Help Needed

J

Jim Pool

Member
Hi my name is Jim and my cat Ripley was diagnosed with diabetes about a month ago. The vet put her on 1 unit (u40 needle) twice a day. At the time she was also on prednisone which wasn't helpful. The vet couldn't do a glucose curve so I just checked her levels using a reli on human meter. The vet did manage to take one reading using their meter and the reli on meter. They said to add 50 to my readings to normalize the readings.

I changed to u100 needles and gave her 3 units, twice a day.

She still lost weight and pees a lot. I ran a BG curve today starting around 0700 and tested every two hours the last being at 1500. Her readings were (normalized by adding 50) 442-412-396-394-393. So essentially no change. I'm going to up her dose tonight and was wondering if I should up to to 4 or 5 (u100 Needle). I also was wondering if I should give her the shot one hour early. Thank you for your help. I'm going crazy and the vet isn't helpful at all. Jim.
Oh I did test for ketons and it read as trace.
 
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Hi Jim and welcome! It’s good that you’re helping keep your kitty safe by home monitoring and checking for ketones. I assume since you posted under the Prozinc forum, that is the insulin your kitty is getting. Prozinc is a u40 insulin so measuring using a u100 syringe means that when you draw back to 3units you are actually giving 1.2units of Prozinc. You should always give the measurement in u40 increments, as though you were dosing with a u40 syringe. This will help us help you better (The conversion is u40 units x 2.5 = u100 units). Make sure you don’t confuse the two as going in the other direction can result in overdosing. If you have both syringes, please store them in separate locations so you don’t accidentally grab the wrong one!
Also please ignore your doctors instructions to add 50 to the number. This will be dangerous once you get down to the lower numbers as 50 is the “human meter” take action number to prevent hypoglycemia. A majority of the people on this forum use human meters, so just say what the actual number was and put in your signature the meter that you are using.
It’s hard to tell from one day’s numbers exactly what the whole picture looks like. These numbers could be the result of a bounce or it could indicate the dose is too low. The only way to know for sure is to get preshot values and midcycle numbers as often as you can and watch for the trend.
My suggestion would be to increase the dose to 1.6units (4 on the u100 syringe) and monitor for a few cycles to see if she ever drops lower at her nadir (low point). Get glucose readings at a minimum before every shot, and then try to get at least one midcycle test per day between 4 & 8 hours after the shot. This will help you put together the bigger picture.. which is far more important than individual readings.
Also go ahead and read the stickies under this forum to get some good info on the Prozinc protocol and preparing a hypo toolkit just in case. Then go to the following link to set up a spreadsheet and post it in your signature so we can see at a glance how her numbers are trending: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

There’s a lot of information to learn but you are certainly on the right track already!
 
Hi Jim! Welcome to you and Ripley! SpotsMom has already given you some good info, so I'll just add a few things.

As she said, when using a human meter, you don't really want to add 50. While I get why your vet is saying that, there really isn't a direct conversion from human to pet meter like that. So while it might be 50 apart at lower numbers, the number might actually be further apart at higher numbers...they simply don't convert like that. You can continue to do that when reporting numbers to your vet if they prefer, but here on the forum it'll be better to report exactly what you get on the human meter. :)

Dosing: So you gave 1 unit on the u40 needles then drew to 3 units on the u100 needles? As said above, that actually isn't a big increase. So the GOOD news is if you were wondering why the increase didn't really work, it's because it was barely an increase! The better news is that we actually like using u100s for Prozinc since you can do much finer increases with that. The math was listed in SpotsMom's response, but here is the Conversion Sheet in case you're bad at math like me. I find this easier to use.

How long has she been on the 3 unit on the u100 needle dose? Okay, so you said she had trace ketones? That's definitely not something to play around with. With that in mind, I agree that you should probably go ahead and increase the insulin, but keep an eye on Ripley. Can you monitor tonight to be sure that it doesn't drop her low? I doubt it will, but you just never know.

Is she still on pred? Can I ask what she was on it for? Any other health concerns? This info all helps us give you better recommendations. :)

If she is high enough tonight yes you can give the shot an hour early (hope I'm not too late).

I know there's a lot of info, so please ask all the questions you have! We are more than happy to help and I know it's a lot of stuff coming at you all at once.
 
That's to everyone for the support. It's driving me crazy. The trace ketons is disheartening but it was one read in the litter box. I think I explained her dose was in U100 talk.

