9/26 - AMPS 392 (+24 hrs since last shot) - Adjusting dose

Hi all-
I posted on the main forum and need some guidance regarding my cat's insulin dose for tonight.

Joe was diagnosed diabetic on 8/17/2016. At that time, the vet started him on 3U of insulin BID. We started him on Lantus. On 9/1/2016 he did a glucose curve at the hospital where I work (that's also where his doctor is) and it went something like this:
1. Pre-shot AM - 470
2. 4 hours post AM shot - 250
3. Pre-shot PM - 350

At that time, the vet decided to increase his dose to 4U BID. We started him on that and he has been on it since that day. This weekend I chose to do a "curve" at home and here's what I found:

1. Pre-shot AM - 270
2. 4 hours post AM shot - 58
(Gave 1/8 cup Royal Canin Glycobalance and packet of Fancy Feast Broths (1.4 oz) mackerel & vegetables)

At that point, I posted on the boards and have been monitoring him at 15-20 minute intervals since. Here's how it has gone. (I will also note that at one point (measurement #2) I noticed since it was a new glucometer that the code was incorrect. It read "14" and should have read "08." I changed the code & continued the readings):

3. +15 min - 60
4. +15 min - 45 (this is when I changed the code)
(Gave 1 packet of Fancy Feast Broths (1.4 oz.) chicken & vegetables + small amt. of Karo syrup on gums)
5. Immediately following (code change & food) - 71
6. +15 min - 110
7. +15 min - 113
8. +15 min - 103

I am unsure at this point how to proceed with his shot this evening. He is to get it in about 3 hours. Please let me know your thoughts.

(I apologize in advance if I am slow to respond. I am trying to test my cat and study for an exam and respond to posts. Thank you in advance for your patience.)

 

Good for you for home testing! It's the only way to kelt keep a diabetic kitty safe. And good for you for posting, you still have quite a bit of time before the shot. Someone will come along who can help you decide what to do. For sure, you will want to reduce the dose. Do you have plenty of strips? What meter are you using?
Liz

 

Hi Liz!
I do have plenty of strips (for now...) I may have to run to work to get more. Thankfully we are close by so I can go grab some. We use the AlphaTrak2.

 

Hi Kirsten, how much does Joe weigh? What is his ideal weight? And what are you feeding him? Sorry for all the questions but they factor into our decision.

Good job handling the lows today so far.

 

Wendy will help you decide what to do, she's a very experienced member and will give you excellent advice. Very fortunate that you work in an animal hospital!

What does Joe eat?
Liz

 

I have to go out for a bit to move an outboard motor, but will be back well before your shot time.

 

Thanks for your encouragement! I couldn't have done it without the help of folks on here...

1. Joe currently weighs 17 lbs.
2. Ideal weight 13 lbs., which is what his doctor based his first dosage on.
3. Eats - He was prescribed the Royal Canin Glycobalance dry because he has always been a kibble eater. He gets 1/4 cup of that AM & PM with his shot.

I have been adding in some Primal freeze-dried wet to the dry food for about a week now. He seems to really like it. My goal was to start home testing and use that information to get us on the Primal freeze-dried entirely. Been trying to transition all of my cats to it because I've read such good things about it.

 

Let me guess: 3 orange boys?
Liz

 

Haha... Yes!

 

Great plan to transition the cats to something other than dry food. If no one has directed you to this site, Lisa Pierson, DVM has wonderful information on her website about feline nutrition and there is also information about transitioning a cat from dry to canned food.

Generally, we use a weight based formula to establish the starting dose for Lantus. The formula is: initial dose = 0.25 x ideal weight in kilograms. So for Joe, his starting dose would have been approx. 1.5u. That amount of insulin does, however, presume a cat is on a canned food diet.

It's entirely possible that the lows you're seeing today are a result of the switch over to more of a low carb diet. Low carb (LC) can make a huge difference in how your cat responds to insulin. We've seen any number of cats go into remission very quickly once their diet eliminated the dry and/or high carb (HC) food.

There are two dosing methods we use -- Tight Regulation (TR) Protocol and Start Low Go Slow (SLGS). Both methods are described in the sticky notes at the top of the board. Because Joe is still eating dry food, your only option is SLGS. Given the low in the 70s, you would want to reduce his dose by 0.25u.

It would also be very helpful if you could put together a spreadsheet. This will allow you to track Joe's progress in a concise way and will give us the information that will allow us to quickly give you a hand if you want input.

 

Thank you so much for your response. Joe always ate dry kibble for the most part but has been on grain-free high protein dry food his entire life. We had him on Blue when he was younger and then we moved him to the Nature's Variety Instinct for a while. Then most recently we tried Orijen and Annamaet. Would a change to the Royal Canin Glycobalance make this kind of difference? I don't understand how that food could be better for him and make his numbers switch over any of those other foods.

