Just dosed @ 8pm & 2nd thoughts. Some input requested

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christoph

christoph

Member Since 2015
Going by the vet's scale I gave 0.5 with BG @ 171 (Alphatrak) and now wondering if it should have been lighter. I think her scale is too heavy handed. At what hours should I track Poncho's BG? Any thoughts please?
 
I would start checking at +2 myself and then as long as it's over 100, I'd probably go hourly from there until you know for sure he's rising.
 
Just tested @ +2.5 hrs BG209(Alphatrak). He had food (Hills ad force fed 20ml) right after 8pm shot.
 
It looks like the numbers could actually improve a little if there was a little more insulin at the lower end of the scale, and a little less insulin at the higher end. I don't know what your current scale is, but decreasing your no shot cutoff, and slighty increasing the dose given from 200-300. Decrease the dose you give from 400+.

When he is above 400 the 1 unit is dropping so low that you don't shoot or shoot a small amount, then the sugar after that is high again. The other option is to split the difference, and try a steady lower dose for a couple days to try to stabilize the sugars. Ie. above your cutoff, give 0.5 regardless of the sugar. If sugars remain high, increase. This might stop the swings. It's best to try to get your AM and PM doses as close to the same dose as possible.
 
Here's the scale:
400> 1.5 units
300-400 1 unit
125-300 0.5 unit
<125 no shot
lower #s were revised Fri. ....before revision: 200-300 was 0.5 units, below 200 no shot
I'm just wary after the bad hypo experience. Thanks!
 
So yeah I guess see where the revision takes it. If 0.5 from 125-200 takes him too low, maybe do 0.25 in that range, and 0.5 from 200-300. Its hard when you worry all night and feel like you want to check all the time. Max was doing that to me when his insulin need started going down. Low numbers every day, that was fun....
 
Meya14 said:
So yeah I guess see where the revision takes it. If 0.5 from 125-200 takes him too low, maybe do 0.25 in that range, and 0.5 from 200-300. Its hard when you worry all night and feel like you want to check all the time. Max was doing that to me when his insulin need started going down. Low numbers every day, that was fun....
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Should I test every 2 hrs until +7 or +8 hrs? Guess I'm going to test and feed again @+4. Looks like another sleepless night.....thanks again.
 
It might not be a bad idea, not so much that you need that frequently to catch a hypo (probably every 3 if he's not going down to fast), but because you'll see what it's doing at this level, and it might let you get some piece of mind for dosing at this BS level or some info for a dose change.

I do really think that if you cant get this insulin to cooperate pretty quickly, lantus or levemir might let you get some better sleep, and be more manageable. They are better for cats prone to ketones too because of the basal action (no time without insulin due to the depot).

There are pros and cons for each, some cats need the stronger action of prozinc to get the high BS down. Some cats need the smooth even action of the slower insulins. It does take time to get any insulin managed, so don't throw in the towel on prozinc too early, but know there are other options.
 
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+7 was 200 on Relion meter. Pre-shot BG this am was 257 Alphatrak. Hopefully his pm reading will be in the same range or close.
 
Those look good. Once you find doses that keep him squarely in the 200s for his preshots without going too low at the nadir, then you can work on slowly shifting the scale to bring them down more without the swinging.

The biggest issue with the sliding scale method of dosing is that often the doses are "correction doses". That is, the amount of insulin is given because a cat's sugar is outside of a normal range. The problem with this is about half the day, the cat is hyperglycemic. This used to be the preferred method with humans as well, but research in humans showed that this is the least effective method of managing diabetes and had the highest level of complications.

The current thought is that we want to be dosing "base doses" instead of "corrective doses". A base dose is insulin that is given AHEAD of a blood sugar rise. That is, you give the insulin when the sugar is in the normal range in anticipation of the rise that will occur throughout the day in response to food, activity, stress, and the previous dose wearing off. In fact, even the risk of hypoglycemia is lowered with base doses, because you should never have to give a large dose at the top end of a scale. In these insulin scales, in humans, the no shot cutoff would be very low, or there might not even be one.

This article is an interesting read that sums up current changes in thought regarding human approaches, and is pretty interesting:
http://www.todaysgeriatricmedicine.com/archive/110612p8.shtml

It's too bad there isn't more animal directed research.
 
