Screwed up big time

That skinny 0.5 wasn't so skinny I'm afraid.
This morning her numbers are way above the 500 again.

The things I do are making her worse!
What kind of a person am I??

And of course no way of testing her these day's. Gotta work again.
How can I shoot based on pre shots only??
Next curve day, not earlier than friday.
Can she hold on that long??

I think her perfect insulin dosage at the moment would be somewhere between 0.25 and 0.5...
How do I measure that? It's impossible.

 

Awww ((hugs)))
Don't beat yourself up. You have a really sensitive kitty and this adds to the challenges.
Has anything changed in the last couple of days? Is her mouth redder and inflamed?
If he ends up needing insulin long term ( after dental ) then I encourage you to make that switch to a longer lasting insulin. Much gentler on her system.

Meanwhile...you know that measuring a consistent dose is really important.
What size needles are you currently using? u40s?
You can get a magnifying tool that allows you to see much closer up to the syringe.

Microdosing is hard but there are ways to make it a little easier.
There is a u100 syringe that measures smaller doses.
Currently you are using u40s..yes?
You will need a conversion chart to accurately measure this but it is not hard. here is the chart.. http://www.felinediabetes.com/insulin-conversions.htm

Your local pharmacy should have this u100 syringe....
Ask about microdosing and syringe conversion on "health" as well, there are quite a few people who have used u100s and needed to convert.
I would think your dose could be 0.4 ideally right now.


Today is probably going to be a weird level day, don't worry about it though. You know how to solve it and bring it back down again.

What you know..

0.25 does not seem to allow for the lower levels needed over a couple of days
0.5 creates huge swings and possibly a too fast and too low dip.

That in between dose is needed.

As for testing through the day..you have to have a life too, it does get in the way but we all have them ...
Do what you can to test, get spot checks in the evening to fill in the info a bit, leave a little food out while you are gone and minimize the risks by being a little cautious in your absence.

Any chance she got into higher carb food by mistake?
If you could add what you are feeding and when, in the notes of your Spreadsheet that would help as well.

That is a lot of stuff to throw at you....Any questions?

Kimmee

 

Hi Ella and Spacey

1) you did not screw up,

2) agreeing with everything Kimmee said.

It seems you've got a micro doser on your hands. My Goo was the queen of that! It also looks like she's not too comfortable with the idea of decent numbers just yet, so you may find she bounces up if she drops too low for her comfort, even if that level is nowhere near too low. Basically she needs some time to adjust to lower numbers (again, very reminiscent of Goo!)

A few questions just to get me up to speed with Spacey - are you giving a snack an hour or two post shot? That can really help smooth things out with Caninsulin, and I see some early drops there that she may not like. Can you also clarify if you're using u40 syringes? The u100s will enable you to give much smaller doses (Goo was on as little as 0.1 of a unit at times). As Kimmee suggested, 0.4 would be a good dose to try, which you would draw to the 1u line in a u100 syringe. I think if you can find a dose that keeps her in a reasonable range (not too high, not too low for her comfort so she bounces) and hold it for a while she may hopefully settle into some decent numbers. Others may differ in their opinion about how long to hold a dose on caninsulin before increasing, but I personally found Goo needed at least a week, and the closer she got to regulation the longer she needed. And I saw the same pattern with numerous other cats too.

I'm also going to second Kimmee on switching to another insulin post dental if you need to. I used caninsulin with reasonable success for over a year because I had to (we had nothing else available in New Zealand at the time), but life with Lantus was sooo much easier (other than the measuring stupidly small doses with a u100 insulin, that I could have done without!).

Lastly, please don't fret about not being able to test during the day. Yes, it's good to know how low a given dose is sending her, but you can still get some spot checks in the evening. Honestly, many people work and are simply unable to test throughout the day.

So, to recap:

1) u100 syringes for ease of measuring small doses, using the conversion chart Kimmee linked
2) snack an hour or two post shot (tricky if you're working, I know. How long after morning shot do you leave for work?)
3) try the 0.4 and stick with it unless she goes too low.