I am very familiar with Lisa Pierson's website. I have read it for years and have played with my cat's diets, only now after having more trouble with my one cat's hair balls did I try the Primal freeze-dried re-hydrated with Honest Kitchen's Pro-Bloom Dehydrated Goat's Milk. They all seem to love it.

So you're saying to reduce his dosage by .25u. Does that mean I give him his normal shot with his food at 8pm tonight, when he usually gets it? I'm so concerned about his levels!!!!

 

The Glycobalance is approx. 29% carb. Just because a food says it's high protein and grain free doesn't mean it's low in carbs. There can be potatoes, fruit, etc. that drive up the carb count. The Glycobalance ingredients include corn and wheat gluten, tapioca, and barley -- all are high in carbs. So the quick answer to your question is yes, transitioning to the Primal means you are removing a source of VERY high carb food which can cause a sharp drop in BG number. I don't think it's the difference in the dry food that has cause the lower numbers -- it's the introduction of the Primal that is influential (IMHO).

I would suggest you test and post with Joe's +11 number so we can help you assess if it's safe to shoot. I'd suggest that you put something in your subject line (change the subject in the first post in this thread) to reflect that you need help re your PMPS shot.

 

This is the link to the original posting:

http://www.felinediabetes.com/FDMB/threads/first-time-bg-curve-at-home-58-mg-dl-just-now.165590/

I have suggested that all posts be now done on this thread to avoid any confusion with advice.

 

OK, so you're saying I should post a new thread in the Lantus forum saying "Need help with PMPS"? I'm a newbie, forgive me.

 

Changed the title. I think this is what we need here...

 

No just us this thread for your posts. There are people giving advice on both threads and it could get confusing if different advice is given on the different threads.

 

Let me give a little history re: this number, however. I have been giving him small amounts of brothy food consistently (mostly because I'm a newb and don't know what I'm doing)
+9.5 - 103 (Gave 3 crunchy naturals treats & 2 tsp. FF Broths)
+9.75 - 91 (Gave 2 tsp FF Broths)
+10 - 100 (Gave 2 tsp FF Broths)
+10.25 - 105 (Gave 2 tsp FF Broths)
+10.5 - 108 (Gave 1 tsp FF Broths)
+10.75 - 118 (Gave no additional food)

 

What does PMPS mean?

 

Oh good that 118 looks good.

 

Pm preshot. Amps is your morning (am) preshot.

 

PMPS is the PM (evening) preshot test number AMPS is the AM (morning) preshot test number All other numbers are shown as the number of hours since the shot...+2 +3 +5 etc

 

I started reading the abbreviation page... All of this is really overwhelming. Thanks for being kind to newbs.

 

@Wendy&Neko @Sienne and Gabby (GA) all current information is being done on this posting. Since both of you were assisting with deciding the PM dose I thought I would tag both of you so that you both have the latest information.

Thanks

 

We were all newbies once. It took me months of reading and following before I felt comfortable posting.

 

+11.25 - 115 (No food given)

 

Joe seems nice and safe now so I'm going to head off for a while. These fine folks who are more familiar with your insulin will be really helpful in deciding on the best dose.

You did an awesome job testing today!!! High five!

 

BTW a little neosporin on Joe's ears will help them feel better after all the pokes today. What a good boy.

 

You're so awesome, thank you a million times for all of your help. I appreciate it so much. HUGS

 

And thank you for saying this... His little ears are really sore right now.

 

I assure you they heal up quick.

 

Will post a +11.75 number but given the above information, how should we approach his PM shot? He's due now to eat and get his shot and I am unfamiliar with how low is too low to shoot. I know there are guidelines and I just haven't read them yet. Please help.

 

Here is your previous thread on Health, for those following along: http://www.felinediabetes.com/FDMB/threads/first-time-bg-curve-at-home-58-mg-dl-just-now.165590/

Sorry, time for more questions. Were there any complications when Joe was diagnosed, such as DKA? (diabetic ketoacidosis). How much of his food is primal vs. the "diabetic" dry food now?

I was suggesting shooting 1/2 hour later today, cause you gave food at +10.5 and we want that food to be cleeared out of the system to see what his non food influenced blood sugar is. You can get back on schedule by moving shot times up (or back) 15 minutes a cycle (2 cycles a day) or 1/2 hour once a day.

 

When you are stalling like this, you need to also not feed him. Sorry.

 

+11.75 - 124

 

He had no other complications, no DKA diagnosed. I was only giving him a small amount of the primal (like 0.2 of a total serving) mixed in with his full serving of Glycobalance (1/4 cup) BID.

 

I'm so sorry, I'm unclear about how to move forward right now. As of right now, it's been 1hr. 20min. Since he had any food and he is at 124. Do we give him food now and delay his shot? Also, how much do I give? 3.75u?

