2nd night on caninsulin and reading 3.7 (66.6) at +4

Hi everyone

Remi is on 1 unit of caninsulin and tonight is his second dose.

Yesterday remi reading were :

23.2 mmol/l pre shot
+ 2 15.06 (271.08)
+12= 7.7 so no insulin given (148.6)
+17= 20.8

Tonight :

23.0 pre shot (not feed for five hours)
Fed
+2= 12.4 mmol/l (223.2)
Fed
+4= 3.7 mmol/l (66.6)

Have just fed him and added in some of his old food as I am currently transitioning him of the dry food.

Will his level go any lower? It took me five attempts to get a BG reading and I don't much fancy doing it again tonight. He is alert at the moment

 

'fraid the testing's not over yet, Sarah. You'll need to test him - possibly several times - to make sure his numbers rise and continue to rise.

 

I have fed him a handful of his old biscuits and his new wet food. I had been transitioning him of the dry royal canin. Hypoallergenic onto applaws chicken in jelly and had been reducing the dose. This evening and tonight I hadn't given remi any of his old food.

So in reserve I have honey and I have royal canin convalescence support sachets which I will make up now in case I need to use.

It has been an hour since his last BG and at least twenty minutes since he last ate. I guess I will try to get another BG reading and wait for responses. It is +5 now and so will this be the peak low? My main worry is that last night remi was lower in the morning 7.7 mmol/l

 

Hi Sara,

I've just posted on the TR forum to ask if someone can come to help you.

Have you managed to feed Remi some higher carb food? If so, can you let us know. Then can you test him again shortly after to see if his BG comes back up?

 

It's likely to be a long night, Sara.

It might be a good idea to make up the high carb food and give some to Remi to give the insulin something to work on.

 

Yep have fed him some of his old higher carb food and his new wet food. Will retest in a minute

 

That's great.

Warm his ear a little longer and maybe you'll find it easier to get the blood drop for the test.

Post the result when you have it. Then keep refreshing your browser so that you can see replies when they come in.

 

The dry may take a little longer to see a response in BG.

 

Thank you for replying, Darin.

I'm a novice and I don't have the experience to help Sara.

Sara, Is the convalescent food a wet food?

 

It is now 5.9 mmol/l (106.2)

Heating worked a treat

 

I've only given him the dry food so far and it has raised the level. The liquid convelsance food is made up ready in case I need to use it. Will syringe it as I used to.

 

The steering numbers routine for low glucose is this:

Feed 1 to 2 teaspoons of high carb gravy or regular food with a few drops of syrup/honey/etc on it
Wait 20-30 minutes then re-test.
Repeat if needed.

High carb gravy and syrups will wear off quickly; the dry will take longer. Since you've given some dry already, I would go with just gravy or syrup at this point, until the dry starts kicking in.

Once you're past +7 (approximate end point of likely nadir period), with 3 rising glucose levels, and above 100 mg/dL, you're going to be able to relax a bit, and go longer between tests.

 

Once over 2.8(50) you will test every 30 min and need to see 2 rising numbers that are not influenced by food.

 

What number are we looking for it to rise to?

Remi is very food sensitive and I am concerned that giving a gravy food with all the other crap in it will set of a panc flair and so if okay with people here I would prefer to give the liquid royal canin convalescence

http://www.vetuk.co.uk/royal-canin-vete ... hets-p-254

But do I still need to now his numbers have raised?

 

It never got that low. It went down to 3.7 and the latest one after dry food was 5.9 mmol/l

 

If he'll eat it, go for it. The important thing is getting in some calories quickly without giving him so much he vomits.

How long has it been since the shot now?

 

Thanks to you, too, BJM.

Is it OK for me to take down the 911 alert in the TR forum post now?

 

Yes. I'll keep monitoring.

 

Thank you so much. I was so worried for Sara and Remi.

I'll go remove the alert. I'll check back in a while before I go to bed.

 

You just want to keep him above 2.8(50) I use lantus but use to use vetsulin, same as what you use, it would peak around 4 to 5 hrs after shot.

 

oh he loves it. I only stopped it last week.

So it is now nearly +6 since his shot. The last reading after his dried food was 5.9 (106.2). Will give him a little of the liquid food.

 

I was just letting you know that when he is less 2.8 you need to start higher carb food intervention.

 

That recent number is pretty good. You can go about 30 minutes until the next test.

 

Thankyou. I was worried I had written the wrong number so where

 

Have given him a 5 ml syringe of his liquid food. Will retest in about five minutes as that will also be +6

 

Just done at +6 and it reading 7.3 mmol/l ( 131.4)

What needs to be done now. Is it safe to go to bed yet? As I could sleep!

 

Ummm ... I'd retest in 30 minutes without feeding to see if he's stable.

