GA Dear Shelley, now at rest.

Discussion in 'Feline Health - (The Main Forum)' started by Anthony Morgan, Jun 15, 2017.

  1. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    My cats pre shot numbers are varying from 19 to 8. My vet insists that Caninsulin only works properly if given in the same dose consistently, 1.0u in my case. He says I should inject 1.0u as low as a pre shot number of 8.
    As my cat had a hypo earlier this year this is making me very concerned that this could cause another?
    Thank you for reading!
     
  2. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    Anthony, I tend to agree with you. With Caninsulin, and a lower pre-shot with a 4.9 mid cycle during the previous day cycle, I'd be very wary of giving the full dose particularly on a night cycle when having to monitor intensely is not ideal. That said, the pre-shot of 10.6 could be slightly >11 or it could be slightly <10 given meter variance allowance. I always tend to be conservative particularly on night cycles when I cannot monitor as closely. That lower mid cycle can make kitty a little more sensitive to insulin for a few cycles too.

    What you can do in a situation like this, if your schedule allows, is stall for 30 minutes without feeding Shelley and take a 2nd reading to see if she is rising on her own, staying steady or still dropping. If her BG is rising, then you could shoot the regular dose assuming she is very close to 11 mmol. If she is steady I'd reduce the dose slightly like 0.25u and if she is dropping I'd consider a big chicken shot of 0.25 to 0.5u. or just skip depending on the reading.

    You have lots of data and a sliding scale of dosing might be something to consider at this point. I'm going to tag a member who has used Caninsulin and is good at suggesting sliding scales to get you more input on this.

    @JanetNJ can you have a look at Shelley's SS and give Anthony your opinion/suggestions about a sliding scale. Thanks.
     
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  3. Anthony Morgan

    Anthony Morgan Member

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    Hi Linda,
    Thank you very much for your comments. What you suggest is basically what I have been doing. The 1st test this morning was 10.1. 2 hours later 10.3 with no insulin.
    But the difficulty I have is that my vet says the sliding scale I have been using is causing the fluctuations in BG levels.
    He wants me to shoot 1.0u consistently even at low pre shot levels and then do a curve after 10 days.
    @JanetNJ has kindly had a look at my case before and confirmed that the sliding scale was the way to go.
    Shelley is brighter on 1.0u but it is the hypo that worries me.
    Thanks again!
    P.s. sorry my spreadsheet is not right up to date, problems with my laptop.
     
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  4. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Anthony, my feeling is that you know Shelly better than your vet ever will. You are aware of what's going on with her 24/7 and are in a better position to make decisions for her than the vet is. Our vets can give us guidelines but many don't seem to realize that this sugar dance is not a one size fits all proposition. Nor do they appreciate that they are NOT going to be the one dealing with a hypo cat in the middle of the night. You hold the needle and have to be comfortable with the treatment you are giving Shelley.

    As for your vet's assertion that the sliding scale is causing fluctuating BG levels, I agree that in the early days when you are struggling to find the best dose, a sliding scale can muddy the waters but you have lots of data and at this point, can see how much she usually drops on several different doses so if you have any concerns at all about her possibly dropping too low, go with your gut. No two days' readings are identical even when you do consistently give the same dose with the same diet and activity so acting conservatively to keep Shelley safe and you sane is IMHO the only way to handle this. :)
     
  5. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    If I gave Noah the same shot every time he wouldn't be here. Consistency is a fairy tale with too many variables. What and when he ate, did Lewis eat half his food when we turned our backs, did he eat and then promptly vomit in our huge basement, higher AM than PM. Your vet, like so many others, has his head buried in a book but you are there with your cat. If your cat goes HYPO all you'll get is a huge bill and his misplaced judgement.
     
  6. Diana&Tom

    Diana&Tom Well-Known Member

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    Anthony, I know how frustrated you are about this and how you feel stuck in the middle, between wanting to do what the vet says yet knowing that his advice may not always be safe. You DO have to do what feels right for you. Shelley seems to throw an unexpected green now and then during the cycle and you certainly wouldn't want her going much lower than the 4s you've had a few times... you are well aware of the issues there.

    I think for your own peace of mind, you have to make a decision about this... give 1u as the "default" dose, but when a PS number is around 10 or 11, either give a reduced dose or test again half an hour later, as Linda says, and make a decision then.

    Vets just do not have the kind of hands-on, day-to-day experience of treating a diabetic cat to make sweeping statements about dosing... they may mean well and believe they are right, but as I think I've said a few times recently, cats are living beings, not robots...!
     
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  7. Anthony Morgan

    Anthony Morgan Member

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    Linda and Noah & Me,

    Thank you, I have just been getting the spreadsheet up to date.
    Shelley was only picking at her food earlier which was another reason for caution. I just did another test and the result was 11.4.
    I think I will wait until this evening now before I inject again.
    Unfortunately my vet, who is fairly new but does discuss with senior colleagues, is adamant in his opinion, so I don't know how we can work together on this.
    But I will have to continue to be cautious at these low numbers although I do worry that I am causing harm when I don't inject.
     
