Would you increase kitty's insulin without talking to vet?

Hello!

I posted a few days ago right when Ophie started her insulin here:
viewtopic.php?f=28&t=107019

We started insulin last Monday night. The vet asked me to test her blood every 4 hours on Friday and email her the numbers, which I did. I then called her on Saturday to hear she was out and that there was no one for me to speak with about Ophie. I then emailed again this morning. I'm still hanging.

What would you do based on our spreadsheet numbers (link to SS in signature)? I feel like her BG isn't spiking all over the place, but clearly, I'm not in the right range... right? Should I up the dosage myself? I feel like I'm wasting valuable time here and should be properly dosing my cat. It seems so many folks here make their own decisions on how much insulin to give their cats, but as a newbie, this scares me.

Thanks for any input ...!

Joely

 

Re: Would you increase kitty's insulin dose with talking to

I myself would increase the dose to 1 1/4 units.

 

Re: Would you increase kitty's insulin without talking to ve

Hi! Welcome to the group!
The general rule is... wait 7 days before increasing or decreasing the dose. You have done this, so you're ready for a dose change. It looks like the switch to low-carb food has helped bring the BG down from the 400's (along with the insulin), so that is good. Generally, you don't want to increase the insulin AND change the diet to low-carb all at once, but I think the four days on low-carb foods is enough to see some results. My suggestion would be to increase the dose to 1.25 units and see how that holds for a week. You are testing at home every day so you probably don't need your vet's permission at this point (though it is always good to check). As long as you keep checking the BG throughout the day, you should be fine. Good luck!

P.S. I started out with the Freestyle Lite meter but I found that it was showing lower readings than actual numbers (Freestyle strips are also very expensive). Most everyone on the site agrees that Freestyle Lite numbers are not accurate (it will say 300 but it's really 350!). I switched to the Glucocard vital ($15 for meter plus 20 strips), which is more accurate and less expensive. Other folks on this site really like the Relion meter from WalMart.

P.P.S. Can you tell us what low-carb wet food you are feeding?

 

Re: Would you increase kitty's insulin without talking to ve

Thank you so much for the input! I will bug the vet tomorrow, just to be safe. But it is most helpful to know that folks allow 7 days to see what impact insulin doses or changes in diet have on BG levels.

I am feeding Ophie Wellness Turkey and Fancy Feast Chicken Classic. She's been eating between 10-12 ounces (4 3oz cans) since she got her appetite back last Tuesday. She weights 11lbs. Is that normal?

 

Re: Would you increase kitty's insulin without talking to ve

if you follow the tight regulation protocol described in the Lantus Tight Regulation forum , after holding the initial dose 5 full days, subsequant dose adjustments may be made every three days IF you are testing around +5 to +7 hours after injecting insulin on the 4th day and have the lowest glucose levels higher than 50 mg/dL on a human glucometer, 80 mg/dL on a pet specific glucometer, or 2.7 mmol/L on an international meter.

(To get to Lantus TR, just click on the down arrow in the lower right and pick it, or go to the Index button at the lower left, and click into the sections for the insulin groups.)

 

Re: Would you increase kitty's insulin without talking to ve

Those 1/4 unit insulin doses that people recommend are a challenge to measure, since there are no insulin syringes with markings on the barrel for quarter unit doses. Some of the 3/10cc syringes have 1/2 unit markings on the barrel, but that is the finest gradation available. You do the best estimate you can and try for consistency from shot to shot.

Making a reference syringe can help. Take a used syringe, draw up some colored water into the syringe to the 1.25 estimate mark and put that syringe aside. Then, when you draw up the insulin into a new syringe, you can compare the two amounts.

Here is a picture of what 0.25 (a quarter) unit looks like So draw up your 1 unit, and add a little bit more to get the 1.25U.

The TR protocol is a very aggressive method of dosing and you really want to be doing plenty of testing if you decide to use that protocol. We want to keep your kitty safe.

Food choices sound good to me. Wink ate 10-13 ounces at first, before his numbers got under better control. It's perfectly normal for a diabetic cat to need more food at first. Now, Wink is down to eating 6-7 ounces daily and he weighs 10.6 pounds now.

 

Re: Would you increase kitty's insulin without talking to ve

Hi extra sweet Ophie and Joely! Welcome to the sugar dance!

Yep we change our insulin by our test numbers without our vet being involved. Insulin isn't a chemical medicine - it's a hormone that Ophie's body needs to process food into energy. There is no 'take 2 and call me in the morning..' - blood glucose will vary due to many reasons. Food, stress, medicines, excitement....that's why we test and how we can determine needed changes. You WILL wrap your head around this, it's just different and takes a bit of time.

BIG HUGS and welcome!

 

Re: Would you increase kitty's insulin without talking to ve

Are you able to get additional tests in during the cycles? If you are, then it will be really helpful to see just how high or low she is going.

And to answer your question, if you follow the protocol, keep posting here and are testing, then yes I would feel comfortable adjusting the dose without talking to the vet. Especially if the vet doesn't return calls. But you have to do what is comfortable for you.

I managed Maui's diabetes without vet assistance, partly because I had to.

