Dose increase?

Based on Pepper's results today on SS, should I increase for tonight's dose??

 

I'm sorry no one was here, Missy. What did you decide to do? Raising the dose by .25u would be fine. If you did not do it this evening, you could always do it tomorrow.

 

I raised it .25u, it was kind of difficult with the u100 syringes, instead of the u40 syringes. (Pepper hisses and cries if I use the u40's. I'm just nervous she will go low at night, because she eats less.

 

@AshleyDiamond was using U100 with her ProZinc. Her dose increment changes were different. Maybe she can help you with that.

 

I really do not think she is at too much risk of going too low tonight. Her PMPS was pretty high. Her drop today was not too harsh, and what history you have does not seem to indicate her ever going too low. You could check her before bed tonight or set an alarm to check her close to the middle of the cycle.

 

Thank you so much

 

I agree with the dose increase. If you're using U100 syringes that have half unit marks you have many more fractional dosing options because you can increase by 0.2 u at a time.

http://www.felinediabetes.com/insulin-conversions.htm

 

Ok. Thanks @Kris & Teasel . I'm not thinking straight. I was rushed to the hospital last night with a severe allergic reaction. I have brain fog today from the epinephrine they gave me.

 

Oh no! Glad you’re ok

 

Thank you. I was scared to say the least. But my sweet Pepper never left my side last night, when I got home.

 

I use U100 syringes with Prozinc. I like having the flexibility to increase or decrease by such tiny amounts. That seems to be what Cleo needs.

I hope you're feeling better and that Pepper was there to take care of you.

 

@Peppersmom72 I'm sorry I'm just seeing this after being tagged. Today is my birthday so I've been out all day but usually I receive emails from this site. Weird. Anywho, like others have mentioned already if you are using the U100 syringes instead of the U40, your doses will be a little different just because of the conversion chart. We don't really have a .25u dose, so if that's the dose you are wanting to try then you would do a .20u dose of insulin which is drawn to the 0.5 line on the U100 syringe.

 

I think 1.75 is what she was attempting.

 

Ahh okay I see. Well in that case our choices are a 1.6u dose or a 1.8u dose. So with that I think I would try the 1.8u which is drawn up to the 4.5u line on the U100 syringe. @Peppersmom72 do you have a copy of the conversion chart on hand?

 

Yes I do have the chart. It just looks like so much.

 

It does look like your giving a lot more insulin when you are pulling it back into the U100 syringes, but rest assured that if you are following the conversion chart you are only giving the 1.8u of Prozinc, its just in a different syringe than what it calls for. Did you decide to go with 1.8u then?

 

Ashley is right. With the u100s, you want to go with .2 unit changes instead of .25. While it's a bit weird at first, the conversion chart makes it super simple...no math required! Let us know if you need help with it...it can take some getting used to.

 

I guarantee that if you're using U100s with the conversion chart you'll be drawing up the correct amount. It looks like too much because the U100 syringe barrels are a smaller diameter so the column of insulin inside is longer. That's the advantage of using these syringes - easier to see small fractions.

 

Yes, and now she's higher again this morning.

 

It's okay, it can take a couple of cycles for them to adjust to a new dose. Hang in there.

 

I'd like to go back down and do 1.6u instead. She's bouncing like crazy.

 

You hold the syringe and can always do whatever you think is best. However, she isn't bouncing. She is getting insufficient insulin. She needs more, not less. Those pinks and reds will never disappear if you lower her dose right now.

 

It's like we went up a whole unit on the conversion chart . She was only getting a little over 3.5u on the u100 syringe and now she's getting 4.5u on the u100 syringe.

 

I'm just scared.

 

One of the tricky things about the conversions, is that we don't talk about those numbers in units. She is still getting 1.8u. You draw to the 4.5 line. Her increase was only 0.3u, not a whole unit. Our usual increases are 0.25, so at 0.3, she's just getting a hair more. And in the protocol, it says if the nadir is 200 or above, you can usually do a 0.5u increase. Her nadir was 199, which is essentially 200, so it's really a small, safe increase.

