Beau-7/28-first BG curve tomorrow, need advise on PM dose

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alicia.1771

alicia.1771

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Since we started Beau on ProZinc at 2.0U BID on 7/19 and dropped to 1.5U BID on 7/22 per our vet his BG has been fairly consistent with high AM/PMPS #'s and lower # at +6. But I'm not quite getting his curves these few days. I had skipped his PM shot 3 nights ago because his PMPS was 144 with no appetite. Later I coaxed him to eat 3/4 cans of Fancy Feast by adding some dry kibbles (first time adding dry since I switched him to all wet food on 7/19) because I was worried of him not eating, although his BG went up (due to food?) at +15 to 287 I was too scared to give him insulin since we're way past his shot time.

The next day I gave his regular AM shot and at +6 his BG is 65 and PMPS is 138, another unshootable #...I panicked and posted on the Feline Health Forum for the first time to get advise after few days of just reading and gathering info. Not knowing better I didn't wait and retest before feeding him 1 can of FFC with dry kibbles (seems the only way he'll eat these 2 days). Again his BG went up to 198 and thanks to suggestions here I did not skip a shot this time but gave a reduced dose of 0.75U.

Yesterday morning his AMPS is 292 (almost 100 lower than his previous 4 days). And given his low +6 and +12 # yesterday I decided to give a reduced dose of 1.25U. But there was a bit of struggle during injection and I lost a drop or two, so the dose is probably closer to 1.0U. His +6 was 146 and PMPS at 347 so I gave his regular dose of 1.5U. Since his # has been wacky I tested at +4 and was surprised to find his BG at 92 which was a really big drop given that he has eaten about 1.25 cans of Fancy Feast in between PMPS and +4.

This morning I was shocked to see his AMPS at 66! I waited 30min and retest it was still low at 70. So I went ahead and fed him 1 can of FF. 1 hour after feeding his BG is 97 so I decided not to give his AM shot. Did I make the right decision?

I need some advise on tonight's PM dosing again because we're scheduled for his first BG curve tomorrow morning at the vet. If I have another unshootable PMPS tonight and/or AMPS tomorrow it will really mess things up! The thing about my vet is she only works Fri/Sat and the clinic only opens 1/2 days on Sat so they won't be able to do BG curve. They have another vet who works Mon/Tues, and another on Wed/Thurs. I do not want to see the Mon/Tues vet (who I saw to get the insulin since my vet is off) because he actually scolded me for testing Beau's BG's at home "against his instrution" (not that he does not support home testing, but he thinks it's used for later in the course of the treatment monitoring and thinks I was probably not doing it right and doing it too often can scar his ears and make them necrotic....yes, his words)

I will post his +6 (would it be +18 then since he didn't get his AM dose?) and his PMPS # here and hopefully can get someone's advise in the mean time.

Also, how do I know whether to post in the Feline Health Forum or the PZI Forum? Is there one forum that gets more response (since I'm quite desperate at this moment...)? Thanks in advance!
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

first thing, i just noticed your location in your signature. where you at in xxxx county? i work in yl and live out in xxxx so hey there neighbor :-) lori and tom is here too but a bit south of me in laguna

second, yes, you did the right thing by skipping that am shot on those under 100 numbers. you could keep testing and then shoot when kitty got higher but that also can throw off the next scheduled shot time so what you did is just fine.

third, as to which forum to post in, either is fine. there's more traffic on health so if you need a quick answer to something, posting on health is probably better. if you're not in a rush about something, one can post in the appropriate insulin support group. also, in the insulin support groups people tend to post daily and other members using the same insulin tend to keep track of the daily happenings and help people fine tune dosing, feeding, etc.....

as far as testing now vs. later in treatment, i've been testing Mousie's ears since October 2006 and they look as beautiful as a newborns ears :-)

now, you noticed that when you lowered the dose you actually got better pre-shot numbers right? that could mean the higher dose is too much for now. and raising and lowering the dose at every shot time has kitty on a bit of a teeter totter it looks like. what i myself would suggest is pick a dose and hold it steady for several days as it takes their bodies a few days to figure out what to do with the insulin. i'd probably go with the .75 or even 1 but talk to some more prozinc people first on that. and of course, the exception would be if kitty is too low to shoot, then that throws off the steady dose plan of course :-)

oh, and yes the clock starts with each shot so yes, you would be + however many hours since the last shot was given
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

Hi Cindy!

