Today's curve for my Barn Buddy

Joanne, can you create a spreadsheet by chance so we can see all your testing data in one place? Here are the instructions: viewtopic.php?f=6&t=16 Or even just a word document that lists the info, written in this format (numbers made up):

AM PS 400 9u (morning preshot of 400, dose given)
+2 300 (bg 2 hours after the shot)
+9 355 (bg 9 hours post shot)
PM PS 433 9U (evening preshot of 433, dose given)

Sorry to create more work, but it would help us! Thanks!

dancing_cat

 

Everybody, Group question:

Since its going to take some time to:
-figure out the insulin switch,
-coordinating the vet, and Joanne's work schedule so she can test (like next weekend),
-and leave Joanne some time to read up on the new insulin before the switch,
would it make sense to try stopping all dry food next, switch him to Fancy Feast or Purina DM only (silver top, not gold), and see if we can't get better control of those really high BG numbers? It might really help him, and it would be great to know how much it affects him, before we start messing with the insulin. Joanne, you will need to test BG during a food switch.

Joanne, I know canned food is pricey, but you potentially could make up the cost difference in insulin reduction.
I seem to remember you have another cat that will only eats dry (Siamese?) Lots of us, including me, have other cats with different eating situations. There must be some way you could separate them, and not leave any dry food within Buddy's reach. It's a constant struggle at my house- (some of my posts are worth a good laugh - I'm about to start a new one "Things Cody has Eaten" kidding) but seriously, the food is sooooooo important. Read Phoebe's last post- her cat dropped 10 u /day, just with eliminating dry food.

Anybody else agree? :?:

 

I'll try to create a spreadsheet tomorrow evening.

As for the dry food I'm guessing the Siamese won't be an issue much longer:-( How often should I test the BG when I drop the dry food?

Joanne

 

The conversion for BGs is 18, so the curve is:

PS .. HI == >600
+2 29.4 == 529
+4 20.9 == 376

Sorry about your Siamese - so sad when they're getting weaker. (((((hugs))))))

Switching insulins... not sure what to tell you, other than sharing my experience.

Norton - acrocat.
Changed from Humulin N to PZI
We started the change on a Saturday morning (work M-F)
Humulin N dose 8 units BID
PZI started at 5 units with a sliding scale intending TID (3 shots of 5 units ~= 2 shots 8 units)

El Tigre - regular diabetic
Changed from PZI to Levemir
Again - started new insulin on a Saturday morning.
PZI dose ~2 units BID
Levemir - started at 1 unit BID and eventually reduced a bit. He is currently getting 0.75 units BID most days.
Tiggy is well regulated and spends 95% of the time under 150. (read the stickies in the Lantus / Levemir Insulin Support Groups about becoming "data-ready" to shoot lower preshot BGs)

 

I found your old post and saw that you are feeding "low carb canned and dry DM". You would think dry DM is OK, but any dry food has carbs in it, including dry DM.

You seemed to indicate that Buddy mostly eats canned. Is that true? How much dry do you think he's getting now? Could you reduce it gradually this week and test especially around +4 which I seem to think has been his nadir? right? Maybe if you offered more canned he'd be less interested in the dry. He will need to make up the calories missed from the dry. I'm pretty sure dry has more calories per ounce, so he's going to need more food.

 

an idea......(long)

hey there. ;-)
carolyn and carolynn (lol) both asked me to stop by here to see if i can help here at all.

first i wanted to say something to the HD peeps..i have an idea i have been playing with for situations just exactly like this in my mind when 'to do a rebound check or not to do a rebound check' (said in best Shakespearean voice) is on the line....what about a reverse rebound check using R? credit lorna/GirlCat with the idea that time she shot GC with 7 units of R instead of 7 units of lantus by accident pre-acro dx and ran to ER while GC giggled. R being the powerful insulin it is, having the action it does, once GC's numbers did not move from that, the acro test results we were waiting for were just a formality, that incident gave all the answers right there.
no i'm not saying to shoot BB with 9 units of R, what i was thinking was a 2 part process ~in case this is an IAA cat can't shoot any real dose of R first time since you can have the kinda 'mismatched' insulin response like what jan/buddy (an IAA cat) to lantus vs. her R.

