Unsure About Correct Doses

At night Victor rarely eats all of his food and my mom and I are never sure about what dose of insulin we should give him cause it's really difficult for us to judge how much he ate based on what's left in his bowl. His vet told us to follow these instructions:

1/4 food = 1/4 insulin
1/2 food = 1/2 insulin
3/4 food = 3/4 insulin
All food = all insulin
(His full dose is 2 units)

Could anybody give us a bit more advice on how to best judge how much he's eaten? We are just really worried about giving him an incorrect dose and are so stressed out by it all. If we were to ever wind up with an emergency situation, we have no easy way of getting him to a vet as we don't have a car, so I don't know what we would do. Is it okay if we skip a dose if we're not sure about how much to give him?

We're also not sure where on the syringe would be 1/4 of the dose and 3/4 of it. (We are using U-100 syringes, 0.3cc)

Please give us all the advice you possibly can.

 

It will help if you'll get syringes with half unit markings. All these syringes have half unit markings (very important when you're doing microdosing) and are the correct syringes for a U100 insulin and are available from ADW online:
UtiCare
Monoject
Carepoint
Sure Comfort
B/D

They're also available at WalMart if you have one near you. Their Relion brand 3/10ml, 30 or 31 gauge, 6mm or 8mm insulin syringes all come with half unit markings and are only $12.58 for a box of 100 (although a lot of them don't realize they DO come with half unit markings!)

You might want to get a small kitchen scale like THIS ONE

You just weigh the bowl with food, then after he's eaten, reweigh and do the math.....that will tell you within a gram how much he's eaten.

 

These are pictures of .25 and .75 in syringes with half unit markings

 

I'm new to this discussion. Here's a handout I made up for new people a while ago. Read it through and ask any/all questions you have:

It would help us if you set up your signature (light grey text under a post). Here's how: You've already done this.

• click on your name in the upper right corner of this page
• click on "signature" in the men that drops down
• type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.

Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/ This is essential for us to see if we're going to offer good advice.

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Here's the basic testing routine we recommend: This is the basis of everything we do here.

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

This is useful: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

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Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:

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.

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Here are some tips on how to do urine ketone testing (VERY important if BG is high and kitty isn't eating well!):

• 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.

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You've been thrown in the deep end of managing feline diabetes and it's very stressful. We've all been there. Here are some more questions and comments:

• how was the 2 unit dose arrived at? Is it based on your kitty's weight? One blood glucose test at the clinic? The usual (safe) starting dose is 1 unit but don't change anything until you set up a spread sheet and begin gathering data from home testing (ESSENTIAL!)
• the testing routine described above will give you a good idea of how he'e responding to the Humulin
• Humulin can act quickly and drop the BG fairly low so a more cautious approach is needed
• it's best to wait at least 20-30 minutes after a meal before giving Humulin so there's food on board to cushion its impact
• your goal for the mid cycle low BG is in the range of 90 - 110 because of the more aggressive action Humulin can have
• if the W/D food is dry it's likely very high in carbs so you should consider a switch to a low carb canned food. This will definitely help with weight loss and BG control. Very careful monitoring of BG by home testing is essential during the switch because the new diet can have a big impact on BG.

Keep asking questions here. Post often. Unfortunately there's no escaping learning to test BG at home to keep your kitty safe - especially if you can't easily get to a vet if needed.

 

Thanks so much for the response. We weren't able to get everything we needed yesterday, so were unable to start testing then, but we should be getting everything today for sure but not until after his morning dose. Would you suggest starting testing before his nighttime dose or waiting until tomorrow? (The meter we'll be getting is the Relion Confirm) I've read that it might take a few tries before you get a successful test done, so if we don't get it done successfully, should we still give him his shot?

I do have some other follow-up questions:

We don't give him any food for 2 hours before we test him, we test, then feed, and then give his shot based on how high or low his numbers are, correct? And if his numbers are below a certain level we shouldn't give him his shot at all, which is referred to as "no-shoot" right? What would the no-shoot number be?

How many hours after giving him his shot would be considered mid-cycle?

What exactly are the "days off" you mentioned?

Do we still need to adjust his dose based on how much of his food he's eaten? If so, how do we go about that? (His food is dry, but we should be looking into switching him to canned/wet)

I'm not quite sure how our vet arrived at the 2 unit dose. We initially took him in because he was drinking more water/urinating more than usual and their test showed his blood glucose level was in the upper 480's, so I assume it was based on that. I don't know if his weight was a factor. When we took him back in a week later to be checked, his BG was at 510, and the vet wanted us to increase his dose to 3 units, but after researching on here, I convinced my mom that we shouldn't increase it until we were able to start home testing, so we've still been giving him just the 2 units.

Regarding the waiting for 20-30 minutes before giving him his shot, he doesn't eat all of his food in one sitting. He'll eat a little bit, leave for a few minutes, then come back and eat some more, and just repeat that 3 or 4 times before he finishes most of it or decides he's had enough. How do we account for that?

His next vet appointment is today actually, and I'm kind of nervous about telling her that we haven't been giving him the 3 units. She's one of those vets who discouraged home testing when we asked about it. Do you have any advice on how to handle that? And are there any other questions you think we should ask her? Again, thank you so much for taking the time to share your advice, and I hope your kitty gets feeling better.

 

My cats are a grazers. As long as he's eating something I wouldn't worry too much. My cat takes hours to finish a can of food. Lol

 

Maybe just be honest with the vet. Your not comfortable giving that much insulin without knowing if the glucose is high enough to warrant that dose safely. Tell her matter of factly you will be home testing as soon as everything arrives which is today.