? Shelley - is back on Caninsulin, hoping for views on doseage ?

Discussion in 'Feline Health - (The Main Forum)' started by Anthony Morgan, Feb 28, 2017.

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  1. Anthony Morgan

    Anthony Morgan Member

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    Having received a great deal of help and advice on my previous thread, I am now hoping for member's views on how things are going, as I try to bring Shelley's diabetes under control again.

    The following paragraph from my original thread, explains why I was here to start with:

    http://www.felinediabetes.com/FDMB/...insulin-after-hypo.173338/page-2#post-1906674
    Shelley has had diabetes for 6 years which has been controlled with Caninsulin with no problems and a most recent 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 now have a spreadsheet showing how things are progressing and I would be very grateful for any comments.
    Thank you, Anthony
     
    Last edited: Mar 1, 2017
    Reason for edit: Add link.
  2. Sharon14

    Sharon14 Well-Known Member

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    Hi Anthony, I don't give dosing advice, but I wanted to bump your post up so others can see it. You may want to put a link to it in your other thread so the people that were helping you will see it.
     
  3. Sootyca

    Sootyca Member

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    Hi Anthony, hopefully more will chip in.

    Personally I would keep her on the 0.75 morning and night for at least another day so she has had 3 full days on a steady dose. If her numbers don't drop by the fourth day - so Thursday - I would then increase her to 1 unit morning and night (with a little bit of testing at +4/5/6) and then keep her at that dose for another few days to see the impact it has. Obviously if she drops too low for you to be comfortable you could reduce it. The key would be getting the testing done if you do increase.

    I'm fairly sure you will need to increase her insulin to at least 1 unit, possibly even higher but doing it slowly will find what she needs. She has been on less than 1 unit now for 10 days and hasn't really dropped to what I would call nice numbers- I don't like reds! I like my starting colours to be yellow.

    The drop between morning and evening today is quite interesting - possibly food related. I'm glad that you have recorded what she has eaten so you can compare back next time she eats similar food and see if she responds the same way. I know I've mentioned before Sky is sensitive to certain foods and when they were removed from her diet her BG dropped considerably.

    Karen
     
  4. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You started at a low dose so my guess is these high numbers are because the dose needs to go up rather than being too high and causing bouncing. I would try 1 u next and hold it for 3 days to assess its effectiveness.
     
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  5. JanetNJ

    JanetNJ Well-Known Member

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    1 unit
     
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  6. Diana&Tom

    Diana&Tom Well-Known Member

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    Yes, 1 unit!
     
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  7. Anthony Morgan

    Anthony Morgan Member

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    Thank you very much for your comments. Things have gone a bit wrong this morning. I did the test and was shocked to get a reading of 5.4. I immediately fed Shelley and then half an hour later tested again and got 19.1 but didn't know if this was a result of the food or was the 5.4 just an error reading?
    So I dare not inject. It does worry me if her levels are too high and she has lost some weight since this all started but I think all I can do now is just test and monitor today and if levels run as they have been, start injecting again this evening.
    Thanks again for your input, it is much appreciated and helps with my worries!
    Anthony
     
  8. Anthony Morgan

    Anthony Morgan Member

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    Thank you very much, that seems to have worked.
    Kind regards,
    Anthony
     
  9. JanetNJ

    JanetNJ Well-Known Member

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    . Next time you get an unusual reading, stall for 20 min without feeding and recheck the number.
     
  10. Anthony Morgan

    Anthony Morgan Member

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    Thank you Janet NJ, I just felt a bit worried because the last time I had a very low number was when she had the Hypo, so I thought I better feed her. But I would obviously have got a clearer picture without the food.
    Kind regards,
    Anthony
     
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  11. Diana&Tom

    Diana&Tom Well-Known Member

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    Gosh yes, that 5.4 must have been a shock, Anthony. It does look like a rogue error reading. The 19.4 sounds more likely to be correct but it is unnerving not knowing. I'm not sure what to say about dosing now other than err on the side of caution until you are reasonably sure that her numbers are consistently high. From recent numbers it was looking likely that she could handle a dose of 1u to get her down into not-too-high and not-too-low numbers, if you see what I mean, but I do appreciate that an out-of-the-blue low is disconcerting. If I were you I'd just monitor closely today and see what happens, just as you say yourself... instinct is very useful in a situation like this.
    If you do test again during the day and get more "wonky" numbers it might be worth putting a call in to the vet to see what they say. Again, just being cautious.
    Let's hope this was just a minor blip.
     
  12. JanetNJ

    JanetNJ Well-Known Member

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    That's a really steep rise in a half hour. I'm wondering if your blood sample was too small causing the meter to read wrong.
     
  13. JanetNJ

    JanetNJ Well-Known Member

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    I wouldn't give her nothing. Maybe stick with the 0.75 for another time.
     
  14. Anthony Morgan

    Anthony Morgan Member

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    Thank you Diana, that's what I'm thinking. Kind regards, Anthony
     
  15. Anthony Morgan

    Anthony Morgan Member

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    I'm thinking more likely an error test too. I will do another test shortly and see how it goes. Thank you1
     
  16. Anthony Morgan

    Anthony Morgan Member

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    I just did another test and got 23.8. So it looks like the 5.4 was an error? Oddly she has been brighter today than usual.
     
  17. Diana&Tom

    Diana&Tom Well-Known Member

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    Yes almost certainly an error.
    So is your plan to wait until this evening to test and shoot? That's ok if you want to do that but it would mean that Shelley would be without insulin and in high numbers for a long time. An alternative would be to give her a small dose now - say 0.5u - and see what duration she gets from that... if she drops and then rises again by usual shot time, you can reconsider your plan at that point, or you can tweak shot times, ie instead of shooting at 9am and 9pm or whatever you do, shoot at 11am and 11pm.. it is hard to know what to suggest to you because some owners are naturally and understandably cautious, while others want to get going with the numbers ASAP! So it's your call... but I would try to forget that low number, it was clearly off.
     
