? HELP!!! Dosage ???

Discussion in 'Feline Health - (Welcome & Main Forum)' started by hhelman08, Apr 8, 2015.

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  1. hhelman08

    hhelman08 Member

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    As I was sifting through my research today, I discovered a HUGE mistake! Ness is prescribed U40 insulin but the vet was calling in U100 needles to my pharmacy without ever mentioning a conversion factor! He is actually getting 3.2 u NOT 8 twice a day. The vet also advised me to take away his dry food WITHOUT stopping or reducing insulin. I have lost all faith in my vet and I can't get in to see a new vet until Saturday! We don't even have an emergency vet. Needless to say his bg dropped to 50. I followed the hypo instructions and gave him a can of wet food with honey mixed in and some dry food. 15 minutes later I retested and he was at 90 and an hour later 148 I DON'T KNOW WHAT TO DO NEXT SOMEONE PLEASE HELP ME!!!!
     
  2. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Hello,
    Just going to check your recent posts. Back soon.
    And you are doing just fine... :bighug:
     
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  3. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Aha....
    If it is the case that you've been measuring Prozinc to the 8 unit mark in a U100 syringe then yes, he's been getting 3.2 units of insulin; and it would appear that Ness isn't a high-dose kitty after all...
     
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  4. hhelman08

    hhelman08 Member

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    Yes! I am relieved but I am not sure what to do with his doses tomorrow since my vet turns out to be an idiot. :arghh: He dropped so low tonight. What is the recommendation on switching kitties diet to wet food while on insulin? The vet told me to just stop feeding it to him and it resulted in the low drop?
     
  5. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    You're actually seeing a lovely response to the insulin now. And I think it might be good to reduce the dose slightly. It looks Like Ness's numbers are either trending downwards and/or that he is dropping out of a bounce.
    If you've switched to low carb food it's highly likely that this is the cause for the better numbers.

    The general advice re switching to low carb food is; not to do it until you are hometesting and can monitor, and, don't switch it over in one go (maybe do it over a few days). The latter is mainly to avoid GI upset, but also so that the numbers don't drop so fast that the caregiver can't keep up.

    There are quite a few vets who don't seem to understand diabetes. It's not at all uncommon. ;)

    Eliz
     
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  6. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Regarding dosage, my best guess at this point is that you may need to drop back to 2 units (5 unit mark in the U100 syringe), but let's see where Ness is by the next preshot. (His blood glucose may jump up in response to the low numbers, and/or because of the honey and dry food, but don't worry about that.)
    FYI, the general advice for those new to dealing with diabetes (or with limited hometesting data) is that no shot is given if the preshot blood glucose is below 200.

    Gonna go back and have another read of your posts. Sorry if I seem a bit hazy, am just on my first cup of coffee of the day...:coffee:
     
    Last edited: Apr 8, 2015
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  7. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Hi again, Heather,

    Can I ask a few questions:
    How long ago did you remove the dry food?
    What is Ness eating now?

    I think you are doing a fantastic job.
    In just a short time you've learned to hometest, you've got a spreadsheet going, and you've worked out that you don't have a high dose kitty! I know the situation has been stressful for you, but you really should congratulate yourself. :)

    Eliz
     
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  8. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Heather, I'm tagging folks with Prozinc experience, who should be able to help with dosing advice: @BJM , @Sue and Oliver (GA)
     
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  9. hhelman08

    hhelman08 Member

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    Thank you so much! Yesterday was his first almost full day of no dry food. He has been getting 3 cans of fancy feast per day. 1 can before his first shot, 1/2 can at 3pm, 1 can before 2nd shot and 1/2 can before bed. I guess I just feel like I should have caught this all much sooner than I did.
     
  10. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    OK, then his numbers may continue to drop a bit over the next few days as the carb load leaves his system.
    Please don't beat yourself up, Heather. You're doing brilliantly. And with all that you've learned this looks like being the beginning of real positive change for Ness! He is blessed in having you as his caregiver. :bighug:
    .
     
    Last edited: Apr 8, 2015
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  11. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Heather, here is some info from the FDMB FAQ's that may help to give you a context for the numbers that you're seeing:

    "Q6.1. What is regulation?


    A6.1. There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":

    · Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]

    · Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]

    · Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]

    · Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]

    · Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]

    · Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]"

    "There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated. On the other end of the spectrum, it is possible for a cat who is not getting insulin to have blood glucose as low as 40 mg/dl (2.2 mmol/L) on a home glucometer. If you have a non-diabetic cat, try testing her with the same meter to get a safe comparison figure."

