Eukanubo, The Cat (not the food)-dosing questions

Hello, all,

I started this thread on the general Feline Diabetes Health forum, and it's been suggested that I move it here. I hope I'm able to link to the thread by cutting and pasting as follows: http://felinediabetes.com/FDMB/viewtopic.php?f=3&t=5769

In summary, Eukanubo is a 12 y/o Russian Blue, diagnosed in October 2009. After a brief 2 week course of Vetsulin while boarding, for a while it looked like he was in remission, but then I discovered that the meter was off by at least 100 points, no wonder the poor cat kept losing weight! So he was put on ProZinc 1 unit twice a day. His sugars wouldn't budge, but a week ago I switched him to wet food, and that HAS made a big difference. However, I'm not sure about when to dose with insulin and when to withhold the dose. The vet doesn't want me to give insulin if his BG is less than 300, but then his sugars stay high. So, I've been using the cutoff of dosing above 200 mg, his numbers overall look much better, but I'm fearful of dosing when his BG is less than 200 (like this morning), due to fear of hypoglycemia, however, when I don't give the insulin, the BG skyrockets again into the 300's. What would be a safe cutoff? One more problem is that it is becoming VERY hard to test his BG, especially in the mornings, when he is especially combative and hates that I have a hard time getting a good specimen (for some reason, his ear bleeds much more easily later in the day).

His spreadsheet is under my signature, any help/advice will be appreciated.

Thanks!
HB

 

Hi and welcome! I don't have the dosing thing down yet myself, and so I can't really offer advice for that.

But you mentioned that testing was more difficult in the morning and that is our situation sometimes too. Sometimes its because I'm in a hurry and I don't do anything well when I feel rushed. But sometimes I'm relaxed and Buddha is HUNGRY. If he's hungry then he's much less cooperative. So sometimes we compromise and he gets a little bit of food before his test. I wonder too, if cat's temperatures vary so that ears are starting off cooler in the a.m.

 

OK well to start with on the testing. In your Health topic I listed my suggestions. The 28g lancets can help. And are you getting that ear good and warm? It can take a while and could account for the difference morning/day especially this time of year. If your cat is particularly crazy you can try to clothes pin / peg trick:
http://www.felinecrf.org/giving_sub-qs_ ... _peg_trick

Make sure you have read the info in the Sticky at the top of this forum.

As for your dosing it appears 1u is likely going to be too much insulin at this point. How would you feel about using U-100 syringes and doing the conversion? So what you are going to need to do is find the right dose between 0 and 1u. It's going to be difficult with U-40 syringes to get a consistent dosing with under 1u. In the mean time you might try reducing you dose to an eyeballed "0.75u" and seeing how things go with that. On 1u your drop/change/delta from PS to nadir did not seem that big and once you get a little data with the 0.75u you might want to reduce your no shoot to 150ish?

Hopefully others will be along with their input.

 

I agree with Gator. I think that you need to go lower: lower dose and lower "no-shoot" line.

If you are going to lower your "no-shoot" to something like 150, then you need to be sure that he can get to food sometime between +4 and +8. Some people can just leave out extra wet food all day. But others (like me!) have at least 1 cat who will binge so a timed-feeder is necessary.

Oh~ and the U-100 syringes make life easier. (A bonus is that they are cheap!) They have then at walmart for ~$15 and at CVS (or RiteAid) for ~$30. You want to ask for the 1/2cc U-100's with 1/2 unit markings.

 

The 1/3 cc would be the ideal. I think the space between markings might be a little bigger with the smaller barrel? The 1/2 unit markings are the key absolute must.

BTW, Michele I offered Soccer's spreadsheet as an example of as inspiration forward in this case in the Health topic.

 

Thanks for the replies. I think the problem with the AM testing is that he is hungry and cranky, plus he's learned that when I start touching the ear, the pinch is coming, lately I've had to restrain him with a towel, which is even more stressful. The rest of the day it's easier, as he's usually more relaxed, just woke up from a nap, and he has an easier time. It doesn't help that in the morning, I'm in a hurry to go to work, so I don't really have the time to wait until he eats and calm down. I've never heard of the clothespin, so I'll definitely give it a try! I'll be looking for U-100 needles and larger lancets this week. Thanks!

