Seeking opinions and input on timing of dose increase, please

Dee Dee C

Dee Dee C

Member
@MrWorfMen's Mom

Clarence had been staying in the 200s a lot of the day, BUT His PMPS is 383
I would appreciate any thoughts, suggestions, etc.

Thanks in advance for any advice on how much Vetsulin
 
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Sorry Dee Dee. The darn tag didn't come through...sometimes they don't work. Was just looking to see what Clarence was up to and found this and I wasn't on the board last night due to a personal matter.

I see you gave Clarence 1u last night and this morning. I'd stay with that dose for tonight at least provided his pre-shot is high enough to shoot. I think he may be bouncing a bit right now so better to under dose a bit than give too much till you see what he's up to.
 
MrWorfMen's Mom said:
Sorry Dee Dee. The darn tag didn't come through...sometimes they don't work. Was just looking to see what Clarence was up to and found this and I wasn't on the board last night due to a personal matter.

I see you gave Clarence 1u last night and this morning. I'd stay with that dose for tonight at least provided his pre-shot is high enough to shoot. I think he may be bouncing a bit right now so better to under dose a bit than give too much till you see what he's up to.
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Hi Linda. I hope everything is alright with you. I had an appt. this morning and had to leave this morning.

Yes, 1u last night and this morning. He seems to be sitting mostly in the 200s with that dose until late in the cycle, but does drop a lot in a relatively short period of time. I noticed him drinking water today, not excessively, the first time I've seen him actually drinking in a while, tho. I found a website that had an excellent explanation of 'bouncing' (Somogyi phenomenon) and it helped me a lot to understand it. Because of that I felt it a good idea to keep his dose at 1u for today and tonight and see how he does. BTW I did give him a little food after his +3 like I normally do.
Should I be concerned about the water drinking? ​
 
I wouldn't worry too much about the water right now. When his BG was staying down in normal range for long periods, he wasn't trying to get rid of excess glucose in his urine so he peed less and wasn't as thirsty. Now with his numbers up, he probably is dumping some glucose into his urine and peeing more so he needs more water right now. Definitely something you can watch to make sure it drops off as numbers normalize again.

I'm fine. Just got some bad news of a friend passing away last night so I was on the phone for some time and missed my normal evening time online.
 
MrWorfMen's Mom said:
I wouldn't worry too much about the water right now. When his BG was staying down in normal range for long periods, he wasn't trying to get rid of excess glucose in his urine so he peed less and wasn't as thirsty. Now with his numbers up, he probably is dumping some glucose into his urine and peeing more so he needs more water right now. Definitely something you can watch to make sure it drops off as numbers normalize again.

I'm fine. Just got some bad news of a friend passing away last night so I was on the phone for some time and missed my normal evening time online.
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I'm sorry to hear about your friend and hope that you will be blessed by lots of fond memories to honor your friend.
 
Oh boy That's a tough one. He's obviously come out of the bounce which is great but whether 1u will drop him too much is a good question. How about trying 0.75u tonight and see what he does?
 
Okay, Thank you. I was thinking about doing that. (I've stalled a bit on feeding him, so maybe it came up a little while I was waiting). It makes me wonder how low he went, I tested him at +6.5 and he was at 165 and I figured he wouldn't be going super low. I'll do the .75 and see what he does - darn cat, really like the night-time company!
 
Linda, if you are checking, his AMPS is 367
At this number, I'm unsure - I don't want to give him too much, thinking about 1 unit but just not sure. What would you suggest??
 
HMMM! Clarence is being a bit of a puzzle? When I saw that run of yellow last night I really expected you might get another yellow pre-shot this morning. Given Clarence's habit of late nadir's I wonder if he did drop a bit lower last night setting off another bounce to pink.
If you can monitor today, then I think going with 1u is a good choice. If you can't monitor I'd stick with the 0.75u.
Come on Clarence....stop messing with Dee Dee! :p
 
He was pretty anxious to eat this morning, I wonder if his hunger got him higher than he otherwise would have been. Here's my concern: if I give him .75 today, then I would prefer to give him .75 tonight as well inspite of what his number is just to keep things easier for me so I don't have to get up and test him. I've seen him go fairly low fairly quick when he is up pretty high.
 
