Woody BG!

This a.m. At Woody's +11 he is 283! It looked likes he slept through the night too! No kibble gone . So, I know I am not suppose to look at that number to base his injection (well I know I will sometime, but I know I need to look at his lowest) but do I give this injection?

I know I won't be home tomorrow or Friday to monitor him, I will be today. Someone can pipe in!

 

How much are you giving him?

 

Well, last night was 1 and I just gave him .5 and will check him in 15 min at +1

 

Good call! I'm glad you only gave a very small dose. Keep a close eye on him, since we know how easily he can drop too low.

 

I didn't even want to do that much!

 

Understandable, given his propensity to bottom out. I think he should be safe with 0.5U, just keep checking him periodically to be sure.

 

By the way, you are doing a great job!

 

I feel like I've done so many dumb mistakes. The vet was only worried with the high numbers and I am struggling to get off that bus! Woody was 363 at +1

 

It's definitely a learning experience! We've all made mistakes, it's almost impossible not to when you are new to this sugar dance. We all expect our vets to be fonts of knowledge, and in many ways they can be, but not every vet is experienced in dealing with feline diabetes.

What did Woody eat this morning? Did he have breakfast just before his shot?

 

He had about 4 oz of canned w/d and he ate at 7 and I gave his injection at 7:30. I'll be checking him again in 15 minutes

 

They both ate more this morning than what I've seen for a long time! Now Buzz was begging for bread last night at the table and again for waffles this morning. No, I didn't indulge on that! No more high carbs for that carb junky!

 

I second Lucy's comment...... You are doing a great job! Those high numbers are very hard to ignore but ignore them you must and focus on the lowest numbers. Interesting that Woody didn't get into the kibble. I'd try to keep it out of the mix from here on unless absolutely needed for an explicit reason!


@Squalliesmom So glad you were here to help with the morning dose! Much appreciated!

 

The kibble smells horrid to me now! Not that the canned smells better, but something in that kibble turns my stomach!

 

Seconded.

 

337 at +2!

 

It's normal for BG to rise after food, so don't panic at the 363 reading. MrWorfmens Mom is absolutely correct - right now you need to ignore those higher numbers!

@MrWorfMen's Mom No problem!

 

I assume you're feeding w/d canned in which case that AM+1 pink is highly likely to be a food rise.

Much better curve overnight. Flatter. A nice sunbathe with a brief dip into the lagoon.

The smoother curve should also be much gentler on Woody's system than the recent roller coaster rides.


Mogs

ETA - +2 may also be food influenced.

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Lol, tell Buzz that bread and waffles (even if he forgoes the syrup) are big no-nos!

 

Also ^this^ will influence numbers.

It's really helpful when you post observations like this, MO2F. Did they not eat very much before injection time before today?

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Ditto!

 

Buzz has always had a thing for bread. He'll jump up on the counter and chew through the bag. Yes, I am putting up the bread. I'll need to find one of those bread boxes to have it back on my counter!

 

How funny! My Bengal boy likes bread, too. His favorite are rolls, though, because they can double as toys, lol.

 

Gee now I wonder if Menace was pilfering my bread rather than the peanut butter the day she covertly snacked on my sandwich!

 

Buzz will also knock the food can down, paw the lid off if it's not on good enough, he's just a stinker. Woody was out climbing around on the windowsills, we haven't seen that for awhile either. I am so glad we enclosed the porch 2 years ago! The sun comes in, they have windows and the slider to look outside, and the best of all they love it and neither minds going out and being out there. So, feeding separately is easier!

 

Woody +3 354. I guess I wait to see what + 4. + 5 looks like. So would you increase insulin to 1 unit tonight if he doesn't drop below 300 today?

 

+4. 346

 

Let's wait a bit and see how his numbers shake out before making a decision. Are you able to monitor him through the night?

 

I could do a +3 and probably a +5. I will be working tomorrow with 17 first graders which has had 2 snow days lol

 

Great job so far today with Woody. Hopefully he'll be able to level out a bit over the next day or two, clear any bounce that's still hanging around from yesterday and then you'll be able to see where his numbers really are on a low dose.

