Regulating Angel - very high numbers

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Bobbi & Angel

Bobbi & Angel

Member Since 2016
Angel is a newly diagnosed 16 year old cat eating k/d dry food for the time being because she is also dealing with possible kidney disease. Her appetite is still returning so I am not going to switch her food over just yet.

Her test this morning came back as "HI" which on my meter means over 600. I am assuming this is because she ate pretty much exclusively the k/d dry yesterday and it's high carb. I know she should be eating low carb food, but this is what she will eat right now and what the vet told me to feed her.

Her dose last night was 1 unit of Humulin, even though her preshot number was high last night as well (499). We had just gotten back from the vet so I didn't want to mess around with her dose.

I think I need to up her dose, but I'm not sure by how much. I will be able to stop in at lunch (+5) and then I'm home form work at +8/9.

Should I do 1.5 units or 2 units? What is a safe amount to jump?
 
I asked for the supplies to give fluids at home and he gave them to me. He wanted to do blood work, but we have an appointment to do that Saturday, so I told him we would wait.

He said he is very puzzled by Angel's condition because she seems to be showing pretty extreme symptoms for both kidney disease and diabetes based on bloodwork, but her clinical symptoms don't match up.

I am going to do the fluids every other day.
 
I'm going to do the 1.5 units now and then if she's still very high tonight, I can do 2 units? I'm not sure how much of a jump is a safe jump (in dosage).
 
Glad you got the fluids. That will help her a lot. One thing you may check into is start adding a phosphorus binder to her food. That way you can give her a wet food she likes, but the binder will make it a low Phos food. I'm checking into that now for Colin, because he doesn't care for the expensive low P foods either but loves the hi p Fancy Feast!
I think that's a good dose. Hopefully Sue will be here to give you dosing ideas for tonight and the future. Please try to get that lunch time test too.
 
Ok. What Fancy Feast foods do you feed Colin?
I jut put the Wellness Turkey in front of Angel and she wanted nothing to do with it, so I offered the k/d dry and she immediately ate some. She's very picky. For now, I just want her to eat. Once she's back to eating normally, I will try to transition to better food.
 
I just tried that trick of putting Angel's Pepcid pill in some cheese and she gobbled it right up!!! I'm so happy! Giving her pills is always the worst part of all this. I can't believe that worked!
 
Yea for easy pilling!!!
I agree she needs to eat. When I find out more about the binders, I'll let you know. I give Colin Fancy Feast ClassicTurkey for breakfast and Wellness Turkey or Wellness Core for dinner.
 
Ok. I tried reading about the binders, but there were so many, I got a little confused. When we get Angel's bloodwork again this weekend, I will ask the vet about it.
 
Hi there Bobbi, and sorry about Angel having two conditions. You are probably doing the best to just get Angel to eat and you can worry about transitioning later. Sharon's suggestion of the Phos binder is a good one so that you can use lower carb wet food that she will eat.

As far as increasing doses, we suggest increasing in .25 unit increments so you don't go over the right dose. I am not real familiar with Humulin. Are you using U40 syringes?
 
Bobbie And Bubba said:
Hi there Bobbi, and sorry about Angel having two conditions. You are probably doing the best to just get Angel to eat and you can worry about transitioning later. Sharon's suggestion of the Phos binder is a good one so that you can use lower carb wet food that she will eat.

As far as increasing doses, we suggest increasing in .25 unit increments so you don't go over the right dose. I am not real familiar with Humulin. Are you using U40 syringes?
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No, U100.
 
Oh good. Where the nice blues you got when she wasn't eating well? I see you shot the 1.5 so glad you can get a test in during your lunch hour.
 
When you try to transition her to wet food you can try grinding up some of the dry a small amount and then sprinkle on top of her wet food. When she starts eating the wet, her numbers could go down a lot! So do it when you can monitor her carefully. Then the dose might have to be adjusted down.
 