A note on naps: if you nap in 45 minute increments, it is easier to wake up. So nap 45 minutes, 90 minutes, etc

 

So do you think the same thing happened to him last night? I only got one reading at + 2 yesterday and it was 15. Then when I woke up and tested at + 7 it was 7.7 mmol/l (138.6). So maybe in the night he went quite low?

Also if I ever make it till morning what do I do when his next dose is due? Playing about with the higher carbs will have upset his levels anyway and going on these two evening doses is 1unit too high?

 

Hi, Sara.

You're doing great. Since BJ has been offering wonderful help and support, I'm not going to interfere. I'm to overly familiar with Caninsulin. However, there is a post we use on the Lantus board that you may find useful. It's a step-by-step guide to handling low numbers.

 

I think 1 unit is probably too high. You might drop down to 0.5 units and get your spreadsheetset up so the patterns can be seen in his response.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.

 

Thanks for the info.

I think we had a quick nap. Remi is reading 11.0 now (198) at +8. No food has been given. Is it safe to go to bed? Poor remi's ear is terrible now. That took four attempts.

What about tomorrow morning. If it is above the safe range shall I give half the dose ? The needles aren't very accurate for such a small dose. What is the safe range. Above 11?

Do I give any more food now?

 

You may relax on the food. Leave some regular food out in case he wants to nibble.

I think it is safe to go ahead and crash.

If you have a wood or metal ruler with fine markings such as millimeters, you can set that next to the syringe to estimate 0.5 units consistantly.

 

Thankyou. Remi looks terrified every time I come near him now. His ear looks really bad. It can be so easy one time and impossible the next. He is just eating his new wet food. Then will go to bed.

So if the number above 11 tomorrow am I will go ahead and give a half dose. Will try my metal ruler. Then I don't think I can cope with monitoring him every hour but if I do it at plus 2 and plus 4 and plus 6 we should be okay? What sort of drop should I be looking for?

Finally I had nearly got him off the dry food. On the lower dose it should be okay to give him little to zero of that shouldn't it? I am as much worried about messing with his food and causing panc flair as anything else.

Am off to bed now but finally I can't thank everyone who has helped me tonight and over the last few days. Without you I think it would have been impossible.

 

As long as his pre-shot is OK to give insulin, you can wait to test him around +5ish if you want.


If you can get some Neosporin ointment (not creme) with pain relief or something similar, putting a dab of that on the ear can help immensely in healing. Also, apply direct pressure after the test to reduce bruising. Just a minute to help it clot in a small area instead of seeping.

A high protein, low carb treat with every test, even if not successful, can help a lot.

 

Well, how are things the morning after the night before? I hope you got some sleep at last? Remi js obviously very sensitive to insulin - that was a big steep drop at +2 - so although it was a stressful few hours you can at least see now how very important it is to test as often as you can. It may well have been that Remi dropped pretty low the night before, too. So despite the anxious few hours you have in fact made progress because you have collected more data and begun to see a pattern.
You have had good advice from BJ and others on what to do this morning at what number, but still test after dosing so we can see if the pattern - steep drops - repeats.
As for poor Remi's ears, again you have had good advice so if you follow that, it will help you also to feel less stressed. And please remember treats - they really are important, so that Remi isn't too freaked out by all of this and co-operates willingly because he knows he will get a little something nice for good behaviour.
I hope today is better for you.

 

Morning everyone. I got a few hours sleep but not very restful.

This morning I really heated the ear and got a good blood drop. The reading was 25.5 mmol/l (459). So I went ahead and gave .5 of a unit. Or at least I think I did. The needles are set to give up to 20 units and it was near impossible to try to find the 0.5 of a dose even with a metal ruler. I am also not sure that such a small dose got into him properly. Can I get smaller syringes from the vet or elsewhere for the caninsulin. I can't go on like this.

I have accu fast clicker and I am not sure what depth to set it on. Last night I went up to three and it pierced his ears. Plus it is okay to pierce the top of the ear?

 

Morning! I expect the reading is up at least partly because of the additional/different foods given last night to offset the drop.
OK, so did a successful blood test (congratulate yourself) and you've given 0.5 units, or tried to. I know what you mean about being unsure if the insulin was injected - a small dose like that can be hard to tell. Was Remi's fur at all damp at the injection site? If people don't inject correctly it is sometimes called a 'fur shot' where the insulin ends up on the surface of the skin/fur. It's easier to tell if you're injecting bigger quantities, but for such a small dose I think most people would be unsure. Not much you can do for the moment but bear it in mind in future, and take your time injecting so you can be confident you're getting it right.
I don't know about smaller syringes but I expect Elizabeth, our main UK expert, will know. I will ask her to come here and read your posts from overnight.
As for the ear pricking, yes, you prick the edge of the ear where the vein is. If you look back at your previous threads I think someone (KPassa?) posted some useful links there. This morning could be a good time to chill a bit and check up on some things like that - knowledge is power!