  8. Diana&Tom

    Diana&Tom Well-Known Member

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    I think there are times when you just have to do what you have to do... does the vet need to know you don't always give 1u by looking at your spreadsheet? If he doesn't have access to it, don't show him so he won't know.
    If you are pressed into explaining why you don't always give 1u just explain that you don't feel at all confident that the dose won't cause a hypo...
     
  9. Anthony Morgan

    Anthony Morgan Member

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    Thank you once again Diana. I have got the spreadsheet up to date and it looks like I will be skipping today's injection as Shelley is currently at 11.4.
     
  10. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    Sorry, should have clarified. MrWorfMens' Mom and Janet NJ, among many others, have years and more years of practical experience, something not offered in any veterinarian college course. I was just giving you a pep talk. When it comes to actual medicine I defer to these members and, luckily for me, a vet who is willing to accept an alternate way of doing things. Her Dad was a vet as well and together we have taken care of 14 cats and a dog over the last 12+ years. Nothing is as simple as it seems. That's it for me, now you need help, not words. All my hope.
     
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  11. Anthony Morgan

    Anthony Morgan Member

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    That is a fair point and one way around the problem. It may be the best way to go.
     
  12. Anthony Morgan

    Anthony Morgan Member

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    Thank you very much, I am not doubting the validity of the advice received on the FDMB from the wealth of experienced members.
    As you may notice, I am not blindly following the vets instructions but it's just that every time I get a low pre-shot number, I just have this doubt about what is best for Shelley. But obviously a few hours raised BG is much better than a hypo.
    I appreciate the pep talk! Thank you!
     
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  13. Diana&Tom

    Diana&Tom Well-Known Member

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    EXACTLY, Anthony! A few hours' raised BG is better than a hypo. Let that be your watchword and repeat it to the vet if necessary.
     
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  14. Anthony Morgan

    Anthony Morgan Member

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    Thank you Diana, you have devoted so much time to my issues, so generous of you!
     
  15. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Most vets do not see people who test their kitties numerous times a regular daily basis. You are basically doing mini glucose curves each day so you have very good data on how Shelley is responding. With Caninsulin you need to look at both the preshot number AND the nadir. Also insulin absorption can vary from day to day with each kitty. The whole point is to get Shelley into good numbers BUT also keep her safe. A sliding scale is not a good choice for someone who is not testing or is only testing periodically, but you have a lot of data.



    This is a guideline from the Caninsulin manual used by MSD

    http://www.msd-animal-health.co.nz/binaries/CAN-350-2010_Caninsulin_Tech_Manual_Web_tcm51-37406.pdf

    PAGE 6:

    Blood Glucose Curve Results Recommended Action:

    Nadir < 3 mmol/L Decrease dose by 50%
    Clinical Signs of Hypoglycaemia Decrease dose by 50%
    Nadir between 3 – 5 mmol/L Decrease dose by 10% (Dogs) Decrease by 1 unit (Cats)
    Pre-insulin blood glucose < 10 mmol/L (Dogs)
    Pre-insulin blood glucose < 15 mmol/L (Cats) Decrease dose by 10% (Dogs) Decrease by 1 unit (Cats)
    Nadir between 5 – 9 mmol/L and Pre-insulin blood glucose for dogs > 10 mmol/L Pre-insulin blood glucose for cats > 15 mmol/L No Change
    Nadir > 9 mmol/L and Pre-insulin glucose values > 15 mmol/L If clinical signs present, increase dose by 10% (Dogs) Increase by 1 unit (Cats)
     
    Last edited: Jun 15, 2017
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  16. Diana&Tom

    Diana&Tom Well-Known Member

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    You are very welcome, Anthony. I do sympathise with your dilemma! But I think you should have more confidence in yourself and how you're treating Shelley... you've actually had at least as much if not more information given to you than vets have, and you have a good handle on it all now. I think you will feel much better if you stick to a simple plan, a plan that gives you less worry and ensures Shelley is safe - the vet can say what he likes but he is quoting the textbooks and cats as we all know do not conform to the rules!!
     
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  17. Anthony Morgan

    Anthony Morgan Member

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    Hello Mary Ann,
    It is really good to hear from you. That is very useful, I will study those figures.
    Unfortunately the vet and I are on different pages and I don't seem to be able to make a convincing argument to get him to agree with me. He is very adamant about consistency and full day curves, the text book approach but not necessarily the safest approach for Shelley.
    Best wishes!
     
  18. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    I wish with all my heart that vets would acknowledge this and appreciate rather than berate any client who takes the time to really understand their pet and work so hard to keep them not only healthy but also safe which you are so evidently doing.