the first part would be to wait until after whatever little vetsulin nadir is happening here in a cycle and then give a teeny tiny touch of R, say 0.25 units. (and must have person get U-100 syringes, the usual 3/10cc with 1/2 unit markings). do an R curve from there (should be over before next PS easy). if nothing then next day give at the same point in cycle 1 unit of R and do another R curve. (of course making sure have well stocked hypo toolbox in house just in case). if still no response, then i think you have gotten pretty good hints as to the answers to a lot of questions about this cat and the current vetsulin dose. unless a cat has ketones **(joanne see below paragraph to you about this) which in and of themselves cause insulin resistance 1 unit of R should cause good movement of numbers, even through rebound hormones (when i first got settleD, i used R all the time to cut through rebound hormones, it does). hence a 'rebound check' has been done w/o letting ketones enter the picture and at same time clues as to what is really up with this cat have been given.
and if there ends up being a response to the first tiny test dose of R then it is a whole new ballgame and you've opened the door to suspect bad insulin, IAA or way over dose, in other words rebound check was positive, unless IAA cat(rare). (you can get an IAA test done easily in canada, and while waiting for results would get a new insulin (lev) and start over using regular tilly protocol)
this technique could only be used in very special circumstances like that is going on here. it is not something to be suggested in lieu of a real rebound check to a newbie on health when one is indicated there.

if the reverse rebound check is negative (no response to 1 unit R), this would also help decide what does of lev to start barnbuddy at if switching to lev is done, plus i would STRONGLY suggest having R in house anyways when doing the switch, while that first shed is building it is a very dangerous time for a HD cat, R greatly lessens the ketone dangers associated with that and is a safety net until real lev dose needed is worked up to through the start middle-ish dose and move really fast technique.

so what do you guys think? does this idea have merit?
i know i is kinda different than anything proposed before and i really wish i could do this in my own household first before throwing the idea out there but unless someone knocks on my door tomorrow with a BB like cat, it ain't happening. but like i said, i've used R plenty of times to cut through rebound on my own cat in past (and this was back when he was on doses around 5 units lev). i've had this reverse rebound check idea for long time, and when i was asked to look at BB's threads and saw 'let's do a rebound check' and 'cat has trace ketones' in same thread i had to throw this idea out there.

***joanne~ i read above that you believe you have 'between negative and trace' on urine ketone stick. can you take one of those test strips and wet them with water (or even use it on yourself) and then look at it under same light you have been? asking because even a trace on a urine ketone test strips "pops" when it is positive at all. like when you look at it you would have no doubt in mind that it was positive. you are timing the seconds when measuring it's color to chart on bottle right? this is important because if there really is trace ketones then things have to be played differently, and a rebound check of cutting insulin given down cannot be done. (nor does it need to be, too much insulin cannot cause ketones, only too little). and an insulin switch should not be attempted to long lasting insulin until the trace ketones are long gone.

well hope that helps....
~jojo

 

wow Jojo

That is a great idea, and cost-saving too, esp since acro test is so much $ outside US.. I will have to put that one in my bag-o-tricks!

BTW Joanne, Jojo is a vet tech, not a poorly trained acrobatic typist with slipping grasp of the English language, though it may appear that she is the latter.

 

Did the ketone test under the same light with water...no change in color. What is R? Can't test at 4 hours as I'm not home:-/

Canned food is also left out. he eats his fill of canned food then moves onto the dry.

Need to read this more thoroughly this evening. Gotta go feed the horses and get ready for work.

Thanks!

Joanne

 

R (Humulin R) is a very fast acting, harsh insulin that shows a drop in bg fairly quickly in a kitty. Not meant to be used alone as it doesn't last long in the system at all (typically 3-4 hours max) but many high dose moms have used it to help out with their basal insulin. Here's more info on it: http://petdiabetes.wikia.com/wiki/Humulin_R

Love jojo's idea, especially since you may be seeing trace ketones.

