Dosing Going Forward For Bear

@MrWorfMen's Mom

So Bear is due an increase of insulin.
I have the conversion chart U-40/U-100. I have printed a copy to put on my fridge.

Small problem though the chart doesn't correspond to the syringes I purchased. Apparently I have goofed again and bought the wrong syringes at WalMart.

My latest buy of syringes have increments of 5. They are ReliOn Insulin Syringes, Capacity 3/10 ml. cc. dosage up to 30 units, Gauge 29, Length 12.7 mm. (1/2").

The numbers are increments of 5 and each line in between would be a unit. There is no half units.

I either have an incorrect chart for these syringes or I have the wrong syringes.

The only positive, if I messed up again is that I haven't opened any of the bags and should be able to exchange them.

Do I have the wrong syringes or do I need a different conversion chart?

 

The conversion chart will work with any brand of U100 syringes but you need syringes with half unit markings. I'm pretty sure there are ReliOn syringes 3/10ml, needle length 8mm with half unit markings but whether they have the half unit markings with the longer needle I don't know. I know you prefer the longer needle due to Bear's thick fur. I never had a problem with the 8mm needles but have to admit the 6mm were definitely too short for my liking. I used a roll technique rather than the tent method so I could see skin to inject into because Menace too has a very dense coat. I'll see if I can find the video of what I did.

I'd take the syringes back to Walmart and ask them to show you what they have with half unit markings. The Walmart pharmacy staff don't necessarily know they even have syringes with half unit markings.

The syringes with half unit markings will have a 2nd set of marks to the left of the full unit marks/numbers. If you cannot find what you need in the ReliOn brand, Uticare, BD, Carepoint, SureComfort and Monoject all make syringes with half unit markings.

 

Liking those blues on Bear's SS today A LOT! Go Bear!

 

I'm loving those blues. By the way, those needles do have half unit marks, I just couldn't see them, I'm such a goof ball.

How long does it usually take for a cat to stabilize after an increase? I seem to remember that you shouldn't increase again until after 3 cycles correct?

 

Your right on. It usually takes 3 or 4 cycles for kitty to truly show you what they are going to do with a dose. Some take a bit less time and some a bit longer so just watch his numbers and if he stays high for more than 3 or 4 cycles again, then another increase is probably needed.

Syringes can be very confusing. You are not a goof ball. How many times have you had to deal with syringes before? None I'm betting. Cut yourself some slack!

 

Still trying to understand this conversion chart and the needles, just looked at everything again and figured out that he got 3.4 units this morning, (8.5 on u100 syringe), oops. ): I'm guessing we need to stay at this 'unit' for a while?

Now I see why he went so far down into the blues, still love them but not this way. lol

 

Maybe we should ease up on the amount for his PM?

 

@MrWorfMen's Mom

I'm really glad I tested his BG more often today. I was so pleased with his numbers but thought don't get too excited, he won't be stable yet. I hate making newbie mistakes.

 

@MrWorfMen's Mom @Djamila @Kris & Teasel @Rachel

Ok Guys, I need some help. I was talking to Linda but I think she went offline.

This is what happened. Saturday my husband Jeff gives Bear his shot to let me sleep a little longer. We had decided to up Bear's units to 2.25. We have the correct needles with half unit markings but Jeff made a mistake when he converted the units.
Bear actually got 3.4 Units.

We are less than 1 hour away for his PM Shot. Should I lessen his dosage for the PM or stay with the 3.4?
Bear has never had a dose larger than 3 Units.

I just am not sure what will happen to Bear's BG. Possibly he will give similar BG numbers as today or because it is a PM he may drop too low?

I need suggestions, please.

 

Hi Lora. Hopefully someone more knowledgable than me will chime in, but if it were me, I would go back to the intended dose, 2.25.

Bear had a nice curve today, and he didn't get anywhere near the danger zone, but 1) it can sometimes take a few cycles to "get active" on a dose, and I would HATE for that to happen on this 3.4 tonight!! and 2) small dose increases mean that you won't accidentally sail past the right dosage.

Again, hopefully someone else will pop in to confirm/counter-argue, but that is what I would do.

