Asher Fri Jan 14

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donnahc

donnahc

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Morning kids:
I hate to keep asking advice day after day but here I am again. You guys are just too good.
And I am scared to listen to my vet on this dosage thing now.

We had an AMPS today of 394. Seems like things are creeping up/high on 1.5 units of PZI.
Anyone out there think we should be trying 2 units today or is that moving him around too soon?
His SS is current.
Thanks in advance!!!!
-Donna and Asher
 
Don't feel bad! I posted for help daily for about the first 3 months. It'll get easier. Generally, when you're checking for chronic rebound it is recommended that you give it 72 hours on the lowered dose before raising it. This allows the hormones that were keeping the body safe from going into hypo to clear out of the system. According to that recommendation you should hold the dose of 1.5 for this am shot, but then would be able to increase it a bit tonight. Maybe to 1.75u? That would just be my recommendation, though.
 
Thanks tons guys. That's what we did, the 1.5. I'll test mid cycle at some point then make a new decision for tonight.
Have a great day!
Donna and Asher
 
I think Claudia's advice is spot on. I'd possibly continue the 1.5 for 4 days (8 cycles) instead of 72 hours (6 cycles), depending on the #s.

You'll never be asking for too much advice!
 
If you continue the lower dose even tho his numbers are high (3-400 range) is that putting him at risk for any organ damage or the other nasty things diabetes does?

-donna
 
Well once you know you're not getting results from this dose you should absolutely go up. At that point you can start increasing the dose every couple of days. Are you testing for ketones periodically? That is the most immediate concern from the higher numbers. I always prefer to raise the dose at an am shot so I can watch him more instead of increasing at night.
 
Hi Donna,

I would test for ketones during this experiment on the lower dose. It is a good idea anyway: ketones You can buy ketostix at the drug store. They are just like human diabetics use. You test his urine. Just a tip: Oliver would not let anyone watch him pee. So we used aquarium gravel in a litter box and left him with it in a room until we had results. :mrgreen:

Agree with one more day and some tests. Then I would increase the dose.

What would we do with ourselves if no one asked questions? :lol:
 
I have no idea what ketones are and I asked the vet and she told me not to worry about it. But considering she insisted we do 3 units from the start
even thru that whole "almost hypo" day, I lost my trust there.
So if you can explain what i need to know about ketones, that would be great.

Yeah, I can see raising the dose at night could pose a risk since you aren’t watching him closely. But I only talked about going from 1.5 to 2 units.
Don’t know if that is considered significant or not.

He is more hungry today if that means anything too.

It’s all so confusing so I don’t know what to do. Wringing my hands already.

I will test maybe +3 or +5 today (I have to do it when Tom is home) and I’ll report in.

Thanks much,

donna
 
Read the site I gave you in blue type. It will explain ketones.

Actually going from 1.5 to 2 is a pretty good jump. You might consider increasing by .25, from 1.5 to 1.75 if you have 100U syringes. Agreed that it is much better to change the dose in the am.
 
The ketones show sugar in the urine.

Definitely test at +3 or +5 if you can. I think a jump from 1.5 to 2 is significant. I currently raise and lower dosing by .1 units.
 
Kristen...a correction, please don't take it personally

Ketones are not sugar in the urine. Ketones are a biproduct of fat burning; if you are familiar with the atkins diet that used to be all the rage, people at high amounts of protein and used ketostix to check for ketones in their urine.

The problem is, cats do not tolerate ketones well. Ketones are produced when the cat can't metabolize its food and starts burning its body fat. Ketones are produced and if they build up in the blood can lead to diabetic ketoacidosis which is a life threatening condition.

A newly diagnosed cat is at huge risk for developing ketones as it is not yet regulated; insufficient insulin, insufficient food and/or infection can bring about ketones. Doing a rebound check is important, but it is also important to check for ketones at that time just incase.
 
Now I am really stressed out. I can run and see if I can get some strips today, but I am starting to worry I am not going to be able to do all of these tasks properly and do work, which I need to do to pay for all of this medical stuff. I know, breathe.

Also, when we bump his insulin up, people are saying to go up less than half a unit. I can eyeball a half unit. We have U40 syringes, do I have to get some other kind (I think I saw somewhere here people use U100?) so I can see these fractions lines for the dosage?

I was glad to think we could raise his dose tonight and maybe see a better number tomorrow, but now I am scared to do that..... and confused again.

I’m gonna go have a good cry and I’ll be back with mid day numbers as soon as I can get some.

