Discussion in 'Feline Health - (The Main Forum)' started by Critter Mom, Aug 6, 2015.
No, not at all!
I tested him again at 6:03 and he was at 157, haven't tested again since it seems he's on an up-swing, hate to keep pricking his ears, they're already red and a little swollen, poor baby :-(
Will test again pre-shot, if I don't like his numbers I'm not giving him any insulin.
Oh, I will be monitoring, don't worry!
So sorry to hear that, Aine! I hope you feel better soon! Hugs for you and Saoirse!
Sounds like things are fairly stable, Lucy. Do you agree? If you do, I'll pop back to the first post and take down the 911 flag.
Squallie doesn't seem ketone prone, thankfully. I think I'm going to give him a small dose to keep him from rocketing up, but low enough that I don't have to worry.
I'm very much afraid that my other kitty has fallen into serious misadventure and is no longer with us. He would have come home by now if he was able to. I feel like a bright light of my life is no longer burning. It's breaking my heart. He was a super special little man.
I'm back and can help out for a bit now. I have experience with Vetsulin although I'm no expert by any stretch of the imagination.
I think I'd be very inclined to look for a new vet at this point...
Yes, I think we can manage for a while now. Thank you so much for "rallying the troops" to help me out! Means more to me than you can know (I'm technologically challenged and don't know how to express hugs, except to just say it, so hugs to you and Saoirse!)
yes, that had crossed my mind a couple of weeks ago...
We'll take the hugs any way they come, Lucy! I'll take down the 911 in a moment. (On the off chance you need it put back up again, ask one of the people here helping you to ask one of the mods to change the thread title to display 911 again.)
Migraines are awful! Hope you feel better soon
Thank you, I will
Did your vet even look at your spreadsheet? NOTHING on that spreadsheet indicates that "lack of duration" is a problem. I realize that the overwhelming majority of people here would suggest a "longer lasting insulin" like one of the "L's" or Prozinc. And sure, they work great for most cats. But I can't see where anybody can examine your spreadsheet and conclude that Vetsulin isn't working, or that you aren't seeing good duration. It looks like you are seeing nadir at +6 or +7? That's better duration than I got with PZI.
It may be that you will switch insulin at some point. But you do that when the insulin you have is proven by your data to not be working.
I agree with the dose reduction. 4u is what I mentioned yesterday. But I DON'T agree with shooting every 8 hours. First, you are getting more than 8 hours from a dose now. As someone else pointed out, it looks like you might even be seeing some carryover beyond 12 hours some cycles. TID shooting may cause the 2nd dose to start working before the 1st dose is done. Then you would see faster drops earlier in the cycle, and you'll be testing around the clock.
My opinion is that your vet really doesn't "get" feline diabetes. Maybe she's more familiar with canine diabetes? Her insulin choice indicates that. Vetsulin/Caninsulin were created for dogs, not cats. But a cat can respond to any insulin. Cats have gone OTJ on Humulin.
I agree, right from the start I got the feeling she had very little experience with feline diabetes. I actually asked her to test him for diabetes about a month-month and a half before she finally did; when I had first suggested it she ruled it out right up front. Unfortunately I live way out in the boondocks and she is the closest vet to me. And I like her, I just don't trust her opinion!
Okay , I'm gonna bail for a while, gotta set up "wet dins" and go look for Khoji again. Please everybody say a prayer for him that he is safe and comes back home, he is my very special little bright star and I love him so much.
and "come home, Khoji" prayers...
@Squalliesmom, crossing fingers and paws for Khoji's speedy and safe return.
Squallie's PMPS was 224. I don't think it's a very good idea to give him any insulin tonight, I'm afraid he'll bottom out, even at 4 units. Anybody else want to weigh in on this? Am I making the right decision?
Has he had any insulin since the AM shot? Just checking to make sure. And assuming he hasn't, I probably wouldn't give any, given his performances the last two days.
I certainly understand not wanting to give him 4 units. And a 224 after 12 hours is a really nice number to see. With no shot, you might see a higher number in the morning, but it's just a number. You could skip if you prefer, or maybe go with even less, like maybe 2 units? And no matter what the number is in the morning (assuming it is high), I wouldn't go any more than 4 units, then see what it does.
Your call. It's always your call. You hold the syringe, and I always advise people to "go with their gut" when in doubt.
