? Please advise - to shoot or not too shoot

Discussion in 'Feline Health - (The Main Forum)' started by Helena & Murinka, Sep 3, 2016.

  1. Helena & Murinka

    Helena & Murinka Member

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    Hi there, we are quite new to this adventure and everytime I think I got the logic of it, something surprises me and I don´t know what to do.

    3 days ago we switched to 2xtimes a day Caninsulin 3 Units. I shoot her this morning (AMPS @18,4) and when I wanted to shoot her this evening, her BG was 7,2, I fed her and tested her 1 hour later and her BF was 6,7 ... but I was supposed to shoot her 3units...

    She ate one low carb Sheba in jelly (85g) but generally she is still on dry Hills Prescription R/d - I want to switch to the wet soon but I need to make the calculation how much calories she was eating and how much wet she should eat then.

    But now, the question is. should I shoot her a lower dose - 1unit? should I giver her more food and wait? SHould I wait and shoot her later?

    Thank you very much for your advise!

    Helena & Murinka
     
  2. Alexi

    Alexi Member

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    Apr 10, 2016
    Don't give any insulin - can you check her again in an hour, with that number you are safe to skip a dose and a hypo in the night is what you don't need right now. I have to pop out for an hour but will be back and review her spreadsheet.
     
  3. Helena & Murinka

    Helena & Murinka Member

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    Thank you Alexi, will do.
     
  4. Alexi

    Alexi Member

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    ok - I'm back and have had a look at the spreadsheet. I am quite surprised at the advice given by your vet, as the start dose looks high (not to mention giving Caninsulin once daily) and I think the dose is still too high.

    Has Murinka ever had ketones?
    Do you know what the sugar level was at diagnosis?
    How much does Murinka weigh?
    Do you know what her ideal weight should be?

    It may be best to start again with the dosing but if you can answer the questions I can have a think about what the best way to deal with this would be. I see the +2 was 7 so she is in nice safe numbers. What has happened with the high doses is she has been going too low then bouncing up again so we need to give her a little rest such that she gets blue mid cycle numbers from a good safe start point, it may take a little while to find her ideal dose but it is better to start low with the insulin dose then slowly raise it. It looks as though her dose was too high from the start.

    Can you answer the questions and then I can try to make a suggestion with where to go from here.
     
  5. Helena & Murinka

    Helena & Murinka Member

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    Yes, it was way too hight - I know it now, but I had no clue back then :( - the vet is I think more experienced with dogs where as far as I understood Caninsulin can be taken once a day ... after reading stuff here I came to a conclusion that her dose is a nonsense - too hight and once a daily and we agreed with the vet to split in 2 per day. First he said 4units morning and evening but she was slighty hypo and I had once decreased her PM dose, then he decreased her dose to 3units 2xday. But today she only had her morning shot of 3 units and was in good numbers even after 12 hours after the shot!? Why? When at the begining with 7 units in the morning she had above 20 in the evening. This makes me desperate :(

    But to your questions:
    - I don´t think anything about ketones and don´t think she´s been tested and the vet never said anything about ketones - he only took her blood
    - I think she was at 25,8 but not sure - I have the report from the at home and Im out off the town now and back tomorrow and I will complete the spreadsheet with numbers from the first day she was diagnosed - but basically AM she was around from 18 to 25 and the evening the same.
    - when she was diagnosed her weight was 5,7 kg - she lost around 3 kg before we figured out something was wrong. she was overweight for ages (8,7 kg) despite our effors end her diet (she´s been on Hills Prescription R/D - I know now that this was not good for her, but again, back then I had no clue, that this kind of dry food is terrible and not appropriate at all ...).
    - her ideal weight actually should be around 5.5 kg. But I think she might have lost a bit, because I took her for vacation with me and here she´s moving much more than at home so she might have lost a little bit, but I can´t weight her here.

    I spoke to the vet this morning and we agreed we stick to 3units 2 x daily, I test her and call him on Tuesday noon to update him about her number. I don´t want to blame him, I think he´s trying his best and he´s available almost all the time, I can call him almost 24/7 but it seems not to be enough...

    I would be very grateful for your suggestion. Thanks a lot for your time and advice!
    Best from Prague. Helena
     
  6. Alexi

    Alexi Member

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    With Caninsulin the dose decisions are based on how low the dose takes the blood sugar, the pre shot tests are to check if it is safe to give the insulin, looking at 8/8 she went from 19.6 to 4.1 on 5 units which is a big drop, 22/8 she went into hypo numbers on 7 units and did the same again yesterday on 3 units. What happens with such a steep drop is that the body's protective mechanism comes in to release sugar from stores in the liver but eventually it can't do that anymore. This is why her pre shot numbers looked ok even with a steep drop.

    You can check for ketones on a urine strip test, I use keto-diastix, I don't know what is available to you but you can buy some from any pharmacy that sells diabetic supplies or on-line. It is a good idea to check the urine periodically whilst the cat is on insulin.

    It doesn't sound as though Murinka has had ketones.