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Meya14 said:
The biggest issue with the sliding scale method of dosing is that often the doses are "correction doses". That is, the amount of insulin is given because a cat's sugar is outside of a normal range. The problem with this is about half the day, the cat is hyperglycemic...
...The current thought is that we want to be dosing "base doses" instead of "corrective doses". A base does is insulin that is given AHEAD of a blood sugar rise. That is, you give the insulin when the sugar is in the normal range in anticipation of the rise that will occur throughout the day in response to food, activity, stress, and the previous dose wearing off.
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Ummm.....

I'm not sure where to start here, and am feeling slightly awkward. And if I said everything I feel should be said this post would get very long indeed, and I don't have time for that, so, I'm going to try to comment on just a few points...

Most cats who are on insulin will have blood glucose levels outside of a "normal range" (ie, will be hypergylcemic). It is only a very lucky few who can consistently keep their blood glucose in a normal range. And some diabetic cats rarely even come close to a normal range despite their caregiver's best efforts.

Some cats do very well on fixed doses of insulin. Some cats do well on sliding scale dosage. My cat is in the latter group.

My cat has been on sliding scale almost since he was first diagnosed (8 years ago). It is a system that has worked well for him. Sliding scale means we can adjust the dose according to how the blood glucose level is moving. To me, this actually makes more sense than giving a cat a fixed dose of insulin at every shot. Sliding scale dosage has enabled us to have far greater control of blood glucose levels than we ever had previously on fixed dosing.

The idea of a "base dose of insulin that is given AHEAD of a blood sugar rise" is a sound idea; but in practice it can be extremely hard to predict in advance what dose will be needed. There are a lot of variables. And it is difficult to calculate with any degree of accuracy "the rise that will occur throughout the day in response to food, activity, stress, and the previous dose wearing off".

With experience gained through data collection it does become easier to predict what may happen with any insulin shot (fixed dose or sliding scale), but life can still be unpredictable...
.
 
Believe me, in human diabetic care, this culture change away from giving reactive doses, and also towards giving insulin at normal blood sugars is a HUGE shift. Nurses who for years would be instructed to hold under a certain BS are terrified to give insulin, and doctors still can't get away from sliding scale, even though all current nursing home and hospital guidelines do not even include sliding scale. In fact, nursing homes can even get quality of care citations for sliding scale since is so far from the current recommendations.

My comments weren't directed at any individual's regimen, but rather for those interested in the current information regarding the subject. In addition, humans have much more at their disposal than cats in the way of medications and treatments (orals, different insulins), that are not safe or don't really work well in cats. Again, I wish there was much more research in animals.
 
I have never heard of this type of approach used in cats on ProZinc/PZI.. While I am certainly not a vet, I have helped hundreds of diabetic cats and their owners over the past 10 years on this forum. My basic premise is that Every Cat is Different. And some ProZinc/PZI cats have done amazingly well with a sliding scale; some seem to do well with a stable dose.

The suggestion that a no shot cutoff could be very low is a dangerous premise, it seems to me. A tried and, I think, true tenet to follow is to not give more insulin until you are sure the bg level is rising, not falling. With ProZinc, the insulin can certainly be given in shorter intervals than every 12 hours, but I would suggest only after it is determined the cat is not responding well to BID cycles, after careful and frequent monitoring, and certainly not with a cat whose levels may be influenced by infection, antibiotics and inappetite.

I don't know how well human studies ever correlate to feline diabetes.

If your comments are not directed to this bean's cat, perhaps this topic might be better in the Think Tank Forum?
 
Poncho's BG this evening was 337. His sinus congestion is gone and appetite stimulated so hopefully his am number is in range and he keeps going forward. He's got a lot of weight/strength to gain back. And I need a good night's sleep!
 
I'm so glad that Poncho's sinus congestion has cleared up. Fingers and paws crossed that he'll eat well and regain his strength quickly. You've done a terrific job nursing him through this, Chris.

Sending more :bighug: and scritches. :)
 
Strange....8pm pre-shot BG was 550. I did feed him recently but stopped just before 6pm. Could his system be slow and that last feeding influenced the reading even though 2 hrs had passed? I was expecting a good number. His +7 hr reading was around 220 at the vets.
 
