3/8 Kiwi Need advice

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Kiwi F

Member Since 2012
As some of you know, I tried to bring Kiwi's dose up to his prescribed amount (1u) two days ago, but he went too low, and we had to return to his .5u dose. We were sticking with that. Yesterday his AMPS was 439 and his PMPS was 345. The big surprise was this morning when his AMPS was 190. I retested to be sure, and got 167. I know you'd like me to post here before feeding, but my boyfriend fed him, without realizing. So we didn't shoot. Can anyone tell me what might be going on with the numbers? I wish I would have gotten a test during the night, but I didn't. Obviously I don't want to keep skipping shots. Could that 1u dose the other day still be affecting him? Anyone have any ideas?

Kim and Kiwi
 
I really hate to point this out but most of us are hamstrung when it comes to interpreting your data when half of the data are missing. Please start getting tests at night. Even one test -- a "before bed" test -- will help.

If I had to guess, between the blue numbers (which could have triggered a bounce - but we don't know since there are no PM tests) and the skipped PM shot, numbers yesterday throughout the PM cycle were likely rising. The AM shot did it's job and numbers were coming down. The PM shot obviously brought numbers down but we don't know how much.

We strongly encourage people to always get a pre-shot test and at minimum, to always get one test per cycle. Otherwise, you're relying on a crystal ball to help you make dose decisions.

If you are going to be around to monitor, it would be safe to shoot this morning. You and your boyfriend may also want to get into a routine so the Kiwi isn't fed until you get a test.
 
Hi Kim,
Here's the link to your previous condo (on 3/6):
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=65574&p=711724&hilit=Kiwi#p711724
We link each condo to the previous one so that people can follow the discussion. Right-click on your subject heading of the previous day's condo, choose "copy link" from the drop-down box, then, in the first post of the new condo click on the URL box, go up to the "edit" button of your browser, and click on "paste".

Sienne encourages you to try to get a bedtime test every night so that there is some data for the evening/nighttime cycle. I wholeheartedly agree. Can your boyfriend do the blood tests? If so, maybe he can be in charge of getting that important test.
As for this morning, I assume that you went ahead and shot the 0.5 unit dose. Don't forget that since you shot late, your next shot will be 12 hours after you shot this morning.
I hope that you and Kiwi with the help of your boyfriend can get into a routine for tests and shots. Once you have that, things will start to fall into place.

You are doing fine,

Ella & Rusty
 
We did get a test before he ate. The miscommunication happened after that, and he got fed with the other cats at the regular time.
 
One thing I wanted to ask was your feeding schedule. If you are feeding two meals a day, you might feel better and Kiwi might be more buffered from a drop if you divided into more smaller meals. I really don't know the ideal because it depends on the cat. Maybe others can make a suggestion. Simon gets 1/3 of his allotment at shot time and +3 and +5. at night I have an auto feeder set for +5 or 6 to make me feel like he will have food if he goes low. Keep in mind that people giving advice want to make sure Kiwi is safe. I will look up an auto feeder link for you.
Did you shoot? Breathe:)
Will there be a day this weekend when Justin might be around to get a few mid cycle tests aka a curve? That might help a lot.
I know you're trying really hard to get tests and doing your best. Every bean is different (the bean is you:)
 
We're feeding more food at shot times, and a smaller amount halfway in between (at +6). Any recommended adjustments to that? Thanks everyone.
 
~O) ~O) ~O)
Hi there,

that AMPS was very pretty. :-D

I know it's tough getting tests. If, for the PM cycles, you can try and get a "before bed " check and a spot check around PM+10 or PM +11, it would go a long way toward bringing Kiwis BG picture into focus.

As an example, if you had a +10 or +11, you would have had a better idea if at AMPS Kiwi was going up or down. That may have alleviated anxiety about shooting.

regarding feeding and meals, I could not have survived without our timed feeder. I have one made by Petsafe, it has 5 compartments and a timer you program.
BK eats 2 3oz cans of FF per 24 hours as follows:

AM - 1/2 can - fed by us, not the feeder
+4 - 1/4 can - fed by timed feeder
+8 - 1/4 can - fed by timed feeder
+10 - 1 chunk freeze dried chicken treat - fed by timed feeder
we repeat this for the PM cycle.

