? BG numbers have gone up with increased Insulin dose

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Griffin's Mom

Griffin's Mom

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Do not know what to do to correct this issue...... Keep going with higher dose, return to original dose or something in between ?

If you look at Griffin's spreadsheet his initial curve was high numbers that only came down 144 "points" at +3 and then began to rise again.

I increased from 2 units to 3 units. Had one low reading and now numbers are higher than before.

Don't know how to help my boy.

Griffin's Mom (Moe)
 
Hi Moe,

To help members give you appropriate suggestions could you add details to your signature of the insulin type, meter type, and food being given (name of the food plus whether it is wet or dry food). I know they're in the spreadsheet already but if people can see them in your signature it will be easier for them to identify quickly whether they have appropriate knowledge and experience to share which might help you. Also, if Griffin has ever had any history of throwing ketones or DKA that's another sensible addition for the signature.

If you're not already testing regularly for urine ketones as part of Griffin's regular monitoring then I very much recommend you start ASAP- especially with numbers being on the high side right now. Here's a link to a helpful forum sticky:

http://www.felinediabetes.com/FDMB/threads/are-you-testing-your-cat-for-ketones-if-not-do-it.48383/


Mogs
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@Alexi - Next time you're online could you have a gander at Griffin's spreadsheet, please? (He's being treated with Caninsulin.)


Mogs
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Critter Mom said:
Hi Moe,

To help members give you appropriate suggestions could you add details to your signature of the insulin type, meter type, and food being given (name of the food plus whether it is wet or dry food). I know they're in the spreadsheet already but if people can see them in your signature it will be easier for them to identify quickly whether they have appropriate knowledge and experience to share which might help you. Also, if Griffin has ever had any history of throwing ketones or DKA that's another sensible addition for the signature.

If you're not already testing regularly for urine ketones as part of Griffin's regular monitoring then I very much recommend you start ASAP- especially with numbers being on the high side right now. Here's a link to a helpful forum sticky:

http://www.felinediabetes.com/FDMB/threads/are-you-testing-your-cat-for-ketones-if-not-do-it.48383/


Mogs
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Thanks, will definitely do that
 
Moe, a couple of questions:

1. Is the Medi-cal Diabetic food a dry kibble? Do you have a link you can give us to details of its ingredients and composition?

2. I see from your spreadsheet notes that you sometimes give Griffin a little wet food. Does he prefer wet food? Also, which wet food do you give him to tempt him to eat?


Mogs
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Critter Mom said:
Moe, a couple of questions:

1. Is the Medi-cal Diabetic food a dry kibble? Do you have a link you can give us to details of its ingredients and composition?

2. I see from your spreadsheet notes that you sometimes give Griffin a little wet food. Does he prefer wet food? Also, which wet food do you give him to tempt him to eat?


Mogs
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Hi Mogs,

1. Yes the kibble is dry, I don't have a link on the food. It is from the vet.

2. This weekend is the only time Griffin has not eaten with gusto (it was thanksgiving, we have new noisy tenants above us and I started doing home monitoring) I gave him friskies mariners catch - he absolutely loved it. Other than that I have only fed wet as a holiday treat
 
My thinking is that the jump from 2.0 IU Caninsulin to 3.0IU may have been too big a dose hike and that may be pushing numbers higher at the moment.

If you can get a +3 on AM and PM doses for a few days and, if possible, +6 tests on both cycles that would be a good start toward understanding better the effects of the 3.0IU dose.

Is there any specific medical reason why the vet has recommended the Medi-cal dry food? If yes, please post details of advice you've been given by the vet about this food choice.


Mogs
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I can only get a +3 on the am cycle on weekends as that is 10am. The same with the +6 as that is at 1pm and I am at work.

I can get a +3 on pm all days but the +6 pm is at 1am.

Yes the food medi-cal is the vet line prescription food for diabetics. He just said it is a more controlled (slower) crab to avoid spikes.

Wondering if I should drop the dose back down to 2 or is that something that needs to be done slowly?
 
Critter Mom said:
Is Griffin prone to stress-induced urinary tract problems?


Mogs
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He had urinary crystals once three years ago. Vet said it was caused by his food, Blue buffalo wilderness. He had two courses for medication and a switch to vet food. No urinary problems after that.

Except the excessive urination with the diabetes.
 