It's entirely up to you. Do what you are most comfortable with dose wise. He'll catch up if it turns out he needs the full unit dose. You know Clarence better than anyone else and your observation about his hunger suggests you may be right about that pre-shot. And that hunger could be from a lower BG last night than you are aware of.
 
I just don't like him spending too much time in higher numbers. But, maybe the .75 will keep him low enough to be out of danger. I think I will go with the .75 for today and maybe check him around +5 or +6 to see what its looking like. Then I can go ahead with the .75 tonight too and see what happens. If he'll catch up as you say, then .75 would be my choice.
 
With Vetsulin being an in and out insulin, it's a bit more straight forward than other longer lasting depot insulins. With those, you could potentially set Clarence back a few days by going too low on the dose but with Vetsulin you see the results of dose changes almost immediately other than bounces which can muddy the water a bit.
My rule of thumb with my girl was always to make sure I was not exhausting myself to keep her in optimal numbers. There are enough times that they surprise us and we have unplanned PJ parties. We shouldn't be intentionally causing them with dosing in the name of "normal" numbers. If you need to back off on the dose for a few cycles to recharge your batteries, Clarence will be fine. Right now you aren't sure whether the 1u is still too high or just right so backing off to 0.75u for a few cycles seems a perfect compromise for both of you.
 
MrWorfMen's Mom said:
With Vetsulin being an in and out insulin, it's a bit more straight forward than other longer lasting depot insulins. With those, you could potentially set Clarence back a few days by going too low on the dose but with Vetsulin you see the results of dose changes almost immediately other than bounces which can muddy the water a bit.
My rule of thumb with my girl was always to make sure I was not exhausting myself to keep her in optimal numbers. There are enough times that they surprise us and we have unplanned PJ parties. We shouldn't be intentionally causing them with dosing in the name of "normal" numbers. If you need to back off on the dose for a few cycles to recharge your batteries, Clarence will be fine. Right now you aren't sure whether the 1u is still too high or just right so backing off to 0.75u for a few cycles seems a perfect compromise for both of you.
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Okie Dokie! I have been super anxious about all of this and on days after I've been up most of the night watching him and essentially being a helicopter kitty parent, I start to get even more anxious and feel like I'm basically doing more harm than good all the way around. I certainly am glad I got the human meter, tho, I'd be shelling out big bucks for those expensive strips otherwise!
I hope you are doing well and have a good day. Thanks again.​
 
Linda, Just wanted to update you a little In case you check in. I ended up doing a few more tests than I had intended :( because Clarence was seeming really hungry at a couple of points and I wanted to make sure he wasn't dropping too fast and possibly setting up for yet another high reading in reaction to it. He stayed I the 200s today and I did his PMPS a little earlier (but only by 10 minutes). Anyway, his PMPS was pretty-much the same as his +8. I will go ahead with the .75 tonight and see what that brings. Have a nice night. :)
 
Clarence has stayed pretty flat all day so I think sticking with 0.75u tonight is a good decision. SOmetimes those flat yellow cycles foretell an active cycle coming so just hold the course and see what he does. Thx for the update. :)
 
@MrWorfMen's Mom

Hi Linda,
Clarence's AMPS was 211 this morning. I hope you are available to look at his SS and advise if .75 is what I should do this morning. I can maybe stall him on breakfast for a little just to bring it up if need be.

Thanks! DeeDee
 
I think you are fine to give 0.75u today as long as you can check at some point mid cycle. Probably don't really need to stall. I was thinking about the AT2 meter but you've switched to the human one now so over 200 you should be fine to shoot.
 
Thanks. Right after I sent that, I realized that I was doing the same, thinking about the pet meter, not the human one. :oops:

I went ahead and fed him. He had a really good night, I could tell he was feeling good. Didn't rise too quickly. Didn't beg me to feed him, even after his almost +6 test.

But he did come in and wake me up about an hour before his regular test/feeding time by knocking stuff off the headboard to wake me up! Back to his old tricks, at least he didn't sink his claws into my scalp like he often has done! lol!

Just so I don't go into panic mode, how low should I let his readings get before maybe giving a bite to eat to slow it down? My concern here is another bounce...
 
