Today's curve for my Barn Buddy

Just thought I'd throw this out there for some input. He is still on 9 units of insulin twice daily. Still waiting for the test results from his lost urine sample. And I still haven't tested him for Ketones. Here are his numbers for today....

PS-32.9/592
+2-27.7/499
+4-23.7/427
+6-26.5/477
+8-26.1/470
+10-31.5/567
+12-HI/594+

Any thoughts on these numbers? Is this still considered flat?

Joanne

 

All I can say is "ack"! Those numbers are high and I can feel your pain/frustration. However, I don't have any advice (except to make a spreadsheet...really, super easy...instructions are in the tech forum).

I did look at your pictures of Buddy on Face Book - he's a handsome boy. Hopefully, one of the more experienced High Dose people will be along tonight or tomorrow.

 

Thanks Heather...I think he's the most gorgeous cat on Earth And I'm not ready to lose him:-(

Joanne

 

There is some movement but still not enough. Brings me back to when Spook & I were where you're at now.

Have you considered changing to Levemir? At this high of a dose on Caninsulin, even if you were to get better numbers, that insulin just does not last the full 12 hours. When I did the switch, I did not have my vet's approval. We were at 11 units of Caninsulin and she wanted me to keep increasing but Spook was miserable and I couldn't keep putting her through that. We first switched to Lantus, improved results but still not great, then switched to Levemir which worked wonders for her. She was still a very high dose kitty but this insulin at least lasted the full 12 hours.

Hang in there, it's a huge learning curve but you're proving to be a wonderful caring mom for your boy.

 

Have to agree with Suzie. Not much movement there at all.

Ok I'm going to mention something here and I know it's very controversial. Right now you are stuck with Vetsulin until you have the option to change to anything else. There IS a way to work with Vetsulin using a sliding scale where you dose with this insulin based on the blood sugar but use varying doses. I did it with Boris and it's been used elsewhere. It is not promoted here on FDMB but it has worked. I am willing to help you. AND it might even address the whole issue of whether or not you were started on too high a dose or not. It looks like you are home enough to test. The only thing would be is that you would dose insulin more frequently if you could and it would be great if you could test the urine for ketones. Here is what the SS would like like to START with:

BG Dose

151-170 0.25u
171-185 0.50u
186-200 0.75u
201-220 1.00u
221-250 1.25u
251-290 1.50u
291-350 1.75u
351-410 2.00u
411-450 2.25u
451-500 2.50u

IF after a couple days we don't see any improvement we change the scale. This is how we worked with the PZI too. You can dose every 6 hours this way IF you can. You DON't have to. But if you could dose at least 3x/day - that would work best!

If it would help to understand better what I'm trying to explain - look at Boris' update and see how I "charted" everything.

You can think about it and let me know. I am willing to help you. I have to say tho - there may be some that come and contradict this approach. But I will say honestly that I have seen this work for several cats now. We are doing this for another cat on catacro who is in France and cannot get any other insulin.

Let me know Joanne. I'm more than willing to do anything you need. Your most handsome boy is sooo lucky to have you!

 

Joanne, welcome back, we missed you. I'm not on facebook and I want to see your kitty! Here's some easy directions to set up an avatar (mini pic next to your name).

This is a copy of my post in the tech forum that might help you , from one computer challenged bean to another. The name/date of the post is below if you want to read all the other explanations, which I'm sure are better than mine:

Re: Help with signatures/links/images/avatars here!
by Nancy and Cody » Wed Jan 06, 2010 7:42 pm

Ok, so last night I spent forever trying to figure the avatar out, but today I got it. Heres what happened and heres what I did in order
FYI I have a MAC book which is brand new to me so... plus I'm "not of the Twitter generation"

went to my pictures (iphoto) and found one I liked that the subject was kind of square
photoshopped and brightened it a bit
then
I found the above chats and went to shrinkpictures.com
clicked make avatar
then in this exact order 1 2 3
1 click choose picture- brings up my photos and I find the one I brightened- click it
2 type" 90" in where it asks for size
3 click resize and wait

then choose the 1 of 3 you like best
click download below that one
save it to your desktop

open user control panel in the FDMB
select profile tab
select edit avatar
shrink the open window enough to expose the avatar on your desktop
drag it onto the box that says upload from your machine, wait till you see a plus sign appear(+), and drop that baby
click submit and hold your breath

arent they cute!

Last night when I hit resize the picture came up black everytime
today I choose a different picture and ta da!

Hope this helps! :razz:

 

I have a quick question before I head out to work...is Vetsulin and Canninsulin the same???

Joanne

 

Yes, Vetsulin is the name in the US and Caninsulin in Canada & Europe.

I like Patti's idea, too, if that helps!

Have a great day!

 

I like Patti's idea as well.
Plenty of people on the old board used a sliding scale quite successfully with Caninsulin although it's not usually discussed.
If you can manage to shoot TID or even QID, you'll be able to build up some momentum and hopefully get those numbers to start coming down nicely.

 

For what it's worth, I agree with Patti - if you have the flexibility to shoot more frequently, you can hopefully gain control of the BGs.

I did change Norton from BID to a flexible TID with sliding scale, and it helped a lot. The change did also include changing insulins -- I was using Humulin N BID (similar in action and duration to vetsulin) and switched to PZI

 

I am definitely new to the FDMB so my question may seem stupid:

Is Vetsulin the only insulin she can get where she lives? I imagine at 18 units/day she goes through a vial in about 2-3 weeks and isn't the manufacturer asking vets to transition pets to another insulin because of some problem with the short acting portion of Vetsulin?

Perhaps that would be a time to try starting with a lot lower dose or flexible scales or TID or whatever. :?:

 

I think she's in Canada...if so, I think she can buy Lantus and Levemir OTC, without her vet's blessing.

 

Yes - Joanne is in Newfoundland, so she can get Levemir or Lantus OTC.

 

That's what I did. My vet didn't approve of the switch and I'm in Ontario so I went to a pharmacy and got Levemir OTC, no prescription required.

