Advice please - skeptical of vet

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Matthew Brennan said:
608 at +7. Thoughts?
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He might still be bouncing from that recent blue. It's also possible that his dose needs to be tweaked but I wouldn't change anything right now. You're still in a data gathering phase. I see that you're using Freestyle strips in your AT meter. That can work fine just make sure you do a couple of same blood drop tests each time you open a new vial of FS strips. Leave the AT meter at the last cat code you used.
 
Matthew Brennan said:
608 at +7. Thoughts?
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Well... it would seem that the 2u did drop Timmy ok to start with, but because his pre-shot number was so high, the insulin had a lot of work to do. The higher doses dropped him lower, but as we're assuming he is bouncing and therefore lowering the dose, that lower dose isn't doing enough. It starts to become a Catch 22 situation. What we really need to do is get the pre-shot numbers down... that should make life easier. But how to do it is the issue...

We have advised sticking to the 2u dose for a couple of days and I still think it's worth doing that, even if only in an attempt to clear the bounce. But if by midweek he is still so high, you have several options - go right back to 1u and be very methodical about testing regularly to get some accurate data; try the eight-hour dosing regime as Janet suggests - maybe 2u each time; or show your results to the vet and ask for a full discussion about changing to another insulin.

We don't like to bad-mouth Caninsulin as it can and does work for some cats, but for others it just doesn't.

@Marlena ?
 
My opinion... I think doing 2 is a waste of time and is keeping the cat in high numbers too long. I don't want to see him develope dka. If it were me I'd go back to 3 or do 2.5 three times a day.
 
JanetNJ said:
My opinion... I think doing 2 is a waste of time and is keeping the cat in high numbers too long. I don't want to see him develope dka. If it were me I'd go back to 3 or do 2.5 three times a day.
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I agree, poor Timmy does need to get out of these high numbers asap. Matthew - you've taken on board what we've been saying over the past few days, this is your call, of course. We are going by the book when we say that a dose should be adhered to for at least a couple of days, but these very high numbers are worrying... if you feel capable and confident of not only shooting three times a day, but testing at intervals in between, that should theoretically get numbers down. If you decide to do that, I'd go no higher than 2.5u for now.
 
Ok let's hope this will help... just be mindful that you will be shooting more frequently and probably at lower numbers than you've been used to and this should produce a different type of curve... when in any doubt don't shoot or shoot a lower dose... and post here with an URGENT heading if you need to.
Good luck! Paws crossed...
 
Diana&Tom said:
when in any doubt don't shoot or shoot a lower dose... and post here with an URGENT heading if you need to.
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Going along with this, I think it's a good idea to start a fresh thread with the new dosing strategy if you're going to a round-the-clock schedule. Otherwise, if you need help during one of the quiet times on the board when none of the other folks on this thread are around, it will be hard for a new person to jump into a 100+ message thread and figure out what's going on currently. On the first post of the new thread, you can put a link in to this one, so that anyone who wants to will be able to refer back for the history.

Good luck!
 
Nan & Amber said:
Going along with this, I think it's a good idea to start a fresh thread with the new dosing strategy if you're going to a round-the-clock schedule. Otherwise, if you need help during one of the quiet times on the board when none of the other folks on this thread are around, it will be hard for a new person to jump into a 100+ message thread and figure out what's going on currently. On the first post of the new thread, you can put a link in to this one, so that anyone who wants to will be able to refer back for the history.

Good luck!
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Excellent idea!
 
I'm sorry but I'm too tired right now to think clearly.
Matthew could try what has been decided but make sure Matthew that your kitty eats properly.
 
Hey-- am I misreading the spreadsheet? It looks like you had a PMPS (at the new time) of 365, after a +14 on the old shot of 664 (so, two hours before the PMPS). If that's true, that worries me, because it would mean Timmy was in the process of a really severe drop at shot time (maybe a bounce breaking????).