    The next time the vet suggests you keep shooting 1u despite a lower pre-shot or a low nadir, ask for an after hour telephone number at which they promise to be available to deal with the fallout at any time day or night. ;) I'm betting that would turn off the negative rhetoric.
     
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  19. Anthony Morgan

    Anthony Morgan Member

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    Yes, I am sure you are right! Thanks again!
     
  20. Diana&Tom

    Diana&Tom Well-Known Member

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    Absolutely.
     
  21. Anthony Morgan

    Anthony Morgan Member

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    That's a thought! Thank you!
     
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  22. Diana&Tom

    Diana&Tom Well-Known Member

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    Courage, Anthony!!!
    Did you know that there have been occasions on this board when vets have eventually bowed to the superior knowledge of their clients who are members here and have educated themselves in all the ins and outs of FD... it takes a certain kind of vet to admit that but there are some. Remember, vets are like our GPs....they can listen, examine and diagnose, but they are not equipped with ALL the right information to treat EVERY disease that presents in the surgery. We humans have specialist diabetic clinics, don't we...can't expect that for cats but it does prove that diabetes needs more specialist treatment than the GP can offer. Same with vets. In this case, we on FDMB are the "specialists"!
     
  23. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Anthony

    The link I posted IS a text book approach. It is a Caninsulin technical manual that shows that sliding scales ARE used. In the beginning it is usually advised not to change the dosing for the first week and to do dose increases weekly as needed. However when it comes to hypos there is no hard and fast rule about holding a dose that takes your kitty too low. High glucose numbers are hard on a kitty's body over time, but a hypo can cause serious or deadly results. Once a kitty has been on Caninsulin for awhile the way Shelley has been, then dose changes need to be based on empirical data, which you are gathering each and every time you test. The often quoted ECID (every cat is different) plays such a big role in determining what approach to use. The body is not a static entity and needs can change daily. Caninsulin is one of the best insulins to use a sliding scale with since it is an "in and out" insulin and does not leave residual effects once it has worn off.

    If changing the doses is becoming a huge area of contention with you and your vet, you could "lie" to him about what dosing protocol you are using and still follow your own gut feelings and the advice that everyone on here has given you. Not the approach I would prefer, but your data shows that a consistent dose is not the best approach. You need to do what is best for Shelley.
     
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  24. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    When doctors refuse to learn. This is the Wikipedia link to "Bloodletting"
    https://en.wikipedia.org/wiki/Bloodletting
    Yes we're making progress but a degree in medicine doesn't mean there's not more to learn and it's sad we have to initiate things ourselves.
    Read about George Washington's Death, December 19, 1799. It's gruesome, leeches, bloodletting, the "vapours".
     
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  25. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Thank you Mary Ann. I just had to go out but I will have a close look at that later.
    I think I will have to steer a middle course for Shelley's benefit.
    As I have learnt here Caninsulin is an in and out insulin but I was only told last week at the vets, that it is long acting and yesterday's dose has an effect on today's BG. Obviously there is some doubt about the validity of this advice.
     
    Last edited: Jun 15, 2017
    Reason for edit: Edit
  26. Diana&Tom

    Diana&Tom Well-Known Member

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    Hmmm yes this an interesting point... I don't have the info to hand but @Tuxedo Mom will be able to tell you how Caninsulin works... it has a first and second stage, in simple terms. But there is also the issue of dose of course... a very small dose might be used up quickly and be completely out of the system by the time the next shot is due. So when you get a high pre-shot number it would suggest that the insulin is all gone, and when you get a lowish one it might mean that there is some overlap... but I don't think you can say anything with certainty. It would be interesting to see what others say about this.
     
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  27. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    I have just done another test and Shelley's BG was 9.3. So I will not give a shot yet. If this were to continue I believe I would need to check for ketones?
     
  28. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    From the Caninsulin manufacturer:


    "
    How does Caninsulin work in cats?

    A lente (intermediate-acting) form of insulin, Caninsulin contains approximately 30 percent amorphous insulin for rapid onset of activity. The remaining approximately 70 percent of the formula is crystalline insulin which is absorbed more slowly. This formulation allows for a more continuous utilization of glucose to support the body's basic functions. In cats, the peak activity following subcutaneous administration of Caninsulin occurs between 1.5 and 8 hours (with an average of about 4 hours), and a duration of activity varies between 8 and 12 hours. Caninsulin should be administered subcutaneously twice a day in diabetic cats."

    http://www.caninsulin.ca/faq-answers-p.asp

    Caninsulin does not have any carryover and in many, many kitties the duration of effect is only an average of 8-10 hours, which is why you will see the numbers rising after this time. Some more advanced users have actually shot Caninsulin 3 times a day in order to keep glucose levels lower and level, because of this short duration. Again ECID as to how long a duration they will get from Caninsulin. You could try doing another full glucose curve...testing every 2 hours for 12 hours. The last full curve you did was March 5 and you will see that the effects were definitely wearing off at +10.