I have been scratching my head on this one but it is starting to make sense. Was it Sunday pm you gave him the friskies? If so that could account for the big drop then. Last nights drop was not so dramatic. I am not familiar with the dry food but if it is that high carb then the dosing and numbers make more sense. As the OP can't monitor during the day any food change will have to be done slowly and carefully as that dose will have to come down at some point but for now the numbers are ok even if not ideal. Dry food isn't good for crystal prone cats, even if it is vet recommended. If he ate the Friskies with gusto he is a smart cat. Others who are experienced with crystal prone cats should be able to give you some food advice. Do not try to change his food yet.

It would be good to get more data - can you do a curve this weekend? Also let us know what the urine ketone test shows.
 
Alexi said:
I have been scratching my head on this one but it is starting to make sense. Was it Sunday pm you gave him the friskies?
It would be good to get more data - can you do a curve this weekend? Also let us know what the urine ketone test shows.
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Glad I am not the only one scratching my head with this. No I did not feed any wet food till Tuesday pm. The big drop on Sunday was dry food only, however he wasn't eating as per usual. Normally he eats everything in less than 15 mins. Sunday he started leaving 3/4 of his food and picking at it over several hours.

As this did not get much better Tuesday I mixed about a 2tsp into his dry.

I can do a curve this weekend. Looking into finding Ketone test stuff today.

Moe
 
This morning's AMPS was 23.6 that is the lowest PS number he has had since I started testing on Sunday Oct 9th! I know it is not that much lower but it made my heart jump. The what if's where creeping in and I was worried that I wouldn't be able to help my boy.

I know there is still a long way to go.
 
This is what you want to see, a nice gradual drop in the numbers. I think those black numbers were a bounce from that low +3 on Sunday so you want to see lower numbers but it is scary when they start to happen, he has a way to go but the curve should hopefully give us some valuable data on where we go from here as we need to know where his lowest point is and how low he goes. You have everything you need to help your boy and the fab people on the board will help - we all started just the same.
 
Moe, while I understand your concern and frustration, try not to focus on and get down hearted about one number out of many. What you need to look at are the patterns over time. Your meter has a variance allowance of 15% plus or minus so if that test tonight is reading 15% high, Griffin's actual BG could be as low as 24. We all get what look like "rogue" readings from time to time and the only time you need to be concerned about them (unless they become a pattern) is if you suddenly get a very low reading in which case, you retest to confirm and act accordingly. :bighug:
 
MrWorfMen's Mom said:
Moe, while I understand your concern and frustration, try not to focus on and get down hearted about one number out of many. What you need to look at are the patterns over time. Your meter has a variance allowance of 15% plus or minus so if that test tonight is reading 15% high, Griffin's actual BG could be as low as 24. We all get what look like "rogue" readings from time to time and the only time you need to be concerned about them (unless they become a pattern) is if you suddenly get a very low reading in which case, you retest to confirm and act accordingly. :bighug:
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Thank you for the pep talk! I imagine quite a few of us newbies tend to panic in the early days. Your words are clear and comforting, thank you for your support.

Moe
 
I did a curve last night not sure what to make of the numbers, doing checks every three hours today. We where both to tired to do a full curve today.

He wanted lunch a bit early today (that usually happens on weekends) but instead of giving him his dry food, I gave him 1/4 of a 156g Friskies can.

Not sure if I need to do a full curve tomorrow?
Not sure if he is adjusting to the new level ?
Not sure what to do next?
My gut says he is not taking to the new level, he is quiet and less playful but my gut has no experience or real knowledge to draw from.

He also loves the wet food and I would love to be able to get him of food that is better for him.
 
He looks stable on that dose of 3 units with a nice steady drop by +4, as you are now able to get the monitoring in then you could try a slow transition to the wet food which will help to bring his numbers down. I did it over a week gradually adding more of the new to the old until by the end of the week it was just the new food. As the dry food seems to be high carb you might want to do it more slowly. What you want to see is a gradual drop in the pre-shot numbers, with a blue number at the lowest point. It will take time but the numbers look fine for this stage of the game. The general advice is not to give insulin if the pre shot number is less than 200. As you gather more data the dose can be reassessed. It takes time for behaviour to get back to normal, are you checking urine for ketones?

Can you also weigh him weekly and monitor his fluid intake/output as these also help to assess how well he is responding.
 
