? Marcus was fed early, checked during eating 108, 40 min later, 114. Shot or no shot??

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Nicki & Marcus, Feb 7, 2020.

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  1. Nicki & Marcus

    Nicki & Marcus Member

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    Hi everyone,
    I have posted over the past several days to the Lantus page, since that was the insulin last prescribed for my Marcus before his 2 year remission, but as of tonight, we were given Vetsulin.

    My question: We, at first, had thought that maybe because Marcus had sneaked in and eaten dry cat food that it had bumped him out of remission. He spent today at the vet, and about $500 later, he had bloodwork, urine testing, and even an antibiotic injection--in addition to new insulin and syringes. He seemed lethargic again (he actually seemed more himself last night and this morning, even with a BG of 300+) and my daughter and I noticed what we thought was a poop smudge on his back hip. Upon closer inspection, it was a scab which when peeled back revealed a puss-filled small hole about half the size of a pea--and another one next to it. They are painful. He was not happy, but we removed the puss, put on some Neosporin--We are fairly sure that this was a bite from the newest rescue cat we just adopted. We did not see him get attacked, but we did see the new guy bite one of our other cats (we now have 4 total).

    Could this bite wound be the cause of Marcus's spike in BG? Should I take him back to the vet tomorrow morning? $$ I already called and left a message for them to call me. I know they gave him an antibiotic injection, but there is a hole that worries me. (I will probably take him anyway.) I gave Marcus the new insulin earlier. I've checked BG twice and it is in the 200's, so down some more. I'm worried--still. He has no energy and not very hungry.
     
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  2. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Yes, take him back to the vet to get the bite examined. Depending on how it's healing and how deep it is, they may want to put a temporary drain tube in. And yes, infection/inflammation could definitely cause higher BGs. Poor Marcus. :bighug:
     
  3. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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  4. Larry and Kitties

    Larry and Kitties Well-Known Member

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    What antibiotic was given? Given tyour description of the bite it is draining. Thus, the only treatment would be antibiotics. Yes, the bite could raise BGs.
     
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  5. Nicki & Marcus

    Nicki & Marcus Member

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    The antibiotic Convenia was given. I took him back to the vet an hour ago. (No charge for today since they just saw him yesterday.) They shaved the area and cleaned the wounds. Because his BG was 208 and they are only open until noon today, they said to wait until tomorrow to check and start the insulin. They want me to check him before and an hour after breakfast first. They are open Sunday from 9-4.
    Thanks, everyone, for your advice and input. It is taken and appreciated!
     
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  6. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Warm, wet compresses can help keep the wound draining. I hope he gets better now.
     
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  7. Nicki & Marcus

    Nicki & Marcus Member

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    Marcus update: Wound area looks better. Tested him and he was 253 in the a.m. I gave him breakfast, then waited 2 hours as told by vet, and he was 275 pre-shot. I gave him 1 unit of Vetsulin, checked 2 hours later and down to 171. Checked 3 hours later and down to 147. I will check again before dinner.
     
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  8. Deb & Wink

    Deb & Wink Well-Known Member

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    Yeah Marcus! for the wound area looking better.

    That sounds a little odd to me. The sequence that you are doing.

    Test, feed, wait 2 hours, test again (Pre-shot test), shoot insulin, +2 171, +5 147

    + time hour system for recording on the spreadsheet is counting from the shot of insulin
    The pre-shot test for the morning goes in the AMPS column
    The pre-shot test is the test you do just before giving insulin.

    The +2 ( 2 hours after giving insulin) goes in the +2 column. (current cycle is AM)
    The +5 ( 5 hours after giving insulin) goes in the +5 column. (current cycle is AM)
    The 253 you got, is part of the PMPS cycle from the previous day. That would go in the PMPS side of the SS +10 column for 2/8/20.

    Don't think of this as being equal to the current day. Think in 24 hour blocks of time, with 2 12 hour cycles in that block of time. From one AMPS, and the next 11 hours of the 12 hour cycle. Then PMPS and the next 11 hours of the 12 hour cycle.

