Ozzy's Spreadsheet

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That +4 today is quite a drop. Where are you in his cycle right now? He might be at nadir at +4 and on the rise now. Maybe a test to find out? It's possible that 1.25 u is a bit too high.
 
He is +4.5 right now. He came up yesterday at +5 but we also gave him some food because we were concerned about the +4 BG=66 reading and that he might go lower. I wanted to try the 1.25 U dose because if you look at my spreadsheet, that's what he's been getting for the last week when we were not able to do a curve. I don't know if 1.25 U is too much but I want to know so that I can reduce the dosage when I go back to work tomorrow. He's obviously still with us so he made it through the week, but I was not home those days so don't know how low his numbers went.

Last night we gave him only 1U and his +2 and +4 tests showed he was still high (in the yellow). I am not sure how long it's going to take for him to start showing blue numbers though. We are still really early on and it's all new to us. And obviously we haven't figured out the correct dosing yet. I'll be testing him to his next shot and then will do a +2 and +4 after his PM shot. Poor kitty- he's been stabbed a zillion times doing a 2-day curve. I think he might start hating me soon! :blackeye:
 
Does anyone have a chart they can share with me for a kitty on Vestulin so I can see what normal drops and a regulated kitty looks like? I know all cats are different but it would just be good for reference. I have no idea what we should be looking for, hoping to see, is ideal, or is worrisome (except going too low of course).

Once the insulin dose is figured out, how long did it take for your kitty to start throwing blues and greens? Do your kitties always have high (+300) BG numbers pre-shot?
 
Ozzy Pawzbourne said:
Does anyone have a chart they can share with me for a kitty on Vestulin so I can see what normal drops and a regulated kitty looks like? I know all cats are different but it would just be good for reference. I have no idea what we should be looking for, hoping to see, is ideal, or is worrisome (except going too low of course).

Once the insulin dose is figured out, how long did it take for your kitty to start throwing blues and greens? Do your kitties always have high (+300) BG numbers pre-shot?
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http://www.vetsulin.com/vet/Cats_Monitoring_About.aspx

Ozzy Pawzbourne said:
normal drops and a regulated kitty looks like?
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A regulated cat will be in the mid 200s at preshot and in the low 100s or high double digits at nadir. If a dose produces consistent results over time that fit these criteria then the kitty is regulated.

Ozzy Pawzbourne said:
I have no idea what we should be looking for, hoping to see, is ideal, or is worrisome (except going too low of course).
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I described the ideal above. There are many deviations from it that are still acceptable.
Some things you don't want to see:
  • high numbers all through a cycle (could be from too low a dose or bouncing high and getting stuck up there)
  • starting high and dropping to a very low nadir (too sensitive to this insulin's fast/harsh effect)
  • starting at a good PS, falling nicely then shooting up high (bouncing from an overreaction to the insulin's glucose-lowering effect)
  • nice array of numbers but nadir is too low (dose is too high).
Ozzy Pawzbourne said:
Once the insulin dose is figured out,
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This can take some time, sometimes a few weeks, sometimes many weeks or many months. And to make it even more interesting the best dose can change over time for a myriad of reasons. We say it's a moving target. Some cats are easy and settle in quickly at a dose that works consistently. Many don't.

Ozzy Pawzbourne said:
how long did it take for your kitty to start throwing blues and greens?
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That can happen right away or can take some time. See above.

Ozzy Pawzbourne said:
Do your kitties always have high (+300) BG numbers pre-shot?
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No, not always. High preshot numbers can happen if a dose is too low or if a kitty has bounced up as an overreaction to lower numbers mid cycle.
 
ok- his +4 was 82 and his +5 taken just now is 143. So I think the vestulin nadir's around 4 hours. Does that sound about right. He did not eat between +4 and +5.
 
I checked out the vestulin website you sent me a link to. Based on their curve examples, it seems Ozzy is metabolizing his insulin rapidly. Their recommended solution is to switch to a longer acting insulin.

