Is Duke dropping too fast...

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Thank you so much everybody for your help yesterday, i don't know what i would have done without you all, thank you, thank you, thank you and a very happy new year to you all.
We go again today with a 0.5u injection and hopefully it will be a better day for Duke.
Just a quick question about the steroid, @Deb & Wink @Shelley & Jess what is it about the 3 month post steroid injection, does it stay in the system for so long?
Tee.
 
teetee (UK) said:
We go again today with a 0.5u injection and hopefully it will be a better day for Duke.
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Oh, crikey, Tee, what a New Year's Eve for you.... Well done for dealing with that. I know how scary it can be. And it's great that you got such good support and advice.

Don't be surprised if you just see higher 'flatter' numbers today. Although you may not. A 'bounce' can last anything from hours to several days. But don't let any higher numbers over that time tempt you into raising the dose.
Quick explanation of a 'bounce': When the blood glucose drops too low or too fast (or both) the body can respond to that stress by releasing stored glycogen to raise the blood glucose level. It can also release counter-regulatory hormones that cause temporary insulin resistance. The net result of this is typically higher blood glucose levels that may be 'flat' and unresponsive to insulin. There's nothing to be done except wait for it to clear. And it will clear...

Steroid-induced diabetics have a higher than average chance of going into remission. And some only need a short time on insulin to give the body the support it needs to heal enough to do that.
Because of Duke's diabetes 'probably' being steroid-induced it will be important to keep an eye on those blood glucose levels, especially over the coming weeks when he is new to insulin.

Again, well done for dealing with that. (((Big hug))) :bighug:

Eliz
 
Morning Eliz, happy New Year.
Thanks for explaining everything.
It was a terrible day yesterday, we were pleased and very apprehensive to get Duke started on the insulin to try and get him sorted and then that happened. I was expecting it to happen at some time in the future but not on his first day, it's a good job we had the hypo kit sorted prior to him starting. I'm checking him again every two hours again but as you say i'm not expecting any true numbers.
Tee.
 
teetee (UK) said:
Just a quick question about the steroid, @Deb & Wink @Shelley & Jess what is it about the 3 month post steroid injection, does it stay in the system for so long
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ECID (Every Cat is Different) but when the effects of a steroid injection start wearing off they can tumble down the dosing ladder quite quickly especially if the diabetes was caused by the steroid injection in the first place. Taking into consideration your steroid injection 3 months ago, the low carb diet and that his numbers weren't terribly high before the injection, I'd rather see you start out at a lower dose and work your way up in 0.25u increments if needed rather than starting high and risking hypo numbers (again).

Jess was getting steroid medication daily, we tapered the dose down slowly and when the effects finally cleared her system it was like I had a different cat. She still needs a bit of insulin but she's doing great. Another member I can think of off the top of my head, @NoahFL (Rebecca and her kitty Max), had a steroid shot and when the effects started wearing off for him he didn't just tumble down, he rocketed down the dosing ladder. You can peek at his spreadsheet here: https://docs.google.com/spreadsheet...tCcG_k13ZS9g68NHrGt5iqW0zYmbU71TfNxWN/pubhtml

I'm not saying the same thing will happen with Duke - just giving you an idea why it won't hurt to be a little cautious going forward.
 
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Wow that's some drop Shelley, be nice if that happened with Duke and got me thinking as to what his BG would have been just after his steroid injection, it must have been really high. I don't understand the 3 month thing though, does it stay in the body so long? Duke had one of those 2 week long lasting injections.
Tee.
 
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Well i have just done Duke's bloods and it looks like he's going through a bounce after yesterdays episode, i will check him again at +10 and +11 to see where he's at. Hopefully he won't go too high.
 
teetee (UK) said:
I don't understand the 3 month thing though, does it stay in the body so long? Duke had one of those 2 week long lasting injections.
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Good question!

I'm voicing my concerns from personal experience and general observation of numerous kittys that have had steroid injections and have come and gone (some rather quickly) here at FDMB.

@Juls and Billy can you help us out here since Billy used to get steroid injections too?
 
Tee @teetee (UK), that has all the hallmarks of a bounce...
If you look at the SS today the blood glucose starts off high, but then as the insulin gets close to the peak of the cycle (when the effect of the insulin is strongest), it manages to briefly pull the numbers down a bit. But as soon as it's past the peak of the cycle the blood glucose is yanked up again.... That is the effect of those counter-regulatory hormones. ....But it will wear off.... Honestly....

What are you feeding Duke at the moment?
 
Tee @teetee (UK) , I know this is hard to watch, because pretty much all we can do is to 'sit on our hands' and wait....
However, with my own diabetics (only two of them, not legions, hehe!) I've found it helpful to feed the lowest carb foods, and also to add as much water as possible to help keep the kitty hydrated. Adding a bit of warm water to food and making it 'soupy' can increase fluid intake; and the warmth of the food can give encouragement for them to eat if the high numbers make them a bit nauseous.
 
