Starting Hypurine after failed Vetsulin regime

http://www.felinediabetes.com/FDMB/threads/i-am-from-uk-and-feeling-very-overwhelmed.149970/
previous
After struggling with Vetsulin I finally managed to get Hypurin 100% bovine insulin and syringes.
Vet wants me to start with 0.5 unit bd but I can see how difficult it may be to draw such a small dose into the syringe.
His PSAM BGs are about 25 (450) with Accucheck Aviva meter and it was a similar number at the vet's. Rocky was on 2 units Vetsulin. I am going to start Hypurin tomorrow morning so I will have a fresh BG and I am going to use two meters: one as above and the other one is AlphaTrack lent by the vet.
I would like to ask you to help me start new regime for Rocky.
Any input would be most appreciated.
Best wishes to all of you and many thanks for your help.

 

Marlena. I'm not familiar with that insulin at all. As far as using two meters wouldn't that be confusing. Human meters read lower. Is your vet wanting you to use AT just for starting the new insulin so she/he can see how it's doing since that is what they use?

 

Marlena, which syringes do you have? Do you have 100 iu syringes with half unit markings..?
I think most of us in the UK use these ones:
http://www.amazon.co.uk/MicroFine-0-3ml-Insulin-Syringes-U100/dp/B00K86ZO20

 

@Elizabeth and Bertie, is the Hyperin 100U? I am glad you got it, Marlena. It has worked wonders for Bertie.

For those reading this thread, it is an insulin similar to the PZI we had in the US years ago that, as far as I know, is only available in Europe - maybe just in the UK? The difference between it and ProZinc is that it can have longer cycles. Is that right, Elizabeth?

 

Thank you Sue. Didn't realize there are so many different insulins now. And some only in US and some only available outside the US.

 

Yes, that's pretty much it, Sue.
Hypurin bovine PZI is a U100 insulin that's manufactured in the UK. It can be imported to the rest of Europe (and also to Canada for some reason!). Apparently it's the longest lasting of all the insulins, and some cats can have very long cycles on it.
.

 

Dear Eliz,
I have exactly these syringes but I don't think it is possible to do 0.25.
It has been over 8 hours when Rocky had his first shot of Hypurin (0.5 maybe 0.75u) and his BG is now 22 from 16.4. So looks like his BG is not coming down. Do I give PM shot as normal?

 

There are some pics somewhere on the forum that show what a .25 looks like, Marlena. I'll try to find them for you. (But is Rocky getting .5 at the moment..?)

He's still got a few hours to go, Marlena, but yes, it looks at this point as though he should get his next shot as normal.

When you give the next shot it will quite possibly have more welly than the first shot. That's because of the overlap. The first shot will still be in Rocky's system even though it's appearing to have little or no effect at this point. The earlier shot will be wearing off as the new shot starts to work.
I found with Bertie that it took a couple of days to get into it's stride (but 'your mileage may vary' ). And you're starting out at a nice low dosage, so, if this dose doesn't have an effect then you can increase it in a while. But it's better to start out low and work up than start with a higher dose and then have to back-pedal....
.

 

Marlena, if you scroll a bit down this page (from the Lantus forum) you'll see pics of what a .25 unit, and .75 unit look like:
LANTUS & LEVEMIR - NEW TO THE GROUP? PLEASE READ...
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Woodsywife, I am not going to use two meters at the same time although doing so wasn't really problematic. The idea is to see how they compare but I have to admit I really like AlphaTrak. Like everything with FD even the glucometers are not easy to understand and figure out. Human meters can be whole blood or plasma calibrated so there a difference in BG numbers between them, then there is animal one calibrated to plasma as well and there is laboratory measurement again different to everything else. So I don't think we can say that human ones always read lower but please correct me if I am wrong. At the moment I am happy with Accucheck Aviva Nano which gives me correct readings at least when it comes to higher numbers. Read somewhere that some meters give accurate high numbers but not so when comes to low numbers!

 

God bless you dear Eliz, many thanks for your message. It makes sense to me.

 

As a general rule of thumb, human meters read lower than pet meters, *in lower ranges*. This is the reason for reducing at 68 on a pet meter, compared to 50 on a human meter.
Most all home meters, whether pet or human, are calibrated for whole, capillary blood. The pet meters are calibrated to match the venous plasma that would be lab tested.
Hope this helps

 

Marlena, I use Alpha Trac as I didn't know anything when I started home testing. Vet recommended it as he uses it. I have to say the number of times we checked results, my readings are spot on with outside lab readings. The only thing is that the strips are very expensive.

 

Hi @Marlena , how is Rocky doing today?
.

