Beginning Journey for Ottie - CKD and diabetes

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So the aim is to have your kitty BG at 146-247 or 8.1-13.7 ??

I thought 13 is too high?
 
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I see Ottie has already earned “another” reduction back down to .25 (as we previously discussed) after you increased the dose back up to .5 units during the p.m. cycle. When following Start Low Go Slow the goal is to try to keep kitty between 90 and 150. This is a goal and a good place to start. It does not mean that the cat will stay within this range at all times. We make dose adjustments based upon the nadir (lowest point in the cycle.). We do also give some consideration to the fasting preshot test numbers because we must make educated guesses about where the cat will be at nadir based on the preshot numbers. This is more the case even with a single cycle insulin like ProZinc, but as we gather data on the spreadsheet, it makes decisions easier as we learn the cat’s onset and duration and response to various carb percentages, etc. ProZinc will onset about +2 for most cats, so it is important to know where they are at +2.
 
Suzanne & Darcy said:
He dropped below 90. Both @Shelley & Jess and I said he had earned a reduction. We also addressed the issue that is it a small amount of insulin. I had previously suggested that she not follow the vet’s recommendation of starting at 1 unit and I said to cut it to .5. It was pointed out to me that the .5 was a small amount of insulin. Yes, but Ottie dropped bow 90 on that small amount of insulin. Therefore, I also said that, per SLGS, a reduction to .25 units should be given going forward. I understand that.25 units is a small amount of insulin. I am aware of this. Nevertheless, insulin is a hormone and not a drug. Cats are sensitive to small insulin changes and doses. Ottie may eventually need to go back up to .5 units, but the dosing protocol is written with safety in mind. Therefore, last night I said (and Shelley too) that the new dose was .25 units going forward and was to be held for 7 days/14 cycles unless another reduction was earned during that time.
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Agreed! Sorry, I wasn’t on the other thread. I believe @Bron and Sheba (GA) has a picture of how he marked a syringe with a pen to make the 1/4 unit easier.
 
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Ale & Bobo & Minnie (GA) said:
Agreed! Sorry, I wasn’t on the other thread. I believe @Bron and Sheba (GA) had a picture of how he marked a syringe with a pen to make the 1/4 unit easier.
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I don’t think Bron has been around. At least I couldn’t find her (but maybe that was just me.). But I did link the sticky about drawing and fine dosing that has photos about how to draw a .25 and a .10 and a drop dose.
 
Kili said:
So I will now maintain the 0.25 unit dose for at least 7 days?
In hindsight, I think it was a big mistake for me to go up to 0.5 unit.
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Yes. That’s right. Please hold the .25 dose for a week (14 cycles) unless he drops below 90 again. You are doing great and I know what it is like to see preshot numbers that are higher than you would like — and the temptation is to shoot down the higher numbers with an increased insulin dose. I think you are in a good place because Ottie’s numbers are not really high. He has a very good chance at regulation.
 
Kili said:
With my insulin, am I trying to hit an ideal zone of 5.6-11.1 or am I supposed to hit an ideal zone of 3.8-5.5.

Yesterday, I have 0.25 unit as his early AM shot had a reading below 5... but it didn't go much below 9.1, so I returned to the original dose of 0.5.
Was that the right thing to do?

Ottie's PMPS is 13.7... gave a 0.5 unit Prozinc, and +2hr reading is 8.1... Is that too low, too fast?
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Not really. If your cat goes under 90, regardless of how much under, it earns a 1/4 unit reduction and that becomes the new dose. You don’t go back to the previous dose.
 
Ale & Bobo & Minnie (GA) said:
Yes, when you follow the SLGS method you keep the same dose for 7 days at least unless your cat drops below 90 again. That’s the exception. Have you had a chance to read up on SLGS?
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I did read, but it must have went in one eye, and out the other... Just when I think I got the hang of it, I realise I do not know anything again. This panicky feeling is such an emotional rollercoster.
 
It’s okay here’s the gist of it again. I printed it out and posted it to my fridge when I was starting so I could easily reference it :cat:

I agree with Suzanne that it’s looking like he has a good shot at remission :bighug:

Starting Dose:
  • 1u BID if kitty is not on a wet/canned low carb diet
  • 0.5u BID if kitty has been switched to a wet/canned low carb diet
  • If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
  • Generally, shots are to be given 12 hours apart.
Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.

Reducing the Dose:
  • Anytime the BG drops below 90 mg/dL, reduce the dose by 0.25u at the next shot.
Lather, Rinse, and Repeat!
 
