2nd night on caninsulin and reading 3.7 (66.6) at +4

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Thanks for the information about the difference between Somogyi and bouncing, BJM. I've not seen that explained so well before. It's good to be learning more. :smile:

(Told you I was a novice, Sara! ;-) )
 
BJM said:
No, Somogyi is not the same as bouncing. Bouncing is a short term response of up to 3 days. Somogyi is chronically higher numbers due to too much insulin and has not been demonstrated in cats. Dusty went OTJ in a couple of weeks and I only tested him weekly when I went over to his owners. The day I came in and he was too low, we tried no insulin - he never went super high due to insulin he didn't need, he just ate what he needed to compensate for the insulin.

And a dose of 0.6 units would be fine too, if you can't quite measure the 0.5 units.
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Ok I think I understand what you mean. Not sure what OTJ stands for.

I am getting extremely nervous about tonight. People will keep an eye on me won't they.

My plan for tonight is to test pre shot. All ok give him food-mainly wet with just a bit of dry. Then give his 0.5 unit. Then a +2 and +4 test. I will feed him after I take each new BG reading. All being well I hope to be able to go to sleep then. Yes?

I know I looking for a slight drop and should be happy even if it isn't into the ideal range.
 
Phlika29 said:
Ok I think I understand what you mean. Not sure what OTJ stands for.
I am getting extremely nervous about tonight. People will keep an eye on me won't they.
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Hiya,
'OTJ' means 'Off the Juice'. The 'juice' is insulin. So, 'OTJ' refers to cats that no longer require insulin and can be diet-controlled.

Regarding support tonight, there should be US folks online long after UK folks have got their 'slippers and cocoa and have gone up the wooden stairs to Bedfordshire'. ;-)
But I honestly think you'll be just fine on that reduced dose tonight so long as the blood glucose isn't actually dropping significantly at the time you give insulin.

I know this is causing you a lot of stress. But you really are doing an amazing job. It takes some folks a long time to get where you are in terms of grasping this whole 'feline diabetes' malarky.
Be kind to yourself. Draw breath. Eat chocolate. Drink wine (well, heck,it works for me :lol: )

Hugs,

Eliz
 
Oh off the juice! Would never have worked that out :-D
Thankyou for your continued encouragement.

I have finally managed to have something to eat myself and feel much better now.

So I have taken his preshot reading and it is 22.5mmol/l (405). He then ate mainly wet food with a little of his crumbled dry on top. So have gone ahead and given 0.6 unit of insulin (the closest measurement I could get it to). Remi jumped as I have it him and so hope it all went in.

My plan is to do a +2 and a +4. I just hope they are okay as me and my partner are beyond exhausted. We are still struggling with the ear. Sometimes it works and sometimes it doesn't. He now has quite a lot of blood clotted in his ears. Does this hinder getting more blood out? It must be very painful for him:( .
 
Phlika29 said:
...So I have taken his preshot reading and it is 22.5mmol/l (405). He then ate mainly wet food with a little of his crumbled dry on top. So have gone ahead and given 0.6 unit of insulin (the closest measurement I could get it to). Remi jumped as I have it him and so hope it all went in..
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Always apply a bit of direct pressure after getting the test. This reduces the amount of scabbing and bruising. If you are ever desperate to check the glucose, you may aim for the vein, however it does bleed profusely so be prepared to blot quickly and firmly if you do that. One good shake of the head and you'll think you've been in a slaughterhouse.

If you find you're not sure the full amount went in (aka partial or complete "fur shot"), never give more as it may wind up being too much. Yes, Remi could be high that period. He will be safe, though, and that is what is important.

Phlika29 said:
...My plan is to do a +2 and a +4. I just hope they are okay as me and my partner are beyond exhausted. We are still struggling with the ear. Sometimes it works and sometimes it doesn't. He now has quite a lot of blood clotted in his ears.
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That's fine. The important time period for mid-day tests is during the expected nadir. That is usually between +5 to +7 hours post shot. Get 1 in there when you can.
 
Thanks. Will make sure I do a nadir test tomorrow during the day. He is off the vets for a full curve on Monday.

We are just past +1 post shot and he suddenly got up and wanted food as he did the other times. That is common isn't it? It doesn't mean he is going too low too quickly. I put down some of his wet food. I was going to feed him again at +2. It just made me nervous.
 
Remi's +2 is 17.6 mmol/l (316.8) so that seems like more of a gentle curve doesn't it? Do I need to try to feed him again as he ate about 30mins before his +2.

Ear much easier this time. I think key is to get it nice and hot with the hot rice and then do it immediately .
 
Hi Sara,

Sounds like you're getting the hang of testing. :smile:

I found that +1 'appetite uptick' very helpful when monitoring Saoirse because it let me know the insulin had started working. With your +2 you got confirmation that Remi received the insulin OK.

