Question about hiding

My initial post, which I posted in the intro forum was:

My cat, Dorian, was diagnosed a few days ago. To my knowledge, his BG has never been past 459. He is 11. There was no sign of ketones in urine at the point of diagnosis/beginning of treatment. There was an indication of infection, which the vet is initially assuming is UTI. SO, for the 6 days since diagnosis, he's been on antibiotic and also insulin. He started on 3 units of insulin twice a day (he's almost 15 pounds - somewhat fat, but also very large boned and long). The day we did the all day BG testing (for a curve), he was around 40 for an hour. There was no sign of hypo reaction, but it scared me. We reduced at that point to 2 units. The vet thinks he'll end up on 2.5, but for now he's on 2. He did not handle ear pricks as well as cats seem to usually. It was highly stressful for all. He fought and fought every single time.

Since beginning treatments, along with a diet change, he is drinking much less water and is urinating much less. He seems to have more energy. But, he is also periodically hiding under the entertainment center. He will come out if I call him for a while, or pet him for a while, but it scares me that he's doing this when he hasn't done it before. He should be feeling better. Any thoughts?

Thank you so much!

The first response asked for me to post here, and also to answer the following:

What insulin is he on? He is on Novolin.

What diet changes have you made and when? He used to be on Iams Weight Management (dry). Before that it was Iams sensitive stomach (or something like that). He's never been on very high grain foods. He had hepatitis of the liver when he was 2, and very nearly died. So, his food has had to be easy on the liver since then. The day he was diagnosed, the vet suggested Purina DM. Because I wasn't able that day to get anywhere to get that, I got wet kitten food (the vet's second suggestion). He didn't like that. So, I got online for a very long time and ended up with the idea that Fancy Feast chicken (classic) was probably the best bet. So, the next day, Thursday, he started on that. He has had only Fancy Feast chicken classic since last Thursday.

What meter are you using? A human glucometer. His BG was never checked at the vet. The diagnosis was initially based on sugar in the urine. She said that BG checks at the vet were less accurate because of the stress, so if I was willing to do it at home, I should. So, I did the first check Wednesday evening, after which his diagnosis became official (he was diagnosed Wednesday, a week ago today, when I texted the vet the number). I did it only every 8-12 hours until Sunday, when we did a curve, after he'd been on 3 units twice a day for 3.5 days. I will upload the curve image. I overlaid the 'ideal' curve, with his in black. It was a 12 hour curve, from the first insulin injection and feeding, until time for the last. There was a meal at the second low point as well, followed by the rise.

Prior to last Wednesday, he had been drinking and urinating a concerning amount, which is what led me to seek diagnosis. He has not been doing that since last Thursday. He has a few times still gone to linger around the water bowl, but he's not drinking as much. Thank you!

Original thread: http://www.felinediabetes.com/FDMB/threads/newbie-question-about-hiding.161273/#post-1724063

 

Based on our curve and using N insulin I would have reduced dose to one unit.
Your graph tends to indicate that you are dosing once daily since it shows a low at about 12 hours and N insulin peaks at about 4-6 hours
How

 

The entire curve is 12 hours. It is the 12 hours from dose to dose.

 

From the curve you have posted it looks as though he is dropping about 300 points from pre-shot to nadir (lowest point) which is a big drop compared to other insulins and seems to be typical of Novolin from what I have read although I am not familiar with it. Although he wasn't displaying hypo symptoms I do wonder if the hiding is his way of telling you that he is not happy as his level is too low. 3 units is a big starting dose and I think you were right to reduce the dose. Do you check him pre-meals and at other times?

 

I have not been checking him since Sunday because it was such a HUGE stresser for him. Vet said lowering to 2 had been the right choice and I should wait a few days and do another curve.

 

It is recommended to check before every shot as you need to know if the number is safe to shoot. It does take some getting used to, always give a treat after each test so your kitty learns it is a good thing, given time most cats take to it very well. Here is the link to home testing tips with lots of information and advice on how to make it easier for both of you. http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

Larry who posted above is experienced with the use of Novolin.

 

Ok, thank you! So, I need to test before his shots. And, you guys are thinking the likely scenario is his BG is too low? So, I will likely need to test again at a peak point?

