? Shelley - going back on Caninsulin after hypo?

Hi, I would just appreciate some advice on my situation please.
Shelley has had diabetes for 6 years which has been controlled with Caninsulin with no problems and a current dose of 1.8 units. Last week she had a hypo and her blood sugar fell to 1.1. She was in hospital for 2 days when she had another hypo after the vet injected 1.5 Caninsulin units. The hypos happened about 4 hours after the injection. So her insulin was stopped in the hospital and her glucose curves were normal over 24 hours, suggesting remission and no glucose was present in her urine. Since she came home I have been testing with Alpha Track and getting readings between 17 and 25, without insulin and glucose is present again in her urine.
I have given yesterday's curve to my vet and have been told to restart the Caninsulin tomorrow at 1.0 unit and the monitor her blood glucose and take her to the vets if it drops below 5.0.
I am just concerned that Shelley will have another Hypo as she is an elderly cat with high blood pressure and a heart murmur. The vet can't explain why she had the hypo after 6 years of being ok and this all seems a bit risky to me. Thanks for reading.

 

Hello Anthony....I am not experienced in such matters but someone with much more knowledge than myself will be along shortly. Will be interested in hearing their input on this . To draw more attention to your thread u need to add a question mark icon at the beginning of your title . Hope that helps .

 

Can you post the BG values from your curve with respect to the time the shot (1 unit) was given?
What are you feeding and when?
Has that changed since Shelly had no problems with a hypo?

 

Hi Beth,
Thank you for that, will do, I appreciate your help. Regards.

 

Hi Larry, in fact the first 1.0 shot has not been given yet, it is planned for tomorrow. She has not has any insulin since the second hypo. Since the hypo she has had a mixture of RC Diabetes wet food, which she is not keen on and her normal food, Applaws, Felix, Lilys, all wet food.

 

Just checking about your last post - is she not eating well? If her food intake is down, it might be wise to start back on insulin at a lower dose - maybe .5 unit and see how she responds. Her bg is high so she needs some help, but we certainly don't want to send her plunging again.

 

Hi Just-As-Appy, thanks for your reply. Shelley is eating quite well, maybe a bit less than before the hypos. I think you are right about .5 unit. I asked the vet about changing to a different insulin, someone mentioned Prozinc but he didn't think that was a good idea. I just wondered if some insulins are less likely to result in a hypo.

 

Too much of any insulin will result in a hypo. Caninsulin action is generally a pretty steep drop and then an equally steep climb. Prozinc also has a fairly steep drop and climb, but not as dramatic as Caninsulin. The good (and bad) thing about these 2 is that they do not have a long duration in the cat - as little as 8 hours for some. The more gentle insulins like Lantus and Levemir have a much longer duration. Because the protocol for these 2 insulins is well developed and researched, hypos seem to happen less frequently. Unfortunately when they do they are more difficult to treat due to the longer duration of the insulin.

Whether or not to change Shelley's insulin is a tough call. I would think that Prozinc might be easier on her, but your vet probably has reasons for not wanting to switch. Maybe explore that with him to see what his reason are. It maybe as simple as he is not familiar with Prozinc, or he might feel that her body is used to the action of Caninsulin and doesn't want to change.

Do you have the numbers from a curve that you could share? It might help others who have experience with the insulin comparisons to provide you with thoughts.

 

I didn't mean to sound trite with that first sentence. Diabetes is a delicate balancing act between food and insulin, and even more tricky as a cat ages. You have obviously done a great job for many years.

 

Thanks again for your comments and the information on the insulins. Having to manage the after effects of the hypos is a new and rather unwelcome experience. I only started home testing last year and prior to that relied on the fructosamine tests when good or excellent control was reported, so really all I had to worry about was 2 injections each day.
But obviously the situation will have to be monitored very carefully from now on. The curve numbers from 15th February hourly starting at 0900 were as follows;
20.2/17.9/18.9/18.3/24.3/23.8/missed/17.9/21.1/17.5/19.7

 

Thank you everyone but I am logging off, it is 23.25 in the UK. Will be back tomorrow, goodnight.

 

Just wondering how Shelley is doing today. She (and you) have had a rough few days. Thanks for posing the bg numbers. If I understand correctly, these numbers are from a day without insulin - is that correct?

It seems that many vets in the UK favour Caninsulin so it is not a surprise that her vet prefers to stick with it. If she has been doing well for 6 years then it may well be that she will continue fine with more careful monitoring and fine dose adjustments.

The fructosamine test gives an indication of the average of the bg numbers over the past few weeks. If you are testing at home, you don't really need a fructosamine test as you can see from your own numbers how she is doing.

Many of us use a spreadsheet and share the 'read' link so that others can see how the insulin is working. Would this be useful for you? It requires a google account.

