Susie, Diabetic Cat
Index & Contents 

Susie's Insulin Graphs, 2004

• In some of the graphs there are periods where it looks as though her dosage was constantly cycling by 1/4 unit.  This is simply where I decided to change her daily dosage by 1/4 unit, so that her morning and evening injections were slightly different.

• Variable (whenever I got a sample) - sometimes more than 1 per day, or could be several days between samples.

• If the urine glucose reading fell between 2 of the colours I simply took an average.  If the colour on the stick reached the highest point, I took this as 2% if it took the full 30 seconds.  If it reached 2% more quickly I estimated a higher figure (e.g. I assumed 2.5% if it only took 25 seconds).  Whilst this was only a rough approximation, it illustrated more effectively where Susie's urine glucose was clearly high.

• Jan 2004: fructosamine = 335 µmol/l, once again in the "excellent control" range.  I wouldn't want to see it any lower than this.

• Susie was off colour for a few days from the end of January.  As a result, I had been reducing her insulin dosage a little and missed out one injection altogether.

• In spite of this, on 5th Feb, Susie was ill during the day, having eaten only 2g of her food that morning and having received a full injection.  The result was that by teatime, she was suffering another hypo, her 2nd ever, and I had to administer syrup twice.  I also managed to get her in to an emergency appointment at the vets.

• The vet advised that I should reduce her insulin dosage as this might have been causing her to be ill.  I re-started Susie on 2.5 units.  Beforehand she had been on 4 units.  Over the course of the next 2 months I had to increase Susie's dosage steadily to maintain control of her diabetes.  However, in Nov and Dec 2004, I followed this advice again and it seemed to have better results.

• In general, I had to continue the gradual increases in Susie's insulin dosage throughout this quarter, eventually getting back up to 4 units, but I did this very conservatively to minimise the chances of any more hypos.

• The occasional dips were where I decided to reduce specific injections either because she was off colour or simply hadn't eaten as much food.

• At the end of April her fructosamine was 446, slightly higher than normal, but as expected for a period in which her insulin dosage was having to be increased.

• Generally stable, with occasional fine-tuning of dosage and single small adjustments for specific issues.

• In mid September I took her to the vets for another routine check up.  The vets had just started working with a different lab for fructosamine tests and it has different reference values.  Susie's figure was 348 µmol/l.  At the old lab, this would have been in the "excellent control" range, but with the new reference values being 146-271, "good" or even "fair" would seem more appropriate to me, which would also be consistent with her recent urine glucose figures and drinking.  I had to request the lab's interpretation as they hadn't provided it with the result.

• It turned out that Susie's figure was actually below their "excellent" range (i.e. potentially dangerously low).  When I queried this with them, I felt that their response was disappointingly patronising, and that their interpretation of the level of risk was too inconsistent with that of the other lab which I have found over several years to be reliable and appropriate.  After discussing this with my vet, I was pleased to be able to have Susie's Jan 2005 sample sent to the old lab once again.

• During November, I decided to change the way I treat Susie's diabetes.  Up to this point, I had been adjusting her insulin dosage based on her urine glucose figures and drinking.  She was off colour for much of October and into November and I began to consider whether I might be treating her diabetes a little too aggressively, perhaps causing a slight Somogyi reaction.  I tested this by sticking to about 3 units.  There was no increase in her urine glucose figures during December, so I hope to stick with this in the future.

•  Separately, there were several times when she had eaten much less food than I had left out for her.  In these situations, I reduced her next injection by a small amount to minimise risks of a hypo and this generally seems to have worked well.