Struggling to find the right dose

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Smokey and Jessica

Smokey and Jessica

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I posted before on the health forum about Smokey’s glucose bouncing wildly. The vet took 5 glucose curves over the course of 2 weeks to set him on 2 units, but when I just started testing at home approx two weeks later, the first day he continuously went up, next day caught a low of 38, next day at the vet this time continuously up, so at home the next day I lowered to 1.5 but he still hit a low of 47. (I use an aphatrak) Now I lowered to just 1, once last night once this morning. Today we started with 190 pre- shot, for the rest of the day got 281, 172, 214 which seem to be really good right? But his evening pre-shot was 393. I only gave him 1 again since all day was great numbers, but is that really an ok pre- shot number to shoot for? I’m wondering if he’s now recovered from the too high dose of 2 and the 393 is a more true reading since a few days ago he was struggling with too much? Like should I give him a few days to get completely over that before I say ok this is a good dose? I want to do 1 for at least one more day to see if I get those awesome daytime numbers again, but I don’t know if he should be getting as high as 393 between shots? What really is a good pre-shot number to shoot for?
 
Welcome! I read your post on the main forum and looked at the photos of your handsome kitty. I agree with the others that he isn't too fat.

Now re dosing: congratulations on testing his BG at home and taking it upon yourself to lower his dose to 1 u. Data from vet curves isn't very reliable because vet stress generally elevates BG and the vet then prescribes too high a dose. The BGs from today are fairly flat and the higher number at evening pre shot is either the insulin wearing off or a bounce from the lower numbers. His responses are probably erratic from the frequent dose changes. If you're willing to work with us and follow a structured dosing routine as well as keep the type of spreadsheet we use here I'm sure we can get you moving forward in a safe way. I'd stay at the 1 u twice a day dose for now.

Here's the basic dosing routine we recommend:
  1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
  2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
  3. do extra tests on days off to fill in the response picture
  4. if indicated by consistently high numbers on your SS, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
  5. post here for advice whenever you're confused or unsure of what to do.
Here's an explanation of BG rebound AKA "bouncing":
  1. BG goes low OR lower than usual OR drops too quickly.
  2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
  3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
  4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
  5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
  6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
  7. Many vets have little/no understanding of the bouncing phenomenon.
Here's the link to the online Google sheets spreadsheet we use. It's viewable by all members and is the first thing we look at before offering advice:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

It requires a leap of faith on your part to deviate from your vet's guidance and try what we suggest here. Many people before you have struggled with that - me included! ;)
 
Also important: the "take action because BG is getting too low" is 50 on a human meter/68 on a pet meter like the AT.

It would be very helpful to us if you would set up your "signature" (light grey text under a post) by clicking on your name at the top of the page, clicking on "signature" in the drop down menu and typing in the text box that opens. Here's what to include:
  • kitty's name and age
  • date of diagnosis
  • what insulin you use
  • what glucose meter you use
  • what he eats
  • other health issues/meds he has.
I hope you'll set up a spreadsheet and you can then put a link to it in your signature.
 
I will definitely try to get that done this weekend. For now I’ve just been scribbling in the book that came with the alpha track. The info is there just a mess!
Also, by suggestion from my other post, he’s had 1/4 can split to 3 snacks today, which I think is what kept him pretty level? I’m still familiarizing the talk here, but what I got today was amps 190, +2 281, +6 172, +9, 214, and pmps 393. I didn’t track his snacks but they were after each test so now that I think about it that last one was about 2 hrs 15 min maybe 2 1/2 after his snack so maybe he digests a little slow.
I’ll stick with 1 and work on the spreadsheet and signature info and then I’ll be back!
Thanks for everything!
 
Spreadsheet is up!
I feel like I'm chasing the low number right now instead of working to bring down the highs. He had pmps 422! But I will give it a couple more days at this for now. I already know 1.5 put him at 47 so I can't do that much. I have U40 whole unit syringes so want to make sure 1u is completely stable before I would even think of trying for 1.25.
 
Jlko said:
Spreadsheet is up!
I feel like I'm chasing the low number right now instead of working to bring down the highs. He had pmps 422! But I will give it a couple more days at this for now. I already know 1.5 put him at 47 so I can't do that much. I have U40 whole unit syringes so want to make sure 1u is completely stable before I would even think of trying for 1.25.
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I can't see your SS. You have to set it up using the blue "share" icon at the top of the page.
 
Kris & Teasel said:
It requires a leap of faith on your part to deviate from your vet's guidance and try what we suggest here. Many people before you have struggled with that - me included! ;)
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That can be more than a leap. Maybe that's why pole vaulting was invented.
Noah is a high dose bouncer and it's still a struggle for me to see his readings go higher than the meter can register, give him less insulin and magically watch his numbers come down. It only looks like magic, once I sat down and read about bouncing it all made sense. The techs at my vet all think I'm nuts already but getting educated about something is not the same as living with it.
 
