08/27 Fistuk, AMPS 457, +2.5 437

Morning Shelly

shellys said:
Since the pm shot will be the 7th cycle of this dose I'd love to get your suggestions on what tests would be great to have during the pm cycle and if I shot the same dose the am cycle (I guess we'll need the +9 and PMPS to get a sense of that)
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With the +3, being red it was likely that he would stay high all cycle, so thought it was as good a time as any to have a break if you felt you needed one. Having said that getting a just before bed test like you did was good, it reinforces what would have otherwise been a suspicion had you not got a +5.
As for the +10, +11 I always liked to get one or the other, my reasoning for that is I wanted to know which direction he was heading at PS. Also when Instarted getting lower ps it gave me time to formulate a plan, and ask for helpmif I was nervous.

shellys said:
+2.5 437
He's clearly bouncing. I'm going to give his ears a break today. maybe I'll take +10 or +11?
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Possibly, or this dose is not doing it for him. This is cyclec7 since the blues which clearly triggered the bounce, so in theory if this is that bounce we are looking at it would be over, typically bounces last maximum 6 cycles.

Its possible that he attempted to clear the bounce from that blue with that 12hr run in yellows yesterday morning and that in itself may have triggered a bounce which we are still seeing the effects of. Either way unless he throws something below 200 this morning I would be taking him up to 3.75u, it looks like he needs more insulin. If he is below 200 let's reassess whether we take him up or wait a couple of cycles.

My opinion is thatche just hasn't quite got to the dose he needs yet.
 
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shellys said:
+2.5 437
He's clearly bouncing. I'm going to give his ears a break today. maybe I'll take +10 or +11?
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Appears that way, give yourselves a break, maybe grab a +6 if you are home, just in case he surprises us, sometimes they through some high numbers before they break a bounce,.

With him being in reds he will be peeing more, does he seem otherwise OK?
 
Gill & George said:
Appears that way, give yourselves a break, maybe grab a +6 if you are home, just in case he surprises us, sometimes they through some high numbers before they break a bounce,.

With him being in reds he will be peeing more, does he seem otherwise OK?
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Thanks for all the info and explanations, Gill. It really helps me learn.

It feel to me like he's run the course of this dose. But I will wait till pm to see where he's at. I'm home so I might try a +6.

I'm feeling inside myself that a 3.75 dose is coming. I wanted to do that in the morning but at the same time if it'll be tie to up his dose I don't want him to stay longer than needed in high numbers. He's been there for too long

He's peeing a lot more since yesterday. Some in the box some outside. He's been drinking excessively. He's eating well. Giving him a snack every couple of hours and he appreciates it.

But other than that I must say that his energy yesterday was lovely. And the treat of him asking to be picked up on the bed and have a belly scratch was touching.
 
He has been having an initial reaction to a dose increase... so he may well give you an active cycle tonight. Having said that those reactions were to 0.5u increases so maybe we won't see that in this next dose increase.

Ordinarily i would say do it in the morning cycle, but dka is still in the recent past, with the increase in symptoms and high numbers, in your position I'd take the increase tonight.
I hate seeing reds at the best of times and if kitty has a history of dka, it makes me very nervous.
 
Gill & George said:
He has been having an initial reaction to a dose increase... so he may well give you an active cycle tonight. Having said that those reactions were to 0.5u increases so maybe we won't see that in this next dose increase.

Ordinarily i would say do it in the morning cycle, but dka is still in the recent past, with the increase in symptoms and high numbers, in your position I'd take the increase tonight.
I hate seeing reds at the best of times and if kitty has a history of dka, it makes me very nervous.
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Yes, that nervousness about DKA speaks to me! Which is why I thought increase tonight despite the lack of sleep which really turns me up side down. I have lots of work to catch up with but at home. So I’m ready to do it tonight if it’s his best.

@Bandit's Mom thoughts?
 