Try to hope for the best. I live on a main road in Los Angeles and we got Mushu back after 3 weeks. It happens.
I haven't given up all hope yet, but he's never done this before. I'm doubly concerned because he really hates our new Bengal girl , who, ironically, we got as a playmate for him. I'm afraid maybe he won't come home now because of her (barring something bad having happened to him).
Squallie's BG this AM is 370. After he eats breakfast I'm going to give him 4 units and monitor to see how he does with that. I did NOT give him any insulin last night so I feel like we're starting off fresh this morning. Fingers crossed!
I did skip last night's shot, he's at 370 this morning so we're going to go with 4 units and see where that takes us.
"Go with your gut" is excellent advice; I should have gone with my gut yesterday and not given him the 7 units in the AM. Lesson learned!
My naughty, rotten, spoiled, beloved, I'm-gonna-kill-him, so-relieved-he's-back, worried-me-half-to-death, special baby boy Khoji is home!
WOOOT happy dance and party time
So far so good with Squallie. He seems more tired than usual but he's had a hellish couple of days, and I'm sure all the steep BG drops and rises must be hard on him physically. I plan on checking his numbers again in about an hour, will post them when I do.
Khoji's home! Woooooooooot!!!
I am beyond relieved and so very happy for you, Lucy.
Squallie's AMPS was 370, gave 4 units Vetsulin, +2 hrs is 307
That is good shows he is not cliff diving...
Thank you, Aine! It's a huge relief, I was just sick with worry about him, on top of worry about Squallie!
Think I might have accidentally sabotaged Squallie today :-(. In my scramble to lure Khoji back inside this morning I grabbed the first can of food that came to hand-high carb gravy food. I left it on the kitchen floor with Khoji eating from it while I ran around and closed up all the doors I had left open for him, and promptly forgot about it as I got involved with dishing up everyone's "wet brekkies." Long story short, Squallie just came out the the kitchen looking very pleased with himself and set about cleaning his face; that's when I remembered the open can. *sigh* I guess I'll know for sure when I test him next. Poor guy, I really had hoped he might have a fairly level day today. And it's entirely my fault :-(
WOO-HOOOOO!!! Happy dance!
Don't worry about it. Stuff happens under the best of circumstances. I'm sure Squallie enjoyed his "treat".
The effects of the higher carb food will pass. Don't eat yourself up over it! Tomorrow is another day...
With all that you've had to cope with in the last few days it's not a critical error though. You must be exhausted from all this. I know I certainly was when Radar was racing down the dosing scale and he had low readings every cycle every day. I could barely keep up. Rest, Lucy and remember it's better to be high than low.
I may have been wrong about Squallie eating the high carb food, maybe it was one of the other cats because Squall's BG is down to 81 at+5 hrs? DOn't know whether that's good or bad, based on the last two days of lows. Anybody have any thoughts to share?
The mania continues! I could be wrong but I think 81 at +5 is good as long as he doesn't dive too much further in. The dives from vetsulin would give me a heart attack lol.
Trust me, it's not doing me any favors, lol! The last coupled of days have been so stressful I'm amazed I haven't had a stroke or a heart attack!
I'm going to test him again in about an hour, just too make sure he isn't dropping any farther.
It'll keep you young. Lol. I'm so glad you got your other cat back.
Based on my experience only, with only my cat,
81 at +5 is a number to watch in case it keeps dropping while you approach the nadir. It looks like Squallies nadir is about +6 or 7 so you are close.
Maybe give him something to eat to soften the coming drop a bit??
If he were mine, I would also be thinking about dropping the dose... ??? What do you think Lucy??
Based off your SS I take it feeding small meals through the day really helps with vetsulin's dramatic drops?
Yes, of course every cat is different, but I found that giving Radar more food early in the cycle helped to steer the numbers so he didn't drop soooooo much. I got much better at it with practice and a lot of testing.
Lol! Thanks, me too!
I will try giving him a snack. Going to test him again shortly.
I gave him 4 units this morning, but it seems to me that the drop is almost as bad as when he got 7 units.
Okay, he's dropped a little more, to 77 at +6 hrs. Should I try some higher carb food or just his regular no carb food?
I went ahead and gave him about a tablespoon of gravy food, hope I made the right call.
I was very glad to read earlier that you reduced the dose. Just checking your spreadsheet ...
