Am I allowed to whine?

Oh, how I hate this. I hate poking holes in my baby girl's ear to make her bleed! Every 3 hours, no less! Ugh. The poor thing has no idea why I'm torturing her. I just want to cry. Will her ears be ok? Will they be all crusty and scabbed? Of course, I know in the grand scheme of things, that's better than having uncontrolled diabetes, but I just hate this.

Does it get easier?

 

If you hold her ear tight with a tissue on the hole for about 20 seconds after getting your blood drop, you should have no bruising or scabbing any more, and no pain next time. Jock's been doing this for 5 years now and vet cannot find where I poke him.

It definitely gets better, and if your needles are even making her wince, you can find smaller needles too. Also, look for a glucose meter that takes 0.3 microlitres of blood, which is an unbelieveably small drop. If you need more than that, you may be making too much hole in the ear.

 

Thanks. I actually do have one that uses 0.3 microlitres. That's fabulous. I just did the PMPS and not much blood came out and it did work. And I did the tissue thing. And when we were done, she rubbed up against me, so I guess she doesn't hate me. I guess I'm just going to have to toughen up!

Glad to hear your Jock has been holding steady for 5 years! Makes this seem worth it!

 

Well, I've been sticking Mishka's ear for over 6 yrs. 4 months, Hope was over 4 years but is off insulin right now, and there are many kitties who have been stucked a lot longer. Ears are all fine, never an infection, and the only time I see Mishka jerk is in the sipping of the blood......I think she feels it and it may tickle. I can guarantee that if it hurt AT ALL, Mishka would never let me near her. She even butts my head and licks my hand while I am getting the meter ready.

 

of course you are. that's how we deal with this dance.

just remember, with prozinc, you don't have to test all day every day for the rest of kitty's life.

i do want to comment though as i did take a look at your spreadsheet. you did two units last night and this morning and then upped it to 2.5 tonight? and there's a note that the vet wants you to go up to 3. i'd stay at the two units myself a bit longer and give it a chance to work. the two units this morning looks to me like it worked really well for so early in this dance.

the goal isn't for each shot to bring the numbers way down to double digits but more so that the whole picture comes down and that will happen as their body gets used to the insulin and settles into a routine. bumping things around at each shot time will set their body up for a rollercoaster of a ride and it's dang hard to get off the rollercoaster if it won't stop moving. make sense?

 

Just fyi, the spreadsheet doesn't reflect that she started 2 units of prozinc actually a week ago. I just started the sheet today basically when I started doing home testing. I guess I can update the sheet with the dates I gave 2 units without testing too. But, he definitely wants me to start 3 units tomorrow morning. Do you think I should ignore him?

 

personally, yes, i wouldn't be raising the dose yet. there's not enough data to support it in all honesty.

if you had a weeks worth of data and the numbers were staying where they are then maybe but with what we have right now, i think it's too soon myself. for all we know the starting dose could have been too high too but my gut says probably not based on the results we're seeing with prozinc so far

do you test for ketones or even know what that is yet?

 

No testing for ketones. I don't know what it is, but I do know that you have to test the urine...

 

http://www.gorbzilla.com/ketones_for_dummies.htm read this link first and then what I posted below.

The Hows and Whys of Ketones

from Kathy and Cashew (GA)


--------------------------------------------------------------------------------

Energy Supplies of the Body

Before we discuss Diabetic Ketoacidosis let's review how ketones are used in the body. There are two basic forms of fuel the body uses to keep the body running at its most basic cellular level. The primary form of energy used is glucose. Glucose is obtained from digested foods (carbohydrates). Protein can also be converted to glucose in a process called gluconeogensis. Fat when digested is broken down into fatty acids and glycerol. Glycerol can also be converted to glucose. Fatty acids can used by the body or be converted to ketones. In addition to digested food, the body has reserves of fuel in the liver called glycogen, which can be converted to glucose when needed. There are also small stores of glycogen in muscle tissue. When necessary protein can be stripped from muscle mass to convert to glucose in times of extreme need. Likewise fatty acids can be converted to ketones by breaking down fat stored in adipose tissue and converting it into ketones in the cells of the liver.

Ketones: Do they deserve their bad reputation? When do they become a problem?

It may seem like ketones have a bad reputation since we've seen so many problems occur with DKA but ketones are actually used by the body everyday to provide energy to some primary body organs like the heart and can be used as an alternate energy source when glucose is lacking. They also help reserve the glucose supply for those organs that prefer it like the brain. They can be found at normal basal levels in blood and urine. When we talk about losing weight and burning fat, we are actually talking about using ketones. Dieters and people stranded in the wilderness rely on ketones to survive.

Ketones only become problematic when they replace glucose as the primary energy source. It's the excessive use of ketones which can cause the body's PH to lower and turn the blood acidic creating metabolic disorders such as diabetic ketoacidosis. When ketones have reached the level where they can be detected using urine test strips – that is the danger sign.

Who directs the body and tells it when to use which fuel?

Hormones in the body work like air traffic controllers signaling positive and negative instructions regarding its energy needs and fuel supplies. Insulin for example inhibits the production of ketone bodies by inhibiting the breakdown of fat (ljpolysis) in adipose tissue while in the liver it inhibits the conversion of free fatty acids into ketones. Glucagon, a pancreatic hormone stimulates the release of natural insulin which in turn inhibits ketone formation however in diabetics when there is either none or little supply of insulin to be stimulated, glucagon actually stimulates fat breakdown (lipolysis) in adipose tissue and enhances the conversion of fatty acids into ketones in the liver (ketogenesis) and can cause DKA. Stress hormones (catecholamines) such as epinephrine, norepinephrine, ACTH in addition to glucagon also stimulate ketone formation.