 

Hi Diana

It didn't feel damp but I haven't seen him perk up yet at all and it is now 1 hour post shot. The last two times he suddenly came to life and acted more like his old self. Now he is just laying on his side asleep and doesn't have much energy.

I phoned the vets and they said they would look into it and get back to me but those are the right syringes for caninsulin. A dog maybe but not a cat!

Yes I have read KPAssa guide. It is very helpful but when it comes to actually doing it I still panic. I think a big part of my problem is that when I am anxious I rush things to get them over with. I

 

Hi Sarah,

Gosh, you've had quite a night. Well done! And thank goodness you are hometesting!

I absolutely agree on that dose reduction to .5 unit.

Regarding measuring .5 unit, are you using the 1ml or the .5ml Caninsulin syringes? (It's easier to measure smaller amounts in the .5ml syringe).
Also, VetUK also do their own range of U40 syringes (suitable for Caninsulin). I've just emailed them to ask if their syringes have .5 unit markings and will let you know what they say. (And incidentally the VetUK syringes are way cheaper than the Caninsulin ones...)

Another option to consider, if it looks like Remi is going to be needing small doses, is to use U100 syringes with your U40 insulin.
Different insulins come in different concentrations/dilutions. Caninsulin has 40 units of insulin per ml and is generally used with U40 syringes. Many other insulins have 100 units of insulin per ml and are measured in U100 syringes. If you were to put a unit of U40 Caninsulin into a U100 syringe it would come to the 2.5 unit mark there (but would of course still be one unit of Caninsulin). Using U100 syringes can make it much easier to measure small doses of U40 insulin. But the idea can take a bit of 'getting your head around'. And you'd need to feel comfortable about the idea of it. There is a conversion chart here if you're interested in seeing how it works: http://www.felinediabetes.com/insulin-conversions.htm

Eliz

 

I don't know if I am tired but I think I understood what you just said.

The box says it is 0.5 ml caninsulin syringe. So I was using the first mark on the syringe. This morning I just had to guess the halfway point which was impossible. The vets haven't got back to me yet but said they would look into it. Should I phone them and suggest the U100 syringes? I don't want to have to do the same tonight if at all possible. Especially as my hands are quite shaken at the moment. For all I know I only gave him .25 of a dose!

 

Hmm so at +2 the BG is now still high at 23.3mmol/l (419.4) Does this mean I missed the shot /got the dose wrong or may it still drop?

Many thanks.

 

My vets don't have any U100 syringes and the nurses very suspicious about who told me to drop to .5 of a unit. I told them my vet (who is away on holiday did).

Can I source these syringes anywhere else in the uk today?

 

They have got some syringes and I am off to get them in a bit. I am so relieved.

Now I have another concern. When I was fiddling about with trying to get the right amount in the syringe a drop formed on the outside of the bottled. Before I realised what I was doing I flicked my hand down twice to get the insulin drop off. Have I ruined the insulin? I asked the nurse and she said no. What do you guys think?

 

I know it's easy to say but do try not to worry. You are doing brilliantly. And it will get easier very soon. Really!

There are a number of reasons why the blood glucose may still be high.
First off he had higher carb food which may still be keeping his numbers high.
And it may be that the insulin didn't go into Remi properly.
It is also very possible that he is experiencing a 'bounce'. Bouncing is a common phenomenon, especially in newly diagnosed cats.

'Bouncing'/'Rebound' can be triggered when a cat's blood glucose drops too low or too fast (or indeed both). "Too low" doesn't necessarily mean 'dangerously low'. Bouncing can be triggered when the blood glucose drops lower than the cat has become accustomed to.
The cat's body senses danger and releases glucose into the system. (The blood glucose level can swing up very high as a result of this.) The body can also release counter-regulatory hormones, the purpose of which is to keep the blood glucose high for while. This looks like temporary insulin resistance (ie, you give the shot but the blood glucose remains high and unchanging('flat').

In Remi's case it could be that the speed of the drop was sufficient to trigger a bounce all on it's own. (Typically, drops of 5.5 mmols or more per hour may trigger a drop (and that may well vary from cat to cat)). But he also dropped quite low too.
That 3.7 was actually a very nice number, and in different circumstances you might have been very pleased to see it (ie, if it was a bit further into Remi's diabetes story and you saw it at the peak of an insulin cycle where the preshot level had been maybe around 9 - 10). But to 'freefall' to that number from a great height will have given his body (and you!) a bit of a fright.

Bounces can take up to a few days to clear, but may well clear faster than that. You may see a response to the next insuin shot you give. I know it's hard, but it is a bit of a waiting game. Try to be patient. And rest assured that you've done everything you can do at this point.

