? Regulating Brimley

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Jessyca

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Hi everyone! I'm very new to all of this, and I'm sure I'm going to have a lot of questions and need a lot of advice. Let me explain. No, there is too much. Let me sum up. :-P I have a post in the Intro section if I'm missing any details. :-)

I work in rescue. We have a cat in our system, Brimley, who is diabetic. He is currently on a very high dose of Novalin, 15units twice a day, and his dose was increased to that much faster then it should have been (from what I'm reading). He is still not regulated. At his last check, he had a fasting BG over 250. Our vet tech has only ever checked fasting BG, never mid day, and I never knew better. I also thought that he was coming in for weekly checks, but I found out that Brimley has not had his BG checked in over 3 weeks. I'm not happy with his diet either (perscription Hills w/d, half wet half dry). He still has excessive drinking and excessive urination, he eats every meal like he's starving, and was pretty underweight the last time I saw him. Tomorrow I will be getting a Glucose Curve on him, which I will post throughout the day. I have no idea what we're going to be dealing with, and I'm not going to lie, the more I read, the more I wish I would have found this site when we got Brimley back in January. I'm feeling a bit like I've failed him, but hopefully it's not too late to fix our mistakes and get him healthy. Slowly, with one change at a time, I know :-)
 
When you have a moment, could you add a few tidbits to your signature? It will help us give you feedback without having to go look in all your past posts.

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as
your name,
cat's name,
date of Dx (diagnosis)
insulin
meter
any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.
Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.
 
Ok, hope someone can answer soon. The foster came to the office and picked up the spare glucometer today. He just texted me. He tested Brimley at 9pm and his BG was only 53. He fed him dinner immediately (it was dinner time anyways) and tested him again a few minutes ago (10pm) before he went to give him his insulin. He is only at 140. He texted me and didn't give him insulin. He's been getting 15 units at each meal. I don't know what to tell him. Do we shoot him? Not at all? Lower the dose? If so, how much? I don't know how we went from crazy high numbers to this in less then a month, but I guess that's why we should have been checking him more often. And the fact that I made it through this post without swearing is a minor miracle...
 
It sure looks like he is getting too much insulin. We urge newbies not to shoot under 200.

I think I would skip tonight. He will probably be high in the morning, but I would still reduce the dose. The trick is how much to reduce. Maybe halve the dose, if he can monitor and make sure he doesn't drop too low?
 
Jessyca,

You can go to thread tools, and edit your title to include a prefix. I suggest you add the ?. It will let others know you're looking for advice.

I'll post a link to your thread for others to see in the ISG forums.
 
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Thank you for the quick replies. I've been trying to get a hold of my two human diabetic friend, not even sure if they would be able to give sound advice, but neither of them are answering (probably in bed). I'll tell him to go ahead and skip the dose tonight and we will start fresh in the morning. Anyone else want to chime in about his morning dose? I'm liking the idea to halve it... I edited the title. I'll try to update my signature bin a few.
 
A good option is to stall 30 minutes without feeding and re-test to see how fast he is rising.
And I definitely wouldn't give that 15 units any more!!!
I wouldn't go back to 1 unit just yet. Can your foster do tests at +3 and +4 hours post-shot tomorrow, to check the nadir?
And halving the dose sound reasonable, so long as the foster can observe how he does.

You got the How to Handle a Hypo to the foster, right?
 
Ok, so we tested again at +2 and he was at 232. So the foster gave him half a dose (7 units). Waited another hour and tested again, and he's at 177. Hopefully he'll be safe for the night, because the foster is hoping to go to bed. He will be doing a curve in the morning, and I will try to set up a spreadsheet and all that. But not tonight. I just spent over an hour on the phone with one of my co-workers talking about Brimley and other work related stuff, and I'm falling asleep in my chair. Thank you for the quick advice everyone. I'm looking forward to getting Brimley on the right track!
 
Sounds like you and he are on the right track. I'd suggest trying the half dose, getting tests in to see where and what the lowest point is and adjusting from there. (With N, the nadir or lowest point can be anywhere between 2 - 6 hours after the shot. In most cats, it's early, like 3-5 hours, but it is a pretty harsh insulin and the drop can definitely vary depending on the cat. Yesterday, it looks like it was an early low and then he stayed low for a long time. I'd think that was an unusual reaction to too much insulin rather than any kind of an on-going pattern)

Once he gets an idea of how the insulin is working - how early a drop, How long a cycle etc. - he will have a better idea of what to do with dose.
 