 

Is ID checked? I live in Michigan and will need some insulin in the spring -- Windsor is about 35 miles away, so could I just walk into a pharmacy and buy it? (I could exchange some cash beforehand, so I walk in with the right currency and just ask for it?)

 

Hi

I was at the vet's today with my 19 year old Siamese. So we had a chat about Buddy too. She seems willing to look into the rebound thing. She's also willing to look at another type of Insulin. However the urine culture should be back tomorrow so she'll wait and see if anything shows up on that. She thought that his starting dose was low. She went with .5 units per KG as his starting dose. What is the normal starting dose for a cat? I thought it was .5 unit twice a day per cat? she was also under the impression that Canninsulin was the only insulin available for animals. She thought everything else was for people. She also mentioned that a lot of things available in the US was not available here. I assured her that Lantis was available here. And I see by some of the other posts that I was right She said that she would look into it for me.
I am only home alot on the weekends but will definitely keep the sliding scale in mind if the other things don't pan out.

What does TID and Qid mean???

Nancy I will try my best to get a pic of Buddy here

Now to go completely OT...my 19 year old Siamese has an infection and I'm trying to get liquid antibiotic into him. We have a history with pills...he won't take them. He's weak now but he still has plenty of pill fight left in him. I managed to get it into him but he promptly threw it all up. Any ideas?

Joanne

 

I am very relieved to read you may investigate the possibility of rebound, and also other insulins....!!!

I believe the caninsulin website has info on dosing by weight but honestly, in any insulin, 1 unit is typically best. Hopefully you and your vet can learn together I guess!

Will be interested to read what your plan will be

Jen

 

this is a link to the jargon used on this board:
viewtopic.php?f=14&t=1124

TID is 3x/day
BID is 2x/day

 

As for the Siamese/antibiotic problem, I'm at a loss

in the main 'board index' there is a section for posting other cat 'health issues'. Maybe if you start a new topic and open it up to the whole board, you might get some ideas

 

Hi

I will certainly let you know what the plan is Jen...as soon as I find out myself At least my vet seems to be open minded and didn't seem to be offended by my questioning.

Thanks Nancy for the terminology link...that helps!

As for my siamese I'm going to call the vet again in the morning. I tried to give him about 1/5 of the antibiotic a little while ago and he started to drool and stagger and then he got a nosebleed!! I know his kidneys are failing and his time is very limited. I guess now I have to weigh how much I'm willing to put him through:-/ He's had a long and happy life.

Joanne

 

I've never heard of one, but are there any antibiotics injections available? anyone know... obviously the vet will know when you call. Sounds like the liquid isn't working out at all, poor thing.

 

I'm afraid I have no idea about the antibiotics but it is quite alarming! is he ok now?

 

Yes there is an injectable that lasts for 2 weeks but the vet felt that it was much too strong for him with his kidneys so bad. He's back to normal now....normal being very weak with a bad infection:-(

Joanne

 

If he's not eating, I've heard that a little freeze dried salmon crumbled on top of the food can do wonders to get a kitty to eat. Not sure how that would be for his kidneys. Poor thing

 

Ok that is what I was worried about; covenia. It is a new thing that vets seem to like but it can have bad effects on cats...and because it lasts 2 weeks you can't just stop giving it! Please do a search of the forum for posts on it from Dr Lisa especially. What is your plan?

Jen

 

QID is 4x per day (every 6 hours)

Lantus is the same as "glargine"
Levemir is the same as "detemir"

glargine and detemir are the names used in Canada

Caninsulin gives a dose formula by weight that is for DOGS. Cats should not be dosed by weight, but start at a low dose twice per day.

 

Dear Joanne,
Sorry to hear you are going thru so much with your other kitty too. We are just starting to go thru the CRF with an older kitty.

Just a few thoughts altho you probably know all of this so please forgive me if I sound too "know it all". I don't mean to be. Had a long hard day at work yesterday so am probably feeling way too oversensitive here! :roll:

Have you ever tried pill pockets with your kitty? We JUST tried them with one of ours who we could NEVER get a pill in and it was amazing. We stuck the pill in it and she ate the "treat" and there went the pill like oh so easy. I was amazed. I know our vet sells them - probably more expensive then what I got thru KV vet on line but at least they are readily available. I know geting liquids in can be even worse sometimes.

And as far as eating - have you tried any baby food for your kitty to get him to eat more? I know it's not the perfect thing but at least it gets something into them. For us - the best brand is Beechnut or Gerber - no onion powder. Or I know with Merlin - he always loved boiled chicken and broth. Again - I know they don't have all the nutrients but when they aren't feeling the best....Funny - we always said Merlin would act sick just to get these treats sometimes! ;-) Oh and have you tried any Pepcid Ac - 1/4th tablet. (Famotidine 10mg tablets is the generic name - an over the counter med)

Let me know if you want to try that Sliding Scale (SS) - it's easy to do and I'm off now thru the weekend. It can be done even when you are working as there were days when those of us using things like this could only shoot twice a day (bid) and on our off days shoot 3 or 4 times a day (tid or qid). I am not trying to push you at all tho - just trying to let you know that I'm home alot now and could be readily available for any questions/help.

Keeping you and all your animals close in thought. I'll check back later today!
xxx

 

No ID or prescription necessary for any insulin in Ontario. Just walk into any pharmacy, go to the prescription counter and ask for the one you want. They'll ask if you have a prescription, say no, they'll fill it regardless.

 

Thanks Suzie!

 

Hi again

I told the girls at the clinic what happened this morning. I asked if there was another injectable that wasn't so strong and then I made a "just in case" appt for Friday afternoon for him to be PTS. I know that without antibiotics he will die from the infection. His breathing is very congested. There was a message for me to call the clinic when I got home from work. When the vet heard that I was considering euthenasia she said that she'd try the antibiotic injection so I agreed and I'm bringing him over tomorrow. The way I'm looking at it is if he doesn't get it he's definitely going to die. If he does get it there's a chance he may be ok. BTW this cat is still eating and drinking. That's why I'm willing to try....I know he's not ready to go yet. As for the pill pockets they are available here too but this cat doesn't even eat treats so I very much doubt he'd eat them. Buddy ont he other hand would eat just about anything so I'll keep them in mind for him if I ever need them

The vet also has the results of Buddy's culture so we're also going to discuss him tomorrow. I'll wait and hear what she has to say before I make any decisions for the sliding scale, etc.

