Please tell me how to dose Jack right now. Jack was newly diagnosed. I have only been successful at monitoring Jack’s BG for the last 4 days. His AM BGs have been 410, 400, 436, and this morning only 210. I’m not sure what’s going on here. I have struggled with getting enough blood (until I learned a new technique 4 days ago), and have given a couple of fur shots (but not last night). I have to leave for work in a couple of hours, so I’m afraid to dose shoot him because of the low BG. His one low BG day, on Fri., 2/22, was done with another meter that I have since replaced. I don’t think the numbers are accurate for that day. What should I do now? I won’t be home to give him his PM shot until 7 ish. (My work schedule changes, so his shoot times change also). Thank you. ~ Carolyn
Hi Carolyn- Since your shot times change, how many hours has it been since his last shot? And how many hours will it be between now and his PM shot?
Hi Carolyn -- adding to Djamila's question (here we are cross-posting again!), I see that you have been increasing your doses quite frequently, including going up to 2u last night. Are you basing that solely on the PS numbers, or do you have some mid-day numbers as well that just haven't made it to the spreadsheet yet? Especially because of the probable fur shots, without midday numbers, it can be hard to tell how effective a dose is.
I have no midday numbers yet. I'm finally able to get a reading now (because I learned the thumbnail trick), so I will be doing more testing this weekend when I'm not working. His vet wants 2U twice a day. I started lower and gave 3 rounds of 1, then 3 of 1.5 units before I did 2 units last night. I have been really concerned about his high AM numbers. If I had given him his shot as planned this morning (8:30), it would have been 12 hours. Now, it would be 13 (9:30) because of the delay with his lower number. If I gave it to him now, it would mess up the dosing timing, as I want to give it to him at 7:30 (I'll be home around 7:00) tonight because I work early tomorrow, and he'll get the shot around 6:45. I know it stinks with my schedule changing. I'm very aware of that, and I will make sure that I don't shoot before 11 hours. Should I let this shot go and then do some more frequent testing on Sat and Sun, to see what is going on with his numbers?
The thing that's tricky is that without mid-cycle numbers, we have no idea if his PS numbers are red because he isn't getting enough insulin, or if they are red because he's getting too much insulin. Just looking at PS numbers, the two problems can look the same. So it's not really safe to give dosing advice right now. Since you're over +12 and he's over 200, it's likely okay, but there's really no way to know. I wish I had a clearer answer for you, but I don't feel comfortable saying go ahead and give 2u when I don't know if 2u is okay for him.
We can't know if his morning high PS numbers are a result of the dose being too low or a result of maybe the entire dose not getting into his little body. Let's say 1.5 would be a good dose . . . but if he only got 1u into him, then his numbers would be too high in the morning because even though you "gave" 1.5, he only "got" 1u. It can take a kitty a couple of rounds of good doses to clear the higher numbers . . . [stopped to read @Djamila 's post that just came up] . . . so it's just really, really hard to tell if 1.5 was truly too low a dose. Given what Djamila just wrote + the above + the fact that you can't be home to monitor today, if it were me, I'd play it safe and reduce back to 1.5, trying that for a couple more cycles without fur shots (and yay! for perfecting your technique! They can be squirmy little critters!) to see what that dose is actually doing for Jack. Just my two cents. As the saying goes, you hold the syringe.
I'm comfortable with not giving him a shot right now, and I'll monitor his numbers on the weekend. I'll dose him as early as i can this evening. Thank you. ~ Carolyn
This certainly has been a learning experience. I think I also figured out how to avoid the fur shots, as the last couple went pretty well. So hopefully, I'll be able to successfully monitor his BG and actually get his shots into him this weekend. For now, I am going to go back to 1.5 units. I thought I was doing the right thing by staying at three cycles with one unit and then three cycles with 1.5 before I went to 2U. But maybe I was in too much of a hurry to see those numbers go down.
I'm going to be more patient this time. I thought I was supposed to do three rounds with one dose, but I have to admit that my frustration with his numbers being made me go higher sooner.
I know now that I went up to 2 units too quickly with Jack. The vet suggested 2, so I was trying to get to the point where it was suggested. Should I go back to just 1 unit, or 1.5? And then this weekend I'll monitor him during the day, and see what that dose is doing. What would you do? Would you give him 1, or 1.5 units?
