Introducing Our Good Boy Duke

Duke is a tortie, Maine Coon mix. He was diagnosed shortly before valentines day this year.

He has always been fed a low carb diet - wet Friskies for most of his life. No dry food except a little as a treat.

We just started home testing.

He started on Vetsalin. He is currently taking PZI compounded by a local compounding pharmacy. It is U-100. Last week he just crashed. (please see diabetes heath forum introducing Duke post for details). He was on 3 iu 2x. We were later advised to go to 2 iu which we did.

I just started a spreadsheet. My current concern is that Duke tested last night near 500 so we gave him 3 at 7:00 am. Tonight at 7:00 about an hour after eating:

PMP 212

I didn't know if we should give him a shot or not. I went ahead and gave him 2 iu. I will test in the AM and watch him tonight.

I was unsure if I should give him a shot or not.

Should we have a no shot value at this time? I know we don't have much data yet. This has been especially emotionally draining on my wife. Duke is a momma's boy. Being a scientist by training, I can take a more detached clinical approach. This has caused some tension. I will do a curve this weekend.

 

Though close to the newbie 200# cut off, I would have still shot the 212 with 2u. I know it is gonna stink, but try to stay up and get a test done at +6 to see how low he goes tonight. I see that you have been giving 2u for a few days now. The 3u this morning might have given a bit of a 'honeymoon' effect where the numbers go lower with a dose increase. Try to stay steady at 2u for a few days no matter what you see (with the exception of ultra low #s of course) and then reassess the dose then. If Duke stays above 60 or 70 tonight, then you are golden! Sending cyber coffee your way

 

Thank you for the laugh. Sometimes it hard to know whether to laugh or cry.

I will stay up to get a +6. It won't be the first or I'm sure the last night that I stayed up with Dukie. When I do get to bed I usually have to slip in around Duke's brother Elmo or sister Tatiana or both to get some room in the bed to sleep.

I will update my spreadsheet.

 

Hi Bone Daddy, I hate to disagree with Kelly but I was concerned with you 2U at pmps 212
I would have gone to 1u and stayed with that for a time. your just starting out and 2 and 3 units is a high dose. it's natural to see those high #'s at first...but the sudden low is time to check out for a low mid cycle # and be prepared with high carb if you see a number under 50 or so. Your very new so I'm just watching out for those big shots with low pmps.
I did'nt know you were here so I put a watch for you in Health in case you get in any problems tonight...more traffic there.
good luck.
and if you do go to low tonight....either skip the am shot or shoot .5U
They become very insulin sensitive when they go that low and will spike up with a number that looks like it wants a higher dose...but don't do it.
IMHO

 

I'm getting ready to run out the door, but wanted to check in. I am real curious as to what Duke's amps# is this morning. If you can't be home to monitor, and it is 250 or less, you might want to go with 1.5u for the shot this morning. (based off of the decent curve from last night but with extra food and treats) If it is 300 or more, then I would stay with the 2u if it were me. Of course, in the end, you know Duke best and we are all stating opinions based off of how our kitties react to doses!

 

Glad to see Duke is ok...and I read your latest post on health and just wanted to chime in some info FWIW. You've had a cat that has 'crashed' several times, gone hypo, even gone to er or vet over it. the 2U is likely too high a dose which it appears you are correcting with carb treats. If your not opposed to avoiding all that and want to lower dose and ride out the number for a while you won't have to be in hypo alert mode each shot.
Am I the only person who may have suggested using 1u? and you are currently on pzi right? I see originally you've been using vetsulin and was'nt sure you've made the change.
Anyway continue to post both here and health as it can be a tad slow here lately.
just want to see you and duke in good hands :smile:

 

I will have a +4 and a +12 reading tonight. Duke's spreadsheet was updated for this morning.

I realize I've missed sharing large chunks of the story up to this point.

When Duke was first diagnosed in February, he was started on 1 unit of Vetsiln. This dose was increased to 2 units then again to 3. With Duke not regulating, he was switched to the compounded PZI. First 2 units then 3 units which stand as the current order from the vet that saw Duke up until last week. This vet also administered Humulin when he thought Duke's numbers were too high and he needed a fast acting insulin. This happened as recently as last week.

