Vannecheta
Member Since 2018
How many units should I give Mario tonight? I have to give him a shot in 1 hour.
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? Mario, 12/24 Amps 466, 319 +6, 250 +11, Pmps 250, 323 +2
- Thread starter Vannecheta
- Start date
Kris & Teasel
Member Since 2016
Take heart ... you'll get there. Easier said than done but try not to react to individual numbers or the size of dose he needs to get his BG down. He IS responding to the insulin even though his numbers are still high-ish. The experienced folks here can help you get Mario doing and feeling better. 
Vannecheta
Member Since 2018
So you don’t think he is insulin resistant? or that he has acromegaly?Take heart ... you'll get there. Easier said than done but try not to react to individual numbers or the size of dose he needs to get his BG down. He IS responding to the insulin even though his numbers are still high-ish. The experienced folks here can help you get Mario doing and feeling better.
Thank you
Olive & Paula
Member Since 2015
Your signature has Fancy Feast in gravy. Are you feeding that? The food in gravy is high carb, that could be some of the issue.
Kris & Teasel
Member Since 2016
It's too soon to know for sure. He'd have to be tested for acromegaly. Some kitties can develop anti-insulin antibodies that results in a higher dose being needed. That can go away on its own eventually. Many people just do their best to follow one of the Lantus dosing methods and leave it at that.
Vannecheta
Member Since 2018
Ok, I’ll stop giving him that immediately. Although I started giving him fancy feast a couple of days ago.
Olive & Paula
Member Since 2015
Fancy Feast classic or pate is fine to use. The gravy is super high in carbs. It's used for when kitties glucose goes to low and needs to be boosted up.
Please monitor closely when you stop giving the gravy food, glucose can drop significantly.
Vannecheta
Member Since 2018
Ok, thanks so much
Olive & Paula
Member Since 2015
And give it some time (a few days) for things to settle once you stop the gravy.
At the start of this process, there is an overwhelming amount of information to try to wrap your head around as well as a lot of "rules" that we really push people to follow. We've all been there and know how daunting it can be. The good news is that this all becomes routine. It's time consuming and brain numbing in the beginning. Give yourself a month of doing what we're suggesting and when you look back, I'm pretty sure you will appreciate just how helpful the information you're gathering is and how all of this has become second nature.
I would not jump to the conclusion that Mario has acromegaly or insulin resistant. Getting high carb food out of the daily picture will help to clarify what the influence of the food is. Also, if you look at Mario's spreadsheet (SS), the drop from 419 to 187 yesterday has triggered a bounce. That's likely why you're seeing a high AMPS today. It can take roughly 3 days for a bounce to clear. It's not advisable to increase the dose in response to a bounce since the higher numbers are an artifact. Once the bounce clears, if the numbers come back to those blues, Mario will be on too high of a dose. It looks like you've been increasing his dose despite lower nadirs and bounces and it's not clear whether the higher carb food was also pushing numbers up. This is a place where you need to be patient in order to get all of these variables sorted out.
I would not jump to the conclusion that Mario has acromegaly or insulin resistant. Getting high carb food out of the daily picture will help to clarify what the influence of the food is. Also, if you look at Mario's spreadsheet (SS), the drop from 419 to 187 yesterday has triggered a bounce. That's likely why you're seeing a high AMPS today. It can take roughly 3 days for a bounce to clear. It's not advisable to increase the dose in response to a bounce since the higher numbers are an artifact. Once the bounce clears, if the numbers come back to those blues, Mario will be on too high of a dose. It looks like you've been increasing his dose despite lower nadirs and bounces and it's not clear whether the higher carb food was also pushing numbers up. This is a place where you need to be patient in order to get all of these variables sorted out.
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Hroswitha
Member Since 2011
There are some good stickies on this board for bouncing - what it looks like, what triggers it, etc. Having worked our way through an ultra-bouncy kitty recently, I can boil some of this down to you.
Let's say Mario started the day around 400 before you fed and gave insulin. Two hours later, the lantus will begin to affect him, and he will have dropped. If he drops fast and hard - over 100 points at onset - you'll see considerable drops until you're through the nadir. Perhaps, just as an example, those nadirs drop below 200 or into the low 100s. (Or, for the feline meter, call it colors - he starts in the reds, drops to yellow by onset, nadir in the blues.)
