Salem #2

LOL! Does it take video you could post? I'd love to see Salem's reactions to the camera!

 

sounds like a great idea .. Cat TV

 

So I’ll take a video later but here’s a picture. That’s Salem on the right and my other cat Nyx on the left staring at it.

 

Thanks for the pic. Got a good belly laugh out of that. They are a couple of black beauties!

 

Uhhhhh so I just took Salem’s ps twice and he was at 72/89 on the AT2. I’m not giving insulin tonight on that. And he’s had food too, he’s had probably at least a can this afternoon. I'll just see where he's at in the morning.

 

Good call on the no shot and GREAT numbers. Sometimes due to discomfort and the stress of the day, BG can be elevated for a few days post dental. Apparently Salem isn't going to do "normal" but what he's doing is just fine!

 

Yeah I was honestly expecting him to be a little high just due to being stressed and having stuff done. It could be a fluke, but I'm definitely not giving anything on that and I'll just see how much he goes up in the morning. I also would expect it to be low on no food, but I gave him a can and a half this afternoon and he seemed to eat most of it so he has food in his system. I'm not going to complain about him being low, I'm just curious what he'll be tomorrow. Surely even the vet can't argue with me not giving a shot on that low.

 

I mean I'm not going to get my hopes up but I'm pretty surprised since I expected him to be pretty high.

 

All you can do is follow Salem's numbers. He appears to possibly be on a mission and a good one so don't get too hung up on holding a dose. Keeping him safe is #1 priority.

 

Yeah I'm just going to chill and see where he's at in the morning. He's still a little out of it even though he was playing some earlier. Even if he spikes tonight it probably won't be too much bc honestly he hasn't been spiking a lot with food lately. Plus I seriously need to sleep tonight so not giving the shot means I won't be up worrying. Since he's in normal range I really don't see a need to.

 

Get a good rest in tonight and take a break from testing. Give Salem some scritches for me. Nyx too! I agree Black cats rock!

 

I will! They're both spoiled brats but they're my babies. I'll definitely update you in the morning on where we're at, which who knows at this point but I'm just going to roll with it.

 

Okay I just tested twice on the AT2 and he’s at 119/125. Which is higher than I’d like but not too high. I can wait an hour before giving him a shot so I’m going to wait and see if he goes up. I’m wondering if the .5 would be safe to give.

 

If he has only come up just over 50 points with no insulin last night I wouldn't give him the 0.5u dose. He's sitting in normal range right now. I'd reduce to 0.25u at least and be monitoring him closely at least in the early part of the cycle.

The lowest pre-shot you've given insulin was 138 on the 17th but we don't know exactly what occurred that night because you used the AT2 for pre-shot and the Relion for follow up readings. We also don't know how low Salem went on the day 17th day cycle but it looks like the night cycle might have been pretty flat.

 

I tested again and he’s at 133 which is about the same? I know I gave him .5 on 138 so I might give a little less than the .5. I can monitor him today at least. I guess I can call the vet and see what he thinks but I don’t know if he’ll get back to me in time.

 

Okay I gave about .3? I’m going to check him every hour for the first few hours and see what happens. If he goes too low then I’m calling the vet.

 

That rise in BG is negligible and could just be meter variance. I think Salem is on a mission.

 

Let’s hope so! I’ll see where he’s at in an hour. I have food and Karo I can boost with if I need to. I’m pretty sure his BG didn’t rise much after eating last night bc he was up playing all night.

 

1 hour out and he’s at 175 so he went up a bit. Hopefully what I gave him is enough to bring him back down.

 

Food bump perhaps. Patience.....insulin onset hasn't started yet.

 

+2 he’s dropped to 136 so he’s dropping but not too dramatically.

 

Insulin is just starting to click in. Also whatever pancreas is contributing is now lowering BG too. Patience....... nadir is still to come.

 

+3 is 120. He still has some time to go for nadir since I guess he’s peaking later this cycle.