    Because of the make-up of Caninsulin the faster acting portion will drop levels earlier in the cycle and then wear down. The slower acting portion is then working to keep the numbers more level. Some users will see a slight dip when the slower acting portion takes effect but it is no where as drastic as the initial drop from the fast acting part.

    Not to be unkind but perhaps your vet should check with the Caninsulin manufacturer and get accurate information.


    ETA The longer a kitty stays in better numbers the better the chance for the pancreas to start to heal itself (something that kitties are able to achieve) and begin working more efficiently at producing insulin again. There is no time frame for when this happens or how quickly this happens. With proper food and good glucose control the healing is happening. This is another reason that home-testing is so important and watching the numbers is critical. The endocrine system is a very dependant on everything working properly and if the pancreas decides to start "sputtering" into action again that will certainly affect the glucose levels.
     
    Last edited: Jun 15, 2017
  29. Anthony Morgan

    Anthony Morgan Member

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    Thank you very much Mary Ann, that is a very comprehensive explanation. Much appreciated!
     
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  30. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    A thank you is always nice, truthfully a little ego boost, but never required. We're all friends here.
    Do you know how to "tag" someone? If you want someone's attention and they're in another thread do this:
    Type @, then leave a space, then start typing that persons name. For example, as you slowly type N, then O, then A, a list will appear with all the members whose name matches what you've typed so far. With each letter you type the name gets more specific, then just click on the name and you're done. @Anthony Morgan
    The tag will appear in that members Alerts. It can be helpful if that member is occupied elsewhere or even logged off. It's not rude so forget that part. We don't do rude here, only help. Make sense?
     
  31. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    What do you think of this scale....

    250+ (13.9) 1 unit
    200-250 (11.1-13.9). 0.5 units
    170-200 (9.5-11.1) 0.25 units
    Below 170 just a small few drops
    If the 0.5, and 0.25 prove to not be enough, you could shift it to be 0.75 and 0.5 respectively.
     
  32. Anthony Morgan

    Anthony Morgan Member

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    Certainly does!
     
  33. Anthony Morgan

    Anthony Morgan Member

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    Hi,
    Yes, that makes sense. The last number I got tonight was 11.2 and I decided to inject 0.5u, so that fits. Unfortunately my current batch of syringes only have 1u increments, so it is a guesstimate. Thank you!
     
  34. JanetNJ

    JanetNJ Well-Known Member

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    Are there syringes with half unit markings available where you are? If so you may want to pick them up for fractional doses and use the 1u increment syringes when dosing 1 unit.
     
  35. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Yes Janet, but I usually get the from the vets and the type vary each time I order. I will have to get some of the others.
    Thank you!
     
  36. Diana&Tom

    Diana&Tom Well-Known Member

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    I'm pretty sure you can get these online, Anthony
    @Elizabeth and Bertie
     
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  37. Anthony Morgan

    Anthony Morgan Member

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    Thank you Diana, I'm sure you are right. I will look into it.
     
  38. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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  39. Anthony Morgan

    Anthony Morgan Member

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  40. Anthony Morgan

    Anthony Morgan Member

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    It has been extremely hot today. Shelley had slept most of the day. She has eaten small amounts. I got a few tests in and the low point at +4 was 4.7 on 0.5u. She has just been in the garden eating grass. Just did the pmps which was 9.5 and she had about a tablespoon of food.
    Trying to decide whether to inject 0.25u or skip the dose?
     
  41. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Do you think she filled up on grass? My old guy eats grass and then promptly divests himself of it if you get my drift so I'd be a bit concerned if Shelley tends to do the same! If you are sure she will eat more then I think 0.25u should be fine but if there is any question about her eating, conservative me would skip.
     
  42. Anthony Morgan

    Anthony Morgan Member

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    Hello Linda,
    Thank you for replying. I think she ate only a few blades, which she does occasionally. It has made her sick sometimes.
    It's a close call. As I said, it has been very hot today and I don't think it has agreed with her. I can test again a bit later and see where it's going.
     
  43. Diana&Tom

    Diana&Tom Well-Known Member

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    Hi Anthony, how are things? Haven't seen you here for a while. Just looked at Shelley's ss though and am pleased to see some very nice numbers in the past week! Hope it continues.

    Diana
     
  44. Monica & Josie

    Monica & Josie Member

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    How spooky i was just wondering about Anthony myself today! Look forward to hearing from him
     
  45. Diana&Tom

    Diana&Tom Well-Known Member

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    Yes! And take heart from Shelley's numbers, Monica... look at the improvement over a period of time as the doses have been tried and tweaked... hopefully Anthony is feeling better about it all now.
     
