? 6.7 Am reading - Now 2.7 at +3 reading

Discussion in 'Feline Health - (Welcome & Main Forum)' started by KyraCat, Aug 11, 2020.

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  1. KyraCat

    KyraCat Member

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    Jul 1, 2020
    Morning!
    We have just had a 6.7 Am reading...
    I know this means Kyra has earnt a 0.25 reduction (to 4.5) but what do I give him this morning???

    I am waiting 20 mins with out and will test again to make sure he is still on the up bit even if he is do I still give him the new 4.5 dose this morning? On do I skip?

    Why are lower numbers so exciting and so terrifying!!!
     
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  2. KyraCat

    KyraCat Member

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    Jul 1, 2020
    20 mins later he is 8.5 so going to give him 4.5units.

    Just letting him get some food in his belly first.

    I'll be stopping up tonight to see what get gets to at +6 and +7 as this morning was so low
     
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  3. KyraCat

    KyraCat Member

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    Jul 1, 2020
    Just done a +3 hour check and he is 2.7

    He seems fine within himself but I have given him 10grams of dry food (sheer guess at what to give him - don't want to undo all the hard work by giving too much dry but also don't want a hypo) and will test again in 20 minutes. Will be dropping his does again to 4.0 this evening - all depending on this evenings reading.

    I think time difference is making it pretty quiet on here today but I look forward to hearing from any of you with advice.

    I'm sure the dry food may have been an error but I just wanted to be safe. After the test in 20 mins I will give him one of the gravy foods I have.
     
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  4. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    I’m not a dosing expert but 4.5u is a lot of insulin to give on a 6.7 amps. It sounds as if you have things under control but do make sure he doesn’t go below 2.7, that’s rather a scary number. I’ll tag our UK expert @Elizabeth and Bertie to see if she can give you any pointers.

    Overall, it looks as if you’re getting some steep drops on Caninsulin. Is there any chance you could discuss an alternative with your vet?
     
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  5. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Are you feeding and waiting 30 minutes before you give the insulin?
    I would look into swapping to a gentler longer acting insulin such as Lantus or Prozinc.
     
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  6. KyraCat

    KyraCat Member

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    Jul 1, 2020
    Thanks @Diana&Tom and @Bron and Sheba (GA)

    We have recently changed to a new vets so they wanted to see how we got on with the Caninsulin for now. Maybe these new numbers will help in getting us changed over to something else. I have already mentioned to the new vet that I would like this to be a possibility.

    I test then wait 20minutes (while he is eating) to do the shot, he continues to eat during and after the shot - basically it doesn't interrupt his meal. I know this may not be the most ideal but it seems to be the best time to administer the insulin, when he is distracted...I have started to try and push it back a few minutes each day though....

    I did wonder if 4.5 would be a high dose but I did wait 20 minutes, without feeding, and did a retest and it had climbed up to 8.5 (this is in the notes of the SS). As you can maybe see from our SS I panicked at a 16 reading on a pmps the other night and dropped the dose (potentially) too low and I didn't want to do that again. So, I was trying to go by the rule of he is below 90 (even though he was above 90) so earned a .25 reduction in his am shot this morning so instead of giving 4.75 I gave 4.5. Do know though that I only did a shot (be it a higher than should be one) knowing I was in all day to keep an eye on him and do regular checks on him. Had I have been going out for the day I probably wouldn't have done a shot at all with being our lowest amps reading to date.

    Hopefully someone can give me some guidance on what I should have given him this morning. I really don't want to mess this up by over or under dosing him. At the moment I feel like I start to understand the rules (like the one I mentioned above) but then a new situation presents itself that that rule doesn't really apply to.

    Yes 2.7 is scary but I am proud of how quickly I handled it, calm as a cucumber and I was really happy to have my hypo kit all ready, meaning I had his biscuits and gravy food to hand.
     
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  7. Diana&Tom

    Diana&Tom Well-Known Member

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    Yes you did really well this morning that’s for sure, celebrate your achievement! (in this weather I think an ice lolly might be in order ;) )

    I hope someone with some practical experience in using Caninsulin will be along soon to answer your questions but meanwhile know that you’re not alone in experiencing new situations... this insulin and the whole “sugar dance” does keep us on our toes, and despite there being certain principles to follow, that doesn’t mean they work out in practice! But, the further you go along the road the more experience you build up and it kind of becomes more intuitive, if that makes sense.

    Good luck, you’re getting there :)
     
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  8. KyraCat

    KyraCat Member

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    Jul 1, 2020
    Oh yes I'll definitely be after a treat haha

    Yes I'd love to hear from an experienced Caninsuliner, I'm sure someone will be along soon - though they do seem a rarity on here, and I am sure for good reason with everyone getting to switch to alternate (better suited) insulins. How annoying* Kyra had the perfect curve the day before we saw the new vet meaning we stayed on it for a bit longer!

    *the situation, not my baby!
     
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  9. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    There aren’t too many Caninsulin users here, although several of us, myself included, did use it to start with (until we learnt enough to convince our vets to prescribe something else). But at least you know the way Caninsulin works - it (usually) has a fast onset and drops bg quite steeply, meaning that it’s used up quickly and doesn’t last the ideal 12 hours or so. It doesn’t have a good reputation here but that doesn’t mean it doesn’t and hasn’t worked for some kitties. Have you looked at the Caninsulin forum? You could cross-post there, you may get more response.
     
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  10. KyraCat

    KyraCat Member

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    Jul 1, 2020
    Good point! I'll do that now and see if I hear anything.

    Thanks for your support today :)
     
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  11. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    I didn’t do anything but I would just say keep a cool head and when in doubt, err on the side of caution... insulin is a powerful substance!
     
