Munchkin - Test Readings & Dosing

Previous Thread, just for reference.

PMPS last night was 214 (checked twice and averaged two readings: 211 & 217), which was below our guidelines (pre-shot = 220-270, then give 0.8u) so I gave a reduced dose of 0.5u. I couldn't hold his PM shot for any later otherwise I would have had to give his AM shot too early, given when I had to leave for work. I guess I could have given 0.6u maybe, right? Checked bs at PMPS+2 and was 211. This morning AMPS was 267 and gave 0.8u, going by our guidelines.

I'm very pleased all pre-shot readings have been less than 300 (all yellow or better) for more than 48 hours. :smile: Haven't gone more than 48 hours without a 300+ reading since we started testing.

Nice blues!

I like all the numbers below the renal threshold (250/270 and under depending on who you ask.). I'd stick with this scale awhile and see if he drops further.

Thanks guys! I appreciate you following our numbers and giving recommendations, always. And, yes, we will follow this scale for a bit and see how it goes. It sure would be nice if I rarely have to give the full "regular" dose of 1u because his readings stay low!

Well, PMPS last night was 283 and gave 1.0u. 3 hours later bs was 191; nothing was "off" to indicate a need for another bs test at +3, its just that Munchkin has gotten used to his bedtime treats that come with the bs test, and I obliged. AMPS was 305 and gave 1.0u. Dissappointed a little to see a pink, but I remind myself that it was only pink by a few points. I did check ketones last night and it was negative. Had the perfect opportunity and showed my husband how to do it. Speaking of, my husband has never done a bs check on Munchkin solo, and tonight will be his first. I'll be in town until late. We've gone over how to do it, but I think both he and I are a little nervous to see how it will go. I'm also nervous that he is not familiar with using the chart with the u100 syringes. We've gone over it several times but he still makes mistakes half of the time; he will correct his mistakes but after two or three tries. Shoot, I still double and triple check my own use of the chart, because I know it is pretty easy to get turned around and make mistakes.

The colors are wonderful, but they are discouraging sometimes when they don't really need to be. Your 283 last night and 305 this am are only 22 points apart - way less than the meter 30% variable. I'd sit with the new scale awhile and see if he settles in. Good that DH is getting involved. He could always call or text you to double check if he needed?

Thank you Sue! It is only a few points difference between PMPS and AMPS. We're sticking with the scale.

My hubby is wonderful with the fur-kids. He has been giving Munchkin his insulin shot as often as I have over the past two years, just not recently with the changes in the dose over the past month. I'm sure he'll call if he is in doubt about the dose or syringes. In all the time that we've swapped off dosing Munchkin as we come and go, we haven't double-dosed him yet. We just try to be extra careful because we know mistakes are so easy to make, but difficult to impossible to take back. Now, the bs check . . . eh, that may not go so well. We'll see.

My husband did the PMPS bs test by himself with a little bit of trouble but got it done, and gave PM shot (PMPS = 230, 0.8u). +3 was 211. AMPS was 208 and gave 0.5u. All in all rather uneventful with pleasing numbers.

Sidenote, does anyone have any resources looking at the effects of accidental intramuscular injection of insulin (instead of sub-q)?

Glad hubby did well. I think Carl did the in the muscle shots as a rule and Bob had no adverse results. Not sure but I know it is not done often or recommended in general. I don't know the reasons.

I believe it may hasten the absorption of the insulin giving it IM.

In people, IM injection of insulin results in an earlier onset, and can sometimes cause a hypoglycemic episode. But, I don't know how it impacts the rest of the cycle. And, I think IM injection behaves differently with different insulins. But, there are specific situations where it is done on purpose - I just don't know which situations and why exactly.

I have no clue how IM injection would effect a cat, but interested. (BTW - not planning on doing them on Munchkin.)

PMPS was 237 and gave 0.8u. No +3 test reading; Munchkin didn't come to pester me so I just let it be. AMPS was 194 so I didn't feed him but retested 30 minutes later. Got 225 and gave 0.5u. Very pleased with the good numbers all week and plan to do a curve on Saturday. We have lots of yardwork and gardening to do so we'll be in and out of the house, so not minute-by-minute monitoring, but it could be if we needed to.

I'm wondering what my "no shoot" reading should be. Munchkin's readings have been trending lower and he had that <200 reading this AM. It won't be long (hopefully) before I'm in the pickle of how low is too low to shoot. If Saturday AMPS is <200 then I don't mind being aggressive with his dose and monitoring, but I can't do that during the week and preferably not on Sunday either. What do you think?

