Dosage question

[Oliver the Roman]

Hello, I have a question for posibly a pretty singular case.
I am discovering a certain pattern with my cat.
I give him 2 injections of Caninsulin @ 0.25ui every day, approx. at 01:30 & 13:30.
I have been checking his BG every day around 01:00, the numbers are petty stable, around 120 - 150, sometimes even under 100.
Then the last couple of days I found out the reading at 13:00 much higher, 238 & 253.
So the pattern is, the reading is at night is consistently "almost" normal, but at 13:00 much higher at around 250.
I am tempted to try 0.5ui at 01:30 and 0.25ui at 13:30, but is it absolutely essential to stick to the same dosage every time?
TIA for any second opinions, and I wish all of you a Happy Easter, despite the situation!

 

[Deb & Wink]

Seeing those numbers on a spreadsheet, would be really nice. Gives a better visual representation then what you said in words.
We have a standardized, color coded template that you copy and then link into your User Id "Signature".

Set up instructions include screen captures, directions for pc, tablet, smartphone. Versions for US, World (non-US). Versions for pet meters and human meters. Pick the template that matches where you live and the type of meter you use.

FDMB Spreadsheet Instructions

I'm a gardener, so for me visuals have more impact and greater understanding. I can't see the pattern you are talking about, but if it was on a spreadsheet, it would be pretty easy to see.


Varying the dose night and day rarely works. Why? I'm too tired to explain right now. Tag me in the morning and I'll get back to you.
Understanding the Spreadsheet/Grid

 

[Oliver the Roman]

Seeing those numbers on a spreadsheet, would be really nice. Gives a better visual representation then what you said in words.
We have a standardized, color coded template that you copy and then link into your User Id "Signature".

Set up instructions include screen captures, directions for pc, tablet, smartphone. Versions for US, World (non-US). Versions for pet meters and human meters. Pick the template that matches where you live and the type of meter you use.

FDMB Spreadsheet Instructions

I'm a gardener, so for me visuals have more impact and greater understanding. I can't see the pattern you are talking about, but if it was on a spreadsheet, it would be pretty easy to see.


Varying the dose night and day rarely works. Why? I'm too tired to explain right now. Tag me in the morning and I'll get back to you.
Understanding the Spreadsheet/Grid

I tried to simulate the given spreadsheet style. Is this compatible enough?

 

[Deb & Wink]

Yes, that kind of works. But you could have simply copied the template we have and then linked it to your signature. Instead of "reinventing the wheel."

Kind of blurry too. Plus, with putting it directly in the post, we won't be able to see updates.

Looks to me like 0.25U of Caninsulin is too much for your cat. He's probably dropping low in the middle of the 12 hour cycle, then bouncing back up at PMPS pre-shot.

I'd suggest dropping the dose for both AM and PM to 0.1U.
Picture of U100 syringe showing the plunger placement. Concept is the same with a U40 syringe.

Plus, you want to test during the middle of the cycle, to see how low the insulin is dropping your cat. What is called the nadir or the peak (for peak action).

Changing the dose from cycle to cycle, giving more or less insulin based on the pre-shot test, instead of adjusting the insulin dose based on the nadir and the patterns over time, usually simply results in more "bouncing."

Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Hope that helps. Stay safe out there, and enjoy your holiday.

 

[Oliver the Roman]

Yes, that kind of works. But you could have simply copied the template we have and then linked it to your signature. Instead of "reinventing the wheel."

Kind of blurry too. Plus, with putting it directly in the post, we won't be able to see updates.

Looks to me like 0.25U of Caninsulin is too much for your cat. He's probably dropping low in the middle of the 12 hour cycle, then bouncing back up at PMPS pre-shot.

I'd suggest dropping the dose for both AM and PM to 0.1U.
Picture of U100 syringe showing the plunger placement. Concept is the same with a U40 syringe.
View attachment 52616

Plus, you want to test during the middle of the cycle, to see how low the insulin is dropping your cat. What is called the nadir or the peak (for peak action).

Changing the dose from cycle to cycle, giving more or less insulin based on the pre-shot test, instead of adjusting the insulin dose based on the nadir and the patterns over time, usually simply results in more "bouncing."

Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Hope that helps. Stay safe out there, and enjoy your holiday.