 

Yes, we did have another user recently using a different insulin whose cat got aggressive and would hide during the day. When they started regular testing and halved the insulin dose their cat stopped the odd behaviour and they are getting good numbers now. I would drop the dose as Larry suggested if Dorian was mine and check before each shot and when you expect the low point to be, and at other times if you can.

When you have a moment can you add some information to your signature and set up a spreadsheet. This will make it easier to see patterns in the glucose levels and will be useful if you need further help.

It is better to let the levels run a little high until you get more information on how Dorian's body reacts to the insulin, and what his ideal dose should be, than to have to deal with a hypo, especially as you are just starting out.

 

Thank you, Alexi! I just sorta like copied Cappuccino's sheet. I will do a check before his 8 pm shot (cue the fear and loathing). Should I switch to 1 unit now, or see what happens tonight and tomorrow at lunch time (which is when the lowness problem occurred Sunday)?

Thanks you guys for all your help!

 

Ok, so one hour before his next shot is due I did a test. He was acting quite hungry and I didn't want to make him wait for his meal that he has been having at 8, and so gave it to him at 7. So, I wanted to get the test done prior to his eating. His BG was 95. It will raise some by 8, since he's eating now, maybe even by 100 or more. But, then he won't eat again between whatever amount of insulin I give him at 8, and his next dose.

Can anyone give me an if/then on level at 8 and dosing or skipping? @Larry and Kitties ?

Thank you, guys!

 

Since you tested at +11 and already fed, the only number you can really go by is the +11 test of 95. If you retest in one hour the number will be food influenced. Considering the lower number at +11 and the big drop you had yesterday, I would skip the shot for the night. Novolin N tends to drop the numbers fairly quickly .That 95 is too low to shoot. It was suggested that maybe you should start back at 1 unit....that might be a better starting point for Dorian for tomorrow.

I suggest skipping the shot altogether for tonight and then post in the morning with the preshot number..(.without Dorian having any food for at least 2 hours before the preshot). If the number is less than 200 then you could post for advice about the dosage.

 

Ok, thank you!

At dose time, it was 146. So, I'm skipping it unless someone says something different. The big drop wasn't yesterday. It was Sunday, on 3 units.

 

OK..I looked at the last numbers you had on the spreadsheet and didn't look at the date. Regardless Novolin N does tend to drop the numbers pretty quickly. Even with that 146...and that was after eating...I would still suggest skipping the shot for tonight. Has Dorian ever been diagnosed with ketones or DKA (diabetic ketoacidosis)...he would have been hospitalized if he had DKA? If not then skipping would be the best approach. You said he was being treated for a possible UTI and you did a diet change. If he had an infection and was on higher carb food before, both those factors could have contributed to the higher numbers. With clearing the infection and switching to a low car wet food, Dorian's insulin needs could drop quite a lot. Definitely test in the morning before doing a shot and if the numbers are still low, then repost for advice.

 

Ok, thank you so much! No, he has just been showing any symptoms of anything for the past month or so (increased drinking and urinating), and I didn't put it together until a bit over a week ago. I was chalking it up to Texas heat, but then his urine was having a chemical reaction with his (silicone gel) litter. Even that didn't ring a bell with me right away. But then last week, we set the testing in motion, and Wednesday (one week ago) the results were positive for sugar, and negative for ketones.

 

Humulin/Novolin NPH guide

 

Thank you, @BJM !

 

Great..with no ketones having shown then skipping a shot is not a problem. With the infection clearing and being put on a low carb wet food, it is very possible that Dorian will be needing a lower dose of insulin in the future. It is better to be safe when your kitty has shown that he can drop quite low. Not all kitties will show signs of hypo until it gets very low, so you can't always rely on the visual signs.

 

Can we get you started using our grid to record your glucose tests? It will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning, pre-shot, test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening, pre-shot, test)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

The nadir is the lowest glucose between shots. There is a general period when it will happen which is specific to the insulin being used and testing then helps make sure your cat doesn't go too low.

It is merely a grid for storing the info; no math required.

 

I'm confused a little. I used this exactly for Dorian's sheet. I only changed the colors so I could more easily sort in my brain (higher is closer to red on a rainbow). Is it the color change that means I need to do it over?

 

Whoops - didn't see your link (my apologies - I've crappy eyesight)

I will note that folks expect the colors in a particular order and when you change them, it takes more time to review the glucose test patterns because the color order is not the same.