Hang in there - it will get better - you will establish your routine and be in the groove before you know it :-D
 
Hi guys .. we also use the petsafe 5 compartment feeder for mocha .. more so when we go out now, but it came in so handy at night! Mocha gets fed at 8 a.m., 12, 4 and then 8 p.m. and 10 p.m. Because she is now controlled off the juice, she gets no night time feedings .. this means she can have free roam of the house with her civvie sister twix .. Also, we set up alarms to go off when we needed middle of the night testing .. actually, we had three alarms set cause somehow the ones right next to our heads magically turned themselves off half the time .. but that one across the room was a real buggar :-D hang in there, things will get easier!
 
Thanks for the advice about test times and feeding. Has anyone used an automatic feeder with multiple cats? We have three cats, and they all like the Wellness. The other two cat get pushy and hog the food, which is why my bf watches them eat (and directs them back to their own bowls). Have any of you dealt with this? I sure hope there is a good solution. Before you ask, they can all jump onto counters, none are small enough to get somewhere the others can't... or any of the usual vet advice.

Thanks again everyone.

Also, is it possible the .5u is too high? (it just took awhile to work)? And how high are the risks of ketones when we don't shoot? Also, are there any good articles to have bf read about the importance of testing? He loves Kiwi, but doesn't want to hurt him, and therefore isn't supportive of the extra tests (he'll do AMPS and PMPS)? Kiwi does fight us and cry through it, making it harder to convince him.
 
kim and simon said:
P.S. way to go on getting your SS in your signature!

Kim told me they did not shoot.

I got so much help with the spreadsheet, that I can hardly take credit. :smile: Thanks you guys.
 
Have you been giving Kiwi treats after his tests? that might help. Something high protein/no carb like freeze dried chicken. I am using these, but there are lots of brands. I just started using treats because with the dental, Simon has gotten a little oppositional ;-) I have to say I don't speak from great experience because Simon hasn't been very difficult to test, but the treats have already made an impression! He knows to expect one and likes it. I think he also feels like it's a special bonding time because he gets my attention. I really think as you practice testing, it doesn't really hurt the cat anymore. I use the lancet pen on the very shallowest setting. I tried it on my fingertip and I can barely feel it. I try to position my thumbnail so that the nail is right under the ear. I try to get as close to the edge of the ear as I can, poke, and if I miss it won't poke my skin (because it hits my nail instead!) I hold Simon on my lap while sitting cross-legged on the floor (obviously won't work for everyone, but might work for DBF!)

The more DBF practices, the better he will get. And he won't be hurting the kitty anymore either. Simon doesn't really have much bruising--maybe a little, but not very often. I still think it's better for them than having uncontrolled diabetes! Kiwi may or may not get off insulin, but to maximize his chances, more tests will enable you to proceed more aggressively and confidently with the insulin dosing.

Try this journal article for DBF (and also for the vet). It mentions home testing in the title!

(glargine is Lantus).
 

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Kiwi F said:
Thanks for the advice about test times and feeding. Has anyone used an automatic feeder with multiple cats? We have three cats, and they all like the Wellness. The other two cat get pushy and hog the food, which is why my bf watches them eat (and directs them back to their own bowls). Have any of you dealt with this? I sure hope there is a good solution. Before you ask, they can all jump onto counters, none are small enough to get somewhere the others can't... or any of the usual vet advice.

Thanks again everyone.

Also, is it possible the .5u is too high? (it just took awhile to work)? And how high are the risks of ketones when we don't shoot? Also, are there any good articles to have bf read about the importance of testing? He loves Kiwi, but doesn't want to hurt him, and therefore isn't supportive of the extra tests (he'll do AMPS and PMPS)? Kiwi does fight us and cry through it, making it harder to convince him.