    That info is from this document:
    http://binkyspage.tripod.com/faq.html#regulation
     
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  12. Larry and Kitties

    Larry and Kitties Well-Known Member

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    I would very likely cut the 4/8/15 AM dose. I would halve it to 1.6 but it depends upon the the AM PS.
     
  13. hhelman08

    hhelman08 Member

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    His AM preshot was 424! What is going on with these numbers? What should I do with the dose for his shot?
     
  14. Rachel

    Rachel Well-Known Member

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    He's probably high because of the honey and dry food. Don't panic! I would have been surprised if he DIDN'T jump in response to that. I'd still reduce today since he dropped so low yesterday, honestly. Maybe go with what Larry said and halve the dose? He might surf along in higher numbers for a day or two, but I wouldn't worry about that too much...as you get more data, we can help figure out what's a good dose to help bring him into better numbers.
     
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  15. hhelman08

    hhelman08 Member

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    Ok thank you! I am freaking out I am terrified that he will die from all this.:( I will give him half of the dose and I am going to do a glucose curve today.
     
  16. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    He'll do just fine, Heather.

    It's no surprise at all that Ness has swung up into high numbers at this point.
    It's very likely that the low numbers last night gave his body a bit of a scare; and when that happens the body can try to protect itself by releasing stored glucose into the bloodstream to raise the level. It can also release counter-regulatory hormones, the purpose of which is to try to keep the blood glucose high for a little while.
    It's also probable that the honey and dry food have contributed to the high numbers you're seeing now.
    But don't worry. This is a temporary thing. It will settle out again. Honestly.

    Even though the numbers are high, reducing the dose is still the right thing to do, because the numbers you're seeing right now aren't 'real' (they're being skewed by the temporary 'bounce')
    Because of the bounce the curve results you get today will be atypical, and it may be that you don't see much of a curve at all. That's OK though.

    I know it's all a bit confusing at first. But you'll soon get the hang of things.

    Eliz
     
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  17. Blamethecats and Hannah

    Blamethecats and Hannah Member

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    Maybe you already are aware of this, but I am posting it anyway, just in case it can be helpful to you or others viewing this post.

    Because you are using a U40 insulin with U100 needles, THIS CONVERSION CHART will be useful. I also use a U40 insulin and U100 needles, so it can work with the help of the chart. Best of luck to you and Ness. And you are doing wonderful!!!
     
    Last edited: Apr 8, 2015
  18. BJM

    BJM Well-Known Member

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    You're doing great.
    Switching to low carb food and/or eliminating dry food may reduce the glucose level 100-200 mg/dL. It also may reduce the insulin dose by as much as 2 units.
    Any time he drops below 50 mg/dL on a human glucometer, you intervene to keep his numbers safe, which you did,

    See my signature links Glucometer Notes and Secondary Monitoring Tools. Both will help you evaluate how he is doing.
     
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  19. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    What a great job you did - so glad Elizabeth was there to help.

    Looks like your cycle yesterday was maybe a combination of too much insulin and a reduction in levels due to the change to wet low carb. And yes, your evening jump was most likely both a bounce (release of extra glucose by his body because of the low number he hadn't experienced in awhile - a sort of panic attack from his body.) and the extra carbs you cleverly gave him to bring him up.

    I like your new dose. I'd plan to give it awhile to let his body settle down. If he is still low at nadir today, then go lower. But I'd guess it will take a few cycles to see how this dose is really working. Also the wet low carb may continue to have an effect for awhile.

    The protocol for ProZinc that we put together is in my signature, if you haven't seen it.
     
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  20. hhelman08

    hhelman08 Member

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    I don't know what I would have done without everyone's help! Thank you all!
     
  21. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    A couple things that might help. With ProZinc you want to be careful about not giving a shot on a falling number. On yesterday's cycle, he was still going down by +12. This is an indication the dose was too high( if the cycle's nadir is that late, the dose is too much). And giving insulin on a falling number can mean more insulin on top of insulin still working in his system. The way to be sure the number is rising, not falling, is to hold food and retest in 20 minutes. If the number is rising from the previous test, you can generally assume the previous shot is out of the body.

