River's first week on insulin — advice appreciated

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by Paigeworthy, Oct 25, 2018.

  1. Paigeworthy

    Paigeworthy Member

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    Oct 22, 2018
    morning. I just started testing River last night with the new monitor. She was DKA last weekend when she was diagnosed.
    She was 244 +3 last night and 242 AMPS this morning.
    I’m new to interpreting these numbers. What to do?
    She’s currently chowing down on her breakfast. I wanna go back to bed!!! :(

    EDIT: She was 266 after a can of food. I gave her the shot and will test again in a while. How long should I wait? An hour? Her poor little ear.
     
    Last edited: Oct 25, 2018
    Reason for edit: More info
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I suggest you give the 1 unit dose and test her again at +2. That +2 can give a hint of what's to come:
    • if higher than PS there won't likely be any steeps drops in the cycle
    • if similar to PS or very slightly lower it's recommended to get another test at +3
    • if significantly lower than PS (100+ points) definitely test again at +3 because she might drop fairly low by nadir.
    Nadir (the lowest BG in a cycle) can float around day to day but is often in the +4 to +6 range for Humulin. If you haven't seen/read this it has a lot of great info in it:
    http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-novolin-humulin-nph.186097/
     
  3. Paigeworthy

    Paigeworthy Member

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    Thanks kris!! Will test her at +2 and go from there. That sticky is my bible.
     
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  4. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes! Those stickies are really valuable. I'm glad you found it and are using it. :)

    You're at the very start of this FD road so it's a bit more difficult to advise on dose. We rely heavily on accumulated spreadsheet data to show us response patterns. I based my suggestion of 1 u today on the fact that her PS was in the mid 200s and she *should* have a good cushion between that and nadir. With a stronger acting insulin like Humulin it's best to aim for a nadir in the (roughly) 90 to 110 range to allow for that safety factor. It's an insulin with an action that can start fast and drop the BG low so caution is needed.

    We all worried about kitty's ears when we started testing. It really doesn't hurt if the ear is warm and bleeds easily. Hitting the vein is more painful. It's important to keep the testing goals front of mind - learning River's responses and keeping her safe. :)
     
  5. Carol & Murphy

    Carol & Murphy Well-Known Member

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    Hi Paige - how exciting that you are testing successfully!! yay!! Last night, you figured you were giving one half unit - correct? Are you going to give the whole 1 unit this am?
     
    Last edited: Oct 25, 2018
  6. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I saw that 0.5 u from last night and debated about suggesting 1 u this AM. I was considering the DKA as well. I think Paige has already given it. It should show us what it can do when Paige gets a +2 test. I'm glad you weighed in, Carol - the benefit of a peer reviewed forum. :)
     
  7. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Paige - make sure to get that +2 test and post it in your SS right away.
     
  8. Carol & Murphy

    Carol & Murphy Well-Known Member

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    Hi Kris how are you? I had the pleasure of meeting River last night such a teeny tiny sweet little kitty. I have no experience at all with this insulin. Hopefully the Lantus will arrive soon.
     
  9. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Yes, I recall reading your offer to go help Paige. That was very kind of you. I don't know the back story on River's dosing, how the 0.5 u was determined, etc. I hope that River responds reasonably ... :)

    I have to leave soon. Will you be around to check on Paige and River? You know the drill should kitty show signs of dropping too quickly.
     
  10. Carol & Murphy

    Carol & Murphy Well-Known Member

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    It turns out she lives only a few miles from me
    I think River was prescribed 1 unit but looking at the syringes last night, Paige figured out she had only been giving 1/2 unit.
    I'll be home on and off this am
     
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  11. Carol & Murphy

    Carol & Murphy Well-Known Member

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    Great Paige I see her +2 is 252 - so I'd get another test at the expected nadir of +4-+6
     
  12. Paigeworthy

    Paigeworthy Member

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    @Carol & Murphy and @Kris & Teasel, YOU ARE MY ANGELS.
    Yes, we got 251 at +2.
    Will test again at +4 and +6 — I'm home today and only have one meeting.

    Does the fact that she won't. stop. eating. mean her BG readings will be skewed along this baby curve we're doing?

    Also, did my first Ketostix today to make sure all that is copacetic. The first one showed as trace, the second showed as none. How the hell am I supposed to get reliable readings when her pee clumps instantly and I…don't really know where to stick the 'Stix?
     
  13. Paigeworthy

    Paigeworthy Member

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    The back story is short and silly: "Paige doesn't know how to read markings on a syringe." Now I do. The vet originally prescribed 1u 2x/day.
     
  14. Carol & Murphy

    Carol & Murphy Well-Known Member

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    the curve doesn't need to be without food - it is just to make sure she doesn't go too low - since these are your first readings, you need to see how she is reacting to the insulin. without food 2 hours before the amps and pmps
    you put the stick (with the indicator end) ideally into her stream as she is peeing here are some tips
    I always found it difficult to distinguish between negative and trace on the sticks - good that last one was negative
     
  15. Paigeworthy

    Paigeworthy Member

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  16. Carol & Murphy

    Carol & Murphy Well-Known Member

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    come on, River - a little lower, little girl
    well, I would get another one in a few hours - every cat is different in how they react to insulin
     
  17. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I'm glad she hasn't dropped too low. This *could* be one of the all yellow curves that *can* come before a drop in numbers. We don't know why this happens, only that it's a commonly observed pattern. Let's see what +6 looks like and then I think you can give her little ears a break until PMPS.