    The manufacturers recommended start dose for Caninsulin is 0.5-1 unit per 24 hours per kg of ideal body weight (split into 2 doses). I would suggest being at the lower end of that once you have a number that it is safe to give insulin. If she still is in the blue or low yellows tomorrow you could skip again if you feed her the low carb food - if she is purple numbers or above then you could try 1 unit if you can monitor during the day - what you are looking for at the moment is blue numbers mid cycle. If she has a small drop in her numbers at +2 then that is what we are looking for. Provided she is giving you ok numbers then you can hold that dose for 6 doses and re-evaluate.

    In some cats a hypo can kick start the pancreas into producing insulin, and the switch to low carb food can bring numbers down dramatically. It may be you just want to give her the low carb from now on as this morning's dose should be out of her system so an ideal time to change over the food, some cats even can come off insulin all together with a low carb diet. Can you post her AMPS number as I should be around, not sure what time zone you are in - how many hours away is she due for insulin?
     
  7. Helena & Murinka

    Helena & Murinka Member

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    Alexi, we are + 1 hour your time.

    Her morning shot is supposed to be at 8 AM (7 AM your time), in 8,5 hours. So now she´s + 15 hours after her morning shot giving the fact that I skiped the evening shot.

    So let me repeat what do you suggest:
    - if tomorrow morning she´s in blue or low yelllow, I don´t shot her.
    - If she is in high yellow and above I give her 1 unit and will monitor her and evening the same?

    But what if her numbers are not ok during the day, what should I do then? And one thing - we´re coming back home tomorrow which means 2hour car drive which she doesnt like at all - should I take it into account somehow?

    And yet another thing - she´s a lazy cat, in Prague she lives only in a flat and she almost doesn´t move. Now we have spent 10 days in our contryhouse and she has become a completely diff cat - running, moving, playing - I guess it also helps to her numbers and Im affraid what will happen once we´ll back home to our daily routine when she only sleeps and eats :(

    As for the food - I am very keen on changing the diet completely, I only don´t know how much should I give her of wet so that it will be more or less the same that she had up to now.

    Thx a lot.
     
  8. Alexi

    Alexi Member

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    If you are travelling tomorrow then you could skip her morning shot and start her insulin again in the evening, I have other cats on Felix jelly pouches and they have one pouch each twice a day, I think your pouches are about the same calories. I weigh Cappuccino every week, and adjust her food if she is over target weight, I try to keep her slim as that is what my vet advised and she gave me the target weight.
     
  9. Helena & Murinka

    Helena & Murinka Member

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    OK, thank so much! I will try my best.
     
  10. Helena & Murinka

    Helena & Murinka Member

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    Alexi, her AMPS was 17.1. In the end, I gave her 2units and will feed wet food (I don´t know why didn´t feel like decreasing to 1unit as per your advice, please do not take it as not enough of respect for your knowledge and experience, maybe it´s partly the fear from the vet, it´s sad and shouldn´t be this way but ...).

    I will test her and Im curious to see what numbers we will get.
    Thank you once again!
     
  11. Alexi

    Alexi Member

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    I am also curious to see so I will check in later on, don't be scared of the vet, you will be able to teach him about the diabetic cat and then he will be in a better place to advise other owners about the care of their cat. Will you be able to do a +2 test?
     
  12. Helena & Murinka

    Helena & Murinka Member

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    THANK YOU!

    Yes I will monitor +2 and then again ideally when?
     
  13. Alexi

    Alexi Member

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    Looking at her previous numbers I would try a +4 and +6 if you can, I appreciate you are travelling today so may not be the easiest to do.
     
  14. Helena & Murinka

    Helena & Murinka Member

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    it might be feasible.

    Last question: she ate one low carb pate of 85g. she looks at me like being still hungry.. should I give her a bit more? Should I resist? so far she ate 1/2 pate plus cca 25g of the dry R/D Hills.
     
  15. Alexi

    Alexi Member

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    You could give her a bit more wet food, my cat is always hungry these days but I've noticed it is worse when her levels are high. Other people find their cats hungry when their levels are low, you need to do what you are comfortable doing.
     
  16. Helena & Murinka

    Helena & Murinka Member

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    @ +2 she´s 2,9! so you really were right about 1unit. I gave her 1/2 gourmet gold pate with a bit of grape sugar. Almost impossible to test her when she´s in low numbers..
     
  17. Diana&Tom

    Diana&Tom Well-Known Member

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    Helena, have I got this right? She was 17.1 at morning pre-shot and then 2.9 two hours later??? That's a massive drop. Can you test again to check? You definitely need to keep a close eye on her to make sure she doesn't go any lower. She may need a little honey on her gums.

    I haven't been following your posts up to now but from what I have read I would have to say that your vet's dosing suggestion is high. Most cats would start out at 1u twice a day and go up from there IF NECESSARY.

    @Alexi @Elizabeth and Bertie can you look in here please?
     
  18. Helena & Murinka

    Helena & Murinka Member

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    I will test her in 1 hour or so, I gave her to eat and also with a bit of dextrose (quick grape sugar). her dosing and numbers are a mystery to me ...
     
