Still bouncing, then hypo, what do,I do

Discussion in 'Feline Health - (The Main Forum)' started by Bellasmom, Feb 18, 2018.

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  1. Bellasmom

    Bellasmom Well-Known Member

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    He won’t eat much dinner, so do I give insulin or wait till he eats more
     
  2. Nan & Amber

    Nan & Amber Well-Known Member

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    I would hold off for a little while before giving insulin. Continue to encourage him to eat.

    He doesn't have any history of ketones or DKA, correct?
     
  3. Bellasmom

    Bellasmom Well-Known Member

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  4. Bellasmom

    Bellasmom Well-Known Member

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    Correct
     
  5. Nan & Amber

    Nan & Amber Well-Known Member

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    OK, then there's a little more leeway (and an in-and-out insulin like Novalin has time flexibility in any case). So, let's try to get him eating a little bit more-- at least half a regular meal would be good. He is probably feeling a little yucky from having his BG bounce up and down like a yo-yo, and he's definitely at a high point for him right now. He may start to feel better after eating a little, and just needs a little more time. Maybe there's something he really likes you can tempt him with? Even a few treats might get him interested in eating.
     
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  6. Bellasmom

    Bellasmom Well-Known Member

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    He just ate some Stella and chewys a few min ago
     
  7. Becky & Baby Girl Kitty

    Becky & Baby Girl Kitty Well-Known Member

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    I was told Novolin N had some carry over & not an in & out?!? I’m sorry if I was wrong but when Baby was on this, the vet said that... nope? She keep going lower the longer amt of time... ok
     
  8. Nan & Amber

    Nan & Amber Well-Known Member

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    I'm not directly familiar with Novalin N, so it may have some carryover (like the crystalline fraction of Vetsulin?), but I do know that it does not act like a "depot" insulin like Lantus or Levemir. With those, you have to try to keep to a 12-hr schedule, and always have to be conscious of the effects of the depot. With something like Novalin, I think you have more flexibility on shooting late, which it seems is what is going to happen tonight. Again, it's not an insulin I've used myself, so I may have the details wrong!

    In any case: I'm glad he's eating a bit more. Would you say it's approximately a meal's worth of food he's gotten in the past hour or two (I guess he'd eaten a bit before)?

    Another option might be to shoot an even smaller dose, like 1.0U. Here's the caution on that: we've been decreasing insulin rapidly over the past couple days, he's in high numbers right now, and he's not eating well. What we don't want to do is to trigger a ketones episode (potentially dangerous, and expensive to treat). So if we can get him eating enough that you are comfortable shooting the 2.0U, I'd feel better about it.
     
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  9. Bellasmom

    Bellasmom Well-Known Member

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    What food do you feed, he seems like he’s tired of fancy feast, I opened 3 different flavors
     
  10. Bellasmom

    Bellasmom Well-Known Member

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    Yes he are normal over a cpl hrs
     
  11. Bellasmom

    Bellasmom Well-Known Member

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    I think he may not feel real good or he’s just tired of this, he’s tired of being stuck, de doesn’t understand
     
  12. Nan & Amber

    Nan & Amber Well-Known Member

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    OK, if you think he's gotten a reasonable amount of food in him in the recent past, I think you can shoot.

    I'd get a reading around +2, the way you've been doing. to see where he's at.

    Poor little guy :(. Hopefully we can get him feeling better soon.
     
  13. Bellasmom

    Bellasmom Well-Known Member

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    I worry about how much to give him in the am before I go to work, I won’t be here to check it
     
  14. Nan & Amber

    Nan & Amber Well-Known Member

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    Hopefully @Kris & Teasel will be back online later tonight or tomorrow morning before you shoot, she's very good at this kind of thing, and by then, we should have a good idea of what he's likely to do with the 2.0U.

    With any luck, he's just feeling a little "off" because of the high numbers, and once the insulin pulls him down a bit he'll feel better. although, as I said earlier, just the ups and downs themselves can be unsettling (at least according to human diabetics who experience it).
     
  15. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I suggested on your other thread you drop him to 2 u tonight. Ignore the black bounce number. Try for a +2 or at least just before you go to bed. That plus your AM test should give a hint of what to do tomorrow. Post here in the AM. I'm in EST and am usually checking FDMB by 8 AM my time.
     
  16. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Keep offering very small snacks (1 tsp) of anything he seems interested in.
     