Thanks guys,

-donna

Sorry, i do see now you mentioned the U100 syringes, sorry, stress makes me read poorly.....
 
The u100 syringes are the ones that make it easier to do the smaller doses, you just have to use the conversion chart so you know what amount equals what. I printed it out and put it on my fridge. I know it's stressful, but it will mellow out as you get more comfortable with everything and continue to learn.
 
Hi Donna

The beginning days/weeks of treatment ARE stressful, and it is very easy to become overwhelmed with options and advice and concern over our pet.

All I can tell you is that you are doing a great job! And to take a break if it is getting overwhelming. I often recommend chocolate and your beverage of choice.... :)

As to the dosing. This is not an exact science, it cannot be because we cannot manage all variables. All we and you can do is make an educated decision based on a. what's been observed and b. past experience . It may well be that Asher needs more insulin and is underdosed and therefore at risk for ketones, BUT waiting to see what happens today will be valuable. Then if things really don't improve, going up by 0.5 units a dose will be a step in the right direction.

Things WILL settle down, I promise.

Meanwhile, remember you are doing a great job.

Jen
 
Breathe, Donna, breathe.

We are suggested testing for ketones because it is one more way for you to get information on how he is doing, and to keep him safe. The good news is ketostix are very inexpensive.

It is really hard with newbies to balance between too much info and not enough. We would like to take you along one step at a time, but we also want you to be informed. I am so sorry if we are causing you stress.

You are doing FINE! You know more than 90% of diabetic cat owners ever thought about learning. And his numbers are not in dangerous territory. We are trying to help you find a dose that will work and gradually get him down to some great numbers.

If you get 100U syringes, come back on and ask for help. There is a conversion, but I don't want to throw that at you until you are ready for it.
 
Thanks SO much guys! I DO want all the info, I just panic sometimes when it’s hard to process or I can’t make a decision on what to do. I would do anything for Asher, I love him so much.
I will try to run out today and get the U100 syringes. If not today tomorrow.

more info to come at 11am or so....

-donna
 
Well the 11 am post of a number ain’t gonna happen. Tom’s lunch appointment got here early so I will post if I can test the cat while he is asleep or maybe +5 when Tom is back home....

-donna
 
Hi Donna,
It is very overwhelming to everyone at first, and it is great that you are posting and asking questions. I asked about dosing several times a day forever when giving Squamee insulin.

A lot of cats have elevated BG and never have ketones, but it is something to check for. The problem can be in getting fresh urine. I used to put down a litter box with just a little shredded newspaper, and keep an eye on Squamee so I could get to the urine pretty quickly after she went.

I think it is probably impossible to give reliable small increases of insulin with syringes that do not have 1/2 unit markings. Be careful to check the syringe when buying, many people here have thought they were getting the ones with 1/2 units and got home to discover they were not. They can be purchased easily from the online Hocks. There are ads on this site you can click on to get there.
Keep up the good work! Your cat is lucky you are so dedicated to learning.
 
BD brand .. at Walmart.
(83.86 KiB) Not downloaded yet.

Although Walmart's ReliOn diabetic supplies page (http://relion.com/diabetes/syringes) says, "All three needle gauges are available in three different sizes (1cc, 1/2cc, and 3/10cc)..... NOTE: All 3/10cc syringes feature half unit markings" I've not been so lucky as to get them.

Managing this can be very stressful with a whole lot of wringing of hands, running to the computer for advice, crying, sleepless nights... and it's all worth every second. We all have been where you are *right now*... and most of us as still sane.. drinking09

As others have said... you really ARE doing very well. It does get easier.

BREATHE.. BREATHE.. BREATHE.. BREATHE.. BREATHE.. BREATHE.. BREATHE.. BREATHE..
 

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Well don’t fall over but I was able to test asher by myself. He was in the window watching birds with his brother so it’s not THAT impressive but anyhow...

His +4 today is 254

If that means anything to anyone out there.

Thanks,

-d.
 
Great job testing on your own! See, it gets a little better every day. I use the Walmart Relion U-100 syringes (with the conversion chart). They are $12 for a box of 100. My dh bought them and he had no idea what size of syringe or length of needle to get, but he told the pharmacy worker that it was for a cat and she got him the correct syringes. Make sure they have the 1/2 unit markings. In Ohio we don't need an rx for syringes, but I don't know what the law is in PA. The walmart ones are way cheaper than buying the U-40s from the vet! But be careful with the conversions. I have an i-phone so I keep one of the browser pages set to conversion chart. I check it frequently. But printing up one is just as easy! Just keep it close by wherever you shoot him.
 