 

For the U-100's The link in the sticky is also a place you can order from online the type etc. [as well as the conversions chart which is critical]:
http://felinediabetes.com/FDMB/viewtopi ... =24&t=1979

Hopefully you are leaving enough food out at night? It sounds like he is hungry in the morning. I add a little water to H's food and that helps it stay out longer. For instance I know H generally needs 120g at night. So I put that down with some water and in the morning he will hopefully have just a smige left on his plate. I say hopefully because H has appetite problems as a result of his other things goings on.

Did I ask how you guys are feeding yet? How are you feeding? Is Eukanubo overweight?

In your spare time you might also put together a "profile" of you guys. And link it in your sig. The instructions for that can be found here:
viewtopic.php?f=6&t=531

 

[quote="Gator & H]The 1/3 cc would be the ideal. I think the space between markings might be a little bigger with the smaller barrel? The 1/2 unit markings are the key absolute must.
[/quote]

Sorry, my bad. That's what I meant to say! LOL!

 

Gator~ I tried to do a profile and couldn't mamage it. what am I missing? :?

 

Michele, for the profile thing You can start with this Cyn and Cosmo post which is a couple down from the top. If you still have issues please let me know and I'll do everything I can to help:
viewtopic.php?p=4423#p4423

The old codification thing is good to get all the right questions answered.

Also as a bonus if you would like to clean up your signature you can clean it up by using this code instead:

Code:

[size=85][url=http://spreadsheets.google.com/pub?key=ttQCUeCeJj04BPEvEZPZvzw&output=html]Soccer's Spread Sheet[/url][/size]

 

Hi, again,

He is a free-feeder and I make sure that I leave plenty of food and water for the night. He used to be overweight but with his diabetes, he lost weight dramatically, all the way down to 10.5 pounds (he was around 14 when diagnosed, but he was at one point like 16,17 pounds). He is now putting weight back on, he's around 12 pounds currently, and clinically, he is definitely more active, playful, and energetic, it also seems that he's not drinking as much water as he used to, although he still has some peeing accidents occasionally.

I just tried the clothespin method, it seemed to work although he didn't go limp or unconscious like the link suggests, but the true test will be tomorrow morning, I'll let you know!

I'll try to set up a profile but when I tried earlier, I couldn't figure it out, I'll check out the links.

 

On the no-shoot, what I have typically seen recommended is to start at 200, then lower to 180 as soon as you have the data & comfort level to do so, and then lower to 150 with more data & comfort level.

I agree with what others have suggested - the next time you get a PS that is over 150 but below what you are used to, try shooting a lowered dose (I'd say either 0.5u or 0.75u, whatever you feel more comfortable with), and try to get a nadir reading on that cycle to see where it lands him.

You may end up still needing to shoot 1u on those lower PSs, but it makes sense to me to proceed with caution (assuming he is feeling reasonably well and does not have a ketone history) until you have a bit more data. 1u is working nicely to bring his #s down, it looks to me like you are on a good track, and really close to just small fine-tuning. Go LC canned food, yay!!! :mrgreen:

 

I also wanted to add that when you get a PS that is too low, try rechecking in an hour or so if he will tolerate it. The idea is to go ahead and shoot once you cross the threshold of the no-shoot (or have a clearly rising # to shoot on that is approaching the no-shoot), rather than skipping the shot. Although it can get a little wacky with the schedule, that will generally keep the #s from zooming out of control that cycle. I'm not sure he is a good candidate for that (some test every 1/2 hour until they get a shootable # - with Bix a low PS usually meant a 2-hour ride for him in good #s, so I never tested that often), but those who have used the clothes-pin technique swear by it, so maybe that will do the trick!

 

This morning, the reading was 249, so he got his 1 unit. The clothespin helped a little but he hissed and clawed anyway, luckily, I was able to get a reading on the 2nd try. It will be hard to re-check the sugar at the nadir some days because of work schedule, I'll try to wing it the best I can.
Thanks!

 

Sorry you're having so much trouble testing. I don't remember from your other posts if you're giving a snack with the test. I give Blackie Halo's Liv A Little's dried chicken. He will do anything for one of those treats. When I open the jar, the civies start crying because they can smell it. If Eukanubo associates the yummy food with testing, it might make it easier.

