Dosing advice

Heather and Gizmo

Heather and Gizmo

Member
I need dosing advice. I just did a BG reading on Gizmo, because I feed him at 6:30 and shoot at 7 pm. His BG readings is 190. I am celebrating the number, but I don't know if I still give him his insulin or not. Do I give him a lower dose? Any advice you can give me would be appreciated.
 
Well, at some point you have to experiment with giving a full dose on a lower PS. Why not tonight? Get a +2 test to see what's going on.
 
I am so nervous that he is going to go hypo. Is honey okay instead of Karo syrup? I just want to make sure I have everything I need before I give him the insulin shot.
 
Heather and Gizmo said:
I am so nervous that he is going to go hypo. Is honey okay instead of Karo syrup? I just want to make sure I have everything I need before I give him the insulin shot.
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Yes, honey is fine. If you're very nervous about trying the full dose you could drop it back to 2.25 u for your own peace of mind.
 
This is nerve racking. I have been praying for this kind of preshot number and now i am so nervous giving it. I did another BG reading at 6:45. I use both the freestyle insulinx and the alphatrak 2 strips. i used them both this time and got 194 with the insulinx and 216 with the alphatrak 2 so the number went up a smidge in a half an hour. If i go back to the 2.25u will this mess his numbers up for the next few cycles? How nervous were you the first time you gave a full shot at this number?
 
Heather and Gizmo said:
This is nerve racking. I have been praying for this kind of preshot number and now i am so nervous giving it. I did another BG reading at 6:45. I use both the freestyle insulinx and the alphatrak 2 strips. i used them both this time and got 194 with the insulinx and 216 with the alphatrak 2 so the number went up a smidge in a half an hour. If i go back to the 2.25u will this mess his numbers up for the next few cycles? How nervous were you the first time you gave a full shot at this number?
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No 2.25 u won't mess him up much and might make you feel better. I was nervous giving a full dose on a lower PS at the start too. Once Teasel was on Lantus I had to learn to give a full dose on a dark green PS. That was scary! After a few times you get used to it. ;) If you look at my SS you'll see that it happens often but I'm so accustomed to it that it doesn't bother me too much. I make a point of getting a test at +2 or +3 afterward though. I'm able to do it because I know Teasel's patterns. The way I learned them was by trying those scary experiments.
 
I just want to make sure that I do everything correct if he does go hypo. I give him honey which is temporary, so I would need to give him his high carb food. Do you suggest dry food or is a high carb wet food okay. I used to feed him the FF grilled, which is somewhere around 15 carbs per 3oz can. Is there anything that i am missing.
 
Heather and Gizmo said:
I just want to make sure that I do everything correct if he does go hypo. I give him honey which is temporary, so I would need to give him his high carb food. Do you suggest dry food or is a high carb wet food okay. I used to feed him the FF grilled, which is somewhere around 15 carbs per 3oz can. Is there anything that i am missing.
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If he's the same or higher at +2 you won't likely have to feed snacks to prop up BG. If he's significantly lower, feed a few tsp of regular low carb food and test again at +3. If he keeps dropping and gets near 68, feed higher carb snacks like the FF grilled. Post here for help.
 
Heather and Gizmo said:
What does the "F" and the "S" stand for before the dose on Teasel's SS?
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F = "fat" dose - a drop more than
s = "skinny" dose = a drop less than

These micro adjustments are done to fine tune the dose once you find the good range. They work if your kitty is very insulin sensitive and 0.25 u changes are too much. Teasel is like that.
 
Yes they are an amazing bunch!! I also would suggest if that happens again and you have a half hour before you shoot after he eats- get another test right at shot time to see if he goes up from a food spike Just a thought. If you know he’s heading up you may feel better giving the full dose
 
Well, his numbers went up at +2 by 170. He is a grazer and he had just eaten some of this low carb wet food about 15 min before i tested him again. I am assuming that this is from the food. Would i be correct in my assumption?
 
Heather and Gizmo said:
Well, his numbers went up at +2 by 170. He is a grazer and he had just eaten some of this low carb wet food about 15 min before i tested him again. I am assuming that this is from the food. Would i be correct in my assumption?
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Could be food or the onset of a bounce from the blues. I think you can relax tonight.
 
Great job with your first blue shot!!! Those are scary until you see what your cat will do. What you saw last night was that your AM shot got a longer duration than normal which gave you the lower PMPS. Then by +14 (14 hours after the AM shot), the insulin had worn off, the new shot hadn't quite kicked in, and so you got the 364.