I can see it. That 63 on your AT meter for 10 Feb is a sign that the dose is a little too high. The red PM pre shot is probably a bounce because of that low. I suggest you try hard to eyeball 0.75 u as your next dose. Do your syringes have half unit marks on therm?
 
No I have whole unit, and I literally JUST gave him 1u again. I'm home all day to watch him though and could lower tonight. It would be easier to eye .5 but I could try .75
 
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I was reading something about 6 cycles being the goal after changing a dose? This morning's shot was the 5th 1u shot. If he doesn't go lower that upper 60's again today would it be safe to try 1u one last time tonight or just go straight to .75?
The Hills M/D costs $70 here. I had planned to use it up ( 7 days worth left) but if I lower him again to not even a whole unit I wonder if I switch to fancy feast, would the lower carb be enough to give him that one last push to NO insulin? I would rather get him to stop bouncing, use this food, then switch next week, but feeling hopeful!
 
Following the last few days, today was consistent with low- high/ flat the next day- low the next. It was a fairly flat day ending with another huge jump at the end. Lowered to .75 to see if it’ll help stop another bounce tomorrow.

Does anyone test on the paw? I’ve watched videos on it but I haven’t seen anyone here mention it. I need to slow down on his ears and thinking of trying an alternate place to get blood. I want to watch at least 1-2 mid day tests to catch a bounce if needed but I’ve been poking A LOT. It has to hurt, although he still comes for it purring because food is more important! He takes it like a champ but there’s getting to be some inflamed skin and irritation on both ears. Neosporine is helping.
 
Holding the dose for 3-6 cycles is for increases. Decreases can happen at any time. The bouncing your seeing is likely caused at least in part by the higher carbs in the food. Although I can definitely understand not wanting to waste something so expensive!

I tested on the paw a little when we were first starting. I found it a little harder to get blood from there, and my kitty wouldn't hold still for me, so I went back to the ear, but there is nothing wrong with testing on the paw if you and your kitty prefer it. Are you pinching his ear a little when you're done to stop the bleeding? It also reduced the bruising and swelling after the test. Just hold the poke spot between your fingers for a few seconds before you let him go.

Hopefully the reduced dose will settle him down a little. Have you found a low carb food for when you run out of the M/D? And it looks like you're in Japan, yes? we have another member who lives there as well!
 
I’ve done some looking and I plan to switch to fancy feast classic. I’ve already accepted the loss of the dry food I stopped giving but that wasn’t as expensive as the cans. If he settles down in the next couple days I’ll switch sooner although there’s only about a week left anyway so either to the end or I’ll only have a few unused cans. Not a big loss.
I actually saw that there’s someone else here! I’ve spent hours reading so many posts trying to soak in as much info as I can and came across their post. I sent an introduction to them earlier actually. It was nice to see someone else here going through this. This group is amazing!
Thanks!
 
Ah! For some reason I was thinking that was one of the dry foods. The m/d wet is only 13% carbs which is too high, but only by a little. I don't think one more week would be too bad, although I could suggest starting the transition now as cats tend to have rather fragile stomachs and switching all from one food to another can make them sick. You might also want to hold back a couple of cans that you can use if he ever goes low - having higher carb food in the cupboard is an important tool in raising BG if an insulin dose turns out to be too much.

You have FF classic in your city? I don't think scs islander has been able to find it there.
 
Good idea to hold a few! I’ll get some fancy feast today. It might not be available out in town. I’m here because my husband is military so I have access to stores on base. That might be why. I’ve never looked for it off base, it might not actually be available. If I come across it I’ll let them know though. This island is only so big so it might help if there’s 2 eyes looking out.
This mornings amps is only 206 after the .75! Not sure if I should lower to .5 or stick with it?
Edit: I’m going to stick with it. If he follows the same pattern, this is the day he will curve and I want to see how low .75 takes him. 1 took him to 63, so .75 might only take him to maybe 80’s- 90’s and I don’t want to miss that. I guess I should mention I’m a stay at home mom for the time being so I’m always able to watch him during the day.
 
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Very nice! Fingers crossed for a good cycle today!

I believe there is a version of FF available out in regular stores, but it goes by another name....which is of course escaping me at the moment. :rolleyes:
 
No extreme low yesterday but still went high last night. Higher amps too. Will continue at .75 1-2 weeks though to see if amps and pmps start to go down and I’m running low on test strips unfortunately so now that I know he’s not going too low I’m going to minimize testing until I get some more. He seems to be cruising in the blues during the day and I’m introducing fancy feast so that’ll help too.
 
Just a note that since you’re introducing a lovely low carb food that can impact numbers in a BIG way. We’ve seen drops of more than 100 points overnight on a food change. I’d be careful about minimizing testing too much during this. I know it’s tough when low on strips but I’d just do the best you can to be sure he doesn’t suddenly drop!
 
