Help adjusting Tasha's dose w/ < 200 BG readings

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stacia

stacia

Member Since 2014
First, I have to thank dirtybirdsoaps for giving me the reassurance I needed yesterday to decrease the vet's prescribed dose. I think I could have a very sick/dead cat this morning otherwise.

Her spreadsheet is below w/ all numbers.

Tasha just started insulin yesterday. The vet prescribed 2u of PZI based on a BG of 427 taken a week previously on a dry food diet. This despite me changing Tasha to 100% Friskies pate in the meantime. (Yes, I know. Grr.) I'll skip other GRR except to say her plan was "go home, inject 2u every 12 hours, come back in a week for an in-office curve."

Based on BG numbers throughout the day and the experience of the aforementioned dirtybirdsoaps, I gave her 1u at 9:30p (BG 222). At 2:30a, she was 107 and I gave her half a can of food. Now at 9:30a, her PMPS was only 181 so I don't want to shoot.

So two questions.

1. "Don't shoot under 200." So I wait an hour and retest. Then shoot what? Another 1u? My syringes don't go lower than that.

2. My girl is HUNGRY. She's telling me all about it, singing me the (angry) songs of her people. But I shouldn't feed her until she's had her insulin, right?

Thanks, this stuff seems complicated. Is it always going to be so complicated?
 
Re: Help adjusting Tasha's dose w/ low BG readings

An hour later, 168 and still screaming for food. I thought for sure her number would be going up. So I'm feeding her. I don't know what to do about the insulin.
 
Hello Stacia! While I dont normally give dose advice, I think you would be ok to skip this shot, being under 200 and not rising! Since she has dropped after 1 hour, and you have already fed her , then you might just want to get another test in an hour to see where shes headed. If she is still low or lower, I would feed a wee bit more and retest again in an hour. If she goes below 50, then you will need to put up a post for advice, but also remember if you cant get a reply, please feed a little high carb gravy if she does go below 50 at any time! Hopefully someone else will reply soon as well.
 
I wouldn't shoot unless she is sure heading up. If you take another test and she is still dropping, I'd skip and we'll figure out tonight later. (You can always shoot earlier if you skip) If she has risen, and is over 200, how about one unit and monitor.
 
An hour after eating, she's finally over 200. Barely (218). My syringes only do full units. I'll do what needs to be done but ideally we'd like to be at more of a 6a/6p schedule and she's pushing us at 12a/12p at the moment (she's such an obstinate kitty). So w/ the limitations of my syringes (and me as a newbie), what's best for kitty at this point? I plan to dose her once my husband's off the phone, unless you think I could watch her and wait until 6? I really just want the best for Tasha above all else, Destination Remission is the goal.

And thank you for the ProZinc link. I need to explore the subforum some more. I'm so overwhelmed in the last week. Especially now that we're actually doing it. BG testing is going rough. We've had some hard tests.
 
if the test was more than 20 minutes after she ate, it's possible that food raised the number. If it's while she ate, it is likely to more of a true number (not food influenced) I am not sure what you mean about your schedule - how long is it until you would ideally shoot (to get back to a schedule you want?)

It is scary when they are in the higher ranges -300 and above - but generally those are safer than the low numbers. So for new diabetics, we tend to err on the side of caution. If your ideal schedule will be before less than 12 hours after her regular shot time this am, I think I would skip until then. She may be high for the evening shot because she will have been without insulin for a number of hours, but I would still reduce the dose. Depending on where she is, maybe one unit or 1.5 if you can monitor at night.

Does that make sense?
 
That totally makes sense. I realized I didn't put how long after she ate that I did the test and edited my post while you were probably typing. The test was an hour after she ate. Her last shot was at 9p, she just registered 218 at 12p, we'd LIKE to go for 6p, so another 5.5 hours. One of us (me or husband) will be home during that time to watch her. And I'm willing to get up with her at night if necessary. My husband has an early flight tomorrow so I think he'll be up around 4am anyways.
 
