Did I miss? PMPS 10.8 (194). +2 14 (252)

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Elizabeth20

Elizabeth20

Member Since 2020
Hi

I gave Lily an eyeballed 0.2u this morning and she went down to what she usually measures. Her new 0.5 needles arrived after breakfast so I used one of them this evening. She was about 10.8 this evening, fed and injected only just under 0.5u, then two hours later she's reading variously 15, 14 and 12. Did I miss? I've had eyes on her all evening and she hasn't had anything else to eat. What should I do?
 
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Sorry you didn't get an answer sooner! Anytime something like this happens, make a new comment on your thread so it brings it back to the top of the forum!

It's possible that she went lower today. She dropped pretty fast from AMPS to +2...it would have been good to get at least 1 more test to make sure she didn't drop too low.

I'd hold the .2 dose for a few days unless she drops below 2.8
 
Thanks Chris. I waited and she still didn't drop to anywhere near what I'd expect after a shot. She was at 16 AMPS today so not sure what's going on with her. Just not stabilised I suppose. It has only been 9 days.
 
Hi Liz,

I agree with Chris about sticking to the 0.2IU dose unless Lily drops below 2.8 - and I think there's a strong chance that she will (if she hasn't already done so). As it is, nadirs in the 3s are very low for a Caninsulin kitty. (If it was my cat then for safety reasons I'd be looking to switch to a gentler-acting insulin like Lantus.)

Looking at Lily's latest numbers, if you see yellows or higher there's a very strong likelihood that they will be bounces from such low nadirs. The Caninsulin can drop numbers like a rock from higher PS levels, as you saw on the AM cycle of 26 November. Please don't be tempted to increase the dose if Lily's numbers do bump up a little: any bounce will clear in its own time (can take up to 6 cycles) and BG levels will drop back down into a better range. You can post for help at any time and ask for an experienced member to give feedback on Lily's spreadsheet if you do see a bit of a rise in numbers.

You're doing great with the testing. For safety, I strongly recommend that you do your best to test a bit later than +2 on both AM and PM cycles because usually cats drop lower than the +2 BG level (see AM on 26 November: +2=5.4, +3.5=4.2). With the readings Lily's getting at +2 there's no wriggle room at all.

Safety issues aside, Lily's doing really well. How is she feeling in herself?


Mogs
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Hi Mogs

Thanks, I think I was a bit confused about the 2.8 bit but I did wonder last night if this was a rebound issue. So stick to 0.2 but reduce if she dips lower at nadir?

She was at 12.4 this morning. She's just having breakfast and I'll give her a small dose again and try to grab her for blood more often. I appreciate 16ish isn't as high as 3ish is low. I can get a slightly better idea of how much she's having now with the 0.5u needles.

I emailed the vet on Friday showing her Lil's charts and asking if I could move her onto Lantus. I'm very lucky to have been offered some by a diabetic who has kept it well but I'd definitely pay for her to have a smoother ride. I'll let you know what the vet says.

Lily is doing well, she's put on 200g since Friday before last and is purring a lot more. She's had an upset stomach a few times but she does tend towards diarrhoea - I think she has mild IBD because the vet said at the last check up that she has slightly rubbery intestines. She's getting a lot of water because of eating so much food, so still flooding the litter tray too. It's slightly less of an issue when I give her Carny instead of Bozita because it has a lower water content. Of course I just stocked up on 36 boxes of Bozita because she likes it so much...

She also has a tendency to hide in new places and we can't find her - part of the reason for fewer tests. Currently behind the Christmas tree is most popular, along with under the dining table, and my favourite is behind the toilet bowl! There are others we haven't figured out yet, and she just wanders out of a room we've thoroughly searched.
 
Critter Mom said:
Hi Liz,

I agree with Chris about sticking to the 0.2IU dose unless Lily drops below 2.8 - and I think there's a strong chance that she will (if she hasn't already done so). As it is, nadirs in the 3s are very low for a Caninsulin kitty. (If it was my cat then for safety reasons I'd be looking to switch to a gentler-acting insulin like Lantus.)

Looking at Lily's latest numbers, if you see yellows or higher there's a very strong likelihood that they will be bounces from such low nadirs. The Caninsulin can drop numbers like a rock from higher PS levels, as you saw on the AM cycle of 26 November. Please don't be tempted to increase the dose if Lily's numbers do bump up a little: any bounce will clear in its own time (can take up to 6 cycles) and BG levels will drop back down into a better range. You can post for help at any time and ask for an experienced member to give feedback on Lily's spreadsheet if you do see a bit of a rise in numbers.

