Help with Tigger's fine-dosing plan

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by Kerri & Tigger, Feb 9, 2020.

  1. Kerri & Tigger

    Kerri & Tigger Member

    Joined:
    Dec 17, 2019
    http://www.felinediabetes.com/FDMB/...r-almost-diet-controlled.224786/#post-2523588

    Hi Deb and my new Vetsulin/Caninsulin friends....

    I was posting under the thread "Dosing advice for 'almost' diet-controlled" in the Main Forum. Now moving here for help with fine-tuning. Big thank you to Deb (and angel Wink) for taking me under their wing.

    Deb, I've been practicing with my control solution (yes! why couldn't I think of that name?!) and my U100 syringes. Unfortunately, I didn't order the ones with half-unit markings. So. . . to be sure I am on the same page with you. . . my one-unit line on the syringe equals 0.4 units of Vetsulin. Yes?

    I have been experimenting, and I see that I can get either 4 drops out of that "first line" measurement or 3 drops. (I don't mean it goes back and forth on different tries--I mean that I'm able to say "okay" I'm making 4 drops out of this and make the drops a little smaller. Or I'm making 3 drops and they are a little fatter. (Kind of like in that photo series you shared with me, where the drops varied.) So maybe that gives us a starting place?

    I haven't been on that UAE roller coaster you mentioned, but I don't want to send Tigger down it!

    As for the duct tape. . . . I'd like to say rainbow-colored for happy thoughts. But probably I should choose red so the blood wouldn't show. :cat:
     
  2. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    1 unit line on U100 syringe for U40 insulin is 2.5 times the Vetsulin concentration.
    0.4 times 2.5 = 1
    Answer is YES!
    Good job on practicing to see how many drops you are getting. I want you to use the slightly smaller drop size you were practicing. Those drops are each 0.1U of Vetsulin.
    1 drop = 0.1U
    2 drop = 0.2U
    3 drop = 0.3U
    4 drop = 0.4U

    Fantastic job Kerri! Four drops is perfect.

    [​IMG]
     
  3. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    YAY!!!! Never thought I'd be this excited to see rainbow duck tape!!!:)
     
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  4. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Make a big note on your SS as to when you started to use the U100 needles for the MICRO DOSING/ CHASING THE DOSE. A big note, like you have for the Alphatrak meter.

    You'll need to get some PM cycle tests around +5 and +6. Every night. Can you do that? It may mean setting an alarm to wake you up. Let me know if this works for your work/life/responsibilities, which like most of us is a busy and full life.

    Now to figure out a sliding scale dosing for Tigger and Tigger only. DO NOT COPY THIS DOSING FOR YOUR CAT. This was developed for Kerri and Tigger only using an Alphatrak. I'm going to stay a bit conservative here, and keep the BG test ranges at bit higher for now, partly because you are using an Alphatrak, partly because Tigger hasn't been getting insulin for a while, partly because we need to see how this sliding scale works, and taking those low numbers on 1/10/20 early in the cycle into consideration.

    If Tigger is not eating well, "all bets are off." You may need to skip the shot entirely and pick back up at the next dosing cycle.
    If Tigger seems off, not her usual self for some reason, skip the shot. You are there and you know her better than we ever will.
    With Vetsulin, you should always make sure Tigger eats before the shot. About 20 minutes or so from food to shot.

    Ok, here goes. Like I said, pretty conservative on the sliding scale.

    If BG < 150 skip shot (or stall)
    If BG = or > 150 and < 190 0.1U (1 drop)
    If BG = or > 190 and < 240 0.2U (2 drops)
    If BG = or > 240 and < 350 0.3U (3 drops)
    If BG = or > 350 0.4U (4 drops)

    We can adjust this as time goes on and we see how well Tigger does on this sliding scale.

    There is no information in the Vetsulin forum on the "Advanced information for Experienced Vetsulin Users" but there is a similarly named document in the Prozinc forum. Print yourself out a copy and replace the word Prozinc with Vetsulin and you have yourself a rough guide.

