Jaxa (Dosing advice, please)

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Glassgoblin

Glassgoblin

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I've been following my Vet's protocol so far, but we went from pretty high for Jaxa yesterday at her vet appt to very low at her +5 last night. I posted in the main health forum last night, but basically she got down to a 51, I gave high carb treats and tested as she gradually got to 111 over two and a half hours. This morning she is at 345. I don't want to do the increase that my vet told me to do yesterday, going from 4 to 5 units in the AM, but am not sure what kind of dose is best so she gets a shot this morning. 3?

I haven't been able to add the last tests to the spreadsheet because I am on a Kindle and it won't let me access Google Docs.
 
Give some thought to how you'd like to proceed after this experience. Many people want to work closely with their vet and it can take quite a mental shift to deviate from that for a lot of reasons including not wanting to antagonize their vet. We do things differently from most vets and the outcome can be better. It's completely your choice, though, and we're always here to help whatever you decide. :)
 
Kris & Teasel said:
Are you going to try 3 u this AM? I think she needs a reduction from 4 u after that near hypo and I don't think dropping only 0.25 u is enough at this point. A whole unit drop seems safer. do get a +2 test though to see what's going on.
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I did finally give her 3 units, she has eaten, drank, been combed, ate more, had a normal bm, and is now napping. All normal for her at this time of day. Will get a +2 in 1.5 hrs.
 
Sorry I disappeared, but I'm glad to see Kris was here to take care of you! It was time for my kitty's test/feed/shoot at the same time and I ended up having a klutz moment and broke a glass all over the kitchen floor.

It can be hard to deviate from vet advice, but we're all here for you if you want help! As I recall, your kitty has pancreatitis as well, is that right? How is she right now? Is she taking any meds for it at this time or showing symptoms?
 
Kindle doesn't support Google. I also use kindle fire. If you have a smartphone, you can get Google there an enter your data. However, using the phone for Google sheets has some limits to formatting but you can do what you need to on it. Once a week I boot up pc and fix whatever formatting has to be done.

In other words I enter the data from my phone. Then use kindle to be here in the forums reading and answering posts. You can open ss on kindle. You get an option to view using Silk or sheets. Always pick Silk. You can not enter data though you can only view ss.
 
Djamila said:
Sorry I disappeared, but I'm glad to see Kris was here to take care of you! It was time for my kitty's test/feed/shoot at the same time and I ended up having a klutz moment and broke a glass all over the kitchen floor.

It can be hard to deviate from vet advice, but we're all here for you if you want help! As I recall, your kitty has pancreatitis as well, is that right? How is she right now? Is she taking any meds for it at this time or showing symptoms?
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I don't want to quote and answer each post so here goes:

The pancreatitis actually seems to be okay for the moment. She had some tests, which they thought looked normal at the beginning of March, and she has been consistently eating, no visible signs of nausea or pain so I haven't given her any pills for her pancreatitis since 3-10. I worry that her use of prednisolone contributed to getting diabetes; she was on it for more than a month. Every time I start thinking things are getting better something bad happens though; I swear whenever I cried all over her she seemed better the next day (eating, etc).

I've thought about how much I can trust my vet; I want to work with them, but I don't see what the weekly visits do when she is stressed from the trip there and back, and her tests are always higher there. Of course they like to guilt me by talking about cats that are not watched and only come in when there is trouble, so they claim it is harder for them to treat. I have another test set up but had already been planning to tell them we need to taper off to once a month or so; I might ask them to do the full chem 17 panel again to see if all of her liver and other values are okay. It would be nice to see if they are trending toward better or staying the same. I had shared a copy of my spreadsheet with them last week, which is when they increased the evening shot dose, but I don't know if I want to continue sharing with them if I am not following their advice. If that makes sense?

I use the kindle a lot, though I usually have my desktop on once or twice a day too. My "smart" phone is a tracfone though, so the memory is crap and I can't even update anything already on it atm.

