3/14/20 - New Member - AMPS/PMPS all over the place

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CrystalLynn

CrystalLynn

Member Since 2020
Hello everyone! Crystal and our very fluffy patient, Monamie, here.

I'll try to be brief but thorough...

Monamie, currently:
- 10.4 lbs
- 11 years old
- diagnosed March 2019
- current diet: wet only. 1 can of FF classics pate (beef or chicken, hates turkey?) plus a half can of Glycobalance with each meal, 7am and 7 pm.
- currently on 2 units of Vetsulin 2x per day, down from 3.5 units a month ago, a self-directed decision seeing low pre-shot numbers and low +4 numbers on her spreadsheet and getting worried
- Meter: AlphaTrak 2 meter


I've attached her spreadsheet in my signature below. Her pre-shot numbers seem all over the place to me, sometimes too high, sometimes too low. Any clues as to why that's happening and how to stabilize her a bit better?? (Is this normal?)

Apologies for the holes in the data, I inherited Monamie from my Mom in November, and I'm still feeling very new to understanding all of the facets of this diagnosis. Please let me know what other info I can provide that might be helpful?


History:
- March 2019: diagnosed with diabetes, put on diet of Glycobalance wet food at meals and Glycobalance dry food to free feed in between. 2 units of Vetsulin, with each meal, 7am/7pm.
- Summer 2019: repeated glucose curves (at vet), adjusted dosage (beyond and then back down) to 3 units by July 2019.
- January 2020: changed vets. Fructosamine test "in the 500's," no ketones in urine, vet suggested upping dosage to 3.5 units and suggested I start home testing. Vet also found a tooth decay issue with several teeth.
- Early February 2020: 5 teeth removed, dry food removed from diet after dental surgery, just 2 cans of Glycobalance per day
- Late February 2020: Fructosamine test "looking better, but still too high", losing a little weight from under-feeding with only 2 cans Glycobalance. Vet said some dry Glycobalance between meals would be ok, but we decided instead to start introducing Fancy Feast classics (1/2 can per meal) to compensate for no dry food. Trying to keep the carbs as low as possible.

Thank you for any ideas or suggestions. Your generosity in sharing your expertise is greatly appreciated!!
 
Welcome to Crystal and your sweet girl Monamie.

JT does the welcomes, I'm more of the "just the facts and SS review" style poster.
My first thought on reading your post was that the amount of food was too little.
But, 5.5 oz of glucobalance plus 2 cans of Fancy Feast at 3 ounces each give us 11.5 ounces.
May still not be enough.

Is Monamie losing weight, gaining weight, or just right? (Kind of like Goldilocks and the 3 bears.)

Hypo (hypoglycemia) symptoms can be very subtle. More vocal, dilated pupils, etc.
Do you have a hypo kit ready? Have you found and printed off the thread with hypoglycemia symptoms and what to do when. Linking the hypo documents, just in case you have not seen them yet.
Sorry, I strongly disagree with your vet in thinking the meter was wrong when you got those low numbers <68 on the Alphatrak. Good thing you got the control solution to double check. A 32 mg/dL reading on an Alphatrak is dangerously low. Next lower reading would have been LO and possible seizures and coma and an emergency visit to the 24 hour vet.

In my opinion, that 3.5U dose was way too high for Monamie. Good thing you reduced on your own initiative to 2U of Vetsulin.

Do you feed at least 20 minutes before you give the insulin shot? That is needed with Vetsulin/Caninsulin, so the food has time to start digesting and get some glucose into the bloodstream to counteract the quick onset of the Vetsulin.

Have you found the Vetsulin guide we use here, the Sticky: Beginner's Guide to Caninsulin (Vetsulin)
Linked it for you above, just in case.

Please test before every single dose of insulin. That is to help keep your cat safe from too much insulin. That pre-shot test lets you know if your cat's blood glucose (BG ) is high enough to give insulin in the first place.

Vetsulin is not the best insulin for cats, but it's what you have to use for now. If there is anyway you could get your vet to write a prescription for Prozinc, or Lantus, those are much better insulins for cats and recommended by the AAHA.