I live in Orange and work in Anaheim near 91 and Lakeview. The vet I'm seeing is in Yorba Linda so we are really close! She is a new vet for me since both of my cats (1 civilian FS 15yo) have been pretty healthy most of their lives we haven't needed to see a vet for the last 5-7 years.

I feel pretty comfortable skipping the shot this morning since both #'s were < 100. But I get quite nervous and unsure what to do when the #'s hover between 100-150 as well as 150-180. I don't want to put him into hypoglycemia and at the same time I don't want to keep skipping doses so early in his treatment. I wish there is a step-by-step handbook in what to do with clear guidance!

For the ear pricks, I try to be as careful as I can to hit the space between the vein and the edges as well as rotating sites. However, I still notice bruises (red spots when shining with a flashlight) from the spots I had hit. Is this normal?

I'm also getting a sense that 1.5U is definitely too high for him right now since we switched to wet food at the same time we started insulin treatment. And I noticed both his water consumption and urination has decreased since starting treatment. I gave him 1.5U last night because his PMPS # was so much higher than previous 2 nights and I only got about 1.0U in him at AM shot so I thought perhaps 1.0U was not enough. But now to think of it, it would probably be a better choice to go with 1.25 or even 1U last night given his low AMPS # today. I very much want to keep a consistent insulin dose for several days but sometimes his BG# scares me so much I go with the conservative route which might not be the best??? I worry because I am only able to check on him at around +6 once during work hours (9am-6:30pm) and don't want his BG go too low during the times I"m not home.
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

dang we ARE neighbors! as a matter of fact i'm there at the 91/lakeview area at least once a week. like tonight i will be there about 6:30. i drop my fiance off there in the lot across from kaiser once a week and he jumps on the bike trail there and rides home and tonight's the night he's doing it this week. he usually goes for it either wednesdays or thursdays but he tweeked his back a little yesterday so he didn't ride home last night.

and when i first moved to california i lived in xxxx as a matter of fact, in old towne over by chapman . we only moved out to xxxx in xxx so i'm much more familiar with orange than xxxx county

wonder what vet you see up here in xxxx. there's quite a few to choose from i know. my favorite retired years ago and i tried a few after him but couldn't find another one i was happy with until my Mousie was diagnosed with her diabetes actually. since then i've been going to one out off the xx and xxxx whom i love dearly. she tends to prescribe lantus insulin though so i'm pretty sure you're not seeing her :-)

some bruising is normal, especially in the beginning as their ears aren't used to it. even now, 5 years into this, i get Mousie just right sometimes and give her a bruise for a day or two but they heal quickly. fwiw, you can also put a dab of neosporin on their ears to help with healing too.

and this part is strictly my own opinion but i have no problem with erring on the side of caution so early in this disease when both human and kitty are trying to figure out how to use that insulin. key is to be testing for ketones too though while the numbers are running a bit high in the beginning. remind me if someone has covered that with you or not yet?
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

OMG! We are so very close! I work just north of Kaiser in the business plaza off of La Palma & Lakeview. Maybe one of these days we can get together and talk about feline diabetes (lol) when I'm not so sleep deprived and Beau is more stabilized.

The vet I'm seeing is on Rose off of Yorba Linda. I chose that location because it's close to my work and the few reviews available were pretty good. But I didn't realize until after I had my first appt that she only works 1.5 days of the week so I had a hard time get in touch with her the other days of the week when I have questions. Basically I get referred to whichever doctor was working that day. Apparently the 3 doctors share patient load but I find that difficult to discuss treatment plan and progress especially when there are difference of opinions. My vet was honest and told me she didn't have many experience treating diabetic cats but had recently took a class for it. It sounds like you really like your vet and I am thinking maybe I should take Beau in to get a 2nd opinion from her if she is more experienced in this field. Does she work 5 days a week? And how easy is it to get in touch with her when you have concerns about your cat?