 

Sorry Lora. I just ran off to have some dinner and cook up some steak for my geriatric sweetheart's fussy appetite. I'm just reading your posts and will be right back.

 

Thank you Jenna. I appreciate all advice.

 

Well since he got such a good run today, I'd hate to take him back down too much even though we don't usually increase by that much in one go. How about a compromise of 3u or 7.5u on the u100 syringe. As Jenna said, Bear didn't get near anything too low today so this should be enough of a decrease to keep him safe through the night as long as his pre-shot is in somewhat the same range as this morning. I'll keep an eye out if you want to post your pre-shot for final decision.

 

Thanks Linda, that's kinda what we were contemplating if we didn't get a response from anyone. How often would you test tonight, in this situation?

 

Get a before bedtime test (around +2 or +3 or whatever works for you) and if he is down, give him a snack of MC food to hold him. If he's dropped a lot, you may want to set an alarm for +6 too but I'd play that by ear. He may very well bounce up to higher numbers given he is not used to those beautiful blues yet.

 

You were right on point with his Saturday evening bounce, he was still rising 2 hours after his shot.

What seems strange is that his numbers since his whole unit increase are pretty much the same as when he was getting 2 Units.
Do you think that is because he had stayed at 2 Units so long he was in a rut/toxicity?

He has had 3 cycles since his increase to 3 Units, do you think this evening we should back him down to 7.0 or 6.8 U-100?

The only difference I have seen in Bear since his increase is he is a bit more grumpy at testing and the last two ear pricks he bleeds much more profusely. His ears have been warmer since the heater is kicking on more often with this cold front.

 

Looks like he may need a bit more juice and yes he likely does have some toxicity from sitting in higher number for awhile. The cure is to bump up the dose and overcome the toxicity and then the dose will likely drop back down. My preference has always been to do increases during day cycles but that is your call. I'd increase him a bit tonight or tomorrow morning to 3.25u or 8.0u on the U100 syringe.

FYI - best to just refer to the dose as it would be on the U40 syringes so anyone helping doesn't get confused and think you are giving a much larger dose than you are.

ETA warmer ears are likely from the heat being on. Menace always bled better in the winter than when the AC was going. As for the grumpy stuff, it could just be the bit of a roller coaster in his numbers the past few days.

 

@MrWorfMen's Mom

Off subject a bit. Saturday when I asked my husband if he had marked the needle to make it easier for me to give Bear his evening shot he said yes. I had hair dye in my hair and couldn't put on my glasses, I'm far sighted. I used a magnifying glass and realized something was wrong with where he had marked the syringe. Looking at the conversion chart he realized he had messed up. I said well, you need to write Linda and ask her what we should do. Looking at the previous posts it looks like I was writing to you. I was able to put my glasses on after I had rinsed all the dye out of my hair and start writing but you were busy taking care of your kitties. Lol.

 

That's funny but also could be scary. Solution to this problem is to take a used syringe and use some coloured water to draw up the dose you are currently on. This gives you and hubby a sample to compare to and you can double check the dose in the coloured syringe to make sure there is no error when it';s convenient to draw it up and double check it. When you want to increase or decrease, you just adjust the sample syringe.

I would also suggest if both of you are giving shots that you make sure you have some way of making sure there is no possibility of both of you shooting at the same shot time. It's happened when there is more than one person doing shots. Keeping a note on the counter/fridge or whatever and marking shot done prevents any potential for duplication.

 

I can understand that. The only thing I don't like is the U-100's do not have quarter markings but tenths so if I wanted to give an actual 3.25 with the U-100 it would need to be between 8.0 and 8.5. I know it is only a 0.005 difference at a 8.0 and my O.C.D. is coming into play so I will let this go and give the lesser amount.
That was why Jeff messed up he was trying to get an exact 2.25 and was counting the half units markings as tenths.

That is why Jeff and I can work/play together, we are both O.C.D. It is when we are both around other people that aren't O.C.D. that we can drive others up the wall.

 

We have a notepad on the counter that we write every testing time and BG plus the amount of food given.

 

0.05 difference

 

I will increase tomorrow morning.