Most people start with a 180 no shoot number, when they have the data, which you do. Maybe see how the .5 did today with the 225 and see whether a .2 or .4 looks better for the 180? At this point, even if you will be monitoring, I would be cautious about below 180. Some people eventually get to 150 but it takes a lot of monitoring.

If you haven't, you might check out the remission threads above and look at their ss as they were going OTJ (anti jinx) and see how different people dealt with different numbers.

Looking good!

Ok, I'm comfortable with readings <180 being my "no shoot" numbers. I'm not sure if I'll use 0.2u or 0.4u to dose readings between 180 - 220. We'll see what this weekend brings.

About the spreadsheets, I hadn't checked them out much since I am not expecting Munchkin to go Off-The-Juice. I want a better quality of life for him and I want less worry for me, and I'll have that if we can get him regulated. But, after you suggested it I looked over several of the spreadsheets in the OTJ thread. Its a long thread! I haven't even looked over half of them yet but I'll keep studying-up. :smile:

Thanks, and ya'll have a good weekend!

Very nice trend you've got going here.

Munchkin is very close to being regulated. Congrats!!

If your husband is better with math, the conversion is:
U-100
Syringe
Marking * 0.4 = U-40 dose
0.5 * 0.4 = 0.2 units U-40
1.0 * 0.4 = 0.4 units U-40
1.5 * 0.4 = 0.6 units U-40
2.0 * 0.4 = 0.8 units U-40
2.5 * 0.4 = 1.0 units U-40
3.0 * 0.4 = 1.2 units U-40

Thanks Rob! I think so too! Though this weekend's readings were a little bit odd.

And, thank you BJ for the formula. My husband is not a numbers person, that's me! :smile: But he can work a calculator, and double checking the dose by using your formula is probably what we need to be doing. We need a way to double check when we're dosing solo (when the other isn't there to do the double checking for us).

I've entered the readings we got from this weekend and I'd appreciate it if ya'll would give me some feedback (like you always do). Our dosing scale is:
if bs reading >270, then give full dose of 1.0u
if bs is 220 - 270, then give reduced dose of 0.8u

And, then we kinda decided (on Friday) to add another tier to the dosing scale, so we could dose below pre-shot readings of 220 (if bs reading is 180 - 220, then give 0.4u). Maybe ya'll were thinking differently, but I was thinking of it as a "consolation prize" type of dose, i.e. not a "real" dose but better than not dosing at all. But, then in the time since I was last able to log on, 4 of the 6 doses have been 0.4u (a majority of Muchkin's doses). For not being a "real" dose, I give it reather frequently. I don't know if we need to change his dosing or not. He has been getting great readings, but he has been sick too.

He started sneezing (& snotting) Friday night and it continued through the weekend. I didn't see him sneeze this morning but I might not have been up and around long enough. Maybe a respiratory infection, viral (clear mucus), or maybe just allergies (though he has never had allergies before). I am leaving work early today and we are going to the vet. I think our vet, Dr. Ruff (great name for a vet, don't you think?), probably won't be able to do anything for Munchkin. But, if it gets worse I do want Dr. Ruff to have seen Munchkin already, so he can watch it develop.

BJ, this is your field, right, sort of? Is the timing right that maybe Munchkin picked up a bug from boarding at the vet's office? His symptoms started exactly 14 days after checking-in for boarding.

About Munchkin's dosing, I thought the bs readings were supposed to elevate when infection was present? But, his readings are flat, and at the low dose. I don't know what to make of it. Anyone got any thoughts?

I like the dose for under 200. Sorry he has a cold. As far as the numbers increasing with infection, it's that ECID thing. Some go up with an infection; some don't. It could be that he would have been lower instead of flat if he was feeling better.

rvontrapp said:

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He started sneezing (& snotting) Friday night and it continued through the weekend. I didn't see him sneeze this morning but I might not have been up and around long enough. Maybe a respiratory infection, viral (clear mucus), or maybe just allergies (though he has never had allergies before). I am leaving work early today and we are going to the vet. I think our vet, Dr. Ruff (great name for a vet, don't you think?), probably won't be able to do anything for Munchkin. But, if it gets worse I do want Dr. Ruff to have seen Munchkin already, so he can watch it develop.

BJ, this is your field, right, sort of? Is the timing right that maybe Munchkin picked up a bug from boarding at the vet's office? His symptoms started exactly 14 days after checking-in for boarding.

Click to expand...

