? Baxter - 1st 38 days Dosage ?

Baxter 15yrs., Male, Orange-part coon cat, Diagnosed 6/2/17. Full senior lab test showed no other health issues.

Well, figured we would give it a month to gather data, get acquainted with the testing and all before posting the chart and questions. Baxter has improved tremendously since the initial diagnosis.

He has gained a lb. (lost 5), excessive hunger, thirst and urination have stopped, back legs much stronger, generally alert and much more physically active in a very short time. Total wet food -FF Classic only. We had started two months previously. Give shot half way through the meal.

The vet started him on 2U x 2 Prozinc U-40 even though we had not gotten the BG meter yet. Nor test results from the vet which would have been of no sense to us any way at the time. BG curve @ vet on 6/8/17 was high and bouncing so recommended to start on 3U. As we began testing (AlphaTrack soon moving to Relion) we knew 3U was too high and dropped to 2 then 1 with the vet’s halfhearted agreement.

We have been within the 200-300 yellow range with some consistent success. Yet days with a No Shot would just up the BG number. We would go low then high and vice versa then even out. Tried some .5 and .75 doses eyeballing the U40. We are sticking with the 1U x 2 based on his overall demeanor.

The vet has been of NO help. “Email in a month to update on BG, no need to test every day, call if an emergency. All you have to do is give the shot 2 x.” Very thankful for this Board!
I realize another curve is needed and more frequent midday testing.
Major concerns:

1. How can I regulate the BG so not to have the No Shot issue which seems to mess up the achievement of a consistent BG in the yellow zone?

2. He insists on a snack about 4 hours after the AM & PM shot which we give. ¼ can. (1 can 3oz.with shot, sometimes leaves a little.)

3. The constant excessive hunger has STOPPED but an hour before the AM & PM shot/feed he is begging for food.

4. To us, based on what we have read, his figures appear to be pretty good though bouncing. Or are we way off base?

5. Should we purchase the U 100 syringes and convert the numbers for measured doses?

6. Will there ever come a day where the “daily” testing stops. Really getting worn out worrying about BG, shots and food. Taking a toll.

Most pressing is the inconsistent BG with NS and his need for snack.

Appreciate any input and advice. Amazing how far we have come in knowledge of the disease and treatments in such a short time. ALL due to the wealth of information on this site.

Thank you

 

Welcome to you and your boy, Baxter! Let's get started:

1. When that happens we usually suggest a lowering of the dose to achieve two shootable PSs. It's also better in the beginning to keep the same dose AM and PM. Changing it according to PS test is a method best used once your kitty is further into treatment and you have a lot more BG data to go on.
2. Many people here feed multiple small meals a day but keep the 2 hour window before the PS test food free. If your kitty is still hungry with the amount you're feeding you can increase his daily ration.
3. Feeding more frequently between shots might help with the excessive hunger/begging. A lot of people find that an automatic feeder helps.
4. Yes, he does have some good numbers. He needs to have a more stable dosing regimen in place over time to get things calmed down. Bouncing is frustrating but very common. Some cats are very bouncy by nature while some bounce more because of what we're doing.
5. Using U100 syringes with the conversion chart can be a huge benefit in fine tuning dosing. Get U100 syringes with half unit marks on them.
6. No, daily testing never stops if you follow the "FDMB way" unless/until your kitty goes into remission. It does become a lot easier, more efficient and rewarding - if I can use that term - when you see how it gives you peace of mind and better control over Baxter's FD.

Re curves: they're of limited benefit. Look at your curve data for the 1 u dose - seems as though that dose is too low, right? Yet if you look further down you have data that shows 1 u was too high to give you a shootable PS.

What DOES work: the daily testing routine we promote here (yes, more testing than you've been doing!):

• AM/PM before feeding and injecting insulin (no food 2 hours before) to see if the planned dose is safe
• at least one other test in the +4 to +7 range if possible as well as one before bed test every day to see how low a dose will take him
• extra tests on the weekend or days off at random times in the day/night cycles to fill in gaps in the BG picture.

I think I can safely say that if you're willing to do this I guarantee you'll get Baxter's FD under much better control and that's the first vital step in regulation, if not remission. We're here to help every step of the way. This is a marathon, not a sprint!