 

Hi, thanks for coming back to me on this. Shelley seems her normal self today, bright and eating OK. But I had to go out unavoidably this morning, so I didn't restart the insulin. Spoke the the vets office, the vet I've been dealing with is off today. They said it should be OK to wait till tomorrow, I didn't want to start it late in the day in case something goes wrong. I just checked her glucose level and it is high, 25.2. But the hypos have made me very unsure about injecting her, I know I will have to of course.
The numbers are all without insulin. I will look at setting up a spreadsheet, I do have a google account.
I'm very grateful for your comments, thanks again.

 

Take a look at Sky's spreadsheet - in a way she sounds similar to Shelley in that she is very responsive to Caninsulin. I came to the conclusion that her dose lasts longer than the 12 hours it is supposed to and when I dose her she probably still has some acting in her system. It's possible that Shelley had hypo episode for similar reasons - that her dose had become unsuitable for whatever reason.

The only way I can manage her is on a variable dose and missing it if I don't feel safe dosing her.

I would definitely restart on a lower dose - I switched back from Prozinc earlier this year and was initially on a 1 unit . I had to increase slightly as it wasn't doing much but now she has more of it in her system the 1 unit would be too much for her sometimes.

Testing before injecting is by far the safest way to go if she will tolerate it.

Good luck

Karen

 

Hello Karen,
thank you very much for your message, I do see what you mean on the spreadsheet. Actually Shelley is a placid cat and is very compliant, except if it is every hour, then she does start to get fed up with it.
I will definitely test before any shot, my worry is that it causes another hypo but I am going to have to start the caninsulin again and monitor carefully.
Very grateful, Anthony

 

if you know how she is likely to react to each dose then it does make knowing what to give her easier and will reassure you into having faith she won't hypo. There can obviously be other things going on that could impact her reaction to insulin but most of the time she would probably react the same. Sky hypo'd in the first week - I know what you mean about worrying it would happen again but through testing I have a rough idea of how she reacts a lot of the time and if ever I'm unsure I will leave her without a dose.

Sky used to drop down 10 "marks" on a 2 unit dose and 5 on a 1 unit but I haven't checked for a while to see if it has changed. I need to do another curve on Sky to see how she reacts to her smaller dose. Sky usually continues dropping until the 6 hours so I do think she has a slow metabolism.

I think the general advise is keep her on the same dose as far as possible for 6 cycles which may not be possible for Shelley if her needs are changing.

I would definitely get her started again but keep an eye on her numbers.

Karen

 

Hi Anthony
Cats can be very sensitive to insulin after a hypo so you are wise to consider dosing conservatively. Those numbers you're getting are pretty high and a lot of cats would tolerate 1u of Caninsulin at that level, but I agree with the suggestion above to give 0.5u for the moment - test before you shoot though and then an hour later if you can, to make sure Shelley hasn't dropped too fast. If you can do further tests during the cycle it is always a good idea to see what the dose is doing. Hopefully she will be fine on 0.5u and if she is still on the high side on that dose for a couple of days, that would give you the confidence to increase to 1u - but do keep checking to be sure.

We can certainly all understand your apprehension but as you are home-testing you have the means to monitor Shelley and make sure you are doing the right thing. So re-start on a low dose and keep testing. Keep a note of numbers and post here so people can see what's happening. If you can, set up a spreadsheet to record this data (there are tech gurus here who can help with that) and for now, can you post in this format so we can see what BGs are at the different times in the cycle (you don't have to test every two hours but collecting data is what it's all about so if you have the means to do so, it is not wasted effort):

AMPS (morning pre-shot BG: ??
+ 2 hours - ??
+ 4 - ??
+ 6 - ??
+ 8 - ??
+10 - ??
PMPS (evening preshot): ??

Good luck!
Diana

 

Thank you Karen,
I will keep that in mind. I have had a further look at the spreadsheet and its given me more idea about managing this. I didn't think to have high carb food and treats in for example so that is all very helpful.
I will start the insulin tomorrow and keep monitoring.
Much appreciated, Anthony

 

Hi Diana,
Thank you, I am going to do as you suggest. I will look into setting up a spreadsheet but in the meantime post the numbers in that format. I have to make a start again and having joined this site is going to be a great help.
Most grateful, Anthony

 

There is a good document here http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/ about hypo. Being prepared should lessen the anxiety.

 

Hi, thank you. I did get some maple syrup in just in case. I will study that in detail. Started Shelley on 0.5 can insulin this morning. So far at +2 hours not much effect. I will post the numbers later. Thanks again!

 

OK Anthony - what was the pre-shot number and what is the number at +2? This is what we need to know to comment so yes, post these numbers and any further ones when you can. Hopefully she has gone down a little at least, even though 0.5u is a small dose... we need to see some data over the course of the day on that dose, in order to suggest raising it... or not.

 

OK, thank you:
AMPS 22.7
+1 hour 21.8
+3 hours 17.1
+4 hours 16.9
+ 5 hours 15.1
+6 hours. 17.3
This is what I have so far.

