Question, building up data

Good morning everyone,
Rosie and I have just finished our first week of insulin and despite a great start we hit a rough patch which I'm sure is very normal. You'll see this on the s/sheet and you'll see me trying to respond to it.

Today is my first chance to be home to collect some data to help understand what's going on for Rosie. I'll provide this info to the vet and aim to see them next week some time. I have been trying to get in extra readings where possible over the past few days.

If I look at last night as an example would I be right in saying that the lowest BGL may occur 6 hours post-shot? Should I aim to capture this reading or just plot everything for 12hrs?

 

Oh I should add that she's just on Hills DM at the moment and she's stopped howling for food. She eats most of the food at meal time and is now grazing between.

 

Looks to me like Rosie may be peaking around +4 or +5 based on what data you have so far but the nadir, while sometimes fairly stable, can change. With Caninsulin some cats peak as early as +3 while others may not peak until +6 or so. There can also be another small dip in the +7 to +8 period in the cycle with some cats but it is not as pronounced as the actual nadir.

 

Thanks for checking in Linda I got through 11 hours of testing and had to leave the house so she got her pm shot 30mins earlier then when it was due. I was so pleased to get a good spread of testing done.

Have I possibly stopped her bounce?

Will it give anything of value to the vet?

 

You can't do anything to stop a bounce. They are a normal biological occurrence that you just have to ride out. Bounces can take up to 6 cycles (3 days to clear). I think Rosie bounced after those blue readings and the problem is that if the 2.0u dose is a bit high, it's set off more bouncing before the first bounce cleared which is why I suggested sticking to the 1.7u dose for now. My concern is that the vet may look at those numbers and want to increase the dose which I don't think is advisable until you see what the 1.7u dose can do for Rosie. My other concern is that vets usually want to increase doses by 0.5 to 1.0 unit and that definitely will set off more bouncing.

Bouncing occurs if kitty drops to a lower BG they have become unaccustomed to due to the diabetes (those lovely blue readings the other day), if they drop a significant amount (drop from 25.1 to 13.6 in 4 hours on the 5thApr is a big drop) or if they drop quickly or to levels that really are too low.

Insulin is not a medicine. It's a hormone so if too much insulin is given, it can look exactly the same as not enough. It's the data over time that is really telling because a curve only captures data for one day which may be a very good or not so good day. Curves are fine but if done on a day when kitty is bouncing the information may not be as accurate as you'd like.

 

Thank you for that reminder, It's not medicine, of course, it's a hormone and I'm expecting it to act like a medicine! I especially should know that's wishful thinking after 7 years of Thyroid hormone replacement.

Stay the course, be patient. I'll go back to the 1.7 and stay there!

Is there any use in testing more than twice a day at the moment? Eg. Should I continue with a +6 reading for reference?

Rosie has been brilliant about it but I suffer from high functioning anxiety and I think I need to force myself to step away from the bgl monitor and go with the flow a little and stop thinking that is something I can control. I can provide consistency in diet, dose, testing and cuddles, and my poor girl cay can control nothing at the moment!

As always I appreciate so much the support x

 

There is definitely a very good purpose to testing in the middle of each cycle. That is the only way you figure out if the dose is too high or too low. Testing before each shot tells you if it is safe to give insulin. Testing mid cycle tells you how low that particular dose of insulin is taking Rosie and that is critical information because you don't want Rosie going too low but you also don't want her staying high either.

Testing at +6 everyday is Ok but not as helpful as testing randomly between +3 and +7 which is when the insulin will reach peak action. While some kitties are pretty regular in when they nadir, they do change it up occasionally just to keep us on our toes. Catching an early mid cycle test can often tell you how the rest of the cycle might pan out. So if you see a big drop early on, then further checking might be needed or some higher carb food to slow down the drop. We can help you figure this all out.