Same here. I was confused and I’d ask the same question over and over. Eventually, it all starts to sink in and make sense. The more data you gather the easier it gets to understand how the insulin is affecting your cat and how it all works.

for now, the 3 most important things are:

  1. hold the dose for 7 days
  2. Unless he drops under 90. Then he earns a .25 reduction - and that becomes the new dose - he’s already at .25 so likely he’d go down to .1
  3. If you get a preshot value that’s lower than usual and you’re not sure what to do, stall without feeding, post here asking for help, retest in 20 minutes to see if the bg is going up on its own.
Tattoo these to your forearm and you’ll be fine :p

As Suzanne said, who is still helping while on vacation, we are here for you!
 
I'm not particularly liked on this forum [...], but I just wanted to say that I'm in regular touch with Kili too (given that we are on the same time zone, it makes life easier) and I think she is doing absolutely fab, so is Ottie! Let's allow both Bron and Suzanne to recharge ;)
 
@Kili you are doing great. I’m really proud and impressed with the testing that you have been doing. I was just checking in on Ottie’s spreadsheet and the blues that I see so far for today are looking good. Try to get a +6 at least so we can (hopefully) get an idea of his nadir on this dose. Keep up the good work. You’ve got this!
 
Oh, and try feed him small snacks of low low carb wet food during the early portion of the cycle as this will stabilize his blood sugar and help prevent steep drops — and try not to feed after +6 (unless it’s a tiny low carb treat that you give for testing him, as he should always get a treat at test time.) Feeding much at all after nadir can shorten the duration of the insulin and cause BG numbers to rise prematurely during the second half of the cycle.
 
Thanks all for your continued support... Esp Eve who has been there to help in the panic. It's been such a rollercoaster for the past 24hrs, where I have panicked TWICE... Both times got through it thanks to real-time help from Eve.

Now I wonder what you guys think...
Ottie went below 5 twice in a row... Do you think for tonight... Is it best to not shoot tonight... Give poor little Ottie a rest and then shoot 0.25 IU in the morning?

OR reduce to 0.1 IU and still shoot tonight. I don't know how I would handle a 3rd hypo event in a row...
 
With all the amount of BG testing... Ottie's ears are all sore... I don't know if it's prudent to keep poking his ears. It looks so painful. He is never going to get a chance to heal...

I feel that the last time I did it, it pierced out the other side Bleeding on both sides... I feel so bad for him.

Ottie is so fed up now that he is starting to hide. I feel bad for him.
 
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You're very welcome :bighug:
We all know how it feels to start out and how overwhelming it is with the amount of information we need to remember and apply.

Ottie is an amazing candidate for regulation (and even remission in my opinion), but him not having insanely high numbers, puts you in a difficult position regarding dosing.
I let the others advise you on that, so you're more confident in making the decision for tonight.

I have mentioned you the FreeStyle Libre CGM in one of our very first encounters. Although it can be unreliable in the higher numbers, you may want to consider it if Ottie is bothered about the ear pricks. Due to the discrepancies, it absolutely can not substitute ear pricking at AMPS/PMPS/nadir at this point, but it'd perhaps benefit you to identify when is he going low, so you know when to test during the cycle. It would also give you an idea how his curves actually look.
I find it the most relaible between 3.0-9.0 mmol/L (human meter), and since Ottie is mostly within those numbers (although it may looks different on your pet meter), it could be an option for you guys.
 
.:. in.active .:. said:
You're very welcome :bighug:
We all know how it feels to start out and how overwhelming it is with the amount of information we need to remember and apply.

Ottie is an amazing candidate for regulation (and even remission in my opinion), but him not having insanely high numbers, puts you in a difficult position regarding dosing.
I let the others advise you on that, so you're more confident in making the decision for tonight.

I have mentioned you the FreeStyle Libre CGM in one of our very first encounters. Although it can be unreliable in the higher numbers, you may want to consider it if Ottie is bothered about about the ear pricks. Due to the discrepancies, it absolutely can not substitute ear pricking at AMPS/PMPS/nadir at this point, but it'd perhaps benefit you to identify when is he going low, so you know when to test during the cicle. It would also give you an idea how his curves actually look.
I find it the most relaible between 3.0 - 9.0 mmol/L (human meter), and since Ottie is within those numbers, it could be an option for you guys.
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Ottie is quite unique. He is a cat that doesn't like to be bothered. Ottie's affections are also one sided. He determines when to give some affection... Outside that he will be annoyed. He is also very stubborn. We obviously love him, but makes him a nightmare to deal with esp health related issues. Recently we have put Ottie on low carb diet... and he's not particularly fond of it... BUT because of two hypo situations... we gave him carb richer wet food, which he loves... and now he refuses to eat his low carb diet.