    Read the entire document. Print out a honest to goodness hardcopy, a paper copy. Print 2 copies.

    Do you have a Wal-mart near you? Do you need a prescription to buy insulin needles in your state? Relion 3/10 cc syringes with 1/2 unit markings on the barrel would be a wise investment. You'll likely need a prescription from your vet.

    Talk to your vet about doing this. Please. I'm a layperson, but your vet may have some feedback I have not thought of.
     
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  5. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Hi Deb--thank you so much! This is all sounding good to me. I will respond more fully and make SS edits in just a little while. In the meantime, PMPS was 169, so one drop tonight. All set. More in a bit.
     
  6. Kerri & Tigger

    Kerri & Tigger Member

    Joined:
    Dec 17, 2019
    Thank you again, Deb, for putting these notes together for me! This is all so incredibly helpful.

    So far, I have . . . .

    --made the big "MICRO DOSING/CHASING THE DOSE" note on SS and indicated the U100 needles.

    --read the "Advanced information for Experienced Prozinc Users" (I will print two copies at work tomorrow) (I understand the disclaimer at the end of that document and also in your message--that this is a community of laypeople and not a substitute for veterinary advice).

    --been thinking hard about life/work schedule. The short answer is yes, I can get the late tests. In a perfect world, I may be able to back up my test times enough (both tests, keeping the 12-hour spread) to not have to set an alarm (Which I know hubby would like; he has to get up really early for work.) But I can set an alarm if I won't otherwise be up late enough. I understand how important the data is. My own schedule is a little haphazard in a good way; I teach at a university and different days look different ways. But at least I'm often able to catch good daytime measurements and rarely have to shoot and walk out the door.

    --read closely the "chasing the dose" scale you've suggested. I love it. I am very happy being conservative. And I absolutely understand the directives to not shoot if Tigger doesn't eat well or if something just doesn't seem right. I will be vigilant about both.

    Finally, the Walmart question. . . . Yes to that--Walmart nearby (and emergency vet, too, which is nice). I am not sure whether I have to have a prescription for syringes in person (I bet so), but I was able to buy from AWS online without a prescription. I need to order more strips and can add the 3/10cc w/ 1/2 unit markings to the order--unless it's better to have the Relion brand in particular?

    And I'll keep in contact with my vet, of course.

    Whew! I think that's it for now. Thank you so much for all the time you have invested in Tigger and me! Tigger sends many happy purrs your way. :cat:
     
  7. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Good recap of what I said. Thanks for letting me know you understand what was said.

    Ok, Tigger!! Ready for some more microdosing?

    It may take some time to bring her BG numbers down, but we are doing it slow and steady. Safely.

    Buying insulin syringes from AWS (Amazon Web Services) online is fine. You may find syringes there that are more highly rated. I only gave you the Wal-mart Relion info as a backup choice. Half the time, the pharmacy techs do not even realize they have insulin syringes with those 1/2 unit markings. We (FDMB members) often tell them they do and to check the boxes of the 3/10 cc syringes they store behind the counter.

    I can't be here 24/7. Need to sleep sometime and run errands and take care of my own cat and such. Vetsulin ISG is not as active as Main Health. So, I'll keep my eye out for you and Tigger. But if you need help, a post in Main Health is prudent too. Use your best judgement.

    Sometimes I'm they only one checking the Vetsulin ISG. Especially now that MrWorfMen's Mom had to euthanize her old cat and isn't helping anymore, Marje and Gracie had a family emergency and upcoming vacation and has extremely limited time to respond. Resources are a bit thin on the ground right now with our volunteers.