 

Another member posted a link to this forum sticky. Study it ASAP because it will help you better understand the Novolin insulin and give you key pointers to consider when making dosing decisions (and also show you that others have had similar problems to yourself with this particular insulin).

Humulin N Primer (Humulin N is the same as Novolin - different manufacturers)


Mogs
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Novolin is same as Humulin N (different manufacturer).

Key points from Humulin N Primer for immediate consideration:

• FOOD. Always make sure kitty eats about an hour before his/her shot.

• [Humulin] N, in [author's] experience, can peak at anywhere from 2 to 6 hours.

• You cannot adjust a dosage on preshot alone. Preshot numbers can be deceiving in that if you are going too low at peak, you will have high numbers at preshot.

• Consistently high preshots without knowledge of your nadir number could mean rebound, at which point you don't need to increase your dosage you need to DECREASE. [Possibly where your vet went wrong.]

• If kitty is going too low ([author didn't] like Bunny to be anywhere under 100 [NB: HUMAN METER VALUE - Alphatrak equivalent BG would be HIGHER than this] and [author], personally, [did] not “shoot” under 250 [HUMAN METER - again, Alphatrak equivalent BG would be HIGHER than this]), definitely decrease your dose. [@mrworfmen's mom - any idea on possible Alphatrak guidelines for these thresholds?]

• Many people have found that ½ a unit BID or 1 unit BID ends up being the perfect dosage to keep kitty in the 100-300 range. [HUMAN METER - again, Alphatrak equivalent BG would be HIGHER than this.]

[Emphasis & comments mine]

The primer also features the following cautionary tale:

Ring any bells?


Mogs
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Ok, so do I keep this .5 to see if he will start to even out? Then up to 1 this weekend when I can monitor him the whole day.

 

Its

This is a repeat!!

 

Pretty much chapter and verse.

 

Are you testing for ketones?

How is the infection at the moment?

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So, probably keep him on .5 at least until Saturday am so I can monitor Saturday Sunday and at +5 on Monday. I could slip home at +2.75 but I'd have all but 5 minutes!

 

Could you answer the questions above, please: they have a direct bearing on insulin requirements.

 

I have no way to catch his urine. We have no aquarium rocks available in this town. His eye is red but he doesn't have the goop coming out.

 

His other eye is clear.

 

If the infection's still on the go and you have no idea of ketone status then you don't have as much wiggle room in terms of dosing flexibility because you need to balance risks.

Can you monitor till +5 or +6 tonight?

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Also can you tell me the exact name and size of syringes you are using.

 

I can do that for Woody! but I can't tomorrow morning. The syringes are Ulticare 1/2 cc. 29 gage x 1/2.

 

I was worried that he was getting constipated because I had seen his pudding poo, but he and Buzz are separated today and I just saw that he almost back to normal. It's not pudding, but it's also not solid. And his urine output is not so much the last 3 pees

 

I had this problem too! Ended up putting all bread products in my microwave or in the oven (of course you have to remember if you put it in the oven and make sure you take it out before you start pre-heating it.....Oops.....LOL)

 

He has a good mama.

You've got a bit of a balancing act going on here. With the infection you need to be a little extra careful with the high numbers. With the harsh insulin, major history of hypos and treatment of the infection all going on you need to make sure that Woody doesn't go low (quadruply so when you need to be out during the day and can't test from +2 onwards).

Here are some options to consider:

1. Give 1 unit and see if it takes him too low tonight. (This will make sure he has insulin but carries the risk of him going too low.)

2. Give ½ unit and see if he levels out and dips down a bit during the night (hence the question about monitoring). There is a chance he may stay in the pinks but there's no way of knowing until you try and test. (Because Woody has an infection the smaller amount of insulin may increase the risk of his developing ketones.)

3. Give 0.75 units as a 'compromise' and test to see if this will lower his BG better than the 0.5 unit dose. (Don't know if you can measure this dose relatively accurately with your syringes - plus it's an unknown quantity.)

If I were in your shoes and working with a harsh in-out insulin like Novolin N (and I'm just speculating here) if I knew that ketone risk was higher than normal I would possibly look to keep numbers higher and safer when I could not monitor and perhaps just a little bit lower (but still in the high 100s at nadir) when I was home at night and knew I could monitor to keep my cat safe over the night time cycle.