If you can manage it, a +3 reading is useful on Caninsulin since that's the time that the manufacturers advise the crystalline insulin starts having maximum effect.

What's Remi's feeding schedule (meal sizes, time between meals)?
 
I think it was more of a lucky hit that time. Iam still averaging only 1 usual blood drop for every two missed.

I think I will stick to a +4 tonight and do a +3 tomorrow morning and evening as I am only just coming off the ceiling.

Now remi s feeding amount is a bit all over the place since the transition to wet. It goes like this

Wake up
Antepsin and asthma puffs
Wait 30 minutes then give new wet food/dry food mix (of course now I a take a BG reading and then his insulin)
Then his other oral meds
Then he might get a mid morning snack if someone was at home
A meal at lunchtime
Antepsin when I get home
Meal at about 6.30 but this will be pushed later now I guess because of BG /insulin injection
Feed again (small amount)at 8or 9
Oral meds and astham puffs
Feed again (small amount) between 10 to 11

I used to measure out his dry food and give over the course of the day with two larger meals and a variety of smaller.

I am afraid the change to wet has thrown me with regards the quantity I should be giving him. I am averaging somewhere between 2.5 to three sachets of the applaws meals given over the same sort of schedule. I am worried that when back at work no one will be here to give him a mid morning snack at his +2 .

I am really not great with maths and so haven't attempted to work out the actual amount he needs from that food. It's on my list for tomorrow as well as setting up a sheet.
 
You might try freezing some of the canned, to be eaten as it thaws, for the meal you won't be home to feed.

Or see if you can pick up a Pet Safe 5 from our shopping partner Amazon (use the link above and the purchase will help support the message board)

Moisture content in dry food is only a few percent. In canned food it is usually between 70-78% moisture. You might think of the size of a grape vs a raisin for an approximate comparison of volume between dry kibble and canned food.
 
Hi BJM

Will look into that more tomorrow.

His +4 reading is 8.4 mmol/l (152.2) is that okay. I would very much like to go to bed:). He will have one more meal before we go up of mainly wet with just a few sprinkles of old dry.

Besides having very red ears he is happy enough and has been laying flat out on top of me like his used. Came downstairs off his own back.

Again in the morning the lowest reading upon which to use the insulin is 11.1?
 
That's quite a steep drop from 17.6 at +2 to 8.4 at +4.

Am I doing something wrong regarding feeding? Or is this just how remi does it. I know I have been told already but what are the nadirs of caninsulin. Critter mom mentioned 3hours for the first part of the insulin but there is a second one isn't there? Is that +4. When do the biggest drops occur with caninsulin?
 
Phlika29 said:
I used to measure out his dry food and give over the course of the day with two larger meals and a variety of smaller.
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That sort of schedule would go well with the Caninsulin action profile, with the large meals given just before his insulin injections.

BJM has given good advice about the timed feeders. I find them a godsend. The Petsafe 5 wasn't an option for me because during the worst of Saoirse's flare-up she needed tiny meals once an hour, so I got several 1- and 2-meal Catmate feeders. The mechanical timers aren't precise, but they stand up to Saoirse's attempts to burgle them when her appy stimulant is at peak effect.
 
Thanks critter mom

Will sort the food dosing next and look into a feeder

So it's ok to go to bed now?
 
Phlika29 said:
That's quite a steep drop from 17.6 at +2 to 8.4 at +4.

Am I doing something wrong regarding feeding? Or is this just how remi does it. I know I have been told already but what are the nadirs of caninsulin. Critter mom mentioned 3hours for the first part of the insulin but there is a second one isn't there? Is that +4. When do the biggest drops occur with caninsulin?
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The steep drops are part of the problem with Caninsulin as a treatment for FD, and even more so at lower numbers. I had to stop giving it to Saoirse as her numbers got lower because even at 0.2 IU the drops were still large enough to make it unsafe for her.

Technical info on Caninsulin:

http://diabetesindogs.wikia.com/wiki/Caninsulin
 
So it's ok to go to bed now?
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That's something I can't advise you on, Sara.

I always stay with Saoirse until her numbers start rising again. I can't cope with the uncertainty. I have PTSD so sleep is a major issue for me. I used to regulate my sleep cycle with meds, but I had to stop taking them after Saoirse's Dx (they were becoming less effective and they were worsening the nightmares, so my GP is glad they're gone). Now I can't predict when I will sleep, and once I do pass out my body is so wrecked I don't respond to alarm clocks in order to nap and then wake to do spot checks. At the moment I only give her insulin once a day. I'm doing the daytime cycles at the moment, but I did nights before that to get more readings. I can't monitor her properly over the 24-hr period to keep her safe and I don't have enough data yet to feel OK about sleeping until I have a better idea of when her numbers will rise. She's fairly well regulated at the moment and runs low at night (euglycaemic most of the day on less than 1/4 unit per day) so we're managing for the time being until I gather more data and recover enough to do a few 24-hour curves. She needs to get back to 12/12 dosing to induce remission but I won't attempt that till I can do it as safely as possible.