Hi Kim,
I have the same issue with my kitties. I have a piggie civie who will eat everything in sight, and Mr T will allow her to push him out of his bowl. Someone has to be the food police for every meal, even with the feeder. It's a difficult problem to solve unless you can isolate the non-assertive kitty from the others during meal time.

It's possible that the 0.5u is too high, but unless you can find a way to shoot consistently, it's going to be really hard to see how it's working. When you skip shots, the shed drains, and you have to refill the shed on the next shot. I know you are doing the best you can, not criticizing, just explaining! I would continue to test for ketones regularly whether you skip shots or not...it's impossible to quantify the risk of ketones, some cats are prone to them, others are not. Ketone tests are an inexpensive way to monitor and catch ketones before they become a big problem (hopefully!)...it's truly a case of an ounce of prevention being worth a pound of cure. I'll have to look for some articles about hometesting...I'm sure they are out there, but I don't have ready access to anything like that at moment.

You're doing fine...it will get easier, really!
 
I don't think .5 is too much, however we don't have the data to really say.
If the numbers feel scary to you right now, you can drop down to .25u. I'd rather see Kiwi get a dose you feel comfortable shooting consistently every 12 hours, rather than one that results in you skipping shots. If you can string together 6 or 8 cycles, without skipping, a picture of what Kiwi needs in terms of insulin will emerge.

Ketones are always a risk. Testing for their presence is important.

kim and simon said:
Have you been giving Kiwi treats after his tests? that might help.
I can attest to the power of treats! BK was an intact male off the streets and it was 2 months before we were able to get him neutered. Testing in those early days of FD was a 2 person job and difficult at best.
The freeze dried chicken treats made all the difference. They are often referred to around LL as "kitty crack" :lol: They are powerful.
I highly recommend you try some. I'll bet in a short time you could train Kiwi to jump in your lap and "assume the position" at test time just by shaking the bag of treats.

Nowadays while BK is waiting for a test, he drools in anticipation of a chunk of kitty crack :-D
 
I don't like testing either. That blood thing kind of makes me queasy. What I finally decided though was that a little poke on the ear is nothing compared to the damage that blood sugar does to internal organs. So if it takes a bunch of pokes to get Zener's blood sugar down and to keep it in a safe range, then that's what I'll do. Feline diabetes is a crazy disease and it seems like a bunch of testing is the best way to manage it. You and DBF are doing great!
Liz, Zener's other mom
 
i just want to respond to the part of your post asking for information about the importance of testing. perhaps your boyfriend could read some of the advice on here. i can sympathize - i think everyone comes here and says "i feel like i'm hurting his/her ears and i hate it." i know i said it and i suspect we all did at the beginning. who wants to poke the cat? who wants their cat to hide from them? it sucks. i had to pull punkin out from under the furniture, hoping i didn't dislocate his little arms.

but . . . the flip side is that you have to be convinced, yourselves, that kiwi needs these tests in order to be safe. insulin is a very powerful hormone and it can be very dangerous if not used properly. i'm a mom - and i have done "things" to my children that they had to have for the same reason. I have sat on them. i have cajoled and wheedled, but when it came down to it, i made sure that they got what they needed no matter how much they didn't want it. that's what parents do.

my youngest daughter is shot phobic - and i have had to pry her fingers off of the car door and drag her in, literally kicking and screaming, for vaccinations. if i didn't and she got measles and developed encephalitis from it and died - it would be me that knew better and didn't make her do it. that's a dramatic example in order to make a point, but it's truly not far off. the only way you know what the insulin dose is doing in your child's body (kiwi) is by testing the blood sugar. unfortunately, your bf can take a peek at the Grief section of the forum and find cats whose owners came home and found them dead from hypoglycemia.

i'm not trying to scare you, but this is the truth, and if you don't know, how can you do the right thing for kiwi?

when we started this "sugar dance" i thought it was going to be like the blood pressure meds i take every day. the doc tells me how much to take, i take it, we check my bp every 6 months or so and readjust the dose if necessary. in the meantime, my bp has gone down and it stays there.