  18. Anthony Morgan

    Anthony Morgan Member

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    Hi Diana,
    thank you for coming back to me. I have just been wondering what is best to do. I had decided to give her a shot but was thinking about the timing but as you say I can change it for now and can always gradually come back to my usual time.
     
  19. Diana&Tom

    Diana&Tom Well-Known Member

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    Yes that's the thing, Anthony... Caninsulin is traditionally dosed at 12-hour intervals but there are circumstances in which you have to tweak that. If a cat needs insulin, she needs insulin, don't wait until the clock says it's shot time. So if you're at home and are able to be flexible with dosing schedule, do so... just gradually of course, as you say.
     
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  20. Anthony Morgan

    Anthony Morgan Member

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    Thank you Diana. As the last 2 numbers were what I have be seeing lately, I decided to stick to 0.75 to try an get some consistency, hope I'm not wrong. But as you say the 5.4 can't have been right. The advice on here has been such a great help, because I find there is usually a long wait to speak to a vet. I suppose there is always going to be the odd incident with this illness. Strangely, Shelley is brighter and more awake this morning than for a while?
     
  21. Diana&Tom

    Diana&Tom Well-Known Member

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    I think .75u will be fine, test again in another hour to see what effect that has if you can.
    Ref the vet, yes they are rather elusive because they are often consulting, I suppose, but if you ring and ask to speak to someone as a matter of urgency they should call you back as soon as they can. I'm sure they know the owners who are responsible enough to ring only when it's really necessary.
    As for Shelley being brighter - could be any of a number of reasons not necessarily to do with BG. Most cats sleep more when it's cold, and some are affected by the moon and goodness knows what else... every cat is different and we never really know what goes on in that respect. But if you're keeping a diary of her BGs, food intake, behaviour etc you might like to note when she looks brighter than usual. Sometimes you can link it back to something specific.
    I'm off to work now but wish you and Shelley a good day! I'm sure others will be around on and off so keep asking questions if you're concerned.
     
  22. Anthony Morgan

    Anthony Morgan Member

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    Thank you! My vets used to be locally owned and I had a very good reltionship with one of the directors who I had known for 17 years. But it was sold to a big company and now you see a different vet, usually inexperienced, nearly every time. And, Richard, to whom I am referring would try and keep costs down because he new I was helping stray or abandoned cats, whereas the new vets seem to want to get you to spend as much as possible.
    Still, I am glad they are there when I need them.
    I hope you have a good day too and thank you again, you have been a great help!
     
  23. Diana&Tom

    Diana&Tom Well-Known Member

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    I'm not sure if anything I've said has been "a great help" at all, Anthony... this is a tricky situation and it's hard to know what to say for the best except carry on as you are, monitoring and dosing as you think appropriate. It is certainly best to stick with a dose for a few days before changing it, but (not including this morning's "rogue" low number) Shelley's numbers generally are still high and we do need to get them down which would normally mean a higher dose. There is also ketones to consider if she is consistently high and is not getting enough insulin, and we don't want to go there!
    Keep posting whatever numbers you get (I know you said the spreadsheet is slow, don't have any answers to that I'm afraid) but you can add updates in this thread if you think any number you get is significant (eg lower than you thought).

    FD can be a very frustrating business but if you can get Shelley's highest numbers down by a few points, that would be progress. So once we have established that she is giving you more "normal" (at this stage) numbers, you may have to consider upping the dose a tad... I completely understand your reluctance but it may be what's needed to turn a corner.
     
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  24. Anthony Morgan

    Anthony Morgan Member

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    It is a great help to get a second opinion when I am unsure what to do for the best, especially from someone with a lot more experience in this than myself. I am using the spreadsheet, it's not so bad just enetring a few numbers. It just seemed to be a bit slow entering the older details in one go.
    I do think a small increase is warranted and all being well, that will be soon.
    Thanks again, Diana
     
  25. Diana&Tom

    Diana&Tom Well-Known Member

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    OK Anthony, see how the PM number is and do post here with that info if you're unsure.
    You're doing a grand job and you're very calm which is always an advantage!
     
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  26. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Hi Anthony @Anthony Morgan
    I am SO sorry if I've forgotten this (I'm an old fart with diminishing brain cells..) but can you remind us exactly what you're feeding Shelley? And how often are you feeding her?
    Thanks!

    Eliz
     
  27. Anthony Morgan

    Anthony Morgan Member

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    Hi Eliz,
    Thank you for coming back to me. The vet recommended RC Diabetes wet. I did try it but Shelley wasn't eating much of it. So I have gone back to her usual food; Felix Pouches, Gourmet Solitaire Pates, Applaws Chicken in Jelly and other Applaws flavours, Marks & Spencer Foil Trays, Game, Mackeral & Beef flavours. Also fresh chicken.
    She really likes Gourmet Solitaire Beef in Tomato but I have a feeling that will be high in sugar. Her appetite isn't as good as it was. She usually is asking for food every couple of hours but only eats a small amount. I am trying to leave as long as possible between the am/pm food and tests. When first diagnosed she weighed about 6.5 kg but now is about 4.5.
    Regards, Anthony
     
  28. Diana&Tom

    Diana&Tom Well-Known Member

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    Hi Anthony
    I'm up early this morning catching up on various things and have just had a peek at your spreadsheet... that 11.9 last night must have been a surprise, then the 24 at pre-shot just an hour later? I'm beginning to wonder if some of Shelley's numbers are food spikes or otherwise connected with food intake in some way...you say she is a grazer or eats little and often? This, or specific foods, might cause her BGs to go up and down during the cycle. I wonder what Elizabeth @Elizabeth and Bertie thinks about this, and the foods you are feeding Shelley? Some of the even high-quality brands have more carbs than you might imagine.
     
