Evie's Updates Cont.

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AliceL

AliceL

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PREVIOUS THREAD: https://felinediabetes.com/FDMB/threads/evies-updates.277793/#post-3077711

Evie is having some strange high numbers again since the insulin increase, I know it can take a few days to adjust so I'm just waiting it out. Everything else seems ok, she isn't drinking more water, still eating, stomatitis looking ok - just super vocal for food and sleeping so much since yesterday afternoon.

I have another problem and I don't know what to do. I have to go out of town for one night next week because I have an 9am immigration appointment in another county. It's a 5 hour drive so I absolutely have to go the day before to make the appointment. Our non-diabetic cat will be just fine for that time with kibble & water but obviously that won't work with Evie.

There is a vet in my town that will board her for 24hrs from 3pm to 3pm. The only issue is that they won't check her overnight as they are closed - so basically they will just give her insulin & food and lock up for the night, then insulin & food the next morning.

I don't know which is worse - staying at the vet and risking hypo with no food & no one around (they assure me it won't happen because her BG will be elevated from the stress anyway) or letting her relax at home with no insulin for two cycles but at least I have cameras to watch her and can have a pet sitter come in to feed her periodically. The sitter won't stay overnight, won't shoot insulin or test her. Another option is to subject her to the 5 hour drive there, leave her in an airbnb, and then drive 5 hours back the next day...but at least she gets her insulin & is monitored all the time (except for during the appointment of course)
What's the best thing to do?

Also don't think I should be increasing her dose in the coming few days until this incident has passed.

@Suzanne & Darcy @Diane Tyler's Mom @Shelley & Jess
 
One thought may be to see if there's a vet tech at your vet's office who could come by and give Evie her insulin. When I travelled, I always reduced my cat's dose since there was never a guarantee that my cat would eat if I was gone. (Well, it was a pretty sure thing that she would eat since she was food motivated but it made me less nervous if I reduced her dose.)

The reality is that it's not likely that anything bad will happen if you skip two shots. It's not ideal. However, we've had members who gave 2 fur shots, who ran out of insulin or broke the container, and any other scenario you can imagine. As long as Evie hasn't recently had ketones, it should be fine if you have to skip.
 
Sienne and Gabby (GA) said:
As long as Evie hasn't recently had ketones, it should be fine if you have to skip.
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I wouldn't know if she recently had ketones, she was only diagnosed a month ago but she was quite sick when she was diagnosed. Skinny, weak & lethargic. The vet couldn't ever get a urine sample. However since eating wet food she perked up, gained weight, stopped drinking water, appetite is great. Do you still think it's safe to risk without knowing if she had ketones?
 
I’d call your vet and ask if they did or check the lab results you got. Is there a reason why you’re giving .8 or 1.2 instead of going with the 1/4 increments?
 
@Ale & Bobo & Minnie (GA)
Just a couple of points to clarify. Since CG is using Prozinc, there is no TR dosing method, that only is applicable to what we use for Lantus, Lev and Biosimilars. It looks like CG is using a conversion because she is using U100 insulin syringes and dosing a U40 insulin.

Ale & Bobo & Minnie (GA) said:
I’d call your vet and ask if they did or check the lab results you got. Is there a reason why you’re giving .8 or 1.2 instead of going with the 1/4 increments?
Click to expand...

Ale & Bobo & Minnie (GA) said:
Btw, you’re testing enough to do TR if you wanted to
Click to expand...
 
Suzanne & Darcy said:
I’m loving those blues on the spreadsheet both during the day and the evening! Congratulations!
Click to expand...

We are getting some really low blues today, started really early in the cycle at +3. I fed her a little LC wet at +4 BG and it only popped the BG up by 7 points at +5. I'm a little worried what is means but I am monitoring closely. This incident makes me even more worried to leave Evie alone overnight at the vet :confused:

Christie & Maverick said:
Just a couple of points to clarify. Since CG is using Prozinc, there is no TR dosing method, that only is applicable to what we use for Lantus, Lev and Biosimilars. It looks like CG is using a conversion because she is using U100 insulin syringes and dosing a U40 insulin.
Click to expand...

