Discussion in 'Feline Health - (The Main Forum)' started by Anthony Morgan, Mar 10, 2017.
Thank you very much Yong!
I think I found it Diana, Dr's Best, so I will look into that. Thanks again!
Yes that's it Anthony. And maybe ring the vet and ask opinion re neuropathy v arthritis... could be both/either, we don't know but vet may have better idea as he has examined Shelley.
My two both showed varying degrees of arthritis when they had x-rays done. If that is within your budget it might be a good idea to have those done. Both mine show arthritis to one degree or other in the back legs/hips area.
Thank you, yes certainly will do, may well have some arthritis as she has had some stiffness in the past. But has perked up a bit at +1. She always seems hungry at this time and more active. All the help is very much appreciated!
I have tried to keep Shelley's dose at 1.0u as much as possible and she has been better. Her walking has returned to normal so I haven't needed to consider the use of supplements at the moment.
Shelley's blood glucose has been a bit unpredictable in the last day though. Last night at pre-shot time it was only 12.8, so I waited 1.5 hours and after some food it had increased to 23.0.
Then this delay throws out the routine. I had to inject half an hour early this morning due to a dental appointment and at +5 I got a reading of 4.9 which I think is a little to low to be happy with.
So I will have to see what tonight's number is and decide what to do then.
Thanks for reading!
4.9 is a perfect number for nadir....that's what you want to see.
That 4.9 ( 88 US) is actually a nice normal number. It was at +5 which should be near Shelley's nadir ( lowest number) You would not have wanted it to go any lower than that especially if you weren't able to monitor. If you had got that reading earlier in the cycle you would definitely have wanted to intervene with honey/syrup and HC food.I see the +6 went up to 9,3 (167 US). Did you give honey/syrup or high carb at the lower number? This is good information to list in the comments, since it is useful to know for future reference if the number is too low. If you did not give anything then Shelley will be bouncing into higher numbers.
Also with Caninsulin it is not as critical to keep to a strict 12 hour shooting schedule, since in most kitties Caninsulin does not last the full 12 hours and since it is NOT a depot insulin it is safe to shoot early/late as long as you know the numbers are rising.
With the big drop in this morning's cycle it is very possible Shelley's numbers will bounce up higher this evening. If you are unsure of what dose to shoot you can post for advice after testing. If you get a low preshot number, do not feed any food and retest again in 20-30 minutes to see if the numbers are rising.
Thank you Janet!
Hello Mary Ann,
Yes, I gave Shelley some Sheba in gravy when I saw the 4.9. I will follow your advice for tonight. I did think half an hour early should be OK but it just made me wonder when I saw the low number. It's the lowest number I have had for a while, for no obvious reason?
Thanks for your advice!
Awe man.. Next time just let her surf in the greens.... Unless she has a ways to go to nadir, it was perfect. Or if she wants a little snack, just give regular low carb food. Those nice dark green numbers is when her pancreas is healing.
You should try a bit of regular food first if you are uncomfortable with the lower ( but not dangerous) number.If you had tested that 4.9 at +2 or +3 hours after the shot, then by all means a quick intervention of honey/syrup and HC food would have been in order. Now you know that Shelley is fairly carb sensitive and you have seen how much a higher carb food can bring the numbers up, so that is useful information. I am not sure of the carb content on Sheba in gravy is, but it certainly brings the readings up.
There can sometimes be lower numbers with no real reason...perhaps the insulin is absorbed better on that shot ( absorption rates can vary with any insulin on any day), perhaps Shelley's pancreas decided to "sputter" in for a bit, perhaps Shelley's body is accepting low numbers better...any number of things can influence the numbers. This is why this forum is so strong on home testing for all kitties...which you are doing a great job of
Ideally with caninsulin you would like to see Shelley spending more time in the blues and higher greens, with using a pet meter. Of course if these numbers happen too early in the cycle, you want to be vigilant about testing. As I said if you get a low preshot number, wait without feeding and retest in 20-30 minutes to see where the numbers are going, and post for some input from other members.
Thank you Mary Ann!
OK Janet, thank you.
Hi Anthony, I'm very glad to see that Shelley's walking is back to normal. That's one less thing to worry about!
I don't have anything useful to add to what Mary Ann and Janet have already said... it does seem as if Shelley is going to throw you an unexpectedly low number from time to time, and you just have to monitor the situation as it arises. It may mean that she is metabolising her insulin dose in a slightly different way, or it may mean that her little pancreas has suddenly decided to produce a little of its own insulin... whatever the reason, this is an ongoing "dance" and it's a matter of staying vigilant.