At first I wanted to go with Lantus given all the positive results I read here, but the hospital only have ProZinc (my first appt was on Friday, blood work came back Sat. and I went in on Monday to see the other vet). He told me there is already trace ketones that day and say he has to get a shot of insulin (ProZinc) in and they can order Lantus if I want, which will come the next day or the day after. But he said Beau will need to be hospitalized for 3 days on Lantus. I did not read anywhere that hospitalization is required for Lantus treatment unless the cat is in DKA... I asked to speak to my vet to get her opinion but thy couldn't get in touch with her and I had already been there for 2 hours. I was crying in the exam room because I couldn't decide which insulin to put him on and the vet basically told me it's my choice and either will be fine. But since I know Beau gets really stressed outside of the house and will probably not eat anything while hospitalized, I went with ProZinc....I am hoping with his diet change and recent BG numbers and continuous treatment he will also have a chance to go into remission on ProZinc especially when I will be going out of the country for 3 weeks in Oct/Nov to visit my mom (she is undergoing chemotherapy for colon cancer) and really hoping he will be OTJ by then.

Speaking of Ketone testing, Nancy has mentioned the need to test and I'm eager to start. I just need to find time to buy the strips (hopefully tonight) and figure out how to collect urine since I don't really know when he pees... I don't know much but is ketone something I need to worry about if Beau is eating well and his BG are not too elevated? I had thought it's when a cat stops eating and BG remains high that ketones becomes an issue....I definitely need to read up and learn more about this subject.
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

alicia.1771 said:
At first I wanted to go with Lantus given all the positive results I read here, but the hospital only have ProZinc (my first appt was on Friday, blood work came back Sat. and I went in on Monday to see the other vet). He told me there is already trace ketones that day and say he has to get a shot of insulin (ProZinc) in and they can order Lantus if I want, which will come the next day or the day after. But he said Beau will need to be hospitalized for 3 days on Lantus. I did not read anywhere that hospitalization is required for Lantus treatment unless the cat is in DKA... I asked to speak to my vet to get her opinion but thy couldn't get in touch with her and I had already been there for 2 hours. I was crying in the exam room because I couldn't decide which insulin to put him on and the vet basically told me it's my choice and either will be fine. But since I know Beau gets really stressed outside of the house and will probably not eat anything while hospitalized, I went with ProZinc....I am hoping with his diet change and recent BG numbers and continuous treatment he will also have a chance to go into remission on ProZinc especially when I will be going out of the country for 3 weeks in Oct/Nov to visit my mom (she is undergoing chemotherapy for colon cancer) and really hoping he will be OTJ by then.
Click to expand...


I find what your vet told you about Lantus bizarre--first, your cat most definitely does not need to be hospitalized for 3 days. If you're home testing you know how the insulin will affect your cat. You also don't have to wait for a vet to order it--the vet just writes you a prescription and you take it to any pharmacy and get it filled immediately. Lantus is a human insulin so you can get it anywhere. I get mine at Walmart or Wegmans.

Prozinc is a good insulin. If it's not working well after you've tried it out a while you can always switch to Lantus. All you need is a script from your vet--that's it. No vet visit, vet testing, or hospitalization is needed.