Good morning everyone! Brimley is doing good this morning. His fasting BG was 82 at 8am, and then he was fed breakfast. Tested again at 9am, and it was 122. He did not give any insulin, and plans on checking again in an hour. (half hour now I guess). I am not a morning person, so forgive any typos, I'm not awake...
 
With that low of a glucose after. 7 units last niight, you now know that it is still too much insulin, because you weren't able to shoot on schedule. If/when Brimley gets up over 200 mg/dL, you might go with 1 unit and run a curve. (Test every 2 hours to see how he handles the insulin.)
 
10am, he's only at 180. Still not giving insulin. Foster called his personal vet, and was told not to give at all today. Said he's going to check again in 2-3 hours.
 
It may be that feeding small mini-meals will keep the glucose more level and lower for Brimley, possibly enough to get him off insulin.
 
While you are not giving insulin, it's a perfect time to switch his food to low carb canned food. diabetic cats do best with it - dry food can increase the blood sugar by hundreds of points. In fact, we've had people document that as few as 3 pieces of kibble can increase their cat's blood sugar by hundreds of points.

Once you've switched his food to low carb canned, then you can restart the insulin and monitor his blood sugar to see the response. The best site for figuring out what to feed is Dr. Lisa's website http://www.catinfo.org/. Most people feed around 5%, in the 3-8% or so range. All the pate, classic type of canned foods are likely to be in that range.

The best insulins for cats are the ones that provide the longest lasting control - levemir & lantus are the 2 longest and last around 12 hours, ProZinc is next longest at around 10 hours. Those are approximations for most cats. If you have the opportunity to get one of those for him, his blood sugar would thank you. :)

There are high dose conditions that cause a cat, even on low carb food, to need higher doses of insulin. Just be aware of that (my punkin had acromegaly) so that if dropping his dose while he's eating low carb canned food isn't sufficient to bring down his blood sugar, he might need more insulin. Given the story you've said, though, he probably is simply overdosed.

FYI - too much insulin can raise blood sugar. The cat's body will keep the cat alive through the overdose by releasing stored sugars and hormones that send the blood sugar high.

You've got the best site to get advice now, so just keep asking questions to get help with his dose.
 
Ok, I updated my signature and made a spreadsheet. Did I miss anything? Also, the foster talked to his vet who recommended only fasting BGs... I basically told him that that is exactly how we got into this mess in the first place, and he said he would try to get more numbers on Brimley tomorrow, but I don't expect a bunch of updates today...
 
Can we get you started using our grid to record your glucose tests? It will help us give you better feedback. Instructions are here. Alternatively, modify the spreadsheet you started to include a line with the AM or PM PS and the +#s and units.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
I have a copy of the spreadsheet you're talking about, but because his numbers have been so low, we've had to test multiple times before giving his insulin. I wasn't sure how to mark this on the available template... Also, I did have one question about the template. I see the AMPS/PMPS, but, if I'm understanding thing correctly, you don't give insulin until an hour after eating. So shouldn't there be two columns pre-shot? Test before food, then test before insulin, then the +1 +2 etc? Or do you normally not test before food? Our vet tech and both of the vets that we've talked to were so fixated on "fasting levels" that it just seems odd that there isn't a column for that in the spreadsheet...
 
I'm really not sure how we are going to get a "normal" curve on this cat... 8pm he was 330, got dinner, and 5 units. 10pm he was at 134, 11:30 he dropped to 58 and the foster called me. he waited 15 minutes, tested again, and Brimley was down to 45. So he gave him half a can of food (presumable the hill wd he's been eating) and will be testing him again in 15 minutes ish. How are we supposed to get a curve on him if he keeps dropping too low to get his insulin on a schedule, or drops so low he needs fed off of schedule? The foster is talking about taking him off the insulin entirely for a few days, and getting a non-medicated curve, but I don't know if we can even do that (he's calling his vet in the morning. *frustrated*
 
Down to 40. Hoping the food kicks in soon. Testing again in 15 minutes. If it's still going down , giving honey.... If this is how low he's dropping on 5 units, I don't know how he's not dead. 15 bloody units for the past month... This is insane....
 
