3/30 Rusty #2 AMPS 556; +3 558; +6 379; +9 366; PMPS 422

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SantaCruzSPCA

SantaCruzSPCA

Member Since 2017
Back to black. Today will be his first 24 hour period with no dry food. I'm hoping to see these numbers start coming down some. I came back last night and got a +3 (which was 364) but I think I would have needed to get something +6 or after to see how low it really took him. Any suggestions on dosing at this time. Stay the course? Experiment? Can they sustain health while in the blacks and reds for this long as long as Ketone tests are neg?

Yesterday's Condo: http://www.felinediabetes.com/FDMB/...593-9-482-pmps-400-3-364.175532/#post-1929007
 
Also, his dental health is not great which is probably not helping the situation. Because of the DKA and his numbers now being really high I've been holding off on the procedure. At what point during his regulation is a dental suggested (or not suggested)?
 
Bad teeth can prevent regulation, it's a catch 22. And the ongoing possible infection is an issue with recent DKA. Neko had her first dental when she was far from regulated and did fine.
 
Wendy&Neko said:
Bad teeth can prevent regulation, it's a catch 22. And the ongoing possible infection is an issue with recent DKA. Neko had her first dental when she was far from regulated and did fine.
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At this point do you recommend experimenting with a lower does or staying the same? I'm going to fax our dental vet his recent blood panel and see if I can get him scheduled for next week.

Also I was reading a little bit more about injection sites and didn't realize that you're supposed to try to get the insulin injected into the fat and not just under the skin. I'm not sure if I'm getting it into the fat or not. I just give it like I give normal vaccines, not right into shallow skin but I pull up the scruff or shoulder area and inject low and angled slightly down. I'm wondering if it's not getting into the fat and not being absorbed properly.
 
17098550_10213304827161492_3827138687543645456_n.jpg


The image on the left shows sub q injections. The one on the right is for IM injections
 
I never heard about trying to inject into the fat. I always thought you just injected under the skin, the way you describe that you do. (and as in Tuxedo Mom's first illustration). If you inject into muscle, it can hurt and is not readily absorbed (I think).
Sometimes too much insulin can produce high numbers. But with Rusty there are so many variables because of his DKA, ketones, diet, teeth, etc. With a newly diagnosed diabetic our protocol usually works (starting at 1 unit and working up to the best dose in 1/4-unit increments so as to be sure not to pass the right dose). But in Rusty's case he was on a too-high dose of Humulin (?) and that had to be taken into account. I hope that someone can help you with this. Maybe, in addition to @Wendy&Neko, @Marje and Gracie or @Sienne and Gabby (GA) will have some thoughts.

My previous diabetic cat, Stu, was overdosed by his vet when we switched to Lantus because his previous insulin (PZI Vet) had been discontinued. The vet treated Lantus like a non-depot insulin and raised his dose by 2 Units at a time (Stu crashed and that's when I found this board). I started out by gradually reducing Stu's dose, and got him pretty well regulated over the course of a few months. But it became apparent that Stu had several serious health issues (hyper T and Chronic Kidney Disease; and then cancer). I think that if Feline Diabetes had been his only problem, I could have gotten him better regulated. You can take a look at Stu's spreadsheet (it's in my signature). I should point out that I had shot Stu "blind" for 4 years when he was on PZI Vet before I found this board and learned what to do!

Hang in there, Mandi!
 
Tuxedo Mom said:
17098550_10213304827161492_3827138687543645456_n.jpg


The image on the left shows sub q injections. The one on the right is for IM injections
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Thanks for this :) I'm for sure doing it the first way, however in one of the Lantus stickies, I read that your not supposed to inject into the skin but rather the "fat"... (read the attached image that I grabbed from the stickie)
 

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I don't think it's possible to inject into the fat. Can you point us to what you were reading? The fat layer is just under the skin and the amount varies depending on how, ummmmm.... "fluffy" your cat is. Most cats who are diagnosed with FD have lost weight. The insulin is supposed to be injected subcutaneously.

I'm wondering whether you read about how Lantus is deposited into the adipose (fat) tissue. What this means is that when you inject, the insulin molecules migrate to fat cells where they form micro crystals. These crystals gradually dissolve. This is the process whereby you have a depot and it's what give Lantus is long duration.
 
The sub q layer contains fat cells as well as fluids:

"Subcutaneous tissue, also known as the hypodermis, is the innermost layer of skin. It's made up of fat and connective tissues that houses larger blood vessels and nerves. Subcutaneous tissue acts as an insulator and regulates body temperature."

images


You do not inject insulin into the muscle as it is much more painful and can cause more rapid absorption of the insulin.
 
I always think of SubQ as just under the skin but that picture that you posted @Tuxedo Mom shows that it also contains fat.

This was the quote that I read and I'm like uh oh!
http://www.felinediabetes.com/FDMB/...insulin-info-handling-drawing-fine-doses.151/

"Some veterinarians feel that the scruff is not the best place to inject because the area is prone to the formation of lumps under the skin, and because it is easier for the owner to mistakenly inject muscle or skin. Any of these would interfere with proper insulin absorption. Whichever injection sites you use, the key is to use proper pinch-up techniques so that the needle goes into the fat layer below the skin – not into the skin or muscle, and not through the pinch and out the other side."
 
Here is a post on Testing and Shooting Tips that might help. I almost alway gave Neko her shot in the scruff/behind the shoulders and it didn't seem to make much difference. I did rotate left and right from morning to night.

Rusty did quite a bit drop again today from +3 to +6. Unfortunately big drops can also cause bounces. :rolleyes:

Until you get your syringes with 1/2 unit markings, it going to be hard to do any increases. Is Rusty back on mostly wet food today?
 
