Dosing advice ASAP

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WELCOME TO FDMB and CONGRATULATIONS on that first test!
I dont know if this is your first post but we are glad you found us.
I'm not qualified to give dosing advice but with numbers this low with a newly DX'd cat I would not give any insulin. What meter are you using?
@Deb & Wink What do you think?

WELCOME TO OUR FAMILY Jessie and Forrest:bighug:

We'll do our best to get you and Forrest sorted. You are in a safe place because its the best place to learn everything you need to know about feline diabetes.
We look forwar to getting to know you both!
jeanne
 
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tap on your avatar where it says your name ,then hit profile page ,tap on that ,then go up to the very top, upper right hand side and tap on your name ,it will bring down a drop box, tap on signature, the signature will be under settings, tap on the signature then and you can start to add what I posted above, make sure you hit save ,
Welcome to the best place you could ever be and an awesome group of people


Do you see mine , it is in gray letters
 
Now that we've decided you're not going to shoot tonight, let's get you started on some of the "housekeeping duties"

If you go to the top right and click on your sign on name you'll be able to choose "Signature". A new box will pop up for you to enter information like:

Your name/Cat's name, age, sex, date of Dx, type of insulin, type of meter, type of food, any other health problems or meds?.....and then put the link to your spreadsheet in. Save it all and you're done!

Having that done gives us the answers to the most common questions we'd ask so it saves us the time of asking them over and over again.

If you look below our comments, you'll see we all have our "signatures" done
 
Maybe so. Maybe so.

Thanks so much for getting your User Id Signature up and the SS (spreadsheet) attached. It makes all the difference for those of us helping you, to be able to see that type of information.
Oh great you can see it! Do you mind if I ask you a question? I've seen in multiple places that if he is under 200 pre-shot that means no insulin. So what if he continually does not have a BG over 200?
 
You think so??? I am honestly shocked by these number and hopefully maybe closer to remission if at all possible!

Well, those are within the normal BG range for kitties, so they're an excellent start! Forrest got a pretty big dose of insulin this morning, so it's a little early to talk about remission, but it's certainly very promising that he's reaching these numbers!

Oh great you can see it! Do you mind if I ask you a question? I've seen in multiple places that if he is under 200 pre-shot that means no insulin. So what if he continually does not have a BG over 200?

Right now, it probably means that he needs less than 2.5U of insulin (later, with more BG data, you can start to sneak your "no-shoot" number down below 200). I believe that the 73 he just got, being less than the reduction cutoff of 90, means that he's earned a reduction of 0.25U :).
 
Next time, you want to get the pre-shot test BEFORE you have fed Forrest. No food for 2 hours before is best, so the BG levels are not food influenced. I'd also suggest another test around +2 tonight, even though you skipped the insulin this PM. Some cats get more than 12 hours of duration from a shot, and you want to know if Forrest's BG levels are still dropping or going up or holding steady.

The BG of 200 pre-shot is when people are new to testing, and just getting "their feet wet" and getting better at the testing process.
As you gather test data, that pre-shot dosing threshold gets lowered and lowered.

Over in the Prozinc ISG forum, the pre-shot BG level is 150. But here in the Feline Health forum, people keep their cat a bit higher, as they learn how to treat feline diabetes. It's a learning process, to see what the insulin is doing for YOUR cat and how low the insulin takes them during the 12 hour dosing cycle.

So another important technique to learn, is "stalling". That means not giving any food when the pre-shot test shows your cat's BG level is lower than normal, or lower than what you are used to. Stall for 20 minutes, retest without food and see if the BG number is rising or falling. Repeat that process for up to 1 hour.

Nan types faster than I do! But she is correct about reducing the dose by 0.25U.
Right now, I wouldn't give Forrest any insulin if his BG numbers at pre-shot are <200. AS LONG AS he has not had DKA or ketones.

One "housekeeping" type request for you. Would you please put the dose in the U column for this morning? If you have any other days when Forrest was getting insulin, adding rows for those days to the SS would be helpful to see too. Even if you weren't testing before this, you were still giving insulin, and we like to see that.

Thanks. You are doing fine so far!
 
Next time, you want to get the pre-shot test BEFORE you have fed Forrest. No food for 2 hours before is best, so the BG levels are not food influenced. I'd also suggest another test around +2 tonight, even though you skipped the insulin this PM. Some cats get more than 12 hours of duration from a shot, and you want to know if Forrest's BG levels are still dropping or going up or holding steady.