We moved to 2 units at the advice of the second opinion vet who we use in the future. She wanted to keep overnight to do a curve and said we should consider taking him to an emergency vet for 24 hour as his potassium was a little low. I explained to her that I would not leave Duke overnight or take him to an emergency clinic for days of hospitalization. Duke literally pines away under these conditions. He looks absolutely pitiful and near dead until he sees my wife. The stress is too great on him and on us. I told the vet I syringe feed when needed and have administered sub Q fluids. That I am now testing at home. She knows that if Duke crashes to the point the only option is extended hospitalization, we will spend some quite time with him at home and have him humanely euthanized when the time is right for all three of us. We will not have him be miserable in the hospital, poked and prodded, uncomfortable and dirty from laying and being tube fed only to be called in to make the decision when to euthanize.

If it comes to this, we want Duke to spend his time with us being loved and comforted. We want his last hours to be dignified not degrading. We bring Duke in to be euthanized when we know the time has come to let go. I know this may sound harsh to some, but we are at peace with the decision, even as I start tearing up as I type this.

I'm sorry if this is choppy, misspelled and with poor grammar, but I really don't want to reread it.

With all that said, Dukie looked strong and sassy this morning and I promised him again that I'll get better at drawing blood.

Thanks again everyone for your support and listening.

 

Thank you for the note.

I am not adverse to trying 1 unit. The general consensus has been to continue to give 2 for a while with monitoring.

Will one are two of those Natural Temptation treats with each shot raise his blood sugar that much?

I am going to boil some turkey tonight for snacks. Tatiana and Elmo will appreciate that also.

He really liked the spare ribs.

Tonight I'll do +3, +6 and +12.

BD

 

I don't mean to be countering what you suggest Lori, and I admit I am a more aggressive shooter sometimes because imo hypos are easier and quicker to treat than dka. Please correct me if I am wrong bonedaddy, but I think the crashes were with a 3 u dose, and 1 unit dose reduction each time is a big dose reduction to me. I see huge changes with a 0.2u dose reduction.

I am glad to see that Duke was not above 400 this morning for a change though. If you can get ahold of ketostixs and Duke is negative for ketones, then it would do absolutely no harm to try 1u for a while and see where that puts his numbers.

Last thing I want to do is make this more confusing for you when the home monitoring is so new. Whichever dose you go with, if it puts Duke in safe numbers all the time, then try to stick with it for a few days to see how his body settles in to it.

 

Thank you for the input.

What type of syringe do you have that's calibrated to allow such small changes? The ones we use are only calibrated at 1 unit increments.

I've been curious if small amounts make much of a difference. Since the syringes we were first given (actually paid for) by the vet were calibrated in 1 unit increments and we were initially told to administer 1 unit. This kind of freaked me out since 1 unit was so small and the odds of having exactly 1 unit in the barrel seemed unlikely. We were basically told yes it is do the best you can. My impression was that accuracy and precision in measuring the insulin had a generous margin of error since being off by only 1/10 of a unit represented a 10% difference in the amount of insulin delivered.

 

A lot of us use u100 syringes with 1/2 unit markings to give our cats u40 insulin -- either PZI or ProZinc. Each 1/2 unit mark on a u100 syringe equals .2u of u40 insulin. If you are using u100 insulin with u100 syringes, then getting some u100 syringes with 1/2 unit marks will make .5u increases or decreases easier.

I think there's something in the sticky about them and a conversion chart at the top of the PZI page.

 

Hi Bone Daddy and Welcome to PZI land.

I had bought my syringes at Walgreens. The U-100 30 gauge 5/16 (8mm) short needle. I was told that you can only get these now in 1/2 unit markings? Here is the link to the Insulin Conversions: U-40 and U-100
http://felinediabetes.com/insulin-conversions.htm

I was lucky enough not to have to use the 1/2 units, but when I did use the regular U100 syringes. I kept a printed photo of this taped to my bathroom mirror.. where I would get Pru's shot ready. There's actually a good tread about this, but I need to go back and find it for you! Hope this helps.

 

Hi Bone Daddy,
The people that are using the fine doses (.2 or .4 for example) are using U-40 insulin with U-100 syringes. Thus the conversion. Since you stated that you are using compounded PZI that is U-100, you can't do the conversion and get those fine doses. You can use the U-100 syringes with the half unit markings. And you can eyeball a .25 that is between the whole and half unit marking.