I was so happy when the vet said to try 4 units instead of 7. Then she said to give it three times a day... not so happy with that. If he's still got low numbers at +8 hrs I am NOT giving him any more insulin!
I don't think my vet is taking into account how much impact Squallie's new diet is having on him. He went from very high carb canned food and at least 31% carb dry food to zero carb canned food and 8% carb dry. That's got to be having an effect on his BG, too.
Did the vet look at both of your spreadsheets or just the Alphatrak numbers, Lucy?
She didn't look at either of them. I just told her where his numbers had been going the past few days. His scheduled "appointment" yesterday was not really so much an appointment but a quick test and check of his numbers by her. Also, we were there over an hour early because I got panicky when his numbers started to drop again, figured if things went crazy I wanted it to happen there rather than here! So we were only there maybe ten minutes, she didn't even charge for the visit, it was so brief. I'm really not kidding when I say that, at this point, I think I know more about feline diabetes than she does. When I first asked her, several months ago, if he might have diabetes (based on my observation of his behavior and symptoms) she ruled it out without even testing him, and if he's not hte first diabetic cat she's treated, I don't think there have been many before him!
Lucy, with a diet change my Radar went from 7 units 2x a day to none required in basically one week!! My former vet had no real idea of how the diet change was impacting what was happening and she did look at my spreadsheets. For us it was a nail biting plummet that we only survived because I used the data I collected and made the appropriate adjustments to the dose.
Needless to say I fired that vet and have decided that driving 40 minutes across the city to my original vet is a better option. For sure you know your cat and his numbers better than anyone because you test him regularly.
That's awesome! I really think his diet is having a huge impact on his numbers; all of this craziness started shortly after we weaned him over to the new low/no carb foods. She wants me to try him on 4 units 3x daily at eight hr intervals but I just tested him at +7 and he's only at 95. There's no way I'm giving him insulin with numbers that low!
I think you're on the right track. I also would not give any insulin at that BG level. Keep up the monitoring and let us know how Squallie does.
Thank you, I really do appreciate the advice and the encouragement.
Your experience of trying to get Squallie diagnosed is pretty much identical to what I went through last year. The vet in question gave a diagnosis of "old lady" and dismissed me as a hysterical pet parent, and point blank refused my direct request to have diagnostic tests run on Saoirse who, incidentally, was clinically a poster kitty for diabetes at the time.
I've said it once. I've said it twice. Now I'll say it a third time: Your vet made a HOWLING ERROR yesterday and unnecessarily put your cat in harm's way. That 22 should have scared the living carp out of her. It did out of me.
You need a vet who is there should there be an emergency (e.g. hypo, ketones), and for day-to-day management of Squallie's diabetes and all his other health concerns you need a vet you can trust. You need one who: will listen to you; who will look at your cat's data; one who acknowledges any gaps in their diabetes knowledge and who is willing to learn more. Most of all you need a vet who will work in partnership with you in caring for Squallie and keeping him safe on the insulin he needs.
I don't have the communication skills to couch this in softer terms. I would rather risk being a bit (a bit?!) blunt and give you my honest opinion (and it's only my opinion; other members' opinions may differ):
I would not take any dosing advice from your current vet for my cat.*
If I was in the same situation with Saoirse and there was a choice locally I would look to move to a practice that was more diabetes-literate, who would listen to me, and whose vets paid much greater attention to their patients. The door wouldn't hit me on the way out.
* I'm not saying this based on the knowledge and experience I've gained through studying FD and managing Saoirse's diabetes over the last year. Even if it was this time last year when I knew hardly anything about diabetes I still wouldn't have taken any advice from your vet for my cat. I would have listened to my cat's body screaming at me that the doses were too high. I am so thankful you are home testing.
Oh golly gosh - that diet change likely did have a huge impact on his need for insulin! You did good managing all this.
WOOHOO on baby finally showing up!! BIG YARD DANCE!
Believe me, I don't disagree with you! Squallie had all, and I mean ALL, the classic signs of diabetes when I first asked her to test him. And I think that 22 alarmed her tech more than it did her! Sadly she really is the only one close to me and, at least until I get my car repaired, I'm pretty much stuck with her. Also, because I'm disabled, I usually need someone to go with me to help and I have to work around their schedules. I can get him there myself in an emergency, if I have my car, but it is extremely hard on me. I will say she was a little more receptive to my input this last trip; maybe next time I go in I should just have all my data (my tablet) with me and give her no choice but to look at it. I mean, what's the worst that can happen, she'll fire me as a patient, lol? Don't think so.