  29. Anthony Morgan

    Anthony Morgan Member

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    Hi Diane,
    Very good of you to have a look at the spreadsheet. You are quite right, I wasn't sure what to do, so just injected 0.05.
    Did a test at +2 = 18.4 and +9 = 22.6. I am wondering if she drops more than expected when she has not eaten. On the day of the Hypo she had a longer gap in eating than usual. I don't think she ate much when she was hospitalised after the Hypo and her curves where normal without insulin? But now numbers are up again. She did seem hungry after the 11.9 test?Could it have been another error test? Two or three more hours before I can inject again.
    It's all rather confusing.
    Thanks again, Anthony
     
  30. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    It is all very confusing, Anthony, I agree... it could be food related or it could be that Shelley is one of those cats who might produce her own insulin at unpredictable times - such an instance could have caused the hypo if she was also being given exogenous insulin at the time, ie she simply had too much insulin in her system. This is called a "sputtering pancreas" - look it up for more info. I'm by no means saying that this IS the case, but it could come into play in a situation like this.

    I am reluctant to suggest you raise the dose when the numbers you're getting are still quite variable, and I'm not great at looking at spreadsheets to see patterns at the best of times. There are people on this board who are much better than me at that! Hopefully Elizabeth will be around later to give you her comments, and meanwhile I am tagging Mary Ann @Tuxedo Mom who is another long-standing, experienced member who will also hopefully take a look and offer her opinion.

    As you're seeing and have already commented, FD is tricky to treat. You will probably have to persevere with testing on a regular basis and maybe also look closely at the content of different foods... some innocent-looking foods may actually raise BGs significantly in some cats. Elizabeth has detailed info about UK foods and again, may have some useful input here.

    Sorry I can't be more specifically constructive than that. See what the others say, and if you start to get too stressed about what's going on you could perhaps ring the vet and ask if it's possible to email the link to your spreadsheet so they can take a look.

    Will pop back later.
     
  31. Sootyca

    Sootyca Member

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    Personally I would now increase to 1 unit and not worry to much about the intermediate readings. If you hadn't tested an hour before her PM shot you wouldn't have known about it being an "odd" result and would have given her the 0.75 dose as normal. Sky throws out odd numbers every now and then but I only really base her injection number on the one at 12 hour when the insulin should be out of her system (and her appearance during the day if she is low).

    Is there any way you can keep to one particular type of food for a few days and rotate around - so for 2 or 3 days feed Gourmet, then felix etc just to see if you can pinpoint any food reactions? If you can rotate the food I would keep to the same dose of insulin so you know that it is more likely to be food related rather than insulin.

    It seems clear that the 0.75 isn't bringing her down to a better level. She has been in the reds now more often than not so I think an increase is in order.
     
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  32. Diana&Tom

    Diana&Tom Well-Known Member

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    Anthony, I don't disagree with Karen about upping the dose but I know it's hard to overcome the fear of hypo so an increase depends on how brave you're feeling. Very good idea of Karen's to try to pinpoint specific food reactions in which case yes, stick to the same insulin dose... one of the golden rules of FD treatment is to change one thing only at a time, so you start to get a clearer picture.
    You do want to get Shelley out of these reds so why not take a deep breath and give 1u a try on the next morning shot (when you are more likely to be around during the day to keep an eye?)
     
  33. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Anthony

    I just want to cover a couple of very basic points first. How old is the Caninsulin and do you keep it refrigerated? Some people have found that this insulin tends to lose some of its effect after a month of so. Also are you properly rolling the insulin before injecting? What site are you using for the injections? Some people find a poorer absorption from the scruff than from the flank or abdomen. Also are there any health issues such as poor teeth? Dental issues can cause higher glucose levels and more difficulty with good regulation. I know you have been doing this for years, but I always like to clear out the basics first.

    A hypo of 1.1 (20 US) is indeed a scary episode to go through and I can see your concerns about having another hypo when the last one came out of nowhere. You have received a lot of good advice from people since you first posted. Tracking your food type and amount is a good idea to see if there is some correlation with the food and the readings. As has already been stated, preshot tests should be done when there is at least 2 hours with no food and with Caninsulin Shelley should have eaten a good meal about 20-30 minutes before the shot. The "usual" effect of Caninsulin is a steeper drop with 2-3 hours after the shot and a nadir ( lowest reading) around 4-6 hours after the shot although every kitty is different in how they react. Shelley's spreadsheet shows a fairly smooth curve with no major drops. You are doing lots of testing so my thought is that she may need to have an increase. But as Karen suggested trying to see if the food type is part of the problem first may be a good approach. As she usggested "Is there any way you can keep to one particular type of food for a few days and rotate around - so for 2 or 3 days feed Gourmet, then felix etc just to see if you can pinpoint any food reactions? If you can rotate the food I would keep to the same dose of insulin so you know that it is more likely to be food related rather than insulin." If you can try this for a few days and see if the food type is affecting the numbers then you can look at the dose next. It may also be that it may be time for a change to a different insulin. But first the other potential issues need to be ruled out.