Sending you a big reassuring (((hug))),

Eliz

 

Although insulin needs to be handled gently I think it's unlikely that flicking the vial a couple of times would have damaged it. When I've collected insulin from my vet I've occasionally seen him or the vet nurse sometimes give a bottle a quick vigorous shake before handing it to me. I cringed when I saw that. But the insulin was still fine...

 

Morning Sara.

Pleased and relieved to see that you got through the night OK. Yourself and Remi have had a bit of a baptism of fire. I know his ears have been through it but they'll heal quickly. Better tatty ears than a hypo.

When testing, always give Remi treats (even hand feed him a little piece of home-cooked chicken by hand), and talk to him soothingly, positively and confidently. Even if you don't feel confident, fake it till ya make it! ;-) Remi loves and trusts you, and seeing you more positive will reassure him. Give him lots and lots of fusses and tell him what a good, handsome boy he is. (And he is handsome! Lovely avatar picture.) Maybe groom him a little as part of his testing routine? (Saoirse likes that.)

WRT Remi, the lethargy and the worry about whether or not you gave the insulin properly this morning, you'll need to monitor his clinical signs and test during the day. Every cat responds in their own way, but FWIW Saoirse had a big drop during her transition to wet food and the following day she was absolutely poleaxed after it. Her clinical signs were better the following day.

I'm only a novice sugar kitty parent and experienced members will be able to give much better information, but on review of events I think there is a strong possibility your pre-dose number last night may have been influenced by a Somogyi rebound. Remi's low number yesterday morning was most likely the lowest that it has been in a while, his system may have panicked and signalled his liver to dump extra glucose into his bloodstream in response. The rebound may continue to affect his numbers for several days but there's no guarantee of that. Also last night's low might make him even more sensitive to the Caninsulin so the smaller dose could have a strong effect.

Remi has also had some higher carb food overnight and that will affect his numbers for a while, too. When his body uses up that food, it is likely that his numbers will lower accordingly. That, too, will influence dosing decisions.

Be sure to have your hypo kit laid out on standby just in case you might need it. It's easier to get it organised while everything's calm and relaxed instead of trying to grab stuff in an emergency when you may be flustered. Be sure to always keep a good stock of lancets and test strips at home.

The early weeks after diagnosis can be absolutely exhausting for care-givers. It's important to factor your own tiredness into your dosing decisions. Once the insulin is in, you can't get it out and should Remi's BG get worryingly low (as it did last night) you need to know that you'll be able to stay awake to monitor him and see him through the low safely. I offer this not to alarm you, but so that you might be saved from situations such as the one I found myself in when Saoirse's BG levels took that huge drop during her unplanned but very abrupt transition to wet food (necessitated because of her unexpected refusal to eat dry high-carb after an adverse reaction to a spot-on treatment). I had already started running Saoirse's first 24-hour curve while she was still on high carb dry with only a tiny amount of low carb wet and i was absolutely shattered after it. The stress and worry over the unexpectedly abrupt cut-over to low carb wet (the only thing she'd eat) drained me even further. I was in the fortunate position that I had already gathered some data so I knew that Saoirse hit nadir at +2 to +3 and started rising after only a few hours. I did a pre-bed test for her nadir and thankfully caught the hypo (4.3 on Alphatrak- c. 2.8 on a human glucometer) but I was in great danger of passing out from exhaustion. It's a predicament I wouldn't wish on anybody. I will be forever grateful to the FDMB members who helped me stay awake that night so I could keep my girl safe. I had to remain standing the whole night to avoid losing consciousness. Not recommended.

I completely understand your desire for Remi to have BG levels in the normal range as soon as possible. We all want that for our little ones. But his body needs time (not necessarily a long time) to get used to the low carb food and the insulin and for his pancreas and liver to learn that these lower, safe BG levels are OK. As long as Remi is clear for ketones and you're monitoring for them at home, a high number is MUCH safer than a low one until you have more data and know Remi's pattern. Once the insulin goes into his system, you can't get it out again. "Start low and go slow" and "better high for a day than too low for a second" (ketones permitting) are two of the best general guidelines I have learned since joining FDMB. As you gather more test data, hopefully you'll see Remi's day averages gradually drift down into the euglycaemic range as his therapy continues.

Well done for getting through last night. You must be exhausted. Give Remi some scritches for me and treat yourself to something nice! cat_pet_icon

 

Thanks eliz and Crittermom

I've just got back from the vets and I cried so much at the receptionist that she went and got one of the vets. He had a nice chat with my and explained the syringes and printed me out the conversion table for the u100 syringes. So tonight as long as the BG reading is above 11.1mmol/l (which I am sure it will be) I will give a o.5 unit dose of caninsulin. This will be will be from a U100 syringe and this I will take the insulin up 1.5 notches (as there is no .25 marker).

Please someone confirm that this is correct. We went over it a few times so I should have that right.

I have just taken a +5 reading and it is 21.1 mmol/L (379.8).