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  46. Anthony Morgan

    Anthony Morgan Member

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    Hi Diana and Monica,
    Very nice to hear from you. Shelley's numbers have been keeping in a lower range. She seems well but I haven't noticed much difference in her behaviour, except not drinking as much.
    Slight concern when she dropped to 4.3 on 25/6.
    I decided to get in touch with the vet who treated her previously who is now at a different branch, just to see what he thought about dosing. Whilst he is an advocate of consistency, he did agree that a small dose was appropriate at these levels, 0.5 or 0.25u.
    I did get some of the syringes with the 0.5 increments but still getting use to them. 0.25u seems even less on these, I did wonder if I had actually injected any. I'm sure I will get use to them though.
    I am happier about these better numbers but still feel worried if I notice anything different around the time of the nadir. So just pressing on and keeping vigilant.
    Thank you for looking in!
     
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  47. Yong

    Yong Well-Known Member

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    Jan 11, 2017
    I wondered the same thing when I had to draw those tiny doses :). After you give her a shot, push hard on the plunger towards the needle. Chances are you'll still get a drop to come out from residual left in the needle. Don't give to her lol, just to see for yourself, if you push the plunger before drawing insulin, it does in fact draw a drop into the needle before you see it on the markings. I hope that made sense :smuggrin:
     
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  48. Diana&Tom

    Diana&Tom Well-Known Member

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    Pressing on and keeeping vigilant is good, Anthony. You're doing really well, give yourself some credit!
     
  49. Anthony Morgan

    Anthony Morgan Member

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    Hi Yong,
    Yes it does, thank you. I actually tried with a used needle and some water and although not much appeared on the scale, it was there.
    Kind regards!
     
  50. Anthony Morgan

    Anthony Morgan Member

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    Thank you Diana!
     
  51. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Wow, Anthony... What an improvement! Keeping fingers, paws, and everything else crossed that this continues, onwards and upwards..... :bighug::bighug::bighug:
    .
     
  52. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    I agree with Elizabeth. Shelley's numbers are looking very good...lots of those lovely blues and some safer greens showing up. Contrary to what your vet said the sliding scale you are using seems to be working nicely with Shelley. WTG!! [​IMG]
     
  53. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Anthony, are you using U40 syringes? With doses this small you might want to consider using U100 syringes with a conversion chart. ...In a U100 syringe .2 of a unit of Caninsulin for example, would measure to the .5 line, so, much easier to measure... Here's the link to the conversion chart so you can see how it works:
    http://www.felinediabetes.com/insulin-conversions.htm

    If you'd like some to play with I'll gladly send you some of Berties. I could pop them in the post on Monday. Just PM me your address if you'd like some.
    .
     
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  54. Anthony Morgan

    Anthony Morgan Member

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    Hi Elizabeth and Mary Ann,
    Thank you for looking in. Today the amps was 13.4 and at +5 6.2. I just did the pmps and that was 9.8.
    Although the numbers are looking good, Shelley has been very quiet today, sleeping most if the time. She has been eating when she wakes up.
    At this low pre shot number, I am thinking I should skip the shot. Maybe test again later.
    Elizabeth, thank you for your offer, that is extremely kind of you but I wouldn't want to put you to any inconvenience.
    I am still using the U40 needles but I have managed to get those with the 0.5 increments, so that is easier to estimate.
    Just hoping Shelley brightens up a little at the moment.
    Thanks again!
     
  55. Yong

    Yong Well-Known Member

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    Jan 11, 2017
    Have you ever done the stalling technique, Anthony? Withhold feeding, wait 20 minutes and re-test?
     
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  56. Diana&Tom

    Diana&Tom Well-Known Member

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    I wouldn't worry too much that Shelley is sleeping a lot, Anthony - this is after all what cats do, and as they age they may sleep even more. It has been quite warm too,which can make cats sleepy. You mentioned earlier that you'd noticed she was drinking less - that's a good sign - and she is eating in between sleeps, so that's good too. If she showed no interest in food that might be more worrying, but it sounds as if she is being a fairly normal "mature" cat. If you notice signs of pain, discomfort or distress, that again could be cause for concern, but I don't think you're saying that's the case so try not to worry for now.
     
  57. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    That is a lower preshot and I can see why you would be nervous shooting it. It is hard to say, since your spreadsheet is not up to date right now and 4 or 5 days of data can make a difference in advice.
     
  58. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Hi Yong,
    Yes, I have heard about that but on this occasion Shelley did eat a little. I will test again in a couple of hours.
    Thank you!
     
  59. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Anthony, I agree with Diana. ....I have 5 cats aged between 2 and 19, and all of them have been knocked out today (in the UK) by the heat and humidity. They're only just beginning to wake up now that things are cooling down. So don't worry too much on that score. :bighug:
    ....My two oldies have been so knocked out today that I've actually shaken them a bit to wake them up just to check that they're OK!