So I would plan to shoot at whatever time tonight you want her schedule to be, going forward. If you tell me in terms of +hours from now, I'll try to be around. (We are in different time zones)

Since you are new to this sugar dance, and she recently changed foods, I think I might restart at one unit. It is so much easier to increase the insulin every few cycles if needed (you tell by your testing) than try to figure out how much to reduce a dose.
 
Thank you so much, I would appreciate that! It will be in +5.5 hrs from now and I'll plan on giving her 1u at that time. Meanwhile, I think naps for everyone.
 
Good job with the home testing. Looks to be going smoothly. Yup, I'd definitely skip this mornings dose and start fresh this evening at what every time you plan on having her schedule. 1 unit seems to be a good number....and look to Sue and Oliver for great advice. Everyone on this forum has loads of knowledge but most of the info I have gathered about prozinc and dosage was from her. She was a great help in getting Hidey in remission. Also, if it comes to you needing to do 0.5 units, you can eye ball it or get different syringes. I got different ones right before Hidey went into remission.....figures by time they got here he didnt need them and I'm definitely NOT complaining lol.
 
I would love nothing more than to waste money on supplies we don't need because Tasha the Stubborn has decided it's a good time to go into remission.
 
After skipping Tasha's morning dose, completely, now at the +21hr mark, her BG is 279. Do I give her a full 1u now like I had planned? She was 222 at her PMPS last night (1u), which is what's brought us here now.

Thanks, vet, for telling us to blindly shoot 2u every 12 hours. That seems like it would've been a brilliant idea.
 
I would reduce more. One unit lasted a long time and gave you an unshootable amps. Can you eyeball 1/2 unit? One way to do it is to draw up one unit of water and let it out drop by drop counting the drops. Then draw up the insulin to that one unit mark and count out half that number. What is left in the syringe should be half a unit. Or try to eyeball 1/2 of that one unit line.

And I'd plan to get a test around +2 to be sure she is not headed down too fast and then maybe one midcycle.

It looks like you will need some new syringes that measure small doses. The food seems to be really making a difference. You can use U100 1/2 unit syringes to measure amounts like .2 units using the conversion chart.
 
Thanks so much, Sue. We just eyeballed 1/2u and will look into getting the other syringes. It was my husband's first time injecting her and it went well - the only catch was that it was such a small push on the syringe, he wasn't sure he had actually done it. But I'll test her at +2 and +5 before bed to see where her numbers are and maybe she's just going to be a low dose kitty? I would be OK with that.
 
While you wait on getting the syringes, a ruler with fine markings may be used as a reference for the level you shoot, even if it doesn't measure the volume exactly - ex. less than 0.5 units, 0.3 mm on the ruler.
 
Great tip about the ruler! I may do that until the weekend if we keep her at the .5. I'm so slammed with work and cat-care, I'm not sure I'm going to be able to track down syringes until then, especially with an out-of-town husband for a couple of days.

+2 she's at 246, down from PMPS of 279 (plus she ate w/ her PMPS). I'll check her again at +5, then her mama needs some zzzs as long as she's behaving.

You guys are seriously the best.
 
Down to 200 even at +5. By comparison, we were at 107 last night on twice the dose. Interested to see where we are at AMPS. If anyone has any ideas, I'm very open to hearing them. Her spreadsheet is up-to-date in my signature. Time for kitty dinner and people sleeps.
 
Give PZI a couple of 12 hour cycles to settle a bit, then evaluate your nadir period before adjusting right away.

You might consider a sliding scale approach as you collect data to support it.
 
I don't know what to make of Tasha's numbers. I'm a pattern girl and patterns should make sense and these seem so wild.

Another uninjectable AMPS, even after going to .5u last night. We're at 158 this morning. And of course it's breakfast time and she's screaming at us. If yesterday's numbers are any indication, I'm inclined to feed her.

I need to read more about the PZI protocol Sue linked but my understanding is that being based on the nadir, it still assumes a shootable AMPS/PMPS, which I'm not getting.
 
