Is Duke dropping too fast... Con't

Hi, just creating a new thread as the other thread is over 90 posts long.
https://www.felinediabetes.com/FDMB/threads/is-duke-dropping-too-fast.240750/

 

You're doing great.

 

Thank you Janet
Duke's at 16.2mmol/L (292mg/dl) do i stick with the 1 unit? gulp!!!!!! it's frightening.
Tee.

 

Just adding my 2 cents regarding furshots. If you give a furshot or think you give a furshot or partial furshot NEVER give an additional shot. You have no idea how much insulin went into kitty in the first place and you could end up double dosing. Once the insulin is injected there is no way of getting it out!

 

Yep I would!

 

Thanks @JanetNJ 1 unit given. I will check at +2 and +4 just to make sure he's Ok with it being a new PM injection.
Tee.

 

Thanks @Judy and Freckles
Rest assured that i would never do that and i would just wait until the next injection.
Tee.

 

So 1.5U was too much. 0.5U was too little, but the 1U of insulin looks "just right" for now.
That 1U dose brought Duke down into some nice blues today.

Yeah for Duke!

 

Thanks Deb, that brought a big smile to my face. @JanetNJ was fantastic helping me through last night when i was up till 3am doing Duke's PM BG's. (She got fed up of me after a while and banished me off to bed lol)
I,m doing another late one again tonight just to make sure Duke is ok with his new dose.
Just checked him again and he's gone up slightly but i gave him a mini feed about 3/4 hour ago so he should be ok till the morning now.

 

That's right and I'd do it again.

 

Good. He's fine. Go to bed. Lol

 

Lol

 

That's a nice response to that one unit, Tee.

How is Duke coping with the shots and the tests? And how are you doing?


Eliz

 

Good morning Eliz.
Thanks for asking.
Things are going well as you can see with Dukes BG spreadsheet, i'm really chuffed at his progress now that there is some response with the 1 unit.
Duke hates the ear lancing procedure and bobs his head up and down when i try to prick him but having said that he's always hated his ears being messed with even before all this. The injections well that's different, no problem whatsoever, he doesn't even feel it and it's over in a few seconds.
As for me i'm fine and certainly a lot more less stressed now Dukes over the bounce and his numbers have come down a bit, plus i think he's feeling a bit better in himself as well.
The help i have received on this forum from yourself and others has been so unbelievably fantastic and i just cannot thank you all enough.
Tee.

 

It's really not necessary to test every hour.


Try the preshot, +4 -5 , then a + 7, then pmps, and a before bed test.

Testing 4-6 times a day is plenty (unless of course there's a lower than expected number).

 

Thanks Janet, that's what i'm going to be doing now i am happy he settled on this dose. I have done the AMPS, +3 and will probably do +7 or +8 then PMPS and before bed test.
Tee.

 

I hear you... My girl, Bonbon, absolutely hated having her ears touched at first. And she has thin, flimsy little ears that don't bleed at all well, so it does take some work to get some blood out of them... (Sometimes I'd swear she has a turnip for a head, haha!)

I gradually got her used to having her ears touched just by doing that at times when I wasn't trying to get a test. So, whenever I was stroking her I'd also incorporate a very brief touch of the ear, just massaging between fingers and thumb for a second. And then I'd give her a treat.
Even now, if I pass a chair that she's sitting or dozing on, I'll gently stroke the top of her head and be sure to touch her ear too. And, if she's winding herself around my ankles trying to get me to feed her, I'll lean down, stroke her head, and include the ear...
Making ear touching 'normal' and nothing to fear has made a huge difference for us. She still doesn't 'like' having her ears touched, but she doesn't 'hate' it any more. She doesn't recoil from it. And life is much easier, thank goodness...

 

Good idea Eliz, i will try that on Duke when i'm stroking him or passing by.
It's very early days for everyone as you know and a massive change in life for Duke but hopefully he will become accustomed to it in time. Plus as i'm reducing the testing now which he will enjoy.

 

Well what's going on now with Duke. I checked him at +7 and he was a brilliant 11 mmol/L (198 mg/dl). I then checked him at +9 and he had flown up to 28.5 mmol/L (513 mg/dl) i checked a few times to make sure it wasn't a bad strip. Checked again at +10 and he's at 29.3 mmol/L (527 mg/dl) Could he be going through another bounce? just when i thought he was settling down. He's had nothing to eat since +5 when i gave him a teaspoon full of food, he had a wee at +9 and that's all he has done.

 

any chance he got into some high carb food?

 

No, i gave him the Feringa Pure Salmon with potato & parsley at 1.9 carbs at +5 that's all. There was no other food down, nothing.

