Regulation Help

Hi everyone,
I'm new to the message board. My 6-year-old kitty Diablo was diagnosed last March after a bout with steroids. Even though his diagnosis is not new, all of this information is. I was never aware that remission or regulation was possible with home testing, wet food, etc., etc. At this point, I am doing as much reasearch and gathering as much information that I can before I start the process. I'm here to get advice from anyone who has been through this and could provide some support. Here's where we're at..
Diablo is on low-carb dry food (looking to switch him when I get this started, IF he'll take to it... not a fan of dry food), and he gets 4 units 2x a day, eating before his shots. Taking him to the vet for his BG testing really stresses him out, which is why I'm looking to move toward home testing, so we can get more accurate results. When testing at the vet he is usually 200-300. After dosing up and up and up, he still gets the same results when going to the vet. At one time, he was stable, in the low 100s, but that went out the window.
Since I work from home, I know that moving to this new regulation is definitely plausible, so if I need to feed him three to four times a day, I can do that. What I'm looking for first of all is some kind of feeding/shot schedule I can follow. Does anyone have an example of what they do? Do I test, then feed? Feed then test? Shot, if necessary, after eating? It's all a jumble in my head right now, and I'm just trying to sort this out and start his regulation with a clear idea of what I need to do.
If anyone can help provide any kind of avice, I would deeply appreciate it. Thanks!

 

Hi and welcome to our group,

Good for you for doing all the research, knowledge is power. We can help you with all of this.

What insulin is Diablo on?

 

Diablo is on ProZinc (protamine zinc recombinant human insulin). I don't know if all ProZinc is the same? Like I said, I'm still learning.

 

I posted a quick reply hoping you would see it and stick around but since you didn't.

The process is test, feed, shoot. We test first with no food in their tummy for at least 2 hours so the bg reading you get won't be food inflated.

You will want to set up a spreadsheet and link it to your signature to track your progress and we can see it, Sue and Oliver can help you with that, she'll be along soon.

You can pick up a human glucose meter at Walmart, they have Relion Confirm, Micro and Prime meters, the test strips are the most economical around. The Prime being the cheapest. You will also need lancets, ketostix for testing his urine for ketones, and extra test strips, the meter only comes with 10.

You will want to start testing before making the food switch.

4 units twice a day is a LOT of insulin. Most start at 1/2 unit to 1 unit twice a day, moniter to see how well that dose is working and adjust from there.

I'm guessing that when you had those nice 100's that was a better dose and then adjusting the dose up it went out the window because it caused him to go low, his liver panicked and dumped sugar into his system sending his bg's high and that starts a rollercoaster effect.

Since he is a steroid induced diabetic I think you have a good shot at regulation and maybe even remission with the food change to low carb wet under 10% carbs or raw food. We can flood you with that information later when you get to that point.

 

Are there any other underlying health issues, was he ever DKA?

What dose did you start at?

There are some conditions like ACRO/IAA that require high doses of insulin but unless you start low and go slow with the insulin increases you won't know if you skipped over the best dose by starting at or increasing the dose to much or too fast.

 

Looks like I'll be making a trip to Walmart then. Do the lancets come with the meter? If not, are they also available at Walmart? What about the ketostix? How often do I need to test his urine, and what am I looking for?

Also, with the test, feed, shoot order, how do I determine the correct amount of insulin? I did print out a chart from the FDMB website that curves the dose based on the BG number. Is this what everyone else uses? Another method?

I have compiled a list of potential foods based on the chart on catinfo.org. If anyone has something that's worked well for them, I'm all for suggestions, especially since my cat is a diehard dry food eater.

 

He started at 1 unit 2x daily. His numbers kept rising. Now being at 4 units, and I've refused to go any higher, which brought me here. He had no previous underlying conditions that we or his vet were aware of. It all started with a UTI, cortisone shot, and him getting very sick.

 

Poor Diablo,

The kit come with a few lancets so you will want to buy an extra box. Get the 26 or 28 guage, the lower the number the fatter the needle and easier to get a blood sample with when starting out.

The Ketostix might be behind the counter so you have to ask for them, they should be about $15. If you're lucky and he's not modest about his LB habits, you wave the stick in his urine stream, the stick will turn colors if ketones are present. If he is modest we have some tips and tricks for that too. In the beginning you will want to test as often as you can.

As for the dose, since he was never DKA I would drop the dose back down to 1 unit twice a day and start over. We use a "start low go slow" approach. We do adjust the dose based on his Pre Shot numbers and take into consideration his Nadir (lowest point in the 12 hour cycle, usually 4 to 6 hours after the injection). With a Prozinc 12 hour cycle we are looking for a gentle smile curve. Prozinc should have a duration of 10 to 14 hours and then it is out of their system. We increase by .25units at a time so we don't miss the best dose.

For food mine liked the Wellness for about a year, we started out with the Fancy Fease Classics, Friskies Special Diets. The best food is the one Diablo will eat.

I hope I didn't miss anything.