Welcome to PZI Land. I hope that Duke gets into some good numbers very soon.

 

Hi again! I've been reading your posts ... you've mentioned that your cat has "crashed." I'm not sure I know what you mean. Is that a low blood sugar event? It sounds like maybe from the treatment Duke has received that it means something else. For low blood sugar, a hypo, you can often just offer high carb food, or honey, or syrup, or even just regular food if blood sugar is just slightly low. Knowing the signs and treatments for hypo is VERY important. Or by "crash" do you mean that Duke went DKA -- diabetic ketoacidotic? That would make more sense with the syringe feeding and possibly the potassium issues. Did the vet tell you he had ketones? Is that what you were testing for with the urine test strips?

Either way, it is possible for your cat to recover completely and live a very long and happy life. Don't give up on him, you can do it.

You did say too, that Duke is a Maine Coon? That's a very large type of cat ... is Duke underweight? If so, lots of extra food is probably needed. Unregulated diabetic cats often need extra food of the low carb/high protein variety, and lots of water.

I know you have posted a lot of information in this and the health forum, but if you would create a profile and add a link to it in your signature along with your spreadsheet, it would help those who want to help you.

Anyone have that link to the profile setting up information?

 

Ele, thanks for clearing that up! I just read Donna's posting about u100 vs. u40 PZI and my head is spinning. Sorry BD!!! I should of caught that. ohmygod_smile

 

Hello Everyone, it's so nice to see everybody on board with this cat :mrgreen:
Kelly I also felt bad dissageeing with you earlier....it was just what I got from the story about Duke. I took the crashing and the hypo-ing to mean the same thing, thus, too high a dose. And many cat's get used to those high #'s and have a hard time coming down...but that does'nt mean increase dose necessarily.
I guess we all need more time to watch duke and his #'s to form any real consensus on what's happening.
I don't like the idea of chancing a hypo rather than ketones....I don't think Duke has been diagnosed with ketones and you can ride high much more safely than hypo-ing...
Bone Daddy to answer your original question....yes it can make a difference just upping your dose a smidge. .2 or .4 it's really quite rare to go up an entire unit at once.

 

Here's Duker's numbers:

PMP 515

Duke's behavior is normal. from what I've gathered, we should just ride this out w/o changing the dose and keep testing. He just came up stairs to visit while I'm typing this. He hasn't done this in a while. Of course my wife was here also since I was showing her Duke's spreadsheet and the your spreadsheets, which probably explains tonights visit

There's a lot for me digest in the last couple of posts. What I realize is that every time we went to the vet and were shown various blood tests or told BG levels, we never took any notes. At this point, it's all a blur. Our new vet had the tests from last week faxed to her. I'll get a copy next week and make a post.

I'll set up a profile this weekend.

I switched lancets to the BD Ultrafine II 33 guage lancets. Much better than the Walgreens lancets I was using. I tried one out on my finger and got an excellent drop w/o pain. Basically I just jabbed it into my finger. Duke gonna like them a lot better too. Our stick tonight took only 2 attempts. He flinched at first, but didn't yelp like he did with the other lancets.

I boiled some turkey legs for treats and snacks. We test Duke in the bathroom (following someone's advice I read about doing it in a dedicated room) and I would shake the bag to get him to follow me. Tonight I had some turkey in a dish and Duke followed my right in. I treated him before and after. I'm a little conflicted by the fact that Duke needs to eat, but when he eats a lot, his BG level goes up. My take based on what y'all have been sharing is that Duke needs to gain weight so feed him what he will eat. Is this correct?

In my hurry to get Duke tested, I left the turkey leg on the counter. When I came out Elmo and Tatiana were both on the counter top feasting on turkey like a bunch of vultures on road kill.

Duke was never a big cat. I don't think he ever weighed more than 10 pounds. Eight or so years ago, my ex roommate and his wife coaxed a feral cat with 4 kittens onto their enclosed porch. The Mom, Claire was a very small cat, even for being feral. When I got married and moved out, I took Duke, Tatiana and Elmo with me. Leopold stayed with Ron. (Ron had 13 cats when I first moved in with him, but that's a story for another time.) Elmo is a big brown mackerel tabby. He is the quintessential Maine coon. Duke and Tatie are torties. Duke has the M, the furry ears and feet, long whiskers, chirps like a canary but is a more slender beast. Tatiana has the longest, bushiest tail I've ever seen.