Hi Shelly, I suggested an increase tomo morning only because you wanted to increase in the AM and not in the PM. We usually suggest that for cats who react to an increase in the very first cycle. However, I agree with Gill - with a history of DKA, you want to get him to good numbers sooner. :-)
 
shellys said:
why I thought increase tonight despite the lack of sleep which really turns me up side
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Maybe try and grab a nap during the am cycle.

Has the temperature come down in Switzerland?
We woke toma beautiful fress 18degrees, 20segree drop from yesterday's high. Winter can't come soon enough for me!
 
Gill & George said:
Has the temperature come down in Switzerland?
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Yes! We've had buckets of rain in the past two/three days. We're down to 17 degrees, the heating is lightly on. Fistuk def appreciates the lower temps. My Israeli blood would have loved a bit more heat ;) And it looks like the weather is going through a BG bounce as we're expecting a jump to 24/5 degrees in a week
 
Gill & George said:
Good luck with the new dose, hope it gets him out of the reds!

How is he ?
Stillmpeeing loads?
Otherwise ok?
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Thanks, Gill.

Must say i don't feel comfortable with his energy. He got up demanding food at 17.00. I gave him some but not much so he's hungry for the 20.00 with shot. When I poked his ear now he hasn't protested much and his breath makes about sounds which I've come to recognise when his BG is high. Ketones are 0 but I know I'm still traumatised from that episode.

He's peed lots still yes.

I'll keep posted how it went in super time with shot
 
It's beginning to get really tough to give him the shots. He gets really angry. Something doesn't feel right. I believe him that he doesn't want this and I just don't know what's not working for him. He's had a good appetite. But as soon as I come close with the syringe he already knows and starts growling then wanting to run away. He looks terrified. He doesn't the ear poking no matter how loudly I might do it or how many times a day. I can't keep on hurting him like this.
I try to take the insulin little earlier from the fridge so it's not too cold.
I feel lost
 
shellys said:
But as soon as I come close with the syringe he already knows and starts growling then wanting to run away. He looks terrified.
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Maybe Lantus is stinging him? Cats usually feel the sting at much higher doses but some cats feel it at lower doses as well. Try shooting at other locations? Where do you shoot right now?

shellys said:
He doesn't the ear poking no matter how loudly I might do it or how many times a day.
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He doesn't like the ear poking? If so, you might want to test less in bounce cycles and give him a break :(

shellys said:
I feel lost
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He will get better :bighug:
 
shellys said:
But as soon as I come close with the syringe he already knows and starts growling then wanting to run away. He looks terrified. He doesn't the ear poking no matter how loudly I might do it or how many times a day
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I'm sorry,
Is he getting a treat every time you pone his ear?
Their ears can get bruised and tender, I found that it helped if after the poke I held a cold compress, I would use a damp cold cotton wool pad, hold it with gentle pressure to his ear count slowly to ten. I also bought a tube of local anaesthetic cream that I used one time when his ears got particularly sore.(when i was a newbie and before i started using cold compress) But usually he didn't even know he'd been poked
If you are not getting him in quite the right place with the ear pokes it can be sore. Have you seen the picture of the 'sweet spot'?

It's possible that the lantus stings him, some cats are more sensitive to it than others, I never had a problem, though as marje mentioned she felt her Gracie did.

Are usually sure you are not getting him in the muscle? I know that on the occasional I got him in the muscle, he would really protesta.
Also very important is to come in at the correct ángel and the needed pointing the right way and also not to reúne needles.

Let me get you some pictures
 
Bandit's Mom said:
Try shooting at other locations?
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At first I tried at the scruff but when I shifted to the flank and it was better but then he started resisting again.
I asked the vet if they have levemir but they don't

I was thinking - could it be that he reacts more strongly when his BG is higher? Because since yesterday when his numbers went up he reacted more aggressively. He wasn't so accepting before but it seems to maybe increase when his BG is high

Bandit's Mom said:
He doesn't like the ear poking?
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Sorry I wasn't clear... He doesn't resist the ear poking, he's totally ok with it

Bandit's Mom said:
He will get better
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Thank you! At the moment my heart breaks that I hurt him like this and just adding to his trauma
 
Gill & George said:
Is he getting a treat every time you pone his ear?
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Yes absolutely gets treats. But I didn't make myself clear - he doesn't resist the ear poking at all, even if I get it sometimes bit wrong. But the insulin shot is a nightmare

Gill & George said:
as marje mentioned
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I did ask the vet but they don't have levemir.

