8/13 Garth; AMPS 379, +6 301, PMPS 331, +4 379

[StefO]

Wondering if I should increase to 4U, i don't have half unit syringes at the moment

poor guy is definitely constipated

also now quarantined to the kitchen

 

[Dyana]

I would not go up by 1 unit, especially since he was getting some decent numbers just a few days ago on a unit less. I would not have raised his dose from 2 units to 3 units, since the dose adjustments should be based on how low the insulin is taking him and that would be the 111 you saw on 08/08.

I would try to find some syringes with the 1/2 unit marks. Do you have a Walmart near you? If not, you can order some online.

If he has no history of ketones or DKA, I think I would let the 3 unit dose ride for a couple more cycles. Find the syringes with 1/2 unit markings, and if you need to increase then do so by 0.25.

If he is constipated that may be raising his BGs. Does the Miralax seem to be working?

 

[julie & punkin (ga)]

Dyana asked for more input on Garth's situation. I actually think he looked a lot better on 2u than he does on 3u. He got down to the low blue numbers on 2u not even a week ago - that says that 2u is in the neighborhood for a good dose.

It's very counter-intuitive, but too large of a dose can create high numbers. The cat's body is fighting what could be an overdose, so it will keep the blood sugar high if the dose is too large.

At this point, I would drop back to 2u and not increase his dose until you have syringes. Are you using the pen needles right now? Cats will respond to tiny adjustments in dose when you're at a pretty good dose, which the 2u was. With a low blue number, if you are following the guidelines for the Tight Regulation protocol, you would hold that dose for 8-10 cycles to see if Garth will "settle in" to it. After 8-10 cycles, if you had some nadir checks to show you with confidence how low the dose was taking him and you wanted it lower, you would only increase by 0.25u.

INCREASING THE DOSE:

• Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
  • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
  • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

• After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
• After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

With Start Low Go Slow guidelines, you would continue to hold the dose at 2u with low blue nadirs.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours:
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit

• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose

• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

The only time we would suggest someone increase the dose by 1.0u is if they have a high dose cat, ie, more than 6u per shot, and that dose has been arrived at methodically and appropriately. You can't rush a diabetic cat towards regulation. When you keep their body in normal numbers, sometimes the cat's pancreas will heal and begin putting out some insulin again. That healing takes time.

Hope some of that helps you!

 

[julie & punkin (ga)]

One more thought - do you understand thoroughly about bouncing? I haven't been on the board in months - my family life is occupying me at the moment - so don't know if others have taught you about it. One single low number can cause a cat's blood sugar to go high for as many as 3 days afterwards. Getting a test right before you go to bed can often be the most revealing test of the day because so many cats have their low numbers at night. There is a thing called Dawn Phenomenon which raises blood sugar in the morning, so pm cycle tests are really important.

Here are a couple of threads that you might find helpful:

Where Can I Find?
(Dawn Phenomenon is in the second half of the first post, under "starting out with a diabetic cat."
Simple, user-friendly explanations on New Dose Wonkiness and Bouncing - 2 times when you might see high numbers that don't mean the cat needs more insulin.

 

[StefO]

I would not go up by 1 unit, especially since he was getting some decent numbers just a few days ago on a unit less. I would not have raised his dose from 2 units to 3 units, since the dose adjustments should be based on how low the insulin is taking him and that would be the 111 you saw on 08/08.

I would try to find some syringes with the 1/2 unit marks. Do you have a Walmart near you? If not, you can order some online.

If he has no history of ketones or DKA, I think I would let the 3 unit dose ride for a couple more cycles. Find the syringes with 1/2 unit markings, and if you need to increase then do so by 0.25.

If he is constipated that may be raising his BGs. Does the Miralax seem to be working?

Thanks Dyana. I was able to find syringes on adwdiabetes.com. They did not need a prescription and 60 syringes cost about $16.

We kept him on 3u for a few days but reduced back to 2U, in hopes of getting back in the blues. It's been about 6 cycles in the reds.

The Miralax seems to be helping, giving him 1/8 tsp for breakfast, I have been seeing overnight BMs and he's even covering his litter!

Thanks.

 

[StefO]

One more thought - do you understand thoroughly about bouncing? I haven't been on the board in months - my family life is occupying me at the moment - so don't know if others have taught you about it. One single low number can cause a cat's blood sugar to go high for as many as 3 days afterwards. Getting a test right before you go to bed can often be the most revealing test of the day because so many cats have their low numbers at night. There is a thing called Dawn Phenomenon which raises blood sugar in the morning, so pm cycle tests are really important.

Here are a couple of threads that you might find helpful:

Where Can I Find?
(Dawn Phenomenon is in the second half of the first post, under "starting out with a diabetic cat."
Simple, user-friendly explanations on New Dose Wonkiness and Bouncing - 2 times when you might see high numbers that don't mean the cat needs more insulin.

Thanks for links. Just got the new syringes today. We are not using pen needles. I, too, have not had much time to spend on the board but my husband and I definitely need to learn more about bouncing.

Shortly after Garth's first curve at the vet, (6/12/17) his doctor increased his dose from 1U to 3U. It was not until members of the message board informed that that was too much of a dose increase. We also were not home testing for the first month that he was on 3U, but now we always test before both shots and nadir/before bed when we can. Looking back, no wonder his numbers remained so high a month ago.

Thanks again for the info!