 

It will depend on what his BG (blood glucose) is at shot time. You have to delay both feeding and shooting by 1/2 hour. Normally people here will test, feed, then shoot, all within about 15 minutes. If he doesn't come up significantly, you may be skipping the shot tonight. For people who are new to testing and following SLGS, the Sticky Note on the Start Low, Go Slow Method says:

How to handle a lower than normal preshot number:

In the beginning we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.

• Below 150 mg/dl (8.3 mmol/L), don't give insulin.

• Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.

• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.

• In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.

• Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.

Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

Since he seems to be coming up very slowly, I don't know if he'll make it over the 150 mark. On the Health Forum, we suggest to new users that under 200 they skip, until they gather enough data to know it's safe to shoot those numbers. People here will shoot much lower numbers, but only when they've gathered the data to do so. If you skip, you would start your new reduced dose tomorrow morning and can do it on a time frame that suits you.

 

@Wendy&Neko , Kristen is questioning the dose also. I think you suggested for her to reduce the dose to 3.5 but, it just seems like he was started way to high of a dose. What do you think of a restart back to 1 unit or 1.5?

 

Thank you very much for all of your help. I'm sorry I don't have all the information necessary for y'all to help me with the best information, but what you did post here was very helpful. Since he was 124 at +11.75 I think we will feed and not shoot and then measure in the morning before his morning dose. These guidelines are really helpful, thank you.

Again, I'm sorry for my urgent posts but going through this the first time is terribly stressful as I know you all know. Thank you again.

 

After today will be starting a spreadsheet for sure.

 

He's on dry food, just started seeing greens (albeit too low) on 4.0 units. I think cutting back that low is too much of a reduction. As Sienne stated above, for Joe's weight, he would start on 1.5 units if eating an all low carb wet food diet. Dry food makes a big difference.

If you can get that spreadsheet going, that'll be the best tool for us to help you. If you have problems with the spreadsheet, we have people who can help.

We all know how stressful the first time lows are. I was "lucky" in that it took months before Neko gave me her first low, so I had plenty of time to read threads from others to see how they handled it.

 

Kirsten, you are doing a SUPER job! We are all very proud of you and what you've done today. Feline diabetes is a tough disease, kudos to you for taking such good care of Joe. You'll figure it out as you go along. It's a marathon, not a sprint.
Liz

 

Since Joe is a kibble addict can I suggest you go to Youngagainpetfood.com and ask them for a free sample of the Young Again Zero carb dry food. I credit this dry food with my cats quick turn around and remission. It is less then 1% carb. I feed my cat 1 1/2 -2 ounces of wet fancy feast classic pate in the morning and evening and let her free graze on Young Again Zero carb any time she wants. It's amazing. An 11 lb bag is $50 but lasts about 3 months with one cat eating it... It's nutrient dense and high calorie so they eat less of it then regular dry food.


If you look at my spreadsheet you can see where I started feeding it and how drastically my numbers changed.

 

Well it sure helps knowing this community is here. We couldn't have gotten through the day otherwise.
At +12.5 he read 142 so we fed him and did not shoot. We will test him in the morning tomorrow and depending on the result will shoot based on the information above. I will also talk to his vet tomorrow to tell her what all went on.

We will most likely dose him at 3.5 tomorrow morning - does that sound reasonable?

 

Thank you so much. I'm sitting here in tears because my husband and I are both facing deadlines and it made today a bit different than I had originally anticipated. But I LOVE my cats and will put anything aside for them... It's just stressful when you have no idea what you're doing. I know you all understand, so thank you for being there.

 

THANK YOU Janet!!! I have been on a journey these past few months to find a dry food that would be good quality but also super high protein. I don't understand how Young Again can be a dry food with 1% carbs but I will definitely look into it... Joe likes Fancy Feast (as we found out today) so we may try that with the dry food as you suggested. They need that moisture, which is my biggest concern. Working at a vet hospital I see so much feline diabetes, blockages, urinary crystals, you name it... All because (I believe) we feed our cats inappropriate diets. This is also why I've been exploring the Primal freeze dried. It's a very convenient raw diet. Anyway... I should get back to studying... I can't thank you all enough for your help and support today.

 

@JanetNJ, your spreadsheet is awesome. I'm going to start one ASAP because information gives you control and I need that right now. Today was too much of a heart-wrencher for me... Can't say thank you enough to you all for your help.

 

Exactly. The spreadsheet is a very powerful tool. Helps you feel more in control to make educated decisions. After a few weeks I could predict with fairly good accuracy what each dose would do and had very few surprises. If I hadn't started monitoring her at home and keeping records there's no way she would be insulin free right now.

 

I love it... I'm definitely going to look into the YA food. Now to read all the threads about how to make your cat not hate having his glucose checked.