Thank you, I try to be vigilant. I do observe more than the tests suggest. Shelley often gets hungry and more active a hour or so after her injection, so I try to make sure I am there to feed or let her in the garden. Its sometimes after 11 pm when she likes to sit out a while and i try to accommodate her, as so much of her life is sleeping now.
And then obviously in the nadir period.
But there are times when I am not able to be there and it's those that are the worry but I realise there is only so much that is possible.
Just keep trying to make the right decisions. My vet seems to have been right about sticking to 1.0 u, although I have lapsed a couple of times when Shelley wasn't eating too well.
Very nice to hear from you!
You're doing a great job Anthony. We can't monitor our pets 24/7 ... we have to sleep, work, shop, keep appointments etc etc! I know it's a worry when you do have to be "off duty" for a few hours but you sort of work round that by checking the situation just before you leave the house, or go to bed, so you can be as reassured as possible. You're right - it's "just keep trying to make the right decisions", take each day and each reading as they come.
It will be interesting to see what your vet says about Shelley's BG readings at your next appointment... her fructo test will probably show an improved result, but her daily numbers and especially those pre-shot numbers could be lower. Some people might be more aggressive with their dosing but you have to do what's right for you.
Keep going and keep smiling!
Thank you Diana, yes I suppose the occasional low number that worries me is less significant than the overall pattern which perhaps is not that good. I will have to let the vet see how things are going.
Today's +5 was 15.9, I think I must have shot a little short this morning with the new bottle of insulin?
Since I started the new bottle of insulin, Shelley's blood glucose has been getting higher and not responding like it was with the old bottle.
I contacted the vet and have just been to get another bottle in case there is some problem with the new bottle.
So I will start using the second new bottle tonight and see if it makes any diifference.
Hmm that's odd...you did the right thing asking the vet. Keep us posted.
There are two possibilities that I can see here. Either the lower number on April 13 (4.9) is still causing a bounce OR the new insulin has been compromised at some point in the system. MY own thought is that Shelley is still bouncing form the lower ( but still safe ) number on April 13. Although it is not a hypo alert number it is still lower than what her body is "used" to and the counter-regulatory process then releases stored glucose into the system can last up to 3 days ( one of my kitties takes 4 days!!) before the bounce settles down. I would hold the 1 unit for another cycle or two... up to 1 day and see where the numbers go before deciding to make any dosing changes. It is always very frustrating and disturbing when you start to see numbers rising, but sometimes giving just a little longer will be a good indication of whether this is a bounce or if it is possible the new insulin is not working right.
Thank you Mary Ann, that is a very valuable consideration. Shelley has not been as bright today, sleeping most of the time. Eating OK, still drinking a lot. In the couple of hours before the PM shot she was doing a lot of purring, not contentment though, I felt something was troubling her. I will just have to see how she goes on the new vile.
Very grateful for your advice!
The ups and downs can be very draining on the body. Trying to get a smoother range of numbers will be easier on Shelleys body. Unfortunately the bounces can happen and there is not a lot we can do to stop them. Until Shelley "learns" to accept the lower numbers as normal her body will continue with the counter-regulatory process which gives higher numbers for a day or so when she hits lower than usual numbers. There is always a possibility that a new insulin has been mishandled in the process, but although it can happen. it is not the usual problem. Since insulin is a hormone it is not always a direct linear process and numbers can go up and down for no apparent reason. The main thing is to look at trends over a 2 or 3 day period and then question whether there are other factors at work. I have 2 FD kitties...one is 2 1/4 years on insulin and will never be well controlled because of other health issues. The other kitty is just over 1 year since diagnosed as FD and overall is doing fairly well, but her numbers can jump all over the place sometimes for no understandable reasons. You are doing a great job with Shelley and you are monitoring her numbers very well. Right now that is the best that you can do for Shelley. In the future if there is no good progress you may look at a different insulin, but right now you are doing a great job
Thank you, it is very good of you to say so! Your knowledge is a great help to me in understanding more about what may be going on with Shelley.
Anthony the whole fact that you have kept Shelley going for 6 years with FD is a testament to doing a good job. Even if Shelley never gets to remission the treatment you are doing has been keeping her going..some days good..some days not as good..but she is still here. Sometimes treating a FD kitty can be a very trying experience, but everything we do gives them more time and hopefully a better quality of life.
