First Time Poster: Please Check Nicky's SS

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Luann and Nicky

Luann and Nicky

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Hello Everyone,

I have been lurking here ever since Nicky my 3 yr old male cat was diagnosed with diabetes on 01-Jul-2015. I created a spreadsheet (see attached). I am very fortunate that Nicky does not mind ear pricks for glucose testing. I have been testing him quite a bit. All 3 of my cats were free fed on dry food. As soon as he was diagnosed, I put him on wet food but the other remained on dry. About 2 weeks ago, I totally took the dry food away, because I caught Nicky eating some. My other cats are not happy. I suppose I eventually will get them all on wet food. On some weekends I travel about 3 to 4 hours to my vacation home. Now that Nicky is diabetic, I take him with me. He is getting used to the drive and does not seem stressed. The dates in red are the dates I am at my vacation home. Interestingly, he seems to go lower when he is away from the other cats. Looking at his SS, I am trying to find a pattern. I am not sure if he is bouncing or if he needs a longer acting insulin. I have just sent the SS to my vet to see what she thinks. Nicky has never had a symptomatic hypo but I did feed him gravy on 3 occasions, when I thought he was to low.

I should also say that he is active, no more hind limb issues and is urinating much less. I only tested him for ketones once and he was negative. I have a hard time catching him in the litter box. Sorry for the long post. Would you please take a look at Nicky's SS to see if there is anything more I can do. I really want him regulated. Thank you for your help!!

-Luann

PS, I will try to get a picture uploaded soon.
 
Welcome LuAnn,

I can't access Nicky's spreadsheet. I think you need to go back to your signature and put

Nicky's SS [\url]

Also be sure you have checked that you are sharing the spreadsheet with "anyone with the link"
 
Hello,

Sorry about that, I updated my signature and shared the SS. I hope it now works. I am technically challenged sometimes <g>.

Sincerely,

-Luann
 
Now it works! Yes, he is bouncing all over. You have gotten some great nadirs and then he has bounced. A couple ideas:

1) maybe your 2.5 is the best dose. I think I'd leave him there for a few cycles and see. (As long as your pre shot isn't too low or he doesn't drop below 50) He seems like he might be a kitty who takes a while to settle into the dose. Often it doesn't work to shoot a higher dose into a bounce. It really doesn't work if it follows a low nadir because most likely you'll get another low nadir. Any dose that gives you under 50 deserves a reduction, even if he bounces high for the next pre shot.

2). The insulin is working - a little too well at times. Now it's a matter of fine tuning the dose.

3). What are you feeding?

Have you seen the protocol we put together for ProZinc? It is in my signature in blue.
 
HI Su,

Thanks for responding. I am feeding Nicky FF turkey giblet feast and occasionally salmon feast. I have seen the protocol. When initially diagnosed, the vet had him at 1unit. We then went to 2 and then to 3. I backed off from 3 when he was low at the pre shot. I think I was reacting to the high numbers and not the nadirs. I will dose at 2.5 now as you suggest. I will learn.

Sincerely,

-Luann
 
Hello Luann and Nicky. Wow you have done a great job in testing. It really give you a great picture of how NIcky is handling the insulin. You also have done a great job in catching those low numbers and appropriately gave him the higher carb food. You can tell that overall, his numbers have improved just in the past couple of weeks. Just to make sure, you do not want Nicky to eat two hours before your pre-shot test in the AM and PM.
 
Hello,

Last night I was totally unable to dose Nicky due to a late work commitment. This is the first time I was not able to be home to dose Nicky or even feed him. So I put out the dry EVO kitten and turkey food for the cats and hoped for the best When I got home about +5 of what should have been his cycle, I tested him and he was 504. I did not dose him. This morning at around 6 am he was 473. I dosed him at 3U this morning. I will pick up some 100U syringes so I can accurately dose him at 2.5U.

Cindi, I do now make sure he has not eaten 2 hours prior to pre-shot test. At the beginning that may not have been true because my other cats were free feeding dry food. I placed their food where I thought Nicky would not be able to get to but I did catch him eating it. Now they do not free feed They all have a set amount of time to eat their food then it is taken away.

I currently live alone and have a very crazy work schedule. This was bound to happen sooner than later and will most likely happen again. Right now I do not have any backup to give the shot. All of my cats are very shy around other people and hide when they come in the house. Hopefully this does not set us back to far. Any additional advice?

You know, I have never been much of a poster on forums, but at least in this instance, it does make me feel better to talk/write about it to people who understand. Thank you!!

Sincerely,

-Luann
 
Have you considered getting a timed feeder? If you live alone with a crazy work schedule (and trust me...I totally get that!!!) a timed feeder might be helpful. People here often recommend the PetSafe 5 I think. You can let it move to an empty compartment when it's 2 hours prior to shot time. And if you're going to be away at night so you can't be home to feed, it might help since you can provide food at normal dinner time.