 

Funny enough, this is what I did with Fletcher (before we knew he officially had acromegaly, but knew his doses weren't normal). When he didn't respond at all to a unit of R and then 4 units only dropped him 20 points, we knew there was definitely something going on. At that time he was getting 8u tid (three times a day) of PZI I believe.

To try this Joanne, you'd need 4-5 hours where you know you'll be home so you can get at least hourly tests. If nothing else, you can forego the Caninsulin dose to try the R, then dose with the Caninsulin once the "R curve" is done. This is something to think about so take your time.

As for the ketone strip, I'm thinking if the color is the same with water, then there are no ketones. I would keep checking just in case, though, because that's not something you want to have to deal with.

(((hugs))) to you

 

Hi Joanne.

I read through this whole thread and I am wondering why BB has not been tested for acromegaly?

My concern with everything that has been posted is that there are some unknowns that make it difficult for anyone to know what is really needed for him. The dry food is a factor adding to higher numbers and it doesn't sound like the dose was ever low enough to rule out that less than a couple of units isn't working. Plus, you are using an insulin that may be compromised from the get go (Caninsulin warnings). And, unfortunately, it sounds like you vet is pretty clueless about feline diabetes.

Is there another vet in your town that you could call and see if they have more experience with FD?

Your experience has similarities to mine with Beau. Although Beau was started at 2u of vetsulin (caninsulin), he was 486 (27) at diagnosis and his diet was not really addressed for 6 months. He was also dosed once a day (sid) instead of twice, but he was raised to 7u and his numbers got worse, then better, then he hypoed, then they got worse and the whole time he was drinking a ton of water and peeing a lot. It wasn't until I came here, started home testing, started to phase out dry food and lowered his dose that he started to get better. I took a month to get rid of the dry altogether and it made him go from numbers in the 400s, 500s (upper 20s to lower 30s), and 600s (HI on my meter) to 200s and 300s (about 12-20) at preshot time. His dose went from 5u sid to 1u bid.

To be honest, I think the R test is an advanced technique and has not been proven to work because it has not been tried. I am not sure that you want to be the person to try this since you are so new to this whole thing. I do not think that I would want to try this, actually.

A rebound test, while testing for ketones, is something that is known and many people here can help you with. You do have to give it the full time (2-3 days), not just a few hours or one cycle because his body is programmed to dump stored glucose in response to insulin. It will take some time for that mechanism to shut off and you see his "true" blood sugar numbers. I am not surprised that his BG actually climbed on the reduced dose because it wasn't reduced enough.

 

I spent about 2 hours working on the spreadsheet this evening. Very time consuming as I have to convert all the numbers. I'm about halfway through and now I can't seem to find it.

I printed some of the articles and gave them to my vet today. Haven't heard anything from her yet.

Sheila some of the problems that I'm encountering is that I'm on an island on the east coast of Canada. There are very few resources here. The vet that I have is the only one in my area. I don't think she's completely clueless about diabetes it's just that she's never encountered a case like Buddy's before. We haven't discussed the acromegaly yet although one of the articles i gave her today was on that.
The R test sounds very scary to me and I don't think I'd want to experiment with it.
I'm now in the process of taking away the dry food. It's difficult with 3 other cats in the house!

I'll try and finish the spreadsheet tomorrow if I can find it!

Joanne

 

Ah, Joanne, I spent a long time looking for a file at work today. I know what you are going through. Was it a Google doc? You would have to long on to Google and then it would be under documents. If it was on your home computer try clicking on 'Start' and then 'My recent documents' - that's for a PC. Not sure what to tell you for a Mac.

As you phase out the dry, be sure to be spot testing so that you can catch any drops in BG. Dry can account for 100 or more points - um, that would be 5 or more for you :smile:

 

I found it. I finished the spreadsheet but I want to take 1 more reading before I share it. He's been off the dry food for almost 24 hours now. Why does he look at me like I'm trying to kill him????