  19. Diana&Tom

    Diana&Tom Well-Known Member

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    I understand your confusion Helena, this is not easy at first. The thing is, you have to give enough insulin for a cat to stay in healthy numbers but not too much to create a potentially "hypo" situation. This can be serious and is why we are saying that your dose may be high. Please keep a very close eye on Murinka and test again when you can. You really don't want her going lower...
     
  20. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Helena, please TEST RIGHT NOW. Don't wait.

    With low numbers like that you really need to be testing every 15 minutes.
    You do not want her dropping any lower than this.

    Please update us ASAP.

    Eliz
     
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  21. Diana&Tom

    Diana&Tom Well-Known Member

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    Yes PLEASE test again, Helena, and let us know the number.
     
  22. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Helena, your kitty still has maybe several hours to go until the peak (lowest number) of the cycle. She may drop further.

    Simple sugars like glucose/syrup act quickly, but they also wear off relatively quickly. You cannot rely on a single amount of glucose to carry your kitty through the cycle.
    Whilst this 2.9 may be OK you do not want her dropping any lower.
    .
     
  23. Helena & Murinka

    Helena & Murinka Member

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    2,1 :(
    when last she was under 2, I gave her dextrose in a syringue and she went up. But Im affraid I will run out of test strip. I only have 8 of them till tomorrow :(
     
  24. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    That's too low.
    Yes, give a little dextrose now.
    .
     
  25. Diana&Tom

    Diana&Tom Well-Known Member

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    Helena, for now, don't worry about running out of strips, if necessary don't give insulin until you have strips again. Right now it is vital that she doesn't drop lower. Please give more dextrose or honey.
     
  26. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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  27. Helena & Murinka

    Helena & Murinka Member

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    I gave 1 tbspoon of dextrose. Should I give her some more food? My hands are trembling. I don´t understand at all why did it happen?!

    Can this massive drop be only because of the wet food? she was on dry till yesterday.
    When should I test her again? Have to say she starts looking better, when she´s not well - in low numbers she goes under the bed and now she stayed on a chair.
     
  28. Helena & Murinka

    Helena & Murinka Member

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    I have already read it several times :) actually I spent almost my 10 day holiday reading FDMB ...
     
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  29. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    (((Helena))), I know it's scary, but you're doing really well.
    Test again in 10 - 15 minutes to ensure that she's not dropping any lower, and just keep an eye on her for any unusual symptoms.

    Do you have any cat food in gravy?
    .
     
  30. Helena & Murinka

    Helena & Murinka Member

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    No I don´t :( but in emergency I can give her a bit of this damned dry R/D Hills?
     
  31. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    If she will eat a small amount of food that would be good (we don't want to fill her up in case she needs to eat more later).

    You have a couple of options.
    You can give a small amount of her ordinary low carb food. And then repeat giving food/glucose to keep her numbers up as necessary until she's past the peak of the cycle.

    Or, if it seems likely that you will run out of test strips - or if you're not sure that you can manage the first option - then another option is to give a higher carb food and basically 'abort the cycle'.

    Maybe do another test and make a decision from that point?
    .
     
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  32. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Is it about 2.5 hours since the shot now?
    From the SS it looks like there may still be perhaps another 2.5 hours to go until the peak of the cycle.
    .
     
  33. Helena & Murinka

    Helena & Murinka Member

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    Sounds like a plan. I´ll test her in 10 minutes, she looks much more better - she started make her hygiene.

    If she goes up after the dextrose, can she afterward drop again? I unfortunatelly don´t know exactly when her nadir is.
     
  34. Helena & Murinka

    Helena & Murinka Member

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    it´s 3h15 minutes from her shot
     
  35. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Okey dokey.
    It's good that she's looking better.
    Would be good to get another test as soon as you can, just to check that the numbers are coming up and that they aren't dropping further.

    Yes. (In my own cat it will wear off after about an hour).
    Dextrose/glucose/honey work the fastest, but also wear off relatively quickly
    Ordinary food takes a little longer to take effect, but lasts in the system longer.
    Dry food takes a little longer to take effect, but can last in the system for quite a long time. (But it can be used in an emergency).

    If the dextrose is raising her blood glucose OK, then it may be that you only need to follow it with some ordinary low carb food. Let's see what the next test result is.
    .
     
  36. Helena & Murinka

    Helena & Murinka Member

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    It´s driving me crazy! Thank you for your support. How on earth she could drop that low. I resigned and gave her a bit of dry as emergency just to be sure and she ate it with apetite. Im going to test her.
     
  37. Diana&Tom

    Diana&Tom Well-Known Member

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    Helena, she can drop that low because had had too much insulin in her system. Carry on as you are for the moment and keep testing until she shows higher numbers.
    When this is resolved, please have a word with your vet to tell him what has happened and that we think the dose is too high for safety.
    I am going out soon but Elizabeth may be around for a while. Good luck!
     
  38. Helena & Murinka

    Helena & Murinka Member

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    It´s going up 4,2... I will test her in about 2 hours, okay?
     