By the PM test period, he may jump up sharply again to the reds or pinks. It's not an issue with the Lantus, which is doing its job, but a question of how his body reacts to the insulin. Often, a kitty who starts with high numbers and drops that fast will see a reaction from the liver. His body panics at what are normal numbers, but feel dangerously low to him. The liver dumps glucose into his system, and his numbers for the next 5 or 6 cycles will remain high and flat. He may not drop out of the reds or pinks for that period.
That's when you have to take a breath, put on your patience pants, and wait out the bounce. Bounces may take up to 6 cycles to clear - my Mala needed around 8 this time around - and the dose should NOT be adjusted during this period UNLESS his nadirs drop below 50 (You'll have to look up the conversion number from human to feline meters for that one.) If he drops into hypo range at nadir, you will reduce the dose. With such a high dose, you may have to drop it by around a full unit, but more experienced advisors will help with that.
He may also bounce if his nadir numbers drop into low range. Again, be patient. Data is really critical during this period, as you need to learn how long his bounces last, how high he goes, and how low he'll go when they break.
I suspect you have him on too high a dose right now. However, you're also feeding a very high carb wet food. As others have stated, move him onto a low carb pate. I linked in Dr. Pierson's excellent list that breaks down carb percentages on yesterday's conversation. Take some time, see what's available and that Mario will eat, and put the gravy food away to use as a tool should Mario drop into danger levels.
You're using the board well now. You need to embrace evening tests as well, and keep that spread sheet up to date. In the evening, test before shooting insulin, then get at least the onset numbers. If you test and shoot at 7:30, test him again at 9:30. If he's dropping hard - more than 100 points - you will need to test him again an hour later. He may drop into dangerous territory. If his onset numbers are close to the pre-shot numbers, he *should* be okay for the night, and you can get some rest. That's the beauty of bounces - until they clear, you can relax a bit and get some rest.
You're getting the hang of this. SOOOOO much information to process at once. We've all been here. Read the stickies on hypoglycemia when you have a minute, and make sure you have the means to safely move him into better numbers if you must. That Fancy Feast gravy will come in handy then. Also, honey and ice cream can help. We've all spent frazzled evenings spooning honey and corn syrup into the mouths of resistant cats, so we understand.
And know that if he DOES slip into low numbers, if you post a 911 on your header thread, someone on the board will stay up with you and coach you through the worst of it until Mario is in safe ranges again. We are here for you, we've got your back.
This board saved Mala's life twice when we made mistakes and she became hypo. It happens.
Keep posting number updates on the subject line. You've got this.
Let's say Mario started the day around 400 before you fed and gave insulin. Two hours later, the lantus will begin to affect him, and he will have dropped. If he drops fast and hard - over 100 points at onset - you'll see considerable drops until you're through the nadir. Perhaps, just as an example, those nadirs drop below 200 or into the low 100s. (Or, for the feline meter, call it colors - he starts in the reds, drops to yellow by onset, nadir in the blues.)
By the PM test period, he may jump up sharply again to the reds or pinks. It's not an issue with the Lantus, which is doing its job, but a question of how his body reacts to the insulin. Often, a kitty who starts with high numbers and drops that fast will see a reaction from the liver. His body panics at what are normal numbers, but feel dangerously low to him. The liver dumps glucose into his system, and his numbers for the next 5 or 6 cycles will remain high and flat. He may not drop out of the reds or pinks for that period.
That's when you have to take a breath, put on your patience pants, and wait out the bounce. Bounces may take up to 6 cycles to clear - my Mala needed around 8 this time around - and the dose should NOT be adjusted during this period UNLESS his nadirs drop below 50 (You'll have to look up the conversion number from human to feline meters for that one.) If he drops into hypo range at nadir, you will reduce the dose. With such a high dose, you may have to drop it by around a full unit, but more experienced advisors will help with that.
He may also bounce if his nadir numbers drop into low range. Again, be patient. Data is really critical during this period, as you need to learn how long his bounces last, how high he goes, and how low he'll go when they break.