 

He's due to be checked again in 30 mins for his PMPS. Do i still go with the 1 unit?
He's begging for his supper now, suppose that's with the big spike causing the hunger.

 

Yes do 1 unit. I'd he's starving you could test a little early and feed him.

 

Just done his PMPS and he's at 28.2 mmol/L (508 mg/dl) and he's just getting his supper now. I have used two different Alphatrack meters but the results are the same. What the heck has gone wrong with him.

 

no idea. I think he's trying to drive you crazy.

 

Well he's doing a damn good job.
I dread to think what his BG will be in +2 hours after his supper, so he's had his supper and his shot and now he's gone into his box for a sleep.
Is it going to be a long night again?

 

Don't test two hours after the shot. You won't see much difference. Go for a +4 or 5 then go to bed. No purpose in losing sleep over high numbers.

 

Thanks @JanetNJ i will leave it to +5 and check him then.
His numbers were never this high even before he started his Prozinc, normally about the 20 mmol/L (360 mg/dl)

 

I have done Duke at PM +4 and +5 and he's come back down to 17 mmol/L (306 mg/dl) although no change in 2 hours , but at least he's come back down.

 

Spectacular bounce off that 11 earlier today! Good to see Duke's come down a fair bit from the peak.


Mogs
.

 

Massive increase @Critter Mom , i just don't know why that happened Mogs and there was me thinking he had settled on his new dose. I gave him a little low carb food at +5 checked him at +7 and thought brilliant and then +9 whoosh. Thinking back he was asleep in the room with me between +7 and +9 so he couldn't have sneaked any food, plus the only food we have is very low carb apart from high carb food in his hypo kit.

 

If it were my cat I might try 1.25.

 

Hi Janet, thanks for that, he's been a bit higher today than yesterday, maybe the high readings today are caused by what happened last night, you will know better than me about that.
I do think he does need an increase to 1.25 as well. It won't be too soon after last night episode will it?
Also i'm starting to give him mini feeds now at +4 and +7 just to keep his weight stable.
https://felinediabetes.com/FDMB/threads/mini-meals.241075/
Tee.

 

Hi @JanetNJ regarding your post, i will give Duke the 1.0u tonight and increase in the morning to 1.25u. does that sound ok with you. Then i can keep my eye on him during the day.
Tee.

 

Good plan.

 

I upped Dukes dose to 1.25 this morning and checked his BG at +4 but he's dropped to 9.8 mmol/L (176 mg/dl) from AMPS 22.5 mmol/L (405 mg/dl). He's just had a +4 mini feed. I will check him again at +5 as i think he could be heading quite low. Also drinking quite a bit as well.
Tee.

 

176 is a GREAT number! JUST KEEP AN EYE out. remember NORMAL is 68-150 (3.7-8.3)... you WANT him in that range as long as possible. That's when his pancreas can rest and HEAL.
a little lower carb snack was a good idea. Lets hope he surfs in those blues and dark greens. I'd like to see him around 90-110 today. If it turns out he dips too low you could always go back to 1 unit.

 

It's just me panicking Janet, i thought he seemed to be dropping too fast from AMPS to +4.
This is frightening.

 

ok well you're watching so no need to panic. You've got this. He will stay safe. You have some medium and high carb food on hand in case you need it? The key is to not OVERDO it when trying to steer up. you want him surfing in these healing numbers and not zooming back up to the moon.

 

He's down to 6.1 mmol/L (110 mg/dl). Should i give him a little high carb food?

 

Just maybe a tablespoon or two. we just want to slow him down. This is a great number but we don't want him going too much lower.

 

I'd test again in a half hour.

 

Good catch!

 

I've just tested him again and he's back up to 9.8 mmol/L (176 mg/dl)
Panic over?
I will check him again in 1 hour and post result.
Tee.

 

Ok I see it went back up, so no food, let's see what happens.

 

Thanks Nan, Until you actually have a cat that's diabetic you just don't realise how important it is to be so vigilant.
How on earth do people monitor their cats without a meter, it's impossible.
Thank god i found this forum.

 

Thanks Janet, i will check at +7 to see where he's at.
I never in all my life realised that insulin could be so potent, i only upped him by 0.25 and to have that affect is mind boggling.
Tee.

 

Another option would be to try a "fat" 1.... Just over the one line but not quite 1.25.

 

I can't believe you said that, i was just going to suggest the exact same thing.

 

Duke's up to 13.4 mmol/L (241 mg/dl) maybe i fed him a little too much, but it was only about 40 grams of Gourmet gold in gravy, 25% carbs.

