Dose Advice needed

After being diagnosed as diabetic and DKA last week, my guy spent 4 days in the hospital and was able to come home on Saturday. He gets 1/2 unit of Lantus twice a day, 3 pills at night and 2 in the morning (antibiotic, Pepcid, appetite stimulant).

Saturday night went ok. He was so worn out I was able to do paw stick and give him the shot without him really flinching. He also took the pills pretty easily. Yesterday the glucose testing (morning and night) was a little more problematic because he was protesting, the shot went fine, and the pills were an absolute nightmare because he rejected the pill pockets and I ended up having to put them in the back of his mouth. Today the glucose testing was a hassle and he started pulling away when I was giving him the shot (both morning and night) as if it was hurting him. I haven't even gotten to tonight's pills yet.

I'm completely beat down by this. I know I am doing this for his own good, but he is an absolutely different cat than he was before last week. He recoils anytime I go near him, hides from me, won't sit near me (he used to want to be near me constantly), and basically just waits until I'm asleep or leave the apartment to even come out into the open. While I want to do right by him, I feel like I am just tormenting him at this point.

Does anyone have tips to make this less miserable for him? I'm supposed to do a curve on Saturday and I can't imagine testing him every 2 hours. Just the thought of it is making me sick.

I'm sorry for the novel, but I'm really struggling right now with whether I'm causing him more grief than I am saving him from and I just don't know what to do.

 

Re: 3 days and my nerves are shot. Tips?

Oh Sweetie, first off, sending lots of hugs your way.

Yes, it's really hard to do this at first.

Would some testing tips help you?

 

Re: 3 days and my nerves are shot. Tips?

Hello there
Take a deep breath. It will get better.. It's very stressful at first, having your kitty sick, trying to work out what is best for him, learning to test etc but it does get better.. And when you see him running around like before all happy, it will be worth it. Testing becomes so routine you hardly notice it. And nobody will be able to tell he is diabetic!

Ok a few things

1. You are blood testing his paw? Many of us use ears since there are few nerve endings. Tips.. https://docs.google.com/document/d/13c_CPZVKz27fD_6aVbsguadJKvjSrSAkD7flgPPhEag/pub

2. Remember to give a treat after testing, whether or not you are successful. And give him attention, outside of the shot and testing times!

3. What are the appetite stimulants for? Is he not eating? And what are the antibiotics for?


Wendy

 

Re: 3 days and my nerves are shot. Tips?

And maybe you don't need to do a full curve. You could do a mini curve and test every 3 hours or even every 4. Or even just some spot checks during the week would give you a good idea. Ie around midday (5-7hours after shot) and maybe before bed on a couple of days.

Wendy

 

Re: 3 days and my nerves are shot. Tips?

I've been doing the paw because I tried the ear twice. The first time it worked great, the second time, not so much. I had to stick him 3 times to get a drop of blood and he shook his head so fast I almost lost it. The paw has been a better target and less pulling away. But tonight he really seemed to not like it (I may have pushed a little deeper tonight). I actually looked to see what kind of feeling they had in the paw but maybe I should focus on the ear.

The appetite stimulants are because he had always been a really picky eater and skipping food for a day is nothing unusual for him. Before it was no big deal; but now eating regularly is much more important. He also lost a ton of weight since his last checkup (he was 14 lbs in October but 11 last week) and I suspect he lost more in the hospital. The upside is that those are actually the smallest pills and easiest to give him, and they have been working (this is the first time I have ever seen him eat a full 6oz of wet food in a day, let alone 3 days in a row). So, since he now gets no more dry food, I'm ok with those if they get him into good eating habits.

I'm not 100% sure what the antibiotics are for. The hospital thought he might have some sort of infection but couldn't say for sure so they might just be precautionary.

I just feel like the pills and the shots and the testing all at once are really too much for him (and me).

I know blood testing is important, but if I am not going to be changing his dose is it critical that I do it before every shot? Midday checks are hard because I am not home. I give him a shot at 8 and leave for work shortly thereafter. So the only time I could do a mid-day test is on a weekend.

 

Re: 3 days and my nerves are shot. Tips?

Ok cool it does sound like he has made some progress, eating is good! Does he take a treat after testing?

Wendy

 

Re: 3 days and my nerves are shot. Tips?

He isn't huge into treats. I offer, but he turns them down more often than not.

Thank you for the advice, by the way. Before I took him home I was scared, but now I'm just flat out overwhelmed.

 

Re: 3 days and my nerves are shot. Tips?

Some pill tactics:

Some pills may be cut into small bits and placed in an oral syringe. Next water is drawn up into the syringe, the tablet dissolved, and a bit of mushy food sucked into the syringe. Shake well and administer.

There are devices to hold pills and deliver them into a cat's mouth.

It may help to coat a pill with butter, especially if it is foul tasting. The butter will keep it from dissolving on the tongue as much.

If dry pilling, follow with 1-2 mL of water to flush it down the esophagus. Pills that stick in the throat can cause ulceration and pain.

 

Re: 3 days and my nerves are shot. Tips?

It really will get easier, and it won't even take that long . . . soon you'll be giving tips to others.

My cat is not particularly cuddly and at times has been a bad biter. The first few days of blood sugar testing were NOT easy. I felt like I needed to be an octopus to try to restrain the squirming cat and do the testing! I realized the biggest thing I needed to change was my own feelings, because I saw that my cat didn't object at all when the vet calmly poked her ear. I just tried to imitate his matter-of-a-fact attitude when I approached my cat to test her - be calm, act like it's no big deal even if you are really just trying to convince yourself more than the cat! It was my stress she was reacting to more than the actual testing, which if you do on the ear, really doesn't hurt the cat.