Thank you so much for the feedback. I already had the spreadsheet from the previous episode almost 2 years ago, at that time things got resolved within 3 weeks and I stopped monitoring for a year and half, until late last year when the problem resurfaced.
The formula programmed in the spreadsheet wasn't cooperating with me, so I just made up my own chart, but I will try to study a little further and see if I can restart the existing chart.
I was indeed aware of the +4 hour peak, and the possibility of hypoglicemia. I was monitoring his behaviour pretty closely, but he wasn't demonstrating any of the alarming symptoms (he remained alert and as active as a lazy-bone like he is could possibly be) so I didn't do the reading, to save his ears from further butchering - but I think I should test for the reading at nadir at least to be more precise in the next few days at least, because you may be right about bouncing.
I will monitor even more closely for a few days, and I may switch to 0.1 - and Thank you for showing the picture for a 0.1ui dosage! I had been using the U40 syringes previously, but did get the U100 in order to administer 0,25 more correctly.
Hopefully I will manage to get the spreadsheet updated correctly soon, and will be able to show it to you.
Happy holidays and stay safe!

 

[Deb & Wink]

so I didn't do the reading, to save his ears from further butchering

If you have some triple antibiotic ointment with pain relief, that can help the ears heal. Neosporin is one brand, but there are others. The ointment is recommended over the cream, because the ointment version has a higher oil content, and will help the blood drop bead up. A tiny dab will do the trick.

In regards to the problems you are having with your old spreadsheet, I suggest you send a PM (Start a New Conversation) with @Marje and Gracie who is an expert at figuring out issues with the spreadsheets and formatting issues.

I thought you lived outside of the US (you called the insulin Caninsulin and it's known as Vetsulin in the US), so was surprised to see the attachment you did with the mg/dL values as opposed to the mmol/L values. But thank you for that, since I'm a bit more used to the mg/dL values but can work with both.

Marje will want to get editing rights to your google spreadsheet version, the copy of the one that is our standardized template. She'll probably want to add a tab for the current year, 2020 so it doesn't take as long to load for those of us looking at the SS. Too much data, from multiple years gets unwieldy and can take several minutes to come up for those of us with slower internet connections.

It's the big Easter holiday here, so many Christians are trying to spend time with their families, perhaps not in person, but via Skype or Zoom or phone calls or other means. It may take a bit to get a response from her.

In the meantime, having a bit of data in your User Id "Signature" can be really helpful. By the "magic" of computers, that information is attached to your posts, even retroactively. Takes about 60 seconds to setup the "Saignature." Link below with the how to's.

Editing your Signature, Profile, and Preferences

I realize that you are posting in the Caninsulin/Vetsulin ISG, so it's easy to see what insulin you use. But if you ever have an emergency situation, and don't get a response in this forum, please post in the Feline Health (Welcome & Main) forum for assistance. Having that data in your signature will save people a lot of time when trying to help you.

 

[Oliver the Roman]

Thank you again @Deb & Wink for further assistance. My OH is an IT expert who knows everything about excel and then some, so I will get him to have a look at it first.
Is there a specific brand name for the antibiotic ointment, to make it easier to find an equivalent product over here? Yes indeed I live in Italy and all the measures/dosage I use is according to the veterinarian I am seeing. So I think it is also common in other parts of the world.
Oliver, my cat, is quite chill about testing, he doesn't struggle when I pick him up for testing, and almost never feels the pain of pricking so it seems. Occasionally though I have a difficulty getting the drop to form (it sometimes spreads out instead) and I have to repeatedly stab his ears (which does annoy him!), or some other times a surprising amount of blood spews out and it becomes a bit of a bloodshed which traumatizes me much more than Oliver himself.
My new glucometer requires much less blood for the reading and it is helping a great deal, and I will try to improve my skills - it is such a delicate operation and I have gotten so much better than the initial trials, when I had to deal with wildly trembling hand and pounding heart!
It's quite late here in Italy now, I will sort out my profile as you instructed me tomorrow, or as soon as possible.
Thank you again!

 

[Oliver the Roman]

@Deb & Wink Hi, I did update the existing spreadsheet. I hope I did it right.
I also decided to go ahead and reduce the dosage to 0.1, it seems to be so far so good. Fingers crossed

 

[Deb & Wink]

Good to see you reduced the dose. Oliver may not need insulin for much longer, is one possibility, with him getting those low numbers.

When you get a chance, please get at least 1 mid-cycle test. Somewhere in the +5 to +7 hour time frame, after the insulin shot. Vary the test times each 12 hour dosing cycle. Maybe do a +6 one cycle, and a +5 the next cycle.

The brand name of the triple antibiotic ointment with pain relief that many people use is called Neosporin + Pain Relief Ointment. Or they have a new product called Neosporin + Pain/Itch/Scar that may work also. If you have some petroleum jelly, Vaseline is one brand, you can put a dab of that on your cats ear to help the blood drop bead up better. Only a little bit, so wipe off any excess. I copied pictures below. The ointments and the petroleum jelly have a higher oil content. Do not buy the cream version of the Neosposin, because the cream has a lower oil content and can cause the blood drop to flatten out and disappear into the fur on the ear.