Sharon14 said:
Just found a chart that has K/D dry listed as 43 carbs! The wet is 23, so that would explain the high readings you're getting.
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I agree. The dry KD is probably a big part of the higher levels. I would be careful increasing the insulin until you can get some numbers in the middle of the cycle. If she is dropping midcycle into good numbers, you don't want to increase the dose and push those numbers into levels too low. Also fluids can lower levels, another reason to be careful with any increases.

So, I'd work on increasing wet and decreasing dry. Some ideas are to put tuna juice on top of the wet, adding Parmesan cheese to the wet (I know, it sounds crazy) and add warm water to make a gravy. Maybe offer the wet first and then if she won't eat enough, offer some of the dry.

When you can, get some numbers 4/5 hours after the shot.

And yes, the binder sounds like a plan.
 
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My non sugar kitty is a dry food addict. What has been working with her is I put a little bit of dry down and put wet next to it (different bowls). After eating one or two pieces dry she then eats the wet and then goes back to the dry. It appears she needs the option. If I put only wet down she won't touch it.
 
At +5, she was at 227. I just did her pmps and it was 263. What should I do for tonight?

I will work on the wet food, but she's only just started eating more and I don't want to mess that up so soon.
 
I'd be cautious. The wet food she will eat and the fluids can both cause levels to drop.
0.5 may be too little but could be fine and you could sleep tonight.
 
Okay, thanks.
I'm still leaving the dry out for her, she really only takes a few bites of wet food, and I want to make sure she's actually eating. The vet told me to do 100ml of fluids every other day (so tomorrow, not today).
 
Is she eating good? Will you be able to get a mid cycle test again today? I would think 1 would be ok. I know a lot depends on how and what she's eating, but maybe ask Sue for a scale you can use to determine dosage. Sorry I'm not more help, I just don't know your insulin. How is she feeling today?
 
She has been much more lively since her last trip to the vet (Tuesday) when she had fluids. I'm going to try to do fluids tonight (I hate giving fluids ah!!). She's eating a lot more, but it's mostly the k/d dry, so I guess that's why her sugar levels are super high.

I was thinking to try 1 unit this morning and then get the +5 test again, hopefully. Then tonight maybe I will try 1 unit again just to see what her number ends up being tomorrow morning.
 
Did you get a test last night before bed to see what the .5 was doing? I think it will be fine especially since you can test and she's eating the dry. The 1.5 dropped her 400 points which is a really steep drop in such a short time. I don't know but it seems like that could make you feel funky. Do you leave food out for her during the day?
 
The one unit may be okay but the fluids can lower the levels. I 'd consider one unit if you can get an early number and one mid cycle and if you'll be around after the fluids
 
Timing should not make a difference. However, keep the insulin injection site away from the subQ injection site. If too close the insulin will likely have less effect but for a longer time since it might be diluted by the subQ fluids
 
Larry and Kitties said:
Timing should not make a difference. However, keep the insulin injection site away from the subQ injection site. If too close the insulin will likely have less effect but for a longer time since it might be diluted by the subQ fluids
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By keep the injection sites apart, do you mean I should do the insulin in a completely different spot? Like not near her shoulder area?
 
Okay, thanks. She definitely does not like the fluids, but she stayed in one spot for the whole time (mostly). The needle seems huge compared to the last time I did subq fluids, but maybe I've just gotten used to how tiny the insulin needles are.
 
This morning, Angel's amps was 532. Should I do 1 unit again or try for a little more than 1 unit? I will be at work most of the day, but can come home around +5. (My syringes are only marked in 1 unit increments so estimating anything smaller than .5 units is kind of difficult.)

If someone knows what sort of numbers I should be looking for at different times in the cycle, that would be helpful. With the high carb food she's eating, her numbers are very high.

Also, are mid-cycle numbers affected by Angel's food intake?
 
I did my best to do just a little more than 1 unit. I will be able to try a higher dose tonight, like 1.5 or a little less than 1.5, since I will be home and can stay up.