Gill & George said:
Are usually sure you are not getting him in the muscle?
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Not sure at all. In fact since he lost so much weight he doesn't have much fat to grab. I've watched several videos on youtube and I try to do a good tent, I pull the hair back so I make sure the skin is tenting and also I can see the skin and not fur-shoot.

I hold the syringe in horizontal, no angel.

I think you meant reusing - At first I did! the vet's assistant said it was ok :( But here I learned it's not (so the pics) so I'm using a new needle each time.

My poor little boy
 
shellys said:
Sorry I wasn't clear... He doesn't resist the ear poking, he's totally ok with it
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That's good
Here's a l8nk to testing and shooting tips

https://www.felinediabetes.com/FDMB/threads/testing-and-shooting-tips.85113/

  • Method of Shooting
Some members choose to "tent" the skin to shoot. They raise the fur to form a "tent" and then shoot into the base of the tent. Another technique, which might help more in decreasing fur shots, is the "roll" method. In this method, you lift the fur and skin with your non-shooting hand, and then roll your hand back so the back of your hand faces the kitty's head. This opens up a nice bit of skin that you can clearly see. It's important that you lift and then roll so you are guaranteed of shooting into the subcutaneous layer. The photo below illustrates how well you can see the skin when you lift and roll so that you know you are not shooting into fur as you might with the tent method.

3d690be9-80e2-48ad-b4a5-3c77cdb55350-jpeg.48122

  • Ready, Set, Shoot!
When you are ready to inject, be sure the syringe is parallel to the spine (edited to add) at a 45 degree angle and the bevel is up so the sharpest point slides in first. The photo below shows the bevel up. Never use an insulin syringe more than once as the needle quickly degrades, loses it's sharpness, and multiple use poses the risk of contamination and infection.
fdf66a97-8f7a-4ece-8d41-6b69103cea6d-jpeg.48123
 
Do look at the link there's a lot of good info in that post

This is what is meant by the bevel

upload_2023-8-27_21-28-50.png


It needs to be pointing up
 

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Gill & George said:
Do look at the link there's a lot of good info in that post

This is what is meant by the bevel

View attachment 67525

It needs to be pointing up
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Thanks! I didn’t know about the bevel

I do the roll technique but I guess I can do it more clearly.

Wish it was easy as it is in the video. He gets his head buried in the food plate but as soo as I approached he already start moving away.
I cant shake off the feeling that something is wrong. And I do wonder if I’m higher BG he feels it more
 
shellys said:
But I guess I need a prescription? When I asked the vet about it they wrote "we do not recommend switching to Levemir, we have no experience with this insulin in cats." :?
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Well let's see how it goes with tweaking technique, perhaps the new vet might be more amenable when you go to Zurich.

Just a quick search this is not the full study, it cites some Cotherstone studies, we can probably help you get access to the full studies so you can approach vet with them, that might help.

Do they have experience with lantus?

https://pubmed.ncbi.nlm.nih.gov/24938314/
 
Gill & George said:
Well let's see how it goes with tweaking technique, perhaps the new vet might be more amenable when you go to Zurich.
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Hopefully … and hopefully ….
Tomorrow I’ll start making some calls
Gill & George said:
Just a quick search this is not the full study, it cites some Cotherstone studies, we can probably help you get access to the full studies so you can approach vet with them, that might help.
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thay’s great. I’ll read it tomorrow


Gill & George said:
Do they have experience with lantus?
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yes. I got it from them. Bc the first vet that gave me insulin was the one in my village and they gave me caninsulin. I called to ask if they have mantis or Levemir they have neither
 
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