Conjecture, but that would be the 'flavour' of my approach. Other members may have different suggestions.


Mogs
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ETA: The infection causes two issues:

1. Greater risk of developing ketones while it is ongoing.

2. Risk of numbers dropping unexpectedly if it resolves.

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I've got severe OCD. Before I can dish up Saoirse's grub or set out her treatment accoutrements I have to make sure there's absolutely nothing containing any carbohydrates on the same surface. I can't even use the microwave because I need that to warm up the water for her tests or to take the 'chill' off her grub.

Thank gawd for the oven.

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He's been on antibiotics since Monday evening. They gave an injection and I've been giving him 1 ml twice a day since yesterday morning. Buzz's eyes are clearing up and he is on the same treatment. I know that Clavamox isn't the drug of choice among members but I couldn't remember at the vets what the name was .

 

I just added a bit about infection to the end of my earlier post.

 

+6. 347

 

What have you fed Woody today and when?

 

Need to sort out some food for my little one. Will be back in a while.

You're doing a phenomenal job with the home testing.

,

 

I know I have Caninsulin experience but never having used Novolin I would very much like to see suggestions and comments from other members for MO2F to consider.

@MrWorfMen's Mom, @Chris & China, @manxcat419, @Squalliesmom -

I'd be grateful if you could review my earlier post to see if there is anything out of place in my suggestions for an overall approach to treatment in this situation or whether there is anything better you could suggest to MO2F? I don't feel comfortable being the only person chiming in here.


Mogs
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He got 4 oz of canned w/d at 7:00 this morning. He has had nothing else. I didn't mix any friskies for him. But, he did
Have a very good appetite this morning.

 

Just reading back on the thread now...been off for a little bit doing Rosa's meds.

 

Be sure to log when and how much you feed every day. Between the food log and the BG tests you get when you're able to monitor it will give you a much better guide to how Woody's BG might go when you're away from the house.

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@manxcat419 - Thanks, April.

 

Ok

 

I wonder if his increase in food this morning helped keep his BG up and he didn't eat that much yesterday morning when he dropped so hard and fast. But they haven't been eating a lot until today.

 

Not really true:
Humulin is Eli Lilly's trade name for a family of Recombinant DNA origin insulins. They include N (sometimes called NPH), and R (very fast actions) and mixture of the two. Only N/NPH is OK, but not that good, for cats.
Novolin is Novo Nordisk's trade name for a family of Recombinant DNA origin insulins. They include N (sometimes called NPH), and R (very fast actions) and mixture of the two. Only N/NPH is OK, but not that good, for cats.
Novo Nordisk's Novolin insulin is typically less expensive that Eli Lilly's Humilin
Walmart also the same insulin under there house brand of Relion and it less expensive than Humulin and Novolin

 

I don't have direct experience with anything except Lantus for cats (I do know Novolin in humans, but it doesn't translate across very well I don't think). Your suggestions look good to me - I agree that it's definitely vital to keep Woody running in safe numbers any time he can't be monitored but without losing the overall control. 0.75u could very well be something that would work for him if it can be measured but you'd probably want to try it on at least a couple of cycles where you can monitor before using it on a day when you can't be home with him. I'm sure at least one of us will already have mentioned this, but for all we like to have cats as carefully regulated as possible, you have to be able to survive this too...there are going to be nights where you're too tired to monitor as well as days where you can't be home so finding a safe option for those times is really going to help. It may well be that the 0.5u will be the best option for that for now - so far it doesn't seem to have got him into ideal numbers today, but I'd rather see him run in the 300s when you can't monitor than have the possibility of him getting down to the 20s and 30s when you're not home.

The infection also concerns me - of course it's concerning that it's there and checking for ketones, if you can do it, would really help to make sure it isn't causing him issues there. But given that that is quite possibly making him run higher, there is the possibility as Mogs says that he will drop quickly once it resolves. I'm not sure exactly how you get around that - as you have some physical signs of the infection, monitoring for those to start resolving and knowing you may need to be alert for lower numbers at that point may be the only way of managing it.