insulin is a hormone, not a drug per se. it's more equivalent to estrogen. think about how you were at age 12 or 14. my daughters were sunny happy one moment, tears and slamming doors the next. it's a crazy up and down. after taking care of my cat, i've had the light bulb moment :idea: that this is why people have complications from diabetes! this is why they might have an amputation or some other serious problems. it's extremely difficult to get regulated. between humans, dogs and cats, cats are the very hardest to get regulated. the strange thing (i think) is that you can be giving the same dose over and over and suddenly, the dose that was just right 2 weeks ago (or 3 days) is now too much! that's the hormone part of the equation. the same dose can bring about different results. that's why we test.

some of our Lantus Land cats are "well-behaved" blood sugar wise. they follow such a nice gentle curve and are relatively easy to get regulated. some of our cats are "divers." no nice gentle curve for them, they get their shot and 3 hours later they've dropped 300 points. their liver responds by letting loose hormones and then the cat's BG zooms nice and high. until we've got a better picture of Kiwi, we just don't know what she's doing or which "type" of cat she is.

and on the really great side, cats ears seem remarkably tough. when they get into a fight their ears always get torn up. i have to think it doesn't hurt that much, either, because as much as punkin didn't like it at first (i had to wrap him in a beach towel to test him), now, he comes when i call him and he hops up on the sofa to be tested. the part i think he hates is the feel of the blood bead on his ear. he takes the poke just fine, but if the blood drop gets big, he's flicking his ear and trying to get away from me to get it off. that's not so bad. if it really hurt too much, he'd never come when i called. sometimes he even hangs out at the testing spot and cries to be tested because he wants the food that comes after the test.

anyway, i'm not trying to lecture - and seriously hope it doesn't sound like i am. i'm just trying to put some perspective into it that hopefully will help with the cause.

it's hard to get started on this - we all understand!! truly! the first couple of weeks are the very worst and if you can hang in there until you understand a little more, it gets infinitely easier! we're just trying to give you the diabetes crash course on how to manage all of it and keep kiwi safe.

hugs, julie
 
Hi Kim

You've gotten a lot of info today. Have you been putting Neosporin Pain Relief ointment ( not cream) on his ears after each poke? It helps. Sending hugs!
 
Much gratitude to everyone who responded.

I think our household is coming around to the idea of testing more. Its unfortunate that our vet's office so firmly discouraged home testing.... that has made it harder to get everyone on board. But, as you will see on our spreadsheet, I got a test at PM +3 and +6. I hope that helps you, help us. I will also try to get a test at +11, in case the AMPS is low.

I'm still confused about the bg drops. I keep hearing how slow Lantus works, but then we have such big drops, like going from an AMPS of 439 to a PMPS of 129, with only a .5u shot. If he can drop 310 after one shot, I'm scared of injecting him if he's under 200 (which I realize is still high). I do realize there are other factors, but won't those still be factors when he's 129? If I gave him the same amount of insulin when he is 129 (or even 167), what would likely happen? How likely would he become hypo? Do they drop less at lower numbers? I might not be 'getting it' yet, but even though a few days ago, .5u didn't seem to be doing enough, now it seems like its dropping too much. Is it likely that his shed is now full, and the dose is now too high? I am hesitant to change his dose again (I made that mistake already), but I don't want to drop him too much. I got some PM tests last night. I realize one day isn't a lot to go on, but could you guys look at it and tell me what you think so far? I'll commit to testing more, and if there are more beneficial times to test, please let me know.

As for his morning shot... if I test at +11, and he's lowish, should I try feeding him a little, or just wait for the AMPS, to see if he's headed up or down? Will anyone be around between 7-8am, in case we have trouble?

I can't thank you all enough,
Kim and Kiwi
 
Yay for the household coming on board with the testing it really is the only way :smile:

You are correct in your thoughts that kitties don't drop as far when their numbers are lower. Don't worry about not getting it all yet it seems to me that you're learning really quickly. Keep asking questions the way you are and it will all come together for you.

You definitely do not want to feed at +11 this would mean that your pre shot (PS) test would be higher because of the food. You want to make sure you get a clean test at PS that has nothing to do with food - hence no feeding after +10 until shot time.

