10/17 - Newly Diagnosed Bear - PMPS 148, +2 89, +3 74

Bear was recently diagnosed. He tested tonight at 148. Should I give him a shot or skip it?

 

Stall, DON'T feed and test again in 20-30 minutes

 

Damn, I fed him. What should I do...

 

Let's see what Chris thinks, but I'm inclined to give a token/reduced dose of 0.25-0.5U. are you able to stay up and test if needed? Plenty of strips?

Edit: Chris, I know he cannot go too far off schedule because leaves very early for work

 

Ill be up for another 3 hours.

I have plenty of strips

 

Ok give it about 10 more minutes for Chris to chime in. If she doesn't, I'd go 0.25U (to the best of your ability to eyeball on the syringe), catch a +2 and post here. I should still be around

 

Cut dose by .25u or shoot at .25?

 

Shoot at 0.25U. It likely isn't enough and he'll probably go into higher numbers, but I believe safest option right now. It'll get easier to decide once you have more data.

 

Ok, just gave him the shot. .25u. Will test at +2 and report back. Thanks.

 

Sorry....went to feed the cat and noticed the dishes in the sink.

Glad you went with the token dose...when you get a little more data and experience under your belt, you could start to shoot anything over 150 (the scheduled dose). 148 would be close enough....of course with the caveat that you have plenty of test strips, medium and high carb food, Karo/honey/syrup and the ability to test as long as might be necessary.

 

I know you're overwhelmed with information, but for later reference - I'll tag @Hshray as a perfect example of learning to shoot lower and lower over time on ProZinc. Hopefully she'll stop by and you can see her spreadsheet (she's since switched to Lantus).

 

Thank you all for your responses.

I am a bit overwhelmed but willing to learn and ask for advice on whats the best thing to do.

So a normal dose in this situation would have been ok?

 

It's been +2 and bears at 89. should I test again in an hour?

 

That's quite unexpected with the .25 dose.

Go ahead and feed him a couple teaspoons of his regular low carb food and test again in 30 minutes. Want to see if that slows down how quickly he's dropping

 

As I said....once you have more data and experience! 3 days worth of data isn't enough to shoot lower Pre-shots but later on, when you have a better idea of how Bear reacts to both food and insulin and understand what his usual onset time is, when his usual nadir is, what kind of duration he usually gets....these are all things you learn with experience and lots of testing data.

Has anything been different today? Different food? Not eating as much?

 

Done. He ate it up. Ill test in 30 min.

 

He only had half a can for lunch. I usually give him 3 a day. he was acting Hungry as usual. He was caught walking out of the Pantry with a load of bread.

 

Aw come on Bear! No shenanigans allowed tonight.

To add to what Chris said - it's generally better to give some insulin vs none (but not always... sometimes it is better to skip).

Ideally, you would have stalled for 20 mins without feeding (don't worry, nearly everyone makes that mistake the first time). We want to see if he was rising on his own without food. If he was, then pretty safe bet to shoot something on the higher side (half to full dose). Since he had already eaten and you can't be too far off schedule, no way of knowing. So based on the data you do have, I went with what I thought was pretty conservative 0.25U. Had you shot the full 1U we'd be having a pretty interesting night.

It's possible the last few cycles were bounces, and he's breaking that bounce throughout the day and heading into PMPS. Right now a bit hard to say if 1U overall is too much, tonight will tell.

Per the more conservative ProZinc dosing method, your new dose (effective tomorrow AM) would be 0.75U because he dropped below 90. But let's see what happens tonight and if we might want to consider lower than that.

 

Yeah, next time its test and stop and get advice and not go on like business as usual. I appreciate your help.

 

Bad kitty!!

I finally had to start putting all bread products in my microwave. I tried my oven first, but then I forgot they were in there and was baking a cake so I pre-heated the oven. Needless to say, you only make that mistake once! At least with the microwave, you have to open the door to put whatever you want to heat into it before you turn it on.

 

He has always had a thing for breads. When I first go him he got into some Almond Poppy Seed Muffins and ate some of the Muffin Tops. Always have to keep things locked down from now on.

 

He's at 74....

 

Hi Tom I just had to laugh, I wish I could have seen that
He's so adorable

 

Hmm. Borderline. We usually don't give MC til into 50s/60s, but we also don't know when his nadir is.

I'd err on side of caution and give him 2 tsp MC (so about 13-15% carbs).

 

My husband just showed me that Seinfeld episode the other night

@Chris & China (GA) my mom used to dry dishes in the oven (family of 9), she melted many a plastic cup or bowl

 

*and recheck in 30 mins

 

@Bron and Sheba (GA) @Bandit's Mom are either of you around yet? Getting close to bedtime here and I don't want to leave Tom without assistance

 

Do you guys pull shifts?

 

It's a bit of a free for all. Some of us are on pretty much every day, some a few times a week. Lately I've been hit or miss, but I do check in if there's someone I've been helping/active conversations. Bron and Bhooma are Australia/India, and are usually the ones helping people at night US time.