 

You are a wonderful person! You are doing your best and did not "screw up".

I totally agree about the need for u100 syringes. They make dosing caninsulin so much easier. I used to say all the time that there are many doses between 0 and .5u! LOL. When you use the u100s making .2u changes are easy. You can even do .1u changes without much difficulty (and maybe a pair of reading glasses).

Are you feeding again at 2-3 hours after the shot? That can help soften/slow the drop and maybe stop some of the rebound "bounce". I think the speed at which Beau dropped on caninsulin (vetsulin) was what caused most of his rebound and not a very low number.

 

Hi and hallo all of you,

First of all a bit of info on Spacey's food schedule.
Her shots, if necessary, are 7 am and 7 pm.
At that time both of my cats get each a little can of food, preferable between 3% and 7% of carbs.
Yesterday she had a few nibbles of some food that had +/- 10.9%. I have a lot of food which has higher values, but that's not used. I even have the food of 1st choice (the really low carb, 3%-7%) in a different box, so I can't get confused by accident.

Okay... next she get's her meds (Metacam & insuline) and after that I'm eating breakfast, drink some coffee and try to wake up.
Then, I'm cutting some fresh meat in bits and peaces and chunks. And on that they can nibble all day long. Which they do.
Spacey started to regulate her feeding times on her own. She eats mostly +2, +3 and +4.
I'm having food lying around all the time, knowing that she needs to nibble sometimes and knowing that they don't overeat anymore. When they're not hungry, they don't eat.
Because of all of this I don't think food and eating is an issue.

The dosage is the problem. I'm going to the pharmacy tomorrow, ask if they can give me those U100. I'll take a U40 with me as an example, so they know what I want.
So, yes. I've got the U40's from my vet.
I think I'm going to use the same U40 I am using now till I have the new ones. Same syringe with the same line I made and the same dosage.
Btw.... she did drop from the 500+ to 374 at the end of the first 12hr cycle. So I stayed with the 0.25.
I don't think I want to change too much now. It's too much of a guess work with those syringes.
So.. thanks for the idea to get the U100 syringes and for the link. :smile:
I can upgrade the dose when I have the ability to truly measure. Pffff.....
Spacey seems to be fine btw. She drinks, eats, pees etc.
(did some checking on bg again: +3 = 259)

She is really really sensitive.... Pfffffff :YMSIGH:

 

Also... I can't check her mouth, she doesn't allow it. But from what I can see, it's okay.

 

Hi Ella

completely agree with only changing one thing at a time. Let's see what holding at 0.25 for a few days does. So far so good today!

And it's great that she's looking good and doing all those normal cat things. We have a saying here to remember to look at the 'whole cat', they're more than just numbers. The other one is the 'five P's' - purring, preening, peeing, pooping and playing - all good things .

Do remember to check for ketones whenever you can, really important for a cat with infection trying a lower dose. Any sign of ketones and we're going to have to rethink the dose.

On the food thing, raw meat is great for them obviously, but it it's making up more than 10-15% of their diet you'll need to learn about adding supplements to make it balanced. The raw also won't slow the drop to the same extent as something with some carbs in it. But, as I said, nice drop so far today so let's just see how it goes.

 

Make sure the u100 syringe is correct

It should be a 3/10cc with half unit markings, probably 30-31 gauge. I like the short needles, but they take some getting used to.

I would not take a u40 syringe with you. It will probably confuse them and they also will tell you that you can NOT use a u40 insulin with a u100 syringe, but many of us do (or did) all the time using the conversion chart Kimmee linked for you.

 

can't say much cuz I don't have any experience with your insulin, but I did want to say to make sure your syringes have 1/2 unit markings, makes it so much easier to micro dose.

 

Her numbers this morning are even higher than those yesterday.
I thing too much roller coasting yesterday? she did drop quiet rapidly on those 0.25 in the evening. Actually during all day.

Gave her the 0.25 again, but I'm starting to wonder if even that is too much now?
I will leave some higher carbs food + the meat chunks today. More choice, see how she's doing when I'm home.