    Plus, many of the more experienced members can't get their heads wrapped around the Alphatrak BG readings. Different enough that the mental adjustment of what the ranges mean can be tricky and interpreting the SS needs that mental adjustment. Think of it as being like switching from English to Greek and vice versa, when you don't read the Greek alphabet.:rolleyes:
     
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  8. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Good morning! Tigger is ready! She might be a picky eater, but she is BIG on getting treats. Even if the treats come with pokes.

    I'm thrilled with slow and steady. Fast is scary. No roller coasters. :)

    I'll get stocked up with the right syringes and strips. And I really am so grateful that you could help with the AlphaTrak. I feel like I understand it better and trust it more, though I also understand others' aversions. (And I totally get the English/Greek parallel. So grateful that you have a bilingual brain!)

    I totally understand. Though I've been under the impression that you actually might never sleep! I don't know how you keep up with all the responding you do....(How do you ever have time to get those flowers duct-taped??? :D ) If I run into an emergent problem, I can definitely reach out where there is heavier traffic. But I bet I can be pretty independent for a stretch, until it's time to think about adjustments. If nothing else, my rocky start taught me that I can notice and handle/head off hypo. But hopefully we'll be so slow and steady that won't even pop up. Fingers crossed.

    For the moment, my only lingering question is Tigger's constipation. She finally pooped this morning. HOORAY. (It had been almost 2 days, not normal for her at all.) Decent size, a bit on the small side, but I could tell it was dry. I always add water to her wet food. Dry food she is only getting about a TBSP of Elsey's a day. Before we pulled the YAZ, it was about a TBSP each of both kinds. (I know no dry at all is best, but right now it's still a way to get her finicky stinker self to eat.) You think it best to still keep the YAZ away? I do think that's made a difference in the bowel situation. If we stick to no YAZ, do you recommend I start trying a little Miralax? Or just give it a little more time (and pumpkin) and see if she adjusts?

    No rush to answer that!

    Big huge thank you for everything. (And to Mr.WorfMen's Mom, too. She helped me a bunch when I first landed in this world, and I am so sorry for her loss. So hard to say goodbye to these sweet souls.)
     
  9. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Constipation. Many canned cat foods do not have enough fiber. Plus, with the excess peeing a diabetic cat does, more water is drawn out of the intestinal system and can make the poop firmer and harder to pass.

    Options.
    1. Some plain canned pumpkin, no spices. Start slow 1 teaspoon. Adds fiber. See if Tigger will eat it on it's own. If not, mix with a bit of food.
    2. Psyllium husk fiber. Start with 1/8 teaspoon mixed well with the wet food and an extra bit of water. You can dose to effect. Cat has to eat their food quickly, <15 minutes, since it turns to a gooey gel consistency. Has a bit of a texture and taste to it.
    3. Miralax. Start with 1/8 teaspoon mixed well with the wet food and an extra bit of water. You can dose to effect. Cat can take their time eating, over a few hours if other pets not eating the same food. Has a bit of a gritty texture but no taste to it.

    Better or worse bowel situation? Less stinky? Other? What do you mean when you say a difference?

    I'd like you to still keep the YAZ away, only because you are trying the microdosing. Changing one factor at a time helps to see the result of the single change being tested.

    p.s.Winter in New England. Drab and cold, leaves off the trees. Not much green except the evergreens. Flowers are all hibernating for the winter and so is Deb.
     
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  10. Kerri & Tigger

    Kerri & Tigger Member

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    Oops! Yes--I wasn't clear at all. I think the YAZ was keeping Tigger regular / keeping bm's soft. They were a little extra stinky, but I never let her have very much YAZ, so we never ran into the loose bowel trouble I had read about connected with that food. I figured maybe the YAZ was helping make up for the lack of fiber in canned. (But I also had the terrible funny thought that YAZ seems like those awful "diet" potato chips a few years back, the ones cooked in some strange non-absorbable fat....The bags carried the tiny warning label about 'anal leakage.' For real. Does anyone really want potato chips that badly???)


    Happy to keep it away! You've given me three great options if Tigger stays a little stopped up. Now I really am all set!