Stay safe there in Italy. Hope you are not in one of the hardest impacted areas.

 

[Deb & Wink]

2nd reply to you to answer more of your questions. First reply was getting long, with those pictures I included.

I did look at the current SS (spreadsheet) and it looks fine. Where it says "Sheet2" would you or your other half change the name on that tab to say "2020". That way, it's easier to see which is the current data.

Now, if you could get that current SS linked into your signature, you will not have to include a link in the post. A link in the post is static data, and we can't see any updates. A link in the User Id Signature is View Only, but we can see updates every 5 minutes.

Directions on how to link that spreadsheet into your User Id Signature are in this thread. FDMB Spreadsheet Instructions

Look starting about 1/3 of the way down in that thread, where it says 5. Click on "File" again, scroll down the list and click on "Publish to the web":

And follow the steps from that point on. Linking it to your signature is down about half way, and starts with saying
Instructions for pasting the SS link in your FDMB Signature block:

One other thing when you get a chance. Please update your User Profile information to include your location. Knowing that you are in Italy will be very helpful for people to know.

 

[Deb & Wink]

3rd reply to get you yet more information. About the testing.

Occasionally though I have a difficulty getting the drop to form (it sometimes spreads out instead) and I have to repeatedly stab his ears (which does annoy him!), or some other times a surprising amount of blood spews out and it becomes a bit of a bloodshed which traumatizes me much more than Oliver himself.

Oh yes, I remember not holding Wink's ear firmly enough after the poke and he would shake his head and the bathroom walls and floor would look like a crime scene.

Try a double prick, 2 pokes really close together.
Try that Neosporin or the Vaseline to get the blood to bead up.
Use that old sock filled with rice or another form of dry grain, heated in the microwave, to warm up Oliver's ear.
You are aiming for the capillary area on the edge of the ear, not the marginal ear vein. The area between that vein and the very edge of the ear.
Use something firm to back up the area of the ear where you are poking.
Flashlight or bright light or a headlamp can help you see the vein better, so you know where not to aim.
Shave a tiny patch of fur on the edge of the ear, very gently with a safety razor. It can help to see the area better.
Try poking on the inside surface of the ear, not the outside surface where all the fur grows.

Here is a diagram of where you should be poking. If you are getting a lot of blood, you probably accidentally hit the vein.
"Testing
We all know the basics:

• Warm the ear with a rice sock or a warm washcloth wrapped in a plastic bag.

• Either freehand or use a lancing device; new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed; then progress to a 31g or 33g which are finer.

• Be sure to poke in the "sweet spot" and not the major vein that runs along the length of the ear. Poking the vein will not only hurt, but will result in a lot of blood. The sweet spot is on the edge of the ear.

But did you also know there is a particular way for the lancet to be used? It has one side that is beveled so the sharpest part goes in first, if used correctly."

More in this great link: Marje and Gracie's Testing and Shooting Tips

 

[Oliver the Roman]

Hello @Deb & Wink thank you so much for loads of practical information and suggestions!
I linked my spreadsheet and added the location on my profile as suggested.
Now I do get a faint idea of what vaseline looks like indeed practically the identical product is widely available also here, and I am quite sure I have seen Neosporin being sold here, too. So I will have another excuse to break the quarantine and take a walk to the pharmacist
I do try to follow all the do's of the pricking technique, but I guess I have accidentally stabbed the main vein when we had the bloodshed. Thankfully Oliver remains quite zen-like throughout the whole thing, the only thing that annoys him is when I fail to get the blood to form a proper drop and have to keep on trying. Shaving the area is a good idea, and thanks for the link for the testing and shooting tips, it's a relief to see I am not the only one who occasionally struggles!
I am also a free hander with the lancet, I figured that out pretty quickly it makes it much easier, as the noise the device makes tends to freak out Oliver while he is mostly not bothered by me free-hand jabbing.
Anyway the reduced dose is so far so good, I will keep on checking at various times as you suggested in the following days.
He has been hovering around the threshold of being "almost" independent but not quite yet for a couple of months. He was free of injections for nearly 3 weeks last month, but the readings started to steadily creep up again so I had to restart the therapy with the minimum dose possible. According to my veterinarian 0.5 was the minimum dose possible, but even that was becoming too much for him, so I am grateful for the advice of the members of this forum, which have worked out very well.
Fingers crossed that he will attain another remission soon!

Thank you also for your well-wish, Rome is not a hard-hit area, the major problems are happening on the other side of the country, mostly in Lombardy. So we are pretty calm here.
Let's hope this global madness will be over with soon, but until then, everyone stay safe!

