2 BIG ?s - 8/10 Sushi: AM+9~303| PMPS~294 | +3~318 | +6~271

[Sushi (GA 5/05-3/14)]

YESTERDAY
2 BIG QUESTIONS TODAY:
Okay so it happened AGAIN today!! Our AM+6 was 335!
I thought +6 was supposed to be the LOWEST #. Both last night and this morning it was the HIGHEST. What gives?
Here are a few factors--could they be the culprit?:
He's grazing. Should I stop that? Will his +6 # be that high even if he eats a few bites of his food?
BIG QUESTION 1: Where and how I'm giving his shot. I give in the side of the chest. I shoot directly into his side without pinching. This is how my vet instructed me to give the injection. I even asked if I should be pinching his skin at a later appointment and he said no. I'm gathering from this forum that that is incorrect? The vet tech that has helped with Sushi in the past left me these instructions:

Is this how I should be doing it instead? Can someone point me to some instrucitons of how to do it correctly?

I was just offered a job in Baton Rouge!! Wahoo!! I start in a week. Here's the kicker: I have to go to Baton Rouge tomorrow (they wouldn't let me wait until next week) to do a drug screening.
BIG QUESTION 2: Our usual PM dose is at 5:30, but I'll need to leave town around 2pm. Please advise!!
(a) Give his PM dose @ 2pm (3.5 hours early)
(b) Give his PM dose when I get home around 11pm (6.5 hours late)
(c) Skip? (note that I'm skipping Sunday morning too; is that too much skipping?)
>>I'm thinking (a) because his numbers are still very high -- PLEASE ADVISE!!

 

[Sandy and Black Kitty]

Re: 2 BIG ?s - Sushi 8/10: AMPS~277 | +3~287 | +6~335

Hi Ashley,

I love the illustrated instructioins! :lol: The vet tech has a good hand. . .

Regarding the numbers, I can't see ss from tbp and without the bigger picture I can't comment...

regarding shooting, I used the tent at the scruff method like in the illustration, however I shot from the back door (shooting toward the cats head) while he had his head in the food bowl. It worked best for us. If you chose this method you just have to watch out that you don't stick the needle in one door and out the other (which I have done more than once...).There are other methods, I'm sure others will chime in.

Great news about the job! Rearding the scheduling conflict...I'll defer to those more experienced. My gut instinct is to say no to shooting 3.5hrs early. On the other hand 6.5 hrs late will then put you in a position where your next shot will be 11am... and you would have to gradually work out a way to get back to 5:30p. And skipping would be OK once. Twice, I don't know..although I have had 2 fur shots in a row... I've never had to do that kind of juggling...

 

[Sushi (GA 5/05-3/14)]

Re: 2 BIG ?s - Sushi 8/10: AMPS~277 | +3~287 | +6~335 | +9~3

I love the illustrated instructioins! :lol: The vet tech has a good hand. . .

I know!! I was really impressed!! : )

I've never had to do that kind of juggling...

I wish I didn't!!!!! :roll:

I have another BIG QUESTION:
I know that shooting early is like giving a dose increase--is there some kind of equation that would help me figure out how much of an increase relative to how early?

 

[julie & punkin (ga)]

Re: 2 BIG ?s - 8/10 Sushi: AMPS~277 | +3~287 | +6~335 | +9~3

i would tend to go with skipping, although am i remembering right that sushi had a DKA episode? ergh. the thing about shooting off schedule is you have to look at the curve of lantus and imagine them overlapping by however much you're moving the shot time ahead. i've given a shot an hour early if punkin was already high and we were trying to get back on track, but i kinda think 3.5 hrs is over the top. don't think i'd do it.

any chance of getting that vet tech to come give the shot? any chance of getting your new job thingie earlier in the day so that it's not such a problem?

you're giving the shot straight into his body without lifting the skin? :shock: i can't imagine that's ok, but maybe someone else knows more about it. it's supposed to go into their fat layer that's right under the skin so that the absorption rate is stable.

look 1/2 way down the page here: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139 at these two sections:

Injection Sites for Cats

Shot Placement & Overlap: Flank vs Scruff

the wonky curve happens. could be a number of different things, including the possibility of acro. but it also could be related to how you're giving his shots, could be just the way the moon is sitting in the sky. i don't know - i know we see it here and there on most of the cats. i wouldn't overfocus on that because you can't control it. just keep consistent shot times & dosages, get off the dry food and it might settle down into a "normal" curve.