Joanne

 

Hi Joanne,

Jojo is rarely on the board anymore, but she's the absolute best around. You might consider doing the Humulin R rebound test she described. You would only do it on a day that you are home and can test often (and possibly on a Saturday, when Jojo is around).

Barn Buddy is looking at you like you're trying to kill him because you've taken away his kitty crack! Poor thing!

Heather/Boo

 

I didn't even understand it:-/ This is all so new to me.

Joanne

 

I know it's hard.

I'll try to paraphrase jojo's post.
1) Buy Humulin R & U-100 syringes. In the US, it's about $30 for a vial. It lasts FOREVER and is good to keep around with a high-dose cat. Also, ensure that you have plenty of cans of high-carb food on hand (always be prepared).

Pick a two-day period when you'll be available (such as a Saturday & Sunday) in the morning.

Day 1 - Shoot .25 u R. Test BB every 30 minutes to 1 hr until he hits his low (nadir) and then numbers start back up. R is generally out of their system in 4-6 hours. If there is no noticable response to the .25 u, you will proceed to Day 2. Boo's R nadir was at 2.5.

Day 2 - Shoot 1.0 u R. Again, test every 30 minutes - 1 hour until he nadirs.

The reason she's recommending a two-day approach is for safety. R is very powerful. If BB has IAA, he might actually respond to R (Jan's Buddy has IAA). If BB has acro, it's likely that you won't see anything with 1 u R (like, when Boo was on 11 u Lantus, I would also shoot 4 u R if I had a "pink" number).

Does this make sense? Also, even if you don't want to do the R check, jojo recommends that you still get some R and keep it around.

 

Can you get R in Canada?

 

Yes - it goes by the same name as in the US "Humulin R"

http://www.canadadrugsonline.com/DrugMoreInfo2575.aspx

 

Here is the link to my spreadsheet.

http://spreadsheets.google.com/ccc?key=0AhWumFFQqx48dDlpMmlIWndibWtud1BsWm8wbTBuaVE&hl=en

Hopefully that will work. He has gone 24 hours with no dry food. There has been a drop.

Now I have to go to bed...work in the morning;-/

Joanne

Edited by moderator to make a link.

 

Joanne, are you only shooting once a day?

Sleep well.

 

Oh hell no!!! Twice a day. Didn't realize I had to fill in the evening dose where I wasn't taking any readings after the evening shot. Except for the first week on 4 U, what he got in the morning he got in the evening as well. Sorry.

Joanne

 

Joanne,
Re-emphasize-----You need to be checking BG when you suddenly remove all dry food and keep the insulin the same. It will affect his numbers! Please try to get us more readings any time you can during the cycle.....

Great job on the spread sheet - thank you !

Dont forget, he will need more canned left out now that the dry is removed.

Moderator or Joanne, can we get the link in her signature? :?: :?:

 

I'm trying to check more often now. I'm leaving canned food out all the time as well. He still hates me:-( Do they ever get over that wanting dry food? Does it get easier? Should I expect more changes from dropping the dry or is this it for the numbers change? My vet felt I need to wait a week before changing anything else.

Lantus or Levimir will cost me about $160 plus tax per vial!! She also warned me that she could do the test for Acro but it would be very expensive. I've been looking at that reverse rebound test some more. It's starting to make more sense to me now. Should I print it and give it to my vet to read? She's pretty much leaving things up to me at this point. Scary!! But at least she is being quite open minded about it all.

I don't know how to add a link to my signature.

Joanne

 

Lantus also comes in cartridges and it works out cheaper in the long run, with a fairly hefty upfront cost. I know you have limited options in Nfld but hopefully you'll find a pharmacy that can help you with this.

And yes, they do get over hating us, although some never stop trying to get dry! My Squeak will eat the dog's food sometimes...

And yes, talk with your vet about your options because you need local support

Hugs

Jen

 

I'm in Ontario and was able to get a package of 5 vials (for pens) for $170. You should be able to get the same thing for a similar price there. It is more expensive than Caninsulin but I can't begin to explain the difference it made in my girl.

