Bibo and I need your advice please!

Last night, I gave him .40 at +2 and that was at 9:00pm. It's 7:00 am and I just tested his bg and it measured 361. It hasn't been 12 hours yet, can I give him his shot because he's hungry? I'm confused about scheduling, I understand it has to be every 12 hours, but that could change, if he's lower than 150, we skip that hour and the whole system changes, and the morning shot, becomes almost noon. I don't know if I was able to explain it right, but please let me know if I can give him his insulin now.

 

Are you home today and able to test? I'm asking simply because it looks like you may have a cat who could be diet controlled or a micro-dose insulin kitty. The .8U yesterday brought those numbers down quite a bit. The 0.4U last night may have done that too, but if you're like me, you need sleep and probably didn't test after that.

You can shoot PZI early, the number is high enough where if it were my cat, I'd want to start helping him lower that number. But I'm not sure I would want to give .8U unless I was home today.

Was the food change recent? The canned food only diet could be affecting his numbers and bringing them down naturally.

What dose do you have in mind?

 

You are using PZI, right?

You can inject early with PZI, but you don't have a whole lot of data yet.

With Blood sugar at 361 at +10 after previous shot - YES - safe to shoot PZI

You seem to be changing the dose a lot -- 1.25 does seem to be too much

What strength is your PZI? U40? are you using U100 syringes?

When you feel wetness after a shot - smell your fingers. The insulin has a sharp medicinal smell.

No smell means most/all the insulin went in, and the wetness is probably a fluke. One of my cats likes to jump in the bathtub after we shower and lick - so sometimes she is wet from that. Another likes to dip his foot in the drinking fountain and lick the water off. Another is a drooler and gets spit on his bib and other places when he shakes his head.

you might try giving the same dose consistently for a few days -- like 0.5u, or if using U40/U100 conversion, then 0.6u BID might be a good dose to try.

 

I'm thinking .75u. I still don't havr the 100U syringes, so I'm guessing. Have you ever given Tucker a shot before his time?

 

My vet insisted me buying the U40 with PZI Idexx 40U, but it's difficult to measure with that.He's been on canned food for almost a month now. But I feed him few times a day istead of twicw like most people here.

 

When Tucker was on PZI Idexx and PZI BCP he often got shots early, at one point he was getting shots 3 times per day, however I had data that I had been collecting for months so I knew it was safe and I tested often.

PZI doesn't build up in the system like Lantus or Levemir does. But, I did have one cat that could go 36 hours on less than a quarter unit of PZI, her name was Misty. ECID (Every cat is different)

I like what Phoebe said, find a dose and stick with it. Give Bibo's body a chance to get used to that dose, I'd lean more towards .5 then .6, but I'm kind of a chicken

 

When Norton was on PZI, we were shooting TID (every 8 hrs) using a sliding scale that was customized for him.

The key to shooting early is making sure the blood sugar is rising --- to check this means more frequent testing.

for example -- test at +6 and test at +7. If the blood sugar has gone up by at least 20 points, it is ok to shoot

With a sliding scale -- the dose is adjusted based on blood sugar at shot time. If BG is 150 and rising, shoot dose "A" (a small dose). If BG is 200, shoot dose "B" (a slightly bigger dose) and so on.

Sliding scales should not be used with Lantus or Levemir because of the "SHED"

Sliding scales are customized for each cat based on the BG history data in your spreadsheet --
for example, Bibo dropped a lot on 1.25u, so that dose should only be given if blood sugar is very high.

Well, when you run out of U40 syringes (or even before if you have the $) -- buy U100 syringes from a human pharmacy. Most states/areas do not require prescription.

If you get U100 syringes with half unit marks, you can micro-dose much easier -- the conversion factor for using U40 insulin with U100 syringes is 2.5x.

Thus:
0.2u = 0.5 mark on U100
0.4u = 1u mark on U100
0.6u = 1.5u mark on U100
0.8u = 2u mark on U100
1.0u = 2.5u mark on U100

So it makes it easier to measure the tiny doses.

 

I just gave him for what I guessed on U40 .75u 1 hour and 15 min. before time. I gotta go buy the U100 syringes. It's very difficult to use the U40 for smaller dosages. I have noticed that in the evening his bg slowly increases 20 points each passing hour, so when the time comes tonight, I'll be checking that Jen, and thanks Phoebefor the sliding scale info.

 

for U100 syringes, get 3/10cc with half unit markings. higher gauge number 30-31 is better than lower gauge number 28-29 (31 is less ouchy than 28)

I buy these from www.hocks.com
http://hocks.com/hocks-healthcare/hocks ... 40030.html

to get free shipping, I also order test strips and lancets from them.