Thanks.

Joanne

 

HOld on a sec...

he got sick from a liquid antibiotic given in a really low dose...which one? Was it baytril?

The shot is convenia and if he has a reaction to this one you cannot discontinue it! Not sure if this is the way you want to go....what type of infection?

 

It says Clav liquid on the bottle. I don't think it was the antibiotic that made him sick...I think it was the fight to get it into him. It wasn't in him long enough to be a reaction to the meds. This cat has fought me over every thing strange that I tried to put in him for the past 19 years. The infection almost seems like the flu in humans. He ha s a really runny eye, constantly sneezing, one sinus is completely blocked with mucus and his breathing is very congested. Oh and he smells awful. I don't know what else to do.

Joanne

 

Sounds like clavamox, which is notorious for causing stomach upset in some cats, including mine....

It sounds like he has an upper respiratory infection. I've no experience with them but not sure why you'd need to consider PTS just because of this? It isn't exactly life threatening, that I know about anyways. Maybe do a google of feline URI and see what you find? I'm not saying that convenia won't work, just be careful and aware of possible side effects.

Jen

 

ps Joanne, consider posting a separate thread about this cat on the health board so you get more responses....

and if you are considering lantus and a rebound test, I'd start looking over the info at the lantus board and getting advice on what to do next.

Jen

 

Oh Joanne,
Sounds like you are going thru sooo much. Can you tell where the smell is coming from in your kitty? Is it from him not grooming or from secretions in his nose? Any chance he'll let you put any saline in his nose? Any chance you can bulb syringe the secretions from his nose? :twisted:

Another silly maybe stupid thought - any chance you have any kind of "vaporizer" you could put in a room with him? or even boil some water and then set the pot in the room with him for awhile to loosen up the sinus for him to ease the breathing?


And back to the insulin - if you do think of changing and Buddy still winds up a hi dose - Levemir may be a better choice. Lantus in higher doses is said to sting. Just a little FYI. Phoebe and Suzie both here in high dose can tell you more about that.

 

I think if you are to the point of PTS, I would ask your vet if injectable Baytril would be an option. There are side effects (like blindness), but maybe a big gun antibiotic is worth a try to help your furry.

((((hugs)))) to you all...

 

Today's update...I've cancelled all appts for my Siamese. It seems he's fighting this on his own. He was much better last night and is the same this morning. His eye is drying up, his breathing is better and he doesn't smell as bad! The smell came from his mouth BTW. I also put him in a room with a bowl of boiling water with Eucalyptis oil, peppermint oil and Lavender just to see if I could open his sinus.

As for Buddy his culture was negative. Tonight I'm to decrease his dose by 1 unit, tomorrow another until I get him down to 1 unit and then start over much more slowly this time. Does this sound ok? She's also willing to change to Lantis but I decided to try this first.

Joanne

 

Have you looked into the whole vetsulin "recall" issues? I think its on their website. Is it going to continue to be available?

 

I just went to check it out again. This is copied from their site:

Why has FDA and Intervet/Schering-Plough Animal Health issued a VETSULIN Alert?
The product has been found to be out of specification in regards to the long term stability of the crystalline, or long acting, component. Specifically, the concentration of the crystalline component is higher than what is outlined in the specifications of the product. Consequently, the amorphous, or short-acting, component may have a lower concentration. This could mean that diabetic patients on VETSULIN may experience a delay in onset of action, a delay in peak activity and an overall extension of the duration of activity.

Is VETSULIN being recalled?
No. The product is remaining in distribution, but supplies will soon be exhausted. Veterinarians should plan on transitioning their diabetic patients to other insulin products and should not be starting any newly diagnosed diabetic patients on Vetsulin.

Why is Intervet/Schering-Plough Animal Health asking veterinarians to transition diabetic pets from VETSULIN to other insulin products?
In its alert, FDA recommended that veterinarians consider transitioning their patients to other insulins. Due to the fact that we do not know when the situation will be resolved, supply shortages are expected, and the supply of VETSULIN will soon be exhausted. Our primary goal is protecting the health of patients. Therefore, Intervet/Schering-Plough Animal Health is asking veterinarians not to start any newly diagnosed patients on VETSULIN and to begin transitioning current diabetic patients off VETSULIN and on to other insulin products

There is more, at vetsulin . com if you want to read it all. Hope this is helpful. I wish you could try Prozinc. Cody was on 12.5 units vetsulin when we switched recently. He's doing so much better on half that dose now.

 

Glad your siamese is starting to feel better.

Vets will tend to prescribe Lantus over Levemir just because there are more documented studies.

The insulins act nearly the same in cats, and Levemir (aka detemir) is less fragile and does not sting. A human diabetic has told us that Lantus stings when injected - especially when cold.

Anyway, when I had an opportunity, I selected Levemir for my new diabetic, Tiggy, and he is doing great on it. He gets 0.75 units BID, and is "well regulated" according to a fructosamine test. His BGs almost never go above 200 unless he has gotten into the cheezy poofs or banana nut bread.

 

Good morning Joanne,

Sounds like you've come up with a plan for the vetsulin. If you can post numbers and we can watch and help you here if you would like/need. One thing tho is if you can test Buddy's urine for ketones. You only need a drop but I don't know how easy that will be for you. It's just that with changing the insulin dose and if he is a hi dose kitty - that is something we should be really watching.

I'm so glad to hear your other kitty is doing abit better this AM. cat_pet_icon You are going thru alot right now. I so hope everything starts to come together soon for you.

 

Hi I usually don't visit this board, but thought I'd take a read and maybe learn something new.

My Maui is allergic to clavamox - that's because it contains amoxycillin and she is allergic to the cillin family (pencillin, amoxycillin, etc).

There are other options you can try. I've used clindamycin (which is really nasty tasting liquid) as well as azithromycin (comes from human pharmacy in fruit flavors) - these are a couple options that you could inquire about.