    This may already have been posted but @Elizabeth and Bertie put together a food list of UK low carb foods:

    https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml

    I know how frustrating this must be to have had Shelley regulated for so long and then have the hypos and then higher readings, but by ruling out any potential problems hopefully you can get Shelley back to good regulation again. :bighug: :bighug:
     
  34. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Anthiny

    When Shelley went to the hospital for the hypo did you take your own insulin in for them to use or did they use insulin they had at the clinic?

    Still trying to put together the two hypos and then the run of higher numbers.
     
  35. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Thank you very much for your comments. Sorry for the delay in replying, it's been a busy day.
    I used to use one vile of insulin each month. It is kept refrigerated and I always mix it gently before use. I inject in the scruff but changing positions each time. Shelley hasn't got many teeth left but has no issues with those remaining. She has been diagnosed with pancreatitis but that doesn't seem to be bothering her and she is on Amodip for high blood pressure.
    I have been to see the vet today and his advice was to increase the dose to 1u and feed only RC Diabetes wet.
    So I think I had better increase the dose, I am not too happy about the RC and would prefer to go with Karen's idea.
    When Shelley was in the hospital they used a new vile of insulin.
    Very grateful for your time and interest.
    Kind regards, Anthony
     
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  36. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Hi Diane,
    Thanks again!
    I have been to the vets today and his advice was to increase to 1u and feed only RC Diabetic food. Not so sure about the food as Shelley was hardly eating it but certainly happy to try Karen's idea. So that will be the plan for tomorrow.
    Regards, Anthony
     
  37. Anthony Morgan

    Anthony Morgan Member

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    Hi Karen, thank you for your comments. Have been to the vets today and he has told me to increase to 1u and feed only RC Diabetic food. Not sure about the food, I would rather try your idea. Going to have try it and hope all goes well.
    Regards, Anthony.
     
  38. Sootyca

    Sootyca Member

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    Oct 3, 2016
    I wouldn't feed specialist diabetic food either unless there was no option. I think you will find when you increase her dose and look into the food a bit more the numbers will come down.

    I can't remember - do you feed Felix? I think I have said before that removing Felix from Sky's diet really caused her numbers to drop - I'm sure it was linked to the vegetable protein extract. I now avoid anything that has that in it - so she is pretty much on Sheba (fortunately they do lots of flavours and she loves them all). Have a look on the food you are giving Shelley to see if they have vegetable protein or vegetable derivatives and maybe stop that food first - regardless of the low carb content she could be one of the ones that it affects without you realising. I don't want you thinking I'm telling you waht to do (lol) but once I realised what it was it was such a simple fix! Lots of cats have felix with no problems so it may not be.

    Just copied a paragraph from Diabetic Cat Care website

    "Wet cat food with a lower than 10% carbohydrate count based on dry matter (which is not indicated on the label) is best for cats with FD and is required when practicing TR. Avoid foods containing grains such as rice, wheat and corn, glutens, starches, sugars and syrups, gravies and those containing vegetables and fruits. Foods containing soy and/or ‘vegetable protein extract’ can raise the BG even if the percentage of calories from carbohydrates is below 10%. These species inappropriate ingredients can render the liver useless to do its job of protecting the brain in the event of low BG, potentially resulting in clinical hypo and are not at all recommended for cats when starting TR as explained in The Liver's Job sticky."

    I bet you feel like it is a neverending struggle at the moment to get her to numbers lower but you will get there. :)
     
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  39. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Thank you very much, Karen. I haven't found it easy trying to determine which food is best. I look at the tables and a lot of the preferred foods are not readily available. I did get a consignment of the German brands but none of my cats liked it.
    But that's a helpful tip, I will check on that.
     
  40. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Dec 2, 2014
    Anthony

    Thank you for your reply to the questions I had asked. It sounds like there is no problem with the efficacy of the insulin and there are no obvious other medical issues at this point that could be causing the higher numbers. From what I can see it either comes down to the food or to needing a higher dose. I am not familiar with the RC Diabetes wet food as far as the carb count. The one thing I wonder about is that Shelley had two hypos on a dose of 1.5 unit and she had been fairly well regulated for a long period of time. What sort of numbers did you get when you started home-testing. I tend to be leery of fructosamine tests since they are only an average of a 2-3 week period and if there were highs and lows the average could still look good even though the numbers may have been a bit of a roller-coaster.

    My two thoughts are that the food could be playing a factor, especially when you look at the numbers from yesterday. With Caninsulin it is unusual ( but not impossible) that readings would drop towards the end of the cycle such as your +11 and then zoom up for the PMPS. whether this is a food issue or a need for more insulin is hard to judge. I am hoping that some others will weigh in with their opinions. In the meantime if you are increasing the dose make sure that you get adequate tests in (which I can see that you usually do). That hypo you had and the following hypo at the clinic are concerning,

    Hoping that you can get this all sorted out, as it must be very concerning to have such a big change out of the blue. :bighug: :bighug:


    ETA In case you missed it this link has a list of UK low carb foods as researched by @Elizabeth and Bertie who is a UK member
    https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml
     
  41. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Those numbers are too high. We need to get her into the blues.


    I personally would do 1 unit when the preshot is in the 300's and try 1.25 when the preshots are in the 400's. (You may have to go higher, but right now you aren't even hitting high blues.).
     
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  42. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Great post from Karen! Anthony, I hope your vet's recommendation has given you the confidence to try the 1u dose which does seem in order now. It is important that Shelley eats her usual amount of food, so if she refuses the RC the vet suggests, give her one of the other wet varieties - checking the ingredients if you can as above. Sometimes the packaging is comprehensive, other times you may have to go to the supplier's or manufacturer's websites and look there.
    Best of luck! We are all rooting for you and Shelley!
     