Thanks! Hopefully we can get to a point where he needs very little insulin, with this diet.
Woohoo, indeed, lol! Little bugger's spent all day sleeping off the effects of his adventure, too, after eating everything in sight first!
Okay, need a little advice again. We've reached the 8 hr mark where the vet told me to give him another 4 units; I just tested him and his BG is 135 with the Relion (175 with the Alphatrak). I guarantee if I give him insulin at this point that he will have another hypo episode. I called my vet and, of course, she is now closed for the day. So I have made the decision NOT to give him any insulin at this point, rather, to check him again at the 12 hr mark and give 4 units then, if necessary. I hope I'm doing the right thing! If anyone has any other ideas please let me know!
Good decision. That is the smart thing to do.
Ok, you have to work with what you have. You are the one testing and seeing the trends. Diabetes is a disease that needs to be managed at home, anyway.
So work with your vet as much as you can. But trust yourself and your numbers. You are the one staying up all night if there is another hypo. Set yourself a no shot number and try to keep to it until you understand better how your insulin works with Squallie.
Same scenario here. (((Lucy)))
Well, I guess you're gonna have to call the shots on the diabetes side of things from here on in then, Lucy. (Sorry: couldn't resist the pun! ) You need to let her know about the diet change if she doesn't already, including the change in the % carbs between the foods. BTW, how far along are you with the transition (i.e. what percentage of daily food allowance is wet, and how much the high carb dry food)? Also, do you have a target date for completion of the transition?
You've got data to work with now to show how Squallie's responding to the insulin. Maybe you could email the link to the spreadsheet to your vet and ask her to take a proper look at it and say that you're very concerned about Squallie's safety and that you need to agree a plan of treatment that you feel comfortable with and consider safe for your kitty. (You, after all, are the one holding the syringe.)
Let's say, for illustrative purposes only, that you'd feel safer dropping the dose down to 0.5IU BID and your vet insists that the dose should be higher because of blah, blah, blah reason you could present the case to try the ½ unit dose for, say, 10 cycles (safety permitting) with an agreement that you both review the data together and decide on any necessary dose adjustments. Stress that if the dose were to be too low it can always be increased again.
Hopefully you and your vet will be able to find a mutually agreeable way forward.
I think you did exactly the right thing. When I look at his spreadsheet, I do NOT see a kitty who needs insulin every 8 hours at all. Today it looked like 4 units was plenty, and it looks like he might need that much, or less, every 12 hours, not every 8.
If I listened to my vets Luna would be OTJ still
Absolutely the right thing. High # will beat low hypo # any day. You're still buckling down on finding a dose and don't need to be up 72 hours testing every 15 minutes because this vet keeps giving you silly advice.
Not silly, John. Dangerous.
I think you meant to say Luna would not be OTJ still.
Because being OTJ is a good thing!
If I listened to my vet, CJ would still bouncing around on Novolin and very miserable. I shudder to even think of the ER visits that could have happened without guidance from wonderful members here when CJ went hypo.
I meant they literally said to make her go "OTJ".. she was over 300 each time they said that. She's definitely not OTJ lol at 12 units/day.
And I thought I heard it all. This would make a good thread for "bad advice given by vets".
I was wondering about that too. Thanks for the clarification.
I was being very literal, lol. Two vets told us she was in remission, and I did a home test and... 380. One said we don't need insulin - that's stupid and dangerous - just switch to her vet practice brand of RAW food, it'll fix her right up.
@Squalliesmom - Lucy, I'd suggest you start a new thread before your next cycle and ask for Vetsulin dosing advice. You got a massive drop from AMPS to nadir on the 4 units (after no insulin last night). The duration you're getting is longer than typical on Vetsulin too, plus there's a real sense of dose carryover from one cycle into the next in your data (the previous dose continues to influence BG into the next cycle).
Thank you, will do that right now!
I started a new thread but nobody has seen it, I guess. I don't know whether or not to give him another dose, his numbers are still kind of low, and he's not much interested in eating tonight. I don't want another hypo episode, and I'd like to avoid another all-nighter, if possible!
Look through the thread and try and tag the people who use vetsulin for advice. if he's not eating I'd consider skipping again but I really don't know with vetsulin.
Separate names with a comma.