    70 degrees in Mississippi today. But never ending rain. Everything here is green on top--underneath all mud! But there will be sunshine again, eventually, for us both!:cat:
     
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  11. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    How do you think Tigger is doing on his sliding scale dosing plan?
     
  12. Kerri & Tigger

    Kerri & Tigger Member

    Joined:
    Dec 17, 2019
    Hi Deb! Thanks for checking in on us. We've definitely had no drama; no crashing or even almost crashing; still could use some nudges further down. After a couple of morning stalls, I decided to drop my "no shoot" to 140. Tonight I readjusted my 2 drop down to 180. So I had this:
    If BG < 150 skip shot (or stall)
    If BG = or > 150 and < 190 0.1U (1 drop)
    If BG = or > 190 and < 240 0.2U (2 drops)
    If BG = or > 240 and < 350 0.3U (3 drops)
    If BG = or > 350 0.4U (4 drops)

    And I've bumped to this:
    If BG < 140 skip shot (or stall)
    If BG = or > 140 and < 180 0.1U (1 drop)
    If BG = or > 180 and < 240 0.2U (2 drops)
    If BG = or > 240 and < 350 0.3U (3 drops)
    If BG = or > 350 0.4U (4 drops)

    I feel like you'll say that's a good plan for now.... I wonder if, eventually, I might have a lower threshold for 2 drops. Even for 1 drop. But Tigger seems to be doing fine and I want to make adjustments slowly. She feels good, acting normal, normal enough bathroom habits now that the pumpkin is helping. If you see a better way for me to adjust, let me know; maybe the 1 drop isn't enough, for example.

    But we are A-Okay this weekend. :cat: I hope you and yours are well!
     
    Last edited: Feb 15, 2020
  13. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Slow and steady wins the race.
    That adjusted dosing scale looks fine.

    Maybe reevaluate in another week.
     
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  14. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Hi Kerri, This is the current sliding scale.
    I think it's time to adjust Tigger's sliding scale dose. I did some work on this Thursday PM. See what you think.
    She needs a bit more insulin, in every cycle. Made a lot of adjustments, to get her a bit more insulin when she is in those mid-range blues and again in the lower blues at pre-shot. Need to see her more down in the green, at mid-cycle.

    How about this for the new sliding scale

    If BG < 110 skip shot (or stall)
    If BG = or > 110 and < 160 0.1U (1 drop)
    If BG = or > 160 and < 180 0.2U (2 drops)
    If BG = or > 180 and < 220 0.3U (3 drops)
    If BG = or > 220 and < 260 0.4U (4 drops)
    If BG = or > 260 0.5U (5 drops)
     
    Last edited: Feb 20, 2020
    Reason for edit: pronoun fix
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  15. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Deb! Thank you so much for keeping us on your radar. I've been thinking the same thing. Tigger had a little cold or allergies this week (she seems all well now) and hadn't been super regular with pooping (also much better). Today was the first day she's seemed healthy on both ends and I finally saw some greens, but as you can see they certainly didn't last.

    I unfortunately ended up skipping tonight (PMPS 123), which felt like the wrong thing to do. But I had a work obligation and couldn't stay home to stall. BUT the reading I just got (167 @ +2.5) suggests to me that a dose would have been just fine. I kind of figured that....But tomorrow is another day. :)

    Here's your new suggestion:

    I feel good about this! :) I have actually been wondering about 2 drops at 150.... But that can be a bit further down the line, after I use this scale for a bit.

    Thank you again!
     
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  16. Deb & Wink

    Deb & Wink Well-Known Member

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    Kerri, I almost did the 2 drops at 150. But held back a bit. We should reevaluate in 4-5 days. Not wait so long to see what is going on.
     
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  17. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Sounds great to me! And now I really see why it's called "chasing the dose" :p
     
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  18. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Deb!--Good karma that you thought of Tigger yesterday....Even after our skip last night, this morning she was at 116. We would have been back in skip-land. Happy Friday!
     
