Doing it wrong? Exhausted bean - update: vet unhappy w me

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stacia

stacia

Member Since 2014
Less about feline health, more about bean health.

Since we started Tasha's insulin injections a week ago, I feel like I'm 24/7 poking/stabbing/checking the cat. And to be clear, I'll do whatever it takes for kitty's health. That's #1 and our goal here is remission if at all possible, not just regulation.

But... I'm exhausted. I wake up each day at 6am, test, inject, feed. Sometimes I nap (a perk of working from home/being my own boss), we go through the whole thing again for her PM routine at 6pm, then I'm up until around midnight by the time she's had her +5 evening test and dinner. We have to stay up while kitties eat because we have two cats and otherwise there's fighting, we don't know who ate what, food gets left out and she may end up chowing down just prior to her AMPS, etc.

I'm getting at most 6 hours of sleep each night, which my body is saying isn't enough. I've been fighting the urge to fall asleep again since 7:30a today. I spent almost all day Saturday asleep, waking up to various alarms just to stick Tasha's ears.

Is all this testing necessary (please see spreadsheet)? Am I overdoing it? Am I a wimp? Are you all as tired as I am? Am I missing some simple answer with scheduling or something? Please save my health/sanity. Husband is trying to get up to speed on injections/testing but he's not always here (work travel) and I'm a bit of control freak (can I let him do it on his own?).
 
Re: Doing it wrong? Exhausted bean

The most important tests are preshots. BTW, nice blue number this am! The nadir number is also valuable as it tells you how the insulin is working - how low it takes her. Those three numbers help guide you with dosing.

But you need a life and you definitely need sleep. That nighttime test is not imperative every night - every couple of cycles is plenty. The most valuable time to have it is if she is high in the morning - then you want to know if she dipped low overnight and bounced up. But Tasha seems to be on a nice even keel with no bouncing I can see so, if I were you, I'd try sleeping through the nights for awhile. :mrgreen:

Would an automatic feeder help with the night feeding? Maybe two since you have two cats? You can set them so they close 2 hours before the am test, so food isn't an issue. No way to have her eat alone at night? On top of the dryer while the other cat eats below or?

If 6 am is too early, move it up an hour. There are no magic times, just what works for you - as long as they are 12 hours apart.

You might have Hubby test and shoot while you watch until you are confident he is doing it right. It is really nice to have someone to share it with.
 
Re: Doing it wrong? Exhausted bean

it's a lot of work in the beginning but it does get more routine.
I think you are doing fine on the testing...the one thing I would change is a little more randomness. The nadir can move around, it doesn't necessarily stay in the same place.
go for the +2 or +3 at night and then get a +9 or +10 every once in a while....

I was expecting your ss to be littered with color/tests like you were testing every hour ..... :lol:
 
Re: Doing it wrong? Exhausted bean

Thank you for the reassurance. I'm trying to let husband do more on his own. Right after we started last week, he was gone for 2 entire days. Yesterday morning, Tasha was so squirmy, I ended up having to take over the injection. Today, I actually did as you suggested, just supervising. But she threw that "nice blue number" you complimented, Sue, and I actually panicked - thanks for the reminder to update her chart - and insisted we retest after 20 to make sure she was rising before we shot, considered a lowered dose, etc...

Maybe what I'll do is test earlier in the evenings, instead of +5,as Rhiannon has suggested. Get some more areas covered on the spreadsheet. I'm not a morning person but I wouldn't mind 6am if I wasn't also doing midnight. Feeders could also be an option.

Ok, thanks. Great suggestions. I'm just so overwhelmed by it all, easily panicked, and now so tired I feel like I can't keep my head straight. There's reading I want to do, I pm'd someone here for info on a local vet and haven't even been able to follow up on that. I'm just a mess and I have to get it under control. And today, I have to call my sort of unhelpful "no reason to test at home, blindly shoot 2u/2x day" vet about refusing to bring Tasha in for an in-office curve. Not that their office seems to remember they sent me home last week w/ a diabetic cat - they never called to follow-up or anything. Sigh... Thank goodness for FDMB.
 
Re: Doing it wrong? Exhausted bean

Maybe it will help to remember the regulated range we are "shooting" for first - mid 200s at preshot (-30 points for your AlphaTrak) and double digits at nadir, but not below 40(around 70 on the AT). Once you get to that range, then you start thinking about a lower preshot (which you got this am) and lower nadirs (hopefully a nice double digit today). Her numbers are in a safe range and very encouraging one. The only time you start to worry is if you see one near that 70 range and below. And then, you just feed to raise it.

Maybe it'd be helpful to have a game plan (printed off so you can refer to it) for a low number if it comes. And you may never have to use it.

