Jan 6 AM pre-shot BG level 117 mg/dl (6.5 mmol/l), stalling, please help (3)

After a diet change, we did conclude Cedric still needs 0,5u insuline a day.

With the intention of administering 0,5u we just took an AM preshot test with the result of 144 mg/dl (8.0 mmol/l).

I'm hesitant to administer insuline now. What should I do?

Since we are adjusting a delayed schedule, I did already give him most of his meal. It already was 45 minutes later than usual, but there is still a bit left for if I need to inject insuline.

Our vet is closed on Sunday, so many thanks in advance!

 

@Bron and Sheba (GA) hi Bron can you give him any advice, thank you

 

We are going to take another test (1 hour later). If there is an increase, we will give 0,5u insuline.

Update: BG was increased to 178 mg/dl (9.9 mmol/l). Gave 0,5u insuline. Might be partly because he did ate a meal an hour earlier.

We should aim to get the BG nadir, @+4 to be in the greens with 5.5 mmol/l or lower, right?

 

Just seeing this tag. Reading thread Brb

 

I would get a + 2 to see how things are going. If you don’t see this post until later, get a test as soon as you can after the +2.
This test will give you an idea what Cedric might do this cycle

 

Hi @Bron and Sheba (GA), thanks for replying!

Do you mean +2 relative to the AM preshot? Or relative to the moment of administering insuline?

 

The time you gave the insulin becomes the AMPS. So it looks like you gave the insulin at +13 which is 1 hour after the due time. can you change the SS to say 0.5 @+13 please. Then we will know when it was given.
does that make sense?

 

Sorry, but I don't think I understand where the '+13' comes from.

Timeline Jan 5:
08:15 CET: Morning preshot test shows BG 8 mmol/l. No shot. Gave food. Waited one hour.
09:15 CET: BG test showed 9.9 mmol/l. Shot 0.5u.

So asking for a test at +2 should be done at 11:15 CET, right?

So on the spreadsheet, I fill in: AMPS: 9.9 (instead of 8) and empty the +1 value, right?

Since I stalled for an hour, and gave insuline one hour after the due time, the value in U is already correct with '0.5@+1', isn't it? I don't understand why you mention '+13'.

 

When you give the insulin it is AMPS or PMPS. You then start counting the hours after the shot as +1 , +2 etc. when you get to +12 that is when you usually give the insulin. But if you don’t give the insulin for another hour it becomes +13 because it is 13 hours since the last dose of insulin. If you didn’t give the insulin until 14 hours after the last dose of insulin, it would become +14. That tells everyone that the insulin was given an hour later than normal if it is +13 and 2 hours later than normal if it is +14.
You then start again with the +1 which is 1 hour after the latest dose of insulin was given.
So in the U column you put 0.5 @+13 and in the AMPS column you stack the numbers and under the 8 @+12, you put 9.9@+13
Does that make more sense?

 

I see you have fixed the SS. Great!
And the +2 is 8 (144)
I would get a +4 to see how low the dose takes Cedric

 

Okay, got it! That makes sense. I've updated the spreadsheet.

Since we skipped insuline on January 3th, that adds 24 + 12 hours = 36 hours between the last administration on January 2nd PM and January 4th AM.

The number is 8.0 mmol/l (144 mg/dl) @+2.

Update: Just saw your reply! You are quick! Yes, I will do a +4 test.

 

I will probably be asleep at the +4 but if you are concerned post and ask for help.

 

The +4 is 4.4 mmol/l (79 mg/dl)

That's alright @Bron and Sheba (GA), I appreciate your support! It would be nice if this would lead to some sort of conclusion, but maybe another member can provide that as well.

My own understanding from this is that 8 mmol/l is a safe preshot value to shoot 0,5 U. So no need to stall again.
Do I create a new topic if a preshot value is below 7 mmol/l?

Also, with his new diet, a small dosage of 0,5 U gets Cedric in the greens on BG nadir.

So I will continue with 0,5 U twice a day. That's a reduction of a total of 2 U insuline per day, just by switching diets. I know it's a bit to early to know if these number stay stable, but I'm happy to see this positive effect.

 

@Bron and Sheba (GA) hey Bron it's Diane thank you for helping this member, I'm the one who tagged you, thanks so much

 

So guess what. It's 7.30 PM, Cedric's usual evening meal time.

It's been more than 10 hours since his last shot and since Caninsulin is an insuline type of short duration I reckon most of it will be out of his system by now.

So I did a BG test at +10, with the beautiful result of 6.5 mmol/l (117 mg/dl).

That must be too low to shoot right? So stalling again?

We will do a second test at 8.00 PM to see if the number is rising or dropping. Did not feed him anything this time.

The question is of course: When is a number high enough to justify giving insuline? We are using a VetPen, so 0,5 U is as low a dosage as we can go.

A cat must eat at some point this evening, so I can't keep holding his food back from him. Eating very late is also not a good thing.

So I can feed him, skip the insuline, and test at +12. But if the BG has risen to above 11 mmol/l at +12 or +13 and I give the dose at that moment, I just keep further delaying his insuline cycle...

 

BG test at +11 is 6.9 mmol/l (124 mg/dl)

Probably too low to shoot 0,5 U, so skipping. Gave Cedric his evening meal, a cat must eat at some time.

We will do another test before bedtime. Don't really know what to expect.

Update: BG at +13 is 10.4 (187 mg/dl).
This is the last test we can do today.