You're doing great with the testing. For safety, I strongly recommend that you do your best to test a bit later than +2 on both AM and PM cycles because usually cats drop lower than the +2 BG level (see AM on 26 November: +2=5.4, +3.5=4.2). With the readings Lily's getting at +2 there's no wriggle room at all.

Safety issues aside, Lily's doing really well. How is she feeling in herself?


Mogs
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Yeah she's gone up from 12 AMPS to 14 @+3.5 this morning. I gave her 0.2. I'll try to be patient - it's really hard! Hopefully the vet will come back to me again about Lantus. Might order new needles today. I'll be up to my knees in them soon!
 
Elizabeth20 said:
So stick to 0.2 but reduce if she dips lower at nadir?
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That's right. As I said last night, with Caninsulin her nadir is very likely to be later than +2 - usually somewhere between +3 and +5.

With Caninsulin, the +3 is a valuable test because typically most of the big drop has happened by then, but bear in mind that numbers may dip a little more in the following hours - something to be very cautious about when the +2s you've recorded are already very low for cats on this particular insulin.

Re the hiding, I suggest trying to determine what the trigger is:

- After food?
- At a particular point in the cycle?

I made this suggestion because, in some cats, the drops produced by Caninsulin can make them feel not so hectic and that may manifest in hiding behaviours. If that were to be the case then switching to a gentler-acting insulin might help solve the problem. When Saoirse was on Caninsulin, she'd be fine for the couple of hours before the dose and, after receiving the dose, she'd spend the better part of each cycle hiding behind a curtain. It was like having two different cats. She was much happier in herself and the hiding behaviour stopped as soon as she was switched to Lantus.


Mogs
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I'll start keeping a note of when she hides. Today she's spent about half an hour on the sofa and the rest of the time behind the Christmas tree but for the hours pre-shot she's out and right in the way with hungry eyes! I've left another message for the vet about switching to Lantus, especially given the rebound issue, but no reply yet.

So glad I didn't just do what the vet said at first and just keep whacking a full unit into her every morning. Very grateful for this site and for you! I'll update tomorrow and when I hear from the vet.
 
Critter Mom said:
That's right. As I said last night, with Caninsulin her nadir is very likely to be later than +2 - usually somewhere between +3 and +5.

With Caninsulin, the +3 is a valuable test because typically most of the big drop has happened by then, but bear in mind that numbers may dip a little more in the following hours - something to be very cautious about when the +2s you've recorded are already very low for cats on this particular insulin.

Re the hiding, I suggest trying to determine what the trigger is:

- After food?
- At a particular point in the cycle?

I made this suggestion because, in some cats, the drops produced by Caninsulin can make them feel not so hectic and that may manifest in hiding behaviours. If that were to be the case then switching to a gentler-acting insulin might help solve the problem. When Saoirse was on Caninsulin, she'd be fine for the couple of hours before the dose and, after receiving the dose, she'd spend the better part of each cycle hiding behind a curtain. It was like having two different cats. She was much happier in herself and the hiding behaviour stopped as soon as she was switched to Lantus.


Mogs
.
Click to expand...

The vet wants me to take a 10 point glucose curve tomorrow to get a picture of what's happening right now and will give some thought to a slower acting insulin but agrees that this is likely a reaction to those hard drops. Still BG of 16 is a real improvement on the 25 she presented with less than two weeks ago. I'll get those syringes ordered.
 
The vet just rang back and suggested trialling taking her off the insulin entirely for a week and measuring her BG once or twice a day to see how she reacts. She also asked me to try a diabetic specific food (which she referred to as medicated food) on the basis that the fat content needs to be controlled as well as the carbs. I'm willing to try her off the insulin but I'm nervous about changing her food again.

Let me know if this needs a fresh post.
 
You're fine on this thread for now, Liz, it's short.

I'd be wary of a food change, too. Apart from risk of GI upset, with the exception of Purina DM paté, all 'prescription' diets are too high in carbohydrates for a diabetic cat.

I think your vet's perhaps being a tad optimistic in suggesting a remission trial at this time: Lily might be getting to the lower part of the normal feline BG reference range when a dose is active in her system, as soon as the insulin peters out Lily's BG returns to a level above the renal threshold (yellows). It's possible that some of the higher BGs might be a bit bounce-influenced from the lower mid-cycle numbers but, while there might be some improvement in those levels if Lily's BG isn't going through big insulin-influenced drops, I would have reservations about them coming down enough to warrant cessation of insulin treatment. If you do suspend insulin treatment, I'd suggest only doing so for a few days and if numbers start trending upwards go back and discuss it further with the vet. Be sure to test her BG levels after a 2-hour fast (as you would for AMPS and PMPS), and then test at +1 and +2 after she eats to check what effect food will have on her BG levels. Also, I'd suggest daily testing of Lily's urine for ketones as a safety precaution. (Tips for collecting urine samples here.)