So 80 or so (AT) give her a little snack of regular low carb and check again in 30 minutes. You want to see that she is rising. You only feed a small amount so she will hopefully eat later if you need her to, to raise a number.

70 and below, give her a little gravy off a higher carb food. 30 minutes and retest. Once she is in this range, you want 3 rising numbers before you stop testing.

If she continues to drop, either mix a little honey in with the gravy or rub some on her gums.

During this time, you can post and get reassurance and advice.(be sure to mention you are using the AT) The vast majority of cats who are in lower ranges respond to food and come back up. When people are testing and know what to do, we seldom see an actual dangerous hypo, just a drop into lower ranges for awhile.
 
Re: Doing it wrong? Exhausted bean

Sue - we're not on an Alphatrak. We're using a ReliOn. But yeah, I think having a game plan would be great for both me and my husband. He'd feel a lot more confident doing it on his own, not that he can't wake me, for sure. And then I have something to follow as well when I'm uncertain. But I could add that to her supply box, along with the "in case of hypo emergency" sheet.
 
Re: Doing it wrong? Exhausted bean

Such dedication!

Something that I do - and it works for me because it is easy for me to go back to sleep, is sometimes I get up around her plus 6 and test her, and then go back to sleep. Is something like that doable for you?

Is 6 and 6 ideal for you? If it's not - change it!

I do noon and midnight (well, 1215) and it is, frankly, perfect for me. I'm usually home around 630 or 7 so I can easily get an evening number.

Moving your schedule might be something to think about - especially since you work from home!
 
Re: Doing it wrong? Exhausted bean

My husband really thought 6a/6p would be ideal as far as leaving our days/evenings free but I'm finding it to be a nightmare for me. I'm seriously almost non-functional the last 4 or 5 days. I would rather, as you said, set a 2am alarm to get up and test if necessary, and go back to sleep. This just isn't working.

Waiting on a call back from the vet about that in-office curve. The vet tech I spoke to freaked out. "You're testing her yourself? At home? You have a spreadsheet?" They may have sounded less surprised if I had told them I had been abducted by little green men. They'll have to talk to the vet and have her call me back.
 
Re: Doing it wrong? Exhausted bean

I have never done a "for information" nighttime BG. I only did a few when MurrFee vomited up everything about two hours after eating and dosing.
Af first with a new cat you have to frequently test more often (in between shots) to see what is going on so you determine the best does. After that only preshot BGs and occasional mid-cycle BG are required.

A little over a month ago I adopted two already diabetic cats, Badjar and Dulce. Dulce was not not being treated and is doing well on 0.8 units Lantus twice daily. I am now only testing preshot. Badger is not doing as well. I can't get consistent BGs. Thus I may testing between shots.
 
Re: Doing it wrong? Exhausted bean

I'm sorry - replying to 2 people at the same time, Hannah. ohmygod_smile Try this game plan instead:

So 50 or so, give her a little snack of regular low carb and check again in 30 minutes. You want to see that she is rising. You only feed a small amount so she will hopefully eat later if you need her to, to raise a number.

40 and below, give her a little gravy off a higher carb food. 30 minutes and retest. Once she is in this range, you want 3 rising numbers before you stop testing.

If she continues to drop, either mix a little honey in with the gravy or rub some on her gums.

During this time, you can post and get reassurance and advice. The vast majority of cats who are in lower ranges respond to food and come back up. When people are testing and know what to do, we seldom see an actual dangerous hypo, just a drop into lower ranges for awhile.
 
Re: Doing it wrong? Exhausted bean

Thanks. You amazing Wizards are forgiven some confusion here and there. :)

I think we'll stop the "FYI" nighttime checks unless we're fiddling with dose or she's acting weird.

And to add to my exhaustion (updating title of thread), I've just been chewed by the vet for, among other things:
- lowering her dose to "almost nothing", especially without talking to her
- using syringes that don't go with her insulin (I'm using u100 w/ u40 PZI, "we can't compare apples to apples - what conversion chart?")
- "home testing can be helpful but no point in doing it so often when we don't know when cats eat" (yes, I do) and that affects it (i account for this)

She agreed to let me do the curve at home. Said I should do it every 2-4 hours for a cycle. I told her I'm giving .4u (you can't measure that small!) but using a u100 syringe and it broke her head completely. She doesn't understand the idea of the conversion chart at all, insists I go back to the u40 syringes and should be giving a minimum of 1u despite having a spreadsheet of numbers to support my dosing. "You have a friend?" "You have a conversion chart?" Thank Ceiling Cat I didn't tell her I had an internet message board...

I've been thinking an increase may be in order but based on my SS. Not based on "I told you 2u and you went rogue!"