How about just 0.25 units if she's rising after food. Ie, go ahead and feed, and as/if she starts going up, give a token dose if/when she exceeds 200. Test about 30 minutes after she eats.

OR, chase the numbers - when/if she exceeds 200, give a tiny/token dose. It may not be a 12 hour schedule, so get it when you can.

She may having a "sputtering pancreas" - it may be trying to start up again, in fits.
 
Thanks, I'll give her a little time here and then test her again, see where she's at. I couldn't believe her number was so low this morning. Crazy.
 
I know you switched her to wet food, is it only one flavor or is there a couple? Different foods (different carb%) will make a difference in the number as well. Some are very carb sensitive.....Hidey is, and I have to generally stick to no higher than 4%. You & Tasha are doing wonderful though :razz:
 
Tasha just says NO to being tested right now. I'm tempted to keep an eye on her and skip the morning dose like yesterday. Thoughts? I can try to test again in a few hours. We had a tough time getting what should've been the AMPS and she remembers that well.

We bought a ton of food this weekend because she was eating it so well, all Friskies pate but a few flavors ranging from 6-8% (Salmon, Supreme Supper, Mariner's Catch, Chicken & Liver). Do you think that's part of the problem? She's underweight right now, < 10 lbs, and the vet said she should be closer to 12. When I asked how much she should be eating, I didn't get a real answer. "However much she wants." Really? We paid for that guidance? She's getting 2 or 2.5 cans per day.
 
stacia said:
Do you think that's part of the problem?
Click to expand...

I don't think there is a problem. :mrgreen: She is looking great. As BJ said, it may be that her pancreas is helping out. She may be one of the cats that needs a diet change and that is enough. It may be that she will need just a little insulin, diet change and go into remission. Regardless, it is a lovely "problem" to have. :-D

I think skipping is okay, as you are having a hard time testing. She may be high tonight, but I'd still give her less than last night. Any chance you can get some U100 syringes today? Sometimes you can buy a package of 10, I think. It may be that you'll have to give some tiny doses.
 
I'm going to try to pick those syringes up before tonight's dose. I'm slammed with work but I really didn't expect this morning's numbers so I'm going to try make it a point to get them.

And you're right - this DOES seem like a good problem to have. I just feel completely unsure how to deal with it. :) I really can't say enough how grateful I am for the guidance I'm receiving here. And how disappointed I am in my vet's "blindly shoot 2u for a week then come back" plan.
 
LOL your vet seems to be a lot like mine, its like geeeee thanks I'm glad I just dropped $$$ for THAT advice. GRRRRRR! Luckily this board exists for times like these. Most vets seem to want to dose the problem....very similar to drs in that sense, instead of trying to TREAT the problem. Luckily Hidey was one of those ones that only needed a small time period on insulin to kick his pancreas (and myself) into gear. Its so hard to know whats good to feed your cats when your told by vets and all these companies that THIS IS GOOD FOR THEM, and then the cost. Even when I talked to my brother about my parents cats and the dry food he asked me "well if its so bad for them, why do they sell it?" It's so frustrating and then something like this happens and you research and its a slap in the face, like really....I could of been feeding them THIS the whole time to keep them healthy? Yes I know sometimes your just bound to have health issues, thats part of getting older and good old genes but really????why add to the problem lol.

Anyways....after my rant......if you need me to send you some syringes I can, it will take a few days for shipping time. I only need to keep a few on hand (just in case) but I have about 100 I think?????
 
I have a lead on another vet but I'm not switching without getting her feelings on things like home testing. She took a friend's kitty into remission but I found out the vet then recommended a senior dry food (not sure what brand - it COULD be one of the low-carb varieties).

Thanks for the offer of some syringes. I'll let you know how it goes here. I'm going to run out early this evening before her dose and track them down (fingers crossed). We just checked her at theoretical +5 of her missed morning dose and she was 207 so I definitely don't want to give the full .5 again tonight. Maybe I should just let her sniff the insulin and that will be enough.
 