You also don't need to get curves at the vet if you're home testing--you can do your own curve. Curves at the vet will often have inflated BG numbers because of vet stress, so you can't adequately dose based off those numbers. That makes them a waste of money. What I do is call my vet every couple weeks and she takes a look at Bandit's spreadsheet online (the same one in my profile here) and uses those numbers to give dosing recommendations.
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

oh is that the one there next to placentia linda hospital, by the burger king and taco bell? i haven't been to that one myself but i have a friend who used to take his dog there.

oh yes, LaPalma and Lakeview.....the burger place on the corner, and we used to do business with a place around the corner on LaPalma, Miller Catalyzer, until the laws changed regarding catalytic converters here in CA, oh, and a friend of ours has a motorcycle shop up the block down mira loma so not far from you either. what a small world!

as far as my vet goes, she actually works 6 days a week (which i love because of the saturday hours). occasionally taking a day off here or there. if she takes a couple off for a conference or rest i think she has a relief vet that comes in but i've never experienced that since i started going there. if you want to check them out sometime it's called All About Cats Health and Wellness Center and it's at the end of LaPalma off the 91 at Gypsum. are you familiar at all with the ice skating rink that's out there? or Featherly Park? she's right next door to the ice rink and across the riverbed from Featherly Park. if you want to call them and ask them some questions, their number is 714-692-8228 and yes, Dr. Ankone is open to staying in touch via email too once she's seen the pet in question. (tell them Cindy of Cindy, Fuji, LePew, etc.....sent you. LOL!! I'm there every 2 weeks with my LePew so they know me well)

about ketones, it's something we should always be concerned with but moreso in the beginning i think. i mean, if you can't find some tonight i don't think it's critical but i'd plan on getting some by the weekend and test periodically for them.
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

Julia - yes, I find what the vet said about Lantus hospitalization odd as well, so I would prefer not have to see him again especially when he dose not support my home testing early in the treatment. So far Beau seems to be doing ok on ProZinc so I will hold off on switching to Lantus maybe just a bit longer unless he continues to spike and dip despite being on a consistent dosage. The only reason I'm doing the BG curve at the vet tomorrow is because it will be the first complete BG curve since starting him on insulin and I am just starting to get a hang of home testing. Sometimes I still get different numbers on the Relion Micro meter when I do consecutive tests one right after the other (i.e. 390/388, 240/256). I have tested myself on the meter and got pretty consistent consecutive #'s (83/86/85) so not sure why I get different reading on him. The curve tomorrow is mainly to put both me and the vet at ease and if their machine has a better reading. But I will print out my spreadsheet and bring it with me tomorrow so the vet can have a reference point when interpreting the results. They are also doing the fructosamine test tomorrow, which I know may not be the most valuable info if I'm home testing. But since most days I'm only able to test at AMPS, +6, PMPS, and maybe another +4, the test result will hopefully let us know how we are doing so far.

Cindy - yes, that's the one. I love Tom's Place! They have awesome food and we do take outs almost once a week or two from there :) Thanks for the info on your vet, I like that she works 6 days a week and is a cat only clinic so she is more knowledgeable on managing cat illnesses. I just might make an appointment to see her to get a 2nd opinion.
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

UPDATE on Beau's BG: since Beau did not get his AM shot, his +17.5 BG at 1:15pm is 187 and at 2:00pm is 226. So it's definitely creeping up. It's apparent that skipping a dose is really not good for him even if he is at a non-shootable PS reading... :( I didn't give him more food since I don't want his BG to spike too much from now until PMPS.

** I will definitely need advise on PM dosage because I need a shootable AM reading in order for the BG curve to be conducted at the vet tomorrow. If anyone will be online around 7-7:30pm tonight can you keep an eye out for my posting of his PMPS and make a comment? Thanks you all for the support!
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

not sure i'll be home yet by then as i have one errand to run after dropping fiance off but if so i'll check in. i also cross posted in pzi isg linking to this thread so some pzi eyes will be here too hopefully
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

there will be pzi eyes around at that time ..... either here, or pzi .....
memories of southern CA, thanks guys!!
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

When it comes time for you to post your pmps--also post it in the PZI ISG--there should be people around!