The BG of 200 pre-shot is when people are new to testing, and just getting "their feet wet" and getting better at the testing process.
As you gather test data, that pre-shot dosing threshold gets lowered and lowered.

Over in the Prozinc ISG forum, the pre-shot BG level is 150. But here in the Feline Health forum, people keep their cat a bit higher, as they learn how to treat feline diabetes. It's a learning process, to see what the insulin is doing for YOUR cat and how low the insulin takes them during the 12 hour dosing cycle.

So another important technique to learn, is "stalling". That means not giving any food when the pre-shot test shows your cat's BG level is lower than normal, or lower than what you are used to. Stall for 20 minutes, retest without food and see if the BG number is rising or falling. Repeat that process for up to 1 hour.

Nan types faster than I do! But she is correct about reducing the dose by 0.25U.
Right now, I wouldn't give Forrest any insulin if his BG numbers at pre-shot are <200. AS LONG AS he has not had DKA or ketones.

One "housekeeping" type request for you. Would you please put the dose in the U column for this morning? If you have any other days when Forrest was getting insulin, adding rows for those days to the SS would be helpful to see too. Even if you weren't testing before this, you were still giving insulin, and we like to see that.

Thanks. You are doing fine so far!
Thank you for your support!! I have one last question for the night because I have to go to bed but I’m going to try to test him tomorrow morning before I go to work this should be around 0500 maybe 10 minutes earlier (he also will not have food i will not make that mistake again) this would be 2 hours prior to him getting his shot. Hypothetically speaking if his BG is below 150 should I hold again or decrease his 2.5U to 2.25U?
 
Hypothetically speaking if his BG is below 150 should I hold again or decrease his 2.5U to 2.25U?

Until we get more data on Forrest and learn more about how HE reacts to insulin, for safety, I wouldn't give him insulin if he's below 200 (don't worry....cats tolerate high numbers for a long time before they start to do any damage....it's the low ones that can kill quickly)

I have to go to bed but I’m going to try to test him tomorrow morning before I go to work this should be around 0500 maybe 10 minutes earlier (he also will not have food i will not make that mistake again) this would be 2 hours prior to him getting his shot.

Are you saying he won't get his shot until 7am? The Pre-Shot test really needs to be immediately before feeding/shooting.
 
Any updates on Forrest's BG numbers today? You probably haven't had time to enter them in the SS (speadsheet), but it's important for those of us helping you to be able to see that information.

Perhaps you mom can learn to "bribe" Forrest with some treats, so that he let's her test him. Break the testing down into little steps. Have you mom do each of those steps, without the poking of the lancet, and reward Forrest with a treat. Before long, he'll come to associate the treat with the testing process and testing becomes easier.
 
Any updates on Forrest's BG numbers today? You probably haven't had time to enter them in the SS (speadsheet), but it's important for those of us helping you to be able to see that information.

Perhaps you mom can learn to "bribe" Forrest with some treats, so that he let's her test him. Break the testing down into little steps. Have you mom do each of those steps, without the poking of the lancet, and reward Forrest with a treat. Before long, he'll come to associate the treat with the testing process and testing becomes easier.
I have not tested him at all today because like I said to Chris my mom can’t do it by herself and I work from 6 am to 730pm but I do plan on testing him when I get home tonight so that should be +2 pmps
 
Very long!! So please be patient with my spotty testing I’m doing what I’m able to I’m strongly considering freestyle libre
The libre's are great! They only last for a maximum of 2 weeks, but with the reader, you can get the results and put at least some of those results on the SS, if you decide to go that route. The Libre is much more commonly used in the French language facebook group, based in Europe. Not quite as commonly used here in the US but some people love it, and learn to replace the sensors on their cats themselves.

You must be exhausted after such long days at work. Please remember to take good care of yourself, so you can take care of those around you. Life gets busy sometimes. You do the best you can do, ok?
 
I’m strongly considering freestyle libre

That'd be great. It's gaining in popularity in the US too although there can be some issues with it. One of them is that there's no guarantee it'll last the 14 days. We've had cats get them off within an hour of placement and you can't replace it. Some people seem to have luck with putting a onesie on the cat to keep them from getting it off, but not all cats appreciate wearing that either. Another problem we've heard is cats either being sensitive to the glue, or the glue sticking so good that even when it's time to get it off, it won't come (or takes some kitty skin with it). It also doesn't completely mean no regular testing. If your cat is running low, it's important to go back to regular testing. The Libre's numbers are "behind" up to 15 minutes. It also measures interstitial glucose, not blood glucose so if he's running low, you would need to test regularly to get immediate results that are more exact.