    As long as you're OK, Anthony. That's the important thing. You need to be comfortable with what you're doing. And, to be honest, not everyone is comfortable with using different syringes and doing the conversion. And that is absolutely understandable.
    (But if you change your mind it honestly wouldn't be any inconvenience at all to post you some U100's: On the contrary, it would be my pleasure. :cat: )
     
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  60. Yong

    Yong Well-Known Member

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    Jan 11, 2017
    Just to see how she's doing on her own right? :) It's good data.
     
  61. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Hi Mary Ann,
    My laptop is so slow it puts me off using it, the spread sheet won't update from my tablet. I will do it now, probably take about half an hour.
    Thank you!
     
  62. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014

    Sorry the updates are such a problem. Slow computers are enough to test anyone's patience. You are ultimately the one who makes the final dosing decision and as Yong said. if you skip the shot it is all useful data. :bighug: :bighug:
     
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  63. Anthony Morgan

    Anthony Morgan Member

    Joined:
    Feb 16, 2017
    Diana and Elizabeth,
    Thank you very much for your reassurance!
    Shelley has had quiet days before, so hopefully she will brighten up again. There are no other signs of anything wrong, so fingers crossed.
    Your kind support is much appreciated!
     
  64. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Thank you Mary Ann,
    My laptop is only a couple of years old but they always seem OK at first and then get slower and slower. Perhaps I need to update it. Anyway, I have got the spreadsheet up to date now.
    I had to miss the midday tests a few times this week due to commitments unfortunately.
     
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  65. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Yes and depending on the number consider injecting late. It worries me not injecting also.
     
  66. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Anthony, if your laptop is only a couple of years old you shouldn't have to buy a new one. The speed issue may just be that you need to delete/uninstall some things on your hard drive. I'm far from expert myself but a friend of mine recently called in someone who knows about these things to look at his laptop... gave it a thorough check-up, spring clean, etc... two hours later it was much better at a cost of £100 which is cheaper than a new laptop. So that would be my suggestion, if it's bugging you... it depends how much you use / rely on your computer of course.
     
  67. Anthony Morgan

    Anthony Morgan Member

    Joined:
    Feb 16, 2017
    Hi Diana,
    Thanks for that suggestion. It's certainly something to consider, there are a few computer shops nearby. I will look into it.
    I did use it a lot more before I got a tablet. It is only an Amazon Fire. It's very quick in comparison but some things it won't seem to do.
    Shelley is a little brighter today. Went in the garden briefly. Only picking at food, I think she may be bored with the menu!
    I didn't inject last night. Amps was 10.9 so I injected 0.25u.
    I don't know about you but I seem to waste more cat food than they eat. Shelley always wants fresh and then only eats a little and the others never clean their plates. Even the younger cats leave all the solid pieces. Of course it could be that I feed them too often!
     
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  68. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Maybe the answer is to just put a small amount of cat food in the bowls, Anthony - seal the rest of the pouches and keep them in the fridge until the next mealtime. Some cats just don't have big appetites and a big bowl of food may be off-putting, and/or yes, you might be feeding them too often! I always put more food down for my cat when I go out even for a couple of hours, thinking she might get peckish, but nine out of ten times she doesn't touch it. It's only when her bowl is actually empty that she seems to want something it! Maybe if you're giving them all treats as well, that reduces the hunger pangs...
    :)
     
  69. Anthony Morgan

    Anthony Morgan Member

    Joined:
    Feb 16, 2017
    I don't often give them treats as such apart from fresh chicken occasionally. I have tried putting it in the fridge and then warming it up slightly but they don't seem so keen on it.
    Charlie, Jack and Eddie are all good weights shall I say, so maybe I just need to feed them less often!
    I just checked Shelley's BG at +4 "= 5.2.
    A bit lower than I am comfortable with.
    Thanks Diana!
     
  70. Yong

    Yong Well-Known Member

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    Jan 11, 2017
    That is a very nice reading, it seems Shelly might still nadir between +4 and +5 :D
     
  71. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Hi Yong,
    I encouraged Shelley to eat at +4 and at +5 she was up to 7.2.
    So it seems like 0.25u is OK in this range.
    By the way, was it you that recommended the Tesco Feline Cuisine range? I did buy some and Shelley liked it and although it seemed a richer food, I understand the carb content is OK?
    With thanks!
     
  72. Yong

    Yong Well-Known Member

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    Jan 11, 2017
    Guessing it was one of your fellow UK members as I've not heard of Tesco :)
     
  73. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Yes it was Matthew who suggested Feline Cuisine - I've seen it in Sainsburys as well as Tesco.
     
  74. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Sorry, my mistake.
     