Part of my worry over low numbers, is the same worry that I had a day or two ago about getting three readings all different by 80pts. I start thinking, what it the meter tells me she is at 170, but she is really at 40? I worry a lot, which probably doesn't help but at this point I've had about 4 hours of sleep since I woke up at 3:30am Friday morning with a migraine.

I just got her +2 (292mg/dl) which seems a lot better- slower decent than last night. Of course I had to practically wrestle her and hold her down to get it and then she farted on me in self-defense. Since I did the curve last weekend she has been very squirmy about her ear pokes (I think she jerked once when I had the lancet sticking in her ear last Saturday). Everything is updated to this last test on the spreadsheet (though the +0.5 hrs are in the comments).
 
Got a +4, which was 245. So we are much more even today, a slow decent. I will get a +6 and then might let her off the hook until PMPS, and then do a +2 and +4 again so see how fast we are moving. More depending how how the numbers look.

Right now I am wondering if I should do another 3u this PM, or do the usual 4u. I think I would be more comfortable with the 3u right now, but I'm not sure if I trust my instincts on this yet with only a month of experience.

She certainly seems to be feeling good; other than drinking a lot as she has been doing for months. She is nibbling her food again after getting her whole body combed and a two hour nap. I think she enjoys being combed more than her old treats. I could do that four+ times every day and she'd beg for the comb every time she saw it.
 
Please don't let your vet guilt you about that. To be blunt, it's a waste of money and as you said, it stresses out your cat. They can't safely base dosing on stress numbers, so the data they get in-office is worse than useless. It can actually lead to harm. The steroid is a likely culprit in the diabetes, but if it took care of the pancreatitis it's what you had to do. I'm considering that myself right now since my kitty is getting round after round of pancreatitis. It's good to hear that your kitty seems to be in the clear for now on that.

I do share dosing with my vet about once every few months (whenever I need a new vial). And I did get a little talking to at this last insulin pick-up. :smuggrin:
 
I have a kitty like that too! He doesn't care about treats, but get out his brush and he comes running - tail high and making those happy cat noises. :cat:

I tend to be a little more aggressive with dosing than Kris, but I think the 3u might be too little, especially since the 51 was at +5. I think I would suggest a 3.5u dose, however, if you're more comfortable at 3u for a couple of cycles, that's fine. Sometimes mama-sense is telling us something. Will you be able to get a couple of extra tests tomorrow too? If Jaxa has a hard time with tests, you might aim for a +3 and +5 instead to catch a little later in onset. The +2 gives you a hint what's coming, but it's rare for a kitty to really show much at that point (unless it's an early nadir kitty).

One thing to remember is that you usually won't know the right thing until afterwards. So we try something, and then see how it goes and adjust from there. So it's okay to trust your instincts as long as you can collect the data to verify impact. And after last night, you certainly know how to handle it if she does go lower. :)
 
Yes, Djamila and I differ a little in our dosing approach. My tendency to err on the side of caution comes from dealing with my tricky cat and I like to work out dosing by starting a bit lower than what is likely needed and increase from there as quickly as is safe. That's one of the many strengths of this forum - having different slants on what to do. :)
 
I should be able to get a couple extra tests tomorrow before her +9 in the afternoon, and then at least one more in the evening. I am wondering if her nadir is closer to +5, so will have to continue trying to find that lowest number and make sure next weekend gets more tests also.
 
Glassgoblin said:
I should be able to get a couple extra tests tomorrow before her +9 in the afternoon, and then at least one more in the evening. I am wondering if her nadir is closer to +5, so will have to continue trying to find that lowest number and make sure next weekend gets more tests also.
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Maybe give 3 u tonight and tomorrow then go to 3.25 u on Monday?
 