  17. Nan & Amber

    Nan & Amber Well-Known Member

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    OK, seeing a 365 at +2. That's 200pts since pre-shot (which was maybe an hour before the shot, with the delay?).

    How is his appetite doing? Any better? If you could convince him to eat a bit at this stage, it might slow him down a bit, so that he doesn't dive down and bounce up quite so high afterwards.

    Hope he's feeling a little better now!
     
  18. Nan & Amber

    Nan & Amber Well-Known Member

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    Adding: he's still high enough that I don't think he'll drop down too low tonight, this is partially just general advice to try to help tamp down the bounces, now or in the future. :)
     
  19. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I also don’t think he’ll go too low tonight. Try for a +4 test. If his AM test gives you a yellow around 250 drop his AM dose to 1 u. The no shot number for a pet meter when you’re new to gathering BG data is 250. If his AM BG is between 200 and 250 post here for advice.
     
  20. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I see that red this AM and the 2 u dose. He’s bouncing but the dose might not be high enough too. Don’t worry about that right now. Let’s see what he does today. If you don’t have half units on your syringes think about getting some that do. You’ll probably need them to give fractional doses. :)
     
    Last edited: Feb 19, 2018
  21. Bellasmom

    Bellasmom Well-Known Member

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    I have to leave for work at 7am I was just worried if I gave him more then it would go real low while I was at work
     
  22. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You did what I suggested and that's fine. The goal is to keep him safe for sure. The whole unit dose drops I recommended were based on those lime greens and on the fact that Novolin is fairly aggressive in its BG lowering action. There needs to be an extra margin of caution when you get active cycles like you've had.

    It's wise to do urine ketone checks with all diabetic kitties but certainly if he's in higher numbers. I might have mentioned it in earlier posts but you can buy human urine ketone test strips at any human pharmacy and here are some ways to get a sample:
    • put the end of the test strip right in his urine stream as he's peeing
    • slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
    • put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.
    Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

    I also don't recall if you said your syringes have half unit marks or not. You'll need those because his good dose range will likely involve fractions of units.
     
    Last edited: Feb 19, 2018
  23. Becky & Baby Girl Kitty

    Becky & Baby Girl Kitty Well-Known Member

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    Yes! I would not give more than 2 units if you’re going to worry! I know this is so hard for you... :bighug: you don’t want the highs but as they say- better high than a hypo event! Again! Sometimes trusting your own instinct is best!!!!
    Have a great work day! Let it go....
     
  24. Bellasmom

    Bellasmom Well-Known Member

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    I will have to pick up both, thanks
     
  25. Bellasmom

    Bellasmom Well-Known Member

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    Very hard and it’s hard on him, yeah there is no one home and I was worried, heck I wonder how many time I’ve given him 4u like he’s suppose to have and wonder how many times it got close to low omg
     
  26. Becky & Baby Girl Kitty

    Becky & Baby Girl Kitty Well-Known Member

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    I felt the same with Baby at first! Go low & he will be ok! Just for today at least! Glad you did a 2!
    My original vet started Baby on 5 units- it’s a wonder she’s alive! Stupid vet! Also didn’t find Lizzie’s breast cancer soon enough (thought it was a fatty tumor) otherwise I probably could have kept her a few more years! Glad I found a good vet that knows more!
     
    Last edited: Feb 19, 2018
  27. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You were following your vet's advice like all of us did - in the beginning. Now you're on a path to doing things differently and better for Bella. :)
     
  28. Bellasmom

    Bellasmom Well-Known Member

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    I, so glad you found another, I was thinking about the same thing, it’s so expensive those vets
     
  29. Bellasmom

    Bellasmom Well-Known Member

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  30. Becky & Baby Girl Kitty

    Becky & Baby Girl Kitty Well-Known Member

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    Oh my yes & what they charged at the ER vet was craaaaazy! But also glad they saved Baby!
     
  31. Becky & Baby Girl Kitty

    Becky & Baby Girl Kitty Well-Known Member

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  32. Bellasmom

    Bellasmom Well-Known Member

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    It’s 501 right now
     
  33. Bellasmom

    Bellasmom Well-Known Member

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    501 +8, should I got back to 3u, hit wrong number +9
     
    Last edited: Feb 19, 2018
    Reason for edit: Hit wrong number
  34. Nan & Amber

    Nan & Amber Well-Known Member

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    Where are you in relation to the shot time, how many hours?