I suspect you have him on too high a dose right now. However, you're also feeding a very high carb wet food. As others have stated, move him onto a low carb pate. I linked in Dr. Pierson's excellent list that breaks down carb percentages on yesterday's conversation. Take some time, see what's available and that Mario will eat, and put the gravy food away to use as a tool should Mario drop into danger levels.
You're using the board well now. You need to embrace evening tests as well, and keep that spread sheet up to date. In the evening, test before shooting insulin, then get at least the onset numbers. If you test and shoot at 7:30, test him again at 9:30. If he's dropping hard - more than 100 points - you will need to test him again an hour later. He may drop into dangerous territory. If his onset numbers are close to the pre-shot numbers, he *should* be okay for the night, and you can get some rest. That's the beauty of bounces - until they clear, you can relax a bit and get some rest.
You're getting the hang of this. SOOOOO much information to process at once. We've all been here. Read the stickies on hypoglycemia when you have a minute, and make sure you have the means to safely move him into better numbers if you must. That Fancy Feast gravy will come in handy then. Also, honey and ice cream can help. We've all spent frazzled evenings spooning honey and corn syrup into the mouths of resistant cats, so we understand.
And know that if he DOES slip into low numbers, if you post a 911 on your header thread, someone on the board will stay up with you and coach you through the worst of it until Mario is in safe ranges again. We are here for you, we've got your back.
This board saved Mala's life twice when we made mistakes and she became hypo. It happens.
Keep posting number updates on the subject line. You've got this.
Vannecheta
Member Since 2018
What you just said makes a lot of sense and gives me hope. I have been doing things wrongly for sure.
Thanks for your input.
Vannecheta
Member Since 2018
How do I update the title of this thread to add the glucose numbers through the day in the title? Or should I just post a reply every time in this thread?
I understand that each day I should start a new one but I’m not sure how to update it daily.
I understand that each day I should start a new one but I’m not sure how to update it daily.
Hroswitha
Member Since 2011
Go to the top of this thread. Look at the dialog box toward the right of the screen just below your title. You'll see an arrow under "thread tools". Put your mouse on that arrow, and you'll be given the option to "edit title". Click that. You'll get a dialog box that will allow you to update the numbers. Note on that box that, at the far left of the box, you'll have the ability to add a prefix. Your options are "GA" for "guardian angel", meaning the kitty has passed, a ? when you have a question you urgently need answered, and a 911, for when the kitty goes into hypo. Use those sparingly. You've got eyes on your threads now, so response will be reasonably timely. Most of us use the ? if we are looking for new dosing advice or are stalling before shooting insulin.
Good question. If you have more, please ask. You aren't doing things wrong, you're just inexperienced. This is my third go-round with Mala on insulin, and even so, I considered myself a newbie re-entering the board in September. Ask questions when you don't know something, and we'll help as you need.
Good question. If you have more, please ask. You aren't doing things wrong, you're just inexperienced. This is my third go-round with Mala on insulin, and even so, I considered myself a newbie re-entering the board in September. Ask questions when you don't know something, and we'll help as you need.
Hroswitha
Member Since 2011
Oh, and you can also post in this thread multiple times per day, as you get new numbers. Doing that will "bump" your conversation to the top of the board, which ensures people who are watching your threads will see the numbers. Having those numbers updated routinely during the day helps us to see where Mario is and what you're doing.
Vannecheta
Member Since 2018
Than
Vannecheta
Member Since 2018
Ok, I will
Hroswitha
Member Since 2011
Your +6 may be Mario's nadir today, but if you can, for the next several days, try to get a reading at +2 and +4. It would also be helpful, if possible, to see a reading at +11. That will tell us how long the Lantus is lasting and where he goes toward the end of the cycle.
Please please test him during the evening tonight. It's so important to see the PM numbers, as AM cycles don't mirror PM cycles. If you can get a +2 after his PM meal and shot, that will tell us roughly when onset begins and how far he drops. While he's bouncing, that may not be a great drop, but we need to see that to give you good advice.