 

BG pre-shot test for Jan 6 AM is 6.5 mmol/l (117 mg/dl). This is 23 hours after the last dose!

Had to go to work, so gave him his meal, but skipped the insuline. Have no time to stall.

Will ask my girlfriend to try to get a +3 by herself.

Feel bad about withholding insuline from a diabetic cat, since he is not in the green numbers by himself.

 

@MrWorfMen's Mom
Are you able to help with dosing here Linda?
Don’t feel bad. 6.5 (117) is too low for you to give caninsulin especially when you have to go to work.
Hopefully Linda will be able to help you

Did you test again after the 4.4 last night?
If you get a lower number like that during the cycle, always test again to ensure the BG is going up not down.

 

Saw in one of your previous posts that you are using the Vetpen and thought you could not give less than a 0.5 Unit dose of the Caninsulin. The Vetpen itself only allows 0.5 Units as the smallest dose. But there is another way to get smaller doses.

Even with the Vetpen that you use, you can withdraw insulin from the cartridge with an insulin syringe. You would not be using the pen needles. You might want to consider using insulin syringes so you could withdraw 0.25 Unit doses. You may need to learn how to micro-dose even lower than that.

You will need to look for U40 insulin syringes. Your vet may have them or you might find them on-line.



Just an idea for you to consider.

 

No I didn't test again. I thought green = good. We did observer his behavior and there were no signs of a too low BG.

Will do a second test next time when hitting these numbers.

Well I'm a bit scared of needles, and was really nervous to even use the VetPen. I'm not looking forward to it, but if we keep skipping doses, it might be the only option.

Thanks for providing that instruction video. I'll discuss this with our vet.

It appears Cedric is not able to regulate his BG down to normal levels (between 4 and 6 mmol/l) so I don't want to keep skipping shots. Giving 0,5u is probably too much when is pre-shot is 6.5 mmol/l.

A dose of 0,25 would lower the no-shoot treshold significantly, wouldn't it?

 

Green is good but always test again to see the BG is going up not down.
Observing behaviour alone for signs of a hypo is very risky because a cat can drop really low and not show any signs of a hypo. Once signs appear they are usually dangerously low. That is why it is always so important to test, and you can intervene with food to bring them up safely.

 

Cedric is doing great but his numbers are still a bit high indicating he still needs some insulin support but dosing would be more consistent without skipped shots if you could get syringes with half unit markings so that doses less than 0.5u can be given. U40 syringes are available with half unit markings or if easier to obtain, (don't know regulations regarding syringes in the Netherlands) you could get U100 syringes with half unit markings that will allow even finer dose adjustments using the conversion chart we have available here.

Lowering the no-shoot threshold can be employed along with the lower doses as kitty's BG improves but lowering the dose doesn't necessarily lower the no-shoot threshold. That is done gradually to ensure kitty's safety.

 

Yeah, I can probably order them online. I'll discuss with my girlfriend and consult with the vet first.

It's difficult to escape this catch-22 situation. Evening pre-shot at usual dinner time was 8.5, below no-shoot treshold. It was getting late, so I gave part of his meal.

I had a small argument at home as I explained what I thought we had to do: Wait for an hour, test again and if administer if above 11. Then stay up until nadir at 0.30 am (+4) to check if values don't get too low. Because of our jobs, this was no option. My girlfriend wanted to administer 0,5u right way. I told her that's more risky and we need to test at both 23.30 pm (+4) and 0.30 am (+5). So we decided not to shoot. Again ...

Did another test at +1 with BG 9 mmol/l. Small increase, makes sense after eating something, but still below 11.

We will do a last test before bedtime to see how far his BG has risen.

Even if I had the U40 syringes to give a 0.25u dose, it would not have made a difference if the no-shoot treshold is 11 mmol/l. Do I really need to wait until I see such a high number on the meter again?

 

You can lower the no shot threshold but right now doing so with Cedric without reducing the dose below 0.5u is very risky. Vetsulin pulls BG down quickly and steeply so lowering the no shoot number could cause BG to drop to unsafe levels. When you shot 0.5u at a pre-shot of 9.9 on the 5th, BG dropped to 4.4 which is low enough and a little lower than recommended so you definitely don't want to be trying the 0.5u dose for any pre-shot less than about 175 and even then, I'd make sure you can monitor. What happened on the 5th was fine but the next time you shoot that low a pre-shot, the result could be different. Until you are able to see the same result numerous times, you need to make sure to monitor and even then, these furry wonders are known for throwing curve balls. For that reason, we recommend erring on the side of caution.

Cedric's BG is decent. He's below renal threshold and a lot of vets would consider that good enough for now. We try to get kitty's BG down a little lower so their pancreas has more of an opportunity to heal and resume it's job but it's not safe to try to force it. I'd definitely look at getting syringes so you can drop the dose.

 

Many thanks for thinking along with us. We are calling the vet tomorrow and ask for the possibilities for lowering the dose.

 

We consulted with the vet today and asked for the syringes to give a lower dose. We were told that it looked like Cedric was going into remission and that we could stop giving insuline. We were asked to test his BG in the morning every few days and report back next week.

The vet told us that giving a smaller dose is not something we have to do right now, although syringes would indeed provide the option to do so. With syringes it would be difficult to consistently give the same small dose. Personally I think that with U100 syringes, this would be doable, but sure.

We are going to go with the advise of the vet and stop the insuline for now. We will closely monitor his BG levels and decide in a few days again if we are getting the syringes ourselves or wait until next week.