? Help! Not sure how to dose now

I tested smoky for his AMPS and BG was 553, at +5.5 it was 337, and his PMPS dropped down to 188. I raised his dose to 3.5 units of vetsulin starting Thursday night. Should his pm reading be that low? I'm not sure if I should give insulin tonight now. The only thing I did differently was to monitor his food intake more closely

 

I normally give his shot to him in another 20 minutes. Should I delay and check him again after he eats? Does this mean he had a hypo and I didn't know it? I'm trying not to panic.

 

hi Lisa,
When that happens to Angel I wait between 30 mins to an hour and test him again without food. As far as I know if you test after food it gives a higher reading and might result in you giving too high a dose x

 

I see you jumped from 3 to 3.5 u. He's probably just starting to react to what is a significant increase. One thing you can do is stall 20 minutes without feeding to see if he rises above 188. If his BG isn't high enough then, try another 20 minute stall with no food. I've gone as long as an hour in the past. You want to avoid food while stalling to see if his BG is on an upward path on its own. Another option is to give a reduced dose of, say, 2 u if don't have time to stall. It's best to avoid a "no shot" if you can although that's the safest option. Once you're past this incident, try 3.25 u.

 

He was really hungry so he just ate

 

Shoot, I didn't think about not feeding him while stalling. Smokys BG has been so high for so long this experience has me completely thrown for a loop. I'm such a dummy when it comes to FD. I will take your suggestion about the 3.25 dose. Since I already fed him should I just not give a shot tonight? I would have to stall for two hours now before I can test him and then it is probably too late to give him a shot

 

OK. Maybe lower his dose to 3.25 u and test again before bed. If that worries you, try 3 u?

 

No, you aren't a dummy about FD Lisa. This is a stressful and tricky situation for all of us to manage. We get accustomed to high numbers and even get "comfortable" with them. Then kitty throws you a lower number and it's scary. It's a good sign though. Maybe the UTI has cleared.

Try giving 3.25 u as soon as he's finished eating and getting in a before bed test.

 

Now I know not to feed while stalling. I'm worried if I give him insulin he might have a hypo.

 

I really don't think he'll hypo because your SS numbers don't indicate that he's low enough. That blue was lovely but not too low. Try 3 u, or even 2.5 u, instead. Skipping a shot might set him back too much. If he's moving into better numbers territory you'll be up against this type of thing more often. It requires a certain amount of bravery, judgment based on SS data, and willingness to test more in evenings, on days off and even occasionally in the middle of the night. You'll become more confident over time. When in doubt, ask!

 

I don't work the next two days so I can stay up half the night with him if I need to. I heard on this board before not to give a shot if BG is under 200. It is strange that he actually seemed to go down from reading at +5.5 to PMPS. Has anyone else had that experience with their kitty?

 

Thank you for your thoughts on that. It helps me out a lot. I think I will give him a reduced dose, he did just eat 6 oz of wet food so insulin will have something to work with. FD is hard to deal with I think I will give him 3 units and test again in two hours. Is that enough time for the food to clear his system? He was prescribed antibiotics for 28 days so about halfway thru those

 

Yes, 200 is the recommended no shot number especially for newbies (actually a bit higher for newbies). That's because you know kitty is absolutely safe if no shot is given. That's perfectly fine if that's what you're most comfortable doing.

The approach can change after you have enough SS data and can see how your kitty responds. Most of us get to this point eventually. We start seeing better numbers and want to work with them to achieve regulation or, if we're lucky, remission. That's the reason why I made those other suggestions - and they're only suggestions.

I've had the experience of numbers dropping through a cycle. Have a look at Teasel's data for 11/17 - that's exactly what happened. I viewed it as the bounce stopping and the insulin dose making its effect known.

 

He has been in the blacks and reds so much lately, I feel I shld give him some insulin. I'm afraid if I skip his shot completely he will be really high tomorrow morning. at least I can watch him and I have high carb canned food with gravy and Karo syrup just in case

 

Most, if not all of the food effect, should be gone by 2 hours. Sometimes they'll show a food spike though so that can affect the BG. Complicated!

 

I agree. Give him a dose you're comfortable with and do some testing tonight. You have hypo supplies if needed.

 

OK so now I'm thoroughly confused about smokys BG numbers. I gave him 3.5 units last night and his AMPS was 553. I tested him again at +5.5 and it was 337. His PMPS dropped down to 188. I gave him a reduced dose of 3 units and tested him again at +2 and he was at 412 already. I don't know what to do next.

