Dosage questions

My Jester had to go back on insulin after a few weeks of remission. We're going to a different vet now who doesn't believe in more than 2U per shot, but Jester's BG has been in the upper 300s (OneTouch monitor) for nearly a week.

The vet's next suggested step is going to be 2U every 8 hours, which will be impossible for me as I have a PT job three days a week from 9AM until 6:30PM.

Have any of you taken your sugar babies dosages into your own hands against the vet's recommendations?

I'm seriously considering just bumping his dose up to 2.5 and seeing how that works.

Thoughts and/or suggestions?

Thanks!

 

He doesn't 'believe' in more than 2u per shot?! That is stupid. I would press him on what his source is for that belief. The only thing I have seen that comes close to that is that the AAHA guidelines say a STARTING dose should not exceed 2u, even in a very large cat. It is unreasonable to expect you to go to three times a day dosing since you have to continue to have a functioning life. Everything I have read from 'official' sources says that once you have been on a dose for a period of time, an evaluation should be done, ideally by a glucose curve, to determine if the dose should be increased - I have never seen it say to determine if you should start giving doses more often.

Many, many people on here manage the dosing themselves. That definitely requires that you do home testing so that you have the data to know what dose to give. It is always best if you can find a vet that will work with you in managing this, so maybe it is time to shop for a new vet.

 

This is a new vet. I'm extremely low income and he rarely charges me for services. The previous vet was keeping a tab, but when Jester went into remission, he said I needed to go elsewhere for treatment.

The recent vet (like the previous one) was very reluctant about me home testing. I finally got up the nerve to start testing with the OneTouch my diabetic niece gave me (along with a batch of test strips).

The vet's rationale about upping the dosage is concern that Jester's BG will drop to a dangerous level.
He knows I'm home testing and finally admitted the human meter was "damn close" to the pet meter.
I haven't had a free day to try to do a curve since starting home testing. And truthfully I suck at it. Sometimes it takes three to four strips before I don't get an error message.

 

Most of us dose change on our own. My vet has no idea what I am shooting unless she looks at my spreadsheet.

 

Please set up a spreadsheet and add it to your spreadsheet so that we can help with dosing suggestions.

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

 

I don't have a spreadsheet yet. I've been keeping track of things on google calendar.

That spreadsheet has so much more info than I have in my own records. It makes me feel like I'm doing this horribly for Jester.

:-(

 

the spreadsheet isn't as complicated as it looks. really you just need to have the dates, the units you gave, and any readings you've taken. If you want someone can set it up for you from what you aleady have if you aren't sure how to do it. If you have the spreadsheet we can see, then we can help with dosing suggestions for you. the color coding makes it easy to see trends at a glance. PLease, no judgement here. Just home testing you do more than half the diabetic pet owners.

 

I'll work on it this afternoon/evening. I'm feeling a little overwhelmed right now.

Plus I'll have another BG reading by then. The vet prefers the reading four to six hours after his insulin, so I'll do that today.

 

If you have any trouble just say the word and someone will set it up for you.

 

I just put something together. I know I put all the info into my google calendar, but for some reason most of the earlier BG numbers are gone, including original dosages.

 

The good news is Jester's BG went down from 379 on Friday to 304 today. I've been encouraging him to eat lower carb pates, but he's a very picky boy.
Took me almost a month to get him off the 20+gram carb Friskies Indoor food with rice to the mid-teens Friskies filets - and that was almost an accident. (Bought it as an experiment for one of the other cats and found him munching on it. *g*.)

When he went into remission back in September, he also stopped eating almost completely. I had been trying out multiple low carb Friskies flavors, which he'd mostly been eating. Then, the happy day that the vet said he didn't need insulin, Jester just plain stopped eating. He would sit in front of me asking to be fed, but would only eat mouthfuls at a time. It was about a week and a half before he finally started eating more normally again - before that, I was assisted feeding him, giving him dry foods, anything to get calories into his skinny body.

Scared the living crap out of me, so I'm understandably cautious about experimenting with alternative foods for the time being.

 

Can you see my spreadsheet?
I hope I did this right.

 

Yes, I can see it.

 

I can see it! Well done!

 

So now that I've done that, what happens?

 

Ok try to always get a preshot test so you know if it's safe to shoot, and also so you have an idea of how much it's dropping from then to the mid cycle readings. I am confused about what you are shooting in the pm.... You have a few numbers written under pmps (this column is supposed to be for the evening preshot test) and the second blue column is to show what dose you give in the evening. Are you giving two shots a day?