Moe, you must be exhausted!:bighug: You stayed up all night to do a curve and actually intended to try to do more today?! Now that's dedication :Dbut I think we need to make life a little easier on you. Did your vet tell you to take tests every hour? Most if not all of us would suggest doing a curve by testing every 2 hours for 12 hours or every 3 hours for 18 hours....not a 12 or 24 hour hourly marathon. I'm tired just thinking about you and Griffin being up all night.

Curves don't need to be done that often (once a week would be fine) and to be honest, some of us who can test mid-cycle each day, don't bother with curves because they give you one day's worth of data and if Griffin happens to be having an off or particularly good day (or night) it doesn't give you an over time perspective. They are however helpful when mid cycle testing throughout the week is not possible.

If you look at your curve from last night, Griffin had a good drop from PMPS to his nadir at 3-4 hours which is quite normal with Caninsulin. he rose a bit and then levelled off between +8 and +10 post shot which is pretty much as expected. His nadir last night was decently lower than a few days ago although but I can't help but wonder about the 6.9 mmol at +3 on the 9th when the dose was originally increased.

I'd agree with Alexi. Leave his dose as is for now and get the food transition started gradually. Switching to canned can have a profound effect on BG in some cats so be sure to monitor him closely because his dose may need to be adjusted as the dry food is gradually removed from the picture. The no shot number you'll use is 11mmol. which is the equivalent of 200 on the US measure scale.

I know Griffin has been on Caninsulin since 2015 but has his demeanour/behaviour changed recently (since the dose change) or has it remained pretty much the same? Watching other clinical signs is of as much importance as those numbers we collect because they can often tell you if something else might be up with kitty. Things like dental issues, urinary tract issues (our kitties are prone to urinary tract infections) etc. can all have an effect on BG levels so sometimes our day to day observations are even more telling than all our testing. Keeping notes about your observations on your spreadsheet in the comments column will help you track how things are going.
 
He weighs 9 lbs today - before the Dx he weighed between 12 - 14 lbs. I did the at home weigh mom with and with out holding him method. I will start weekly weighing.

I have the Ketone test strips, working on how to test him. Any tips would be helpful.

It is hard to measure how much fluid he is taking in and putting out. He is one of three cats in the house and as soon as I seclude him to monitor his fluids he stops eating and drinking. It really seems to stress him out to be separated from the others.
 
MrWorfMen's Mom said:
I know Griffin has been on Caninsulin since 2015 but has his demeanour/behaviour changed recently (since the dose change) or has it remained pretty much the same? Watching other clinical signs is of as much importance as those numbers we collect because they can often tell you if something else might be up with kitty. Things like dental issues, urinary tract issues (our kitties are prone to urinary tract infections) etc. can all have an effect on BG levels so sometimes our day to day observations are even more telling than all our testing. Keeping notes about your observations on your spreadsheet in the comments column will help you track how things are going.
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His behaviour has not changed much since the diagnosis. he is always happy and playful. he has had his off days over the last year as we all do. He stopped sleeping with me (a sign he is not feeling good) the last week of sept/first week of Oct when he started loosing weight again. That is when I took to looking on line and found this place.

He has continued to be quite and not sleep with mom since starting monitoring and dose increase but I began on thanksgiving (busy house) new noisy neighbours moved in above us as well that weekend and Mom began pricking his ears. So I can't say for sure which has him out of sorts right now.

I think the super low reading on the 9th may have been because he didn't eat much dinner. I did have to lace his food with some wet to get him back on eating with gusto on the 10th. I think I put that in my notes (will double check)

I can only monitor him super well on the weekends, which is why I woke us up every hour last night.

Below is what I can monitor during the week.

Mon-friday

7 am - AMPS /Shot/breakfast
8am +1 test
830-530 work - lunch feed by roommate between 1pm-3pm
6pm +11 test

7pm PMPS/Shot/Dinner
8pm +1 test
9pm +2 test
10pm +3 test /Bedtime snack
 
THANK YOU EVERYONE

Feeling much better about this just now you are all out there and very supportive.

Linda @MrWorfMen's Mom - I tend to jump in to stuff with both feet -100% committed. I am either all in or all out. Yes, that can sometimes be exhausting but I would do anything for my boy. Good to know I won't need to do that again. Thank You for the run down on how most approach home testing. We don't have vet support right now, our current vet is not someone I am trusting with this right now. He was a great vet up to this point. Looking for a vet that has more experience with this and working with home testing.
 