If you are reading this, please follow Marlena's advice and make sure Timmy has lots of food available in this cycle, and please keep testing.
 
Yes-- I'm actually up in the middle of the night and I came here to check up on this, I was so worried. Now I see that the next reading was just the PS for the next shot (572) and that 3U was given.

I am worried that this is a much too aggressive approach. The 3x/day dosing strategy is terribly hard on the caregiver because it's not just a matter of being able to give shots every eight hours, you need to monitor the response to the shot as well, especially with a fast-acting insulin like Caninsulin. If you can't do the monitoring, I don't think it's a safe approach, and that's even without the increase in dose this morning.
 
Hmmmmmmmmmm I wonder what's going on. That 365 could have been the bounce breaking, as Nan says. I can't see any other reason for it really. Maybe those two extra hours after the last shot cleared the exogenous insulin and made enough difference for Timmy's body not to be panicked. So you shot 2.5u and he is back to a black again this morning, quite possibly another bounce.

What to do now...? We are trying almost too many different things now, but we don't know if another 2.5u eight hours on is going to help matters. If you were to wait until late in the cycle again, as at +14 last night, the number *might* show a big drop in two hours again as it did yesterday in which case you'd need to keep testing to see if he's dropping or rising... the trick would be to catch him on the rise. Or you could try a lower dose at +8. It is looking as if "shooting into the bounce" may not be the answer, and it is looking that the 2.5u could be too much. So I'd be inclined to keep testing without giving insulin... see if he starts to drop at any point and then monitor closely for a rise...

Just my opinion... I think we could do with a few more eyes on this so it's worth starting a new thread with very specific heading as per Nan's suggestion.
 
Matthew Brennan said:
Sorry guys,

I set that up badly on the spreadsheet. The preshot last night at 11pm was 664. At 1am it was 355.
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That's another BIG drop, not good. Timmy is showing himself to be very responsive to Caninsulin (not a surprise). See how today goes on the eight-hourly schedule - can you post here with a +3 or 4 and also a +7 so we can see what's happening? It may be that three times a day shooting will work better, IF it is sustainable for you with tests in between as well as pre-shots... if not I definitely think it's time to talk to a vet about another insulin.
 
Ok so that 266 at +3 (?) is a better number - big drop but better to be in better numbers than blacks so much. Try to get a +5 so we can see what direction the bg is going in then.
 
Matthew Brennan said:
Also, surely by using a lower dose 3 times a day that should stop the big drops and keep him more consistantly at a lower bg?
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That's the hope. If the second preshot number is less than usual than you can give a lower dose. Did you do 2.5. Or 3 this morning? You talked about doing 2.5 but I see 3 in the spreadsheet. If the preshot is 250-300 I would give only 2u. If it's over 300 do the 2.5
 
You are right Matthew. The theory is that dosing 3 times rather than twice daily will keep the concentration of insulin in the system more steady which should smooth out the cycles but the trick is to find the dose that is going to do that for Timmy and right now I think he is bouncing big time which is making the picture blurry. Usually you would take the daily dose and give 1/3rd at each dose but with the drops you are seeing right now, I'd be very hesitant to give another 3u if the mid day pre-shot is that much lower.

If I am understanding correctly, the highest dose you have given Timmy lately has been 4u twice daily and you recently were dropping the dose down to see if you could stop what appears to be major bouncing. This morning you gave Timmy 3u again so if you continue to give 3u for each of three doses today, you're actually increasing his dose to more than you were giving him days ago which I don't think is what you intended or advisable.

I am hesitant to make any suggestion about dose right now till we see where Timmy's BG is just before the next dose is due but I will suggest that it should be lower than 3u and you are going to have to monitor Timmy very closely. To be very honest, I think this is going to be very difficult and wonder if it wouldn't be better to stick with twice daily dosing at least until you can hone in on a dose that gives Timmy a bit smoother cycle. Even if his numbers are a bit higher mid cycle, it's those blacks at pre-shot that you need to get under control right now and I don't think increasing his dose even if it is being doled out in shorter intervals, is the way to go right now.
 
