PMPS 277 - Normally over 300+. Do I shoot same dose? Shooting within hour. Please advise. Thanks!

Ozzy's PMPS is 277. This is the lowest he has been PMPS and he has never been in the yellows PS. Do I give the same 1 u dose of insulin or give a lower dose?

Ozzy has been pretty PO'd today about not getting dry food. He has been doing pretty well the last few weeks on wet food only but we are still weaning our other kitty off the dry. Today I tried to give Figgie some secretly and Ozzy heard the crunchy munchies hitting the bowl and came running. He was a carboholic. I decided not to give Figgie the dry so Ozzy wouldn't get jealous. Aren't our cats emotions so much like humans!!?? Later this evening, Figgie was on the washer again begging for dry (this is where we usually gave him his dry food because we had to separate his dry from Ozzy or Ozzy would steal it all) and I snuck out to the garage and put a little in his bowl and brought it back into the house. But as soon as Figgie was crunching on it, Ozzy came running. Ozzy has been pretty pissed at me all day because Figgie is getting Ozzy's favorite food and Ozzy is not.

Goal is to get Figgie off the dry as well but we need to wean him.

Ozzy has eaten a good amount of food today but not his full portion. Trying to get him to eat a big PS dinner now.

So, back to my original question- do I give him the full 1 U of insulin with a PMPS of 277?

Thanks in advance to any responses.

Joanna

 

I think you could give the 1 u and test this evening. For greater peace of mind you could give 0.75 u. What do you think?

It would be helpful if you could add which time zone you're in to your signature info. Then we'd have an idea of how much time you have ahead to test, etc. and you'd know when we're headed off to bed.

 

I'm open to options.

Do you think his BG is lower because he didn't eat as much food today? I don't have much data and his PS numbers are jumping around still, but I think I notice a small trend downwards. What do you think?

I'm in California. Pacific Daylight Time.. It's 7:57 pm here now. Will update signature now. Thanks for the suggestion Kris.

 

Yes, there is an overall trend slightly downward. Not sure about today's numbers - maybe food or maybe a bit better response to this dose. I suggest you try to get several +2, +3 and +4 tests over the next few cycles. They don't all have to be back to back in one cycle. The Vetsulin tends to produce an earlier nadir, often around +4. You need data to see Ozzy's trends in the time range. If he does a nose dive at +2, say, and you've figured out he nadirs around +4, then you'd know you have a tense couple of hours ahead needing testing and maybe high carb snacks to keep him from heading down really low. Data is king!

 

Thanks for the feedback Kris. I'm going to go ahead with the .75U tonight. Will test him +2 and +4. I have noticed his nadir on vestulin is around +3 - +4. Thanks for helping me through this. I have those 'crunchie munchies' on hand if he goes low. I'm sure he'd love that! But trying to avoid all dry food.

I will try to do another curve here in the next day or so. I am off until Jan 3rd so lots of time to get more data.

Thanks again!

 

You're welcome!

 

Do you have some Fancy Feast Gravy Lovers? That's what most of us use if they need some high carb food to bring up their blood glucose....it gets into the bloodstream faster than dry and clears faster too. The gravy part is very high carb. You just pop the top, put it back and squeeze the gravy into another bowl and give a teaspoon or two at a time

You can also add a few drops of Karo, honey or syrup to a little low carb food IF it's necessary to bring him up

 

Thank you for the advice. I don't have that cat food on hand but I will definitely get some next time I'm at the store. I have some of the FF with sweet potatoes on hand. I think that is a little higher in carbs than the classics.

 

Totally confused here.... just did a +1 and Ozzy went up to 321. He ate a good size dinner- all wet food- and his number went up. I gave him approx. .5 -.75U of vestulin about an hour ago. It's hard to tell the dosing with my syringes, so I had to try to eyeball it. Still - he should have went down in the hour. Will check him again soon.

 

Hi Joanna...not sure what to tell you but notified Linda( MrWorfmansmom) who has been helping me tonight. Bless her heart, Elmo and I have kept her up late tonight( I'm in Missouri, central time) ....what they always tell me is better high for a bit than low...have read over your info...maybe double check carb level of food ??? When we were early in this I use to write the carb number on the can ....still do some times just for safety, reminders.