Why does DKA occur?

Diabetic Ketoacidosis occurs when glucose cannot reach the cellular level. The body tries to compensate by increasing the level of glucose in the blood. It does this by breaking down the glycogen reserve into glucose (glycogenolysis) and by creating new glucose from protein and glycerol (gluconeogensesis). The body will use whatever protein is available either from ingested food or it will strip muscle mass from the body. In a predator such as a cat the body will only strip so much muscle mass from its body since historically it knows that in order to eat, a cat must be able to walk and hunt thus promoting use of ketone formation more readily. Insulin deficiency promotes the acceleration of ketone production by stimulating fat breakdown (lipolysis). The body will try to answer the demand for fuel by breaking down more fat to convert to ketones to substitute for the lack of glucose. This causes a high level of ketones in the blood (hyperketonemia) and excessive polyuria causing dehydration and electrolyte loss and acidosis in the blood.

In an analogy I once used in an fdmb post, if the body cells were hungry guests at a party and were anxiously awaiting the pizza man (insulin) to deliver the pizza's (glucose) the host (liver) might start serving chinese food too (ketones) to placate the guests. The longer it takes the pizza man to deliver the pizzas the more chinese food gets used.

DKA prevention
To prevent DKA, all diabetic kitties should routinely be monitored for ketones in the urine using Ketostix. This will provide an early warning system so that if detected, intervention can be started before ketones progress to diabetic ketoacidosis.

Anorexia and/or insulin deficiency can lead to a lack of glucose at the cellular level which can lead to DKA. To prevent DKA a kitty must have a sufficient incoming glucose supply and must be given insulin in order to allow the glucose to enter the body cells. Anorexia is a typical sign of illness in a kitty and needs to be taken seriously with diabetic kitties because they need the glucose (even if they are currently at a high bg) to replenish their glycogen supplies. You also want your kitty to eat so you can give your kitty insulin. If a kitty refuses to eat or eats little but has a high bg and you hometest you can give a reduced dosage of insulin to move some of that glucose into the body cells and discourage ketone formation. If you don't hometest, it's more difficult to monitor the effect of a reduced insulin dosage and you have to weigh the odds of hypo risk versus ketone risk. The basic cause of the anorexia needs to be discovered. Most times DKA occurs when infection is present. This usually causes the kitty to be anorexia and the infection itself can cause bg levels to rise because of the body's greater demand for energy to fight the infection. A visit to the vet whenever anorexia lasts longer than a day is always a wise idea as well as increasing the frequency of ketone testing whenever a kitty is ill.

DKA Treatment
When a kitty is diagnosed with DKA the typical treatment involves a slow rehydration which will help flush out ketones and restore the pH level of the blood and replace electrolytes, and begin moving the body back to using glucose as its primary fuel. Usually a kitty is given fluids, electrolytes, glucose and small frequent amounts of regular insulin to facilitate glucose delivery to body cells. Antibiotics are usually given also since most times the cause is an underlying infection. When a kitty is back to eating and drinking with negative ketones they are on the road to recovery

 

Oh yeah, whining is allowed here!!!

What I often did is try to spread curves out over a couple days, so maybe get a +3 and +6 one day (as well as PSs), and then another day get a +6 and a +9. Something like that so I could still see the relationship between the #s (i.e. they are headed down or up, or are flattish), but not so many tests in one day. Also sometimes I would use one ear for a couple days, then switch to the other ear and give the 1st one a rest (on the days that I didn't totally poke up both ears beyond recognition, that is!).

Vets tend to think in terms of an all-day curve since that is how they do it at the office, but you have more freedom with home testing. Sometimes I would try to get in just one spot test per cycle, at different times each day, just to fill out picture of things.

The good news about curves is you don't have to do them too often - not at all if you get regular spot checks, and if you like curves better than spot checks, then maybe just every week or two while getting regulated (depending on how often you are changing the dose, etc.)

It may not make you feel any better, but every 3 hours is I think considered a mini curve. Full curves are every 2 hours. Now doesn't THAT sound fun???? But yes, it does get easier, and once you have a better idea of your cat's response to the insulin (onset, nadir & duration - I think someone explained more about this in your thread on PZI), you can target the tests more, since you get a better idea of what times in the cycle are the most useful data for your cat.

And remember once you are done with the curve, you get to toast yourself & have some chocolate too!

 

I just saw this... YES, please ignore him!!!! You have only been at 2.5u for one dose right? So it's way too early IMO to even consider 3u. If you are feeling really conflicted going against his advice, I would tell him that you are more comfortable raising in 1/2 unit increments and would like to stay at 2.5u for a week and then do another curve. Personally I think 1u jumps are in most cases not a good idea (although of course there may be exceptions).

You got something on the order of a 50% drop on the 2 units, which is actually pretty good as Cindy said. I'd probably consider trying 2.25u for a week or so and see if the #s come down a little more, and then move to 2.5u after that if needed. Her #s are good enough I would recommend moving in small steps at this point (i.e. 0.25u approx). Staying at 2u a bit longer as Cindy said is a good idea too. You have just started testing, and she's only been on insulin about a week now if I understood right, so you may want to get a better picture of things before raising the dose.

How does Demi seem - is she acting like she feels sick & miserable (ear-tests notwithstanding!), or doing ok-ish? Although there is definitely room for improvement, her #s really aren't all that bad. As long as she is acting ok and you aren't seeing any sign of ketones, with #s like this I don't think you need to rush things personally.