 

Hi and Welcome! Robin has done a great job getting you started. Here is a video that shows how we test: Video for hometesting Many of us did not get a drop at first, so don't get discouraged. What really helped us was heating the ear enough and using a big enough lancet.

Here is a shopping list for hometesting:
A human glucometer. Any one that sips and takes a tiny sample is fine. Some members stay away from any meter with True in the name and the Freestyle meters. Some people think they are unreliable and read lower than other meters. The meters are often free at drug stores; it’s the strips that are expensive. You can, however, buy them on ebay at less than half the price of stores. Lots of people here also like the ReliOn from Walmart. It is an inexpensive meter and its strips are the cheapest around. Try the meter out on yourself or someone else before you try it on your cat. You want to be familiar with it before you poke the cat.

Lancets and a lancet device. Usually, until the ears “learn” to bleed, a 26-28 gauge is good. Any brand will work as long as the lancets match your device.

Ketone strips. (Ketostix) Just like human diabetics use. You will sometimes need to test urine if the numbers are high.

Rice sack. Make this out of thinnish sock, filled with raw rice or oatmeal and then knotted. You heat this in the microwave until very warm but not hot. Then heat the ears before poking. You can also use a prescription bottle filled with very warm water. It provides a good surface to poke against.

Also nice to have. Flashlight: so you can look at the ears and find the little capillaries that come off the vein running down the ear. Vaseline: Put a tiny smear where you want to poke. It will help the blood bead up.

And some lo carb treats to give your kitty, successful test or not Lo carb treats

One warning - be careful with a food change and your high dose. I like Robin's idea of going down to one unit, monitoring carefully (before every shot and midcycle)and testing for ketones. A food switch can mean blood glucose levels of 100 points lower (it did for our Oliver).

We do not use a standardized scale. We like to see you get some data and adjust accordingly. So start with that small amount, get some numbers and consider those small increases or decreases. Generally we consider a regulated cat to be in the 200s+ at preshot and in double digits at midcycle. We ask new members not to shoot under 200, but to wait 20 minutes without feeding and retest. The idea is to make sure the number is rising, not falling. If you get a number in the 40-50 range around midcycle or earlier, be sure to come on and ask for advice. Our scale for a cat in remission is 40 -120, off insulin, with the majority of the time in double digits.

Keep asking questions and reading. We are a small forum. If you ever have an emergency and don't get an answer here, go on Health and post. This forum is usually busier in the am and pm, eastern time.

 

This is all really great info. Now to organize it

A few more questions for now...
Does anyone have a chart template they can send me so I can organize all of Diablo's numbers? I took a peek at Robin's chart attached to her signature, but I'm not sure I can save that to my computer. And I might need some help making sense of the chart.

And just to verify, BEFORE I try changing his diet, I should start testing him at home, on his regular food and regular servings. I test before feeding. Regardless of his number, I feed anyway? Then I shoot? Should I only start at 1 unit after he's on a new diet? Or should I just start all over at 1 right now while he's on his dry food?

This might take me some time to get it all down, but I'm determined to get there! Thanks for all the help already. I feel like we're well on our way to a successful plan.

 

You are off to a great start. Believe me it can be overwhelming at first but gets easier and easier as you go along. Ask questions and we will explain things as they come up.

I would start over at 1 unit right away, tonight if possible.

That 4 units 2x a day scares me a little, I suspect that the dry food is probably what is keeping him safe right now. PS: Good for you for refusing to go higher.

Test, feed, shoot. No shot if bg is under 200 until you have data gathered. If you have any question about the Pre Shot number, don't feed and re-test in 20 minutes.


The information on how to set up the spreadsheet is in the tech forum, as a tech underachiever I needed someone to help me set it up. Lucky for you that Sue & Oliver are our resident experts on doing that. There is a template for you to start with. Send Sue a PM.

Robin

 

Hi - I'm Lu-Ann and my boy Grayson received his FD diagnosis one year ago today! Honest, it DOES get easier!

Grayson eats Fancy Feast Classics - the chicken, and the turkey & giblets. Beef doesn't sit well with him, and the seafood varieties are only recommended for occasional use. PetSmart usually has the best prices - as low as $.53 each. Walmart & Target are also good choices, and it's nice cuz you can also get it at your local grocery store - although typically more expensive. Anything under $.62 is a pretty good price.

I did the food change for a week before I started insulin. That typically brings down the BGs as much as 100 points. But, DO NOT change food unless you're dropping the dose as recommended above.

We started at 1u. Grayson has another condition (for which he had radiation treatment) which made him an extreme high-dose kitty, so don't be startled if you check out his SS.

When we were on ProZinc, my "do not shoot" number was 250. I have since switched to a different insulin which performs differently, so I'm able to shoot lower numbers. I would be VERY conservative when you're first starting out. 250 is a good starting point.