 

Hi Eliz,
Rocky seems to be doing well. His BGs are:
PSAM 14.5, +2 16.5, +8 4.3, +10 5.5, +12 7.4.
Now is the time to shot again but his numbers are too low (I think) so I am going to test again in 2 hours and then decide what to give. What do you think?
Many thanks, Marlena

 

Thank you

 

Hi Marlena,

Wowsy! What a difference!

Yes, I agree that those numbers are just a tad on the low side (given Hypurin's overlap, and given that these are early days and the effect may continue to be accumulative....) And it looks like a pretty steep drop too....

You may find that Rocky is too low to shoot tonight, and that you'd be better skipping the shot.
Yes, the BG does seem to be rising, but....the Hypurin - and the overlap - seem to be having a pretty powerful effect..... And I'm assuming you want to get some sleep tonight and don't want to spend the night testing his BG....

To be honest, given the situation, if it were my cat I might be inclined to skip the shot and see what the situation is in the morning. But see what happens over the next hour or two.

It may be that the dose is too high for you to be able to give 2 shots a day. But it's a little early to tell.
Can you confirm what dose you are giving? Is it still .5 of a unit?
.

 

Marlena, the general recommendation here for folks new to dealing with feline diabetes is that no shot is given if the blood glucose is below 11 (200). That's just until the caregiver can see how the insulin/dose is working in the cat's body. It allows some buffer of safety to prevent the blood glucose dropping too low.

Once data has been gathered to see how the insulin/dose is working, and a baseline has been established, many caregivers then start to feel more comfortable giving shots at lower BG numbers.

Remember, Hypurin isn't like Caninsulin. Caninsulin is an 'in and out' insulin. Hypurin can hang around in the system for a very long time; and even if the numbers are rising, there can still be enough in the system to boost the following shot.
.

 

Hi Marlena,

Glad to see Rocky is off to a promising start with his new insulin.

Really interesting thread: good to learn a bit about how hypurin works.


Mogs
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Dear all!
Many thanks for your kindness and help.
I saw your posts this morning after I gave Rocky his shot.
We had good numbers yesterday and I waited +14 hours before making sure that his BG is rising and over 200 - it was 12.2 (220) - and gave him 0.5u.
This morning his number was a bit high at 21.5 (387) and I gave him a bit more - 0.75.
I have looked at Juliet's spreadsheets and it is helping.
Best regards to all of you,
Marlena

 

Hi Marlena,
Did you get any additional tests during the night? Just wondering if Rocky's blood glucose might have dropped a bit low, and subsequently bounced?
.

 

Hi Marlena,
Looks like Rocky is responding nicely to his new insulin!
I see you raised his morning dose today as his preshot was 21.5? I would give him a couple of days or so on the 0.5u dose as his system becomes used to the PZI, and then think about increasing it if necessary. When switching insulins it's best to us the 'precautionary principle', just to be on the safe side, and to enable his system to adjust to his new regime.
How is he doing now?

 

Marlena,
Me again.
I've set you up a spreadsheet for Rocky (by copying Milo's). Have a look here: https://docs.google.com/spreadsheets/d/1Xwq1jBlV8aaJCGz_-wa6QMQfQ-Rb6rfwrCEBGBaEKM8/edit?usp=sharing
I've put it yesterday's & this morning's numbers. If you feel able, please add his subsequent numbers to it? It will give you a much more visual flavour of what is happening in Rocky's system, it will help out with spotting patterns, and readjusting doses, and it will also help those trying to advise you what to do next if you get in a pickle. If you copy & paste the link into your signature, it will be obvious for all to see.

Happy Monday!

 

Absolutely agreeing with Juliet here, Marlena...

As she says, "When switching insulins it's best to use the 'precautionary principle'... " And I think that's especially the case when switching to an insulin that has a long duration: It can take a little while to see the full effect of the initial dose.
Seeing what that initial dose can achieve will give you a sound baseline to work from.

I don't know whether you managed to get any tests during the insulin cycle last night....?
If you did get tests and Rocky's numbers didn't drop much, or indeed just went up, then I see why you would be tempted to increase the dose. But it may be that this morning's high preshot was just a 'one off'; or maybe it was a 'bounce' from yesterday's 4.3. And as a general rule (there are exceptions) it's not a good idea to increase the dose on a bouncing number. That's because things can get pretty tricky if the bounce wears off and there's too much insulin in the system.

If you didn't get tests during the cycle last night, then we can't know what happened. Maybe his blood glucose dropped. Maybe it didn't. So there's not really enough data at this point to make a decision about changing the dose.