 

The spreadsheet is confusing for me.

I've only just started doing home BG testing and only once a day - between four and six hours after the morning insulin.

 

And yes, Jester gets two shots.

 

The AMPS is the AM Pre-Shot....the test you should get immediately before feeding/shooting in the morning. You want to make sure they're high enough for insulin at all before you shoot!!

The PMPS is the PM Pre-Shot....the same, only for the evening.

The U column is for Units....how much you shoot

The + cells correspond to the number of hours since the last shot....so if you usually shoot at 6am, that's your AMPS.....if you get another test at 10am (4 hours later) that number goes in the +4 cell.....If you test again at 1pm, that's 7 hours since the AM shot, so goes in the +7 cell......all the way up to +11....and then it's time to start the next cycle. The PM cycle

Most cats go lower at night, so it's important to always try to get a "before bed" test so you'll know if it's safe to sleep the rest of the night or if you should plan on getting up later to get more tests in.

Make sure the ear is warm before you poke. It helps to bring blood into the tissues if the area is warm. A small sock with some dry rice (put in microwave to warm and test against your wrist like a baby bottle) works or a small pill bottle filled with warm water works too.

As you test more, new capillaries will grow into the edges of the ear and it'll become easier and easier to get that precious blood drop. You might check and see how big of a sample that One Touch meter requires. Some meters require more than others.

The Relion Confirm or Micro that lots of us use (from WalMart) takes the tiniest sample size and the strips are affordable ($35.88/100)

 

I am completely confused about how to use the spreadsheet.

I did the best I could. But there's nothing to explain what the columns are for.

All you told me was to use the spreadsheet.

 

Ok... Here's a link on understanding the spreadsheet.

http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

Amps is am preshot. The test you take just before injection (no food 2 hours prior). Units is how much you gave. The columns labled +1, +2, ect are how many hours after the shot. So if you inject at 7 am, and then test again at 11 am, that reading would go in the +4 column. Then there is the pmps which is the pm preshot test in the evening (again, no food 2 hours prior), then the blue units column for how nuclear you gave.... And so on. At the end is a column for any notes you wanna make.

Take a look at the link above and look at a few of the spreadsheets in various signatures. If you have any more questions I'll try to help.

 

Since Jester's BG is in the 300s four to five hours after he's had a shot, I can't imagine it would be too low before he eats or gets the shot.
Plus it sometimes takes me four times before I can get a reading. After that I don'twant to keep torturing him.

What do the numbers above all the pluses mean? I assumed they were about his actual BG. That's why I filled the spreadsheet out that way.

I can't afford to get a new meter and I would never give Walmart my money.

 

You can't assume that....I know it seems to make sense, but it just doesn't work that way. For example, let's say before the morning shot he's at 48.....that's too low to shoot, right?....but because you didn't test, you gave it anyway. It's possible that he'd go even lower and his liver would "kick in" and release stored sugars and hormones to bring him back up to a safer place (we call it bouncing)....but it's also possible that he drops too low for that to help out and you could have a tragedy on your hands.

Are you warming his ear first? I know it can be hard on us, but it really is important to keep him safe. That's another reason I suggested checking to see how big of a sample your meter required. Using a meter that requires a tinier sample can make it a lot easier to get a good test and not have to poke them more or waste strips.

You mean the numbers along the very top ? Like <500 in black, 499-400 in red, 399-300 in pink, etc?

Those are the color codes for the different numbers....the spreadsheet will automatically color code the numbers as you enter them so that 500 or higher will be black, 400+ will be red, 300+ will be pink, 200+ will be yellow, 100+ will be blue and under 100 will be green.

BUT, if you enter extra information into a cell (like if you get a test 5 1/2 hours after the shot) that would be ### @ +5.5.....by adding the extra information and not JUST a number, you have to color code it manually....the scale along the top tells you which colors go with which numbers

I was just suggesting, not demanding. Again, my comment had more to do with the required sample size for the meter you're using. It's totally your decision. I don't know what size sample the One Touch requires

 

Why does the vet only have me check four to six hours *after* insulin?

 

They are wanting to see how low the insulin is taking him.....but that doesn't tell you if it's safe to give insulin in the first place.

People are told to never give themselves insulin without knowing what their blood glucose is first....it's the same for our furkids.

The "rules" say that the cat should start higher in the AM, go down by +4 to +6 to the lowest point in that cycle (the "nadir") and then start going up again until it's the PM shot time.....but cats don't read the rules!!....LOL