Monitoring fluid input/output can be done in a very general way, see if you can observe him drinking, and how thirsty he seems, how often you need to change the litter. To get a urine sample to test you can put some plastic food wrap in the tray, use aquarium gravel or sneak up with a long handled spoon and catch some as he goes, keep a spoon near the tray if you are going to try that. Some people can hold the strip in the urine stream but I find it easier to time the strip if I get the urine first and then dip. I do the spoon trick.

Sleeping in a favourite place is a good sign so he will return once he is feeling a bit better, the weekly weight helps you to monitor if you are giving the right amount of food, unregulated cats tend to need more. Do you know what his ideal weight is? He needs to gain gradually.
 
For his ideal weight 14 lbs was a bit too much, he had no shape just a rectangle but 9 lbs visually does not look good. I would say 12 lbs would look good on him.

Tomorrow task - obtain urine sample to test.
 
Moe, it's admirable to go at things all in but remember, if you burn yourself out, you won't be able to look after Griffin as you want to. So always keep your own needs in mind when deciding what you can and cannot do. You can look after a diabetic cat without having to exhaust yourself. It's finding that middle of the road where both you and Griffin are being cared for that can sometimes be tough but it is doable.

Feline diabetes is not something many vets get a lot of experience with and precious little training on in vet school so while you will see us criticize vets sometimes for saying testing is not needed, prescribing dry food, etc. in many cases, it is their lack of training, little hands on experience and few diabetic patients (meaning not much reason to stay up to date on treatment) that makes them seem less than desirable.

To me, it's far more important to find a vet I can work with and who realizes I am looking after my animals 24/7 and I need a partner not a dictator. I want a vet who listens, admits when they are out of their element and not cocky about those letters behind their name. So if your vet has been great up to now, continue to use him for other things and do what you feel comfortable with as far as Griffin's diabetes is concerned. If the vet doesn't support home testing, who cares. It's not dangerous for Griffin and provides you with a safety net to make sure it's safe to give him insulin and monitor him in a stress free environment. There was a time when home monitoring was not done and many vets still follow that routine. Others are padding their pocket books by making clients stress out their animals for weekly or monthly curves in hospital. Either way, what you do at home to keep Griffin safe is entirely up to you.

Numerous folks here, myself included, are treating our furkids ourselves without any input from our vets. I love my vet, but my cat has a rare condition associated with diabetes that my vet initially told me not to bother testing for because of it's rarity. I insisted... she humoured me and then was blown away to find my instincts were bang on. She had no idea how to deal with my girl but with the help of folks here, I have managed to get her insulin needs cut back to 50% of what they were. And to boot, my vet recently called me for some BG reference numbers because she wasn't familiar with using a human meter on cats. Diabetes is very much a hands on disease and you hold the needle, so to me, with home testing you are in a far better position than your vet to keep Griffin safe on day to day basis because every day with a diabetic is a little different than the last. :bighug:
 
Griffin's Mom said:
For his ideal weight 14 lbs was a bit too much, he had no shape just a rectangle but 9 lbs visually does not look good. I would say 12 lbs would look good on him.

Tomorrow task - obtain urine sample to test.
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If Griffin isn't shy about you observing him in the litter box you might try the long-handled spoon trick. Teasel tends to face away in the litter box and I keep a long-handled spoon at the ready near the litter box to stick under his backside when I catch him going in to pee. You only need a very small amount to do the strip test. I was surprised at how easy it is.
 
Kris & Teasel said:
If Griffin isn't shy about you observing him in the litter box you might try the long-handled spoon trick. Teasel tends to face away in the litter box and I keep a long-handled spoon at the ready near the litter box to stick under his backside when I catch him going in to pee. You only need a very small amount to do the strip test. I was surprised at how easy it is.
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So my previously completely unshy cat (he would use the litter box in the bathroom the minute a human tried to use the bathroom) has now decided he is shy. Yesterday was a bust but will keep trying.
 
Feeling much better after this weekend and this weekends numbers.

THANK YOU EVERYONE.

I have replaced his two snacks (lunch and Bedtime) for this week with wet. Which he is absolutely loving!
Since I am not home to test during the day I will leave it at that for now and switch out breakfast to wet next weekend and then dinner the weekend after that.

Is there any danger in going too slow with the switch?
 