 

ChrisCleo had mentioned the same thing too Phoebe. I will do that. I just called CVS and Walgreen and they need prescription for that, and I'm not gonna call my vet for that, he's not gonna like it. So I'll go ahead order online from the site you just sent me. I have a full box of almost 1oo U40 syringes, maybe, i'll give them to someone who needs them.

 

Can I ask where the name Bibo came from? I ask because it is a 'name' used in a children's book that I read to my kids about hippos and their belly buttons

 

Oh, how cute Jen, didn't know at all. When we first got Bibo, my best friend named him Bibo, it was just a name that came to her mind when she saw him. I'm pretty sure she doesn't know about the children's book, because she also doesn't have any children. I'll tell her that though. She never used to like animals, but after being exposed to Bibo, the animals grew on her, and now, she has 5 rescued cats, and she is the greatest advocate for their well being, and for all the animals' in that matter.

 

Sandra Boynton's Belly Button Book http://www.sandraboynton.com/sboynton/boyntonbooks.html

 

I found the with 3/10cc, 5/16" needle, 31 gauge U100 syringes at Walmart and Target. Thee pharmacy technician asked me if I wanted the short needle or the long one? Couldn't answer that question. So anyone could help me with the answer? Thank you guys. I will need some help later on to to learn the conversion. And BTW, I just tested him +2 and the bg was 250 and he had already his meal.

 

short vs long needle comes down to personal preference.

We've been using short needle for years - main thing is making sure it enters (may be hard with a thick-furred kitty)

with a long needle, you have to be careful not to hit the muscle or bone under the skin (OUCH!) so you need to inject at an angle, but not so steep an angle that you go out the other side of the "tent" (assuming you are lifting the skin in a tent shape)

BTW 5/16" is the "short" needle

and yes, usually the first test after a meal (+1 or +2) is higher than at shot time because of the food. The curve is naturally shaped like an S -- where it goes UP after eating, then down when the insulin is kicking in and turning and going back up when the insulin is wearing off.

 

make sure they're the ones with the half-unit markings. you'll only see doses in 0.4u increments if you don't have the half-unit ones.
yes, 5/16 are the short ones. with the short ones you can shoot in the side or belly without tenting. the needle just has to go right under the skin to deposit the insulin.

i was saying to go with 0.5u because your preshot values are too low to shoot. not positive, but guessing this was rebound even on that small dose.
but if you shoot early, you're increasing overlap from one shot to the next, which can increase the effectiveness of the insulin (making that dose the equivalent of a stronger one).
frankly, if you have a high number that could be rebound, you can shoot one more shot of that dose, to clear the rebound out of his system. but it could pay to shoot a little lower, like 0.4u, to avoid another big drop. doing that may take a few shots to get his numbers back down from the rebound but on the other hand it may prevent another rebound off another drop.

 

Hi Chris,
I just had another reading too +3.45 was 65. I read your post, and somehow, didn't understand much. So if I give him .5u in the morning, will help me better regulate the evening glucose? Is it because the lower dosage will have a more average shooting result in the evening, so I'll be able to give a .50u then too?

 

You need to lower the dose a lot going forward.

You're getting steep drops, and this one has me a slightly concerned.

AM PS 361 .75U of PZI
+2 250
+4 65


PZI may peak at +6, so you may drop quite a bit lower. Cats are different and some peak at +4, as mentioned, my Misty went 36 hours on a dose, her peak was around 20 hours after injection.

It's time to watch these numbers and avoid a hypo and please do not let me scare you, I just want you to be informed and know these numbers could go lower.

Going forward, if this were my cat I'd start low, go slow. I'd start at the smallest amount possible.

ETA: I put a note on the Community forum asking folks to look, just in case.

Also, has teeth been checked? Is there any underlying infection going on where this may not be diabetes but just a reaction to an infection?

 

His teeth has never been checked. Since he hardly goes to the vet. But we were there last friday, and the vet didn't even look at his teeth. He never shows any sign of not being able to bite or I don't smell any funny smell from his sweet mouth. What are the signs for bad teeth in cats? I still cannot believe that the vet wanted me to give him 1u every 12 hours, and to check his blood glucose in 2 weeks! You know what's bothering the most is the numbers I get in the mornings. Bibo eats the most at night, I give him 1 can of ff pate after evening shot, and he finishes that in 4, 5 hours.

 

Checking the teeth should be standard practice at all checkups, even with difficult cats. Bad teeth/gums can cause infection and affect overall health as well as blood glucose levels! Look for tartar buildup along molars, look for red/inflamed gums, bad smell, etc.

The reason why your numbers may be higher in the morning is rebound at night...

I agree with the others that you are seeing a very steep drop and backing off a bit more on dose might help

Jen

 

As Jen noted, the vet should check teeth with every visit. They can get cavities, called neck lesions - I believe, at the base of the tooth, where the gums are. If theres' tartar, often once that is scraped off a lesion is hidden underneath. Many of my cats are older and this is just what I've seen with them, it's not a matter of fact, just how my guys are.

