Need some advise asap about BG test & first insulin shots / food changes

[Kris & Teasel]

Ok so I just took her approx 6 hr BG following her insulin this morning and it's now 7.8u. Is that ok?

Also I used a new needle. Is it ok to use the same needle to take her BG multiple times a day or not? Thanks!

You might find that the needle becomes less effective at getting blood if you use it too many times. Some people use them only once and some (like me) use then 2 or 3 times. I use them twice and clean off the needle with alcohol in between.

 

[Chris & China (GA)]

Ok so I just took her approx 6 hr BG following her insulin this morning and it's now 7.8u. Is that ok?

That's not just OK.....it's really wonderful!! Great response so far (and I'm really glad you went with the .75!)

Also I used a new needle. Is it ok to use the same needle to take her BG multiple times a day or not? Thanks!

We usually don't suggest reusing them.....this is why

 

[TanyaG]

Thanks so much everyone that is great news im so pleased! Also she uribated in the bin with the non absorbent beads from the vets so I just quickly dunked in a ketone test strip. I'll retest later when I have more time as rushing to an appointment but for now this is what I got. Looks like no ketones but med/high glucose?

 

[Chris & China (GA)]

YEAH for no ketones!!!

It's normal to have glucose spilling over into the urine at this point in the sugardance

 

[TanyaG]

Just to add that urine was probably from an hr or several hrs ago.

 

[Critter Mom]

So relieved to see that ketone result. Inasfar as it's possible to judge from photo on a PC screen it looks to be negative.

The positive glucose test indicates that during the time between the previous pee and this one Tinka's BG levels were over the renal threshold - the point where glucose starts spilling over into the urine - for some, if not all of that time (impossible to tell definitively hence the need to monitor BG levels to get a better picture of what a cat's levels are doing at different points in the cycle).

Given that you know from your vets that Tinka has tested positive for ketones it's important to still monitor once (or better twice) a day for the time being to make sure she stays clear of them; they can develop very quickly and unexpectedly. It's safer to incorporate ketone testing into a kitty's daily monitoring routine - especially kitties known to be ketone-prone as they tend to be more vulnerable to developing them again.

You are doing great, Tanya! I hope you will be able to get some decent rest for yourself today.




Mogs
.

 

[MrWorfMen's Mom]

Another YEAH for no ketones! This is turning out to be a wonderful day for you and Tinka!

 

[TanyaG]

YEAH for no ketones!!!

It's normal to have glucose spilling over into the urine at this point in the sugardance

Yah for no ketones indeed! I hope nothing contaminated the test. Is it ok to use those non absorbent beads for a home ketone test?

 

[Kris & Teasel]

Yah for no ketones indeed! I hope nothing contaminated the test. Is it ok to use those non absorbent beads for a home ketone test?

I think you can rinse them off, remove excess water and reuse them.

 

[MrWorfMen's Mom]

I'm with Kris. As long as you are getting a clean sample each time, I can't see why the beads would have any negative effect on the ketone test results.

 

[TanyaG]

Hi all please advise I just tested Tinka's BG at 7:30pm 12 hours after first shot and it is 4.1

 

[TanyaG]

I just called vet about the 4.1 reading and he said not to give more insulin and to feed her. Do I feed her regular canned or high carb? I have a higher carb freeze dried treats so I just gave her some of those and now her regular canned food which she's eating some. She's more interested in the freeze dried treats as they more like kibble. But she should go back and eat more canned as she's been eating better past few days. Is 4.1 too low? Do I need to be doing something to curve things or monitoring? Thanks!

 

[TanyaG]

So relieved to see that ketone result. Inasfar as it's possible to judge from photo on a PC screen it looks to be negative.

The positive glucose test indicates that during the time between the previous pee and this one Tinka's BG levels were over the renal threshold - the point where glucose starts spilling over into the urine - for some, if not all of that time (impossible to tell definitively hence the need to monitor BG levels to get a better picture of what a cat's levels are doing at different points in the cycle).

Given that you know from your vets that Tinka has tested positive for ketones it's important to still monitor once (or better twice) a day for the time being to make sure she stays clear of them; they can develop very quickly and unexpectedly. It's safer to incorporate ketone testing into a kitty's daily monitoring routine - especially kitties known to be ketone-prone as they tend to be more vulnerable to developing them again.

You are doing great, Tanya! I hope you will be able to get some decent rest for yourself today.




Mogs
.

Thank you Mogs for this info. I just got home now at 7:30pm and tested Tinka after the 12 hour shot this morn and her BG is 4.1. I wont give any insulin but what should I do to help her? Thanks!

 

[Chris & China (GA)]

4.1 is a safe (and wonderful) number! It's the same as 74 in our scale

Sorry nobody got back to you sooner....if you need to get our attention, change your subject line to something like "PMPS LOW...SHOOT??" ......That way we know you're looking for help now

In the future, what we would usually suggest is stalling, DON'T feed and test again in 20-30 minutes to see if she's coming up on her own

Can we get you working on your signature and spreadsheet tonight? If you need help, feel free to send me a private message by clicking on my name and choosing "Start Conversation"

 

[Chris & China (GA)]

what should I do to help her?