Because Vetsulin tends to drop BG more in the first half of the cycle than the last, I'd try to keep feedings in the first half of the cycle if possible. If he gets down between 100 and 90 or thereabouts I'd feed him to keep him surfing rather than dropping as fast or too much. Clarence tends to nadir a bit later so you might find a snack around +4 or so could help keep him surfing. Timing of food is a bit of an experiment as every cat is unique in how they metabolize the insulin.
 
MrWorfMen's Mom said:
Because Vetsulin tends to drop BG more in the first half of the cycle than the last, I'd try to keep feedings in the first half of the cycle if possible. If he gets down between 100 and 90 or thereabouts I'd feed him to keep him surfing rather than dropping as fast or too much. Clarence tends to nadir a bit later so you might find a snack around +4 or so could help keep him surfing. Timing of food is a bit of an experiment as every cat is unique in how they metabolize the insulin.
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Alright, thanks for that. I know you've said before to keep food in first half of cycle and I mostly try to, so I'll work on that. I need to work on my response to low numbers and keep thinking 'human meter'. I hope he is in a surfing mood today. Last night seemed to me like he was just gently going lower, especially judging by his behavior and lack of wanting to be fed anytime I headed for the kitchen. Thank you! Happy Sunday...
:) ​
 
PMPS is 301
Should I go ahead and give him just the .75? He was acting hungry so I did feed him a little later today (right before +4 hours). Usually he gets a little food well before that so I don't know if that influenced his numbers.
 
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I would stick with 0.75u for tonight. If he's still up tomorrow you can consider bumping him up to 1u if pre-shot is high enough. Glad to see he hit some blue today but he can do better.
 
Linda, I may be way off with this, but I've been wondering if his body was just so used to higher BG that it reacts easily when his BG starts going down a little quicker (like when he was so hungry today) or goes down to a level that his body perceives is too low. Because of that, I think it may be good to ease him into lower numbers (i.e. sticking with the .75 tonight) rather than bump him up when he has a higher reading like tonight. Is this crazy talk?
 
No that is not crazy at all. It's often the case that easing them down works well because bounces are not only annoying but they make it harder to figure out what is going on. The saying around here is that this is a marathon not a sprint. Small incremental changes made methodically often work better than trying to push things along too quickly.:)
 
So, Clarence was high again this morning: AMPS was 369 and from the looks of the 2 tests I did (one before bed and one mid-cycle-ish) he didn't drop very much in the night.
I will go forward with 1 unit as we previously discussed.
 
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Good plan. You gave it a try and it's obvious Clarence needs a bit more juice. At least you got to catch up a bit on your sleep. :)
 
MrWorfMen's Mom said:
Good plan. You gave it a try and it's obvious Clarence needs a bit more juice. At least you got to catch up a bit on your sleep. :)
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Yes, and I liked it!
Cat pulled away just when I was injecting and I know a bit got on him, not in him, so we'll see... He (or probably me) has been better about the shots the past few days, but I have a lot of problems with the current needles I'm using, so I think I'm gonna order some different ones to try. I have some others that I think are a little better, but no numbers, just lines and I' prefer numbers so I don't make a mistake. Good Grief!
 
Syringes without numbers? YIKES! I agree....that sounds dangerous. What brand are those? I've never seen insulin syringes without numbers.

Check your syringes for a good sharp point. Quite some time ago, someone here found the needles she had were blunter than they should be. We all know the markings on the syringes are all over the place so it seems the quality control on them is not what it should be and sometimes you may get a bad batch.
 
MrWorfMen's Mom said:
Syringes without numbers? YIKES! I agree....that sounds dangerous. What brand are those? I've never seen insulin syringes without numbers.

Check your syringes for a good sharp point. Quite some time ago, someone here found the needles she had were blunter than they should be. We all know the markings on the syringes are all over the place so it seems the quality control on them is not what it should be and sometimes you may get a bad batch.
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The ones without numbers actually have numbers, but only 5, 10, and so on - those are ulticare. The ones I am using now are Carepoint VET - they have 1, 2, 3, and so on as well as 1/2 unit marks, and I have some monoject I bought from the vet's office. Virtually all of these needles listed here I have had problems with the syringe pulling down a large 'bubble' because of the friction, no matter how slow I try to draw or no matter how many times I push the plunger up and down before I even put it in the vial. I have been checking the point on the needle, but even with my reading glasses, it is very hard for me to see it well because it is so small. Should I take a look at a couple under a magnifying glass to see what they are looking like? I probably should.
 