 

A treat after every poke is a good one. Pretty soon, they will all come running when they hear the great bag.
Liz

 

wow, you really had a day today! The best thing I can tell you is that everything gets easier when you know more. Yes, an appropriate diet makes a HUGE difference with cats, so if you are changing from a regular high carb dry food to anything lower in carbs, it's going to mean that he will need less insulin. Testing is your key to being able to both keep him safe and to know what to do with the dose.

I want to give you this thread, "Where Can I Find?" It can serve as an index to help you find information on this site, as well as links to good infor elsewhere. The second half of the first post is mostly saved discussions on helpful topics. Specifically, in the lower part of the first post there is a section on starting out with a diabetic cat. The last line has links to several things that will help you with getting successful at testing and shooting. And by the way, most people buy the neosporin ointment WITH pain relief. That's what takes the owie out of the ears after poking.

Starting out with a diabetic cat:
A New Member's Advice to Other New Members
Counting Cycles
Dawn Phenomenon
Expectations, Why You Should Manage Expectations
Pet Specific Glucometers, discussions about pet meters vs human meters: spreadsheet conversions: Pet Meter to human glucometer spreadsheet and AT/Merck value spreadsheet ; Low numbers on pet glucometers
Lantus, repackaged by Wedgewood Pharmacy
Reductions and starting OTJ Trials
Shooting Schedule, getting back on time
Somogyi, latest research disproving its existence: ; Somogyi, Bouncing, Overdosing, Charlie
Spreadsheets: Whole Cat Report and Spreadsheets, Spreadsheets - Jigsaw Puzzle Analogy, Coleman: Adding a new year to the ss
Testing & Shooting Tips: here and here ; Dosing with Calipers; Preventing Overdoses
​

Glad to have you here! I, too, am partial to orange kitties.

Get your spreadsheet going as quickly as you can - it's an invaluable tool. Welcome to the group!

 

Hey everyone!
Thanks again for hanging with us yesterday. Yesterday was a big day for us and we learned A LOT in a very short amount of time. Couldn't make it without the support of this group, so I'm indebted.

We're getting close to Joe's AM shot and I'm unsure what to do about his dosage at this point. @Wendy&Neko suggested reducing by 0.25 to make it a 3.75u dose, but I'm worried it's still too high and I won't be able to monitor today as I have class and work. I can do an AMPS and a +6 but don't have the flexibility to intervene if necessary and I'm still unsure about how Lantus builds up over time (does it? I didn't have time last night to do that research). Another person on the other board I started under Feline Health suggested doing something like a "re-boot" and starting over at 1u, then measuring to see how we do. I suppose that's a bit dramatic considering we started at 3u and didn't have much success prior to. I'm also wanting to get him on wet food (have been trying Primal freeze dried for all the boys and mixing a little in with Joe's dry Glycobalance every day) but can't do that until I've got time and got him better regulated.

So all that said, I'm feeling a decrease to 3.25 right now may be in order. Then I can test and post numbers and gradually increase instead of play with the potential of TOO LOW numbers when I can't be home to intervene. Anyone have any thoughts on this?

Many, many TIA,
-Kristen & Joe

 

THANK YOU for this! It's very helpful and I've already read a few things this morning. For right now, since we need to get him regulated on his normal food, I'm going to stick with the dry Royal Canin Glycobalance and look at getting some samples of the Young Again ZERO Mature as suggested by @JanetNJ. JoeJoe's always been a kibble addict but of late I've been trying to get him on some Primal freeze dried which he seems to like, but I can't fully make the switch until I have a little time at home and can monitor him closely to see what it does to his levels.

Anyhow, thank you very much for this helpful index. I'll be perusing it this morning to find advice on how to reduce his dose!!!!

 

Have you done a glucose reading yet this morning. It should be done when there has been no food given for at least 2 hours prior

 

Also it would be most helpful to add the type of meter you are using to your signature...pet or human? since advice can be different depending on the meter type

 

Later today when you have a chance getting the spreadsheet set up will make a big difference in being able to read trends and get a clear picture on how the insulin is working. When you are ready of you need a hand with it just ask. There are a few "spreadsheet gurus" on here that can get you set up in no time at all.

 

Hey, Mary Ann. Thanks for responding! I have the link to the template and information about getting it set up. I was too exhausted yesterday to actually get it going but I plan on it ASAP. Added the meter to my signature, realize that's very important.

I was going to do a reading just before his shot but I suppose now is a good time. I'm pretty sure he hasn't eaten anything in a couple of hours. Will post AMPS as soon as I get it.

 

A quick recap: Readings done on AT2 pet meter

Yesterday

AMPS 270 4 units
+6 58
were able to bring up the numbers with food and syrup

PMPS 124 no shot given

 

Just about. It was +6 - 58 and were able to bring up numbers with food and syrup.
PMPS - 142, no shot given

 

Thanks I will go back and correct it. A recap is useful if someone new comes into help, so that they don't have to read through all the posts

 

So here's the full story -
Readings done on AT2 pet meter:

Yesterday, 9/25
AMPS - 270, 4u
+6 - 58 (brought up numbers w/ food & syrup)
PMPS - 142, no shot given

Today, 9/26
AMPS - 392

 

That's great, thank you very much for doing that.