If you've already fed her, that's all you need to do....just test again (I'd suggest in an hour since you just fed her) and let's see where she's at

If she dropped below 50 (2.8) that's your "time to act" number.....then you'd want to give something high carb (like the Fancy Feast Gravy Lovers or a couple of drops of Karo/honey/syrup) to bring her up again

 

[TanyaG]

4.1 is a safe (and wonderful) number! It's the same as 74 in our scale

Sorry nobody got back to you sooner....if you need to get our attention, change your subject line to something like "PMPS LOW...SHOOT??" ......That way we know you're looking for help now

In the future, what we would usually suggest is stalling, DON'T feed and test again in 20-30 minutes to see if she's coming up on her own

Can we get you working on your signature and spreadsheet tonight? If you need help, feel free to send me a private message by clicking on my name and choosing "Start Conversation"

Hi Chris,

Thanks I will do that next time The last time she was fed was 2pm as I'm feeding her smaller amounts 4 times a day so she was due to be fed so I was worried she was crashing. Next time I will stall then and retest. I will try to do the spreadsheet now thank so much

 

[TanyaG]

If you've already fed her, that's all you need to do....just test again (I'd suggest in an hour since you just fed her) and let's see where she's at

If she dropped below 50 (2.8) that's your "time to act" number.....then you'd want to give something high carb (like the Fancy Feast Gravy Lovers or a couple of drops of Karo/honey/syrup) to bring her up again

Thanks Chris, she is still eating. As she doesn't have much of an appetite she kind of eats for a bit then wants to go hide under the bed. I have to keep mixing the food up or adding hot water to make it more enticing. Do you think its ok by the way that I'm adding hot water a few times to canned food? Just concerned about bacteria now. Then she loses interest. I try stroking her and then she eats a bit more. She didn't eat much of the salmon canned so I just tried some rabbit now and she ate a little more. Usually she's a big eater and very food motivated so this is only past month or two like this which is why she's lost weight. So do i retest in an hour if she's still grazing or do I wait till later once she's been finished for a while? Thanks!

 

[Chris & China (GA)]

Thanks I will do that next time

It's all good....you'll get a good feel for how much of a "food bump" she gets!! It all helps for those times in the future when she's lower than you're comfortable shooting

 

[Chris & China (GA)]

Do you think its ok by the way that I'm adding hot water a few times to canned food?

it's fine....a lot of us add a little warm water to our food to increase the amount of water they're getting as well as making it smell better. Have you ever tried feeding her from a spoon or finger feeding? Some cats seem to eat better that way (China is one of them who likes to eat directly from a spoon)

Test about an hour after she started eating

 

[TanyaG]

It's all good....you'll get a good feel for how much of a "food bump" she gets!! It all helps for those times in the future when she's lower than you're comfortable shooting

Thanks ok great she started eating at 7:45pm and its 8:30pm now so I will test her in 15 mins? She ran upstairs to hide under the bed again. I'd say she ate about half her food. Should I be concerned by the lack of appetite still? I thought with the insulin today she'd feel a bit better and her appetite would pick up. She's eating but not as much as I'd like and it takes a lot of work to get to her to each much. Its just so unlike her. She doesn't like spoon feeding that much. She'll eat a little from my fingers. Mostly the taking her there and stroking her seems to help, but she just eats a little then wants to leave. It takes her prob 2-3 hours to finish a meal.

 

[Chris & China (GA)]

Is the food new to her? Since one of the first things we usually do here is change foods, it can take some time to figure out which ones they like best

Have you ever tried FortiFlora? It's a powder that comes in individual packets that contains the same stuff that they spray on kibble to make it taste so good....it works on a lot of cats when they're not too thrilled with the food. You can get it from some vets offices or it's available on Amazon

 

[TanyaG]

Is the food new to her? Since one of the first things we usually do here is change foods, it can take some time to figure out which ones they like best

Have you ever tried FortiFlora? It's a powder that comes in individual packets that contains the same stuff that they spray on kibble to make it taste so good....it works on a lot of cats when they're not too thrilled with the food. You can get it from some vets offices or it's available on Amazon

She was on a home cooked diet the past year of cooked pork balanced with Hilary's blend and cod liver oil. Then we switched to cooked duck due to allergies to see if her skin improved. She ate both and enjoyed them, always begging for more and still hungry and a bit overweight. Prior to this she was on kibble and canned but mostly kibble. But she was enjoying home cooked and we transitioned her off the kibble pretty well. Then two months ago she got switched to raw and got constipated on raw duck feet treats. She lost her appetite for duck and we needed something novel which I couldn't source to home cooked. So vet switched her to Rayne rabbit canned and it all went down hill from there. She was enjoying but lost her appetitie and started losing a lot of weight. At first I thought it was because rabbit is lean and this one had no vitamins or minerals. It was probably the diabetes progressing though. Then we switched her to Rayne maitaince kangaroo and she loved it and first but the barely ate much and detiorated more. That was prob higher in carbs. I tried to bring back the home cooked pork as that was always something she loved but she barely ate that past few weeks either. I tried salmon to and not much interest. Chicken liver is her absolute favourite and she'll barely eat that too. I tried tuna and she'll eat a little, mostly just the juice. Yesterday I switched her to Instinct venison and again as its new it excited her and she ate better yesterday but by this morning she's losing interest. I switched to the salmon and again not eating much. I think its not because she's fussy as we haven't seen this behaviour before I think its cause she feels so lousy she's lost her appetite. Is that common for diabetes? Does insulin help appetite over time? I feel her eating is not as bad as say 2 days ago since switching to the instinct but its def less than what she should be eating and drinking and she's underweight now.

 

[TanyaG]

It's all good....you'll get a good feel for how much of a "food bump" she gets!! It all helps for those times in the future when she's lower than you're comfortable shooting

Ok so I just did another BG test at 8:53pm about an 1 hr / 1 hr 15 mins after I fed her. Her reading was 8.3 mmol/L. She'd only eaten about 1/3 - 1/2 her food when I just took the reading. The food did include some freeze dried treats from earlier that may not have been low carb like the rest of her food as I wasn't sure if she was crashing. What are your thoughts on that 8.3 BG? Thanks!

 

[Chris & China (GA)]

What are your thoughts on that 8.3 BG?