Perhaps more experienced will be able to advise you what to do.

Best prices on feeders are on Ebay.
 
So I crashed and remi was fine

His preshot am number is 21.4 (385.2) so I fed him and gave him the 0.6 shot. He seems a littler brighter today. So hopefully slow and steady wins the race. I was maybe 15 minutes late as I turned off the alarm and fell back to sleep. I feel like I have a massive hangover. I suppose all the adrenalin leaving my body.

So I think my plan for this morning is not to get a +2 but to go for a plus +3 and some later ones in the curve say maybe a +5 and a +7 or 8. How does that sound? It is only a guess. Or should I always take a +2.

Many thanks

Sarah and remi
 
Remi 's +3 is 16.5 (297). So it looks like it is on a similar curve to last night where he was 17.6 at +2. Will do a +5 and a + 7. The outside of remi's ear still looks like one big clot. I am still aiming to hit the vein to get enough blood but I guess hopefully over time I can just prick the skin.

I will go ahead this afternoon and have a go at the spreadsheet. Someone posted a message about it a while back in this thread and hopefully a link to the sheet. I usually use my iPad nowadays so don't have the program necessary to run it. I am not sure if you can download it to an iPad or if not I will have to dust off and fire up the old laptop ;-)
 
HI Sara,

Glad all went well last night and that Remi is brighter this morning. I find that with Saoirse that as her numbers get lower, her overall bearing and mood gets lighter.

It's great that you're doing a home curve today because it will be great to have some 'no vet stress' numbers to give your vet tomorrow. :smile:

I'm a bit late to the party for your +2 or +3 question, but the +5 and +7 sounds like a good plan. Based on those numbers, you'll have a better idea of whether or not to take a +8 as well. Check back here if you need suggestions. I might not be online but I'm sure that other members will be able to make better suggestions than a beginner such as myself.

The numbers that you get today should give you a better picture of the length of peak action of the amorphous insulin and the later number(s) may show a possible late nadir as the crystalline insulin rises to peak effect. (Saoirse never had those so I can't give you any idea of what that might look like or when to test after to check when Remi's numbers start to rise again.)

When I was deciding when to check Saoirse's BG in the early part of the cycle, I used to use the appetite uptick as a cue. If it came earlier, I'd test at +2 and +3, especially when her numbers got lower so that I could monitor for a possible hypo risk. I'd recommend that you always do a +3 at minimum. That said, a couple of times when I didn't take +2 readings and the +3 tests had Saoirse in the high 3s (low 2s on a human meter). I'm at home all the time so I was monitoring her clinical signs very closely indeed (every 5 mins). Nevertheless, I would have preferred to have caught her going low sooner in order to feed to steer her numbers before she got that low.

Remi will have his own pattern and your tests will help you to learn it, but I hope some of the above will help you. To a degrees, I was making it up as I went along (goes with the territory since each cat will respond to insulin in their own way). It was nerve-wracking enough being at home all day and being able to keep an eye on Saoirse all the time. If I had had to leave the house my nerves would have been in tatters (and there would have been many withheld doses). nailbite_smile
 
The spreadsheet will be in Google Drive and you access it with your internet browser.
You'll need a Google account (free).

The instructions are in the Tech Support forum; you can navigate there by clicking the down arrow at the bottom right of this page and selecting from the drop-down list.

Go partway down the page and you'll see them.
 
Right just down loading an app now to hopefully allow me to do the spreadsheet on the iPad.

Have just taken a +5 and his levels have gone back up to 20.8 mmol/l (374.4) whereas at +3 he was down to 16.5 (297). He did eat his lunch in between the readings. He probably ate twenty minutes before the last test. What does this mean? He has peaked already and is now just going to climb again? It's a bit disappointing.
 
It's worth taking a later reading because the crystalline insulin may lower Remi's BG again.

The short time at low numbers is a function of the insulin action profile.

Different insulins have different modes of action. The intermediate insulins (like Caninsulin) will lower BG and hold it there for a while during the cycle but the effect wears off as the cycle progresses. Hence there may be several hours in each cycle where the cat's BG is unregulated.

By comparison, longer acting insulins such as Lantus (insulin glargine) may not produce the fast, precipitous drops that Caninsulin does because it builds up a depot (bit like the insulin equivalent of a petrol tank). It takes time to fill the depot and then determine how much to top it up every cycle (so that insulin in = insulin out). Once the depot is filled, Lantus remains active for longer in the cat's body, but generally it doesn't lower BG as fast as the likes of Caninsulin does. To use an analogy, Caninsulin curve peaks and troughs may look like the Himilayas when compared to the rolling hillsides of Lantus.