Elizabeth and Bertie said:
Tee @teetee (UK), that has all the hallmarks of a bounce...
If you look at the SS today the blood glucose starts off high, but then as the insulin gets close to the peak of the cycle (when the effect of the insulin is strongest), it manages to briefly pull the numbers down a bit. But as soon as it's past the peak of the cycle the blood glucose is yanked up again.... That is the effect of those counter-regulatory hormones. ....But it will wear off.... Honestly....

What are you feeding Duke at the moment?
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Thanks Eliz, just a bit concerning at the moment that his numbers are so high, his keytones are fine, just checked them. Food wise we are going to give him the Feringa 'Pure Meat Menu' Pure Salmon with potato & parsley that's 1.9 carbs but higher calories as we don't want him losing anymore weight as he's only getting fed twice a day before his insulin or the Wild Freedom Green Lands, lamb & chicken at 2.6 carbs as a backup just in case he won't eat the Feringa.
Should i keep his dose at 0.5u or up it to 0.75u.
Tee.
 
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Hi @Elizabeth and Bertie
Food wise we also have Lily's Kitchen Organic Fish Dinner and the Lovely Lamb Casserole both zero carbs but lower in calories, suppose we could give him a couple to keep his calories up.
Just going to do his +11
Tee.
 
Nan & Amber (GA) said:
Personally, I'd keep it at 0.5U for now. Give it a few cycles and wait for the bounce to clear before evaluating this dose. You can always go up later, but you can't take away insulin you've already given if 0.75U turns out to be too much.
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Thank you Nan, we will 100% keep it at 0.5U.
Just done his +11 and it's down a bit to 27.6 mmol/L (497 mg/dl) back into the red.
 
Critter Mom said:
Hi Tee,

Nice to see Duke in your avatar. :cat:


Just double-checking that this is a posting error and that you meant Duke gets fed *before* he gets his insulin dose.


Mogs
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Your right Mogs it's an error, he gets fed before his insulin, well spotted thanks. I have corrected it now.
The pic was taken a couple of years ago when he was a bit fatter, half a moustache Duke.
 
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Hi Tee,

Might still be the bounce.

If you watch how the colours trend in the spreadsheet through the different ranges you start getting a bit better feel for bounces. Longer ones are a bit like an ocean swell, rising through reds - possibly into blacks - and then dropping down again. Duke's risen up into the blacks, dropped down through reds and now he's back in the pinks (and numbers seem to be still gradually dropping).


Mogs
.
 
Bounces can last up to six insulin cycles :eek:, so it's possible. It's fine to back off on testing on a day when it looks like he isn't going anywhere.

We sometimes see that a day in "flat, high, yellows" can precede a bounce-breaking cycle. That's on a human meter, which runs lower than the AT2, so those flat pinks might mean it's just possible that he's planning on breaking the bounce tonight.
 
Dukes BG has behaved today, should i increase his dose to .75U this evening? I will check him again at +11, but i think maybe he ready. Any advice please.
 
teetee (UK) said:
Dukes BG has behaved today, should i increase his dose to .75U this evening? I will check him again at +11, but i think maybe he ready. Any advice please.
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It does look like Duke needs more insulin, but I will leave dosing to others who have experience with Prozinc. :)

Just wanted to stop by and say that you should get at least one test every night before bed. A lot of cats go low at night and bounce in the day. One before-bed test (at whatever time), should give you an idea of how he fared.
 
teetee (UK) said:
Dukes BG has behaved today, should i increase his dose to .75U this evening?
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My goodness, he is really making that bounce last... But they can easily last 6 cycles, and this is the sixth...? ..The numbers have come down a smidge during this cycle, and I just 'wonder' if the bounce will break this evening...
I know this is immensely frustrating (my current girl is a serial bouncer since she's come out of remission :confused:) but, if this were my cat, I'd probably wait one more cycle before considering increasing the dose.... The reason for the caution is that 'bounce clearing' cycles can have a lot of momentum to them, and extra insulin in the mix may cause an even steeper drop. Those kind of things can be harder to keep track of at night...

But, I fully accept that the 0.5 dose may be insufficient and may need to be increased... It would just be good to get a clear idea of what his baseline response is to the 0.5...
That's just my ten cents though...

Eliz
 
Elizabeth and Bertie said:
It would just be good to get a clear idea of what his baseline response is to the 0.5...
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I agree. How about holding 0.5u for one more cycle and getting a couple of tests in tonight.

