Help with Toby's strange numbers and sliding scale? Thanks!

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Becky and Toby

Member Since 2013
I'll start by admitting that I have a healthy dose of paranoia when it comes to Toby and hypoglycemic issues, because we followed vet advice for far too long and almost lost Toby at least three times, to explanations such as "You must have injected into fat", "You must have given him more than you thought", "Someone else must have injected him too"... aaand deep breath.

Anyway, we've gotten to a MUCH better point than we started at! In the first week or so after Toby was diagnosed (in May of this year), we saw a 33 and a 37mmol :shock: We're now, as per the spreadsheet, resting much lower! But - due to the aforementioned paranoia, largely - we're struggling to know how much exactly to inject him with, and I know we're skipping shots entirely when we shouldn't be. I tried a .25 shot last night so I do have a little bit of data, but I do find Toby to be very unpredictable too.

He eats Butcher's Classic (around 8% on the carbs), and uses Caninsulin. I'm currently gearing up to order him a different food, and Bozita (around 4%) is probably going to be my first call, but that's a bridge we'll cross when we come to it!

If anyone has any suggestions for me, I'd very much appreciate them.

Thank you :smile:
 
Re: Help with Toby's strange numbers and sliding scale? Than

Hi Becky,

We have many members from England. I'm going to ask them to post here too.

Primarily you are probably seeing numbers all over the place because caninsulin really is not a good insulin for cats. I know it's hard to get the vet to write a scrip for Lantus or Prozinc, but if you can get it, it will be much better for you to manage the diabetes.

Our English members can help guide you with this.
 
Re: Help with Toby's strange numbers and sliding scale? Than

Hillary & Maui said:
Hi Becky,

We have many members from England. I'm going to ask them to post here too.

Primarily you are probably seeing numbers all over the place because caninsulin really is not a good insulin for cats. I know it's hard to get the vet to write a scrip for Lantus or Prozinc, but if you can get it, it will be much better for you to manage the diabetes.

Our English members can help guide you with this.
Click to expand...

I've heard that Caninsulin is not very good for cats, but I was under the impression that was due to it only lasting for a short time for them... that's very useful to know. I have already mentioned a new insulin to my vet, who didn't seem opposed to the idea, and said it would be Prozinc he would prescribe. I started to forget about it as Toby started to show much better numbers, but maybe it's time to think about it again.

Thank you.
 
Re: Help with Toby's strange numbers and sliding scale? Than

(For folks who've not 'met' Becky and Toby before, there is another thread here that shows their story so far: viewtopic.php?f=28&t=106507 )

To re-cap though (Becky - please correct me if I'm wrong!):
Toby was dx in May. Has been on Caninsulin (up to 4 units BID at one time?). Had a history of urinary problems/cystitis and so was on prescription food for that which also happened to be very high in carbs. Toby's numbers had been very eratic - high numbers interspersed with sudden steep drops. Toby has had hypo episodes, and one hypo was life-threatening and an extremely scary experience for Becky. So she is understandably cautious of now allowing Toby into lower numbers.

Becky is now hometesting, and has switched Toby to a lower carb wet food. Toby's numbers have come down and down since then. I suggested that Becky start a new thread to get more eyes and expertise on Toby's chart, especially with regard to working out a sliding scale. Toby's numbers have improved enormously, but this means that Becky is getting lower preshot numbers, and is having to use smaller doses (all very new territory).

Note: Becky has asked her vet about an alternative insulin but the vet needed to see more evidence that the Caninsulin wasn't working (this is a legal requirement in the UK). And in fact, it now seems that Toby is actually doing very well on the Caninsulin: We are no longer seeing the pattern of steep drops and sudden rises that are typical of Caninsulin.