Grayson was a little turnip when we started. I didn't have trouble shooting him, but was EXTREMELY stressed trying to get enough blood for a test! The meter you choose may use a lot or a little blood. This month I'm testing two other meters for DCIN (Diabetic Cats in Need), and it appears that the ReliOn Confirm is consistently accurate with the Bayer Contour, and neither is far off from my Accu Check Aviva. I initially started out using a ReliOn Ultima - it took MUCH more blood for a test. The other 3 seem to use the minimal amt of blood. The ReliOn Confirm is available at Walmart, and test strips are $36/100. They are manufactured by Arkray, and may be less expensive on line at American Diabetes Wholesale.

I know there's a lot to absorb here. Please ask questions, and know that someone is typically around to answer - at least within a few hours.

Lu-Ann

 

I spoke with Diablo's vet yesterday, making him aware I was planning to home test. I plan to begin on Monday, starting with a normal curve, as he would get at the vet. After talking with his vet, I feel the most comfortable going this route first, just to simply see what his numbers are on his current dosage and meal plan in a relaxed and comfortable environment. Wish me luck with my first attempted BG tests! I'll probably need it. And I've gotten directions from Sue on attaching a spreadsheet to my signature and got that done successfully. I'll be updating it as soon as I can and coming back for help Thanks to everyone who has responded so far and has given me much needed advice. I'm already feeling so much better about this process.

For clarification, can someone tell me what AMPS and PMPS are on the spreadsheet? And I'm assuming the +1, +2 and so on just means hours after testing? Then when I test, I enter his BG number in the corresponding time frame, labeling it with the correct color according to the chart at the top. I think I'm in the ballpark, but if anyone can verify for me, I'd greatly appreciate it!

 

Sounds like a plan! Be sure to heat the ear well and have plenty of treats. And if you have trouble, come back and ask. If a curve is too overwhelming at first, just a preshot and few midcycle numbers will help you get a picture of what is happening.

Spreadsheet looks great. Amps=morning preshot number before food. Pmps=pm preshot number before food. Yes, +# is that many hours since the shot.

 

Having a plan is good. Everything will go so much more smoothly in a calm and comfortable environment for both of you.

The colors in the cells of the spreadsheet will fill in automatically when you put the number in.

 

There is more information you need to start.

A normal cat's blood sugar is between 40 and 120. Any number you get below 50 you will need to intervene with food or sugar to bring his bg up. The link below is how to recognize and treat a hypo.

viewtopic.php?f=28&t=15887

You will need to put together a hypo kit. Stock it with medium and high carb food and Karo Syrup. Write the carb content on the top of the cans with a sharpie. In the middle of an emergency isn't the time to start looking for that information.

Don't shoot a blood sugar number under 200 until you have collected enough data to know it is safe.

Since you didn't start out in the Health forum you may not have been given all of the new member information you need. I hope others will chime in.


Also, below is a link to a massive documet that was put together about PZI.

viewtopic.php?f=24&t=32799

 

I got all my testing equipment today and tried it out to get a feel for it. Tested 202 at 6p, 162 at 8p. It's now meal time. What do I do?

 

Skip the shot.

 

Even though he's on dry food? Should I test again maybe an hour after eating?

 

Yes, skip the shot for tonight.

 

Ok. Thanks... just feels so weird to not give him his shot. Not used to this yet.

 

Did you read the hypo info I posted above?

 

The link must be bad, it doesn't take me anywhere. But I do have wet high carb food and Karo Syrup on hand.

 

Sorry about the broken link. If you go to the Health forum and look at the stickies on the top you'll see one that says something like "Hypos can kill, print this out" That is what I was trying to link.

 

I found it, thank you. Below 50 is worrisome, correct? And with Diablo being at 162 preshot and eating dry food, his numbers should go up without his shot?

 

Good for you for testing today.

I was really concerned that you were shooting blind until Monday, you may have saved his life tonight.

Shooting blind is the same as driving your car with a bag over your head. You don't know what is ahead of you.

Tonight with a bg of 162, if you had shot 4 units he very may well have been in in serious trouble.

I've been fretting about his all weekend.

 

I am starting to feel a little guilty and neglectful. He's been on 4u for probably the last 5-6 months without hometesting, and his numbers were always high at the vet. I guess knowledge is power. I'm feeling a lot better about all of this, though. Having never been exposed directly to humans or pets with diabetes, my eyes have really been opened in the past week.

 

Yes he might be high in the morning, but better high for a day than low for a minute.

Yes below 50 is when you intervene with medium carb food, if that doesnt' work then you go to high carb food , if that doesn't work to bring him up you go straight to the syrup.

 

He was 415 at 8am this morning. I gave him his normal 4 units, and I'm going to retest at 11am.

And I have to apologize, I jumped into this head first and didn't read a lot of the boards that I should have before coming here to the PZI group. I now see I should have originally posted on the health board, but I do appreciate everyone's patience and help thus far.

 

Don't feel bad, you didn't know, we all started out following our vets advise to the letter. Give yourself a pat on the back for doing the research and learning to test. You will feel so much more in control now that you are testing. If anything seems off or out of the ordinary you can test and know what is going on.