 

Another update: I tested at +6 and he was 126. I’m going to work now so we’ll see where he’s at when I get home to give his shot. I’m wondering if he doesn’t feel as well today bc he’s been sleeping in his cat carrier all day.

 

Anything is possible. He had a big day yesterday. It's also possible that he is having a tiny bounce from the lower BG earlier. Leave some food out for him while you are gone in case he has any plans to drop later in the cycle per chance. Doubt it but you never know.

 

That’s true I didn’t think about it maybe being a bounce. I’m just going to take it day by day I think. The .5 doesn’t seem to drop him too much so I feel okay about giving it as long as he’s over 130. I’ll be home all day tomorrow so I can keep a close eye on him.

 

PMPS is 153. I’m going to go ahead and give the .5 and monitor him.

 

Over all a good day for Salem!

 

Yeah he’s still doing really well if even he still needs a little insulin. I’m going to check him in an hour and 40 minutes.

 

I'll probably being sawing logs by then but if I am up, I'll check in.

 

Greens and blues for the last few days. That's awesome! I hope this is the beginning of stability for Salem.

 

Welp it's going to be an active cycle. +2 and he's at 75. Feeding a small bit of MC food to keep him up.

 

I genuinely don't get why he drops so suddenly at +2 when ProZinc isn't even supposed to start working until then? Idk how the pancreas works with all of that but maybe it's his pancreas working in combination with the insulin?

 

Okay it's been about an hour and he's gone up to 116 so I'm not going to feed any more for at least an hour and check again then.

 

Just checking in. My geriatric fur kid woke me up. He's a bit senile and gets confused at night. Its not only the extra extra sweet ones that keep us up!

You seem to have a handle on things. Are you Ok or do you want me to stick around till you test again?

 

I think I have a handle on it, but thanks! Hopefully he won't go much lower than the 116 but he still has a few hours to drop maybe.

 

Yes there is the potential for more drop. I'd watch him for at least another hour. Sorry but he seems to have a plan to keep thing interesting right now.

 

He seems to be doing that a lot lately! I guess I'll have to see what he's at in the morning.

 

Well it's been 2 hours and he's at 140 so I'm going to call it a night. I have a feeling he'll probably bounce from this but oh well. I'm going to take advantage and get some sleep. I've left some LC food out just in case, also bc my other cat threw up his dinner and needed to eat more.

 

AMPS is at 204. Gave the .5 again. Hopefully this is just another bounce.

 

PMPS is 142. I’m going to go ahead and give .5 again and I’ll just have to see where he’s at in 2 hours.

 

Are you still testing with the AT2 today?

 

Yeah I got more strips so I’m on it now.

 

I hate to be a pain, but it would be helpful if you could add the data to the spreadsheet in as you get it. Sometimes, those of us helping are monitoring several kitties at once and it's easier for us to just keep SS open to see all the readings together than scrolling through messages.

 

Okay, updated, sorry. I didn't test much today bc I wanted to give him a bit of a break and he seemed to be running a little high.

 

Thank you.

 

Okay I gave .5 so I'll check at +1.5 and see if he's dropping.

 

Just tested him and he’s at 155 so he hasn’t started dropping yet. Hopefully that means tonight won’t be as active. I’ll grab another test around +3.

 

Just an update on Salem, he's pretty much stayed in the 100's all day. This dose only seems to bring him low occasionally now but it seems like his overall numbers are leveling out. I'm going to stick with the .5 through the weekend and then talk to the vet next week. I'm briefly going out of town during the day on Saturday so I won't be able to get numbers then. I'm going to leave plenty of food out though and he might just have to get his night shot a little late but the vet said I have up to 14 hours with it if I have to.

 

Salem is looking good but she has a little more room for improvement and you could try a little increase but I'd only do so when you can monitor closely.
I'm assuming you are using U40 syringes. Something to think about.....you can use U100 syringes with a conversion chart to make dose adjustments in smaller increments. Not sure what the situation is where you live re: obtaining syringes....ie whether you need a prescription or not.