How about keeping 3 u for today then increasing to 3.25 u tomorrow AM. You'll have to eyeball that. If your syringes don't have half unit marks it'll be trickier but not impossible. Consistency dose to dose is important rather than absolute accuracy. You can buy syringes with half unit marks to make it easier. If you're willing down the line, you can dose ProZinc with U100 syringes and a converson chart to get a whole other range of fractional dose options.i
 
Kris & Teasel said:
How about keeping 3 u for today then increasing to 3.25 u tomorrow AM. You'll have to eyeball that. If your syringes don't have half unit marks it'll be trickier but not impossible. Consistency dose to dose is important rather than absolute accuracy. You can buy syringes with half unit marks to make it easier. If you're willing down the line, you can dose ProZinc with U100 syringes and a converson chart to get a whole other range of fractional dose options.i
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I did give her 3u this morning. I don't know if it is just my inexperience, but she seemed to have more consistent 200's when she was on lower doses daily, with a range that stayed a little flatter within 100pts or so. She was eating the higher carb food while we were waiting for our YA delivery, and I wasn't getting help putting her food up soon enough before her PMPS (which I am getting now), so her PMPS were often higher at the same time, but it seemed that the more insulin the vet wanted her to be on, the fewer yellows. Her only red have been when she is at the vet office, though I can't say that she hasn't been that high at a time we were just not testing at home. Maybe I'm just not seeing it all the right way yet. I do wonder, looking at her typical +3,+4, +5, and +6 tests (when I've been able to get them) if her nadir is closer to +5 than +6.

I don't know if it was because of the super low numbers on Friday night, but she didn't eat well yesterday morning, and then yesterday afternoon seemed to get back her full appetite and ate well this morning too. Just did her +3 and she seems to have a good downward slope today also. Will get a +6, and then do a +3 PM. She is very active today; following me, playing, smacking the dog.
 
Yes, there were more yellow PSs for a short spell at a slightly lower dose but I wouldn't put too much weight on them. The recent blues and greens are more important to look at. The way forward is rarely clear cut and linear and that's why we call it a dance. Jaxa leads the dance and you follow.
 
Kris & Teasel said:
Yes, there were more yellow PSs for a short spell at a slightly lower dose but I wouldn't put too much weight on them. The recent blues and greens are more important to look at. The way forward is rarely clear cut and linear and that's why we call it a dance. Jaxa leads the dance and you follow.
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I don't know if I should use the word "goal" but are we seeking lower consistent numbers? Like, lower PS numbers with a good curve that doesn't drop too low between? I'm not sure if her Friday numbers are what would be considered a bounce, but that is what scares me since I'm gone for nine hours every weekday, and my retired mother doesn't check on Jaxa very often since the kitty likes to stay in a quiet room (with her food/water/litter/stuff) away from the dog.

Poor Jaxa, I'm such a control freak. I have to keep reminding myself, and my family, that there is no magic cure and all of this is a marathon not a sprint. I just like having something in sight as a guidepost to kindle hope that we are moving in the right direction.
 
Glassgoblin said:
I don't know if I should use the word "goal" but are we seeking lower consistent numbers? Like, lower PS numbers with a good curve that doesn't drop too low between? I'm not sure if her Friday numbers are what would be considered a bounce, but that is what scares me since I'm gone for nine hours every weekday, and my retired mother doesn't check on Jaxa very often since the kitty likes to stay in a quiet room (with her food/water/litter/stuff) away from the dog.

Poor Jaxa, I'm such a control freak. I have to keep reminding myself, and my family, that there is no magic cure and all of this is a marathon not a sprint. I just like having something in sight as a guidepost to kindle hope that we are moving in the right direction.
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It can take a very long time but there is light at the end of the tunnel. I've been at this for 2 years with Teasel. I had to learn a long time ago that patience was what I needed almost more than anything else.
 
A little higher the last two nights, but looking at her slope between PMPS, +2 and +4 the numbers are staying pretty steady in their jumps. Am I wrong for wanting things to be slow and steady?

The last three shots have been an attempt at 3.25, though I'm not sure if it wasn't closer to 3.5. Wondering if I should go to 3.75 tomorrow. We have the u-40 needles, with no half marks or little lines other than whole unit marks. My scare tonight was almost dropping the insulin when I was rolling it between my hands. I was already planning on getting our back-up insulin this week, so this just cemented that plan. Have her +2 for tonight, will get a +4 later.
 
You can try an increase tomorrow. It’s hard to eyeball fractions with only whole unit marks but I’d try 3.5 u.
 