A quick note on 'bouncing'...
When a cat's blood glucose drops too low it's liver can release stored glucose in order to raise the BG. It can also release counter-regulatory hormones, the purpose of which is to try to keep the blood glucose high for a while. It's a protection mechanism. This can look like insulin resistance, or it can look like the dose isn't sufficient.
The BG doesn't need to be in the hypo range for a cat to do this. It can happen simply because the BG has dropped lower than the cat has become used to. High numbers may have become it's 'new normal'. And lower numbers (even if healthy) can be perceived as a threat.
Bouncing can also be triggered if the BG drops too fast.

I know you want to see Rocky in better numbers (and we're all here cheering him on!), but you don't have to rush this. Rushing can be counter-productive. It's OK to relax a bit, and breathe. Patience, Grasshopper!

I see that Juliet has made a spreadsheet for you! Brilliant stuff!!!

Eliz

 

Eliz,
no, I did not check his numbers at night! I am desperate to see how this insulin is working so I will be getting up during the night to test him. That should give us some more clues.
Today his numbers were:
+0 21.5 (gave him 0.75 u approximately), +5 18.4, +7 12.5, +9 5.4, +11 4.2. Looks like onset is after 5hours, nadir 11 hours.
I will check him again at +12 and than need to feed him.
Marlena

 

Oh my God Eliz, you are right - I am a b.....y Grasshopper!
I really like your explanation of "bouncing", it makes sense.
Many thanks
Marlena

 

Dear Juliet,
you are a star!
Many thanks

 

All done and running!
Marlena

 

(emphasis mine)

It's entirely possible that Rocky does have a late onset and late nadir. Some cats do.
But it might be that other factors are coming into play here... It could, for example, be the case that his blood glucose bounced up high last night in response to an earlier low number, and then 'dropped out of bounce' during the day. When that happens the numbers can come tumbling down, and down, and down.
And also, it may be that Rocky's nadir happens later when he's given a higher dose. That can happen too.

It is great to see Rocky in some better numbers.
He seems to be responding very well to the Hypurin.

If Rocky isn't shootable by +12 on a consistent basis, it may be that you need to reduce the dose in order to try to give 2 shots a day, especially if the alternative is that you find you need to either skip shots or give shots later in the evening (and then have to test during the night). The latter can be doable in the short term, but can get rather wearing if done for any length of time. (When my cat was on Caninsulin (and subsequently on a veterinary PZI) I was doing 3 shots a day around the clock, and testing during each cycle. And it does get pretty tiring when you're continually getting up in the night to test....)

Well done for adding your data into the spreadsheet!
I've just looked at Rocky's spreadsheet and see that he's just starting to come up now at +13.
It's entirely possible that he won't reach a shootable number for a few more hours (or maybe he'll jump up fast - we just don't know!). But I guess you're going to need to make a choice about whether to skip this evening's shot, or wait and give the shot later...

I would suggest that you don't give more than .5 of a unit for the time being. (And in fact, I wouldn't be at all surprised if it turns out that the .5 dose actually needs to be tweaked down a tad in order to level things out a bit.)

How are you getting on with measuring these small doses, Marlena?

Eliz

 

I am going to skip tonight's shot.
What time, do you think, I should test during the night?
Shall I reduce his dose tomorrow am and try to give him 0.25?

 

Again me.
I can only try very small doses - it is so difficult!

 

Nice one, Marlena!
Good plan to skip tonight's shot. Start again tomorrow morning, and if he's bounced, then stick with the original plan of 0.5 units.
If he stays low, though, you may need to get that magnifying glass out to measure 0.25 units!
He may well stay low for a while, since he had a larger dose this morning. Or, he may bounce! Who knows? If his numbers are high tomorrow, keep him at 0.5?
Milo's rooting for him. Ive told him all about Rocky....
J

 

Just noticed Rocky's picture. He's gorgeous, Marlena!
.

 

Thank you on behalf of Rocky.
They are all gorgeous!
But Rocky not only is good looking but boy he's got personality. Absolutely love him!
Marlena

 

Juliet,
thank you as always.
Rocky is grateful that he's got a friend!
Sending best regards to you and Milo.

 

He bounced, then? Poor chap.
Good job with the 0.5 units, though. Still too early to tell whether this is the appropriate dose for him to keep on an even keel. I'll keep all my bits crossed for him today.
You're doing a grand job!

 

Yep, does look like a bounce, judging by those high flat/unmoving numbers.
But don't worry, Marlena. This is just one day.
.

 

Oh, my but you're a handsome devil, Rocky!

 

Thank you!
Rocky
Ps. from silly mum: he is really gorgeous, he's got ginger tummy, beautiful black markings and blue eyes and terracotta coloured nose - real beauty!

 

It's good to see Rocky dropping out of that bounce, Marlena.
.

