autumn- need shot or not?

hello all,
I have been home testing autumn for four days now, against the vet recommendations. she has been diagnosed with diabetes, only from the blood glucose test - result was 370. vet put her on humulin n, 1 unit, bid. to bring in wednesday , for bg testing, i guess? by good advice, i began home testing anyway. the first day, she got her first dose in the evening, and the nest dose the following am, 12 hrs later. that evening, i brought home test kit, and she read 170 & 162- back to back test , to make sure i got an accurate reading. the monitor is a cheapie, but that is the best i could manage for now. no shot that night, as it seemed kind of close to normal.
5 am next morning reading of 155. pm read was 177 no shot that day.
next day, @ noon- read 221- gave her 1/2 unit. at 4:30 pm her bg was 170.
today at 1:30 pm- reading of 157. at 7pm tonight- 184bg-no insulin yet today.
my thinking is that her numbers are not high enough to give her the insulin, not that I know much , but i do not feel comfortable giving it when she is not even in the 200's.
my vet was insistent that it would be fine to blindly (my adjective) give her the two shots per day,without testing, and to wait a week to test in her office. I am a bit nervous about calling her and telling her that i have not been doing the shots as directed. I guess to talk to her about it is the only way to see if she is going to be flexible, or at least, understanding.
Am i making good choices here? i posted the other day, and am still nervous. do not want to be withholding insulin if i should be giving it.
i am also tapering her off prednisolone, and do not want to make her drop too low, with that factoring in .
any thoughts are so very welcome, and appreciated. I am trying to take in the info here, but have been working unusual hours this week. I would normally be able to check her more methodically. inventory, and one evening shift put us off from taking scheduled bg tests.

thank you,
annette and autumn

 

When in relation to shots and and BG measurements are you shooting? It is best to display your data using the + x where x is the number of hours since shot. The term AMPS and PMPS are also used to designate the BG reading before the AM and PM shot respectively. If no shot given you just continue with the +. Sometimes you would be displaying like BG at +36 hours. If you gave shot then the the entry would be both +36 and AM (or PM) PS together with the amount of insulin given.

If you could rewrite your info like above then people can give meaningful input.

 

Insulin really needs to be given on a regular schedule and not random doses at random times. I know your concerns about dosing at a low number without enough info to shoot lows, but regulation can't be reached with such random dosing. Those numbers are low for dosing without enough info, but above normal range for a cat.

I recommend you take your meter with you to your next vet BG testing and find out how it reads in relation to their meter. That will give a better idea of what the number on your meter means. Talk to your vet about your concerns and find a dose you are confortable giving on a b.i.d. schedule. Get enough home test readings that you can understand where your cat will go after a dose so that you can make knowledgeable decisions when you get lower predose numbers.

Setting up a spreadsheet can help those who are knowledgeable enough to give dosing advice around here to assist you onto the right path.

 

you may find it helpful to create a spreadsheet and add it to your signature, this way you won't have to repeat your tests over and over and you will have a good tool to keep track of them AND share with the vet.

HEre is the link: viewtopic.php?f=6&t=16

As you are so new to the testing - AND GOOD FOR YOU for deciding to home test!
Many people when starting this journey have a safe number they use to decide if they are going to shoot insulin or not. This is done, so that you the human can become comfortable with what you are doing and build up enough data (tests) to know when it is safe to shoot or not to shoot.

Everyone's safe number is different, but on average I've seen anything from 150-200.

I absolutely KNOW you are doing the right thing, by home testing. Look at it this way - if you were the one with diabetes, do you think your doctor would EVER tell you, that's ok, you don't need to test yourself, just shoot what I tell you and we can check you in a week to see if you're ok?

Or as one of the longtimers on this board likes to say - would you get in your, blindfold yourself and then proceed to drive your car? Well, shooting blindly is the same as driving blindfolded. You have no idea what may happen.

Regarding your insulin, I have not used it and cannot offer advice regarding it. The one thing I can say is that it is one of the more challenging insulins to use and while some cats have gotten regulated on this insulin, there are other insulins available that are easier to work with.

I do suggest you visit the Insulin support group forums and read about the other options and maybe have a discussion with your vet about changing insulins.

viewforum.php?f=5

That's my 2 cents for the day.