    Edit: oops, just saw that you said, +8
     
  35. Kris & Teasel

    Kris & Teasel Well-Known Member

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    No, don’t increase just yet. He’s bouncing from the recent lows. Keep 2 u tonight and collect a before bed test. If a dose increase happens it’ll be only 0.25 u. I have a feeling that the dose you need right now is somewhere between 2 and 3 units.
     
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  36. Nan & Amber

    Nan & Amber Well-Known Member

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    Let's see where he is as you get closer to shot time. As Kris says, he's probably bouncing. Plus, on at least one day (2/17) he's done a big bounce in the middle of the day that faded by the next shot time, so you wouldn't want to shoot a larger dose if he's already heading downwards on his own.
     
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  37. Bellasmom

    Bellasmom Well-Known Member

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  38. Bellasmom

    Bellasmom Well-Known Member

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    BG 436
     
  39. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Stick to 2 u tonight. Get a before bed test. :)
     
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  40. Bellasmom

    Bellasmom Well-Known Member

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  41. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I suggest you get another test at +4 or just before bed because the data will help the next dose decision.
     
  42. Bellasmom

    Bellasmom Well-Known Member

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    Sorry missed your message, I was in bed, I will try and stay up later at night, will do tonight at +4, sorry
     
  43. Kris & Teasel

    Kris & Teasel Well-Known Member

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    No problem! Sleeping is allowed. ;)

    I see you gave 2 u this AM. Do that again tonight. Try for a mid day or coming home from work test if you can as well as an evening test tonight. That data will fill in the picture better. I'll likely recommend you increase to 2.25 u tomorrow AM. If you don't yet have syringes with half unit marks you'll need them ASAP. In the interim you can make up a reference syringe using coloured water drawn up to your best eyeballed estimate of 2.25 u. Use it as a comparison guide for the 2.25 u doses.

    Think about urine ketone testing too (post #22 above).
     
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  44. Bellasmom

    Bellasmom Well-Known Member

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    I’m not able to check until it’s his dinner time, have to work over
     
  45. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Do what you can. :)
     
  46. Bellasmom

    Bellasmom Well-Known Member

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    Husband took it 224
     
  47. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Hey, not bad at all! :) It was wise to stick to 2 u tonight.
     
  48. Bellasmom

    Bellasmom Well-Known Member

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    We are at 56 at +5
     
  49. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Well, that’s a surprise! Give him a small snack of high carb food, wait about 15-20 minutes and retest. Repeat the small snack, wait 15-20 min, retest until he’s above 68. Then, try leaving him without food for 30 min and retest. If he can hold himself above 68 without snacks test after 1 hour.

    Tomorrow reduce his AM dose to 1 u.
     
  50. Bellasmom

    Bellasmom Well-Known Member

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    Did not see your post till this am after his insulin shot, gave 2u, Im sorry, I’m trying real hard to follow what you say, husband is home today he can watch his BG today, got his BG to 108 last night, hubby woke,me up in panic as he was checking is BG at +4 last night. Will check here from now on before insulin given
     
  51. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, please do check here before you give his shot. He’s reacting strongly to the insulin and his dose needs to come down. I think you said no one is around through the day to keep an eye on him, right? He might be in higher numbers through the day because of the rebound from the overnight lows.
     
  52. Bellasmom

    Bellasmom Well-Known Member

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    My husband is there on wed and thurs, he’s gonna check him at +4 if you think that’s ok, if not he can check anytime, I’m sorry for not checking first, I will from now on
     
  53. Kris & Teasel

    Kris & Teasel Well-Known Member

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    That's great! Get a +4 test. Will your husband post it here or can you via your phone?
     
  54. Bellasmom

    Bellasmom Well-Known Member

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    He will text me and I will document
     
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  55. Bellasmom

    Bellasmom Well-Known Member

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    BG218
     
  56. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Good! He's coming down quickly from the red bounce number. Ask your husband to get a +6. The fact that he's coming down with ease suggests to me that the 2 u is too high but I don't think he'll dive into lime green through the day. I recommend dropping to 1 u tonight.

    Also - low numbers will make them more insulin sensitive for a cycle or two afterward. That's contributing to the drop today as well.
     