Post your +11 (how far away is that?) and we will see where Kiwi is going. I don't know what time you have now but I will be online for a few more hours yet, will that cover your 7-8am?

Do you have the information on how to handle low numbers printed out for when you need it? Most people stick it on the fridge or somewhere else you can access easily when you need it.
 
Our +11 is very soon.

I do need to print the hypo page. I don't have access to a printer at the moment. I'll bookmark the page.

Speaking of hypos... people keep saying they rarely happen? Rarely at all? Or rarely needing emergency vet care? The part about some cats not having any symptoms freaks me out (in no small way)... almost enough to question my desire to try to tightly control. I'm also worried because Kiwi likes to go to sleep after he eats. Since he eats when he gets his shot, he sleeps for at least an hour (sometimes much longer) after his shot. His first couple days on insulin, I woke him up repeatedly (and watched him breathe while he slept). When it comes down to it, he's old and he sleeps a lot. I'm so scared I won't know anything is wrong. Even if he's awake, I worry I wouldn't notice some of the small things. Not to mention, his bg seems lower at night. How do you all sleep? *deep breaths* How often do most people on this forum get to the point of using Karo? Also, do cat hypo symptoms compare to humans (the bg numbers)? I used to get hypoglycemic, and when I was even down to 70, I felt terrible. I panicked, shook, and could have downed a 60 oz. cherry slushy in seconds. I hope thats not how they feel in the lower, but not quite hypo, numbers.

One more question. Is it more important to stay consistent with the insulin dose, even if it means knowing you'll go very low, and then dealing with that? Is that better than skipping a shot? I've skipped a couple shots recently, and I know thats making it hard to interpret my data. Also, can someone link the chart that says when is too low to shoot (and the hypo page), so I can find it fast, since I can't print right now? That would be helpful.

I'm going to go do the +11.
 
Well we're at 259, at PM +11. Technically, it'll be the lowest we've shot at (by a little). Unless there is a big change within the hour, we'll give his normal .5u shot. I did feed him at PM +6, as usual (that meal is usually his smallest, but last night I gave him a little more). Is it good that his bgs look pretty steady through the night? I do think I need to work on his feeding schedule... more on that later.
 
Good morning! Simon always goes for the bigger drops when his pre shot is higher. I honestly don't notice a big difference in the ultimate nadir when I shoot low. I still check him with more interest, though :razz:

Simon went to 28 one time and had no symptoms. Now, we don't WANT cats to go that low, but it is interesting! That one came out of the blue.

Maybe others can speak to the relative incidence of clinical hypo--i.e. with symptoms, on various insulins. (I assume Simon's 28 is a hypoglycemic NUMBER although he acted fine.) I have found my vet is way more worried about Simon's lower numbers than the Lantus Land people :lol:

.5u is a pretty low and conservative starting dose, and you are home testing. This is going to start to give you more confidence to shoot a lower number.

Maybe if you go into the FIRST post of your thread and just change the date to 3/8-3/9, people can continue on this thread and they won't skip over it due to yesterday's date. OR copy the link to this thread, start a new thread with 3/9, link your old thread (here's what you do--click the little URL button right above the text window and then paste your link in between the two tags. It won't work right without that URL code around it.)
If you start a new one, just mention what we were already talking about. I think either way is just fine at this point!
 
Here is the link for handling and shooting low numbers http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=147 and the link for how to treat hypos http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887

Depends on your definition of hypo how often they happen. As far as hypos requiring medical attention they are extremely rare here because of the home testing being done. Low numbers are caught and treated with syrup and/or high carb food. The only time I've seen it happen here the kitty involved had multiple problems going on. I would think the chance of Kiwi going hypo within an hour of his shot at the numbers you have been shooting would be non-existant so let him sleep. I understand your worry and it's not something you want to get complacent about but don't let the worry obsess you :smile:
As you go on and get more numbers in Kiwi's ss you will be able to relax more because you will see how he reacts to the insulin and begin to get an understanding of it - then you know when you can sleep easy and when you shouldn't.