 

[Deb & Wink]

Spreadsheet link is working just fine! Thanks for getting that done. Do we have your OH (other half) to thank? In any case, say hi to the other person helping you, from us.

I'm pretty good at pointing people to information and answering questions.

Shaving the area is a good idea, and thanks for the link for the testing and shooting tips, it's a relief to see I am not the only one who occasionally struggles!

Wink was a long haired cat, with long black fur on the outside of his ears, as well as really long 3" ear floof hairs on the inside of his ear. Shaved a spot for my own sanity, so I could see better, and once I got better at testing, I let the hair grow back. People with lighter haired kitties, have no idea how difficult it can be to test a cat with black fur or black ear edges, like a tortoiseshell cat.

Does Oliver get some sort of a treat after a poke? Any kind of pure protein would be fine. Or if Oliver isn't food driven some extra attention, brushing, chatting with him about your day, singing him a song, or play time is a nice treat.

Good to hear that Oliver is doing well on the small dose of 0.1U. There are actually smaller doses you can try if needed. ''Some insulin" and "drop dosing" can be used.

If you are able to test at +3 or +4, that could give us a lot of information. If Oliver's pancreas is doing a bit of the work and producing insulin, we should see that reflected in the +3 and +4 test times, with lower numbers than the pre-shot.

There is a lot more information on a plethora of topics, in the Health Links / FAQs about Feline Diabetes forum here. There is an Index "Sticky" or pinned post at the top of that FAQ's forum. It's where I copy a lot of information that I link for people.

What I am really, really bad with, is the emotional support aspect. It's not that I don't have a lot of empathy, but that I have too much, and will end up in tears if I start with that type of information.

Let's hope this global madness will be over with soon, but until then, everyone stay safe!

Totally agree. The US has made too many mistakes in responding to the virus, treating it as a political issue instead of a global health issue. Time to stop the threats, time to stop firing anyone and everyone that you don't agree with and actually LISTEN to people that know more and that have decades more experience.

People earn my respect. By their words, deeds and actions. Just because you have a particular job, doesn't mean you are good at it. There is always room for improvement and continuing to education yourself makes you a better, happier person. I'm still trying to get better every day.

 

[Deb & Wink]

Second thing I'm really bad with, is keeping my posts/replies "short and sweet". I like to give the reasoning behind something, so someone learns and can handle a situation in the future.

 

[Oliver the Roman]

Hi @Deb & Wink I just took the reading at +4hr and I am happy to report that it's right where it should be of course it's only been 2 days and I have to stay vigilant for some more days, his numbers tend to take a strange jump occasionally for no apparent reasons (but then goes back to a normal range by itself) - but I am cautiously optimistic! Now that I have been doing a lot more of in-between reading (he will eat anyway right after the preshot reading!), I got him a special treat he likes, dried salmon bits to give him after the testing. I am just grateful that he is quite a trooper when it comes to testing, he often even purrs while I am doing the test, and then just remains right where he is after I am done, instead of scampering away. I know some extremely high-strung cats who would become absolute demons if you tried something of the sort, I really hope they won't become diabetic with all my heart
No problem at all about emotional support, actually I prefer it that way. Oliver has become a bit of a celebrity among my facebook friends around the world, but there are only very few people who knows he has issues with diabetes, and even with them I try to keep a low profile over this topic, unless I have some practical questions.
And I really appeciate your insightful, elaborate replies, it's very helpful and that alone shows that you care a lot, without saying any sweet nothings!

 

[Oliver the Roman]

Hello @Deb & Wink it's been a couple of days - would hate to knock on any wood but I am happy to report that the readings have been excellent overall, the only ??? is the reading at +5hrs this afternoon, I got 117, then at +11:30hrs (preshot) I got 128. Such a small fluctuation considering there was a change of 40 between +3hrs & +5hrs, it seems to be a little strange but is this possible?
Could it have been even bigger a swing between +4hr & +5hr? I thought of testing at +4hrs, but he was playing boisterously with me at that moment I deemed there was no risk of him suffering hypoglicemia, so I skipped it.
Is it a good sign or not so good sign, or could it be that one of the reading wasn't correct??
Let me know what you think! thanks!

 

[Deb & Wink]

Such a small fluctuation considering there was a change of 40 between +3hrs & +5hrs, it seems to be a little strange but is this possible?

Yes, very possible that the numbers, the BG levels could stay close together like that for hours.

Could it have been even bigger a swing between +4hr & +5hr?

40 points is not a big swing at all. Oliver seems to be surprisingly steady at this 0.1U dose. It seems to keep the numbers nice and flat.

Is it a good sign or not so good sign, or could it be that one of the reading wasn't correct??

I don't see anything alarming in the BG readings.
Oliver does not need a lot of insulin. I think his body is starting to produce some insulin on it's own.

