Bel & Buddy Needs Help

  • Thread starter Thread starter Anonymous
  • Start date Start date
Status
Not open for further replies.
A

Anonymous

I posted to the "basic board" earlier today but it was suggested that I post directly to the Levemir board for help.
I'm a beginner. I just switched to Levemir 6 days ago and that was the first day also to do home testing.
My "Buddy" is 8 yrs old, 14 lbs & was diagnosed 11/19/10 with diabetes with a bg of 454. He only eats "classic" Fancy Feast (which he has done all his life) and I just eliminated dry food last week-end too.
I must first apologize because I do not have a ss yet; I definately understand the importance of a ss but just trying to blood test has turned this calm little household upside down (does anyone remember the frustration in the beginning?). I am rather computer illiterate and just the unbelievable frustration caused by the many, many failed blood testing attempts is enough frustration for me to handle right now without throwing a computer spreadsheet in the mix right now. But I have been able to get one trend going everyday and I'm not liking the results.
For history ... Buddy was put on 3 units Humulin 2x/day at time of diagnosis (bg 454).
The first month he did great; bg was 127 at first month's testing;
The next month it was up to 264. That's when I was introduced to Levemir (advised to start low/go slow) advised to give him One (1) unit 2x/day.
There are two times a day I've been able to consistently get a bg reading; the am pre-shot (7am) and at noon (I've only have failed attempts at other times during the day).
As I said we just started this 6 days ago. His am preshot number keeps increasing thru the 400's everyday.
The first day it was 376 ... now the 6th day it is 434.
His "noon" reading keeps increasing too .... the first day it was 264 ..... now today, the 6th day, it is 335.
He has reverted back to hanging over the water bowl and eats like he is starving ... keeps wanting more (all of that disappeared when we got his numbers down on Humulin).
I'm sure it's time to increase the dosage, but by how much? Can anyone out there guide me because Buddy and I are heading in the wrong direction.
Thank you all in advance for your concern and any advice you can give. I'm getting despirate.
 
Bel, it would really help to have all your numbers - even if they are not in a SS or consistent from day to day. Type up something like this:

Jan 16
started lev 1u bid

Jan 17
amPS - 376, 1u
+5 - 264
pmPS ?, 1u

Jan 18
amPS - 380, 1u
+5 - 275
pmPS ?, 1u

and so on. +5 = noon if your morning shot was 7 am. Type this in Word or something and copy and paste it into each starting post, so it is there to review. Indicate when he had his last dry food.

As I mentioned on your first Health post, 3u of Humulin is too high. A blood sugar test at the vet can be off 100 points or more due to stress. So the number at diagnosis and the 127 don't mean much (sorry!). For instance when was the 127? How many hours after the shot?

Now, on the lev dosing, you have been shooting 1u, bid, for 6 days? Do you have any other numbers - other times in the cycle? Any pmPS numbers? Without more data it is too hard to tell if he needs more insulin or less. Both can cause higher blood sugar readings. A lot of cats are managed on less than 1u bid of lev when they are eating all canned as Buddy now is.

I'm sorry I can't be more helpful right now, but with more information, we can help you get him on the right track. It is important to not raise the dose without knowing how low he goes every day. He could be dropping lower before noon or later in the afternoon. And may be lower at the night shot time than the morning. We just don't know yet.

One other thing you should do for now is test his urine for ketones. Get some ketosiks ar the pharmacy and hold one of the strips in his urine stream as he pees or dip immediately after he finishes (shoo him out if you have to). Follow the package directions for timing and reading the result.

Hang in there. It will get easier.
 
Hey you! Take a breather....Welcome to the Lev board (((HUGS))) and let me tell you what you are doing RIGHT:

Found FDMB for direction :thumbup

POSTED on FDMB asking for help :thumbup

Took away the dry food :thumbup

Kitty on Lev and no more Humulin :thumbup

Hometesting as possible :thumbup :thumbup :thumbup

Taking proactive control of your cats diabetes issues :thumbup

THAT is like SO MUCH done RIGHT in such a small amount of time, my head is spinning for you!!!! :dizcat

YOU ARE ONE PAWSOME mommabean and I think you are doing super so far!

If you can take a minute to post your BG test numbers right in your thread like Sheila showed you until you get around to the SS, that would be awesome!

Also, tell us what is happening with the hometesting- what is making things difficult? We can do our best to offer suggestions to make it easier- And It WILL get easier, really!

First thing is to make sure your lancet pen is set on deepest or next to deepest setting...the cap on the lancet should have marks and the cap should twist...let us know if your is different and we will try to talk you through it.

Next- the ear really needs to be warm ( assuming you are ear testing?)...some folks us a rice sock warmed in microwave or warm cloth...I never knew about all that fancy stuff when I started so I just got down on the floor, tucked my Pauly between my knees and rubbed his ear and kinda pressed it in places until it pinked up or felt warmer then- poke!

Tell us what is happening, where it is difficult and we'll see what we can do.