I've always been so scared about breaking the vial (can you imagine the stink?!?!) that I put a towel on the counter when I get out the insulin to roll and draw the dose, so it has some padding if I drop it (which I've done). Also keeps it from rolling off the counter (I'm a bit of a klutz :rolleyes:).
 
3.5u this morning (or so). I am concerned that she is still drinking like mad. She drinks a lot at one time though so I'm not sure if I think she is drinking more than she actually is because of seeing that. She doesn't seem to pee as much as she did a month ago though. Concerned this morning because she drank a lot and then about 5 minutes later puked up a little (less than tsp?) of the water (not the food she just ate 20 minutes before thankfully). Last night she burped several times, so I was almost ready to get out a pepcid ac quarter for her, but it seemed to settle down after a short time. She had been gulping down her food, but I worry that I explain those things away too easily.

Of course right now she is upside down and grabbing her favorite mousie. I freak out and she goes to play.
 
Glassgoblin said:
3.5u this morning (or so). I am concerned that she is still drinking like mad. She drinks a lot at one time though so I'm not sure if I think she is drinking more than she actually is because of seeing that. She doesn't seem to pee as much as she did a month ago though. Concerned this morning because she drank a lot and then about 5 minutes later puked up a little (less than tsp?) of the water (not the food she just ate 20 minutes before thankfully). Last night she burped several times, so I was almost ready to get out a pepcid ac quarter for her, but it seemed to settle down after a short time. She had been gulping down her food, but I worry that I explain those things away too easily.

Of course right now she is upside down and grabbing her favorite mousie. I freak out and she goes to play.
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They mess with our minds! :confused: If you need more fractional dosing options U100 syringes (with half unit marks) with this conversion chart will help a lot: http://www.felinediabetes.com/insulin-conversions.htm
 
Kris & Teasel said:
They mess with our minds! :confused: If you need more fractional dosing options U100 syringes (with half unit marks) with this conversion chart will help a lot: http://www.felinediabetes.com/insulin-conversions.htm
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They really do; we've been on this health roller coaster since November because of the pancreatitis. She hasn't shown any signs of that since February (maybe January if her Feb flare was really the diabetes asserting itself). I can't remember being able to relax much since then. Every day it's all about whether she is eating and drinking properly, does she need anti-nausea/appetite stimulants, how is she moving, what is in the litter box, her general appearance and attitude. Even when everything seems find and she still hasn't had a pill in a few weeks I start wondering if I am just seeing things too optimistically. I am so used to everything going wrong when I start to relax, that it makes it harder to step back. In some ways she is acting like a much younger cat again- and they said she was still 17.8lb but I pick her up and she is like a feather to me now. My last cat wasted away to nothing as he got sicker and sicker and I couldn't do anything so now skinny cats make me worry.

She goes in to the vet again this Friday (when I will tell them we are not going to come in weekly anymore) and I am really tempted to get the second bottle of insulin, more needles, and have them do a chem 17 panel to compare to the one she got on 3-9. They did test her fructosamine (Sp?) level last week and said it was in the normal range, but I put it away without adding it to the spreadsheet- will have to do that later too. We've done curve testing the last two weekends. so maybe this weekend I will stick to a +6 each day and try to let it go a little.
 
Glassgoblin said:
They really do; we've been on this health roller coaster since November because of the pancreatitis. She hasn't shown any signs of that since February (maybe January if her Feb flare was really the diabetes asserting itself). I can't remember being able to relax much since then. Every day it's all about whether she is eating and drinking properly, does she need anti-nausea/appetite stimulants, how is she moving, what is in the litter box, her general appearance and attitude. Even when everything seems find and she still hasn't had a pill in a few weeks I start wondering if I am just seeing things too optimistically. I am so used to everything going wrong when I start to relax, that it makes it harder to step back. In some ways she is acting like a much younger cat again- and they said she was still 17.8lb but I pick her up and she is like a feather to me now. My last cat wasted away to nothing as he got sicker and sicker and I couldn't do anything so now skinny cats make me worry.