 

[Ann & Tess GA]

Re: 2 BIG ?s - 8/10 Sushi: AMPS~277 | +3~287 | +6~335 | +9~3

Congratulations on the new job! :thumbup :YMHUG: That is great news. I would be very nervous about a 3.5 hour early shot. Julie had a good idea, is there a way to go earlier and get home sooner? Say you have an appointment that you weren't able to reschedule? What is you work schedule and weekend schedule? How would the 11:00 work for shooting? If you do end up having to skip it would be a great time to get rid of the dry food and just leave a lot of canned out. If you don't shoot the insulin they can't hypo. I hate skipping too, but at least there are 2 days in between when you may need to do it.

Shooting: I always tent and usually shoot on the side just behind the front legs. You do need to get it into the fat layer under the skin and not into the muscle. That hurts too! I always tent the skin and blow on the fur to part it. Shooting in the scruff is thought to slow down the absorption of the insulin, the tissues are very dense.

Nadir: +6 is often the nadir but not always. Tess had a very early nadir on Lantus. The nadir doesn't always stay at the same time either.

You said Sushi grazes. If he is eating shortly before the test that can effect the numbers. You don't always need to test right at +6. If you see him eating wait and get a +7 instead.

 

[Sienne and Gabby (GA)]

Re: 2 BIG ?s - 8/10 Sushi: AMPS~277 | +3~287 | +6~335 | +9~3

I would not be comfortable suggesting that you shoot 3.5 hrs early and I doubt your schedule can accommodate shooting at 11. I think your only alternative is to skip.

I've always tented the skin. A subcutaneous shot means that the medication goes under the skin (not intramuscularly - which is probably what you're doing).

As for nadir, Gabby rarely has a nadir that's at +6. Take a look at her SS. Her nadir is usually at aroung _3 or +4 but has had cycles where it's at +9. There are also some cats who have late nadirs. What that means is their low is around shot time and their high is mid-cycle. It's what's normal for that cat.

 

[Sushi (GA 5/05-3/14)]

Re: 2 BIG ?s - 8/10 Sushi: AMPS~277 | +3~287 | +6~335 | +9~3

:arrow: Can I just say how much I appreciate you?? Just want to make sure you know.

Schedule:
"i would tend to go with skipping, although am i remembering right that sushi had a DKA episode? ergh."
Yes, he did. How does that factor in here? Does that mean I can't skip?

"any chance of getting that vet tech to come give the shot? any chance of getting your new job thingie earlier in the day so that it's not such a problem?"
"...is there a way to go earlier and get home sooner? Say you have an appointment that you weren't able to reschedule?"
Sadly, no to all of this!

For the next week or so I can really make our schedule whatever I want it to be--I suppose I could do 11am/pm. Hummm...that might actually solve a lot of our problems immediate. And I wouldn't have to ask the tech to come over the weekend. But I could only keep it that way for a week. Regardless, I am going to have to change our schedule soon, probably going to 6 or 7am/pm.
-->How do you "...gradually work out a way to get back to 5:30p" as Sandy mentioned???

Here's what my schedule looks like for the next few weeks:
[Usually dose @ 5:30am/pm]
Tomorrow: gone from 2-11pm
Friday: normal
Saturday: gone from 12pm-till...
Sunday: ...return around 9am (I would love to stay until ~2pm! Can I? Can I?)
Monday-Wednesday: normal
Thursday:
Start new job--here's where the craziness begins and I will need to change our schedule! Should I board him? What should I do?
leave around 6:30-7am, return around 11pm
Friday: leave around 6:30-7am, return between 6 and 7pm
Saturday & Sunday: normal
Monday-Friday: Work 8-5 in Baton Rouge; probably stay all week in Baton Rouge with a friend.

How to give injections:
"look 1/2 way down the page here: viewtopic.php?f=9&t=18139 at these two sections: Injection Sites for Cats and Shot Placement & Overlap: Flank vs Scruff"
I did, but they don't really give info on the "tent technique." I need a basic tutorial on "tenting." There were so many awesome videos out there on how to do a BG test; are there similar videos instructing how to give an injection?

 

[Sienne and Gabby (GA)]

Re: 2 BIG ?s - 8/10 Sushi: AMPS~277 | +3~287 | +6~335 | +9~3

When was the episode of DKA and was there only one. And yes, that can make a difference. In a cat that's prone to ketones, one of the things that keeps ketones at bay is insulin.

Shifting time is generally done in small increments -- 15 min. per shot or 30 min. per day. I don't know if that will be feasible for you.

What is the plan for the week you're in Baton Rouge? Where will Sushi be and how are you managing testing and shots? Is there a family member you can train? Can Sushi stay with you at your friends' place?

Sunday: ...return around 9am (I would love to stay until ~2pm! Can I? Can I?)

