What do I do now?

I am so confused and aggravated with Ducote's numbers We went a couple of days without the dreaded "HI" but now it looks like it is back with a vengeance How do I know if I need to go up to 5 units or if this is a bounce from the much lower numbers that we saw a few days ago? Or maybe I missed the perfect dose by moving up too fast in the beginning? I am just all over the place and running out of ideas

 

Ack, I'm so sorry, I know this is frustrating!

My take, looking at the spreadsheet: I'd hold the 4.5 for a bit longer, and try to get some nighttime tests. I don't think he's still bouncing from the 117 he got a few days ago, but he did get to 117 a few days ago on the 4.5U, so that dose is capable of getting him into those kinds of numbers, I wouldn't push it too much farther just now.

Even though he's probably not bouncing from 5/31, that doesn't mean he's not bouncing. We don't know how low he went yesterday morning between AMPS and +4, but we do know he had a pretty substantial drop (at least 400pts) during that time, and that kind of fast drop can trigger a bounce even if they never get into low numbers at all. It also shows that, when he's "HI" at PMPS, that doesn't mean he's going to stay high, and it's still important to get those nighttime tests in!

In addition to the nighttime tests, I'd also think about testing early in the daytime cycle and, if he seems to be dropping like he did yesterday, experiment with feeding snacks to try to slow him down. That really is an experiment, figuring out what food works when, but in some cats, it can really help discourage this kind of frustrating pattern, where they seem to spend more time bouncing than anything else!

My two cents. Let's see what others think, and hang in there!

 

Thank you so much for the advice! I forgot to mention that I think his big drops have been happening because I have been giving his shots with his food (instead of waiting the 20-30 minutes). He is such a nervous kitty (and can be a meanie) that giving his shots with food made it so that he didn't even notice that he was getting anything. Now that I figured he was kind of used to the shot, for the first time today I waited the 20-30 minutes after eating. Would this change make that big of a difference in his numbers (from a 400 pt drop to nothing at all)?

 

It might make some difference, but I'm unwilling to ascribe all of what you've been seeing to that. I just think he's bouncing today and that's why you haven't seen much movement... It should help later on, though, on non-bounce days!

 

I second Nan’s advice and I agree that I don’t think the feeding with the shot is an issue. A lot of folks do that so their cats are distracted by eating and they can give them the shot. I had to do that with Minnie at first until she got used to it and would let me do it anytime. Hang in there I know it’s frustrating but spikes do happen and we have to be patient and once you’ve gathered enough data you’ll start to understand why

 

I am a newbie here and ppl will correct me, but it's a lot of change of dosing in 2 weeks.

 

That is something that I have worried over. I would hate to have moved too quickly and missed a good dose

 

I agree. You normally would not change the dose because of a single reading. Unless you are following tight regulation protocol, dose increases are usually by 1/4 to 1/2 unit and wait at least a week between increases. It's very possible that you have missed your optimal dose.

I have reached out to the Vetsulin board for someone to help advise you.

 

Thank you! I started the spreadsheet on 5/19 because that was the day that my meter came in the mail. I had been giving him 1 unit from 5/8/20 - 5/20/20. After that I skipped through 1.5 and 2 rather quickly. It was around the 3.5 units that I discovered this board and read that you need to keep the doses for around 6 cycles and not increase by whole units so that is what I tried to do after that.

 

When is time to get a new vial of insulin, consider switching to ProZinc which usually lasts longer than vetsulin.

 

I actually ordered Prozinc from Chewy.com and it came in today My family is leaving on Monday for a week vacation and Ducote will be boarded at the vet. I did not want to start him on a new insulin with me leaving in a few days so I am going to start it when I come back. I am hoping that this new insulin gives us the turning point that we have been waiting for!

 

good plan.

 

When you switch insulins start over at 1 unit and slowly increase it until you find the optimal dose.

 

Would I just do the normal 6 cycles per dose (6 at 1u, 6 at 1.5u, 6 at 2u, etc.) until I see good numbers? Could it be bad for him to go from 4.5 down to 1 the next day, like should it be tapered or do I just go for it?

 

I would not reduce by that much without testing for ketones daily. That is the biggest danger with a sudden reduction like that.

Will the boarding facility be able to test? What dose of Vetsulin will they be giving?

 

Do you think that 2.5 would be a safe starting dose since I never really tried that dose and also rushed through 3 units a little too quickly?

