? Please advise - to shoot or not too shoot

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I have been thinking on this. Here are what I see as the issues.

Prolonged period of high insulin doses, blood sugar drops too low causing bouncing.
Liver glycogen stores probably depleted resulting in hypo numbers.
Transitioning to low carb food.
Running out of testing supplies.
Not able to monitor full day tomorrow.

What do you think of the following plan?

Stop insulin for 24 hours.
Check pre meal and +2 numbers tonight and tomorrow if possible.
Feed only low carb food - quick transition whilst off insulin and helps to replenish the liver stores.
Only restart insulin when you can monitor the cycle - say tomorrow evening? Post the number first for dosing advice - it is possible to do 0.5 units by eyeballing so the end of the plunger is halfway between the two marks on the syringe.

She will likely have a high number this evening - or may have another blue number, either way no insulin, same tomorrow morning.

It may be Murinka is heading for remission but I think she needs a short break and to reassess her numbers on the low carb food. Some cats just need intermittent dosing at that point, others come off insulin just from the switch. As she has not had ketones I think she will manage.

@Elizabeth and Bertie @Diana&Tom what do you think?
 
I'm not the expert you and Eliz are, Alexi, but your suggestions look very sensible to me. No insulin for 24 hours and then re-starting on 0.5u (if pre-shot number requires it of course) with other factors such as food remaining constant.
So yes - great plan!
 
Thank you Alexi, that sounds like a plan.

So if I shot her tomorrow evening (after posting her number and I should be ready to monitor her during the nigh right? I might manage to have home office on Tuesday and stay with her home to keep an eye on her also on Tuesday if necessary.
This evening is clear.
Tomorrow morning I will test her pre-meal but Im not able to test +2 after meal the earliest at +5 unless I feed her at 6AM, I have to leave at 8 AM - would that be useful anyway to test tomorrow morning like this?
Tomorrow evening I test pre-meal and post the number and will wait for your advice as for the dose.

The hardest think would be to explain to my vet, that I cut off insulin for 24 hours and that I decreased the dose dramatically ... I will try to manage to have an appointment with him tomorrow during the day and I will print him out her spreadsheet and will try to explain him why I did that ... and will also tell him of FDMB but Im pessimistic about his reaction - I expect something like: aha ... you were googling ... I sense it's not going to be a pleasant conversation but maybe Im wrong and he will like the information.

Thank you all and sorry for my English, it's not obvious to communicate about diabetes in English and my head is aching like hell after this bloody day. So thank you once again for being here.

Hln
 
Helena, many of us have been in the situation of having to explain to our vet that we disagree with them. Sadly, vets have very little training on FD whereas the experience of people on this board from all over the world speaks for itself. You could give your vet this website address and defy them - in a nice way - to think otherwise!
You could also lay it on the line and simply say that Murinka is your responsibility and you want the very best for her so naturally you are going to inform yourself as best you can. If he really doesn't like it look for another vet.
 
Precisely this forum is the proof that the world is full of vet not knowing much about FD.

I want to sit with him and tell him that during my 10 day holiday I read hours and hours about feline diabetes and that I came to a conclusion that I want to try something that worked for other cats - switching to the low carb food etc etc ... if he disagrees and will be upset then I will look for another one but hopefully he will understand and will find it useful to his practice as well. Will see, he's a very self confident guy but on the other hand over our telephone consultations he acknowledged that I started understand how this disease work :) so maybe he'll take it seriously and not like "something I found on the internet".
 
@Helena & Murinka if you can feed at 6am and get a +2 in the morning that would be really helpful as we need to make a judgement how much of her own insulin Murinka is making to work out the dose - the only slight problem is that I have to be away all day tomorrow as I need to take Cappuccino to the specialist for all day testing (more about all that later) and may not be back by your pm shot time but I will do my best. Otherwise I will review her spreadsheet tomorrow morning and see if I can come up with a dose. No more dry food please.
 
The other thing for the vet to remember is that cats are not machines (!) and therefore they will not always respond to the "theory" that vets might want to apply. We have a phrase here that you will see time and time again - every cat is different (ECID) - meaning that what works for one cat may not work for another. Added to that, how any one cat responds to a certain dose of insulin on one day may be different to the way he/she responds on another day. FD is not an exact science - learn the basic principles but don't expect the results to be always what you expect!

You probably know a lot more about FD now than your vet does.

The other thing to bear in mind is that vets nearly always recommend dry food because they are visited by sales reps from the manufacturers, who may pay vets a commission on sales (I don't know this but am guessing). Food companies may also supply vet practices with all kinds of pet health information leaflets, etc etc which the vets no doubt accept gratefully. All this does NOT mean that dry food is best - not only for diabetic animals, but others come to that. Ask your vet how many animals in the wild he can name that eat dry biscuits...?
 