I'm curious as to what makes you think the numbers from that day are inaccurate? You've indicated you got Jack onto a wet low carb diet as of the 17th and that alone can have a significant lowering effect on BG numbers. I'm guessing you may have questioned those readings on the 22nd because they were lower than readings done previously at the vet's office. The diet change and the lack of vet stress which often causes elevated BG readings in the clinical setting, could and likely did, cause a lowering of Jack's BG. Those numbers on the 22nd may be more true than you think they are. I agree with Djamila and Jenna that it's difficult to determine the right dose for Jack right now because of a lack of mid cycle testing however looking at the readings on the 22nd given the dose of 0.5u and the drop in BG by +3 post shot, I'd be inclined to try a dose of 0.5u until you can get some mid cycle tests to see how low the dose is taking Jack's BG. Those higher numbers the last few days could be from bouncing as a result of too much insulin so it may take a few days before you get an accurate view of what 0.5u is doing for Jack's BG. I'd suggest getting a before bed test every night and depending on your work schedule, if you do get home a while before the shot is due, test then. All data helps to put together a picture of what the insulin is doing for Jack and will make it easier to determine dosing going forward.
I thought those numbers, on the 22nd, were inaccurate for several reasons. First, I didn't realize that too much insulin could give him a high reading, so when I compared those numbers to the numbers I was getting on the last few days, it made me suspicious of the accuracy of those numbers. Secondly, I kept getting an error on the True Result meter that I had used on that day. I wasn't even able to get a reading again until I bought the ReliOn Prime on Sunday. Additionally, I learned, since then, that that particular meter had been discontinued because of inaccuracy. So I had assumed that maybe those numbers were wrong and his high numbers were correct. And to be completely honest, I really didn't know that too much insulin could have made those numbers too high. I'm only now beginning to understand that. Also, I guess I was blindly accepting that the vets numbers were accurate, with Jack's BG being over 400 and his fructosamine level being over 700. And because he's lost 5 lb since October and is really suffering with neuropathy in his back legs, it was easy for me to accept that his numbers were actually high, and Friday's numbers were wrong. I do understand now that those could have been correct as well. And I appreciate your taking the time to help me understand, because for some reason I feel very overwhelmed with information. I'm trying to do the right thing, and I feel like I keep doing something wrong with him right now. But I know I'll get this!
This is probably what I'm going to do. Now that I'm "getting"that has numbers could have been low on Friday because of the switch to low carb, and the insulin I was giving him could have been actually raising his BG, I'm going to start this over again. And now that I have a meter that doesn't give me errors and a method of collecting blood that works, I'll be getting as many readings as I can from this point on.
I think I'm finally getting it right now. I've been confused and overwhelmed with all the information that I've been taking in. So actually Jack's numbers could have been low on Friday because of the complete change to low carb wet food. And my giving him insulin could have actually been making his numbers bounce and causing the numbers to be high. I think I finally understand! I'm going to start low again, monitor his sugar closely, and take it from there. Thank you.
Don't worry about feeling overwhelmed. That is to be expected and we've all been there. This will all become routine in a short amount of time. The idea that too much insulin can look just like too little isn't intuitive at all. Insulin is not a drug....it's a hormone so it doesn't cause the body to react the same as 1 vs. 2 Tylenol for a headache would work. It's amazing how many times we see vets falling down that rabbit hole too so don't feel bad. If your vet prescribed 2u of insulin to start, that is double the usual starting dose and that decision may have been made due to the high readings in the vet's office. You are doing everything right...you are home testing Jack and you are educating yourself so you can look after him the best way possible. He is in good hands! Now that you mention it, I remember one of the True meters being discontinued for inaccurate readings but I believe that had something to do with other substances affecting the readings which may or may not have been in the picture in your case. I can also understand your suspicions if you were getting a lot of error messages. Those readings on the 22nd may indeed have been low but better to err on the cautious side than give too much insulin. It's quite possible that Jack may need more than the half unit dose but starting off slow and adjusting the dose slowly, and incrementally will allow you to keep Jack safe and not skip over the best dose for him. One other thing I would recommend going forward would be to get syringes with half unit markings as we usually suggest increasing dose by 0.25u and definitely no more than 0.5u. You can order U40 insulin syringes with half unit markings online from ADW diabetes as they make giving those in between doses much easier.
Another member was looking for info re: half unit marked syringes but she is in Canada so she posted over on Health and changed her message here. NVM = never mind! Nothing you need to be concerned with.....connected inquiry but different country!