Yes 14 days is not impossible - in food born outbreaks, they often ask you to recall what you've eaten over the past 2 weeks. Glucose impacts may depend on the type of infection and whether it is just respiratory or has gone systemic/into the bloodstream. Also consider if someone from the house might have brought in something on clothing (fomites - objects contaminated with infectious material) or unwashed skin (pet anyone else's animals?)

Allergies can develop as one ages and the immune system becomes less competent, especially if stressed. have you had the windows open? Have a HEPA filter on your furnace/AC? Carpet or smooth floors? Soft furnishings hold dust, dander, and other allergens. If allergy gets diagnosed, there are lots of things which may be implemented to reduce exposures...but can be time consuming.

Many cats are carriers of feline herpes, which may break out under stress (ex boarding, vet visits, changes in the home), l-lysine powder may be added to the canned food to help support it. l-lysine is an amino acid, aka protein building block. There are also gels, and chews with it, ex Vetri Lysine (my cats all regarded that as a big treat!). Discuss this with your vet if/when you go in.

I'm actually more of a chronic diseases epi, although I've recently been moved into maternal and child health and am learning about that.

Okay, I guess the flat readings make some sense then. If I think of it as instead of having a drop mid-cycle, his readings "rose" because of infection to show no drop.

And, I forgot, we went to visit the other boarding facility 6 days before he started sneezing, to show them how we test on the ears. It could have been either place, there or the vet's.

We could easily have tracked something in the house ourselves, fomites, on our shoes. But, we haven't petted any other animals in quite a while, and we haven't had the house windows open (already too hot). If Dr. Ruff says its allergies, I'll believe him. The whole house is an allergen breeding ground: carpet, no HEPA filters, dusty drapes. The only positive on the allergen front is we have slipcovers on most everything and wash them, though we could always wash them more frequently. I guess it could be anything . . . and all the more reason to ask the vet to figure it out rather than second guessing myself.

I'll ask our vet about the l-lysine. Should I be concerned if he wants to perscribe steroids? I mean, Munchkin is already diabetic, but could it make it worse?

He'll want to rule out infection first as steroids suppress immune responses, good and bad.

If he decides steroids are needed, yes, you'll need to adjust the insulin to compensate because those do raise glucose.

Be better to do some serious vacuuming (with a vacuum having a HEPA filter), wiping down any solid surfaces with damp cloths/swiffers, and wash, wash, wash anything that can hold allergen - bedding, curtains, shampoo carpert (if it'll dry fast without mold), replace furnace filters. Investigate costs for adding something like an Aprilaire filtration to the HVAC.

L-lysine can be bought in any store that carries vitamins. You just crush it up and add it into their food. I use it alot because mine also have the herpies sneezies.

Our vet visit went well. The least discussed topic was Munchkin's cold, go figure. Munchkin actually had a diabetes management check-up scheduled for this Friday, so everything kinda got rolled into this one appointment.

Dr. Ruff was very pleased with Munchkin's readings (I took in a copy of our spreadsheet) and we talked about food and dosing a little. The only thing he cautioned was he didn't want us to be too worried if/when we got readings that seemed anomolous (in line with the "cats will be cats" and will be unpredictable philosophy). He also didn't want us to stress out ourselves or Munchkin trying to get bs readings too often. He seemed skeptical when I said Munchkin was pretty okay with it now. And his skepticism is understandable since Munchkin is not really agreeable with anything, especially in the vet's office. And, Munchkin is still sometimes uncooperative with bs testing, just nothing like how he used to be.

The verdict on the cold - nothing too much to be concerned over. Its not bacterial so an antibiotic shot (equivalent to a 10- to 12-day round of antibiotic pills) wouldn't do much for him, though Dr. Ruff did offer it. Cautioned us to be on the lookout for a secondary bacterial infection that might develop, and then the antibiotic shot would help. Lungs sounded good and no ulcerations in his sinuses (so maybe not feline herpes, thankfully). Just a cold. If it got worse we could come back and Dr. Ruff would give a shot of something to dry it up. I'm watching it, and looking to see if Fiona and Pageant catch it; I sure hope not. I completely forgot to ask about the l-lysine.

Dental - needs improvement. Its not too bad, just a couple spots that are irritated. I just bought a dental cleaning kit (toothbrush, chicken flavored toothpaste, etc) but haven't tried it yet. Dr. Ruff said brushing would keep it from getting worse but probably wouldn't take care of the plaque already deposited. He said we could get a dental pick and do it little by little ourselves, but I don't think Munchkin is that agreeable. A full dental in their office is $100 to $120, with the sedation. Reasonable enough, I guess, but not quite in the budget right now since all three are due for their booster shots. I think we will try to keep it in-check and plan for a dental in a couple months.

