11/19 Paws AMPS 209 +5 122 +6 153 | PMPS 170 +2 215 +3 135 +4 62 +4.5 55 +5 70 +6 125

(No yesterday link - first condo, first full day on the forum...)

Paws was diagnosed last Monday, 11/13, was inpatient in the emergency vet thru Wednesday afternoon, and since he was released, I've been giving 1U of Lantus at home, twice daily, right after meals.

Just found the forum Friday, decided to start testing yesterday, and I'm a bit baffled by his numbers!

Last Monday, he was above 450 at my vet, then above 500 at the emergency vet... (these are blood draw numbers, not meter numbers, so I'm not sure how they compare)... when we took him in, he was severely dehydrated, extremely lethargic, and was showing early symptoms of diabetic neuropathy. When they released him Wednesday, they said he was in the 300's - didn't get exact numbers b/c they meant nothing to me at the time!

Yesterday was the first day he had been acting like himself in over a week - he actually played a bit, and started using his scratching post again! Yesterday morning he was in the high 200's, then PMPS 182, +2 208, then we went to bed.

Today his AMPS was 209, then since he's still getting used to all the ear pricks, I waited til +5 to test him, and he's 122! I'm still trying to figure out what all these numbers mean, but from what I've seen, most of your SS are all blacks, reds, and pinks for at least the first few weeks? So a low blue seems to be a rather low number for him in the first week after diagnosis?

He's happy as can be, today, strolling around the place like he owns it, and getting as many snuggles and scritches as he can. Sleeping on the couch right now with his "brother".

He has a vet appointment tomorrow morning for a full blood and urine workup, so I'll have a good opportunity to chat with the vet, too. We were planning on doing a full curve on Thanksgiving Thursday, but with the rate his numbers have been falling, I'm worried they're going to fall too low too quickly.

 

Hello and Welcome,

Great job on getting up and running with the testing so quickly, and for setting up the SS

It's not unusual for kitties to spend quite some time in high numbers at first diagnosis, but equally I have seen kitties have an initial strong response to insulin.
Any chance you can get another test in after that 122? Although the most usual low(nadir) is around +6 they can continue to drop beyond +6.

What syringes are you using? Are you sure they are U100 syringes?

Are you sure you have administered 1u? Does the scale look something like this? 1u is only up to the first line on the right hand scale and to the second line on the left hand scale. It's not unusual for those new to FD, to get a little confused by how small an amount of insulin they are getting, we had someone give 10 a few weeks ago, thinking it was 1u.

 

Welcome Tim & Paws. Looks like you've done your homework. Try to get some spot checks in in the PM cycle at different times each night just to see what's going on with Paws in the wee hours of the night.

 

Thanks for the quick reply! I'll take a +6 shortly and will report back.

They're Ulticare VetRx U100 0.3cc syringes, no .5U marks and it's definitely 1U that I'm giving. Thanks for checking, I've read the scary stories of misreading the syringes...

 

Just read through your post on Feline Health.
http://www.felinediabetes.com/FDMB/threads/newly-diagnosed-lots-of-questions.186858/

From that I gather that you have cut out Dry food altogether? When did he last have dry food? Dry food is so high in carbs that it's removal can have a huge impact on numbers once it's out of kitties system. It might be the reason we are seeing him go from tests in the 400's to 100's so quickly.



Also in the way of some more info with CKD, this site is worth a look (sorry more reading), it's got a lot of good info with respect to CKD and its management in cats
http://www.felinecrf.org/ Worth a look before you go to see the vet.

I'm so glad he got 1u.
You might want to see if you can get the ones with the 0.5u markings, it will make dosing in 0.25u steps a lot easier.

 

Thanks again, I'll read through the CKD stuff. Until we know definitively about the CKD I won't worry about it too much, but good to be prepared.

Their last dry food was on Sunday. Went from half of his diet being dry food to virtually none. So yeah, that could definitely be why.

+6 was 153. So he seems to be all over the place right now!

 

Hello and welcome from someone else who also had a "complicated" kitty. Balancing a lot of conditions is tricky, but managable with the great help I found here.

First, as to blood sugar, some cats get stressed at the vet and get elevated blood sugar. I had one non diabetic kitty that was over 220 at the vet, and 53 next day at home. Your vet numbers may be somewhat elevated from normal at home numbers. Second, Lantus is a depot insulin, as the depot builds it works better. Initially we hold doses for 5-7 days, unless the cat goes too low.

Not all Lantus cats nadir at +6, that's just typical. My girl never was a conformist. Next time, try some tests earlier in the cycle. The other thing to consider is that meters can be out by up to 20%, so your +5 and +6 test are probably within meter variance.

 

Welcome Paws and Tim! You're in the right place; so much good information from wonderfully helpful people!!
There will be a lot to absorb, but just keep reading through the stickies on the Lantus & Levemir forum main page.
I have the feeling you're already aware of this, but make sure Paws doesn't get any food 2 hours before you test him for his insulin injection. That way the reading is not food influenced.