The vet confirmed better to be too high than too low, and yes I tested for ketones this morning and it was negative. I think I am in sure a rush to get under control as his sister died from ketones without really getting the underlying condition in control.

So are you saying that even at .05 dose he could drop too low again :cry: From the somogyi rebound. This is a worry, what I want then is a slow lowering of levels. Will make sure I add a little dry to his food just after the injection but he is nearly off the stuff now. Will make sure I keep taking readings tonight but should I do anymore this afternoon or just leave him be?

He is booked in to the vets on Monday for a curve.

 

Actually, Somogyi rebound has never been convincingly demonstrated in cats. Sienne from the Tight Regulation board has explained this numerous times. That would happen with sustained overdosing of insulin.

Bouncing - compensatory hormones releasing stored glucose (glycogen) - can happen a lot early on. The resulting high numbers may take up to 3 days to clear. Stay calm and wait it out. We'll get you some "patience pants" if we need to!

The conversion factor to use a U-100 syringe with a U-40 insulin is easy if you remember that each 0.5 tick mark equals 0.2 units of Caninsulin. So you can just count the ticks - 0.2, 0.4, 0.6, 0.8 as you go up the syringe.

 

So that's right then. I go up three marks on the during to get to 0.6 of a dose? I might try to just under three marks to get to my 0.5

Is the somogyi rebound the same as a bounce? I read a good thread about bouncing.

I am going to leave remi to rest until we take his next level at 7 pm tonight. I think he has had enough of my manhandling him today.

 

No, Somogyi is not the same as bouncing. Bouncing is a short term response of up to 3 days. Somogyi is chronically higher numbers due to too much insulin and has not been demonstrated in cats. Dusty went OTJ in a couple of weeks and I only tested him weekly when I went over to his owners. The day I came in and he was too low, we tried no insulin - he never went super high due to insulin he didn't need, he just ate what he needed to compensate for the insulin.

And a dose of 0.6 units would be fine too, if you can't quite measure the 0.5 units.

 

Thanks for the information about the difference between Somogyi and bouncing, BJM. I've not seen that explained so well before. It's good to be learning more. :smile:

(Told you I was a novice, Sara! ;-) )

 

Ok I think I understand what you mean. Not sure what OTJ stands for.

I am getting extremely nervous about tonight. People will keep an eye on me won't they.

My plan for tonight is to test pre shot. All ok give him food-mainly wet with just a bit of dry. Then give his 0.5 unit. Then a +2 and +4 test. I will feed him after I take each new BG reading. All being well I hope to be able to go to sleep then. Yes?

I know I looking for a slight drop and should be happy even if it isn't into the ideal range.

 

Hiya,
'OTJ' means 'Off the Juice'. The 'juice' is insulin. So, 'OTJ' refers to cats that no longer require insulin and can be diet-controlled.

Regarding support tonight, there should be US folks online long after UK folks have got their 'slippers and cocoa and have gone up the wooden stairs to Bedfordshire'. ;-)
But I honestly think you'll be just fine on that reduced dose tonight so long as the blood glucose isn't actually dropping significantly at the time you give insulin.

I know this is causing you a lot of stress. But you really are doing an amazing job. It takes some folks a long time to get where you are in terms of grasping this whole 'feline diabetes' malarky.
Be kind to yourself. Draw breath. Eat chocolate. Drink wine (well, heck,it works for me :lol: )

Hugs,

Eliz

 

Oh off the juice! Would never have worked that out
Thankyou for your continued encouragement.

I have finally managed to have something to eat myself and feel much better now.

So I have taken his preshot reading and it is 22.5mmol/l (405). He then ate mainly wet food with a little of his crumbled dry on top. So have gone ahead and given 0.6 unit of insulin (the closest measurement I could get it to). Remi jumped as I have it him and so hope it all went in.

My plan is to do a +2 and a +4. I just hope they are okay as me and my partner are beyond exhausted. We are still struggling with the ear. Sometimes it works and sometimes it doesn't. He now has quite a lot of blood clotted in his ears. Does this hinder getting more blood out? It must be very painful for him .

 

Always apply a bit of direct pressure after getting the test. This reduces the amount of scabbing and bruising. If you are ever desperate to check the glucose, you may aim for the vein, however it does bleed profusely so be prepared to blot quickly and firmly if you do that. One good shake of the head and you'll think you've been in a slaughterhouse.

If you find you're not sure the full amount went in (aka partial or complete "fur shot"), never give more as it may wind up being too much. Yes, Remi could be high that period. He will be safe, though, and that is what is important.

That's fine. The important time period for mid-day tests is during the expected nadir. That is usually between +5 to +7 hours post shot. Get 1 in there when you can.

 

Thanks. Will make sure I do a nadir test tomorrow during the day. He is off the vets for a full curve on Monday.

