Help No Idea What to do....

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Back again. Did PMPS, it was 360. Gave her 0.5 insulin at 9:10, after waiting 1/2 hour after feeding her. She is actively cleaning herself now. Took her injection very well, better then the bg tests. She seems to be happy and content, so I am going to get some very needed sleep and let my son do her bg at 3 and 4 hours into the insulin. I will post in the morning.

I do have one question though, do I need to always check her bg at 3 and 4 hours in until I get her under control. It just seems very excessive to me. confused_cat I will be up and checking the board for an hour or so, so if you have any advice on this one I would LOVE to hear from you! :smile:

God Bless everyone, and especially the sugarbabies, on this site. I still do not have enough words to describe how help you all have been!
 
i'm not familiar with Novolin, but looking at the test results you do have, i wanted to make a couple of observations.

It looks like the Novolin lasts about 3-4 hours max in her body. That leaves her 8-9 hrs with her blood sugar back up. that's the downside of a short-acting insulin.

The dose you gave got her into the 180's yesterday. If your goal is remission, you want everything under 120. You can't get it there faster than is safe, and I'll defer to others who have more experience with this insulin on the dosing.

It looks to me like she bounced from the 188. Notice how she didn't have a curve in the day cycle today? She was high at amps and basically stayed that way all day? That's a bounce. Here's a description of that phenomenon:

BOUNCING

Here is an example of a bounce from someone's recent condo:

you can spot a bounce this way (this only took me 6 months to learn and a bunch of people explaining it! i'm a slow learner!)

yesterday morning you had a 215 - then it went 235, 271, 270, and then 308 this morning - basically straight up. no curve. and then look backwards in the ss and the night before was that sweet little 148 12 hours earlier.

if you imagine that night-time cycle, starting at 148, kitty probably went down in a nice little curve, hitting something under 100 mid-cycle. that lower-than-usual number would've shocked her body. they get accustomed to whatever range they're in, and any sudden dip lower can set this off.

"HELLO WE"VE GOT A 911 HERE- KITTY'S GOING DOWN!" yells Mr. Liver. Fortunately, mr liver has a storehouse of counter-regulatory hormones and stored sugar (in case kitty needs a little nommy sweets in the middle of the night) and when Kitty gets into a range of numbers lower than usual, Mr. Liver lets loose with the sugar and the hormones and sends Kitty on a rocket to the moon. this is the cat's body's protective mechanism to keep the cat from becoming hypoglycemic. unfortunately, mr liver doesn't seem to know that anything above 40ish isn't a crisis and it will do this regardless of the range of numbers, even at 200 if the cat has become accustomed to 400.

A second cause of a bounce is if a cat drops very quickly. 100 points in an hour, for example, regardless of the range the BG number is in, can cause a bounce as well.

So, what to do now? don't increase the dose because of these higher numbers. once this bounce clears, which can take up to 3 days of high numbers if mr liver is super-active, then if you had increased the dose, it would be too high. you are entering the phase of treatment that we say requires "Patience Pants." when you think you're seeing a bounce, you have to wait it out, then you can see what the dose really does. You will know the bounce has cleared when you start seeing numbers you were seeing before - like that 148 again.

edited for clarity.
Last edited by julie & punkin (ga) on Tue Apr 24, 2012 2:30 pm, edited 1 time in total.
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My comments about dosing in the quote above are regarding using Lantus - not Novolin. Because it's short-acting, as Sue suggested, you may be able to adjust the dose during this bounce time. Again, I'll defer to her on dosing. But the bouncing itself happens to all kitties. The more they've gotten used to high numbers, the harder it is to get them to re-accept normal numbers as normal again. If your goal is remission, you want her to get into normal numbers (50-120) and stay in that range as long as possible for her pancreas to heal.

I'd push the vet again on Lantus or Levemir for the best-long-lasting control of her blood sugar. If you haven't looked at it yet, the latest research about Management of Diabetic Cats Using Long-Lasting Insulins is in the PDF about 5 paragraphs down from the top of that link. It's worth reading and worth printing out for your vet. It supports getting cats onto longer-lasting insulin as soon as possible so they can go into remission before their pancreas is damaged beyond recovery.

Promise - i don't get a commission for encouraging you to go to Lantus or Levemir! I have seen so many cats go off of insulin on them - i would just like to see your sweet Baby Girl have a chance too. If we don't tell you, how will you know?
 
and yes, i would always check her about 3 hrs after the shot.

if her preshot is lower than you've shot so far, check her sooner.

if you increase the dose, check her sooner.

your goal is to catch her if she goes below 50, and if she does, give her a little bit of high carbs to pull her back up over 50.
 
Angiebaby said:
...I do have one question though, do I need to always check her bg at 3 and 4 hours in until I get her under control. ...
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If you're not changing the dose and no other health conditions have altered, getting it when you can is OK. You just don't want to be surprised by coming home to a cat in hypoglycemic crisis.

You may find our Humulin/Novolin primer helpful.

If there is any way you could shoot 3 times a day, roughly 8 hours apart, that may help lower the wide swings. Otherwise, getting a longer acting insulin such as ProZinc or BCP PZI as soon as possible will help immensely. As those are both in and out insulins, your vets experience won't be totally contrary to how these 2 insulins work.
 
