rebound dose: 

dose after rebound:

Since that visit we had rebound. Clyde´s PRES and other readings became higher and higher, meanwhile I did hometesting (thanks to the FDMB). Our vet increased to 6 units BID. Clyde became very sick, he had diarrhea, he was vomiting and was very lethargic. Superrebound, readings only HI, Hi, HI!! That happened in our first month.

I stopped Caninsulin and (again thanks to the FDMB) made a new start with a pure beef insulin, Depot Insulin CR Hoechst. I started with 1 unit BID and increased all 7-10 days , only 10 %.

Now we are on 2,8 units TID (BID was not enough duration) and his readings are fine. PRE about 300, peak in the 100´s.

rebound dose: 

dose after rebound:

Zelda has been diabetic for almost four years. She was hard to regulate, and honeymooned twice (she's a steroid-induced diabetic), but overall, it's been a breeze. No hypo episodes, no neuropathy, no ketones. Takes testing well, doesn't mind her shot. She's just a good girl!

We've been on a 3U dose, after starting at 1 unit and working our way up, for over a year now. I have gotten VERY lazy about bg testing. She never displayed any hypo symptoms, everything was status quo.

She goes to the vet every four months for a CBC, blood pressure check, fructosamine, etc. In July 2001, her fructosamine was around 300. This is the highest it's ever been. I really didn't think anything of it, though.

On 8 December, I forgot to give her her shot before leaving early for the vet's office. So, I got to the vet and borrowed 3 units.

On 10 December, I got the latest blood test results. Glucose in urine (remember, this is preshot) 234. Fructosamine - 397!! Something didn't add up.

I called my vet and she said she thought Zelda was going too low and was in rebound. Fortunately, she free feeds, so she always had dry available and must have been eating when she's gone low.

We're beginning again at 1 unit, checking preshot and at peak.

On top of everything, Zelda, who is 14 and to all apprearances is healthy, almost 12 pounds and well-groomed, has high blood pressure and early stage CRF. The vet and I are hoping that with blood pressure control (via Norvasc), and better diabetes regulation, we'll have some improvement in kidney values when we go back for re-testing on 22 December.

The moral of the story NEVER completely relax. By paying close attention to my baby girl in the first place, I caught it early. I was so careful in the beginning. I got lazy. I was tired. Now I'm kicking myself. And hoping that my screw up didn't push her over the edge into CRF (she was high normal in July). Does anyone else cringe every time they head for the water bowl?

Test. test test!

rebound dose: 

dose after rebound:

Why I suspected rebound I noticed though that when he'd have a preshot in the range of 240-280's, and I gave him 1 unit, he wouldn't get much drop from it, peaking just 20 or 30 points lower than his preshot ( and occasionally getting no drop at all, but showing a 30-40 point higher "peak"). As this continued, his bgl's would be higher than normal for his next shot too.

How long the rebound lasted This went on for about 2 weeks, and I posted a message about it. The responses I received said that (in their opinion) it didn't look like rebound, but if I thought it was, I should try reducing his dose and see what happens with his preshots. I reduced CB's dose down to .75 unit, and his preshots also started coming down. Although CB has not yet had a hypo episode, he usually gets around a 150-200 point drop off 1 unit, and peaks at +3. So, I've called this "hidden rebound" as it doesn't present itself in quite the same way as it would in most higher dose kitties.

My theory is In lower dose kitties, they just don't have as much of a drop "available" as higher dose kitties, so their livers tend to kick in quicker, making rebound hard to see. But, because they don't have as much room to safely drop, severe hypo's are a constant threat if rebound isn't detected in time.

To prevent rebound, I've been working on figuring out a sliding scale dose for Care Bear. I also now dilute CB's insulin, making it easier to measure out smaller doses more accurately. So far, I've worked out

under 150 - nothing (Not been so lucky yet!)

<200>150 - .25 unit

<240>200 - .50 unit

<280>240 - .75 unit

<320>280 - 1 unit

<360>320 - 1.25 units

over 360 - 1.5 units

So far, this seems to be effective in bringing CB down at peak to around 130-150's. I may still need to tinker a bit with the sliding scale, but it does help in keeping his preshots lower (if he hasn't managed to get into some tasty forbidden foods!).