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  57. Bellasmom

    Bellasmom Well-Known Member

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    214
     
  58. Kris & Teasel

    Kris & Teasel Well-Known Member

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    He's safe through the day today. I still recommend dropping to 1 u tonight and leaving the dose there through tomorrow.
     
  59. Bellasmom

    Bellasmom Well-Known Member

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    Ok thanks, it amazes me how much you know all about this, I sometimes get so confused as to why it changes so much and I want you to know all your help is truly appreciated
     
  60. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You're welcome! I've learned from others here on FDMB. I came here 18 months ago because I was clueless about how to deal with my very unpredictable cat. Many, many posts and lots of reading/spreadsheet studying later I'm starting to see some things more clearly. :smuggrin:
     
  61. Bellasmom

    Bellasmom Well-Known Member

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    436 at +8
     
  62. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Bouncing. The PM pre shot BG will be an important deciding factor. I might revise my recommendation then. We're both on Eastern Standard Time. What is your usual shot time on the clock?
     
  63. Bellasmom

    Bellasmom Well-Known Member

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    630
     
  64. Bellasmom

    Bellasmom Well-Known Member

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    BG 419
     
    Last edited: Feb 21, 2018
    Reason for edit: Retested
  65. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Because his PMPS is high I think you can try 2 u again. Get a test at +2.
     
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  66. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I'll check in later. :)
     
  67. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Try 2 u again today. If possible get a test between +4 and +7.
     
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  68. Bellasmom

    Bellasmom Well-Known Member

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    I gave 1u this am, he gets it at 630am so I wasn’t sure what dose, since it was lower this am than past cpl days I used 1u, I probably didn’t give enough since you said 2u today, I am trying but his does is so early in the am cause I have to go to work I wasn’t sure what to do
     
  69. Bellasmom

    Bellasmom Well-Known Member

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    My husband can test today while I’m at work
     
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  70. Kris & Teasel

    Kris & Teasel Well-Known Member

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    No worry - you can always increase tonight. Have you tried testing his urine for ketones. That's important too and easier than you think. I'm pretty sure I gave you the how-to tips.
     
  71. Bellasmom

    Bellasmom Well-Known Member

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    I’m getting it today, had to wait till I got paid
     
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  72. Bellasmom

    Bellasmom Well-Known Member

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    I can use any type of ketone strips right, like human ones
     
  73. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, that's what you'd use.
     
  74. Bellasmom

    Bellasmom Well-Known Member

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    Couldn’t test now, he heard beep on machine and hauled butt under bed, he’s never done that before, his paws must be getting sore and he is tired of getting stuck, my poor baby
     
  75. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Don't push it. Maybe try later. With the 1 u dose he won't likely drop low.
     
  76. Bellasmom

    Bellasmom Well-Known Member

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    BG 488. 2u??
     
  77. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes. I'm sorry that I'm late seeing this. Hurray for negative ketones!
     
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  78. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Try for a before bed test tonight. I suggest one more day at 2 u tomorrow. Depending on those numbers I might suggest moving up to 2.25 u on Saturday. Did you get syringes with half unit marks?

    If you're surprised by a yellow between 200 and 250 tomorrow AM, drop the dose to 1.75 u if you can eyeball it. It that worries you try 1.5 u. I don't think you'll have to do that but they can and do surprise us!
     
  79. Bellasmom

    Bellasmom Well-Known Member

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    Yes I got syringes with half units, and no, no yellow this am
     
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  80. Kris & Teasel

    Kris & Teasel Well-Known Member

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    So - 2 u for today. :)
     
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  81. Bellasmom

    Bellasmom Well-Known Member

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    BG 364 +7
     
  82. Kris & Teasel

    Kris & Teasel Well-Known Member

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    So far, it looks like 2.25 u tomorrow AM is the next step.
     
  83. Bellasmom

    Bellasmom Well-Known Member

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    Keep 2 tonight then?
     
  84. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I prefer to start a new dose in the AM on a day I can monitor. Your choice, though. You can increase tonight but make sure to get a before bed test. Sometimes they can have an initial “excited” response to a new dose and then they settle down.
     
  85. Bellasmom

    Bellasmom Well-Known Member

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    Tomorrow is fine, I will be here with him all weekend, I just wanted to be sure, thanks
     
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  86. Kris & Teasel

    Kris & Teasel Well-Known Member

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    He's dropped quite a bit at +2. Looks like the daytime cycle on 18 Feb. That gave you a lime green. I suggest a test at +3 and +4.
     