Just a thought. I've never used a timed feeder, but I really want one, even without sugar cats in the house...just to be able to provide food at night if I can't get home at normal time!
 
Luann, everyone misses a shot sometime or another - schedule or a fur shot. You have a life in addition to being a mom to a sugar cat! You'll get back on track. I'd suggest going back to your last best dose this morning, even if he is super high. (I think we were suggesting 2.5). His number this am will be high because his last shot was 24 hours ago so it is bound to be higher, but I'd still stick with the lower dose.

You'll get him back on track. Yes, this is a great place to get encouragement and to see that you are definitely not alone - everyone is going through the same issues. We are a friendly but small group. If you ever have an emergency or need an answer immediately, post here and on Health, where there may be more eyes.
 
Hello,

Yes, I have considered a timed feeder but I have 3 cats and am not sure how that would work. I would have to get 3 of them and hope they don't steal from each other. I thought putting out the EVO dry food which is supposed to be low in carbohydrates would work. When I was able to test Nicky last night his glucose was 506 at about +6 (midnight), if I dosed him at his typical time (6 pm). This morning (6:00 am) he was 473 which is a typical value for him in the am. I will check him again when I get home from work today. I was able to get some 100 U syringes so I will dose him at 2.5 tonight. thank you all for your encouragement.

Sincerely,

-Luann
 
Hello,

Please take a look at Nicky's SS. He was at 251 for his AMPS which is good but low for him. I know I was going to dose him at 2.5 for a couple of cycles, but I think that is to high. I need to leave for work really soon and will not be able to test him during the day, so I dosed him at 1.5U. Do you think that will be ok? Do you think I need to make arrangements and come home for lunch to test him at around +5 or +6. I may be able to do that. Geez, it seems that the missed shot seems to have been a good thing? I will be home with Nicky for the next 3 days so I can monitor him but just not today.

Sincerely,

-Luann

Yes, I have the conversion chart. Just to confirm giving him 2 U with a U-40 syringe, means I need to draw to 5 Units on a 100 U. For some reason the math seems backward to me. I need to think about it more. Math was never my strong suit.
 
What a nice number. Your dose sounds fine, Luann, especially if you can't monitor. This sugar dance early on is all about gathering data. So, if 1.5 is too little for a 251, next time you'll try a 2. If it works, fine, you'll know that. I am glad you'll be home awhile so you can gather the data and fine tune his dose.

Yes, it'd be 5 on the U100. Seems like a lot, but when you get it into the smaller syringe, it will look like the same amount as you have been giving. Be sure you are using the U100s that measure by 0.5

Here is something BJ posted about the conversion. She is much better at math than I am.

U-100 means 100 units per mL
U-40 means 40 units per mL; the concentration is 40% of U-100

To get a percentage of something, you can multiply by that
Ex 40% of 100 = 0.4 * 100 = 40
Ex 40% of 1 = 0.4 * 1 = 0.4

So each mark on a U-100 syringe would be multiplied by 0.4 to get the U-40 dose it is measuring.
0.5 * 0.4 = 0.2 units of U-40
1.0 * 0.4 = 0.4 units of U-40
1.5 * 0.4 = 0.6 units of U-40
2.0 * 0.4 = 0.8 units of U-40
2.5 * 0.4 = 1.0 units of U-40
 
Hi Sue,

Are the U-100 syringes that measure by 0.5 the 1/2 ml syringes?

Also would you please look at Nicky's SS. He was low this morning so I wasn't sure how to dose him. I dosed him at 2.5 last night when his PMS was 418 and he dropped over 50%. Yesterday morning, with a AMPS of 251 (similar to today's number) and a dose of 1.5, it looks like he bounced. So this morning I dosed at 2U. I am not good at this fine tuning of doses. I know I need to stick with one dose. Fortunately, I will be able to test him today to see he goes. Any advice is appreciated. Thank you!!

Sincerely,

-Luann
 
Glad you got on the gravy. As it is early in the cycle, you'll need to watch him. If the gravy wears off, he might drop again. It would be nice if you don't have To give him anything other than the regular low carb to keep his levels even. Then you are less likely to get a big bounce tonight.

I don't blame you on the challenging dosing. I would have thought 2 would have been good today, looking at last night's evening cycle. All I can think is that he had a low yesterday during the day, that the pmps was a bounce and he is still clearing that bounce today. I'd suggest we back off a bit and maybe err on the side of dosing lower than we think he might need and see what he does. So even 1 on a yellow preshot (making the assumption that 1.5 might have given you a low yesterday) might be good, until you see what he is doing.

The bad news is that he is getting hard to predict; the good news is that he is hard to predict because he is dropping into lower ranges.
 
