Dosing advice

Roops

Roops

Member
We have just started home testing Rupie. We are also now feeding him low carb canned cat food, and the recommended Purina Pro Plan OW management kibble - sparingly.

At 2+ hours after his insulin shot (5 units 2x per day) his blood glucose reading was 26.something. At 5+ hours it was 3.6. And at 10+ hours it was 10.9.
We have been allowing him to graze somewhat throughout the day. We do the same at night leaving him some pate, and a few Purina Pro Plan kibble.

My question, do you think it is safe to get him another 5 units of Prozinc in 2+ hours. Or should the dose be lowered slightly.
 
HI there, do you have a spreadsheet we could see? If not, could you set one up and enter the past week or so of data? http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Dosing isn't based on one cycle, and I'm afraid I'm not good at converting between the world numbers and the US numbers. That does sound like a big drop though, and a huge dose, so I really need to see some data before I would be comfortable giving advice.
 
Hi, and welcome! Yes, that does seem like a very big drop and a big dose as well -- thank goodness you have started testing as that is the only way we can keep our cats safe.

Here are instructions for setting up a spreadsheet. (It’s actually very easy. Just follow the steps!)

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Can you give us a bit about Rupe's history? Did he start out on this high a dose, or did he work his way up from something smaller when you starting treating? How long has it been since you started the switch over to low carb wet food? And what was he on before?
 
Assuming the "26" above is 2.6, that would be 47 but if that is really 26 then it was 468. Need to clarify that because the drop to 3.6 (65) from 26 (468) is humungous. 10.9 would be 196. And that makes me think the former assumption is more likely to be the case. Did you get a pre-shot test this AM? If so what was that reading?

The 47 (2.6) on the AT2 meter is WAY WAY too low so dose definitely needs to be lowered. Even the 65 (3.6) is a bit low.

I agree it's difficult to give you any suggestions without some data to look at but given the readings you've provided dose is definitely too high. The question is by how much. Your warning of potential hypoglycemia is a reading of 3.8 on your AT2 meter meaning you need to give Rupie some food to bring BG up when BG gets that low to avoid a symptomatic hypoglycemic episode.
 
Jenna Josie said:
Hi, and welcome! Yes, that does seem like a very big drop and a big dose as well -- thank goodness you have started testing as that is the only way we can keep our cats safe.

Here are instructions for setting up a spreadsheet. (It’s actually very easy. Just follow the steps!)

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Can you give us a bit about Rupe's history? Did he start out on this high a dose, or did he work his way up from something smaller when you starting treating? How long has it been since you started the switch over to low carb wet food? And what was he on before?
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Rupie has been on Prozinc since February. He began low dose. 1 unit, then 2 units, then took a jump to 4 units, finally ending at 5 units 2x per day. We had him to the vet's office on 3 occasions for a blood curve. He hated it, and the trip there. Cried the whole way up, and back and during the time spent there. We decided to test him at home.

He has not been off Whiskas for long. Only a few days. We were feeding him pate as well but found anything fish related had horrid results. Frequently loose stools to the point of it running out of it. I was constantly cleaning his box, and him. Poor soul. He was a sick kitty. We finally decided to try again once more. We are now feeding him Purina Pro Plan OW management kibble, and IAMS grain free pate. But I am afraid the later may be higher in carbs than is desirable. I have some Fancy feast here for him as well as Friskies but want to slowly re-introduce these since he has had the scoots on at least 2 occasions. Never a constipation issue. He does have neuropathy and is being treated daily with Zobaline. We began treating him about a week ago with Zobaline.

I will be working on the spreadsheet soon. My daughter is the one who gives the injections and typically does the blood glucose testing. I shake too much.
 
MrWorfMen's Mom said:
Assuming the "26" above is 2.6, that would be 47 but if that is really 26 then it was 468. Need to clarify that because the drop to 3.6 (65) from 26 (468) is humungous. 10.9 would be 196. And that makes me think the former assumption is more likely to be the case. Did you get a pre-shot test this AM? If so what was that reading?

The 47 (2.6) on the AT2 meter is WAY WAY too low so dose definitely needs to be lowered. Even the 65 (3.6) is a bit low.