  39. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    4.2 is good!
    You're doing brilliantly, Helena! :bighug::bighug::bighug:
    That rise is from the dextrose. And it may well be that the dry food that you've just given will keep the blood glucose up now.
    However, if it were my cat I would not leave it longer than an hour before testing again, just to be sure that the numbers are either holding or rising.

    Ideally, it's good to see that there are 3 rising numbers in succession, and/or that you are past the peak of the cycle.
    But I do understand that you are getting low on test strips.

    Eliz
     
  40. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Oh, forgot to say...
    Clearly the dose needs to be reduced again!

    As to why Murinka's numbers are getting lower, there are several possible reasons.
    Reducing the carb content of the diet can reduce the blood glucose a lot.
    Also, it may be that Murinka's body is starting to heal, and that means that her need for insulin is less.
    She may even be starting to produce more insulin of her own...
    .
     
  41. Helena & Murinka

    Helena & Murinka Member

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    She also moves more than she used to, which might also be helpful and Im affraid it will change after we´re back home in our flat.

    So if her numbers are okay, I´ll give her 1 unit in the evening? and the same tomorrow morning?
     
  42. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    A quick note on dry food:
    Most people here don't use dry food in low blood glucose situations, because the effects of the carbs can last a long time in the cat's system.
    However, there are times when it can be useful...
    If the caregiver is unable to monitor the cat for any reason, ie. not enough test strips, or will be out of the house and not able to test, then they may give dry food precisely because the effects of it can last quite a long time. They may also give dry if the circumstances dictate that high carb food is needed and they have no other alternatives available.

    If the caregiver is going to be at home, and is able to test, then usually what happens is that the caregiver will give food (or glucose/syrup/dextrose) as appropriate; test at intervals; and then repeat the action until the cat is past the peak of the cycle.
    Sometimes ordinary low carb food is sufficient.
    Sometimes medium or higher carb food is needed (quite a few people use the gravy from higher carb food).
    Occasionally glucose/syrup/dextrose is needed.
    Very occasionally, in certain circumstances, dry food is used.
    .
     
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  43. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Yes, that sounds like a plan, as long as her numbers are OK.
    You may see higher numbers this evening after the low numbers today (and higher carb food) but don't worry about those: Still reduce the dose to one unit.

    Do be aware, Helena, that as you reduce the carb content of Murinka's diet her blood glucose may continue to drop, so the dose may need to be reduced yet again.... ;)

    Well done for coping with this today! I fully understand how scary it is....

    ((((HUGS))))

    Eliz
     
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  44. Helena & Murinka

    Helena & Murinka Member

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    Dear Eliz, Thank you very much for everything. it´s such a releive that I know Im not only by myself in this and that there are people like you helping all of us lost in the middle of diabetes and not appropriate attitude and accurate info from our vets ... :bighug:

    She´s now 3.8 (it´s + 5) so she dropped from last test (4,2) as obviously the glucose is going out. But for the time being I would do nothing but test her in 1 hour again, to see whether the dry food have already started to raise her sugar. what do you think?

    My husbands keeps asking me: do you think that the vets they don´t have a clue that the dry food it´s kind of evil for them, how come they don´t know anything about low carb food diet? And I don´t know what to answer... Yes how come?!
     
  45. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    I'd think the dry food would have started to have an effect by now. I'm surprised her numbers haven't jumped up higher, actually (perhaps because dextrose is also wearing off...)

    Since there is a slight drop (though the numbers are very similar) you could just give a snack of ordinary low carb food.
    From the data that you have on your SS, Murinka should, hopefully, be close to the peak of the cycle by now....

    Unfortunately, many vets do continue to recommend and sell dry food... I think the 'low carb diet' approach is not yet common knowledge...
    Vets get very little education about feline nutrition, and some of that education is actually sponsored by the (dry) cat food manufacturers.... :rolleyes:

    Eliz
     
  46. Alexi

    Alexi Member

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    Sorry I haven't been around but it looks as though you have had good advice already. What we don't know is what she did yesterday to end up with those blue numbers, so can you hold off giving a dose this evening until you have posted her numbers and what she ate. If you are running out of strips we really don't want a repeat overnight. It will be ok to skip the dose again, when can you get more strips?
     
  47. Helena & Murinka

    Helena & Murinka Member

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    Alexi, I should have listen to you and gave you only 1unit this morning ...

    Yesterday evening low numbers are a mystery to me ...
    I have 6 strips. I think I might be able to have some spare this evening - our vet is next door and he´s open till 7PM our time and when back home Im might go there and buy some spare. Otherwise I will have them by tomorrow morning. But also tomorrow I can´t watch her closely - I have to go to work but luckily will be back around 1PM my time...
     
  48. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Hi Helena,
    I just want to say that I'm sorry you've had such a scare with your lovely kitty, Murinka. I've been reading this thread and I'm SO glad you've had good advice to get you through this. This is definitely the best place to be when you have a diabetic cat. Take care. I hope Murinka continues to improve.
     
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  49. Alexi

    Alexi Member

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    All data is useful, so we now know 2 units is too much, it may be that 1 unit is also too much as some cats are very sensitive to insulin after hypos. Are you able to measure 0.5 units on your syringes? Cats can tolerate high glucose levels very well so it will be safer to let her run a little high. Let's see what she does for the rest of the day while I have a think about the best way to handle this situation.
     