It's definitely a steep learning curve and the best thing you can do is to cut yourself some slack. We are here to help you navigate through those early days, learn as much as possible and then to continue to offer support whenever needed. In the early days it is easy to get so wound up worrying about doing the right thing that we forget to look after ourselves. A nice glass of wine or some chocolate can help take the edge off!
I got home a little earlier than I thought I would tonight. Jack's PMPS is 320. I'm going to feed him now and give him .5U. And... I'll take it from there.
Even with the lowered dose, the really important thing is finding out what's happening mid-cycle. Any time you can get a test between +4 and +7 please do. Given the weight loss and the neuropathy, I'm a little worried about lowering the dose that much, so if you can get anything mid-cycle it will help us know what to suggest for next steps.
One of the things that worked really well for us when we were just starting out was to go back and reread the yellow "stickies" that are pinned to the top of the ProZinc forum page. Since I had by then begun to "experience" a lot of what was written there, when I went back to re-read, I was able to absorb a lot more of the details and begin to flesh out the larger picture. It's like the details could "stick" better in my brain because, through experience, I had built a structure to hang them onto.
I'm worried about lowering his dose this much as well. Last night, his PMPS was 320. I gave him .5. I was able to get a reading at + 2 and +3. At + 2 it was 345 and at +3 it was 320. This morning, before another half unit, is BG was for 447. I want to do what's suggested to me and I want to do things right. But I feel like I should be giving him at least 1 unit. I'll be home on Saturday, Sunday, and Monday, so I'll have three days to do some mid-cycle testings. But I think I'm going to one unit tonight.
Great job getting the extra tests! So the +2 shows us the "food spike". it's pretty normal after they eat, and before the insulin kicks in, to see the number rise a little right there. Then at +3, we might be seeing the insulin juuuust starting to come into play, or that might just be variation in the reading since the +2 and +3 are close together. Around here we always say "you hold the syringe" meaning that while we will give our best advice, you get to decide since ultimately you are the one responsible for your kitty. You'll also find that while generally we all agree on the best approach, sometimes when things aren't crystal clear, we will have different opinions. Then again, you get to decide what you think is best. So if you think 1u is the best option right now, it's fine to do that for a couple of cycles, get those mid-cycle tests in, and then we can go from there. Based on your +3 and AMPS, my hunch is that 1u will be a good next step. The more you test, the easier it gets for you both, and as it gets easier, you'll see how helpful all of these numbers are. It's hard at first, but those tests are the most powerful tool in helping jack recover. Also, do you have him on B12? It takes time, but it really helps with healing the neuropathy. Zobaline is designed for cats and you can buy it on Amazon. It's a little pricey, but it gives you the right type of B12 (there are a few types) and the right combination to make it effective. You might get him started on that to help stop any further damage and hopefully start reversing it.
I just added it to my cart (to be purchased as soon as I can). It would be so nice to see Jack walk on his toes again. He's such a gentle little soul.
If I feed Jack during the day (between his AM and PM shots), how will that influence his mid-cycle numbers?
Do you normally feed Jack during the day? If so, you want to just keep doing it even when you are getting mid cycle numbers. Yeah, it might make the numbers a bit higher than they would be without food, but honestly we've found that giving them food in smaller meals throughout the day often helps a lot. I tend to think it helps keep them at a slightly steadier BG level which can help you work on getting the numbers down without worrying that they'll go low as much. Feeding Jack as normal will give you a real picture of what he is likely to do on days you CAN'T get mid cycle numbers.
Before his diagnosis, I fed him grain-free dry food and it was available to him all day long. But since switching to the low carb canned, he doesn't have access all day long. So the problem is that I'm not consistent. On the days when I work all day, the cats are fed in the morning and again at night. But on the days I'm not working, I like to break that up into three meals instead of two. So the mid cycle numbers won't always be consistent. I'll just note when they get that extra meal and when they don't. Actually, I'd like to know the difference in his numbers when he eats during the day and when he doesn't.
Feeding schedule can make a pretty big difference. Alex was getting his pre-shot meal and then one +6 meal, and he was going from very high to very low. It actually made increasing the dose impossible even though his pre-shot numbers were high. I switched him getting more smaller meals at +4 and +8 on the 22nd and you can see the dramatic difference in his numbers, which means I can better adjust the dose without him bouncing so much. If you can't be around to feed him during the day or night you can get an automated feeder that will open on a timer. I put down all his food for the day at shot time, he just can't get at parts of it until the appropriate time.