 

He is indeed, gorgeous!
Marlena, I can understand why you felt you should give Rocky 0.75u this morning, as he was high all day yesterday, and high this morning - however - that could have all been part of his 'bounce'. Sometimes it takes 24 hours for the BG to come down again, so you may find that after the 0.75u this morning, he will simply rebound once more from the higher dose. You may find that you are in the same position tonight as you were on monday night - and unable to give him a shot.
Please stick with the 0.5u dose tomorrow morning? He hasn't had a chance to settle yet, and his system has been experiencing inconsistent doses over the past 48 hours. What he needs is a consistent low level dose for a few days to get used to it first, and then think about changing it, depending on how he responds.
You're doing what comes naturally, and I can completely understand why, and totally empathise with you and now we need to take it gently...softly, softly, catchy monkey....
Big hugs.
J

 

Looks like Rocky reached peak of the cycle at +8 today.

And I didn't notice till Juliet pointed it out that you gave .75 this morning, Marlena.
Was that just because of the higher pre-shot number, or are you trying to use sliding scale dosage for Rocky?
If the former, then as Juliet said, don't be fooled by high numbers that may have been caused by a bounce (what bounces up will come down again at some point).
And if the latter, then it is a bit too soon to try sliding scale dosage...

When switching insulins it is a good idea to find out what a single fixed dose does before raising the dose.
FYI, my cat's BG hardly changed at all in the first few days after I switched to Hypurin. Initially it was almost like I was injecting water! But then, suddenly and dramatically, his blood glucose dropped and dropped and dropped; and I actually had to reduce his dose by about half. If I had raised the dose because of the high numbers I was seeing we could have got into big trouble...

It may turn out that Rocky is suited to sliding scale dosing. Some cats are. (After the initial couple of weeks, my own cat has only ever been on sliding scale dosage). And some cats seem to do better with a fixed dosage.
But at the moment probably the most useful thing you can do is to see what the effect of the .5 unit is. (In my view, at this point the only reason to change the dose would be to lower it if it was evident that the .5 was too high.)
Seeing what the .5 can do will give you a baseline to work from, whether you ultimately go with fixed dose or sliding scale.
.

 

Oh, forgot to say...
The dose you give this evening will be influenced by dose you gave this morning (because of the overlap). This morning you gave .75; so, if you give a .5 this evening it may have a bit more welly than a 'typical' .5........
Are you able to get a couple of tests in this evening, Marlena?
.

 

Oh dear, I have just done Rocky and then read your post! Not good, see what happens, I hope everything will be all right but I was so upset about high BGs.

 

Yes, absolutely

 

Could you please tell me more about sliding scale.
Many thanks
Marlena

 

And another thing: I looked at Milo's scores and it looked like he was getting 1.5 u Hypurin for some time and it seems a high dose which worked so I thought that my 0.75u (and maybe not quite because it is so difficult to measure that, I rather give less then more) is a very modest dose indeed. And also don't you think that 0.25u (or not even that) is not very much? I am really straggling with Rocky's high BGs for sometime and I am worried what that is doing to his organs. Still haven't heard from the vet's about his blood work results.
It is all very "consuming" for me.
And another thing: I often listen to my "inner voice", I mean my intuition and I felt that 0.5u is a very small dose.
I can only learn but sometimes your personality takes over.
I hope you don't mind my "opening up" about how I feel.
Glad you are so patient!

 

Yes, it is indeed a small dose, Marlena. But even though small it had a considerable effect on 10th January.
To be safe, it is better to start with a small dose and work up. We often see cats arrive here on too much insulin. And sometimes the dose has to be cut quite dramatically.

Different cats need different amounts of insulin. And their insulin needs often change over time.
We've had cats here on really high doses; and some who've reacted so strongly to even the smallest dose that their caregivers have had to measure the dose in drops! ...Every cat is different....

The general recommendation here is that cats start out on .5 or 1 unit, and work up (or down....) from there. And in Rocky's case it dose look like the .5 unit is a good starting point.

As to your fears of organ damage, gosh, I used to fret endlessly about that. My cat was in very high numbers after diagnosis and remained that way for quite a long time. And I even stayed away from the forum for a few years because I thought we were such a hopeless case. But things got better for us over time (and with a change of insulin...).
My cat has now been diabetic and on insulin for 9 years. He's now 17, and is in pretty good nick for a 17 year old kitty (touch wood/ant-jinx). My vet says he has never had a diabetic cat live so long and so healthily after diagnosis. Because he's 17 I know I don't have a very long time left with him. But it seems that he has had a healthy life in spite of being diabetic for 9 years, and in spite of being in high numbers for a long time at the beginning. Cats aren't generally affected by high blood glucose levels in quite the way that humans and dogs are. Their bodies seem to be much more tolerant of high blood glucose...
.