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  87. Bellasmom

    Bellasmom Well-Known Member

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    Is there a glucose meter that works well and the strips aren’t so expensive, these strips cost me around 46.00 for 50, I see what you use and also quite a few people use relion, is that one pretty good
     
  88. Bellasmom

    Bellasmom Well-Known Member

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    66 +3 gave high carb food and rubbed gums with honey
     
  89. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, most of us use a human meter because the pet meter strips are SO expensive. The ReliOn Micro and Confirm from Walmart are popular because the need only a tiny blood drop to give a reading. They read lower but we can help you with that.
     
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  90. Bellasmom

    Bellasmom Well-Known Member

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    Can’t recheck, he ran under bed and WILL not come out, should I be worried, he ate quite a bit
     
  91. Bellasmom

    Bellasmom Well-Known Member

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    He was really picky at eating this am, I opened up 4 different flavors of fancy feast and he really didn’t want any of them, he ate Stella and chewys and wanted orijen dry, he meowed and meowed, guess I’m gonna go get something different for him, I’ve tried Dave’s, nope, friskies, he picks at, I think he just wants his old life back where he can have what he wants, he doesn’t understand. I do feed my other cats dry and wet, I tried taking away the dry food from everyone and I didn’t have many cats eating
     
  92. Kris & Teasel

    Kris & Teasel Well-Known Member

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    It's very frustrating when they're picky eaters. I have to go out now for a couple of hours. Do what you can and I'll check in later.
     
  93. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Make notes on the right side of your SS about what and how much you fed to get his BG up. It’ll be good reference for the future.
     
  94. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I'm back. Have you feed giving him little snacks? Any more test numbers?
     
  95. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Have I given you this link before? http://catinfo.org/docs/TipsForTransitioning1-14-11.pdf

    Here are a number of tips I've read on FDMB about transitioning or making wet food more palatable to fussy cats:
    • crush up some kibble that they like and put it on top of wet food
    • add tuna water (plain water, not oil) to wet food
    • shake parmesan cheese on the wet food
    • buy some Fortiflora from your vet (a powdered probiotic to help with digestive problems) and sprinkle a little on the wet food - most cats really like it.
    Some people resort to Young Again Zero kibble that can be bought online. It's very low carb. Another low carb kibble is Dr. Elsey's Clean Protein.
    https://www.youngagainpetfood.com/zero-formula.html
    https://www.drelseys.com/clean-protein/
    Both companies will send you a free sample if you contact them. Dr. Elsey's makes a canned version of Clean Prtotein as well.
     
  96. Kris & Teasel

    Kris & Teasel Well-Known Member

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    New plan for the next few cycles: drop back to 1 u.

    He's dropped too low twice now on the 2 u dose. The higher numbers have been inflated from bouncing. I based the suggestion to increase to 2.25 u on those numbers. That they were bounce-inflated wasn't immediately apparent after 20 Feb but now seems to be the case. He's also more insulin sensitive from those lime green numbers.

    If 1 u seems too low after a couple of days it can be slowly increased. You can see, I think, how tricky it is to get a good dose range when the dose has been too high resulting in very low numbers that make him insulin sensitive at the same time as they cause him to soar into high pre shot numbers. You'll get there ...
     
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  97. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I see the dark green on your spreadsheet. That's a lovely number. Did it take a lot of intervention with dry food and homey to get him there?

    Your thoughts on y suggestion to drop to 1 u?
     
  98. Bellasmom

    Bellasmom Well-Known Member

    Joined:
    Feb 12, 2018
    We are 480 right now, I don’t understand why it goes from 1 extreme to the other
     
  99. Bellasmom

    Bellasmom Well-Known Member

    Joined:
    Feb 12, 2018
    It took 2 snacks and I rubbed honey on gums 2x
     
  100. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    The highs are a rebound in reaction to the low numbers you've had. We call it bouncing. Here's something I wrote a while ago to explain it:
    1. BG goes low OR lower than usual OR drops too quickly.
    2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
    3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
    4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
    5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
    6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
    So: insulin dose is too high --> BG drops too low --> kitty's body tries to protect itself by putting glucose into the bloodstream, getting it from a stored form in the liver --> BG shoots up too high.

    I hope you drop the dose to 1 u tonight so we can get him settled.
     
    Last edited: Feb 24, 2018
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