What exactly is scaring you? Are you afraid she's going to have a hypo? If I understand what's scaring you, maybe I can help?

 

Thank you. Every time I change her dose, she seems to get really sick. (Constipated badly). It's like it makes her feel like crap. (No pun intended). She stops drinking as much and then the miralax doesn't work. The main fear is a hypo episode when I'm not home to help her.....if it ever were to happen.

I love her so much and am tapped out financially to afford another ER visit for her.

 

It's not uncommon for a kitty to feel a little icky at dose increases. Mine can take them in stride now, but earlier on in the process I noticed that too. Just give Pepper some extra love and know that she'll feel better on the next cycle. Staying in high numbers is making her feel badly as well, so getting those numbers down is really important. You'll be so surprised how much her well being improves as her numbers get into better control!

Make sure you are adding extra water to her food. When I feed Friskies, I add 2-3 tablespoons of water to half a can. That really helps with water intake, especially for kitties who aren't inclined to drink much on their own.

As long as you are feeding low carb food and low carb treats, and as long as she doesn't have access to sneaking food from another pet, a severe hypo is very very unlikely. Those happen when a cat is getting too much carbs which causes their BG to be unstable, Or when there is another serious health issue like a tumor or something else unknown and big. If Pepper is healthy (except for diabetes and constipation) and on a low carb diet, and as long as you are being careful and systematic with the increases (which you are), she isn't going to go so low that she'd be in danger.

If you look at my spreadsheet (or lots of other ones), you'll see that my cat does occasionally step a toe into the lime greens. Because he is healthy, his liver is able to compensate when that happens and keeps him safe. I just make sure that he always has access to low carb food in case he needs to eat a little to keep himself in safe territory. It's not that it's impossible to have a low number, it's just that it's very very unlikely that she would have something dangerously low given the care you are providing for Pepper.

Even if Pepper had a lime green number, you are quite capable of caring for her at home at this point. You just keep giving food (high carb if it really starts to get low), and testing, and you'll be able to bring her up without an ER visit.

I can't remember if we've talked about this before, but you might find it helpful to switch to a human meter instead of the AT2. On a human meter, the range of numbers is compressed, so you won't be looking at those wild swings that you see with the AT2. Also, because human meters run lower, you would be less likely to be looking at reds. While in fact the BG won't be different, seeing the lower numbers might help you feel better about the whole process. Also, personally I found it easier to test more when I wasn't spending $1/test. The more data you have, the better you'll be able to help Pepper and keep her safe. When you know what her numbers are (on the weekends if you aren't able to test because of work), you'll feel calmer leaving her for the day.

 

How soupy can you make her wet food and she'll still eat it? If she won't go to the water bowl it's a good way to get water in.

If you can work those extra tests into your routine (evening on work days and mid day on days off) we can help you avoid a hypo. A test at +2 or +3 in the evening can be a good predictor of whether she'll drop low overnight. If the +2 or+3 is significantly lower than PMPS (say, 100+ points) that can be a sign of an impending lower than usual nadir overnight. In that case you can give her a small snack of her regular food before bed.

Some extra testing will give you piece of mind and be far less expensive than a trip to the ER. As far as that goes, it's rare that she'd need to go there if you catch an impending low because of testing and can intervene with a snack and/or higher carb food. More data on your SS gives you more info about her responses at a dose too. Knowledge is power!

Do consider a much more economical human meter too.

 

The more data you can get, the clearer things will be, but there is currently no indication of her ever having gone too low. Hypos are scary and that is why we do such small dose increases and test as frequently as possible (and have carbs on hand!). But, personally, I am also scared of letting Mia stay too high too long. The more time she spends in high numbers - especially over the renal threshold, which is about 250 on the AlphaTrak - the more chance of damage to her organs, especially the kidneys. So, I do what I can to keep her under that without going too low - that is the balancing act that is managing feline diabetes!