We will keep out eye out for it.
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

I took a look at Beau's SS. Here's what stuck out with me. It looks like after the morning shots, on the days were you've tested him a couple times between shots, his nadir appears to be happening at the "right" time, just around +6.
On the nighttime cycle, I see some +2 and +4 numbers, and then I am guessing you are managing the 4 or 5 hours sleep that newbies are able to grab!
What is weird is yesterday... He dropped pretty drastically by +4 and even after feeding him 3/4 of a can between +3 and +5 it looks like he kept dropping to 66 12 hours after his shot. He ate a can and a half of food in that time frame, but nothing after +5, and yet he was "normal" this morning at breakfast.
You got a really nice drop, but then he just kept dropping (which would seem to indicate a higher than needed dose) but then he seemed to reach nadir sometime around 12 hours later...

Question about the vet curve tomorrow. Do they want you to feed him breakfast before bringing him in? Or do they want a "fasting" BG reading. That'll impact what you dose him with tonight, and at what time you might be able to give him a "snack" during the night.

Carl in SC
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

Hi Carl! - yeah I don't really get his curve from yesterday through today either. I don't know what caused that big drop after PM dosing besides that 1.5U is too much for him. Regarding the vet visit tomorrow I was told to feed and give him insulin before I go. The vet knows I dose at 7:30am and the appt is at 8am. Is this the regular way to do curve? What is a fasting BG curve and what info does that provide vs. after feeding/insulin?

I'm heading home now and will post his PMPS reading shortly.
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

Alicia,
I don't know how vets normally do a curve. Bob stayed overnight way back at the beginning for two nights, and I don't know exactly how they did it. I know when I do it, I follow the normal routing, and then just test Bob's BG every 2 or 3 hours all day long. He loves it!

I know doctors (human) want to know your fasting BG number. I thought the vet might want that too so they'd have control over feeding, shooting, etc. to give them a 24 hour "snapshot" of a day in the life of Beau.

The only thing that makes me hesitate to say that last night's dose was too big - usually, if the sugar goes way low, then the liver (I think) will "panic" and dump sugar into the blood, which would attempt to bring his sugar level up to what Beau's body thinks is "normal" which would be diabetic levels.
At least that's how I understand the process. Anybody else?
Carl
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

Ok everyone - here is Beau's BG at +23.5 = 311. Any advise on PM dosing so I can get a shootable AM dosing tomorrow for vet's BG curve??? Please take a look at his spreadsheet for his BG readings. Thanks.
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

Hi Alicia, where are you with things? I'm not sure what the timing is, are you getting ready to shoot? I haven't looked at the SS yet but will open it now.

FWIW I would bag the vet curve tomorrow! I realize it's probably too late to cancel, but you are home testing, so you will most likely get better info at home than the vets will get.

anyhow, brb!
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

I think you could go with either 1u or 1.25. I think he will get better numbers on 1.25, 1u is more a safe bet to ensure the PS in the morning is shootable. 1.5 is giving him some nice numbers, but I think the drop may be steeper than is comfortable for him. Looking past tomorrow, if 1.25 does not give you green nadirs though, I would either go back to 1.5, or try just a hair less than that. It looks like he may have a sputtering pancreas, so you don't want to lose momentum while you've got it.

You already have a good amount of data though - does your vet know that? You have curves essentially - not exactly how they would do it at the vet, but there's enough data to draw conclusions from what you have.

Lookin good in general, yay! If there were anything to discuss with the vet, I think it would be the low eating, if you don't know what is causing that (sorry if you've already discussed that, I didn't take the time to read the whole thread :oops: )
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

Hi Joana -- yes I just fed him 1/2 can FFC and is getting ready to shoot but just need to decide on the amount of insulin. I would like to shoot within the next 15min by 7:45pm so I can get back to his schedule tomorrow morning at 7:30am. Let me know what you think. I still want to keep the appt tomorrow just so I can talk to my vet face to face and get some input.
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

carlinsc said:
The only thing that makes me hesitate to say that last night's dose was too big - usually, if the sugar goes way low, then the liver (I think) will "panic" and dump sugar into the blood, which would attempt to bring his sugar level up to what Beau's body thinks is "normal" which would be diabetic levels.
At least that's how I understand the process. Anybody else?
Carl
Click to expand...