 

It does, Lantus and Leve are depot insulins, here's a link to the sticky, it will probably answer loads of your questions. Skipping the shot last night will have drained the depot so in theory you won't get the full effect of what you shoot this morning for a few cycles (upto 6cycle, though sooner in some cats, it's a case of Every Cat is Different)(ECID)

I would tend to agree with you, I think 1u would be taking it a bit too far, and might set his BG back.

 

Thanks for the update.

The higher AMPS number was totally expected because of the lower 58 yesterday and with no shot last night. This is what is typically called a "bounce" where the body releases stored glucose (glucogen) in response to a rapid drop in numbers or a drop into lower ranges than it is "used" to. This can bring higher numbers for up to 3 days ( 6 cycles) until the extra glucogen clears the system.

It was already suggested that you drop the dose from 4.0 units to 3.75 units. With the bounce happening this could be a safe number, since the higher levels should prevail through this cycle. However once you get your spreadsheet set up and the data entered, it would be good to revisit the dosing ranges. The starting dose of 3 units is actually a little high and if testing was done at a time like today, when there is a bounce happening then it certainly could have looked like not enough insulin, whereas yesterday showed a decrease was needed.

All in all you should be safe with the 3.75 units for this morning, but I would really like for you to have further discussion on here once your spreadsheet is set up, before you continue on with this dose.

Do you leave a bit of food out during the day? If you end up changing to a lower carb dry food...still keep pushing to get Joe eating wet food....you will need to be extra careful with the dosing. A drop in carb content can certainly affect glucose numbers.

 

I was trying to add more to my comment but my computer froze. Often when a reduction has been earned but the next preshot shows a big bounce in the numbers, people will "shoot through the bounce"...that is give the same dose for ONE more cycle to help ease the higher bounce numbers down a bit. Since the 4 units was definitely too high, the 3,75 unit that Wendy suggested should be fine for your morning dose.

Do check back in when you get your +6 reading and post the results. Have a great day!

 

Thank you, this is very helpful. I understand what you mean about getting through the bounce. Then I assume we may change the PM dose based on what the +6 and PMPS tell us today. You've been awesome, thank you. You have a good day as well!!!

 

Yes I personally am not comfortable with a starting dose of 3 units then going up to 4 units. With more data it may show that a lower dosing should be done with a slower increase schedule, but that all remains to be seen.

 

Hey, Kristen, again, you did awesome last night and Joe is one lucky kitty to have you on his team. Just wanted to say that Young Again is a big hit with my orange boys and helped me get them off the dry. Now ,they get it as a treat and recently when Bubba was sick and wouldn't eat, he would eat YA. The company is in MI and their customer service is awesome . A bag is pricey but last a long time as it is very protein dense and an average size cat eats only 1/3 cup a day.

After I knew they would eat it (they loved it!) I put some of it in my Magic Bullet and ground it up and started sprinkling the ground up food over their wet food that I wanted them to start eating. It worked like a charm and after doing that for about a week, I stopped sprinkling the ground YA and they were eating just wet. Hope this helps you.

 

This is FANTASTIC feedback... This is my goal as well. I see tremendous results so far just on this message board with this food, so you can bet I will be getting some. Hopefully I can get my other boys interested in it as well. Your transition tips are excellent and I have been trying to make the transition with my boys but maybe have been a little fast with some of the changes... I need to read more in the food forums but I have known about Dr. Pierson's web site for a long time and have done a LOT of research on appropriate food for cats. I believe we're getting there.

I'm kind of disappointed in the vet community at this point that they still prescribe "diabetic prescription foods" for these cases - particularly the dry. BUT that is an entirely different can of worms. If I get into vet school this is one of the areas I'm really passionate about - I hope I can make a difference...

Anyway, THANK YOU a million times for all of your help.

 

I love that you want to concentrate on feline nutrition when you get into vet school. What a great service that will be!

 

I like that WHEN...

 

Guys... My spreadsheet's up!!!!

 

Ordered a 4lb bag of the ZERO Mature. Will let you know how they like it!!!! Thanks for the awesome suggestions, everyone!

 

Good job!

 

Excellent on the spreadsheet! That will help a lot, you and everyone else. Go, Joe!
Liz

 

GREAT JOB!!!

And bonus kudos on the great notes you are entering!!

 

Hi Kirsten and JoeJoe. I see you made it to this forum and are getting great advice already. Spreadsheet looks good, I enter remarks every day so I can look back and see what I did on particular days, it also helps me interpret what is happening more easily. Good luck - you did great yesterday, one day you will have a chance to pay it forwards just as we all do. I'll keep an eye on your progress.