I see a lot of "bouncing". I see where there could be a bit more testing.

When is Monomie's nadir? How long is the Vetsulin lasting for her? The full 12 hours?
 
Hi JT, Hi Deb, thank you both for your encouragement!

I'll try to respond in line... let's see...
Deb & Wink said:
My first thought on reading your post was that the amount of food was too little.
But, 5.5 oz of glucobalance plus 2 cans of Fancy Feast at 3 ounces each give us 11.5 ounces.
May still not be enough.

Is Monamie losing weight, gaining weight, or just right? (Kind of like Goldilocks and the 3 bears.)
Click to expand...

Good question... I think now she's "just right," but it's hard to tell. She had lost a about a half pound through the month of February, but she feels like she's at a nice, normal weight now. I wish I could give specifics but my bathroom scale isn't too accurate. (I'm open for suggestions??)

Deb & Wink said:
Hypo (hypoglycemia) symptoms can be very subtle. More vocal, dilated pupils, etc.
Do you have a hypo kit ready? Have you found and printed off the thread with hypoglycemia symptoms and what to do when. Linking the hypo documents, just in case you have not seen them yet.
Click to expand...

THANK YOU for this, I have some honey and higher carb wet and dry food on hand, but this level of preparedness is much preferred and will help me sleep much better at night.


Deb & Wink said:
Do you feed at least 20 minutes before you give the insulin shot? That is needed with Vetsulin/Caninsulin, so the food has time to start digesting and get some glucose into the bloodstream to counteract the quick onset of the Vetsulin.

Have you found the Vetsulin guide we use here, the Sticky: Beginner's Guide to Caninsulin (Vetsulin)
Linked it for you above, just in case.

Please test before every single dose of insulin. That is to help keep your cat safe from too much insulin. That pre-shot test lets you know if your cat's blood glucose (BG ) is high enough to give insulin in the first place.
Click to expand...


I have not been feeding 20 minutes before! (I had no idea that was important, thank you for letting me know!!) I have been feeding her her meal, which she joyously scarfs in about 5 minutes, then doing the shot right about as she's done, with a last scoop of glycobalance gravy as her reward.

So to clarify, I should be testing AFTER her meal but before her shot, right? Not testing before the meal, as I have been (inconsistently) doing?

Deb & Wink said:
Vetsulin is not the best insulin for cats, but it's what you have to use for now. If there is anyway you could get your vet to write a prescription for Prozinc, or Lantus, those are much better insulins for cats and recommended by the AAHA.

I see a lot of "bouncing". I see where there could be a bit more testing.

When is Monomie's nadir? How long is the Vetsulin lasting for her? The full 12 hours?
Click to expand...

I think the nadir is about 4+/5+, but I haven't done enough testing to be sure. It doesn't look to me like the Vetsulin is lasting the full 12 hours, and I've been wondering if she needs a longer-acting insulin, too. I think the vet is not opposed to it, and now that I have more testing data to show her, I think she would happily oblige. Any resources on how to switch insulin brands safely would be much appreciated!!

Further lessons to me are to keep more strips on hand. They run out so much faster than I expect them to! And, now that it's less intimidating to both of us, I'll try to test more often. Definitely before insulin each time, but also at the 4+ hour as often as possible. And curves every other week or so? Does that sound sufficient? Any other important testing timings that you'd suggest?

Thank you so much for all of your advice!
 
CrystalLynn said:
So to clarify, I should be testing AFTER her meal but before her shot, right? Not testing before the meal, as I have been (inconsistently) doing?
Click to expand...
The step sequence with Vetsulin is Test, feed, wait 20 minutes, shot of insulin.

So Test before food is correct.

If you do decide to switch insulins, we know of places to get them less expensively than at the vet office.
Switching insulins is a matter of getting the correct syringes, buying the insulin at a low cost if possible. The dose of the old insulin is taken into consideration when you switch to something new. Doses often come out about the same for the old and new insulin.
 
I also see some members are selling lantus pens in the supply closet at a very reasonable price just in case you switch, you might not be familiar about the supply closet, if you are ever interested I can explain it to you
 
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