Well she's gone from 74 to 150 after eating.....that's a pretty good sized food bump.....when you have your spreadsheet going, you'll want to put what you fed over in the "Remarks" column for future reference

I'd get another test at +3 and see how she's doing

 

[Chris & China (GA)]

Usually we see unregulated diabetics eating a lot more than normal because their body can't process the food and get the glucose into the cells without insulin....think of insulin as a "key" and on every cell in the body there's a "lock"....without the key, the glucose can't get in and just stays in the blood (so you get high glucose numbers)

If she likes your raw recipe, have you ever tried getting kangaroo meat? I think @Wendy&Neko used to use kangaroo so I know it's available in Canada (but not sure about where you live)

 

[TanyaG]

Well she's gone from 74 to 150 after eating.....that's a pretty good sized food bump.....when you have your spreadsheet going, you'll want to put what you fed over in the "Remarks" column for future reference

I'd get another test at +3 and see how she's doing

Great thank you, I shall begin to work on the spreadsheet after some dinner, I'm starved Ok thanks I will test again, is that +3 hours from the PMPS BG or +3 hours since I did the last BG?

Is it normal for diabetic cats to have appetite loss? Does this improve after some time on insulin? Thanks again so appreciate your help!

 

[Chris & China (GA)]

Since we live all over the world, we have our own way of telling time here.....You have the AMPS (AM Pre-Shot) and PMPS (PM Pre-shot)....and after that, we use the "+ system"....so if you get a test 2 hours after the shot, it's +2.....if you test 5 hours after the shot, it's +5......all the way up to +11 and then it's time for the next cycle

Since you didn't shoot tonight, instead of a PMPS, you'd have a PMBG (PM Blood Glucose) but the times still work the same......so +3 is 3 hours after the PMBG test

 

[TanyaG]

Usually we see unregulated diabetics eating a lot more than normal because their body can't process the food and get the glucose into the cells without insulin....think of insulin as a "key" and on every cell in the body there's a "lock"....without the key, the glucose can't get in and just stays in the blood (so you get high glucose numbers)

If she likes your raw recipe, have you ever tried getting kangaroo meat? I think @Wendy&Neko used to use kangaroo so I know it's available in Canada (but not sure about where you live)

Yes that makes sense. She use to be like that a bit overweight and always hungry so I'm sure she's had the diabetes for some time. Especially since she was on kibble for about 5 years before we switched her a year ago. So far she's only eaten a little raw but not liked it that much. She also had some digestive upset as she has leaky gut so switching to raw may have to wait a little while. Thats great to know there is a Canada contact for kanagroo thanks! I think right now the biggest issue is that she must be feeling really unwell not to have her usual appetite. She's not excited or enjoying all her usual favourite things. We she didn't eat the liver I knew something was wrong and thats when we took her to the vet. I'm just hoping the appetite improves soon as it really is a challenge getting her to eat.

 

[Chris & China (GA)]

Is it normal for diabetic cats to have appetite loss? Does this improve after some time on insulin?

No, not really, but ECID (Every Cat Is Different).....it's possible that she doesn't feel good and just isn't feeling like eating. It may improve as she gets better regulated, but it's not a sure thing

Is she acting nauseous at all? Sniffing at the food and then walking away (a lot of times licking their lips) is a big sign of nausea

 

[TanyaG]

Since we live all over the world, we have our own way of telling time here.....You have the AMPS (AM Pre-Shot) and PMPS (PM Pre-shot)....and after that, we use the "+ system"....so if you get a test 2 hours after the shot, it's +2.....if you test 5 hours after the shot, it's +5......all the way up to +11 and then it's time for the next cycle

Since you didn't shoot tonight, instead of a PMPS, you'd have a PMBG (PM Blood Glucose) but the times still work the same......so +3 is 3 hours after the PMBG test

Thanks for clarifying, I'm learning a whole new lingo

 

[MrWorfMen's Mom]

Sorry Tanya. Just seeing that you had to skip the shot tonight due to lower BG at the pre-shot check. Glad Chris was here to assist. That was quite the cycle. That means Tinka earned a dose reduction of 0.25u, so if she is high enough for a shot in the morning, you should take her down to 0.5u. Since she's still not eating as well as she should, that might partially account for that lower reading and the reduction may not hold as her appetite improves but for now better to be conservative about dosing. Of course you can post for guidance in the morning. Start a new post and include a link to this thread at the top and use the ? prefix on the title and call the post Dosing Advice Needed or something similar to get timely assistance.

 

[TanyaG]

No, not really, but ECID (Every Cat Is Different).....it's possible that she doesn't feel good and just isn't feeling like eating. It may improve as she gets better regulated, but it's not a sure thing

Is she acting nauseous at all? Sniffing at the food and then walking away (a lot of times licking their lips) is a big sign of nausea

Its possible she may be nauseous as she does sniff a lot and comes to the food but then walks away. I'm not sure about licking her lips but definitely sniffing. They gave her an anti-nausea injection on Tues afternoon but I didn't notice an improvement in appetite with that. Perhaps we could try a different type? Is nausea a sypmptom of diabetes? Thanks!

 

[TanyaG]

Sorry Tanya. Just seeing that you had to skip the shot tonight due to lower BG at the pre-shot check. Glad Chris was here to assist. That was quite the cycle. That means Tinka earned a dose reduction of 0.25u, so if she is high enough for a shot in the morning, you should take her down to 0.5u. Since she's still not eating as well as she should, that might partially account for that lower reading and the reduction may not hold as her appetite improves but for now better to be conservative about dosing. Of course you can post for guidance in the morning. Start a new post and include a link to this thread at the top and use the ? prefix on the title and call the post Dosing Advice Needed or something similar to get timely assistance.

Hi Linda thank you for your message. Yes that was quite the cycle. Ok great thank you I will drop her dose to 0.5u then. So only if her BG is above 11 do I need to administer a shot?

I tested her ketones earlier at about 8pm just after her PMBG and they were normal on my strip and the glucose was normal too so I'm assuming that is at least good.