 

Have you considered a different more gentle insulin ?
Lantus/ lev or even pro zinc ?

 

Absolutely agree with everything said above.
Why use Novolin insulin if you have much better choice at your disposal? I can understand that you might be no expert (as yet!) and you just go with your vet's recommendation but there is something you can do:
BECOME AN EXPERT YOURSELF!
I'm serious suggesting that because vets, unfortunately very often are not experts on FD (feline diabetes) and you showed your intelligence and commitment to your kitty by contacting FDMB and getting help.
We are all the way here with you and you can ask any question regarding cats health. But first .... learn as much as you can by reading all the information provided here. Knowledge is power and you need this confidence to bring your kitty back to health.
Sending you lots of hugs and wishes of good luck on this journey.
Marlena

 

I haven't. I just gave him what the vet said. I didn't know what other insulin existed. I've spent a lot of my spare time researching this (via google searches and multiple sites) in the week since diagnosis, but it's sort of like drinking from a water hose, and insulin type hadn't flowed in yet. Thank you for the suggestion!

This morning he was 304 (after 24 hours with no insulin). So, I'll give 1 unit this morning. I think that's what was suggested before. I also changed back the colors on his chart.

Speaking of insulin, how long do you guys keep a bottle? The pharmacist said 28 days, but said don't refrigerate. The vet said refrigerate, and 3-4 months. What's the reality?

 

since you asked
Reality is many of us make sure to handle to insulin very carefully (with lantus refrigerate and do not shake-do not keep on door of fridge never push ai into the actual liquid/insulin... there is a video)

it last at least 6 months many of us use for a year-if it seems like it is losing potency we will get a new one-but most last at least 6 -9 months-

Lots of cats get very small doses so it is a huge waste to throw away lantus which is very expensive--they do sell lantus pens about 35$ but a vial is about 400$
I have used 3 insulins starting with vetsulin and it was very harsh--Dre was so miserable and he dropped like a rock and went back up like a rocket-
we went to pro zinc which he was happy but did not last long enough in his system-in hindsight I wish I had started with lantus-many also do well with levimer.
My vet also just gave me a bottle of vetsulin and said "I can't imagine he would need less than 1 unit Bid" LOL
no home testing conversation -gave me some DM which I donated LOL
so much I had and have to learn---this forum saved his life!

 

Ok, thank you! I will check into the prices of all of those. I wasn't financially prepared for any of this, and after all the other upfront costs, $400 a bottle might have to wait until I catch my breath on the money side. So, probably I will end up with one of the other two today. Novolin was pretty cheap comparitively, but now since it needs to be tossed was just a waste. Wish I'd known before. But, then, I just left the vet's and went straight to the pharmacy, in a sort of blind panic.

 

You can buy Lantus and Levemir for a fraction of the price by ordering from Canada. I haven't done this personally as I live in Canada, but it seems that many members in the U.S. get their insulin that way.

There is more information in this post:

Insulin from Canadian pharmacies

Edited to add: You can also find more information if you do a forum search.

 

I didn't realize these were prescription in the US as well. So, I'm attempting to get a prescription, and I guess I'll just order it from Canada and linger on the low side and check regularly while I wait. In the meantime, I'll read as much as I can on the site so that the number of questions which are urgent will be decreased.

 

There are pro and cons to all the insulins, make sure you read up on the advantages and disadvantages of each and make sure you have something that fits with your lifestyle, and the degree of flexibility you have with the various types of insulin and the testing regimes needed, as well as the costs involved. You need to make an informed choice as life gets in the way (quite often in my case). If you are home all day to test then that is a very different ball game to having to be out most of the day at work and no time to dash back home to grab a test. The dream is to get your cat into remission, some cats will get there - others won't and the success rate depends on both the cat and the insulin as well as the lifestyle of the caregiver. Take your time and get informed. Just because it works for someone else's cat doesn't mean it will work for yours. I am in the UK where we have less flexibility in choice of insulin due to the prescribing rules, but for me given the choice between Prozinc and Lantus I would want Prozinc, but that is more to do with my work commitments than my cat, others feel that Lantus would suit them better. What I'm trying to say is that it isn't just about the insulin but all the other factors that come into play when your kitty has diabetes.