  43. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Hi,
    Looking back, July 2016, fructosamine test showed only fair control and dose increased from 1.5 to 2.00.
    August home testing,
    13.7, just after am shot
    17.7 +2
    13.6 +4
    14.1 +6
    16.9 +10
    24.2 pmps

    November 2016

    +2 14.4
    +4 3.6
    +6 8.2

    +8 13.7

    Pmps 19.0

    So there was a change and the December fructosamine indicated excellent control.
    Thank you very much for your valued comments.

    My replies may be a little late at the moment.
    One of my other cats, Herbie is unwell, so I am taking him to the vets this morning.
    Anthony
     
  44. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Thank you Diane. Yes, I do feel more confident to try that now. I appreciate your encouragement! Unfortunately, Herbie cat is unwell today. Back to the vets shortly.
     
  45. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Thank you JanetNJ. That is the plan now, going to start on 1.0 today.
    I appreciate your input!
     
  46. Diana&Tom

    Diana&Tom Well-Known Member

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    Poor Herbie... hope he feels better very soon.
     
  47. Sootyca

    Sootyca Member

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    Oct 3, 2016
    Hope Herbie is feeling better soon. Seems neverending for you at the moment.

    Karen
     
  48. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Thank you Diana and Karen,

    Your good wishes are very much appreciated. Although Herbie is around 15 years old he is in excellent health and very active usually. But I noticed last night, that he had been in one postion for a while and when I stroked him he growled and he wasn't eating or drinking. He seemed much the same this morning so I decided I had better get him checked over.
    As soon as I put him in his basket he brightened up considerably and seemed pretty well when we got to the vets. They decide to do a blood test and I am hoping for the results tomorrow. Once back home he has eaten a little but still seems quieter than usual.

    So today hasn't gone to plan.
    I tested Shelley's blood sugar at +12 and got a reult of 12.9. She had not eaten for the past 2 hours.
    Two minutes later it was14.5
    So I didn't inject and tested again at +13 = 13.2, after a meal of Felix

    I know this is not the prefered food but I decided to limit her to this to start with as I am not able to get to the shops so easily at the moment as my car is in for repair, just to add to the complications!

    I decided to give it another hour and at +14=17.4
    I probably should have injected at this point but I just thought I will leave it another hour just to see the trend.
    So at 0.75 she seems to be keeping low for up to 13 hours when she hasn't eaten for a while.
    I would apprecite any thoughts as perhaps I am mistaken and should have injected at + 12 anyway?
    Thanks again for reading!
     
  49. Sootyca

    Sootyca Member

    Joined:
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    Herbie sounds like a typical cat - seems ill until you get them to a vet when they then behave as if nothing is wrong :D

    Your numbers for her suddenly seem to have dropped - can you remember what she ate yesterday? I'm clearly obsessed with food! Injecting at the +12 would probably have been okay - but maybe not at her usual dose. Sky can hold her insulin for 13 hours or so - numerous times I test at +12, I amend the dose and then it doesn't carry her through.
     
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  50. Diana&Tom

    Diana&Tom Well-Known Member

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    Sorry to hear that other issues are causing a headache for you, Anthony. It never rains but it pours, that's for sure.
    It is very interesting that Shelley gave you a 12.9 this morning - a nice pre-shot number! The fact that she has risen since then suggests that she could have taken a small token dose, and certainly at +14 that 17.4 she should really have had a shot, as you say yourself... her numbers were definitely going up.
    So as for whether you should have shot at usual shot time this morning after getting the 12.9 - in hindsight, after seeing the subsequent numbers, yes. But how much would have been the question as you haven't shot at that number before.
    It probably comes down to gathering more data and that will give you more confidence shooting at lower numbers... you may have to work to a "sliding scale" which means you would vary the dose according to what pre-shot numbers you get. I wonder if @Elizabeth and Bertie can explain this better please?
     
  51. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Thank you Diana,
    I did speak to the vet and he was adamant that I should have shot 1.0u, as I had discussed with him yesterday. He also said that Caninsulin was not intended to be used in any other increments than 0.5 units? Eg 0.6, 0.75 etc shouldn't be used.
     
  52. Diana&Tom

    Diana&Tom Well-Known Member

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    Hmmm. Not sure about that! Have just asked Eliz if she's around to pop in here and she says she will, just grabbing a bite to eat. Eliz is one of our most experienced UKers - actually THE most experienced I think - and I'm sure she will be able to fill in a few blanks for you.
     
  53. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Hi Karen,
    If you see my reply to Diana, the vet said to stick at 1.0u. Shelley had mainly Felix, in fact. But her pre-shot number was lower as well last night.
    Thank you!
     
  54. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Thank you, that's very good of you!
     
  55. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Although vets are unused to these kinds of measurements, many folks here do use these where they find them appropriate. And we have even subtler measurements, such as, for example, a 'fat' unit and a 'skinny' unit (!). And some here have cats on such tiny doses that they measure insulin in drops rather than units... :woot:
    And some folks (including me) use 'sliding scale' insulin dosage, where we amend the dosage according to the pre-shot number (along with an approximate expectation of what the nadir (lowest number of the cycle) might be). So, for example, a cat may get .75 of a unit as a 'typical' dose; but that dose may be slightly raised or lowered (maybe 1 unit or .5 of a unit) if the pre-shot is higher or lower than is 'typical' . The specifics depend on the circumstances of the individual cat since, as we say around here, 'Every Cat Is Different'.