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I'll echo MrWorfMen's Mom's comments. This is a situation with many variables and it might benefit from eliminating some of them. Three times a day dosing might work but takes a lot of vigilance on the owner's part and could be fraught with difficulties in a bouncy cat. If you continue to struggle with getting BG under better control with Caninsulin you might ask your vet about one of the longer-lasting insulins.
 
I did 3u this morning as his levels where so high. I intend on doing 2.5u from here on out. I am keen to see how his numbers go 3x dosing today/tomorrow.
 
Matthew, I understand your reasoning but sometimes this sugar dance is counter intuitive and this is one of those situations. Insulin is a hormone not a drug so throwing more insulin at a high pre-shot can backfire to raise rather than lower numbers. While the pre-shot numbers are important, it's the mid-cycle numbers in combination with the pre-shot numbers that needs to be considered. Once you have a stable, somewhat regulated cat, and lots of data that shows how kitty is reacting, adjusting doses according to pre-shots can work, but right now, the goal has to be to smooth out the cycle so Timmy stops bouncing so much and increasing the dose during a bounce just adds exponentially to the bouncing and confusion. This is a marathon not a sprint and patience is key to success. :)
 
Kris & Teasel said:
My FD motto is, "When chaos reigns, simplify, simplify, simplify." You need more baseline data to judge what to do next. Several of the techniques, like TID dosing, are best used after more experience has been gained.
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Great motto Kris! My head was beginning to hurt from all the variables. And I agree - said it myself a few days ago - TID dosing is really something to tackle after a little more experience. Matthew, you are doing well and your dedication is incredible... we know you want Timmy to feel better asap (as do we) but this is something you can't hurry if you want to get it right. Softly softly catchee monkey and all that!
 
I agree with all the points above, but he is up round the 600 mark - a lot. My priority is his health, especially considering he could have been up round them numbers for months due to my (rubbish) vet. I agree gathering data is a big part, but time is of the essence. We have embarked on the 3 times a day dosing. I will keep monitoring him frequently and go from there.

Spreadsheet will stay updated guys. Thanks for all the help.
 
Exactly, Matthew, poor Timmy has probably been in the very high numbers for a long time and believe me, we all want to see him in better numbers and feeling better almost as much as you do. Definitely want to get him down from those blacks.
Collecting data IS a big part to keep him safe and to give us info for the future, because unfortunately things don't always go according to plan so it's very helpful to be able to look back at responses to different doses during a cycle.
So you've given 2.5u now, will be interesting to see how that goes. We're all rooting for you.
 
Matthew Brennan said:
I agree with all the points above, but he is up round the 600 mark - a lot. My priority is his health, especially considering he could have been up round them numbers for months due to my (rubbish) vet. I agree gathering data is a big part, but time is of the essence. We have embarked on the 3 times a day dosing. I will keep monitoring him frequently and go from there.

Spreadsheet will stay updated guys. Thanks for all the help.
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Well the 2nd preshot is better than this morning so that's a good thing! I was glad to see you did 2.5 this time. :)


I think as long as you are there to monitor and steer if needed you made a good choice.

You do have honey or syrup in case of emergency, right?
 
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Eeek!

OK, you aren't quite at the honey stage yet, but high alert is good! I'd test again in a half hour, no later than an hour from now.
 
Is 149 too low? I thought 100-180 was the right range? He is half way through this shot, so I would expect to see his numbers rising again shortly - plus he has just had a big feed of food.
 
149 is a great number but given the 3 times a day dosing and his bouncing there is no telling what he might do so just keep an eye on him and test again in half hour or so. He may spike a bit from the food or he may not if he is sliding downward right now. Knowing what he is doing will allow you to steer him if he is heading down further.
 