Also, I found a huge difference after I started using a little bottle of warm water held inside the edge of the ear for a bit before I prick the ear. I use an old spice bottle with a screw-on lid, and fill it with quite warm tap water. Other people use a rice sock warmed in the microwave. It really gets the blood flowing and it's way easier to get a nice drop after the ear is warm, even with a very fine lancet. Lately I've fine-tuned how I hold the ear during the moment between actually pricking it and reaching for the meter with a test strip in it - I keep my middle finger behind the ear with a square of folded-up toilet paper (provides some resistance so you don't poke right through, and protects my finger back there when I prick the ear, later the tissue gets folded around to the front to press down and stop the bleeding after I test), and put a thumb on one side and index finger on top of the ear, one on each side of where the blood drop actually is welling up. That way no flick of the ear is going to interfere until I've got the test strip into position because the part of the ear with the blood drop is totally immobilized. Now the whole testing process is pretty much like just any other cuddling moment to my cat and she doesn't mind it at all.

I never did the treat thing after testing either, but since testing is pretty much always just before a meal or snack anyway, my cat knows that food is the next thing coming which probably helps her to not mind the testing. In fact my cat got used to the routine so fast that pretty soon instead of her leaving the kitchen after a meal and going to hide somewhere, she would turn around and lie down in the middle of the kitchen floor until I gave her the insulin shot, then be on her way.

Hang in there! Pretty much everyone on this board has gone through the same struggle at the beginning, but it really does become so easy you'll hardly have to think about it. We're all cheering for you!

 

Re: 3 days and my nerves are shot. Tips?

Maybe you just havent found the right treat - how does he feel about cooked chicken bits? fish? maybe there are some things in here he might like that you could sneak a pill into. (below)

Its ok we are here to help. Lets take it one step at a time. lets start with relaxing yourself. Trust me, it gets easier. For now the important thing is to give him his insulin - I like to do it when they are eating or sleeping as they tend not to notice it then - and his pills.

Many people here have an area they like to take the cat too for testing but that just freaks my Tiggy out so I go find him wherever he is - i like it when he is sleeping - i stroke and talk to him. I rub his ears and when he doesnt notice poky poky! then more stroking and spike with the insulin. And he goes back to sleep. I use short insulin needles - what size are you using? He shouldnt really feel it.

How is his BG levels?

Wendy

Giving a pill ideas - shove the pill into one of these. I would always feed 3-4 small pieces of these and give them all - but only put the pill into one of them so that he doesnt think they all taste bad..

- piece of cheese
- pill pocket (broken into 3)
- cooked chicken breast or kfc
- piece of cooked ham or bacon or turkey or hamburger or steak
- piece of butter (could cause diarrhea so only for temporary use while you are doing the pills)
- roll a ball of regular food and put the pill inside - sprinkle with any of oregano/parmesan cheese/freeze dried chicken or liver powder / cooked crumbled bacon piece
- anything else he likes from human food - ideally low carb and low sugar but since this pilling is only temporary you could probably do high carb if you had to - just keep the pieces small. ie Tiggy loves cheesy puffs potato chips and white cake
- you could also try the "food game" - throw the treats so he chases them ( if he likes to play) and they tend to eat the treat once they catch it. Then do one with the pill in. I don't so much throw as scoot the treat fast along the surface of a hard floor. Sometimes you need to wind the cat up first by wiggling the treat a bit till they are watching and then throw it.

Wendy

 

Re: 3 days and my nerves are shot. Tips?

My kitty Zoe adopted me. She hates being held wont sit on OR even get up on the couch Our saving grace to giving AB's has been butter. It coats the pill making it easier to slide down her throat and it is the ONLY human food she will eat.

I never thought something simple as butter would havw worked but it does.

Good luck. I'm keeping you and your kitty in my prayers. It DOES get easier.

jeanne

 

Re: 3 days and my nerves are shot. Tips?

Re: the pills - I am going to try and get some empty gelatin capsules and see if that helps. Maybe getting one capsule with all the pills (broken up, of course) down his throat will be easier for both of us. Hopefully I will only need to pill him for another week and that will be done with.

His BG levels are, from what I can tell, ok but not great. He has consistently been between 340 and 380 at shot time, with the exception of Sunday where he was 490 in the am and 448 in the pm. But that was the first full day he was home so I will assume that nerves were in play. I spoke to the vet and she said the 490 was almost bad but not to get crazy unless it was 500. He doesn't eat at regular intervals so I can't really say how close the the tests he eats.

I'm going to look at different needles today. They sent me home with the 3/10 cc, U-100, 29 gauge, 1/2 inch needles. But I feel like maybe a shorter needle might be better? Also, I did some reading this morning and it seems like a higher gauge might be ok too? I'm not sure he feels the needle as much as he feels it move around when I get my thumb to the plunger. I am going to practice my technique and try to get better at it.

Thank you for all the responses. After reading them last night I made it a point this morning to talk to him through the whole process with a nice, calm voice. He still squirmed but I think it might have gone slightly better. And I switched to the ear for the blood which, while a little more annoying for me, seemed much less painful to him (he tried to get away because he doesn't like his ear messed with, but didn't react to the actual needle itself. He has less issue with me grabbing his paw but absolutely reacted to the stick).

 

Re: 3 days and my nerves are shot. Tips?

What day did he start the insulin? it takes a few days for the insulin to build up in his system. Plus we dont know how low he could be dropping during the day. It might be a good idea to get a before bed test tonite (10 or 11pm) to see how the insulin is working. Or maybe even set the alarm for middle of the night for a test if you can do it. He is on low carb canned right?

For needles we usually recommend - 3/10 cc, half-unit marked, short needle, 30-31 gauge ie Relion 3/10cc 30 & 31 gauge short, BD Ultra fine 3/10cc short, Terumo Thinpro Insulin Syringe 31G 3/10cc.

Short needles are 40% shorter than regular needles. You could practice injecting water into a rice sock or cooked potato or something.