I agree it's difficult to give you any suggestions without some data to look at but given the readings you've provided dose is definitely too high. The question is by how much. Your warning of potential hypoglycemia is a reading of 3.8 on your AT2 meter meaning you need to give Rupie some food to bring BG up when BG gets that low to avoid a symptomatic hypoglycemic episode.
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No the 26 (world numbers) was indeed 26 something and not 2.6 (US).

No pre-shot testing. Never were advised by vet or vet tech to do this.

I think we will be giving him 4 and a half units tonight. We don't want to go to low too fast. Guessing he will hit is lowest mark (nadir) sometime between 2-3 (5+ 6+) in the morning. I am a light sleeper. I will be listening for him. We typically carry him upstairs with us and he stays for a few hours before coming down for the night. Every night around 11:30 I hear him coming downstairs. I will very likely get up extra early to be with him. He is very much a people cat and likes company. I typically rise about 4 each morning so it won't be hard for me. We leave food out for both of our cats at night time. Both upstairs and downstairs and of course water.

Seems the more we learn, the more we realize how little we know about this disease.
 
I am not convinced with those numbers today that 4.5u is a big enough reduction. You have changed diet and reduced carb intake despite the kibble still in the picture and that can make a dramatic difference. Also making dose increases of 2u at a time leaves a huge amount of room for missing the best dose. Too much insulin can look like too little and a stressed out cat having curves done at the vets' is a recipe for overdosing.

Given that humungous drop today and the low BG of 3.6 (65 US) you need to lower the dose more than 0.5u. I'm thinking that perhaps taking him back down to 3u which you totally missed might be a good starting point but that is just a wild guess. Has Rupie ever had ketones or DKA? If he has, that further complicates the picture and needs to be a dosing consideration.

It's very important to get a pre-shot test to make sure BG is high enough to give insulin. Without a lot of data we would advise no shot unless BG is over 11mmol (200 US) using a human meter. With an AT2 I would be inclined to raise that cutoff to 225 to 250 until more data is available. Then it is also important to get the mid cycle tests you have been doing to see how low a dose is taking BG. Dosing has to take the mid cycle lows into consideration.

Dealing with feline diabetes can seem complicated in the beginning but I guarantee that it gets easier as you collect more data. Data is your friend and makes this journey so much easier.
 
One other bit of info......some cats can go into a hypoglycemic event without any prior warning symptoms just as humans can. Any excessive demand for food, lethargy, hiding etc. could be a sign but it's possible for kitty to not display any of this and still have low BG. We advise raising doses by 0.25u increments because our kitties are small creatures and tiny dose increases can have significant effect on BG. Increasing doses in such large amounts often slows down rather than speed up the regulation.
 
I am guessing the vet and vet techs did not give you guidance about the need for pre-shot tests because their likely default is that people do not do at home testing on their pets.

Since you say you are "now" feeding Rupie his current diet, keep in mind his insulin needs may change significantly. Peacock's vet had set her dose at 3u when she was living in the shelter, based on curves his office did, and then when I took her in for a curve at his office after I had her on the new at-home diet, he changed the recommended dose to 0.5u. At the shelter where she was before she came home to us, she was fed a diet of mainly canned DM plus some dry DM to snack on (about 1/4 cup daily). Once she came home I experimented almost right away with cutting out the dry DM, and her BG dropped significantly, like in half, across the board. You can see from her spreadsheet, at the top her pre-shot numbers are almost all pink and red (300s and 400s+) and once I changed her diet her pre-shot numbers are almost all blue and yellow (100s and 200s).
 
Peacock said:
I am guessing the vet and vet techs did not give you guidance about the need for pre-shot tests because their likely default is that people do not do at home testing on their pets.

Since you say you are "now" feeding Rupie his current diet, keep in mind his insulin needs may change significantly. Peacock's vet had set her dose at 3u when she was living in the shelter, based on curves his office did, and then when I took her in for a curve at his office after I had her on the new at-home diet, he changed the recommended dose to 0.5u. At the shelter where she was before she came home to us, she was fed a diet of mainly canned DM plus some dry DM to snack on (about 1/4 cup daily). Once she came home I experimented almost right away with cutting out the dry DM, and her BG dropped significantly, like in half, across the board. You can see from her spreadsheet, at the top her pre-shot numbers are almost all pink and red (300s and 400s+) and once I changed her diet her pre-shot numbers are almost all blue and yellow (100s and 200s).
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I checked out the spreadsheet to fill in data. Going to have to sign in to Google to make copies. Will get my son to help me.