 

Hey everyone! I don't know who may have been able to take a peek at Joe's spreadsheet, but his +7 number was still pretty high. Kind of confused by that! Could it be because of his bounce? Also, his vet recommends we drop back down to 3u and see where we go from there. Any thoughts?

 

That +7 is very normal with a bounce. Quite often you will see high numbers in a flat line for a period of time. Some kitties can "clear" a bounce very quickly in a day or less, some take up to 3 days to clear. I like the idea of dropping back to 3 units. I feel much more comfortable with a bigger reduction after the drop yesterday and now with the spread sheet up it will be easier to track trends with the doses being used. As many tests as you are able to get would be great. Always a test before the shot and another at mid cycle if possible. Good work!!

 

Hi Kirsten - great job on getting the spreadsheet up! There are a couple of reasons Joe is still high later in the cycle. First, he's bouncing and bounces can take up to 6 cycles to clear, especially when kitties are newly diabetic and used to higher numbers. And second reason, the skip last night messed with the depot and it has to build again. But that's OK, that was the right thing to do at that point. His numbers will come down over time. The one interesting thing to note about the bounce, is that it can happen anytime kitty goes lower than they are used to or of their numbers drop quickly. And are one of the reasons we believe in home testing. It's possible for kitty to be high and bouncing when they go into the vet for a "curve" and you don't want to based doses on those temporarily higher numbers.

As for dose for tonight, it's important to pick a dose and stick with it for at least 6 cycles, unless kitty goes low again, for the depot to stabilize. If you want to pick 3 units, that's your call. It's what you have to feel comfortable with. No right or wrong answer. It is easier to go up in dose when you are new to testing than to constantly be fighting low numbers. On the other hand, he did earn a .25U reduction by the dosing methods we all use here. With now being able to get mid cycle tests at home, where Joe will be less stressed, you can determine what a particular dose is really doing for him, whether it be 3 units or a bit higher.

One other data point to consider, when kitties spend a lot of time in higher numbers, their bodies get used to it. It's called glucose toxicity. It sounds worse than it is, but it does mean you have to go a little higher in the dose to get them out of the higher numbers. And it's not until a cat's body is used to spending time in lower numbers than they'll stop bouncing as much. My Neko still bounces, just not as high as she used to.

And one last thing, if you can get any of the blood sugar values from the vet when he was in getting curves, it might be a useful addition to the spreadsheet.

 

PMPS 279 this evening.
We're going back to 3u, at least we'll be able to increase more slowly than just making a huge jump to 4u.
Will keep numbers coming on spreadsheet! Thanks again everyone for the help yesterday.

P.s. @Wendy&Neko, I updated the SS with his curve from the hospital!

 

Not a bad preshot.

 

One word on the vet curve... The numbers are almost always higher at the vet because of stress.... Sometimes by 100 points or more. That's why home testing is more accurate.

 

I think you would've been ok just going to the 3.75u . . . but you're here at 3.0u now, so just stick with it. When you are new, it is easier to have to go up in dose rather than come down in dose. Because changing doses changes the depot and it's a bit like rocking the boat, sometimes we'll suggest that you stay with a dose rather than change it too often.

When a person comes here with a higher than typical dose, I'm always cautious about people automatically saying that the dose is too high. If we can see some tests then we can help figure out if a cat is overdosed or not. The latest research shows that 1 in 4 diabetic cats have acromegaly, which is a condition that causes insulin resistance. Insulin resistance means that the cat needs a larger dose. So . . . it's always good to just sit back, look at the situation as the person gathers data, and look objectively at the numbers to help figure out if a dose is appropriate or not. Having had a cat with a larger-than-typical dose, I'm very aware of this situation. While 4u was too high for Joe, it wasn't drastically too high.

I'm not so much talking to you, Kristen, as to the folks who are helping you. It's good to remember that some cats do need more than others and dropping a cat's insulin back too 1u, for example, after they've already been on insulin with a higher dose, can leave a cat sitting in high numbers unnecessarily long. Cats eating high carb or dry food will need more insulin than the same cat eating low carb canned or raw food.

Back to the situation - great job getting the spreadsheet set up! As others have said, a bounce can last as long as 3 days, depending on how much the cat's body is used to normal numbers. I would look for any test that is a lower 200ish number, and then start checking a little more often to see if the bounce is clearing. The bounce clears when the cat's body "clears" out the hormones and stored sugars that it released when the body perceived that it was experiencing a hypo. It might or might not have truly been a hypo, but any time a cat's body gets into a range that is lower than it's used to, or the blood sugar drops too quickly (just as a ballpark, over 50 points an hour in many cats would trigger a reaction) it can trigger another bounce.