He is going up. He is now 65. I will keep watching him. Fortunately, I am home today and the weekend, so I will be able to pretty much constantly watch him. If he is in the hello at PMPS, I will dose him at 1U but my fear is he will be red like last night. Then what do I do?

-Luann
 
. So, what if we knew that yesterday, the 1.5 gave him a couple greens in that cycle. Then we'd know that the 1.5 on that yellow preshot brought him in the greens and caused a bounce. So we'd think, 1.5 caused a bounce last night And some lows during the cycle, so we don't want that again. With the yellow today, let's drop a smidge.

It's one of the reasons this sugar dance is so challenging. Yes, the preshot is important, but so is the lowest number in the cycle. And when you can't get those (which lots of people can't because they aren't home during the day) you make guesses. And they aren't always right. But every cycle gives you information you can use the next few cycles.
 
So, if he is red tonight - and it is likely he will be, you could probably give him 2 units. Bounces are very hard to decipher and they are different in every cat. Tucker, a ProZinc cat, seems to bounce several cycles after a low - not usual. Some cats will continue to bounce if you shoot what would seem to be a logical higher dose into the bounce red. Some cats do okay shooting a higher dose into the bounce preshot and clear the bounce. Although we have little to go on, Nicky might be a cat that you can "shoot" the bounce - in other words, give more on a red preshot even though it is a bounce - because he drops back down the next cycle. Time will tell.
 
Hi, Luann & Sue - I agree with Sue: Luann, you might want to err on the side of caution re: dosing. I'm wondering if you shouldn't try, say 1.25 (?) & hold that for a few cycles, unless he's climbing up in the reds?

It may be that a couple of things factor in here. (Took me so long to respond because I was making myself a list - 8/4 to now - of preshot #s, doses & total food amounts/day):

1) There's been a fair amount of dose shifting going on - is possible he is sensitive to sudden dose changes, AND ...
2) He's had a significant change in amount of food daily since the period from 8/4-8/6 (a high of 12.5 oz/day) to now (down @ 5.oz/day past few days). So we're talking more than a 50% redux in rations in about a week.

It's a good thing to reduce his food amount to be in line with his own ideal weight. But if we think of the food as "fuel in the fire" and also consider that he's had multiple dose adjustments while the amount of fuel in the fire has been significantly cut ... well, is possible that this could factor into some of the bouncing we're seeing. Maybe should try keeping both insulin and daily ration at a consistent level. Just a thought ...

Luann, can you tell me what he weighs right now & what his optimum weight is? As then we'll have a better idea of the amount he should eat daily.
 
Yes, Robin. I think you have great insights on the food issue and think it is a big part of the picture that people miss.

I agree the dosing has been all over. We thought a reduction to a 2.5 would be a plan, but he has had some cycles when he has really unexpectedly dropped, so Luann is having to adjust more than we had hoped. Good news, bad news....
 
Yeah, is really, really frustrating when this happens ... Luann, can you give me a weight on Nicky?
 
Luann - And can you please note your local time (time of actual test) when you provide next test # (just so I know). As the time stamps on these posts confuse the heck out of me!
 
Luann and Nicky said:
All 3 of my cats were free fed on dry food. As soon as he was diagnosed, I put him on wet food but the other remained on dry. About 2 weeks ago, I totally took the dry food away, because I caught Nicky eating some. My other cats are not happy. I suppose I eventually will get them all on wet food. The dates in red are the dates I am at my vacation home. Interestingly, he seems to go lower when he is away from the other cats. Looking at his SS, I am trying to find a pattern.
Click to expand...
I have a question in regards to your [edited by me] first post above (just trying to help figure this out...):

As you'd noted he tends to go lower when not around the other cats, are you 100% positive that Nicky is not getting into the other cats rations at any time now?
If he needs to be fed in a separate room - and kept there until the others finish their meals (meaning they eat on same schedule as Nicky, even if they don't like that) - I highly recommend you handle in this way, even if it's a hassle. Because unless you have eyeballs in the back of your head;), is awfully hard to catch a determined diabetic kitty when he sneaks a bite out of somebody else's food dish.:rolleyes:
 
First of all, thank you both for helping me out with this. I do not have scale but the last time Nicky was at the vet he weighed just under 10 pounds. The vet does not want him going over 10 pounds. She also told me she wants him to have between 210 and 260 calories a day. I have been feeding Nicky FF classic either the savory salmon feast or turkey and giblet feast. I have been letting him eat until he stopped. I usually weigh the amount he has eaten, but I see that I have not been that diligent in recording the weight in his spreadsheet. For the last several days he has been eating from 2-3 1/2 oz each feeding. I was actually surprised this morning when he ate 5.25 oz. I think he now may actually weigh more than 10 pounds. I will need to get a scale and I will start giving him a fixed amount of food at each feeding. Maybe 3 1/2 or 4 oz. each feeding.