Thank you. But Shelley was such a straight forward cat to treat up until the hypo. She did well to go for 6 years and have the diabetes controlled with no problems. By the way I have just checked her BG at +4 and it is 11.9.
Anthony sometimes you will get a hypoish number out of the blue. I have dealt with a number of very low hypo numbers with my two. With the amount that you are testing you will be able to see when that may happen and take action if it is needed. At the same time you can't hold back on a good dose because of worrying about a hypo event, which at this point is quite a while ago. When I look at your spreadsheet and see the 4.9 on April 13, that is "good" news. It is lower but still safe and at a time during the cycle when it is not worrisome but rather a number to keep an eye on. The lower blue and higher greens on a pet meter are the good numbers that help with giving the pancreas time to heal..something that kitties are able to do, but humans and dogs are not. Understanding how caninsulin/vetsulin works gives a great insight into when to worry about big drops in numbers. The more blues and low greens you see at the +4-+6 hour after shot time with caninsulin, the more time Shelley is spending in the "healing numbers"
Great posts here from Mary Ann! It does seem probable that Shelley is prone to bouncing, as many cats are. It's not surprising when you consider how giving insulin works, not to mention the possibility of a host of variables that can contribute to BG numbers... food, infection, pain, stress, even the weather.
I am a little concerned that Shelley was "purring but not in contentment"... purring can certainly indicate that a kitty is troubled so it's worth keeping a note of when she does this in case you can trace it to something that is causing her to feel uncomfortable.
Hope things settle more now with the new vial but if not have a word with the vet.
Thank you Mary Ann and Diana. Shelley did seem to respond more as usual with the new vial. She had that period of eating more after an hour or so and then at +4 her BG was lower than it had been. And she seems brighter this morning, so I will see how she responds today. Thanks again!
Shelley's BG has been lower than usual for the last 24 hours.
I gave no insulin last night and have reduced today's shot to 0.5 u.
She has seemed quite well today and has been a little more active than usual.
Hoping I am doing the right thing.
Shelley did very well with that skipped shot and is giving good numbers on the 0.5 unit dose. I would hold the 0.5 unit dose for a few days and try to get some mid-cycle testings. It is nice to see the preshot numbers starting to come down and it was a good decision to follow your instincts with the skipped shot and lower dosing. Fingers crossed that Shelley continues to hold steady at the lower dose.
Thank you Mary Ann. It was a borderline decision last night but I thought she should be OK as she is often in that range at some time in the cycle anyway. Hopefully 0.5u won't push her BG too low.
You are doing a great job with testing so you should be able to catch any bigger drops. You might want to do a +3 test to make sure she is not going lower too quickly. As long as you have some medium carb and high carb food available if she should start to drop too much too early you can bring her back up with the higher carb foods. I am sure you have read the information on hypos already but I am reposting it again:
Thank you, that's a good idea, I will do that.
200-250 I would give 0.5
250-300 I would give 0.75
Thank you Janet, I will bear that in mind. My vet advised against using a sliding scale but I can't see any alternative when the numbers are falling.
I can understand not using a sliding scale for lantus, but it is necessary with canisilun. You can't expect to give the same dose at 350 that you do at 220. It wouldn't make sense.
I was told Caninsulin was intended to be given in a consistent dose and that changing that upset the pancreas. And that there was no provision for fractions of a unit? I did try to stick with 1.0u but obviously I have had to reduce it now.
Nice to see those yellow pre-shot numbers at last, Anthony! It's so frustrating I know to see some nice blues mid cycle only to get very high numbers again when insulin is due... it does suggest that sliding scale dosing is more logical and appropriate. The vet is giving you the other option of sticking to a consistent dose which may have some value but is not really doing the job. I think I'd try Janet's suggestion and see how you get on with that. Let us know how it goes.
You are doing really well!
Thank you Diana, it is like starting again when you are in a new range when the dose needs to be adjusted, because you don't know where the numbers are going. Better for Shelley but worrying for me!
Unfortunately, Anthony, with FD you may not ever really know where the numbers are going... they can be affected by all sorts of things, in isolation or in combination. Food is one of the biggest factors that can change BGs, as can stress, infection/illness... so whilst it's great to see Shelley in lower than usual numbers, it's not necessarily permanent! She may still have big fluctuations, just to keep you on your toes... but if she stays in a nicer/healthier range, that would be brilliant and take the edge of the worry for you. Do carry on posting here as frequently as you like... we may not have a magic wand to make things easier but you know we are all rooting for you and Shelley.