Alexi said:
@Helena & Murinka if you can feed at 6am and get a +2 in the morning that would be really helpful as we need to make a judgement how much of her own insulin Murinka is making to work out the dose - the only slight problem is that I have to be away all day tomorrow as I need to take Cappuccino to the specialist for all day testing (more about all that later) and may not be back by your pm shot time but I will do my best. Otherwise I will review her spreadsheet tomorrow morning and see if I can come up with a dose. No more dry food please.
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Thank you Alexi. I really deeply appreciate your effort and others of helping me and Murinka. FIngers crossed for your tomorrow testing!

I'll set the alarm and will feed her and test her so that we know how it works.

She was now at 15.8, I will test her in 2 hours and will put it in the SS. No more dry food :)
 
When I first joined the board other people helped me, so we just pay it forwards, one day you will be doing the same. We all want to improve the care of diabetic cats and spread the word that once you know what you are doing it isn't so difficult. I don't have to be back at work for another week so we have time to get Murinka and you settled into a regime that works for both of you.
 
Alexi said:
@Helena & Murinka if you can feed at 6am and get a +2 in the morning that would be really helpful as we need to make a judgement how much of her own insulin Murinka is making to work out the dose - the only slight problem is that I have to be away all day tomorrow as I need to take Cappuccino to the specialist for all day testing (more about all that later) and may not be back by your pm shot time but I will do my best. Otherwise I will review her spreadsheet tomorrow morning and see if I can come up with a dose. No more dry food please.
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Good morning Alexi,

here are Murinka numbers (in the SS as well) - as agreed she hadn´t any insulin yesterday evening and this morning, I only fed her and tested her before meal and +2 after meal and this is quite interesting:

yesterday evening: before meal (at 8 PM) 15.8
+2 h after meal 12.7
today morning: before meal (at 6 AM) 14.3
+2h after meal 13,1

Curious to hear what do you think about it ... and fingers crossed for the testing.
Best, Helena
 
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Those are good numbers, and what I was hoping for. If she is in a yellow number or above at PMPS then if you can monitor this evening you could try 0.5 units, if a blue number then no insulin. As you don't have syringes with the 0.5 unit markings you will need to eyeball it. You will also need to check at +2, you are looking for a small drop in the numbers. If 0.5 units proves too much then there is a way of giving smaller doses using u100 syringes (Caninsulin is u40 insulin) which have an orange top usually, if you are able to get some today we can explain what to do. @Elizabeth and Bertie I will check in as soon as I am home but not sure what time that will be so if you can keep an eye out just in case Helena needs more help.
 
Elizabeth and Bertie said:
Okey dokey, Alexi. Will do.

Helena, @Helena & Murinka what times do you usually give insulin shots? (I think I need to deduct an hour from that to get UK time.)

Eliz
.
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Dear both, thank you, again :)

I usually give insuline at 8 PM which is 7 PM UK time.

I have to say that Im totally confused - how come her numbers droped after the meal without insuline? should´t they rise up after eating?
I would also be very grateful for advice re the timing of feeding and shoting. Up to now as suggested by the vet, I tested her, shoot her and sometime after (half an hour, one hour) give her food, is that correcte?
 
Helena & Murinka said:
I have to say that Im totally confused - how come her numbers droped after the meal without insuline? should´t they rise up after eating?
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Murinka's numbers are looking very nice, Helena.

There are a couple of reasons why her numbers may be dropping: The switch to just low carb food will help to lower the numbers. And it may well be that her body is producing insulin of it's own...

Helena & Murinka said:
I would also be very grateful for advice re the timing of feeding and shoting. Up to now as suggested by the vet, I tested her, shoot her and sometime after (half an hour, one hour) give her food, is that correcte?
Click to expand...
With Caninsulin it is usually advised that the cat is fed some time (20 - 30 mins) before being given the insulin shot.
That is because Caninsulin can start to work very quickly in the cat's body, and can drop the blood glucose very fast in some cats. Therefore it is good to have food 'on board' for when the insulin really starts to work.
So, the usual sequence here is: Test, Feed, Shoot.

Eliz
 
Elizabeth and Bertie said:
Murinka's numbers are looking very nice, Helena.

There are a couple of reasons why her numbers may be dropping: The switch to just low carb food will help to lower the numbers. And it may well be that her body is producing insulin of it's own...


With Caninsulin it is usually advised that the cat is fed some time (20 - 30 mins) before being given the insulin shot.
That is because Caninsulin can start to work very quickly in the cat's body, and can drop the blood glucose very fast in some cats. Therefore it is good to have food 'on board' for when the insulin really starts to work.
So, the usual sequence here is: Test, Feed, Shoot.