She had IBC and was given the prednisone to help with her diareah. It helped but I think it kicked off the diabetes. She's 17 so I worry about the weight loss and weakness in her back legs. I'll up the dose to 4 tonight (in u100 talk). Hopefully that helps a bit. I'm trying to get her feeding squared away but she's finicky and eats 5 to 6 small meals a day. If I give her a big meal she only eats a little and I end up throwing the rest away. I'm trying to sort the whole protein, carbohydrate issue. Well time for feeding and shot. Many thanks Jim
 
5-6 smaller meals spaced out is often great for diabetic kitties, so her finicky habits are actually probably a good thing! :)
 
I took her reading right before her shot and it was 262 on the reli on meter. Her last reading was 343 at three o clock. So she dropped 80 in the 4 hours prior to the evening shot and only 50 between 0700 and 1500. I don't get it. Anyway I decided to hold off on increasing her dose until I can talk to her vet. They finally called and apologized for all the confusion. Ripleys had 3 vets handle her case, none of which is her regular vet. Bad timing, renovations, babies etc. Now that they are energized I'll see what her regular vet says. Jim
 
Ok, a little housekeeping so there's no confusion.

As has been mentioned... always speak in actual units of insulin given, NOT the "mark" you draw to on the syringe. One unit of Prozinc in a u-40 syringe is one unit. One unit of Prozinc in a u-100 syringe (which you would draw to the 2.5 "mark" on the u-100 syringe) is STILL ONE UNIT. Think of it as putting a teaspoon of honey into a shot glass vs putting that teaspoon of honey into a coffee mug. How far up the side of the container the honey goes will be different, but it's still just one teaspoon. Same with insulin syringes ... the barrel size is different between a u-40 and u-100 syringe but the actual amount of liquid is the same whether you draw to the 1 mark of a u-40 syringe or the 2.5 mark on the u-100 syringe (test it some time with colored water -- I did!). Both ways would be designated as having given ONE UNIT. So when you're using u-40 insulin with a u-100 syringe, it's critical that you use the conversion chart to ensure you're drawing up the correct amount of insulin AND that you're logging the actual units given.

Also as others have said ... Please post the actual values the meter displays; do NOT add 50 points. All we need to know is what meter you're using (human vs pet). You can't convert between the two by simply adding a fixed number of points. It might be a rule of thumb the vet likes to use but it's just that...and it adds risk and unnecessary confusion if you do it when you post here. Doing so could also well prove dangerous. Really dangerous if, for example, you see a BG reading of 25 but post that it's a 75 (low blood glucose can become life threatening quickly -- a "25" is dangerously low and would require immediate emergency intervention whereas a 75 would not).

Is Ripley still on prednisone? Steroids can trigger diabetes in some cats. We call them "steroid-indiced" diabetics. Often when the steroids are removed, the cat's insulin needs are reduced. It's even more important to monitor Ripley's BG if/when she comes off steroids because of that. It's easy to overdose under those conditions and sometimes too much insulin and too little insulin look the same in the BG numbers. The steroid variable is important to know for those trying to help you sort out whether to go up or down the dosing scale and how to best help your cat.

Does Ripley have any other illnesses? What were the steroids intended to help treat? Irritable bowel I believe you referenced?

Edited: can you please confirm that you are indeed using Prozinc?
 
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I think I've figured out the whole u40 vs u100 syringe (dose).

Yes Ripley was on Prednisolone oral meds for Irritable Bowel syndrome. She had her final dose last Saturday. Yes she is on ProZinc.

I will probably buy an Alphatrak meter next month just so I'm comfortable with her readings. Jim
 
Jim Pool said:
Yes Ripley was on Prednisolone oral meds for Irritable Bowel syndrome. She had her final dose last Saturday.
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My Charlie was a steroid-induced diabetic -- the steroids were given in an effort to control the raging diarrhea he suffered from irritable bowel syndrome. He was alternately on prednisolone and then budesonide. As soon as we'd start steroids, his BG would skyrocket. As soon as we'd stop steroids, he'd be off insulin within days.

Please continue to monitor those BG values. It's very possible that if the steroids triggered the diabetes, Ripley will need less insulin now that she's off them.
 
I hope there some warning if her BG levels come under control on there own. I always worry she might crash when I'm not home.

Her first reading this morning was 285 using the human meter. Her last reading at 2200 the night before was 245.

So I'll stick with 3 doses (u100) until I'm more comfortable with what her readings mean using the human meter. Jim
 
You've come to the right place to get the help you didn't get from your vet. The best way to keep your kitty safe is to track her BG numbers in a methodical way, set up the spreadsheet we use here and post on this forum for advice as often as you need it. It's normal to feel as though you're floundering at the beginning - we've ALL been there.