Not sure what your vet means by the 14 hours. You can shoot late anytime but you can only shoot early by an hour. The only problem with shooting late is getting back onto your normal schedule for work purposes etc.

 

I think he meant because the duration is up to 14 hours maybe? Either way he’s getting his shot late Saturday night lol. I can back him up during the week so I’m not too worried. I also ordered an automatic feeder so I can leave food out while I’m gone all day.

And yeah I’m going to look into bumping him up I just want to get through the weekend first. I don’t want to give a higher dose when I’m going to be gone Saturday and can’t monitor.

 

Just tested Salem for his PM shot and he's at 106...I really don't want to shoot on that low. I was gone all day so I didn't get any readings for how low he could have gone. I also have to be gone all day tomorrow.

 

OKay I tested again and he's at 135 so meter variance maybe?

 

Possibly or if he dipped down that might be a bounce starting. Sometimes they can zoom up really quickly. I take you hadn't fed Salem yet?

 

No, I just fed him right now. Normally the pates don't cause him to go up that much though.

 

So if he was up to 135 before food, then you could consider giving him a reduced dose...maybe 0.25u or you can skip. Your call. You've shot 138 before so half a dose shouldn't be a problem.

 

Honestly I might just skip for tonight, just because I really need to go to bed early tonight since I'm driving all day tomorrow and if he goes low for some reason I'd have to stay up. Also it'll make me feel better about giving him a dose in the morning and then leaving all day. I feel bad skipping, but I know he'll be okay for just one night. I'm driving back tomorrow night to give him his PM shot tomorrow so he'll definitely be getting one then.

 

Sounds like a plan to me. Enjoy your day tomorrow and drive safe.

 

Thanks! I have a camera so I can at least keep an eye on them remotely.

 

Out of curiously I tested Salem at 3 hours post food to see how much he went up and he’s at 129. I guess I’ll see where he is in the morning?

 

Actually that is great news. Given that BG is basically unchanged, it tells you that while Salem's pancreas may not be working as well as it should, it is working. In a non-diabetic cat or a cat in remission, the BG +3 hours after eating would be lower than pre food BG due to the insulin that would be pumped into the system to utilize the food eaten.

 

PS today after no insulin last night is 146. Which is lower than I thought it would be. I’m hoping he’s okay to get the .5 today bc I won’t be home until late tonight. I’m going to leave extra food out though.

 

Leave lots of extra food out perhaps a little MC included to keep him surfing.

 

So I left some MC food out and gave slightly less than .5 just to be safe. He’ll probably go up a bit but I’m going to be gone for 14 hours so I’d rather be safe.

 

Sounds good.

 

Salem doesn't like to make things easy...after getting more food than usual today, some of it MC food, and a barely reduced dose +14 hours he's at 132. I guess I'll go ahead and give the .5? I skipped last night so I feel like I shouldn't again. It's also later than usual too.

 

Assuming you might like some sleep tonight, you could do a reduced dose of 0.25u and see what Salem does with it. The last time you shot 0.5u on a 138 he dropped quite low. I'd be sure to monitor a bit with that PMPS knowing how he reacted the last time and through today. Interesting that more food, some MC and he still gave you a low pre-shot. Salem rocks!

 

Yeah on second thought I'll do either that or skip. My problem is I don't trust myself to stay awake tonight bc I'm exhausted after driving all day. I mean he might go up a bit tomorrow morning if I skip but judging by last night it won't be by that much? I really want to start getting him into the double digits I just need to make it to Monday so I can call the vet and figure out a plan.

 

It's fine if you choose to skip tonight too. Salem will get back on track pretty quickly.

Going forward, you can increase the dose to 0.75u to see if you can prompt him into some double digits but you'll need to do it when you can monitor him. He doesn't need a lot more dose wise by the look of his numbers. They've improved immensely over the past week.