Wendy&Neko said:
Here is a post on Testing and Shooting Tips that might help. I almost alway gave Neko her shot in the scruff/behind the shoulders and it didn't seem to make much difference. I did rotate left and right from morning to night.

Rusty did quite a bit drop again today from +3 to +6. Unfortunately big drops can also cause bounces. :rolleyes:

Until you get your syringes with 1/2 unit markings, it going to be hard to do any increases. Is Rusty back on mostly wet food today?
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I got my syringes today!!! :) He's only had wet food today and is eating it very well. His +9 shows another small drop and that was about 1 1/2 hours after his last meal before PMPS (he usually shoots up after a meal.) It will be interesting to see what it does in a few hours.
 
SantaCruzSPCA said:
I'm wondering if his PMPS is lower than his +9 should I do a decrease and to what? 4.25? 4.0?
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It looks like he might be coming down from a bounce. The dose shouldn't be decreased unless he earns it by going below 50 (unless you're following SLGS, in which case a decrease is earned below 90), but a lot of us get a PM +2 BG check to "predict" how the cycle will go. If the +2 is the same or lower than the PMPS, it could be an active cycle. A lot of cats go lower at night, including mine, but when he's coming down from a bounce he tends to go lower than usual.
 
Adrian and Chino said:
It looks like he might be coming down from a bounce. The dose shouldn't be decreased unless he earns it by going below 50 (unless you're following SLGS, in which case a decrease is earned below 90), but a lot of us get a PM +2 BG check to "predict" how the cycle will go. If the +2 is the same or lower than the PMPS, it could be an active cycle. A lot of cats go lower at night, including mine, but when he's coming down from a bounce he tends to go lower than usual.
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Unfortunately I think Rusty and I are caught in a vicious cycle of bouncing because I don't have the capacity to do regular PM readings once I leave work (he's a shelter cat where I work). Last night I came back at +3 to get a reading for the first time and it was a bit of an endeavor with the husband whose level of "understanding" is wearing thin...as I now come in three hours early and stay an hour late just to make sure his shots are 12 hours apart. :(

It's really been hard to tell if he needs MORE or LESS insulin when all I get to see is the bounce. You'd think he'd switch it up and go low at least once during the day...but whatever is happening seems to be happening at night or not at all. I'm beyond frustrated!
 
Wow, that is a tough situation... are you able to leave out higher-carb wet food overnight on the nights when the BG is dropping? That might help slow the drop and limit the bounces.
 
Adrian and Chino said:
Wow, that is a tough situation... are you able to leave out higher-carb wet food overnight on the nights when the BG is dropping? That might help slow the drop and limit the bounces.
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Yes, I can leave any type of food out for him during the night. Although he's headed back up PMPS and after his meal will probably go even higher. I'm starting to wonder if it's a bounce at all though. His spreadsheet is the scariest one I've seen on the whole forum, lol.

Clinically, he's acting better than I've ever seen him. He's alert, playful, happy, keeping weight, eating well, no excessive drinking. If I didn't know his numbers were so high I'd think he was a well regulated diabetic!
 
What a great Rusty report! Sounds like he doesn't care about his numbers.:)

SantaCruzSPCA said:
His spreadsheet is the scariest one I've seen on the whole forum, lol.
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Take a look at early days of some of the other kitties. Also keep in mind that you are using the AlphaTrak that reads quite a bit higher at the high end than the human meters do. A good number of the former AT users switch because they can't get the good price you can on strips. A couple of comparison SS's are Willow in 2016, Raja, and SK (small kitty). All of those used the AT at first and you can see the difference in numbers when Willow and Raja changed to human meters.
 
Wendy&Neko said:
What a great Rusty report! Sounds like he doesn't care about his numbers.:)


Take a look at early days of some of the other kitties. Also keep in mind that you are using the AlphaTrak that reads quite a bit higher at the high end than the human meters do. A good number of the former AT users switch because they can't get the good price you can on strips. A couple of comparison SS's are Willow in 2016, Raja, and SK (small kitty). All of those used the AT at first and you can see the difference in numbers when Willow and Raja changed to human meters.
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Yeah, according to him he feels great!

Although he keeps getting these sores on the sides of his head and cheeks from rubbing on his cat tree, his scratching post, and pretty much everything else. They keep almost healing and then he rubs them open again. I'm thinking something in the food is making him itchy.

As far as the meter goes... which one is more accurate? I would think the pet meter is? Although the other one might lower my anxiety level, lol.

Also, I've sent the dental vet Rusty's recent blood panel to see if we can't get one scheduled for SOON. I want to make sure they have experience doing dental work on diabetics. He's got periodontal disease for sure and it would be great to get it tended to.
 
SantaCruzSPCA said:
As far as the meter goes... which one is more accurate? I would think the pet meter is? Although the other one might lower my anxiety level, lol.
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The pet meter probably matches more closely to the lab values, though my vet really like her Onetouch and how well it compared to the lab numbers. But both the Tight Regulation protocol and SLGS were developed with human meter values in mind - the accuracy with lab values doesn't matter.

Sorry to hear about the sores. Inflammation can also increase blood sugar numbers.
 
I hope he's not rubbing his cheeks because his teeth hurt.
I loved my One Touch and I would often compare it to what my vet got on his meter or the blood work and it was right on or very close. I used to buy my One Touch test strips on EBay, but they are still more expensive than other human meter's test strips, so after years of loving my One Touch, I finally switched.
Maybe the dentist can at least look at his teeth to see if they are the cause of the constant rubbing.
 
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