 

[TanyaG]

Sorry Tanya. Just seeing that you had to skip the shot tonight due to lower BG at the pre-shot check. Glad Chris was here to assist. That was quite the cycle. That means Tinka earned a dose reduction of 0.25u, so if she is high enough for a shot in the morning, you should take her down to 0.5u. Since she's still not eating as well as she should, that might partially account for that lower reading and the reduction may not hold as her appetite improves but for now better to be conservative about dosing. Of course you can post for guidance in the morning. Start a new post and include a link to this thread at the top and use the ? prefix on the title and call the post Dosing Advice Needed or something similar to get timely assistance.

I have just taken Tinka's BG +3hrs 45min since her PMBG and it is 12.6 mmol/L. So thats risen quite a lot then?

 

[TanyaG]

I'd get another test at +3 and see how she's doing[/QUOTE]

Hi Chris, Tinka's PMBG +3.5 hrs is 12.6 mmol/L. So thats back up pretty high then considering she was 4.1 at her PMBG and she was 13.3 at AMPS. That will probably be my last BG for the night as we heading to bed shortly do you think thats ok?

I don't think I'm doing such as great job with pricking her ear. I'm free handing and she keeps pulling her head when I prick her. Sometimes its not enough blood even with pumping it a bit so then i have to do it a second time which I feel awful about. You can see a lot of the places where we have pricked her today where there is some dried blood on her ears. I feel so bad She keeps looking at us nervously like we going to poke her again, poor baby. Is there info on here on how I can do it better? Is a lancet device easier to use? I just need to find a bigger size guage then. Currently I'm using syringe tops from vet - they called Terumo needle and its a 25G x 5/8". Is that a good size to use? Sorry for all the questions Thanks for your help!

 

[Chris & China (GA)]

So only if her BG is above 11 do I need to administer a shot?

If it's above 200 (11.1) yes, you shoot....if it's below, you stall, don't feed and post for help....make sure your subject line is clear ...something like "STALLING, NEED HELP!!!" works....LOL

I tested her ketones earlier at about 8pm just after her PMBG and they were normal on my strip and the glucose was normal too so I'm assuming that is at least good.

That's great!! Means that since she last peed that her glucose pretty much stayed below renal threshold which is really good since kidneys are the hardest hit organ with diabetes. Renal threshold is the point where the kidneys can't handle the glucose any more and it spills over into the urine

I have just taken Tinka's BG +3hrs 45min since her PMBG and it is 12.6 mmol/L. So thats risen quite a lot then?

It's not a surprise considering she went as low as she did today and you skipped the shot tonight....that's 227
.
Whether you reduce or not will depend on which dosing method you choose.....the Tight Regulation Protocol or the Start Low, Go Slow method
It makes a difference on dosing advice we'd give you. TR is the only protocol that's been published in a veterinary journal so it has a lot of science behind it, but it requires you be able to test a little more often than SLGS. It also gives the best chance at remission. We've had cats go OTJ (Off The Juice) on SLGS, but it's much more common on TR because you adjust the dose more often in response to the numbers you're getting.

Some of the basic differences are:

TR...dose adjustments can be made as often as every 3 days (6 cycles)...this is most effective because if they're staying in numbers we don't like, we can increase more often
SLGS...dose adjustments are made once a week....this can be hard on the caretaker IF the cat is "stuck" in high numbers very long

TR...reductions in dose are given if they drop below 50 on a human meter, 68 on a pet meter
SLGS...reductions are given if they drop below 90 on either meter

TR...You'll want to get the 2 PS tests and at least one other test....preferably at least 2 other tests.....One somewhere between +4 and +7 on the AM cycle and a "before bed" test on the PM cycle...if you can only get 1, the "before bed" test is most important since most cats go lower at night
SLGS...You still must get the 2 PS tests in, and then do a curve once a week (testing every 2 hours for 12 hours or every 3 hours for 18 hours)

I think considering this was her first dose, you'd be smart to go ahead and reduce to .5 tomorrow.....it usually takes 5-7 days for the depot to fill and to see how the starting dose is going to do, but with that big a drop today, I think it's best to start a little lower than the .75 for now

 

[Chris & China (GA)]

You can see a lot of the places where we have pricked her today where there is some dried blood on her ears

That's totally normal at first....you might want to use cotton pads or a folded up Kleenex to apply pressure for awhile after the poke to help the blood clot. Her ears will "toughen up".....also, as you poke more, new capillaries grow in and make it easier to get blood....we call it "learning to bleed"

Are you warming her ear first? That's very important, especially at first.....and especially if it's cold out!! A little Polysporin with pain relief ointment smeared on thinly afterwards will help with healing too.

Is that a good size to use?

Actually yes, that's a good size.....the lancet device may be helpful, but it takes some getting used to (for both you and the cat).....a lot of us freehand it instead of using the device. If you DO want to try it, if the lancets came with the device you have, they're probably 33 gauge which is very tiny.....We suggest using 25-28 gauge for "new" ears since it makes a bigger hole

Here's where you should be poking.....along the edge, not directly on the vein.....there are very few pain receptors along the edges so it's not hurting her....she's just not used to having her ears fooled with so much. She will get used to it!!.....just make sure she always gets some kind of reward...whether you get blood or not! We say to try 3 times and if you still haven't got it, take a break and try again in a few minutes.

 

[TanyaG]

That's totally normal at first....you might want to use cotton pads or a folded up Kleenex to apply pressure for awhile after the poke to help the blood clot. Her ears will "toughen up".....also, as you poke more, new capillaries grow in and make it easier to get blood....we call it "learning to bleed"

Are you warming her ear first? That's very important, especially at first.....and especially if it's cold out!! A little Polysporin with pain relief ointment smeared on thinly afterwards will help with healing too.