    Vetsulin only needs 20-30 minutes from food to shot.
     
    Last edited: Feb 12, 2020
  9. Nicki & Marcus

    Nicki & Marcus Member

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    They told me to wait an hour --actually not 2--after feeding to give him a shot, but I was forced to leave the house immediately after feeding and did not return until it had been 2 hours. I agree I have messed up the sequence today and will do better tomorrow.
    So he is 200 now as the pre-shot. I have not given him the insulin. I just asked on the Vetsulin page and was waiting. He just ate.
     
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  10. Deb & Wink

    Deb & Wink Well-Known Member

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    I think you are better off skipping the shot for tonight. That way, you can get back on to your regular schedule tomorrow morning.

    Would you fix your signature please? It still says Lantus and using Alphatrak meter. Is that still correct for the meter?
     
  11. Nicki & Marcus

    Nicki & Marcus Member

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    Thanks so much. I'll start again in the morning
    I had tried for the last week to change my signature, making it super short, and I kept getting an error message telling me it was one line too long. So just now, I put Marcus's ss and the rest in one line--it finally accepted the change.

    Yes, still using the Alphatrak meter.
     
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  12. Deb & Wink

    Deb & Wink Well-Known Member

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    250 character limit and 2 line limit. You can keep typing the characters, using the | mark to separate info. Keep on typing and it should wrap the text down to the next line, as if you were entering data into a post and the text was so long it needed to go down the next line like this.

    Problems like that, ask for help over in the Suggestions, Tech Support & Testing Area forum. Someone, often me, will try to help you the best we can. Hope that helps for next time.

    Yes, we do have a tech support forum.
    Yes, I'm the one that redirected you over here. More people here to help you out, maybe not every minute of the day. But more people here than over in Vetsulin ISG.
     
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  13. Nicki & Marcus

    Nicki & Marcus Member

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    So, this morning--pre-shot was 317. He ate, 25 minutes later, I gave him one unit of Vetsulin. Tonight,(12 hours later) pre-shot is now 212. He is eating. What do you think about a shot?
    Yesterday, he only had one injection in the a.m. of 1 unit--nothing in the evening.

    What do you think?
     
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  14. Deb & Wink

    Deb & Wink Well-Known Member

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    Vetsulin is best dosed 2 times a day. That PMPS of 212 is high enough to give some insulin. Maybe only 0.75U? Do you think you can measure that in your insulin syringes?

    Are you able to monitor some tonight?

    Maybe a +2 and then a test before you go to bed, as close to the +5 as you can get?

    p.s. Dose of insulin changes so frequently having it in your signature is not needed. May be confusing.
     
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  15. Nicki & Marcus

    Nicki & Marcus Member

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    I can definitely monitor him some tonight. I'm giving him a smaller dose right now.
     
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  16. Deb & Wink

    Deb & Wink Well-Known Member

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    Sounds like a good plan.
     
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  17. Nicki & Marcus

    Nicki & Marcus Member

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    Thanks for your help. Is Wink still around? He is beautiful!
     
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  18. Deb & Wink

    Deb & Wink Well-Known Member

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    I hold Wink close in my memories and my heart. I had to let him go to the rainbow bridge almost 3 years ago. The (GA) after his name in my signature is my tribute to him. Don't worry, I simply hug him differently these days. With my heart.

    But he is the reason I'm here helping other people with their diabetic kitties and teaching them the steps of the "sugardance."

    That picture of him in my avatar is still one of my favorites. Besides the one showing his incredibly floofy tail.
     
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  19. Nicki & Marcus

    Nicki & Marcus Member

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    I read now about your Wink. What a great story! I'm so glad you found one another and that he was able to enjoy a much better quality of life.

    At +2 Marcus is at 148. I'm going to set an alarm and get up in 3 hours and check him again. He seems very much like himself, jumping to the dresser and a desk, ruffling papers in a basket to get attention.