I know that he won't be able to cope with a CGM. Whenever we tried to put anything on him in the past, he will spend all day to get it off, and does not give up.
Even when I take him to the vet, I have to sedate him with gabapentin... and he will fight that drug the entire time it is in his system, and will not just sit still to sleep it off. He sleeps when the drug has worn off.
He attacks every vet, and eventhough he's getting on a bit in sense of age, he will not stop fighting. Makes trips to the vet almost impossible.

So in essence, ear pricks are lesser of the two evils. Fortunately, the injections are so far the one he does not fight.

How do most cats cope with the continuous ear pricks? Are their ears constantly red and looking sore? Is it painful for them as it looks to us? You can probably just about make out on the profile picture just how red his ears are. And we've only just started the journey. :(:(
 
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Kili said:
Now I wonder what you guys think...
Ottie went below 5 twice in a row... Do you think for tonight... Is it best to not shoot tonight... Give poor little Ottie a rest and then shoot 0.25 IU in the morning?

OR reduce to 0.1 IU and still shoot tonight. I don't know how I would handle a 3rd hypo event in a row...
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Can someone please share their opinion on this?
 
I tested Bobo a lot and never had an issue with his ears getting scabby or red. Are you applying pressure with a cotton ball on the area after each test ? When you do that, it avoids bruising. What gauge lancet are you using now again? You should be able to go up to a 30 since you know what you’re doing now.
 
Ale & Bobo & Minnie (GA) said:
I tested Bobo a lot and never had an issue with his ears getting scabby or red. Are you applying pressure with a cotton ball on the area after each test ? When you do that, it avoids bruising. What gauge lancet are you using now again? You should be able to go up to a 30 since you know what you’re doing now.
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I do freehand with a 28G lancet needle. I am applying pressure with cotton ball after each poke... but I must be doing something wrong then. The fact that you can see it in his profile picture must mean he is bruised.
 
Kili said:
With all the amount of BG testing... Ottie's ears are all sore... I don't know if it's prudent to keep poking his ears. It looks so painful. He is never going to get a chance to heal...
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I do understand that testing can be hard when we feel we may be hurting our kitty's ears. BUT, the ears are tough little things. Nature has evolved them that way. For safety's sake it's far better to test than to not test. And a bruised ear is not such a big deal in the scheme of things...
As said above, it is important to press on the test site after pricking to try to reduce bruising - if the kitty will let you.
And the ears do seem to 'toughen up' over time and become less sensitive. ...I get a minimum of 4 tests a day with my diabetic girl. And she's often had a lot more tests than that at times... And my first diabetic had a lot of tests every day on a fairly frequent basis at first, till things got a bit better for him... :confused::rolleyes::D

If the kitty is getting a bit sensitive to testing though it may be that the situation would benefit from you working on that, in a very gentle way... ...My diabetic girl hates having her ears touched. And if we have a few 'more challenging' tests she can get a a tad wary... In this situation I use 'fake tests' to build her confidence. I get her to the test spot (her favourite armchair), give her a little cuddle or brushing, and 'just' give her a treat, completely missing out the 'test' part... A few little sessions like this seem to rebuild her confidence...

BTW, some people prefer paw pad testing. Could this be an option for you..?

Eliz
 
I also try to move up and down the ear so I’m not always testing the same spot. I know easier said then done, but I’ve also found it’s easier with my cats to get more blood when I prick lower on the edge of the ear.

let me look at the ss, but I wouldn’t skip any shots. It could be a set back on this road to remission.
 
Ale & Bobo & Minnie (GA) said:
I also try to move up and down the ear so I’m not always testing the same spot. I know easier said then done, but I’ve also found it’s easier with my cats to get more blood when I prick lower on the edge of the ear.

let me look at the ss, but I wouldn’t skip any shots. It could be a set back on this road to remission.
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My vet told me to aim for the triangle in the middle inside the ear. I initially aimed for that, thinking my vet knows better. BIG MISTAKE. All it did was bruise my boy.
It's way better and hurts less for the cat to do the edge of the ear. But even then, I am concerned at the moment because it's all red up and down the edge of both ears. And considering I have just started on this journey, with many more testing ahead daily... I was concerned
 
Since starting Prozinc, we have administered 4 injections. Only once we did not experience hypo. So far, we pretty much experience hypo by +3 to +4 after injection. Once, actual hypo (2.5), and 2 other times... border line (4.8 and 4.3)
We follow the protocol of TEST, FOOD, SHOT sequence. Ottie does have food, at least around 1/2 pouch of food prior to injection. Ottie pretty much eats every 2hrs. But never a lot. He cannot eat much in one go.

