shots. Many changes over the past two years including a move, change of vet, and Bama became indoor only.

Since I wasn't monitoring his BG levels, I paid close attention to his urinating and drinking habits which stayed the same up until about a year ago. I had long ago switched away from the Hills to other dry plus some canned. I tried some grain free dry and after that his BGs have been all over the place. Current vet worked with me to get him regulated last December, did a curve, and had him at 2 units. I started monitoring BG about once a week at her suggestion. Then in March, his numbers started going down, then up and I haven't gotten him regulated since. He's had some other issues--frequent hairballs, mystery pukes, developed a fever 2 days after his bi-annual check-up at the vet first of June. Happened on a Saturday so had to take him to his old vet since current vet not open on Saturdays and I did not want to pay emergency vet prices. Old vet gave antibiotic which seemed to upset his GI tract. He stopped eating his dry food so I switched him over to all canned, started monitoring BG more frequently and logging his spreadsheet, trying to understand the patterns in his numbers.

Victor has this going for him. He is newly diagnosed. He stands a better chance of his pancreas healing and going into remission. Most of the kitties who have gone into remission have done so within the first 6 months of diagnosis when they were immediately started on insulin and the BG brought under control. So, don't give up. This is all so frustrating and overwhelming at times. We all feel it. It's great to have people here who understand because they face the same issues we do and worse things as well.

Hope Victor is nearing a breakthrough!

 

You can start a bouncy kitties club!

Tigger is only at 0.75 units right now and I wonder/worry - will his bounces get any "higher" as we increase the dose? Can they go any higher???? He hit 570 the other day!
He's gonna bounce to the moon soon. Or hopefully I have it wrong and when we hit the right dose his curve will look smoother?????? This is so frustrating!

 

It's very hard to know. Just keep up the dosing according to SLGS. Looks like he'll need 1 u soon.

 

Yes I think we will increase Wednesday (GF can be home to monitor) . . . I'm still thinking about bounces though - if they can last 6 cycles, as in he stays high . . . how can you ever change dose after only a few days? Even a week - it seems like he has bounced 3 times (I have a hunch he went under 200 at nadir today cause he hasn't seen 500's since starting 0.75 unless he's bouncing). It seems to me, scientifically speaking, you need to stay at a dose for longer to really ascertain its effectiveness. I feel like there is even a chance he could have a lower and lower nadir if his body stops fighting the insulin - then you're increasing when you shouldn't be! This is way too complicated for a tiny little fuzz man. His pancreas needs to get itself together!

 

vbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvbvb ~ Tigger, helping me type

also my gf just asked if him being a "Tigger" is why he's so bouncy . . . their bottoms are made outta springs after all