I had to syringe this into Maui, while she didn't like it, done slowly, it worked, followed with a water syringe chaser and lots of treats!

While the tastes are bad, they shouldn't have the same effect as the cillins - meaning upset stomach, vomiting, etc.

Covenia is a very contraversial injection, that I don't have the link handy right now to the discussions about it. But it is something you want to be very careful using. If you visit the old board and do a search under health - you should find the link from Dr. Lisa about Covenia.

Hope this is helpful for you.

 

To do a true rebound test, you should cut the dose by half. Slowly decreasing down to 1 unit could lead to serious problems, especially if he really is a high dose cat. PLEASE PLEASE please check for ketones during this decrease as DKA can come quickly. Just to let you know, when I decreased Spook's insulin in fear of rebound, she went DKA within a week. We almost lost her.

Also like Patti has mentioned, if he is a high dose cat, consider Levemir over Lantus, as it does not sting when injected in large doses.

 

To do a true rebound test, you should cut the dose by half

So do you mean that if I gave 8 units tonight tomorrow I should do 4??? And if i do this should I give him 8 in the morning and 4 at night when I'm home to keep an eye on him?

I have the Ketostix I just haven't caught him peeing;-/

Joanne

 

Yes, you cut the dose in half for 3 days or 6 shots as it can take that long for rebound hormones to settle down. Monitor bgs and urine as much as you can. If numbers do not get worse or they stay the same, it is a good bet you are overdosing him.

Glad your siamese is improving

 

I would definitely like for the other hi dose moms to have input in this but I tend to disagree with the statement that "if numbers don't get worse it's a good bet you are overdosing." This is where the problem comes in on a question of a hi dose kitty (acromegaly or IAA) or not. Some hi dose kitties can have the same numbers at lo doses AND at higher doses until you get up to the correct higher doses. I am all for a rebound check however just having the same numbers doesn't always mean being overdosed. Some of us had flat curves at lower doses - little changes in numbers as we SLOWLY increased our doses just as Joanne's kitty is showing now. So a blanket statement like that can be misleading. Merlin's numbers looked like Buddy's numbers all the way up to 7 units bid on Vetsulin until we eventually switched to PZI. Again he did the same thing up to 7 units PZI bid until we switched to a sliding scale. I can post links to those old numbers if anyone wants to be bored by all that. I also know that I did so many "rebound checks" and spent a year trying to figure out what was going on. Only to find out I was right months earlier in my suspicions that it was never rebound and that something else was going on.

For you Joanne and Buddy - I will definitely hope that cutting the dose tho can give all of us some clearer piccture of what is truly going on.

 

I'm finding this very confusing. Last night I gave 8 units instead of 9. This morning I'm going to give 8 again because I have to go to work. So this evening I will give him 4? and stay at 4 for 3 days? And check blood and urine as much as possible. On Saturday I can do a full curve...sound good?

Joanne

 

When I did a rebound test with Norton using Humulin N (an insulin that is out of the body within 12 hours), I did a half dose for only 1 day. His blood sugar barely budged below HI, where he had been dropping down to the 300's at nadir.

With caninsulin, you may see a similar immediate change because it also stays in the body for a short time.

WIth Lantus and Levemir, it builds up in the body (the "storage shed"), so it can take a few days to see a meaningful change.

Regarding "rebound hormones" --- I don't know. Norton definitely had other symptoms pointing towards Acromegaly / brain tumor. At the time I did the rebound test, he was beginning to walk in circles.

 

Buddy is acting quite normal and if I didn't check his blood I'd never know he was a diabetic. He's eating, drinking, peeing(a lot), and still asking to go outside everyday no matter how bad the weather is.

Joanne

 

I would really love it if Jess or Jojo could help with this thread.

We have a cat on a high dose, which was reached for hte most part without any hometesting. We don't appear to have obvious signs of acromegaly. We have people advising who have had justifiable issues with previous directions to check for rebound. But past issues do not negate the very real possibility that this cat is being overdosed. When Jojo has posted in the recent past, she has stated that it can take up to 3 days for the hormones associated with rebounding to clear.

Joanne, this is why I'm suggesting that you start a new thread in health, where you can get more attention from a broader perspective. You'll have to weed out some 'fluff' perhaps but I truly think that you need some help with this.

IF Your cat is a true high doser, going down 1 unit by 1 unit at a time isn't going to help. A 'quick' rebound test by cutting the numbers in half will hopefully paint a better picture for you.

I don't know what else to suggest.

 

Patti and Merlin wrote:
I would definitely like for the other hi dose moms to have input in this but I tend to disagree with the statement that "if numbers don't get worse it's a good bet you are overdosing." This is where the problem comes in on a question of a hi dose kitty (acromegaly or IAA) or not. Some hi dose kitties can have the same numbers at lo doses AND at higher doses until you get up to the correct higher doses. I am all for a rebound check however just having the same numbers doesn't always mean being overdosed. Some of us had flat curves at lower doses - little changes in numbers as we SLOWLY increased our doses just as Joanne's kitty is showing now. So a blanket statement like that can be misleading. Merlin's numbers looked like Buddy's numbers all the way up to 7 units bid on Vetsulin until we eventually switched to PZI. Again he did the same thing up to 7 units PZI bid until we switched to a sliding scale. I can post links to those old numbers if anyone wants to be bored by all that. I also know that I did so many "rebound checks" and spent a year trying to figure out what was going on. Only to find out I was right months earlier in my suspicions that it was never rebound and that something else was going on.
quote]

Completely agree Patti. Spook's numbers did not change with the rebound test. They remained the same throughout, wether I lowered the dose or increased, they always remained high & flat. It wasn't until we reached the right dose, a higher one, that things started to improve.

That's not to say that rebound is not a possibility in this case, but I just want to caution as to the need to really check for ketones while checking if it is rebound. If numbers do start to get worse, increase right away, don't wait.

 

Jen I am wondering what do you consider obvious signs of acromegaly???