When you do the ear, spend time stroking the ear and not poking too, to get him used to it. Tiggy likes head rubs and I do head, head, head, neck, head, ear, head head and he is ok with it then.. as long as its not too much ear! Also the ears "learn" to bleed in a week or two so the blood flows easier. There might be a little brusing at first so apply the neosporin, and pressure to seal the wound afterward. Also helps to have something hard behind the ear to press against ie a pill bottle cap

Wendy

 

Re: 3 days and my nerves are shot. Tips?

That calm, soothing voice you used is very good. Not making a big deal out of the process, but instead treating it as part of the daily routine. All of these are good ways to get your cat to accept the home testing.

I know I struggle to dry swallow pills so have learned to help my cat with a little water after the pill. A needleless syringe with a little water in it is good to get the pill down the throat of your cat. BJM also suggested this in your post.

Welcome to the crash course in treating Feline Diabetes. It's a learn as you go process, with input from members here, your vet, other resources on the internet. Ask us any questions and there should be someone on here that has some information to share about a similar situation.

Good luck, keep your own spirits up and think positive.

 

Re: 3 days and my nerves are shot. Tips?

Welcome! :YMHUG: You've already gotten some excellent advice on the pilling and testing.

I didn't see this answered anywhere, but YES! It is very important to test before every shot. That way, you know it's safe to give him a shot. We suggest for new members to not shoot under 200 but post here first for advice. Cats are...well, cats. :lol: They do their own thing and there have been numerous times when Mikey has been super low at shot time when I haven't changed the dose or done anything differently. If I were to shoot him at those times, I'd be risking a potential hypo situation made even worse if I weren't at home to watch him.

For testing him other times, at the very least I'd try to get a spot check before bed. Other than that, since right now you have very little data to work with yet, any time you can get a test in is you adding more information to how he reacts to the insulin. We use this spreadsheet for tracking our numbers. Let me know if you need help getting it set up or any other assistance.

Spreadsheet-specific terminology:

• Fur shot: when the syringe needle pokes through almost like a sewing needle through fabric and it is unknown how much, if any, insulin actually made it inside the cat. Usually detected by wet fur or the smell of insulin (it smells like band-aids or scotch or antiseptic). IT IS ALWAYS ASSUMED THAT THE CAT GOT THE INSULIN AND YOU NEVER GIVE ANOTHER SHOT. It is always better to miss a shot than to give too much insulin.
• AMS/PMS: morning (AM)/evening (PM) shot
• AMPS/PMPS: morning pre-shot test/evening pre-shot test (it's assumed the shot is given within 15 minutes or less of this test).
• +1, +2, +3...: How many hours after a shot, i.e. +1 would be one hour after their last PS (pre-shot) test
• BG/BS: Blood Glucose or Blood Sugar (numbers). Usually used in relation to testing and dosing and what "level" or "point" the cat is at. Used in a sentence: "Michelangelo's BGs have been high so I've been increasing his dose."
• AMBG/PMBG: morning/evening Blood Glucose. Used when no shot has been given at the regular shot time.

 

Re: 3 days and my nerves are shot. Tips?

I'm new to diabetes, but a long experienced hand at dealing with sick cats. I do medical fostering for a local rescue group. It will get better. You've gotten a ton of good tips. Remember that having a sick cat is a partnership. Kitty is having to learn all this along with you. As you both figure it out, kitty and you will both calm down.

Every single medical foster I've taken in has required several days to get a good routine down. This is perfectly normal. Promise. Best of luck to you!

 

Re: 3 days and my nerves are shot. Tips?

How are things going? Are the testing and pilling getting easier?

 

Re: 3 days and my nerves are shot. Tips?

It has been getting slowly better. As per the vet I was able to discontinue the pills which has helped a bit. I'm also trying to get blood while he is in his hiding spot (the back of my dresser drawer) so I don't have to pull him out each time. It's harder for me to reach in there but he doesn't squirm like when I hold him, so it is a mixed bag.

Thank you for asking, I appreciate it.

 

Re: 3 days and my nerves are shot. Tips?

Oh wow! Testing him in his hiding spot is a perfect illustration of what Kpassa was talking about in her Ear Testing Psychology document. Test the cat when they are in their favorite spot.

Read the entire document here: https://sites.google.com/site/michelangeloprofilefdmb/feline-diabetes/ear-testing-psychology

 

Re: 3 days and my nerves are shot. Tips?

Nice blue number this morning. I wonder how low he dropped last night. You should try and get some night tests in, before bed and maybe set the alarm for middle of the night too.. Say 5-7hours after the shot?

 

Re: 3 days and my nerves are shot. Tips?

Sorry to hear about you and your kitty's stressful situation, but happy to see the blue number you got in the AM! That's very encouraging, don't ya think? Gotta celebrate the little victories :smile: . I'm guessing some of those pills (e.g., the antibiotics) are only temporary, so like others said I believe you guys will find your groove!

I also dabbled with paw pricking for awhile, with my wife holding Sunny while I pricked the large pad on a back foot. Ultimately though, I went back to the ear because I often had the same issue getting a large enough sample plus being restrained made him want to struggle.

Like I mentioned on another post, my "breakthrough" came when I got very Zen about the whole thing, only test when myself and Sunny are both relaxed, sit next to him on the floor and pet him for a good five minutes first, and practice all the awkward "holding" of his ear before getting down to business. I use a cotton ball (some use tissue paper) behind the ear when I stick, so I spend a while massaging his ear gently, holding the cotton ball against his ear, massaging his cheeks with the cotton ball, etc., so he's somewhat used to it all and not thinking, "why the heck are you suddenly holding my ear funny and what is that white fuzzy thing?"

You *will* find the sweet spot on the ear as well as the right force to poke with in order to get the perfect sample. I didn't believe it for a long time, but it's there. For Sunny it's on the medial edge of his ear (the edge closer to his nose) about 2/3 up towards the tip. Once I found his "sweet spot" it came down to making sure I hit close to that little vein (Sunny has pink ears so I'm lucky) and that I don't jab too tentatively. There's a balance because you don't want to just tap the ear and not break the skin. One solid stick beats 5-10 tentative taps.