That's right! 0.2 increases are easier to measure out in the u100 syringe.

Ale & Bobo & Minnie (GA) said:
I’d call your vet and ask if they did or check the lab results you got.
Click to expand...

It doesn't look like they even tested for ketones, I've had a look over the results. I've started adding them to the labs tab on her spreadsheet.

She is due for a vet visit today, I could ask the vet to do another work up to see how everything is looking. Any specific blood tests I should be asking for?
 
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Christie & Maverick said:
@Ale & Bobo & Minnie (GA)
Just a couple of points to clarify. Since CG is using Prozinc, there is no TR dosing method, that only is applicable to what we use for Lantus, Lev and Biosimilars. It looks like CG is using a conversion because she is using U100 insulin syringes and dosing a U40 insulin.
Click to expand...
I thought there was an adapted TR for prozinc I heard other members refer to here?
 
AliceL said:
We are getting some really low blues today, started really early in the cycle at +3. I fed her a little LC wet at +4 BG and it only popped the BG up by 7 points at +5. I'm a little worried what is means but I am monitoring closely. This incident makes me even more worried to leave Evie alone overnight at the vet :confused:



That's right! 0.2 increases are easier to measure out in the u100 syringe.



It doesn't look like they even tested for ketones, I've had a look over the results. I've started adding them to the labs tab on her spreadsheet.

She is due for a vet visit today, I could ask the vet to do another work up to see how everything is looking. Any specific blood tests I should be asking for?
Click to expand...
Those blue numbers are great and still pretty safe. Anything above 50 is fine. I know it can be alarming when you’re not used to it and I’ll defer to @Suzanne & Darcy here, but for me, I tried to not interfere until Bobo was in the greens because I wanted him to dip below 100 and into the normal range as much as possible. It takes some getting used to but I have a feeling Evie will get there soon! It’s good for you to know that the LC doesn’t bump her numbers up much so if she does get into the 50’s-70’s range, you may want to give MC or HC instead.
 
AliceL said:
PREVIOUS THREAD: https://felinediabetes.com/FDMB/threads/evies-updates.277793/#post-3077711

Evie is having some strange high numbers again since the insulin increase, I know it can take a few days to adjust so I'm just waiting it out. Everything else seems ok, she isn't drinking more water, still eating, stomatitis looking ok - just super vocal for food and sleeping so much since yesterday afternoon.

I have another problem and I don't know what to do. I have to go out of town for one night next week because I have an 9am immigration appointment in another county. It's a 5 hour drive so I absolutely have to go the day before to make the appointment. Our non-diabetic cat will be just fine for that time with kibble & water but obviously that won't work with Evie.

There is a vet in my town that will board her for 24hrs from 3pm to 3pm. The only issue is that they won't check her overnight as they are closed - so basically they will just give her insulin & food and lock up for the night, then insulin & food the next morning.

I don't know which is worse - staying at the vet and risking hypo with no food & no one around (they assure me it won't happen because her BG will be elevated from the stress anyway) or letting her relax at home with no insulin for two cycles but at least I have cameras to watch her and can have a pet sitter come in to feed her periodically. The sitter won't stay overnight, won't shoot insulin or test her. Another option is to subject her to the 5 hour drive there, leave her in an airbnb, and then drive 5 hours back the next day...but at least she gets her insulin & is monitored all the time (except for during the appointment of course)
What's the best thing to do?

Also don't think I should be increasing her dose in the coming few days until this incident has passed.