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  50. Helena & Murinka

    Helena & Murinka Member

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    We just got home after 2 car drive - uf :) she really REALLY doesn´t like it -

    I tested her just before we left and she was at 8,3 (it was +7.5), she is supposed to have her evening shot in 1,5 hour in 8 PM my time (at 7 PM of your time).

    I have U40 syringe and the smallest unit is 1 unit so 0,5 at this syringe would be quite inaccurate. I will test her around 8 PM and I will be very greatful if you could give me a piece of advise what should I do this evening and tomorrow morning when I have to head to the office. And I also have only 5 strips till tomorrow noon :(

    I have also completed her number from the first day after she was diagnosed and I think that the vet really made a mistake in dosing at the beginning. Uf ...

    Thank you!
     
    Last edited: Sep 4, 2016
    Reason for edit: Additional info
  51. Alexi

    Alexi Member

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    I have been thinking on this. Here are what I see as the issues.

    Prolonged period of high insulin doses, blood sugar drops too low causing bouncing.
    Liver glycogen stores probably depleted resulting in hypo numbers.
    Transitioning to low carb food.
    Running out of testing supplies.
    Not able to monitor full day tomorrow.

    What do you think of the following plan?

    Stop insulin for 24 hours.
    Check pre meal and +2 numbers tonight and tomorrow if possible.
    Feed only low carb food - quick transition whilst off insulin and helps to replenish the liver stores.
    Only restart insulin when you can monitor the cycle - say tomorrow evening? Post the number first for dosing advice - it is possible to do 0.5 units by eyeballing so the end of the plunger is halfway between the two marks on the syringe.

    She will likely have a high number this evening - or may have another blue number, either way no insulin, same tomorrow morning.

    It may be Murinka is heading for remission but I think she needs a short break and to reassess her numbers on the low carb food. Some cats just need intermittent dosing at that point, others come off insulin just from the switch. As she has not had ketones I think she will manage.

    @Elizabeth and Bertie @Diana&Tom what do you think?
     
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  52. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    That sounds like an excellent plan to me in the circumstances, Alexi.

    Eliz
     
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  53. Diana&Tom

    Diana&Tom Well-Known Member

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    I'm not the expert you and Eliz are, Alexi, but your suggestions look very sensible to me. No insulin for 24 hours and then re-starting on 0.5u (if pre-shot number requires it of course) with other factors such as food remaining constant.
    So yes - great plan!
     
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  54. Helena & Murinka

    Helena & Murinka Member

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    Thank you Alexi, that sounds like a plan.

    So if I shot her tomorrow evening (after posting her number and I should be ready to monitor her during the nigh right? I might manage to have home office on Tuesday and stay with her home to keep an eye on her also on Tuesday if necessary.
    This evening is clear.
    Tomorrow morning I will test her pre-meal but Im not able to test +2 after meal the earliest at +5 unless I feed her at 6AM, I have to leave at 8 AM - would that be useful anyway to test tomorrow morning like this?
    Tomorrow evening I test pre-meal and post the number and will wait for your advice as for the dose.

    The hardest think would be to explain to my vet, that I cut off insulin for 24 hours and that I decreased the dose dramatically ... I will try to manage to have an appointment with him tomorrow during the day and I will print him out her spreadsheet and will try to explain him why I did that ... and will also tell him of FDMB but Im pessimistic about his reaction - I expect something like: aha ... you were googling ... I sense it's not going to be a pleasant conversation but maybe Im wrong and he will like the information.

    Thank you all and sorry for my English, it's not obvious to communicate about diabetes in English and my head is aching like hell after this bloody day. So thank you once again for being here.

    Hln
     
  55. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Helena, many of us have been in the situation of having to explain to our vet that we disagree with them. Sadly, vets have very little training on FD whereas the experience of people on this board from all over the world speaks for itself. You could give your vet this website address and defy them - in a nice way - to think otherwise!
    You could also lay it on the line and simply say that Murinka is your responsibility and you want the very best for her so naturally you are going to inform yourself as best you can. If he really doesn't like it look for another vet.
     
  56. Helena & Murinka

    Helena & Murinka Member

    Joined:
    Aug 23, 2016
    Precisely this forum is the proof that the world is full of vet not knowing much about FD.

    I want to sit with him and tell him that during my 10 day holiday I read hours and hours about feline diabetes and that I came to a conclusion that I want to try something that worked for other cats - switching to the low carb food etc etc ... if he disagrees and will be upset then I will look for another one but hopefully he will understand and will find it useful to his practice as well. Will see, he's a very self confident guy but on the other hand over our telephone consultations he acknowledged that I started understand how this disease work :) so maybe he'll take it seriously and not like "something I found on the internet".
     