 

I would have expected to have to treat him for a hypo if anything. I'm worried now, if his BG is already at 412 at +2 what will it be in several hours from now? He is very lethargic and sleeping a lot. He is at +3 now. Should I stay up and check him a few more times? I had planned to test him in another hour.

 

Looks like he's just bouncing again from the blue.....if he's gone up that much by +2, I think you can safely get some sleep

I know you were considering changing to a different insulin....have you made a decision on that yet?

 

I'm going to try prozinc for at least a month to see how he does on that. His vet had to order it along with Denamarin which he said is a supplement to help the liver and maybe pancreas. I would start it on a Sunday so I can monitor

 

Hopefully he'll settle down on the ProZinc and not have the big dips and spikes!!

 

Hi Lisa,

I'm glad you didn't have a hypo to deal with. That high at +2 last night was a bounce, as I wrote on another thread. I've looked over Smokey's SS and he had a good array of yellows and blues early on. Then the UTI/pancreatitis (?) happened and raised his BGs and he needed a higher insulin dose. You're just barely getting out of those woods and it'll take time to see what his BGs will settle at. That blue yesterday is a good sign. Now, you have to keep at the dosing and try to be as patient as possible. You're juggling a lot of stuff now: Smokey's recovery, maybe a new vet, new insulin, etc.

Sounds like you've decided to go with ProZinc. You should have a feel for it after a month but I'd say you'll want to give it longer than that especially after Smokey's recent issues. You've been treating his FD for only 2 months which is really early days as far as knowing how your kitty will respond AND he's thrown roadblocks in your path. Give it time.

 

Another thing I noticed is that I started a new vial of vetsulin on Nov 3. Smokys numbers have been in the red and blacks since starting him on it. I am wondering if it is a weak batch somehow. It is most likely keeping his BG down. It just seems a weird coincidence. Smoky did start his antibiotics on Nov 7 so he probably already had the UTI before that. Is it a good idea to do a curve on him right now with everything that is going on?

 

I suppose you could do a curve just to have a comparison reference for when you start ProZinc. You'll definitely want to do a curve after Smokey has been on ProZinc for about 5 - 7 days.

 

OK so I lowered smokys dose to 3.25 units and did a curve today. He didn't seem to do that well on the lower dose though.

 

You've had a lot going on with Smokey so your curve results aren't too surprising. You had some nice blues and greens in early October when the dose was around 2 u. I wonder whether dosing according to the high numbers caused by the UTI has caused so much bouncing that he's staying high? What if you tried 3 or 4 cycles at 2 u to see what happens? Just a thought ...

 

He is still taking the antibiotic for his UTI. I'm not sure if I'm comfortable dropping his dose from 3.25 in am down to 2 units. That's a pretty big drop. He didn't have the pancreatitis or triaditis when he had the blues and greens. I think I might go with 2.5 units. What does everyone think?

 

If you're comfortable trying 2.5 u, go with that. His BG is high right now and probably won't be much higher if the dose lowering doesn't help. I'd try at least 3 cycles at the lower dose.

 

I'm wondering if smogyi effect is taking place right now. I'm also thinking if his dose is too low he will shoot back over 600 again.

 

There's much debate about Somogyi effect. It refers to a very high number that happens in reaction to a very low number. When we on FDMB use the term "bounce" we're broadening that definition to include high numbers in reaction to a drop in BG or merely a "lower than kitty is accustomed to" BG. Much the same thing ... The rebound into high numbers can become chronic though - ie., kitty bounces high and gets stuck up there because insulin resistance develops.

 

So how do you know if the dose is too low or too high if numbers are high all the time?FD is so confusing.

 

Very good question. The easy answer is you don't until you start experimenting. If lowering the dose is the correct answer, the numbers should start coming down slowly over several cycles provided that insulin resistance hasn't developed. If a given dose leaves kitty in high numbers, it might be because insulin resistance has developed and has caused the body tissues to be unresponsive to insulin. Or - the kitty is responsive to insulin but the dose is too low, period. Both scenarios (resistance and just too low a dose) look the same and the way out is the same - gradually and carefully raise the dose until numbers start to drop. What might allow you to distinguish between breaking resistance and merely finding a better, higher dose is how quickly the need for insulin changes. My understanding is that when you find the "breakthrough" dose to conquer resistance, there can be a rapid drop in the amount of insulin needed to achieve good BG numbers.