You're doing great. But I can guarantee you that the more experienced advisors are going to ask for more testing and more numbers.
Please please test him during the evening tonight. It's so important to see the PM numbers, as AM cycles don't mirror PM cycles. If you can get a +2 after his PM meal and shot, that will tell us roughly when onset begins and how far he drops. While he's bouncing, that may not be a great drop, but we need to see that to give you good advice.
You're doing great. But I can guarantee you that the more experienced advisors are going to ask for more testing and more numbers.
Hroswitha
Member Since 2011
Could I also hazard a guess that, with so many animals and a family, you're worried about the costs for treating Mario?
If so, I would like to propose that you get a meter intended for human glucose readings. Yes, you'll have to buy the meter, but it's a LOT less expensive to buy test strips and the meter is not extremely expensive. Most people on this board use ReLion meters and strips, which you can get from WalMart. I have been recently using the meter sold by CVS. The meter costs around $16 on line, and a box with 200 strips is $30. The meter uses less blood than the One Touch I had been using, and is really fast.
The cheapest price I can find on strips for the AlphaTrak 2 is around $50 for only 50 strips.
You might want to look into using the on-line pharmacy in Canada which many of us use for the Lantus. Their price on the 300 ml pens can't be beaten anywhere else. You may want to look around the board for links to that pharmacy - they don't even require a prescription if you note you're purchasing for a cat.
If so, I would like to propose that you get a meter intended for human glucose readings. Yes, you'll have to buy the meter, but it's a LOT less expensive to buy test strips and the meter is not extremely expensive. Most people on this board use ReLion meters and strips, which you can get from WalMart. I have been recently using the meter sold by CVS. The meter costs around $16 on line, and a box with 200 strips is $30. The meter uses less blood than the One Touch I had been using, and is really fast.
The cheapest price I can find on strips for the AlphaTrak 2 is around $50 for only 50 strips.
You might want to look into using the on-line pharmacy in Canada which many of us use for the Lantus. Their price on the 300 ml pens can't be beaten anywhere else. You may want to look around the board for links to that pharmacy - they don't even require a prescription if you note you're purchasing for a cat.
True, but of the four cycles so far, we only have data for two of them. So that means holding the dose longer as we gather data. TR, if you are following that dosing method, has safeguards built into it. One of them is getting a second test every cycle. It’s a really good habit to get into to grab a test right before hopping into bed at night. Many cats go lower at night. Mario may have done so last night, causing another bounce. Or not, we can’t tell at this point.
Vannecheta
Member Since 2018
Ok. I see the importance of testing at night. I can test him +2 after his PM shot. However, last night Mario was in his mini cave and I couldn’t get him out of there. Not even with food I was able to get him out of there. I tried to pull him out but I couldn’t. I got nervous. But, I looked inside and he was awake.
Vannecheta
Member Since 2018
I will try again tonight.
Hroswitha
Member Since 2011
Some cats start to be resistant when you begin this process. If you can't get him out for a reading at one time, leave him be and try again in a half hour.
Start a routine with him as you check his blood. Mala knows that when she gets tested, she gets food. She prefers mini-meals, and after blood checks, she'll get boiled chicken or a small helping of her favorite low carb food.
Cats do adjust to this. Don't force Mario - you were right to leave him be at that point. Always be gentle, encouraging, and loving during the testing process and he'll relax for you.
Do you know what Mario's jackpot food is? This is the food that can be so tempting that he'll do just about anything for it. Mala loves her boiled chicken, and that tends to be a favorite for cats. You also might consider chicken baby food - not a lot, as there's little nutrition in it for cats, but I have wooed multiple reluctant foster kittens into bonding using kitten crack.
Start a routine with him as you check his blood. Mala knows that when she gets tested, she gets food. She prefers mini-meals, and after blood checks, she'll get boiled chicken or a small helping of her favorite low carb food.
Cats do adjust to this. Don't force Mario - you were right to leave him be at that point. Always be gentle, encouraging, and loving during the testing process and he'll relax for you.