    Thank you again, Deb, for being here for people such as me!
     
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  20. Nicki & Marcus

    Nicki & Marcus Member

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    So he is at 181 pre-shot. So maybe give him an even smaller amount? Anyone out there? It's early.
     
  21. Deb & Wink

    Deb & Wink Well-Known Member

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    What did you end up doing with the insulin this morning?
     
  22. Deb & Wink

    Deb & Wink Well-Known Member

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    p.s. In the future, change the title on your thread, put the ? prefix at the beginning, put the pre-shot number in the title and put the word HELP in big letters to get you more attention.

    So those of us scanning the message board Feline Health forum will check your post first.
     
  23. Nicki & Marcus

    Nicki & Marcus Member

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    I gave him .5 this morning, and he was 236 pre-shot tonight. I then gave him .75 this evening, and as I wrote in the new and improved edited thread title, he is down to 129 at +2. I did get up in the night last night to get the +5 reading to see how it went. Shall I do it again?

    Thanks for the advice on the thread title. I didn't even realize I could edit that.
     
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  24. Deb & Wink

    Deb & Wink Well-Known Member

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    Yes, you might even want a +4 tonight. Numbers are dropping fast.
    You really don't want him to fall much below 90 with the Alphatrak.

    If the BG falls below 69 with the Alphatrak, you'll need to give him a little bit of his regular food to bring the numbers back up. then test again in 30 minutes.

    How long ago was the +2? How long until +4?

    Did you/could you feed him a small snack around +2?

    Would you please update the SS with todays BG tests.
     
  25. Nicki & Marcus

    Nicki & Marcus Member

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    He got the snack anyway as the food was still there and he went back at +2, but did not get the retesting done. Did not see your reply until just now. I have him retested now at 220 for amps. Should I give him less in the injection? I don't have the numbers from during the night this time.
     
  26. Nicki & Marcus

    Nicki & Marcus Member

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    Gave him a .5 since I had to leave for work. He seems very alert and chipper. My daughter may be home at +2 and if so, she will test him.
     
  27. Deb & Wink

    Deb & Wink Well-Known Member

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    Not on early enough in the mornings to help you with the dosing.
    The 0.5U this AM 2/12/20 was a good judgment call on your part.
    Marcus seems to drop real fast on the Vetsulin.
    Anytime you can get a +2 would be good.
    If your daughter is home at +2 this morning, I hope she can test him then.

    You may want to invest in a timed feeder so Marcus has some food to eat at +2, and then again at +4 to +6.
    That could help to slow the quick, steep slide to lower BG (blood glucose) numbers.
    Or you could freeze some of the food and make catsicles (hockey pucks).
    Catsicles are the canned food mixed with some water, frozen and leave a couple out in the morning before you leave.

    The catsicles are another way to leave some food available for Marcus to nibble on, since they will slowly defrost.
    You can try the frozen catsicles (ice cube tray size) at night too, while you are asleep.

    The concern is that he would drop into the green shaded numbers, below 69 mg/dL on the Alphatrak.
    If he does, many cats will seek out food on their own to try and bring their blood glucose back up.
    Don't know if Marcus gobbles all his food down at once, or if he is more of a grazer.

    Grazer? Gobbler? A way to leave some food out for him to eat during the middle of the day?
    Timed feeder?

    Those are my ideas for you today.
     
  28. Nicki & Marcus

    Nicki & Marcus Member

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    So, we just got home--we have snow and ice--and the PMPS is 168. He is eating now. So, what about a shot tonight? Should a tiny bit be given? I truly appreciate your help.

