8/3 Bella: Dosing advice please!

Alicia2022

Alicia2022

Member
Hi everyone,
I'm back from my work trip (which was super short because I told everyone over there that I have a diabetic kitty waiting at home and they did everything they could to send me back as quickly as possible!)
and I'm now able to test Bella more consistently so I'm trying to adjust her dosing.
Our vet is on vacation, and she already told me that she doesn't really have much experience with diabetes... so, I hope someone of the experts here could look at Bella's spreadsheet and advise me on what to do.
I'm thinking of increasing to 2.5 units.
What is our goal in terms of BG? For example, what do I do if we reach 200?
Bella is on mid-high carb food because of other issues (CKD, GI).
I'm not able to test AMPS. Whatever I do, there is not enough blood and the cat is super stressed and fierce at that time, so I'm giving up on that at least for a while.
 
Are you saying that she's super stressed and fierce only in the morning when you are trying to test? Can you get a Freestyle Libre put on her? How does she behave the rest of the time when you test?
 
Alicia2022 said:
Yep, only in the morning! And there is no blood. Really. Rice doesn't help. Just no blood in the morning.
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I would encourage you to keep trying. It's still very new. I used a small glass bottle filled with warm/hot water in the beginning. At first, for many cats, they don't bleed well in their ears. You could also try warming your hands under hot water and gently massaging that ear a bit. You'd think with her being mad and all that there would be blood. LOL.

We don't do dose increases here in increments of one half units. We do .25 unit increases here (until the cat has reached a much higher dose than your kitty is on ... 5 units). I'm sure we already lectured you before about the only way to be sure that it's safe to even give insulin in the first place is to get an AMPS or PMPS test. This is very more important with ProZinc because it can really push a cat down and isn't the kind of insulin (like the depot insulins Lantus and Levemir) that give cats flatter cycles without so many highs and lows. With ProZinc you usually see it push them down, they stay down for a while, it starts to wear off, and they go back up again.
 
Suzanne & Darcy said:
We do .25 unit increases here
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Okay, this is what I have done so far, .25 unit increase. But for how long should I stick with the current dose (2 units)?
For example, if her PMPS is around 300+ today, should I give her 2 or 2.25? And if it's 500+?
Just trying to figure out the logic.
Suzanne & Darcy said:
Can you get a Freestyle Libre put on her?
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I was thinking about doing this but looking at her thin skin... I don't know, really, how such a thing can be put on her and stay put. I'm also not very tech savvy. And our clinic never did that.
 
Alicia2022 said:
Okay, this is what I have done so far, .25 unit increase. But for how long should I stick with the current dose (2 units)?
For example, if her PMPS is around 300+ today, should I give her 2 or 2.25? And if it's 500+?
Just trying to figure out the logic.

I was thinking about doing this but looking at her thin skin... I don't know, really, how such a thing can be put on her and stay put. I'm also not very tech savvy. And our clinic never did that.
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Right. I think we talked about her skin before and I am very sympathetic to that concern. @FrostD I would like your input on this situation. The 2 units seems to have gotten her out pf blacks and into a lot of pink, but there are so few tests here…. Alicia is working on the whole testing situation with difficulty, but she’s trying.
 
In the morning particularly my kittys ears are pretty cold from the AC even though she sleeps on me.
This may sound crazy or gross to some of you but I put her in my lap, put her ear in my mouth and breathe my own hot morning breath on the ear to warm it up. It does the trick for us. I do not touch her ear to my mouth, I just put my mouth around her ear enough to warm it with my breath. Unconventional perhaps but… whatever works.
 
Lisa and little said:
In the morning particularly my kittys ears are pretty cold from the AC even though she sleeps on me.
This may sound crazy or gross to some of you but I put her in my lap, put her ear in my mouth and breathe my own hot morning breath on the ear to warm it up. It does the trick for us. I do not touch her ear to my mouth, I just put my mouth around her ear enough to warm it with my breath. Unconventional perhaps but… whatever works.
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We routinely examine cat poop and vomit here, nothing is weird :joyful:
 
I'd hedge my bets she saw high blue on 7/31. So, right now she's bouncing but should clear tonight or tomorrow.

The increases came a little too fast, but you've been giving the current dose long enough I wouldn't go back down just yet. See what happens when this bounce clears.

You'll want to hold each dose for at least 5-7 days, given her diet and testing struggles. You'll follow the SLGS method linked above.
 
Alicia2022 said:
Oh, now I know where I read about a .5 units increase: "If a cat is having nadirs above 200, then dose changes of 0.5u are recommended" :bookworm:
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Yes, of course. She certainly has high nadirs from what I see, that’s true. I just can’t, in good conscience, recommend to anyone a half unit increase with so little testing. I won’t be responsible for a hypo. Also, try as I may I cannot see any blue on that spreadsheet (not even on 7/31 where Melissa mentioned.). Is there something wrong with the SS that I am seeing. I’m confused.
 