Here's some info we need from you so we can help you better and a description of the basic testing routine we recommend:

It would help us if you set up your signature (light grey text under a post). Here's how:
  • click on your name in the upper right corner of this page
  • click on "signature" in the men that drops down
  • type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.
Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
.............................................................................................................................................................................................................
  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 spreadsheet, 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.

This is useful: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
 
Well we're still hanging in there. The weekend was rough. Her readings stayed close to 300 (using human glucose monitor) all weekend. I did up her insulin to 3.5 doses ( using 100u syringe) on Saturday.
Last night here reading at 2200 hrs was 337. When I took her reading this morning at 0640 it was 149. I gave her 3.5 doses at 0700. By 0900 she was at 264 and then started to drop. Here last reading at 1440 was 125 ( almost, 8 hours after her shot! ). She got fed at 7-11-3. I'll keep monitoring to make sure here levels don't drop more. I can't understand why the insulin hasn't started to wear off by now. I figured the nadir would occur after 6-7 hours.
 
There's nothing straightforward or linear in the way kitties respond to insulin. It can vary a lot day to day. That's why we recommend that dosing routine and spreadsheet in my post above. The patterns reveal themselves slowly over time and they can guide your dosing.
 
Hi Jim! It looks like a couple of people have shared the link to the spreadsheet that we use to make sense of all of this. If you need help getting it set up, we have some folks around here who are great at helping with that. Just let us know if you'd like some help. The patterns that are made on the spreadsheet make it much easier to figure out what's going on.
 
I finally upped Ripleys dose to 2 units a few days ago and started getting decent readings. This morning her readings were below the recommended no shot level. I decided to go with the pull up food wait two hours and reshoot if her levels were okay. I did just that but reduced her dose to 1.5. I normally shoot at 7 and 7, but with the two hour delay how do I go back to 7 and 7. Can I test feed and shoot at her normal schedule tonight? I know that ProZinc is an in and out insulin so there would still be two hours left over from the first shot. Any comments are welcome.
 
Jim Pool said:
I finally upped Ripleys dose to 2 units a few days ago and started getting decent readings. This morning her readings were below the recommended no shot level. I decided to go with the pull up food wait two hours and reshoot if her levels were okay. I did just that but reduced her dose to 1.5. I normally shoot at 7 and 7, but with the two hour delay how do I go back to 7 and 7. Can I test feed and shoot at her normal schedule tonight? I know that ProZinc is an in and out insulin so there would still be two hours left over from the first shot. Any comments are welcome.
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Can you gradually move the time by a half hour each shot? If the numbers are high enough you can move the time by up to an hour, but really test.
 
The ProZinc insulin is driving me crazy. I've had several instances in the last few weeks where my cat has high readings (over 300) in the evening and I give her 2 doses. Then in the morning her reading is in the 90 range. I've tried the delay for 2 hours to get her on track. Last night her PMPS level was 380. This morning her reading was 96 before feeding. So I thought of trying the 13/11 advanced shoot method. One hour after eating she was 106. Now what do I do.
 
Kris & Teasel said:
Please consider setting up the spreadsheet we've mentioned above. It's the only way we can give advice.
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Actually I've tried to use the referenced spreadsheet and I can't get it to work on my phone. So I use a insulin curve app to keep my vet informed and a manual sheet I maintain. The app I downloaded is much more user friendly but only tracks for 24 hours.
 
Kris is right that we really can't be of much help if we can't see the data. Guessing at dosing advice is beyond dangerous, and dosing is based on several cycles in a row, not a single day, so an app that only tracks 24 hours still won't give enough information. Do you have Google Sheets on your phone? I would start by downloading that, and then you can connect the spreadsheet to your Google Sheets app and it should work just fine. It is easier on a computer or tablet, but there are lots of folks on here who make it work with their phone.
 
Jim Pool said:
Actually I've tried to use the referenced spreadsheet and I can't get it to work on my phone. So I use a insulin curve app to keep my vet informed and a manual sheet I maintain. The app I downloaded is much more user friendly but only tracks for 24 hours.
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Did you download the google sheets app?
 
JanetNJ said:
Did you download the google sheets app?
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Actually I did. I might be able to figure it out. As it turns out she didn't get any insulin today. Her readings finally reached the 300 level around 1100 which may be food induced since the readings dropped after that. She seems fine so I'll leave her alone to this evenings reading. I have checked her old readings and 1 dose was too little, but 2 made her readings bounce, so probably too high. Anyway I'll see where she is tonight.
 
Sometimes bouncing is inevitable, and not actually an indication of too much insulin. I'll be quite curious to see Ripley's numbers and see if together we can't help you get this sorted out!
 
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