 

Yeah it's like his pancreas is working a little, just not as much as it needs to. I just want to get him into lower numbers so he can heal a bit more. I think it's probably safest for me to skip tonight since I won't be able to monitor him all night. Even if he goes up, I can get him back down pretty easily. It's just frustrating that he's not low enough to be off of insulin, but he's also not really that high.

Also I’m going to try to do most of a curve tomorrow just to make sure he’s not going low on the .5. I haven’t really tested him much in the past few days so I don’t actually know if he is or isn’t.

 

After another night of no insulin he’s at 142. I’m going to go ahead and give the .5 and then test him today and see what happens.

 

Fingers crossed you got some nice dark green in the mix today! Come on Salem.....work that juice!

 

I love how Salem is solid blue! While my cat seems to be in remission (day 13 of 0 insulin!), it has taken her a long time to "feel better". It's not clear how long she was diabetic, but I think probably a couple of months. In the last week, she is more "active" (she's never been very active). She comes up onto the bed asking for pets, purring, and kneading. She also is using the scratching posts. Yesterday she had a brief "psycho kitty" play time where she ran around the bed room a few times and jumped up onto the kitty tower. That's the most activity I've seen in ages!

I hope Salem starts feeling better and his system adjusts to the new normal and he continues to show improvement.

The people here are truly amazing!

 

So I'm faced with another conundrum of what to do....just tested him and he's at 101 on the AT2 and I double checked with the ReliOn and he's at 64 on that. Last time I checked him was +6 and he was 103 so he either went down and came back up or he's just been sitting at that number all night. I really don't want to skip AGAIN but he's in normal range?? I'm seriously going to have to call the vet in the morning.

 

I know sometimes they dose cats with insulin only once a day, I'm wondering if that might work better for him? Since he's fine to shoot in the morning but at night he's still really low. I'm going to not shoot on that number I guess and check him before I go to bed and see how much he's gone up?

Behavior wise, he's acting like his old self again. He still sleeps a lot but he's a cat. He's sleeping with me at night again which I love and he's playing more and just generally acting more alert.

 

Amy, technically Salem has been in normal range all day. Yes AM numbers are a bit higher than you want but otherwise he is looking extremely good.
Once a day shots don't usually work. They create a roller coaster effect that doesn't get them to the finish line and can make them feel off.

How about trying a dose of 0.25u tomorrow if Salem's AMPS is high enough to shoot. I agree that if he is only 64 on the Relion and 101 on the AT2 tonight it's definitely a skip, but it looks like Salem's numbers have been progressively coming down despite missed shots and reducing again now might just take him to that ultimate goal of you know what (don't want to jinx this progress!).

 

Yeah, I'll try that tomorrow morning then. I'm going to test in a few hours and see how much he goes up from the food and no insulin. I'm also going to call the vet in the morning but I doubt he'll be of much help.

 

So I guess my question is what should I be looking out for to potentially get him OTJ? I know I should be probably looking to see if he's coming back down without the help of insulin, but I don't necessarily know how to gauge that.

 

You can check to see that Salem's pancreas is working by testing him as usual at shot time. Then feed him as usual and retest again about 3 hours later without any more food being given in between. If BG is lower than pre-shot, then his pancreas is working.
You want the pancreas to heal as much as possible and right now, while Salem is spending a considerable amount of time in normal range, it would be ideal to get him spending some of his time in the dark green range. So I suggest trying to find a dose you can shoot twice daily to keep BG in good range and as level as possible for 24 hours a day.

See if 0.25u allows you to shoot twice daily. If you are still having to skip, then you can lower it further.

 

Okay so when I checked him last night at +3 he was at 127. Today his PS is 116. I'm going to go ahead and give the .25 and hopefully it won't drop him too much but I won't be here for about 2 hours. I guess I'll leave enough food out? The .5 isn't dropping him dramatically so I'd assume a lower dose won't either.

 

My other question is I know the protocols on here are done using human meters so should I start dual testing him just to have a comparison? The 116 was 73 on the ReliOn.