The more regulated blood glucose becomes, the less they drink. Mia never drinks water anymore - literally, never. Are you adding water to Pepper's food? Wet food has a very high percentage of moisture, so they get a lot just from the food as-is, but you can also add water to it to get even more water in her. I mix bone broth and water into my girls' food and microwave it 15 to 20 seconds to warm it all up. They tell me it is very yummy! My girls had some trouble with constipation and very, very small, hard and dark poop when I fed them Fancy Feast. I used to add pumpkin and finally had to start giving Willow some Miralax. Once I stopped feeding them that, they stopped having those issues. Could the food she gets be contributing to her constipation issues?

 

LOL....wow! Three posts at the same time! Missy, don't ever doubt that we care about you and Pepper!

 

We absolutely do!!

 

And, we are all in harmony! Hopefully, that gives you some confidence in what we are saying.

 

I have the human meter. I've asked to have a new SS that is for a human meter, but have not heard back from anyone. As far as the constipation, the vet wanted to do an ultrasound to see if there is what they expect is scar tissue in her intestines from emergency surgery as a kitten (5 in hairball in her small intestine). I can't afford $400 ultrasound. I am broke as a joke, and my credit card is maxed out from all these ER visits. I always add water to her food, but she is a picky eater. She hates Bonita flakes. So I add a half of a temptation treat to her food, when she refuses to eat. (It's probably bad, but I don't know how to get her to eat).

 

This is where the links are to the different spreadsheet versions: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Could you update your signature to include the type of meter you use?

 

Please tell me I'm not hurting her by putting the 1/2 treat crushed in her food when she's being picky.

 

I will try broth instead of the treats and she if she eats it.

 

You can also try nutritional yeast. You can find usually find it at most grocery stores, but you might need to ask where it is. It's not the same as regular bread yeast. You just sprinkle a little on the top and some cats go crazy for it. At the grocery near me, it's sold in the bulk food section, so you can just buy a few cents worth to see if she likes it. Some cats like that cheap dried parmesan cheese too. You can also buy something called fortiflora - either from Amazon, Chewy, or the vet (not sold in regular pet stores). It's more expensive, but it lasts forever. It's sold in a box of 30 packets, but one packet lasts like a week if you're just using it to entice them to eat. you just spinkle a little on the top like you're "salting" the food. Or a little juice from a can of tuna. Just make sure the tuna is packed in water, not oil, and that nothing else has been added.

 

The fortflora is Bonita flakes. She won't touch it. I'm afraid to use the tuna juice because vet said her kidney values are showing signs of CKD. I'm at a loss. I'll try the yeast, if my grocery stores carry it. The people at the stores don't seem too sharp here.

 

Bonito flakes and Fortiflora are different things. Here are bonito flakes:
https://www.amazon.com/Extra-Large-...pID=51NBtYCa1iL&preST=_SY300_QL70_&dpSrc=srch

And here is Fortiflora:
https://www.amazon.com/Pro-Plan-Vet...532361112&sr=1-2&keywords=fortiflora for cats

Hopefully your grocery has nutritional yeast though. It's cheap and easy and you can just try a little to find out if she likes it first.

 

HMMM. I know I bought mine from Chewy. But mine is in a small bottle and looks like fish flakes. I'll have to check when I get home from work.

 

Now it looks like I have lost all of Pepper's data from her last spread sheet on here. I can view the old SS if I log onto google. But I don't think anyone else can see it now.

 

I can see all of the old data on the link for "pepper's Prior Spreadsheet 2018" and a blank human meter spreadsheet on the link for "Pepper's Spreadsheet".

 

This one?
https://www.chewy.com/cat-man-doo-sprinkles-crushed-bonito/dp/45666

Those are bonito flakes, just a different brand.

 

Ok good. I'll switch her past week over to the new sheet.

 

Yes, that's them. She hates them. Lol

 

If you are going to buy broth, you have to be careful that it does not include things like onion, garlic and other seasonings that are bad for cats. If you want to make bone broth, it's pretty straightforward: https://healthypets.mercola.com/sites/healthypets/archive/2013/12/02/pet-bone-broth.aspx

 

Thank you