 

Also I got the u40s with half unit markings ...that way you have the .50 marking to eyeball from. I still get wobble knees with the whole" eyeballing" thing....having the half unit u40s is helpful.....

 

How do you tell the carb content of wet food. It's unfortunately not listed on the can!

 

what did you feed? If it was the FF Classics, they're fine

Any chance he actually got into a few kibbles? He's been trying awfully hard today!

 

+2 = 210. So went from 277 PMPS to 321 +1 and then back down to 210 +2. Poor kitty - he is all over the map!

 

You don't have any other tests at +1.....most cats do get a "food bump"

I wouldn't worry about it tonight......occasionally get a +1 so you can get a "feel" for what kind of food bump he usually gets

 

He has definitely been wanting his crunchy munchies today- but no, no chance he got into them. Figgie always gets his dry food separate in a bowl on top of the washing machine. Ozzy is a ground dweller and never could jump high enough to get on the washer.

He ate a combo from his petsafe5 tonight when the lid was up. I was just trying to encourage him to eat anything because he was turning his nose up to wet food today since he saw Fig get some dry kibble. The petsafe5 had a combo of different foods- Friskies pate, FF classics, and Sheba pate. All foods that I read on this site are low carb. Right?

 

I looked back at Ozzy's spreadsheet and only see I did a +1 two times, so not a lot of data. Both times, he went down in BG numbers, but I definitely get what you are saying about a 'food bump'. Gave him a slightly lower dose of insulin tonight due to his first yellow PS. I am feeling ok that he is going to be fine tonight.

He's really moody about not getting dry food. My cat is acting like a baby!!

 

But could Figgie drop a few onto the floor for Ozzy to get into?

Right!!

 

I see Chris explained the "bump" and it looks like he's dropping at a bit slower than usual rate tonight if you take the food bump out of the picture. Not sure how much longer you are going to monitor Ozzy. Chris are you going to be able to stay with Joanna a bit longer? I would like to hit the sack but can stay another 30 minutes or so if need be.

 

Go to catinfo.org and she has most foods listed alphabetically by company with carb content. Think it's somewhere here on FDMB too. Super helpful !!

 

I don't want to say never because I don't like to speak in 'absolutes' - however, I really doubt it. Figgie is a little prince and is so delicate and I don't know what other word to use besides 'tinky' because that's his nickname. Basically what I'm trying to say is that it's most likely that he did not drop any food down on the floor that Ozzy got into. His dry food dish is placed towards the back of the washer and most importantly, I actually closed Figgie off in the washer room because I was trying to hide the fact that he was getting kibble from Ozzy because I didn't want him to get jealous. Didn't work though- Ozzy must have smelled it or something. It is so funny to me that I'm trying to describe my silly kitties and explain how they get jealous, as if they were humans. But they really do act this way!

 

Oh thank you so much for commenting MrWorfMen's Mom- both of you really! I really appreciate it. I honestly am not concerned for any type of hypo event tonight, especially since Ozzy ate good and we gave him a lower dose than he has been getting. I am just curious about the sudden change of events with his BG. Please please....go get your very needed rest! Thank you again so much for responding tonight!

 

Thank you so much for sharing this. I will definitely check it out and print it out for future reference.

This is exactly why I love this site and the folks on it!

THANK YOU!!!

 

But they do get jealous and they do show it like some humans! My little guy has to check out everyone else's food bowls to ensure he is not getting an inferior meal!
With that I will wish you ladies a good night and sweet dreams!

 

I really need to go too....I have to take DM to PT tomorrow

 

He probably heard the "crunching"....I swear when you're calling for them they can be deaf as a doorknob but no matter how hard you try to sneak food, they're right there on top of it!!

 

Hahaha!!! This made me chuckle so hard. Yes, my kitties do this too!!! Thanks for making me laugh! Good night Mr.WorfMen's Mom. I am sleepy too... made hubby baked ziti tonight and had a glass or two of wine and now I'm super sleepy too.

 

Here's the Food Chart

It's a bit long to print out though

 

No emergencies here that I am concerned about. Thank you for responding to my questions/concerns. Sweet dreams Chris!

 

This THIS! Exactly!!!! Hahahah!!

 

Thank you so much! I swear I'm gonna feel like an expert here soon with all the knowledge that is shared here on the reg!!