Only other thing that helped me was to wait 5 seconds after sticking to give the blood drop time to form. During that time, I don't restrain his head, I just pet him firmly on the back to take his mind off the ear. Then I freehand the meter up to the droplet being careful not to touch the ear with the test strip (just touch the actual drop of blood). Some people hold the cat's head and ear firmly while getting the sample but with Sunny any restraining just makes him freak out, so I try to take as much of a hands-off approach as possible.

Everyone finds a way that works for them and their kitty - you will too!

I would say (my personal opinion) don't feel bad if you aren't testing 4-6 times a day everyday. Some people (and their cats) are comfortable testing that often, but I'm not there... Do what you're comfortable with and the rest will follow. Be vigilant about signs of hypoglycemia, and if you're changing insulin dose or diet, monitor more closely.

I've home tested occasionally for a year and a half, but only started monitoring daily very recently. That together with switching to canned food has been the turning point for Sunny. Lots of hugs!!

 

Re: 3 days and my nerves are shot. Tips?

I think it's much easier to give a cat liquid meds than pills. A quick plunge of a syringe is much easier than pilling, I think. I never had a cat that would readily accept the pill pockets for any length of time. Once they bite and taste the pill, they are wary of the pocket from then on. It sounds like your pill giving will be temporary. If not, you can ask your vet if he can prescribe a liquid version. There are veterinary pharmacies that specialize in compounding various meds into flavored liquids (like chicken) that might be easier to give with a syringe.

That being said, it helps if he's salivating before the pilling attempt. I put a little dab of food on the roof of the mouth first, no pill, and that gets the juice flowing and helps things go down. Then I stick the pill in a piece of cheese, or a dab of food. Some people swear by butter either to hide the pill or lubricate it before putting it in the back of his mouth.

As far as the sticking, don't despair. All of us had a hard time getting started until we got our technique down! My poor cat was hissing at me as I tried 5-6 times to get blood from her poor ears. Now she sits on my lap and the whole process takes a minute each time, including setting up the supplies.

If he likes to be petted or brushed, use the after pill/test time to give him some lap time and let him calm down before letting him go.

 

Re: 3 days and my nerves are shot. Tips?

I am looking at your sheet and I think he is bouncing off a low number on the night of the 29th.

FYI a bounce

The bounce should clear soon and his numbers should drop. I would keep with the same dose until then because once the bounce clears you may see his numbers drop fairly rapidly. And then you want to do some extra testing because you want to catch that low value. If he drops under 50 (EDITED TO SAY _ PLEASE SEE NEXT POSTING- Since you are using an AT meter this number might be higher for you) - you would decrease his dose by 0.25, so I am hoping you have syringes with 1/2 unit markings to help with that.

You were correct not to shoot when you saw that low number. Until you get more data we wouldn't advise shooting under 200. Here is info on shooting at low numbers http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

And keep testing for ketones when he is over 350.

Wendy

 

Re: 3 days and my nerves are shot. Tips?

Ok just realized you are using an alphatrak (not sure how i missed it - its really big in your signature) so you might need to decrease the dose at a higher level - ie i said a decrease if he goes below 50 but that is incorrect with this meter. I have asked some more experienced members to comment.

 

Re: 3 days and my nerves are shot. Tips?

I've used the Alphatrak and for that pet specific meter, if your cat BG number goes below 80, you reduce the dose.

 

Re: 3 days and my nerves are shot. Tips?

I just added the rest of the data I had into the spreadsheet but it doesn't really show much. I wasn't able to test often enough. I am really hoping to get hourly tests this weekend and random tests more often now that I am getting slightly better at the ear sticks.

I will also add that I have been less than perfect with the timing of the shots. Some have been an hour late, and then I give the next one after 11.5 hours in an attempt to move the times back to where I want them, but then I will be late again... rinse, repeat. So, my two priorities right now are (1) get better syringes (in response to what was posted I looked and I am using 29 gauge, 1/2" needles. I am going to try the thinner, shorter ones); and (2) be more consistent with shot times so that I can get good data.

 

Re: 3 days and my nerves are shot. Tips?

You have 12 days worth of data. In those 12 days, you have had to skip 3 times because the numbers have been below our suggested 200 threshold for shooting. Actually 230 for you, since you are using the Alphatrak. You have needed to skip the shoot an average of once every three days.

I set what appear to be at least three bounces, corresponding with the skipped shots. When you skip a shot, the insulin depot drains, leaving less insulin to be available for use by the cat's body. With less insulin, the numbers tend to go higher for up to 72 hours then what they were.

Looks like he is clearing the bounces really fast, 2-2.5 days after you have skipped the doses. Todays +8 number looks very good. I wonder what the +6 would have been. Nadir on lantus is often around +6, so that would make the +8 a slightly rising number.

I'm wondering if the dose is too high, and you should drop to 0.25. You should be able to shoot the same amount of insulin, 2x a day. That is one reason I'm saying the dose might be too high.

Before you change the dose, I'd like you to get more opinions on the possible change. If you would please go back to your first post in this thread, and change the title to something like "Dose Advice needed" and click on the Post Icon with the question mark, more people tend to read those posts.

 

Re: 3 days and my nerves are shot. Tips?

I second what Deb said about lowering the dose to .25u. Either that or, if you're around enough to be testing often, you can start shooting those lower pre-shots and see how he does, i.e. maintains numbers above 70-80 with no assistance needed besides his regular food. I'm on my stupid iPhone right now, which makes it difficult to link to the "Shooting and handling low numbers" page, but someone should come along with a link to it (otherwise I'll update this post with it once I get to a computer where it's easier for me to copy/paste/edit).

ETA: thanks Deb for posting the link. Never got back onto a real computer yesterday. :lol:

 

Re: 3 days and my nerves are shot. Tips?