No danger going slow with food transition and since you can't monitor mid-cycle during the weekdays, a good plan. A slow transition also helps ensure no tummy issues which sometimes occur with food switches.

I hear you on the urine testing. Menace never cared if I walked up to her using her box. In fact she used to supervise box cleaning and then jump in to re-christen the scooped litter before I got done. Now of course she is having none of it. You could try putting some plastic wrap into the box on top of the litter where Griffin usually pees and see if you can catch anything that way. It only takes a little bit of urine to get a test.
 
HOLLY MOLLY 11.1 AMPS

Checked a second time 11.8
Too close to the suggested no shoot number for me to know what to do.

I gave him regular dry breakfast about 30 mins late, no shot.

I am not home during the day - is there anything my roommate (who is home should or shouldn't do) I get home at 530pm (+10.5) ? should he get his normal lunch or his transition lunch.

PS for anyone that doesn't know or uncertain - I am transitioning Griffin to wet (Friskies) he gets feed 4 times a day and this week he is on two regular dry meals and two wet meals. Switching from Medi-cal (Royal Canin) Diabetic to Wet.

@Alexi @MrWorfMen's Mom is there a point at which I should start a new thread as this topic changes?
 
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Griffin's Mom said:
HOLLY MOLLY 11.1 AMPS

Checked a second time 11.8
Too close to the suggested no shoot number for me to know what to do.

I gave him regular dry breakfast about 30 mins late, no shot.

I am not home during the day - is there anything my roommate (who is home should or shouldn't do) I get home at 530pm (+10.5) ? should he get his normal lunch or his transition lunch.

PS for anyone that doesn't know or uncertain - I am transitioning Griffin to wet (Friskies) he gets feed 4 times a day and this week he is on two regular dry meals and two wet meals. Switching from Medi-cal (Royal Canin) Diabetic to Wet.

@Alexi @MrWorfMen's Mom is there a point at which I should start a new thread as this topic changes?
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You did the right thing in withholding Griffin's shot with an AMPS of 11.8. That's too low for comfort until you have more data on his SS. As you gain experience and knowledge of his responses you might be able to lower your "no shot" number.

You're doing a great job of slowly transitioning him to wet food. Slow and steady is always better.

Re starting a new thread. You can do it anytime and give it a new title. There aren't any hard and fast rules but we suggest not letting your thread run to multiple pages. I routinely start a new thread every Monday morning.
 
I agree with Kris. Today was a different question and while she came along relatively quickly, you might have got a quicker response with a title like ? Need advice - AMPS too low to shoot." for instance. The other good news is that we have re-established the forum specifically for our members using Caninsulin and other similar insulins. Instead of posting on Health from now on, you can post HERE in the Caninsulin/Vetsulin - Humulin forum and there will be more folks available there who are familiar with your type of insulin to assist you.

I agree with Kris. You did the right thing skipping this morning. In the future, if you have time (which I know when one is working isn't always possible), stall...... don't feed Griffin and recheck his BG in 20 minutes or so. You want to see if his BG is rising or staying the same or going lower. You might then find he has risen enough for his shot even if only enough for a reduced shot. You can stall more than once as your schedule permits just keeping in mind that you don't want to stall so long that it disrupts your shooting schedule in the days to come. The other good news is that Caninsulin is more flexible than some other insulins so you can shoot early if need be but again, doing so messes with your schedule going forward so this is where you have to find that happy medium between what is safest for Griffin and doable by you. It's better to have him running high for a cycle than too low for a moment so all's good and that's what is most important.

It looks like the transition to wet food may be having an effect on Griffin's BG so just stay with a slow transition and fingers crossed you will see a big improvement in his numbers. While it can mean a lot of head scratching for you when their BG starts to drop, that's exactly what you want to see and you have lots of folks to help you along as Griffin's numbers improve.

How did you fare in that storm yesterday? Quite the mess in Stayner/Collingwood! :nailbiting:
 
I had been reading about the ISG and posted a quick hello message over there.

The storm certainly messed things up quiet a bit. Wasaga Beach (in my area only got a few power flicker, Creemore where I work completely lost power yesterday and we got to go home early. Both places seem ok this morning but I know Collingwood still has several spots with no power.
 
Glad to hear you got through Ok. I was thinking about you and my other friends up in the area. We had rain but nothing worth mentioning here in TO.
 
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