If getting mid cycle tests is a problem during the work week, I'd still definitely make it a habit to grab a test before going to bed each night. Our kitties quite often go lower at night than they do during the day so those night time tests are important.

While you can't make her diabetes better, you can steer her treatment toward the best result and keeping her safe with testing that allows you to start see her patterns and understand how doses are working for her.

If you are anxious about testing Rosie, try singing to yourself and Rosie while you test. It relaxes you and maybe Rosie will enjoy then serenade. You are not hurting Rosie.....you are keeping her safe but don't hang on each reading number. Each reading is just one reading. What you want to be able to do over time is see what her pattern is like so you have better control over her BG and can get her regulated.

 

Ok that's makes sense. I can definitely do one before bed (around +3) and I'll get as many +3/+7s as I can during the day, most likely weekends though.

The actual testing and injecting is no issue for either of us, so pleased it's not tablets! It's the results that get me anxious. I feel so much better after yesterday. I don't know how people could do this without any support.

We're very lucky to have found this forum !

 

It tough especially in the beginning. We all hung on each number expecting a miracle and it just doesn't work that way for most kitties. It takes some time to get a kitty regulated and in better BG range. If Rosie is OK with testing then just consider it part of her routine to keep her healthy and safe. Getting random tests between 3 and 7 hours post shot when you can will show when she usually reaches nadir, then you can concentrate on tests around that time frame. Hold the 1.7u dose for 4 cycles (2 days) and then we can see what she is doing and decide if the dose is too high or too low.

 

Hey Linda, would it be ok to ask you to have a look at Rosie's s/sheet? Her levels are high but it looks to me a bit more 'stable' since keeping the dose consistent. She's also a much happier cat since I've offered her both canned food and biscuits she's always been self regulating with her eating. She gobbles up that tinned food straight away and grazes at the biscuits if she's hungry.

She turned 14 yesterday

 

Belated Happy Birthday Rosie!

It does look like Rosie has smoothed out a bit but it's still a bit of a puzzle as to whether she needs more or less insulin. Loving that yellow start (AMPS) yesterday but she's bounced back up by PMPS and we don't know how low she might have gone earlier in that cycle. Since Rosie loves her canned food it would be a good idea to start weaning the dry food out of the picture. If you get her off the dry food you can take the remainder of the bag back to the vet and tell them she won't eat it anymore. The manufacturer offers a money back guarantee so you should be able to get your money back or at least part of it.
The dry DM is really high in carbs and getting it out of the picture would likely lower Rosie's BG.

Looks to me from the data so far that Rosie is hitting nadir around +4 post shot give or take so when possible, try to grab some tests around that time frame and do try to get a test in before you curl up under the covers for the night.

 

Cool, thank you for having a look for me. I was surprised to see her pmps jump up too.

I'm finding that she's eating less of the dry food so I top it up if she's eaten it, I will reduce it slowly and hopefully she won't miss it at all when I remove it.

I should have grabbed a night reading but I went to bed early and she was a little bit fussy with testing/ insulin tonight so I figured I'd leave her alone.

Thanks again

 

Hi Keryn and Rosie!
I was just poking around the forum . Linda's given you some great advice, as always ! I was going to ask why you didn't go back to 2.0U yet but I see there was a diet suggestion change first . What dry food is she currently being weaned off of? @Bron and Sheba Are there any diabetic friendly dry foods in Australia if Rosie still wants something crunchy? Thanks in advance .

 

Hi Yong!
Thank you for checking in with us! I was actually thinking of asking this last night, should I be now moving to 2iu after consistent week of 1.7? He levels seem more consistent now but still very high.

I bought the Hills DM food so it's the vet recommended diabetic one. When her levels are high she gets hungrier. I've made a habit now of offering her the tinned food and if she complains I'm giving her small handful the Hills DM (less than the 1/4 cup meal allowance).