Thank you that is very good of you!
A hour ago before food her BG was 14.1. After eating it is now 13.7. I know how the numbers can vary but do you think 0.5u would be safe?
Mid cycle last night I was getting +3 7.8 and +4 9.3.
I would think 0.5u is safe, Anthony, yes. It should still drop her but hopefully not too dramatically. Mid cycle numbers in single figures are nothing to worry about - quite the contrary - as long as they aren't too low of course. So try the half-unit and keep an eye on her for the first part of the cycle... a mini curve might be a good idea at this point!
I have just done that and will keep an eye on her.
She has been eating more this morning as well but the PS number was still lower, but I know it's not all predictable.
Thank you for coming back to me so promptly on that one!
I have tried to inject the same amount of Caninsulin consistently but due to fluctuations in Shelley's BG it has been necessary to adjust this.
My vet's advice was to stick to 1.0u and I have just found the following;
ALLOW 7 DAYS AFTER EACH DOSE ADJUSTMENT
This will allow time for the animal’s blood glucose levels to reach a steady state after a dose adjustment and is a convenient practical interval.
Do not alter the dose more frequently that every 3 days in dogs and 7 days in cats.
According to this therefore I should stick with Shelley's current 0.5u even if her BG starts rising again?
Hmmmm! It does seem logical that a consistent dose might be better, but when you are monitoring BGs regularly and can see that a certain dose isn't working (either too much or too little) there is an obvious argument to change the dose to get the desired result. I do feel for you, Anthony, as you have tried various options and are really giving this your all.
I think what I would do in your shoes is say ok, let's try a consistent dose for a week - go for 0.5u to start with, as she seems to be doing ok with this - and keep a note of her numbers as usual. If she jumps up to the 20s again, that dose is clearly not enough for her, so maybe try a week at 0.75u and see how that goes... etc etc.
That's just my personal way of looking at it. Others may say no, go with a sliding scale... Shelley should have as much insulin as she needs, when she needs it...
Tagging @Elizabeth and Bertie and @JanetNJ who are two experienced Caninsulin users and may have some other thoughts to add.
Hi Anthony @Anthony Morgan ,
Some cats do OK with fixed dosage, others do better with a 'sliding scale'.
Vets almost always recommend holding a fixed dose for a while. But...that is what they've been taught to do. And they're not used to dealing with humans that hometest their kitties and who collect data to show the insulin is actually working in their own cat. (My vet used to adamantly recommend keeping to a fixed dose, but now he leaves the dosing to me, as long as Bertie's numbers are looking OK... )
Sliding scale may be more suited to those kitties who have quite variable BG numbers. It means that, if the numbers are higher, you can give a little more insulin to help pull those numbers down. If the numbers are lower, you can reduce the dose.
It is important to try to be aware of any other likely reasons for high numbers, such as food spikes and bouncing. (Because what you don't want to do - if possible - is to shoot a higher dose on a BG number that may be just very short term thing.)
I'm going to have a look at Shelley's SS. Back later....
Anthony, what exactly are you feeding Shelley at the moment?
And how often are you feeding her?
Does she also have treats, and if so, which kind.
Thank you for your comments. Shelley is having Gourmet Pate, Felix Agail. I happened to pick some Aldi Vitacat Select Jelly the other day which she liked. With all the jelly ones all the pieces are left, she hasn't many teeth now. No treats. Sometimes also Gourmet Beef in tomato sauce.
She has numerous meals each day. Obviously before shots. She then goes through hungry phases at +2 and +4 and is eating again later but I try to leave her without food for the 2 hours prior to testing.
This mornings pre shot number is 19.1.
Very grateful for your input!
Thank you very much. Unfortunately her numbers do seem to be creeping up. She is eating and urinating more and her pre shot this morning is 19.1. I am thinking of shooting 0.75u?
Yes try 0.75u Anthony... it is such a hard call, I know, but sometimes you have to go with your instinct.
Eliz asked you about foods and I do wonder if the sheer variety you are feeding Shelley may be a factor in her fluctuating numbers... some foods, AGAIL among them, do spike BGs in some cats. But she has to eat what she likes so I know it probably isn't easy to stick to one or two varieties!
Anyway try that dose now and let's see what that does.
Thanks Diana, very helpful to get another opinion so promptly!
Shelley does like a variety and sometimes will not eat a certain food. I often try up to 3 to get her to eat before her shot but she does seem to lap up the jelly in that Aldi food well. It is cheap but that's not why I bought it, I just happened to take a relative shopping there.