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  57. Alexi

    Alexi Member

    Joined:
    Apr 10, 2016
    @Helena & Murinka if you can feed at 6am and get a +2 in the morning that would be really helpful as we need to make a judgement how much of her own insulin Murinka is making to work out the dose - the only slight problem is that I have to be away all day tomorrow as I need to take Cappuccino to the specialist for all day testing (more about all that later) and may not be back by your pm shot time but I will do my best. Otherwise I will review her spreadsheet tomorrow morning and see if I can come up with a dose. No more dry food please.
     
  58. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    The other thing for the vet to remember is that cats are not machines (!) and therefore they will not always respond to the "theory" that vets might want to apply. We have a phrase here that you will see time and time again - every cat is different (ECID) - meaning that what works for one cat may not work for another. Added to that, how any one cat responds to a certain dose of insulin on one day may be different to the way he/she responds on another day. FD is not an exact science - learn the basic principles but don't expect the results to be always what you expect!

    You probably know a lot more about FD now than your vet does.

    The other thing to bear in mind is that vets nearly always recommend dry food because they are visited by sales reps from the manufacturers, who may pay vets a commission on sales (I don't know this but am guessing). Food companies may also supply vet practices with all kinds of pet health information leaflets, etc etc which the vets no doubt accept gratefully. All this does NOT mean that dry food is best - not only for diabetic animals, but others come to that. Ask your vet how many animals in the wild he can name that eat dry biscuits...?
     
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  59. Helena & Murinka

    Helena & Murinka Member

    Joined:
    Aug 23, 2016
    Thank you Alexi. I really deeply appreciate your effort and others of helping me and Murinka. FIngers crossed for your tomorrow testing!

    I'll set the alarm and will feed her and test her so that we know how it works.

    She was now at 15.8, I will test her in 2 hours and will put it in the SS. No more dry food :)
     
  60. Alexi

    Alexi Member

    Joined:
    Apr 10, 2016
    When I first joined the board other people helped me, so we just pay it forwards, one day you will be doing the same. We all want to improve the care of diabetic cats and spread the word that once you know what you are doing it isn't so difficult. I don't have to be back at work for another week so we have time to get Murinka and you settled into a regime that works for both of you.
     
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  61. Helena & Murinka

    Helena & Murinka Member

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    Aug 23, 2016
  62. Helena & Murinka

    Helena & Murinka Member

    Joined:
    Aug 23, 2016
    Good morning Alexi,

    here are Murinka numbers (in the SS as well) - as agreed she hadn´t any insulin yesterday evening and this morning, I only fed her and tested her before meal and +2 after meal and this is quite interesting:

    yesterday evening: before meal (at 8 PM) 15.8
    +2 h after meal 12.7
    today morning: before meal (at 6 AM) 14.3
    +2h after meal 13,1

    Curious to hear what do you think about it ... and fingers crossed for the testing.
    Best, Helena
     
    Last edited: Sep 5, 2016
    Reason for edit: add
  63. Alexi

    Alexi Member

    Joined:
    Apr 10, 2016
    Those are good numbers, and what I was hoping for. If she is in a yellow number or above at PMPS then if you can monitor this evening you could try 0.5 units, if a blue number then no insulin. As you don't have syringes with the 0.5 unit markings you will need to eyeball it. You will also need to check at +2, you are looking for a small drop in the numbers. If 0.5 units proves too much then there is a way of giving smaller doses using u100 syringes (Caninsulin is u40 insulin) which have an orange top usually, if you are able to get some today we can explain what to do. @Elizabeth and Bertie I will check in as soon as I am home but not sure what time that will be so if you can keep an eye out just in case Helena needs more help.
     
  64. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Okey dokey, Alexi. Will do.

    Helena, @Helena & Murinka what times do you usually give insulin shots? (I think I need to deduct an hour from that to get UK time.)

    Eliz
    .
     
  65. Helena & Murinka

    Helena & Murinka Member

    Joined:
    Aug 23, 2016
    Dear both, thank you, again :)

    I usually give insuline at 8 PM which is 7 PM UK time.

    I have to say that Im totally confused - how come her numbers droped after the meal without insuline? should´t they rise up after eating?
    I would also be very grateful for advice re the timing of feeding and shoting. Up to now as suggested by the vet, I tested her, shoot her and sometime after (half an hour, one hour) give her food, is that correcte?
     
  66. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Murinka's numbers are looking very nice, Helena.

    There are a couple of reasons why her numbers may be dropping: The switch to just low carb food will help to lower the numbers. And it may well be that her body is producing insulin of it's own...

    With Caninsulin it is usually advised that the cat is fed some time (20 - 30 mins) before being given the insulin shot.
    That is because Caninsulin can start to work very quickly in the cat's body, and can drop the blood glucose very fast in some cats. Therefore it is good to have food 'on board' for when the insulin really starts to work.
    So, the usual sequence here is: Test, Feed, Shoot.

    Eliz
     
  67. Helena & Murinka

    Helena & Murinka Member

    Joined:
    Aug 23, 2016
    Im so confused - the vet told me to wait so that her number drops and thus she feels more hungry and eats enough for the dose ...
    Anyway I made an appointment with the vet this PM at 17.45, I will print it out her SS and will present him what Id like to do - either with him or without him. Im quite nervous. I also want him to thank him that he beleived I can manage it and that he told me I must test because without testing and with these doses she would be dead by now. it makes me shaking...
     