Right now (after eating and shot) she 's less active, seems more worn out and tired.
Going to the pharmacy after work.
0.1 this evening or nothing or???

Ella
*on the edge of giving up*

 

I think the problem is more likely to be lack of duration. You're getting a reasonable response, but the insulin is just wearing off too soon. Last night's drop was really not what I would call rapid based on the +3.

It's up to you of course, but I wouldn't cut back any further.

 

Last update:

@7am 581
+1 462

shouldn't there be a spike first due to food?

got to go to work now...

 

It is hard to say for sure, but I agree with Yolly.

You are not seeing enough drop at what should be nadir into normal numbers to go it without insulin, and when you raise the dose above about 0.4 you get that dreaded rebound bounce.

I would stick with the dose you are giving at 0.25 and try to give it a little earlier if you can, perhaps around +11, just to help keep the levels from climbing up as high once the insulin is out of system.

I am wondering about the teeth causing pain and that adding to stress and higher BGs sometimes as well.. ofcourse this will be sorted and make a more regulated kitty much more possible after the dental.

I would stick it out, and get some ketone tests and those u100s.....
Being a microdose kitty offers challenges, but I do not think less at the moment will help this.

This insulin does not like a lot of change so if you can find a dose you can shoot regularly, you will see greater response over time, than to keep changing the dose, unless you need to lower and I am not convinced that is necessary here.

As you know you have a very sensitive kitty...hang in there..it is in your hands always, ours are just suggestions, but in my humble opinion, I would keep to the 0.25 shoot a little earlier ( making sure the levels are rising ) and make sure ketones don't creep in while waiting for that dental and see what a slightly higher dose will do with the u100s.

Remember it is the preshot in combination with the peak and rate of drop, you want to consider when making dose decision and your feelings about only changing 1 thing at a time are bang on.

Kimmee

 

Not necessarilly, it may be working and slowing the drop so you don;t see it as a spike.
Leaving some food out for a snack yes?
Maybe something a titch higher carb than raw if possible?

 

It's so awful to be at work right now. I can't do a thing, except responding to your answer...
Yes to all: I did leave food for her to snack on, not only raw but also some higher carbs can food (10.9% carb, she usually has 3%-7%).

 

(((Hugs)))) I know how awful it is when all you do is worry about everything that could happen when you are away.

Good that you left some of that food out.....One day at a time.
A wise soul once said, this sugar dance is a marathon not a sprint.
One day at a time....it will get better.
Kimmee

 

Hi Ella,

I have send you a pm with info on where to get syringes in the Netherlands. The pharmacies usually don't have the right one's.

Groetjes Nina en Kat

 

I see you shot .4u tonight. Will you be able to get a +3 or 4 spot check in? I think that is a safe dose, and I would not have thought going without insulin would be good. I am not sure that .25 is enough for her. When looking for fast drops, look for something "faster" than about 100 points per hour as being something that might cause rebound. Also, the first few "normal" numbers - below 100, but above about 70 - may cause rebound because she is unused to them, but things will settle down after a day or two. Beau used to always do that: rebound for about 2 cycles and then settle down.

And I agree that you should try and be consistent, this insulin likes very small dose changes and takes a while for the BGs to settle. I found myself "chasing" the numbers in the beginning (Kimmee had to set me straight :roll: ).

 

Okay...
Good pharmacy, bad pharmacy.

I went to the first I found on my way home from work. And got a lot of trouble. And after 3/4 hours went away with nothing: "We need a prescription." Well... of to my vet hoping it was still open. And there explaining why I needed U100's. But luckily she went along. Now off to my own pharmacy: "I'm here with a bit of an unorthodox prescription." And while she read it, her eyes went very wide... she went to the back, came back and said: "This is so unusual. You can have the syringes for free."
Well.. isn't that something? :smile:
Of course, at home I discovered that I have the wrong ones. They're huge and have no 1/2 units markings. Fortunatly Nina came up with an website where I can buy the good type. So I did that then and tried something of a 0.4 on the syringe I'm using now.
So, the 911 wasn't necessary. Pffff...