It wouldn't hurt to check a few needles out under magnification although I doubt it's a big problem or I'm sure there would be "noise" on the internet and I've never seen anything. I once had a needle separate from the syringe barrel as I took the cap off the needle. That was a BD brand syringe. Started checking all the syringes before using them after that.

The bubbles are a pain but they happen. I think insulin tends to get bubbles more than other injectables I've worked with. (retired R.N.) I tried drawing quickly, slowly, steadily etc. and there didn't seem to be a sure proof way to avoid tiny bubbles and they would happen one day with a vengeance and other days none. Who knows. All you can do is get any large bubbles out. You are injecting SubQ so a few miniscule bubbles don't matter although too many and it would affect dose a wee bit.
 
MrWorfMen's Mom said:
The bubbles are a pain but they happen. I think insulin tends to get bubbles more than other injectables I've worked with. (retired R.N.) I tried drawing quickly, slowly, steadily etc. and there didn't seem to be a sure proof way to avoid tiny bubbles and they would happen one day with a vengeance and other days none. Who knows. All you can do is get any large bubbles out. You are injecting SubQ so a few miniscule bubbles don't matter although too many and it would affect dose a wee bit.
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Exactly what I've learned with my limited experience. I've tried all that too, and it is just as you say, so I've figured I just have to live with that and get out the big ones but a tiny one that won't budge I gotta give up that struggle at some point and give the shot.
 
MrWorfMen's Mom said:
That was a BD brand syringe. Started checking all the syringes before using them after that.
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I was thinking of getting some BD ones but maybe I'll rethink that. The ones I'm using I like because of the numbers, less room for error. I still double check, but don't have to triple and quadruple check like the ulticare ones. Especially right now where I'm changing up his dosing so much.
 
The BD brand is unfortunately the only ones available at retailers here. We could get Monojects many moons ago but they aren't stocked anywhere I've checked at this point in time. Only other place there is another choice is at the pet pharmacy but I never tried those and they are strictly U40 so wouldn't work for human or the really fine dosing. Our Walmarts don't carry the Relion brand. Have you tried those? A lot folks use them and they are very reasonably priced. Just check the box for half unit markings because apparently the staff don't always know they have half unit mark syringes and hand out the first ones they find on the shelf.:rolleyes:
 
MrWorfMen's Mom said:
The BD brand is unfortunately the only ones available at retailers here. We could get Monojects many moons ago but they aren't stocked anywhere I've checked at this point in time. Only other place there is another choice is at the pet pharmacy but I never tried those and they are strictly U40 so wouldn't work for human or the really fine dosing. Our Walmarts don't carry the Relion brand. Have you tried those? A lot folks use them and they are very reasonably priced. Just check the box for half unit markings because apparently the staff don't always know they have half unit mark syringes and hand out the first ones they find on the shelf.:rolleyes:
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The carepoint and ulticare ones I got online from ADW. I will need to get a written Rx from my vet unless Walmart will call them or otherwise obtain the Rx from them so I can buy the needles there. I will have to look into that and try the ReliOn ones. We don't have any pet pharms around here, other than the vet's offices and they charge a lot for supplies unfortunately. I'm blessed that I am in a position to not have to worry so much about the cost of keeping up with this right now, many people with diabetic pets (or even the humans with diabetes) are not so fortunate. I'm all for saving what and where I can, tho, because it really has impacted my pocket book a lot with all the vet costs.
 
The costs do mount up. Here in Canada while we get the insulin cheap, we make up for it with the cost of syringes, test strips and lancets. Our AT2 strips are over $2 each. OUCH! Even human meter strips are almost $80 for 100 except for one meter that is slightly cheaper but only available at one dealer which like the AT2 strip availability is not ideal. Vets tend to add on a handling charge so better to find alternate suppliers. Thankfully, like you, I never worried about the costs but I can well imagine how difficult it is for a lot of folks.

We're also lucky in that we can buy insulin and syringes over the counter without a script. Makes life so much easier.
 
MrWorfMen's Mom said:
The costs do mount up. Here in Canada while we get the insulin cheap, we make up for it with the cost of syringes, test strips and lancets. Our AT2 strips are over $2 each. OUCH! Even human meter strips are almost $80 for 100 except for one meter that is slightly cheaper but only available at one dealer which like the AT2 strip availability is not ideal. Vets tend to add on a handling charge so better to find alternate suppliers. Thankfully, like you, I never worried about the costs but I can well imagine how difficult it is for a lot of folks.