 

Well done, Anthony! That's pretty much what we might have predicted I think. The half-unit drop did have an effect, nice and gentle, and carried on dropping Shelley until nearly halfway through the cycle, so actually she has had quite good duration from this small dose. It looks as if she is climbing again now so you can expect any further numbers to be higher. On pre-shot numbers like this you probably could have given 1u but it is always best to stay safe. Let's see what her evening pre-shot is - as I said, it looks likely she is rising again and you could go for 1u - or you may prefer to stay cautious, especially on the evening dose, and stay with 0.5u for today.

It looks as if Shelley will not need large doses of insulin going forward, in which case it would be a matter of getting her numbers down a bit more and then finding the right dose to drop her and keep her into acceptable numbers for most of the cycle...that might be the tricky part but with careful monitoring and dose adjustment as necessary, it can be done.

I wonder if one of our most experienced UKers has any comments on this @Elizabeth and Bertie

Diana

 

Hi Diana,
thank you very much for your comments and I really do mean that! I am so glad I joined the FDMB, I had no idea I would get this level of help and advice.
It makes such a difference having someone else's opinion on this to reassure me that I am doing the right thing.
The +7 number was 18.3, as you anticipated.
Thanks again,
Anthony

 

You're very welcome, Anthony - all of us have been where you are and understand the anxiety and uncertainty, so you are certainly not alone. Feline diabetes does seem a bit mysterious at first but when you get your head round the logical part of it, you're halfway to working things out for yourself. It does take commitment on the part of the caregiver but it sounds as if you are willing to stay on the case, so hopefully this should be manageable.

Do read others' threads on this forum though and you will learn a lot that way too.

Diana

 

Thank you Diana. As you probably saw from my first post, Shelley has been diabetic for six years and has been well controlled and never had a problem. So I have had it relatively easy, until the last week or so.
I would add that the last fructosamine test result was 312 and the lab report stated that some cats may show periods of hypoglycemia at this level, that was 1 12 16. Thinking back the vet told me we had excellent control but didn't say anything about reducing the dose. It actually says in the report that a doseage reduction may be appropriate. None of this was mentioned and I only found out because I asked for a copy of the report. The vet, who I have had a good relationship with for many years did encourage me to home test and I obviously have not done that enough as I expected all to be well.
The report also stated that Shelley has pancreatitis, this has come up in reports before, but she doesn't seem to have symptoms. I don't know if this would affect the response to insulin? Incidentally, my regular vet is now at another branch and I have been dealing with a younger less experienced vet.
Anthony

 

The thing with diabetes, Anthony, is that nothing is certain... insulin requirements can go up and down.... this is exactly why home testing is so vital. The fact that you are doing this now should mean, hopefully, that you are always aware what Shelley's BG is and therefore her insulin requirements... knowledge is power!

A good relationship with your vet is also very important and if you are now dealing with someone less experienced there is even more reason to inform yourself as well as possible. Many of us here have taught our vets a thing or two about FD. The fact is that most vets are like GPs and have one day's training if that on FD... they hopefully learn more as they go along, but they are not specialists in the field so if we can educate ourselves and pass things on to our vet, everyone benefits.

I'm sure pancreatitis could affect BGs too so if there has been a flare-up of this, we could be looking at a reason for the higher numbers.

I would keep a diary with Shelley's BG numbers and insulin doses, noting any symptoms she may show, and take this to the vet at your next appointment. Some people come to an arrangement with their vet where the vet is happy to be emailed with questions between consults - you could ask about that perhaps.

Diana

 

Thanks Diana, I am going to keep detailed records from now and set up the spreadsheet. I will post the rest of the days numbers as I go along.
Kind regards, Anthony

 

Hi Anthony (waving to you from Surrey!).

Insulin requirements can change a lot over time. Sometimes the need for insulin increases. Sometimes it decreases. (My own cat started out on a high dose of insulin and now (10 years later!) only has a teensy weensy amount of insulin every 2 - 3 days.)

A hypo can make cats much more sensitive to insulin. So you are wise to be cautious with the dose.

I wonder why your vet is reluctant to prescribe Prozinc...? ...It may simply be that your vet doesn't have much (or any) experience of it because it's only been available in the UK for a relatively short period of time... But Prozinc typically drops the blood glucose more gently than Caninsulin does; and lasts in the system longer.

Some people use food to try to slow down the rate at which the blood glucose drops. With Caninsulin it can be helpful to feed the kitty about 20 - 30 minutes before giving the insulin shot, so that the cat's body has food on board for when the insulin starts to work. And it can also be helpful to give a snack (or part of the main meal) about 1.5 to 2 hours after the insulin shot, so that there is also food on board for when the insulin is at it's most active.

Do you know when Shelley usually has the lowest number of the cycle? In many cats this will be around 4 - 4.5 hours after the Caninsulin shot. But it could be earlier or later.

