Dosing Help? Have no idea what to do!

Butter was diagnosed last May with diabetes. Since his diagnosis he has NEVER been in the 100's until this week. The last few days he has thrown up a few times. I do believe it was due to a switch in food. My vet's office told me that when you switch food you should gradually do it. Unfortunately, I gave him 2 cans and he threw up, had diarrhea then was feeling a bit better and that night, hubby gave him 1/2 can of the same food when he arrived home from work. I had texted him not to give him that food but he missed the text. So, he threw up again yesterday. Have no idea if the low numbers are related to the vomiting or what? Woke up this morning and his AMPS was 109. I should be rejoicing, but his numbers have been high for nearly a year so I have no idea what to do. HELP! I waited 2 hours and tested again and it has creeped up to 192. I did not give him a morning shot yet as I have no idea what dose to give him now. He is on 3 units of Lantus every 12 hours. Please see spreadsheet. And, I am doing my best to test him and record on the spreadsheet. He is a very unwilling participant when it comes to testing. Most of the time it is a 2 person ordeal unless I can catch him sleeping and it is definitely a tricky venture. Some other help sites sure do their best to criticize for not testing 3 or more times a day. My animals are my babies and I would do anything to help them get better but sometimes it just doesn't work out with a family and work etc. I hate being made to feel bad for the lack of testing. So, non judge mental help is very appreciated!!! Thank you in advance fur moms and dads!

 

Are you using a pet meter or human meter? Is butter eating today?

 

I am using a human meter. The Bayer Contour. He is eating today.

 

that's good that he's eating. I'm wondering if the lower numbers are because he didn't have much food in his belly. I would give him his normal dose tonight if he were my kitty. I'll tag some people that might be of more help then me. @Wendy&Neko @Amy&TrixieCat @Stacy & Asia . Hopefully someone can help. And please don't feel bad, it looks like you are getting data! Just try to get at least the amps and pmps but it looks like you really try to!

 

Thank you so much! Butter usually eats about 6-8 small cans of food a day. He is always hungry. He was about 14 pounds pre diagnosis and he has now held at 10 pounds for a while. Vet says that he should stop eating so much when we can get the numbers down. And, yes, he hasn't not eaten nearly as much in the last couple of days because he was sick. So, you would suggest skip this morning and just give him his night time shot correct? I know that a bit high is better than too low. Thank you for tagging people. I have also emailed my vet who is great but I'm not sure she will respond on a Sunday morning.

 

What time is the night shot at? It might be too late to do the am shot.

 

Yes, I was thing the same thing. About 9pm.

 

Maybe you could give him 1 unit? 9pm is 8.5 hours away for you, right? Hard to say, I'm no expert but really want to help

 

What time zone are you in? If you shoot anything right now, remember that your next shot will be 12 hours from now, so if you can't afford to be off schedule like that, I would hold off on shooting anything until your usual evening shot time. As for shooting tonight, it's best to see what his BG is at that time before making a decision.

It's hard to say why he's hitting lower numbers now - only time and data can answer the question as to whether it was the food switch or a change in insulin needs.

This is not to criticize, but it really is important to try and get a nighttime test in. Without that, you don't know how the insulin is working for Butter half the time, and it makes it harder for us to analyze the data...plus, of course, it helps keep him safe, too. I know he's tricky, though, but I'd really try to get that in. Right before bed is ideal, because that way you'll know if he's taking a dive before you head off to sleep for the night.

Also, out of curiosity, why did you drop his dose from 4.50u down th 2.0u? Knowing a little history helps us help you.

I'll be in and out this afternoon....getting stuff done around the house, etc, but I'll try to check back a few times, and I'm sure others will check in as they can, too.

 

It says she switched form prozinc to lantus in the notes.

Somebody (don't remember who or where), told me that you could shoot a half dose at any time before the next shot, if you skipped the prior shot. Obviously that's not a good idea, huh? I think it was my vet

 

Thanks, Sean - totally missed that !

I'm not familiar with other insulins, but I absolutely would not shoot half a dose of Lantus (or any dose, for that matter) at any time before the next shot if you've skipped the prior shot, because doing this would make the next shot basically be a potentially significant increase that could result in an overdose with the potential to hypo. There are a few rare reasons that are exceptions to the rule (like kitty has bounced to the moon AND the late shot wasn't TOO late), but in general if you end up shooting late for any reason (your overslept, were stuck at work, etc), your next shot should be 12 hours from when you gave the late shot. You can slowly adjust back to your usual shot time when you've given a late shot. For Trix, I would shoot 15 minutes early with each cycle until I got back to my usual time. Others will shoot half an hour early for one cycle per day until they get back to their usual shot time.

 

Thanks @Amy&TrixieCat . I wonder which vet told me it was ok. I've seen so many vets in the last 6 months. Ugh. And a new one tomorrow!

 

It's hard to say, he could be vomiting from being in lower numbers and it's shocking to his system, or he could have lower numbers because he is vomiting and the vomiting is related to something else.

As far as dose advice goes, I'm just not at all comfortable suggesting anything because you don't have the data to show how low he is going. With these blues you have caught recently, and that red the other day, could have been a bounce from a much lower number. It's not a judgement or criticism at all, please understand, but you just can't get very far regulation wise without knowing how low he goes on a dose. I know you have a tricky testing situation but regulation requires lower numbers and those lower numbers could easily lead to numbers that are too low if you are not able to monitor, and that is a serious safety concern. Without pm data, where many cats go lower, it's really nothing but a guessing game.

Like Amy suggested, if you can find a way to get even one test in the pm a night and vary the times around to fill in the blanks or do a curve once a week, it would help tremendously to get Butter in healthier numbers, because you would be more able to answer how low the dose is taking him and could adjust accordingly. He'd probably feel better once that happens and not be so hungry as well.