Someone had commented on another thread that feeding gizzards could help clean teeth, or help keep them clean (it might have been a vet's webpage). But, no one has commented if they have personally tried it and if it worked or not. We bought some last night and Munchkin loves them - he gobbled his up and then stole and ate Fiona's and Pageant's.

Anyone out there tried the gizzards?

Haven't done the gizzards, but you could post on Health. I know I have seen it commented on. Glad the visit went well. One caution - if the shot is Covena, search for it first. There are cats who have had severe side effects; others have done fine with it.

The dental is usually a toss up. Sometimes it makes a big difference in downward bg levels; sometimes it doesn't. I'd save up and get it when you can afford to.

But generally I see things as good also. I think getting a preshot number is imperative. You only get midcycle numbers on the weekend so that is not overdoing it.

Not too many changes at our house. Munchkin is still sneezing; the girls haven't caught it yet. If onset for the cold is 6 days (if its from the boarding facility) then I'll know by the end of the week if they've truly caught it or not. Loving all of Munchkin's blue and yellow readings! And, I always appreciate ya'll taking the time to follow up with us, look over Munchkin's readings and advise us! Thank you!

(Sue, yes, we won't be giving up on doing pre-shot tests - too important. And thanks for letting me know you don't think we're overkilling it - I didn't think we were either. Getting some l-lysine to try and see if I can tell any difference. Got filters for our vent registers, just have to put them on - never tried them before. Got to remember to change the main A/C filter too.)

Forgot to mention the other day, the vet was also concerned about Munchkin's weight. And, here I kinda thought we were doing good with his weight, at least that's what I thought pre vet visit. (Sorry I left that out yesterday, that was a big omission on my part, but unintentional.) We intentionally worked on getting Munchkin's weight down at the end of 2011 and beginning of 2012. It worked, he lost weight and he reduced his need for insulin, and soon after that is when the hypo episodes started. We weren't home testing at the time.

Prior to this past Monday, our last vet visit was in November 2012, and at that time he weighed 15 lbs - the vet's preferred weight for him. On Monday he was 12 lbs and 4 oz. Eeek! That was not on purpose! The vet voiced suspicion that the loss was do to poorly regulated diabetes. Now, we did pretty okay in April, but that still leaves 5 months where who knows what his blood sugars were. And, that 5 months is where I'm planning on laying the blame unless ya'll have a different idea.

Now, to get the weight back, at least a little bit. We are adding gizzards to the diet, aiming for every-other-day, really for dental health but they include calories too. I can increase his caloric intake by just feeding more. Anything else? I am making a shopping trip for the l-lysine so if I should try a special supplement for weight gain, let me know and I'll pick it up. Maybe kitten milk/formula? Naah, probably high in sugars, right? We will be weighing periodically at home to keep an eye on the weight.

I think he is staying in regulated and below the renal threshold numbers the majority of the time, so my take is that he is doing very well. Re the food. I think I would try feeding him extra for a while and see if that changes things. You can weigh him at home to keep track; step on your scale with him in your arms, then step on it without him and subtract. Milk and kitten milk is generally a no no. I do think Kitten food can be used, but I would check on Health for that.

Kitten food - ex Evo Cat and Kitten - tends to be both higher protein and higher fat.
Feeding 25-50% more may help put the weight back on. Note: increased calories = increased insulin need, so you'll probably need to adjust the insulin some.

Well, now Pageant is sneezing. Not happy about that. Munchkin's PMPS was 257 and gave 0.8u, and AMPS was 306 and gave 1.0. Everyone had gizzards last night as a bedtime snack and then again with breakfast this morn. Its turning into an every day thing instead of every-other-day, which is fine. Fiona and Pageant are still not sure if they like them, so I think Munchkin is getting more than his fair share. If I can find some Fortiflora I'll start sprinkling that on top. My husband is testing and dosing Munchkin tonight and tomorrow night because I'll be in town late. He should do okay (but can of course text me if he is unsure about anything - like the dose according to the chart). Thanks, BJM, for the Evo recommend. I'll check and see if our local PetSmart carries that brand (and Fortiflora and l-lysine).

He is looking good, Rebekah. Sorry about the family sneezes.

Thanks Sue. Yeah, I'm not happy to have a house full of sick kitties, but if the most severe illness I have to deal with is a couple colds then I know I am blessed/lucky.