 

thanks for the replys,
I am sorry , but it is just scary to me, to give her a shot at these numbers, in order to track the results.
I will take the good advice here, and try to do a spreadsheet, and also to take my meter in to compare it to theirs. also to ask about a better insulin. i do not know what to ask for, since she doesn't seem to know much about insulins either. i guess i have to do more research about insulins.
i feel as if i have A.D.D. here, it is confusing. a mistake could be really bad for my girl.

thanks ,
annette

 

hi there

can you remind us what you are feeding Autumn? and what she's getting pred for? i haven't been around much lately so may have missed those details.

and if i got it right, she's had 1/2 a unit in the last 3 days correct?

to be honest, i'm not comfortable telling you to shoot any insulin on those numbers. unless you are gonna be home and feel comfortable monitoring her for 4-5 hours after a shot, to make sure she doesn't drop too low. and if you did give any, i wouldn't give more than 1/2 a unit myself. could you do that one day anytime soon?

now, you have at least one variable that could be raising the BG levels, the pred. so yes, weaning her off it could lower the BG numbers to even better numbers, not requiring insulin. and then if you are feeding a food that is a tad too high in carbs, and you switch to a lower carb food, then insulin may be something you won't need to worry about. let's see.

 

yes, autumn is on a lower carb food, that the vet gave us- purina dm kibble. they get wet food twice daily , i have four cats.
she is on pred, for an undetermined ailment. she got ill over a year ago,and an ultrasound, and xrays, and bloodwork never told us why. she seemed to get better when this vet put her on the prednasolone. she gained three pounds tho, in three months. she has a few days to go of pred. vet thought maybe ibd.

thanks for understanding my dilema.
yes, she has had only 1/2 unit of the humulin n, in the last three days. she free feeds on kibble, it is hard to get her to eat wet food.
thanks , so much,
annette

 

Autumn,
Each cat responds differently to insulin, and even when you think you know how your cat reacts a change in diet or some unknown factor will cause an unexpected outcome. Don't let it scare you, but respect the fact that the insulin will have an effect. You know your cat and you are learning how to regulate the insulin. I have learned (the hard way) that I can't give my Casper any insulin when the preshot blood glucose level is under 200. I would definitely recommend caution and working closely with your vet (if your vet has experience with diabetic cats). Have you tried regulating him with diet (and not insulin)?

 

Annette, Autumn is your catchild, not your vet's. No one loves her as much as you do and your vet has no right to question what you know is right for Autumn. Your vet may not agree with you, and that's just tough. Your baby, your call.

As for the dosing, you need to get into the proper insulin study group and learn from others who are in the same place you are--same insulin, more experience. Your schedule will settle down and you can work Autumn's regular treatment into whatever it turns out to be.

 

Thank you, so much. I am not so computer savvy, but am trying to figure out where to go to find out stuff. and the spread sheets look really intimidating!

yes, i guess my vet will have to decide whether she wants to help my girl or not. I had a kitty with crf, and am used to giving shots, subq's, pills, etc. and I think that i will be able to take care of autumn's home testing , without traumatizing her. i hope! it will help when i know some good healthy foods, ( finding the general opinion of the DM is not great),and snacks. hopefully, i can get them all on wet food, soon as i find an appropriate one for them .

 

Hey you're right, annette, you need to know more.

You can find out lots about blood sugar levels and insulins from the links in my signature (everything else).

But to get the vet to agree to a different insulin, you will want to know why you're asking, so:

Humulin N has, in cats, a typical duration of about 5-7 hours, a typical peak of about 3-4 hours. This means that since about 7 hours after you gave that shot 3 days ago, your cat has been operating on NO insulin (which is dangerous too! If you think giving insulin without knowledge is dangerous, you should read up on the consequences of NOT giving it sometime.)

A "better" insulin for cats such as "glargine" or "detemir" will usually give about 12 hours duration, meaning you can shoot again in 12 hours and be relatively sure that your cat has the insulin he needs at all times. (And it is needed at all times, not just whenever you happen to shoot.)

See these links and maybe your vet can too:

http://petdiabetes.wikia.com/wiki/Lantus
http://petdiabetes.wikia.com/wiki/Levemir
http://www.tillydiabetes.net/en_6importantfactors.htm
http://www.tillydiabetes.net/en_6_protocol2.htm

If you read through all of these you will be GOOD and able to get exactly what you need from any vet.

Best regards,
Steve

 

P.S. Those blood sugar numbers you relate are diabetic numbers but not very high ones. It would be interesting to know how much they come down when the prednisone disappears. If they're lower than 130 you can definitely skip shots.

 

Have you tried regulating him with diet (and not insulin)?[/quote]
Lori and Casper,

I just found out last Thursday that Autumn is diabetic. so it is a new thing here.
one thing that helps me to respect insulin is that my ex-husband is diabetic, and i have seen first hand, the situations caused by improper insulin usage.

