Would like some opinions on BG curve numbers...

My little guy has been all over the place lately, hitting in the 400s way more than I'd like! The vet has been raising his insulin by .5 units whenever it seems necessary, he's been at 2 units 2x a day for a couple weeks now. I did a curve on the 12th that showed a decent curve but the numbers were higher than the vet would have liked - as she had only raised his dose a few days earlier she wanted me to wait a week and then do another curve which brings me to yesterday. I did a curve yesterday that was definitely the most colorful curve we've had! As you'll see on his spreadsheet he was in all of the ranges except for the 500s!

For the past couple mornings his BG has been low enough to not need insulin but then jumps way up by evening. The vet called today after seeing the curve results and his variations in morning to evening numbers and said for now if he's below 300 give him 1 unit of insulin, if he's above 300 give the 2 units.

When I look back at his numbers from a few weeks ago when he was on less insulin his numbers were still still high but not as high as they've been lately, but with his lower numbers this week I'm really not sure what to make of this. Anyone else have any experiences like this?

 

I'd lower the dose a little. You got a 50 for your curve and then he bounced up (when his liver gets a bg number lower than what it is used, it releases more glucose). Instead of shooting into a bounce, it 's best to lower the dose so the bounce flattens out.

The days you got a amps too low to shoot also indicate too much insulin. The goal is to get a dose that gives you shootable numbers twice a day. If he careens from low amps to a higher pmps because he has been 24 hours since the last shot, it makes him feel crummy and it confuses the picture for you.

What would you think about reducing by .5, getting some numbers and seeing how he reacts?

 

The vet said based on his curve she'd like to try giving 1 unit of insulin if he's below 300 and 2 units if he's above so I guess we'll try that for now and see how that goes.

As far as lowering the dose in general, that's where I get confused about him having slightly lower numbers when he was at a lower dose - does that mean we are giving him too much now?

 

Yes, I think the 50 at midcycle and the amps numbers under 200 are an indication of too much insulin. I'd reduce to 1.5 and see what happens. I think it's better to react to your numbers each time instead of a general rule. And your vet's idea doesn't take into account bouncing from lower numbers.

Here's some info about rebound (bouncing).
http://petdiabetes.wikia.com/wiki/Somogyi_rebound

 

I think that's bad avice. The difference in dose is too much at one time. If he had a 290, you're only supposed to shoot 1u, but if he's at 310, the vet wants you to double the dose? 290 and 310 are basically the same number (given meter accuracy of +/- 20%).

I think adjusting the dose based on the PS numbers is a good plan, and it seems to work well for a lot of cats. But if you look at some of the cases where people are using a sliding scale, the increments are tiny, like .1 or .2, between doses based on ranges of PS numbers.

My advice would be to go with a plan like that. You can leave the "line in the sand" at 300, that's fine. But I think I would shoot:

300 or below 1.75
301 - 350 2.0
Above 350 2.25

The increments are big enough to make a difference, but not so big that you'll get radically different curves having 2 doses so drastically different in terms of amounts.

Carl