I was lucky that I had a diabetic friend who flat out told me that I couldn't inject insulin without knowing what his blood sugar was first. That sent me searching the internet for information and I found this site within days of his dx.

Sorry we were posting last night at the same time and I didn't see your question.

Part of the reason to skip last night is because the number was still dropping so late in the cycle. A good curve for PZ should start out at xyz, drop about 50 to 65%, then start back up to xyz. It should look like a smile.

And yes feeding him will bring his bg's up. That 162 wasn't a dangerously low number, but we always want to be sure the numbers are rising before the next shot, if you are not sure it's rising withhold food and wait 20 minutes and test again, that should tell you what direction it's going.

I'm looking forward to seeing your curve for today, post your numbers as you get them. Good luck.

 

Geez we did it again.

Don't apologize, you are doing fine, it's not mandatory to post in Health first. Most people show up here in a panic, overwhelmed and scared, people in health calm them down, give them the basic info, teach them to test, help set up their ss and once they are stable they send them off to their ISG. You came in cool, calm and collected, ready willing and able. I was worried that we hadn't given you all the basic info first.

You're off to a good start, onset of PZ starting to work is about 2 to 3 hours after the injection.

 

So I should get a good, true reading +3 hours?

 

Yes, it should start heading down by then.

 

Probably :mrgreen: It varies with the cat, but usually the first hour or two after the shot, they are a little high as the food raises their numbers. By +3, we expect them to settle in and insulin start to work.

I'm glad Robin was around to help last night with your lower number. The number this am is probably high because it has been 24 hours since his last shot. It will be interesting to see his numbers today. I am guessing you will need to reduce the dose by a little. Skipping was absolutely the right thing to do last night, but our goal is to have 2 shootable numbers at am and pm. The 162 (which was too low to shoot without data and knowing if it was heading up) may mean the dose is a little too high.

Remember, if you have a problem that needs an immediate answer, post on Health. It is much busier than this forum. They probably won't answer specific ProZinc dosage questions, but they would help with a low number or medical issue, etc.

You are doing great! Your numbers today should be a big help.

 

Awesome. Thank you both! When I was trying to find answers last night, the website was down (of course!), so I went to the Facebook page where I got some help. I'll remember to go to the health forum for immiedate answers though.

I'm pretty interested to see how his numbers are today. And to think his PM numbers have probably been <200 and I've still been shooting all this time... :?

 

I logged on last night and saw your post. First, congrats on finding this wonderful site and the wonderful people here. You are doing Great- hometesting is the key to getting regulated or OTJ. I have a diabetic Cat, Chewy, that was on 3 units of PZI and dry food when his battle started. After two months of testing, and a food switch to FF low carb wet food-- he went off of insulin. He has been 10 months without any insulin.

I also had a diabetic cat, Kitty, that brought me to FDMB. She was very hard to regualate and I was "Very Hard Headed" and didn't want to hometest. She was 15 years old, but with the help of the people here- she lived another 1.5 years and became beautifully regulated.

Best of Luck to you. I agree with Robin and Sue- 4 units is A Lot of insulin and the start low and go slow approach is best.

Looking forward to seeing your numbers today!

Kim

 

BG 376 +3... on the right track. Testing again at +6.
If I were to start his dosing back over at 1u, what kind of numbers would I be likely to see?

 

I am sure this is in the thread....but, I am lazy this morning! What are you feeding now? Have you made a diet change?

 

Still on dry. Was told to get some numbers before trying to switch. I'd like to get him on low-carb wet eventually.

 

Nice start. Would you be willing to test every 2 hours for a standard curve? It will give a better picture of when things start changing. If not possible every 3 hours is ok too.

It's hard to say what bg's you would get with 1 unit, it depends on a lot of variables. ECID, every cat is different. If he is in rebound now his #'s might drop down once the rebound hormones clear his system and that could take 3 to 5 days. Today should tell us something.

You should look at Kim's Chewy's spreadsheet to see how it went for them. She posted to you above.

 

I was shooting for every two hours, but I work from home and my schedule varies, so I could only manage every three hours today. Should I try to do another curve tomorrow?

 

Also, what do you mean when you say rebound?

 

Okay, and I agree- get some numbers before switching the food. The truth is, the dry food is the reason for the 4 units. I know you have read this, but the dry is loaded in carbs, which breaks down into sugar-- thus the need for the higher dose. Once you change the food, you will most likely see a dramatic decrease in the amount of insulin needed and hopefully he will become a diet controlled diabetic and will not require insulin! We can hope.

Many cats will see an immediate 100 point decrease in BG with the change over to low carb food, but obviously it is tricky when reducing insulin and changing food at the same time. With some of the low numbers you are seeing, even with eating dry - it is very possible that he will go OTJ! You can do this-- you just need to monitor him carefully. Once you do reduce his dose and start with the diet change, you need to check for ketones. Do you presently check him at home? With the high dose, ketones are probably not a concern now, but once you reduce his dose- you will want to monitor him. You can buy urine strips- ketostix from Walmart or a pharmacy to do this. I know it seems like a lot, but all of this effort will be worth it to you and your kitty!

