Should I give insulin?

Hello Everyone,

I just did spicey's pmps #s at 6pm 198. I don't think spicey had any food. But should i give her 1 unit of insulin? I thought I read not to give insulin if #s were at 180 or below. Not Sure.

By the way spicey actually greeted me when i came home today and started purring, she has not done that in a long time.
You guys are lifesavers. Thanx

David

 

What have her #s been like on 1u? How long have you been giving her that dose, just today, right? Can you tell us all the #s you have gotten from the cycle(s) Spicy has been on 1u?

The usual no-shoot # is 200, and 198 is close enough to that to consider it as 200. BUT before you shoot, please give us the answers to the questions I asked so we make sure that we are telling you the correct action to take.

 

No... please do not give the insulin. I'm posting this and then will edit it with why.

Last night you gave 1 unit when the BG was over 500 and it brought the BG down to just over 300 in 4 hours. I don't know what the BG was this morning or if you gave insulin. If you could show us your log so far with ...

Tues 12 Jan
PMPS 521 - gave 1u
+1
+2
+3
+4 - 317

Wed 13 Jan
AMPS $$$ - gave ? u
+1
+2
+3
+4
etc
+12 198 (could be preshot if you do give some but I don't think you should until we know what the morning was - it may be that you give a reduced dose in an hour)

See what the PZI folks say but in general the practice at this point is to feed kitty and then test again in an hour to see if the food has raised or lowered the BG... sometimes a bit of food will help the pancreas work and if the BG is decreasing, then no shot, if it's gone up a bit then a reduced shot... And I would reduce it to .25 u to start... I think your kitty is VERY sensitive to the insulin... You don't want her crashing again.

I'm going to cross post this in the PZI ISG.

 

her #s sorry if it isn't in correct format

1-12-10
Pmps 521 1 unit insulin 9 pm
+1
+2
+3
+4 317

1-13-10
Amps 298 1 unit insulin
Pmps 198

 

Sorry We are currently doing 1 unit 2x a day after hypo on 1-11-10

 

I agree with Vic (though she's not posted her reasoning yet ). Spicey's likely to be overly sensitive to insulin for a couple more days and, given the extreme and extended lows he had the other day, as well as the New Year's hypo, it's definitely not worth it IMO, especially at a 198.

 

She is acting hungry should i feed her? Than test her in an hour.

 

Glad to see she is doing so well! I haven't checked yet to see if there are new threads since the scary hypo night and I'm not clear on what's been happening since then, so don't want to comment on dosing, but just wanted to say "hi". So glad to see you back on the board and to know that Spicey (love that name!!!) is doing well. Feel free to stop by the PZI forum and say hi, you are welcome to post there as well if you like (but always post here on Health for anything needing a quick response!).

 

I am reading correctly that there have been no checks today during the cycle to tell us what was going on around +6/peak?

 

Correct.

 

Great.. that's a pretty decent outcome.... Nice to have these numbers and this knowledge, eh? I've cross posted and asked for more help specific to your insulin. Without having that nadir (peak) number it's hard to say if the BG went down further and is coming up or if it's continuing to head down..... sooo...

I think it would be safe to feed a tiny bit - half a meal maybe - and then test again before giving insulin. PZI is not as long lasting as Lantus and Lev insulins so you don't have to worry too much about going off a schedule a bit. If the BG is the same or lower in an hour, personally, I'd hold off giving any insulin. If the BG has gone up quite a bit, then I would give that .5 unit.


This is the process you want with the numbers... then you keep lowering the dose as the numbers come down and hopefully they come down to so normal that no insulin is needed. Does that make sense to you?


Are you familiar with the PZI Insulin Support Group? Check it out.. PZI insulin support group. You can post a thread there for more help on dosing. Also, take a look at the other people's threads and their spreadsheets to get an idea of how they treat and the processes they use for this insulin.

 

If it were me, I think I would not feed, wait 30 minutes, and test again. If you feel like you really need to feed her because she's driving you crazy, then I would do what Vic suggested: feed a small amount and test again before giving a reduced dose.

Because of Spicey's reaction to insulin and not having that nadir number, I would also dose as Vic suggested.

 

The reason I say feed a bit is that it tests the pancreas. Sometimes it gets the pancreas working which naturally produces insulin and lowers the BG. If one does not feed but waits it out, the number may rise a bit, the person may then feed and give insulin based on that number and both the insulin and the feeding may lower the BG. I want to know what the pancreas is doing, that's all.

Having said that, if there is a particular reason not to feed, I'm open to that as well. 30 minutes is not that long to wait for David or Spice I would think. :smile:

 

I wanted to clarify on the foods too. I skimmed the other thread and saw there was some question of M/D (which she likes) vs. some lower carb foods (she doesn't like what you have on hand, but someone posted the links to Janet & Binky's chart and other info, so you'll know which other ones you can choose from).