The reverse rebound test is a great idea if you're home and able to test. It will give you a good indication as to what's going on. And an open minded vet is a good thing. Mine didn't approve of my insulin switch but counldn't deny the improvement once she knew Spook's bg readings. Unfortunately a lot of vets don't have a lot of experience with feline diabetes so it's as much of a learning curve for them as it is for us.

Do not hesitate to ask any questions. We've all been through this with our high dose kitties & we're here to help the best we can.

 

I know a few pharmacists...I'll ask about the cartridges. What is the difference between cartridges and vials?

Also someone said that Jojo was a vet tech...could I ask where in case my vet asks? Not specifically...just like the state or province? I'm definitely going to run that by my vet.

Joanne

 

The cartridges are 3mL and come in a pack of 5 (total of 15mL). The vial is 10mL. I've used my vials of Lev until it was all gone (when both Fletch and Robbie were using it). The theory with the cartridges is if the insulin "poops out" there isn't as much waste.

Jojo is a vet tech in Long Island, NY who has had and treated diabetic cats for 16 years.

How's your other kitty?

((((hugs))))

 

You can get a 10ml vial or a package of 5 3ml vials for pens. No difference but size. Many prefer the 5 pack because when dosing in smaller quantities, they last longer. I never did look into the cost of the larger vial but they may be cheaper (depending on how much of it you go through).

Jojo's in NY and extremely knowledgeable when it comes to feline diabetes. She's been around here giving advice for a long time & is pretty bang on. She was a saviour for Spook when I was trying to figure out dosing for her.

 

I think she said it was $160 for a 15ml vial. But at the rate I'm going through insulin this could be $160 a month.

I made the appt today to have my Siamese PTS on Friday. I think he might have cancer. It seems to me that his nose is being eaten away from the inside out. It's usually full of blood now. He's not enjoying life anymore and I feel that I shouldn't prolong his misery. He's eating but it's getting less and less. I think it's time:-(

Joanne

Edited by moderator to add Buddy's SS link to the sig line. Joanne, it will now be there whenever you use the signature.

 

Oh, Joanne, I'm so sorry about your Siamese. It is heartbreaking to see them in pain but it is heartbreaking to lose them too.

Doing the reverse rebound test that Jojo describes might be a good, cost-effective alternative to the IGF-1 and IAA tests.

(((((((((Joanne)))))))))

 

Joanne,
You asked:

I would expect to see the dry food continue to affect his readings for several days, because much of the absorbtion occurs in the small intestines and therefore takes days to pass, but I could be wrong. Just be strong and don't fall for that pitiful face :lol:

I noticed you use canned DM and thought you might like to know the Carb breakdown according to Janet and Binky (of FDMB fame). This is assuming you are using the new silver top cans:

Purina canned DM (Sept 09 recipe) "as fed" according to Janet & Binky, (from data on dry matter, provided by Purina):
35% of calories from protein
60% of calories from fat
5% of calories from carbohydrate
262 mg phosphorus/100 calories

This falls well into the category of "low carb food" at 5%. In general, it is suggested you stay below 10% calories from carb.

Keep hanging in there. FYI I had the IGF1 & IAA tests drawn monday and am waiting for answers tomorrow. nailbite_smile :roll:

 

OMG I got a red number preshot!!!

Nancy I was feeding Purina DM dry. I've been using Janet and Binky's list for the canned food. I'm trying to stick to 6 carbs or less. I'll be looking forward to hearing about your test results tomorrow.

Thanks Phoebe....I almost expected him to be dead when I got home from work today. His breathing is very laboured right now. It'll be hard but I'm making the right decision.

I passed in that email on the reverse rebound to my vet today. I'll probably get to talk to her tomorrow when I bring my siamese in. (Although I may not be capable of talking about it at that time).

Joanne

 

My thoughts are with you and your Siamese today. ((((((hugs)))))))