Is he free fed? Food left out all day to graze on?

Like I said, my Chewy was on 3 units twice a day and eating dry food-- after 2 months he was off insulin.

 

You're fine with every 3 hours.

 

Rebound is the body's way of protecting the cat from low BGs. Once a cat has seen low numbers-- not hypo numbers, but numbers that are considerably lower than they are use to, the body has a way to protect it. The liver dumps sugar and other hormones to protect the cat from going too low-- it goes into a "panic mode". So, the blood glucose numbers are artificially inflated. It is not umcommon for the "rebound" to last for a few days. But, after the "rebound" clears the numbers could fall quickly. You are testing, so don't worry about the drop if it happens.

Does this make sense?

 

I did purchase some ketostix when I got everything else, so I have them on hand. Haven't used them yet.

He does not free eat, although he'd like to. He gets two meals, one with each shot.
When attempting to change his diet, do I start slow and mix half and half? Go all wet? And when the time comes, should I JUST feed him and then test to check his numbers without giving a shot? I guess I would be fearful that his numbers would go too low with both insulin and the wet food.

 

Rebound is when the insulin brings their bg's down to a lower number, that their body thinks is too low (but usually isn't) and their liver panicks and dumps sugar into their system and sends their bg's really high. Also called a bounce.

 

Yes, that does make sense.... kind of I'm starting to get it. So basically, because he was 162 last night, he could be "rebounding" today, and possibly the next few days, producing higher numbers than what is typical due to the extra sugar and hormones?

 

Yes, if the 4 units is too much insulin his body could be dumping sugar to compensate for it. It becomes a roller coaster ride.

We like to have people who arrive here on a higher than normal doses to start over at 1 unit because:
1. 1 unit is the standard starting dose.
2. The kitty is usually stressed at the vet clinic so their bg's are usually higher than they normally would be, so the vet keeps upping the dose.
3. Vets tend to increase doses by full units.
4. By starting over and increasing by .25 units at a time you will know when you have the right dose because you are testing and won't run the risk of skipping over the right dose by increasing by too much.

We have had a couple of members arrive shooting 8 & 9 units twice a day. After starting over at 1 unit and changing their diet both of the kitties are diet controlled/in remission.

 

Wow, that is a good question about how to do the food change. There is no "right" way- but, I can tell you what I did or would do. Please get feedback for Robin, Sue and others and consider all options before changing his diet. I think you have two choices.....one is to make the food change completely to wet and give no insulin for a short period and test, test, test his bgs! Even more importantly if you choose this option is to test for Ketones. Ketones are bad and you want NO part of them. Trust me, I battled them!

The second option is to gradually change the food- by mixing wet and dry- and reduce your dose at the same time. Go back to 1 unit and mix the food. The same holds true with this-- you would need to monitor hard and check for ketones. With no dry food, or less, you will definitely need less insulin.

It will take awhile for the dry to clear the system, so the bg change will not be like "falling off of a Cliff" BUT, it will be like rolling down one, once it starts.

 

There is a recent thread in Health......Diet Change. It discusses the change from dry to wet -- good info!

 

There's a stickey for that. :lol: I hope this link works.

http://felinediabetes.com/TipsforTransi ... -18-09.pdf

I had to mix it at first, Harley was not a fan of canned food at the beginning, it took me MONTHS to convince him that the stuff in the can was really food. But other people open the can and the cat switches right over to it. You need to watch for tummy upsets switching fast.

As for the insulin while switching. I wouldn't do them both at once. I would start with the 1 unit and test to see how he does and go from there.

 

Just curious, how much does Diablo weigh?

 

Robin, do you suggest I start over at 1u tomorrow? Also, I think I may need different syringes. Are there syringes that have quarter doses on them? I currently have U40 1/2cc syringes. Should I change his food before or after I start over at 1u?

Thanks for the input, Kim. I would probably feel most comfortable mixing it at first, mainly because I'm unsure he'll eat wet food by itself, and also because I'm worried his numbers will dip too low.

 

Yes I would start over at 1 unit tonight. Then tomorrow if you could get some mid cycle tests we can compare that to today.

Kim is absolutely right that you will need to start checking for ketones when you drop the dose. You may never see them but at least you will be on top of it if you do. It's easy to check and gives you one less thing to worry about.

When you want to do .25 unit doses we switch to U100 syringes with 1/2 unit markings and use a conversion chart, you can get those syringes at Walmart also.

Lower the insulin before switching the food. If his bg's drop from the food switch he will have less insulin in his system.

 

As far as checking for ketones, I just try to catch him in the act and stick the strip right in the stream, or do I need to collect a sample? What do I do if ketones show up? Do I test multiple times a day?