    Also, consider that a dose like your 3.2 will impact a 300+ number differently than a 200 number. You can generally, but not conclusively figure if a dose brings him down 50% on a 300, it would at the very least do something similar on a 200. (Not for yesterday, as the falling number thing was also in the equation, but generally.)

    Hope that didn't make you more confused. Wrapping your head around the ways insulin can work is a steep learning curve in the beginning, but every cycle you see a different scenario and learn from it, it gives you more tools to work with.
     
  22. hhelman08

    hhelman08 Member

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    No very helpful! When you say a cycle does that mean a week? And the nadir number, is that 6 hours after a shot?
     
  23. hhelman08

    hhelman08 Member

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    Should I still be giving him some of the dry food? I just read an earlier post saying to wean them off over a few days! He hasn't had any in a day and a half. Not sure if this would mess things up or not...
     
  24. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    A cycle is from amps to pmps, so 12 hours. The nadir may vary with each cat, but with ProZinc, it is usually 5-7 hours after the shot.
     
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  25. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Heather, I just looked at Ness's numbers. He didn't stay high for long! :cat:
    That 1.6 is bringing him down really well, and he may continue to drop for a while...
    .
     
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  26. Mogmom and Goofus

    Mogmom and Goofus Well-Known Member

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    Elizabeth is right, the higher numbers you're getting right now are ok, don't panic. We've all been there, it'll be ok. You're home testing so that's a great, it just takes a little time to learn what it all means and the various reactions.

    My vet recommends that if you're going to change from dry to wet (and there are some dry foods that are 12% or less carbs) that you do it over the course of a couple of weeks. Because your trying to find the right insulin, the right dosage, the right schedule and then if the food is also changing, it can make regulating much more difficult. I know most people say wet food is the only way to go, but Goof gets very sick if he eats wet, so he's stayed on dry and has done very well. His numbers are down and he needs only one shot of ProZinc per day. So there's some of trial and error to find what works best for your kitty.
     
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  27. hhelman08

    hhelman08 Member

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    His +6= 244?
    +7= 277?
     
    Last edited: Apr 8, 2015
  28. hhelman08

    hhelman08 Member

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    I just want to make sure I am following you. If I give his shot at 7AM And 7 PM I should be testing 12AM, 1 AM, 2AM, 12PM, 1PM, 2PM to find his NADIR number? ( and it would be the lowest of these right?)
     
  29. hhelman08

    hhelman08 Member

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    +6 numbers were 244?
    +7 numbers were 277
     
    Last edited: Apr 8, 2015
    Reason for edit: forgot
  30. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    You can test every 2 hours if you want, but it is usually easier to just get a test in that 5-7 range every few cycles. Looks like maybe he had an early nadir this cycle around +4.

    Just remember that each cycle is unique and each number is unique. I'd let this cycle play out and maybe the next one, and depending on the numbers, see whether the dose needs to increase or decrease. Think of it as gathering data to help you make decisions.

    If he hasn't had any tummy issues changing over, I'd continue to give him wet and dump the dry. BTW, next time you see a 50, you can just feed him his regular low carb, get another test and see if the food brings him up. If low carb doesn't bring him up, then a few tablespoons of gravy off higher carb (good to have in your hypo kit). We think dry seems to be slower bringing up the levels and may last longer, giving you higher numbers in later cycles.
     
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  31. hhelman08

    hhelman08 Member

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    PMPS was 287 I give the same 1.6 dose right?
     
  32. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Interesting. He had a long surf (staying in the same range for several hours). I think 1.6 would be okay if you can monitor. If not, maybe 1.4?
     
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  33. hhelman08

    hhelman08 Member

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    I can monitor tonight when should I do it? poor guy has been pricked all day long. I am worried about tomorrow while I am at work I will only be able to test him at 7AM (amps) and 3pm when I get home? What would you do?
     
  34. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    I'd go with the lower dose. You can always raise the dose the next time you'll be around, but you can't take the insulin out once shot.

    It is interesting that he surfed. Might be the low carb food still kicking in and lowering the levels.
     
  35. hhelman08

    hhelman08 Member

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    I already had to give him his 7pm dose I kept it at 1.6 I am terrible at this when should I retest him tonight?" I apologize for being so needy...
     
  36. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    No, you are not terrible at this. It is HARD until you have data to help you figure it out. Once you can look back and see what a dose did for a certain number, it'll be much easier. You're doing all the right stuff. You have him on good food, you are testing him ( a HUGE part of keeping him safe) and you are watching the doses.

