Increased Tigger's Dose to 1 U - need advice with readings!

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Tigger's Friend

Tigger's Friend

Member Since 2013
Hi Everyone,

Tigger's been on Prozinc .5 units Sat & Sun for 4 cycles, & his numbers were edging up from the mid 200's to 350 (a new high for him) this AMPS. This was his 5th cycle, so we increased the dose to 1 unit (this was the vet's original starting amount, but I wanted to be m ore concervative). At + 7.5 his test is now at 93 - down from 128 at +6.

This seems like a pretty big drop, should I be concerned at this point? Should I continue to test every hour?

Should I give him a snack at this point or should I wait?

Also, the vet said if at any time in the cycle, his test number dropped below 150, I should only give him a 1/2 dose at the next shoot. That would be .5 units. If his PMPS # is below 200, I'm going to wait to shoot as the FDMB suggests. If it's above 200, given these low numbers, what should I do?

Thanks for your help!!!!!!!
 
Re: Increased Tigger's Dose to 1 U - need advice with readin

I would just monitor every hour. I would not give a snack unless you usually give one at this time.
 
Re: Increased Tigger's Dose to 1 U - need advice with readin

Since we don't have much data on Tigger and how low he will go on this 1U dose, I'd get another test in 60 minutes from your last test.

93 is still a nice safe number. We only get concerned if the number drops below 50.
 
Re: Increased Tigger's Dose to 1 U - need advice with readin

Very nice, Suzanne! I would assume he will start back up toward pmps. Don't be surprised if he bounces at pmps. If he does, I'd continue with the one unit - it looked good today.

I am assuming your vet meant not to shoot a preshot under 150. I'd agree. We are even more cautious, suggesting that newbies don't shoot under 200. If he meant to worry about cycle numbers at 150, I'd argue they are fine and have lots of room to drop.

The general rule on the FDMB FAQs that a cat is regulated if they are in the mid 200s at preshot and double digits at nadir, but not lower than 40, which is approaching hypo territory.
 
Re: Increased Tigger's Dose to 1 U - need advice with readin

OK - Whew! Thanks for all your input.

Tigger's +8 reading was 144 & +9 @ 5:30 PM is 152

Our vet wanted to know if his levels went below 150, so I called.

She feels we should now stay at the .5 unit bid until the Saturday AM shoot, so that Tigger and she can get a grasp of how the insulin's working for him.

She doesn't want any increases before Saturday, even if he goes above 350 for the remainder of the time - as long as he's acting normal otherwise.

Is that a plan you would advise as well? I do understand about delaying injection if his PMPS levels are below 200.

Thanks again for your help!
 
Re: Increased Tigger's Dose to 1 U - need advice with readin

Sue,

I just got your message after I posted :roll: - read my earlier & please give me your thoughts. Thanks!
 
Re: Increased Tigger's Dose to 1 U - need advice with readin

Your vet is more conservative that I am, and I consider myself very conservative. I think his cycle today was lovely as long as he goes up enough to shoot at pmps. We like to start low and go slow, but we are always considering that the longer they stay above the renal threshold, (depending on where you read someplace in the 250- 280 range + or -) the harder it is on their bodies.

Your choice. It is hard to go against your vet.
 
Re: Increased Tigger's Dose to 1 U - need advice with readin

Thanks, Sue.

It is hard to go against my vet - she is cautious, which I normally appreciate. She is a new vet for me & we are also both getting used to each other - It was actually her idea to start Tigger out at 1u & I chose to drop the start to 1/2 unit, & am glad I did.

I think I'll wait & see what the PMPS number is, & will probably do .5 u tonight if it's above 200 & not skyrocketing. That way I can get some sleep since I have a better idea how he responds to the .5.

Tomorrow after AMPS I'll probably be tempted to try a .75, & I think my vet realizes this & asked me to hang with her. She said normally she likes to see the dose stay the same for 2 weeks, but since I'm testing at home she'd be ok just till Saturday (the next time she's in the office) & then reviewing the #s.

I know the longer Tigger is out of normal range, the less chance he has for remission, which is important to me. But, I don't want to jeopardize his health by moving too quickly (or slowly), either.

Wish this diabetes thing was more black & white!!! :?