Have you read thru the subtle ones at all that are raising red flags for so many of us and not just including hi dose people? We don't just jump on someone who is giving hi doses. There are so many other clues. We are all for suggesting and backing up a rebound check but give us some credit for recognizing things that we have been closely watching monitoring for the past 3 years.

As always we hope we r wrong but unfortunately most often we are right on for acro or IAA

 

Patti

I'm not in this for any reason other than to provide a different perspective that I see missing here. I'm not one of the people on health who shout rebound every five minutes, nor am I responsible for any of the issues you or others here have had in the past when trying to figure out what is wrong with your cats, so please stop treating me like I am.

You have a person here who has reached a high dose without the necessary data to support it. I've followed this thread and while I know very little about acromegaly, I haven't seen anything that shouted it to me, but maybe I missed something. I am simply amazed at the lack of support here for a simple fricking rebound test, with the exception of Karen and Janet. Not multiple rebound tests that put the cat at risk, not sending the cat back to 1 unit and starting over. A rebound test. And relying on past posts by people who know more than me, I've suggested that a rebound test should last 3 days, not 1 day like suggested here.

I have no clue how Joanne will figure out how to proceed with all of the mixed messages she is getting here but I sure as heck hope that this lovely cat doesn't suffer because of it.

 

I know you don't know me but..

I am concerned.

I have an acro.

This curve is not one of an over dosed cat IMO. I know I am not looking at his whole history but I'm very very concerned. 150pt drops generally do not happen with an overdosed kitty right at "normal" nadir time.

PS-32.9/592
+2-27.7/499
+4-23.7/427 <---this is evidence of an actual curve, something we don't normally see in an overdosed cat
+6-26.5/477
+8-26.1/470
+10-31.5/567
+12-HI/594+

I think it's entirely possible the cat is not getting enough insulin and we have to be careful here. I do not like the 3 day rebound check, which is not saying that I don't like the rebound check. I am NOT saying the dose is not too high because experience tells us it might well be. I suspect the insulin itself is a problem here but.... I don't like a 3 day test because we're looking at putting a cat into serious danger who may already be in dire need of more insulin. You've got several things going on here and one of them is infection. If this cat is truly underdosed, and has cushings/iaa/acro, putting insufficient insulin and infection together could be a disaster. To be perfectly blunt, and I am worried that the fact that this is vetsulin, which is known for it's rather forceful action, and he isn't hypoing weekly is indicative of something else going on, be it one of the main high dose causes or something else such as underlying illness. Finally we do not know if the vetsulin is bad. We do know the manufacturer had problems, but anything could have happened to that insulin in transit or storage and we could be dealing with lost efficacy. VERY scary to look at this and decide what to do. The rebound check needs to be performed with a known "good" insulin.. ie: something new. Lantus/Lev/PZI/whatever you can get your hands on, it's gotta be new so that you know you're dealing with ONE thing that works. (BTW if you do buy lantus or levemir, make sure you also buy u100 syringes with half unit markings as lantus/lev are u100 insulins)

So. I personally recommend you go buy 1. new vetsulin/caninsulin or 2. lantus or 3. levemir and start at 3u with vetsulin/caninsulin or a lowered dose of 2u for lantus or levemir. With the two latter insulins, you can increase every 6 doses by 1/2u at a time to "catch up" to where you were. Not too sure about that with vetsulin/caninsulin but I don't think you can increase it that fast. You MUST test his urine for ketones during this testing time. Any sign of ketones will require immediate and emergency action. It's not hard, just stick the strip in the puddle of urine after he pees and wait the determined number of seconds.

I also would prefer for Jojo to take a peek and I am going to send her a msg and beg her, because I understand both sides of this problem. Clearly there's ample evidence that this dose could have been reached a little more cautiously, however, there is also question in my head about why this dose has not sent this cat into a devastating hypo cycle. If in fact the insulin is BAD then switching to a good insulin at the same or even half the current dose could be a huge mistake.

One other thing.. for cold symptoms, you can crush one 500mg tablet L-lysine into the food and mix it up to help alleviate snotty symptoms. It's a human supplement.

 

Jen, I too would like to know what "obvious signs of acromegaly" are you looking for?

I don't think anyone has ruled out rebound or is dismissing it out of hand. I agree with cutting the dose in half for a couple/3 days and seeing what happens... IF ketones can be tested for during that time. Otherwise, I don't see another "safe" way to do it than how Joanne's vet has advised. Ultimately, it's up to Joanne to decide how to proceed. We will help and support her no matter what.

 

Rebound was dismissed, with zero support for a rebound test when Joanne first posted; she was told by people that it was unlikely and it was suggested that she test for acromegaly. After a lag in time, TID dosing on caninsulin was suggested instead if she didn't want to switch back to lantus.

I'm not going to contribute to this thread anymore because I can't contribute further knowledge or experience.

 

Carolynn

This cat is not the one with infection, it is a civie cat. If it were this cat there is no way I'd suggest a rebound test.

And yes, a switch in insulins to a reasonable starting dose would be lovely.

 

The "other Carolyn" (who always forgets a letter! :lol: ) mentioned infection, but I know what you meant, Jen. Good to point that out.

Anyway... everyone: can we let Joanne decide what she wants to do? I don't want this to progress to the point where feelings are hurt or a cat isn't helped. We've all laid out our thoughts, but we aren't the ones with Buddy.

 

In regard to the upset going on.. we here on the HD group are an unusual group of people here on FDMB, well versed in FD, and yet still often questioned by the uninformed. Jen is not one of those people. She is one of very few people who do not immediately jump on the rebound check bandwagon on Health, and I respect her thoughts quite a bit as she is often capable of spotting things that others miss. She is also very good about coming to get one of us if there's a questionable cat whose owner is being advised to reduce dose.

This is a very scary situation for not only Joanne, but for all of us looking at it. One missed comment, one missed piece of information, and we advise the wrong thing and potentially harm the kitty. And I just did that very thing, not realizing it was a 2nd cat with infection. Her knowledge and caring puts her far and away one of the best advisors on Health and on FDMB, as well as one of HD's best "watchdogs" so please let's not argue.

