? Dosing Questions.

Hi all!

Hula has been on insulin about a month now and we have slowly been increasing his dose. It is my instinct to increase again to 1.75, but I wanted to check in and get your thoughts. His numbers at Preshot are still really high. They are higher in AM than PM typically. I have added a bit of pumpkin into his food as he has been having some constipation issues. This has helped, but I wondered how it would affect his BG. He has been getting a tablespoon or so throughout the day.

I know sometimes too much insulin can look like not enough. That is why I wanted to check in with you guys. Is it possible to need a different dose in PM than AM?

Thanks!
Stephanie

 

Is that 515 for real? That seems odd....any ideas what happened?

I think the increase is a good idea, but make sure you are really monitoring for the first three or four cycles because Hula looks close to greens to me (and possibly hit one already which might have caused that 515 if you don't know of another cause). You don't need to be doing full curves, but get a couple of tests anytime between +6 and +8 since it looks like he has a slightly later nadir.

As for the pumpkin, I would pull that back to a 1/2t or so. You'll often read on here that pumpkin doesn't raise BG, but that's under the assumption that you're giving just a tiny bit. It is high in fiber, but also high in carbs. It's part of what makes so many of our cats love eating it! I can give Sam up to a teaspoon without any noticeable difference, but if I give him that much for a few days in a row, or if he gets more than that, his numbers start to creep up. 1/2t seems to be enough to get him moving without raising his BG. You'll have to experiment a little to find what works for Hula.

and yes, some cats need different AM/PM doses, but I don't recommend doing that until you're getting nadirs down in the 50's to 80's and you're fine tuning the dose.

 

That 515 got me a little freaked too. But just an hour and a half later he was back down to 300s. I thought it might have just been a misread on my meter. I don’t know if you can get a bad strip or if it was a huge bounce. He doesn’t eat as much food at night so I don’t think it was a food issue.

I will back off on the pumpkin a bit as well. Are there any other suggestions for constipation. I think he is getting plenty of water. My prior vet mentioned Miralax at one time.

 

There are times when a strip reads wrong. It's sometimes worth doing a second test when you get a strange number, but in this case I think it was fine to just move on. If it pops up like that again we can think about what to do.

 

I believe some people use miralax for constipation. I've used egg yolk powder...it doesn't bulk up the poop but is supposed to help with motility.

 

This morning Hula popped up with a 509 again. This was 1 hr before shot time instead of the two. I plan on testing him again in a few minutes just to make sure. I did not increase the dose yet. I knew I would be in and out and unable to monitor and I wanted to see how he did with less pumpkin on this dose because, when I went to 1.5 was when I started adding the pumpkin. I feel like I need to investigate the number. So I am thinking of getting up and checking in the later part of the cycle tonight to see if I can see how low he is going. I may have to do this a couple of nights to see because he didn't have that high number yesterday morning.

I Just checked again and it was 507.

Thanks so much for your help!

 

I will look into this as well if the reduced pumpkin isn't giving results.
Thanks!

 

I used slippery elm bark powder for kitty's constipation and it worked really quickly, even better than pumpkin. And i only used tiny amount, 1/16th teaspoon. He is a very fussy eater and he didnt taste it. I researched and found out about slippery elm bark for constipation and the dose. My kitty was very blocked up and it showed on his xray.

 

Here for the past couple of days, he has not dropped below 200s. He also had those jumps to the 500s. Could another issue be going on, or could my insulin already be going bad?

 

I'd continue the 1.75 u dose for tonight and tomorrow. If you don't see lower numbers try 2.0 u on Wednesday. How old is your insulin? It should be good for at least 4 months.

 

My insulin is only about 1 month old. I will do as you suggested and increase again on Wed.

 

Does Hula have any dental problems that you know of? Did the vet do a full exam when he relapsed in April?

 

He had a dental back in December. (After that was when he quit eating for days and had a bout of pancreatitis). He is beginning to have some tartar buildup again, but the vet didn’t think it was that bad again yet. We also did a full blood panel, urine. And although some numbers were elevated, he wasn’t overly concerned about the ones that were. Most were only slightly elevated.