That is a good sign. A very good sign.

 

[Oliver the Roman]

@Deb & Wink that's very reassuring, thank you!!!
I will keep at it for about 3 weeks and I will try suspending the injection if the numbers remain steady without strange occasional jumps, or the preshot reading goes below 100 - what do you think?

 

[Deb & Wink]

I will keep at it for about 3 weeks and I will try suspending the injection if the numbers remain steady without strange occasional jumps, or the preshot reading goes below 100 - what do you think?

I think that is a good plan.

If the pre-shot readings drop below 100, and stay there for a few days, then you would want to stop the insulin and try what we call an OTJ trial. OTJ stands for off-the-juice, the "juice" meaning insulin.

I don't think that Oliver is quite ready for an OTJ trial, but he's getting close. Ideally, your cat needs to have been stepping down the dosing scale, from 1 to 0.75, to 0.5, to 0.25, to 0.1 and getting good numbers all along before you attempt an OTJ trial. Any blues at mid-cycle tell you your cat is not ready for an OTJ trial. A blue pre-shot tells you your cat is not ready for an OTJ trial.

Your cat should have been getting green numbers across the board, at all testing times before you attempt an OTJ trial. For a week, all greens for a week. Cat needs to be steady in the greens before attempting an OTJ trial.

But that "ideal" often does not happen with Prozinc, so some people go ahead with an OTJ trial anyway, even if their cat is in the blue and green numbers at pre-shot. It's really your choice, as the caregiver.

There are instructions for an OTJ Trial. Here they are for you:

OTJ Trial Guidelines (These are the criteria we use when following an OTJ Trial.)
Here are the instructions for an OTJ trial: If on Lantus or Levimir, depot has to drain first before trial starts, about 3 days or 6 cycles. No depot with in and out type insulins (NPH, Vetsulin/Caninsulin, Prozinc). The trial starts when numbers are in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall. With only occasional readings in the 100 - 120 range. Start the trial on the next green pre-shot test.

If you are posting in the Lantus/Levimir forum, please start a new thread each day which says ‘[Cat name] OTJ trial Day 1 BG xx’ (where xx is the BG reading for that cycle PM), then day2,3 etc. If you are posting in the Main Forum, we don’t require you or need you to do that separate post for each day. In fact, if you have never posted before over in the Lantus/Levimir forum or use a different insulin, you are fine staying in the Feline Health (Welcome & Main Forum). Or in the specific ISG (Insulin Support Group) for your insulin. We’ll cheer you on!

1. Test at your normal AMPS and PMPS times. Remember, you want a 2 hour fast before those AMPS and PMPS test times. Feed multiple small meals throughout the day as much as possible (small meals are less likely to overwhelm a newly functioning pancreas). The morning test is now called the AMBG. The evening test is now called the PMBG.

2. If your cat is green (0-99 mg/dL human meter, 0-130 mg/dL pet meter, 0-5.5 mmol/L) at your normal test times, no need to test further until the next "PS" time, just feed small meals and go about your day. If the numbers are blue or higher (100-199 human meter, 130-230 petmeter, 5.5-11 mmol/L), feed a small meal and test again after about 3 hours. Food raises BG's. So if the number is lower 3-4 hours after a meal, then the pancreas is working!

3. Your cat may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.

4. After 2 weeks, 14 full days, if everything is looking good, we have a party!

Sometimes, the trial doesn't work the first time and we have to give a little more support by starting the cat with a tiny dose of insulin again. I had to do that with Wink. We simply start the cat back on a tiny dose of insulin to support the pancreas with healing for a bit longer. Our goal is a strong remission and it's better to be safe now then sorry later that you rushed it. With just a little more time we will probably get that strong remission we are looking for.

 

[Oliver the Roman]

Thank you so much for much more precise guideline on the way to (hopeful) remission! Now I have much better outlook and am prepared to what to look out for.
My last trial to suspend the therapy didn't work because A. I really had little idea how to follow through, as I got little practical advice from my veterinarian and B. Probably I stopped too suddenly, going from 0.5 to none, I didn't know the dosage of 0.25 or 0.1 was possible.
I would very much like to make sure he is ready, so I won't rush and will monitor carefully.
A question. when you said the guideline of when to start the trial,

The trial starts when numbers are in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall. With only occasional readings in the 100 - 120 range. Start the trial on the next green pre-shot test.

Is this according to a human glucometre, or a pet glucometre? I use pet glucometre.
Another question : when I see a preshot reading below 100 for the first time, would it be safe to keep giving him 0.1 for a few more days?

 

[Deb & Wink]

That < 100 mg/dL I mentioned was on a human glucometer.
So using a pet glucometer, you would be looking for BG (blood glucose) numbers <130 mg/dL (7.2 mmol/L).