Here is the link to shooting and handling low numbers that Kpassa was talking about.

shooting and handling low numbers

In case you want to find it on your own again, look in the forum Insulin Support Groups (ISG) Lantus(glargine) - Tight Regulation - topics section- Sticky Lantus & Levimir: Shooting and Handling Low Numbers.

 

Re: 3 days and my nerves are shot. Tips?

Welcome, and as everyone else has said, it will get easier and taking the Zen attitude definitely helps.

This is a video I took doing a BG test with Leo. In the beginning I was scared and nervous and he knew it. But he got a treat after EVERY TEST, and very quickly he came to associate the stick with a TREAT! That was our psychology. And he also loves to be scratched, so I started giving him a good scratch before every test. Quickly, it became a pleasant routine and he would come when I called him for this "snack." He even comes when he hears the microwave as I heat up his sock.

As you can see, we had a very nice relationship with the testing.

Leo's Blood Glucose Test and Scallop Treat

 

Re: 3 days and my nerves are shot. Tips?

I appreciate the advice re: lowering the dose and what you say makes sense. Because I, once again, did a fur shot last night I am going to be extra careful to get both shots into him today and then try to do hourly tests tomorrow. Once I have those numbers I will see what people here think and what my vet thinks, and go from there. I also didn't realize how long a bounce would have an impact, so now the numbers seem less random to me. (I just got his am shot into him smoothly so I will try to come home and test his blood at +6 if at all possible).

Oddly enough, for the first few days the shot was easier than getting blood. Now it is the reverse. All part of the learning-curve I guess...

I will change the name of the thread as suggested.

Thank you everyone. No matter how much reading I do I'm always afraid I am interpreting the information incorrectly. Hearing from people who know how things play out in reality has made me feel much more in control and less worried that I was going to do something that would harm him by accident.

 

Ask your vet about bouncing ie in this case it might be Somogyi ( very low numbers to very high). Can you also get a curve in this weekend? Like every 2-3 hours all day? I want to see how low he is going - he may be going lower than blue.

Are you going to lower the dose?

 

I'm hoping to test every 2 hours tomorrow, and then a few tests during the day on Sunday to see if the numbers seem to go up and down at the same times (as long as his ears don't fall off).

I'm not going to make any changes to the dose until I have a proper curve done so I will have to revisit the issue tomorrow/Sunday. And hopefully I can make it home for a +6 test today as well.

 

Re: 3 days and my nerves are shot. Tips?

I actually left work early just to test and at +6.5 it was 103. Can I trust that in light of the fur shot last night?

 

I would. Can you get a before bed test tonite? He is starting lower tonite so might drop lower overnight..

 

I will try to wake myself up and get a +6 tonight.

Update: yeah, waking up in the middle of the night didn't quite work out. Cat and I both like our sleep a bit too much. But this morning's number was good (316) and I'm going to test every 1.5 to 2 hours through the day. Fingers crossed for cooperative ears.

 

In my signature link, Secondary Monitoring Techniques, there are some tips for urine ketone/glucose testing. Give that he was initially diagnosed in diabetic ketoacidosis (DKA - you've got it abbreviated ADK in your profile), testing for ketones is very important.

If you use KetoDiastix (or generic equivalent), you'll see if either ketones or glucose are present in the urine. Ketones will show up if the insulin dose isn't high enough and glucose will show up if the blood level exceeds the renal threshold of about 240-270 mg/dL.

Ketones form as a by-product of fat breakdown for calories. Too many may indicated DKA, which as you've found out, is an expensive to treat complication of diabetes, which can be fatal.

 

His AMPS was 316, and his +2.5 was 53.

That's the lowest number I have ever seen for him. I

(deleted irrelevant questions in light of subsequent test result)

Ok, +3.5 is 60 and he is snacking again, so I'm hopeful it doesn't drop.

 

Aha!! Since you are using the alphatrak that's actually hypo territory. I am had you caught it and he did ok. But you definately need to reduce his dose. Can you get 0.25 on those syringes? Do they have half unit markings? That will help you eyeball a 0.25 unit dose.

 

Here is what 1/4unit looks like



Also you will probably see another big black bounce because he did drop too low. He is likely been having these lows for the last while which is why you have been seeing so many high numbers. You are lucky he has been ok.. Who knows who low he has been dropping!!!!

 

I spoke to my vet and he didn't feel that the 53 was so horrible (I specified I was using the Alphatrak). He also felt that because it was only two hours after the shot something else might have caused it.

I asked if I would be looking at reducing the dose and he felt that the same rules should apply - same dose unless he is still low at shot time.

This is where I get flustered... Everything I read here says 53 was extremely bad, but the vet was not at all concerned.

Now I don't know what to do.

 

It's up to you. Cats nadirs (low points) do vary, it's not always midcycle. I will ask a few more experienced people here to take a look. However you could give a reduced dose a try for a few days to see how he does. ... Better safe than sorry and him having a hypo.

Anyway pop back here soon and look for more experienced responses (over 2000 posts)

 

What does he eat? How often and how consistent?

 

Hello. I was asked to come over.
I would recommend you take the dose reduction that your cat earned today because there is a depot/shed involved.
The amounts you shoot each cycle are not the only insulin in play. It build up in their system and accumulates and continues working even
when you skip a shot.
If the reduction does not hold, you can always go back up in dose if necessary.
The most important thing is to keep your kitty safe, especially if you have large absences where you aren't home to monitor.

Your vet isn't home with you and I guarantee one of us here will help walk you thru any problems.
The numbers today aren't such that you need to be so concerned BUT if you stay at the higher dose, you could get a really low number and not
be there tomorrow.

I also recommend that you could do a mini curve ( which is every 3 hours) instead as you are helping your cat adjust to his new routine and learning
what treats will get the best response.