    Marcus and two cats eat together--all Friskies pate--and will go back and forth to the dishes for an hour or more until most of it is gone. So Marcus gulps and grazes for a short period of time. Lately, there is still a chunk left in at least one of the bowls left overnight--it's actually from food we give them at about 10 or 11 p.m. The morning meal is usually gone by the time we get home. We may try the catsicles--our problem might be that Cat #2 and Cat #3 will eat whatever is left. Marcus's brother, Max is 16.2 pounds, so he doesn't miss many meals. Marcus is 19 pounds. The third cat, Toby, is a tiny thing--maybe 6 pounds and is a grazer.

    Thanks for your ideas!
     
  29. Nicki & Marcus

    Nicki & Marcus Member

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    It's 236 now-2 hours after feeding, but he continued nibbling --food is still there and he's been back and forth a ton of times. I am giving him .5.
     
  30. Deb & Wink

    Deb & Wink Well-Known Member

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    Ok. Not always able to get back to people in time to review.

    0.5U it is.
     
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  31. Nicki & Marcus

    Nicki & Marcus Member

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    You can't always be here and I totally understand! You have been here when it mattered the most, and I'm always grateful!
     
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  32. Nicki & Marcus

    Nicki & Marcus Member

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    He's 161 at Amps. Feeding now. What about an injection? Small amount? How small? He'll be on his own with his 2 brothers all day. Anyone here? IF not, I'll make a call.
     
  33. Deb & Wink

    Deb & Wink Well-Known Member

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    We don't usually recommend that people give insulin if the pre-shot is <200. As you gain experience on how Marcus does this time around, you can lower the pre-shot threshold for giving insulin.

    Very small amount. Maybe 0.1U. one tenth of a unit.
    Stopper of syringe would be practically touching the end of the syringe.

    Next time, try to stall and retest in about 20 minutes without feeding. To see if the BG number is rising.
    Concept is the same for U40 syringes. Placement of the end of the plunger is the key factor to look at.
    Pictorial guide using a U-100 syringe marked with half units:

    [​IMG] [​IMG]
    [​IMG]
     
  34. Nicki & Marcus

    Nicki & Marcus Member

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    Help from anyone. Marcus's BG went from 190 at +5 last night, to 182 AMPS. I did not give him a shot. Now, at about 6 hours after that, I check and he's 306. I am leaving soon and will not be back until probably 10 p.m.

    What should I do? I won't be here during regular feeding time. HELP.
     
    Last edited: Feb 15, 2020
    Reason for edit: Waiting at home nervously--hoping someone will answer before I have to finally leave home.
  35. Nicki & Marcus

    Nicki & Marcus Member

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    An hour or so later, it's 299, so down a touch. Any thoughts?
     
  36. Deb & Wink

    Deb & Wink Well-Known Member

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    Dose at regular shot time.
    Are you saying you will not be home tonight at regular PMPS shot time?
     
  37. Nicki & Marcus

    Nicki & Marcus Member

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    I was not supposed to be, but I just cancelled something so I can get here in between and do that. He's acting himself, but I want to make sure he is ok and gets what he needs.
    Thanks so much for answering!!!!
     
  38. Deb & Wink

    Deb & Wink Well-Known Member

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    Marcus looks like one of those cats that have a large increase in BG level between +11 and pre-shot test.

    Basing that assessment on the 1 +11 test you did on 2/12/20.

    You may want to see if you can get a +11 test more often.
    To catch that steep rise between +11 and pre-shot test.
    Need to find a dose you can give twice a day, without feeling the need to skip.

    p.s. Tiki cat sardines may stink but boy do cats love that flavor. Great as a topper on the regular food to get cats to eat.
     
  39. Nicki & Marcus

    Nicki & Marcus Member

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    Hi everyone.
    When Marcus had his first bout with diabetes, we had him on Lantus and he did well and went into remission--diet controlled--for 2 years. This new vet gave us Vetsulin. I don't see that there is as good of a chance that remission could happen again, so I asked today to switch back to Lantus. So, what advice do you have for me getting started? I'll be testing him twice daily at least. They recommended 2 units twice daily--and this was without even telling me to test him! They have not seen him since the first week in February. Should I start lower? Even last time, he only was on 1 unit twice daily. Let me know what your advice is.