He likely wants to eat a lot because he's unregulated and can't make proper use of his food. I really don't see harm in feeding him when he wants at this point, especially as he had lost weight initially. If you are ever able to give a serious crack at regulation, I would reassess the food quantity/frequency situation at that time.

Hope his tummy is feeling better soon.

 

Thank you all so much! So, if I am understanding the suggestions I should try to get a test in after his PM shot? Ideally what I do is try to get a test pre morning. +6 or +7 and pre night shot. Will it help to get a test 2 hours after his nighttime shot? I usually shoot before bed but if I could start his morning dose earlier I could manage to do that. I wasn't starting early in the morning as when I get up he immediately wants to be fed and he would have no part in me testing him. He is angry til he can eat! I just tested him again and he was 230. And I did not give him a shot. I was going to wait until tonight.

 

It's best to get as many tests as you can in a day, but usually 4 is suffecient. What you are trying to find is how low he gets on a certain dose. MAny cats go lower in the pm/early morning. So if he's 200 at pmps, he might get down to 100 at say 3 in the am. You just want to try to get a test in at different hours of the day. So tonight mabye get a pmps, and a 11pm. Maybe tomorrow a pmps and 2 am. Once you find the right dose, you won't need to be testing as much.

 

I hate to ask this, but how do you know he hasn't been there? Many cats go lower at night. My Neko would often go low (and earn reductions) during the night, then bounce during the day. If I had dosed her based on just the day time numbers I would have increased, instead of reducing. This morning you got a hint that may be what is happening overnight. I am not saying you have to increase the number of daily tests, but rather to mix up when you do them and try to get the odd night time test in. One wise member described the spreadsheet as a jigsaw puzzle. Just a little data all around the puzzle shows more than a lot of data on only one spot.

Even a test at +2 or +3 can give us a clue what is happening at night. Those +2 tests are typically a "heads up" on what the cycle might look like. If the +2 is a lot lower than the preshot, then it'll be an active cycle which either means more monitoring, or making sure he has lots of food out to keep him safe.

One last comment, for your last increase, you increased by 0.5 units. On this forum and given that Butters had been seeing yellows, we would have only increased by 0.25 units. If you need to increase again, it would only be 0.25 units, especially now that Butters is showing you his blues.

Here is the link to your previous post here, for continuity and those following Butters.

 

Thank you! You're right. I do not test after his PM shot. I guess I need to set my alarm and get up and test. I went from taking care of my father who passed to my father in law who passed now it's my cat. Just gotta say sometimes this really is hard and stressful. This morning I spent 45 minutes trying to test him. I got clawed and bit and was left in tears.

 

Do you give treats, skritches, and cuddles after testing? Even when you aren't successful in getting blood, rewarding Butters with a (diabetic friendly) treat after ever test attempt should help him start associating test time with good things. Some kitties do stay stubborn about it, but most start making the connection. Things like freeze dried chicken bits are perfect for FD kitties.

Yes, sometimes it is all very stressful. I was CG to my father for a couple years while he battled cancer, too, and now I have taken a similar role with my Mom, who has never taken care of herself a day in her life. Lots of folks here are juggling multiple stressors, but the "good" thing is we can all relate to each other and help each other out, so don't feel like you're alone - everyone here wants to be as helpful as possible. We all just want to help you keep Butters safe and healthy.

 

Do you go to bed right after Butter's PM shot? As I said, even a test 2 hours after shot time is a good one to get.

I have two parents in my mid 90's, so I too get how exhausting looking after our older family members can be. Looking after Neko, who also had CKD, heart disease and lymphoma was very tiring. But worth it when we cuddled.

If you are having a hard time testing, walk away after a couple of attempts. Don't keep trying. Give yourselves at least a 5-10 minute break before trying it again. Make sure you also do "fake" testing where you just cuddle and rub his hears and give a treat afterwards without testing. You want him to associate good things with the routine.

 

Sorry for the venting. It just seems like I can't catch a break. Sometimes I just wish I could take care of myself. Then I get it over it. Haha! I love my Butter! I will try to "fake testing". On the plus side. He seems to be feeling better. Hasn't thrown up again. Have a great day!

 

Thank you so much. Yes, I've tried everything with him. It's so aggravating when I get a good poke and he's ok then it just doesn't bleed. I would be fine managing this if the testing wasn't so hard. He loves the freeze dried chicken treat as well.

 

This is very good advice. What annoys cats is less the prick than everything that goes around it. So whenever you can, do "test-like" stuff to him but trying to stay in his zone of tolerance. And reward (either with a treat, or simply a tiny bit of his food, or a good chin rub). And when you see it isn't working, definitely walk away and come back. It helps you calm down and him too.

I'd like to second what was said about getting some testing done on the PM cycles. Otherwise you're really missing half the picture. If you can move your shot times around so that it's not just before your bedtime, then it allows you to get a +1 or +2 before you hit the sack. You may not realise yet but a +2 is super useful, it's a key that can allow us to "guess" what the rest of the cycle was like.

If you want to move your morning shot earlier and he's troublesome until he has eaten, here are two ideas:
- invest in a timed feeder that will give him a portion of his food 2 or 3 hours before shot time
- give him just enough food to calm his yowling stomach and test right after: the instruction is not to feed before the preshot test because we don't want it influenced by food, but if the food is not high carb food, and you test within ten minutes or so, you'll have a reasonably clean number. It's a trade-off and not very kosher, but maybe it might work for you and him. Then once you have the test in you can give him the rest of the food you'd normally give him.