Long-winded way of asking... what is she eating at the moment? As well as her possibly being sensitive to the insulin, if the food she is eating is lower carb than what she was eating a few days ago, that might also be a reason that the 1u is giving her (possibly) a surprising drop.

As others have said, with PZI you always want to shoot on a rising #, meaning you have two tests, and you know the PS is higher than the earlier test. For those of us who have been doing this a while, we have data under our belts to help us know when our kitty is nadiring (Bix for instance is usually somewhere around +6.5 on PZI Vet). Once we know that, then we tend to skip the rising # test (can be gauged from any one mid-cycle test to the PS, or sometimes people will do 2 tests about 15 minutes apart at the time of PS) when we are shooting at +12, since we can reasonably predict that it's a rising #, knowing our cat's pattern (and assuming the #s are in line with what we expect).

Since Spicey's #s have dropped so much over the past few PSs (which is GREAT), I agree that in your case it's a good idea to double check to be sure her BG is really headed up. Sometimes with PZI they get a late drop, but in most cases I have seen, they will zoom back up pretty soon, but sometimes they do get good duration past +12.

You don't really have to worry about any of that just giving you some background. You are doing an AWESOME job with all this. I know it took me ages to master hometesting, and to get on the right food, etc., so kudos for doing so well so quickly! The learning curve can be overwhelming, but you'll be a pro in no time!

 

Ahhhh, ok, I see the reasoning now. It makes a lot of sense, I just had never thought of it that way. My reasoning on waiting was to see if the number would be a true rising number (if it indeed rose), but if you fed it could just be a food spike and then you would be shooting on a "false" rise.

 

I wilk do what vic says and then I will post results.

She is currently eating the wet canned hills prescriptive m/d. It is the only thing she will eat right now. But I am going to try some different foods off the charts that have been linked to.

Thanx guys.

 

Hey, eating M/D is better than not eating!!! So if she is getting this good (seemingly at least) a response on 1 unit, if you do switch her to lower carb food, you may need to reduce the dose even further. Just something to be aware of.

As far as the food test (if I can comment without confusing the issue!) I would think 1 hour could still be a food spike? When I did a food test for Bix, I got a spike when I tested about 1 hour post eating, and then the # came back down below the original pre-eating test when I checked again 2 1/2 hrs post-test, and then was even lower 5 hours post-test. I may be missing something though, and of course ECID.

I'm not recommending though to wait longer than 1 hour before shooting - PZI will probably be pooping out soon, so if the # is rising, I'd go with the idea of a lowered dose rather than waiting longer. Just my 2c. Sorry to jump in in the middle, and in fact I am going to step out now and go find some dinner!

 

ok here is the new #s with spice eating very little food

8 am -Amps 298 1 unit pzi vet
+1
+2
+3
+4
+5
+6
+7
+8
+9
6 pm pmpsh-198
+1
+2 - 229

Also note spicey has not eaten any food since pmps

So should she get.5 unit insulin and food or just food no insulin?

 

My .02 is I would not want to shoot more than .5u. SHe is rising but you have been on a real rollercoaster and don't know her true dose, you got a BIG drop on 1u. Play it safe. And test. If she doesn't drop too much and as long as she doesn't rise a whole lot (and I mean a lot), I think I would sit on a small dose like that for a while. I suspect she is still really bouncing around from her hypo.

 

Will you be able to get any tests in tonight before bed? If it were me, for my own personal comfort and the safety of the kitty, I would decide based on how long you can/are willing to stay up tonight. I know you've had a rough few days with being up late; I've been there, I know it's really tough. But since we know how sensitive Spicey is to insulin, testing is important at this stage.

I would definitely not shoot more than 0.5u, though.

 

Question? Should I hold off on insulin, let her eat she is starving and check #s in a couple of hours
or give her .5 u insulin and let spicey eat and keep checking #s in a couple of hours?

 

Yep... go with the .5 units and feed her a regular meal...

I thought that the 198 was at preshot time... so you see how important it is to have the + numbers. What you've posted makes a difference...

You did not shoot at the 198 so that was +10. And your 229 is at +12, which is now your preshot number because you will give insulin.

Is it becoming clearer?

So your log will continue looking like this:

Amps 298 - 1 unit pzi vet
+10-198
PMPS- 229 - .5 unit

And then your numbers from this evening like

+1
+3

etc.

You don't need to put in the numbers where you don't get tests.


Note to Joanna...