Having cycles where the duration lasts past the +12 mark is exactly what you want - that's how the PS numbers start to come down - when you start to overlap the doses like that. Some cats are nice and consistent and start to let you do that more and more often. Others are pretty inconsistent and you'll see all variety of PS numbers. That's why we rely more on the nadir numbers to decide on appropriate doses.

Anyway....you did great last night! :bighug:
 
Thank you to all of you. Of course Gizmo is going to be the inconsistent one. Just when I think we are getting him out of those 300's he goes right back to them. Thanks Djamila for explaining what I need to look at when my numbers go from 194 to 364 in a way I have not seen yet. This makes sense. What would all of you advise on his PM dosage? Should I hold at 2.5U or increase by .25u?
 
Heather and Gizmo said:
Thank you to all of you. Of course Gizmo is going to be the inconsistent one. Just when I think we are getting him out of those 300's he goes right back to them. Thanks Djamila for explaining what I need to look at when my numbers go from 194 to 364 in a way I have not seen yet. This makes sense. What would all of you advise on his PM dosage? Should I hold at 2.5U or increase by .25u?
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You could try 2.75 u and make sure to get a +2 afterward.
 
I am going to bump him up. I miss those blue numbers. How long did it take all of you to get your kitties regulated? I am not only a control freak, but I want everything to happen now. This disease is going to teach me some patience one way or another.
 
Heather and Gizmo said:
I am going to bump him up. I miss those blue numbers. How long did it take all of you to get your kitties regulated? I am not only a control freak, but I want everything to happen now. This disease is going to teach me some patience one way or another.
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Teasel is barely what I'd call regulated now. He was diagnosed over 3 years ago. :confused:
 
Yes, it's time to bring out your patience pants. We all have closets full of them. ;) If you scroll down your spreadsheet, you can see that the blue numbers are becoming more frequent. You still have a ways to go, but he's making progress. Hang in there!
 
Is it normal to take years to get cats regulated or is Teasel one of the stubborn ones? Thank you Djamila. As long as those patience pants come in blue and dark green, I will be glad to wear them. I spoke with Gizmo's vet tonight, because I wanted to see about getting a dental done on Gizmo. I had emailed him his spreadsheet on Monday to see if he felt that Gizmo could get it done or if we should wait. He feels we should wait until he is more regulated. Which I am okay with. He wants me to keep Gizmo at 2.5 u for the next week and see where we are at with his numbers. I sent the spreadsheet before I increased to 2.75u. Have any of you went against what the vet wants and if so, how did you deal with it? He doesn't feel I need to do as many BG tests as well. He said I should do less and go more by his clinical signs. Along with control freak and impatience, I hate confrontation, but I guess I am going to have to put my big girls pants on now and do what I feel is best for Gizmo. I am going to run out of closet space with all these new pants.
 
The kitties are worth it though. I have a couple of people at work that think i am crazy. They think i should just let him go and put him to sleep. I told them it is not an option. FD is something that i can manage and would never even consider not taking care of him. They give you an unconditional love that you can't get from any human, so why wouldn't we give them that same unconditional love.
 
Heather and Gizmo said:
The kitties are worth it though. I have a couple of people at work that think i am crazy. They think i should just let him go and put him to sleep. I told them it is not an option. FD is something that i can manage and would never even consider not taking care of him. They give you an unconditional love that you can't get from any human, so why wouldn't we give them that same unconditional love.
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Hear! Hear! :smuggrin:
 
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Here are some patience pants for you -- and a few ideas of how to keep yourself entertained while waiting for Gizmo to find his way to regulated. ;)
 
(It's a gif, but sometimes it gets stuck on the last picture for some reason)

Anyway...about the vet - It's okay not to tell them everything. It's also okay to play dumb sometimes. Like with the dose for example. If he asks why you're at 2.75, just look blankly at him and say "I thought that's what you told me to give him" :rolleyes:

And if he doesn't want you to test so much, just don't show him the spreadsheet. My vet never really looked at it very closely anyway, so now I just tell him something like this: "Sam has been around XXX at PS's, and his low numbers are around XX" That's really all the vet needs to know anyway.

You could take a more direct approach and just explain to him that while you appreciate and value his partnership, you feel more comfortable taking the lead on the dosing decisions since you are with Gizmo every day. That you want his feedback, of course, and hope that you can be collaborative in managing his diabetes.