Counting forward 3 days from the low numbers yesterday would be Wednesday's day cycle. Joe will most likely clear the bounce between now and then. Just watch for any tests that point to his numbers coming down. When a cat is in a bounce they aren't straight 400-400-400. They can bobble around, but it's overall still high. Joe also may not have a clear-cut "clearing the bounce" cycle because of the dose reduction. We'll have to just watch and see.

Hope some of that is helpful. I tell people the things that I wanted to know - and I like to know the "whys" of things.

 

Thank you for all of this, @julie & punkin (ga) !!! Your thoughts are very valuable to me as I do wonder the same things quite a bit. I'm trying to catch up on school work and studying for this week since I lost my Sunday with Joe's low BG party, so I haven't been as active on here. I also haven't been testing as much. I tested him yesterday but not today. His vet said to give him a bit of a break. He's definitely become more sensitive to his shot in recent days. He'll nip at me and run away... It's no fun. He was kind of oblivious to it at first, but he's way more sensitive to it now... Maybe it was all the poking on Sunday?
Anyway, we'll get back on a regular schedule tomorrow probably... In the meantime, thank you for your thoughts.

 

Hey Kristen, how did last night and today's cycle go?

 

Are you giving insulin tonight? If so then you really need to get a test in before shots and another during the cycle. After the big drop from before you don't know what he will do

 

Well I'm awfully confused because his vet said we could move him to 3u and see how he does - not test again until Saturday to give him a break from all the poking Sunday. He has gotten very grouchy about it. I don't understand how you all poke your kitties 3+ times a day every day. What's your secret???

I did not test him today - I was going off what his vet said. I guess we'll test again tomorrow or I'll try and get a test in tonight. Thanks for following up with me.

 

Hard to say how JoeJoe is doing on this dose without testing. Are you putting Neopsorin with pain relief on his little ears after the poke? And make sure you have a low carb treat they really like that they get after the poke. That's usually a good motivator. Both my cats show up for poke time.

It'll help us help you if you keep his spreadsheet up to date too. Hopefully it won't take more than a moment.

 

The problem with not testing even for a few days when you are giving insulin, is that JoeJoe could drop again the way he did on Sept 25 and you would not know. In order to see if the reduced dose is keeping him in safe numbers testing is very important. For sure doing a test before each shot will tell you if it is safe to give the shot at the current dose and a test in between shots will let you know if he is going too low again,

I have 2 FD kitties and although neither of them were overly fond of having their ears "poked" multiple times a day, both of them adjusted quite well. One is very food motivated and always got a little of his regular food or a low carb snack with each poke. He will now go to the test mat and sit and wait for his test...sometimes he goes when I don't even plan on testing since he associates ear pokies with food. My girlie LOVES her brushings, so each time I do a test I cuddle and brush her. Although she is not as excited about tests, she is very easy going about having them done. It was NOT like that in the beginning with either of them.....trust me. With having a regular spot and routine, and having them associate the tests with something positive they have become very complacent about the tests and I test each one at least 5-6 times a day. It can be done

 

I hear you. I'm sorry for not getting the info today. I realize that I need to be testing him every day and keeping up with the numbers - especially given last weekend's events. I know it's better for him and for us to know that information. I guess I was just overwhelmed after Sunday. He hates getting poked, he squirms, he pulls his head away so it rips his ears, he dislikes having the neosporin with pain relief (yes, I went out and got some yesterday due to the suggestion because I wanted to help his ears heal). Low carb treats are his favorite thing, but they don't change the fact that he still tries to get away from me when I poke him. I realize it will probably get better over time as he gets used to it, and I'm trying to reinforce that when he gets a poke he gets a treat - that GOOD things are coming as a result of the poke! But it's still hard.

I'll be completely honest here and say I guess I used my vet's advice to give myself and him a break from the poking. I KNOW, however, that we need to do it in order to find the right dose for him and to help him maybe one day get OTJ. I also know you guys are experts because you've been doing this forever and know a whole lot about it.

We'll get back on the horse tonight and get a reading.

 

When I started with my first FD kitty it was such a mess. I was so scared of doing the testing wrong and so tense about it and I am sure he picked up on my feelings. I still remember the times in the start where I was literally crying in frustration and he was howling at being restrained. When I started to relax and quit turning test time into a wrestling match things settled in very nicely. Home testing is such a valuable tool and eventually it becomes another simple chore, like turning the coffee on in the morning. It really does!!

 

Mary Ann I believe you 100%. It was like giving him his shot. It was scary at first and I was always worried I'd do it wrong, but eventually it just became part of the routine. Same with when we had to start giving our other kitty phenobarb twice a day for seizures. At first it was nerve-wracking but then it became just another thing we had to do.

It's good to hear your experience also... To know that there's hope even when things seem really bleak. I think all of my cats responded to my energy on Sunday. I was manic, scared, you name it... And they sure felt it. It was a very quiet, very tense day at our house.

All that said, I keep a positive outlook on everything most days - today just happened to be a moment of weakness.