 

Plus the amount of insulin given. I look every Saturday and Sunday morning at the notepad as soon as I reach the kitchen.

 

I confessed to being OCD to someone the other day and she said she preferred to call it conscientious and I agree.....much better way to look at it.

You are doing it exactly right....just round the number down or up, whichever is closer, when using the U100 syringe. Your dose may be a smidge off the 3.25u but then consistency rather than precision with the dose is key and on the spreadsheet you can call it whatever you want. When Menace was getting really low on dose, I was using calipers to measure doses and then deciding to call it 0.33 or 0.10 or whatever. My measurements may not have been the same as anyone else's but they were consistent and decreasing in small increments. Works the same way with increases and using the U100 syringe with your insulin.

 

@MrWorfMen's Mom

Thank you again Linda!

I hope we don't become too tiresome to you. I feel like I lean on you too much at times but it sure brings me a since of relief when you post to me.

 

No problem whatsoever. You are definitely NOT leaning too much. I've been where you are and understand how muddling it can be. I'm just paying it forward for what I got out of this forum.
Besides, I've got a soft spot for folks who love their kitties as you obviously do and for those black beauties of ours!

 

@MrWorfMen's Mom

Surprise! Hello blue again.

 

@MrWorfMen's Mom

Have you noticed Bear seems to go lower during the day and then bounce up into the PM. I know I don't have a lot of data in the PM, but what I've got sure points that way. His PM seems like a ECID?

 

Really loving that blue!
A lot of cats do go lower overnight but I am not convinced that some of that isn't because there is less activity and they eat less or a biological thing. ECID and maybe Bear does have his more active cycle during the day. It may be too that he is going a bit lower than you think at night but you aren't seeing it. It's tough to know. Important thing is that he's staying safe.!

 

Yes, for whatever reason a lot of cats go lower overnight. I agree with Linda...I think it might have to do with eating less, less activity, etc.

 

@MrWorfMen's Mom

Well we are into Bear's third cycle from his increase, with not much change. Uhh.. I did a curve test last night.

What do you think at this point and how would you proceed?

I ordered that Zobaline from Amazon yesterday. It should get here late next week. Majority of the reviews on Amazon were great! I have some good hope that Bear can get some relief and healing. It makes my heart sad to see him have so much difficulty walking without his sleek, smooth, graceful cat movement.

I set him on the back of the couch by the window intermittently so he can enjoy the view. He won't jump up anymore and jumping down he loses his back footing. Prayers for healing, please.

 

Looks to me like you might still be dealing with some toxicity from that long run of high numbers on the 2u dose but I can't help wonder what Bear would have done with the doses between 2 and 3u. Let's get some more opinions.
@Kris & Teasel
@Djam
@Rachel
Need your thoughts please.

 

@MrWorfMen's Mom @Kris & Teasel @Djamila @Rachel

More than likely everyone is busy with Jobs and such, lol. No hurry though on this topic, thank goodness.

I have an additional topic which is health related but not diabetic related, but I think with as many bean eyes on this forum maybe someone else's cat has experienced this.
Bear's Seresto Collar lapsed and he got a flea or two from our White Shepherd. The reason we knew Bear had a flea is he would jump and try to run when it bit him. We immediately ordered a new Seresto and it was put on him Oct. 29th.
Before the flea was dead Bear started pulling his hair out beside his spine. After searching online for a reason for his behavior I found that it was common for cats to do this if they are allergic to fleas because the bites are insanely itchy.

Current time, Bear has no fleas and he is moderately pulling out small amounts of hair every few days in different places but not enough that you can see his skin. I need some suggestions on how to help him. My guess is this has become a kind of anxiety relief of sorts. I had thought of bathing him but with his neuropathy I think a bath could be painful to endure. I can tell I hurt him sometimes when I pick him up and place him on my lap for testing, even though I do it very gently. I thought maybe a medical collar but I haven't had any experience with those and don't know if it stresses cats out a lot or not.

Here are some pics of his skunk stripes and his most recent de-furring.

 

De-Furring...