    Anthony, I'm finding some of Shelley's numbers a tad perplexing. For example, on 1st March (am cycle) her numbers went down, then up, then down (quite a big drop for late in the cycle), and then a huge jump up an hour later. There may be something here that we're missing. And I do wonder if food is a factor in these fluctuating numbers. (Looking at the foods you've listed I think you may be using both low carb and medium/higher carb foods (but I'll look into that in more detail and will do some carb calculations for those foods..))... As Mary Ann says above, I wonder if it's possible to stick to just one food and see how the blood glucose numbers are with less variation in the diet..?

    I also entirely agree with Janet that we ideally do need to be seeing lower numbers over all (if that can be done safely...)

    Eliz
     
  56. Anthony Morgan

    Anthony Morgan Member

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    Thank you very much Eliz, I hope I am not taking up too much of your time. I know Felix is not a great food but I have stuck to that just to be consistent over the last 24 hours. It is also readily available and I haven't been able to travel too far as my car has been off the road. But Shelley's numbers have been lower in this period.
    I can certainly see the advantage adjusting the doses and by small increments. My vet seems to think a more broad brush approach is best, but I don't necessarily agree.
    Very grateful for your generous assistance!
     
  57. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014

    Actually that was Karen's advice about sticking with one food for now. I had copied and pasted her advice into my comment. I do think that using one food for a period of time is a good idea. It will at least rule out variables in the carb content so that a good working dose can be reached.

    Anthony, as Elizabeth had advised smaller increments can and are used for measuring dosing. Many vets are "conditioned" to think only in 1/2 or even 1 unit changes, but especially on smaller doses small changes can make a difference. Once you get a dose that seems to be working well for Shelley then doing small changes may make a big difference in getting her back to regulation.

    :bighug: :bighug:
     
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  58. Diana&Tom

    Diana&Tom Well-Known Member

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    Anthony, it is very good that you are taking all this on board and starting to question what the vets advise. The thing is, they have very little training in FD and if they are young and not long out of college they have probably not encountered enough cases of FD yet to realise just what can be achieved in its treatment if an owner is capable and willing to take on some work at home. Very few vets even suggest that owners should home test, yet it is vital if you are giving insulin. This board is global and there are hundreds of members, but I dread to think of all the people whose pets have FD and never find out about FDMB... the combined experience and knowledge here is an absolutely invaluable resource for many people every single day.

    In other words, listen to your vet of course, but continue to learn for yourself here on this board and you will achieve a lot more for Shelley... and if you wish in the future, your knowledge can be passed on to others coming here with questions. Meanwhile, you do have some work to do with Shelley as far as studying her diet and collecting data is concerned... it does take a while so don't be disheartened that you're not where you want to be yet. As others have said, Shelley's numbers do need to come down... but it has to be done safely. Getting there is a process, a journey.
     
    Last edited: Mar 3, 2017
    Reason for edit: Correction
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  59. Anthony Morgan

    Anthony Morgan Member

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    Thank you very much, I am sure that is the best way forward.
    Kind regards, Anthony
     
  60. Anthony Morgan

    Anthony Morgan Member

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    Thank you as always for your advice and encouragement. The FDMB is an incredible resource, I had no idea how much help was available here when I was directed here from Facebook and the people here are so kind and generous of their time and advice. It truly is invaluable!
     
    Last edited: Mar 3, 2017
    Reason for edit: Add text
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  61. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    THIS POST HAS BEEN REPORTED AS SPAM. DO NOT TRY THE LINK
     
  62. Diana&Tom

    Diana&Tom Well-Known Member

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    Reported
     
  63. Diana&Tom

    Diana&Tom Well-Known Member

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    Whoops sorry Mary Ann I have just reported it too not seeing your post!
     
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  64. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    No problem, Any link that requires you to click something to get out of the page is always suspect. I close down my entire browser when I get those sort of links since there is always a chance of spyware/malware when you have to click to exit.
     
  65. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Just increased Shelley's dose tonight to 0.9u.
    Pmps 22.1
    +2. 17.1
    +4. 14.9

    These numbers are not low but Shelley has been very hungry in the last hour. She has got through 4 Felix pouches, she only eats the jelly but was eating ravenously.
    Just concerned as abnormal hunger is the first symptom of hypoglycemia.
    I wonder if anyone else has seen this when increasing the dose?
    Thank you!
     
  66. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Unregulated cats are hungry because their body can't utilize the nutrients in the food properly, so they are often starving. Your cat isn't even close to hypo.
     
  67. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    I feel you are dosing very conservatively. .9 is not enough of an increase from 0.75. I'd go at least 1.25-1.5 when the preshots are mid to high pink.
     
  68. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Thank you JanetNJ,
    It was just that she normally eats small amounts frequently, she had eaten more in the last hour than she had the rest of the day and it was after she had a slightly higher dose. As she had a hypo before makes me worry!
     
  69. Anthony Morgan

    Anthony Morgan Member

    Joined:
    Feb 16, 2017
    Shelley's behaviour between +2 & +4 was very odd. She was eating ravenously. Her pupils were widely dilated and she was moving around a lot faster than normal, normal being quiet slow.
    There have been a couple of tines before when she has appeared agitated in the night, but it did have me worried as she had received the slightly higher dose. This morning she seem to be her usual self.
    Just wondering if any other members have experienced anything like this?
    Thank you!
     
  70. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Hi Anthony
    It's true that eating ravenously can be a sign of an impending hypo, but it can also be a sign - a very common and unsurprising one - that a cat is simply unable to use the nutrients from its food properly, as Janet says above. If Shelley is only licking the jelly and not actually eating the meat parts, that is almost certainly not going to satisfy her so she will be even more ravenous. I know the plan is to stick with one food for a few days while you tweak the insulin dose, but her numbers don't look vastly changed at present so you could mix the Felix with a little of one of Shelley's preferred foods and see if she will eat that. She really must have some food inside her when you are giving insulin.