She goes in to the vet again this Friday (when I will tell them we are not going to come in weekly anymore) and I am really tempted to get the second bottle of insulin, more needles, and have them do a chem 17 panel to compare to the one she got on 3-9. They did test her fructosamine (Sp?) level last week and said it was in the normal range, but I put it away without adding it to the spreadsheet- will have to do that later too. We've done curve testing the last two weekends. so maybe this weekend I will stick to a +6 each day and try to let it go a little.
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I truly understand what you mean by living on the edge all the time. Many of us here do and it's important to find a way to have a break from that. Taking on more of the directing of her FD treatment yourself helps because it's empowering. Learning that you can handle low numbers, make decisions about dosing, how much to test on a given day, etc. helps a ton. You won't feel you're at your vet's mercy - and saving a bit of money is good too. And, of course, we're always here to help. :)

I like last night's yellows. I suggest a bump up to 3.75 u tomorrow AM. Give some thought to trying U100 syringes with half unit marks later on. It's very easy and as long as you put away the U40s where you can't accidentally grab them and have the conversion chart beside you when you draw up a dose you'd be fine. They'd allow you to have dose fractions like 0.2/0.4/0.6/0.8 u reading the syringe lines directly and 0.1/0.3/0.5-/0.7/0.9 u by eyeballing half way between syringe lines.
 
Do you work during the day? I'm guessing from the pattern of testing/not testing during the AM cycle that it's easier for you to monitor in the evening during the week. If that's true, then I wonder about the dose increase tonight instead of tomorrow morning? If you're home during the day though, just ignore all that and do the increase in the morning as Kris suggested. :)
 
It is tough dealing with a sick kitty! We truly get that. As Kris said taking on more management of FD will help. Also remember to do things you enjoy. Take a walk, see a movie, have dinner with a friend. I found that taking an hour for myself and getting out helped tremendously. It’s such a relief to allow yourself some time that can be about you.?
 
Djamila said:
Do you work during the day? I'm guessing from the pattern of testing/not testing during the AM cycle that it's easier for you to monitor in the evening during the week. If that's true, then I wonder about the dose increase tonight instead of tomorrow morning? If you're home during the day though, just ignore all that and do the increase in the morning as Kris suggested. :)
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I usually test/feed/shoot right before I have to go to work in the AM, and hope that my mother puts the food away at the right time before I get home in the evening. She forgot tonight, so I did a test right when I got home and then at the usual time an hour and a half later to see if there was a trend in the numbers. Seemed okay to give the shot as usual, and her +2 is done too.

I think our 3.5 has probably been pretty close to a 3.75, but will try for the 3.5 in the AM and a tad more for the PM tomorrow.

She doesn't know it, but she is being very kind to other kitties this weekend. I have all of these bags of food (at least 4) that she can't eat anymore- from Iams and Purina Beyond to the Hills Prescription (W/D) and the Royal Canin Glycobalance. I can't throw away food, two bags are going to the animal shelter and the other two bags are being given to the animal impound (I work for law enforcement) for the kitties waiting to be picked up or brought to the no-kill shelter after their week in kitty jail.
 
Back from the Vet, where of course we are still high, but she wasn't as high this week as last, and is lower on her PMPS tonight too. I'm just going to be paranoid about having a sharp drop like last week, so will be getting a +2 and +4 tonight, but then sticking with +6 over the weekend since I've done lots of tests the last two weekend. No vet next week (at least not planned); got our backup bottle of insulin and the next batch of needles so we should be set for the moment. We just need to have a good chill weekend for a change.
 
You can bump her up to 4 u soon. You saw a bit of action at 4 u a while ago so get a +2 the first cycle you try it.
 
Kris & Teasel said:
You can bump her up to 4 u soon. You saw a bit of action at 4 u a while ago so get a +2 the first cycle you try it.
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The vet was suggesting the 4u/4u again this week. I told Jaxa that she doesn't have to go back next week, but I don't think she believes me yet. Now I need to find a new water fountain to replace our Drinkwell that just died, and that can be her reward for being a good kitty.
 
