I am not that tech savvy so I don’t know how to link posts. Thanks for posting the links in your reply.
No worries, I think many of us start out with a learning curve, not just for FD, but for forums and SS things too. I know I did. To link to your prior post, go to your prior post, copy the URL at the top of your browser, start a new thread, and paste the URL in that new thread.
We were away the 10 days where there are no sugar checks in the spreadsheet. As you can see, it’s 2/16-25th
Ah I see it now, totally missed that. It's less confusing if you leave all the rows for those days, add the AM and PM shot amounts and just note that you were away and no testing was done. Without that, it just looks like one day he was doing something and the next day something else, when in fact there are several days in between. It will make it easier for others reading your SS to interpret the data to see it that way.
Maybe you’re right about the 0.25 va the 0.5 in different syringes, but then there’s posts from beans who use a caliper to keep the insulin consistent especially between different syringes, and how they are inaccurate. Anyway. I guess there will always be conflicting opinions, but going forward I’ll just have to accept that a 0.5 is a 0.5 across all syringes.
There is no conflicting opinion here. I use calipers too. It's not so much to keep consistent doses between different syringes as it is to keep consistent doses within the same manufacturer of syringes. Some of those lines are printed slightly askew and the zero line may be on the zero, but it also may be printed where the .5 should be instead. It's maddening. As you know, humans require much larger doses, so being off a hair wouldn't make a bit of difference to someone taking 20 units in one go, but to cats on tiny doses, a hair's difference can be huge. If I were going to switch syringe brands, I would not be able to use my same caliper measurements, I would have to recalculate all the measurements for that specific brand of syringe.
I know the SLGS “protocol” by heart, I know I haven’t been following it since we got back but that’s because his numbers are so alarming. Right now we are trying our best to stick with 0.5 units and not to freak out too much and make any changes, but it’s difficult esp being a PA. My clinical judgement says give more insulin, but it’s probably complicating things even more. Trial and error.
That's awesome that you have read and retained the SLGS guidelines. The best part of following SLGS or TR is a lot of the trial and error has been done by those long before you got here, and you only have to tweak things, eventually and slightly, to your cat, no need to reinvent the wheel. There are other stickies at the top they may give you more detailed info on how long acting basal insulins (Lantus/Levermir) work, specifically the depot insulin concept. I'm still going back and rereading things often, it's a lot to digest and I'm always picking up something new or understanding something that I wasn't ready to comprehend the last time I read it.
Rapid, short acting, "in and out" insulins are designed to pull high numbers down right away, Lantus is not. Not only is Lantus bad at pulling down high numbers, but if you try to adjust the dose based on the preshot number you are looking at, you mess up the depot and could likely have an insulin overdose. Dosing is based mostly on nadirs and not so much on preshot numbers. I've often found higher preshot numbers equal more unpredictability for the cycle: sometimes a crazy dive and a wild ride, sometimes a whole cycle of coming down only 20 points an hour.
Being that we can control so many parameters, you'd think it would be quick to get a cat regulated, but it just isn't the case. Some cats just snap to it, regulate right away and go OTJ, some take a little longer and do the same thing, some take a lot longer. I think many vets also give the impression this should all happen in under a month and that's just not the case for many cats, which certainly doesn't make it hopeless!
So many factors to consider and you have a lot of unknowns since Frosty came to you with diabetes. Was it his scavenger diet that did him in (gorging on leftover pretzels, hotdog buns and chips in Central Park perhaps
)? Does he have some underlying condition like pancreatitis that caused the diabetes? Does he have bad teeth or some other medical issue or infection that interferes with regulation? Did he have a previous home, was he given steroids that caused the diabetes? Maybe his pancreas works perfectly well to make insulin and he just can't use it properly? You may or may not ever know (even if you'd had him since he was kitten), but I think how they get diabetes tells some of the story to how things will go with regulation and some of those things will reveal themselves in time and you can rule them out.
The beginning requires so much patience, when I say beginning, I mean the first several
months. We have a saying around here, it's a marathon, not a sprint. I know it's frustrating, but the picture will become clearer, things will unfold and the patience will pay off. You can check out Asia's SS to see where we started and compare it to now. It was ugly, frustrating, and progress was
much slower than I would have liked for a cat that already had kidney disease!
Each cat is different.
While I was gone I pre drew the insulin bc there was NO WAY she could draw the micro doses. Before everyone FREAKS OUT and tells me what i already read about the lubricant in the syringe and insulin going bad, i already read the article that says it’s not recommended, but i had NO CHOICE. It was either no insulin or that. I wasn’t gonna take a chance of her giving him too much accidentally, because that could = death. I did my research and that was the best I could do. Either way, I would try to teach her next time (again) as I realize it’s difficult to tell how much he actually got while we were away. BUT, when we got back his sugar was excellent - 100 at +10 and 150 prior to the next dose. I gave 0.5 units, and then all hell broke loose.
Nobody is here to flog you.
We all do the best we can and sometimes have to make decisions that amount to the lesser of two evils, such as your example of predrawing syringes. I would have done the same. I'd much rather be faced with potentially less potent insulin while away a short time than trust someone unfamiliar with how this works to draw up tiny doses and then leave my cat alone for 12 hours without testing. It sounds like the dose amounts were consistent while you were away, so I think we can rule that out.
As for your last questions, everything is the same, other than the bread. He’s not allowed anywhere near any other food. He’s no longer allowed in the kitchen. He’s acting normal. Just the sugars are giving me palpitations.
That is good news that he's feeling okay and everything is the same.
It looks like he is bouncy, it could be the .5 dose that triggered it, hard to say. Bouncing is normal and not necessarily a bad thing (it at least means the insulin is working and Frosty is responding to it). I would suggest the best thing to do going forward is to stick with the same dose, am & pm for a week, get all the test data you can, and re-evaluate on the weekend when you can do a curve and ask some people here to check out Frosty's SS and try to see what patterns are emerging.
Didn't mean to write you a novel, but hopefully there some things in there that ease your worry and frustration a bit. I've been where you are, most of us have, it gets better. Keep posting and asking questions. Frosty is lucky to have found you.