 

Sometimes dose onset may be a little later. Between that and perhaps Ozzy eating a little extra those are two reasons why one might see a slight food rise early in the cycle.

It's nice to hear about Ozzy and Figgie's antics!


Mogs
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Bump.

 

Ozzy has another yellow preshot this am. 273. I wasn't able to get another reading last night because I fell asleep good (baked ziti and wine will do that to you), but I am going to try to get a +2 and a +4 -+5 this afternoon and will post back. Maybe Ozzy is starting to trend downwards. Fingers/paws crossed!

 

Ozzy the Pawsome's sunbathing again!

Having a quick gander at his spreadsheet, Joanna; BRB ...


Mogs
.

 

Are you checking daily for ketones, Joanna?

When did you last check? (IIRC you were wondering whether it was trace or negative.)


Mogs
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Yes, I am checking daily for ketones when I can get him to pee for me. Last time was yesterday. Looked more on the negative side at 15 secs. Been adding water to his food. Let me go see if he'll pee for me right now and I will post back.

 

ok, he had no pee on deck but Figgie did. That's of no help though! Will try again later today.

 

Figgie's being supportive!

Ta for info.

Are you definitely able to monitor from +3 to +5 today, Joanna?

.

 

I have to go to the dentist lab at 12:30pm. It's just a few minutes down the road. I can test him at 12:15 before I leave which will be +3 -45mins. I imagine I will be back within the hour around 1:30 so that would be +5 and I can test again. Are you concerned Mogs. Should I be concerned? I gave him a smaller dose again like last night. It's hard to tell on my syringes....I eyeballed a .75U pull but it could've been .5U.

 

That's absolutely dandy time-wise for monitoring, Joanna.

With only 2 yellow preshots one can only speculate - wildly! - about what might be happening:

1. The insulin support could be helping the pancreas rest.

2. Ozzy's body may be starting to respond to and better utilise available insulin.

3. The slightly smaller dose might 'suit him better' (less of a battle between injected insulin and homeostatic mechanisms in the body?).

(Need more data to get a better picture.)

The typical recommendation on FDMB for a no-shoot number is 200mg/dL (human meter) so Ozzy's well above that. Thus far his BG tends to drop c. 200-250 points on 1 unit Vetsulin.

The other consideration is Ozzy's ketone history so extra care needs to be taken when tweaking doses downwards.

Options:

- Give 0.75 IU - may not dip numbers down as far at nadir (hence importance of checking) but may smooth out Ozzy's numbers over the cycle (possibly not as high at preshot). Make sure to get a ketone check for peace of mind.

- Give 1.0 IU - possibility that numbers may dip into double digits so closer monitoring might be advisable in active part of cycle.

(Suggest leaving some food out for Ozzy while you're away from home today, regardless of dose.)

You hold the syringe, Joanna. I'm super cautious. If it were my cat:

- If I were home all day to monitor I'd do 1.0 IU.

- If I had to go out I'd do the smaller dose and be extra vigilant for ketones.

Whichever dose you give, I suggest snagging a test at +8 today so you can start getting a better picture of how long the Vetsulin is lasting in Ozzy's system.

I'm going to tag Linda (@MrWorfMen's Mom) to ask her to review these suggestions and see what her thoughts are. (I always prefer to have other experienced members check anything I post about insulin doses.)


Mogs
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+2 = 234. Seems like he is not dropping as hard on these last few shots.

 

Thanks Mogs. Can you explain a little more about what you mean by your above comment on his ketone history? Specifically, with him starting to have lower numbers how do ketones play a part? I am going to test him again today when I can get him to 'pee on demand'. Ha! Like that ever happened to anyone.

Ozzy now has his very own Petsafe5 and he gets food every 3 hours. I am wondering if this might be one of the reasons he is starting to throw some lower numbers. Maybe because he is eating every few hours it is giving something for the insulin to work with? I have also noticed he is not dropping as hard/fast but I only have a little data so it's hard to say. Ozzy doesn't eat exactly every 3 hours, he misses some of the compartments here and there; but overall, he is eating more small meals throughout the day then he has ever before. And he's on all wet food even though he really wants those crunchie munchies!

 

What dose did you end up giving this AM, Joanna? Doesn't show on your SS.