 

245 at +10

 

Fancy feast chunky chicken something or other. He nibbles throughout the day and eats about 6 oz total (one can morning and night).

 

here are the fancy feast ones that are less than 9 %
so you can read you label and see which one you have.

 

Oh. Ok, I've been waffling for a few hours and feeling like a 1/2 dose is the thing to do. My only question is this: what is more dangerous at this point, too high or too low? If he goes DKA again I'm not sure he can handle the stress of the hospital a second time (nor can I, for that matter). But I obviously understand the danger or going hypo.

I am not home during the week so getting tests at shot time is about all I can hope for. So, if I make a change to 1/4 unit tonight I can't change it back until next Saturday. If the reduction turns out to be a mistake, is it a mistake that he can deal with for a week until I can fix it?

 

That's the one. I tried to pick one of the lower carb ones.

 

Hello I was asked to weigh in here, too.
That 53 so early in the cycle and using an alpha track meter, tells me that his dose is too high.
If it were me, I would definitely take the reduction and make the new dose 0.25 units. It's better to be a little high for a little while than too low.
If the reduction doesn't work, you can always go back up if you need to (and you may not be able to tell if the reduction doesn't work for days, so be patient, as he may bounce to higher numbers for up to 3 days).

You are doing a good job of taking care of your boy ;-) .
Congratulations on learning to test and getting that curve in today.
If he bounces high tomorrow, you may not have to test him as frequently.

Good luck with whatever you decide to do.

 

Screw it, I'm going to reduce the dose tonight. Everyone here seems to have so much first-hand knowledge and I just can't discount that.

I'll speak to the doctor at the hospital tomorrow who told me to freak out if I saw a number below 80. Worst case, she tells me to go back to 1/2.

Cat went however long without any regulation at all and then managed to come through DKA like a champ... If this is a mistake I'm sure he can handle another few days of being higher than optimal.

 

I put a link to the Lantus dosing protocol we use here at the end of my post. Since you are using the Alphatrak meter, you want to use Table 3B.

Here is what it says about what you should do for how low your cat dropped today:

Here is the full text. I tried to copy the whole document here but it lost it's table formatting and was difficult to read. http://www.felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf You might want to print this and/or save it to your internet favorites folder.

 

Thanks. I'm going to give the reduced dose and then try to get a +3 before I go to sleep to see if there is another drastic drop like today. If that really is when he goes lowest I might be able to get one each night.

 

fyi, one of the favorite tests around here is the +2 ... after the preshot test.
If the number at +2 is significantly lower than the preshot number , it is a very good indicator that the cycle could be an active one and you should
definitely monitor to see where it is going.
You will use that a lot in the future.
I hope he safes surfly for you. Goodnite from me.

 

Let's see how he does for a couple of days. His blood glucose has pretty high the last few days anyway on the higher insulin dose... We are hoping this new dose will stop that.

I hope you have been testing his urine for ketones.. We recommend it when cats are over 340 or twice a weeK. Since he is prone to DKA and has been pretty high anyway the last week I would strongly advise you get some - like tomorrow!!! That way you can catch the issue early... I can give you urine catching tips. Walmart sells relion ketone strips or you can get keto-diastix.

Are you home tomorrow to do a few mid day checks? For Next week you might also want to get a before bed test and then set the alarm for a few middle of the night checks since you can't test during the day but hopefully this new dose will stop him going too low... And too high!

Now because he was low you will likely see high numbers again (more blacks) which may last a day or two.

Wendy

 

Please continue to check for ketones every chance you get, at least once a day.

 

I've been testing for ketones every third day or so (particularly when I saw the high 600 numbers). So far, every test has been negative (maybe trace, the colors are so similar).

I will do some mid-day tests today.

In any event, the amps was 240. Fingers crossed that the +2 is a less drastic drop than yesterday.

 

Did you get a +3 last night? I stayed up and kept checking but didnt see an update?

 

I would check for ketones at least every day for a while, especially after lowering the dose. DKA can come back, especially if the episode was recent. You don't want that. And I don't find the two colors to be that close in color (negative and trace). Maybe try to hold the bottle and strips under a brighter light to compare. Trace ketones means you have to be very careful. Please post if you start to get trace ketones.

 

I did not (and I'm so sorry you stayed up, I didn't realize). I tried, but I was so tired my hands were shaky and after 3 sticks without blood I had to call it quits. I am absolutely going to do a +1, +2 and +3 today, and then go from there depending on what they show.

Seeing the 240 this morning makes me feel muuuuuch better, particularly because I am home to test. If he does go too low I can address it quickly.

 

No worries, I just wanted to be here in case he went low again and you needed help.

How's he doing with the testing generally? Still hiding? And how is his appetite?

Edited to add... What time is the +1 due? So I know when to check back in. Although +1 probably isn't really necessary, +2 will give you more info since the lantus will have started to kick in then.

 

Also I agree with dyana, try and get a ketone test daily since he is prone to DKA.

 

+1 will be at about 10:50 (15 minutes or so from now). I figured it would be good because if he was starting to drop I would see it early.

Testing depends on the day. I don't want to jinx it but yesterday was a good day despite so many tests.

His appetite is great and has been consistent since he came home. He eats a full 6oz a day, and for the first few days he was eating a little more than that (I wanted to give him a few extra calories because he lost so much weight in the hospital). But now I keep it to just 6oz so he doesn't get fat again.

 

+1 is 234.

 

Yep the insulin hasn't kicked in yet, or he could be bouncing/surfing. Will see what the +2 is like.

That's good on his appetite, I would weigh him every couple of weeks and adjust the food if he starts to lose or gain.

 

+2.5 was 170. I will probably wait until +6 to test again. His ears could use a break (I also can't keep burning through tests strips because I won't be able to look into a new meter until next weekend and don't want to have to buy more of the Alphatrak strips if I am going to switch).