We're also lucky in that we can buy insulin and syringes over the counter without a script. Makes life so much easier.
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Call me crazy, but I just find it so frustrating that MEDICAL SUPPLIES, human or pet, are not more affordable - people and animals need this stuff to live!
 
@MrWorfMen's Mom

Linda, I tested Clarence at +4.5 because he woke up from his slumber and seemed to want to eat. I don't like feeding him this late in his cycle and he had a good-sized meal this morning. His BG was at 181. Seems to me that isn't a huge drop, what is your opinion on this?
 
That's about a 50% drop which is good. If Clarence is hungry, there is no harm feeding him a small snack. It might just get him to hang out in blue a little longer.

ETA a bigger drop would probably result in a bounce so better to have a smooth slow drop than a large one all in the first few hours.
 
Thanks, he decided he wasn't so hungry after all, so I'm just letting him be for now. I'm hoping he hangs in the blue for awhile. With the human meter, blue and dark green are what we want, right?
 
That's what I thought. Thank you.

So, at about +5.5 he decided he IS hungry. Didn't want to feed and test later, so I tested him now and he is 166. I gave him a teeny bit of food hoping it wouldn't linger long and disrupt the insulin too much. I'm hoping for a good day with him, a lower PMPS than his morning one, so I can feel comfortable with the same dose tonight and not have to set alarms or stay up until wee hours.
 
couple of thoughts -- if it's late in the cycle and he's hungry, get out some freeze dry treats or some non-fatty chicken, the protein-only treat may not affect the BG that much -- when Catcat gets miserable about "mom I'm hungry" I break out the bonito curls

syringes -- and bubble -- have been getting a rash of those lately -- I've found that if you depress the plunger as hard as you can and hold it in while you are piercing the vial, then let it go after that, you get smaller bubbles -- with Vetsulin, the way the vet had me shake it vigorously, the real bubble problem was getting them to quit being froth on top of the liquid in the vial -- sometimes I'd have to flick it or roll it for as much as ten minutes before it dissipated

the Relion syringes are a frustration since when you do get the bubble up to the top, it's still at the side of the syringe, not centered, and it won't just go out when you try to expel it, you have to pull plunger back to get more air in the barrel, then flick it to get all the air up to the top to eject it
 
CandyH and Catcat said:
couple of thoughts -- if it's late in the cycle and he's hungry, get out some freeze dry treats or some non-fatty chicken, the protein-only treat may not affect the BG that much -- when Catcat gets miserable about "mom I'm hungry" I break out the bonito curls

syringes -- and bubble -- have been getting a rash of those lately -- I've found that if you depress the plunger as hard as you can and hold it in while you are piercing the vial, then let it go after that, you get smaller bubbles -- with Vetsulin, the way the vet had me shake it vigorously, the real bubble problem was getting them to quit being froth on top of the liquid in the vial -- sometimes I'd have to flick it or roll it for as much as ten minutes before it dissipated

the Relion syringes are a frustration since when you do get the bubble up to the top, it's still at the side of the syringe, not centered, and it won't just go out when you try to expel it, you have to pull plunger back to get more air in the barrel, then flick it to get all the air up to the top to eject it
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I'll have to try the chicken maybe cuz I don't have any of the bonito flakes -- will need to make a trip to town to look for some, otherwise I'll have to go to a special Asian store.

Thanks for the info on the syringes. I currently get bubbles that do the 'stick to the side' thing, very frustrating! And I can totally relate to what you are saying about the frothy bubbles in the vial. I pull it out of the fridge when I feed the cat or a little bit after, shake it, then put it back in the fridge for a while and when I take it out again I roll it and rock it just to make sure it is mixed well. The froth usually dissipates when I do it that way.
 
for treats, check out NW-NATURALS.NET, out of Portland OR -- their Raw Rewards may be in the dog aisle but package says "for dogs and cats" -- Catcat loves the whitefish treats, and they're surprisingly inexpensive compared to some of the other treats, bag is the small (but not mini) potato chip size and the chunks are small enough for cat and crunchy enough that teeth aren't needed --
 
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