And what exactly are you feeding Shelley at the moment?

Eliz

 

Hi Eliz,
Thank you very much for your message. Waving back from Hull, East Yorkshire!
The vet that I have been dealing with is fairly new and refers to his more experienced colleagues. When I mentioned Prozinc, he said he had heard good accounts about it but as Shelley had always been on Caninsulin, he did not want to experiment at this stage.
Shelley used to have a big appaetite and weighed about 6.5 kg when she was first diagnosed. Now she weighs about 4.5 kg and asks for food every 1.5 to 2 hours but only eats a little. But during the course of a day does eat a reasonable amount.
Something I have been thinking about is that on the day of her hypo I had been out for an hour or so and when I came back in was sitting having a coffee when I thought, ' I am surprised Shelley hasn't appeared yet asking for food'. You see my living room is at the back but Shelley usually sleeps in the front room. So I went to check on her and gave her some food but she didn't seem to be interested in it. It was about an hour later when she seemed to be wobbly and weak and when I checked her blood sugar it was down to 1.3.
I am at home most of the time but she is a cat that will not often eat food that is left out. She seems to want to see me bringing fresh food before she is interested.
From the curves I have done before the low point has varied from around 1300 t0 1400. These are todays nubers;

AMPS 22.7
+1 hour 21.8
+3 hours 17.1
+4 hours 16.9
+ 5 hours 15.1
+6 hours. 17.3
+7 hours 18.3
+ 8 hours 16.7
+ 9 hours 22.6

The vet recommended RC Diabetes wet. I have tried it but she wasnt eating much of it. So I have gone back to her usual food; Felix Pouches, Gourmet Solitaire Pate, Applaws Senior Chcken and Lily's Organic Turkey. A general variety but I have tried to find the low carb ones.
With grateful thanks,
Anthony

 

Felix caused Sky problems - if it is the As Good As it looks it has vegetable proteins (I think) and various sugars so even though the carb content was low she was responding to something else in the food. I took her off that and she is on Sheba fine flakes now. Within a few days of stopping the felix her numbers were much better/lower. Not that that is related to the hypo issue, and a lot of cats do fine on Felix, but may be worth considering whether that could be increasing her glucose levels. @Elizabeth and Bertie has done an invaluable food resource spreadsheet.

The half unit you have given Shelley has resulted in a nice and gentle drop and whilst it hasn't taken her very low it's giving you an idea of how she reacts. I wouldn't worry that it hasn't had too much of an effect on her - you can increse slowly when you know how she is responding. I also wouldn't be in a hurry to rush into increasing.

Sky this morning was at 18.4 (I think). I tested just before her tea and she was at 7(ish). I hate the big drops - nothing has changed for her, her food is the same, she's eaten the same amount. Just for some reason she has gone too low for me to be comfortable injecting - especially as I don't know for sure how she is responding. I do wonder sometimes whether Sky just needs one dose a day.

You're doing the right thing. I do think that Caninsulin does work and it is obviously working for Shelley but she just needs monitoring more now to try and avoid problems.

 

Hi Karen,
Thank you for your further comments. It is actually the standard Felix pouches not the AGAIL. I tried that with my cats years ago and although they liked it, they would get diarrhea with it. I have generally avoided the cheaper brands but I just saw somewhere that it was low in carbs and the jelly seemed to satisfy Shelley for one of her many snacks. She never eats the hard pieces. But I would prefer her to have something better, it has been mainly Applaws Senior and Lily's Organic today.
I was surprised to see the drop at 8 hrs to 16.7 but she had been asleep and not eaten. In the next hour she ate, so presumably that's why there was the big jump to 22.6 and also getting to the end of the cycle. I certainly don't feel inclined to increase the dose for the time being, although the vet said start on 1.0.
I am sure I am going to be the same if I see large drops. Prior to her hypo, 3.6 had been the lowest number and then it came back up on the next test. I mentioned it to my vet at the time and he said it was alright but I think Shelley's dose should have been reduced in December when her fructosamine was 312.
Thanks again,
Anthony

 

You are obviously a very caring owner, Anthony, and you're saying all the right things... instinct plays a part in how we treat our kitties so stay with the dose for now. When you have time, think about getting a spreadsheet up and running and you can then keep that up to date and link it to your signature (you will need to go to your profile settings to say something about Shelley) - then we can all see at a glance what's happening without you having to type numbers within a thread or repeat things so everyone can catch up.

Can someone add the link to the spreadsheet here please? Sorry I can't do so.

 

Thank you Diana. Yes, I will do that once I get the opportunity. I will just repeat todays numbers for information;
AMPS 22.7
+1 hour 21.8
+3 hours 17.1
+4 hours 16.9
+ 5 hours 15.1
+6 hours. 17.3
+7 hours 18.3
+ 8 hours 16.7
+ 9 hours 22.6
PMPS 24.4, injected 0.5

Many thanks, Anthony

 

Lovely gentle curve, Anthony, just needs lower numbers!