 

Ok I'm going to suggest you drop back even further at that preshot with that pre-shot. How about trying a dose of 0.10u? Draw the insulin up to the zero line on the syringe.

 

There really aren't any OTJ instructions specifically for ProZinc but the premise of getting into some green readings still applies. You can dual test if you want but from my experience with the pet meter, ideally you want some green in the 70 to 99 range and may get the odd blue up to about 120 or so on the pet meter in a cat approaching remission.

 

Okay is it around here? These syringes are so tiny it’s hard to figure out small doses.

 

Yes. Line up the bottom of the black rubber plunger on the very first line of the syringe barrel. Got a magnifying glass?

 

No, just my phone camera. I'll go pick one up today. So I basically just got the smallest amount possible in there? It's right at the black line with maybe a tiny sliver of space in between.

 

That's fine. You want consistency. That's more important than exact accuracy.

There is a smaller dose yet called a drop dose. It involves holding the plunger in as tightly as you can, inserting the needle in the vial, and then letting go to use the suction created to suck up just enough insulin to get a drop in the needle itself. You actually can't see the dose at all. These fine doses are a bit of a PIA but so worth it if you can get over that final hump.

 

Okay I just gave it. I think I can replicate that amount tonight. I know I need to call the vet, but there's no telling what he'll say. He might recommend getting Salem off of insulin but I'd like to get him a little bit lower first. It seems like his pancreas is working though considering he dropped some from last night.

 

It does seem Salem is on a mission and he is spending most of his time in normal range but some of them are in the higher normal range. The problem with this is that we don't have a baseline to know what our cat's normal BG range was before diabetes. Some non-diabetic cats can sit in the 40s on a human meter but we'd never strive to get our diabetics that low. I'm sure some non-diabetic cats routinely stay in the mid to high range of normal BG too. We try to get our diabetics as low we can safely in order to ensure a strong remission but if the higher range is their normal, that might not be possible without crossing a safety line.

 

Yeah I once tested my other cat out of curiosity and he was at 95 on the AT2. Honestly I'd just prefer him not go much over 120 and generally act like he's feeling better, which he has been at least. I just don't want to take away the insulin just yet because I don't know how he'll do without it.

 

When you get to an OTJ trial, we recommend testing pre-shot as you have been without feeding for 2 hour prior. If BG is within range (depends on insulin and meter) then you test again at night. If BG is higher than ideal, you do the 3 hour post meal test to see if BG has dropped. If kitty can stay in range for a period of 14 consecutive days, you can consider them in remission. Then you continue to test weekly for a while and can if you choose, gradually back off to monthly , although I personally still test weekly so if my girl starts to lose her remission, I will be able to catch it and deal with it as early as possible.

 

So in range would probably be 80-120? And yeah I'd probably test weekly or at least every 2 weeks so I can catch it early if he goes up again. That and making sure I get his teeth checked regularly since I'm suspecting that was a huge part of what threw him into this in the first place.

 

Range wise, once off insulin, even a bit lower than 80 is fine. My girl on her AT2 meter has been as low as 47 since she went into remission. While on insulin, definitely don't want them going too low.

 

So in other news, I checked Salem today at +6 and he was down to 89. His PS tonight was 125 so I'm going to go ahead with the .1 again.

 

Look at that lovely green! Look at that whole cycle! Go Salem!

Good plan sticking to the 0.1 dose Amy. Looks like progress to me.

 

PS this morning is 117. I tested him last night at +3 and he was at 84. I guess I’ll keep with the .1?

 

Yes! He is looking SOOOOO good!

 

Well he moved when I was giving it so I don’t think all of it went in but oh well. I don’t want to risk giving any more and I’ll just see how he does.

 

Good plan. You never want to shoot a second time no matter what. We've all had fur shots. Just mark it accordingly on your SS so we know if numbers start changing.

 

Well Salem really is on a mission it seems, tonight's PS is a solid 80 so it's a no-shoot for me. This is after I don't think he got all of it this morning?