  68. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    There are just 'different opinions' out there, Helena... But our experience is that a cat should usually eat before being given insulin. And this is especially true of the faster-acting insulins like Caninsulin.

    As I said previously, with Caninsulin it's good for the cat to eat a little while before being given insulin, so that there is food 'on board' for when the insulin starts to work (Caninsulin starts to work quite quickly after being injected).
    But there is another very good reason for feeding the cat before giving the insulin shot, and that is that you do not know for sure that the cat will want to eat later... And what we really don't want is to have given insulin and then find out that the cat won't eat.... :nailbiting:

    I know it's hard when our vet says one thing and 'strangers on the internet' say something else... Many of us have been faced with that same contradiction.... But there really is a lot of experience in this group...

    You have seen yourself that it is very useful to test blood glucose at home. :cat:

    I would think your vet may be pleased to see Murinka's progess? I do hope so. You're doing really well. :bighug::bighug::bighug:

    Eliz
     
  69. Helena & Murinka

    Helena & Murinka Member

    Joined:
    Aug 23, 2016
    With all I read here I trust you more than him and I really value your experience! ... But Id like to have him on board as well. I think her SS speaks also for itself,

    And for the food, it actually happenned couple of times, I gave her insuline and then she didnt eat enough and I was trying to force her somehow ... stress ...
     
  70. Helena & Murinka

    Helena & Murinka Member

    Joined:
    Aug 23, 2016
    I just got back from the vet where I showed him Murinka´s spreadsheet, explained him what happened, about the low carb food diet ... I told him everything openly, he appreciated it but he said that Murinka is not his patient anymore, that she stopped being his patient the moment when I started playing with the dosing.
    That I have to regulate her not to change her diet nor her dosing, I try to argue with her numbers and he replied that they don´t say anything anymore because it´s all waisted by my gamble. He tried also to insinuate that I like this gambling and that´s why Im doing it but he wants her to be regulated which is now impossible..

    It was calm conversation but arrogant in a way. He said he saw masses people like me, layperson, playing with the dosingthat ended up by glucose bouncing (but what he did with his massive dose?!) and that he´s not interested anymore to hear about Murinka and that he also can´t give me anymore insuline ... well, at least things are clear now. I have to look for another vet ... I have 3/4 of one Caninsulin vial and hopefully I´ll find someone who´ll be willing to listen.

    Sorry for this long story but I simply couldn´t share it whith those strangers from the internet that are here to help me to get out of it! Thank you!
     
  71. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    I'm so sorry to hear your vet's response, Helena. That must have been upsetting for you. Perhaps what it shows is that he is out of his depth here and doesn't really understand what you've been trying to do.
    So - yes, find a new vet. Are there some in your area that you can ring around and ask over the phone if they have any staff with a special interest in feline diabetes? Or if not, explain your situation and say you are interested in working WITH someone who will take into account your learning on the subject.
    Keep smiling Helena and keep posting!
    Diana
     
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  72. Alexi

    Alexi Member

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    Apr 10, 2016
    Oh Helena :bighug::bighug::bighug:

    I am so sorry to hear your vet does not want to work with you but here is my experience. Today Cappuccino and I have been to see a specialist, someone who is an expert in feline diabetes, and they already had printed out Cappuccino's spreadsheet before I got there and we talked about what had happened when and why, and what I was doing with her food and insulin, and so on. She has made good progress since her last set of tests and they thought the spreadsheet was wonderful. So vets who really understand feline diabetes are impressed with all the testing and so on. You live in the city so there must be many other vets, here is the link to the vet interview topics to help you to choose another vet http://www.felinediabetes.com/FDMB/threads/vet-interview-topics.156663/

    In the meantime we will keep helping you through this. :bighug::bighug::bighug:
     
  73. Helena & Murinka

    Helena & Murinka Member

    Joined:
    Aug 23, 2016
    :bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug:

    Thank you!
    I was expecting he´s not going to agree, but I wanted to be open with him and tell him everything and not to be pretending that I am giving Murinka what he suggested. I was thinking he could be curious to find out whether it will work or not but he kept saying - Im not interested anymore... I have already started looking for another one. It´s just sad....

    but back to the most important think
    I tested her now and she´s 19,6, I gave her one Sheba pouch and will give her 1/2 as agreed okay?
     
  74. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    (((Helena))), I am SO sorry that you've had this experience with your vet...
    But please do not let that make you doubt all that you have achieved. You are doing really well! :bighug::bighug::bighug:

    OK, your current vet will not give you more insulin. But you have enough for now?
    And do you have test strips?

    Huge hugs,

    Eliz
     
  75. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    That sounds good, Helena.
    Do you have strips to test blood glucose?
    .
     
  76. Helena & Murinka

    Helena & Murinka Member

    Joined:
    Aug 23, 2016
    Yes, I have new strips - 50 :) I picked them today but then discovered I ordred a wrong type not compatible with my glucometre but I found a pharmacy where they got them. So yes I have enough of them ...

    And thank you for your nice word and support!
     