 

Welcome Pat, Phil, and Baxter!
Kris gave you great answers for your questions and I can't think of anything else to add . Glad you decided not to go to 3.0U. First thing I noticed is 1.0U is too much, as Kris detected too. I do see the bouncing BUT also see the clear reason for it. Much love to Teasel and Chuck, but if you, Pat, take a look at their spreadsheets (Kris from previous post and StephG), they have kitties that are naturally more bouncy and only sometimes provide the explanation for it

Just to further advocate this forum, I am one (of others) member who solely use the forum to manage my boy's diabetes. We went through 2-3 Vets who never seemed to listen to my concerns or were able to answer my questions . Luckily, I recently found a great Vet but kindly told her I still wanted to manage his FD and would update her. She was completely fine with that and wants me to keep her posted and learn about what I'm doing , even offered me to teach other FD clients and I said tell them to join this forum .

Anyways, we try to to support each other and to sum up what I stated above, I trust the veteran members and their experiences over the majority of Vet's . We all live and breathe FD 24/7/365. Most Vet's have like a 4 hour class and minimal real experience. Can't be too hard on them because they do need to know about a lot of things but kudos to the one's who are more open and willing to work on the same team as their fur babies guardians . I think I'm done rambling Will be checking in on you and Baxter

 

We are going to order the U 100 syringes. Hopefully by the end of the week will utilize and adjust the dosage to try to avoid the NS.
Thinking of starting with .75 AM and PM. Also instead of a full can of food at shot time, maybe break that up into a shot feed then an early snack then a late one but not within the 2 hour time frame.
As Kris stated get the U 100 syringes with half marks.

Is there an exact syringe I should order? I have seen suggestions of:

Currently using and comfortable with U-40 1/2cc .5ml, 29g .33mm,12.7mm 1/2"

U-100's in 1/2 inch 29 gauge
BD Ultrafine II U-100 Insulin Syringe 31 Gauge 3/10cc 5/16 inch Short Needle--1/2 Unit Markings 100
3/10 cc U-100 syringes short or long

 

Nothing specific. I am currently using these: https://www.adwdiabetes.com/product/1289/monoject-ultra-comfort-insulin-syringes

 

Hi,

I get U-100 w/ half unit markings from Walmart. Brand: ReliOn, 3/10cc, 31 gauge, 5/16" length needle. Just go to the pharmacy and ask the pharm tech about them. I like the 5/16" length because I always worried that the needle went in too deep when I was using U-40.

Patricia

 

Thank you! Already ordered from ADW as Yong suggested and were half the price $16. I paid for the U-4os. Already started a lower dose .75 units x 2 by eyeballing till we receive the U-100's. Seems to be working as he has stayed in the yellow 200-300 range.

 

Just try to grab some mid cycle tests (the times in between AMPS and PMPS) when you can. They can help shed light on the direction the dose is taking him

 

Maybe over reacting but for no reason Baxter has gone from 198 to high 400's in two days. Bouncing?
Never had 2 days in a row this high. Acting all hungry again also.
I increased from .75 to 1u . Just did a PM +4 and went up to 488?

 

Possibly bouncing, we're not sure how low the 0.75U took him but I think decreasing to 0.5U twice a day might have been better. Have you tested for ketones? Could he have eaten contraband? How is he acting besides increased hunger?

 

Well, We went to .75 as the guidelines state to use .25 increments. No keytone test, had not gotten test strips since his initial vet visit when he was real high showed no evidence of keytones. No contraband. But we do usually feed a snack at around +4 AM and PM or he will be driving us crazy. Seems fine. Alert, walking ok, just last 2 days about +4 after the PM shot he was" begging" more so for food. Once given, calmed down and went to sleep.

 

Usually the increase protocol is if your kitty is not responding to the current dose. However, Baxter has shown 1.0U to be too much, hence the suggestion to decrease to 0.75U . I'm not trying to discipline you or say your doing anything wrong, just explain our rationale behind the dose decrease and what might be happening .

 

Oh, do believe me, I so very much appreciate the advise. What should we give for a shot in the AM. Especially if the number is still high?

 

Yong, can you explain which cycles make you think that 1.0u was too much? I'm guessing it was the blues, but want to clarify in case there is something about this one I don't know since I haven't been following the first threads.

And Pat and Phil, on the evenings when you've had a blue number and did a NS, were you at +12 since the last shot, or does the shot time vary a bit? And also, did you try stalling without food and re-testing to see if the number was rising? Or is that the initial PMPS test?

 

Most of them lol. To me, his best 3 cycles was on 0.5U, just based on PS numbers though. Sorry for slower/ short responses, Maury is using my right hand as a pillow and I dare not disturb him .

 

Consistently on +12, maximum maybe 5 min early. Never tried stalling as the number seemed so low. Also, the boy is adamant about eating at the shot time.
Starts always an hour before begging for food. Driving us crazy and losing our sleep in AM.