We are all friends, and we shall all always be friends.

 

I am now totally paralyzed. I feel I'm damned if I do and damned if I don't. I have to give an insulin shot in 2 hours and I have no idea what to do!

Joanne

 

I know Joanne is really confused ( because she has said so previously). When I'm confused, I try to get more informed to make a better decision. (and I pray for guidance)

Since it's her cat, and she is the one who has to deal with things in the moment, I hope that she takes the time to carefully reread all the posts from the beginning, and read up on all the jargon and informational pieces available in each forum.

The issues of concern as I remember them:
diabetic cat, high dose, started on 4 units, seems otherwise healthy
large body and paws, no history of hypos, possibly suspicious of acromegaly
eating at least some dry food
BG levels are high
current insulin under a "product alert", the manufacturer has asked owners to stop using due to variations in its action, and has predicted shortages.
mamabean works and is primarily available for close observation on weekends and evenings, currently dealing with sick civie as well.
lives in rural Canada with one vet available, with whom she has begun a dialogue about these concerns
(how do you get insulin shipped without it being frozen?)
has ketostrips, but has difficulty catching him in the act because he is an indoor/outdoor kitty.
Many people offering opinions in genuine attempt to help.
I'm sure I've missed or misrepresented a few and if so I apologize...

I offer no opinions, but I will pray for you, that you receive the info and wisdom to proceed to best help your kitty.

 

I'm sorry Joanne

(((hugs))) Don't be paralyzed. Just shoot what you planned to shoot. That is not already harming him so it's the safe route for now.

Then, let's talk this out. The insulin is not currently working. You have to find out why.

Is it because he needs more? Looks that way but...
Is it because it's bad? Could be.. perhaps we should try a new insulin, or at least a fresh vial of the same insulin.
Is it because it's too much? Doesn't really look that way to me, but it's a possibility.
Is it because he's got an illness? Absolutely a consideration, and I understand the constraints of having the tests done in where you live.

These questions are all answerable, but we have to approach this systematically and help you find this out and without scaring the heck out of you.

Please don't give up on us or him, we can get you there, but there is no fast answer here in my opinion. We all have differing experiences, which can be confusing to the person asking the question, but ultimately our wide variety of experiences will get you to the answer you are looking for. No one here wants to "be right", we all just want to help you get your kitty better. Don't feel stuck in the middle, just review what we've said, answer what you can and bounce your ideas, questions and thoughts off us. It will start making sense to you then and you will be able to make a decision based on what you're reading. No one here is going to say "why didn't you try my idea???" so you can feel totally secure in posting your thoughts and ideas and plans. :smile:

PS: Excellent summary Nancy

 

Ultimately the decision is yours Joanne. Know that we will support you with whichever route you take. I for one was never against the rebound test, I just want to make sure that you do understand the possible outcomes (ie: DKA) so for this reason, I can't stress enough how important it is to check the urine for ketones. There's no harm in doing the rebound check if you do monitor carefully. If you see the numbers consistently staying at HI with no movement then you'll know to increase again. What makes me think that it isn't rebound is that you are seeing a bit of a curve, just not enough of one. Plus, if you're still feeding dry food, that will keep those numbers high.

 

Hi Joanne! After reading through this whole thread, i wanted to add my 2 cents. I too dealt with difficult numbers at the beginning of my FD journey. My French Fry would respond to insulin, sometimes having significant drops, but also often ending up at high numbers. We played the rebound game, lowering the dose, etc. to the point that were were using diluent to make the concentration of the insulin even smaller. We ended up also dealing with recurring DKA as a result.

Our solution came with a change in insulins. We were using humulin L at first which was a moderate onset, moderate duration insulin. Changing to a longer onset, longer duration, gentler insulin did wonders. We started over on 2u with the new insulin and increased aggressively ( 0.5u every 2-3 days) until we found the right dose, and the ketones finally went away.

It looks like Buddy was started at 4u BID? So you have no data at all on any lower dose. Do you have any pre-insulin readings? Like the number when he was diagnosed? If he was significantly lower before he started receiving insulin, there is a good chance that he was started way too high and a lower dose would be in order.

I agree with Carolyn that a change in insulins is probably going to be your best line of attack. And starting fairly low is generally a good idea when doing this. Do test for ketones during this as ketoacidosis is nothing to flirt with.

Please try not to let all the variables and all of the different approaches overwhelm you. We are all trying to help.

 

I'm trying not to panic here but my gut is telling me he was started too high. He was 25 the first time he was checked with no insulin. He was also on a high carb diet of mostly dry food from the supermarket. He was also under a lot of stress at the vets office...this is a stray cat who took 2 years to get used to me. Now all of a sudden he is at a clinic surrounded by all these strange people and animals. He absolutely hates dogs. His BG's have gotten consistently higher ever since. He may show signs of the tumour but his head and feet were always large...it didn't just happen. I've been marvelling at the size of his paws for the past 5 years.

I'm so confused by all of this discussion(arguement) and I'm thinking I should just do as my vet said and quickly decrease him at each dose. It may be wrong but she's the one who is here and is working with me.

Joanne

 

Joanne.... the most important thing for you to do right now is do what YOU feel comfortable with. Simple as that. You are there, your vet has a plan, and it sounds reasonable to me, so I say go for it.

((((hugs)))) to you and scritches to your boy...

 

((((((hugs)))))) Joanne,

I know it is confusing to get a lot of conflicting suggestions.

I think the main worry about lowering the dose is -- Buddy COULD develop ketoacidosis which can turn extremely serious and require hospitalization.

So - people are suggesting testing the urine for ketones using the keto-dia-styx

Some cats are more prone to DKA than others -- my Norton never had a problem with it, and if you are lucky -- neither will Barn Buddy.

If urine testing is difficult or impossible, sniff his breath if he'll let you. A human or kitty with ketones will have sweet or fruity smelling breath.

If he smells like cat food and looks at you like you're crazy - he's probably fine :lol:

Hang in there!!!!

Also -- just to mention -- Norton had acromegaly and he had big feet and strong muscular body / head for several years before he developed diabetes. In hindsight, we think he had the tumor for at least 5 years.