 

You are doing a great job and doing all the things that you should to keep JoeJoe safe. We all have bad days and even meltdowns from time to time. I have had more than my share of meltdowns, and the wonderful people on this forum have boosted me up and kept me going. You are on the right track and the people on here will help you as you go along the treatment road, so hang in there and if you ever get overwhelmed or frustrated, this is a great place to vent.

 

Thanks lady. I was patient and sat with Joe and offered him some of his newest favorite treats, some Wysong Archetype chunks! He loves those. I'll have to present the bag in the future & not give him any until after his shot/poke. It took a second to get him into a good spot... He was not happy with me holding him in my lap, so he jumped onto his favorite ottoman, and that's where he was most comfortable and I got the sample without much protest. Even got to put the Neosporin on right after. He was at 241. This is +3 so we're not really that far in. I'm not sure how low he'll go tonight based on this, but considering he was 270 previously for his first at-home BG curve AMPS and from THERE went down to 60s-70s (given 4u), I'm pretty confident right now that he'll be OK tonight and we'll get back to regular AMPS/PMPS tomorrow.

Thanks for your support, it means a lot. I know everyone's got their own stuff, everyone's super busy and everyone has too much on their plate. So I hate to be a grumble-gus... It's like when people get sick or major life changes happen - you deal with the new normal and accept it. Then you just make it work!!!! Thanks, Tim Gunn!!!

 

Hey Kristen, good job getting that test in last night. It's so important! Along with feline nutrition when you become a vet, encouraging caregivers to test to know that their kitty is safe and also to know how the dose is doing would be another huge service. I don't understand a vet who would recommend not testing but lots of us here have been in the same boat with our vets and had I listened to my vet, I am sure Bubba might not be here now.

I love seeing that +3 last night after a reduced dose and after a skipped shot. Perhaps I was over cautious to recommend you to start over with 1 - 1.5 units as Julie spoke about in post #84 but with out any data and knowing that 3 units is a very large starting dose, I would rather assume that JoeJoe could be getting too much insulin rather than not enough especially after last weekend's very low numbers. I am watching in with lots of interest to see how this dose works for him and to see if he earns another reduction soon. I am still learning lots and if it wasn't for the older more experienced members, I would have been lost.

Once you start feeding him the lower carb YA food it will be important to be able to monitor closely as you could see the numbers come way down.

You are doing an awesome job!

 

Hey Kristen, it is likely that JoeJoe went into the blues last night after the +3 of 241 as that is typically when onset occurs and we don't know what his nadir was. So, not surprised to see the pink bounce this AM. If you can get a +6 or +7 today, that would help to know how low this dose is taking him as today is cycle 4 on this dose and the depot is starting to fill in.

 

Hey Bobbie! Thanks for your on-going encouragement. You know... It's difficult because I want to listen to my vet and yes, right now not testing is certainly the easy way out (ONLY in terms of my guilt for poking him and his hatred of poking!!!) - but it's not good for Joe, obviously!!! The more I thought about it last night, the more I realized how right you all are. People test themselves all the time, why not do the same for our kitties? Well, because we love them and we feel bad we have to poke them with sharp things. But you're right... Change and adjustment take time. We figured out a way to do it last night that was not horrible and we even figured out a way to do it this morning that was not horrible. We'll get there. The encouraging words from @Tuxedo Mom and @Wendy&Neko have helped me get through these last two tests. I try to remember that what I'm doing is good for him and what he needs. I release my stress so he doesn't vibe on it and we cuddle and nuzzle and I scratch his chin and try to make it as pleasant as it can possibly be.

Let me tell you all, you all are wonderful folks for sticking with people and helping them out. I only wish I had more time to check in on here and offer encouragement as a newbie to other newbies and reassure them that they are in good hands with y'all and they need to listen to you!!!! For now, I'll do my best to keep up with you guys and let you know how things go. I was telling my DH last night, (I think I used that right ) that doing all of this is really pretty amazing. It's basically watching a chemical reaction happen - IN YOUR CAT'S BODY... I'm in an organic chemistry lab that I really love right now and putting this into that perspective made it seem WAY more fun.

P.s. In other amazing news, I got a FREE bottle of unopened Lantus yesterday at work. My co-worker's Dad no longer takes it and she just HAD three bottles lying around, offered one to me. It was like Christmas...

Numbers posted for this AMPS. We're a bit high again, but it's reflecting how he was previously on the 3u. Based on his response to 4u and 3u I'm guessing our next move may be to 3.25... But not for a few days yet until we get settled and get some numbers with this dose.

Thanks again everyone. You are all wonderful people.

 

Will be getting a +6 or +7 today for sure. I realize we need that mid-range number to really see what's going on.

 

The first numbers posted on the SS were from his original curve at the hospital. He was at 3u for 2 weeks at that time. That was right after he first started on insulin.