You don't need permission to do what you want. However, if you want to manage Sushi's diabetes, keep him safe, and give your cat the best chance for remission, you have to take shots and testing into consideration. I'm sorry, but I'm not terribly empathic on this point. I'm Gabby's sole caretaker and I am grateful that most of my friends understand that Gabby's health and well being is my priority. At times it's not convenient and I have turned down a lot of invitations if my petsitter isn't available because that's how I choose to handle my commitment to Gabby. This is not unlike having a sick child.

 

[julie & punkin (ga)]

Re: 2 BIG ?s - 8/10 Sushi: AMPS~277 | +3~287 | +6~335 | +9~3

i think what you're hoping is that we can suggest ways to make the lantus/sushi mix work flexibly for you - but the truth is that it is a fairly rigid insulin and sushi will do best when you follow it the way it wants to be followed! we can offer ideas & help you understand how lantus works and what will help sushi do best, but it is hard putting it into practice. there's really no way to make it convenient for you.

sienne is right - having sushi with diabetes is just like having a sick child. that's gotta be hard for a young woman with a social life . . . but it is what it is.

 

[Sushi (GA 5/05-3/14)]

Re: 2 BIG ?s - 8/10 Sushi: AM+9~303| PMPS~294 | +3~318

Good evening!!

I just went back through my notes and did some more research/homework. I'm not entirely sure that Sushi ever had an episode of DKA. If he did, it was in mid-January. I can't tell if the note I have about DKA was a note of a diagnosis or if it was my vet giving me the worse case scenario. Again, I don't feel like I was ever given a through explanation of what exactly happened to him. When the vet initially called and gave me the news of the critical condition he was in, I was so shocked and upset that I was not able to retain the information or make sense of it all. I just scribbled "ALT range. His 900.-- Normal range 74-159. His 411." (I think this is a liver enzyme level) -- Liver enzymes ^ -- Diabetic -- Insulin -- <fatty liver syndrome> -- Liver failure -- Critical" on a sticky note. After a few days passed and I was able to process what was going on, my vet (a different doctor than the one who did the diagnosis) simply said he wasn't totally sure what happened, he thinks it was pancreatitis that affected his liver, and, basically he has diabetes, and if we tackle the diabetes all the other issues will be resolved. This is definitely something I need to clarify with my vet, and I apologize for the confusion.

I appreciate the information and your insight and perspective. I do understand that Sushi being diabetic is a very rigid situation and a huge commitment that is often inconvenient. I too have turned down many invitations, left social functions early when I wanted to stay and missed out on activities I would have loved to be a part of. Right now just so happens to be a time of exceptional chaos. It's my birthday, class reunion, I'm starting a new job and moving. In fact, I was hesitant to even join this board right now because of all of the craziness. I knew it wasn't a good time, but I'm so glad I did! The help and information I've been given have been absolutely invaluable. You couldn't put a price on it! I'm so appreciative of all of you. Once we are back in Baton Rouge these chaotic schedule changes will no longer be a part of our lives. I just need to get through the next few weeks and we'll be smooth sailin'.
I'm not asking for you to make this easy or convenient, I'm just looking for some insight to the consequences of my different options so I can make the best decision. A part of me still feels too ignorant to make the best decision. I hate how flakey I must seem. I've neglected Sushi mostly out of ignorance, not selfishness! I appreciate your patience and for helping me wade through it all.
Which would you suggest is the better option:
SCHEDULE A:
[Usually dose @ 5:30am/pm]
Tomorrow: [am]5:30 / [pm]skip
Friday: 5:30am/pm
Saturday: 5:30am/pm
Sunday: [am]skip / [pm] 5:30
Monday-Wednesday: move dose in 15min incriments to 6:30am/pm
Thursday-Sunday: 6:30am/pm
Monday-Friday: Work 8-5 in Baton Rouge; probably stay all week in Baton Rouge with a friend.*

SCHEDULE B:
[Usually dose @ 5:30am/pm]
Tomorrow: [am]5:30 / [pm]11 (I could even do the am dose at 11am or whenever)
Friday: [am]10:45 / [pm]10:30
Saturday: [am]10:15 / [pm]skip
Sunday-Wednesday: move dose in 15 min incriments to 8am/pm (Sunday: [am]10/[pm]9:45 -- Monday:[am]9:30/[pm]9:15 --Tuesday: [am]9/[pm]8:45 -- Wednesday: [am]8:30/[pm]8)
Thursday: 6:30am/pm -- THAT'S AN HOUR AND A HALF JUMP!
Friday-Sunday: 6:30am/pm
Monday-Friday: Work 8-5 in Baton Rouge; probably stay all week in Baton Rouge with a friend.*

*"What is the plan for the week you're in Baton Rouge? Where will Sushi be and how are you managing testing and shots? Is there a family member you can train? Can Sushi stay with you at your friends' place?"
I'm not sure and it's really stressing me out!! No family members. I'm leaning toward boarding him. I feel like I need to make a decision now because so many other decisions rest on it.