 

Thank you very much for all your help today, it has been greatly appreciated!
Anthony

 

Hello,
Just wanted to seek comments on recent numbers. Early hours BG seemed to drop very fast and I was worried about possible hypo;
PMPS 20.6
+3. 14.8
+4. 11.8. Fed Dreamies
+5. 15.8

I know these are not really low but out was the speed of the drop compared to Sunday that worried me.
Should I continue on the 0.5 dose or reduce?
Many thanks, Anthony

Cc @Diana&Tom @Sootyca

 

That is quite normal I believe - Caninsulin can be fast acting and cause a rapid drop. Her numbers were okay though and well within safe levels- I know you are worried about hypo but at 11.8 I would not have been concerned. If you had tested at +5 and +6 and the numbers were still dropping I would have intervened at that point. The increase at +5 was probably due to Dreamies - your previous post suggested she would drop again at +5 before starting to increase.

It's a real balance but I would stick with the 0.5 and test again at +4/5/6 just to be sure.

You're doing a great job.

Karen

 

Hi Karen,
Thank you very much for replying so quickly. +6 was 3 am, I was still awake and could have tested but Shelley was sleeping peacefully and I decided to leave it as +5 had shown the increase.
But thanks once more, will continue with 0.5
Anthony

 

Hi Anthony, I agree with Karen - these numbers are actually rather nice and not cause for concern. The drop may *look* steep but that's after three hours - numbers at +2 might have been somewhere in the middle and you wouldn't have been so worried, probably. The increase at +5 may have been due to the Dreamies or she may have been rising then anyway, we don't know - but another time there would be no need to give carbs at that number. So try not to worry, this is looking good. I do understand that it's scary when you start to see better numbers and dread another hypo, but you have the knowledge and tools at your disposal now to ensure that such a thing is unlikely to happen.

And yes, stick with 0.5u for now and see how the next couple of cycles pan out.

Keep going, you're doing just fine!
Diana

 

Hi Diana, thank you for getting back to me. I can see that now but in the middle if the night I'm afraid I overreacted, worrying that what looked like a steep drop would continue.
I will press on with the 0.5.
Very grateful,
Anthony

 

Very understandable, Anthony. Everything looks worse in the middle of the night. Everything looks fine, just carry on keeping a close eye.

 

How's Shelley doing?

 

Hi, thanks for asking. Shelley seems quite well, her numbers today were;
Amps 21,7
+4. 14.8
+6. 18.2
I haven't tested so often today as the pattern seemed to be the same as the last few. I will perhaps have to think about a gradual dose increase though, as the numbers need to be a bit lower.
Anthony

 

Shelley's numbers have crept up today.
Amps 26.0
+5 18.7
Pmps 28.7
I have had some trouble getting the samples today. Gave up at +4. Took about 10 attempts at +5 and 3 testing strips.
Shelley was getting really fed up, so thought I would leave it until the pm shot.
28.7 is the highest reading I have seen. I have increased the dose to approx 0.6/0.7, it is hard to judge these small changes.
If the am test is high I think I better increase to 1.0.
I found out that Shelley likes Applaws Tender Chicken in Tasty Jelly. This is new for her and does have quite a lot of vegetable gelling agent. I don't know if this is anything to do with the spike in numbers.
Grateful for any comments.
Thank you Anthony

 

I've just suggested this elsewhere but possibly keep a food diary of what type and flavour you have fed to se if it correlates with an increase? took me ages to work out what was causing Sky's spikes and eventually narrowed it down to the Felix.

Maybe if she is getting fed up give her a bit of break from the testing? I know it's good to do it and get numbers but it's a marathon not a sprint and if she is showing signs that she isn't happy with it then just do morning and evening and maybe 1 between +4 - +6 if you can't relax.

I think I would also be increasing to a 1 unit. She has been on a low dose for a few days without it bringing her very low. Of course, increasng the dose does increase your worry by the same amount especially when the numbers start dropping!

I've had to increase Sky to a 1 unit - as she was high after her injections. She has dropped a massive amount from her morning test so I need to keep an eye on her.

 

Thank you. It would be easier if Shelley had a more consistent diet. But something she is keen on one day, she will pick at the next. A diary is a good idea though.
I haven't tested so much the last couple of days but just had a real struggle this lunchtime. I will keep it to a minimum but look out for any large drops.
I see Sky's number shot up, similar to Shelley's, it's not an easy illness to manage by any means. I think I will have to get something to test for ketones also. Very grateful for your comments!

 

I have injected just under 1.0. The Amps was 24.9. I don't think she was as bright as usual yesterday and is much less vocal than usual.

 

High BGs may well be making Shelley feel off, Anthony, and it does seem that the higher dose was warranted. Keep an eye on her of course, and do what tests you can in the early part of the cycle, but on a high AMPS like that she shouldn't drop too low.