    (I'll change the signature when I start on the new insulin.)
     
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  40. Deb & Wink

    Deb & Wink Well-Known Member

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    Usually 1U twice a day or 0.5U twice a day is the starting dose for Lantus.
    Depends on if your cat is eating dry food and which dosing protocol you use.
    TR (Tight Regulation) or SLGS.

    So are you using Vetsulin for now? No Lantus yet?

    You also take the dose of the other insulin into consideration when you switch from one insulin to another.
    So what is Marcus's current Vetsulin dose?
    Did you go ahead and give him the 2U dose as recommended by your vet?

    I see by your SS that you have really bounced around on the Vetsulin dosage. Since 2/5/2020. Was that the day you started Marcus on Vetsulin? I only saw 1 2U dose. You've been changing the Vetsulin dose almost daily. So it's going to be very difficult to suggest a starting dose for Marcus on Lantus.
     
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  41. Nicki & Marcus

    Nicki & Marcus Member

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    Yes, 2/5/2020 was the day I started him on Vetsulin. I adjusted the doses following advice I got, and I never was able to get his BG to go down into the green with it. I am hoping it will be better with Lantus as it was last time.
    I don't have the Lantus yet, but I talked to the vet and the prescription is there to pick up tomorrow. Marcus is not on any dry food. He is on all Friskies, some Tiki cat.
     
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  42. Deb & Wink

    Deb & Wink Well-Known Member

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    Do you think you want to start Marcus on TR or on SLGS lantus dosing protocol?
     
  43. Nicki & Marcus

    Nicki & Marcus Member

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    I have the prescription now, but have not had it filled yet, so he has not yet started it. I need to look and see what the difference is between TR or SLGS dosing.
     
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  44. Deb & Wink

    Deb & Wink Well-Known Member

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  45. Nicki & Marcus

    Nicki & Marcus Member

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    I have been checking prescription prices for Lantus--and the discount price through Good Rx, but it's still over $200. I was expecting around $100. Marcus did well the first time on it, so I was going to switch to it...but...the price. What would you all do?
     
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  46. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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  47. Deb & Wink

    Deb & Wink Well-Known Member

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    I'd order from that Canadian pharmacy that Sienne linked for you. You do need to send the prescription to them. But I think you can email it, send a picture by phone, or other ways.

    Or check the supply closet forum to see if there is someone that has some lantus they do not need anymore.
    Supply Closet - For Sale or Free
     
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  48. Nicki & Marcus

    Nicki & Marcus Member

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    Thanks!!! Lantus ordered from Mark's Marine Pharmacy for half the price!! It should arrive before the week is over. We'll hang in there.
     
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  49. Deb & Wink

    Deb & Wink Well-Known Member

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    Darn, if we had realized price was a major factor in switching we would have told you about Mark's Marine Pharmacy much sooner.

    So until you make the switch, you know what we are going to ask you to do?
    Get more tests.
    At least 1 more test in the PM cycle before you go to sleep. Every day.
    A test during the AM cycle also. When you aren't at work.

    Hope you ordered the insulin pens from Mark's. They last longer and people often can use them "to the last drop."

    You might also consider buying a human glucometer. Your signature says you are still using the Alphatrak. Strips for that can be expensive. Your spreadsheet does not indicate which glucometer and strips you use. And it should.

    All the dosing protocols here are based on using a human glucometer. You might want to consider the Relion Prime meter from Walmart or another human meter with less expensive test strips. Although those meters need a bigger blood drop than the Alphatrak. About twice as large. But the test strip cost on the Relion meters is 1/6th to 1/3 the cost of the Alphatrak test strips. Depends if you purchase them in lots of 25 or 50 or 100.