I'm glad that you are hometesting and not giving the 1U every 12 hours. You're doing a great job.

 

taline, i was saying i believed the 0.75u was too high. don't overreact to a higher number. i would have cut the dose to under 0.5u. especially coz you shot early, the 0.75u equaled a higher dose.

so, what we do now is feed him. he went too low and he's setting up for another rebound situation (higher numbers). to help cut down on a rebound number tonight and slow the drop right now, give him some food. you could give a bite or so of high carb food if you have any (something with gravy or sauce). or you could give some regular low carb and test again in half an hour to an hr. (test either way regardless of what you fed him.)

use his reactions as a gauge. if he eats ravenously, give high carb. if he's clearly eating just because you fed him, low carb is fine. when you test again in another half hour, expect to feed him more if his number is low.

 

ah, to answer your question, remember we're trying to give a dose that will allow us to shoot every 12 hours.
with the 0.8u your evening number was too low to shoot, so we went down to 0.5u. now it looks as if we got a rebound number this morning, so we wanted to reduce even further.

so 2 goals with bibo specifically:

1. shoot a low enough dose that we can shoot twice a day, and
2. shoot something low enough to avoid rebound (a big bounce upward because his system perceived he was going too low).

shooting 0.75 over an hour early this morning was possibly the equivalent of shooting 1u at his normal time (no way really to figure the effect of overlap at this time). so his number dropped a lot. don't know how easily you can eyeball a dose on the syringe, but you might want to try 0.25u this evening, regardless of whether you get a high number or not.

what's going on is very encouraging. looks like his pancreas is healing.

 

But do you guys know why an almost .5u last night, made his bg go to 361 this morning at+10? What's intriguing me is that when I give him.75u AM, his bg at +12 is usually in mid 100's and then when I give .5u at PM his bg is way up at+12? I know I may be frustrating you all for not understanding well, forgive me for making you repeat the same things over and over again. English is not my first language, so please bare with me. ;-)

 

I really got it this time Chris! Thank you so much for being patient with me. So, I'll stick with what you said. No more than .5u and possibly ,25u tonight. And see how it goes the coming days.

 

What we don't know is how much lower he went after the .5 last night. Could have gone too low and his liver produced glucose to protect the body.

 

I understand that Jen, but the fact that he's going low in the morning too with 57s or 63s and for some reasons, the liver is not doing the same thing during the day and I'm still getting nice readings after 12 hours. It's only at night, he's rebouncing. That is one mystery, I will try to solve, hopefully, by giving him lower dosage in the morning, and lower dosage at night.

 

There is something called the "dawn phenomenon." You can google or maybe others can explain it. It's an early morning rise in blood sugar, it's not like rebound, it's a natural release of sugars, you'll find a lot of info on human diabetes sites about it. But some of our kitties experience this too.

 

I just tested and it was 45 at +5.45. I'm feeding him, a ff with gravy right now. Should I just watch him, and check, or should I give him some honey so it doesn't go any lower?

 

yes, check again in 15 minutes. it's your call whether you want to give honey or not. i might wait 15 min and then give more FF with gravy, with some honey mixed in, if he's gone lower.


right now, no more 0.5u dose, taline. looks very much like he went too low last night and bounced up. (i thought you gave 0.5u but just saw you gave 0.4u last night). so if he bounced on 0.4u, we'll reduce more.

give 0.25u if you get a shootable number at shot time. if you don't get a shootable number i might even just skip the shot tonight and start the 0.25u tomorrow. otherwise, test again 20 minutes later and then shoot if he's high enough again. if not, wait another 20 minutes and then shoot if high enough, if not, repeat the wait.

he is doing fantastic on pzi vet. many cats don't even get 9 hours duration on it. he's definitely getting the full 12 hours and then maybe even more.

 

Thanks for replying so quickly. I'm so glad I'm home, and you are checking on us. I'm hesitant to give him any tonight, but if you look at the ss , the 1st day, I skipped the PM shot and the next morning it was quite high. (That's what I don't understand).

 

some cats don't need to be on insulin too long before they're in remission. the low carb canned food and a little time on insulin may heal their pancreas enough for it to work well on its own again.

plus, when we start giving insulin, their body needs to learn how to use it, and it flushes through the high glucose that built up in their system while they were becoming diabetic. that takes some time. there's usually a little bit of overlap between shots anyway, so remember the numbers may reflect what is going on after two or 3 shots in the case of pzi vet (idexx), rather than just the one shot you gave.

the reason i'm thinking you can skip the shot tonight if the number is too low to shoot is that he got overlap with the earlier shot today. so another shot may combine with that overlap and be too much insulin. it may not, tho. i'd expect to be shooting a higher rebound number but don't react to it. just shoot the new low dose of 0.25u.