We are just past +1 post shot and he suddenly got up and wanted food as he did the other times. That is common isn't it? It doesn't mean he is going too low too quickly. I put down some of his wet food. I was going to feed him again at +2. It just made me nervous.

 

Remi's +2 is 17.6 mmol/l (316.8) so that seems like more of a gentle curve doesn't it? Do I need to try to feed him again as he ate about 30mins before his +2.

Ear much easier this time. I think key is to get it nice and hot with the hot rice and then do it immediately .

 

Hi Sara,

Sounds like you're getting the hang of testing. :smile:

I found that +1 'appetite uptick' very helpful when monitoring Saoirse because it let me know the insulin had started working. With your +2 you got confirmation that Remi received the insulin OK.

If you can manage it, a +3 reading is useful on Caninsulin since that's the time that the manufacturers advise the crystalline insulin starts having maximum effect.

What's Remi's feeding schedule (meal sizes, time between meals)?

 

I think it was more of a lucky hit that time. Iam still averaging only 1 usual blood drop for every two missed.

I think I will stick to a +4 tonight and do a +3 tomorrow morning and evening as I am only just coming off the ceiling.

Now remi s feeding amount is a bit all over the place since the transition to wet. It goes like this

Wake up
Antepsin and asthma puffs
Wait 30 minutes then give new wet food/dry food mix (of course now I a take a BG reading and then his insulin)
Then his other oral meds
Then he might get a mid morning snack if someone was at home
A meal at lunchtime
Antepsin when I get home
Meal at about 6.30 but this will be pushed later now I guess because of BG /insulin injection
Feed again (small amount)at 8or 9
Oral meds and astham puffs
Feed again (small amount) between 10 to 11

I used to measure out his dry food and give over the course of the day with two larger meals and a variety of smaller.

I am afraid the change to wet has thrown me with regards the quantity I should be giving him. I am averaging somewhere between 2.5 to three sachets of the applaws meals given over the same sort of schedule. I am worried that when back at work no one will be here to give him a mid morning snack at his +2 .

I am really not great with maths and so haven't attempted to work out the actual amount he needs from that food. It's on my list for tomorrow as well as setting up a sheet.

 

You might try freezing some of the canned, to be eaten as it thaws, for the meal you won't be home to feed.

Or see if you can pick up a Pet Safe 5 from our shopping partner Amazon (use the link above and the purchase will help support the message board)

Moisture content in dry food is only a few percent. In canned food it is usually between 70-78% moisture. You might think of the size of a grape vs a raisin for an approximate comparison of volume between dry kibble and canned food.

 

Hi BJM

Will look into that more tomorrow.

His +4 reading is 8.4 mmol/l (152.2) is that okay. I would very much like to go to bed. He will have one more meal before we go up of mainly wet with just a few sprinkles of old dry.

Besides having very red ears he is happy enough and has been laying flat out on top of me like his used. Came downstairs off his own back.

Again in the morning the lowest reading upon which to use the insulin is 11.1?

 

That's quite a steep drop from 17.6 at +2 to 8.4 at +4.

Am I doing something wrong regarding feeding? Or is this just how remi does it. I know I have been told already but what are the nadirs of caninsulin. Critter mom mentioned 3hours for the first part of the insulin but there is a second one isn't there? Is that +4. When do the biggest drops occur with caninsulin?

 

That sort of schedule would go well with the Caninsulin action profile, with the large meals given just before his insulin injections.

BJM has given good advice about the timed feeders. I find them a godsend. The Petsafe 5 wasn't an option for me because during the worst of Saoirse's flare-up she needed tiny meals once an hour, so I got several 1- and 2-meal Catmate feeders. The mechanical timers aren't precise, but they stand up to Saoirse's attempts to burgle them when her appy stimulant is at peak effect.

 

Thanks critter mom

Will sort the food dosing next and look into a feeder

So it's ok to go to bed now?

 

The steep drops are part of the problem with Caninsulin as a treatment for FD, and even more so at lower numbers. I had to stop giving it to Saoirse as her numbers got lower because even at 0.2 IU the drops were still large enough to make it unsafe for her.

Technical info on Caninsulin:

http://diabetesindogs.wikia.com/wiki/Caninsulin

 

That's something I can't advise you on, Sara.

I always stay with Saoirse until her numbers start rising again. I can't cope with the uncertainty. I have PTSD so sleep is a major issue for me. I used to regulate my sleep cycle with meds, but I had to stop taking them after Saoirse's Dx (they were becoming less effective and they were worsening the nightmares, so my GP is glad they're gone). Now I can't predict when I will sleep, and once I do pass out my body is so wrecked I don't respond to alarm clocks in order to nap and then wake to do spot checks. At the moment I only give her insulin once a day. I'm doing the daytime cycles at the moment, but I did nights before that to get more readings. I can't monitor her properly over the 24-hr period to keep her safe and I don't have enough data yet to feel OK about sleeping until I have a better idea of when her numbers will rise. She's fairly well regulated at the moment and runs low at night (euglycaemic most of the day on less than 1/4 unit per day) so we're managing for the time being until I gather more data and recover enough to do a few 24-hour curves. She needs to get back to 12/12 dosing to induce remission but I won't attempt that till I can do it as safely as possible.