I probably should to take her to the vet for a review. She's not unwell other the expected increased urine output and hunger. I think the vet will say take her to 2iu anyway. I'm happy to give her what she needs but I wanted to get some consistency happening with her diet and dosage. They had suggested adjusting her dose based on PS BGL levels.

 

There are no diabetic friendly dry foods here in Australia as far as I know. The MD dry is around 16 % carbs so is high carb. That is about the lowest dry as far as I know. I haven't used dry for years so I could be wrong..
I will leave it to the knowledge vetsulin users to steer you with this as I don't use vetsulin.
Glad you are posting over on this page Keryn

 

Thanks for sending me this way Bron x

I'm going to stock up on some of the bigger cat food tins if I can find any suitable so I can give her a big wet food serving rather than the teeny tins I currently have. This might help her forget about dry biscuits!

I have to admit before this diagnosis she was a dry biscuit cat. She had issues with her skin and it took a long time (years) to settle it. I wonder now if the steroids she had to have while we were figuring this out contributed to this condition. Old habits die hard.

 

Yes most likely the steroid did contribute to the diabetes.
Don't change the dose AND the diet at the same time. Choose one and do it, then the other. Probably the diet first.....see what others think who use vetsulin...(that's what I would do with Lantus insulin.)

 

Her hunger is relentless at the moment and really not her normal self. She always ate small portions. I think once she can get a break from these high levels she won't mind the wet food alone. Honestly she's 14, I'm really asking a lot for her to deal with this massive change to her normalcy. I'm focusing on making sure she's happy and calm at the moment. I won't take the dry food totally off her with the increased dose, I just won't put it out unless she's indicating she's hungry.

 

I increased Rosie's dose to 2iu and this morning it's the first time since diagnosis she hasn't screamed for food in the morning!

There was still a bit of food from the night before in her bowl and she wanted to go outside to 'garden' (poo in my plants) before breakfast. That was airways her routine. BGL still high but I was expecting that.

 

Oh dear, something's not right with my girl. I could see last night that AMPS would be high. This morning she hasn't eaten, she hid away in the cupboard and her tummy feels full and hard. One of her back legs is shaky. Waiting out the front of the vet for it to open.

 

Hi Keryn, how is Rosie?
I hope they tested for ketones.
I noticed she dropped from 22.2 to 11.4 in 3 hours last night. She could wellhave dropped further. It is always a good idea to get another test after a drop like that. That is also probably why she is so high this morning.
I really think you would be much better to swap Rosie over to Lantus insulin. It is a much gentler insulin and is longer lasting. You have given her a good go on the caninsulin and it is just keeping her in high numbers most of the time.
She is going to be hungry if she is in those high numbers.
Please let us know how she is after the vet visit
Bron

 

Rosie has had a lovely day at the vet where she was doted on by the vet staff and she's home and in good spirits.

Her blood had nothing alarming, no ketones but some evidence of minor kidney deterioration. No cause for alarm at this stage, it's degenerative but manageable.

The vet would like to leave her on the caninsulin for another week while they do some research on Lantus (spelling?) and the best diet for kidney and diabetes.

For now, they just want me on the Hills DM to control variables. I did discuss why I was moving her to tin food and they understood the logic. This kidney deterioration is a new issue to contend with, which is the lesser of two evils for her high protein or high carb. ith so I'll follow the vet on this advice for now. I'm very lucky to have a university hospital close to me so my vet will talk with the specialists there.

 

Hi Keryn
I am glad Rosie is ok. I’m sorry about the kidney issue. Sheba had early kidney issues but she remained stable until she died about three years later from an unrelated illness.
If she is in the early stages of the kidney deterioration, it is better to keep her on a high protein, low carb diet but look for canned food that has a lower phosphorus level. Under 200 mg phosphorus / 100 kcals is best. That diet is good for diabetes and kidney issues.
Have a look at this link. I used to use some of the weruva cans before i changed to raw.
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
I’m glad they are looking at Lantus. I think she will do much better on it.