 |
How do I adjust the insulin dose
according to blood sugar levels?
A blood glucose curve is periodic testing of the
blood sugar levels to see what effect the insulin is having. The
values will ALWAYS vary; you are looking for values outside of acceptable
ranges, which will be approximately 100-200 or maybe up to 300 depending
on your cat.
In the initial stages of therapy the usual recommendation
is to test blood glucose (BG) three to four times per day. See the
section on urine testing for suggestions
on when this testing should occur. After regulation has been achieved,
routine tests before the morning meal two to three times weekly
will be enough to let you know if your pet is staying regulated.
BE VERY CAUTIOUS WHEN MAKING CHANGES IN YOUR CAT'S
INSULIN DOSE WITHOUT CONSULTING YOUR VETERINARIAN. My recommendation
is to always consult a veterinarian before making a change. Also,
once a dose change is made, give your cat 3 to 4 days to adjust
to the new dose before considering another change.
Here are some rough guidelines:
- If ALL of the BG readings are HIGH, an approximate
10% INcrease in the insulin dose can be made.
- If ALL of the BG readings are LOW, an approximate
10% DEcrease in the insulin dose can be made. If your cat is symptomatic,
the dosage may be reduced further.
- If the readings are HIGH only before insulin
is given (or around the time of the morning meal) OR at the time
the insulin duration is almost over, do NOT change the dose.
- If the readings are HIGH at BOTH the morning
and evening readings, consider Somogyi effect and DECREASE the
amount of insulin.
Interpreting the Glucose Curve*
To determine the dosing interval or
the type of insulin given, evaluate the peak time.
If the peak time is:
- <5 hours change to t.i.d. (3/day)
administration or administer a longer-acting Insulin.
- 5-8 hours continue b.i.d. (2/day) administration.
- >8 hours change to s.i.d. (1/day)
administration.
To determine the dose of insulin or if
dysregulation is a problem, evaluate the nadir and range midpoint.
If the nadir is < 100 mg/dl, decrease
the insulin dose.
The ideal range midpoint is 200 mg/dI, and
150-250 mg/dl is acceptable. If the range midpoint is:
- <150 mg/dl, reduce the dose of Insulin.**
- 150-250 mg/dl, don't change the dose.
- >250 mg/dI, several possibilities
exist:
- The cat may have been stressed when
the blood glucose curve was performed.
- The Insulin dose may be too low.
- There may be an insulin problem (inactive
insulin, insulin not mixed property, poor injection
technique, poor absorption).
- Insulin resistance may be occurring
due to concurrent disease (systemic Illness, hyperthyroidism,
hyperadrenocorticism, acromegaly) or insulin antibodies.
*Based on twice-daily dosing of insulin.
**The nadir also should be below 100 mg/deciliter.
|
Source: Veterinary Medicine, Nov
1995, by Gary Norsworthy, DVM:
The importance of consulting with your vet
before making insulin changes can not be overemphasized. A mistake
on your part could result in the death of your pet. Use the information
on this page only as a guideline to understand the changes that
your vet suggests.
|
