? 10/25 Tibby amps 434; +5 328; PMPS 416. Need advice

[Anna and Tibby]

Hello, first post here - sorry it's long! I am looking after my parents' (former) cat Tibby Tabby and trying to get her regulated. My older parents are not really able to care for her at this level so I've taken her on, but I am looking for a better long-term home for her as I travel between provinces fairly often. (Any advice on rehoming diabetic cats welcome, but not the main topic of my post today.)

I have been doing some reading since discovering this forum, and added my data into a spreadsheet, but I feel like I can't make sense of it. It doesn't seem to follow much of a pattern and I wonder if it's just going to take a long time, or if I'm doing something wrong.

I am trying to follow TR in spirit, starting about a month ago, but I can only make dose changes in whole units currently as I am using whole-unit insulin pens the vet gave my parents. Because of that I'm holding doses longer than specified for TR - that and I feel like I am getting into pretty high amounts with 6 units twice a day for Tibby who is probably 11 pounds at her ideal weight but is about 10 right now. Before that I was gradually increasing her dose but kind of using my best guess on the details, and I spent some time trying to adjust her dose based on her pre-shot numbers. She had some good BG numbers with 3 units in early September, then the odd good number with higher doses since then but mostly higher numbers.

Hoping you all may have some general advice to offer, and can tell me if my current approach is OK and just needs more time/keep increasing, or if I should be changing something. I had hoped to have her on a more stable dose by now. I am going to another province for a month in a week and am not sure what to do - my parents can take her back and are fine with giving insulin but have not been able to get the hang of home testing.

Spreadsheet here: https://docs.google.com/spreadsheets/d/1sKgpgjqs_1d8hyXvI579Yn40z3F_59TgQx_V9ULvISY/edit?usp=sharing

 

[Wendy&Neko]

Hello and welcome. Waving at you from the Wet Coast (yes, deliberately spelled that way!).

Are you using Lantus insulin? We have a few things we like put in your signature, details here: New? How You Can Help Us Help You!

The BD Ultrafine II syringes (purple and yellow box) are available in practically all human pharmacies, and are U-100 syringes with 1/2 unit markings. I'd go and get them as soon as possible. We eyeball the 0.25 unit changes between them. Which brand/type syringe are you using now?

I'd strongly recommend (as TR requires) that you get a second test every night in the PM cycle. One just before bed if it's at least +2 or +3 will help.

Does Tibby Tabby do car travel? How did you find out she was diabetic? Sorry for the million questions to start.

 

[Anna and Tibby]

Whoops, forgot the insulin type in my signature. Yes, it's Lantus.

I am not using syringes now. I'm using the insulin pens the vet provided, which only do whole units. I was figuring I would switch to syringes once I was out of these - I don't really want to throw out all this insulin, and since even whole-unit increases don't seem to make much difference I figured I was safe for awhile?

Have been trying to get +3s before bed on a regular basis, but I can up it to every night if that will help.

My parents found out she was diabetic because they noticed her symptoms and took her to the vet, who diagnosed her. There's a bit more detail on her initial treatment in my profile.

She's not great with car travel. She was very stressed on the 3 hour drive from my parents' house, panting and refusing to eat or drink anything.

 

[Wendy&Neko]

We use our insulin pens like mini vials and use syringes to draw from them. Like this, though that's a picture of a cartrige/pen refill:

The bonus on doing it this way is that we can store the pen in the fridge and use it to the last drop. In Canada, buying cartridges from the pharmacy is actually a cheaper option with less waste. In BC we buy insulin OTC in pharmacies, I think you can in Ontario too.

Testing every night is helpful. A lot of cats go lower at night and a +3 should be able to tell you if that's a cycle she's dropping.

 

[Anna and Tibby]

Oh wow, didn't know you could do that. Thanks! I assumed you wouldn't be able to since there's no air in there and no way for replacement air to get in. Does it draw the plunger down as you withdraw insulin? My pen type doesn't have a removable cartridge, as far as I can tell, it seems like it's designed to dispose of the whole thing once it's empty.

Anyway, I can pick up syringes - do you think based on her numbers I should be continuing to increase, but in quarter or half units now? I am not sure how to make decisions about increases when she had one good day in the greens there but never repeated it. Do I just look at what the majority of her results have been while on that dose? I wouldn't want her to be going much lower than the 4.3/77 she got last week so it doesn't seem clear to me whether increasing the dose is the right thing.

 

[Wendy&Neko]

This Sticky Note has a video on drawing insulin from a pen: Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing I don't think you really replace the cartridges in the pen, I just withdrew insulin from the cartridge as per the picture above. But it's called a pen refill.

With night time testing you'll get a hint whether she's seen more numbers under 100 at night, or whether she just saw them once and won't again. With TR, we typically hold doses for 10 cycles if you saw green nadirs. And over 6 units you increase by 0.5 units.

 

[Anna and Tibby]

Thank you. Her +3 is usually the same or just slightly higher or lower than the pre-shot number, so it doesn't tell me much about where she's going unfortunately. The +4 is better and I could do that occasionally but not every night. However, all her greens have happened when her pre-shot number was lower, in the mid-teens. Possible she had a green on the 16th when I wasn't able to be there to test. How many greens (or what proportion of nadirs being in the green) would be grounds to not increase the dose?

In this case, since she has been on 6 units for 25 cycles I guess I should increase but not until I've bought syringes so I can do a half-unit.