 

If he will let you, that's the easiest way. Oliver would not let anyone watch, so we put aquarium gravel in a clean box and left him alone in the room with it. He'd christen the box and we would have our sample.

Once a day should be okay for ketone testing, less if no changes and everything is going well.

If you get anything trace or above, it really needs a vet visit. One way to help keep ketones away is to add water to the wet food so they are more hydrated.

 

If you can stick the strip in the stream that would be great. Some people use a ladel and catch it.

Checking once a day is fine in the beginning. If the strip changes color showing that ketones are present you would need to take him to the vet for fluids to flush them out of his system or have the vet show you how to do it and you can do it at home. It's really pretty easy.

Untreated, ketones can lead to DKA (Ketoacidosis) which is extremely expensive to treat and can be deadly. Ask Kim, I think it cost her over $3000. to treat Ms. Kitty.
DKA is brought on by not enough insulin plus an infection like UTI, etc. Once they go into DKA they are more prone to getting ketones after.

So you can see why waving an inexpensive strip in his urine is the easy way to go and is just a safety net when dropping the dose. Some kitties are not prone to ketones.

Also when you get him switched to wet food you can add water to the food to keep him better hydrated.

 

I think the hardest part will just be trying to catch him to get any kind of sample. If he's already had a UTI, is he at great risk for ketones?
Also, just tested 315 +6.

 

No, he would need to have an infection of some kind right now to be more prone to ketones.

 

No, the past UTI does not make him at greater risk for ketones.

I will try to explain ketones to the best of my understanding, which is very elementary at best..... insulin helps in the proper digestion of food. Glucose is what fuels the body--- but, with insufficient insulin, then the glucose cannot be broken down. We know that with diabetics, this is a problem. When insulin is insufficient, then the body does not digest food properly and the kitty's cannot get proper nutrition, thus the weight loss. To compensate for this, the body starts to break down the muscle and body fat--- ketones are a byproduct of the muscle breakdown. DKA, is a condition that develops when the ketones get at a high level and the body becomes too acidic. With DKA the electrolytes get out of balance. The acidic condition (ph level) is very hard and bad on the organs. DKA can happen very quickly. A BG does not have to be at "High" levels for ketones or DKA to develop-- I have seen cats in PZI go into DKA with BGs in the 200s. It is a good practice, to test all diabetic kitty's for ketones on a regular basis. The keys to warding off ketones are-- fluids, insulin, and food. Anytime a diabetic kitty starts eating less and becoming lethargic, I would immediately check for ketones.

Like anything else, ketones can be treated quickly and successsfully as long as you are testing! So, don't fear this......Just be vigilent, especially when you are lowering the dose. You have a cat that has been getting 8 units of insulin a day and eating lots of food. You are now considering going to 2 units a day and are not certain if he will eat as much. But, to get him regulated, he must get off of the dry food and in doing that he eventually will need less insulin.

You have a tremendous support system here, so just give everyone a heads up when you are going to start your reduction and food switch. AND, get your Ketostix!

 

The ketones make sense. While science was never my strong suit, you made it make sense

I am planning on going to 1u tonight and seeing what happens. I'll check for ketones tomorrow... hopefully. I'll be following him around all day trying to do so.

 

Are you going to start adding the wet food tonight also?

 

No, just planning on lowering the dose and keeping food the same for now.

 

Would you consider starting, at least partially with low carb wet, when you reduce the dose?

The dry food can raise the bg levels 100 points, or more. So by lowering the insulin and continuing the dry, you are most likely to get high levels with less insulin to counter them. It is very possible than the dry food has been keeping him in high enough ranges to avoid a hypo with the previous high dose.

It would be good to make only one change at a time, but in my opinion, at this point, I would reduce the dose and feed low carb and monitor ketones and bg levels carefully.

 

It's fine to do that short term, but you would expect to see higher BG numbers on the lower dose without the diet change. It's okay though. You'll be establishing a "baseline" on the lower dose that you can use going forward to see how much improvement happens once the diet is switched. You just don't want to delay the switch for more than a day or two so that he's not hanging out in the higher numbers for long.

Kim, good job on explaining the ketones, by the way

Carl

 

I can go along with starting the food switch right away since you are going to be mixing it together at first. I was thinking that we wouldn't know if the numbers were being influenced by the dose or food, but it doesn't matter, it's better to switch right away for his health.

As long as you reduce the insulin to 1 unit first.

 

What if I reduce to 1u tonight and tomorrow morning, then feed a mix of his dry and low-carb wet starting tomorrow night? I don't have any wet low-carb on hand yet. But if I should start that I'm the morning, I will run to Walmart tonight. Any recommendations for low-carb wet at Walmart? Also, I haven't been able to update his chart yet, but his most recent reading was 335 so he's headed back up.

 

Do it however works best for you, 1 unit tonight and AM, switch the food when you can. I hope he takes to it right away.

Special Kitty Pate's, Friskies Pate's, Fancy Feast Classic's are all low carb.