Cause numbers are, of course, still high, my hubby and I took a while this evening to try and find the 0.4 spot on the syringe. Look how that's works out. (At the moment she is grooming, and grooming, and grooming, and grooming... you get the idea....)

I hope I have those syringes I ordered soon.
Thanks for all your patience.

 

Hi Ella

To get 0.4 of caninsulin in the u100 you just have to draw to the 1u line, nice and easy! Make sure the increments are 1u not 2 though, I think some of the bigger volume ones only have markings every second unit. Or did you decide not to use the new ones at all?

FWIW, I couldn't get syringes with half unit markings here in NZ, and I managed Goo's tiny doses. If you can get them, great, but if not you'll work it out

I don't think that you need to leave out the higher carb food, just something with some carbs as opposed to just the raw meat.

 

Been folowing your journey, just cheering from the sidelines :RAHCAT

You can order u100 syringes from sanicare pharmacy on the web. It's German, but real quick.There BD make.
V.late here but can send you a link if your interested.
Your doing great

 

Ella, after seeing a high number like 500, you are bound to have some weird anomale levels for a couple of days.

Unless you see signs that she is going low at peak, I would hold on and let this 0.4 ride out for about 3 days.
I and others are watching the levels with you. let us know her whole behaviour as you ahve been as well okay?

History is showing that 0.25 could not maintain lower levels, and yet 0.5 was pushing the swings up.
It takes a little for those swings to find equlibrium, like a pendulum if you see whatI mean.

Do you suspect there is any pain from her mouth?

(((hugs)))

agree, higher carb than raw, but still low carb wet food for snack

 

Oh my.... I'm being watched. It's like being in East Germany all over again. :lol:
No, it's good. Of course and very much appreciated.

I'm not sure on how she's doing. She walks and talks. Get's irritated again when I want to poke her, which is her character. She eats and drinks, is alert.
But I have no idea when she did poo lately. Could that also be upsetting?
Is it normal for cat's to poo less when they switched form dry to wet?
Well... we did give 0.4 (?) again. I also left food again. Low carb wet/canned. ;-)

I don't think that she experiences pain from her mouth. She has painkillers every day and I can't see her chew differently or in a way that would indicate pain. So, holding on and crossing paws....

Off to work now.

 

It is normal for them to have fewer poops with wet food - less "useless" stuff passing through, so less waste. They can get constipated (some do, none of mine so far) and that would cause problems and discomfort. Do you add a little water to the wet food? I add just under a half can per can of food - swish the water around the can to get all the bits and then mis into the food. The extra water helps to prevent dehydration and constipation.

 

So how do I know that she's constipated?
I bought some mircolax today, but that has to be administered rectal. And if I can prevent that, that would be nice.
Yes I do add water to the food, every time. But she is low on fibres. I don't know if that's the problem.
Is there anything I can give that is not so invasive as a laxative?

 

I would not give a laxative unless she is prone to constipation or you know she is already constipated. I have no experience with this, so I don't know the symptoms, but I think you would know something is wrong because she would act "off" somehow. You might post on the Health forum to ask about what the signs and sympoms are and also what treatmets are used.

Cats don't need a lot of fiber. They are not small people, so don't need mini versions of our diets as far as fiber goes. Think about the nutritional breakdown of a mouse or small bird. Very little fiber, but plenty of protein, moisture, calcium and some fat.

 

Hi Sheila,

Thanks for responding. :smile:
I was also really uncomfortable with given laxative. So I went to a pet shop with natural health stuff and so. They gave me a powder I can mix through her food, something without carbs.
The funny thing is thow, when I came at home I saw a couple of poop thingies in the litter box. So I think that's all okay. I'm still using a bit of this powder (with probiotica etc.) so that the stool is going a bit better than now. Also as preparation for next week when she has her operation. But I'm giving only a tiny tiny bit. ;-)