Perhaps more experienced will be able to advise you what to do.

Best prices on feeders are on Ebay.

 

So I crashed and remi was fine

His preshot am number is 21.4 (385.2) so I fed him and gave him the 0.6 shot. He seems a littler brighter today. So hopefully slow and steady wins the race. I was maybe 15 minutes late as I turned off the alarm and fell back to sleep. I feel like I have a massive hangover. I suppose all the adrenalin leaving my body.

So I think my plan for this morning is not to get a +2 but to go for a plus +3 and some later ones in the curve say maybe a +5 and a +7 or 8. How does that sound? It is only a guess. Or should I always take a +2.

Many thanks

Sarah and remi

 

Remi 's +3 is 16.5 (297). So it looks like it is on a similar curve to last night where he was 17.6 at +2. Will do a +5 and a + 7. The outside of remi's ear still looks like one big clot. I am still aiming to hit the vein to get enough blood but I guess hopefully over time I can just prick the skin.

I will go ahead this afternoon and have a go at the spreadsheet. Someone posted a message about it a while back in this thread and hopefully a link to the sheet. I usually use my iPad nowadays so don't have the program necessary to run it. I am not sure if you can download it to an iPad or if not I will have to dust off and fire up the old laptop ;-)

 

HI Sara,

Glad all went well last night and that Remi is brighter this morning. I find that with Saoirse that as her numbers get lower, her overall bearing and mood gets lighter.

It's great that you're doing a home curve today because it will be great to have some 'no vet stress' numbers to give your vet tomorrow. :smile:

I'm a bit late to the party for your +2 or +3 question, but the +5 and +7 sounds like a good plan. Based on those numbers, you'll have a better idea of whether or not to take a +8 as well. Check back here if you need suggestions. I might not be online but I'm sure that other members will be able to make better suggestions than a beginner such as myself.

The numbers that you get today should give you a better picture of the length of peak action of the amorphous insulin and the later number(s) may show a possible late nadir as the crystalline insulin rises to peak effect. (Saoirse never had those so I can't give you any idea of what that might look like or when to test after to check when Remi's numbers start to rise again.)

When I was deciding when to check Saoirse's BG in the early part of the cycle, I used to use the appetite uptick as a cue. If it came earlier, I'd test at +2 and +3, especially when her numbers got lower so that I could monitor for a possible hypo risk. I'd recommend that you always do a +3 at minimum. That said, a couple of times when I didn't take +2 readings and the +3 tests had Saoirse in the high 3s (low 2s on a human meter). I'm at home all the time so I was monitoring her clinical signs very closely indeed (every 5 mins). Nevertheless, I would have preferred to have caught her going low sooner in order to feed to steer her numbers before she got that low.

Remi will have his own pattern and your tests will help you to learn it, but I hope some of the above will help you. To a degrees, I was making it up as I went along (goes with the territory since each cat will respond to insulin in their own way). It was nerve-wracking enough being at home all day and being able to keep an eye on Saoirse all the time. If I had had to leave the house my nerves would have been in tatters (and there would have been many withheld doses). nailbite_smile

 

The spreadsheet will be in Google Drive and you access it with your internet browser.
You'll need a Google account (free).

The instructions are in the Tech Support forum; you can navigate there by clicking the down arrow at the bottom right of this page and selecting from the drop-down list.

Go partway down the page and you'll see them.

 

Right just down loading an app now to hopefully allow me to do the spreadsheet on the iPad.

Have just taken a +5 and his levels have gone back up to 20.8 mmol/l (374.4) whereas at +3 he was down to 16.5 (297). He did eat his lunch in between the readings. He probably ate twenty minutes before the last test. What does this mean? He has peaked already and is now just going to climb again? It's a bit disappointing.

 

It's worth taking a later reading because the crystalline insulin may lower Remi's BG again.

The short time at low numbers is a function of the insulin action profile.

Different insulins have different modes of action. The intermediate insulins (like Caninsulin) will lower BG and hold it there for a while during the cycle but the effect wears off as the cycle progresses. Hence there may be several hours in each cycle where the cat's BG is unregulated.

By comparison, longer acting insulins such as Lantus (insulin glargine) may not produce the fast, precipitous drops that Caninsulin does because it builds up a depot (bit like the insulin equivalent of a petrol tank). It takes time to fill the depot and then determine how much to top it up every cycle (so that insulin in = insulin out). Once the depot is filled, Lantus remains active for longer in the cat's body, but generally it doesn't lower BG as fast as the likes of Caninsulin does. To use an analogy, Caninsulin curve peaks and troughs may look like the Himilayas when compared to the rolling hillsides of Lantus.