I talked to them about making sure that he gets his two shots each day, 12 hours apart and they said that they will make sure that this is done (I was worried bc they are only open from 7-5:30). I am sending his glucometer with him and an instruction sheet that tells them to test before each dose. I also made a log for them to record glucose results each day. Since he is currently on 4.5 units and his numbers are staying high, I was thinking of just having the vet stay with this dosage.

The other issue that makes me incredibly anxious is that he is a VERY NERVOUS kitty, to the point of being a meanie to strangers. In the past trips to the vet, they have had me go to the back and get him out of his cage because they had such a hard time getting him out (even told me that they would pull straws on who had to get him when time for his procedures) . When I go back there I can hear him as soon as I open the door, he is normally making very deep growl/moan that I never hear at home and he hovers in the back corner of his cage with ears back and ready to strike (once he sees that it is me he perks up, starts purring, and turns back into my sweet kitty). I am SUPER NERVOUS that he is going to be VERY HARD for them to test or administer his shot

 

Does he eat at the vet?

Wondering about a reduced dose for the boarding... it's a tough one, because, again, there's the ketone risk, especially if he's stressed and not eating at the same time. Hmmm...

 

I never thought to ask if he ate an appropriate amount at the vet, I just always assumed that they would let me know if he didn't. This is the first time that I am sending him with food due to his new diet so I should be able to tell when I see how many cans are left over. In my instruction list that I typed up, there is a section for food. I let them know that he is only allowed to eat the food provided and that he must have his food with his shot (I bolded and underlined must have food with his shot). I mentioned on there that it might be a lot easier for them to test and stick him while he is eating.

 

with all these unknowns I would do a reduced dose while there

 

Have you boarded him with them before, then? If you have, and he eats for them (even if he's complaining all the time!) then that's great. It's only a worry if he doesn't, because 4.5U of vetsulin would be a lot if he wasn't eating, especially if they are not there overnight.

If there's any question about whether he'll eat while being boarded, I'd consider reducing the dose, but you don't want to reduce dose too much. Not to keep harping on this, but the risk of ketones/DKA is real in a kitty who is not eating, not getting enough insulin, and totally stressed out because he's at the vet.

Maybe add a "?" and edit your post title to see if you can get some more ideas about this?

 

Maybe she should put that at the top of her list in BOLD letters?

 

Would the vet be able to do a flexible dose, based on how much he's eating and the preshots?

If it were me (keeping in mind I've only been home testing for a week), I'd go 3.5-4U while there. Then provide them guidance that if he isn't eating as much as he does at home (whatever that amount is) and preshots are in the 300-400 range, reduce by about 0.5-1U. if they're still getting 400+ preshots, I'm not sure I would change the dose...but you know your cat best!

Edit: and perhaps they could try to check for ketones 1-2x a day?

 

He has stayed overnight at the vet before for certain procedures but never just to board. He always was perfectly fine just staying at home when we went away. I would just leave out extra food and water and have my mom come in mid-week to check on him. Now that he requires meds twice a day my only option is to board him. At home he is still acting like he is starving and he eats his whole meal in minutes without delay. I do not know how different this will be at the vet. I will make sure and stress to the vet to monitor his eating due to him being overly stressed.

 

I understand and agree with everything you posted, except for one little thing. The vet cant always be there and techs (in my experience) dont always follow (or they interpret different) written instructions)

 

Right now, and for the past couple of months, the vet's protocol is to stay in your car and they come out and get your pet. Because Ducote is so nervous, they have let me go in with him each time. I am hoping that they will let me go in Monday when I drop him off and I will be able to talk to someone face to face about his routine, progress, and what he needs while I am away.

 

I hope so too! Sending positives just for that. Tell them to write down your concerns.

 

I know, I thought about that too. So I guess I envision clear directions such as:
"If he eats less than 1/2 his usual meal (so 1/2 can, whatever measurement), reduce the next dose by 0.5U. Hold that dose unless he starts eating more than 1/2, in which case return to the XU dose"

dose adjustment will be lagging, but I think it's better than maintaining too high or too low of a dose the whole time.

If it were me, I'd print out a paper copy of the spreadsheet we use. I'd explain to them that I'm trying to get him regulated, so i need them to enter the numbers, as well as notes documenting what he ate, reasoning for dose adjustments, etc. Might not be very popular, but might be a way of keeping them a little more "on their game".