Vestulin seems to be one of the more affordable insulins. Are there other insulins in the similar price range that are longer acting? I have been seeing folks talk a lot about the L insulins, but I think those costs around $200-300/month.
 
Hi Joanna,

I'd suggest dropping the dose down to 1.0 IU Vetsulin. Because of the nature of the insulin it is better to aim for a nadir around 100 (on a human meter) so that there's a bit of a safety buffer.

Here's an FDMB general guide to Caninsulin/Vetsulin:

FDMB Vetsulin/Caninsulin User Guide

If you do get high preshots they may partly be influenced by the body's response to the fast, steep drops that this insulin may produce. NB: sometimes you may get an unusually high preshot test but don't be tempted to increase the dose in response: Vetsulin can really yank down numbers. You need to take into account the nadir as well as the preshot in order to make safe dosing decisions.


Mogs
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Ozzy Pawzbourne said:
I checked out the vestulin website you sent me a link to. Based on their curve examples, it seems Ozzy is metabolizing his insulin rapidly. Their recommended solution is to switch to a longer acting insulin.

Vestulin seems to be one of the more affordable insulins. Are there other insulins in the similar price range that are longer acting? I have been seeing folks talk a lot about the L insulins, but I think those costs around $200-300/month.
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Try feeding a snack of regular food at +1.5 to slow the drop (see tips in the Vetsulin guide).

Lantus (and, I think, Levemir) is available much more cheaply from Canada (many members here buy from Marks Marine Pharmacy - look on the FDMB FAQ section for a thread about buying insulin from Canada).


Mogs
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Thank you for the feedback Mogs. We gave Ozzy 1 unit last night and his +2 and +4 readings never got below 200. Don't we want to see him lower than this at nadir? I know it can take some time and it's still early on. Above it was suggested that ideal ranges at nadir are high double digits or low 100s. It seems like that is what happened this afternoon. Sorry, still so new to this, just really want to get it right for Ozzy! He's relying on me to make the best decisions for him to feel good. He has been acting wonderful today BTW. When he was at 88-124 he was laying in the hallway with his belly in the air and purring. He always used to do this in the past and hasn't done it yet since he came home so I was so happy to see him looking comfortable and happy finally!
 
Ozzy Pawzbourne said:
I checked out the vestulin website you sent me a link to. Based on their curve examples, it seems Ozzy is metabolizing his insulin rapidly. Their recommended solution is to switch to a longer acting insulin.

Vestulin seems to be one of the more affordable insulins. Are there other insulins in the similar price range that are longer acting? I have been seeing folks talk a lot about the L insulins, but I think those costs around $200-300/month.
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They're expensive in the US. Many people order from a Canadian pharmacy, Mark's Marine Pharmacy, where it's a lot cheaper. ProZinc is equally expensive in Canada and the US. I'm in Canada and pay $127 CAD for a vial of ProZinc. Lantus is a human insulin and the cost here is lower because of our socialized medicine system that subsidizes medications.
 
Ozzy Pawzbourne said:
We gave Ozzy 1 unit last night and his +2 and +4 readings never got below 200.
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I see from Ozzy's spreadsheet remarks that you gave him dry food during the AM cycle. Also he did have quite a drop nadir. Both things can feed into higher numbers many hours later, especially carbs from dry food: it takes a while for the carbs from dry to start raising BG and it also usually takes a while for them to work their way out of the cat's system thus keeping numbers higher for quite some time.


Mogs
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You know what Mogs, I looked back at Ozzy's chart for today and when he did is +2 reading and was at 190, he went and had a small snack (about .5 oz of LC wet food). His +4 hours were at 82 (sorry I misquoted 88 above), so he could potentially have dropped lower at +4 if he did not have that snack. Definitely need to be careful here. I'm going to stick with the 1U for now and talk with the vet this week after I send him my completed chart from today.

As I mentioned above, Ozzy has been on 1.25 U for a week now but we were not able to take additional readings during the work week so this weekend has been an interesting learning experience.
 