    (And no, we absolutely do not recommend using test strips not made for your specific meter. Any meter. No matter how many folks on the facebook sister site say this is "OK" to do. Think Tank discussion on that last fall. If you can accept 82% inaccuracy at low BG numbers, and your cat never gets low, and want to risk it, maybe. But if your cat is that low and has a hypo, you may want to rethink what you are doing. You are risking seizures, possible brain damage, coma, death.)
     
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  50. Nicki & Marcus

    Nicki & Marcus Member

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    20200301_170958.jpg This is what Walmart had. This is how the meters compared just now. So, words of wisdom?

    Same drop of blood.
     
    Last edited: Mar 1, 2020
    Reason for edit: added last sentence
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  51. Deb & Wink

    Deb & Wink Well-Known Member

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    Pet specific meters are always going to read higher at the higher numbers.
    It's the low numbers, under 100 when the meter readings really matter.

    Alphatrak takes a smaller blood drop than the Relion.
    Remember that the Alphatrak has the little black spots on the sides of the test strip for sipping up the blood.
    The human meters have the little black spots on the end of the test strip for sipping up the blood.

    Pick the one you feel most comfortable using.
    Pick the one that has more affordable test strips.
    Keep the other one as a backup, in case you accidentally drop your primary meter, like into the cats water dish and fry the electronics. Or the battery dies on you.:rolleyes:

    All the dosing protocols on here are written with human meters in mind. But we can understand both.

    Note which one you are using in your user id signature and on your spreadsheet (SS).
     
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  52. Deb & Wink

    Deb & Wink Well-Known Member

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    p.s. Is Marcus still on the Vetsulin? Marks Marine Pharmacy order has not arrived yet with the lantus?

    Don't expect it has, since you only ordered the insulin Saturday if I remember correctly.
     
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  53. Nicki & Marcus

    Nicki & Marcus Member

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    He's still on the Vetsulin until the other arrives. Yes, I ordered it yesterday.

    I bought the Relion Premier Classic at Walmart today with 100 strips, and I'm down to just about 5 of the Alphatrak strips. So, then, the spreadsheet numbers are written for the human meters? And when his numbers are lower, do the two meters come closer to each other in their readings? I'll just have to get used to figuring out and getting comfortable with different numbers for him. I'll adjust the spreadsheet so you know what I'm using, and update my signature. Thanks again!
     
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  54. Deb & Wink

    Deb & Wink Well-Known Member

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    Simply splash a big bold larger than normal size font across the spreadsheet row when you do the meter switch, and make it a pretty color to make it stand out. Fill the row between +1 and +11 on the AMPS side. Then start your new date and data with the new meter right below that.
    Change the meter at the top also. But some sort of comment that the old numbers were with an Alphatrak, perhaps list the Relion first, then the Alphatrak.

    I do believe the SS ranges are for all meters these days. Except perhaps the lowest range, the under 68 for pet meter, under 50 for human meter.

    Yes, the meters come closer together in lower bg ranges. There is no set formula.
    Yes, takes a bit of getting used to, adjusting mentally. Ask if in doubt.
     
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  55. Nicki & Marcus

    Nicki & Marcus Member

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    Done. I may look and try to start a new SS page when I get the Lantus. I see there are instructions on how to make one in the tech forum section. I just haven't tried yet. That would make it easier to follow, probably.

    I will definitely ask for help if I am in doubt.
     
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  56. Deb & Wink

    Deb & Wink Well-Known Member

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    Yes, the SS setup instructions are here if you have never had a SS, FDMB Spreadsheet Instructions, and Marje and Gracie always posts a reminder to add a new tab to the SS for the new year.
    **2020 Spreadsheets--PLEASE READ **

    You do have a template tab, but I see that tab at the top of the SS workbook. Should be easy to follow Marje's directions and add a 2020 tab to your SS workbook (spreadsheet)

    It takes a lot longer to scroll down through years worth of data.

    If you need help, send a PM (start a new conversation) with Chris & China (GA)
    She is the only person around right now that knows how to help with SS setups and changes, since
    Marje is on vacation.
     
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