 

I got a bg 59 at +6.5, I guess that fancy feast helped a lttle. I still can't believe that the vet asked me to give Bibo 1u every 12 hours and he assured me that he won't go hypo with 1 unit!!! My baby would've died on that dosage.

 

It is very common to start at 1 unit -- but both my diabetic cats (adopted here at FDMB after my first guy passed away) are well regulated on a tiny dose...

Tiggy gets 0.25u Levemir BID
Rusty gets 0.25u Levemir BID

Hopefully using the U100 syringes with the U40 insulin will help you get the tiny doses measured easier.

 

He's really keeping you jumping isn't he? :roll:

The reason you are seeing such a different response between daytime and nighttime is that he keeps getting too much during the day and not enough at night. For now, I would plan to skip tonight and start over tomorrow morning with .5 units. If that takes him too low again, then drop back from that. Personally, I wouldn't drop all the way back to .25 units. You already tried that and had to shoot early.

Hang in there!

 

i disagree (terri and i are friends, tho).
i suggest 0.25u. it may not be enough to bring the numbers down on only one shot but with the overlap he seems to be having it will still be fine over the long term. just want to settle any bounce down so we know what we're dealing with. you shot 0.4u and it sure looks like he went too low and then rebounded off of that.
remember, we're not just working with one shot. the shots build upon each other. and it looks like we have some pancreatic action in the mix here, too. you can always bring the dose back up if his numbers trend higher.

 

Chris, I got a new #: 95 at +9, so he's slowly coming up. I still don't have the U100 syringes, so have you given a .25u on a U100 before? It's a little had to estimate the right amount, but I think I can be close. What do you think Chris?

 

If she's skipping tonight's shot as you suggested Chris, there won't be any bounce. Even on .8 units, he isn't dropping into dangerous numbers, and by tomorrow morning he'll probably be back up in the 300s. Look at yesterday when she shot .4 units after losing overlap. There's no reason to think tomorrow will be any different. She needs a dose that she can shoot for more than 1 cycle.

 

My concern is the big drops she's getting. The .8 on Sunday given at a PS of 368 dropped Bido down to 67 at plus six. Today's big drop, wether partly due to overlapping, not really sure as we don't know how long this kitty takes to metabolize the PZI, 361 down to 45.

I'd love to see Bido start getting less dramatic curves and think that the food change is a major player in this. Two of my recently adopted FD kitties went into remission, one on the first day, the second after 3 of the food change.

For this reason I would want to give the 0.25U and see how Bido's pancreas works with that dose and see if he can bring down that numbers gradually so that this little man is feeling wonky from having the highs and lows that he's been having.

 

I just got another number on +11.10 and it's 99, definitely I won't give him any shot tonight, and tomorrow, we'll start a new dosage of .25u. He's very upset, He bit me by my shoulder because he didn't have much relief today, i poked him too many times. Could you please give your feedbacks, if you're around? Thank you guys!!

 

I agree with Chris on this. Yes, he gets a nice drop to good numbers on the 0.75-0.8u dose, but his preshot is too low to shoot after that cycle. That means the dose is too high. I would go with 0.25u tomorrow morning, see how that works. As Chris said, you can always go up a little if it's too little, but with the bouncing it's really hard to see what is going on.

So, I would not shoot tonight at all, he's too low. Tomorrow morning, I would try 0.25u and get some spot checks during the cycle.

 

Thank you all for your caring posts!

 

you may see a higher number in the morning but don't let that worry you. just shoot the 0.25u and expect to shoot it again in 12 hours. he has some excess rebound hormones to clear away and because of the bounce down and back up even after a rebound i think he needs a tinier dose, plain and simple.

cats get such small doses and insulin syringes aren't really perfect for that, so a lot of the time you're eyeballing. but when you have a U100 syringe and a U40 insulin you can dose a lot more precisely. if you have the U100s with half-unit markings, each mark represents 0.2u. so to do 0.25u play with that mark a little (the insulin level would be near the bottom of the mark rather than smack dab in the middle).

i'm not even sure you're going to need U100 syringes in the end, he's responding so well. it really does make dosing so nice, tho, with U40 insulin. when i switched to a U100 insulin i was a little bummed coz i missed being able to dose so precisely!

 

Just to clarify Chris's remark about how to measure a 0.25u dose of U40 insulin in a U100 syringe...

QUOTE:
if you have the U100s with half-unit markings, each mark represents 0.2u. so to do 0.25u play with that mark a little (the insulin level would be near the bottom of the mark rather than smack dab in the middle).
-----

the first half-unit mark would be 0.2 units .... to get 0.25u, it is just a teeny bit more -- so "BOTTOM OF THE MARK" is if you are holding the syringe with the needle pointing up