Mogs- re-read your post above Re: giving Ozzy dry in the AM cycle that could have caused his PM cycles to be a little higher. Got it. This is really overwhelming - I feel like my poor kitty is a science experiment. I don't want to keep poking him over and over every day. I'm a little drained after this weekend. I am sure my kitty is too.
 
Ozzy Pawzbourne said:
This is really overwhelming - I feel like my poor kitty is a science experiment. I don't want to keep poking him over and over every day.
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We all understand that feeling. :bighug:

I understand it may not be what you want to hear just now but daily testing is the key to keeping Ozzy safe and also the best guide to finding an effective, safe dose to help him become regulated (and possibly achieve remission). You definitely need to do the AMPS and PMPS tests to see whether it is safe to give insulin. (Note: assuming that Ozzy is in safe numbers at the time you should not feed anything for two hours before a preshot test because you don't want it to be food-influenced.) You also really need to do at least one mid-cycle test each day to check how low the dose is taking Ozzy's BG. If you're out during the day a 'before bed' test at +3 will guide you as to how the dose is working (+2 if you're worried he might be dropping earlier). It's advisable to run a curve once a week when you're at home all day to get a better picture of what the dose is doing over a full cycle and whether any adjustment is needed.

Ozzy Pawzbourne said:
I'm a little drained after this weekend.
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The early days are overwhelming and exhausting but as you both adapt to the new routine it does get better. Promise.

:bighug:


Mogs
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Thank you Mogs. I have been dealing with other stressful things in my life right now on top of the fact that my fur baby kitty almost died 2 weeks ago. Things have just been so stressful as of late. I feel so bad poking my kitty's ears. He HATES it. He cries sometimes and one time growled at me. I love him SO much. I don't want to hurt him in any way. He has been so spoiled with love and kindness all his 8 years and has never felt a hand of harm or any sort of pain. It just breaks my heart to hurt him. I am so sad.

I was getting pretty good at the testing, or so I thought, and then I lost my confidence today or something happened out of whack and I ended up having to poke him 6 times this am to test him before his insulin shot. I felt so awful; made me want to cry. Tonight I did his blood glucose at +4 and his ear bled a lot: more than either of his ears have so far. Not sure if this is what you folks refer to as 'ears learning to bleed' or if I just poked him really hard.

I am so tired of all this. I really really am. I just want my normal kitty back and to not have to hurt him to make sure he is safe. My heart feels so awful that he is in this situation because I was such a bad kitty mom and didn't do more to make sure he was healthy and at a healthy weight. He has been an indoor cat only his entire life and relied on me 100% for his well being and I failed him.

Not sure if you know my story- but 6 months ago, we started trying to diet him to try to make him loose a little weight. I was concerned he was going to get diabetes as he got older. I had no belief he had this.....he was just getting older and was a little overweight-even for a maine coon. I looked at him sweetly one night and thought I really want him to be with me for so many more years because I love him so much so I wanted to do something about his weight so he would be healthier. And he did lose weight; and when he was losing weight I said to my husband I was concerned. But we kept reminding each other that we had him on a diet, so this was normal. I just can't believe that he now has diabetes- the exact thing we were trying to be proactive to prevent- and we almost lost him. In some ways, I keep thinking that if we never had tried to diet him- we would not be in this situation. He was fine before.

When he was in the hospital for 4 days, I was beside myself in grief. I visited him every day, morning and night, sometimes there for 4-6 hours a day so he could get could get out of the cage and I could hold him and comfort him. I read on this board today about 2 kitties that passed-it broke my heart. I kept thinking that could've been my kitty. I'm so sorry I am venting - this is so much. I really admire all the courage and strength of the people on this board with all they have gone through and all the help and hope they give to others -sometimes half way around the world. Thank you to everyone who has helped me so tremendously these last few days. I have really needed this support. And as I am crying as I type this..after feeling so awful after poking Ozzy shortly ago....he is sitting in the window in his kitty bed admiring the Christmas lights and his new tree. Us women...we can be a wreck sometimes. I'll try not to take myself so seriously...my cat sure doesn't.
 
:bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug:

So much of our stories is similar. I'm very tired so I can't write too much just now but please know that I and many others here understand just how you're feeling right now.