No, FD isn't an easy thing to manage and does require ongoing commitment, but you're doing all the right things and hopefully more of a pattern will emerge as time goes on. Food changes can certainly make a difference in BGs, as can infection and other conditions, and stress... some people even find that their cat's BG is affected by the weather so Shelley might even have been sensitive to the dreadful conditions yesterday.

By the way, you don't specifically mention it but you are getting through a lot of strips... are you getting supplies through your pet insurance if you have it? Strips can be very costly. Many people buy from reputable sellers on ebay.

Hope today is better.

Diana

 

Hello Diana,
It's very good to hear from you. An hour or so since the injection and I think she is a little brighter already and has just meowed for my attention.
As well as everything else I think she is fed up with the testing, especially when it takes numerous attempts. Earlier in the week I was getting the blood easily.
Sadly, I don't have insurance. Having 5 cats it didn't seem cost effective. I just got some strips from the vet this week, 50 at £86.00. I have seen them at less than half that on the internet so I will order the next ones on line. I think the vets are a bit unfair to charge so much. If one of my cats is poorly, I do whatever the vet suggests and never worry about the cost but the prices have risen a lot in the last few years. Shelley's 2 days in hospital cost nearly £1000.00.
Thanks again,
Anthony

 

Wow that's a lot of money, Anthony, but of course we all do whatever we can within our means for our beloved pets.
Those strips are VERY expensive though so have a look around and see what you can find... you may even find it more cost-effective to buy a different meter that takes cheaper strips... this an instance where "expensive" doesn't necessaeily mean "best".

I'm tagging a few other UKers to see what meters they use and where they get their strips @Elizabeth and Bertie @Marlena @Sootyca

ETA - by the way, when testing, are you making sure the ear is warm? That helps to produce blood. And also give Shelley a treat at test time so she comes to associate it with something nice. Treats don't have to mean Dreamies - small pieces of cooked chicken, ham or cheese usually go down well too.

Good luck!
Diana

 

Thank you Diana, that is very helpful. I got the Alpha Track kit from the vets, that was over £100.00. I have followed their advice when I should have done my own research but I didn't know about all the wonderful help available here then.
I do try to warm her ear with my fingers, I will spend a bit more time on that. She usually has a little food afterwards, I will try the chicken and cheese, she loves cheese.
Thank you!
Anthony

 

Crikey, I thought my vet was expensive at £65. Animed do them at £40.

I haven't tried them but someone suggested that Freestyle lite strips give close readings and are significantly cheaper:

http://www.felinediabetes.com/FDMB/...e-vs-alpha-trak-2-strips.172666/#post-1889701

http://www.felinediabetes.com/FDMB/threads/alpha-trak-2-question.172927/#post-1893524

Sky bleeds much better when she has been asleep with her head tucked under so she is warm, or she has been toasting in front of the fire - has to be really warm to make a difference to her. She also come running when she sees the test kit - bless her - as it means she is going to get fed afterwards

 

Thank you Karen, Sky is obviously well trained! I will have to do some research to try and make this a bit more economical for me. My vets were independent until a few years ago and are now part of a national company. I guess they have to generate as much as they can to satisfy the corporation. I know everything is monitored. One of the original directors told me his new job was to audit underperforming branches.
Regards, Anthony

 

These are today's numbers;
Amps 24.9 Injected just under 1.0
+3. 20.9
+4. 14.6
PMPS. 21.4 Injected 0.75

Shelley has been much more her usual self today as a result of the higher dose. Decided to reduce the pm one due to a lower PS number.

 

Nice I would still have been tempted to leave her at a 1 unit before the evening dose but it's a real balancing act. I think you probably have enough data to let go a little of your fear of another hypo You are beginning to see real patterns now in how she reacts to her doses which will help you work out what to give her in future. She seems to drop about 7 points on a 0.5 unit and 10 points at +4 on a 1 unit and her nadir is probably about +5 based on the earlier numbers you put up so she possibly dipped slightly lower during the day. It will be interesting to see where she is tomorrow morning after a slightly smaller dose this evening.

Have you started a spreadsheet? It really makes seeing patterns a lot easier.

My plan for tomorrow is a curve - Sky won't like me as the vet said every hour - nearly told them to provide me with all the test strips!!!! I had a tough call tonight - she was at 20 this morning, gave her a 1 unit and tonight she was at 8.9! I fed her and retested before injecting and she had increased slightly so gave her more food and a tiny dose. Going to test again in an hour to see where she is. Just to spite me she will be high!

My vets did the same - became part of a bigger group (without making it known to anyone!) and since then prices have rocketed and service hasn't improved.