 

Thank you! that makes so much sense to me. You explained that so well. The people on this board are so understanding, especially for us newbies to the sugar dance

 

Very glad I could help, Lisa. Believe me, all we want to do is help even if we sometimes suggest things you disagree with or don't seem to make sense. Now, if only we could make regulating kitty easy for everyone ...

 

It's possible he'll go quite high but high is high, whether 450 or 600. It's not the same to kitty as the difference between 100 and 35 at the other end of the BG scale. That's where you really have to pay attention.

 

What is the normal time frame for keeping a kitty on a new dose? I have heard 3 days up to a few weeks. Does it just depend on what pre shot BG's are?

 

As you get to know your cat's individual response to Vetsulin, you'll be able to see if a couple of days gives you enough of an idea how a dose works, if you want to hold it an entire week.
As you collect pre-shot and mid-cycle data, you'll be able to develop a sliding scale based on the pre-shot and how much your cat drops per unit when starting at that level.

With Vetsulin, the nadir is often in the +4 to +6 hour range. Feeding after the nadir can really spike the next pre-shot. I noticed you are giving 3 meals, so I thought you might want to check the timing of the meals. Also, I'd give the bigger meal(s) at shot time and a smaller meal an hour before estimated nadir to help cushion it.

 

Smoky has pancreatitis so it is hard for him to eat a lot at one time without feeling sick. My vet suggested giving him three to 4 small meals a day or three shots every eight hours which I can't do as I work full time.
There have been quite a few members on here who suggested a timed feeder for Smoky. The problem is how do I keep my roommate's cats out of it?

 

I get that.
- maybe divvy it up as 1/2 at shot time, 1/3 around +3 and 1/6 around +6, or freeze a chunk to be nibbled as it thaws.
There are timed feeders which use a microchip on a collar to open the feeder for the designated recipient.
- or - will he and the others just nibble? if all of them would just nibble, you could leave food out for him to eat whenever hungry enough. I let mine graze and it worked pretty well.

 

He won't wear a collar and I can't afford to buy an automated feeder that uses a microchip in a collar. The problem I have with leaving food out all day is that he will eat all day. He is not hungry then when I need to give him his shot. The other two cats in the house eat very little canned food so I could probably get a cheap timed feeder somewhere.

 

Lisa,
Tigger was on Vetsulin, and his insulin needs would vary sometimes. Vetsulin will drop your kitty's BG pretty quickly, as it's a faster acting insulin, instead of an extended release insulin like Lantus or Levemir. With Tigger, I would also leave his cat food out so he could eat when needed, just because the Vetsulin would drop him pretty quick sometimes. I also found -- for him -- that sometimes it would start to fade off around the 10-11 hr mark, instead of the full 12 hours. Also, Tigger was prescribed 3U, at shot time, but that was actually too much for him. He had a couple of hypos back to back, and then he was bouncing, so I did not give insulin that night, and we started fresh the next day with 2U, and I would adjust after that, based on his numbers. Every cat is different, however, so it might work better for your kitty than mine. I wanted to change him to Lantus or Levemir, which, based on my research on the boards here, seem to be gentler and longer lasting than Vetsulin. We didn't get to do that before he passed away, but if I were to ever have another diabetic cat, that is the way I would go, unless it just didn't make sense for some reason.

Also, we set Tigger up a XXXL dog crate as a cat condo for him, complete with kitty bed, food and water dishes, and a litter box for night time. However, that might be an idea for you while you work, so he could have his own food in there and you wouldn't have to worry about the other kitties eating it before he could. Just a thought.

 

I'm so sorry for your loss. I found out if I leave out food in the kitchen for my roommate's cat he will usually eat that food. Smokys food is in my bedroom but I feel bad locking him in there all day.
Smoky seems to have been bouncing into higher numbers and then getting stuck there, at least on the 3.5 units of vetsulin.

That's why I have been lowering his dose the last few days. Smokys numbers are still high but not in the high 500's and over 600 the way they were. I am switching him to prozinc next month. I'm trying to figure out how Long to keep him on a lower dose and when to raise it again .

 

That's what I thought too. The vet at the cat clinic wants me to bring smoky in for a curve the same day he starts the prozinc. I don't get her reasoning for that.
What good would that do? Also, is the goal for the AMPS and PMPS to be similar to each other? Smokys am BG was 474 and his pm BG was 480. I am thinking I shld increase his dose from 2.5 to 3, anyone have any ideas on that?