Is a second opinion in order? How do I know the second vet is going to be any less, umm, like this? This just increased my stress ten-fold. Now what?
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

If she will learn, I'd say you could work with her. But, I can't believe that she can't see that 2 units would be a dangerous dose. The best argument we usually have for testing at home is that we wouldn't give our 2 legged children insulin without testing their blood glucose levels first. So we treat our 4 legged children the same way.

If she will let you continue giving your numbers to her (sounds like she is okay with a home curve) and will agree to disagree about dosing (she isn't around when you draw up the insulin), you may be able to use her for vacines and insulin. Hopefully in a short while, you'll be able to show her your spreadsheet and Tashia will be in remission and she will listen to success. Lots of people here don't consult their vets about diabetes, just the things they can't do at home.

She can't make you give more insulin or stop home testing

If you want to look for a new vet, start a new thread with your city and state to see if anyone knows an FD vet near you
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

While I agree that basically agreeing to disagree with the vet re: FD is an option... do know that there ARE actually decent vets out there that actually understand FD. The vet who diagnosed Tink was exactly like the one you're describing. FD is expensive - in a cat this old, euthanasia is recommended. (It's expensive because they wanted to see him in the office a couple times a month for a curve!) No need to home test, just shoot blindly and bring to the office for a curve in a couple weeks. Feed high carb prescription kibble that you can only buy here. What? You got info from the INTERNET? You can't believe everything you hear on the internet! Oh... and if I wanted him to "research" (ie. read the published veterinary article on FD that I provided to him) I'd have to pay for his time to do so.

Luckily, I tried another vet that I've always heard great things about. I LOVE THEM. They KNOW diabetes. When I talk, the vet listens. He knows nobody knows my animals as well as I do. His response when I showed him my SS was "wow... this is great! WOW!" (yup, that's 2 "wows" in one sentence). He encourages home testing and didn't even check BG in the office because I had such "great records". He KNOWS that I know what I'm talking about and he actually listens to me. It's amazing. I never thought I'd find a vet like that, but I did. I'm sure in some areas this may not be the case... but definitely look around. Call around and ask how knowledgable the vets are about FD. Granted, I'm sure many will say they are when they aren't... but ask if they support low-carb wet diet and home testing. If they do... well, at least that's a start. If they dont... I'd say keep looking.
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

Yeah, we stopped talking to a vet about my cat's FD because of a similar reaction. They actually encouraged home testing, but then when I started making changes based on my own research and getting markedly better results pretty much immediately after months of rotten numbers, the office wasn't happy. It seriously seemed like they thought I might be a witch or something, even though I offered to pass on the links to the veterinary journal articles that my methods were based on. Anyway, we decided to just stop mentioning it and that went better for everyone.

We ended up moving to a new vet anyway because the office was too disorganized and we never got follow-up on things, but the FD interactions definitely added to that choice in the long-run.

Who has the list of vet interview questions in their signature? I know I referenced that when we were looking for a new vet.
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

Also remember your cat is more than a glucose number. See my signature link Secondary Monitoring Tools for some other assessments you can make to evaluate how your cat is doing - like playing, purring, and grooming.
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

You are all amazing. I'll be back to read more thoroughly and respond later. I have to get away from the house briefly (really briefly - Tasha's due for PMPS in just over an hour) before I burst.
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

stacia said:
I'm getting at most 6 hours of sleep each night, which my body is saying isn't enough. I've been fighting the urge to fall asleep again since 7:30a today ... Are you all as tired as I am?
Click to expand...
Can't speak for anyone else but I'm in the same boat as you on the exhaustion front, Stacia. It's the night-time cycles at low numbers that really freak me out.

Sending waves of empathy your way.

Edit:

I'm conscious that my vets may think I'm bonkers for testing Saoirse's BG more than other clients do their pets'. I'm very conscious of it at the moment now that Saoirse has been moved onto Lantus. She has only been on it for a week (on TR protocol). I really wish I didn't have to prick her ears at all but I live alone, I need to get some sleep myself in order to make sure I can look after her and I need to know that she will be safe while I sleep. It's a rotten but necessary catch-22. Her numbers are quite low and I need to learn how her body is responding to the insulin in order to protect her.
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

Ok, back from a bit of a breather. I got wild and crazy, went out to purchase more testing strips and cat food. Yeah...

Thank you so much for the reassurance that I'm NOT out of my mind and that the vet isn't necessarily in the right. She isn't necessarily 100% completely in the wrong either, but regardless, I could tell she was feeling very defensive by her remarks. And when I get defensive like that, it's usually for a reason. (Hey, I don't liked being questioned either in my field of expertise!)

I'm going to look over the interview questions and definitely the secondary monitoring tools. Those both sound promising for where we are right now.