 

Re: Would you increase kitty's insulin without talking to ve

Thanks again everyone!

The vet finally returned my message. She told me to up my dose to 2 units. Does that seem drastic? Also, since yesterday (and when I posted), Ophie's appetite has taken a downturn. She has barely eaten today... maybe 2-3 oz at most. Sigh. It really just gets me so upset! I gave her a tiny handful of Meow Mix dry (this is what she ate when she was super sick before last Tuesday) and she gobbled it up. Like me, she turns to the junk food when she's not feeling well. She threw up last night and then again today after eating this morning. What could that mean? She was doing so well. She was on Cerenia last week (not any more)... could that be what was helping eat?

As we are new at the whole ear pricking thing, I have challenges. As I get better, I will increase my testing frequency. Right now, after that day that I poked her every 4 hours, she gave me a very hard time the next day. So, if she is cooperating before her shot--when I need her to cooperate the most--I will give her time. Also, she's not good at bleeding yet... so, the multiple pokes don't help much... poor kitty, it's upsetting :cry:

I will test her at her time tonight and see how she did today without having eaten much... sigh. Considering how much money I have paid the vet over the past two weeks, I'm really bothered by how difficult it is to get her to respond to messages. Maybe it's time for a new vet. Anyway... now I'm just ranting!

You may hear from me later (in a panic) if she doesn't eat something substantial soon!

 

Re: Would you increase kitty's insulin without talking to ve

We consider adjusting dosage in 1 unit increments to be a big adjustment. We typically like to make adjustments in 1/2 or 1/4 unit increments.

What do you think? Do you think adjusting by 1 unit is too high?

 

Re: Would you increase kitty's insulin without talking to ve

Hello Hillary & Maui-- Yes, the increase feels like a lot to me. I gave her her shot a little while ago and I did not give her the two units. She's not eating well today, so I'm feeling especially cautious. Her BG was 190, after eating a bit of high carb food an hour before I took the BG. I am going to get a mid-cycle BG from her tonight, if she lets me. Oye, this is hard. I'm going to call the vet's office tomorrow and ask for a different veterinarian. Also, I have some Cerenia left, and will see if I should start giving her that again. Thank you!

 

Re: Would you increase kitty's insulin without talking to ve

Joely, I just noticed your signature says you are in Boston. I'm up on the North Shore, in the Newburyport area. We're practically neighbors! :shock:

Hope Ophie feels better soon and eats her foods.

 

Re: Would you increase kitty's insulin without talking to ve

Hello Neighbors Deb & Wink!!! Wow!! We are super-duper close! Thank you for the well wishes for Ophie...

 

Re: Would you increase kitty's insulin without talking to ve

Does she appear nauseous? Licking lips? putting face in food, then turn away and not eating? meatloafing?

If she is doing any of this and seems off, then give her some cerenia since you have it and see if that helps.

and it is a delicate balance when a cat is not eating, about giving insulin and be concerned about hepatic lipidosis. http://en.wikipedia.org/wiki/Feline_hepatic_lipidosis

 

Re: Would you increase kitty's insulin without talking to ve

Ophie's appetite has sprung back today and she is eating much better. She ate overnight last night (I leave out food), so it was relief when I woke this morning to see that.

This is a roller coaster ride... Sigh. We will see what tomorrow brings. Her BG was up over 300 this morning after going as low as 114 +2 last night (after a day of mostly not eating). It's random to me why she would not eat for just a single day (but probably not random to her, I guess ).

Thank you all again...

 

Re: Would you increase kitty's insulin without talking to ve

Its nice to see less pinks but she might need another increase again to see if we can get some greens in there. Read the protocol and see what you think :http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. I would do 0.25 since she is showing some yellow.

Wendy

 

Re: Would you increase kitty's insulin without talking to ve

Hi Wendy & Tiggy, I am thinking I should increase Ophie's dose. She's been eating well and I have been giving her 1.5 (or so I think it's 1.5, I don't have the needled with the half mark). I've been so freaked by this whole hypo talk, that I think I might be doing more harm than good by getting freaked over a single day of poor eating. I would say her numbers have been consistently high (right?) and I should up her does to 2 units as my vet instructed a week ago.

 

Re: Would you increase kitty's insulin without talking to ve

One more thing! If you were me... would you up the dose to 2 units if you would NOT be home for 10-11 hours? I can be with her on Thursday, so maybe I should stick to 1.5 units until Thursday?

 

Re: Would you increase kitty's insulin without talking to ve

I would increase her dose by 0.25 as the protocol says - because her nadirs are blue at best and it has been over 10 cycles i.e.

Also Lantus is a depot insulin (more reading here http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=150) so it will probably take a few days for an increased dose to take effect. The lantus dose needs to build up in her system to the right amount.

So I would increase her tomorrow and by Thursday you should see the effects. Just make sure you get the pre shot test and before bed tests (PMPS +2 or +3) like you are doing. And if her before bed is lower than her pre shot, I would set the alarm for a mid night test to make sure she isn't going to drop too low. Make sense?

Wendy

PS are you still using the freestyle meter? If you are the chances are the yellows are higher than you think too.