Actually yes, that's a good size.....the lancet device may be helpful, but it takes some getting used to (for both you and the cat).....a lot of us freehand it instead of using the device. If you DO want to try it, if the lancets came with the device you have, they're probably 33 gauge which is very tiny.....We suggest using 25-28 gauge for "new" ears since it makes a bigger hole

Here's where you should be poking.....along the edge, not directly on the vein.....there are very few pain receptors along the edges so it's not hurting her....she's just not used to having her ears fooled with so much. She will get used to it!!.....just make sure she always gets some kind of reward...whether you get blood or not! We say to try 3 times and if you still haven't got it, take a break and try again in a few minutes.
View attachment 24885

This is super helpful thanks so much!! Warming her ear only a little with a large wheaty bag so need to make a smaller rice one tmrw. Will post her AMPS test result in the morn before dosing good night

 

[TanyaG]

If it's above 200 (11.1) yes, you shoot....if it's below, you stall, don't feed and post for help....make sure your subject line is clear ...something like "STALLING, NEED HELP!!!" works....LOL



That's great!! Means that since she last peed that her glucose pretty much stayed below renal threshold which is really good since kidneys are the hardest hit organ with diabetes. Renal threshold is the point where the kidneys can't handle the glucose any more and it spills over into the urine



It's not a surprise considering she went as low as she did today and you skipped the shot tonight....that's 227
.
Whether you reduce or not will depend on which dosing method you choose.....the Tight Regulation Protocol or the Start Low, Go Slow method
It makes a difference on dosing advice we'd give you. TR is the only protocol that's been published in a veterinary journal so it has a lot of science behind it, but it requires you be able to test a little more often than SLGS. It also gives the best chance at remission. We've had cats go OTJ (Off The Juice) on SLGS, but it's much more common on TR because you adjust the dose more often in response to the numbers you're getting.

Some of the basic differences are:

TR...dose adjustments can be made as often as every 3 days (6 cycles)...this is most effective because if they're staying in numbers we don't like, we can increase more often
SLGS...dose adjustments are made once a week....this can be hard on the caretaker IF the cat is "stuck" in high numbers very long

TR...reductions in dose are given if they drop below 50 on a human meter, 68 on a pet meter
SLGS...reductions are given if they drop below 90 on either meter

TR...You'll want to get the 2 PS tests and at least one other test....preferably at least 2 other tests.....One somewhere between +4 and +7 on the AM cycle and a "before bed" test on the PM cycle...if you can only get 1, the "before bed" test is most important since most cats go lower at night
SLGS...You still must get the 2 PS tests in, and then do a curve once a week (testing every 2 hours for 12 hours or every 3 hours for 18 hours)

I think considering this was her first dose, you'd be smart to go ahead and reduce to .5 tomorrow.....it usually takes 5-7 days for the depot to fill and to see how the starting dose is going to do, but with that big a drop today, I think it's best to start a little lower than the .75 for now

Thank you for this info. So which one do you think would be best for Tinka the TR or SLGS? I like the sounds of the better options for remission with TR option and I'm committed to doing 4 tests a day. So if I drop to 0.5u tmrw morning can that work for the TR method? If she's anything above 11.1 then should I go ahead and shoot with 0.5u or do I need to post her AMPS result first? Thanks!

 

[Chris & China (GA)]

So if I drop to 0.5u tmrw morning can that work for the TR method?

Yes....usually we'd say not to reduce until she actually dropped below 50, but considering today was her first dose, I think it's best to go ahead and start at .5 instead and plan on holding that dose for several days and then we can re-evaluate (sure am glad you didn't go with the 1U dose!)

If she's anything above 11.1 then should I go ahead and shoot with 0.5u or do I need to post her AMPS result first?

If she's above 200 (11.1), go ahead and shoot the .5.....I'd plan on getting a +2 if you can too

We've seen the +2 test can be a really good predictor for what the rest of the cycle is going to look like (some cats are better with +3)

If the +2 is about the same number as the PS, it's usually going to be a pretty normal cycle....gradually down to nadir and then gradually back up to the next PS

If the +2 is higher than the PS, that can indicate the beginning of a bounce....those are the cycles where it's usually going to be OK to take a break from poking so much (or get some sleep!)

If the +2 is lower than the PS, that's your "Early warning" that tells you that you should plan on getting more tests in during that cycle

do I need to post her AMPS result first?

Only if she's below 200 so that you can have someone signed on to watch out for you

 

[Wendy&Neko]

Hi and welcome from the other side of the Rockies. I just got Chris's tag on the raw meats. I used to feed my Neko premanufactured raw food, including kangaroo. The manufacturer is Red Dog/Blue Kat Deli. They are made in BC. I don't know if you can get them in Banff, but they are sold in Calgary. I've seen a couple of other local raw food manufacturers sell kangaroo too. Plus I can get plain kangaroo at the local exotic meat butcher and I've even seen it for sale in the local Save On Foods grocery store. If she's off raw at the moment, there is a new brand of canned cat food called Koha that now is available in Canada, and they have a kangaroo pate that I believe is low carb. (also brushtail and other novel proteins). Ziwipeak is a good quality low carb canned food with rabbit, venison, and lamb options. Interestingly enough, both of those options come from New Zealand.

It does sound like she might have nausea if she is sniffing and turning away from the food. If she got an injection, it was probably Cerenia and it lasts for 24 hours. You can also get Cerenia pills for administration at home from the vet. Another alternative is a medication called Ondansetron (Zofran) that can be given up to 3 times a day. But be warned it's really expensive in Canada. You get it from a human pharmacy with a script from the vet. Nausea by itself is not a symptom of diabetes, but there could be an underlying condition, pancreatitis is one example, often associated with diabetes and that can cause nauesa.