At 70 a cat would not be feeling bad the way you do, many non-diabetic cats test in the 50s. When they get lower they do tend to eat and bring themselves back up though - same as a human would. When Vyktor has been below 50 he has headed straight for the food bowl for a feed. What is Kiwi's feeding schedule, can he be free fed or is he a bit piggy?

It is very important to be consistent with the dose and time of Lantus - however you don't want to be shooting numbers that are too low until you have the data you need to know how lantus works in Kiwi. Also it doesn't necessarily follow that shooting a low number will result in very low numbers in the cycle following. When you have some time check out some other kitties spreadsheets to see the sorts of things that can happen.

You do have syrup and HC canned food there in case you need to use it don't you? Also plenty of strips, you never want to run out at the wrong time.
 
Please go back to your original post and edit it and put your test numbers in the subject line there as you get them then people can easily see that there has been an update and what has happened - and you thought you just had to learn about lantus :lol:
 
I'm just stopping in again to say "hi"! You're doing great - asking lots of fabulous questions, and getting lots of fabulous answers! I hope you're starting to feel more comfy about everything. I'm glad to hear everyone is getting on board with the testing, too! Many of your questions reaffirm why testing is so important...it is the one thing that keeps Kiwi safe, and will prevent a hypo. For the life of me, I will never understand why vets discourage it....

Have a great day - keep asking those questions!

Amy
 
Vyktors Mum said:
Please go back to your original post and edit it and put your test numbers in the subject line there as you get them then people can easily see that there has been an update and what has happened - and you thought you just had to learn about lantus :lol:

Thanks for explaining. And, yes, there is always something to learn! :-D
 
Amy&TrixieCat said:
Many of your questions reaffirm why testing is so important...it is the one thing that keeps Kiwi safe, and will prevent a hypo. For the life of me, I will never understand why vets discourage it....
The cynical side of me says that vets don't make money on home testing and it's also an ego/control thing. Quite frankly, even the most knowledgeable and caring vet in the world could never give you the advice, information and support available 24/7 here. Kim, you are doing a great job for Kiwi.
Liz
 
Marjorie and Gracie said:
Hi Kim

You've gotten a lot of info today. Have you been putting Neosporin Pain Relief ointment ( not cream) on his ears after each poke? It helps. Sending hugs!


Is that safe if other cats might try to lick it off?
 
hi kim! good morning!

i've caught anya licking punkin's ear where i've put the neosporin sometimes. it doesn't seem to hurt her.

we differentiate between low numbers without symptoms and hypoglycemia. it's not that there's no possibility on lantus of having a true emergency, but that's true of any insulin. lantus and levemir are slower acting than the older insulins. those drop the blood sugar in the immediate 4 hours or so, so they were considered "harsher." so this is one of those "everything is relative" situations - lantus/levemir are better than the other options.

i think you'll find it interesting that as you gather test information, the picture becomes clearer and clearer on how kiwi does on the lantus. then you gain a certain amount of predictability, so it's uncommon for something to just pop up in a crisis out of the blue. that's kinda vague, but i guess what i'm saying is that you will learn a lot over the next couple of weeks about feline diabetes, we'll be able to learn a lot about kiwi from your tests, and we'll point it out to you. then things will become more routine.

punkin's been in the 30's a couple of times without any incident. didn't seem to bother him and he loved getting the gravy out of the high carb cat food!

your question about the high numbers and dropping - i thought exactly the same thing. if he can drop from 350 to 150 on .5u, then if i shoot the same amount at 150 i'm going to have one dead kitty. but it doesn't work that way. it's like there are 2 completely different "games" - one with high numbers and a whole different thing with low numbers. people shoot at 70 and the cat only moves 10 points in the whole day. it's fascinating. when cats get to that point, they are on the way to going off of insulin. it's an awesome thing to see. newly diagnosed kitties have the best chance at that, which is why we are encouraging people right off the bat. you don't get much time to get used to the whole thing before you're plunging right in to the deep water.
 
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