  77. Alexi

    Alexi Member

    Joined:
    Apr 10, 2016
    Great - so if you can do a +2 test we can see how this dose works for Murinka with her low carb food.
     
  78. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    May 18, 2016
    I hope you find a vet that is willing to learn alongside you.
     
  79. Helena & Murinka

    Helena & Murinka Member

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    Aug 23, 2016
    OK, Im going ahead with 0,5 unit and will test +2
    I also got some U100 syringes.
     
  80. Helena & Murinka

    Helena & Murinka Member

    Joined:
    Aug 23, 2016
    Dear @Alexi @Elizabeth and Bertie,

    Murinka is 9,7 at +2 after shot!

    I gave her something like 0.5 unit of Insulin (with U40 it´s not evident to eyeball 1/2 unit...) and I can´t beleive how much she dropped, should I test her also + 4? just to be sure? and how about tomorrow morning?
    (sorry for all those questions...) hugs and thanks
     
  81. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Helena, can you give Murinka a snack of her low carb food? That may slow down the drop.
    And, if possible, I'd suggest you test at +3, as we do want that drop to slow down....
     
  82. Helena & Murinka

    Helena & Murinka Member

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    Aug 23, 2016
    Okay - 1/2 of the pouch is enough?
     
  83. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Yes, I'd think that would be plenty. It should, hopefully, slow down the blood glucose drop and level it out a bit...
     
  84. Alexi

    Alexi Member

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    Apr 10, 2016
  85. Helena & Murinka

    Helena & Murinka Member

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  86. Alexi

    Alexi Member

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    Apr 10, 2016
    1.0 on the u100 is 0.4 units which is near enough. Murinka does need some insulin but it looks as though she is producing some of her own as well.
     
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  87. Helena & Murinka

    Helena & Murinka Member

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    Aug 23, 2016
    It´s crazy - she´s 3.2 at +3?!

    after 0,5 unit?
     
  88. Alexi

    Alexi Member

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    Apr 10, 2016
    She is very insulin sensitive, we need to try to keep her in safe numbers for at least the next couple of hours. Is she hungry still? If so can you give her a little of the higher carb food and keep monitoring?
     
  89. Helena & Murinka

    Helena & Murinka Member

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    Aug 23, 2016
    Okay, I think she will be willing to eat something more but I haven´t thought of bying some wet with higher carb, I wouldn´t have expected that with 0,5 she would go that down - I have Gourmet Gold Pate which is slighty higher than the pouch she had.

    It looks like it will be a long night :)
     
  90. Alexi

    Alexi Member

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    Apr 10, 2016
    Do you still have dry? Gravy type foods are higher carb and you can just give the gravy.
     
  91. Helena & Murinka

    Helena & Murinka Member

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    Aug 23, 2016
    yes, plenty of the dry :) should I give her a bit? she ate with apetite 1/2 of the gourmet gold.
     
  92. Alexi

    Alexi Member

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    Apr 10, 2016
    Yes some of the dry, and keep monitoring.
     
  93. Helena & Murinka

    Helena & Murinka Member

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    Aug 23, 2016
    done, I will keep an eye on her. I think I will manage until safe numbers ... you also should get some sleep after this demanding day. but tell me please what should I do tomorrow?

    It would be maybe better I stay home? I can manage to have home office, otherwise Im gone for the whole day.
     
  94. Alexi

    Alexi Member

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    Apr 10, 2016
    I'm not going to sleep yet, I have 94% humidity so waiting until it cools down a bit! I am wondering if it's best to not give insulin in the morning again and see what she does.
     
  95. Helena & Murinka

    Helena & Murinka Member

    Joined:
    Aug 23, 2016
    keep droping ... 2.9 - I will give little bit more dry and test her in 30 minutes she already hates with all the testing :( okay? or sugar again? like yesterday? she´s now + 4

    why all the little snacks are not on board yet?
     
  96. Alexi

    Alexi Member

    Joined:
    Apr 10, 2016
    Can you add some sugar to the dry? I am worried she will get full up before we hit +6. I think probably best not to give any insulin in the morning and just wait and see again.
     
  97. Helena & Murinka

    Helena & Murinka Member

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    Aug 23, 2016
    she ate app 2 handfuls of dry
    just tested her now and it looks like she´s on the rise 3.2 but Ill stay up for at least yet another hour and if still on the rise I can go to bed, I guess.

    Im exhausted, I almost couldn´t sleep tonight - was thinking of the conversation with the vet that was ahead of me and Im up from 4 AM :(
     
  98. Alexi

    Alexi Member

    Joined:
    Apr 10, 2016
    :bighug::bighug::bighug:

    You have had a stressful couple of days with all this, I'll stay up with you.
     
  99. Helena & Murinka

    Helena & Murinka Member

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    Aug 23, 2016
    You are so kind! THANK you. it´s amazing what you guys do with the forum. it´s amazing!
     
  100. Helena & Murinka

    Helena & Murinka Member

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    Aug 23, 2016
    still on the rise 4.2 now, which means @+ 5 I would say she´s safe, do you agree, Alexi?
     

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