• With respect to your food test, the numbers may have gone up without the food and back down due to the insulin... You want the +2 and +5 to be lower than the preshot number. But yes, one does not want to shoot one a decreasing number that looks high due to a food spike but what the test tells us one of two things... 1) If there is a food spike, the pancreas isn't working as it should and so some insulin is likely needed... 2) If the number goes down, the pancreas is working and we really do NOT want to give insulin. In that case, we feed more smaller meals to coax the pancreas to work but to not overwork it. There might still be a need for a small dose of insulin even at that time, but at least we know not to push it into rebound with too much insulin. Does that make a bit more sense?

 

yes i can do 2 or 3 more tests tonite. As long as spicey will let me maybe she will after she eats )

Thanx victoria that does make sense. and thanx for more info on the chart.

 

Try to get the +2 and if it's not dropping to fast you can wait it out for a +4...

Please post the numbers so that the forum members can see if the drop is too steep... If she's dropping fast, we can walk you through the steps again for the hypo... Hopefully, if she drops fast, we'll catch it around 100 and you'll just have to keep her there... But I do think you are on the right track and she should be good on this low dose...

Exciting, non?

 

Yes I will Post the new #s here

And thank you again. This is so wonderful and makes more sense. Do vets tell you any of this info. Mine sure didn't.
And I can see a great improvement with her. When We started insulin at 3 units 2x a day spicey never seemed like she acted right . Thinking back i am suprised nothing worse happend to her in a years time. Wow.

When I got the food ready she acted like she used to following me around can't wait to eat lol.

 

Oh yes, I didn't pick up either that 198 was +10 not +12. It can make a big difference with PZI - shooting a little before +12 is generally not a problem, but depending on when you shoot you may need to reduce the dose. With PZI there is overlap between shots, and shooting at +10 (not that you did, but had you, just so you know for future reference) will mean that the new shot kicks in 2 hours earlier than it would if you shot at +12 and if the old shot has not worn off yet, it could be a problem.

So if your cat (just as an example - the timing will vary by cat and you won't know for Spicey til you have more data) typically starts zooming at +14 (insulin poop-out) and you have an insulin onset of +2, shooting at +12 means that the new shot will be kicking in once the old one is wearing off, which is perfect. So in that scenario if you shot at +10, the new one would be kicking in 2 hours BEFORE the old shot has worn off, which could end up putting your cat too low.

Although PZI is pretty forgiving about shot timing, if you stray more than an hour or so on either side of +12, you will likely have to make an dose adjustment to compensate. Just want to be sure you know that in case you need to adjust the timing of shots (which we all do now & then!).

Vic, thanks for the info. I will think on it, and PM you if I have follow-up questions.

 

Some vets do tell you the correct info and start you out on a proper dose (and proper insulin), with good diet suggestions. Some, unfortunately, do not. My vet wanted me to start Buzz on 3u of PZI SID. I caved, despite having heard otherwise from the board (to which I was new), thinking that she knew what she was talking about, and not really understanding the true dangers of hypoglycemia. 4 hours after that first shot of 3u, Buzz's BG was at 38. Had I not been hometesting, the result would have been disastrous, as, like your Spicey, she was showing no symptoms of hypoglycemia. I would have never known until it was too late.

I am glad that Spicey is eating and acting like she used to. It's a great feeling, isn't it?

I will be around for awhile yet, so please do keep posting and let us know how things are going. FWIW, I agree with Vic re: +2 and then depending on the #, waiting until +4.

 

That's great, David. It's nice to see them be themselves again. I remember that well. Sundance was better after the diagnosis and treatment than she had been in years - due in large part to the diet change.

Nopes... the vets didn't tell me any of this. And they tried to get me NOT to test saying they could do it every two weeks for $10 a shot - which, at the time, I thought was a good deal. Thankfully, the night that I brought Sundance into the vets, I found this site. So, I was really relieved when the vet came back with the words: "It's not a tumor. Your cat has diabetes."

What got me home testing, giving the right food and the right dose of insulin was this site. Thankfully, Sundance didn't like the prescription dry food so went to wet on her own... which is what put her into a state of hypo twice a day for two days - without me knowing... because I was still giving her 3 units BID of the caninsulin... Anyway... we all start out where you are... I'm so glad that you found this site and posted.

 

Updated #s for spice.

1-12-10
Pmps 521 - 1 unit pzi vet 9pm
+ 4 - 317

1-13-10
Amps 298- 1 unit pzi vet 8 am
+10 - 198
Pmps 229 - .5 unit pzi vet 8:30 pm
+2 - 399

 

Give it some time. Remember you are still on a rollercoaster from all the hypoing.

 

oh i know. this is making more sense than the vet saying to give her insulin 2 x a day after she eats.

 

You are doing great, David, getting so many tests in and learning so much already. Keep it up!