    I would be inclined to try to get her to eat her food properly and when she is doing so, up the dose as far as you dare... again as Janet says, these numbers are nowhere near hypo and as long as you are testing regularly, which you are, you can really afford to increase. I completely understand how scary it is but look again at your spreadsheet and see how far away these numbers are from where you want to be, and think also about how tiny the increments are that you've been trying... you may get to the point where you have to bite the bullet and increase - but do make sure she is eating and do test regularly, especially in the first half of the cycle.

    Good luck and keep us posted.
     
    Last edited: Mar 5, 2017
    Reason for edit: Spelling
  71. Anthony Morgan

    Anthony Morgan Member

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    Thank you Diana for coming back to me on this.
    Felix has been one of the foods she eats regularly plus Gourmet, Applaws, M&S, etc. But she generally eats perhaps a tablespoon or so every couple of hours.
    The only one she has really tucked into recently, apart from the early hours of this morning, was Gourmet Solitaire Beef & Tomato. It is in a sauce and I have a feeling will be high in sugar?
    So getting her the right amount of the best food for her tricky but yes mixing is an idea, I have tried before, will have a go.

    Kind regards, Anthony
     
  72. Diana&Tom

    Diana&Tom Well-Known Member

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    Yes, I think the Gourmet brands may have vegetable protein extracts and "various sugars", both of which can affect BGs in some cats... I can't see them on Elizabeth's UK foods list (click on the link at the bottom of her signature on her post above, for a comprehensive list) but if she's around today she might be able to tell you more @Elizabeth and Bertie

    We're looking for foods that are low-carb (ideally in jelly, not gravy) and that Shelley will eat, so this may be a trial and error situation....
     
  73. Anthony Morgan

    Anthony Morgan Member

    Joined:
    Feb 16, 2017
    Thanks again Diana. Well I just fed Gourmet Ocean Fish pate, which seemed to be liked.
    Amps19.4 inj.1.0u
    See how that goes.

    My vet said feed only RC Diabetes wet food. Leave it down, she will eat it if she is hungry. That doesn't seem to be the right advice.
    Also wondering about low carb dry food, Shelley will eat dry food. Some of the others like Orijen and Acana?
    I have got some Yarrah and Granata which I ordered on line. I have a feeling she won't like it. I have had all the German brands before. Most if it was wasted.
     
    Last edited: Mar 5, 2017
    Reason for edit: Added sentence.
  74. Diana&Tom

    Diana&Tom Well-Known Member

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    I know how frustrating it is, Anthony. I think we have to bear in mind that Shelley is an elderly kitty and maybe her sense of smell isn't as good as it was, so she may prefer the stronger-smelling foods such as fish. I would try to stick to wet varieties if you can as most dry foods have a high percentage of carbs which is exactly what you have to avoid. The vet saying she will eat if she's hungry strikes me as rather a cop-out statement - she may not have much of an appetite so she not eat, in which case you're stuck for giving her insulin.

    So she is 19.4 this morning and you've given 1 unit - we can only see what happens and it is at least worth a try because other doses haven't done enough. Keep an eye on her and now she's on a new higher dose, test at +2 onwards to make sure she isn't dropping too low... you never know with Caninsulin. You have high-carb foood and honey just in case, but don't panic if you get a number that is actually a "good" number! The thing then would be to try to keep her in better numbers until the end of the cycle... not always easy with Caninsulin. The way it usually works is to drop the BG quickly and sometimes steeply, and its effect is then more or less "used up" so the ascent begins again too early in the cycle. There are other insulins that have a gentler effect but vets need to see that Caninsulin isn't ideal before they will prescribe anything else.

    Today could be interesting with the 1u dose. I will be offline for the middle part of the day but hopefully others might pop in to see how you're doing @Sootyca @Elizabeth and Bertie
     
  75. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Thank you very much Diana, that is very helpful, I appreciate you taking the time to reply very much. I am sure you have plenty to do.
    Going to try and fit in a visit to Pets at Home but will take longer, car still not available.
    Thanks again!
     
  76. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    I understand your fear of hypo, but you can't let that keep you from getting her in healthier numbers. Over time being 250+ can cause organ damage. You've gotta push her down into the low blues. When she hypoed the first time you weren't testing, correct? Well now you are, and can steer her up if she drops low too fast.
     
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  77. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Thank you JanetNJ, yes that's right.
    I have her on 1.0u today and am monitoring regularly. But no repeat of last nights unusual behaviour. Quite calm and sleeping most of the time at the moment.
    Will see how it goes, I realise I am not helping her keeping her in higher numbers. So it will have to be done.
    Kind regards, Anthony.
     
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  78. Diana&Tom

    Diana&Tom Well-Known Member

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    And I see an 8.4 at +4 Anthony, that's a great number.... keep an eye and see how she does now...
     
  79. Anthony Morgan

    Anthony Morgan Member

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    It seemed like a big drop. +5 was 11.6.
    Thank you very much for your comments, it helps ease the worry!
     
  80. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    It is a biggish drop but that's how Caninsulin works... it drops quite fast amd steeply, and then is "used up" so there isn't much insulin left for the second half of the cycle. Try not to worry. She may be at her nadir (lowest point) now or she may go a little lower... we can but wait and see. Keep posting so we can check.
    When she gets out of these really high numbers she will probably need less insulin to keep her in decent numbers. For now we do need to keep her in the blues for as long as possible and it may be that the only way to do that is give the 1u if her pre-shot number is high and if that drops her sufficiently.
     