Can anyone tell I've never boarded before?

 

well kinda lol
I'd just bribe them with more money. SOMEONE TAKE AN INTEREST IN MY CATS WELL BEING!
I think Heather's got this.

 

Lol

Around here (not sure about elsewhere) it costs quite a bit to board when they need medications and testing like this. So as far as I'm concerned, I'm paying more, filling out a spreadsheet and adding some notes isn't too much to ask! I guess I'm that lady lol

 

He's not even close to being too low. I'd stick with 4.5... or do 4.25 if you are really worried. If you were seeing blues I'd say reduce more.

 

I am "that lady" as well when it comes to my family and my pets I am sending a detailed list of instructions, a copy of the most current spreadsheet for reference, and another log that I made with times and dates for his stay where they will log test results and units given. My husband says that they are going to hate me over there I have just heard too many times from too many people "It's just a cat", "there is no way I would be doing all of that", and the famous "You should just put him down". I just want the vet to see that I am completely invested in Ducote's well being and that I take his sickness and recovery VERY seriously. I am sure that I will get a few words or snickers when I leave the vet but I'll take it if it means that they understand my expectations.

 

That is what I am thinking. I put in the instructions to always test before his dose and if it is under 200 to stall, feed, and test again in an hour but if it stays under 200 to hold the dose. I do not see this being a problem and I doubt that it will come to that but put it in there just in case. With his numbers staying as high as they are, and if they are really checking him before each dose, I am thinking that he will be safe at the current 4.5u.

 

I sent like 2 pages of notes plus spreadsheet the last time I had her boarded. I have to leave her for a few nights mid July. I always worry. I should still have the document in my computer from last time.

 

Enjoy your trip away. When you start Prozinc, we do NOT go back to 1 unit. We take the dose of the existing insulin, and how they are doing on it, into consideration.

 

Thanks! With Ducote currently on 4.5 units of Vetsulin and not doing so well, what would be the ideal starting dose of Prozinc? I was planning to maybe start at 3 (since I rushed past this dose initially) and work up .5 units from there. Should I reconsider and start closer to his current dose?

 

I decided not to board Ducote I talked to my sister tonight and she agreed to keep him. I am going to go to her house tomorrow (in time for his pm dose) and show her the procedure and let her try to test him and give him his insulin. I figured that as nervous as he is, it might give him some comfort to be in a home instead of a small cage at the vet. I was also nervous about the vet being closed on Sundays and no one there at night. He is still not good with "strangers" so I know that he probably won't be easy for my sister to poke but I am hoping he will be too distracted with his food to care too much. My sister taking him for me is a big relief but I can't help but feel a bit guilty. I know how stressful it is for me and I hate to put that on someone else

 

Yeah for your sister!

I think you'll need more than 3 units, but if you want to try it for a few days then fast track the increases up to closer to his Vetsulin dose, that's OK. Also depends how much you can monitor when you do the switch.

 

I would start at 4.5.

 

Wow, what a wonderful sister! So much less stressful to leave him when you know there will be someone there keeping an eye on him all the time.

Now, if he'll just cooperate and be a good boy for her !!!!!

 

I’m so glad your sister will do this for you! Now you can better enjoy your vacation. Fingers crossed he will cooperate!!!

 

Luckily I will be home during the switch. I am a school teacher so his diagnosis coming in May was actually one of the silver linings with this whole thing.

 

I am beginning to think that Ducote has a vendetta against me lol! If you look at my SS you will see that EVERY MORNING his AMPS is in the black (mostly HI). On 5/31 I woke up with a surprise AMPS of 291. I should have been excited but I was a nervous wreck because of all days this was the first time that I was leaving my house in a long time. I had to go to my grandmother's birthday lunch and she lives 45 minutes from home . I checked him before I left and he was 117. Since this is super low for him and I was leaving, I fed him gravy food and stayed scared to death the whole time I was away. Well, today is the day that I bring him to my sister and then leave for a week and low and behold he was 258 this morning . Why doesn't he give me these numbers any other day

 

Oh, they know these things, lol!

 

PLEASE!!!
Leave your wonderful sister a link for this message board! If she has any problems she can come here for advice (with your permission of course)

 

I will definitely do that! She also said that she will text me his results each day so that is another plus!

 

we REALLY need a thumbs up emoji...