  75. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Thank you Diana!
     
  76. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Last night Shelley's pre shot was 8.6, so I didn't inject.
    This morning's pre shot 10.3.
    Trying to decide whether to give a small dose or none again?
    Thank you!
     
  77. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    @Anthony Morgan , just going to have a quick look at your SS. Back soon...
    .
     
  78. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Anthony, that .20 seemed to work well for Shelley yesterday. Or you could try a smidge less than the .2....? Are you going to be around to monitor if you give the shot? You need to be comfortable with whatever you decide to do...
    Alternatively, you could try giving a small amount of low carb food and waiting to see if her blood glucose goes up or down as a result of that. (You might need to wait an hour or more though to see the effect of that, and that might throw your schedule out..?)

    This is looking very good for Shelley. She's producing insulin of her own. I'm guessing you may need to keep reducing the dose.... :cat:
    .
     
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  79. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Elizabeth, thank you very much for replying!
    I will be around this morning, so I can monitor. I will test again a little later and see which way things are going as you suggest.
    Thanks again!
     
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  80. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Great advice from Elizabeth, Anthony! Shelley is doing so well!
     
  81. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Diana,
    Thank you! She is eating etc. But still seems less bright than usual. Perhaps she needs to adjust to lower numbers?
     
  82. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Anthony, what do you mean exactly by "less bright that usual"? You've mentioned that a few times. She is eating normally which should be a good sign, and as we've said, cats - particularly older cats - do sleep more in warmer weather, and are often not as playful as they were in their younger years. But you're her owner of course and a very committed and observant one - have you seen a significant difference in her recently or she looking uncomfortable in a specific way? It may be, yes, she's getting used to better BG numbers, but if you're concerned it migjt be best to ask the vet. When did Shelley last have a check-up? I don't think it was that long ago but if you've noticed a change in her since then you might need to pop back with her. The vet would also ask you of course what signs you've noticed.
     
  83. Anthony Morgan

    Anthony Morgan Member

    Joined:
    Feb 16, 2017
    Diana,
    Well I just retested and got 13.2, so I feel more comfortable to inject 0.25u.
    When Shelley was on a higher dose, when her BG fell she seemed to become more active, sitting in the garden, being more vocal and demanding food.
    The last few days she has just been quieter. Sleeping a lot, eating but not with the usual enthusiasm. Not going in the garden and not very vocal.
    As you know I do keep a close eye on her, so if I am concerned I will see the vet. She had a urine analysis about a month ago but no blood test since February.
     
  84. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    My best guess would be the warm weather making Shelley a bit lethargic, Anthony - if you've spotted no other symptoms she is probably fine. Demanding food is s sign of an unregulated diabetic cat so the fact that she is now wanting less food is actually a positive... and normal, really, I would say, for a cat her age.
    I do understand your worry, we all take our kitties' health very seriously here, so I think I'd just make a note of how she's doing during this month and take her to the vet for blood tests in August - senior cats should have a health check twice a year anyway so she's on schedule for that.
     
  85. Anthony Morgan

    Anthony Morgan Member

    Joined:
    Feb 16, 2017
    Thank you Diana,
    Good advice, much appreciated!
     
  86. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    Anthony

    Just checking in and how wonderful to see Shelley's numbers staying in a much tighter range. As Elizabeth said it appears that Shelley's pancreas is working at producing some insulin on its own. Kitties have the amazing ability to heal their pancreas and the longer she stays in a good range the better the chances are for further healing. I know it is difficult for you to update your spreadsheet, but perhaps you could post the newer numbers all together with the updated readings on your daily post, just in case you need advice during the cycle and people who are following you are not available at that moment.

    PMPS 8.6 No shot
    AMBG 10.3 Stalled
    AMPS ? hours after first test 13.2 0.25 unit


    When you got the second reading of 13.2 had you already fed Shelley? If you had fed her after the first test, that would bring the numbers up.

    Warmer weather can cause the appetite to be decreased. Also as Shelley's numbers start to remain in a good range you should find that her demands for food decrease since her body is using the food she eats properly and she does not have the usual hunger that FD kitties in higher numbers will have. When my Tuxie's numbers were in good numbers for a period of time I would notice a much decreased appetite and he was a real food beggar. However as Diana said if you start to notice that she is not eating properly for her size or weight or you notice any other signs that are out of the ordinary, then a vet visit for full blood work and urinalysis may be in order.

    This is very exciting to see Shelley responding positively and I will keep my fingers crossed that this continues. :bighug::bighug::bighug:
     
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  87. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Sorry, I might have caused confusion...
    I'd suggested to Anthony that he could try feeding a little bit of low carb to Shelley to see whether her BG went up or down as a result of that, to see if the pancreas would produce insulin in response to the food, and drop the BG on it's own. (..I often have to do that with Bertie to see whether I really do need to give him insulin...)
    This is, of course, distinct from 'stalling' where you wait, without feeding, to see if the numbers come up on their own.