@Suzanne & Darcy @Diane Tyler's Mom @Shelley & Jess
Click to expand...
Definitely do not increase if things are up in the air right now (with your trip.) At least it sounds like you have options. I would be inclined to take her with me, but I don’t know if she’s a great traveler or not. I would not trust the vet to take care of her and would just have them shoot a reduced dose (maybe half) just for peace of mind. Since you are not using a depot insulin, we don’t have to worry about depleting the depot and we can more or less just take each day and cycle as it comes. I also don’t think it would hurt her long-term to skip a few shots because I think you can get her back on track — but you may not want her BG going up while you’re away.
 
Ale & Bobo & Minnie (GA) said:
I’d call your vet and ask if they did or check the lab results you got. Is there a reason why you’re giving .8 or 1.2 instead of going with the 1/4 increments?
Click to expand...
Hi there! She’s using U-100 syringes with the ProZinc and so we follow the conversion chart for drawing doses using the U-100s. It’s all good. She cannot obtain the U-40s in her country.
 
Ale & Bobo & Minnie (GA) said:
Those blue numbers are great and still pretty safe. Anything above 50 is fine. I know it can be alarming when you’re not used to it and I’ll defer to @Suzanne & Darcy here, but for me, I tried to not interfere until Bobo was in the greens because I wanted him to dip below 100 and into the normal range as much as possible. It takes some getting used to but I have a feeling Evie will get there soon! It’s good for you to know that the LC doesn’t bump her numbers up much so if she does get into the 50’s-70’s range, you may want to give MC or HC instead.
Click to expand...
We want to try keep Evie between 90 and 150 for the SLGS.
 
Alice, I am really pleased with the morning cycle. That string of blues is fantastic. Remember, our target BG level right now while following the SLGS method is to keep her between 90 and 150 — so she was even at the upper end of that range during a large portion of that cycle. Do not worry. Those are VERY safe blue numbers and she should be feeling well. Look at how stable and smooth she was during that cycle. This is allowing her body to adjust to spending more and more time in healthier numbers. I’m really pleased with how she’s doing since we increased to 1.2 units. It looks like just what she needed. And she would not be ready for another increase yet anyway before we had held the dose for a full seven days— and then we would reevaluate things. I hope maybe you can work it out that she can go with you! But you will find the best option for Evie, I know.
 
Suzanne & Darcy said:
Thanks to @Shelley & Jess for alerting me to this new thread. If it had been on the ProZinc board I would’ve seen it, but the tag didn’t work and I didn’t get any notification of this new thread.
Click to expand...
I'm so sorry. I'll start my next new thread on the Prozinc board! I guess I'm no longer a newbie :joyful:

Suzanne & Darcy said:
Alice, I am really pleased with the morning cycle. That string of blues is fantastic. Remember, our target BG level right now while following the SLGS method is to keep her between 90 and 150 — so she was even at the upper end of that range during a large portion of that cycle. Do not worry. Those are VERY safe blue numbers and she should be feeling well. Look at how stable and smooth she was during that cycle. This is allowing her body to adjust to spending more and more time in healthier numbers. I’m really pleased with how she’s doing since we increased to 1.2 units. It looks like just what she needed. And she would not be ready for another increase yet anyway before we had held the dose for a full seven days— and then we would reevaluate things. I hope maybe you can work it out that she can go with you! But you will find the best option for Evie, I know.
Click to expand...

I'm so glad. We've never had that happen before so I just tested her every hour to be sure nothing bad was going on.

Unfortunately all that good work has been wiped out somewhat by the vet visit this afternoon but I'm really glad we went.
The vet saw her numbers today and didn't think it was safe to leave her unmonitored overnight so she arranged to get Evie booked into a proper pet hospital on Sunday evening.
The hospital said they will follow my protocol exactly with insulin, testing during the night & food type/frequency - I'm so relieved!
I do believe this is the best thing for Evie because she absolutely hates travelling in the car.
She is due to increase dose in 3 days but I'll definitely hold the dose for now and we can make the call when I am back on Monday.