 

With sliding scale the dose is altered according to the pre-shot number (and should also take into consideration the likely nadir of that dose).
Sliding scales can be particularly useful for cats that have very variable BG numbers; in that instance the varying dosage (if done well) can help to keep the kitty's blood glucose on a more even keel.

We don't have a 'set formula' for sliding scale dosage here; it all depends on the individual cat.
The type of insulin used also makes a big difference.

I think it's easier to use sliding scales with the intermediate-acting insulins like the US Prozinc and PZI, and indeed Caninsulin/Vetsulin also, because these insulins are out of the system faster then the longer-acting insulins, so it's less likely that any given shot will be affected by the one that preceeds it. With longer-acting insulins sliding scale is trickier because each shot is affected by the shot that preceeds it (or in some cases, maybe even by several shots that preceed it....).
Most people here who use the longer-acting insulins Lantus and Levemir find that these work best on fixed dosage, precisely because of the way that the insulin builds up in the system. However, in my experience the longer-acting insulin Hypurin can work with sliding scale. And in my cat's case it works very well. But it is always important to be aware of the long duration and overlap, and try to factor that into the equation when making dose adjustments. It can get complicated sometimes...
.

 

Marlena, re your comments above about Milo's BG scores I'm going to tag Juliet for you, @Dr Schrodinger
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Hi guys, it looks like Rocky bounced! His BG now at +2 PM is 21.6!
Don't call me anything, I should have listen to you.
What now?
Please

 

Hmmm, any chance that was a dodgy test, Marlena?
Or could the shot have been a 'fur shot' (ie some went onto the fur and not into the cat)?
Or has Rocky had any different food this afternoon? Anything he might have nibbled that he shouldn't have...?

Sometimes bounces can take a few days to settle out, and this may still be part of the bounce from 2 days ago. Perhaps the earlier shot is wearing off and the higher numbers are breaking though again... It's quite a jump though.

Try not to be concerned. Cats' BG numbers often go up and down quite a bit (if you look at a few people's spreadsheets you will see that they vary a lot), so don't worry about this one instance. It's just one day.
Make yourself a nice cup of tea. Or pour a glass of wine. Or eat chocolate...
Relax. Breathe......
.

 

Dear Eliz,
many thanks.
The only thing which was different today was that he was in pain - his front leg was bothering him and he was kind of waving his paw and I could see he was in pain. It seems to be arthritis.

 

Ta dah!!!!



In this sugary world, everyone should have a pair of Patience Pants.


Mogs
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Hi Marlena,

Apologies if this is garbled, I've been out with the OH & might have had some wine.

There is no standard dose to start a cat on insulin. You judge by weight, and clinical history, including glucisamine & current BG levels.

Milo is not only a big cat (Maine Coon cross), but he had also been through ketoacidosis, and was walking on his hocks with neuropathy. We'd had *that* conversation about letting him go & hypurin was his last chance.

I chose his starting dose, not the Vet. I chose half the dose he was on with caninsulin. If you look at his scores, he didn't get into the 'green' numbers for 3 weeks - at which point I wanted to throw a party! If I had started him on a lower dose, he may have got there sooner, or he might not have done at all, who knows?

Consistent dosing is key to regulation in the outset. Keeping insulin at a constant level helps the liver store glucose, and gives the pancreas a chance to recover from the toxic effects of higher glucose levels. If you find that he has a sputtering pancreas like Bertie, then use a sliding scale, but at the moment, we don't know that is the case with Rocky.

Anyway, I am blethering. Start low & keep it consistent for a few days, then think about change if necessary. Only with a few days of data will we know what's appropriate for him.
J

 

Dear Juliet,
as always very helpful.
I am going back to the beginning.
So stick with 0.5.
I was going to fast and now we don't know.
Let's hope I get it right this time.
Best regards
Marelna

 

No, the test was ok, double checked and the shot was done properly I think, I had no evidence to think otherwise but who knows.
I am going back to low dose of 0.5 for as long as you tell me to continue.
It is not easy but you guys have experience so at least I have support.
Thank you
Marlena

 

I really like the pants!

 

Pain can certainly raise blood glucose.
Are your sure it's arthritis? Could he have something wrong with his paw? Is there any swelling there? Any sign of injury?
.

 

Eliz, Rocky has had problems with his leg for sometime. It looks like he is waving and holding it up, he certainly is in pain with it as he hisses while he does that. It happens not too often. The vet thought it might be arthritis, she examined him and said his joints are a bit tender.
I used to give him turmeric extract and he always gets fish oil capsule. So this is an ongoing problem.
Marlena

 

Aw, poor litttle chap...
I do sympathise because my oldest kitty, Jonesy, has a bit of arthritis. He gets Cosequin every day (glucosamine and chondroitin supplement) and that seems to make quite a difference to him (I know that because if I forget to give it for a little while his symptoms worsen...).
Have you tried Cosequin for Rocky, Marlena?
.

