? 3/29 Yum new to the group +3.5 480 +6 510 +10 642 PMPS 562 +3 536

[MJW]

Yum is a 15 year old spayed female. Her glucose was normal in August. In December at a 4 month checkup it was 314. After an immediate change to low carb food and maybe a week on 1 unit of insulin twice a day she was in remission before Christmas. She had monthly checks. On Feb 28 her glucose was 377. The only diet change post remission was the introduction of cosequin and omega fatty acids drizzled on her food from capsules. I stopped those. We started on a half a unit Lantus once a day. We did not do a curve, but she had numbers at various times of 399, 298, 346. After 2 weeks we increased her to .5u twice a day. We had numbers 293 and 386 in one day morning and afternoon. After 8 days we increased her to 1u twice a day. We had numbers 317 and 397. She went to 1.5u twice a day on March 25. By now I have my own AlphaTrak2 glucose monitor. On the morning of March 28 five hours after her shot she was 484 her highest number yet. Today I am trying to do a curve at home. I did not do the AMPS test. At +3.5 hours she was 480 and at +6 hours she was 510. She is not very active today. I have not done a recent ketone test. She has a good appetite. She is not vomiting. I heard some gagging this morning before breakfast but I didn't find anything and it might have been one of the other cats. I will finish this curve for the vet tonight. Will an evening pre shot test be as useful as an AMPS? Do we expect an AMPS to be high or low? I was expecting her nadir to be around +6. I understand the nadir to be the most important number. Of course it seems every time I take a reading it is the highest yet. She sometimes has an elevated WBC. She had a dose of convenia on March 9 when she wasn't eating. There were no other unusual numbers at that time---I attributed it to a toad she had eaten. She did just finish 4 weeks on adequan. Any words of wisdom?

 

[Tracey&Jones (GA)]

Hi to you and your kitty!

I am too new to give dosing advice but I can ask all the beginning questions and bump up your post.

Also, you may want to edit your thread to include a question mark (drop down menu) to get more eyes on this and put something like "dose advise needed"

It sounds like you are home testing which is great. Did you happen to set up a spreadsheet? It is the one we use here and is used by one giving dosing advise.0 And it sounds like you are taking pre-shot tests? Is that correct? Do you take any mid-cycle tests as well? Because that will tell you how low she is going which will assist in deciding dose amounts.

May I ask is it the vet that is changing the dose or are you changing her dose? We tend to make dose changes in .25u on this forum. It helps us from shooting past a good dose. I learned that the hard way.

Sorry for all the questions, just trying to get a history. If you look at my signature (the light grey lettering) it has information in that other members like and so you don't have to keep repeating your self.

Here is a great starting post with links (dark blue) to some great information on how to get started.http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/

On a side note - that WCB count - has that been recent or just comes and goes?

 

[MJW]

Thanks for your suggestions!

Oh no. At +10 she is 642. She has been on 1.5u (measured from bottom of syringe stopper not top) twice a day for 5 days, so I guess it's not a bounce. But these numbers are so much worse than when she wasn't on insulin, when we started a month ago. The vet is telling me what to dose. She was on vacation for a week and her assistant gave some advice, not sure how well they communicated. These high numbers all started with the 1.5u. I did buy a new bottle of Lantus when I made that switch. I also increased the ratio of Fancy Feast classic chicken to DM Savory Selects for her morning meal, as the FF is supposed to be lower in carbohydrates. So I changed 3 things at once, 4 to 5 days ago.

 

[Tracey&Jones (GA)]

the FF is supposed to be lower in carbohydrates

Ok, you need to be careful when dropping the carb intake. It can change insulin requirements pretty dramatically sometimes. With a dose increase on top of that, she may have gone very low and is now bouncing. I can't really say without knowing her testing history. A spreadsheet with Yum's testing results are needed before any dosing advice can be given. Can you set that up? And add it to your signature? If you need help let us know, we have some experts that can help you with that.

 

[Tracey&Jones (GA)]

Added question - have you ever tested for keytones?

 

[MJW]

Ok, you need to be careful when dropping the carb intake. It can change insulin requirements pretty dramatically sometimes. With a dose increase on top of that, she may have gone very low and is now bouncing. I can't really say without knowing her testing history. A spreadsheet with Yum's testing results are needed before any dosing advice can be given....

Thanks. I will work on the spreadsheet. A bounce can last more than 6 cycles? I will need to decide on her ff/DM ratio tomorrow morning. She came down to 562 PMPS. She hasn't been tested for ketones for 2 weeks. I have gladwrap in the litterbox and new ketostix. Vet appt tomorrow afternoon. She didnt feel well today (all the ear pokes didn't help) but her appetite is good.

 

[Tracey&Jones (GA)]

It can last a awhile sometimes. Then just when the clear a bounce they dive and next you know you are in another bounce.

 

[Tracey&Jones (GA)]

If you have dosing questions you can always start a new tread with a question mark. Something like PMPS number and the dosing advice.