 

Thank you Karen, I probably should have done, it's just looking at that syringe and wondering which way to go.
I started to look at preparing a spread sheet but it didn't work out on my tablet. I will try on my laptop.
I think an hourly curve is quite tough. Shelley sleeps a lot and just being disturbed every hour is a stress. Luckily when I did the last curve I was getting the samples easily, today again its been harder.
Hope all goes well,
Anthony

 

Good luck today, Karen and Anthony - Karen with Sky's hourly curve and Anthony with the spreadsheet. (Anthony, do you have the link to the spreadsheet used here? I can't link it myself but if you don't have it or have problems getting it set up, let us know and we will tag the experts here who will get you up and running in no time.)

Diana

 

Thank you very much Diana, I will have a go and let you know if I have a problem.
Shelley's Amps was lower than usual, 18.9, so I only used 0.6 insulin.
+ 4 was 13.3

Kind regards, Anthony

 

I have been trying to put together a spreadsheet. My laptop and connection are very slow, so its been a long job. I can't see on the spreadsheet though how you save the information. Is this automatic?
Thank you, Anthony

 

Tagging one of the spreadsheet experts who may be able to help @Marje and Gracie

 

Hi Anthony, are you also buying syringes from your vet, or are you buying them online?
Just in case nobody has given the link (and they may well have done!) the VetUK U40 syringes here are a very good price:
http://www.vetuk.co.uk/insulin-syri...nsulin-syringe-with-needle-box-of-100-p-11335
.

 

Anthony it saves as soon as you change anything on it so there is no save function.

 

Hi Diana, apparently it is saved automatically, so that is the explanation.
Thank you!

 

Thank you Karen, the last time I used a spreadsheet you had to save everything, I'm a little behind the times.
With thanks!

 

Hi Eliz,
Thank you for that. That is what I pay for 30. I can't understand why the vets charge so much more. I just paid £86.00 for 50 Alpha Trak strips but I now know I can get them for half that on-line. I appreciate the information.
Kind regards, Anthony

 

Hi Anthony, these are the 'generic' ones made by VetUK (rather than the branded 'Caninsulin' ones). But, not only are these cheaper, they also have half-unit markings (which I think the Caninsulin ones don't?) ...This makes it a lot easier to measure doses that aren't in whole units.
.

 

Supplies are generally MUCH cheaper online than from vets... vets put a hefty mark-up on everything to add to their profits, while online suppliers do not of course have overheads or middlemen in the same way so can make a better "offer". I don't think there's much in the way of FD supplies that you can't buy much more cheaply online - except insulin, of course.

 

I think they may be the same as the ones the vets have supplied lately as they do have the half markings. They haven't been able to get the Caninsulin ones for some reason.

 

Thank you, I am beginning to realise.

 

I think I will have to have a word with my insurer to see if they will accept a claim with internet receipts for Sky's supplies.

 

I don't see why they wouldn't, Karen - fingers crossed.

 

Shelley's numbers were looking better today then suddenly had a steep increase?
Amps 18.9. Inj 0.6
+4. 13.3
+8 12.5
Pmps. 25.7. Inj. 0.6

+5, +6, Shelley was in a very deep sleep so I didn't disturb her. I didn't increase the dose due to earlier lower numbers. Was eating just before the test. Also got a much larger blood sample at pmps, earlier ones very small. Don't know if this affects it?

 

How soon before you tested did she eat? Food can increase the BG - I think the general "rule" is no food for 2 hours before injection. I'm not sure how fast acting on BG food is but could be fairly fast as the general recommendation is to inject the insulin 20-30minutes after eating.

I think you did right not to increase as it could be a food related increase.

 

The amount of blood shouldn't make any difference tomthe reading. As long as the meter doesn't give you an "error" reading, it should be correct.
That IS a big jump from +8 to PMPS and it certainly shows how some cats can rise fast when they are completely out of insulin, which most cats on Caninsulin usually are after a few hours. I'm sure you were disappointed to get the 25.7 after those nice mid-teen numbers - but it does show that those numbers can be achieved... and hopefully you can continue to tweak the dose until you see numbers in the teens at every test... and then carry on monitoring until you start to see gradually lower numbers... It is a commitment but Shelley will feel much better for it and that of course is your reward.

 

Hi, it was about half an hour. I did read somewhere that it was good for the cat to have some food in their stomach when you injected but I am sure you are right.
Thank you.

 

Thank you Diana, I hope so. I cant help wondering, if in being too cautious I am not really helping Shelley as her blood sugar stays high for too long. I can only persevere and hope it works out.

 

It's a tough one, Anthony. You aren't wrong to be cautious but it does look as if Shelley will need a higher dose to get her down from these numbers...so yes, all you can do is persevere. You don't want to increase the dose too fast, but the doses you're giving at the moment aren't enough to drop her as much as we'd like. See what her AMPS is and if she's still in the 20s give a little more insulin...I know the hypo incident will always be in your mind but she should be able to tolerate a higher dose at these pre-shot numbers.
Give yourself some credit - you're doing well.