 

Mr. Paws is quite the handsome gentleman, by the way...

 

Isn't he?! Love that face.

 

Welcome Tim & Paws! So much great information and support here. Glad you were able to set up a spreadsheet and start testing. I think someone else said this to me and it's so true: this is the best place you never wanted to be

 

LOL thanks Alicia & Susan! He is so photogenic. And yeah, Stacy, this definitely seems to be a great place that I never wanted to be.

I feel bad for the poor guy, I'm poking and prodding his ears so much... they're all red along the edges where I've been testing him, anything I can do to help that? I did realize I got the wrong lancets, I thought smaller (higher number) would be better and hurt less, but I can't get any blood whatsoever if I use the lancet tool, I have to prick his ear manually, and he always flinches. So do I just need to get the right size lancet? I always dab with Neosporin+pain before prodding him.

And do I need to worry how much he eats, or is it enough that he did eat? He has always been a grazer, so having big meals isn't working out for him too well. But I don't want to overload the insulin if he doesn't eat enough.

 

One of the nice things about Lantus is they don't need to eat a certain amount before shooting....The "onset of action" is usually around +2 to +3, so you have 2-3 hours to get food into them before the insulin usually starts to "kick in".

It's fine to feed him in between shots. Most cats do better with multiple small meals instead of 2 big ones.

Are you warming his ear really good before poking? Also, massaging them (from the base of the ear, UP) will help get blood up into those capillaries.

Luckily, as you poke more and more, new capillaries will grow into that area and it'll be easier and easier to get blood. I think I could just look hard at China's ears and they'd bleed!!

It will probably be easier for you if you get some 25-28 gauge lancets though, at least until his ears have "learned to bleed"

Are you applying pressure after poking? It can help reduce bruising. The Neosporin with pain relief ointment (not cream) will help too.

 

I haven't really been warming his ear before poking. I'm kinda afraid to at this point, he now seems traumatized any time I go near his ears! I am applying pressure after poking, that's the only way I can get any blood at all... But I'll give it a shot and see how he reacts.

I'm using the Neosporin+pain ointment (it's the only stuff I use for myself, too, I hate the cream).

Here's to hoping it's going to get better with time! And I'll go get different lancets tomorrow, at least those are (relatively) inexpensive!

 

a small sock with a little dry rice in it (microwave to warm) or a small pill bottle with warm water work well.

test the temperature against your wrist (like a baby bottle) before holding on the ear for a few seconds

 

Wow, just a little bit of warming made so much of a difference on his +4... getting that test was SO easy!

But his +4 is 62 - that's so low compared to anything I've seen - do I need to get worried?

 

I would offer a tsp or two of regular low carb food, no more. And test again in 30 minutes. Do you have high carb foods around? What type if meter are you using?

 

And his +4.5 is 55 ... when do I get concerned?
I put out his old dry food and he seems ravenous, but otherwise just fine...
Meter is OneTouch Ultra2

 

Sorry just read the intro again, it's a human meter. We give high carb food if below 50 on a human meter.

 

Please pick up the dry food.

 

Dry food is up, he ate a couple bites, and then curled up on my lap purring. Low carb wet food is still out from earlier, he's ignoring it.

 

Do you know what day he started the one unit of Lantus? I presume it was at the vet hospital. I am wondering how many days he's been on Lantus and if the depot is full. That will impact my dosing suggestions.

Test again in half an hour . He's probably be higher from the dry foid, but we want to make sure he is safe. Sounds like he's feeling good.

 

He's being so snuggly right now... which is mostly normal for him.
The ER vet gave him some sort of fast-acting insulin on Tuesday morning (the specific type isn't listed on my report), then .5u Lantus Tuesday evening, and 1U Wednesday morning, and then I started him on Lantus at home on Wednesday evening, 1U twice daily. So 5 days? I'll test again at +5?

 

OK, the depot should be full and you are seeing the full effect of 1 unit. Let's see where he is at +5.

 

Ok, +5 was 70, which I guess could either be the dry food or that he's an odd cat that peaks early?
When do you think I should test again? He's mad at me now for keeping bothering his ears. Ran away and hid in his cat tower. Poor guy.
Good news is I have the lancets working perfectly now...

 

If you can add "human meter" into your signature, it'll help in the future.

You have a pretty long signature so you may need to shorten it up a little. You can just put Lantus (we know it's insulin) and we know it's twice a day. We'll always look at your spreadsheet to see what the current dose is too so that's not necessary

I'd really like to see another test in 30 minutes

Does he get a special treat after each test? Getting the right "reward" can go a long way in getting cooperation from the cat!! China's favorite is Orijen Wild Boar dog treats (broken into smaller pieces) but anything that's pure protein like freeze dried treats or even a little piece of baked chicken will work....as long as it's a "high value" reward for him!