 

I agree about not understanding why the vet wants to do a curve the same day he starts on ProZinc. Maybe she wants to give a dose and have a full picture of how that dose affects Smoky so she's sure of the dose she'll recommend to you. She might be factoring in his treatment with Vetsulin over the last few months and wants to see whether she can start the ProZinc at around the same dose or not. Smoky's case is different in that respect than a newly diagnosed kitty who's never been on insulin.

Re AM/PMPSs: yes, the goal is for them to be in the same general range. The goal for the nadir is for the BG to be in the range of 50% of what the AM/PMPSs are. Yes, I think you could try 3 u again or maybe eyeball 22.75 u if you want to approach cautiously.

 

Now I just have to figure out what his average nadir has been. I think I will try the three units again. His numbers are still in the reds.

 

I picked up smokys prozinc tonight. The vet said to give him 2 units twice a day. Is that too much to start with or should I try 1 unit instead. His AMPS was 388 and his PMPS was over 600. What the heck happened?

 

I'm just going to give him one unit of prozinc to start and monitor tonight.

 

Usually we take into consideration the dose they were on before.....I think you're probably going to need to go up to at least 2 U to start

Make sure you make a definite "line" on your spreadsheet to show when you changed to ProZinc

 

OK thanks. I gave him one unit tonight of prozinc per the vet since I can't monitor him for a full 12 hours. I can do that tomorrow.

 

Not very tech savvy, how do I make a "line" on SS?

 

Check your Inbox for a private message

 

I'm a little worried now about Smoky. I checked his BG at +3 after giving one unit of prozinc. I'm not sure how long it takes for that to start working. His BG is still reading the same as his PMPS, over 600.
I am wondering if there is something wrong with the meter or test strips. I have a new box of them I could open and try one out.

 

I think that you just started at too low a dose

Since he was up to 3U on the Vetsulin, it probably would have been better to go ahead and start at 2 or 2.5U on the ProZinc

Saw your post on the ProZinc forum too.....trying to compare the results you get on the Relion with the AlphaTrak will just give you a headache and won't produce any meaningful results.

There's no direct correlation between them other than the "time to act" number ....50 on a human meter = 68 on the AT......other than that one instance, you can't compare them

 

I'll be checking him soon for a +6 reading
I'm just getting the AT2 meter to do weekly curves, his new vet won't treat him unless she thinks we are using the same meter.

 

I think my meter is acting up. I tested Smoky at +3 and meter read high so that means over 600. I tested again at +6 and meter read high. I waited 5 minutes and tested him again and second time it read 457. What?

 

That's possible....remember, the FDA allows a 20% variance....even using the same meter on the same drop of blood

600- 20% = 480

457 + 20% = 548

 

What if it was a different drop of blood?
I guess it would still be the same

 

yup...the rule remains the same

that's another reason why trying to compare a human meter to a pet meter is so impossible to do and be able to make any kind of sense out of the numbers you end up with

Just asking for a migraine to try to get some kind of formula that would make sense

 

I agree with Chris (and China). The 1 u dose of ProZinc is too low although I understand why you did it. I see on your SS that you gave 2 u this AM. You're home today to test. Maybe stay with 2 u until the weekend and then try 2.25 u and test again. I'd give some thought to trying U100 syringes eventually because they give a lot of dosing flexibility. It's actually a very simple conversion using the chart available on FDMB.

 

I have a lot of the Carepoint u40 syringes with half unit markings. I find them to be easy to use for .25 and .5 doses. I can't really buy u100 syringes right now. I just spent $170 yesterday for prozinc and Denamarin. I have an appt Monday for smoky at cat clinic for CBC, chem panel, spec fPL test, urinalysis, and fructosamine test, that's another $300. I am so afraid he is insulin resistant even though it's early in his diagnosis.
I hate to see him feeling so sick and this has been going on since before his dX on Sept 1. I want to get back the kitty that he was before all this.

 

I understand about the syringes completely, Lisa. BTW insulin resistance can certainly develop in a unregulated kitty but it's not permanent. Careful dose increases will eventually get you to a point that breaks through this resistance and kitty will become more responsive to the insulin.

 

That's reassuring to hear it might not be permanent for insulin resistance. His regular vet put down to start at two units of prozinc twice a day. I am working on transitioning him to the new vet at cats only clinic. I am nervous about what his test results might be on Monday. I slept 3 hours last night so going to try to get in a few more hours of sleep.

Happy Thanksgiving to all!

 

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