If the urine catch is only for testing ketones, would there be any possibility of just sticking a ketone test strip under him when you see him in the litter box? I have been able to do that a few times and it is sometimes easier (and definitely quicker) than any of the other options.

I thought it was only me who did that! And if I've cooked anything with onions or garlic or anything else that's bad for cats in it, I can't prepare Rosa's meds or food until every last thing is cleared away, all the surfaces wiped down (even if nothing touched them) and all the pots and dishes in the dishwasher. I'm not sure exactly how I think the onions are going to jump from one side of the kitchen to the other, but I have it in my head I'm going to make her sick if I'm not that careful!

 

Thank you for the clarification on insulin types, Larry. (I was going on the information in the Humulin N Primer.)

Mogs
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I did go get some strips to check his ketones. Now to figure out how to catch it. My husband will be thinking about this lol

 

I knew being anal about this stuff and testing with both human and pet meters would all be worth it at some point. I just checked my spreadsheets for multiple readings in the 245 - 270 range on a human meter and on my AT meter the range was 365 - 405. So from that I would personally think I'd set the limit about 375 as a no shoot limit on the AT meter if Woody were my guy. I think that still provides a little cushion.

 

Ok, the 300's aren't too high?

 

Thanks, Linda.

 

The composition of cat blood is different from human blood. Most human meters now read plasma equivalent instead of whole blood. Most of a human's glucose is carried in the blood cells whereas a cat carries most of theirs in the plasma so that's why the readings are different. The AT is programmed to count plasma glucose based on cat blood whereas the human meter extrapolates based on human blood composition. So the readings for a cat on a human meter are lower than their actual levels. So while you don't want kitty sitting at 300 all the time on either meter, it's not as "worrisome" a number on a pet meter as it would be on a human meter.

 

Oh, ok. Has anyone had experience on an ipet mentor? That's what the vet uses

 

I am not aware of anyone using one here but I did see someone selling some strips for it in the supply closet not long ago. I'd expect any differences would be minor between that and the AT....somewhat like no two human meters will ever read exactly the same but they'd be relatively close. You could always do a comparison in the vet's office next time one of the boys has blood drawn.

 

+9. 279

 

That's not OCD. That's being technically perfect and you are to be commended for your diligence in my books! I have a hot water dispenser but if I needed the microwave I'd probably buy Menace a small one for her birthday. I'd be lost without mine!

 

The vet upped his insulin to 15 at 226 at +9

 

I'm going to have to say it one more time - I don't think your vet has much of a clue how to handle insulin dosing. +9 on Novolin is usually well after nadir and I don't think that number warranted an increase from a single reading like that. Linda, I don't suppose you have comparison figures for your AT for the low 200s by any chance do you? I can get a rough idea with the 30% although I know we can't take that as being accurate, but a real comparison would be good to see.

 

The ketones are negative. He let me place it!!! He is glaring at me though!

 

The characteristics of the insulin one is using has a huge bearing on the range in which it is safe to keep the cat. With harsh insulins like Novolin and Caninsulin they can drop blood glucose levels very hard so it tends to be necessary to work in higher BG ranges for safety. In comparison, insulins with gentler action (e.g. Lantus, Levemir) they don't tend to produce the steep drops so there is greater opportunity to keep a cat in more tightly regulated numbers.


Mogs
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I was being sarcastic lol I get myself in trouble sometimes.

 

Unfortunately I don't have a lot of lower readings YET but I'll peak at my data and see what I can find. Hopefully if things keep progressing I might start getting some more data in that range in the near future. Fingers crossed!

I have to agree re: the vet. It doesn't appear he knows much and his wife's claim that he researched anything seems very questionable to me.

 

Woot!

Well done, both of you! It's very good news that ketones are negative. (And may they stay that way!)


Mogs
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YAY! Good stealth work! Congrats!

 

The very same here!

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I'm so glad this is one place where we can all have our paranoid moments and find understanding from others instead of people looking at us like we're crazy!

 

Trust me, Linda; it's OCD. (I neglected to tell you about all the counting rituals and having to have every bit of paraphernalia put out in exactly the same sequence in exactly the same place every time. )

But I'll take the plaudit, regardless.