Both types of insulin have their strengths and weaknesses. For example, the precipitous drops can be quite alarming with Caninsulin, especially when the cat reaches a nadir in the hypo range. The advantage with Caninsulin in such a circumstance is that the insulin is used up faster and the risk period is relatively short. In comparison, if a cat's BG were to drop to hypo levels when being treated with Lantus, because of the depot nature of the insulin, the cat can be at risk for 16 hours or more and will need intensive monitoring, testing and steering throughout the period until the requisite number of non-food-influenced rising numbers are recorded.

For all of the (justified) criticism of the '1 feed of Hills w/d Dry + 1 dose Caninsulin BID' protocol being applied to cats, it is not without merit in terms of possibly keeping the cat safe from hypos (the high carb diet basically feeds the insulin). Trouble is that using such a protocol places strain on the pancreas and may result in keeping the cat diabetic unnecessarily.
 
Thanks I am learning all the time from yours and everyone's posts.

I think I can see now why they just say ideally feed twice a day as I think if remi hadn't had lunch then he levels would still be lower. As it is I just took another meter reading at +7 and his reading is 23.2mmol/l (417.6) and so it looks like the insulin has stopped working much at all. I can't say I am not a little disappointed but am just trying to keep in mind what is said here and at the vets yesterday is that it is better to be high than too low.

I am not able to only feed remi twice a day as he would most likely vomit as his stomach acid increases. But is it better to feed them early on in the cycle at say +1 or +2 rather than later on in the cycle. Or lots of little meals. Feeding didn't seem to have quite the same affect last night but then again I didn't test so late on in his cycle.

Do I need to get another BG reading before his next shot? I do feel sorry for him having us prod him all the time.

On another note. When I open the spreadsheet I can only see the us figures to fill in. The second sheet behind just has headings but no chart. Does that mean I have to convert all my uk ones or has something gone wrong?
 
The standard Caninsulin protocol - like the insulin itself - is very much suited to dogs.

Saoirse had exactly the same problem with the 2 pre-dose meals per day. Prior to the recent flare-up, the only symptom she had of pancreatitis was that she would vomit if she fasted for more than 3-3½ hours. Our previous vets were beyond insistent about the protocol being the only way to go and that Saoirse would have to get used to it. I found that completely unacceptable. I fed Saoirse 3 meals plus a snack each cycle (large before insulin, medium after +3 test, small at +6, snack at +9). That way the majority of her food was offered during the period of insulin peak effect but she had something in her tummy all the time so that she would not get sick. Worked fine because i could monitor her.

Gentler, longer-acting insulins like Lantus work better for cats because the insuiln action profile supports small meal feeding/grazing. Indeed, the small regular meals are kinder on the pancreas (as you know so well) and are less likely to cause big food spikes in BG levels.


I do feel sorry for him having us prod him all the time.
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Me three. I really wish it wasn't necessary. I find it especially difficult to run longer curves because my wee Bonnie's ears don't get as much time to recover. But I do all I can to cheer her up and reassure her through the process and I take heart myself from knowing that this is the best thing I can do to help her get better, and to keep her safe while I'm doing what's needed to help her heal. My little one was bright, alert, cheerful and serenely regal in her bearing this morning, so I thought her BG might be a bit better than yesterday morning's somewhat disappointing 8.2 (only giving < 0.25 iU insulin on AM cycles at the moment). I can't describe the joy I felt when I saw her reading this morning: 4.7 / 85 !!! (Alphatrak) First pre-dose number in double figures as measured in American units. Right now, the light of my life is having a snoozy sprawl on the sofa, relaxed as a kitten. Her coat is smooth with a beautiful lustre, and there's not a trace of tension in her body. Compare that to the tatty, depressed, starving, thirsty hiding-behind-the-curtain meatloaf of a few months ago. All those pinpricks got her here and seeing her improve makes them all worthwhile. Saoirse looked me straight in the eye and smiled after her test this morning: I think in her own quiet way she was telling me she now understands what all the pricking, pills and pestering were about.

WRT the spreadsheet, you need to fill in the World mmol sheet. I've got to get some rest now (eyes won't stay open), but if you start a thread asking for help with the spreadsheet, I'm sure someone will be able to help you with it in short order. :smile:
 
It sounds like you and Saoirse are getting yourselves sorted. I cant wait to see remi back to his perky self again. I must say today has been a bit of a disappointment after last night figures looked good. I have just taken a +9 reading and is about the same as before-23.3 mmol/L. He hasnt eaten anything in between his +5 and +9. He doesnt even want the treat after his BG reading. He is laying on the bed all lethargic when he looked so good this morning, even coming down to slep by the open patio door.

I have got my spread sheet uploaded and will start a new thread asking people to comment before i go to the vets tomorrow
 
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