As for the dental, is there a known issue with his teeth? Or it's just time for a cleaning? Vets don't seem to know or believe this, but there is a very clear connection between dental health and BG numbers. So if there is a known issue, it may be difficult to get him regulated until after his teeth are taken care of. So it might be important to push for the dental to happen sooner and not try to wait. If it's just a regular cleaning, then it's probably fine to wait a little bit.
 
More testing is good, but your vet may be right in that clinical signs are important not to ignore! Alex isn't really regulated and still spends a lot of time in the high numbers, but even getting him down to good numbers for half the day/night has dramatically improved his condition. He's running and jumping and purring again rather than hiding. He's put on weight, his coat is healthier, he's not drinking all the time or acting like he's starving. Numbers are good but don't get fixated on them so much that you end up missing the tangible improvements in his quality of life, since that's the real goal is to make them feel better and get back to their old selves.
 
I am celebrating Gizmo's first dark green number!!!! Whoo hoo!! We got an 85 at + 5.25. I love the pants! They look like a good pair to do a little celebrating in! In the spirit of positive thinking, what dose of insulin should I give him if he is in the low 100"s at the AMPS? I know it may not work out that way, but I want to be prepared if it does. I work during the day so I will not be at home to do a +2 BG reading. I come home at lunch, which I can take anywhere from 11 am to 2 pm. I should have asked this last night so that I know you all would get it before 7 am tomorrow.

Thank you Djamila on the suggestions on how to deal with the vet. You gave me two great ways to handle it. I will not know which one i will end up doing until I am face to face with the vet.

I have noticed some red gums around a couple of Gizmo's teeth. I am ashamed to say that I have never had a dental done on him because of fear. My previous kitty, Norma Jean, had a dental done and two days later I had to put her down. She had developed some fluid around her lungs and could not breathe due to it. She was 16.5 years old and the vet never did any kind of pretesting to see if she had any conditions that would be affected by the anesthesia. The vet said there was nothing they could do for her and suggested having her put down. I cried for two weeks straight.

Thank you Asiina for reminding me to celebrate the improved clinical signs. Gizmo has not had any real clinical signs since i took him off dry food on 12/21/18. He has not been drinking, eating, urinating excessively since then. His weight has been maintaining at 16.5 lbs for several weeks. Gizmo's biggest issue is his high numbers.

Has any of your kitties gotten more tired at the low numbers at first? Gizmo sleeps through out the night when his numbers are lower. He usually wakes me up at least once at night. He seems to be more himself when he is in the 200's. Maybe he just needs to learn how to live at the low numbers again. Any thoughts?

Ok. Off to bed i go. Thanks again to everyone for the advice, kind words and positive thinking.
 
Yes to many kitties feeling tired or "off" when they first get to healthy low numbers. Dental issues can make regulation difficult and can also be a risk factor in ketone development if kitty isn't eating well, etc.
 
Yay for a green!! This morning's higher PS is probably a bounce from him not used to being in the good numbers, but hopefully he'll clear it soon and, once he has some more of those numbers, he'll get used to them and his little body won't overreact, leading to better and better PS numbers and a smaller range of BGs overall.

As for shooting on blues . . . I'm only *just* now getting comfortable with that, but for what it's worth, it helps me if I know that she's on her way up, so sometimes (if I get a "feeling" she's going to be low), I'll test 30 mins or an hour early. Then when I test at the actual time, and the number is up, I'll go ahead and shoot the full dose. In those circumstances, I'm comfortable shooting as low as the 140s (on a human meter), but it took me a long time -- and experimentation: shooting/monitoring in the 190s, then the 180s, etc etc -- to get to this point with my nerves!
 
Yay for green! That's so exciting!!! As for the dental, I can't even imagine going through that, and it's no wonder you hesitate to take Gizmo in! I really hope you have a different vet now? For what it's worth, diabetic cats tend to need more dental care than most, and we have lots and lots of cats around here who come through better off than before.

Jenna gave you some good advice about working into shooting on lower numbers. It's a process. And as Kris said, feeling a little extra tired with the green numbers is pretty normal. It takes some time to get used to those again.
 
Thank you to all of you for celebrating with me. Jenna already answered my next question of why his number was so high this morning. I gave him his regular dose this morning. I don't know what to expect and I am at work. I will be going home at lunch to check on him. I am always weary that he will end up hypo because his numbers fluctuate from such highs to lows.

Gizmo is not eating as much as he was before. He was eating about three and a half cans of fancy feast in a 24 hour period. Which I thought was a normal amount until I read some post the their kitties only get about 2 cans a day. I would say he is eating about 2 to 2 1/2 cans a day now. Does this sound right to all of you? I have been adding more water to the food. I checked for dehydration and he is good there.