 

BTW...I gave him the eyeballed .5 - .75U this morning. Will curve him for the rest of the day since I'm only out for a bit this afternoon.

 

Whoops! Just updated it.

 

"Ozzy now has his very own Petsafe5 and he gets food every 3 hours. I am wondering if this might be one of the reasons he is starting to throw some lower numbers. Maybe because he is eating every few hours it is giving something for the insulin to work with? I have also noticed he is not dropping as hard/fast but I only have a little data so it's hard to say. Ozzy doesn't eat exactly every 3 hours, he misses some of the compartments here and there; but overall, he is eating more small meals throughout the day then he has ever before. And he's on all wet food even though he really wants those crunchie munchies!" [/QUOTE]


Ozzy has had a DKA episode so he's proven to you that he can develop ketones if BG stays too high. You want to keep this in mind when Ozzy gets stuck in higher numbers either because a dose is too low and is held too long or if a drop triggers bouncing that puts him up on the ceiling. Hence, small dose increases as needed but not too much to avoid bouncing.

 

The lower numbers are good news ketone-wise; the body is getting more glucose into the cells to provide energy for normal metabolism.

Cats with a history of ketosis or DKA tend to be more prone to developing ketones so they need closer monitoring. When considering a dose reduction in a ketone-prone kitty it's a good precautionary measure to keep a closer eye on ketone levels just in case the dose reduction might have an impact on ketone status.


Mogs
.

 

Ok, this is very important to know. Thank you. He is eating again. Will try to get him to 'pee for me' when he is done and will test his ketones again. I am trying to do it once a day. I am adding more water to his food because of the weird looking inbetween negative and trace results. Will let you know what the next test reveals.

 

I was browsing Ozzy's sheet last night and was thinking then 0.75u to 1.0 seems to be the ticket right now. I just had another peak. I too tend to be super conservative and agree with Mogs.

If you can monitor, the 1.0u might push Ozzy down more at nadir but with monitoring/steering if need be, I think it's worth a try.

I also agree on the lower dose of 0.75 if you have to be out especially in the earlier part of the cycle. I use a different insulin but I have on occasion lowered my girl's dose for a cycle just to accommodate my schedule so I know she will be safe when I am out. I leave food out but can't be sure who is eating it. I'm guessing you might have the same problem!

The ability to "graze" may very well be helping smooth Ozzy out a bit.

Gotta run and start loading the little one for a vettie visit. Will check back in later!

 

Kris, so far on only 1U he goes lower for a few hours and then is back in the pinks before every preshot. Last night and this am were his first yellow preshots. I gave him a little smaller dose because he tends to drop fast on the vestulin. If I get another yellow preshot tonight, do you think I should do the 1U or .75U? I am curving him this afternoon so will have more data by this evening.

Just tried to get him to pee for me again so I could test his ketones (camera in hand this time). But nope.... I think he's secretly peeing without me knowing! Haha!

 

Let's see what your data looks like later on.

 

Thanks! Appreciate your feedback. Good luck at the vets! Hoping it's all good news for you and yours!

 

Sounds like a plan.

 

That's the nature of the insulin, Joanna. Typically you'll see that pattern of rising up again in the last part of the cycle regardless of BG range or dose; Vetsulin typically doesn't have sufficient duration of effect in cats. Increasing the dose may produce a wider, steeper swing, not a longer, steadier low period (and the swings can make a cat feel crummy).


Mogs
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@MrWorfMen's Mom - Thank you!


Mogs
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I don't like the sound of this.. Why do they give kitties vestulin then? Am I missing something????I think you said it was originally meant for dogs. I don't want my kitty to have such crazy BG swings and feel crummy all the time. Who wants to live like that? I know things are still early on and I want to give it some time, but I really am interested in looking into another type of insulin that can be gentlier on Ozzy and not have him on the mountain and in the valley constantly every day. That sounds awful.

 

I think Vetsulin is prescribed because it's relatively cheap and vets are more accustomed to it because dogs get it. Some vets have a hard time distinguishing between cats and dogs when it comes to FD.

 

Mogs- will you get to see the lunar eclipse on tonight's winter solstice from your area in the UK? Tonight celestial event is supposed to be very rare and it will be one the longest and darkest nights in history.

 

Response to any insulin varies with the cat, Joanna (hence my italicised 'typicallys').