We did get some dark greens last night but it was at nadir (her +5 from what I've seen) and she was eating, playing and acting normal, curled up with me and though I planned on getting a +6 as well, we fell asleep. She is eating, etc. this morning so I stuck with the 3.75 and will see how things go to determine tonight's shot. If we are getting big drops between numbers that makes me not want to go to the vet for that reason as well since I've only seen that in the tests on Vet day. I think she gets super stressed from two car rides/kennel, being at the vet all day, and then she doesn't eat much during the day even though I bring her food to the Vet office. Will have to test next Friday to see if there is a difference or not.
 
Glassgoblin said:
We did get some dark greens last night but it was at nadir (her +5 from what I've seen) and she was eating, playing and acting normal, curled up with me and though I planned on getting a +6 as well, we fell asleep. She is eating, etc. this morning so I stuck with the 3.75 and will see how things go to determine tonight's shot. If we are getting big drops between numbers that makes me not want to go to the vet for that reason as well since I've only seen that in the tests on Vet day. I think she gets super stressed from two car rides/kennel, being at the vet all day, and then she doesn't eat much during the day even though I bring her food to the Vet office. Will have to test next Friday to see if there is a difference or not.
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You did the right thing in sticking with 3.75 u. Those dark greens last night are very nice numbers. :) She might be high today because of bouncing. If this proves to be her pattern over time, it's possible to give a slightly higher dose in the AM. Something to consider another day.
 
Kris & Teasel said:
You did the right thing in sticking with 3.75 u. Those dark greens last night are very nice numbers. :) She might be high today because of bouncing. If this proves to be her pattern over time, it's possible to give a slightly higher dose in the AM. Something to consider another day.
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She didn't seem too bad yesterday, though I thought it was odd that her +2AM was the exact same as the AMPS, her +7 looked like it was good though, and the evening +4 was a nice blue instead of the usual yellow. I was all set to give the 4u this morning, but when her AMPS was under 300 decided to stick with the 3.75 one more time, and see how today goes.

I've been thinking about getting a can of food open too; we have a variety of lower carb pate options, but she usually hates canned food. I give one spoon (cereal spoon size) and she won't eat all of it in a whole day even f I warm it or add warm water to make it smell more appealing. I need to find one that is more like the biqsue packets she used to like (but not seafood as she is refusing all seafood flavors currently).
 
Good call to leave her at 3.75 u this AM. Get a +2 or +3 and then maybe a +6 or +7. Cats and their food quirks! Very frustrating sometimes. I thank my lucky stars I have three good eaters who aren't at all fussy.
 
That's always tough. Trying to figure out what food they'll eat can be time consuming and frustrating!
 
A little higher last night, but she was under 300 again this morning, so kept dosing consistent. I'm wondering if that means that her AM dose should go up to 4u to get the PMPS numbers lower or keep it the same and give it a few more days to see if there is a bigger pattern since I won't be home during the day to check how low she gets.
 
Glassgoblin said:
A little higher last night, but she was under 300 again this morning, so kept dosing consistent. I'm wondering if that means that her AM dose should go up to 4u to get the PMPS numbers lower or keep it the same and give it a few more days to see if there is a bigger pattern since I won't be home during the day to check how low she gets.
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I'd keep it the same AM and PM for now. I suggest waiting until a day off to raise the dose so you can monitor.
 
She decided to be a creep this morning- I was making my coffee before our AMPS, and while she usually goes back to the bedroom to wait for her food, she didn't today. I heard a crunch behind me, turned and she was eating a piece of dog food. The dog doesn't usually leave anything overnight, but I guess that is something that has to be put up every night now just in case. I hope it was just the one piece that she ate, but I can't know for sure.
 
Well, crap. We just had our first real fur shot. I don't know if I got a through and through or if it came out of the injection spot; I felt the needle go in, but I usually massage around the area after and it was definitely wet and stinky. I will check a +2 or +3 to see if she got any, but I expect higher numbers tonight.

I just needed to slow down a little more I think. It has been a manic day at work, and too much stuff to do at home so was trying to be quick. I washed her down a bit, so she can't lick anything off her fur and will just keep an eye on her.
 
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