 

Dear Joanne
I want to apologize to you for making this so confusing and overwhelming to you. That was never my intent. Please forgive me. I will step aside and let the others help you. Once things have been worked out if I can help you at all I am always here or you. I wish nothing but the very best for you and Buddy
xxx

 

I think most everyone here will agree that there is nothing more important in treating FD than gut feeling.

Like the others said in unison, please test his urine as you are doing this to make sure he does not develop ketones. If you do catch him positive for ketones, you must stop decreasing right then and there and get help for him. We can teach you how to test his urine, I know it's tough to catch him but where there's a will, there's a way.. right? We're here for you, no matter what route you take.

 

Something's not right...he was 28.3 PS this evening. A;most 4 hours later he's HI..it's gone up! This was with 7 units of Insulin. What should I do? Still haven't caught him peeing.

joanne

 

Can you keep testing throughout the night? Have you tested since and if so, what was the number? Did he eat anything between the preshot and the next test? (ie: dry food?)

 

At this point I doubt I'll sleep. I called the vet. I just got him to eat some food and gave him another 2 units of insulin. I don't think he's eaten anything since he had his supper. At this point she has no clue as to what to tell me to do. I managed to get a drop of pee on a Ketostix and it showed trace. I don't know if I got enough on it or not. Buddy's very lethargic and is excessively thirsty. I'm scared!

Joanne

 

If you put fresh litter in a clean litter box and put him in there, could this by chance entice him to mark it? Mine love brand new litter (Although my guys will usually go anytime I put them in the box)

Just be sure you have the ketostix ready to stick in the stream or the fresh puddle.

When you PM someone I think it sends them an email. You might try that for Carolynn.

 

Did you test again before giving the extra 2 units? If so, what was the number, and when did you give the extra insulin? Try not to panic. Can you get another bg reading?

 

The test before the other 2 units was HI...as in off the charts.

I didn't realize that I could use pee that went into the litter. I'll try it.

Trying hard not to panic but it's hard:-/

Joanne

PS I don't see anything there for PM.

 

Ideally, try and test the pee while he's urinating, catching it midstream on the stick, but if the puddle is still fresh, you can still test that way too. Try placing fresh litter in a new pan or box to entice him to go, most cats can't resist this. Try and get another glucose test in if it's been a couple of hours since the last 2 units were given. Don't panic at the HI, cats can handle it remarkably well, it's the ketones that can be very dangerous so if you see them, take him to an emergency vet right away.

 

If you wait for the page to load fully, you will notice a "PM" icon under the user name on the right hand side of the page, you should also see an "online" banner if that user is currently on the forum.

 

Agreed, when a cat goes high, they drink a lot of water to flush the extra sugar out of their blood.

In cats, the ketones and very very low numbers are the scary things. BTW many cats never have trouble with ketones and chances are buddy will not either. Unfortunately, testing is the way to tell to be sure.

The private message icon is a little gray box below the user info at the right.

 

He went for the litter box...it showed somewhere between trace and negative. Should I go back to 9 units in the morning? He seemed ok with 8 this morning...it's when I went to 7 that things started changing.
The excessive water drinking was really scaring me.
That and the fact that he wasn't interested in his Halo treat.

I see the PM box now...thanks.

Joanne

 

Personally, I would go back to the 9 units. Again, the choice is yours but if you choose to reduce some more, please check for ketones again religiously. The pattern in your numbers is so very much like so many of us HI dose moms that have been through this already that I would be very surprised if it really was rebound.

 

I don't know if it will help keep you calm but,

2 months ago Cody went from 12 units vetsulin (your insulin) to no insulin for a cycle, to 2-3 units of PZI the next day, and didn't have any ketones. He wasn't happy the day with no insulin, his sugar went up and he drank a lot, but no ketones, no trips to the vet. I didn't know about the FDMB and I was just doing what my vet suggested in order to transition away from Vetsulin.

any luck with the new litter?

 

oops , sorry you beat me to it. The delayed 2 units might lengthen your duration a bit this cycle so you may have a slightly lower number next AMPS, just in case you notice that tomorrow.

 

Hi Joanne,
Suzie and I are in EST (10 p.m. at this time) Both Carolyn(n)s are also in eastern US. Patti and Kimmee are on the west coast, so they'll be up later.

This is the time to get a glass of wine and some chocolate -- take a deep breath. If you're upset, your kitties will get upset, so be calm. Everything is going to be ok.

Do you have to work tomorrow? If you could get one more test in tonight, that would be good. I have to work tomorrow, so I will need to go to bed in an hour or so.

((((((((hugs))))))))
phoebe

 

Things seem to be getting back to normal. I did another test and it was 30.4 so it has gone down. He went crazy for his Halo treat and then headed to the food dish. I think now I can go to bed. Back to 9 units in the morning. Thanks everyone for getting us through this. I don't handle crisis' very well:-/
And yes i have to work in the morning so I'd better get off the computer now.

Thanks again.

Joanne

 

Have a good sleep Joanne, you handled it quite well.
Please keep us posted as to how he's doing in the morning.

 

He seems to be back to normal this morning. I'm exhausted but he's ok Sticking iwth 9 units this morning. Will contact the vet again today to see what we should do next. I'm thinking change the insulin.

Joanne

 

((Joanne)) Sorry I wasn't on last night... I'm not normally on late and it was another day with headaches so I was in bed early. You got some great support and advice from the others, though, and you were in good hands.

Anyway... talk with your vet, test for ketones if/when you can, add water to Buddy's food (that'll help flush anything out), give him a smooch and a hug, and go from there. Today is a new day. Buddy's ok. You're tired, but you are also a fabulous mombean to your boy.

(((hugs)))

 

Buddy is back to normal today. (Normal still being high BG...but normal for him). Still have no plan as to what to do next. Was talking to the vet tech at the clinic but not the vet.

Carolynn I can sympathize with you...I have headaches too. Hope you're feeling better today.

Thanks everyone for being there last night. It helped to know that I wasn't entirely alone.