I'm going by some older pet meter number guidelines here, saying the pet glucometer readings could be higher. There is a difference of opinion here on this forum in regards to that. So some people would say the number on ANY type of glucometer would need to be in that <100 mg/dl range.

So you might want to strive for BG pre-shots that are <110 to 120 mg/dL with the pet meter.

 

[Oliver the Roman]

Hi @Deb & Wink can you take a look at his readings in the last few days and tell me what you think? Looks like his numbers are crawling back up (I knew I shouldn't have spoken too soon!! ) should I go back to 0.25?? I just wouldn't want that then in a few days it proves the dose is too much and I have to modify again... (I understand that the dosage should be as consistent as possible, and not to change frequently?)
TIA!

 

[Deb & Wink]

Oliver is getting some nice low numbers at nadir (mid-cycle) on the 0.1U dose of insulin.

Would you give it another 24 hours, to see what his BG numbers are over the next 2 cycles, before increasing?

 

[Oliver the Roman]

Oliver is getting some nice low numbers at nadir (mid-cycle) on the 0.1U dose of insulin.

Would you give it another 24 hours, to see what his BG numbers are over the next 2 cycles, before increasing?

will do! I will keep you posted! thank you!

 

[Oliver the Roman]

@Deb & Wink again, the number is good at nadir but not so good at the 11th hour.. (actually +11:30hr)

 

[Deb & Wink]

@Deb & Wink again, the number is good at nadir but not so good at the 11th hour.. (actually +11:30hr)

This often happens with Caninsulin (Vetsulin). The duration can be short.

Oliver looks close to not needing insulin anymore, but the Caninsulin is not quite getting him there.
One thing you can try, is to use the 0.25U dose for 1 cycle. Sometimes, this can give the pancreas an extra push, a kickstart, and get the numbers to come back down. Worth a try.

So say the next time his pre-shot test is >150 mg/dL, try that dose increase for a single cycle, then drop it back down to the 0.1U on the next cycle.

Alternatively, is there anyway you have access to a different insulin?
Sometimes, switching to glargine (lantus) for the last little bit, can get a cat into diet controlled remission.

Maybe you know a human diabetic, that can not use all of their glargine (lantus) insulin. Either from a 10 ml vial, or from an insulin pen. You would need different insulin syringes, U100 syringes.

I realize that can be difficult to do something like this right now.
You are still under lockdown I see? I understand from the news, that maybe the lockdown will ease starting on May 4th.

 

[Oliver the Roman]

@Deb & Wink thank you so much, as always your advice helps me a whole lot especially when I don't get much access to the vet, but TBH your advices have been much more helpful and practical than she ever could have been anyway
All the same I will have to ask the vet if Lantus is available here. In the meantime I will try the 0.25 boost and see how it goes and if it doesn't give him a consistent result I shall ask her.
Yes, finally from 4th of May some of the normality will be back, and we can go outside almost without restrictions.
I work from home and have always been a semi-hermit at the best of times so the lockdown itself didn't affect me too much, but it will be nice to be able to go out for a walk or cycling out in the open after a month and a half!
Needless to say, further report to follow shortly!

 

[Deb & Wink]

Keep me posted on how Oliver does on the 1 time boost in dose to 0.25U.

We are all looking forward to some normality returning to our lives.
Unfortunately here in the US, and the state of Massachusetts where I live, is a virus hotspot right now, in the city of Boston.
It's going to be awhile before things get reopened.
Essential business are open. Grocery stores, pharmacies, car repair businesses, health care, etc.
Schools are closed for the rest of the school year, which normally runs into the end of June.

But it's still scary going out, and keeping yourself safe.

 

[Oliver the Roman]

@Deb & Wink Oh yes, I read about NYC and its major spread, indeed Boston is not so far off from there, hope it won't get too serious in your neighbourhood!
Here in Italy schools will remain closed for a safety precaution. Italy took a huge hit because its economy depends largely on tourism - which will still have to wait for all the restrictions to be eased.
And since it gained a certain reputation regarding all this virus saga, I am afraid it will cast a long time effect on their tourist industry.

Well, back to Oliver, I shot 0.25 last night and got up to check the reading at 4.5 hrs, 70 - good, but it was back to 153 at preshot, wee bit high, so I shot another 0.25 this afternoon. I hope I made the right decision!

 

[Deb & Wink]

I shot 0.25 last night and got up to check the reading at 4.5 hrs, 70 - good, but it was back to 153 at preshot, wee bit high, so I shot another 0.25 this afternoon. I hope I made the right decision!

Yes, I think that was the right decision for Oliver.