I see a 222 @ +5 on 7/31. Given that PMPS was only 269, I suspect nadir is a little later for Bella (or at least it was on that day) and she dipped into high blue around +6/+7. Could have just been a pretty flat yellow cycle.

Blacks could be a bounce from pinks, but in the high numbers it's a little harder to discern.

I'm sure I've asked but - are.you giving fluids or anything else for CKD?
 
FrostD said:
I'm sure I've asked but - are.you giving fluids or anything else for CKD?
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OMG I guess I forgot about subq fluids because I thought as long as Bella is drinking and also getting water added to her food she's okay.
Have to call the clinic and ask them. BTW, they told me they don't have equipment to check blood pressure in cats. Can this even be possible?
I was trying to wrap my head around Adequan and forgot all the rest. Haven't decided about Adequan yet.
Also B12 supplement... we need one, right? What would be the best brand for sugar cats?
 
The combo of CKD and diet will make it difficult to get her regulated, so you'll want to do everything possible for the CKD. In turn, the diabetes is rough on them kidneys, so vicious cycle. Ask about the subQ, because if she has potential heart issues it changes things.

I've never come across a vet that doesn't have the equipment to check BP....maybe ask them for a referral to someone who can?

The type of B12 you need depends.... - https://felinecrf.org/vitamin_b.htm

The injectable/complex is different than the straight methycobalamin we give for things like neuropathy. Your vet is probably best person to ask about what she needs.
 
I copied this directly from a post by @JL and Chip because it's such good information and why you should consult with your vet on what type of B12 she needs.

"First, there are multiple forms of B-12, and each serves a different purpose.

Cyanocobalamin is the form of B-12 used for GI issues, such as IBD, cobalamin deficiency (I believe Henry showed a cobalamin deficiency on the TAMU GI panel report), and so forth. This is likely the red liquid you describe and is in injectable form. It is poorly absorbed orally, hence the need for shots.

Methylcobalamin (methyl-B12) is good for diabetic neuropathy. A popular brand for diabetic cats is called Zobaline and is an oral pill. Other brands can be used, but you need to be careful about checking that any additional ingredients are safe for cats as well as aren’t a form of sugar.

The two forms of B-12 aren’t interchangeable (I’ve seen that misunderstanding here a lot over the years). Some cats are on both forms at the same time depending on their medical needs. Henry might be one of those cats."
 
Our vet already said that she doesn't usually do things I'm asking about and she needs to do homework to figure them out. Like checking SDMA (she told me this is a controversial test) . Or using Libre. Mind you, she's one of the most experienced vets around. And none of the clinics nearby can check for blood pressure. They refer patients to 24/7 emergency hospital in a closest big city for that.
 
Alicia2022 said:
OMG I guess I forgot about subq fluids because I thought as long as Bella is drinking and also getting water added to her food she's okay.
Have to call the clinic and ask them. BTW, they told me they don't have equipment to check blood pressure in cats. Can this even be possible?
I was trying to wrap my head around Adequan and forgot all the rest. Haven't decided about Adequan yet.
Also B12 supplement... we need one, right? What would be the best brand for

Sub
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Sub-q fluids are not started until the kidney values reach a certain level. Also, with her delicate skin, I would wait until they are necessary. I see that you say she is stage III. do you have labs to share? If she needs them then she needs them. I have, unfortunately, quite a bit pf experience with CKD.
 
I do think it’s interesting that your vet does not completely trust the SDMA test. Most people put a lot of stock in the SDMA test, but as I was just saying to someone else this morning, I have cats who had elevated SDMA about 8 years ago. I was told they would get kidney disease. It’s never happened. Also, my cats’ SDMA (this is a lot of cats as I have quite a few) tends to fluctuate around quite a bit. How much of a reliable indicator can it be?
 
Alicia2022 said:
Oh, now I know where I read about a .5 units increase: "If a cat is having nadirs above 200, then dose changes of 0.5u are recommended" :bookworm:
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By the way, aren't you following the SLGS protocol? quote above is from the Tight Regulation protocol and not from the SLGS protocol. You aren't testing enough to follow the Tight Regulation method. Also, cats on TR must be on an all low carb wet food diet. So it's SLGS. Here's the section I copied from that document:

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • 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
 
OBTW, I hope you and Bella are doing well and that she's eating well and is (maybe... I hope) calming down for the testing. It's so good that she has you to care for her and try to do what's best for her. Many cats aren't so lucky (sorry, feeling a little sad right now about people who won't take care of their cats.) :cat::cat:
 
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