If he's using W/D that's OK because it's high carb, but he really needs to have some "Gravy Lovers" foods in the house....When they drop below 50, we open one of those kinds of foods and "squeeze" out the gravy (that's where most of the carbs are) and give them a teaspoon or two and then keep testing and give more as needed

We don't usually suggest a big "feeding" because the BG can come back down quickly and if they're not hungry anymore and won't eat, you can be in big trouble
 
Tested again, up to 48. Testing again in 15. He is apparently being a pain in the butt and trying to get into the trash can, so it sounds like he's not feeling to bad at least. Lol
 
It's OK to wait about 30 minutes between tests...most cats it takes a little longer than 15 for the carbs to "kick in"...if you're using honey, syrup or karo, it can work quicker because they are simple sugars, but with any "food based" carbs, it can take a little longer to really see a difference
 
Ok, I'm just going to post a timeline and start updating the post rather then spamming my thread, lol. Chris, I got your post right as the foster texted me with an update, but I told him what you said about complex sugars taking longer to break down :)

8:00pm - 330 Gave dinner and 5 units of novalin
10:00pm - 134
11:30pm - 58
11:45pm - 45 Gave 1/2 can of w/d
12:15am - 40
12:30am - 48 Foster said his breathing was a little faster then normal
12:45am - 46 Fed a small amount of dry food.
1:15am - 67
 
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You are both really staying on top of this. Sounds like Bromley needs even less insulin. The 40 is a signal that the dose needs to be reduced again. Otherwise, unfortunately the curve looks pretty standard for N. A fast drop and fairly early nadir.

What do you two think about halving the dose again? Down to 2.5? It may be that you can never get a flatter, smoother curve (because that generally isn't how a cat reacts to N) but you might stay out of those scary low numbers and even out the curve (crashing from the 300s to 40 in 4 hours can't feel good)

Are there any alternatives to using N? Are there any of the longer lasting insulins in our supply closet (Lantus, Levemir or ProZinc). Would the shelter support changing to a milder longer lasting insulin?

It does look like he is not a high dose cat and that is VERY encouraging!
 
Yup. Not a high dose cat, just a high dosed cat! It may be that with better food, spread out over the day, he could even be a no insulin diabetic, ie diet controlled.

One 12 period is unlikely to be a problem for him; maybe give him that off insulin, with the meals spread out into several mini-meals to see just how high he really goes.
 
So the foster transposed all of the medical notes we've had on Brimley. Is there any way to post a word document, or should I just copy paste?
 
If you upload it to Google Drive, you should be able to add it to your signature as an attachment - that way people will be able to see it in the future as well as on this post.
 
Ok, that should be uploaded correctly. Anyone want to take a look at the crazy? The foster talked to his vet today, went over his records with her, and apparently she had to read them twice because she couldn't believe how fast our tech raised his insulin. Said it was insane... *sigh*

Also, the current plan (as per his vet) is to spot check Brimley today (no insulin). If he goes over 200, get a curve on him tomorrow without insulin. If he goes over 300, get a curve on him tomorrow with 1 unit of insulin. Vet says he will probably need 2-3 units based on previous records and body weight, but there's not much to go on, so we're basically starting fresh.
 
Wow! I'd have to agree on the "insane" for the speed his dose was raised. And from the numbers you've been getting, it doesn't look as though he should ever have gone anything close to that high in dose...15 units is a huge amount and even 5 was clearly too much for him on the 31st.

It sounds as though the current vet is giving you better advice in seeing where he goes without insulin and taking things from there. That way you will at least know that the dose he ends up on has been arrived at by methodical dose changes based on readings throughout the cycle.
 
His last spot check was 480, several hours after food. I didn't get all the details (ie when he was fed and how much, and when exactly that was taken) but that's high enough to imply he'll probably need to be on some insulin. He's going to start him at 1u in the morning I believe.
 
Hello everyone! This is Brimley's foster, Will. (Brimley's pic is my avatar). First, and foremost, thank you all so so much for all your help. It's hard to fully express my gratitude on a forum, but I sincerely appreciate the help.

As Jessyca said, I talked with a vet today. Going to start one 1 unit insulin tomorrow and do a full curve. Did a few readings today per the DVM's recommendation just to get an idea of where he is.