Boston is it's own "virus hotspot" in the nation right now. I'm only 30 miles north of there, as the crow flies. Cases still on the increase in Massachusetts right not. Not expected to peak for a few more weeks. Boston is also an area that is very dependent on tourism and many colleges/universities. All the tourist sites are closed, colleges as well as the local schools for children in grades K-12 are closed too. Many people losing their jobs and unemployment is only going to get worse. Restaurants were allowed to do "take out" meals or delivery, but many restaurants will never reopen.

People are in for some very difficult times. Our social safety net and health care are not as good as in many countries in Europe.

 

[Oliver the Roman]

Thank you, I will remain vigilant regarding Oliver's numbers, and will stick with 0.25 unless the number goes back to the 120-130 range at the preshot.

I would say the real damage that this virus saga is casting is not the virus itself but the panic. They need to understand the risk group and how to protect them - as the infection doesn't cast any serious effect on 90% of the cases, which Italy is just beginning to understand. It is quite probable that the virus will not just go away, but by learning how to deal with it properly, panic and paranoia is not necessary and it is possible for the world to move forward.
We can pray for the best but surely, with a president who would blurt out in front of the whole world about "injecting disinfectant"... things must be very rough...

 

[Deb & Wink]

Yes, keeping a close eye on Oliver is a good thought.

We can pray for the best but surely, with a president who would blurt out in front of the whole world about "injecting disinfectant"... things must be very rough...

People that earn my respect, take responsibility for their words and actions, instead of trying to shift the responsibility to someone, anyone else. You make choices in life, and live with the consequences.

 

[Oliver the Roman]

Hi @Deb & Wink I am afraid his reading is becoming a little volatile. He gave me a hair raising moment 2 days ago giving me 340 then went back to normal - almost normal for a day and a half, then this afternoon it was 251
The dosage has been 0.25ui for the last 4 days.
Curiously enough, the bad numbers happen almost always at the afternoon reading, while the night reading has almost always been good to ok, except one occasion. I am not sure if it's just a coincidence, the only difference I can think of between the afternoon reading and night reading is that, amount of the two meals he has before the afternoon reading (meal I give before the night injection, and the breakfast) is larger, because the interval between the meals is longer. during the afternoon - evening he eats smaller portion 3 times. Do you think this affects the reading? Would it be better to feed him the smaller portion with smaller interval also during the wee hours? (It shouldn't be impossible, as we have an automatic feeder with refrigerating function.)

 

[Deb & Wink]

If you ever get a blood glucose reading, that seems inconsistent (like that 340) , please retest the BG right away. It could have been a bad test strip. That does happen from time to time.

High numbers are not as worrisome as low numbers. Low numbers need some food, to bring them up quickly. High numbers do much slower long term damage. You certainly don't want Oliver to have those high numbers, but I would not worry about them as much as a number < 50 mg/dL.

amount of the two meals he has before the afternoon reading (meal I give before the night injection, and the breakfast) is larger, because the interval between the meals is longer. during the afternoon - evening he eats smaller portion 3 times. Do you think this affects the reading? Would it be better to feed him the smaller portion with smaller interval also during the wee hours?

Yes, different amounts of food could be making a difference.
Try that food change, so Oliver gets the same amount of food for both the AM and the PM cycles, at about the same time.

The other possibility is that the auto-feeder malfunctioned, and he got a meal too close to the PM cycle.

Also, Oliver's activity level could be higher at night. Many cats have play time during the night when we are sleeping. When cats are more active, that brings their blood glucose levels down lower, because they are using more of that glucose as energy to play.

 

[Oliver the Roman]

Hi @Deb & Wink it's been a few weeks - things went on pretty much steadily, however in the last several days the readings have become a bit... volatile He was giving some high numbers for a few days, so I increased the dose ever so slightly, from 0.1 to 0.15 (approx. - such a slight change is rather difficult to be exact) - after two injections with this dose his preshot was down to 97, so I changed back to 0.1, then immediately he gave me two nasty numbers in a row.
I just can't seem to find the right balance, with the numbers he has been giving me, I toyed with the idea of going back to 0.25, but I am afraid the number will go too low at nadir, and that might trigger more unstable ups and downs.
I just gave him 0.15 now after the number was 287 I would like to see your opinion what would be the best course of action in coming days... Thank you!

 

[Deb & Wink]

I would like to see your opinion what would be the best course of action in coming days...

I think some tests during the middle of the cycle would let you know better what Mr. Oliver's BG numbers are doing. If they are dropping him really low at some point, then he may be bouncing back up.