If she likes tuna, you can get bonita flakes (dried tuna) and sprinkle them on the food. You can get them sometimes at pet food stores, or at asian grocery stores. I've also been known to sprinkle crumbled low carb freeze dried treats on top to get my furkids eating.

 

[TanyaG]

Yes....usually we'd say not to reduce until she actually dropped below 50, but considering today was her first dose, I think it's best to go ahead and start at .5 instead and plan on holding that dose for several days and then we can re-evaluate (sure am glad you didn't go with the 1U dose!)



If she's above 200 (11.1), go ahead and shoot the .5.....I'd plan on getting a +2 if you can too

We've seen the +2 test can be a really good predictor for what the rest of the cycle is going to look like (some cats are better with +3)

If the +2 is about the same number as the PS, it's usually going to be a pretty normal cycle....gradually down to nadir and then gradually back up to the next PS

If the +2 is higher than the PS, that can indicate the beginning of a bounce....those are the cycles where it's usually going to be OK to take a break from poking so much (or get some sleep!)

If the +2 is lower than the PS, that's your "Early warning" that tells you that you should plan on getting more tests in during that cycle



Only if she's below 200 so that you can have someone signed on to watch out for you

Thank you SO much Chris for this informative response it's super helpful! I'll go with the o.5u if she's above 11.1, else I'll stall and post. I will try my best to get a +2 test tmrw and feedback Good night, chat soon

 

[TanyaG]

Hi and welcome from the other side of the Rockies. I just got Chris's tag on the raw meats. I used to feed my Neko premanufactured raw food, including kangaroo. The manufacturer is Red Dog/Blue Kat Deli. They are made in BC. I don't know if you can get them in Banff, but they are sold in Calgary. I've seen a couple of other local raw food manufacturers sell kangaroo too. Plus I can get plain kangaroo at the local exotic meat butcher and I've even seen it for sale in the local Save On Foods grocery store. If she's off raw at the moment, there is a new brand of canned cat food called Koha that now is available in Canada, and they have a kangaroo pate that I believe is low carb. (also brushtail and other novel proteins). Ziwipeak is a good quality low carb canned food with rabbit, venison, and lamb options. Interestingly enough, both of those options come from New Zealand.

It does sound like she might have nausea if she is sniffing and turning away from the food. If she got an injection, it was probably Cerenia and it lasts for 24 hours. You can also get Cerenia pills for administration at home from the vet. Another alternative is a medication called Ondansetron (Zofran) that can be given up to 3 times a day. But be warned it's really expensive in Canada. You get it from a human pharmacy with a script from the vet. Nausea by itself is not a symptom of diabetes, but there could be an underlying condition, pancreatitis is one example, often associated with diabetes and that can cause nauesa.

If she likes tuna, you can get bonita flakes (dried tuna) and sprinkle them on the food. You can get them sometimes at pet food stores, or at asian grocery stores. I've also been known to sprinkle crumbled low carb freeze dried treats on top to get my furkids eating.

Hi Wendy thank you for this info It's super late here and got to be up early to take my fur baby's AMPS. I'll will write to you tmrw as would love to chat more about this. Thank you, good night

 

[Critter Mom]

Hi Tanya,

Sorry I wasn't around last night to reply to your post (I'm in the UK) but you were in great hands with Chris.

Tinka's responded really well to her insulin.

Here are some helpful links for the eating issues:

Nausea, vomiting and inappetence - symptoms and treatments

IDEXX pancreatitis treatment guidelines (nausea is a big issue for pancreatitis kitties and there's very helpful info in this document)

Crumbling freeze-dried treats on top of food can make it more appetising. While it's good to add some water to wet food, adding too much water can put a cat off (bit like soup that has been watered down to much is pretty tasteless to us, perhaps?)

Ondansetron is an excellent med for managing nausea symptoms. It's usually dosed at 1mg BID for a 10lb cat but when nausea is more pronounced a dose of 2mg BID can work much better. It can take a day or two for the full benefit to appear. Cerenia in addition to the ondansetron over the first couple of days can work well.

The other thing to watch for is any issue with gut motility. Because high BGs can affect the nervous system some cats can have motility problems which may then cause nausea. Is Tinka pooping well (frequency, stool consistency)? If she's slightly constipated or her stools are dry then addressing this may help with the nausea. If poor gut motility is an issue then treatment for a day or two with metoclopramide (Reglan) can help to restore better regularity. (Reglan is not a good med for cat nausea per se - they don't have many of the receptors it targets so not a substitute for Cerenia or ondansetron - and it is not a safe medication for long-term treatment because it has potentially harmful and irreversible side effects relating to dopamine and the nervous system).

If constipation is at the root of the nausea it needs to be addressed first. Otherwise ondansetron and Cerenia will be ineffective.

If an appetite stimulant is needed cyproheptadine is gentle with greater dosing control than mirtazapine (and it doesn't carry a risk of inducing serotonin syndrome).


Mogs
.

 

[Kris & Teasel]

I'd get another test at +3 and see how she's doing

Hi Chris, Tinka's PMBG +3.5 hrs is 12.6 mmol/L. So thats back up pretty high then considering she was 4.1 at her PMBG and she was 13.3 at AMPS. That will probably be my last BG for the night as we heading to bed shortly do you think thats ok?

I don't think I'm doing such as great job with pricking her ear. I'm free handing and she keeps pulling her head when I prick her. Sometimes its not enough blood even with pumping it a bit so then i have to do it a second time which I feel awful about. You can see a lot of the places where we have pricked her today where there is some dried blood on her ears. I feel so bad She keeps looking at us nervously like we going to poke her again, poor baby. Is there info on here on how I can do it better? Is a lancet device easier to use? I just need to find a bigger size guage then. Currently I'm using syringe tops from vet - they called Terumo needle and its a 25G x 5/8". Is that a good size to use? Sorry for all the questions Thanks for your help![/QUOTE]

One suggestion that might help if she likes to pull her head away: sit on the floor and put Tinka between your knees with her facing your feet and sitting upright. Now raise your knees and cross them to enclose her in that little space but don't squeeze her. Her head will be around the height of your raised knees and you can use your leg/knee position to restrain her head more or less as needed.