 

Can you do me a favor and change the thread title to "10/17 - Newly Diagnosed Bear - PMPS 148, +2 89, +3 74"? That will help those scanning the board to know to keep an eye out when they see that number trend

 

not exactly but those of us that have been here for years know when each of us is online. Bron is in Australia and Bhooma (Bandit's mom) is in India, so they're just starting their day when those of us in the US are starting to wind down.

But we also have a tradition here. If somebody encourages you to shoot a lower PS than you're used to, they agree to stay online as long as necessary to make sure you and your cat are both doing OK....or find someone else they trust that can take over for them.

We don't advise somebody to shoot and then disappear on them (although we have it happen in the opposite direction occasionally and it drives us crazy. We're waiting for updates to make sure everything's OK and the original poster doesn't update us)

 

how do i change the thread title?

Edit: I figured it out.

 

About time for another test?

 

Hes at 106.

 

Ok good. MC was probably a little much then but that's ok. No food, test again in about 45 mins, catch a nap if needed.

 

Will do.

 

Bear tested at 111.

 

Perfect! No food. One last test in an hour, then you're hopefully done. As long as he's flat/rising for 2 hrs without food, you're in the clear for the rest of the cycle.

Will post AM dose guidance in a minute ..

 

So for the AM dose, since you can't be home here are my thoughts. As we say "you hold the syringe" so by all means do what you're comfortable with, I probably won't be around at your shot time. Tonight's trend was a little unusual, so want to be careful.

Remember insulin is a hormone, it doesn't work the same way every time. So even though it dropped him 75+ points or 50% even with food tonight, it may not do the same tomorrow, or any other cycle. We just want to get to a point where you have enough data to see trends, and hopefully keep him above 90 for now so we have a buffer.

If he's above 185, I would stick with 0.25U. And try to hold that for a few days to see how he really does at that dose, provided it's safe to shoot, you can keep an eye on him, etc.

If he's below, I would stall for 20 mins without feeding if you can. If he goes above 185 with that stall, then I'd lean towards 0.25U. If you can't stall and/or he's under, I would skip.

I believe you said you can get a +2 before you leave the house, I would do that. Try to get him to eat a little LC before you leave. But if he's below 90, which I absolutely do not expect using 185 as cutoff, I'd leave 1-2 tsp MC

 

Ok ill test in an hour and post.

Ill follow your guidance. I cannot get a +2 before I leave, I usually leave after shooting.

 

I do have to head to bed, I think you're out of the troublesome part.

I'll set an alarm for an hour just to check on you.

Gotcha about the +2, no worries. You may want to consider 200 as the shoot/no shoot cutoff for now then. Up to you.

 

Thanks for your help! Goodnight.

 

@Biggietoms I’m just popping in to say hi and that you’re doing a good job tonight! Bear is definitely keeping you busy!

As Melissa mentioned, I gradually started shooting lower and lower numbers when I was using Prozinc if you want to take a look at my spreadsheet sometime when you’re less busy. I was actually scared to shoot lower numbers at first (for like kind of a long time), but George didn’t do well on token doses so over time I gradually reduced the number I was comfortable shooting full doses on and ended up shooting full doses in the greens once I had enough data and guidance (mostly from Melissa ).

Anyway I don’t want to take up too much of your feed since you’re busy tonight, but you’re doing a great job, and seeing some really nice numbers especially for being so newly diagnosed!

 

Bear tested 160.

 

Looks like you're over it and it'll be safe for you to sleep!

Good job tonight!

 

Thank you

 

This morning bear tested 175 then 177 with the stall. Going to skip this mornings shot.

 

Bear is 155 @ +11.

Has eaten 2 can of food today. Breakfast at 3am, Lunch at 9.

Should I stick with the advice from Melissa and maybe skip?

 

I stalled and tested 30 minutes later and he's at 147.

 

Hi I'm here one second

 

I'd suggest a drop dose if you can monitor again, hypo kit, plenty of strips, the usual.

It's where you push the plunger all the way in as hard as you can, while holding it down insert in vial, then release. Result is one drop of insulin, not even visible.

When you give the shot you do the same - hold down as firmly as you can without hurting cat, for 10 seconds so it has time to absorb

 

155 and 147 are essentially flat

Was he by chance on steroids at all recently? No other health stuff in past year?

 

He was Sick at the beginning of the year with a unknown cause fever. They thought he was diabetic then but two vets wouldn't or couldn't diagnose. This was in March. He was given antibiotics and 2 other things that I cannot think of. he came out of it a week later. other than that he's been fine. He and the new cat piggy get along some of the time but mostly ignore each other.

Ill go with your advice and do the absorb method.

 

Sorry for multiple replies, just wanted to get you an answer before finishing my thoughts.

Hopefully the drop dose will work, but this is definitely a little unusual for a newly diagnosed diabetic cat.i suspect the yellows you saw were bounces because 1U was too much, his body dumped sugar into bloodstream to protect itself.