 

Thank you Diana, it makes such a difference being able to share my concerns here. The help and advice from yourself and everyone else is so much appreciated!

 

Yes, you should have food in them before injection but not before testing. I'm fairly sure that your PM number would have been food influenced if she ate 30 minutes before you tested.

Test, Feed, Shoot. Sky hates the testing before food as she really wants her breakfast but have to do it that way to be accurate on the numbers.

http://www.felinediabetes.com/FDMB/threads/vetsulin-caninsulin-user-guide.302/

I think Diana has it right - the numbers you are getting suggests she could take more insulin but do small increases - or keep her at 1 unit but make sure you do it morning and night UNLESS her evening number plumets. I know Hypo will always be in your mind but she is quite a way from that territory at the moment. You have a lot of testing done to show how she reacts. Shelley is very lucky she has you.

I didn't get round to doing an hourly curve today but going to have to tomorrow as the tests I did do surprised me with a very slow decrease and then a sudden drop at 6 hours and then she stayed low until +12 despite having eaten. It's definitely not a curve!!!

 

I'm glad you got the SS issues worked out but send me a private message if you still need help. I'm out of town but can possibly do minor fixes.

 

Thank you Karen, that is very helpful. The Amps today was 24.3, so I have injected very slightly under 1.0.
Hope today's curve goes better.
Kind regards, Anthony

 

Thank you, that's very good of you. I did make some progress yesterday, still need to finish off, but I will bear your kind offer in mind.
Kind regards, Anthony

 

Thank you Diana, the Amps today was 24.3. I injected just slightly under one, so will see how this goes.
Anthony

 

Yes, see how that dose goes. And if you can keep your spreadsheet up to date, you might like to start a new thread asking for other comments... it never hurts to get other opinions!
Hope today goes well.

 

Thank you very much Diana!

 

I have managed to get the spreadsheet running. Today's numbers have been better with the higher dose. Shelley does sleep a lot usually but has been asleep even more today, I don't now if this is because she feels more comfortable.

 

Looking really good - spreadsheet really makes things clearer. Hopefully you can start seeing some lower numbers.

 

Good job Anthony! I'm not great at instantly translating US numbers into international ones (ie the ones we use in the UK) but I can see that you have a nice 11 there mid-cycle which is great and does show that the higher dose was both safe and justified.
If I were you I would now start a new thread and give it a title to get more eyes looking at your spreadsheet... other members may have some specific advice for you, although I'd say you're doing well as it is by increasing very gradually and testing frequently. Hopefully you really are on the right road now!

 

Thank you Diana, you may not agree but I only gave 0.6 tonight due to the lower numbers. I am sure you are more familiar with the spreadsheet than I but I seem to be able to switch between the different measures by clicking the blue icons just below the spreadsheet title.
I am in the UK, Kingston upon Hull, by the way. Yes, I will start a new thread, to see what other members think. Regards, Anthony

 

I wouldn't disagree with your dosing decisions, Anthony, you're Shelley's caregiver and have an instinct for her treatment, which is how it should be. As I said, you are on the right road - it may take a while to reach the perfect dose and this may vary over time - you understand how it all works better now so hopefully things will gradually improve.
FD is an ongoing condition, as you know - some lucky cats (and their owners) go into remission (ie don't need insulin) - but for most it is part of daily life. Don't hesitate to post here any time, either within an ongoing "general" thread you've started or a new one if you have a very specific question or urgent concern.

Will be interesting to see what other people think!

 

Thanks again, Diana, much appreciated!

 

Depending on her level tomorrow morning I would consider keeping a higher dose at night but that would just be my thought as her evening number is still quite hte high. As Diana says though, you are her caregiver and have to comfortable with that. You are the one holding the needle

Her pattern is clear though - when she was on a 0.5 unit both morning and night her AM and PM number was very similar. When the dose varies you are getting more variation in numbers - especially in the morning when she has had a lower dose in the evening.

My hunch is you will have a red number tomorrow morning.

May be worth thinking about a 0.75 dose morning and night for a few days and see if the morning and evening readings level out. The 0.6 doesn't seem to be as effective as the 0.75. It's a real balancing act. You are doing so well getting all the data and looking after her.

 

Thank you, its very good of you to take the time to look at Shelley's numbers, as I'm sure you must be very busy with Sky.
That's an idea, will bear that in mind tomorrow.

 

Just looking in quickly before I go to work - you had some nice mid-cycle numbers yesterday but the dose wasn't quite enough to keep her in those numbers for the second half of the cycle so you got a higher AMPS... good idea to try 0.75u this morning to see how she goes on that. I suspect that you may have to continue to increase slowly with the aim at the moment of keeping numbers in the teens... not saying I would be hiking up the dose too quickly either, it is always best to err on the side of caution. But things are looking good!

 

Hi Diana, it's very good of you to check. These small differences do seem to have a marked affect and of course it is a bit if guess work with just the 0.5 increments.
Thank you!