 

Got it! Updated my sig, and added it to the SS too. Actually have both a human meter and an AlphaTrak (so I can communicate in numbers my vet will understand), but rarely use the AlphaTrak. +5 on the AlphaTrak was 84, vs the 70 on the OneTouch.

Thanks so much for everything, this is so stressful for me - doing my best to not pass that stress along to him but I'm sure he knows. Only treats I have at the moment are HC. I'll look into something better tomorrow, we have a couple awesome local pet stores around here. Paws is usually such an attention-craving sweetheart, it's never been a problem before, but I've also never been fussing with his ears this much.

 

Try singing!! It forces you to use a different part of your brain....If he's anything like China, he'll think you've gone out of your ever-loving mind, but that doesn't matter!!...LOL

We suggest the Hokey-Pokey song

 

You might want to look for some high carb wet food too. It'll wear off faster than the dry food.

Have you looked at our two dosing methods here? They are tight regulation and start low go slow. Depending on which you want to follow, Paws may have earned a reduction down to 0.75 units. More motivation for finding syringes with half unit markings.

 

LOL we sing to both Paws and Smokey all the time, and they just look at us like they think we're nuts.
+5.5 was 92, so sounds like I may have gotten scared for nothing. Or over-compensated it with the little bit of dry food.
Gonna be up for another several hours, so I'll keep testing him to make sure he doesn't drop again after the carbs wear off.
Next question is what dose in the AM. I work from home so I'll be with him all day. It sounds like as long as I monitor him to make sure he doesn't fall below 50, I should stick with it, since the depot is full and he should be close to stabilizing on this dose? He just has such huge swings, and I'm so new to this.
I still need to build my hypo kit, so probably better get that done tomorrow morning to be safe. We do have honey and Karo, it's just scattered all over the place at the moment.
I've looked into both the Start Low Go Slow and the Tight Regulation (and its variation) - was planning on going with the Tight Regulation since I can monitor him so closely and am a test-a-holic... but I absolutely wasn't expecting him to be getting numbers in the greens on day two of testing, so that's kinda confused my plans.

 

If you're out tomorrow, I strongly suggest you run to a WalMart and get some Relion insulin syringes, 3/10cc, 3o or 31 gauge with 8mm or 6mm needles

All their 3/10cc insulin syringes come with half unit markings (no matter what they might tell you)

They're $12.58 for a box of 100

You can wait and test again in an hour....if he's still going up, you're probably good for the night

 

+6 was 125, so looks like we're in good shape for tonight. I'll still be up for a couple hours, so I'll check it right before I go to bed.
Unless you guys think strongly otherwise, I think I'll stick with 1U for tomorrow, and monitor his numbers fairly closely.
Wish we had a Wal-Mart close by - closest one is over half an hour away in ideal traffic.
Going to see the vet tomorrow for the CKD and thyroid tests, so I'll chat with her about his numbers tonight, and a strategy for managing things.

One more question - I'm having a LOT of trouble getting the air bubbles out of the syringe - is that b/c of the type/brand of syringe the vet had us get, or is there just a trick to it? For giving 1U, we draw 3U, tap it to get the bubbles together, then dump to 1U. After reading the stickied tips, we don't really want to shoot the Lantus back into the pen, but we also don't want to keep having to pitch syringes b/c we couldn't draw without getting it full of air and then being unable to dump all the air. It's like the air bubble gets stuck to the side, and then it's the Lantus that we squirt out dumped, and no air bubble.

 

That's a lot of waste

Do you pull the plunger in/out a few times before inserting into the pen? That helps spread the lubricant around.

I'd try pulling like 1.5....then remove the syringe from the pen and add a little more air!! Then do your "tapping".....getting that bubble to move into the air can be easier.....THEN push the plunger in to leave you only with 1U of insulin

 

ooh, that's a good way to do it, I'll give that a try in the morning. You'd think I'd know how to do this, after having gotten allergy shots for 10+ years.
We weren't too worried about waste, b/c we assumed we'd have to pitch the pen far before we ran out, even with drawing extra. But it sounds like it might end up lasting longer?

 

Good morning,(just waking up here), exciting night for you and Paws.

What I did/do with George was rub his ears when I was just giving him a cuddle, not just when I was poking him. That way he didn't associate the rubbing with poking.

As long as you keep the pen in the Fridge, it will last way longer than 28days.

 

Sorry to hijack the thread, but just wanted to say THANK YOU for this tip. The little air bubble has been driving me nuts and I try to get rid of them because I know it changes the dose amount but the tiny one I get from the pen is hard to flush out, adding more air and combining the air bubbles , so easy and it works like a charm! Your tip just saved me money, I've been wasting a lot of insulin to try to get rid of bubbles!

 

You're very welcome!!

The air bubbles are a problem for a lot of us!! Glad my tip worked for you!