If the drop dose also takes him lower than you prefer (that's relative... personally, if I had to be gone all day I'd be aiming for nadir of 80 or 90 )...then you have 2 options. A switch to Lantus that may or may not do the same thing, or just let him hover in these ranges without insulin but keep an eye so they don't creep up

 

while I test him tonight whats a number thats dangerously too low?

 

Ok let's see how that works. This isn't typical diabetic pattern/trend which is why I asked

 

The vet told me he was at 1000 when they ran the blood last week....I dont know what that was about. I since started him on a wet diet and 255 has been the highest number ive seen.

 

It's moreso the drop that indicates whether to intervene. If he'll let you I'd actually try a +1 tonight, if he's dropped more than 25 pts give a little LC (he should stay flat or get a food bump at +1, a drop likely indicates a fun time ahead).

But for sure a +2. If he's around 100 I'd give 1 tsp MC plus little bit LC. 90 or lower, 2 tsp MC no LC.

I should be around to help, minus getting kids to bed

 

Raising my eyebrows at that. Diet changes can have significant impact, but 1000??

 

Ok, Its done. He got his drop. Ill test in an hour.

Thanks Melissa. I appreciate your help.

 

+1 @ 193

EDIT: Maybe I didn't do the drop dose correctly...

 

No, you likely did. This is actually good. This is a food bump from his dinner, what we want to happen.

+2 should hopefully be about even with PMPS or a little lower

 

without the drop dose would the 193 be higher?
will return at +2.

 

Little hard to say. Onset is when the insulin starts working, for ProZinc is usually +2 or +3 (but can vary).

The reason I asked for +1 was because he had such a big drop by +2 last night...so it either meant (1) dose was too high (2) he onsets earlier than most or (2) combination of the two. Tonight's +1 ruled out the early onset, but that's not to say it won't happen some cycles.

With the testing we try to build the whole picture over time - so we want to find trends for onset, nadir, and duration.

Bear seems to be a different case altogether, but the trends help us keep the cat safe when we get to lower numbers/aim for remission, or know that perhaps a change in insulin is needed (sharp drops, not enough duration). You just kind of got thrown in the deep end from the get-go.

Edit: I'd refer you to my spreadsheet but it's not exactly a textbook example. Last year was a waste of bad vet advice. This year he was diagnosed with a pituitary tumor, which in effect causes his diabetes. His onset and nadir were never truly predictable, so we just had to spot check him anyway. Then we started medicine for the tumor and he crashed into remission.

 

I noticed that his numbers we no where as high as other ss I’ve seen on other recently diagnosed. Not that it means that all cats are the same it just popped out to me that he was only a 255 at the first test I had ever given him and not as high as I thought they would be after the “1000” level test I was told by the vet.

 

Tuna comes to mind as a sort of similar case. I suspect he had the pancreatitis brewing, and/or possibly some other underlying inflammation/infection that were elevating his numbers - combined with too high of a dose causing swings. Then once that was taken care of you can see it was night and day.

I'm curious to see what happens with Bear. There's a niggling thought in my head he may not be permanently diabetic, and this is hopefully just a blip in the radar.

Whenever you get a chance, and no rush, would be interested to see whatever recent lab results you have.

 

I will reach out and see if I can get a copy and I’ll upload it here.

could it be stressed induced? He really hasn’t been the same since his companion cat passed last November. I got another cat but they haven’t clicked. They ignore each other or chase each other around. There has been a few fights.

Bear does have some of the symptoms. Constantly peeing, weak back legs etc.

 

I'm not sure unfortunately. Stress definitely affects BGs, how long have you had the new cat?

Has anyone ever mentioned B12 for the neuropathy? See this post.

 

+2 217

 

Ive read about it. ill read the post.

 

Ok I see the +2. It's either that the drop dose wasn't done right, or it's not enough. Do your syringes have half unit markings?

You have two options:
1. Try drop dose again tomorrow, both cycles. See what happens. I'd use 150 as shoot/no-shoot.
2. Try 0.1U. That can be difficult to eyeball...at these low doses some people use calipers. You could also buy U100 syringes, but the conversion between the two can be a little complicated (for example, a 0.1U U40 dose is drawn roughly to the 0.3U marking on a U100 syringe). I would not attempt 0.1U unless your syringes have the 1/2 unit markings.

I suppose option 3 is try 0.25U again but only in PM cycle.

Option 4 is different insulin, but that may not solve problem.

Anyway...I'd catch a +4 just to be on the safe side, but I think he'll stay in blues.

 

ok I’ll get a +3 and a +4.
I’ll see where he’s at tomorrow morning and decide then. I’m gonna go over these posts again.

edit: I have the Merck U40 syringes. They only have the full unit markings.


Thanks again.

 

That's a urine glucose number, not a blood glucose number

 

Sounds good. Let's start a new post tomorrow though this one very long

 

+3 @ 207

 

+4 @200

 

Ok flat, get some sleep. I have a feeling he'll end up around 175 again in the morning, but yellow more likely.