 

[TanyaG]

Hi Tanya,

Sorry I wasn't around last night to reply to your post (I'm in the UK) but you were in great hands with Chris.

Tinka's responded really well to her insulin.

Here are some helpful links for the eating issues:

Nausea, vomiting and inappetence - symptoms and treatments

IDEXX pancreatitis treatment guidelines (nausea is a big issue for pancreatitis kitties and there's very helpful info in this document)

Crumbling freeze-dried treats on top of food can make it more appetising. While it's good to add some water to wet food, adding too much water can put a cat off (bit like soup that has been watered down to much is pretty tasteless to us, perhaps?)

Ondansetron is an excellent med for managing nausea symptoms. It's usually dosed at 1mg BID for a 10lb cat but when nausea is more pronounced a dose of 2mg BID can work much better. It can take a day or two for the full benefit to appear. Cerenia in addition to the ondansetron over the first couple of days can work well.

The other thing to watch for is any issue with gut motility. Because high BGs can affect the nervous system some cats can have motility problems which may then cause nausea. Is Tinka pooping well (frequency, stool consistency)? If she's slightly constipated or her stools are dry then addressing this may help with the nausea. If poor gut motility is an issue then treatment for a day or two with metoclopramide (Reglan) can help to restore better regularity. (Reglan is not a good med for cat nausea per se - they don't have many of the receptors it targets so not a substitute for Cerenia or ondansetron - and it is not a safe medication for long-term treatment because it has potentially harmful and irreversible side effects relating to dopamine and the nervous system).

If constipation is at the root of the nausea it needs to be addressed first. Otherwise ondansetron and Cerenia will be ineffective.

If an appetite stimulant is needed cyproheptadine is gentle with greater dosing control than mirtazapine (and it doesn't carry a risk of inducing serotonin syndrome).


Mogs
.

Hi Tanya,

Sorry I wasn't around last night to reply to your post (I'm in the UK) but you were in great hands with Chris.

Tinka's responded really well to her insulin.

Here are some helpful links for the eating issues:

Nausea, vomiting and inappetence - symptoms and treatments

IDEXX pancreatitis treatment guidelines (nausea is a big issue for pancreatitis kitties and there's very helpful info in this document)

Crumbling freeze-dried treats on top of food can make it more appetising. While it's good to add some water to wet food, adding too much water can put a cat off (bit like soup that has been watered down to much is pretty tasteless to us, perhaps?)

Ondansetron is an excellent med for managing nausea symptoms. It's usually dosed at 1mg BID for a 10lb cat but when nausea is more pronounced a dose of 2mg BID can work much better. It can take a day or two for the full benefit to appear. Cerenia in addition to the ondansetron over the first couple of days can work well.

The other thing to watch for is any issue with gut motility. Because high BGs can affect the nervous system some cats can have motility problems which may then cause nausea. Is Tinka pooping well (frequency, stool consistency)? If she's slightly constipated or her stools are dry then addressing this may help with the nausea. If poor gut motility is an issue then treatment for a day or two with metoclopramide (Reglan) can help to restore better regularity. (Reglan is not a good med for cat nausea per se - they don't have many of the receptors it targets so not a substitute for Cerenia or ondansetron - and it is not a safe medication for long-term treatment because it has potentially harmful and irreversible side effects relating to dopamine and the nervous system).

If constipation is at the root of the nausea it needs to be addressed first. Otherwise ondansetron and Cerenia will be ineffective.

If an appetite stimulant is needed cyproheptadine is gentle with greater dosing control than mirtazapine (and it doesn't carry a risk of inducing serotonin syndrome).


Mogs
.

Thank u Mogs. Will reply more soon. Just took Tinka's BG her AMPS and it is 17. Which is higher than yesterday's start which was 13.3. Do I still drop the dose to 0.5u?

 

[TanyaG]

If it's above 200 (11.1) yes, you shoot....if it's below, you stall, don't feed and post for help....make sure your subject line is clear ...something like "STALLING, NEED HELP!!!" works....LOL



That's great!! Means that since she last peed that her glucose pretty much stayed below renal threshold which is really good since kidneys are the hardest hit organ with diabetes. Renal threshold is the point where the kidneys can't handle the glucose any more and it spills over into the urine



It's not a surprise considering she went as low as she did today and you skipped the shot tonight....that's 227
.
Whether you reduce or not will depend on which dosing method you choose.....the Tight Regulation Protocol or the Start Low, Go Slow method
It makes a difference on dosing advice we'd give you. TR is the only protocol that's been published in a veterinary journal so it has a lot of science behind it, but it requires you be able to test a little more often than SLGS. It also gives the best chance at remission. We've had cats go OTJ (Off The Juice) on SLGS, but it's much more common on TR because you adjust the dose more often in response to the numbers you're getting.

Some of the basic differences are:

TR...dose adjustments can be made as often as every 3 days (6 cycles)...this is most effective because if they're staying in numbers we don't like, we can increase more often
SLGS...dose adjustments are made once a week....this can be hard on the caretaker IF the cat is "stuck" in high numbers very long

TR...reductions in dose are given if they drop below 50 on a human meter, 68 on a pet meter
SLGS...reductions are given if they drop below 90 on either meter

TR...You'll want to get the 2 PS tests and at least one other test....preferably at least 2 other tests.....One somewhere between +4 and +7 on the AM cycle and a "before bed" test on the PM cycle...if you can only get 1, the "before bed" test is most important since most cats go lower at night
SLGS...You still must get the 2 PS tests in, and then do a curve once a week (testing every 2 hours for 12 hours or every 3 hours for 18 hours)

I think considering this was her first dose, you'd be smart to go ahead and reduce to .5 tomorrow.....it usually takes 5-7 days for the depot to fill and to see how the starting dose is going to do, but with that big a drop today, I think it's best to start a little lower than the .75 for now

Hi Chris
Just took Tinka's BG her AMPS and it is 17. Which is higher than yesterday's start which was 13.3. Do I still drop the dose to 0.5u?