Thanks so much for your time, it really helps to have experienced input
 
Re: Increased Tigger's Dose to 1 U - need advice with readin

If your vet doesn't have many patients who home test, it is more logical for her to be very conservative. The beauty of home testing is that you can keep him safe - you know exactly how the insulin is working, what his numbers are when you are going to give a shot and when he is too low or too high. Maybe it will take a while for her to realize that you are top of the numbers and he will be safe with you. And that you can move a little faster.
 
Re: Increased Tigger's Dose to 1 U - need advice with readin

Well said, Deb & Sue!

Tigger got a late snack @ 7:20 instead of 5:30, so that may have skewed the PMPS @ 7:55: 306

I gave .5 u. tonight. When I go to bed - I'm down, & would hate to have a problem when I'm not there to help Tigger.

Tomorrow is a new day, though.

I like your logic & it makes sense to me, & I agree with your assessment of my vet. When I brought Tigger's test numbers to our 1st appt. she said it was too much information for her, that most vets don't know what to do with all the info. I think they like to do the fructosamine level q. 2 weeks, & visual / urine monitoring for ketones, but maybe its a liability thing with home testing, I don't know. She's ok that I'm doing it, as long as I also count the visual monitoring equally.

:?: Do you have any suggestions for a hematoma? Tigger's ear ( I only poke the ear above his good eye - he gets freaky about the other one) has developed a hematoma from all the testing. It was a gusher this last poke. I try to poke in different places each time, but he gets squirmy when I hold his ear, so I can't always be precise. I warm & massage the ear beforehand, & apply pressure after I poke (sometimes I don't poke hard enough tho' & it doesn't bleed & don't apply pressure - or maybe that's how he got the hematoma(?) Should I let that part of his ear rest for a few days or lance it or ???

Thanks so much for all your details & response to all my questions & problems - I know I've been high maintenance, but I don't think I could've got this far without you guys!
 
Re: Increased Tigger's Dose to 1 U - need advice with readin

Thanks so much for all your details & response to all my questions & problems - I know I've been high maintenance, but I don't think I could've got this far without you guys!
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I don't think you've been 'high maintenance' at all! You've asked what you have needed to know and gotten the answers you have needed. We expect new members to have lots and lots of questions.

Keep asking as many questions as you need to and we'll keep providing information where we can. If you ever need clarification, or don't understand something that has been said, let us know. We'll try to say it a different way.

This is a dialogue, a two way conversation. Please, push back and let us know if you can't do something we have advised you to do.

People come here to vent when frustrated, cry on our shoulders, as well as get that day to day management information they just can't get from vets that simply do not have enough time in their days. We understand and can sympathize because we live with our challenging sugarhunks and sugarbabes every day, 24/7.

There is a lot of collective experience here with other cat health issues also and we can point people to other resources.

There is a whole other forum here specifically for PZI and Prozinc users. It's under Insulin Support Groups (ISG), PZI. You can either click on the word Insulin Support Group and it brings up a list of the subforums, and click on PZI or you can click on the text PZI underneath the Insulin Support Group heading.

It's a small group of people, very welcoming and helpful. Maybe not as busy as the Feline Health forum but a group that has more specific knowledge of PZI and Prozinc. If you post over there and are not getting the answer you need, you can always post here in Health too.
 
Re: Increased Tigger's Dose to 1 U - need advice with readin

Tigger got a late snack @ 7:20 instead of 5:30, so that may have skewed the PMPS @ 7:55: 306
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Yes, that snack would have influenced the BG heading. It only takes about 20-30 minutes before you start to see the BG numbers rise with a bit of food.

Good thing to note on the SS, meal and snack times.

Do you have any suggestions for a hematoma? Tigger's ear ( I only poke the ear above his good eye - he gets freaky about the other one) has developed a hematoma from all the testing. It was a gusher this last poke. I try to poke in different places each time, but he gets squirmy when I hold his ear, so I can't always be precise. I warm & massage the ear beforehand, & apply pressure after I poke (sometimes I don't poke hard enough tho' & it doesn't bleed & don't apply pressure - or maybe that's how he got the hematoma(?) Should I let that part of his ear rest for a few days or lance it or ???
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Are you applying pressure on the poke spot for 30-60 seconds after you have got the blood on the test strip? I would apply pressure even when you don't get enough blood for a valid test. That is why many of us use a folded tissue or cotton ball on the inside of the ear because it's right there to help apply the pressure after the poke.