Here are his glucose numbers today. I didn't test him at 1 or 2 hours and was shocked when he was at 52 at +3. As you can see I monitored him closely but didn't give him gravy until he was under 50. I should probably should have given him gravy earlier but I was hoping he would start rising. I should have known that would not happen because it was so early in his cycle. Sue was with me all the way. Thank you!! I am on the east coast so my times are eastern standard time. I also had a mistype in one of my glucose values above. I said 65 when it should have been 45. Sorry for any confusion.

AMPS - (5:31 am) - 249
Dosed - 6:00 am
+3 (9:00 am) - 52
+3.25 (9.17 am) - 50
+3.50 (9:34 am) - 36 - gave 1/3 of can of grilled FF turkey feast in gravy
+4 (9:58) - 45
+4.25 (10:18 am) - 70
+5 (11:00 am) - 115
+6 (12:06 pm) - 295

I am certain that he is not getting into any of the other cats dry food because they only have access to it when Nicky is in the bathroom behind a closed door eating his wet food. I take the dry food away once Nicky finishes eating and he leaves the bathroom. They are no longer free feeding (they are not happy about this). As I initially said, I was not doing this initially. But since the last week of July, I am confident Nicky has not been getting any other food other than the FF I have been giving him.

As you can now see his +6 number is 295. I think he will be really high tonight.that is what happened the last 2 times I had to give him gravy (7/28 and 8/6). He went high red and black. Again thanks for you help and advice. Please let me know if you need any additional information.

Sincerely,

-Luann
 
Luann:
VERY IMPORTANT QUESTION:
What ml syringe are you using? Please go look.
Does it say 3/10cc or...?

I fear you may be using the much larger barrelled SYRINGES.
 
Recently my pharmacy have me U100's that were the wrong CAPACITY.
We dose here with the 3/10 ml. Not the other much larger dose that you reference to in post above #19
 
I am still using the 1/2 cc insulin syringe for U-40 Insulin. I got a pack of U-100 insulin syringes 1 ml, but the conversion was confusing me so I have not yet used them. I was just asking about the 1/2U100s.
 
Ok, so you're still using the U40 syringes right now, is that correct?

And that's good because if your U100 syringes that you bought do NOT read on the package:
"capacity 3/10mL (cc)" then you have the wrong U100 syringes and cannot use those. If you plan to switch to U100s using the conversion table, the U100s you need are the 3/10mL capacity - very important!
 
Yes, I am still using the U-40 syringes right now. I wanted to switch to the u-100 syringes to get more precise dosing since I am fine tuning Nicky's dose, but the u-100s that I got just did not seem right. I guess my instinct was right on this one. Thank you all for your concern and help with this.

I guess you can see by Nicky's SS that he is rising. He is now 366 at +7.5. What should I do about this evening dose?????
 
Incidentally, pharmacy staff will often assume the U100 syringes are for human use (and the larger-capacity U100s are typically used for people) - most of them don't realize that we need that 3/10mL(cc) capacity for feline use. It's a common mistake; has happened to others here - including Brenda (Tucker&Me) who posted to you above.
 
This one's kind of a tough call ... If he's in the reds by shot time, you could just try holding steady @ 2U (as Sue had suggested earlier). You can monitor tonight, is that right? Or you might even drop it down just a bit - say, to 1.75U - if you're worried about him going too low & can't monitor.

I think what you're trying to find out now is where's the sweet-spot as far as dosage is concerned. And one of my concerns is that too large a dosage shift (as in a full unit, yesterday) may be what's hard for his system to handle. Your thoughts?
 
You're hangin' in there just fine, btw! Luann, I know how frustrating:banghead: & confusing:confused: this sort of thing can be.
Don't worry, he'll start straightening out for you before much longer. It's just hard on you when it's going on. :bighug::bighug::bighug:
 
Hello,

Again, thank you all for helping me with this. I am so thankful you guys are here. I will be here tonight as well as the next 2 days to monitor him closely. I think I will stay at 2U and see what happens. and be more gradual when changing doses. I will get the appropriate 100U syringes (3/10 cc capacity U-100) to be better able to fine tune his dose.

SIncerley,

-Luann
 
Sounds good, Luann! (Make sure you check the bag when they give you the right syringes: once they gave me the 3/10 capacity ... and when I got home, I saw that they weren't marked on the half-unit:banghead:. Isn't it interesting, all this stuff we have to keep track of when we have a diabetic cat?:p)
 
You know the irony of all of this is that for the last 10 years I have been working for Novo Nordisk, the company that makes Levemir. I work in the clinical trial group and spend much of my time working with human diabetic clinical trials. Now that I have a diabetic cat, I am realizing how much I don't know <g>.
 
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