Rachel said:
Just a note that since you’re introducing a lovely low carb food that can impact numbers in a BIG way. We’ve seen drops of more than 100 points overnight on a food change. I’d be careful about minimizing testing too much during this. I know it’s tough when low on strips but I’d just do the best you can to be sure he doesn’t suddenly drop!
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Right now I have about 27 strips left and the new ones should be here next week so I should be fine with every am, pm, and scatter some mid day checks, just not everyday mid unfortunately. So, you’re right I need to be careful. I’ll stretch out the full switch to ff until I get more strips. He’s still half/ half at meal time. He’s had some EXTREME lows before with no symptoms so I won’t make anymore changes until I can test regularly.
It takes so long to get things here sometimes and this is the first time I had to restock strips and I definitely timed it wrong. Hard lesson learned.
 
Sounds good! Yeah those AM and PM preshots are important and getting mids when you can is good...I think just stretching out your food change will be good too. I do that usually to avoid any GI upset and it'll help those BG numbers hopefully come down slower. :)

Just do the best you can. That's all any of us can do! I only mentioned the testing because of the food change..otherwise, you'd probably be fine. You might want to look at getting a human meter as a backup? It'll give you lower numbers than the AT, but it could be good just to have in an emergency situation. You could use AT but if you ran out of strips with no more coming for a few days, you'd have something there that you could work with, even with the numbers looking different. No rush on that though...just something to think about and if you decide not to do it, I totally get that too! :)
 
I'm just going to echo Rachel here...:)...you can definitely keep using the AT2, but I just wanted to make sure you've seen that most of use human meters. They read differently, but they give sufficient information for the decisions we need to make regarding dosing - plus they are easier to get and cheaper. Either option is fine though - it's up to what you prefer.
 
I do plan to switch later when he’s more stable and I’m more experienced. I think starting with the AT was the best decision though. I’m still learning and making mistakes so I don’t want to change it up just yet until I get his all figured out.
 
Jlko said:
Right now I have about 27 strips left and the new ones should be here next week so I should be fine with every am, pm, and scatter some mid day checks, just not everyday mid unfortunately. So, you’re right I need to be careful. I’ll stretch out the full switch to ff until I get more strips. He’s still half/ half at meal time. He’s had some EXTREME lows before with no symptoms so I won’t make anymore changes until I can test regularly.
It takes so long to get things here sometimes and this is the first time I had to restock strips and I definitely timed it wrong. Hard lesson learned.
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Hi - just a quick thought- the local Vet can get the strips- I order through mine in the morning and they are available that evening usually. Costs a bit more I realize.
 
scs islander said:
Hi - just a quick thought- the local Vet can get the strips- I order through mine in the morning and they are available that evening usually. Costs a bit more I realize.
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Which vet? Animal hospital 22 had never seen it before so I don’t think they could. Maybe I’ll ask Kadena. They use the alpha track there.
 
Jlko said:
Which vet? Animal hospital 22 had never seen it before so I don’t think they could. Maybe I’ll ask Kadena. They use the alpha track there.
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Wherever Animal Hospital 22 orders their supplies from can more than likely provide testing strips. My vet is far north of you and I was surprised how fast they got them. I have also ordered via the U.S. and have my daughter send a couple of bottles every so often so I am covered both ways. You're probably right about Kadena - If they use the meter surely they have the testing strips available.
 
scs islander said:
Wherever Animal Hospital 22 orders their supplies from can more than likely provide testing strips. My vet is far north of you and I was surprised how fast they got them. I have also ordered via the U.S. and have my daughter send a couple of bottles every so often so I am covered both ways. You're probably right about Kadena - If they use the meter surely they have the testing strips available.
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Or if you do happen to get in a bind I could get a vial to you in the interim.
 
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scs islander said:
Or if you do happen to get in a bind I could get a vial to you in the interim.
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Awe thank you!
I will be just fine. I picked up a human meter and box of 50 test strips for like $17 today. I’m not sure if it’s a very reliable one, maybe I’ll ask if anyone else uses it over on the health forum, but it’ll get me through as a back up so I at least don’t give any insulin blind. I’ll know if it’s safe and that’s all that matters. I still want to use the alphatrak, but this will do for now.
But, when he’s stable, if this meter is accurate, I definitely like the idea of $7/50 strips instead of the $50 I pay now!!!! That’s just crazy!!
 
Jlko said:
Awe thank you!
I will be just fine. I picked up a human meter and box of 50 test strips for like $17 today. I’m not sure if it’s a very reliable one, maybe I’ll ask if anyone else uses it over on the health forum, but it’ll get me through as a back up so I at least don’t give any insulin blind. I’ll know if it’s safe and that’s all that matters. I still want to use the alphatrak, but this will do for now.
But, when he’s stable, if this meter is accurate, I definitely like the idea of $7/50 strips instead of the $50 I pay now!!!! That’s just crazy!!
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Okay- Glad every thing worked out for you.
 
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