It doesn't look to me like Beau is in liver training - he's gotten some great numbers, and I don't see an overreaction to that. You don't want the drop to be too steep though, that can make them feel icky, and can cause rebound (which I don't see though). I'd still stay shy of 1.5 though unless something like 1.25 does not give him good results. It was a pretty steep drop for early in the cycle, though it might be ok, but I'd lean towards a little caution and gather some data.
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

I would go with 1u. For the reasons Joanna stated. Should give you shootable BG in the morning, and won't drop him too low overnight.

Carl
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

Hi Alicia!
You are doing well, nice SS and I also wonder why a curve? You could do this week-end and it would be more accurate than at the vets. Nice #'s and I thought a sputtering pancreas also, Joanna came up with good #'s but since he goes so low ..... I might do 1u .... but you have the cat.

You have been at this a very short time and it is hard to get patterns in the beginning but it looks very promising.

You need to check for ketones ....
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

i'm finally home and checking in at 8:30 :-) had to stop at Stater Bros and make a bank deposit and decided to grab a bottle of wine. darn if i didn't get sidetracked by the cantaloupe and then cottage cheese with pineapple and a pretty good price on low carb/low phosphorous friskies. $0.40/can! LOL!!

you've shot by now i'm sure but i was thinking if i for sure wanted a shootable number in the morning i think i'd go with 1 unit. fwiw i don't think a 311 nearly 24 hours after the last shot and less than a week on insulin is that bad sooooooooo i'd want to probably be a little conservative so i would have that shootable number in the morning.
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

Thanks Cindy for checking in! Yes I went with 1.0 to be conservative so I can get a shootable # in the morning. The grocery store can be a dangerous place if you don't have a shopping list! I generally arm myself with a list and head straight for those items then checkout. Otherwise I always end up with more things than I need :P Speaking of Stater Bros, I also saw the ads on Friskies and was planning on stocking up over the weekend! So far Beau's eating ok on Fancy Feast but some days he just isn't interested so I had mixed in a few dry kibbles for him. But I don't want to keep on doing that so I am looking for alternative wet food as his other options when he won't eat FF. Did you find your cat favor one type of canned food over the other? Any appetite issues while on insulin treatment?
 
Re: Beau-7/28-first BG curve tomorrow, need advise on PM dos

all my cats are rescues of some sort, either pulled from the streets, car engines, out of the ground, or even out of trees and what i've learned is former street kitties don't care what they eat, just that they eat so i fortunately have never experienced food issues in my house.

i do low carb/low phos as i had a kidney kitty up until a couple years ago and they need low phos so i found that a few flavors of friskies are both low carb and low phos so i could feed that and not have to worry about the diabetic getting in the kidney kitty's foods and vice versa. and now i have another senior kitty that has borderline kidney issues and a youngster kitty who unfortunately was dealt a bad blow at birth who is on meds that could damage his kidneys so we have to try and preserve his kidneys as much as we can so i stick with the same friskies flavors mostly. i do do some raw too as treats mostly. for instance i picked up a little tub of liver for them tonight while at the store.

oh and Mousie's never had appetite issues. she's a rescue too and actually food is an interesting feature with a diabetic street kitty. she too will eat anything i put in front of her, even a few years ago when she had what's called a vestibular episode wherein her world was spinning due to an ear infection she developed. it scared the bejeezus out of me when i got up one morning and she couldn't walk without falling over. first thought was hypoglycemia but tested her and she was fine. got her to the vet and the vet found an ear infection. basically she had a case of dizzy because of it and we had to worry about food and her throwing up and how much insulin to give a cat in the shape, etc....but she surprised us all by eating with gusto at every meal and never once throwing up thru the ordeal.

as a matter of fact, she stresses over NOT having food and can make her glucose level go up by doing so. it's as if she thinks every meal is her last and if there's no food in her bowl when she goes to it, she gets worried or something.
 
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