Mogs
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I think she just thought as Lil was down in the blues in her pre-shot BG for a couple of days it was worth a go, but that was only for two days. I said I would try it and keep an eye on her BG. I'll test as you've suggested. She thinks Lily is stressed hence the hiding but I'm not seeing any of her usual signs of stress. No issue collecting urine.

She's just perfectly timed a foray out from behind the Christmas tree to ask for a couple of dollops of food, 3 hours before her next test is due. I took the opportunity to test her while she was out and she's at 12.9.

Thanks for the food info. I thought there was probably a reason they weren't on the list here. As it is her food is less than 5% fat so I'm assuming that's pretty good. Certainly looks about standard for most of the ones on the list.
 
Elizabeth20 said:
She's just perfectly timed a foray out from behind the Christmas tree to ask for a couple of dollops of food, 3 hours before her next test is due.
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I like your girl's style! :cat:

I took the opportunity to test her while she was out and she's at 12.9.
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Shneaky! ;)

Looking at Lily's readings today, she might be bouncing a little.


Mogs
.
 
Critter Mom said:
It would be interesting to see whether Lily's hiding behaviour might reduce after suspension of the Caninsulin treatment.


Mogs
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Yeah. She's at 17 now and I'm a bit nervous of leaving her without insulin but as she was on 0.2 units and the recommendation is to reduce, I think that doesn't leave her anywhere to go really except to stop. I did some reading and the thought of her little body running out of compensatory resources and going into hypo is dreadful. I could kill her by treating her. Hopefully stopping will at least give her system a rest.
 
I've ordered the new syringes - not really expecting her to have gone into remission. Keen not to give her any more Caninsulin because surely we'll end up in the same cycle.
 
Critter Mom said:
If you do suspend insulin treatment, I'd suggest only doing so for a few days and if numbers start trending upwards go back and discuss it further with the vet.
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Agree 100%

Liz, on your spreadsheet you have "MOVING TO WORLD MMOL TO AVOID CONSTANTLY MULTIPLYING BY 18!" on the US side.

Your spreadsheet should do that converting for you and it's important to keep up with it since most people on the board are in the US. The only time you should have to do the converting is the times you enter something other than just a number in the cell. If you enter 3.4 and nothing else, it should convert automatically to 61, but if you put 3.4 @ 5.5, you would have to do the conversion (and the color coding)
 
Chris & China (GA) said:
Agree 100%

Liz, on your spreadsheet you have "MOVING TO WORLD MMOL TO AVOID CONSTANTLY MULTIPLYING BY 18!" on the US side.

Your spreadsheet should do that converting for you and it's important to keep up with it since most people on the board are in the US. The only time you should have to do the converting is the times you enter something other than just a number in the cell. If you enter 3.4 and nothing else, it should convert automatically to 61, but if you put 3.4 @ 5.5, you would have to do the conversion (and the color coding)
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Critter Mom said:
@Bandit's Mom - FYI, Liz is the other member who seems to have been having a problem with the mmol/L | mg/dL conversions.


Mogs
.
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I think I was just using the wrong (US) sheet initially. Now I put the readings off my meter in the world one and it works without me doing sums. I need to transfer the data from the wrong sheet over but I lost patience.

Lily measured 15.6, 16.9 and 17.1 AMPS. I have put 16.9 in. She's eating now. Will measure in an hour and two hours. Her stomach was not upset at all last night after no Caninsulin. Could be coincidence.
 
Elizabeth20 said:
I think I was just using the wrong (US) sheet initially. Now I put the readings off my meter in the world one and it works without me doing sums. I need to transfer the data from the wrong sheet over but I lost patience.

Lily measured 15.6, 16.9 and 17.1 AMPS. I have put 16.9 in. She's eating now. Will measure in an hour and two hours. Her stomach was not upset at all last night after no Caninsulin. Could be coincidence.
Click to expand...

Oh I just figured out it does them between sheets, sorry for being a bit dim! Will try to update both on the occasions I have something additional in the cell.

She's 16.4 and 17.3 an hour after breakfast although she's still asking for food. Also drinking out of the Christmas tree holder but she did that last year too!
 
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