Yeah I think I could test him by myself anytime but in the morning. As they say here in PA Dutch County, he’s “rutchy” in the morning because all he wants to do is eat. He was always this way, when he was a kitten, and before diabetes as an adult too.

Anyhow, do you folks still think we shouldn’t go right up to 2 units tonight or tomorrow morning?

I see the point in not doing it tonight since we can’t watch him all night. Didn’t know what to do in the morning.

I always want to make things right immediately so it’s hard for me to be patient.

I don’t know if I can get out today to walmart or a drugstore. Trying to deal with some clients here (we work at home some days) so it’s iffy.

Let me know if anyone has time.

Thanks,

-d.
 
What about letting him eat and then testing him?
The problem with raising the dose in larger increments is that you might skip over a smaller number that does the job.
 
Yeah I see that point. I will post his pmps later and if I could get the new syringes or not.
Thanks,
-donna
 
Even if you can't get the u100 syringes, you can maybe eyeball 1.75 u if you decide to increase in the morning. That'd probably be better than going straight up to 2 u's.
 
It *is* impressive you did the test! It's getting better, eh? ;-)

I don't know if this will help you, but how about cutting up some boiled chicken into bit size treats, sit on the sofa and put him beside you against your leg.. pet and praise and give him a bite of chicken... and then test him.. Give another treat after.

Bud actually purrs now when I start to test her (we don't need the treats, tho) and she patiently waits for me to get the pen and meter loaded. Are you putting anything under his ear when you lance it? Using the pen or just the lancet? Bud tends to jerk so I put an a very smooth emery board under her ear and hold the ear to the board and with her wedged next to my thigh, she really can't up and leave.

I'd stick with the 1.5 for a few more cycles.
 
Thanks Claudia, that makes me feel better about it all. I have been sitting here stewing about what to do and that is a fine suggestion. So we could do 1.5 yet tonight and go to 1.75 eyeball tomorrow am.
Doing conversions right now (with u100) is just one more thing when I am numbers challenged and stressed.
Making a mistake scares me a lot right now, I really have to concentrate since my mind is all over the place.
(hopefully I am not posting this twice, it seems I lost it the first time)

Yes testing is getting a bit better but like I said earlier morning is rough.

At someone's suggestion here in the forum, we put warm water in a small pill bottle and hold that behind his ear to poke against. The warm helps us get some blood in the morning when his ears are colder. (we heat with wood so mornings are chilly here)

We r using the lancet pen that came with the meter. I have to do it without the limiter cap to line it up properly. As long as I have my glasses on and he isn't moving too much we have been getting it on first try.


-Donna
 
Yes Sue, thanks, I did find the chart, even printed one out. I think I may get to that, but I am a bit scared to do it right now, am I being a baby? Just scared to make a mistake.
-donna
 
Nothing wrong with being scared. It's because you love your cat so much and don't want to make mistakes (even tho some are inevitable). If it helps you, when you are ready to try using the conversion chart, you could post here to confirm the amount you are shooting by describing to us what line you are at on the syringe. You would be far from the first to do that!
 
You can always practice the conversion with water. Just don't shoot the cat with water since it is unlikely sterile. Make little tests for yourself. Do you have anybody you live with that can help test you [not BG test but test you ability to get the conversion right]?

Each line on a 1/2unit marked U100 syringe is worth .2u of U40 insulin. So you can just count "2s" .2-.4-.6-.8 etc.
 
Hi kids:
Wacko here calmed down a bit and was able to sneak out and get some ketone stick thingys and some U100 syringes :)

Just did the pmps and it was 232, which ain’t to bad I think. We had a laser exercise session today, wonder if that brought things down a bit.

Anyhow, I guess we are sticking with 1.5 units tonight then will re-decide tomorrow morning where we’re at.
Sound good?

-donna

Oh and yes, my partner Tom lives here and is the kitty daddy :) I had him check my dosage when we first were doing the U40 syringes, didn’t trust my eyes with the tiny lines, etc.
Practice filling them with water is a good idea too.
You guys are full of good ideas, thank you all :)
 
Personally, 1.5 u sounds high for that PMPS. I'd shoot 1 u, maybe less since it's an overnight. Might want to see what others say. You're doing great!
 
What I'm seeing is some see-sawing going on from PS to PS on your 1.5u.

Food is the first thing to come to my mind. Of course food is just about the first thing to always come to my mind. :lol:

So Here's the deal, are there any inconsistencies in the way you are feeding? Are you timed feeding or free feeding? Is he eating the same amount during the day as night?