It is good to know the information on the dental. The vet I have now is a new vet. I will not take Gizmo to the previous one anymore. I voiced my concern to the vet last night about the anesthesia and he was comforting to let me know that they monitor the kitties very carefully during the process and will wake the kitty up and forget about the dental if there is any indication that the kitty is in trouble. Also, he mentioned that once the dental is done, that we would need to watch his numbers more carefully since they may go down once it is done. So it is nice to know that he is telling me a lot of what all of you are advising me of. It makes me more confident in his knowledge. I let him know that he ketones have been negative. He asked if I was testing for sugar in his urine. Do any of you test for sugar at home? I am going to look for some strips to do this and was wondering if any of you can lead me in the right direction.

I am in need of a new order of insulin syringes. Where is a good place to order them online? I could get them through my vet but they are expensive since they don't offer them without the sharps container.
 
That amount of food does sound about right to me. He's probably less hungry because he's getting better regulated. Most cats appetite drops as they get into better numbers and feel better.

I've never checked the urine for sugar. I think he means the same thing as checking BG through blood, but urine testing is less specific and not really useful if you're testing blood.

As for syringes, I know you can order from Chewy and ADW, but I don't have good info on that since it's been years since I needed any myself!
 
Sam and Atty are both about 12 pounds, and at this time of the year, not super active. When they were eating canned food, they would eat about 2.5 cans of FF/day each, plus treats. It's so great that your vet knew that the numbers might come down. I think Sam had three dentals with the follow-up improvement before my vet started to believe me!
 
Gizmo is holding at 16.5 lbs, He was 19.2 lbs before diagnosis of diabetes. He has not lost anymore weight though, even though he needs to. I am not sure how much food he should be eating to lose the weight slowly. Do any of you know what the calorie intake should be for his weight? He is not super hungry today. I will check his ketones when I get home from work to make sure that is still negative. I know that Rachel mentioned that the decrease could be from better regulation.

Kris thanks for the link for the syringes. I am assuming they need a prescription for the syringes. Do you know if they request the script or do I need to get it and send it to them?
 
I think if you search for calorie calculator out on main, or look through the stickies on the Lantus forum, you might be able to find something. or just post on Main and ask. I don't know how to calculate them myself, but I know I've read threads about it in the past. And yes, food intake does go down as they get better regulated.

As for the syringes, not all states require prescriptions for syringes. Mine doesn't. If yours does, I would suggest contacting ADW and asking them how they process that. I'm sure they have a way to do it.
 
I am not sure if I should post a new thread for this or not. Gizmo just had a very aggressive episode with me. He does this sometimes when we are playing, but we were not in play mode. I kept walking backwards away from him and he just followed me around with his tail thrashing and meowing aggressively. I had to call my husband in to distract him to break the aggression. My husband thought it was because I was backing away from him and he wanted me to stop, so I sat down on the couch and he attached my arm. Then he was all lovey dovey to my husband and that is not normal. Once he calmed down to where I could touch him again (around 5 min) I did a BG reading and he is at 453. Why has his numbers been crawling up all day? Why the aggressive behavior? He has been this high before. I imagine part of the high reading is from his aggressive behavior. Could he have been to low only after an hour after his insulin shot? I have never seen him act this way before.
 
And just before this incident he was really hyper and running around, he sat in the window for a little bit and then came and got me out of bed. He was fine. He went to the back door like he normally does, he used to be an indoor/outdoor cat so he thinks if he sits there long enough he will be let out, I went to pick him up as normal and that is when he started. He urinated after this so i checked his ketones and they are negative. Now he is back to the normal diabetic kitty. He did eat a quite a bit of food just before this too. I don't know if any of this information is significant or not, but I figured I give you as much detail as possible.
 
I'm so sorry that happened! I have a kitty who used to be aggressive quite often, and still has moments when he forgets he's "tame" now ;). It sounds like he might have been mad that he didn't get to go outside. Any chance you could leash train him so he could still go outside? I never thought I'd be able to do it with Sam, but now he's really great on the leash! For now, I'd just keep lovin' on him and remind him that attacking mama is never okay! :bighug:
 
He never initiates play with aggressive behaviour. This is totally uncharacteristic of him. One minute he was racing all over the place, the next he was calm and then the aggression. He is so used to not going out now. He has not been allowed outside for a couple of years. I will take him out while holding him about once a day. I was going to do this with him when i tried to pick him up but that is when the aggression started. i am really baffled by this.
 
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