 

Those skunk stripes would be cute if they were just white fur. I am by no means an expert on flea issues (never had a problem with them) but my girl has de-furred her abdomen and vet thought it might be an allergy so she prescribed an antihistamine. Is it possible the bites are still itchy? If so, you could try an antihistamine like Benadryl or Zyrtec to see if that stops Bear from taking her fur out. I've never used a medical collar either although the thought had occurred to me with Menace. I am sure those collars have to cause some stress at least in the beginning and I sure wouldn't like to have a bad itch I couldn't scratch. I guess how much stress would depend on the kitty.

 

I think it might be worth a vet visit to get a closer look and see if it could be a skin condition, allergy, or some other thing besides the flea bites. It's also possible that it's related to the neuropathy and maybe he's biting himself when it hurts.

Speaking of neuropathy, is he taking zobaline or some other b12 to help with that? It takes time and consistency, but it really does help.

 

No, I have ordered the Zobaline yesterday. I think you missed Linda's tag because it only has part of your user name in it. She asked for your thoughts on dosing. Thanks for checking in for us.

This is from Linda below:
Looks to me like you might still be dealing with some toxicity from that long run of high numbers on the 2u dose but I can't help wonder what Bear would have done with the doses between 2 and 3u. Let's get some more opinions.
@@Kris & Teasel
@Djam
@@Rachel
Need your thoughts please.

 

@Djamila

Sorry I got excited at a response the #32 and #33 are pertinent.

 

Usually if the dose is too high we'll see some hints of that - sudden lime green numbers popping up from time to time, big swings up into the reds or even blacks, or really late nadirs - are all signs of a dose that might be too high. You're getting enough data that we likely would have seen one of those little hints by now. So I would be more inclined to say that the dose is too low rather than too high. I would try some steady increases - every 4th cycle or so usually works well and lets you do the increases in the morning cycles when you can keep an eye on things. If you keep creeping up by 0.2u you will hopefully start to see some better numbers. If Bear suddenly starts getting dramatic swings or gives you a green, then slow down and hold the doses a little longer.

 

Thank you Djamila! I know Linda wants eyes on Bear other than herself only because she isn't as experienced dealing with Prozinc and wants to do right by Bear.

I am slightly avoiding our new vet. I think she is pretty great but I think Bear and the wet food diet/ possible remission are an interest and incentive to her to basically take the reins and control this situation, like dosing for example.
I on the other hand have read quite a few threads and have decided that there is much more experience with feline diabetes right here. Bear is a more like an exciting experiment for the vet, at least that is the feeling I came away with.
So with that understanding I feel like Bear's well being is better served right here as far as dosing and diabetes.

I will continue to use our new vet as needed of course but would like a little bit of time to elapse so she understands I am not and won't rely on her for all of Bear's diabetic journey.

I think all of you, @MrWorfMen's Mom, Djamila, @Kris & Teasel, @Rachel, have love for Cats and lots of knowledge and experience that you use to make a wonderful difference. Hugs sent to you all, you help Bear and I so much!

 

So sorry! I saw the tag yesterday at work, but when I got home I didn't have time to pop in like normal.

I tend to agree with Djamila. You get good data and you get it at different times throughout each day which helps us really fill in the picture. I think that we'd have seen SOMETHING by now if you were too high in dose. I'd do the steady increases as well and stick with that for a bit. See if you can break through those high numbers. I will say that usually when we see a cat with some glucose toxicity, the steady increases seem to do nothing and nothing and nothing...then one day BAM they do something and suddenly the cat starts running down the dosing scale. I've seen it time and time again here. No one ever believes me until they see it.

Hmmm...we didn't have flea problems like that. Sounds like maybe Bear is allergic? You could try bathing wipes to see how that helps.

 

I'm sorry I haven't been here to help - other non-FD stuff has been filling my days. I'm glad Djamila, Rachel and Linda have advised.

 

@MrWorfMen's Mom @Djamila @Kris & Teasel @Rachel

I have a few questions, please.

My son having a kind heart, bought Bear a case of tiki canned food, because the Pharmacist he works with had a 3 year diabetic cat that was switched to tiki and immediately went into a diet controlled diabetic remission. I posted this in the main forum as Tiki Surprise. Linda has already told me there are other members that have tried Tiki and not had those results, but it can't hurt Bear and maybe he will like it. I didn't think tiki would be a cure all or I would see Tiki all over the place in threads, lol.