Getting ready to begin work life again, now that I have some sort of routine. I did manage to find a vet that prescribes PZI, but no one will do any of the human insulin besides the Novilin. So I am taking her in to see a new vet here in town that uses PZI. They do condone home testing, however, they said that a human monitor is useless. I want to be prepared to talk to this vet intelligently and get it across the right way that you can indeed use a human monitor effectively. Does anyone have any ideas on how to accomplish this. I am fresh out of ideas and honestly exhausted at this point. I need to find way to do this for my kitty. I cannot stop now, love her too much to just not do all that I can. Thanks again everyone & God Bless!
 
I'd keep looking for a vet that will prescribe Lantus (glargine) or Levemir (detemir). They are the 2 that are recommended with the only dosing protocol for diabetic cats that has been published in a professional veterinary journal. I can't believe in all of Battle Creek there isn't a veterinary clinic that has the latest information on treating diabetic cats.

Here is the original protocol: http://www.felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf They recommend human glucometers because they are accurate enough and in order to follow the protocol you have to test a minimum of 3-4 times per day. Alpha Trak strips cost $1 each. Human meter strips cost about 10 cents. The AT cost is prohibitive for most people.

That PDF is the most recent update to the above protocol. They do use an alpha trak in this update - but we've had thousands of people come through FDMB and we always encourage the human glucometers because of the cost.

Here is the study as published in a professional veterinary journal - also using home monitoring with a human glucometer. http://www.ncbi.nlm.nih.gov/pubmed/19592286

All of these links are in the first part of the Tight Regulation Protocol page for using Lantus and Levemir. All of them support home-testing and the documents above should be enough to support using a home glucometer.

Seriously, if remission is your goal, I'd make an appt at the Veterinary School at Michigan State University. Looks like it's just a one hour drive for you, and you don't need to make that trip regularly, just to get the prescription. We can help you with dosing by following the published dosing protocols. It would probably be one time to get a prescription for insulin and then you can use your regular vet that you're currently with for ordinary care. Prozinc is a world better than Novolin, but Lantus & Lev are proven to be more successful for remission. The comparison data for these are all in the PDF that you can download on managing diabetic cats using long-lasting insulins. Also on the TR Protocol page - about 5 paragraphs down from the top.

Good luck! It sounds like you've got a challenging situation!
 
See my signature link Glucometer Notes for reference ranges using human glucometers.

These are based on articles written by feline diabetes expert Dr Janice Rand of the University of Queensland.

The human glucometers read about 60% to 70% lower than AlphaTrak meters.
Thus:
Human glucometer / 0.6 to 0.7 = AlphaTrak estimate
AlphaTrak * 0.6 to 0.7 = human glucometer estimate
 
Angiebaby said:
Getting ready to begin work life again, now that I have some sort of routine. I did manage to find a vet that prescribes PZI, but no one will do any of the human insulin besides the Novilin. So I am taking her in to see a new vet here in town that uses PZI. They do condone home testing, however, they said that a human monitor is useless. I want to be prepared to talk to this vet intelligently and get it across the right way that you can indeed use a human monitor effectively. Does anyone have any ideas on how to accomplish this. I am fresh out of ideas and honestly exhausted at this point. I need to find way to do this for my kitty. I cannot stop now, love her too much to just not do all that I can. Thanks again everyone & God Bless!
Click to expand...


If you like this new vet, ProZinc should be fine. I know you are mentally and emotionally exhausted and can appreciate that trying to look for another vet might be too much. It's true that Lantus has published studies but we have had many cats go into remission here with ProZinc. There just haven't been any studies done. It's very encouraging that he'll prescribe a better insulin and does encourage home testing.

As far as the meter, there are the studies Julie cited. You can also just say to the vet " I know the readings will be lower than the pet meter, but I will take that into account. I can't afford the pet meter or the strips. I am doing the best I can for my cat and hope you will accept that."
 
Well looks like her bounce may have rebounded. I hope so. My son is going to try to do her bg in an hour just to make sure her peak doesn't go down too low. I am encouraged though. She seems to be a happier cat already. I have read about the difference in meter, but am still confused. I got a 159 on the Relion at 3 hours after insulin. Does that number become 129 if I account for the difference in human to pet meters? Or is it that I take the 159 and divide it by 0.7 to get 227? Just want to make sure I have it right. I appreciate all your advice so much.

I also decided not to try and take my cat to State of MI Vet Clinic because she freaks out on a ten minute ride let alone a hour there, then a hour back. Also, the vets in town did say they would not work with me if I used another vet for insulin. It's all or nothing with them. I am praying that PZI will make a bigger and better difference than the Novilin. After all it can't get much worse than Novilin. lol.

Thank you for the articles to take to the vet and the advice! Good night and God Bless!
 
Report the numbers you actually get, no math.

Use the reference ranges in my signature link Glucometer Notes for approximate interpretation.

See the link Secondary Monitoring Tools fro additional assessments you may wish to make, especially urine testing for ketones or ketones and glucose. Ketones form as a by-product of fat breakdown for calories. Too many ketones may indicate diabetic ketoacidosis (DKA), a potentially fatal, expensive to treat, complication of diabetes.
 
then definitely go with ProZinc - it's a good insulin too and it lasts much longer in a cat's body than Novolin.

i agree - just put the numbers in the ss as you get them from the meter. Make a note on the ss as to which meter you are using - experienced people will know what they mean.

hang in there! it gets infinitely easier - really. :YMHUG:
 
hi everyone i am new to this whole thing but i just discovered by cat is diabetic. I brought him to the vet in the summer because he lost tons of weight all of a sudden. she gave him some worm pills and nothing happening and we got a huge vet bill. So i started to research and took a reading of his blood today and it came out to be 24.3 mmol/L! Now what do i do? i really want to limit going to the vet because it seems to never work for my family.
 
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