 

[MrWorfMen's Mom]

Hi Tanya, I think I would still stick with the 0.5u despite the higher pre-shot number. She had a very good drop yesterday but if she isn't eating well, you do not want to push this too fast. For now, until you know Tinka's appetite is improving, I'd be inclined to stay with the Start Low Go Slow method of dosing and she earned a reduction yesterday based on that method. Having skipped the shot last night, the higher AMPS is not unexpected at all so no worries. Once Tinka's appetite improves, you can switch over to Tight Regulation if you want to.

 

[TanyaG]

Hi Tanya, I think I would still stick with the 0.5u despite the higher pre-shot number. She had a very good drop yesterday but if she isn't eating well, you do not want to push this too fast. For now, until you know Tinka's appetite is improving, I'd be inclined to stay with the Start Low Go Slow method of dosing and she earned a reduction yesterday based on that method. Having skipped the shot last night, the higher AMPS is not unexpected at all so no worries. Once Tinka's appetite improves, you can switch over to Tight Regulation if you want to.

Hi Linda thank you I have gone ahead with 0.5u. I will test again +2 and report back. So with tight regulation you wouldn't drop the dose then? Yeah her eating is not where I'd like it to be. She ate a bit better this morning though. Last night was only about half though. I just spoke to the vet and he wasn't impressed I dropped to 0.5. But that's my decision. He also suggested again that I can give her a 0.5 shot tonight without pre testing her BG. I would never do that, so dangerous. So glad I found you all on this forum! I asked for an anti nausea med but he says it's not nausea as she didn't respond to the one anti nausea injection they gave her a few days ago. He said she's probably formed a habit with food not being so nice as she feels unwell. I still would hv liked to try a different anti nausea though. My vet is sully more open to ideas but she's away for a few weeks. I asked for an appetite stimulant though and he says I can give Remron. Not sure if that's good or if I should try this for her? Thanks!

 

[TanyaG]

Hi Tanya,

Sorry I wasn't around last night to reply to your post (I'm in the UK) but you were in great hands with Chris.

Tinka's responded really well to her insulin.

Here are some helpful links for the eating issues:

Nausea, vomiting and inappetence - symptoms and treatments

IDEXX pancreatitis treatment guidelines (nausea is a big issue for pancreatitis kitties and there's very helpful info in this document)

Crumbling freeze-dried treats on top of food can make it more appetising. While it's good to add some water to wet food, adding too much water can put a cat off (bit like soup that has been watered down to much is pretty tasteless to us, perhaps?)

Ondansetron is an excellent med for managing nausea symptoms. It's usually dosed at 1mg BID for a 10lb cat but when nausea is more pronounced a dose of 2mg BID can work much better. It can take a day or two for the full benefit to appear. Cerenia in addition to the ondansetron over the first couple of days can work well.

The other thing to watch for is any issue with gut motility. Because high BGs can affect the nervous system some cats can have motility problems which may then cause nausea. Is Tinka pooping well (frequency, stool consistency)? If she's slightly constipated or her stools are dry then addressing this may help with the nausea. If poor gut motility is an issue then treatment for a day or two with metoclopramide (Reglan) can help to restore better regularity. (Reglan is not a good med for cat nausea per se - they don't have many of the receptors it targets so not a substitute for Cerenia or ondansetron - and it is not a safe medication for long-term treatment because it has potentially harmful and irreversible side effects relating to dopamine and the nervous system).

If constipation is at the root of the nausea it needs to be addressed first. Otherwise ondansetron and Cerenia will be ineffective.

If an appetite stimulant is needed cyproheptadine is gentle with greater dosing control than mirtazapine (and it doesn't carry a risk of inducing serotonin syndrome).


Mogs
.

Thank you Mogs. I spoke with the vet this morning. I'm not really agreeing with much he says as he wants me to give Tinka her PM shot without doing a PMPS which too me is crazy to shoot blind. He asked how I was even able to do o.5u. I said by slowly twisting the syring you can get a drop out at a time, which I learnt from the video Chris shared He's a nice vet just pretty relaxed about dosing and BG testing. My vet will be back in s few wks so hopefully she's more on board, but regardless I'm so happy we went with all your advise to give 0.75u yest instead of 1u as Tinka may hv dropped to low then. With regards to the loss of appetite I do feel it could be nausea causing this due to the sniffing. I asked the vet is we can give her something for nausea but he said no he doesn't think it's nausea as she had one injection with I think it was cerenia on Tuesday but I didn't notice an improvement. Perhaps it wasn't given for a long enough period as I think the injection only lasted 24 hrs? I asked if we could give her something else but he says if Cerenia didn't work it's not nausea. I don't necessarily agree though Cause maybe it just wasn't used long enough or maybe a different kind would work better. Can ondanestron be bought without a script or not? The vet says she's probably gone off her food out of habit because she feels unwell from the diabetes. It's possible but if she's nauseas I would have liked to try something for a few days. I then asked if we could do try an appetite stimulant and he said I could pick up a script for Remron. What are your thoughts on that?

Her bowel movements are currently good. In the past she's had constipation which def made her off her food but not for a little while. Last week one stool was a bit hard and then with food changes that went a bit loose for a few days. Since switching to Instinct canned 95% protein this Wed they have seemed more normal and consistent. Not hard, but maybe a little bigger.