Current time: Tiki came in the mail today and my son called to give me special instructions from his pharmacist. ARG!
I will try this new food because it can't hurt and I know my son is trying to help Bear.

Instructions were to not give Bear his Insulin because he could bottom out and go Hypo and to test him through out the day. Wow! This pharmacist is truly convinced!
NO WORRIES, I WILL NOT WITH HOLD BEAR'S INSULIN.
The rest of these instructions are fine- I can test Bear more often and keep a close watch on him, even though I am a Doubting Thomas that his BG's will plummet.

So Bear had his AM Shot and regular Friskies Pate this morning.
I fed him his first can of Tiki-Mackerel & Sardines 2.8 oz after his (+3) 298 BG. He ate half of it (1.4 oz).
At his (+5) 263 BG he ate half of what was left (0.7 oz) after I chopped it up a bit.

Now for the questions Tiki is much lower in Carbs and he isn't eating as much of it compared to the Friskies.
Is this a bad thing?

Bear has had a few Red numbers lately and with less than his normal calories today.
Could his liver dump some stored Ketones?

I would like to see if this Tiki makes any difference at all in his BG but not if it becomes a negative.
What do you guys think?

Any Suggestions?

 

I'm glad you're not withholding insulin! We recommend feeding under 10% carbs for diabetic cats but some do better on extremely low carbs and some do better with slightly higher carbs in that under 10% range. It's possible the pharmacist's cat responded really well to very low carbs. Kitty has to eat though and if the Tiki Cat doesn't appeal you can mix it with his usual food to see if that helps.

 

I was wondering more about Ketones possibly coming into play with less calories and three high Reds recently?

 

Well Bear certainly ate all the Tiki Tuna in Crab in one sitting at his +7. I'm glad he enjoyed it! It might go on a favorite list.

 

It's possible. More food and a high enough insulin dose is what she needs. Ketones occur when kitty starts breaking down fat tissue to get energy because there isn't a big enough supply of carbs in the bloodstream or insufficient insulin being given. That can happen when kitty isn't eating enough, is vomiting or when the insulin dose is too low to get enough carbs from the bloodstream into the cells. Being dehydrated (from vomiting or insufficient water intake) can concentrate the ketones once they form. Other inflammatory processes or infections can also contribute to their development. It's complicated.

 

Kris, I'm always so impressed with your science-y explanations! I'm so glad you're here!!!

Lora, I'm so glad you're being mindful of ketones and testing for them regularly. I'm definitely not loving seeing those reds on Bear's SS and I'm glad you're working the increases right now to hopefully start to get some better responses.

It's good to hear that Bear is loving his new food! Many kitties do go into remission very quickly with just a food change and a tiny bit of insulin support. During Sam's first diagnosis, he went into remission in just under three weeks. When he came out of remission a year or so later, I thought it would be just as easy to get him into remission again. I certainly never expected to still be here two years later. Sometimes the food is enough. Sometimes it isn't. I do hope that it will help Bear to come down at least a little since Tiki Cat is so low in carbs.

Be careful about how much you give him for the first few days - a sudden food switch can lead some cats to get an upset stomach. If that happens, a gradual transition usually does the trick.

 

@Kris & Teasel @Djamila

Thanks, you guys are great.

I will check his Ketones twice daily while he is eating this lower Carb Tiki.

I think I will hold his insulin at his current 3.4 U for the next two cycles (tomorrow morning & evening). If there aren't any greens then I will continue to up his dosage to 3.6 U.

 

I think that sounds like a good plan.

 

@MrWorfMen's Mom @Djamila @Rachel @Kris & Teasel

Bear just got a nice low green, 61BG. I tested twice and it is legit! Yahoo! I hope this is the start of him getting out of the glucose toxicity. I fed him since it is such a lower green.

 

Way to go Bear! Now if his numbers are higher tonight, don't get discouraged because that is just a normal bounce reaction to that beautiful 61. Nice work Lora!