One option is to see if your vet is willing to learn. Send him your spreadsheet and show him what 2 units could have done. Maybe he can be converted to the values of hometesting and wet, low carb food. If he will, you may be able to save some other diabetic cats who come to his practice in the future.

Yes, you may have to give tiny doses like .1 and .2 and she may have longer cycles even on those doses. This is a hard part of the sugar dance. If her body is healing, then it is hard to predict when her pancreas will work and when it will get "tired". (it usually comes back in spurts for awhile). You just keep testing and monitoring to keep her at safe levels, both high and low.
 
Maybe that's my most appropriate response. Because I'm trying hard to detach emotionally when it comes to assessing the vet situation. My goal is Tasha's remission, not a tantrum with the vet. I'll reread the "Convert a vet" post and think about that some more before giving up on the current dr. There are a few other issues there as well though most of the staff is lovely. I wondered what I would tell them when they called (they promised to call yesterday to see how we were doing) but then they never called so it was a moot point.
 
I have syringes!!!

And good thing, because after not having a dose for the past 23 hours, Tasha's PMPS is a whopping 210. She's barely shootable. I assume I should give her something now with her supper, especially now that I have the u100 syringes and the conversion chart. .2? .4? .5 took us to +23.

I still don't have ketostix. Everyone has been out of them, like they're on all the back to school lists or something. I'm going to order them on Amazon I think - I can have them in a couple of days and with one cat w/ urinary history and another pretending to be diabetic, I should have them around.
 
Sounds good. Was just going to see if I could figure out how to measure .25 but .2 seems less complicated. Will feed and give .2, test at +2. I'm going to pay close attention to how much she's drinking/peeing the next couple of days as well. It seems she's slowed down. I'm wondering if the change in food alone was enough to drop her down to more of a borderline situation. I wish I could get her to a 12-hr injection schedule - I'd feel less overwhelmed about having no idea what to do all the time. I feel like the pestering newbie. Thanks!
 
You are NOT a pestering newbie. Remember that each of us is paying it forward for help we received. You'll be able to do the same. It's reassuring for a new poster to hear from one with a week under her belt that testing is doable or what a difference wet low carb makes. It gives the rest of us credibility!

The only dumb question is the one not asked. :mrgreen:
 
You could also try mini meals to help give the pancreas an extra kick. Thats what Hidey needs to keep his numbers below 100. I have finally got him down to 4 feedings a day instead of 5 lol.

Its amazing to see what diet alone can do, with a kick from some insulin....its like bringing the pancreas out of hibernation lol
 
We ended up eye-balling about .25u with the old syringes because the ones we got from Walgreens seem to be the wrong thing. They look like this:



The package says 29 gauge, 1/2" length, 1.0mL volume, 100 units or less.

I don't know if I overthought it or what but I was sure I was going to over-do it. I'll try again for more specific syringes tomorrow.
 

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You need the
U-100
3/10 mL(ie cc) volume syringes.
Short or long needle
30-31 gauge (note: finer needles bend more easily!)
Half unit marks


Even with the whole unit marks, 1.0 on a U-100 is only 0.4 units of a U-40 insulin
 
Thanks. I'll try again tomorrow. I'm looking at 12 hours of editing so I'll use that as my lunch break.

Just took our +2 and she's up from 210 to 245. Last night on twice the dose she went from 279 to 246. Will take a +5 before bed. She may have been elevated because we (me and husband, not me and cat) were passionately discussing the vet situation. Stress everywhere.
 
Finally an injectible AMPS! Barely. 208. But I'll eyeball the same .25 as last night and try again on the syringes today. It feels like a bizarre victory to inject my cat with insulin this morning. What kind of twisted world is this? Thank you everyone!
 
NOW I have the right syringes. We'll see what tonight's PMPS brings. Hopefully something I can inject on in an accurately-measured tiny dose.
 
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