I would ask a friend in Baton Rouge to take him in for me for a few weeks, but he’s a lot to deal with between the diabetes, his pooping everywhere, his intensive shedding (meaning there's fur EVERYWHERE!) and his litter box is crazy due to the excess urination. So here are options I’m considering:
Boarding him here -BUT- I don’t have a vet I trust. And Sushi HATES the vet. HATES it!!
Boarding him in Baton Rouge -BUT- It could be for 2+ weeks!
Bringing him with me back and forth –BUT- I’m not sure that would go over real well even if I’m around to take care of him, and he gets so stressed in the car! Would it be too much for him?
Find a cat sitter and try to only stay in Baton Rouge 3 of the 4 nights of the work week? –BUT- I'm not sure I have someone that can help me that often.

…any other ideas??

Again thank you thank you thank you!!!

 

[Sushi (GA 5/05-3/14)]

Re: 2 BIG ?s - 8/10 Sushi: AM+9~303| PMPS~294 | +3~318

To simplify:
Schedule A offers more consistency as far as the times the shots are given, but it involves skipping twice.
Schedule B only skips once, but the dose time will be steadily changing.
...which is a better choice?

 

[julie & punkin (ga)]

Re: 2 BIG ?s - 8/10 Sushi: AM+9~303| PMPS~294 | +3~318 | +6~

hmmm, i guess i would lean towards the second option, just because it only has one missed dose. i would guess shifting by 15 minute increments would be fine even when you're constantly doing it for a week. seems like it'd be a little confusing so you might want it written down to help you stay as close as possible to it, but i'd think it's workable.

for that week when you have to board or ? - i don't know how the prices compare between boarding at the vet's and having a vet tech come test and shoot, but if it's possible, i'd try to get someone to come to your place. you said sushi hates the vet (like mine and probably most cats) so it would probably be easier on him to have someone come over. in fact, i'd even wonder if you could advertise and train someone like my son to do it.

i worked in youth ministry for a long time and there were lots of times that people would call me and ask if i could find them a teenager to do x job - short term/one time type of stuff. i just wonder if you have a teenager in your life who likes animals, maybe wants to be a vet who would let you train them. or a vet school student? a church youth group near your apartment? $30 per day for a few minutes of work is a lot to someone who young who hasn't had a regular job and might want to learn a new skill - you just need someone who will be dependable and willing to learn. what about 2 teen siblings that could help each other through it? we have had petsitters post on here and we can help if needed - although you're probably going to be available by phone.

or, at our vet's office there is a bulletin board with a zillion petsitters who advertise and i know some of them give meds. have you checked there?

could you post it to your friends on facebook "need someone to learn to give insulin to my diabetic cat 6am/6pm for dates x-y" kind of thing for $30/day? you might be surprised who would be interested.

 

[julie & punkin (ga)]

Re: 2 BIG ?s - 8/10 Sushi: AM+9~303| PMPS~294 | +3~318 | +6~

oh yeah, and if you look for a high school student they might be willing to pay YOU if they can stay at your house and get out of their parent's house. seriously - i had fabulous parents and even so, i remember LOVING overnight babysitting or housesitting jobs that got me away from home. my kids have had jobs like that and they're eager to do that kind of stuff.

one more thought - the FB friend's thing - maybe one of your friends would barter you for it so you don't have to pay. perhaps there is something you could do as a trade.

 

[Sushi (GA 5/05-3/14)]

Re: 2 BIG ?s - 8/10 Sushi: AM+9~303| PMPS~294 | +3~318 | +6~

Hummm...these are some awesome ideas Julie! Once again, saving my day!

...if I went with schedule B, what time should I give his dose tomorrow morning? Should I go ahead and bump it to 11am?

 

[julie & punkin (ga)]

Re: 2 BIG ?s - 8/10 Sushi: AM+9~303| PMPS~294 | +3~318 | +6~

just stabbing in the dark, i think i'd split the difference in the morning and hit in the middle. so if you shot him at 5:30 tonight and you're going to 11 tomorrow night, i guess i'd go somewhere around 8am if you could. but i really don't know - i'm just guessing.

 

[Carl & Polly & Bob (GA)]

Re: 2 BIG ?s - 8/10 Sushi: AMPS~277 | +3~287 | +6~335 | +9~3

I've always tented the skin. A subcutaneous shot means that the medication goes under the skin (not intramuscularly - which is probably what you're doing).

Not necessarily, but it is likely that she's hitting muscle. It depends on the angle of the syringe, and how far in she's sticking it. If she's parallel to the body, and using short needles, the insulin may not be going into muscle. Regardless, tenting for a sub-q shot is the way to go.

Carl in SC