I sent yesterday's numbers to the doctor at the hospital and she was also not concerned about the 53 because of the low dose he was already on. But she thought it would be ok to stay with the 1/4 dose and do another curve next weekend.

So, unless I see numbers consistently rising I will stick with this. I will worry about high pre-shot number if or when they happen.

 

I would get a + 4 or + 5 instead because yesterday his low point was before +6. And definately you need a new meter .. Alphatrak is too expensive!!!

Edited to add.. May bailey had a hypo on 0.25 so just because its a low dose doesn't mean anything.

 

Nice numbers today. Any chance of a PMPS +2 or 3 just to see what his nighttime trends are?

 

Wasn't able to do any more last night. Today's numbers are not making me happy, but I need to get to work so I'm going to have to stick to pre-shot tests through the weekend. Hopefully today is just an anomaly.

 

That's a shame you can't get a nighttime test in, I wonder if he dropped low last night.maybe you could change your shot time so u can get a before bed test?

I just worry that he could be dropping dangerously low at night and you are missing it. My bailey did that and nearly died... He was only getting 1/4unit too!!! I happened to wake up in the middle of the night and xouldnt sleep so I thought I would test him only to discover him in a coma on the stair. I could easily have lost him.


Now I always set the alarm for a middle of the night test twice a week. Humans sleep in four hour cycles so I set it for four hours after I go to bed so that its not too disturbing. I got to think its like waking up to feed a baby.. Except you are back in bed quicker!

 

Ah yes, that pesky thing called work is just one of the many responsibilities pulling you in so many different directions. After all, you do have to work so you can buy your kitty lots of food and special treats. ;-) You do what you can. That is all we have ever expected from any of our members.

Sometimes, people get what we call 'an in the door' test. When you get home from work, take a test. That can give you some more data if you think you are interested. It does not need to be every day either. More of a "when you can" time to test.

Also, since you are still using that Alphatrak with the more expensive test strips, only do the tests if you have enough test strips to get you through until you can buy a different meter with more affordable test strips.

 

Just ordered a Relion Micro and lots of strips. I should have few strips left for the Alphatrak when it gets here, so I will save those for backup if I see a really high or low number one day.

 

Please make sure you test for ketones.

 

Another high number today. I'm starting to wonder whether the dose reduction was the right move.

 

I dont like to harp on, but a major issue is that you arent getting any tests in at night. He could be going dangerously low and bouncing high. Many cats do go low at night. If you raise the dose and he is doing that (which I do strongly suspect) he could have a hypo and die. Can you move your shot time to say 8am and 8pm and then do a test at 10pm at night?

A bounce =

 

I will start moving it back gradually. It will take a few days to get to 8 (I'm at 945 now).

Thank you for all the help.

 

Great! You can do it 30 minutes a day !

Still testing for ketones right?

 

Yes. Tested again last night.

 

A dose change takes time to 'settle in'. Your cats body needs to get used to the new dose. We have a term for it NDW or "new dose wonkiness". :shock:

For that reason, you need to be patient when changing a dose and make sure you can get some more test numbers, especially around the nadir which is usually around +6 give or take an hour. We realize that you have a very full life,work full time, like to go out with friends, hobbies, family etc... But your cat needs some extra help right now.

We ask people to hold a dose change for a minimum of 3 full days or 6 cycles, maybe longer.

Without the test numbers in the middle of the cycle, especially at night, it will be almost impossible to know if your cat is dropping low still and this even lower dose you are giving may be too high. We can't know what to advise next without some data to support our recommendations.

Dose changes for lantus are based on the nadir, not the pre-shot values.

Stay with the course for a few days more, be patient and get those tests if you can. Glad to see you will be shifting your pre-shot times 30 minutes earlier for the next few days. That will allow some other testing to occur.

You are doing great and sending you {{{{hugs}}}. Keep up the good work and let us know if you have any questions.

ETA: Would you please put those ketone tests and results in the comments/remarks column at the right side of the spreadsheet. Thank you.

 

Technically, NDW only applies to dose increases. ;-) Regardless of the technical definition, I've always noticed similar "wonkiness" with Mikey on his dose decreases so maybe someone has some other explanation or name for it. Usually though, it only takes a couple of days after a decrease before his numbers stabilize again.

 

I agree. Please add Ketones are Negative, or whatever the test result is, into the Remarks section of your spreadsheet.

ETA: Please let us know by posting if you see a trest result other than negative, or if he is acting off, or lethargic, or throwing up, or if his appetite wains.

Thanks.

 

Well, because I can't do another curve or be sure I can get mid-cycle tests until Saturday, I would never change a dose during the week anyhow (unless it was an emergency situation). So, I will stick with the 1/4 unit until the weekend at minimum, do another curve, and then go from there.

As for ketones, let's just say that no news is good news. And if I ever do see keytones any post on here will begin with "and I just got off the phone with the hospital and already did x, y, and z." And I mean no offense at all to anyone here when I say that (I would never have gotten this far without everyone's knowledge and advice). But because that is a situation that can go from bad to horrible in a flash, I want the doctor who would be handling the worst-case scenario to be in control the entire time.

Likewise for any behavioral changes... now that I know the things which should have raised flags when I saw them a while ago I will be much quicker to pick up on them and not just write it off as "he's getting older."

 

Here are some additional monitoring tools you may find helpful (well .. depending on the number of cats in the household!):

Water Consumption
Measure the amount of water you put down each day.
Measure how much is left at the same time the next day.
The difference is water drunk and some evaporation.
This will gradually decrease as you get better control.

Food Consumption
Measure the amount of food you put down each meal.
Measure how much food is left at the next meal.
The difference is food eaten and some evaporation of moisture from the food.
This will gradually decrease as you get better control.