Is there a way to post pictures forum?

Next reading will be +6.

 

I saved an old post that may help you put the picture next to your name (the avatar) . I struggled with it, and so I wrote it down right after I figured it out ( in simple terms )

 

I saw Maine Coon and 7 pounds for a current weight (correct?) and thought wowsa! that's light! If 10 pounds is Duke's ideal weight, 7 pounds is still a ways off. Does he feel all bony?

If Duke's previous problems have been DKA, which is a potentially life threatening problem caused (in part) by prolonged high blood sugar, then you will probably want to check frequently for ketones using Ketostix (dip sticks for urine). If his "crashes" were hypoglemia, then you need to be extra vigilant for low blood sugar problems. If he has other issues besides the diabetes then those may need to be addressed too. These issues are very important and can affect how aggressively his diabetes needs to be treated.

When I'm at the vet and any tests or blood work is done, I try to ask for printouts. I never remember as much as I think I will. I'm usually too embarassed to ask them to spell those long complicated medical terms, but I wish I would. Even when I can repeat them outloud, I often can't google them when I get home.

Yes! Post pictures. When you are posting, below the save, preview, submit buttons, next to the "options" is "upload attachment". Browse for and choose your file. Then under "posted attachments", click on the "place inline" button. And your picture will be added to your post.

 

Thank you for the help. I'll try to get my avatar up (so far it has confounded me) tomorrow.

Duke's BG

+5 183

Spreadsheet updated.

Shot was given about 1 hour after eating. He ate his normal food well. It was almost continuous Thanksgiving the rest of the night. He had two pretty good sized bowls of turkey. Just now after testing he ate some more.

Those new lancets are like day and night compared to the old ones. Is there somewhere I can post warning about the use of the Walgreen brand ultrafine lancets? Of course someone with more experience might be able to use them with no problems. For those of us new to the hobby of BG testing, the BD Ultrafine II 33 gauge should be highly recommended.

He is bony, but nowhere near where he was. Duke lost a lot of weight when he was first diagnosed. He would gain some back, but when he crashed again (I'll use crash at this point just to mean ill hyper/hypo until I can piece together what was going on. I believe Duke has had episodes of both. I do know that early off we were told his ketones were high and he spent a few days at the vet. More on this later.) he would lose a little or stop gaining.

Good night everyone and thanks for watching.

 

Hi BD, You mentioned about his eatting and how important it is. I totally agree, and Duke should eat as often and as much as he wants.....however if you can avoid food for a couple of hours before testing you will get a more accurate picture of his true bg's. I would imagine he could go up 50 to 100 points after a meal, even a small one. He IS diabetic so not processing the way a normie cat would.
try to only reward the pokies rather than giving them before the pokie...may see an encouranging difference.

 

That's Duke in front. The cat behind is Chewie one of his old roommates.

 

very handsome boy!

 

5/29 PMP

Thank you. He takes after his mom (or maybe his dad, but we have no idea who that was or what he looked like just that he must have been quite handsome).

PMP 365

Spreadsheet updated.

There is no AMP for this morning. Both us of are battling the flu. Because of this, I only gave him 1 unit. We gave him 2 units tonight.

 

If you have vit d3 in the house take some. It is needed for immunity and will help you fight it

 

Vit E and C, we'll have to get some b3. We both feel a little better after sleeping most of the day.

5/29

7:00 PM after meal

PMP 365

+5 108

Several small meals of turkey through the night. He's eaten about 3 turkey legs plus meals since I cooked them up. He is definitely putting some weight on. I can feel it between his shoulder blades. His hydration is excellent using the pull up the skin technique. This has been a problem in the past when he is visibly ill. I am adding a little water to his meal.

We do not have any ketone test strips. I'll pick some up. I'm going to make an appointment with our vet for next week just for a look see. It'll be about 12 days since she first saw him. I'm going to ask her to run a blood panel (which she'll want to do anyway, right?)on him to see he how looks compared to last time. All in all, he looks great. He's grooming himself. He's acting pretty much like himself. His appetite remains strong. We remain cautiously optimistic.