Some cats do just fine on Vetsulin - and may get better dose duration. Some cats achieve remission on Vetsulin.

Monitoring of BG and clinical signs will help you to determine how well Ozzy does on his current insulin. A good thing to monitor is whether or not he develops a pattern of unusual lethargy/sleepiness for most of the time the Vetsulin is at peak effect but then perks up in the couple of hours before the next dose is due. Another thing to watch during peak period of effect is withdrawal behaviours or low mood. These clinical signs may indicate that Vetsulin doesn't agree with a cat. If Ozzy remains 'himself' and has normal levels of activity and rest during the cycle then the only sticking point would be the dose duration (assuming that his BG readings continue to show it petering out in the final third of the cycle).


Mogs
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Thank you. This is extremely helpful advice, especially what to look for in his clinical signs during peak times. I will start taking note. He normally sleeps a lot, don't all cats? So how can you tell the difference between normal cat napping and lethargy?

 

BG 160 at +3.5. Tried to get him to pee again. Nope. He looks grumpy and unhappy. Putting him in front of his food bowl. Be back soon to retest.

 

BG = 153 at +5

 

Looks like some time under the renal threshold today. Ozzy seems to be responding well to his insulin.

.

 

Thank you Mogs. That is an encouraging comment.

What is the 'renal threshold'? Why is this important?

Thanks.

Jo

 

Looks like I won't be hearing back from my vet until sometime in January. He is off this week until Christmas Eve. Not sure I will be hearing from him then so probably will have to wait until after the holidays. Looks like I'll be looking here (like I have been since day one!) for some guidance when needed.

 

http://petdiabetes.wikia.com/wiki/Renal_threshold
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440050/
When BG concentration exceeds the reabsorptive capacity of the proximal convoluted tubules, glucose will persist in the renal filtrate and cause an osmotic diuresis. The renal threshold for dogs is usually between 160 and 220 mg/dl; the value for cats is not well established but appears to be higher, at 230–280 mg/dl.

 

Explained here:

http://petdiabetes.wikia.com/wiki/Renal_threshold

(Very good educational site, BTW.)

The longer BG remains under the renal threshold the better the regulation, although the cat may still be in diabetic numbers. (Some vets have this as their primary (and possibly sole) objective when treating diabetics - unfortunately.)


Mogs
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@Larry and Kitties -

Snap!


Mogs
.

 

Thanks Larry and Mogs - you guys rock!

 

Back atchya!

 

Reading up on the links you and Larry sent me. Maybe this is the reason I can't get him to pee for me today (yet). He probably just doesn't need to urinate as much as he was before.

I'm convinced he peed in secret at some point today though. Just doesn't want his mama behind him with a strip looking like a wierdo!

 

This is excellent news! I'm glad you posted this, Jo, because I meant to ask how Ozzy was doing in terms of water consumption and urine production. Reduction in thirst and urine output are key clinical signs pointing to improvements in regulation. (Some people rely exclusively on water consumption to monitor their cat's regulation status - but it's a very crude metric since it only points to BG levels being under the renal threshold.)

Here's another very helpful petwikia article which explains the mechanics behind polyuria (excessive urination) and its consequence, polydipsia (excessive thirst):

http://petdiabetes.wikia.com/wiki/Polyuria


Mogs
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Thanks Mogs. I will read and bookmark that one next.

Should I also be testing for glucose in the urine? I am only testing for ketones now. Looks like that might be important, too?

 

May not have mentioned this before, but Ozzy's tests on his pancreas both before his DKA episode and a week after were normal. So he did not/does not have pancreatitis. He did have one slightly elevated liver test that improved after his DKA episode, but the vet said the number was elevated slightly and he was not concerned. So...I assume his liver and pancreas are not damaged. With this info, how likely is it that he might be able to go into remission????? Down the line of course....not like tomorrow.

 

Urine glucose monitoring isn't really necessary when one is regularly monitoring blood glucose levels at home. However when a kitty's not yet regulated it can be helpful to use urinalysis strips which test for both glucose and ketones. (Keto-diastix or similar - I use Bayer Multistix 10SG strips because, in addition to panels for glucose and ketones, they have panels for protein, pH, and a number of other markers).