 

Feliway might be another option? I'm not big on smelly things - I cannot tolerate perfume or any of the room "freshener" crud for instance. [I'm more into natural smells like BO and fish rot in my trash LOL.] And I would have great sympathy for my kitty if I poisoned his environment with stinky things. BUT under the circumstances it might be something that could help calm your kitty.

http://vetmedicine.about.com/od/behavio ... eliway.htm

 

thanks! I'm going to try to do the profile too... we'll see! :?

 

Great profile! Soccer is so beautiful, too.

 

Hey there HB,

One more thing to add to the growing list. I was just having a convo over in Community and someone reminded me of the old "one-kitty-kitty." That is to say, after you have pressed the "go" button on the "clicker" count "one-kitty-kitty" to yourself before moving an iota. this will help you keep the clicker still for the go. If you move to early you can pull the cliker out of position early and not get your knick in.

Hope this helps. Please keep us updated.

 

Update:

It seems we have gotten into a routine of sorts. I notice that he is VERY irritable first thing in the morning because he is ravenously hungry, and it's impossible to check his glucose until after he eats. So I put on the clothespin and let him eat, after he eats I'm able to pick him up and put him on my lap. He still growls a little and sometimes I need a few pokes, but I'm able to get it done. The afternoon readings are always easy.

The good news is that his glucose readings are vastly improved, and I'm giving about 1/2 unit twice daily now (I'm eyeballing the amount with U40 needles). At this rate, I think he may even be able to get off insulin soon! The link to the spreadsheet should be by the signature below. Right now, he is on my lap, purring and happy, as I write this, and his energy level has picked up. He still eats a lot, but he is hardly drinking any water, which hopefully is a good sign. Is he on the way to remission? I certainly hope so!

I'll be going out of town for 5 days next month, so I'm not sure what to do about feeding. I would hate to put him back on dry food for those days so he can free-feed, but I would hate to put him through the stress of boarding, especially if (IF) he is off insulin by then. I don't have anybody that can come in every day to feed him, so any ideas?

Thanks for all your help!

 

Glad to hear he his doing so well - his #s these past few days look AMAZING!!!! :mrgreen:

I would look into a timed feeder. Several people around here use them - if you start a post with that in the title here or on Health you might get some info, and/or I'm sure you can google it for info. I'm not sure you could run that for 5 days (!!) but maybe if there is someone who could come in every other day or something they could work it?

I'd hate to see you go the dry food route too, and lose the awesome progress you have made. A lot of cats who have gone OTJ end up back on insulin due to small amounts of dry food that their beans don't realize could be a problem. There's no guarantee if you get back in high #s that you will go right back to nice regulation and OTJ possibility - personally I wouldn't risk that unless it's life or death (like if a cat won't eat and that's your only choice). You could also post on Community, maybe there is someone on the board near you who could pet-sit for you, who knows, worth asking around...

 

If money isn't an issue, I'd look into hiring a petsitter. If you aren't leaving until next month, then you should have a little time to ask around -- call vets, they can often give referrals. Responsible teenage children of friends or college kids can also be good choices. It's always nice to come home to a scooped kitty litter box and the cat sickup pried up off the carpet. I don't know how often you travel, but I always think its nice to have someone trained and available for when I need to go somewhere on short notice.

 

I would definitely post on Community. I know there are several members in FL, just not sure exactly where. It will take some time to find a petsitter who can also be taught to give shots and test, at least that's what I found (and I never did find one). Hopefully because you're starting early, you won't have any problems.

 

Thanks, all!

It looks like he may get off insulin soon! Check out the spreadsheet, the numbers are getting better and better! I did try one day to hold all of the insulin and the numbers stayed pretty decent but then it rebounded next morning, but it seems that he needs less and less and the insulin seems to last more time, this morning the BG was 98, so no insulin. This will make a difference on whether he gets boarded or get a sitter, if he's still on insulin, he will get boarded, if he's off insulin, I'll get a sitter. Either way, I'm pleased with his progress. Thank y'all!

 

YAY!!! Hope you see green today!

Have you asked your vet if any of the vet tech's pet sit? or go to the animal emergency clinic to see if anyone there pet sits :smile:

Have a great day!!!

 

If you are planning on boarding, you should check them out first. At my vet clinic in town, they don't show up for work until 8 and start leaving at 5. If 12/12 insulin schedule is important, you'd want to make sure that they could follow your cat's schedule. I also found out AFTER I boarded my cat that they charge twice as much for boarding my diabetic cat then my other cat. They also messed up the food. So vet care isn't necessarily more reliable than a sitter.