We dealt more with the vet tech than an actual vet. Only a few of the vets at this office returned calls. It left a sour taste in our mouth. We were not impressed. We decided to home test simply because having it done at the office was too hard on Roops, and it was becoming too expensive for my daughter. Three tests or blood curves were done at the office. Each one cost about $200. They would have liked us to bring him back for further testing but we decided we were capable of doing it at home. From January to March/April she'd spent over $3K for his care.

The next time my daughter is off work we will do a pre-shot. She leaves fairly early and can't do it on work days. I'd try (have done it before) but I have problems seeing, and I shake. We only use the lancet. Not the pen thingy. I need to learn how to give Roops his insulin shot. At the moment only my daughter can. Yesterday my daughter shared that she thinks he is getting better. Doesn't lie still like he used to to get his ear pricked.

Thank you for sharing your experiences.

btw are there are alternatives for AlphaTrak 2 glucose monitors. I mean other than using AlphaTrak 2 glucose strips. They are rather costly. We live in Canada.
 
MrWorfMen's Mom said:
One other bit of info......some cats can go into a hypoglycemic event without any prior warning symptoms just as humans can. Any excessive demand for food, lethargy, hiding etc. could be a sign but it's possible for kitty to not display any of this and still have low BG. We advise raising doses by 0.25u increments because our kitties are small creatures and tiny dose increases can have significant effect on BG. Increasing doses in such large amounts often slows down rather than speed up the regulation.
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We have wondered since reading several messages on this forum...if he wasn't being overdosed. But when we cut his dosage back, he began to wee a lot. Now with the exclusive of Temptations, Whiskas kibble, and Friskies Turkey and Gravy (all that contraband) we may see better results. How many times per week do they recommend testing at home.

btw he has been gorging at times, sleeping a lot, and hiding recently. But he did this in the past (hiding). Scared the life out of us when we couldn't find him. He was under the couch.

I hope to work on better blood glucose levels, healthier eating habits, and then work on losing a few. He is presently about 18 pounds. I can feel his ribs if I press a bit. Something we couldn't before he was diagnosed. He lost between 5 to 6 pounds before he was diagnosed. His fur felt terrible and he was becoming quite bony for him. Not quite certain what is a good weight for him. I am thinking about 15-16 pounds or less.
 
MrWorfMen's Mom said:
I am not convinced with those numbers today that 4.5u is a big enough reduction. You have changed diet and reduced carb intake despite the kibble still in the picture and that can make a dramatic difference. Also making dose increases of 2u at a time leaves a huge amount of room for missing the best dose. Too much insulin can look like too little and a stressed out cat having curves done at the vets' is a recipe for overdosing.

Given that humungous drop today and the low BG of 3.6 (65 US) you need to lower the dose more than 0.5u. I'm thinking that perhaps taking him back down to 3u which you totally missed might be a good starting point but that is just a wild guess. Has Rupie ever had ketones or DKA? If he has, that further complicates the picture and needs to be a dosing consideration.

It's very important to get a pre-shot test to make sure BG is high enough to give insulin. Without a lot of data we would advise no shot unless BG is over 11mmol (200 US) using a human meter. With an AT2 I would be inclined to raise that cutoff to 225 to 250 until more data is available. Then it is also important to get the mid cycle tests you have been doing to see how low a dose is taking BG. Dosing has to take the mid cycle lows into consideration.

Dealing with feline diabetes can seem complicated in the beginning but I guarantee that it gets easier as you collect more data. Data is your friend and makes this journey so much easier.
Click to expand...


Roops was tested for ketones when he was first brought in. No ketones. The vet suspected diabetes from the get go. Before blood results or further testing done.