    Apologies for any confusion caused... :oops:
    .
     
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  88. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Hello Mary Ann,
    Thank you for looking in. Sorry for the delay in replying but I had a visitor and then had to go out.
    I did feed Shelley after the 10.3 but did wait almost 2 hours before the second test. I have just updated my spreadsheet, the pmps was 10.8 so I have injected what I guesstimate as 0.2u.
    I would say Shelley has been a little brighter today, the weather has been a bit fresher here. I am keeping a close eye on her and would certainly see the vet if I thought there was a concern.
     
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  89. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    No problem Diana. Even though Shelley might not eat that much of it, she is so used to getting food on demand I find it very hard to deny her.
     
  90. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014

    Thank you for the information Anthony.

    What a lovely run of blues today!! [​IMG] This lower dose on a sliding scale seems to be working very well for Shelley. It is quite amazing to see a rather flat cycle with Caninsulin, but they are pretty good numbers, with no big drops or rises. Glad to hear that she seems more herself today. Kitties just like people can have a bit of an off day, and I know you will keep a close eye on Shelley to make sure she is okay. Your dedication is very obvious. :bighug::bighug:
     
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  91. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Thank you Mary Ann, I do try to do the best I can for Shelley but as we all know making the best decision is not that easy. Especially when there is so so little margin for error at these low numbers.
     
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  92. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Yes, all looking very good, Anthony, you're doing such a good job and we all know it's not always easy! Other newish members here such as @Monica Lewis should be encouraged by what you've achieved, too.
     
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  93. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Thank you Diana!
     
  94. Monica & Josie

    Monica & Josie Member

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    Apr 16, 2017
    Thanks for tagging Diana..
    Hi Anthony , yes I'm most definitely encouraged by Shelley's brilliant response. I'm really pleased for you guys, it's such an amazing achievement!
    I also very much admire your dedication and determination Anthony.
    You've come so far in the past few months by constantly wanting to learn so much, listening to good advice and eventually being able to make decisions by yourself, your hard work and loving care is definitely paying off.
    I'm rooting for you, may those beautiful blues/greens long continue! :)
     
  95. Anthony Morgan

    Anthony Morgan Member

    Joined:
    Feb 16, 2017
    Hi Monica,
    Thank you, it's very kind of you to say so. I have just tried to do what I can to keep Shelley safe whilst trying to control her diabetes.
    I was criticised by my vet for dosing too conservatively and I think he may have been right in the first few months after the hypo. The more recent drop into lower numbers actually came after I started trying to give 1.0u as advised by the vet but then found I dare not continue with that as I didn't think it was safe.
    So I have just really dosed according to the pre shot numbers and Shelley's blood glucose numbers have gradually fallen.
    Thank you again for your kind words and encouragement!
     
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  96. Monica & Josie

    Monica & Josie Member

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    Apr 16, 2017
    Well you seem to be making the right decisions Anthony..:cat:
     
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  97. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    This is surely a classic case of when "dosing according to pre shot numbers and blood glucose numbers have gradually fallen" makes complete sense. Vets don't like the "inconsistency" of a sliding scale, but they don't seem to consider the logic of it. You give the kitty as much or as little insulin as is warranted... what's wrong with that? If you're starving you naturally eat more than if you're only peckish. If the garden is parched during a heatwave you give it a good watering that wouldn't be needed after a torrential rainstorm. OK these things might not quite equate to BG and insulin, but to my little mind the basic principle is the same. I try not to give specific dosing advice here or make too strong a suggestion because owners should come to decisions themselves using information they have learned and observing their own cat... but to me, a sliding scale or dosing according to pre shot numbers makes perfect sense. Well done again, Anthony!
     
  98. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Thank you Diana!
     
  99. Anthony Morgan

    Anthony Morgan Member

    Joined:
    Feb 16, 2017
    Shelley has started with a cold, she had been sneezing during the day.
    Also her BG has gone up:
    Amps 15.7 0.25u injected
    +4. 17.1
    Pmps 16.3

    I did get her some Feline Cuisine food today as I thought it might be more tasty and encourage eating. So I don't know if it is this that has increased her BG or the cold?
     
  100. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Sorry to hear Shelley isn't feeling great, Anthony. A cold, or an upper respiratory tract infection as vets would call it, can certainly raise BGs. I think @Elizabeth and Bertie looked at the carb content of Feline Cuisine recently and found it was ok... I'll leave it to her to answer.

    It's a shame to now have some higher numbers to deal with just when Shelley was doing so well, but if you dose accordingly it may help to get BGs down. If Shelley's symptoms persist or get worse you might want to get the vet's opinion on antibiotics for her.

    Hope things look up soon.
     

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