Ale & Bobo & Minnie (GA) said:
It’s good for you to know that the LC doesn’t bump her numbers up much so if she does get into the 50’s-70’s range, you may want to give MC or HC instead.
Click to expand...
That's an excellent point, thank you.


@Suzanne & Darcy @Ale & Bobo & Minnie (GA) @Shelley & Jess @Christie & Maverick @Sienne and Gabby (GA)
I just want to thank all of you for your comments and help, I appreciate it so much!
 
Ale & Bobo & Minnie (GA) said:
I thought there was an adapted TR for prozinc I heard other members refer to here?
Click to expand...
Yes, you are right, just not referred to as TR or even adapted TR which can be confusing to Prozinc users, since we know that terminology as part of our dosing methods over on the Lantus, Lev and Biosimilars sub forum :). As part of the dosing methods for Prozinc, there is an option to do a modified method, which offers some suggested modifications for caregivers, and even goes further to an advanced method.
Prozinc Dosing Methods

@AliceL you are welcome, happy to help.
 
AliceL said:
We've never had that happen before so I just tested her every hour to be sure nothing bad was going on.
Click to expand...
Oh, I would have done exactly the same thing! It's new for her and you want to see how her cycles go... will she go down or will she stay stable? You need to know, and you did everything just right. I'm really happy that Evie is booked into a place where they will be able to monitor her. You should have a good chat with them ahead of time to make sure they're going to do things the way that you want them to and even that they know exactly how much insulin to draw up for her (we've seen some mistakes made here by vets.)
 
So, other than driving her numbers up a bit and getting her booked into a pet hospital... did the vet check anything else?

With regard to ketones that we talked about before, can you buy in Portugal the ketone strips that are urine test strips. A lot of people use them here and put in the urine stream of their cats while they're using the litter box. I bought a Nova Max blood ketone meter that is a handheld meter that uses a special test strip for ketones. Anyway, I doubt if she's producing a lot of ketones now with the better numbers that she's seeing, but many people want to know for peace of mind.
 
Suzanne & Darcy said:
You should have a good chat with them ahead of time to make sure they're going to do things the way that you want them to and even that they know exactly how much insulin to draw up for her (we've seen some mistakes made here by vets.)
Click to expand...

I'll explain everything to them when we check her in on Sunday but I have to pack all her own needles, insulin and food... so of course I am planning to be annoyingly overprepared and make a folder with blown up pictures of her dose in the syringe & any how-to steps in English AND Portuguese :D
So hopefully it all goes ok.

Suzanne & Darcy said:
So, other than driving her numbers up a bit and getting her booked into a pet hospital... did the vet check anything else?

With regard to ketones that we talked about before, can you buy in Portugal the ketone strips that are urine test strips. A lot of people use them here and put in the urine stream of their cats while they're using the litter box. I bought a Nova Max blood ketone meter that is a handheld meter that uses a special test strip for ketones. Anyway, I doubt if she's producing a lot of ketones now with the better numbers that she's seeing, but many people want to know for peace of mind.
Click to expand...

Yes! She has put on another 150g of weight and the stomatitis is looking really good, very diminished and no longer inflamed. She also confirmed they didn't check for ketones when she was first diagnosed. I do want to get some ketone urine test strips. The vet confirmed they are available here in Portugal so I'll look for some tomorrow and start checking her periodically for my own peace of mind.
 
AliceL said:
I'll explain everything to them when we check her in on Sunday but I have to pack all her own needles, insulin and food... so of course I am planning to be annoyingly overprepared and make a folder with blown up pictures of her dose in the syringe & any how-to steps in English AND Portuguese :D
So hopefully it all goes ok.