Normal cats should eat 10-20 small meals per 24/hr. So generally [unless your cat is a hoover or you really are trying to effect the curve with food] then I recommend free feeding and trying to ensure the same amount goes in day and night. If you have a hoover kitty then there are ways to try to approximate the feedings spread out over the 24 hour cycle [many here use 5 position timed feeders to help achieve this]. If you used a 5 position feeder and changed it every 12 hours then that would be 10 feedings per day :smile: .

Also adding water to the food [it should be much softer but not soupy] is a good way to extend the life of the wet food so that it does not get crusties.

I'm a little bit of a control freak and I went so far as to weigh in grams all the food H got. If you weigh then food then it is really easy to put 2+2 together and tell if food is playing a role in the curve.
 
We feed 1/2 to 3/4 can of food mixed with water, twice daily, plus some chicken snacks at blood test time and some chicken if he is pesty for food. Sometimes if he doesn’t eat a whole 3/4 can, he will come back in an hour or two to finish it. The only variable here, I think, is the amt of chicken snacks (1/4” cubes of baked plain skinless chicken) and how much exercise he gets (if we are home or not). He is a bit of a hoover kitty, but when he’s done, he does walk away. So he always seems to have a good appetite and is ready to eat, but will not finish the bowl if he’s done. And we aren’t weighing his food, just eyeballing 3/4 can.

Feeding twice daily is going to work for us if we both can’t be home all day, unless we find one of those feeder thingys you spoke of. We are self employed so every day if different.
We are home a lot now but things will be busier as the season goes on.

-donna
 
A non-hoover kitty is one that you can feed all they want without limiting to 3/4 can or whatever and they will maintain their ideal body weight. In my book, if they will gain weight by over-consuming and thus you have to at some point withhold food then they are a hoover kitty.

And just going on the very small pictures I see I see a cat that could probably stand to lose a little weight.

So I'm guessing you do have a hoover kitty and thus you may find that spreading the meals out over as many feedings as you can might help with the consistency of the numbers.

At least while you are getting started and trying to figure things out my recommendation is to be very structured about what you do. PZI is an awesome insulin in it's flexibility and when you get to a point to capitalize on that it's very cool. But to start with the idea is to be as consistent as possible so that you can reduce variability and reduce the number of things that can be affecting the curve.

http://www.drsfostersmith.com has some timed feeders and I'm sure you can find them on amazon and even in pet stores. There is a style of 5 position one that is supposedly good for cats that like to break into feeders too. But I don't know which one that it. Claudia or Nancy would be better at advice on that topic.

This chart show what ideal body weight is supposed to look like for cats: http://placervillevet.com/feline%20body%20condition.htm
Cat's should have a waist and I bet most people think their cat is normal weight when they should probably lose a little.

Dr. Pierson also has a very good writeup on her page about weight and cats:
http://catinfo.org/?link=felineobesity# ... Overweight
 
Yes both kitties of ours could stand to loose some weight. Asher was 21 lbs at his heaviest, he was 17 lbs at diagnosis two weeks ago and 16.7 or something close to that Monday of this week. My guess is they got so big because we free fed dry food all their lives (7 years).

I feel awful about that now, I was a bad Mom and just didn’t know how bad dry food was. I even got “the good stuff” at the pet store thinking I was doing the best for my guys. I beat myself up about it now a lot. I remember an old vet , a few cats ago, telling me not to feed wet food as it was bad for their teeth ;)

But now is now, so we made changes.

My current vet told me feeding them 3/4 to 1 can per meal, am and pm, is normal. We carefully eyeball the 3/4 can we feed each cat, so we are paying attention, but not weighing food.

The vet felt they would loose weight naturally being on the low carb food. I have to feed both cats the same food, or at least both wet low carb food in case they eat out of each other’s dishes if we cannot be here. And if we ever get to leave the house again, I want the cat sitter to have it as easy as possible.

The cats have eaten out of the same dish all their lives too. They both have made the transition nicely, and in this short amount of time too I think.

I am trying to play laser every day we are home too because they need some exercise. Asher loves it, his brother could care less :(

Thanks for the links. I will check out the feeders and the ideal weight info will be interesting too. I find myself kind of shocked when I notice Asher’s weight loss, then I think about it and realize he needs to loose more, but gradually.

peace,

-donna
 
The feeder we love is the PetSafe5. You can get it on line or at PetSmart. It is easy to program and very hard to break into. Oliver broke 2 feeders before we got this one and never could get into it- although he really tried!
 
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