When home testing BG the sole advantage of also testing for presence of glucose in urine is to get an idea of the approximate value for that particular cat's renal threshold. (Renal threshold varies from cat to cat.)


Mogs
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I am beyond pleased for you that Ozzy tested negative for pancreatitis!

If the pancreas isn't inflamed it has to be a good thing all round. I've not done any research into it but I would imagine that beta cells would have a better time of it in a non-inflamed pancreas. (Speculating here - never searched for evidence to prove or disprove such a tentative hypothesis.) It is worth noting that it is possible for cats with chronic pancreatitis can and do achieve remission.

Cats in DKA have seriously messed-up metabolic functions so I'd imagine that it might well take a bit of time for things to settle down.

For general info, occasionally Saoirse might have very slightly elevated liver markers but our main vet said it was not something which he was really concerned about. She seemed fine in herself at the times the test samples were drawn.


Mogs
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+7 = 212. He is on his way back up now. So much for that below the renal threshold. That's over now for the next 8 hours.

 

Jo, you remind me so much of what I was like when Saoirse was on Caninsulin (UK brand name for Vetsulin)! I'd have these schizophrenic moments in the second part of a cycle where half of me would be hacked off at seeing higher numbers on my Alphatrak and the other half would be sighing with relief that Saoirse was in no danger of going hypo. (There's just no pleasing some folks ... )


Mogs
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Ozzy is over his nadir and he did not get below 150 today even with a yellow preshot. I'm thinking go back to the 1U. What do you guys think?

 

No Kidding!! Sorry if I sound crazy! It seems we go on top of the mountain and down in the valley along with them, I guess. See what happens when you're home for the holidays and have nothing to do....you spend all day on FDMB, researching FD, and turn your kitty into a science experiment!! I should go bake some cookies or finish my Christmas shopping, or something!!!

 

Ok- saw Ozzy finally head to the kitty box so I ran after him with ketone strip and camera in hand and got the 15 sec test with photo. I am going with negative on this one.

I seriously have turned into a mad woman!

 

Agree. Love negative ketone results.

You get a lot of that round these parts!


Mogs
.

 

Chris- this was really helpful. I finally had some time to look the whole thing over and grabbed all the kitty food out of my cupboard so I could do a comparison. I noticed one of the FF (roasted chicken) is a little too high. I will give that to Figgie (non-diabetic) until it's gone and not reorder. Shame- they both LOVED it. No wonder. Also another FF -turkey and giblets was not on the list even though it was listed as a classics on the can. I found it on the list under the "GRAVY" versions but it doesn't say that on the can so will probably skip that one from now on, too.

 

Ozzy's PMPS was 341 so the celebratory yellow PS will have to end for today. Hoping for another one tomorrow though. Going to go ahead and give the 1 U. Shoot in about 30 mins.

 

Look under "Miscellaneous" .....right after "Gravy Lovers" in the FF list...it's 3%

 

I missed that, thanks Chris. Good- my kitties really liked that one, too! Glad we can keep it.

 

It's a gradual thang, Jo.

Ozzy'll be breaking out the Ray-Bans again.


Mogs
.

 

Well.... Ozzy started out with another pink PS this am and he has stayed in the yellows (no healing blues so far this cycle) for the last 7 hours. He's been a total sweetheart all day though, looking and seeming to be very happy and content and very lovey dovey - so that is good. He's been surfing in yellows all day though and not really having too much of a drastic drop or rise so far, so I guess that part is good. Who knows, maybe he'll surprise us and end in a yellow pre-shot tonight.

I know it's a marathon, not a sprint. I'm just jogging along side my cutie right now.

It has been so very helpful to look at other people's charts and see the gradual dips in pinks, to yellows, to blues, and then greens. It's like you can literally see their kitty getting well before your eyes. I'm really hoping for this for Ozzy, too.

I have spent a little time in the Vestulin forum and am feeling a little better about Ozzy being on this type of insulin. Lots of folks had good things to say about it and that it worked really well for their kitty. The comment that was most interesting to me was from someone who said their kitty went low and fast early on and the insulin would poop out around 6-8 hours- just like we are seeing in Ozzy's reaction. But overtime, their kitty normalized on the insulin and had a smoother curve and the insulin would last longer. Their kitty eventually ended in remission.

Ooohh...don't I wish I had a crystal ball!!!