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Hear, hear!

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How many times a day do I check them?

 

My family is starting to think I'm crazy! Watching to stick a pee stick will definitely seal the deal with my daughter!

 

I think checking ketones daily would be ideal until the infections are cleared up.

 

Remind her of how well you cared for her when she was a baby.

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I don't have any experience with Novolin or any of the faster acting insulins but FWIW, based on what I have learned since joining, I think your recommendations make logical sense and are sound.

 

Thanks for the review, Linda. All I have to offer are general principles, not anything specific to Novolin as I've not used it either. It's even harsher than Caninsulin.

 

Buzz has a 134 BG and he's hasn't had an insulin shot for almost 48 hours.

 

Excellent news! Happy dance!

 

Might improve even more when the infection clears. Be sure to also check Buzz for ketones to be on the safe side.

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Did Woody eat anything between AM+6 and AM+9? (And if yes, which food and how much?)

 

No, he did not. I don't know what happened except he was taking a nap.

 

I think you're right on the money, Mogs, it sounds good to me. I know Novolin and Vetsulin aren't exactly the same but they are very similar, and that's probably how I would handle a similar situation, using Vetsulin.

ETA: I will always err on the side of caution. Better to make small mistakes you can recover from rather than HUGE ones that could be irreversable!

 

@Squalliesmom - Thanks for the thread review, Lucy.

 

I can relate to the kitchen OCD. I have pretty much given up coffee because I have to basically clean and disinfect the entire kitchen before I can make a pot. I can't even begin to describe what feeding raw and having it out in the kitchen and handling it does to me!

 

Sorry I'm so late to the party! Been dealing with some health issues of my own.

 

I've scoured my data and to my surprise I did have a lot of readings in this range (YEAH! that's good news for me). I guess I pay more attention to my AT numbers and of course I use mmol. so not as attuned the US equivalent on daily basis!

For readings between 198 and 225 on a human meter, my spread of readings on the AT was 274 to 398. Averaged out it's roughly 300-337. I think this gives us a ballpark but it's important to note I had only one or two comparisons for some human reading numbers and a dozen for others so these numbers are certainly not precise.

OF INTERESTING NOTE: Although just supposition at this point........there appears to be a pattern of a higher difference between the readings when Menace is having a very obvious bounce and the AT meter appears to pick this up sooner than the human meter. Same seems to hold true when her numbers have gone lower than her usual. Looks like the AT picks that up a tad earlier too. Got to pay more attention to see if this continues to hold true or is just an anomaly or my imagination.

Thanks for asking me to do this April. It has been an enlightening exercice!

 

I know you've written before about exactly how the glucose is measured in various meters, Linda, but PTSD won't let me remember it properly so forgive my following question: Could a difference in the way the Alphatrak meter process the blood sample account for the (apparent) increased sensitivity?

That's the trick with data: it only becomes really powerful when finally fathoms out the right questions. (Same goes for the information on the intertube. )


Mogs
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I think that may be the reason or possibly it's because the glucose in a cat's blood is carried mainly in the plasma and most human meters are providing a plasma equivalent by doing some computations based on the whole blood human sample where the majority of glucose is in the red blood cells. The AT meters are simply old human meters with new programming so if the meter is still providing a plasma equivalent reading (and I think this is a safe assumption given we think the strips are same as the FS strips and they work in the AT meter) could it be that the cat's ratio of blood cell glucose goes up before it's plasma level and this is being accounted for by the algorithm in the AT meter in such a way as to make the increase look more apparent. Just a guess!

I'm going to pay more attention to this and see if the trend continues. Menace doesn't have seriously pronounced bounces but as I went through the numbers I noticed a few times when I had multiple comparisons that the difference between the meters was more apparent when her numbers were on the way up or down. For example at a reading of 11.8mmol (212 US), I had readings from 15.6 (281 US) up to 19.7 (355 US) with the majority being in the 18's (324 - 338 US). Happened to notice a notation regarding thinking she was bouncing and the lights came on. It would be really interesting to be able to test a cat on one of the faster acting insulins where there are more dramatic changes in BG throughout a cycle to see if that showed any similar trend.