We are scheduled to go on our honeymoon (3 years married) June 12 to Hawaii. Our pet sitter will come by twice a day and feed the cats and give Dukie his shots.

Thank you for watching over us.

 

Type : vit D3 & flu & immunity
into your google browser and you will get dozens of articles about how D3 strenthens your immunity from MANY things, including the flu.

or you could go outside and sit in the sun for 30 minutes

The ketostrips (ketones only) or Ketodiastyx (ketones and sugar) both cost about $13 & $15 for 50 which will last a long time. They are available at any pharmacy without a prescription, you just have to ask for them.

The 108 at +5 would have made me a little nervous, (Cody sometimes nadirs around +8)

How familiar is your pet sitter with any of this? Might be worth paying her to come for a "instructional 30 minutes" visit to give you some peace of mind. Any chance she could come midcycle just to check that everybody is OK? Also there are 2 & 5 meal timed feeders that could provide an extra midcycle meal if that would help.

Happy 3 years!

 

5/30 BG Cut back dose?

Thank you. It's been a great three years.

AMP 430 after feeding 7:00 AM
+ 5 54

spreadsheet updated.

Is this a serious hypo number? He is acting fine. Meowed and danced around when he saw the chicken can. Squirmed with gusto when I tried to stick him. Watched him groom himself.

Should we cut him back to 1.5?

We gave Duke some canned chicken as a reward and 2 Natural Temptation dry treats to give him some carbs. We will watch him closely.

Duke is a hard bleeder. I will get 2 sticks close together that look perfect and get nothing. Even though I rub the ear towards the punctures nothing happens. I think I may not be waiting long enough for it to bleed? If I hit really close to or actually hit the vein he bleeds nicely. I've watched the various how to videos numerous times. I'll be watching them yet again today. We are using:

BD Ultra-Fine 33 gauge lancets
by hand at a 45 degree angle.

I think I used the wrong name before. They are very sharp as my finger can attest to.

Our sitter has experience with diabetic cats, but we will have her over before we leave to talk to her about Duke and show her where everything is. I'll look into the automatic feeders.

 

BD,
I have NO experience with hypo, but I do not like the steep fast drop from 400's to 54 at all! IMO that is WAY too fast. I would be feeding him a HC meal if he were mine. There is a very good chance that it will DROP LOWER AFTER +5, and that would be too low. I believe the Prozinc studies put the average nadir at +7 of course every cat is different. I predict he will bounce back up in a major rebound next.

You did not put the dose that caused that on your ss. I would definitely cut it back, and get the ketodiastyx today. and get some gravy food in the house.

If you are leaving town in a week, I would be testing as much as possible to find out what is going on the whole cycle, in order to get data to decide what to do. Ie every 2-3 hrs. Next week there wont be anyone there to give a HC treat to slow a hypo. i always prefer to undershoot when I'm not home, than overshoot. Cody ran high for years and is still kicking. It depends on his tendancy toward ketones.(get the styx)

 

I too agree that is way too steep a drop to be seen at +5 already. Karo syrup is not in order yet, but I would give some higher carb food and/or treats. I would cut back to 1.5u for the next shot.

 

Some folks prefer the lower number ie 28 guage lancets because they bleed better with a bigger hole.

My best advice is if you have a lancet pen with a CLEAR top, use that. I rub his ear, blow at his face to make him shake his head, fold his ear over my finger, pick a pinkish spot, HOLD THE LANCET firmly on the pink spot for 5 seconds or so BEORE I press the button, and hold it there for another 5 sec after it shoots, until it bleeds enough. With the clear top you can see it bleed and know when you have enough to lift it off the skin. I never shoot anywhere near the edge of the ear. He bleeds just fine right in the middle of his ear. After I test, I always press on it to clot the bleed.

 

5/30 Update

Thank you everyone.

Dose was 2 units.

I looked for syringes calibrated in 1/2 units today with no luck. My pharmacist said he couldn't order any and recommended a medical supply store up the street. They won't be open until Tuesday. I'll also check there for a lancet with a clear tip.