 

Hi there! Suddenly, Hula has been giving me good numbers mid cycle. I did not increase him yesterday as discussed. I wanted to get another days data at that dose and I wanted to ask questions today.
He is getting down to 70s at his nadir for the past 2 days.(daytime data only). He is back up to 300s Preshot. Do I still increase? Those numbers seem to be getting low and I am super nervous about going hypo. Will the increase lower those further? How do we get Preshot numbers lower when those Nadirs are so low already? Do some cats just behave this way?
Thanks for all the help and questions answered! I don’t necessarily feel like a total newbie but there is still so much I don’t know yet.

 

No dose increase - those are lovely greens. Some cats will have PSs that slowly come down as the nadirs stay in greens but some always have a dramatic flair that gives a deep curve. In that case, focus almost solely on the nadirs to assess the dose. If you get a nadir lower than 60+ after a very much higher PS, I'd consider reducing by 0.25 u. Those monster drops are hard on them.

 

Stephanie - getting the PS numbers down can be a little bit of a dance on Prozinc - a little bit forward, a little bit back. Some cats, you just keep watching those mid-cycle numbers, and as long as they stay green, you keep the dose, and watch and wait, and the longer they spend in good mid-cycle numbers, the more they heal, and eventually the numbers start to come down.

Other cats, you can increase a smidge and the mid-cycles stay the same, but you get longer duration, and that brings the PS numbers down. That is a little riskier because cats have different responses to Prozinc. Some will get that longer duration, others will just send the mid-cycles too low. My kitty gets better duration, but I've watched plenty of spreadsheets that the kitty goes diving. So it's the kind of thing that you have to understand there is a little risk, be able and willing to monitor more closely for awhile, and be prepared to intervene with some food if needed.

Since this is Hula's second diagnosis, it's often recommended to be a bit more aggressive than the first time around, because the pancreas is more resistant to healing. However, because he just got his first real run of greens, I don't know that I'd start pushing it just yet. Give him some time and see what happens - if they start coming down on their own in the next week or so, then you can just keep doing what you're doing.

 

I thought I would check in again with you all. Hula is keeping me on my toes!he had that great run of greens and now it has been every other day with good numbers. The other day he has stayed flat. I don’t want to keep him at too low a dose for too long but on his good days, he is giving me great numbers. I will check him today as I have kept him on the same dose. I don’t think there have been fur shots either, I think they were all good.
I just wanted to lean on your expertise and experience. He is just confusing me! Just when I think we have it, he switches it up on me.

 

Sam spent a couple of months with his cycles going: good - bad - bad - good - bad - bad....over and over.

He may be ready for a fat 1.75u or a skinny 2u, but before you raise the dose, I would recommend getting some night cycle numbers. It's possible that there's more going on there that might be impacting some of the daytime numbers. I know it's really hard to get tests during the PM cycle. If you can, you can keep the testing supplies by the bed and set an alarm to wake up, grab a test, and go back to sleep. Or anytime you get up to use the restroom during the night, grab a test. Or shift your shot time so you can at least get a +3 or +3.5 before you go to bed.

 

I got a couple numbers last night at about +3.5 hrs and then +5.5. Not a lot of movement. It makes me question my shot. But I can feel it going in. I am going to be more aware of that just in case that is the issue. And I will try to get more numbers tonight. When I wake up to do it I feel all cross eyed It’s tough to get blood.
I can try shifting his shot time a bit too. It got pushed later because my kiddos have sports late in the night and I kept going later on the shot so I just moved it later. How many minutes can I shift it safely at shot time?

 

Prozinc has up to an hour of flexibility for most cats (it depends on how long it's lasting for Hula), but we've found that the more consistent you can be, the better.

As for the "fur shot" (when the insulin doesn't go in), the amount of liquid in the syringe is so small that it can easily hide in their fur. One trick is to make sure you part the fur and see the needle enter skin. Another thing is to stick your nose in his fur and sniff. Insulin has a smell like band-aids. Once you've smelled it, you can't miss it. It's pretty strong.

And I can definitely relate to the cross-eyed feeling during the night. I moved Sam's shot time early, so I wake up super early, just to avoid having to wake up at night to test. It's nearly impossible for me to wake up. I usually just get a test before bed unless something seems really off, or if Sam wakes me up himself during the night (he's pretty good at letting me know when he's too low).

 

I got a few data points at night. I can get some more this weekend. I did give him a “fat” 1.75 this morning. I will be able to watch him pretty closely today. Hope this was the right call. I so appreciate all the help! This is a delicate dance.