 

They do have a bit of a Rocky vibe going on.


Mogs
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Dear All,
Rocky is in pink this morning so hopefully there is an improvement.
I really have to start some holistic treatment for arthritis. I was considering Cosequin but have found that there is something else which might be better (forgot the name but it will come to me as soon as I feel more awake). I am going to take arthritic supplement together with Rocky as we both share the condition!
Another thing is acupuncture which I am having at the moment but the therapist didn't want to do Rocky (ha ha ha)!
We live in the sticks so it is too far to go to a holistic vet.
I hope you and your furry children are well.
Best regards,
Marlena

 

Hi, could you guys please have a look at Rocky's spreadsheet because we approaching PM shots and his numbers do not improve so I need your opinion as what to do. I am worried about his high BGs damaging his kidneys. He is drinking a lot of water. Do I still continue with 0.5 u?

 

I would keep the .5 for this shot, Marlena, and maybe review it in the morning if there is no improvement in the numbers.

Try not not worry (easier said than done, I know) but Rocky is probably just drinking water because his BG is high.

How is his leg/paw? Does he seem to be any more comfortable?

Hugs,

Eliz

 

Dear Eliz,
Thank you.
Could anybody help me with review in the morning or could I please have some suggestions tonight please? So if his numbers are not better tomorrow am what do you suggest I need to do?
Rocky's paw is fine now, it only happens once in the blue moon and lasts for few minutes and then he's fine.
I am considering some supplement for arthritis.
Love,
Marelna

 

I feel for you over the worry, Marlena. I can't help with input on the insulin side of things but I am sending good vibes for Rocky and these for you -->>


Mogs
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If there is no change in the numbers then I think you could probably try a small increase. But I think any increase should be done with caution because we've already seen that at a preshot of 21.5 a .75 dose dropped him to 4.1 very late into the cycle, and then he bounced.

These very flat numbers are odd, almost like there's some other factor in the mix. And if it's not the pain in his leg, and there is no change of food then it might be something else...
Marlena, these may seem like daft questions but...are you having any problems with the insulin shots? Are you sure the insulin is actually going in OK? With Hypurin it can be helpful to keep the syringe in place for a few seconds (I usually do a 'quick' count of 5) before withdrawing it.
And are you mixing the insulin (tipping/rolling the vial) before each shot? (I'm sure you are, but just thought I'd ask...)

I'm going to tag Juliet @Dr Schrodinger to see what her view is....

Eliz

 

Dear Eliz,
your questions are indeed needed to try to find out what the issue might be. His PSPM is now 23.6 so rising rapidly.
I can not be sure 100 percent that the injection was done properly but I really have no reason to think otherwise. I read everything and printed everything and keep it handy so I have it in front of me and I refer to it.
Strange

 

Sorry to be late to the party, Ladies, I just got in from work.
I agree with Eliz completely. Stick with 0.5u tonight.
It does look as if he hasn't has any insulin today- there's been no real change in BG. 'Fur shots' are so easy to do, and Milo had quite a few!

 

Ok darlings, thank you so much.

 

One more thing: I have a record of a very similar situation back in November (when on Vetsulin)!
I thought that the meter was broken so started using a different meter which gave me a completely different reading (lower).
In the end I started using the old meter again after checking it with control solution.
I did in the past missed shots but I was aware of that. This time I am pretty sure the insulin went in.
But his pm shot is done now. See what happens am.

 

Good morning,
time for morning shot and I am not sure what to do, his numbers don't change much basically staying high.
I am a bit worried.
Help please.

 

Marlena, are you going to be around today to test Rocky?
If so, then if it were my cat I would increase the dose to .75 at this point. I agree that it is important to get him out of these high numbers.
It may be that his blood glucose drops low and bounces, but that may not happen... And these high numbers are looking kind of stubborn...
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Marlena, I forgot to ask; what exactly are you feeding Rocky at the moment?

 

Eliz,
I am at home today so testing often will be done, no problem.
I feed Rocky raw home made diet, more less the same all the time. Low carb, medium fat, high protein and supplements like fish oils, evening primrose oil, herbs, etc.
I have this feeling that the 0.5u dose is just not doing anything but this is just a feeling as I can't be sure.
When he went into remission with Vetsulin it was just like I could drop his dose slowly as his numbers were improving and it was kind of just predictable. Unfortunately Vetsulin did not work well last time as it was dropping his numbers quickly and then raising them high not lasting long enough.