It does however relieve some of the pressure you're feeling and gives you time to work on your regular testing without feeling like you're somehow failing him or anything. It's been a great option for quite a few other members here!
 
I agree-- definitely need to reduce dose.

The dry food "nibbles" are probably helping to keep him out of crisis, but you don't want to have to rely on that (not all cats seek out food when they go low). At least until you can get something like the Libre going, or get your mom testing, you must give him less insulin as a safety measure. It could save his life. You can be more aggressive with dosing later, when you can monitor more closely, but not now.
 
You need to reduce his dose before you end up with a cat in hypoglycemic crisis (or worse). You do not have enough test data to be shooting that much insulin at that low blood glucose. PLEASE listen when we tell you it's not safe.

Did you not get any Pre-shot tests today?
No I could not get any Pre shot tests yesterday because I was at work from 6 am to 730 pm and my mom can’t test him by herself. I would love to reduce the dose but don’t I have to do that slowly? He’s been getting 2.5 for a couple of weeks now
 
I agree-- definitely need to reduce dose.

The dry food "nibbles" are probably helping to keep him out of crisis, but you don't want to have to rely on that (not all cats seek out food when they go low). At least until you can get something like the Libre going, or get your mom testing, you must give him less insulin as a safety measure. It could save his life. You can be more aggressive with dosing later, when you can monitor more closely, but not now.
How much less of a dose should I give him? I was under the impression that I have to reduce the dose slowly he’s been on 2.5 for a couple of weeks now
 
I'm not a Prozinc person, so will defer to more experienced folks if they disagree, but if it were me I'd reduce by at least 0.5U, and still keep leaving the dry food nibbles out for him. Just until you can get some more tests in to fine-tune the dosing.

That's a really tough work schedule you have, so you have to do what you have to do. The really good news is that Forrest's numbers indicate that he's responding well to the insulin treatment since his diagnosis! Now we just have to get him the rest of the way, safely.
 
I'm not a Prozinc person, so will defer to more experienced folks if they disagree, but if it were me I'd reduce by at least 0.5U, and still keep leaving the dry food nibbles out for him. Just until you can get some more tests in to fine-tune the dosing.

That's a really tough work schedule you have, so you have to do what you have to do. The really good news is that Forrest's numbers indicate that he's responding well to the insulin treatment since his diagnosis! Now we just have to get him the rest of the way, safely.

I feel like .5 u would be a good starting point I don’t want to drop him so fast and his diabetic neuropathy come back. I did actually drop him .5u this morning
 
Just saw on your spreadsheet that you had another green pre-shot. There's a 2 in the dose column; honestly, if you're needing to be at work all day today I might skip. Either way, definitely leave him some dry food today!
The reason I gave it today is because I will be home all day to monitor just so everyone’s clear!!! And I will be testing him throughout the day today my goal is to test during his nadir
 
Just to give you an idea of my thinking here... in an ideal world we'd like to know both how he does on a normal day where he gets access to the dry, and also how low he'd go without that propping up. Since we can't do both on one single day, I figure a compromise approach is to start off without the dry to see how he does while monitoring closely. If he goes low, you might have a chance to see how much boost he gets from dry food (if he's really diving, though, it might be better to use high carb wet food or honey to be sure you bring him up quickly. We'll see how he does!).

Fyi, on the SLGS (start low, go slow) dosing method with Prozinc, any drop under 90 means a dose decrease of 0.25U. I'm glad you only shot 2U today; we'll see what happens!
 
Update: amps +4 is 49. Should I consider giving him some honey or putting out some dry food? He is obviously going to continue to drop considering he hasn't hit nadir yet. I am still home and will be for the remainder of the day to monitor him. Just a little nervous is all
 
I'm not qualified to give dosing advice, but I think you need to do something. This is from a sticky:

TREATMENT

During treatment for hypoglycemia, try to test every 15 - 20 minutes until you see the bgs begin to rise. Then continue to test until you are satisfied that the cat is out of danger.