  12. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Hi Jemma @KyraCat , gosh that was a scary situation for you... Well done for dealing with that! (((Hugs))) :bighug:

    For those new to using Caninsulin we advise that no insulin is given if the pre-shot number is below 11 (as measured on a human meter).
    You did the right thing to 'stall' to see if the number was rising to a shootable level, and it was indeed rising, but was not really high enough for insulin.

    I actually suspect that the dose is much too high, since that 2.7 was bordering on hypo....
    With Caninsulin it's advisable at first to try to not let the blood glucose drop below about 5 - 5.5 (as measured on a human meter). This is just because Caninsulin can drop the blood glucose really fast in some kitties, and trying to keep it at that level can help to give some buffer of safety in case it does actually dip lower than that.

    The fact that your kitty's blood glucose was so low this morning 'most likely' means that the pancreas is able to produce some more insulin of its own and is able to extend the cycle. This is a good sign! But it can make dosing a bit more tricky because if the cat has a 'sputtering pancreas' it can be hard to predict when it might pulse out some insulin.

    The numbers may be high later because of the high carb food you've given. But just take those numbers with 'a pinch of salt', they will pass. And don't base the dose on any high numbers that you see this evening...

    Has your kitty ever had DKA, or has his pee tested positive for ketones? If not, I'd probably suggest a significant dose reduction at this point to see if the numbers level out a bit.

    Eliz
     
  13. Diana&Tom

    Diana&Tom Well-Known Member

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    Good reply from Elizabeth, do note what she says!
     
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  14. KyraCat

    KyraCat Member

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    @Diana&Tom - Taken on board for sure!!

    @Elizabeth and Bertie - Thanks for your post, and again for more information - You appear to be one of my diabetes gurus these past couple of days :)

    OK so in future if we get any preshot test that is below 11 - Do not shoot! - Got it!!

    I was going to, based on his numbers from today so far, drop his dose tonight to 4.25 (unless of course he is less than 11 and I will not shoot) and stay up and do tests up to +6 or +7. Is 4.25 still too high do you think? Would you have a suggestion on what I should drop it to?

    I'm more than 'happy' if we get some high numbers following this, the bounce is one thing I feel I have a little bit of a grasp on.

    No ketones, I did double check with the vet we have just moved away from as I know he tested the last time I took Kyra there.
     
  15. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Hi Jemma, I'm guessing that you may be considering a 0.25 unit reduction because of info in the Caninsulin guide? ...Just copying the 'dose change' info for reference here:
    "The general guidelines for making dose changes are:
    • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
    • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
    • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit"
    ...These are very general guidelines on dose reduction, probably based on a cat's blood glucose just dipping below 5mmol, but they don't necessarily cover all situations. And there are certainly situations in which the dose should be reduced much more, for example, if a cat's blood glucose drops into hypo or near-hypo numbers on Caninsulin.

    This morning, with your kitty, there were two main things playing into that situation. The first of those was the low pre-shot number. The second of those was the 4.5 unit insulin dose. Because the preshot number was so low the large dose of insulin was too high and dropped the blood glucose too low. And it was already dropping the blood glucose too low by +3, possibly a couple of hours before his typical peak of the cycle, so it could have actually continued to drop the blood glucose and get into a real hypo situation. Thankfully your wonderful testing skills were there to 'save the day'! And I also 'suspect' that Kyra's own body may have foreshortened the insulin cycle by releasing some of its stored glycogen.

    Another thing to bear in mind is this morning's low preshot number. Because Caninsulin 'typically' has a short cycle it is unusual to see low numbers at the end/beginning of cycle, because when the insulin wears off the numbers come up.
    So, low numbers at the end/beginning of a Caninsulin cycle need to have some additional 'cause'.
    Sometimes, an insulin dose that is too high will cause low numbers at the end of a cycle, but this is 'less likely' with Caninsulin than with longer-acting insulins. 'More likely' with Caninsuln is that the numbers will drop hard and fast early on in the cycle (as happened this morning) and then bounce (assuming the body has enough glycogen reserves to release into the bloodstream).
    A common reason for low numbers at the end/beginning of a Caninsulin cycle is that the pancreas is producing more insulin of its own. In this case you may see the insulin cycle being extended beyond the point where the Caninsulin will have usually worn off. This is often good news, and is a sign of pancreas healing. But a 'sputtering pancreas' can also be unpredictable, and it may mean that caution needs to be taken with the dosage.

    ...If this were my kitty I would reduce the dose considerably at this point, maybe to something like 2 units, to see if the numbers settle out a bit more on that dose; and then reassess in a few days (unless it becomes apparent that the dose is still actually too high, in which case I'd reduce again). But this is just my opinion. Others may well have other suggestions.

    Eliz
     
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  16. KyraCat

    KyraCat Member

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    Jul 1, 2020
    Thanks Eliz!

    You got me! I was basing the reduction on the Caninsulin info!

    I understand you don't want to give exact numbers but I appreciate the suggestion of 2 units as a starting point. I will do 2 units tonight, unless his pmps is less than 11 (though unlikely as I think we are already in to the bounce) and do a couple of tests this evening. I am also pre-armed with knowing that higher numbers will be popping up because of the bounce but will stick to 2 units to give that a chance to work once Kyra's system settles in to it. Unless of course, as you say that still presents itself as being too high a dose.

    Only a couple of days ago I said to another new member, just on the verge of learning to home test, that I couldn't imagine not testing now after doing it for a month or so - double that sentiment after today's readings!! I dread to think if Kyra was still on 5 units without being home tested, we would be in a right state!!

    Of course all other suggestions welcomed! But until then I am going to stick with the above plan :)

    Thanks again, Eliz!!
     
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