Do you know what Mario's jackpot food is? This is the food that can be so tempting that he'll do just about anything for it. Mala loves her boiled chicken, and that tends to be a favorite for cats. You also might consider chicken baby food - not a lot, as there's little nutrition in it for cats, but I have wooed multiple reluctant foster kittens into bonding using kitten crack.
Vannecheta
Member Since 2018
Well, his favorite food is fancy feast in gravy. But I won’t give it to him anymore. He also likes a lot stella and Chewy raw freeze dried morsels. Can you tell me again what you feed Mala? My cats need food rotation, if not, they get bored of one food and won’t eat. Very spoiled cats. I want to add to their menu healthy foods. I will also try boiled chicken.
Hroswitha
Member Since 2011
I have Mala's food on my signature. If Mario isn't CKD and doesn't have other issues, you don't need expensive food. Right now, Mala gets either Nature's Recipe chicken and chicken liver in grain free broth, and Weruva Chicken Frickazee. The former I get for free from my local Humane Society (as I foster for them and do TNR programs), the latter is about $50 every 25 days for food. Really costly.
Could I recommend you start with something like Fancy Feast in a pate variety? Look at the food list I'm linking below. Mario might like the FF without gravy. If not, try something like the 9 Lives. It's not high qualify food, but the pate is low in carbs.
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
If you want to add chicken snacks to his diet, I would recommend you pick up some 10 lb. bags of chicken hind quarters sold in WalMart. A large bag only costs $6, and we divide them, freeze the raw meat until we need it, and boil up 2 thigh/leg combos at a time. Stripped, they yield about 2 days worth of snacks.
One half a day, if you have chicken mad foster boys like my two.
Mario might also like the broth, if you boil without garlic or onions.
Could I recommend you start with something like Fancy Feast in a pate variety? Look at the food list I'm linking below. Mario might like the FF without gravy. If not, try something like the 9 Lives. It's not high qualify food, but the pate is low in carbs.
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
If you want to add chicken snacks to his diet, I would recommend you pick up some 10 lb. bags of chicken hind quarters sold in WalMart. A large bag only costs $6, and we divide them, freeze the raw meat until we need it, and boil up 2 thigh/leg combos at a time. Stripped, they yield about 2 days worth of snacks.
One half a day, if you have chicken mad foster boys like my two.
Mario might also like the broth, if you boil without garlic or onions.
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Vannecheta
Member Since 2018
I can’t find Nature's Recipe chicken and chicken liver in grain free broth anywhere.
I bought fancy feast classic today. Mario liked it!
Ok, I’ll go to Walmart for the chicken. My cats will be super happy
Hroswitha
Member Since 2011
Nature's Recipe has been discontinued, which is why I get it free. It's really low in carbs, and low in phosphates, so Mario doesn't really need it. Same with the Weruva. Expensive and high quality food, but you can get by with Fancy Feast pate and get him into better numbers.
Here's a link to Chewy.com for Fancy Feast pate that would work for Mario. It may be less money than you pay in the grocery store.
https://www.chewy.com/fancy-feast-classic-poultry-beef/dp/104049
Here's a link to Chewy.com for Fancy Feast pate that would work for Mario. It may be less money than you pay in the grocery store.
https://www.chewy.com/fancy-feast-classic-poultry-beef/dp/104049
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Vannecheta
Member Since 2018
Vannecheta
Member Since 2018
I’m nervous the glucose levels get too low at night. I realize now that 6.5 units is a lot and this is the third day on that dose.
Also, I want to share with you that I’m going on vacation with my family next Monday for a week. I’m super scared about Mario. My mom can give him the shots but I don’t think she will be able to do the testing. I would like to leave Mario on a safer insulin dose.
Kris & Teasel
Member Since 2016
Post about that nearer your departure date and ask specifically for help with a pet sitter's dose.
Hroswitha
Member Since 2011
Excellent advice. When it gets closer to your departure time, put up a thread with a question mark in the header. Ask for specific advise for dosing.
You might want to bring your mother over and teach her how to get a reading. It's pretty easy, once someone gets used to it. I have had pet sitters who were not cat people who did for Mala.
You might want to bring your mother over and teach her how to get a reading. It's pretty easy, once someone gets used to it. I have had pet sitters who were not cat people who did for Mala.