 

PMPS was 301, so he's going back down again... which I don't understand. I'll do the 1u tonight and tomorrow morning. Then with his PM shot, I'll try to mix low-carb wet with his dry and see if he takes to it. Do you suggest half and half?
Also, any advice for his poor ears? They look like they're taking a beating (mostly thanks to our inexperience in pricking them). I know it doesn't hurt him because he's not reacting, but he's got bruising for sure. I try to rub them a little bit, but he doesn't really let me all that much.

 

Half and half is okay. You can hold his ear for a few seconds after poking to help with bruising. Neosporin with pain relief will also help. Just a tiny smear.

 

Started at 389 this morning after 1u last night. Also, to the person who asked about his weight, I'm sorry I overlooked your post. He is 11 pounds.

 

Are you going to be able to get some mid cycle tests today?

Love his picture. He looks like an angel not a devil.

 

Yes, I'm planning on every two hours today so I can stay on top of it with the dosage drop. Hoping to do a ketone test as well.

He'd like to have you believe he's an angel But he sure is a feisty little guy.

 

Oh, good on the testing, I'm sure he's feisty, he's still a youngster.

What canned food did you end up getting, or are you getting that today.

 

Good Morning!

I was reading some of your posts from late yesterday. I saw where you had a late cycle test of 335 and then a pmps of 301-- and you considered this as his BG going down. In the diabetic world of hometesting, these would be considered pretty much the same reading. We all kind of accept, that there is a 20 percent variance possibility in each test. So, I would say his readings were flat. I just wanted to give you some feedback regarding the test!

I am looking forward to seeing how he does today on the 1 unit. Did you start mixing the wet food in or are you going to do that tonight?

I also saw you asked about Low Carb food at Walmart. For what is is worth, Kitties seem to LOVE Fancy Feast! In fact, it is often referred to as Kitty Crack here! My crew loves it. It might prove to be a good choice, especially in trying to transition him.

Good Luck!

 

Thanks for clarifying about last night's numbers. I was baffled as to why he'd be going "down," but that makes more sense now.

I'm planning to get some wet food today for him and start mixing that in tonight with his dry. I'll probably grab a couple different kinds just in case. Sounds like Fancy Feast Classics and Friskies Pate are the top choices for low-carb.

 

394 +2
Little sneaker tried to outwit me, but I caught him just in time to get a ketone test. Negative!

 

YAY!! :RAHCAT Good job.

 

Just curious, has anyone ever used the foot pad to test? I'm starting to feel terrible pricking him in the ears so much. Plus, he doesn't exactly sit still, which makes it even harder. I'm thinking if I can scratch him into submission, the foot pads might be easier, but I'm hesitant to try.

 

Some people do but there are concerns about them having wounds on their pads and the Litter Box, etc.

The brusing on his ear will get better as you perfect your technique. You can switch ears, move up and down the side of the ear, etc.

And apply pressure for a few seconds after the test using a tissue or gauze pad, that will cut down on the bruising too.

We are aiming for the capilary blood between the vein and the edge of the ear. Harley mostly bruised when I accidently hit the vein.

 

That's good to know because I have accidentally hit the vein several times. I'll just stick with the ear.

 

Have you tried the canned food on him yet?

 

Not yet. He eats at 8p CT. So just under a couple hours to go. Should I test him after he eats?

 

No give his ear a break. Nothing is going to happen that fast.

 

Good. I was hoping that was the answer I'd get. He's getting pretty angry/frustrated with us. Hopefully he comes around with the testing part. As far as the canned food, he took to it like I couldn't believe. I did do half and half, but he snarfed it down. He was still really hungry, so I threw a few extra pieces of dry down and he wanted nothing to do with it... so I gave him a few treats instead The switch might be easier than I thought!

 

Good, lucky you. I hope he's smart enough to like the canned food better and switch right over.

Low carb treats, Bonito Flakes, Freeze Dried Jerkey, etc. is the key to testing, they get a treat for every poke, sucessful or not, so if it takes you 3 pokes to get a test they get 3 treats. Soon they associate the pokes with the treats and will come running to be tested.

 

What I became convinced of with Bob was that time went by, the testing and the shots got a lot easier. I think my technique improving had a little to do with it, but what I really believe is that as the cat starts feeling better, they are smart enough to associate the "routine" with actually feeling better. I think they put up with it, and with us, because they figure out that it's helping. Your boy will "come around" too.

Both my diabetic, Bob, and my civvie, Mullet, took to canned food like fish to water. I'm not sure if they'd eat dry again after a year and a half of not having any, and I know I'm sure not going to try. But I'd be willing to bet that if I stuck a bowl of dry and a bowl of canned side by side for them, they'd clean the canned food bowl before touching the dry food.