Did you take another test? It's a good idea when you get a number you don't expect. If the number is accurate, then my only idea is that he dropped low today and bounced up. Don't get too worried about one number or one cycle. He seems to be responding well so far.
 
I didn't test again. Should I test again soon since I gave him 1 unit? If he was in the 200s I might have given too much insulin. I fed him 20ml hills AD right after the shot.
 
AM BG 246 Last night BG was accurate as I tested again +4. His buprenorphine 3 day injection wore off yesterday so that might have caused the spike. Last week the vet didn't think he was in pain and I'm not sure but something is making him feel down....unless it's the cyproheptadine's sedating him. Anyway I went back to get him some more pain meds today. How long does it take for the pancreas to heal to the point of no pain? She also said he probably wont regain most of the weight he lost.....so he will be skin and bones from now on.
 
Interesting that he is lower at amps and during the day. Wonder if he is asleep and in less pain at night? I certainly like your idea of more pain meds. I can't remember if pancreas is part of the picture or if it is the infection?

It may help to remember our ECID byword. Every cat is different. There may be some cats who do not regain weight due to complicating factors, but most cats I have seen did recover the weight, once they were eating regularly and in regulated numbers. I wouldn't give up.
 
Yes, he was diagnosed with pancreatitis and all the while the URI was growing the vets disregarded it until it was full blown and Poncho's pancreatitis was worse, then they tried to do a curve twice with disastrous effects sending him into hypo territory each time. Anyway, I don't plan to give up, however, due to my small disability pension I and pets are moving into a small travel trailer at the end of March and towing it to AZ and live on BLM land (long term). We were due to make the move the end of Jan (actually the end of almost each month this past year) when Poncho got sick. Now most of my $afety net is gone and I have no other option and one last small window of opportunity coming up fast. I pray Poncho is stable by then but at least I will have extra money for continued vet care where we are going since I wont be paying rent/utilities etc. I've told the vet this so she knows she can't be casually trying this and that to get him better. I should have a vet lined up there before we go. We all made the same trip 3 yrs ago (to test the water) and Poncho handled it very well. With all the trips to the vet lately he'll be primed for this trip.
 
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I'm so sorry, Chris, that Poncho's troubles have come at such a difficult time for you personally. You've learned a lot about how to best care for him, in a short amount of time. Unfortunately you have hit the trifecta, in a bad way, with diabetes, pancreatitis and an infection. You can find lots of help with and information about them all, here. You might start a new topic about pancreatitis + diabetes + infection and get some information and resources. I know you have seen the Pancreatitis thread, but there is more info around. Once you have the meds for the pancreatitis and know how to treat it, the diabetes may seem like the easy part. I hope his infection is not back. Maybe ask a question about the antibiotic you're getting for that in the new thread and see what people think.
 
Hi Chris,

Wow! That's a big change ye have ahead. My best wishes for a safe and smooth journey.

Unless there is something else major in play, I'd be inclined to nod sweetly at the vet and wait to see what happens with Poncho's weight now he's eating better. When Saoirse was first Dx'd I was told it may be a challenge to keep weight off Saoirse while she was on insulin. That might have been the diagnosing vet's experience of cats on the Hills w/d Dry that she prescribed for Saoirse, but since changing Saoirse to wet, low carb food and buying a digital baby scales I've not had any problems keeping her weight stable (and she has more to eat than the kitty cornflakes she was prescribed). If she starts gaining or dropping I make minor adjustments to the amount I feed her.

Couple of questions for you:

1. What colour are Poncho's stools. Is there any difference between the outside colour and the inside colour?

2. Are his stools whiffy at all? If so, how bad? Are they well-formed / soft / loose / "fluffy"?

3. What dose of cypro is he on and what does he weigh?
.
 
Sue and Oliver (GA) said:
I'm so sorry, Chris, that Poncho's troubles have come at such a difficult time for you personally. You've learned a lot about how to best care for him, in a short amount of time. Unfortunately you have hit the trifecta, in a bad way, with diabetes, pancreatitis and an infection. You can find lots of help with and information about them all, here. You might start a new topic about pancreatitis + diabetes + infection and get some information and resources. I know you have seen the Pancreatitis thread, but there is more info around. Once you have the meds for the pancreatitis and know how to treat it, the diabetes may seem like the easy part. I hope his infection is not back. Maybe ask a question about the antibiotic you're getting for that in the new thread and see what people think.
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Sue, it looks like the antibiotic he's on has beaten it back but it still lingers. His sense of smell and nasal breathing are good for a change, hence his appetite getting better (the cypro is helping too), but I think he's been having some pain issues and the vet is going to have to find a cheaper way for me to deal with it. I think the pancreatitis is the main event now and besides the buprenorphine, cypro, and ondansetron I'm giving 75ml twice daily of potassium infused sub q fluids. He gets 80ml-105 ml of food (his weight was 5.5lbs Tues.)......mostly Hills ad and some Fancy Feast Classic. His weight before this was 10lbs. Poor thing is really trying hard. He had the oral buprenorphine yesterday and then I gave another dose today @ 5pm. His 8pm BG was 563 after 8am BG 185, so I guess I'm convinced now he's having some pain.
 
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Critter Mom said:
Hi Chris,

Wow! That's a big change ye have ahead. My best wishes for a safe and smooth journey.

Unless there is something else major in play, I'd be inclined to nod sweetly at the vet and wait to see what happens with Poncho's weight now he's eating better. When Saoirse was first Dx'd I was told it may be a challenge to keep weight off Saoirse while she was on insulin. That might have been the diagnosing vet's experience of cats on the Hills w/d Dry that she prescribed for Saoirse, but since changing Saoirse to wet, low carb food and buying a digital baby scales I've not had any problems keeping her weight stable (and she has more to eat than the kitty cornflakes she was prescribed). If she starts gaining or dropping I make minor adjustments to the amount I feed her.

Couple of questions for you:

1. What colour are Poncho's stools. Is there any difference between the outside colour and the inside colour?

2. Are his stools whiffy at all? If so, how bad? Are they well-formed / soft / loose / "fluffy"?

3. What dose of cypro is he on and what does he weigh?
.
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Aine, Poncho's on 2 mg cypro daily and he weighs about 5.5lbs. The vet said 4mg if needed. I think it's having a sedative effect on him. I read where it takes a few days for the appetite stimulus effects to kick in. His stools are well formed, firm and a sort of caramel color, color of his food, on the outside and inside, and the smell isn't strong. Thank you for the well wishes regarding my trip/transition. This is something I've actually been wanting to do for a long time.....live a nomadic life surrounded by nature, but now I have no choice given today's cost of living. I'll be able to save "a lot"of money.
 
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Glad to hear that Poncho's poops are OK. That's good.

Saoirse weights 10lbs on average. She did great on 1/8 of a 4g tablet twice a day initially. It did take a little while for the effect to build up. Gradually the appetite stimulant effect of the 1/8 - or even less - of a tablet lasted longer and longer (and seemed to have some synergy with the ondansetron). Over time, I was able to drop the cypro and maintain Saoirse on the ondansetron.

Isn't it terrifying how much it costs just to survive nowadays, Chris! The further away from nature western society gets, the more uneasy I feel. I hope that your new path, far from the madding crowd, brings you great contentment of spirit. :)

:bighug:
 
Thanks Aine. Poncho used to weigh over 10lbs so he has a long way to go to get back there from 5.6 lbs. He's so skinny and frail looking I have a hard time being optimistic.....and I'm starting to wonder if the present vet is stringing us along so she can make the most money out of it. One would think Poncho would be close to getting these hard BG swings tempered. I think part of it is pain.....but I thought a cat will not want to eat if in enough pain to cause a BG rise. I can't afford much more of this Bupren. stuff so will ask the vet for a cheaper pain med.

I never had a problem affording rent until the greed of the '90s set in. Also heating was more affordable. I think this movement away from nature and the spiritual side is about to backlash in a big way and I hope I'm settled into the new lifestyle by then and far away from the city. You might enjoy browsing a website which covers the nomadic (full time RVing) life....CheapRVliving.com. It has a wealth of info which would come in handy if there was a power grid collapse. I'd like to eventually be solar power dependent.
 
Given the occasional very high numbers I was worried about ketones so tested today....None, thank God! We go to the vet again today for BG check/check up. I'm getting to the point where I feel I only need a vet for supportive meds/fluids, but need to even the am/pm numbers.
 
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