The problem is that AFTER injection... He doesn't always eat at +2 and +3 hrs, and quite often doesn't eat much. This is more problematic during the day where he just wants to sleep, and not eat. This leads to his BG falling even further. It's really hard for me to get him to eat when he doesn't want to.
He is on low carb diet, but Ottie is not 100% happy with it. Now during all the times he had hypo, due to my shock and panic... I feed him some carb rich food (which he likes)... Ottie then gets a taste for it... and then starts to not eat his usual low carb diet after the experience. Now I see a slow pattern emerging on Ottie not eating until he gets what he wants.

I'm pretty sure if he just ate what he's supposed to, he will be in remission already... BUT I don't know how to balance this out.
 
That was a problem for me with Bobo too. It’s hard to find low carb foods they like. What about the freeze dried treats? Is he liking those? I’m sorry and the fact we have more choices here in the us than you sucks. I was able to give him FF shredded that is higher than pate but still under 10%
 
Kili said:
My vet told me to aim for the triangle in the middle inside the ear. I initially aimed for that, thinking my vet knows better. BIG MISTAKE. All it did was bruise my boy.
It's way better and hurts less for the cat to do the edge of the ear. But even then, I am concerned at the moment because it's all red up and down the edge of both ears. And considering I have just started on this journey, with many more testing ahead daily... I was concerned
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You’ve seen this diagram right?
 

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Kili said:
Even when I take him to the vet, I have to sedate him with gabapentin...
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I would like to mention here, that Gabapentin can have an effect on BG. It is claimed to be safe for diabetic patients by every vet I have ever spoken to (and believe it, there's quite a few), however, it can both either raise or lower BG, although it's listed as a very rare (1 in 1000) adverse side effect on its official leaflet.
I have a rare unicorn disguised as a cat here too, and guess who's that 1 in a 1000? :rolleyes:

I just wanted to mention this regarding your vet prescribing an initial 1 IU, which we have established before that was uncalled for. So let's say Ottie's system reacted to Gabapentin the way my cat's does, add in the white-coat effect and it suddenly makes more sense why he had such a high reading at the vet compared to what you see at home.

I am very mindful with Gabapentin use on my diabetic one. The others are fine on it. They're just getting fat :D
 
Ale & Bobo & Minnie (GA) said:
I’m not sure where you’re in the cycle, but I’d give .1. Do you know how to measure that? I defer to Suzanne if she thinks otherwise.
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It's her shot time in 10mins.
I offered her a walk-through on microdosing when we saw that 2.5 earlier, but I haven't heard anything back regarding that matter. I also advised her to ask you guys publicly too, because the more opinion the better.
 
.:. in.active .:. said:
It's her shot time in 10mins.
I offered her a walk-through on microdosing when we saw that 2.5 earlier, but I haven't heard anything back regarding that matter. I also advised her to ask you guys publicly too, because more opinion the better.
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So she knows how to measure the .1? It’s so much easier with the U100 syringes but at least she’s got 1/2 units marked U40s
 
No.
She didn't ask, I didn't say.
I was, too, going to urge her to pop to the pharmacy to pick up U100s for it, but it's too late for that now anyway, both re: shot time, as well as pharmacy closing times.

Edit: Here, I thought I'd get back-lash for suggesting U100 for an U40. Glad to have like-minded people around, still ;)
 
.:. in.active .:. said:
It's her shot time in 10mins.
I offered her a walk-through on microdosing when we saw that 2.5 earlier, but I haven't heard anything back regarding that matter. I also advised her to ask you guys publicly too, because the more opinion the better.
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TO SHOOT OR NOT TO SHOOT PEOPLE.
For safety, I was inclined for no shot... Please advise. I have no experience microdosing.
 
I'm throwing my hands up on this one.

I outlined the pros and cons on both skipping and going for a 0.1 IU.
I'm sorry, I can't confidently advise you what to do, it all depends on your confidence on drawing, because it's too late now for you to go to a chemist and get U100 syringes.
I offered help on it, but you didn't reply :(

Either way, I will be around tonight, as always, if you needed me to hold your hand and Ottie's paw.
 
I already recommended .1 units but it all depends on your ability to measure that. Again, can you post a pic of the syringe? If the .25 was at the first line after the zero line, the .1 would be just slightly more than the zero line but less than .25.
 
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upload_2023-7-18_20-15-28.png


USING A U40 SYRINGE
 

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I’m looking at the conversion chart and you might have to do a drop instead. You press the plunger all the way in and hold it. Then once the needle is in the insulin, you let it go. Don’t draw anything else, just let go of the plunger that will suck in a minimal amount. Does that make sense? If this is all too stressful, skip the shot tonight and let’s see if Suzanne will be able to log in
 
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