Urine output
Roughly measure the amount of wet litter produce each day and it’s characteristics
- have you got oceans, lakes, ponds, or cups?
oceans = uncontrolled or possible some other problem such as renal disease or hyperthyroidism
cups = better controlled or lack of water intake

The 5 Ps
Purring - is the cat exhibiting customary signs of contentment or happiness?
Playing - will the cat play and interact with others?
Preening - is the cat maintaining its fur and cleanliness?
Peeing - occurs, and is a normal volume?
Poohing - fecal material is formed and passable? Constipation may happen with a food change; adding a tablespoon or so of water may help, plus ensures the cat is hydrated properly.

Weight
Obtain a reliable, digital baby scale (Craigslist is one resource to check)
Weigh weekly, at about the same time and before a meal.
Pre-shot might work well as the time to do this.
Unplanned changes of more than 0.25 pounds (3-4 ounces) should be noted
Unplanned changes of 0.5 pounds may indicate something is happening.
A consistent, unplanned trend over time may suggest a problem; see the vet.

 

Good for you! I agree completely with your plan.

Yes, indeed. Excellent plan in place there.

 

Amen Sister! A little knowledge changes everything.

 

Ok, so if I see a "trace" ketones result (without any other suspect behavior), do I need to do anything other than keep testing for ketones in case they increase?

There had been no change in eating, drinking, activity...

Could a "trace" result just be from the fact that he isn't well regulated yet with the insulin?

EDITED TO ADD: the vet told me right from the start not to get nuts about a trace ketone result and to really be on the lookout for the higher levels. So, I don't want to overreact to anything (I'm at max stress level with the insulin and blood tests these days).

 

Because he recently had DKA, I would check at least once a day, and make sure they do not go above trace. Some cats, are more prone to ketones for some reason, and you don't want Mync to have to be hospitlized again.
My cat J.D. is a DKA survivor too, that's why I am concerned. He was hospitalized for 8 and 1/2 days and I'll never forget how scary that was.

If you test yourself with the test strips and compare it to the test result you get from Mync, is it a different color, or is it just the lighting in your house?

If he has trace ketones, make sure he eats plenty and is not dehydrated. Maybe add extra water to his food if he'll eat it. If he goes higher than trace, or shows any of the other symptoms like not eating or lethargy, I would call the vet as you said you would. Higher ketones can happen very fast.

 

He had much better numbers today. Hopefully, that is helping to reduce your stress level.
I am hoping I am not upsetting you more. I just want you to be cautious and diligent, is all.

 

Ok, thanks. I kind of assumed that trace just meant to keep looking. He is eating and drinking as normal and I will make sure to test every night. I can try to test mornings also but I can only stand around and wait for him to pee for so long.

And no, I don't want him to be hospitalized again. Beyond the financial, I saw how much stress he was under while he was there the first time. Doing that to him again is not a decision I would make lightly.


Just tested again and at 15 seconds exactly there was less of a color change than earlier today. So I may have waited a few seconds too many before.

 

Nice yellow numbers today. I wonder if he went blue last night? I See you are getting a cheaper meter too - great!!

 

Yeah, I ordered the relion the other day. The meter came yesterday and the strips are supposed to arrive today.

I wasn't crazy about the 600 last night but the 224 and 298 (meal and shot in between) made me feel better.

Is there any course of treatment that involves one shot a day instead of two, or is it all (2x day) or nothing?

 

Not as far as I know - I think there are insulins that need more shots but those are really rough on the cat. Why? whats your logic?

The 618 was probably a bounce off the 148 (assuming he didnt go lower than that). He has done that a couple of times after a low blue. He will eventually stop doing that once his body gets used to being in normal blue and green numbers.

Definition of a bounce:

Remind me again what brand/type of food you are feeding?

 

Because Lantus is a depot-style insulin, micro-dosing .25u (or even less) twice a day is preferable to once-daily dosing so the depot isn't lost and the numbers remain more stable. If you dose only once a day, your cat runs out of insulin towards the end of the 24 hours and has no coverage and this also increases the likelihood of bounces and higher numbers.

 

I was curious about whether there was a once-a-day solution just because the pm shots are problematic for me. Being home in time to give it is really causing me grief and if I move the shot time to later it causes problems in the morning. I didn't think there was a way to do one shot every 24 hours but I figured I would ask.

He is eating the Fancy Feast chunky chicken. He seems to like it, is eating a full 6oz a day, his weight seems stable, and it isn't expensive. So, win-win.

So I just got home and the strips for the relion were here. I tested, and his +9.5 was 79. That's roughly a 109 if I were using the Alphatrak, correct?

 

Just do the best you can with two shots a day. A couple of years ago my cats were on an 8/16 hour schedule on the weekends. That lasted for over a years.

 

That is roughly, correct. It is a good number :mrgreen:
My cats like the Chunky varieties too. They are a little higher in carbs, but not too far up there.
I would test again at +11, so you can compare the PM dose test to the +11, and will then know whether he is staying the same or rising or dropping at shot time.

 

He only has 4 teeth so I have to mash the chunks out of the food anyhow, but this is the first time he has ever been content with just wet food so I'm fine with it. When he grows tired of this flavor I will try one of the not chunky ones. But for now I will take the victories where I can.

 

79!! What dose did you give this am? That's a nice number and likely eh went even lower earlier.

 

1/4 unit. Same as all week.

+11 was 205 vs this morning's +11 of 224 on the Alphatrak. So, pretty much the same.

 

Wow ok then I am so glad you didn't increase like you were considering. You can expect another big bounce btw. At this rate I am thinking he might get another dose reduction soon. Be good if you can get some extra tests this weekend as if he drops below 50 he gets another decrease. Next time it's to 0.1iu and I can send you another syringe pic to show how that looks.

At this rate he might end up coming off entirely or being a micro dose cat. Like my bailey who is getting pretty much a sniff of the

Shooting every twelve hours (give or take 30mins) is ideal but you also have a life so try to get to that as much as possible but if you are late at night then you are doing the best you can.

Has he always been on FF chunky chicken or was he on dry or something else prior to diagnosis?

Wendy