 

David... the "phase" you are in now is one of recovery from the hypo and data collection. The .5 units may not be enough, but the 1u appeared too much right after the hypo. Some kitties need .6 or .75 or what we call a skinny 1 unit (just under 1).... So right now, the insulin may not have hit her yet and what you have is the beginning of a pattern from +10 to preshot to +2. This tells you when the insulin wears off and when it hits - how long it lasts in her body.

Of course, you've lowered the dose to keep her from going too low, so you can expect a AMPS that is slightly higher than tonight's PMPS. Having said that, as her pancreas heals, it may produce its own insulin so don't be too surprised if she goes a bit lower by +4 or +5 (if you can stay up that long) and then stays a bit lower for the morning. Like I said, you are gathering data on which to rely for future dosing decision.

It is best to stick to one dose for several cycles though before increasing. And due to her sensitivity, when/if you do increase, you might consider going up by .25 at a time. I know, hard to measure, right? But you will get used to seeing the lines... just be consistent.

Have you learned about testing for ketones? On such a low dose, with higher numbers, there is a chance she can develop ketones. You can check for those using ketostix and testing her urine. Ketones can develop into something dangerous quite quickly, so you do need to keep checking for them.

Also, remember that play/exercise helps to lower the BG in cats, just as it does in humans. So if Spicey is up for it, give her a good 10 or 15 minutes of play or chase. I bet you'll see a good difference in her numbers.

 

So if her amps nuimbers are high in the morning what amount of insulin should i giver her. I know that is hard to tell right now but any thoughts would help.

As far as the ketones where do you purchase the test and how do you do it.

And i am going to get her +4 numbers in about 40 mins. I usually stay up late any way until 1 or 2 am anyway except the other nite .

 

I would post to the PZI group with your morning number, also including your log from the last two days... and see what they say. I think if she's not too much higher that sticking with .5u may be safe and appropriate.... Let's also see what she is at her +4 tonight. The group in PZI may suggest 1 u again and that would be reasonable if she maintains a higher BG... but let's not project... we learn and determine from the pattern...


As for the ketones... some people are able to put the stick in the stream of pee. I was NEVER able to do that. So I would stalk Sundance and sort of disturb her just as she finished her pee so that she would head out of the box before covering it up. Then I could use the puddle and dip the stick in there. The ketostix bottle has instructions on how many seconds to wait before checking the colour. Normally it's 15 seconds.


To determine if your litter affects the pee and therefore makes the test from the puddle not worthy, you take a bit of litter in a cup, pour water in it to make a puddle and stick the stick in. Wait the 15 seconds and see what the colour is. If that colour is the same colour as another stick placed in a stream of water from the tap, then you are ok to use it as a test. If the colours are different at the 15 second point, well, then you are stuck with catching it in the stream or putting a ladle in the stream to catch some. Others have other tricks to catch fresh clean pee... I'll see if I can find a thread on the subject.

 

Where do you purchase those test strips? At the vet?

And should i post my topics here or in the pzi area?

 

You can post in both forums for now if you would like. Health is a good place to post late at night as you are likely to get more eyes. If you want to post in one forum and then provide the link to that post in the other forum, that would be great.

 

The ketostix can be purchased at any pharmacy... both diabetic and dieters use them so you can easily get them. They are about $8 for 50, I think...


OOOH... I just saw that photo of Spicey!! ACK... she is soooooo cute... what a beauty.

You can post in both places if you like - preferably linking each thread in the other so that we can follow both. A lot of people use the ISGs for dosing and problems while general diabetes questions are covered in health - like where to buy supplies and what to do for non-eaters and such. But just make sure that if you have an emergency that you post in Health. It gets more traffic and we can find the PZI people to come see it when we need them.

 

Spicy's +4 results

1-12-10
Pmps 521 - 1 unit pzi vet 9pm
+ 4 - 317

1-13-10
Amps 298- 1 unit pzi vet 8 am
+10 - 198
Pmps 229 - .5 unit pzi vet 8:30 pm
+2 - 399
+4 342

 

Spicey says thank you.

I love all the pics of cats they are all so beautiful.

 

Well, good log there. It looks as if she's getting some reaction from the insulin but not a steep drop. She may go lower tonight and if you wanted to stay up to get a +6 you could - for interest. But she likely won't drop into really low levels tonight.

You can give her a little low carb snack if you like... again, that helps the pancreas to work and it's good to have food on board mid-cycle to make the curve a bit gentler - though hers doesn't look steep at all yet.

Don't worry about any number you get in the morning. Just post it and see what people think. This becomes like a little dance and it's sometimes hard to catch the beat...

I'm heading to bed... it's been a "fun" couple of nights, eh? :razz:

Ciao for now.

 

Good nite. I need to do the same.