I will have to get some different syringes...are there any U100 syringes that have smaller increments? Like maybe .5 units instead of by 1 unit increments. I had a prescription for the syringes I have now, is it possible to buy them without a prescription?
 
I think regulations are different in each state, but most can buy syringes with out a script. I get the Relion from Walmart.
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Is your insulin U40 or U100? If U100, the syringes Sharon showed you are fine. If U40, you can use them but you must use a conversion chart, as you'd be using U40 insulin with U100 syringes.

One unit sounds good for today. It will be good to see if the subq fluids bring her numbers down (it often does). If so, you can adjust the dose for cycles with and without fluids. She had lower numbers when she wasn't eating well. If she is eating better, that is good, but the high carb food will keep her numbers higher and we'll have to adjust the dose to compensate.

In general, we look for regulation first. So, with a human meter, a preshot in the mid/lower 200s and a nadir in the low 100s or double digits (but not below 50) is the first goal. Then you fine tune. We consider a cat in tremission if they range from 40-120 for two weeks, off insulin.
 
Ok. Today Angel's +5 was 136. I'm not sure if this is her nadir, but from the one day I was able to do testing all day, it seemed to be lowest at +5 and the data the vet got doesn't contradict this.

Her preshot was 442, but I'm pretty sure she ate a little while before the test. I will try 1 unit again tonight and see what happens tomorrow morning.

We have a vet appointment tomorrow for blood work to see how her kidney values are. She seems to be doing better based on her appetite and energy levels. Once she seems to have recovered fully, I will try to switch her food. I am supposed to be getting some samples of the Young Again food, so maybe we can switch to that...
 
Went to the vet today. They rechecked her blood work and her kidney values are down a bit. I put them on Angel's spreadsheet, I think all the pages get shared, right?

We are continuing with the fluids every other day (2-3 times a week as needed) and we talked about at-home monitoring. He was very supportive. I'm glad we were able to see a different vet, rather than the first one who did not seem interested in the at-home glucose testing.

Thanks everyone for your help. It helped me a lot to be so informed today when I met with the vet.
 
She seems to be doing well, although her pmps was lower than usual the last two days. I'm just going to give 0.5 units.

She is due for her 3x weekly fluids today (I am doing Tuesday, Thursday, Saturday). She doesn't seem too dehydrated, should I do the fluids anyways? I'm not sure if I should just stick to the schedule or not.
 
Hi Bobbi, glad Angel is doing well. I wouldn't think it would hurt to give the fluids , but if you don't think she needs them, maybe skip and try tomorrow. I hope someone else chimes in on that though. @Sue and Oliver (GA) ?
 
Sharon14 said:
One thing you may check into is start adding a phosphorus binder to her food. That way you can give her a wet food she likes, but the binder will make it a low Phos food.
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Yes, please talk to your vet before giving a phosphorus binder. I'm not sure a phos level of 2.9 is considered high enough to use a phos binder. Discuss with your vet and check out Tanya's Comprehensive Guide to Chronic Kidney Disease as well.

Bobbi & Angel said:
She doesn't seem too dehydrated, should I do the fluids anyways? I'm not sure if I should just stick to the schedule or not.
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Whenever I wasn't sure about whether I should administer fluids as often as directed, I called my vet. If it was after hours I either gave a reduced amount or skipped and then called my vet the next day to ask. :)
 
We skipped two days of fluids because Angel has been pretty well hydrated and its very difficult to give her fluids at all.

We tried today and got the needle in with no trouble. The fluid was warmed. But as soon as the fluid starting flowing, she freaked out as usual and starting hissing and growling (she's normally a pretty calm cat). We didn't manage to hold her down well enough and the needle came out.

I know she's supposed to get these fluids, but at this point, I am having a hard time justifying traumatizing her so much. She hides for hours after we do the fluids. Last time, it was at least half a day and even then, she's been giving me trouble over doing the insulin ever since.
 
Is she eating and drinking well? If she's well hydrated, you can skip. Just keep an eye out and try to stay ahead of any dehydration.
 
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