    You're doing great!! :)
     
  18. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Don't worry about the BG readings. It's wonderful that she's eating really well. That's essential for DKA recovery, along with insulin and good hydration. Are you adding extra water to her wet food? Teasel gets very soupy meals - 3 to 4 tablespoons of warm water to every 1/3 can of wet food (5.5 oz cans).
     
  19. Paigeworthy

    Paigeworthy Member

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    • AMPS: 242
    • +2: 251
    • +4: 271
    • +6: 238 !
    @Kris & Teasel I will try to add some water to her wet food. So happy she is eating damn Fancy Feast instead of needing some Actual Fancy ****™.
     
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  20. Paigeworthy

    Paigeworthy Member

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    OMG the board bleeped me!
     
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  21. Kris & Teasel

    Kris & Teasel Well-Known Member

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    That +6 is essentially the same number as the others. Meters are allowed up to 20% variance in readings.
     
  22. Paigeworthy

    Paigeworthy Member

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  23. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Don't be disheartened. This takes a long time and the learning curve is very steep. :bighug:
     
  24. Paigeworthy

    Paigeworthy Member

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  25. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Looks like you can give 1 u again this evening.
     
  26. Carol & Murphy

    Carol & Murphy Well-Known Member

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    Paige - Kris has experience with DKA so she's a great guide for you.
     
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  27. Paigeworthy

    Paigeworthy Member

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    Done! Gonna test her BG again at +2 — her PMPS was 249.
     
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  28. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I see that 152 last night at +2. That was a big enough drop to warrant a check at +3. I'm not criticizing, just making a suggestion. You're doing very well given how early you are on River's treatment journey. :)
     
  29. Paigeworthy

    Paigeworthy Member

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    Thanks Kris.
    Next time I see a big drop like that I will check again an hour later. I was just excited to see blue :|
    She was back up in the 270s this morning pres-shot. Will check her today as much as I can…is every 2 hours enough? am I going to lose my job? :p
     
  30. Kris & Teasel

    Kris & Teasel Well-Known Member

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    No need to overdo the pokes. Check at +2 as a predictor and then another in the +4 to +6 range to see if you can't get an idea of her nadir at this dose.
     
    Last edited: Oct 26, 2018
  31. Paigeworthy

    Paigeworthy Member

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    This is gonna sound silly, but...do i also need to set alarms to test her during the middle of the night? I don’t have kids so I don’t know a world where I have to sacrifice sleep for another being.
     
  32. Kris & Teasel

    Kris & Teasel Well-Known Member

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    No, get a before bed test and if it looks OK go to bed. If it’s low be prepared to sacrifice some sleep and/or set alarms.
     
  33. Carol & Murphy

    Carol & Murphy Well-Known Member

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    For me, it would depend on what the before bed test is - last night I might have gotten another at between +3-+4, and depending on what that is -go from there. You are in the process of gathering data right now - to see how River reacts to the insulin. So the answer is - it depends
    I agree with Kris
     
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  34. Paigeworthy

    Paigeworthy Member

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    I guess I'm still learning what "low" is for her — or is it anything that seems like a deviation from the curve in terms of her current numbers?
     
  35. Carol & Murphy

    Carol & Murphy Well-Known Member

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    Here's another sticky to print out -
    you are looking for patterns - and be on the lookout for big, quick drops
    what really helped me was to read some of the threads people post - on this forum or the prozinc forum for now while you are using an in and out insulin - look at spreadsheets
     
  36. Paigeworthy

    Paigeworthy Member

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    I’m wondering now if yesterday morning was a fur shot.
     
  37. Carol & Murphy

    Carol & Murphy Well-Known Member

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    could be - as we discussed, make sure the needle is such that it will not go out the other side of the skin - I usually smell Murphy's skin for the smell of insulin or feel for wetness at the injection site afterwards
    So exciting to see her respond to the insulin - this would call for another test at +4-- +6
     
  38. Paigeworthy

    Paigeworthy Member

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    Kind of looks like her nadir is happening right around +2. Seems fast.
     
  39. Carol & Murphy

    Carol & Murphy Well-Known Member

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    All I can say is, I think when you 1st start insulin, the body is trying to adjust to this new hormone, and the response can be erratic before it settles down. I don't have any experience with Humulin but it does seem quite early in the cycle.
    You are so great at getting this - and so quickly!!
     
  40. Carol & Murphy

    Carol & Murphy Well-Known Member

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    So the 328 number may be the result of a bounce from the very quick drop this morning - when the blood sugar goes lower than the body is used to, or it drops quickly. @Kris & Teasel explains it perfectly in here
    It still happens to Murphy
     
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  41. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Teasel is still an enthusiastic bouncer too! ;)
     
  42. Paigeworthy

    Paigeworthy Member

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    Ahh that’s a fantastic explanation. Well, I hope that’s what it is, and hopefully her little bod will start to cool it soon.
     
  43. Paigeworthy

    Paigeworthy Member

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    I'm losing my GD mind seeing these purple numbers in the SS after they've been yellow for the past couple of days. I just don't know what to expect :(
     
  44. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Try not to worry. Keep the 1 u for tonight and tomorrow. A small increase might be in the cards but you need more data.
     
  45. Paigeworthy

    Paigeworthy Member

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    Thanks Kris. Today her BG took a gentle dip at +5 and I’m just ¯\_(ツ)_/¯
     
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  46. Carol & Murphy

    Carol & Murphy Well-Known Member

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    to complicate things, bounces can last for several insulin cycles - then suddenly "break"
     
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