One odd thing that happened just an hour ago: his BG dropped nearly 90 pts without insulin. His BG had been decreasing throughout the day until food time. This struck me as odd because the first time I did no insulin curve, he was steady high and it rose. But he hasn't had insulin since Sunday night so maybe his pancreas is kicking back in a bit and the non-insulin curve was just a continuation of Somogyi? Just curious what y'all think.

Today's numbers:
4:45 PM – 480 BG
7:40 PM – 453 BG
8:50 PM – 386 BG (had given 2 treats after last test) – Feeding ½ can food, ½ cup dry food (W/D)
10:00 PM – 495 BG
11:00 PM – 402 BG
12:10 AM - 358 BG (updated! wow!)

I'm thinking that if he's below 300 in the morning before his meal, I shouldn't give insulin and see if he continues to show the same pattern and let Somogyi wear off? He hasn't started PU/PD yet.

Thank you all again!
 
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Welcome to the FDMB Will!! Thank you for fostering a special needs kitty too!!

As we've already determined, Brumley has been very lucky since he's been getting an insane amount of insulin. What may have been saving his life was the fact he was eating high carb dry food (the W/D) The wet W/D isn't really low carb either.

As long as you're home testing now, I'd strongly encourage you to switch him over to a low carb canned food. It will probably reduce his insulin needs even more. If you look at our Food Chart (column C) there are lots of foods that are under 10% carbs and that's what we recommend. What a lot of us feed is Fancy Feast Classics or Friskies Pates! If you look at the ingredients for W/D and compare them, you'll see there's no special magic in W/D...as a matter of fact, one of it's ingredients is cellulose...that's a fancy word for sawdust!

It'll be interesting to see how he does on the 1U ....hopefully he'll do great and his time on insulin will be a short one!

Also, it'll be really helpful if you'll go ahead and download our spreadsheet. I know Jessyca had started keeping track of his BG levels, but it'll really help for you to get it started and fill in the info she has and then put the link to it into your signature. Here's instructions on "How to create a spreadsheet"

As for Somogyi, there's really no proof it really exists, but there is something called "bouncing" that does. When our cats blood glucose goes too low, goes lower than their body has become used to, or drops quickly, it can set them up to "bounce". Bouncing happens because the liver releases stored sugar and hormones when it detects that the BG is going too low (or dropping quickly...or even just lower than the cat is used to). Bouncing is normal (although frustrating) and when it happens, all you can do is wait for the bounce to clear which can take up to 3 days

Keep asking questions! The people here are full of experience that they are happy to share with you!!
 
Chris & China - Thank you! I already have some Friskie's pate in the cupboard and I did notice that the "low carb" prescription stuff isn't really that low carb. The Blue Buffalo no grain dry food I feed the other cats has about the same carbs as the prescription stuff!

I'll look at the spreadsheet tomorrow (getting a bit late for me) and fill it out!

Yeah, the bouncing is what I was referring to. I wonder if he's coming down from that bouncing. I'm quietly hoping he can be managed through diet alone once he normalizes. This BG decrease is giving me hope that his pancreas is still functioning, even if not 100%.

Again thank you!
 
Yeah "no grain" is the current buzz word in the pet food industry and it doesn't really mean much....only that certain grains aren't used, but the pet food companies replaced the grains with things like potatoes...which means dry foods are still high carb

If you can get all your cats onto Friskies only, they'll all benefit!! When China was first diagnosed and I learned that the high priced "premium" dry I'd been feeding my cats for most of their lives probably had something to do with it, I switched all my cats over to low carb canned.

My two civvies lost weight (that they needed to lose) and their coats are in better shape than they've ever been. One of my civvies I've had to have a lion cut done on at least every April because she became so badly matted....this year, after being on low carb canned food, her coat is perfect! I realized in May that it was "after April" and she still didn't have any mats in her coat (and I mean she was really bad every spring) ..... Of course China's condition has improved greatly too!
 
Update: 1:00 AM - 336 BG - Continuing to decrease!

Yeah, I know the "grain free" is a buzz thing, but it has helped my one cat who used to have really bad dandruff. I think she just needs to be off wheat.

I'll check in the morning what Brimley's at and see what the vet recommends if it's still low!

Thanks again!
 