 

probably another bounce...

 

please no, not again.

 

@JanetNJ - If Tee's in a position to monitor intensively, would it be better in future when around this BG level/point in the cycle level to try low or medium carb to steady numbers/keep them in the safe range? (Trying to learn a little about situations like this for kitties on Prozinc.)


Mogs
.

 

Yeah

I think we hit the higher carb stuff too quickly.

 

That's me panicking Janet. My thinking was that Duke was at 6.1 mmol/L (110 mg/dl) at +5 and his nadir is about +8 i reckon. He had dropped 12.7 mmol/L (228 mg/dl) at +4 and then another 3.7 mmol/L (66 mg/dl) in 1 hour from +4 to +5, still roughly three hours to his nadir so i was thinking he's going to drop lots more as he approaches his nadir.

 

For his PMPS injection tonight i will give him a fat 1 unit and in the morning i will give him a another fat 1 unit and see how he goes.
What do you think?

 

Try it for a few days and let's see.

 

Ok @JanetNJ will do, i gave him a fat 1 unit (about 1.125) this morning.
I really appreciate your help.
Thank you.

 

Ok. I'm pretty sure you're probably going to have to go back to 1.25 in a couple days though and just keep a close eye. Lol. He never really did come down too low. That little bit extra just reallymade him drop fast but I wonder if after a day or two on that dose if it would smooth out a little.

 

Yea i think your definitely right Janet. Looking at his BG results it does seem like he struggles with any change in his dose, regardless of the amount.
Do you think it would be a good idea to leave him on this dose until Monday, by doing that it will let him get used to this new 1.125 and then increase to 1.25.

 

Maybe leave him on this dose through tomorrow and then we can up it again sunday if he needs it and you will be home to monitor. It looks like he may run higher at night.

 

Sounds good Janet, hopefully this time i won't panic when he drops . I was expecting a bounce today but his numbers have been pretty stable and fingers crossed the same tomorrow.

 

hi, I'm Angel's mum Cassandra, also from uk. We're back after a long silence due to a few upsetting life events, as Angel now has ckd. Not sure if it would help if you looked at Angel's last spreadsheet when he had his 'blip', the link is in my profile. He'd been diagnosed in 2014 on insulin for a few months and then in remission. until that month in 2016. Since then he's been in remission partly I'm sure due to an ultra low carb diet. He was on prozinc and I was confident enough to adjust the doses slightly according to his blood sugar. Fingers crossed for Duke. xx
ps I was feeding Angel Felix as good as it looks and Gourmet Gold chicken pate, but now he's on a renal diet and I just hope he doesn't become diabetic again

 

Hi Cassandra thanks for that, sorry to hear about Angel and the ckd. We had a cat with ckd a few years ago that we tried with a renal diet, Hill's kd but she refused to eat it point blank so it went back to the vets for a refund.
How did you achieve such fine dosing such as 1.10, 1.20, 0.80, 0.85 etc?
Food wise we feed duke a max of 3% carbs in his food so the Felix agail and the Gourmet are too high in carbs for him.
Tee.

 

Oh! Interesting numbers so far today.

 

Just let those blues ride. If he gets to lower greens just steer with his regular food.

 

I'm going to guess she's using u-100 needles with a conversion chart.

 

Yes very interesting Janet. The only thing i can think that's happening is that he had a smaller calorie breakfast this morning. He had about 25% less calories this morning compared to yesterday, also on the 7th he had about the same 25% less, both times his numbers dropped fast, whereas more calories yesterday kept his numbers up and not dropping as fast. The amount of food is roughly the same but a lot less calories. Could this be the reason because his dose is exactly the same. Also he started with lower numbers this morning than yesterday morning.

 

It's more the carbs then the calories. I'm glad to see these numbers though

 

Oh darn, that huge fast 78% early drop is setting him up for a high, hard bounce. Please keep it down Duke!

Following Prozinc SLGS dosing method that 79 (4.4) on an AlphaTrak - Duke earned a dose reduction to 0.75u.

 

Me too Janet, a bit frightening this morning though with his numbers coming down so fast. I need to check him at +8 just to make sure he's fine.

 

Oh no!!! please no bounce.
I was going to ask that question about his dose for tonight, what should i do, keep it the same, or drop it.

 

Dosing and dose changes are based on the nadirs or lows Duke gets on a particular dose. Take the reduction, regardless if Duke bounces from todays low or not. Hold the dose and wait for the bounce to clear. That was a strong reaction to the insulin early in the cycle today. We want to keep Duke safe.