Matthew Brennan said:
Is 149 too low? I thought 100-180 was the right range? He is half way through this shot, so I would expect to see his numbers rising again shortly - plus he has just had a big feed of food.
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... don't forget he had 3u this morning and another 2.5 eight hours later so he's had more insulin than usual today. We might see a bounce again later. Be very cautious about dosing at next due shot time... post here and let us know what numbers you're getting.
 
I think that is a combination of feeding and bouncing. He's already has 5.5u of insulin in under 12 hours compared to the 4.5 u he got yesterday over 24 hours. If he were my cat, I'd be inclined to stick with 2u - 3 times per day (total daily dose of 6units) for a few days to see if that doesn't level him out a bit. Then adjust accordingly.
 
MrWorfMen's Mom said:
I think that is a combination of feeding and bouncing. He's already has 5.5u of insulin in under 12 hours compared to the 4.5 u he got yesterday over 24 hours. If he were my cat, I'd be inclined to stick with 2u - 3 times per day (total daily dose of 6units) for a few days to see if that doesn't level him out a bit. Then adjust accordingly.
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My thoughts exactly.
 
How can you tell the difference between the natural curve and bouncing? Surely once he hit the 100's he was going to start heading back the other way as it was after the mid point of his insulin curve. What stipulates the difference between BG rising from that curve and a bounce?
 
While the curve using Caninsulin is generally a rounded "V" shape, with what appears to be a steep valley, Timmy just doubled his BG in the span of an hour which would pretty much give you a line going straight up instead of on any angle if you graphed his readings right now. There is no way to tell how much is food influence and how much might be bouncing but it seems the goal of smoothing out the cycle has not be achieved today.

All mammals have a built in safety system that will activate when the body perceives the glucose level is falling to what it has learned to assume are unsafe low levels. This causes a rapid and almost instantaneous rise in BG. That is what I believe we are seeing with Timmy right now. He has become used to functioning in higher BG numbers. He is not used to BG levels of 149 and so his defense system is activating prematurely.

The goal is not to force the BG down to normal levels but rather to coax it down so that Timmy becomes re-familiarized with lower more normal readings and his defenses stop activating so quickly. This means it would be better to have Timmy not reach such a low, albeit safe, mid cycle number just yet. His defenses are kicking into action too quickly and stopping that process and getting it back to working more normally will bring those pre-shot numbers down.
 
Just looking in here before signing off for the night - been up since 6am... I'm sure Linda, Nan and Janet will continue to post if they can after your 11pm result in an hour's time... my own input would be to dose conservatively, and test again whenever you can... although we know Timmy is prone to bouncing there is always a possibility that he will surprise you and go the other way. Hopefully you're ok with staying up late or getting up a couple of times in the night (many caregivers do). In the longer term, if you revert to twice a day dosing, you will want to pick times that suit you to not only shoot but test again during the cycle... everyone has different routines.

Hoping for some nice numbers when I look in again in the morning!
 
11pm preshot and the meter read Hi. Done a second test and it was 713!! Im very concerned guys.

I gave him 2.5u, but im worried. I need direction as to the next steps to take.
 
that is one bouncy boy! are you very sure he has no infections or anything?... you are feeding just chicken, right? No high carb foods? No chicken with any kind of sauces or sugars on the outside?
 
Im at a loss. And struggling to find a good vet thats clued up on diabeties near me at all.

Would love for advice on the next steps I should take - dosage wise / 2 or 3 times a day wise.
 
Looks like severe bouncing from the lower numbers. I'm not sure what others would say but if it was my cat I'd do a "restart" at a moderate dose (2 u?) BID and keep it at least 3 or 4 cycles to get things calmed down. Then I'd increase the dose by 0.25 u increments, holding for at least three cycles.

You appear to have a bouncy, reactive cat - not a bad thing, just a trait of his physiology. These guys don't take well to too many changes and I know that from direct experience with Teasel.
 
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