 

Yes, it is strange, Marlena, because he seemed to respond so well to the .5 unit on 10th January, and also (almost too well) to the .75 on the following day. So, there doesn't seem to be any clear pattern emerging yet.

These numbers are quite similar to the numbers that my Bertie had when he was first diagnosed (and on Caninsulin at that point). He'd have high numbers for a while interspersed with sudden low numbers. Very frustrating!
Sometimes we never know the reason for these patterns, but I do sometimes wonder whether one possible reason is the cat's own insulin output... Perhaps Rocky's pancreas is producing insulin of it's own intermittently. He's been in remission twice, so he has shown that his pancreas has the power to recover....
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Many thanks

 

How weird! He has gone from responding really well 5 days ago, to just ignoring what you are giving him...

Stick with the 0.75u for a couple of days & see how he reacts, I think.

You're doing really well. How is Rocky? Still drinking & peeing loads?

 

Dear Juliet,
many thanks for your reply.
It is very strange, it looks like he doesn't get any insulin! We can expect maybe one missing shot (fur shot) but not every single one unless I am completely useless and don't know what I am doing (God help me).
He seems ok, not too bothered about anything. Oh, maybe food. His appetite is always very good and he always wants to eat regardless of having high or low BG. There was not one day in the 11 years of Rocky's life that he wouldn't eat his food!
He was drinking more this morning but since afternoon he is not drinking.
With regards to peeing - I don't know because he absolutely refuses to use litter tray and only does his business in the garden. I spy on him as much as I can, use a good torch in the dark but he is so good at hiding away from me...
Well, keeping him on 0.75u for now and see.
Please pray for us, I feel like crying now but I also feel positive at the same time.
Thanks for your time.
Marlena

 

Oh, (((Marlena))) - hugs, hugs, huuuuuuugs!

You are a truly wonderful cat-Mum. And you are doing everything that you possibly can.
This is very early days and there is every chance that this is just a wierd 'blip'.

Keeping fingers and paws crossed here that you will see an improvement tomorrow.
Chin up, sweetie!

Eliz

 

Dear Eliz,
thank you, thank you, thank you.
Your encouraging words are very much appreciated.
I need to stay focused and patient, I am sure everything will fall in place and it will start making sense.
Best wishes for you and your gorgeous Bertie.
Have a good night and "see" you tomorrow.
Marlena

 

Below 7! Go Rocky!

Massive cuddles to you, Marlena!

 

Wowsy!
It's good to see that his numbers can drop.

...But that is also a very steep drop and may continue for a while yet... I'm sure you're keeping a very close eye on him, Marlena.

Am keen to see what the next test result is. We don't want him continuing to drop at this same rate...
If necessary, it is often possible to slow the drop by giving a little ordinary food. You can do this to level out the drop a bit, or to try to keep the blood glucose from dropping too low.

If it does look like the blood glucose is going to drop too low, and the low carb food doesn't do the trick, then it might become necessary to give something a little higher in carbs.
Do you have any higher carb wet cat food available just in case, Marlena?

An alternative (if the numbers really need to be stopped or brought up fast) is to give the kitty a little bit of honey/glucose syrup etc. That is the quickest way to raise blood glucose. These simple sugars also leave the system fairly quickly, so the effect is relatively temporary.
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Dear Eliz,
I thought that as well - a little steep drop! And it happened when his numbers were high and I thought I would relax a little about frequent testing because frankly I was prepared to wait a bit and not panic so I don't know now when his onset happened. I am going to test him again at +2 from the last test. I give him small amounts of his regular food every so often but I know what to do in case of his numbers dropping down to hypo.
Rocky is so easy because he would eat anything if allowed including mashed potatoes, that would do the trick I think in case of hypo! I also have glucose syrup in a tube (special one for diabetics).
Let's just keep our fingers crossed that he won't go too low for sake of his health and my sanity!
Thank you guys for keeping an eye on us, I shall keep you posted.
Next test at 2.15 pm Greenwich time.

 

Many thanks

 

For future reference, if you keep an eye out for a sudden uptick in appetite a little while after the insulin dose was given it can help you spot when the insulin is kicking in. If Rocky is running in good numbers at PS, then checking BG when the appetite picks up can help you get an early warning that you need to monitor more closely during the current cycle.


Mogs
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Any update on Rocky's blood glucose, Marlena?
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Shortly before his check up Rocky went to his bowl to drink and I thought it is a bit strange because his BG is supposed to be low. Guess what?
It is now 14. Is it ok?

 

Might be a bounce after the steep drop earlier on. Thoughts, @Elizabeth and Bertie?

 

@Marlena - you're doing a very good job with the observations of Rocky's clinical signs.

 

I agree, Mogs. That does look like a bounce.