Becky,

I've become an avid follower of Toby's chart, and it is so heartening to see the numbers improve like this. In less than a month you really have turned his situation around. :smile:

Once a cat's body gets into better blood glucose levels the pancreas is more able to heal itself. And it seems to me that Toby's body must be producing more insulin of it's own, because he's able to hold his blood glucose level in pretty stable numbers between shots. For example, on the evening of Nov 3rd he had a preshot number of 16.2 (291): You gave .5 of a unit and 24 hours later his blood glucose was 12.9 (232). This trend of improvement is extremely promising, and I'm really wondering to what extent Toby's pancreas may recover further...

It may be that Toby's numbers 'plateau' and he remains on a low dose of insulin permanently. (That is what has happened with my cat, Bertie). But if Toby's numbers keep improving as they are at the moment, well, who knows, maybe remission could even be on the cards one day... ;-) ('Remission' means that the diabetes can be diet-controlled). I don't want to give you false hope about this, but just want to make sure you're aware that it can happen.

Eliz
 
Re: Help with Toby's strange numbers and sliding scale? Than

Hi Becky, I'm in Surrey, not far from Elizabeth, and I will start by saying that you won't get much better advice in anything FD-related than from her. There aren't actually that many of us on here from the UK these days - people come and go for all sorts of reasons - but Elizabeth is a long-standing member of the board and can give you an excellent overview on everything. She is devoted to Bertie and her other cats and has built up a wealth of experience. I would trust her implictly. (She is also an absolutely lovely person who really cares about other people!)

You have probably seen this written elsewhere before, but the only thing I would add to what's been said above is that every cat is different and every cat's FD journey is different. Just like humans, animals metabolise foods and medicines in different ways, sometimes surprising ways. So, although most of us did indeed find that Caninsulin didn't work well in our cats, it certainly doesn't mean that it can't work well for yours. The other thing (sorry if you've heard all this) is the other popular mantra here, FD is a marathon, not a sprint, ie there is no quick fix, unless you are really lucky, so you have to be prepared to be in it for the long haul, as things can change... The pancreas can start to heal, a cat may use an insulin differently, BGs may be affected by an infection, etc etc etc.

You seem to have a very good handle on it all already so well done, keep up the good work and keep posting here with questions. FDMB people are the best!

Diana
 
Re: Help with Toby's strange numbers and sliding scale? Than

I think he is looking pretty good, Becky. What a lot you have learned in the past few weeks! I like the idea of a sliding scale because sometimes the .50 seems a little heavy and sometimes it seems a little low. How is dosing at .25 - do you feel like you can eyeball it well? (some people take a sample syringe and mark it with colored water, permanent marker or tape so the doses are fairly consistent.)

The way to make a sliding scale is to look back over the ss and see what .25 did for a certain number vs .5. Toby's numbers are hard to decipher. For example, .5 on 292 was too much, but on the 234 was okay. This may be explained by the difference in eating/activity habits overnight vs daytime? If you were home today and could monitor, you might have tried a light .25 (squirt a teeny bit out of the .25 dose before shooting)


BJ has done scales for people - she is definitely our resident mathematician. You might send her a PM - it's BJM. She might also be able to tell you whether you could switch to U100s with Canninsulin and use the conversion chart. That would make these low doses much easier to deal with.

I see no need to hurry to another insulin. You are getting long cycles and nice numbers with Canninsulin.
 
Re: Help with Toby's strange numbers and sliding scale? Than

I'd definitely suggest the U-100 syringes because you are moving into micro-dosing territory.

How it works.
U-40 means 40 units of insulin in 1 mL
U-100 means 100 units of insulin in 1 mL
Thus, U-40 has 40% of the concentration of U-100.
That means the markings on a U-100 syringe need to be adjusted lower by 40% to get the dose of a U-40 insulin.

ie U-100 syringe mark * 0.4 = U-40 dose
0.5 * 0.4 = 0.2
1.0 * 0.4 = 0.4
1.5 * 0.4 = 0.6
2.0 * 0.4 = 0.8
2.5 * 0.4 = 1.0
3.0 * 0.4 = 1.2
etc

To develop your sliding scale, take the last week or so of numbers which happened with no special circumstances (no vomiting, inappetance, etc) and put them in a new spreadsheet for calculation (actually, you can add a page to your current spreadsheet for him).
Order them by pre-shot levels, then by dose.
Examine the mid-cycle tests around the nadir and calculate the drop (put in another column)
Look for patterns of response.
You may find it useful to group by 2.5 mmol/L increments (45 mg/dL).