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  19. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Tiny bits of insulin, like the drop dosing can make all the difference for some cats.
    Tigger is one of them.

    Good Karma indeed!
    Hoping to see another picture sometime of lovely Tigger girl.
    When you have a chance.
     
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  20. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Oh, thanks for asking for a pic! How fun.... :)
    This afternoon, she has stolen her brother dog's bed. Which she does a lot. Pretty sure she thinks it is hers--and he just sometimes trespasses.

    Tigger has a fun little rescue backstory....Hubby's and my heart kitty, Puddy, had passed away from kidney disease at 16, and we were finally ready for a new kitty. Or, hubby was finally ready. I had been ready and just waiting for the go-ahead. Anyway, I dutifully searched the shelters, the rescue posts, etc., etc., but kept thinking. . . . No, these kitties are safe/rescued/fostered already. If I'm patient, a kitty who has zero chance will come my way. . . . Then I set my eyes on some basically feral babies under a shed at our county's recycling / dumpster area. SO wild. Couldn't catch. Tried for a month with wet food and tuna; no luck. (Important side note: Next to dumpster area is kind of "county barn" facility for all the heavy machinery.)

    One day I am halfway under that shed at the dump, with my butt stuck up in the air, calling "here kitty kitty" with a can of tuna. And a guy I had noticed driving through on a trackhoe comes up behind me and says "lady if you want a kitten, I've got one at my shop next door that's really friendly. It's no trouble to catch it." And it NEVER ONCE crosses my mind that he might be a serial killer with the oldest trick in the book. But sure enough, I drive over to his place--and by the time I get there, he's driving back toward me on his backhoe holding a little orange-and-white flea-infested kitten by the scruff of the neck. And that's Tigger.

    The guy (who apparently wasn't a serial killer, at least not that day) said Tigger showed up all alone one day. He figured someone must have tossed her out. (There is also an animal shelter nearby, and they get toss-outs. Mississippi is an unkind place for unwanted animals.) I'm sad to say I don't know the fate of the kittens under the shed. I fear I'm better off not knowing. But lucky Tigger, that she found herself a guardian angel guy on a trackhoe.

    Do you know Wink's story, I wonder? Where he came from before he came to you? These sweet creatures and their stories, so many twists of fate. Wish the twists could be lucky for them all.
     

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  21. Deb & Wink

    Deb & Wink Well-Known Member

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    I have a word type document typed up, and linked to my signature. Just click on the part of the signature that says Wink's Profile. A little bit of background info on wink is in there.
     
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  22. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    What a gorgeous tribute. Love, love, love. Lucky Wink.
     
  23. Deb & Wink

    Deb & Wink Well-Known Member

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    Lucky me.
     
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  24. Deb & Wink

    Deb & Wink Well-Known Member

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    Tigger is getting more greens. :D Took a peek at the SS today.
     
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  25. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Yes! And we are learning! (Learning I need a new glasses prescription to see the air bubbles, for example. But I grabbed some readers to do for now.):rolleyes: And I think you were spot-on about the no-carb foods. Seems like a couple of her highest recent numbers coincide with 0 / super low carb wet. I'll be weeding those out. . . .

    Hope you and yours are well! And thanks for checking in on us--looks like you have had your work cut out for you on this busy board lately!
     
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  26. Deb & Wink

    Deb & Wink Well-Known Member

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    How are you doing Kerri down in Mississippi?
     
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  27. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Hi Deb! Good morning. Thank you so much for thinking of me! My life is a little crazy, like everyone's right now. I teach at a university, and I am pretty buried with moving all my courses online. But that should settle in the next few days, once I get everything "built." Hubby and I have his mom (widow) and my parents (all in their 70's) pretty well supplied. Unfortunately, his mom has dementia--bad enough that she is struggling to process the situation, but NOT bad enough to prevent her from driving. So it is herding cats to keep her in her house. My parents, luckily, have a healthy fear and are committed to staying home until this passes.