 

[Oliver the Roman]

As you suggested, I tested at +4hrs, then +5hrs after he was 161 at the last pre-shot reading. 126 after 4hrs, 97 after 5hrs. A little high for his normal level at this period.
I will keep a closer observation for the next few days, with a dose of 0.15 (or 0.1+) and then I will report to you how it is going.
A question. to change the dosage or not to change, according to the reading.
My veterinarian says I should stick to the same dosage for at least a few weeks so his system will get accustomed to it.
But I see a lot of members here who often switch the dosage according to the reading.
Obviously I would reduce the dosage if his numbers go too low.
My uncertainty is when, or if to increase the dosage when his number starts going up (as an average - he might give a normal number at some tests, but starts to hit 200+ more often)
Do you have a suggestion how to decide on it?

 

[Deb & Wink]

My uncertainty is when, or if to increase the dosage when his number starts going up (as an average - he might give a normal number at some tests, but starts to hit 200+ more often)

There are no hard and fast rules, on changing or increasing the dosage. But knowing YOUR cat, and how he is doing in the middle of the cycle, will let you know if those 200+ BG readings at pre-shot are a fluke, or a pattern that says you need to give Oliver more insulin. And you need some of that mid-cycle test data, in both cycles, both the morning (AM) and the evening (PM) cycles.

Running a curve, where you test every 2 hours from one pre-shot to the next pre-shot, for a total of 12 hours, can also give you some good data, to know what is going on with Oliver. Our dosing protocols need that mid-cycle data, the nadirs or lows, in order to know if a dose change is needed.

A question. to change the dosage or not to change, according to the reading.
My veterinarian says I should stick to the same dosage for at least a few weeks so his system will get accustomed to it.
But I see a lot of members here who often switch the dosage according to the reading.

The people that you see changing the dose, are doing that based on a protocol for the type of insulin they use. Or they change the dose, because they can not monitor as much for a cycle or 2 and want to keep their cat safe, and they lower the dose temporarily.

 

[Oliver the Roman]

Thank you as always for your advice @Deb & Wink Well today his BG 135 at +4.5hrs and 176 at +6hrs I will go back to 0.25.
He has been given 0.1 for about two weeks in April, then I had to switch back to 0.25, then after a month he was back on 0.1, then again after two weeks his numbers start to go haywire, it was as if the time expired. (I mean just by numbers though... throughout the time he looks and acts perfectly normal, no issues whatsoever)
This really reminds me of the classic situation with a cat who hangs around at the threshold of the door, not wanting to enter nor left outside.

 

[Deb & Wink]

Some cats actually get slightly better numbers with a brief boost (increase) in the dose. Sometimes that dose increase can be for as little as 1 or 2 cycles.

With the BG levels trending higher, increasing to 0.25U seems a good decision for now.

Do you think you will be able to run a 12 hour curve for Oliver in a few days?

 

[Oliver the Roman]

Yes, that's possible. The number is back to pretty much normal for now. I will see how it goes today and perhaps I will do that tomorrow!

 

[Oliver the Roman]

@Deb&Wink I checked 4 times during a cycle today - the readings took an utterly unusual course, peaking at +7hrs at 151 (I am quite sure he didn't find anything to nibble on before the 7hr testing), then the number came down and at the preshot he gave me 78, it didn't seem right so I redid it, then it was 85, so he is very low at this point. I dread seeing something like 300 tomorrow but I guess it's better than risking having him go into a hypoglicemia while I am zzzing, so I won't give him anything at this point. I will try to measure as early as possible in the morning. Fingers crossed!

 

[Deb & Wink]

Yes, skipping the shot for tonight is the right thing to do.

When cat's get into those better numbers, the blues (100-199 mg/dL) and the greens (<99 mg/dL), the numbers can get a little strange or unexpected as the cat's own pancreas starts to sputter and produce insulin in fits and starts. It's not a constant steady process all the time, the pancreas putting out insulin on it's own.

Sleep well. Oliver can not go hypo, since he did not get any insulin tonight.

 

[Oliver the Roman]

@Deb & Wink I am glad I made the right decision, this morning he was still at 70, 20hrs after the last injection. Knowing his pattern (or should I say lack of any pattern) still too early to rejoice, but now that you explained, I understand his numbers have been sort of erratic at times for the last few months. So I see he has been trying
Another question - if I see the numbers starting to creep back up, is it better to give him a little boost (mininal dose) immediately, or should I remain vigilant for a while (say, another cycle or two?) to see if he manages to regulate himself?
_____________________________
Edited to add: he was 237 at +24hrs, and that was a jump of almost 170 in 4hrs, so I gave him 0.1 and will see how he reacts.

 

[Deb & Wink]

Looks like his pancreas is trying to produce insulin, but can't quite do the full job on it's own yet.

The 0.1U dose brought Oliver's BG levels down nicely. Not too low, not too high.