Yes! She has put on another 150g of weight and the stomatitis is looking really good, very diminished and no longer inflamed. She also confirmed they didn't check for ketones when she was first diagnosed. I do want to get some ketone urine test strips. The vet confirmed they are available here in Portugal so I'll look for some tomorrow and start checking her periodically for my own peace of mind.
Click to expand...
You’ve got everything under control! Excellent! Being over prepared is good! I hope your trip/appointment will be smooth and successful. Keep me posted on Evie in the meantime. I’ll be peeking at her spreadsheet
 
Oh my gosh. We have a green number! It's 88 at +6.

She had a slightly lower than usual number at +3 but I didn't think much of it because she has been meowing for food a lot today so I fed her a small portion at +3 plus I've been giving her boiled chicken piece snacks all morning... I certainly didn't expect such a low number now at +6.
I gave her some more wet food now so I'll check the result again in an hour - that should be fine right? Or should I check sooner?

Suzanne & Darcy said:
Remember, our target BG level right now while following the SLGS method is to keep her between 90 and 150
Click to expand...

It's under 90 today so does that earn her a dose reduction?
These numbers are making me mighty nervous with my upcoming overnight trip in 3 days, perhaps a reduction isn't the worst idea anyway?
 
Also, depending on what numbers you get on the new reduced dose, you can do a temporary reduction for during your trip - to let her run a little higher for the time you are gone. She will get back on track! Congratulations. She’s doing really well! I’m pleased. Good job!
 
Suzanne & Darcy said:
Yes. She’s earned a reduction so I would drop her back down to the previous dose.
Click to expand...
Thanks for answering so quick. So back to 1U for this evening's shot then right? That's 2.5 mark in my u100 syringe.

I just pulled out the last few used needles from the sharps box to double check them, and I see two of them have plungers that start at a smidge under the 0 mark instead of right at the 0 mark. I've attached a picture. Do you think this might be responsible for the dips? Is it worth getting some callipers so I can be more accurate with her dose in future?
 

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Before i used calipers, I'd look at where the plunger zero'd out and if there was a big enough difference I kept that in mind when I drew the desired dose - on the line, at the bottom of the line, at the top of the line, that sorta thing if you're comfortable with that.

Calipers sure help, especially when drawing those teeny tiny doses, however it adds another layer of confusion when administering U40 insulin using U100 syringes then converting to the caliper measurement.

I did it, but I don't recommend it unless you're absolutely sure you understand what you're working with. There's a couple tabs on my spreadsheet you can look at to see what I mean.
 
AliceL said:
Thanks for answering so quick. So back to 1U for this evening's shot then right? That's 2.5 mark in my u100 syringe.

I just pulled out the last few used needles from the sharps box to double check them, and I see two of them have plungers that start at a smidge under the 0 mark instead of right at the 0 mark. I've attached a picture. Do you think this might be responsible for the dips? Is it worth getting some callipers so I can be more accurate with her dose in future?
Click to expand...
Yes to 1 unit. And I see you already did it so it’s perfect!
 
Shelley & Jess said:
Before i used calipers, I'd look at where the plunger zero'd out and if there was a big enough difference I kept that in mind when I drew the desired dose - on the line, at the bottom of the line, at the top of the line, that sorta thing if you're comfortable with that.
Click to expand...
I'm going to take note of the plunger position and try this first. I don't think I understand the whole calliper thing enough just yet..
 
Just a quick update.

Evie spent Sunday afternoon & most of Monday at the pet hospital for babysitting.
They tested her and fed her perfectly according to my schedule. They were quite tickled by the file I delivered with her, which included detailed pictures of her dose and all the instructions in both English & Portuguese :smuggrin:

They used our glucometer so I had all the results and times in the memory. Only the AMPS result from yesterday morning was missing, which they confirmed they did it on their pet specific monitor. Her results during the stay were a bit elevated but that's to be expected from the stress.

It looks like she bounced back beautifully last night with a great curve, and we have a nice low pre shot number this morning.

Correct me if I'm wrong but I think I should hold dose for a few days to see how it evolves - 1U seems to be really working a lot better lately than the 1.2U a few days ago - it looks like her results are getting better every day.
 
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