You may have hit the vein if you got a 'gusher'. When you absolutely need to get blood, hypo situation for instance, aim for the vein. I still occasionally hit the vein even though I'm aiming for the area between the vein and the edge of the ear.

You can certainly let that part of the ear rest for a few days. Not sure about lancing the hematoma. I'll send a PM to BJM who might now about that.
 
Re: Increased Tigger's Dose to 1 U - need advice with readin

If it is a large bruise, it will dissipate in time.

If it appears to meet the description below - a large fluid filled swelling - you'll need to go to the vet.

Merck Veterinary Manual online
"These small to large fluid-filled swellings develop on the concave surface of the pinnae in dogs, cats, and pigs."
"Treatment is surgical to allow drainage. After draining and flushing, several mattress sutures can be placed to eliminate the pocket. The addition of a drain made out of a teat tube, piece of soft urinary catheter, or IV catheter increases the success rate of surgery. Drainage and glucocorticoid instillation are successful in ~50% of cases. Drainage is best obtained with a butterfly connection or an IV catheter. Glucocorticoids are instilled to fill the cavity without causing skin distention. A short course of a low anti-inflammatory dosage of oral glucocorticoids is commonly added to this treatment.
"
 
Re: Varying Tigger's dose

Thanks, Deb & BJM.

Tigger's hematoma is smaller this AM, I punctured it lightly last night with a terumo needle to let it weep a little. It's not huge, so I'm putting triple antibiotic on it & puncturing less today in other areas. Will apply more pressure longer. I'll also try my 20 guage terumo needles for lancing - they seem much sharper than the lancets from W.M.

Deb - I read Wink's SS last night - that's a pretty amazing job you did. Seems a number of Board Members foster diabetic cats for their Shelter & get them into adoptable condition - that's really incredible, all of you. Why did the vet not return your insulin - because he wanted you OTJ? Also, when you got your Confirm Vs. the other meter, there seemed quite a consistent discrepancy, with the Confirm lower. Should this be taken into account when testing?

Tigger was at 288 this AMPS, so I gave .75, higher than the vet wanted @ .5, but lower than 1.0 yesterday AM. Estimating is difficult w/ the U-40 syringes - I understand now why people goto U-100 & do the conversion - will seed if I can buy U-100 without an rx.

I'll post my numbers more on the insulin-specific group board - they are a great group. Just don't want to lose my Lantus friends!
Thanks again!
 
Re: Increased Tigger's Dose to 1 U - need advice with readin

Glad to hear Tiggers' hematoma is better today.

Deb - I read Wink's SS last night - that's a pretty amazing job you did. Seems a number of Board Members foster diabetic cats for their Shelter & get them into adoptable condition - that's really incredible, all of you. Why did the vet not return your insulin - because he wanted you OTJ? Also, when you got your Confirm Vs. the other meter, there seemed quite a consistent discrepancy, with the Confirm lower. Should this be taken into account when testing?
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Yes, the vet kept the insulin because he thought Wink was ready to be OTJ. Not that I trusted these vets. If I had kept Wink on the high carb diet (Hill's w/d) that they wanted me to use, I'm convinced Wink would still be insulin dependent to this day.

Wink's spreadsheet does not show all the horrible high numbers he was getting in the shelter for the 4 months before I fostered him. Nor the months when he was diagnosed and his owners refused to do anything. Nor the fact that he got bounced from one shelter to another. Nor does it show the absolutely crippling diabetic neuropathy he had when he came to me to foster. I was teaching the people at the shelter as much as I was trying to teach the vet, better ways to manage the diabetes.

As far as the consistent discrepancy goes between the confirm vs other meter (Alphatrak 2), built that way. Human glucometers will read lower than pet specific glucometers.