Both types of insulin have their strengths and weaknesses. For example, the precipitous drops can be quite alarming with Caninsulin, especially when the cat reaches a nadir in the hypo range. The advantage with Caninsulin in such a circumstance is that the insulin is used up faster and the risk period is relatively short. In comparison, if a cat's BG were to drop to hypo levels when being treated with Lantus, because of the depot nature of the insulin, the cat can be at risk for 16 hours or more and will need intensive monitoring, testing and steering throughout the period until the requisite number of non-food-influenced rising numbers are recorded.

For all of the (justified) criticism of the '1 feed of Hills w/d Dry + 1 dose Caninsulin BID' protocol being applied to cats, it is not without merit in terms of possibly keeping the cat safe from hypos (the high carb diet basically feeds the insulin). Trouble is that using such a protocol places strain on the pancreas and may result in keeping the cat diabetic unnecessarily.

 

Thanks I am learning all the time from yours and everyone's posts.

I think I can see now why they just say ideally feed twice a day as I think if remi hadn't had lunch then he levels would still be lower. As it is I just took another meter reading at +7 and his reading is 23.2mmol/l (417.6) and so it looks like the insulin has stopped working much at all. I can't say I am not a little disappointed but am just trying to keep in mind what is said here and at the vets yesterday is that it is better to be high than too low.

I am not able to only feed remi twice a day as he would most likely vomit as his stomach acid increases. But is it better to feed them early on in the cycle at say +1 or +2 rather than later on in the cycle. Or lots of little meals. Feeding didn't seem to have quite the same affect last night but then again I didn't test so late on in his cycle.

Do I need to get another BG reading before his next shot? I do feel sorry for him having us prod him all the time.

On another note. When I open the spreadsheet I can only see the us figures to fill in. The second sheet behind just has headings but no chart. Does that mean I have to convert all my uk ones or has something gone wrong?

 

The standard Caninsulin protocol - like the insulin itself - is very much suited to dogs.

Saoirse had exactly the same problem with the 2 pre-dose meals per day. Prior to the recent flare-up, the only symptom she had of pancreatitis was that she would vomit if she fasted for more than 3-3½ hours. Our previous vets were beyond insistent about the protocol being the only way to go and that Saoirse would have to get used to it. I found that completely unacceptable. I fed Saoirse 3 meals plus a snack each cycle (large before insulin, medium after +3 test, small at +6, snack at +9). That way the majority of her food was offered during the period of insulin peak effect but she had something in her tummy all the time so that she would not get sick. Worked fine because i could monitor her.

Gentler, longer-acting insulins like Lantus work better for cats because the insuiln action profile supports small meal feeding/grazing. Indeed, the small regular meals are kinder on the pancreas (as you know so well) and are less likely to cause big food spikes in BG levels.

Me three. I really wish it wasn't necessary. I find it especially difficult to run longer curves because my wee Bonnie's ears don't get as much time to recover. But I do all I can to cheer her up and reassure her through the process and I take heart myself from knowing that this is the best thing I can do to help her get better, and to keep her safe while I'm doing what's needed to help her heal. My little one was bright, alert, cheerful and serenely regal in her bearing this morning, so I thought her BG might be a bit better than yesterday morning's somewhat disappointing 8.2 (only giving < 0.25 iU insulin on AM cycles at the moment). I can't describe the joy I felt when I saw her reading this morning: 4.7 / 85 !!! (Alphatrak) First pre-dose number in double figures as measured in American units. Right now, the light of my life is having a snoozy sprawl on the sofa, relaxed as a kitten. Her coat is smooth with a beautiful lustre, and there's not a trace of tension in her body. Compare that to the tatty, depressed, starving, thirsty hiding-behind-the-curtain meatloaf of a few months ago. All those pinpricks got her here and seeing her improve makes them all worthwhile. Saoirse looked me straight in the eye and smiled after her test this morning: I think in her own quiet way she was telling me she now understands what all the pricking, pills and pestering were about.

WRT the spreadsheet, you need to fill in the World mmol sheet. I've got to get some rest now (eyes won't stay open), but if you start a thread asking for help with the spreadsheet, I'm sure someone will be able to help you with it in short order. :smile:

 

It sounds like you and Saoirse are getting yourselves sorted. I cant wait to see remi back to his perky self again. I must say today has been a bit of a disappointment after last night figures looked good. I have just taken a +9 reading and is about the same as before-23.3 mmol/L. He hasnt eaten anything in between his +5 and +9. He doesnt even want the treat after his BG reading. He is laying on the bed all lethargic when he looked so good this morning, even coming down to slep by the open patio door.

I have got my spread sheet uploaded and will start a new thread asking people to comment before i go to the vets tomorrow