VERY LOW NUMBERS – WITHOUT SYMPTOMS
Retest glucose using a large blood sample to make certain you have enough blood, and if you still get a very low number (under 40 mg/dL or 1.9 – 2.2 mmol/L) administer a teaspoon of corn syrup, liquid glucose, pancake syrup or honey, or INSTA-GLUCOSE and follow with food until the blood glucose numbers rise to acceptable levels. The syrup can be mixed with wet food or poured over dry if the cat will eat the mixture. If using liquid glucose, dilute with water for a thinner consistency.

LOW NUMBERS – WITHOUT SYMPTOMS
Retest glucose using a large blood sample to make certain you have enough blood, and if you still get a low number (40 – 60mg/dL or 2.2 – 3.3mmol/L) give food or treats until the blood glucose numbers rise to an acceptable level. If the cat refuses to eat even his/her favorite foods, you can syringe feed or administer a small amount of syrup.


LOW NUMBERS – MILD SYMPTOMS
Try feeding first or give a little syrup or honey followed by food until the blood glucose numbers rise to an acceptable level and the symptoms disappear. The syrup can be mixed with wet food or poured over dry if the cat will eat the mixture. If the cat will not eat, syringe feed. If your cat will eat dry food. the high carbs will help to increase his/her bgs quickly, but remember the effects of dry food usually takes longer to clear kitty's system once the crisis has passed. Feeding a high carb canned food is preferable to feeding a high carb dry food because the effects will clear kitty's system faster. You can then follow with his/her favorite canned food. Keep in mind that giving syrup (Karo, etc.) or honey is not enough because the effects wear off quickly. You need to follow with food.
IF IN ANY DOUBT, TELEPHONE YOUR VETERINARIAN.

LOW NUMBERS – MODERATE SYMPTOMS
Give a tablespoon of syrup, a teaspoon of liquid glucose, a tablespoon of honey or a tablespoon of sugar syrup followed by food and continue doing so until you see the blood glucose numbers rise to an acceptable level and all symptoms disappear. The syrup, honey, or glucose can be rubbed against the inside of the cat’s cheeks or on the gums for quick absorption. You can also mix the syrup with wet food or pour over dry if the cat will eat it. Continue to give syrup and food as needed and observe your cat for signs of recurring hypoglycemia. Keep in mind that giving syrup (Karo, etc.) or honey is not enough because the effects wear off quickly. You need to follow with food.
IF IN ANY DOUBT, TELEPHONE YOUR VETERINARIAN.

LOW NUMBERS – SEVERE SYMPTOMS
Rub syrup, honey, or glucose on the gums and cheeks if your cat will allow it. Another option for administering syrup, diluted liquid glucose, honey or sugar syrup to a cat who is seizing is to fill a needleless syringe with the mixture and insert via the rectum.
NEVER TRY TO SQUIRT SYRUP, HONEY, OR GLUCOSE TO A CAT WHO IS SEIZING AS THE CAT COULD CHOKE ON IT! RUSH TO EMERGENCY.

AGAIN! ANYTIME YOU CAT IS SEIZING OR LIMP, RUB KARO, GLUCOSE OR HONEY ONLY ON GUMS OR ADMINISTER RECTALLY AND GET TO EMERGENCY OR YOUR NEAREST CLINIC IMMEDIATELY!!!
 
Thank you! I rubbed a little bit of honey on his gum. We were trying to get a sense of what his numbers were without dry food that I typically leave out for him during the day obviously they’re not very good so I’m thinking maybe I need to decrease his insulin. Thanks!
My understanding is that the honey wears off in pretty short order. You might want to feed him "food or treats" and then continue to monitor his BG until you're pretty well sure he's past his nadir.
 
Well it shows that the dry has been keeping him from hypoing. I'm not a qualified "helper" but you are on the precipice of a break through. when you remove the dry lower the dose or monitor so closely to catch a low. Please reread this:

Just to give you an idea of my thinking here... in an ideal world we'd like to know both how he does on a normal day where he gets access to the dry, and also how low he'd go without that propping up. Since we can't do both on one single day, I figure a compromise approach is to start off without the dry to see how he does while monitoring closely. If he goes low, you might have a chance to see how much boost he gets from dry food (if he's really diving, though, it might be better to use high carb wet food or honey to be sure you bring him up quickly. We'll see how he does!).

Fyi, on the SLGS (start low, go slow) dosing method with Prozinc, any drop under 90 means a dose decrease of 0.25U. I'm glad you only shot 2U today; we'll see what happens!
 
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