    I keep being a little slow updating Tigger's spreadsheet (though I'm testing as usual). I've been kind of trusting my gut and modifying down to "some" rather than her whole .1 drop sometimes. She has slipped down into the neon green a couple times and has had a couple skips, so I'm trying to adjust for consistent twice-a-day dosing....Once I get my courses all settled, I can think think more carefully about my sliding scale and what adjustments might be good. The good news is I should be working from home for a long time now, so can keep a close eye. She feels great, is maintaining good weight, pooing regularly and doing all the cat things, so that's nice. (One thing I wonder is whether I should buy a new vial of vetsulin. . . . I'm pushing 42 days, but it still looks good / no particles and seems to be working fine. But will still probably pop by the vet soon to have a fresh one on hand.)

    How are you? Healthy and well stocked with food and supplies, I hope!

    I've been lurking less frequently on the board but see you working with so many people. I so admire your commitment, and I would love to jump back in and try to contribute as I am able. I can at least do some supportive cheer-leading. Once my classes are settled, I'm hoping to do just that.

    Wishing you well!

    Kerri
     
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  28. Deb & Wink

    Deb & Wink Well-Known Member

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    I've been looking at Tigger's SS now and then. To see how she has been doing. So far so good. You thought you'd be able to do this on your own, and you've been doing a good job. It's why I haven't been replying back to you.

    Life is "surreal" right now.
    Talk about an overload of work, to get all your courses up and running as on-line courses. Can't imagine the workload required with that.

    Take away the car keys and maybe the car too. I had friends that had to do that with their parents. One person's mom got lost while out driving, and could not remember how to get back home.

    Getting by just fine. Plenty of supplies for myself and my cat.
    I do have to get my snow tires switched over to my summer tires. Have an appointment next week, after the snowstorm on Monday. :(
     
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  29. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Ugh, a snowstorm! But so glad to hear you are all stocked up. So much uncertainty right now.

    And yes, to taking away the keys/car. She lives in our neighborhood, which is wonderfully helpful. And one of us rides with her driving at least once a month to be sure she is still driving safely and not getting lost. Take us to Walmart, we'll say, or some other place she frequents. And we're in a small town with things close by. BUT those keys are probably going to have to go, at least for now. Then if we can just keep her crazy neighbor friend down the street from picking her up! Hubby caught them going to Home Depot a couple days ago. For absolutely nothing necessary. And after he had told the neighbor friend half a dozen times "do not take my mom anywhere!" Poor hubby was beside himself. . . . I swear, it's like having a couple teenagers who think they know better. But we'll get it sorted out. :)

    If you see someone you'd like me to chime in on, please tag me! I can make time and would enjoy the little breaks from other things.

    Wishing you warmth and fast-melting snow. Let's have green and flowers instead!

    K
     
  30. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    It's hard to take care of an elderly relative with mental and physical issues.

    Will do!

    My dark purple crocuses have been up for weeks. Hoping the snow is light, and does not smash my daffodils to the ground. They are just about ready to bloom in the next week. Snow doesn't usually last long this time of year.
     
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  31. Kerri & Tigger

    Kerri & Tigger Member

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    They sound gorgeous! Post a pic when you have a chance!
     
  32. Deb & Wink

    Deb & Wink Well-Known Member

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    You're in luck, it's a sunny day here, so the purple crocuses were open. They close up when it's cloudy or rainy.
    crocus 2.JPG crocus 3.JPG crocus 5.JPG
    They are scattered in different perennial garden beds around my yard.
     
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  33. Kerri & Tigger

    Kerri & Tigger Member

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    Dec 17, 2019
    Those are so gorgeous!!! What a nice bright spot in our strange new world. Thank you for sending my way!!!
     
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