I agree- try to get some ketostix ( kitty pees on them and it measures for ketones- something that could happen when numbers are high) to keep kitty safe until we can get more readings..

...and, if it were me, knowing now what I didn't know when I was new- I'd probably hold the 1u dose until I could get more BG readings...

Hang in there! We got your back! :smile:
 
Welcome.

The others have given you some words; I will direct you to the stickys to read because you need to understand the SHED and how it works:
Lantus & Levemir – Insulin Depot –AKA- Storage Shed

Lev works differently so it's a good idea to read the sticky on the protocol that many follow - because it works:
Tight Regulation Protocol
the important part of it....keep this next bit handy as it will help you understand how increases and decreases are best done:
"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.

In order to decide safely if a dose change is due, you need more numbers, more around the mid cycle. The ps numbers are important BUT dosing is not based on the ps numbers.
You need to find your cat's nadir, and that will be found by testing at diff times between the shots, recording data on your spreadsheet
How to do a Curve
Example of a typical curve:
+0 - PreShot number.
+1 – Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 – Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

Now, it is safer to have a higher number than a number too low.
You need to have a hypo kit ready just in case your cat drops low because you have changed foods and often cats drop low after food improvements.
List of Hypo symptoms
How to treat HYPOS-They can kill! Print this out!
Jojo’s HYPO TOOLKIT

With the high BG numbers, be sure to test for ketones. Pick up a box of ketostix from the pharmacy and test your cat's urine for ketones. If even a trace registers, please post on the board and you can get help.
Ketones
Pet Diabetes Wiki: Ketoacidosis

If you have any questions at all, please do not hesitate. Just ask and someone will help you.
 
Making dose change decisions with so little data can be a mine field. There is a link I'd like you to read however, which may help you use what limited data you have PLUS the outward symptoms you see to decide when and how to raise his dose.

http://www.uq.edu.au/ccah/docs/diabetesinfo/link3.pdf

The term "pre-insulin" I take to mean preshot time. So if you can at least get a preshot test and a midcycle test at approximately 8 hours after the shot (cats generally nadir later on Levemir than other insulins) that may give enough data to make sure we're not dealing with too much insulin.

Also, do you think you would have luck testing his urine for glucose? We have had members of the board with fractious cats who had to use urine output as a guide to dosing. Pamela, can you help me out on who that was?

For now, the fact that you note his drinking and peeing have increased seems to indicate he needs more insulin, although yes, rebound numbers can cause excessive PU/PD too. If you have read some of the stickies and feel comfortable that you understand how Levemir works, you could try to increase the dose to 1.25U and see how his numbers trend as you can get them, also note the drinking and peeing frequency.

I hope you've received some reassurance in your Health thread to help with the home testing frustrations. If you feel comfortable giving your general location, we probably have a capable member close enough to help show you some tricks. My advice is pretty general, but may be things people don't realize.

Try to enclose him in a small room. I use my bathroom with a board across the sink. It was a godsend in the beginning. Some cats are calmer in a small space, unless they are skiddish, it can make them worse because they feel trapped. Try it if you think it will help.

Also, you can use lancets without the clicky pen. We call it freehand. I like BD Ultra fine lancets or Wal-Mart has the Reli-On brand ones which work well. Try to get 30 gauge, which are fine enough to not hurt but make a large enough hole to get blood.

Have you seen this picture? http://i106.photobucket.com/albums/m267 ... etspot.jpg

I did the testing all wrong in the beginning. I tried unsuccessfully with the lancet pen, then realized I could use a lancet without the pen and I'm someone who HAS to see what she's doing, so the difference was amazing for me. But I would sit on the floor with him between my legs and it was horrible, he felt tortured. I realized he always liked to visit me in the bathroom, so why not try there? Success!

Getting them comfortable with testing is trial and error, but you have to get comfortable with it first, as they will pick up on your anxiety about it. Treats help too for some cats. You have probably tried distracting him. Some people can do that, others find it too difficult as the cat isn't in a good position with their head down.

Spend time before you use the lancet stroking his head and trying to calm him before attempting a test. That might be calming for both of you. Play soft music - they say classical music is soothing for cats. Sounds crazy, but hey, you never know and you do reach a point where you'll try anything and there's nothing wrong with that.

I hope this helped some on all fronts. There is a tremendous amount of information in the stickies and link I provided, so if you read something you'd like an interpretation on, please ask.

Oh, and welcome to Levemir, Bel! It really is a better insulin than Humulin, it just may take a while to wrap your head around how it works.
 
You are in the perfect place for your cat.These people are Angels and they will help you so much. You are doing an awesome job and Buddy will be on his way to feeling great with your help.Sending tons of healing green light to the three of you . Hugssssssssssssss & Angels on the way to your home Kath
 
Several of us posted to Bel on her Health thread and gave her a lot of information, including the link the Lev 101 info already. We are just trying to address her questions posted on this thread right now.
 
Status
Not open for further replies.
Back
Top