I think it was one of the vets at the office that decided to jump his insulin from 2 to 4 units because he was not responding well on 2. They never seemed to take into consideration the stress of traveling, being at the office, seeing all those strange animals...let alone strange people. And then being touched and poked. He also had digestive problems during one of he blood curves. The vet tech said stress could have brought it on. we were given Fortiflora.
 
Just for your info did a pre-shot today. We were curious. Done 11+ hours after his insulin shot last night. Given 4.5 units then, not normal 5. Had kibble this morning, as well as chicken pate. 28.7 this morning. High as it was yesterday morning 2 hours after insulin shot. Will maybe make more sense as we continue testing him.

Do cats sometimes need a higher dose in the morning, and a lower dose at night.
 
Many if not most cats go lower during the night cycle. Not sure why...maybe it's the lack of stimulating activity during the night compared with the day. In the early days as you work to get a cat regulated, it's better to stick with one dose for several cycles to see how the dose is working. Changing doses frequently only serves to muddy the waters and make it much harder to determine what the ideal dose is for kitty. Once a cat is regulated, in a few cases, a slightly lower dose at night may work.

Not surprised by that 28.7 this AM given the massive drop in BG yesterday. It's probably a bounce which is a natural phenomenon caused when BG drops fast, drops to levels kitty has become unaccustomed to or drops too low. Bounces can last for several cycles and do not indicate the need for a dose increase. If the dose is too high, bounces are often that much more pronounced.
 
Thanks for sharing. We will keep him at his normal dose for a while unless the blood glucose test indicates he should miss a dose.
Good to know bounces can last for several cycles. Never knew that.
Wondering if kitties are like people and experience the pre-dawn phenomenon.
Pretty sure we will be needing more glucose strips. 50 doesn't last long when you are testing several times a day.
 
Roops said:
Wondering if kitties are like people and experience the pre-dawn phenomenon.
Click to expand...
It's possible as is Somogyi effect but the veterinary community doesn't seem to often if ever comment on the lower night cycle BG or higher AM pre-shots. I often wonder if that is because research is usually done during daylight hours. We the 24/7 hour caregivers who home test on the other hand, see this a lot.

Roops said:
50 doesn't last long when you are testing several times a day
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No they don't and those AT2 strips are costly enough in the US but double the price here which is why so many folks switch over to a human meter. :)
 
I've been trying to find a cheaper place to buy his strips. All seem to be around the same price. $100 for 50. Not cheap.
 
You might try posting out on Main. I know there are a number of folks from Canada here - someone might have suggestions for you on how to save money on the strips.
 
Cheapest I found was at the Pet Pharmacy in Vaughan. Their current price is $92.68 for 50 strips but then there is tax on top of that which is an added cost not applicable to human meter use. I was lucky as I could go pick up my order there. I think delivery is about $14.
 
After 3 months I recently switched to a human meter, and I wish I had done it sooner. I am now spending just under $10 per 50 strips, making it much more manageable. My plan is to hold on to the pet kit so I can to a monthly curve with pet numbers, to substitute for the vets office curve, and use the human kit for daily insulin management, as well as a shadow-curve to run concurrently with that monthly curve (just so I can get used to what both sets of numbers mean)
 
Unfortunately, while our insulin is far less expensive than yours in the US, we don't get any bargains on test strips here. Cheapest here is $40 for 100 strips but the caveat is that the meter takes a larger blood sample than ideal and the strips are only available online so unless you spend $200+, there is a delivery charge. Retail, I think the cheapest strips are about $80 for 100.
 
Yikes. At those prices it's almost worth a drive to that WalMart just across the border in Michigan! We could start a FD smuggling ring and y'all could drive down some insulin, and we could drive up some meters and test strips! :rolleyes::smuggrin::p:stop:
 
Yes, we discussed doing the smuggling ring thing with cat food back when my girl was still being a stubborn kibble addict.
I thought about making the drive to Niagara Falls (about 1.25 hours drive for me) for food but found out our Border folks think cat food is a contraband substance (security risk :woot:) unless you have the cat that will eat the food with you. Menace doesn't like the car! :blackeye::woot: Diabetic supplies would be a lot easier to get across. I know Wendy (Wendy & Neko) did it all the time out in BC).
 
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