@Marlena , sometimes just the speed of the drop can cause a bounce.
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Eliz,
There is one thing I need to mention: this morning when I drew the insulin into syringe I really struggled to get 0.75u. I needed to draw a little bit more than 0.75 and squirt some out to get to the dose but I struggled with it and in the end it is possible that the dose was just over 0.75. Maybe even this tiny increase in the dose (unintentional and I can not be sure that that was the case) could have some sort of effect.

 

Yes, it's possible, Marlena. Or it may just be that the .75 dose was starting to build up in his system. It may be that Rocky is sensitive to small dose changes.

My cat usually gets between .5 and 1.25 of a unit, and I have to hold the syringe close to a light source to see the dose clearly. (I'm very longsighted, and also need strong reading glasses for close vision). It sometimes also involves a fair amount of squinting and eye-rubbing as well, especially first thing in the morning, ha-ha!

Please don't be discouraged by the up and down numbers at this point. All the test results you are getting are providing really important data. You're doing a brilliant job!
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Eliz, many thanks.
I feel a lot more positive now and kind of more relaxed.
The biggest problem with the syringe I have is that when you draw insulin in you need to take some more and then push some out to arrive at the correct dose (0.75u ) but trying to push the plunger ever so lightly or slightly I should say to push it to the right level is soooooooo difficult. My husband gave me a wonderful magnifying glass on a stand so I can see really well and I think it helps.
Anyway, Rocky seems well and not really bothered about my struggles but it is typical behaviour of cats, am I right?
Lots of hugs to you,
Marlena

 

Try twisting the syringe plunger at the same time you are depressing it gently. I never got that exact with doses, but I've read others have used that technique.

It looks like "patience" paid off looking at today's numbers

I wanted to ask @Elizabeth and Bertie and @Dr Schrodinger (as they are familiar with hypurin PZI and I am not) a couple questions.

A "typical Prozinc cycle" looks like this:
Onset at +2 - +3
Nadir between +5 & +7
Duration between 10-14 hours.
(According to the Prozinc website)

Today, I found this on the petdiabetes wikia site about Hypurin PZI:

• onset 2-5h,
• peak 12-24h
• duration: maximum 36h

Would you say that in your experience, that would be accurate as far as "typical"?

If so, it isn't anywhere close to what most PZI users here would be familiar with. I'm thinking that " typical" must be defined in order for "atypical" to be recognized.

To me, it would appear that if HPZI works the way it is shown above, you almost have to think "depot insulin" instead of using your "PZI brain" in order to use it effectively. Is that a fair way of thinking?

In fact, today's +5 could be the nadir from last night's dose if the "peak" can be 12-24 hours after a shot, right?

 

Try using a twisting action to squeeeeeeze rather than push the excess insulin out of the syringe.


Mogs
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Thank you.

 

A magnifying glass on a stand? OH, that's just what I need. Wonderful! I'm doing the squinting thing too..plus I'm developing cataracts, grrr. But a magnifying glass would be so helpful!

 

Hi Carl,
I remember seeing that info before on the petdiabetes wikia, and did a 'double take' at the time because those numbers are the ones that refer to it's action in humans. I made a mental note back then to get in touch with the author of the site (Steve, from FDMB?) to ask how he got that info. But time passed, and I just forgot about it...

My cat possibly has an earlier cycle than most. His typical onset is +1.5 to +2 hours, then peak at around +4 to 4.5, and maybe a surf for a few hours (although for a 'larger than typical' dose his onset will the same but the peak could be a few hours later).

One lady on here struggled with HPZI because her cat had long cycles on it, maybe 18 hours.

Juliet @Dr Schrodinger did, as I recall, start to work with HPZI as a depot insulin using one of the known protocols (?). But there wasn't a lot of time for this experiment because her cat, Milo, went into remission!
Milo's SS is here:
https://docs.google.com/spreadsheets/d/19uMgm1_fhGUbwouy15pCn1NNYwsQaD5Otrr251-HM8U/edit#gid=5

One of the things most people notice when starting using it is that the preshot numbers come down. So, despite the pattern during the initial 12 hours there does certainly seem to be some overlap/depot effect going on. I have tried many times to find out more about this, but there just isn't the info out there that there is on Lantus and Levemir. (I don't know how HPZI is stored in the body, for example).

I tend to think of HPZI as the 'love child of PZI and Lantus', because it seems to have some of the properties of both. It certainly has some kind of overlap/depot, but can also adapt to sliding scale dosing (although the overlap/depot does have to be factored in).

Over on DCC and similar sites they seem to think that HPZI is good for their protocol 'as long as people can handle the overlap'. And the dosing is done after 10 hours as long as the number is rising. Given HPZI's overlap/depot the thought of giving shots 10 hourly on a routine basis scares the pants off me!
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