Eliz
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Im so confused - the vet told me to wait so that her number drops and thus she feels more hungry and eats enough for the dose ...
Anyway I made an appointment with the vet this PM at 17.45, I will print it out her SS and will present him what Id like to do - either with him or without him. Im quite nervous. I also want him to thank him that he beleived I can manage it and that he told me I must test because without testing and with these doses she would be dead by now. it makes me shaking...
 
Helena & Murinka said:
Im so confused - the vet told me to wait so that her number drops and thus she feels more hungry and eats enough for the dose ...
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There are just 'different opinions' out there, Helena... But our experience is that a cat should usually eat before being given insulin. And this is especially true of the faster-acting insulins like Caninsulin.

As I said previously, with Caninsulin it's good for the cat to eat a little while before being given insulin, so that there is food 'on board' for when the insulin starts to work (Caninsulin starts to work quite quickly after being injected).
But there is another very good reason for feeding the cat before giving the insulin shot, and that is that you do not know for sure that the cat will want to eat later... And what we really don't want is to have given insulin and then find out that the cat won't eat.... :nailbiting:

I know it's hard when our vet says one thing and 'strangers on the internet' say something else... Many of us have been faced with that same contradiction.... But there really is a lot of experience in this group...

You have seen yourself that it is very useful to test blood glucose at home. :cat:

I would think your vet may be pleased to see Murinka's progess? I do hope so. You're doing really well. :bighug::bighug::bighug:

Eliz
 
Elizabeth and Bertie said:
There are just 'different opinions' out there, Helena... But our experience is that a cat should usually eat before being given insulin. And this is especially true of the faster-acting insulins like Caninsulin.

As I said previously, with Caninsulin it's good for the cat to eat a little while before being given insulin, so that there is food 'on board' for when the insulin starts to work (Caninsulin starts to work quite quickly after being injected).
But there is another very good reason for feeding the cat before giving the insulin shot, and that is that you do not know for sure that the cat will want to eat later... And what we really don't want is to have given insulin and then find out that the cat won't eat.... :nailbiting:

I know it's hard when our vet says one thing and 'strangers on the internet' say something else... Many of us have been faced with that same contradiction.... But there really is a lot of experience in this group...

You have seen yourself that it is very useful to test blood glucose at home. :cat:

I would think your vet may be pleased to see Murinka's progess? I do hope so. You're doing really well. :bighug::bighug::bighug:

Eliz
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With all I read here I trust you more than him and I really value your experience! ... But Id like to have him on board as well. I think her SS speaks also for itself,

And for the food, it actually happenned couple of times, I gave her insuline and then she didnt eat enough and I was trying to force her somehow ... stress ...
 
Elizabeth and Bertie said:
There are just 'different opinions' out there, Helena... But our experience is that a cat should usually eat before being given insulin. And this is especially true of the faster-acting insulins like Caninsulin.

As I said previously, with Caninsulin it's good for the cat to eat a little while before being given insulin, so that there is food 'on board' for when the insulin starts to work (Caninsulin starts to work quite quickly after being injected).
But there is another very good reason for feeding the cat before giving the insulin shot, and that is that you do not know for sure that the cat will want to eat later... And what we really don't want is to have given insulin and then find out that the cat won't eat.... :nailbiting:

I know it's hard when our vet says one thing and 'strangers on the internet' say something else... Many of us have been faced with that same contradiction.... But there really is a lot of experience in this group...

You have seen yourself that it is very useful to test blood glucose at home. :cat:

I would think your vet may be pleased to see Murinka's progess? I do hope so. You're doing really well. :bighug::bighug::bighug:

Eliz
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I just got back from the vet where I showed him Murinka´s spreadsheet, explained him what happened, about the low carb food diet ... I told him everything openly, he appreciated it but he said that Murinka is not his patient anymore, that she stopped being his patient the moment when I started playing with the dosing.
That I have to regulate her not to change her diet nor her dosing, I try to argue with her numbers and he replied that they don´t say anything anymore because it´s all waisted by my gamble. He tried also to insinuate that I like this gambling and that´s why Im doing it but he wants her to be regulated which is now impossible..

It was calm conversation but arrogant in a way. He said he saw masses people like me, layperson, playing with the dosingthat ended up by glucose bouncing (but what he did with his massive dose?!) and that he´s not interested anymore to hear about Murinka and that he also can´t give me anymore insuline ... well, at least things are clear now. I have to look for another vet ... I have 3/4 of one Caninsulin vial and hopefully I´ll find someone who´ll be willing to listen.

Sorry for this long story but I simply couldn´t share it whith those strangers from the internet that are here to help me to get out of it! Thank you!
 