Any thoughts as to why that happened??
(Without totally confusing me

Joanne

 

Well, it seems like Barn Buddy needs more insulin.

My brief rebound test with Norton also had immediate HIGH results.

So -- your insulin seems to still be effective -- and it seems that Buddy needs the dose that you are giving him.
<Edited to add: and probably more insulin than you are currently giving him>

----------------

Possible next steps to consider to try to gain control over his Blood Sugar:
1. reduce / eliminate dry food. (need to be testing blood sugar and prepare to reduce dose when needed)

... when I got Norton completely off dry food, his insulin dose decreased from 13 units BID to 8 units BID

2. change to a longer lasting insulin

... caninsulin only lasts approx 10 hours in a cat. that means every day, twice a day, there are several hours with NO insulin on board, so blood sugar can rage out of control (roller-coaster blood sugar curve)

... with a longer lasting insulin, the insulin remains active more than 12 hours --- so the blood sugar remains lower overall since the second injection is given before the blood sugar has rocketed back up to high levels

3. try TID dosing (if you want to stay with caninsulin)

... this would essentially help get some overlap -- giving insulin before the previous dose is all gone, so the blood sugar stays lower.

4. request tests for Acromegaly and IAA

... both tests are conducted by the lab at Michigan State University Vet College (the only lab in North America that does these tests -- least expensive if your vet contacts them directly instead of going through a "middle man")

Gotta go for now - will be back online later this evening

phoebe

 

Thanks Phoebe. Sorry I didn't reply earlier but I'm the one with the headache this time. Can't concentrate when I have a headache.

Now to throw something else into the fire. I wasn't going to bother doing a curve this morning but decided to anyway. Here are his numbers so far.
PS HI
+2 29.4
+4 20.9 !!!

What's up with that???

Ketones are showing somewhere between trace and small.

Joanne

PS Would it be ok if I print some of these things off to show my vet? She readily admits that she doesn't know what to do:-/

 

Joanne,
You should REALLY go poke around the Caninsulin/Vetsulin Insulin support group and read about his insulin. As a sample, I copied this from it:

I am not familiar with your blood glucose conversion factors, but its obvious that at + 4 you had a good drop in BG, which would fit with how this insulin is suppose to work. It is also obvious from the preshot highs you always get, that this insulin is not lasting Buddy the full 12 hours between shots. A different insulin should last longer so that he doesn't keep fluctuating like that.

If you go read more in the Vetsulin Insulin support group (especially about the FDA warnings about vetsulin) it may help you decide about trying a different insulin.

KNOWLEDGE IS POWER. before you change things, you will be less likely to panic if you understand why and what you are seeing in Buddy. Go do some reading. :razz:

As for printing things off -- I did, and it was very helpful to my vet. You have a vet who wants/needs to help you, so get her connected- she's the one with the veterinary degree so she should absorb the info more easily than a lay person.

Please keep an eye on the ketones and keep posting- remember the "exactly 15 sec" rule. I'll ask others to comment on that. Is he eating and drinking normally? :?:

 

Hi Nancy

I'm already looking into changing the insulin. My reaction to the drop is that nothing has changed...he's been on 9 units for about 3 weeks now and has had very flat curves. Now all of a sudden we see this big drop. Is it cause for some optimism????
(For a change) Yes my syringes are U-40.

I'll be speaking to my vet about Levemir tomorrow instead of Lantis in case he is a true high dose cat. What is the best way to go about transitioning him to another insulin?

Thanks!
Joanne

 

OOPs...missed a question. He is drinking a lot but eating is normal.

Joanne

 

Is this the same vial that you have been using?
Maybe mixing/rolling it this time was different,
maybe your seeing some of the product alert issues, before I switched I suddenly started getting really low numbers (for him) also.
maybe he didn't eat dry food recently, that can have a BIG effect.
maybe he's just a cat that keeps you guessing... ;-)

gotta go to church

 

Great post Nancy!

If you switch to Lev... hmmmm, I'll do some asking about what you might start at. Usually you'd start over at 1u and maybe increase more quickly, but with the possibility of ketones we don't want to be messing around in higher numbers for long. I'll get back to you on that, k?

Hope you both have a great day!

 

Also meant to ask... how's your Siamese kitty doing????

 

OMG that's going to be terrifying starting at 1 unit after what happened Thursday evening. And I have to go to work. How do people manage that?? He's now at 9 units twice daily.

Oh and at 8 hours in todays curve he was already back at HI. I was almost tempted to give him some more!! Poor boy:-(

My Siamese is deteriorating before my eyes:-( His eyes have dried up and he's sneezing less but he looks absolutely awful. And the smell has come back. I'll probably have to put him down sometime this week. I think that quality of life has to come into this. If he's not going to get better I'd rather not prolong the suffering.

Joanne

 

I'm not sure that you would start over at 1u-- especially with the ketones. That's why I want to get some input.

I'm so sorry about your other kitty. On Feb 16 it's a year that I had to help my old (she was 23? 25?) girl Gabi to The Bridge. She finally had a grand mal seizure (4th one) that she couldn't fight back from. It was the hardest thing I've ever had to do, but she actually cuddled with me... laid her head right on my heart... something she never, ever had done... and I knew it was the right thing. I can still feel her little head in my hand... how her fur felt... as she left. You'll do what's right for your kitty, no matter how hard.

(((((((hugs))))))) and understanding....

 

No matter how many times you do it it never gets any easier. I've had numerous cats and dogs PTS over the years and it hurts just as much each time.

Joanne

 

Hi, your post caught my eye because of using Caninsulin.
I'll leave the sliding scale stuff to Patti-she knows her stuff :mrgreen:

I read about the Convenia, here is a lonk from Dr Lisa:
http://www.felinediabetes.com/phorum5/r ... ?8,1905168

and this was her updated one on this board:
viewtopic.php?f=3&t=2107

I've heard people be very successful with the pill pockets.
I used to hide Lucky's pills in either a piece of fresh boiled chicken or a small cube of Felix meat (just cut into it and then squashed round it-like making a cornish pastie! Sorry best analogy I can think of)

Hope Barn Buddy is ok