Thank you for being so understanding, I really appreciate it!
We all understand, Anthony... FD can be very frustrating to treat and it can and does take over our lives... all we can do is the best we can in any given circumstances. Hang in there!
I am having difficulty dosing Shelley at the moment as her numbers are varying a lot. Last night her PS was 23.2, this morning it is 12.2!
I had a vet appointment yesterday as Shelley had been limping badly. I thought it was neuropathy as it improves when her numbers are lower. The vet thinks it is arthritis.
I asked him when I get a low pre-shot number should I reduce the dose or wait until the number rises. He said the latter as it was better to try and maintain the 1.0 u dose.
I would be grateful to see if other members agree with this advice.
I have been delaying shots and that means injecting at midnight and getting up about 4 am to check her at the nadir at the moment.
Thanks for reading!
It is very tricky for you, Anthony, I do sympathise. You've tried many combinations of dosing according to numbers, but not seen any real consistency. It may be that Shelley is in pain - that can certainly cause BGs to rise. Did he give Shelley anything for pain relief? I have often wondered and still do wonder if some of her BG fluctuations are due to dietary changes - some foods are known to spike BGs in some cats, and I know Shelley has a lovely varied diet!
I'm really not sure what to say... we do need some experienced eyes on Shelley's ss. I think if it were me I might start a new thread now with a very specific header to try to get more people reading amd answering... sometimes a fresh pair of eyes can see something we've missed. Do keep going - FD is rarely easy to treat but you are certainly giving it your best shot and you deserve some better numbers soon!
Thank you for your comments.
I have been wondering about pain. She started to limp again at the weekend, I thought it was neuropathy due to her numbers rising. Once I increased the dose she gradually improved.
I asked the vet about pain relief but he wants to check her kidneys before starting her on some.
I have been trying to be more consistent with food but that may still be part of it.
I can certainly try a new thread.
Thanks again for your support!
Just to bring you the latest on Shelley.
She has had a BP check and that is OK on Amodip. She had a urine test which showed the presence of protein, specific gravity of 1.014 and protein creatinine ratio 1.2.
My vet has devoted some time to studying Shelley's BG results and has discussed with colleagues.
He says the constant fluctuations are occurring because I keep changing the dose. The BG normalises in response to 1.0 u but then rises when I reduced the dose because of the lower pre shot numbers.
He insists that this is not good for Shelley and that I should consistently dose 1.0 u, even at low pre shot numbers.
He said the urine test was inconclusive because she has so much glucose going through her kidneys.
Shelley is her usual self but has never been as well since before the hypo when she was on the higher dose.
Thanks for reading!
Ask about adding Benazapril for the protienuria. My cat was on Booth Benazapril and amlodipine.
Hi, thanks for that, will do.
Good to hear from you!
Actually Anthony, I had a look at Shelley's ss a few days ago and thought she was doing ok... not necessarily consistent, but that's hard to achieve because cats are living creatures and not robots! As for fluctuations being caused by different doses and the need to keep to one dose - we may have discussed this before, there is a school of thought that says that's correct, and there is another school of thought that says sliding scale dosing is more appropriate. See Elizabeth's comments at No 148 above.
I can't remember if you have tried following what the vet says? - the problem with that is when you get a low pre-shot number it is tempting to reduce the dose for safety, and no-one would disagree with that. The problem is that 1u may be too much sometimes and drop Shelley too low. Hard to know what else to say. Are you going to follow the vet's advice and report back to them in x weeks? It's worth a try - if you try it and it doesn't work it might give you ammunition to ask about a different insulin which may be gentler on Shelley's system.
Let us know what you decide!
Good to hear from you, thanks for keeping an eye on things. I know its been discussed before and I tried to stick with 1.0u until I felt it was unsafe.. I think this is the third time I have been told this, so I plan to give it a try and will just have to be very vigilant.
I'd do the same, Anthony, I wouldn't give any dose I felt was unsafe. But the vet seems insistent.... tbh I still doubt if he is as knowledgeable as he could be, but give it a shot and see what happens... if you end up with very low pre-shot numbers you can show the vet your ss and see what he says then!
Shelley's BG numbers today.
I think this is borderline whether to give insulin or not? I would just welcome any thoughts.
Shootable pre-shot number, Anthony, if only a small dose, but I understand your hesitation, especially as she has come down a little... maybe test again in an hour and make a decision then?
Thank you. I will try that, perhaps 0.5u.
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