I'm not suggesting your vet and clinic isn't reliable, just warning that not all of them are.

 

I totally agree with Donna. I had Prudy on 9am/9pm schedule and when I went away that first week, they changed it to fit their schedule 7am/7pm. They didn't tell me that they were going to do that :-|
I was only charged another $7 for med fees on top of the boarding fee. I was disappointed to learn that she wasn't eating at night, so they skipped her shot for 4 nights. Of course they didn't tell me when I called every other day checking up on her... and this was my vet! so, if you have to board at your vet or another facility... tell them what you want and find out what they do. I also brought my spreadsheet to let them know I was serious about the care of my cat.

Good luck with the green/blue #'s today!

 

Thanks for the suggestions. I've been holding off because it looks like he may not be on insulin at all, and this will make a difference in my decision whether to board or not. It looks like he's on his way to getting off insulin!!!! His numbers have been so low that I haven't had to give insulin the last 2 days, yeay!!!! How long does he needs to be off it before I can officially celebrate his being OTJ? He is like a whole new cat, full of energy, he's been ramboncious, playful, aggressive, alert, like when he was a young kitty. Obviously the food change made a huge difference, and it seems that he has reverted. Of course I plan to monitor his glucose levels for now, as I realize it could be temporary, so, what should I expect?

Thanks for all your help!
HB

 

HB - where in Orlando are you? If it's northern, there's a pet sitting group up in the Longwood/Apopka area that will test, give shots, etc. My sugar kitty tends to go all wonky with the BG's at the vets, and this group has been a lifesaver. I checked all the others in the area and no one would sign on for a diabetic cat (or one that needed to be tested) and lucked out finding these guys.

 

In just south of downtown, so Longwood/Apopka wouldn't be the most convenient options, but I'll keep it in mind. Thanks!

 

I think the rule of thumb is to keep testing for 2 weeks, if the #s remain too low to shoot then it's OTJ party time!!! Paws crossed for you guys!!!! :mrgreen:

 

But you will want to keep testing periodically. Tapering off...I don't recall the routine, maybe like every other day to very week to every other week kind of thing.

I'm happy for you guys and hoping no more juice for him. Make sure to post in the recent remissions topic here in PZI if you guys ultimately end up OTJ.
viewtopic.php?f=24&t=5659

 

HI,
I'm late to the discussion, but REALLY wanted to add me 2 cents.

I used to work part time for a animal hospital/ boarding/ vet, and that was the first I realized that NOBODY is in the building from 6 PM until 8AM M-F, and weekends are much worse.

On Sundays a kennel tech and vet tech blow through, "walk" the dogs, slop out the food and meds around 8-9AM, then leave and return around 3-4 PM for the second visit. They are usually in the building less than an hour each time. So your 12 /12 schedule becomes a 6/18 schedule. and nobody's watching for that hypo ...

The folks at the front desk that take your reservation and answer your questions have no contact with the animal care, so they have no idea that a 6/18 schedule could be disastrous for a diabetic cat. And they definitely don't advertise that nobody is there evenings and Sundays.

The whole nature of the place is much more dog centered, and so the schedule is around the dogs, and the convenience of the techs who gets stuck with weekend/Sunday duty (at $8-10/hr).

On the other hand, many vet techs love to pick up extra cash income (its not usually a high paying career). They know how to do injections, are experienced handling animals, and they would be more familiar with what a sick cat might look like, and when it's time to call you, and take action.

I use a vet tech from our vet clinic to pet sit, and she actually likely saved Cody's life on one of my VERY rare trips to move my daughter into a new apartment. Now if I have to go out anywhere (saturday night date) she comes to help out and give the shot, right on schedule. I write out current details and know that the focus of her time is on my animals.

If your cat isn't OTJ when you go away, and you leave him at a kennel, it is possible that the stress of being there, being left and caged, would put you back to square one with needing more insulin again. And I doubt if it is standard practice to "test then shoot", even at the vet, (especially on weekends).

Lastly, many kitties seem to come and go OTJ, so starting a pet sitter on your routine, gives you more flexibility in case of that inevitable out of town emergency.

just my experience... been dealing with this for years

Oh and congrats and good job on your success with Eukanubo! He is lucky to have such a caring daddy. cat_pet_icon