    I think the 1.6 will be fine. I'd get a number about 2-3 hours from the shot. If he is dropping fast, then you might have to stay up and test and give him small snacks. If he looks okay then and hasn't dropped much, maybe set the alarm and see how he looks in the 4-6 range. I was just thinking you could both take a break, but it is probably good to have some numbers for tonight to help you figure out what to do tomorrow.

    Remember, many diabetic parents have the kitty put to sleep because they can't deal with the shots. Others just shoot blindly without testing. You chose to do all you can to keep him safe and healthy. You are being a great kitty mom! And some day soon, you will pay it forward by helping someone who is scared.
     
  37. BJM

    BJM Well-Known Member

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    Check around +2 to see if he's dropping a lot.
    If he has dropped a lot (ex below 100 mg/dL) by +2, you may want to steer his numbers by giving 1-2 teaspoons of higher carb food and recheck in 30 minutes. See my signature link Glucometer Notes for some reference values.
     
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  38. Mogmom and Goofus

    Mogmom and Goofus Well-Known Member

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    Another good carb booster, especially if you can't get them to eat easily, is to swirl a Qtip in some corn syrup and put it in his mouth, usually they'll lick it, a couple of dips should do it. And you're not terrible or needy, we've all been there! It's just really hard! Like my vet told me, "Just take a couple of deep breaths, and say to yourself, I CAN DO THIS".
     
  39. hhelman08

    hhelman08 Member

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    +2 dropped to 210 from 287
     
  40. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Not a fast drop. Things are looking okay.
     
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  41. hhelman08

    hhelman08 Member

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    I am probably going to check +4 since that is around when he had
    +4= 165...I also fed him again
     
  42. bsmith

    bsmith Member

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    I'd just like to chime in and say that it seems you are doing a really good job taking care of Ness and getting a hang of all this new medical information and procedures. Thank goodness it was U40 insulin in U100 syringes and not the other way around. Keep up the good work and the testing. Having your spreadsheet up now, and keeping it updated, will make it much easier for people to see what is going on with Ness.

    I would second the opinions of others here who have suggested that you try changing the insulin dosage or the food, but not both of them at the same time. Doing both at the same time makes it much more difficult to see what is making his BG numbers change. It can also make his BG much more unstable as too many things are changing at one time.
     
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  43. Rachel

    Rachel Well-Known Member

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    Hey! You're doing GREAT at this. Being a bean to a diabetic cat is hard. Trust me, we've all been there. We remember! For a very long time, I basically got up in the morning, tested my cat, and then posted her number in the PZI forum. I did the same in the evening. I was constantly seeking the advice of those with more experience to help me figure out the right dose. I was doing this daily for awhile before I felt comfortable choosing my own dose...and even then, I would post what I thought and get opinions! You'll get this. Just keep doing what you're doing!
     
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  44. hhelman08

    hhelman08 Member

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    Thanks Rachel! That means a lot I am putting every brain cell I have into figuring this stuff out!
     
  45. hhelman08

    hhelman08 Member

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    He was 326 for amps today. I gave the 1.6 dose and I am going to try and leave work on my lunch to get his +5 reading and give him a bit of food.
     
  46. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Sounds like a plan! You are doing great and so is he.

    Someone early on in my sugar dance gave me some great advice. She said "remember to breathe". It sounds silly, but it's true. Take nice deep breaths and you will be less stressed. You are using the best techniques we know to keep him safe - a mild, longer lasting insulin, home testing and a wet low carb diet. It takes time for his body to adjust to using the insulin and the food. He will be fine and you'll be learning every day.
     
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  47. hhelman08

    hhelman08 Member

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    That is very good advice! I need to take a deep breath and try not tostress so much. I havent even slept much in 2 nisghts because I have been so anxious and worried. Thank you for all you do for the kitties!!! I know Ness says thank you too :)
     
  48. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Just had a look at Ness's SS, Heather.
    That's a nice response to the 1.6 units. :cat:

    How does he seem in himself?
     
  49. hhelman08

    hhelman08 Member

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    He seems to have perked up a bit...he was climbing on the cat tree last nigh which he hasn't been on since I bought it!
     
  50. Rachel

    Rachel Well-Known Member

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    Ness seems to be hitting some good numbers on that dose! Any data from today? Just wondering how it's going now since it's been a few days.

    Glad to hear he's perked up! He certainly must be feeling better.
     
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