Generally, lower test values get lower doses. If you're ever not sure because of a low test and won't be home to monitor, skip. Better too high for a day than too low for a moment!

Also, you may lower your no shoot number to 8.3 mmol/L (150 mg/dL) if you will shoot no more than 0.2 units under 11.1 mmol/L (200 mg/dL).

As you become accustomed to your cat's response to food and insulin, you tweak the doses as needed.

Another tip: your insulin may have 2 different times of peak action, as it is a mix of 2 different types of insulin which peak at different times (this may be more evident in dogs, but is worth checking). You may find that a +7 or +8 gets you some different info about how the insulin is working in him.
 
Re: Help with Toby's strange numbers and sliding scale? Than

Welcome Becky and Toby

You have come to the right place.

Those numbers look really promising as others have said - we had a similar journey on the Canninsulin and blind dosing we nearly lost our little one and now suffer the same hypo-paranoia you mention! Sadly Bailey's numbers are back up again and so we're now working on brining them back down.

We saw a massive change in Bailey the day we moved him onto Lantus and started home testing. The whole Canninsulin / flying blind saga terrifies us to think back and not good that this is still standard practice over here. This forum and the kind people who have helped us on here have quite literally saved Bailey's life we would be none the wiser if we hadn't found this forum.

Best of luck,

Barnes and Bailey
 
Re: Help with Toby's strange numbers and sliding scale? Than

Hi again, Becky,

I don't want to put any pressure on you to try the U100 syringes. I know that's something that you'd need to feel comfortable and confident doing. But if you would like to have some U100's on hand then I'm very happy to pop some of mine in the post to you. You could have a little play around with them and see how the conversion would work IF you do decide to go that route. If you'd like some just PM me your address.

I'm sure I read here once (possibly going back a couple of years now) of someone who compared doses by squirting them out onto absorbent paper and seeing how much space they took up. Maybe some experiments along those lines (perhaps with coloured water?) could help to reassure you about the measurements...?

Edited to add: Becky, because you're using a U40 insulin you do actually have an advantage over people using a U100 insulin when it comes to 'micro dosing'. Those using U40 insulin can switch to U100 syringes (with conversion table) so that they can measure the tiny doses more accurately: Those who are already using U100 insulin are stuck with U100 syringes, and so are reliant on good eyesight/magnifying lenses etc: And some folks on teensy weensy doses have to use really subtle measuring techniques such as the 'drop method', where doses are measured in 'drops' of insulin... So, despite what you've read/heard about Caninsulin and it's 'disadvantages', there may actually be one advantage to using it! ;-) :lol:

Eliz
 
Re: Help with Toby's strange numbers and sliding scale? Than

Thank you so much for the replies, everyone. This board is so helpful :-D

Elizabeth: You're pretty much spot on. 4 units of Caninsulin twice a day at the most. As for the hypos... he's had more than one that was life-threatening, but 'only' one that was an injection directly into the heart threatening. I have no idea what I was thinking!
Oh yes, I'm very aware that remission can happen :-D I try to be realistic and know that he could very well be on insulin for life, so the real goal is getting him on as little insulin as possible and getting the numbers as smooth as possible, but if remission did happen... well, I think I could handle that :razz:
Thank you for summarising that for me.

Diana: That's definitely the impression I've gotten of Elizabeth, and indeed the board as a whole!
We're definitely in it for the long haul - we've been running around after him for fifteen years so far :lol:
Thanks :-D

Sue: Thanks for the ideas regarding the partial doses. We've tried one .25 now, and I do feel pretty confident about hitting that mark. As for his eating habits, I'm not sure that they do differ all that much between the day and night, to be honest. It's something I'll have to really monitor and see if I can explain. Maybe I'll put an "I Fed Toby" chart in the kitchen for everyone to use?