I'm not sure how an automatic feeder would work for me. I have 4 other cats, so it would have to be enough for them too. Or, if it opens only for Jack (which I just recently learned that he can wear a special collar?), then I think that would be so unkind to do to the other cats. Can it work with multiple cats? I think I may try leaving some chunks of frozen canned when I leave for work, and maybe even when I go to bed. My concern with doing that is that I could not be certain that Jack won't consume some of it (or the lion's share because he is, hands down, the biggest eater of all of them) within that 2 hour time frame before his AMPS.
So I've had Jack on 1U for 4 cycles. Yesterday, and so far today, his mid cycle numbers are in the yellow. Do you think I should increase his dose or wait for another cycle or two? And, do you think I should increase by .5, or .25? It's getting so much easier to test him now. I find that warming his ear well (and he LOVES that part) helps to get a much better bead of blood. And now that I've learned to just scrape it right onto my thumb nail, it's made both of us much happier. And the more we do it, the easier it bleeds. I can see good changes in Jack since he started on insulin. His poop is not watery, as it had been for a while. And it no longer smells so sour that it could gag a maggot. And although movement takes real effort on his part because of his hind legs, he is definitely moving more than he was and now visits with us in the living room at night. (Before, he was staying in the bathroom, which is his favorite room in the house.) As a matter of fact, he got so happy last night that he forgot his legs hurt, and he nearly did an old fashion fairly trot like he used to do,. Sadly, it made him lose his balance and he fell over a little. Also, he is talking to us again. He's never been a big talker (like some of my other feline critters), but it seemed like he had nothing to say lately. It's music to my ears to hear his little squeak toy sounding meows. (And his purr is squeaky too.)
It sounds like Jack is definitely feeling better which is great news. As much as we tend to deal with BG numbers, those clinical signs of kitty feeling better speak volumes that things are moving in the right direction and definitely things to keep note of. It does look like Jack could use a little dose increase so you could try 1.25u for a few cycles and then re-evaluate again. If possible, getting a before bed test every night will provide clues as to what Jack is doing overnight. If BG is down significantly when you do the before bed test, you can take action to slow him down with some food. Many if not most cats go lower at night than they do during day cycles so it really helps to see at bit of what is happening during the night cycles. SOunds like Jack has some diabetic neuropathy. You can get some Zobaline (available online) to help with this. It should improve as his BG gets under better control but the supplement does seem to help speed up the process for a lot of cats.
My poor Jack really does have some neuropathy . I ordered Zobaline from amazon, and I can't wait to start giving it to him. I'm so hoping that as his BG comes down, and as he gets that supplement into him, he can start walking on his toes again. He stood next to the dining room chair last night, and his body posture and movements made it clear that he really wanted to jump up. But he knew that he just couldn't do it. It was sad to watch. And I miss seeing him stretched out on his back with his little belly exposed. I hope he can do that again some day. I am going to raise it by .5 tonight, and I'll try to get some bedtime testing done.
I increased his dose to a skinny 1.5, which I think looks to be somewhere between a 1.25U and a 1.5U.
Jack did something tonight that he hasn't done in a while. We have five cats, so we have a variety of empty boxes and blankets all over our home. Today, I cut the flaps off of an empty box and put it in the middle of the floor. A little while ago, I realized that Jack was laying in that box, with his head smashed up against the side and his eyes contentedly closed. I would have loved to have seen him get into that box, as I can't imagine that it was too easy for him to do. But he did it!
It's fine that you raised the dose to 1.5u however, while 0.25u does not seem a big increase, when starting at a dose of 1u, it's actually a 25% increase which for our little furry friends is substantial. You don't want to increase too quickly as you risk jumping over the best dose for Jack. Just some food for thought going forward. Finding Jack in the box must have been so heartwarming especially when he looked so content having made it in there. Our kitties are really quite the resilient little creatures.
When I (if I) raise it again, I'll go slow. I don't want to miss that perfect (at least for now) dose for Jack. This morning, his AMPS was only 300. I was happy to see his AM number out of the red! I'll get some mid cycle testing (I'm not working today) so I can see how he reacts to the increase. And I'm going to try for a testing before bed tonight. The problem with before bed testing is that I get sooo tired at night, so the ear poking feels a bit overwhelming then. But I need to do it for Jack. It will get easier as the poking becomes our norm.