 

@Shelley & Jess did you find any answers for this https://felinediabetes.com/FDMB/threads/trying-to-figure-out-dosing-for-gizmo.239917/#post-2701127 because i'm sure that i went into his muscle this morning, purely because the needle seemed to have more resistance going in. Could that affect the fast drop in numbers?
Also this.
https://felinediabetes.com/FDMB/threads/trying-to-figure-out-dosing-for-gizmo.239917/#post-2701967
https://felinediabetes.com/FDMB/thr...4-5-67-5-60-5-5-64-7-105.238419/#post-2677515

 

Hi Teetee, yes I had a pretty accurate needle and I just got as close to those measurements as possible. Duke looks like a sweetie, I have 2 black and white 6 year olds brother and sister who both adore Angel. Fingers crossed here for no bounce xx

 

That thread was more a question of resistance shooting in fat. Doesn't look like we got a definitive answer in Gizmos thread and the article Deb posted made my brain glaze over - that's as far as I got with any further research. I think Debs reply in that thread is the take away though, when shooting in the scruff, an area generally thicker and more fatty for most cats.

Whether you get the low number early in the cycle or later in the cycle, it's still a low number.

From what I understand, injecting in the muscle hurts. Did Duke react to the shot, flinch, give you a dirty look? Not sure who to tag to try and answer this one!

 

What sort of needle/syringe. @JanetNJ suggested you used a U-100 syringe and converted.
Thanks, yes he's a nice and so placid cat, big softy he is.
Tee.

 

No reaction at all Shelley, the injections never bother him at all, but as you say a low number is a low number. Luckily he didn't go too low and held quite good today. Just hope there is no big bounce.

 

Nice numbers today! the fat 1 brought him down nicely. Did you have to steer at all to get the number up from the green? If not I would keep the dose the same. If you did maybe drop it to a regular 1 u.

 

No steering at all Janet, he was 4.4 mmol/L (79 mg/dl) at am +3 and i fed him a mini meal with 8%carbs at his normal time at +4 and then all i did today was just keep my eye on him. From the 4.4 mmol/L he just rose up steadily to his PMPS at 21.2 mmol/L (382 mg/dl)

 

Do you think you're going to follow MPM dosing protocol from now on? (You certainly test enough to follow MPM safely) If so, quick housekeeping chore, can you change your dosing method from SLGS to MPM on your spreadsheet please - that way anyone following (especially for those new members that may be reading) aren't confused by what Janet is recommending. Thanks!

 

A much smoother drop today. I like seeing those blues

 

Hi Shelly, i have changed my spreadsheet to MPM.
I decided to keep Dukes dose at 1.00F because i'm convinced that i hit a blood vessel, vein/muscle that caused the insulin to disperse through his body way too fast.

I read this on a diabetic site.
When insulin is produced by the pancreas, it is released in small amounts in response to blood glucose levels over the course of several hours. Injecting insulin just under the skin simulates this response most effectively and safely because the insulin works gradually.
When insulin is injected intravenously, the effect is immediate but very short-lived. Instead of the insulin being gradually absorbed into the circulation from tissue, it is immediately available in the bloodstream. This results in abnormally high insulin levels that can cause a rapid drop in blood sugar levels

I'm 100% convinced this what happened to Duke and why he dropped to 4.4 mmol/L (79 mg/dl)

 

Hi Janet
He's doing well today,yea. He's going back up now but at least it's steady compared to yesterday. I decided to keep Duke at a fat 1.0u because i'm 100% convinced that yesterday i injected into a blood vessel causing the very fast drop. I did quite a bit of reading about it on various diabetic sites.

 

I agree I wouldn't lower it. In the even bg I might even push it to 1.25. He seems to run higher at night.

 

Thanks for sharing Tee!

 

Ha ha of you're nervous stick with the fat 1 a while longer.

 

I think i will do that Janet, maybe just a tad more than a fat 1.

 

fingers and paws crossed here for Duke xx

 

Thanks Cassandra, he's had a good day numbers wise and today is probably his best yet without any interruptions. Hopefully tonights before bed reading will be good as well.

 

Duke's BG numbers have been consistent today albeit a little higher than yesterday, still a lot higher AMPS than PMPS, so tonight i have upped his dose to slightly 1.25u from a fat 1.0u because as @JanetNJ noticed he seems to run higher at night.

 

That's encouraging, consistent is good. My Angel went into remission on Prozinc so fingers and paws crossed x

 

Thanks Cassandra, i've upped his dose a little bit tonight so i'm up for a few hours yet just to make sure he does not drop too far.