Thursday, the vet gave (sold, i mean) us a bag of purina dm, and said that she wants me to leave the kibble out for her all the time. Autumn does not do wet very enthusiastically. after some research here, i can see that we need a better choice for her, and the other kitties, who are all adults, actually.
Autumn has been on lactulose a good bit, for constipation issues. she has slow bowels, and miralax has been a staple here. i also give her pred with pill pockets .
Thanks ,
annette and autumn

 

[q

Humulin N has, in cats, a typical duration of about 5-7 hours, a typical peak of about 3-4 hours. This means that since about 7 hours after you gave that shot 3 days ago, your cat has been operating on NO insulin (which is dangerous too! If you think giving insulin without knowledge is dangerous, you should read up on the consequences of NOT giving it sometime.)

Steve,
thank you for the post and for the links. I have a question,tho, about your comment above. If autumn has only been on insulin for five days(,and actually has had only three doses), is it dangerous that i am not giving it to her? do you think it makes sense, that i am thinking her numbers are too borderline to give it ? especially since she is tapering off the pred?
I am not wanting to put her at any risk, i am just not sure that she is needing this insulin. I know that you are right,that these are diabetic numbers, i recognize that, but i cant determine how her insulin affects her, if i am afraid of her dropping too much.
I guess i better call the vet tomorrow, even tho we go in wednesday. i will take my little documentations in to share with her.
thanks again,
annette

 

Possibly, yeah. A lot depends on if she's making her own, which from the numbers you're seeing it seems she is. If she were not, then I wouldn't stop it for anything.

Well if you can get her off that dry food and the prednisone, and very fast, it's quite likely she won't need insulin, you're right. Dry food for cats is mostly carbohydrate -- it is like Krispy Kreme donuts and Sugar Pops for diabetic humans.

And with numbers that low I'd certainly be dosing very cautiously if at all. But I'd be considering the removal of the dry food and the pred to be a very important step in lowering her blood sugar, and testing every few hours to see how that works out.

And removing the 'kibble' is not just a nice thing to do, it usually makes a huge difference in blood sugar numbers. see http://www.catinfo.org written by Dr. Lisa Pierson on how you can convince a cat who prefers dry food to change to wet. It's important for other reasons too -- dehydration is a constant possibility for diabetic dry food eaters. Some people think you can't leave canned food out for a few hours but it works just as well as dry and it's much healthier.

If you can see numbers below 130 all day long as you change to the wet-food and no prednisone, and insulin may not be necessary. But for now I'd be testing at least twice a day as I change those things.

Cheers,
Steve

 

Thanks Steve,
I called autumns vet today, and she was really supportive of my decision to home test, and frankly was surprised at autumns low numbers. she feels that her numbers are very borderline, and that tapering the pred, and changing foods to wet, high protein may just bring her out of the diabetes. She said that unless autumn reads 200, not to give any insulin. She encouraged my filling out of a spread sheet (looks complicated, to access), and to log food choices, readings based on food choice, her demeanor, and readings and times.

I was so relieved. I had been prepared for her to not be happy with me, and i tried calling various vets to see who believed in home testing. None that i called did, and I was frantic. So, thank goodness- our vet is open, and flexible! she said that all she asks is that we do the best for our pets, and I appreciate that she is that protective of them!

autumn read 177 and 167 today- amps and pmps- no shot for her today. it is the last day of her pred. am going tomorrow, to find some nice wet foods to entice her with .

thank you for listening and for the guidance.

thanks to carolyn and latte- for insisting i get a meter! love ya both

 

this is great news. so glad you have a supportive vet. It's so important.

When shopping for food - the idea is to look for ones that are 10% or less in carbs.

While some cats may do fine with 8-10%, keep testing your cat to see if that amount of carb is too much or ok. As you may need to go lower down the % scale.

I feed anywhere between 1-5% to my girls.


The spreadsheet looks more complicated than it is. It's a google spreadsheet and if you fill in the BG numbers, it will automatically color code it for you.

The AMPS and PMPS - refer to morning pre shot and evening pre shot, the U - means how many units of insulin shot.

Then it goes up the time table from the PS , + 1 hour all the way up to +11 hours and then the next PS (think of it like a clock on a 12 hour cycle).

since you haven't given any shots - I would put 0 in the U section and whatever times you are testing, just fill that in accordingly.

For example:

If you would have shot at 7 am

AMPS = BG number, U = 0

Then you tested 2 hours later, put that number in +2

Does that make sense?

Take a look at others spreadsheets and see if it starts to make sense.

Also, there is a comment section, so you can add the observations and foods, etc as the vet suggested there.