  81. Anthony Morgan

    Anthony Morgan Member

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    +6 9.7, Thank you!
     
  82. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    Nice to see the blue!! [​IMG] YAH!!

    Caninsulin is a mixture of 30% semilente insulin which acts quicker and brings the numbers down faster usually in the first 3-5 hours after the shot. The other 70% is ultralente insulin which gives a less dramatic coverage usually from 4-12 hours after the shot. Together this mixture should bring the numbers down faster in the earlier part of the cycle then slowly "wear off" as the cycle progresses. What you are seeing today is a very good response, with a decent drop but not too steep and then levelling out as the cycle goes along. It looks like the 1 unit is a good dose for now. Keep on getting some more tests to show how long the Caninsulin effect is lasting with Shelley. :bighug: :bighug:
     
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  83. Diana&Tom

    Diana&Tom Well-Known Member

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    Thanks Mary Ann! Useful info.
    It looks as if the vet's suggestion of 1u was a good one... let's see how the rest of the cycle pans out but if as seems probable Shelley will start to rise now, it may be best to stick to the 1u this evening... assuming she doesn't get better than expected duration from this morning's dose and stay in these nice blues.
     
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  84. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Duration with Caninsulin can range from 8-12 hours depending on the individual kitty's response to it. That is why getting tests through the whole cycle is valuable information. Of course no kitty stays the same all the time either...that would make it far too easy, but it gives a good baseline for what can be expected.
     
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  85. Anthony Morgan

    Anthony Morgan Member

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    Thank you Mary Ann and Diane, very helpful!
    +7 11.3
     
  86. Anthony Morgan

    Anthony Morgan Member

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  87. Anthony Morgan

    Anthony Morgan Member

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  88. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    That is a nice flat surf Shelley is doing. It might be an idea to keep track of what foods and amounts you are feeding during the testing to see if there is any pattern to the slight rises you have gotten. Also if you can enter the recent numbers on the spreadsheet it is easier to follow the progression when they are all in one place. Thanks :bighug:
     
  89. Diana&Tom

    Diana&Tom Well-Known Member

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    Shelley is getting great duration from that 1u. The 13.3 at +8 could have been a food spike, since she has come down nicely again. It will be very interesting to see if she can sustain this number for a while longer or if she suddenly starts going up...
    Good work getting the testing, Anthony, and hopefully you can see that the 1u has done a good job.
     
  90. Anthony Morgan

    Anthony Morgan Member

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  91. Diana&Tom

    Diana&Tom Well-Known Member

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    Mmm was exepcting this. The Caninsulin is almost certainly used up. A big jump from an hour ago. But see what happens next.
     
  92. Anthony Morgan

    Anthony Morgan Member

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    Thank you, I have just updated the spreadsheet and have been keeping a note of the foods.
     
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  93. Anthony Morgan

    Anthony Morgan Member

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    Yes Diana, thank you. That small extra amount has made a big difference.
     
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  94. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Thank you. Since you are at +10 do not give any more food at this time. You should allow 2 hours before a preshot test with no food so that you can see where the numbers are at without food influencing them.
     
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  95. Diana&Tom

    Diana&Tom Well-Known Member

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    The next couple of tests and what dose you give could be very significant, Anthony. It's been a trying week for you but you have persevered, worked hard and stayed calm, and had the courage today to shoot the 1u. Now the task is keeping Shelley in nice numbers, and even a little lower, as the days go on. You may have to remain brave whilst being even more vigilant.
    If you need urgent help or advice as the evening gets on, you could tag Mary Ann or Janet (in this thread) who are several hours behind the UK so will be up later. You know how to tag people? Just type @ followed by the user name, eg Mary Ann is Tuxedo Mom.
     
  96. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    OK, thank you, will do that. Her next shot is due about 21.30, so I could test now and again in an hour.
     
  97. Anthony Morgan

    Anthony Morgan Member

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    Feb 16, 2017
    Thank you Diana, planning to test again now and then in an hour before the next shot.
     
  98. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Shelley is on the way up which is normal with Caninsulin starting to fizzle out. You can wait until her next preshot to test again. It looks like the nadir (lowest number) is around +4 with some slight ups and downs after and the duration is about 9-10 hours, which is very typical with Caninsulin. These can of course change around but it gives a good starting base.

    What you decide to shoot tonight will depend on how long you are able to monitor and how tired you are. The 1 unit seems to work well for Shelley, but you would need to get some tests in preferably up to +4 and possibly later. At some point you do need to sleep so I don;t know if this is possible for you.
     
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  99. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Anthony

    I just wanted to add in that Shellie's numbers today have been very promising on the 1 unit dose and in no way are concerning as far as the amount she dropped. However I know that you are hyper-vigilante about the hypos she had recently. You have done a wonderful job getting all the data today and Shelley has been so good about allowing all the pokies. :bighug::bighug::bighug: for you and [​IMG][​IMG] for Shelley
     
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  100. Sootyca

    Sootyca Member

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    Yay you got blues! Such a lot has been said since I last checked in but I would never give my cat a food that they didn't like and I don't subscribe to the theory of leaving the food down and they will eat it - both of mine would willingly starve before they ate some of the foods I have given them! As to her unusual behaviour, she's a cat - it's part of the job description to keep us on our toes! Have you tired Sheba fine flakes or Whiskas for Shelley? I know they aren't best foods in the world but the Sheba especially is really stinky so Shelley may like it.

    The curvve you have done today is very promising. The 1 unit dose has done a good job today - will be interesting to see where she is on the next test and for the next few days. The drop is always scary when you aren't used to it but as others have said that is how it is supposed to work.

    Well done today. Shelley is a star for putting up with it :)
     
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