Changing dose after 1st curve

I just did my first all day curve with Master Tyson and relayed the #'s to the vet. She called today and told me to increase his units from 1 twice a day, to 2 twice a day. This seems like quite a jump, but she said no, its completely normal for a newly diagnosed diabetic cat. His numbers average in the mid 300's, sometimes went up to the 400's and a couple times were even in the 500's the past 12 days since diagnosed. Do you guys feel this is too much of a jump in insulin. I knew she would increase the dose, just didn't think it would be a full unit twice a day. She also told me I could increase his wet food from 3 oz twice a day to 5 oz twice a day, as he seems famished all the time and keeps trying to steal food from the dog and myself. Any advice would be happily accepted. thank you in advance.

 

We would all respond with a resounding "No! This is too large an increase." We recommend increases of only 0.25 units at a time because it's too easy to zoom past a good dose when you increase by more. Many vets recommend feeding only twice a day but few of us do that. We split the daily ration into multiple small meals a day. Kitty is more satisfied and it seems to have a stabilizing effect on BG for many. Wet food is the way to go as long as its under 10% carbs as fed.

Would you mind posting your curve numbers here?

 

Diabetics should eat 4 or 5 small meals a day, it helps regulate the bg. I know if you work you can’t always do that. If the bg numbers aren’t controlled, then they’re going to be hungry as they can’t process it correctly. Just feed all they want.. starving! Lol
I agree on going slower on any increases, you could end up having a hypo event & not find the correct dose! Most vets are not as knowledgeable- sorry to say but true. My vet is amazed at what I tell her! Also, cats should always be dosed 2 times a day... every 12 hours.
Hope this info helped & good luck...

 

I have them at home, will post tonight. TY. I specifically asked about the jump increase being too large, and she she no, its the "norm", but wouldn't need to be as large next time. I don't want a next time.

 

I asked about getting him a timed feeder so that he could have multiple smaller meals, for example every 6 hours, as I work during the day. She said no to this, as his sugars could spike during the feedings when I wasn't around and it wasn't healthy. Its very confusing to read and believe something that makes sense and get information from your vet to the contrary. I'm happy she was in total agreement with me switching to all-wet food, even though her initial recommendation was vet-prescribed dry food.

I think i'll only increase to 1.25 units tonight and post to this forum and get feedback from you guys, my new friends and experts and see what you recommend, as Kris recommended. I would like to start a spreadsheet as well.

 

Almost every one of us went through that mental struggle when we got advice here that conflicted with our vet's so we understand how you feel. However, we all made better progress treating our kitties once we started doing things the FDMB way. I can vouch for that personally.

Here a new member's handout I made a while ago:
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It would help us if you set up your signature (light grey text under a post). Here's how: You've already done this.

• click on your name in the upper right corner of this page
• click on "signature" in the men that drops down
• type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.

Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

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Here's the basic testing routine we recommend:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

This is useful: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

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Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.

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Here are some tips on how to do urine ketone testing (VERY important if BG is high and kitty isn't eating well!):

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

 

Oh I understand... it’s very confusing & a lot to take in. Human diabetics are advised to eat several small meals a day... if they are low carb, they will not spike enough to hurt. A diabetic has to eat - the drop in bg after a shot without food is more dangerous. Hypo.. Kris has given you a ton of info & years of experience & knowledge. I don’t know why they want them to eat a higher carb dry food?!? Makes no sense. But most try to prescribe it.
I also have never heard of once a day insulin.. it just doesn’t work that way. Testing is very important in order to keep them safe. Hang in there... it’s a lot to take in but it works.

 

Thanks so much. Yes, I did the signature. I do the AM and PM testing as I have been reading much on this forum and have been doing extra testing when I've been home, especially during the weekend, although its only been 12 days so far. 1st curve was Saturday. I will be doing a spreadsheet as soon as I can figure it out and find the time. I did ask the vet about testing Ketones, but she said no need, as my kitty is ravenous, therefore has no signs of presenting issues, but will if he shows any signs for sure.

 

Oh no, my kitty is on twice a day insulin, i'm sorry if I mis-typed. He gets am and pm shots, 1 unit twice a day. She just asked me to bump him up to 2 units twice a day. I think its an extreme bump is all.

 

When I asked my vet about urine ketone testing she said she was reluctant to suggest it to clients because she didn't want to invite any litter box issues. However, my guy is very relaxed about all this so I grab a sample periodically when I see him going into the area where the box is. He had a bout of diabetic ketoacidosis two months after his diagnosis so I want to be proactive.

 

I entered Tysons information into the spreadsheet. I think i've figured it out.. Hopefully its right.. Please let me know if I've confused anyone with the information.

Thanks for any insight offered!

 

I can see the data on your spreadsheet. Two things we'd recommend:

1. increase the dose by only 0.25 u at a time, so up to 1.25 u instead of 1.5 u
2. get a scattering of BG tests on no curve days: when you get home from/leave for work, every evening before bed.

 

Maybe I haven't done my spreadsheet correctly, then.. as that is where my #'s are from outside the curve day. am/pm before work preshots. I can get more on the weekends when I am not at work, but the other #'s are typically prior to/after work and before he's fed and given his insulin shot, always on an empty stomach. Am i imputing the #'s in the wrong place? I am putting those under AMPS and PMPS

I had every intention of going home last night and upping his dose to 1.25, however I have invested in the 40U needles and didn't realize until I got home that they only had measurements in the .5 increments. So instead of blindly guessing on the 1.25 dose I met in the middle of my vets recommendation and the advice I got on this site and did a dose of 1.5 so I was clear on the amount he was getting.

 

The pre shots on an empty stomach are in the correct place on your SS. I was referring to other tests between those when you’re off - not a full curve, just one or two extras. On busy days get a before bed test.

 

Oh yes, I see what you are saying. Yes okay. I will as I go along, absolutely. I've only just started writing the #'s down. I need to be better at night testing, as I tend to fall asleep while watching tv, waking at crazy hours. I guess I could try to take it then! ty!