 

[Wendy&Neko]

Hello and welcome. There is lots of good information on the Sticky Notes on the top of this forum. We love to help here, so keep asking questions.

I second Tracey's caution on lowering the carbs in the food you are feeding. Savory selects is supposed to be 10% carbs, which we consider a medium carb food. Going to a true low carb food, less than 10% carbs can lower the insulin requirements. Today probably was a bounce to wherever she went last night. Are you testing in the PM cycle too? Cats often go lower at night and we determine how to change the dose based on how low it takes the cats, so we need to catch those night time lows.

It's also really important to get the AMPS and PMPS tests before you shoot. You want to make sure it's safe to give insulin.

Bounces usually last up to 6 cycles. Today's curve data from the bounce is not valid for deciding on changing a dose.

 

[Julie and Eleanor (GA)]

Thanks for your suggestions!

Oh no. At +10 she is 642. She has been on 1.5u (measured from bottom of syringe stopper not top) twice a day for 5 days, so I guess it's not a bounce. But these numbers are so much worse than when she wasn't on insulin, when we started a month ago. The vet is telling me what to dose. She was on vacation for a week and her assistant gave some advice, not sure how well they communicated. These high numbers all started with the 1.5u. I did buy a new bottle of Lantus when I made that switch. I also increased the ratio of Fancy Feast classic chicken to DM Savory Selects for her morning meal, as the FF is supposed to be lower in carbohydrates. So I changed 3 things at once, 4 to 5 days ago.

Hello and welcome. A bounce can happen any time the blood glucose drops lower or fast. So it could be a
bounce after 5 days. It is really important to test before each insulin shot and during the cycle as well to see
how low the insulin is taking the blood sugar.
I'm not sure I understand what you mean, you are measuring the insulin from the bottom of the syringe stopper, not the top. Why aren't you measuring from the top? Or tip I guess it would be? I'm sorry, I'm probably misunderstanding!

 

[MJW]

Added question - have you ever tested for keytones?

Added question - have you ever tested for keytones?

No ketones in her urine this evening.

Hello and welcome. A bounce can happen any time the blood glucose drops lower or fast. So it could be a
bounce after 5 days. It is really important to test before each insulin shot and during the cycle as well to see
how low the insulin is taking the blood sugar.
I'm not sure I understand what you mean, you are measuring the insulin from the bottom of the syringe stopper, not the top. Why aren't you measuring from the top? Or tip I guess it would be? I'm sorry, I'm probably misunderstanding!

I added more measurements to the title. She is higher at PMPS+3 (536) than AMPS+3.5 (480).
If she's not bouncing, then what could be going on? Infection? Disease progression?
Her urine is ketone free.
She is maintaining her weight.

I am a bit obsessive about measuring the insulin. The stopper in the syringe is almost a half unit thick. When the syringe is completely empty, the bottom of the stopper is just above the 0u line. So when I started using the half unit syringes, I lined up the bottom of the stopper with the desired dose instead of the top of the stopper. Right now I just need to be consistent when I increment. I am suspicious the syringes aren't accurate for such small doses, but I am out of my area of expertise and probably wrong.

Thank you everyone for your advice. I will try to figure out the google spread sheet tomorrow. I made an excel spreadsheet for my vet.

 

[Wendy&Neko]

If you are obsessive about measuring insulin, and welcome to the club, you might be interested in this post on Dosing with Calipers. I used the BD syringes which could often have a lot of space between the bottom of the zero line and the end of the syringe, as much as 0.5 units!

 

[MJW]

I posted her spreadsheet. We went to the vet yesterday to try to figure out why I was getting all those black numbers in my first try at a curve. Her WBC was slightly elevated, but it is usually slightly elevated.
We did blood work, a urinalysis, and an ultrasound. There was no smoking gun. She will take a dewormer for 3 days, then I might start her on desiquin.
We increased her dose to 2u BID. I have to say---because I measure from the bottom of the stopper which is .5u wide---others might interpret the dose as 1.5u.
***IS THERE ANYTHING I COULD HAVE DONE WRONG TO PRODUCE THE BLACK NUMBERS ON HER CURVE WITH MY MONITOR?***
I had to squeeze her ear pretty hard to get enough blood. Sometimes I would fail, pull out another strip, and squeeze some more.
As long as it beeps it's okay, right?
I think our long vet visit yesterday pushed her over the top. She is suspicious of me today. There will be no testing, but I am watching her closely.
I hope I can get the dewormer down her.

 

[Wendy&Neko]

We increased her dose to 2u BID. I have to say---because I measure from the bottom of the stopper which is .5u wide---others might interpret the dose as 1.5u.
***IS THERE ANYTHING I COULD HAVE DONE WRONG TO PRODUCE THE BLACK NUMBERS ON HER CURVE WITH MY MONITOR?***

It's possible that she is now on too high a dose and her body is resisting it. Too much insulin can look like too little insulin and her numbers seem to be looking worse the higher in dose you have gone. Especially since you lowered the carbs of the food she is eating, I would be extra vigilent with testing, not less. It would help if you put a note in the Remarks section as to when you changed the food.