Looking at yesterday's numbers, yes, he went down a little at pre shot, but he is still high enough to definitely need insulin. Just for a general reference, we say a cat is well regulated if they are in the mid 200s at pre shot and in double digits at nadir (but not below 50 which is approaching hypo territory) on insulin. Off insulin, we consider a cat in remission if they range from 40-120 with most of the cycle in double digits.

I like your idea of restarting at one unit and seeing how he does.

And welcome to the group. Kudos on fostering Brimley. Between you and Jessyca, he is one lucky cat!
 
Spreadsheet created! Doing tests every 2 hours at the moment. Will go back to every hour after next meal and continue curve for a few hours. Will start on 1 unit of insulin tomorrow with AM meal.

Thank you Sue and Oliver!
 
Generally, there is a food spike in the glucose level after eating. The bigger the meal, the bigger the spike can be and the more work the pancreas has to do. By feeding mini-meals and spreading out the food to match the insulin process, the overall glucose may remain lower.
 
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Glad you joined, Will. I will tell you that I was feeding both my cats Blue Buffalo as well, and when they were healthy (before Shiloh's diagnosis), I was amazed at what the switch had done for the litter box. Smaller poos, and less stinky too! Sometimes I wonder if that is just a benefit for us. Shiloh also had bouts of really bad dandruff, which would eventually clear up. Since I switched her to all canned (less than a week ago), her coat is better, the dandruff is almost gone, and her BG is better. But definitely switch Brimley over gradually. I admit, I panicked, and switched too quickly, so the litter box is now a runny mess. So slow and steady with the transition is definitely the way to go.

I've been here and with the diagnosis for less than a month. I know it can be overwhelming, but you have found a great resources. I have learned so much! And bless you for fostering Brimley!
 
So Brimley's BG stayed fairly level all day... I was really hoping to see a peak... Is that normal? It seems strange to me, but I'm new to all this, lol. (Will is keeping the spreadsheet up to date now, not me)
 
Since you're essentially starting over with Brimley, it may take a day or so for him to start showing how a given dose is doing.
After 3 shots at a given level, if the lowest number is above 300 mg/dL, you may increase by 0.5 units. If it is above 150 mg/dL and less than 300 mg/dL, you may increase by 0.25 units.

Today, he went from a pre-shot of 412 to 371 at +5, a drop of 91 mg/dL on 1 unit of insulin. Insulin doesn't have an exact amount of drop for a given dose, but this does start setting the stage for developing a sliding scale where based on your test data, you may adjust the dose based on his starting glucose range. I'm going to guess that he might wind up on about 3 units per shot unless the new diet lets his pancreas rest enough that he may get off insulin at some point. You want to get to that carefully and gradually, though, so he doesn't get overdosed again.
 
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It's really not necessary to do hourly tests unless Brimley is dropping too low .....a standard curve is every 2 hours for 12 hours or every 3 hours for 18 hours. With that much testing, Brimley's ears may get pretty sore

If you want to do a curve now and then, it's fine, but what we suggest is just to sprinkle tests at different points in the cycle. Think of the spreadsheet like a puzzle...if you want to see what the picture is, having pieces sprinkled throughout makes the picture clearer
 
So, it looks like his low points are still over 300. But, the insulin syringes Will has are not able to accurately measure .5 units... So the plan for now (I believe) is to keep him at 1 unit for 3 days (ie through today) and bump him to 2 units tomorrow. Does that sound ok?
 
You can use a ruler with millimeter marks or calipers to measure the dose when there aren't sufficient lines, although many of us eyeball between lines. That will be safer than increasing an entire unit.

Next round of syringes should be 3/10 mL, U-100, with half unit marks. All of the 3/10 at WalMart have these.

By the way, in your signature, is the meter the Confirm, or is there a new one called Control?

And what city and state are you in?
 
Although most of us seem to suspect he will need more insulin, if he were mine, I would take it slow - especially if you are changing over to lower carb food. I'd increase to 1.5 and hold that dose a few days. Does he have syringes that only measure full units? He could either mark a sample syringe between 1 and 2 units and use that one to measure each dose, or he could buy some .5 unit syringes (not expensive)

Increasing too fast, especially if lower carb food is in the picture, could get him back into that roller coaster of needing to reduce but not sure how much. Increasing slowly is a safer approach, IMHO.
 
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