I'm so sorry to hear your vet's response, Helena. That must have been upsetting for you. Perhaps what it shows is that he is out of his depth here and doesn't really understand what you've been trying to do.
So - yes, find a new vet. Are there some in your area that you can ring around and ask over the phone if they have any staff with a special interest in feline diabetes? Or if not, explain your situation and say you are interested in working WITH someone who will take into account your learning on the subject.
Keep smiling Helena and keep posting!
Diana
 
Oh Helena :bighug::bighug::bighug:

I am so sorry to hear your vet does not want to work with you but here is my experience. Today Cappuccino and I have been to see a specialist, someone who is an expert in feline diabetes, and they already had printed out Cappuccino's spreadsheet before I got there and we talked about what had happened when and why, and what I was doing with her food and insulin, and so on. She has made good progress since her last set of tests and they thought the spreadsheet was wonderful. So vets who really understand feline diabetes are impressed with all the testing and so on. You live in the city so there must be many other vets, here is the link to the vet interview topics to help you to choose another vet http://www.felinediabetes.com/FDMB/threads/vet-interview-topics.156663/

In the meantime we will keep helping you through this. :bighug::bighug::bighug:
 
:bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug:

Thank you!
I was expecting he´s not going to agree, but I wanted to be open with him and tell him everything and not to be pretending that I am giving Murinka what he suggested. I was thinking he could be curious to find out whether it will work or not but he kept saying - Im not interested anymore... I have already started looking for another one. It´s just sad....

but back to the most important think
I tested her now and she´s 19,6, I gave her one Sheba pouch and will give her 1/2 as agreed okay?
 
(((Helena))), I am SO sorry that you've had this experience with your vet...
But please do not let that make you doubt all that you have achieved. You are doing really well! :bighug::bighug::bighug:

OK, your current vet will not give you more insulin. But you have enough for now?
And do you have test strips?

Huge hugs,

Eliz
 
Yes, I have new strips - 50 :) I picked them today but then discovered I ordred a wrong type not compatible with my glucometre but I found a pharmacy where they got them. So yes I have enough of them ...

And thank you for your nice word and support!
 
Great - so if you can do a +2 test we can see how this dose works for Murinka with her low carb food.
 
Dear @Alexi @Elizabeth and Bertie,

Murinka is 9,7 at +2 after shot!

I gave her something like 0.5 unit of Insulin (with U40 it´s not evident to eyeball 1/2 unit...) and I can´t beleive how much she dropped, should I test her also + 4? just to be sure? and how about tomorrow morning?
(sorry for all those questions...) hugs and thanks
 
Helena, can you give Murinka a snack of her low carb food? That may slow down the drop.
And, if possible, I'd suggest you test at +3, as we do want that drop to slow down....
 
1.0 on the u100 is 0.4 units which is near enough. Murinka does need some insulin but it looks as though she is producing some of her own as well.
 
She is very insulin sensitive, we need to try to keep her in safe numbers for at least the next couple of hours. Is she hungry still? If so can you give her a little of the higher carb food and keep monitoring?
 
Alexi said:
She is very insulin sensitive, we need to try to keep her in safe numbers for at least the next couple of hours. Is she hungry still? If so can you give her a little of the higher carb food and keep monitoring?
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Okay, I think she will be willing to eat something more but I haven´t thought of bying some wet with higher carb, I wouldn´t have expected that with 0,5 she would go that down - I have Gourmet Gold Pate which is slighty higher than the pouch she had.

It looks like it will be a long night :)
 
Do you still have dry? Gravy type foods are higher carb and you can just give the gravy.
 
Alexi said:
Yes some of the dry, and keep monitoring.
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done, I will keep an eye on her. I think I will manage until safe numbers ... you also should get some sleep after this demanding day. but tell me please what should I do tomorrow?

It would be maybe better I stay home? I can manage to have home office, otherwise Im gone for the whole day.
 
I'm not going to sleep yet, I have 94% humidity so waiting until it cools down a bit! I am wondering if it's best to not give insulin in the morning again and see what she does.
 
Alexi said:
I'm not going to sleep yet, I have 94% humidity so waiting until it cools down a bit! I am wondering if it's best to not give insulin in the morning again and see what she does.
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keep droping ... 2.9 - I will give little bit more dry and test her in 30 minutes she already hates with all the testing :( okay? or sugar again? like yesterday? she´s now + 4

why all the little snacks are not on board yet?
 
Can you add some sugar to the dry? I am worried she will get full up before we hit +6. I think probably best not to give any insulin in the morning and just wait and see again.
 
she ate app 2 handfuls of dry
just tested her now and it looks like she´s on the rise 3.2 but Ill stay up for at least yet another hour and if still on the rise I can go to bed, I guess.

Im exhausted, I almost couldn´t sleep tonight - was thinking of the conversation with the vet that was ahead of me and Im up from 4 AM :(
 
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