How can you tell too much/little insulin?

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bookw0rm

bookw0rm

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Some history if you've not been following: Cassie was dx 8/1, sent home on 1 u ProZinc sid. He was home for about a week, then landed at the vet hosp. fo 8 days for DKA. He crashed at the vet 2-3 in this process, but also wasn't eating so everything is screwy. He came home at 1.5 u bid. The first day I pulled a furshot, 6 hours later we gave 1 u, as per advice from the board. He then crashed royally for 3 hours. I've been keeping him at a low dose (.5 u bid), but I don't like how high he's running either. No ketones Sun. or Mon. Spreadsheet is up to date.

I'm trying to figure out what's going on with my boy Cassie (see spreadsheet below). How can I tell the difference between too much insulin and too little insulin? I'm walking a tightrope since I have no data before he went DKA. He's only been back home since Friday night (spreadsheet starts Sat. am) and I'm feeling my way to the "right" dose. I'm worried about how high he is pre-shot I can't always get in between numbers but it looks like he's dipping into the mid 200's at min. and mid 50's at max. I can't tell if the big dips are too much or too little. I'm afraid too little will cause ketone problems. I haven't seen any but I didn't manage a test last night.

Some history if you've not been following: Cassi
(pasting)
 
Sorry, trying to cut & paste on my non-cooperating phone. Paragraphs should be reversed (duplicated on pzi forum)
 
Are you using u-100 syringes with the conversion chart? I assume not based on your dosing increments. It would be better to use the u-100s just because you can do microdoses ( .2u increments) that really seem to work well with prozinc. My experience with pz is that most (not all, obviously) cats who are going to do well on prozinc are very low-dose cats. They seem to get the best response from it. So microdosing becomes very important. If I were you, I would hold at .5u for 5 cycles, then increase to a fat .5u (between .5 and .75). You can increase to .6 if you get a hold of u-100 syringes. If you do switch syringes, you need to follow the conversion chart very carefully. Here is the link for that: http://www.felinediabetes.com/insulin-conversions.htm
 
Right now u-40. If necesary I'll switch. We have a vet appt. Sat, so I'm trying to get some ammo to talk to the vet (who isn't too keen on home testing).
 
Home testing can save your cat's life.
There is nothing to stop you from testing at home, keeping a spreadsheet and just don't tell the vet.
 
Gayle and Shadoe said:
Home testing can save your cat's life.
There is nothing to stop you from testing at home, keeping a spreadsheet and just don't tell the vet.
Click to expand...

I'm already testing, so you're preaching to the choir. I'm just trying to figure out what's going on because I suspect they're going to tell me to drastically change the dose Sat. when I go in.
 
Just like they can tell you not to home test and you just smile and nod and then go home and continue testing. You can do the same thing with the dose, smile, nod and then go home and consult with the folks here that use your insulin, look at your own data that you have collected through home testing and go from there.

As my own vet has told me...." I can only suggest a treatment plan for your cat/dog, but I can't make you give the pill, or squirt the liquid down their throats. Afterall once you leave here, it is ultimately you who holds the syringe." But then again this is the same vet that has also told me that if he dies and comes back as a cat he is beating a path to my door :-D

Mel, Maxwell, Musette & The Fur Gang
 
My first vet was very old school and heavy handed with dosing. I stopped calling in my bg readings. I decided that I was only going to call/go to the vet if there was a medical need. Managing diabetes is not a medical need. If a human has diabetes, they aren't required to go to the doctor every couple weeks to adjust their dose, or to have blood testing done. People manage it on their own through home testing. You can do the same with cats. After a few months I found a new vet that I could trust, and who was fine with me dosing autonomously. Even now with an awesome vet, I only need to go in for an annual exam, plus a few other exams (x-rays, ultrasound) a year (he has acromegaly, a high-dose condition that leads to a host of other medical problems). I only call to get refills of his insulin, or to talk over treatment ideas with my vet. It's a great collaborative relationship. But you need a vet who is willing to learn new things, and won't get a bruised ego from you being knowledgeable on the subject. You can try posting on Community to see if anyone knows of a fd-friendly vet in your area. Good ones are out there, but you have to do a little searching and questioning.

I think your ss shows clearly that Cassie does NOT need any more insulin. She was dropping into greens on .75u. That's awesome! Now it's just fine-tuning to get it right. In Ohio we don't need a script for syringes, so when I was using prozinc I just got them from Walmart without telling my awful vet. I have read that a lot of Walmarts are no longer carrying the syringes with 1/2 unit markings (we need those for the tiny doses that we give kitties). But you can order some from online diabetes supply sites. It's not a requirement to use them, but it really helps with dosing those tiny amounts.

Cassie is on low-carb wet food, right?
 
Charliemeow said:
Cassie is on low-carb wet food, right?
Click to expand...

Actually, not yet. When he went DKA he essentially went on a hunger strike. He refused to eat wet food. He came home with an appetite stimulant (which I haven't used since the first dose since he did not react well to it). I've been focusing on making sure he eats SOMETHING and trying to keep his numbers down. He won't eat wet at all at the moment. I'm going to start experimenting with lower-carb dry like Evo (assuming I can find it around here, no luck so far) and try to find something wet he'll eat. I'm aware that he's likely to have a reduced insulin need once I get him transitioned over.

His civi brother, however, loves the FreshPet select roasted chicken. (Which isn't really either, it's a refrigerated fresh food; looks to be relatively low carb.) Cassie took a few bites and has ignored it ever since.
 
If his stomach is at all upset when he tries a new food, he may associate feeling sick with the food and then refuse to eat it again. You mentioned an appetite inducer; is there also something to give him for nausea? Calming an upset stomach may help him eat more too.
 
I agree that it's more important that Cassie eats, than what he eats since he is a DKA survivor. (sorry that I called him a her. the name threw me off :oops: ) Food, water and insulin are the best things for a DKA kitty. The petsmart and pet supplies plus by me carry Evo. Are you near one of those stores? Once you switch to low carb food (whether kibbles or wet) you will want to be extra cautious with his dose. Maybe even dropping back a little. He seems to get a pretty good response from the insulin, so if he is eating less carbs, the numbers may go even lower. But you have to balance that with caution towards the ketones. When you do transition, and if you lower the dose a bit, you'll want to make sure you're frequently testing for ketones. Once you get switched to low-carb kibbles, you can work on transitioning to wet. There are lots of tips for doing that when you're ready. But for now, it's most important to make sure Cassie eats.
 
We're used to people thinking he's a girl. In fact, we thought he was a girl at first, then Cassandra became Cassidy, Cassie for short. No problem--even the vet gets it mixed up. :)

The closest PetSmart is 45 min. away. They carry Innova, but not the Evo version. There's another one about 1.5 hour away. I'm going to check it this weekend. I'm there semi-regularly with my girl scout troop, so it won't be too big of a deal, if they carry it.

I found a sample (1/2 cup) of Evo at a Whole Foods store (not close, unfortunately). I added some to the dry food feeder last night. Cassie actually ate some of it. If he keeps eating it, I'll see about getting more. If nothing else, I can order it online somewhere--once I know I'm not wasting my money and it will be eaten.
 
cjleo said:
How about Wellness Core? Not as low as Evo, but still on the low end of dry foods.

Claudia
Click to expand...

Didn't see it. They had Wellness, but not that version.

I spent about an hour running around PetSmart with the food list when Cass was in the hospital. Of course, they didn't have any of the ones I was looking for. I'm not giving up yet, though.
 
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