Carl

 

I guess I should look at it kind of like his shot. Before we were testing, when he was first diagnosed, he did not like his shots. Eventually he got to the point where he didn't care, and I could even do it while he was sleeping. Like you said, because he knew it made him feel better.
One thing I need to change is a treat for every shot. I've been giving him treats at the end, but I should stop to give one every time I prick him. I have also found out that NOT using the lancet pen is a bad idea. I thought I'd be more accurate, but it turns out I just prick too hard that way. Hopefully he comes around soon and will be less squirmy.
Also, will the canned food keep him filled up longer? Seems one of the hardest parts about testing AMPS/PMPS is he's soooo hungry, he doesn't want to sit still at all... just eat.

 

AMPS at 289 this morning! Since he's eating the wet food with dry mixed in, should I go ahead and switch straight to the wet? I already fed him this AM with the mix. Also, how often should I test over the next few days with new food? I don't want to overdo it and stress him out more than necessary.

 

The trick to the testing thing is to figure how it will work best for the two of you. Everyone does it a little differently. You could give him a few treats while you are poking, and then lots of praise and a few more when you are done. (you have low carb treats, right?) And anytime he is squirming, you can get a drop on your fingernail and test it from there.

Nice amps! Yes, I'd go with the wet and ditch the dry. For now, unless you get a number that makes you nervous, you could do the preshots and somewhere in that +5 - +7 range. Put on the Neosporin and give his ears a while to look less ragged. :mrgreen:

You two are doing great!

 

Thank you so much! I seriously could not believe he was at 289 this morning... just from food! Is it likely to go down more after we completely kick the dry and it's all out of his system? Also, when should I start changing his dose? Should I wait until he's just on wet for for a while to think about that?

 

It's one of those "every cat is different" things. Some react right away to the low carb (for Oliver 100 points overnight) some gradually go down, some take a week or more. I'd just watch and see. As long as you monitor and he is on one unit, he should be okay.

You would lower the dose if you get a midcycle number in the 40-50 range or a preshot too low to shoot. (remember that waiting 20 minutes without feeding and retest thing). It may take awhile for the insulin and food to work together, or you may see differences in a few days. The trick is just to stay on top of it.

 

Nicer AMPS.

Yes, if he will switch to the wet right away go for it. You can donate the left over dry food to a local shelter.

Unregulated Diabetics can not process their food properly so they are literally starving, for now feed him as much as he wants, when he becomes more regulated his appetite will go back to normal. We also suggest more frequent smaller meals throughout the day to support his pancreas.

Always test pre injection, somewhere between +4 & +7 at a minimum.

A +4 will tell you where he is headed for the day or if he is dropping faster than normal. You are going to want to experiment with tests at different times to find out when his nadir is, usually between + 4 and +8.

Also test anytime something seems off with him.

 

Well, I did three smaller meals yesterday, starting with all wet in the afternoon. He was at 309 last night and 335 this morning. Am I needing a dose increase, or does he still need time to adjust to the wet food?

 

Good Morning- I can't pull up your SS due to firewalls at work! Imagine that! So, do you have any tests during the cycle or just the amps and the pmps?

It normally takes longer than 24 hours for the dry to totally leave his system- so I would wait another day before increasing. And, once I started increasing, I would go up in small increments. Be sure you are testing for Ketones!!!!

 

Yesterday AMPS was 289, 239 +4, 298 +8 and PMPS was 309. The last time he had dry was yesterday morning when I mixed it half and half with his wet. I just ordered some U100 syringes yesterday because I couldn't find any at Walmart, so I guess I kind of have to wait to increase until I get those anyway, right?

 

I Never used the U100s. I always used the U40s and just "eyeballed" the increase-- but, my Kitty loved insulin and .1units was like water to her! I never had any problem increasing by .5 units and using the U40. I even used the U40s when dosing Chewy, who was sensitive to insulin. You will hear many here say they gave a Fat 1 unit-- just meaning that they made sure the unit mark was showing when pulling back the dose. People that are increasing by .1 units might need the U100s, but I think you can increase and dose without them-- Be SURE to use the conversion chart if you decide to use the U100s. Prozinc is a U40 insulin and anytime you use a U100 syringe with it, You MUST use the conversion chart. Do you have it?

They should have U100 syringes at any Pharmacy. They are normally behind the counter. I buy U100 syringes for Sally, My Diabetic Dog (yes, I know.......) from Walmart.

Good Luck

 

I do have the conversion chart. And I guess since I already bought the U100s, I'll be using them I guess I should have asked the pharmacist at Walmart. Oh, well. Lesson learned! I think I'll see how he does today, and maybe start an increase tomorrow. I think he's going to need it regardless, but it would be nice to see how he does on a full day of wet food.

Diabetic dog and cat? How did you get so lucky?? ;-)

 

Morning,

Here is the conversion Chart, I printed it out and hung it on the side of the fridge and checked it twice when drawing the insulin, you can never be too careful. Did you order the U100 syringes with the half unit markings?

http://www.felinediabetes.com/insulin-conversions.htm

When I get home tonight I will get you the information on the Walmart syringes, so you can take it with you, they often told me they didn't have them when I knew they did.