 

Guess we will go with the 0.5u in the AM. Just the big increase in BG numbers scares me so in my mind increase the Prozinc a bit. The next 3 days will be able to do a mid cycle test.

 

I think those mid-cycles will really help to answer the question of whether it's too much or too little insulin. There's no way to tell just from the pre-shots, so look forward to getting a clearer picture!

 

So does it seem safe for the 0.5u or should I go back to 75u if the AM is high?
Really confused and worried.

 

I think you could probably do either one safely. Djamila made a good point that more mid cycle data is needed to sort out whether the insulin dose is too low and that's why you're seeing pink and red or whether it's too high and bouncing is driving him up into pink and red.

 

Thank you all. I really trust and value the information. Talked with the Vet's office yesterday and they still feel I should be at 3U.
NO WAY! Tomorrow, another day.

 

It's possible that Baxter will end up at a higher dose than where he is at the moment but that dose is best discovered through careful, small increases instead of lurching upward a unit at a time. It's far too easy to zoom right past the good dose that way. Also - be prepared: the good dose is a moving target. It can, and will, shift slightly up and slightly down over time. It's the nature of FD.

 

Djamila, Kris and Yong, took your advice on the more frequent testing and since we received the U100 syringes dropped the units to 0.6U.
Well after 3 days, I am at a loss. Baxter seems to be going up in BG numbers. Acting fine, just starting to get hungry more often.
Would you advise going to 0.8U in the AM?

 

Looks like an increase is a good idea at this point! He's getting some nice drops mid cycle but not quite where you want them yet. Can you monitor tomorrow?

 

Yes, can monitor for next 2 days, but probably just a +6 and +8 in addition to PS as our schedule allows. He has been hungrier (he had lost 5 lbs. but has gained back 1.5lbs) so have been feeding a hefty +4 snack. Could that be affecting the BG level? Never was quite clear on how food works on the BG other than to not give
2 hours prior PS. Will do a 0.8U.

 

He's probably hungrier right now due to the diabetes being unregulated. Until they get regulated, they are hungrier because their bodies can't use the food as well.

Generally, food will cause an increase in BG numbers, which is why we say not to give it for 2 hours preshot. Beyond that, whatever works as a feeding schedule for you and Baxter is fine!

 

Ok. We were worried about snacks and tried to shy away from them thinking they were messing up the mid cycle levels and BG overall. In fact the vet was very insistent to only feed twice a day which is IMPOSSIBLE with this cat!

 

One good thing is that the lower dose AM/PM has allowed you to give insulin every 12 hours. Now it's time to sneak up on the dose that will safely bring the curve down. Going to 0.8 u at AM and PM is the next step. Baxter is a bouncer and that's one reason you had high/low PSs on 1 u.

Good job sticking with the testing!

 

That feeding schedule doesn't work for most cats, especially diabetics. If he needs to gain weight and he's always hungry, let him eat. He'll thank you for it!

 

Yes to what Rachel and Kris say. While the numbers aren't so nice, he was able to receive insulin twice a day, every 12 hours. If you recently started adding the snacks, his body could also be adjusting to those, which is fine since he needs to gain some weight, and as we get closer to 1.0U may not result in so many NS for next cycle. I am curious to see how this 0.8U dose will do .

 

Thanks! Anxiety level is going through the roof.

 

Have you tested for ketones yet? Just to be safe, it's good to try and check weekly.

 

Ordered the strips. Will have this week.

 

Try to breathe. It does get easier and you have a lot of help here.

 

We KNOW and truly appreciate the assistance. Can not believe how we were introduced to FD. 2U x 2 and do a curve every two weeks. Just shoot and forget.
No follow up, feedback or anything from the vet except schedule an appointment and we will examine $$$$$.
With out this board there is just no way we could properly manage the treatment or learn.
You all are fantastic! You know, the way this country, world and human nature seems to be going, nice to know there are decent, caring and helpful people out there.
Thank you

 

Just updating Baxter’s progress since the last conversation on July 17,2017. Thought, we had it figured, but now with a few No Shots, confused!

As everyone agreed, we started Prozinc @ 0.8 U. He seems to be doing well by PMPS. On 3 occasions he was in the high “Blue” but we felt comfortable giving a minimal dosage 0.2 U to keep up the consistency of insulin intake.
Initially, were considering adjusting his evening dosage downward to say 0.4 U as he does not seem to need as much at night and the larger dose possibly elevates the AMPS - Our humble interpretation of data. That was our thinking but now??????

Any suggestions?