I will don my magnify lenses and do my best to measure out 1.5 u for the next shot at 7:00 PM. I will do a PMP first and update my spreadsheet.

Duke continues to act normally. He's getting along fine. Jumping up on tables and window sills. Bright eyed. He is also very interested in the turkey smell permeating the house.

 

bone daddy, 1u, no matter how high you get at pmps. it will either be a bounce, or a result of HC you may have fed. we don't know if the 54 was the lowest he got. he WILL be insulin sensitive tonight.
IMHO duke is showing you he needs less insulin. please do not over react to a high pmps. it won't mean he needs more insulin but less.
and also why are you still testing AFTER feeding? or am i misreading? that would be an inaccurate #.

 

Do you have a Walmart or Sams nearby? Reli On brand 30 units or less U100, 31 guage 5/16 inch needle .3cc with half unit markings are supposedly good and inexpensive. and available mail order if you need, I'm sure.

BTW what meter do you use? If strip price is a concern (dah!) the Maxima meter available from Hocks (green box above) costs like $32 for 100 strips and the meter, and refills are $16/50 (or .32/strip - thats why I test so much) Its been reliable for me.

Even if he was acting ok I would have tested him again after the +5

Heres a link to 1/2unit u100 syringes from Hocks but I don't know anything about them
http://hocks.com/Merchant5/merchant.mvc ... de=A910291

 

My 2 cents ... I would have retested at +6 too. Just to see if Duke's bg was getting lower or staying the same or zooming up. He could be acting fine through all of those situations.

I would also recommend testing before the morning or evening meals.

Do you use a rice sock to warm his ears first? Warm ears make all the difference for us.

Happy Anniversary!

 

PMP 480

1.5 units

spreadsheet updated

I had much better luck with tonight's stick. I'm thinking I may not have rubbing it and giving it enough time to bleed. Or I just got lucky.

Thank you for the advice on not freaking out too much over high numbers.

We give shots at 7:00 AM and 7:00 PM so these are my preshot times . We feed at 7:00 AM and 5:30 PM. Should we move our evening meal to 7:00 PM? This would be no problem. But we are giving Duke small meals in between these times anyway. These small in between snacks really seem to be helping.

I've been doing +5 in the evenings rather than +6 because at 12:00 I can still get 5 hours sleep before I have to get up for work. I hope this doesn't sound too selfish.

We are both off tomorrow so I'll test +6.

I looked at our syringes with magnifying glasses and found that If I line up the bottom of the plunger with the 2 unit mark, it is as close to 1.5 as you can get.

We use a ReliOn meter from Walmart. Not really worried about the cost of strips.

It is amazing that Duke has gone from near dead on May 17th, to strong, bright eyed and bushy tailed today. At that time he was getting 3 units 2x.

Both Tatiana and Elmo have come up to visit. They both like to sit on the window sill with the window open - perfect for a 90 degree plus, humid Texas day.

Thanks again for all the advice. I want to apologize if I don't respond to questions immediately . It takes me a little time to take it all in.

I just looked up and Els and Tats were gone and Duke had come up and hopped on the window sill. Without building up too much false hope, I can't begin to describe how good he looks.

Hope everyone is having a quite, peaceful night.

 

Hi Bone Daddy,
See if you can get some U-100 syringes with 1/2 unit markings. I use Relion from Walmart. It will make it easier to use fine doses. At this post, there are pictures of different doses of U-100 with 1/2 units markings: viewtopic.php?f=9&t=157

I think most people feed the biggest meal at shot time. If you're feeding 1.5 hours before shot time, you might get an artifically high reading at pmps. You also want to make sure you have food on board when the insulin starts taking effect which is usually 2-3 hours after the shot.

As for spot checks, you need to do the time that works best for you. I usually get a +7 instead of a +6 so I can get 3 hours of sleep before I have to get up to test.

I hope this helps.

 

Thank you Ele and Blackie.

Artificially high values are what scares me the most.

 

I apologize if you already know this, but i cut it from the list of "jargon" on the board and it explains what happened to Duke today, and why we want you to cut the dose even though he had a high PMPS.

heres the link to the rest of the "jargon".
viewtopic.php?f=14&t=1124

BTW its probably time to start a new post for Duke.

 

New post starting

Thank you a new post was started.

6/1/10