The Alphatrak 2 is a pet specific meter that Abbott Labs developed a number of years ago for pets. I think they saw a marketing opportunity and took advantage of that. The Alphatrak is known to read about 30-40% higher than a human glucometer will with a pet. In my mind, the much higher price of the meter and especially the test strips was not worth the difference. We here at FDMB have learned to adjust the numbers and most of us are used to the readings with a human glucometer. It is the opposite instance, where someone is using a pet specific meter that we have to adjust our thinking.

I had to fight the shelter to get them to pay for the lower cost Relion confirm test strips. Alphatrak test strip $1-2 each. Confirm test strip $0.36 each. I could do three tests a day with the Confirm for the price of one Alphatrak test strip. They only wanted me to test maybe 2 times a day or less. I was not willing to do that. I wanted to know what was going on, get Wink on a better low carb diet, test as much as I needed to get him regulated and possibly into remission. I was very lucky and it worked and Wink is OTJ for 3 months now and his neuropathy is gone.

I cried to see him walking on his hocks and stopping to rest every 3-5 steps, couldn't jump, had trouble climbing the stairs. Neuropathy is PAINFUL! Ask any human diabetic with neuropathy. Wink jumps with the best of them now. The only time he scares me with his jumping is when he jumps to the kitchen island when I have the cooktop going. Open flame and long cat fur do not mix. ohmygod_smile

If I can help one person, to get their cat regulated, to maybe get their cat eating a better diet, to get an improvement in the neuropathy, I'll be happy. That is why I try to help so many people here. Your cat can get better, Wink is proof of that. Yes, it's very hard and stressful. But it can be done.

Sorry, time to get down off my soapbox. ;-)
 
Re: Increased Tigger's Dose to 1 U - need advice with readin

Wow, Deb, that makes me cry just reading all that - poor Wink! Yes, I saw a video about a cat with crippling neuropathy, & it was heart rending) BUT- Lucky Wink Now! :-D Thank you for rescuing him.

I hope the Shelter people and the vet(s) see Wink as a learning opportunity & not an exception, & have altered some of their protocol.

I don't understand how vets can expect a client to inject their cat for 1 week before running any bg curve, with no other tests to rely on other than urinalysis (impossible with Tigger - I have to test the clay patties, which ain't so reliable, & he's almost always at 3+++) & visual monitoring. If a human doctor gave blind injections to a human diabetic patient for that week, hepr obably could lose his license! Further, re. visual monitoring (which I do agree with as a secondary assist), cats are so stoic, many will act fine until they drop - case in point, Tigger's 'asymptomatic' dm, which was uncovered during a dental prep......

Re. human vs. pet monitors - should I be mentally adding 30% to Tigger's numbers? Or is the human meter reading the more reliable number? oooh - another layer! nailbite_smile

So far no response with the .75 u - but then I did drop it to .5 last night per the vet.........will need to see if he can come back. The terumo needles are working much better - sharper than the lancets I think - can get him with 1 small poke, rather than a big jab with the lancet. So - for any other newbies out there reading this & having trouble with poking - try a terumo syringe needle instead - just be careful - they slice through like butter!
 
Re: Increased Tigger's Dose to 1 U - need advice with readin

We use reference ranges for cats on human glucometers; leave your numbers alone, please!

< 40 mg/dL = headed to hypo if not already there; implement hypo protocol. Also, dose decrease for long term diabetic

< 50 mg/dL = caution, could be heading to hypo if early after shot. Dose decrease for diabetics < 1year duration

50 - 130 mg/dL = well controlled

180/200/240/280 mg/dL = depending on your data source, this is the renal threshold where glucose starts spilling into the urine. At these levels, you may wish to test for urine or blood ketones. If your cat has ever had diabetic ketoacidosis, you may want the pricier blood ketone meter to get the most accurate measurement you can
 
Re: meter readings, hypos, seizures, etc

Thanks, BJM - I won't alter my SS numbers!

I purchased the blood ketone meter because Tigger's so hard to dipstix test, so I'm ready if necessary

I saw a video on u-tube re. a hypo cat seizure: http://www.youtube.com/watch?v=zEDbinidIZI

It's more muscle twitching & dilated eyes. Is that typical of a hypo seizure?

We have an epileptic cat with classic grand mal seizures, and the hypo seizure is much more mild-looking - I would not have taken it as serious, so that video supplied some critical reference information.
 
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