And of course since I've promised to do an in-home curve and send the vet my spreadsheet? Tasha's decided "hey, let's prove that my HORRIBLE bean is withholding my necessary insulin by giving her a PMPS of 280 tonight!" Highest we've seen from her. We went up to .50, in part to placate the vet but moreso because I was considering it anyways (actually, I may have gone to .6u).

Critter Mom - I'm glad I'm not the only one. Tasha's lower overnight and the idea of her seizing and needing my help while I'm upstairs asleep freaks me out. Zzzzzs to both of us! We did her injection at about 7:30 tonight. I plan to shoot a +3 and unless there's funny business, I want to be in bed by 11.
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

It loks like her shot this am was 7 am and the one tonight 7:25. If that's right, it can certainly explain why she might be a little higher? It's only 20 points hogher than last night - not a big deal.
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

Thank you, Sue, you're right. She DOES run higher in the evening. It's just she was so low this morning, it was a shock. Plus, it's the closest she's been to 300 since we started and my own stress is running high. I should add a column for my own BP next to her BG. Plus (embarrassment), I left dirty dishes in the sink and it's possible she was caught licking the frying pan late in the afternoon. Could something so simple contribute? Silly kitty.

Mama needs a drink. Daddy-bean is taking the +3 and I'm going to bed early. We'll do a curve tomorrow on .5u unless we have any huge surprises in the morning.
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

280 PMPS to a +3 of 164? That seems like strong movement for her... Feeding now, planning to set an alarm and check in 2 hours unless someone chimes in soon with another opinion. We've only ever measured at +2 and +5 so I don't know if this is normal or not. Will check back in before I actually call it a night.

So much for that 8 hours of sleep for the bean. Really, .1u increase? What are you doing, kitty?
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

Nice drop - maybe a little fast. Maybe get one more test and leave out food for her?
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

Both kitties just chowsd and are sleeping. I'm going to set an alarm for two hours and check her then. Most likely I won't sleep in the meantime and will end up on the sofa nearer to her anyways. Haha, I thought I might sleep.
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

MIdnight oil's burning over here, too, Stacia. :smile:
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

Sigh, another high (for her) number this morning. She's determined now to make me look bad to the vet. At least I got more sleep last night - with a 2am alarm just to make sure she was still breathing and acting ok.
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

Not a "high" number - just a few points higher than usual. A high number is in the 400-500 range, like she was on dry food at the vet the first day. If you were giving the original dose of 2 units on this AM number, she would mostly likely crash midcycle.

I would hold the .5 (that is the other positive - that is still a tiny amount of insulin) for a few cycles to give it some time to work - unless you get a low number.

Really, she is doing GREAT! Nice numbers on a small dose. Very safe ranges. We think the renal threshold (the range where the pancreas can heal) is 270/250 and below, and the more time cats spend below the renal threshold, the better. She seems to be below the renal threshold most of the time.

I don't know that we ever got your name?
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

I'm Stacia. And thanks - I'm very grateful that Tasha's numbers are staying in a relatively low/safe area. We've never seen her over 300 other than the vet's initial number, never seen her near the hypo range. I'm just such a black and white, patterns, and "I did this so why didn't she do that" kind of person that sometimes her spreadsheet makes me a little bonkers. Tasha's oblivious - just moved from her early morning nap spot to her mid-morning nap spot, happy as a clam.
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

The whole having to wake up early even on weekends was the worst part for me!
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

Keep in mind that glucose control is multifactorial, so it isn't just if A, then B.
Activity level, food batches, other medical issues, activity levels, stress, and more may play a part in what happens.
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

At least the vet seems to be coming around and working with us. But she (the vet) is kind of slow to respond so we're going to up Tasha's dose tomorrow. I'm not happy with how long numbers have been this high and I'm tired of waiting on the vet to weigh in.
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

You might shoot a sliding scale - one unit if she is above 300, .5 if she is in the 200s. She definitely drops but she has room to go into some green nadirs.
 
Re: Doing it wrong? Exhausted bean - update: vet unhappy w m

I think I'll probably go with the shooting scale. This morning, she was only at 165 at AMPS so I retested half an hour later. I had expected her to be through the roof due to stress (she has long hair and had a poo incident that required scissors and some sink-cleaning). She's really all over the place. Sliding scale may be the best situation with her. I'm sure the vet will have a fit but at this point, I don't even know how much I care. I did Tasha's curve on Tuesday, sent it around 8pm that night and I realize the vet has Wednesday off (though not sure given the holiday) but here it is Friday and I haven't heard back. This diabetes thing is trying my patience enough without waiting THAT long to hear back from the vet.

I appreciate the continued support. She's such a puzzle to me. Always has been so no reason this should be any different.
 
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