BJ: Thanks for the information! I'll try and get that worked out for him - it sounds do-able. I was aware that the Caninsulin is a mix, but it's never occurred to me that that could be a factor. I'll work on getting some +7 and +8 out of him too.

Barnes: I know exactly what you mean. I just can't believe that I didn't question it sooner. The vet can't tell me many things without me going home and Googling them, but he just made it seems so straightforward in this case, I guess. I don't know what I was thinking.
Thank you, and good luck with Bailey, too.


Regarding the U100 syringes, I feel quite comfortable with the idea of conversion, but I do feel that we're going to manage with the U40s, too. Then again, how long will it be until Toby needs even smaller doses? I'll get my mitts on a few of them, all ready for even lower numbers (are you reading this, Toby?) :-D
Thank you very much for the very kind offer, Eliz, but I wouldn't want to impose like that. It's easy enough for me to poke around locally or order a couple, but thank you all the same! :smile:
 
Re: Help with Toby's strange numbers and sliding scale? Than

Gosh, Becky,
That 3.8 (68) at +4 was a bit of a surprise... :shock: Haven't seen a drop like that in a wee while... confused_cat

Eliz
 
Re: Help with Toby's strange numbers and sliding scale? Than

Elizabeth and Bertie said:
Gosh, Becky,
That 3.8 (68) at +4 was a bit of a surprise... :shock: Haven't seen a drop like that in a wee while... confused_cat

Eliz
Click to expand...

Tell me about it =/ Maybe his number this morning was 'false' because whatever sent him up to 17.5 yesterday cleared? Who knows. He seems pretty happy in himself.
 
Re: Help with Toby's strange numbers and sliding scale? Than

Becky and Toby said:
...Maybe his number this morning was 'false' because whatever sent him up to 17.5 yesterday cleared? Who knows...
Click to expand...

Bertie does exactly the same thing at times, and I do wonder whether it is just what you say, that something in his system that has been elevating the blood glucose (food, furball...) has "cleared' and his blood glucose drops as a consequence. (Sometimes it's as though I've given him his shot twice!) I wonder too whether it is the pancreas suddenly waking up from a nap and putting out a bit more insulin... And then again I wonder also (yep, I do an awful lot of 'wondering'! :lol: ) whether the way that I've injected him has meant that the insulin absorbed faster.... Ooh, those pussycats are a puzzle at times....
confused_cat

Eliz
 
Re: Help with Toby's strange numbers and sliding scale? Than

Elizabeth and Bertie said:
Becky and Toby said:
...Maybe his number this morning was 'false' because whatever sent him up to 17.5 yesterday cleared? Who knows...
Click to expand...

Bertie does exactly the same thing at times, and I do wonder whether it is just what you say, that something in his system that has been elevating the blood glucose (food, furball...) has "cleared' and his blood glucose drops as a consequence. (Sometimes it's as though I've given him his shot twice!) I wonder too whether it is the pancreas suddenly waking up from a nap and putting out a bit more insulin... And then again I wonder also (yep, I do an awful lot of 'wondering'! :lol: ) whether the way that I've injected him has meant that the insulin absorbed faster.... Ooh, those pussycats are a puzzle at times....
confused_cat

Eliz
Click to expand...

Yeah, all of those sound like an option to me... also that he listens in on me and slightly misinterprets what I'm hoping for :roll:

I can't help but eye his food up a little, even though I know it's all low carb. He was suddenly all over the place when he was eating his sugar treats, started to level out when I took them away and started feeding Bozita, and then he had his first can of Catz on the evening of the 13th...

I'm sure it's just a coincidence, I avoided the higher carb flavour =/ He just wants to mess with me. And he's doing a good job, with a 11.1 where we got a 3.8 yesterday ohmygod_smile
 
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