When I struggled with testing and injections at the start I forced myself to be a bit 'businesslike' to help me get through it. When I felt myself wavering I would ask myself: Which scares and upsets me more; doing the pokes and prods or Saoirse being sick/too low on insulin? The answer is a no-brainer. It helped us to make it through the early days.

I can tell you from terrifying first-hand experience that there is most definitely one thing much, much more frightening and stressful than sticking pins in your cat's ear and that is administering insulin completely 'blind'. The vet treating Saoirse at time of Dx point blank refused to support my desire to home test. For the first few weeks of Saoirse's treatment I had to give her insulin with no way of knowing whether the next dose was safe to give and no way of identifying whether or not she might be hypoglycaemic during a cycle. (The Caninsulin absolutely wiped her out so I had no way of spotting any clinical signs of something being 'off' with her.)

Soon after Saoirse's Dx we moved to a different practice where there is support for home testing. I can assure you that the relief I felt when I could check Saoirse's BG levels to make sure she was safe was immeasurable! Like you, I beat myself up really badly for not spotting the diabetes symptoms sooner and for anything I might have done or failed to do which led to my beautiful, beloved girl becoming ill (still do, being completely honest). Like you, I felt I had completely failed her. :( However, it would have completely destroyed me if anything bad had happened to her as a result of my giving her insulin. (Just the thought of that alone was enough to make testing a far more appealing prospect.)

Try singing or forcing yourself to speak in a cheery voice during testing. You might not feel very cheery but it may make you less tense and that in turn may help Ozzy to relax a little. Cats are smart: they might not understand their person's apparent descent into madness but they quickly work out that all this strange poking and prodding is directly related to them starting to feel much better. Cats truly are the most amazing creatures.

When I first joined FDMB I read about many cats here actually going to their testing station by themselves to remind their person it's time to get their BG checked (and, of course to get a yummy treat or fusses). I was a bit sceptical about this - until Saoirse started doing the very same! I couldn't get over it; she'd purr her way through the whole routine. Fingers and paws crossed that it will become so for Ozzy, too.

Courage, mon amie!

:bighug::bighug::bighug:

(((Joanna & Ozzy)))


Mogs
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Let me say, ladies, that I truly understand this. I, like Mogs, adopt a "business-like" approach in testing/injecting Teasel. I sometimes have a little spell where he reacts to injections and it makes me feel less confident. However, I've been at it long enough to know that it will pass and I'll get my mojo back. Teasel too has learned to come for tests (and treats!) and is always sitting outside our testing site (the bathroom) after he's finished his breakfast or dinner.

BTW, Joanna, an ear prick will sometimes bleed a lot more because you've hit the tiny vein that runs along the margin. I've also gone completely through Teasel's ear and was mortified. But he was fine and it healed. :cat:
 
Kris & Teasel said:
I sometimes have a little spell where he reacts to injections and it makes me feel less confident.
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This!!!

(((Kris)))

Less confident. And more guilty! :banghead: :rolleyes:

I felt some bit of relief (and a little bit less like a complete numpty) when I read here that sometimes mild discomfort may be due to a dull needle rather than poor technique.


Mogs
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Thanks Ladies! Appreciate your kind words. Had a bit of a rough night last night with all this. Feeling better today and Ozzy Pawzie is doing great. Cute and cuddly and his wonderful sweet self. I am thrilled to see him getting back to normal.
 
About the low dose of insulin: I know it is too early to tell- but what do you think of his chances of going off the juice since he only needs such a low dose? Our vet said it is unlikely- not impossible- for a cat that has had DKA to go into remission. He didn't explain why but I am guessing it has something to do with how bad his system got- maybe permanent damage or something to his ability to produce his own insulin. Vet also said that he thinks Ozzy's best chances would be to go on prescription all wet Hills diet food.

What do you think of the vet's comments on remission and food recommendations?
 
Hill's Rx diets are too high in carbs. The only Rx diabetic diet low enough in carbs is Purina DM canned.


Mogs
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