From the GENERAL INFORMATION AND IMPORTANT LINKS
  • Following a bounce, a cat’s BG may stay high and flat for several cycles. Avoid the temptation to increase the dose at this point. If the BG does not return to normal in 6-8 cycles, an increase might be needed based on the method of regulation you are following.
Another possibility:
I'm trying to read between the lines here, guessing what may have happened in the PM cycles.
PM cycle 01/01 - PMPS 513, +2 412. This is a 20% drop in 2 hours, *usually* indicative that a kitty will go lower during the cycle. Prozinc generally doesn't start working until +2 or later.
And because he has been high and flat yesterday and today I'm wondering if he went low(er) than his body is used to during the PM 01/01 cycle too.
 
Shelley & Jess said:
just a sec, brb
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I've got to get my bookmarks all in one place! :confused:o_O

This document is a great guideline when first starting out: Why the +2 Test is Important - more detail information for Prozinc users by Deb & Wink

teetee (UK) said:
Is there any specific times i should test him to help evaluate him better.
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Start with the +2 and depending on the number go from there. If it looks like a 'normal' cycle maybe another test around the +5 or +6 mark to try and catch the nadir. If the +2 is lower than the PS, a few extra tests are always a good idea. If you have any questions after reading the above document let us know!
 
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His PMPS is 18.8mmol/L (338 mg/dl). I don't know but i am beginning to think that i'm doing fur shots with those results, but i can feel resistance with the needle when i give him his injection.
Tee.
 
Whenever I wonder about a fur shot first I feel for any wet then bury my face in her fur where I shot and have a good smell. For me, I can smell a very faint 'bandage' smell if it ever happens.

Draw a little extra insulin next time and squirt the excess out on a cotton pad or something similiar and smell to see if you pick up any scent from it. Some say they do, others don't.
 
Shelley & Jess said:
squirt the excess out on a cotton pad or something similiar and smell to see if you pick up any scent from it. Some say they do, others don't.
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Much easier to detect fur shots with Lantus: it's rather pungent.

Thanks for the practical hints on checking for a fur shot when using Prozinc. Handy thing to learn about. :)


Mogs
.
 
Shelley & Jess said:
Whenever I wonder about a fur shot first I feel for any wet then bury my face in her fur where I shot and have a good smell. For me, I can smell a very faint 'bandage' smell if it ever happens.

Draw a little extra insulin next time and squirt the excess out on a cotton pad or something similiar and smell to see if you pick up any scent from it. Some say they do, others don't.
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Just tried the smell test and i could smell nothing yet my wife said it was a very strong smell, something like anesthetic or a dentists, something like that.
 
teetee (UK) said:
Thanks Janet, i'm doing Dukes BG all night tonight but his numbers are just not coming down. I just cannot understand why.
Tee.
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Get some sleep. It's not going to go too low. I think it's just too low of a dose. 1.5 was a little too much and it did earn a reduction, but I think the dose was dropped too low. It's a marathon. We will find what works. :)
 
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Thanks Janet, as you say i will up his dose to 1 unit on the AM shot and keep a keen eye on his BG throughout the day. I will do a couple more at +6 and +7 then call it a night i think.
Tee.
 
teetee (UK) said:
Thanks Janet, as you say i will up his dose to 1 unit on the AM shot and keep a keen eye on his BG throughout the day. I will do a couple more at +6 and +7 then call it a night i think.
Tee.
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There's no point to more testing tonight. Go to bed. Lol
 
Yes, that'd be a good idea, especially as the early posts are now quite out-of-date.

You can include a link to this whole thread in your new thread, that way anyone who wants to review history can easily go back and read up :).
 
teetee (UK) said:
Just tried the smell test and i could smell nothing yet my wife said it was a very strong smell, something like anesthetic or a dentists, something like that.
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Just adding my 2 cents regarding furshots. If you give a furshot or think you give a furshot or partial furshot NEVER give an additional shot. You have no idea how much insulin went into kitty in the first place and you could end up double dosing. Once the insulin is injected there is no way of getting it out!
 
Judy and Freckles said:
Just adding my 2 cents regarding furshots. If you give a furshot or think you give a furshot or partial furshot NEVER give an additional shot. You have no idea how much insulin went into kitty in the first place and you could end up double dosing. Once the insulin is injected there is no way of getting it out!
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Thanks for the advice Judy, rest assured that i would never do that and i would just wait until the next injection.
Tee
 
Shelley & Jess said:
ECID (Every Cat is Different) but when the effects of a steroid injection start wearing off they can tumble down the dosing ladder quite quickly especially if the diabetes was caused by the steroid injection in the first place. Taking into consideration your steroid injection 3 months ago, the low carb diet and that his numbers weren't terribly high before the injection, I'd rather see you start out at a lower dose and work your way up in 0.25u increments if needed rather than starting high and risking hypo numbers (again).

Jess was getting steroid medication daily, we tapered the dose down slowly and when the effects finally cleared her system it was like I had a different cat. She still needs a bit of insulin but she's doing great. Another member I can think of off the top of my head, @NoahFL (Rebecca and her kitty Max), had a steroid shot and when the effects started wearing off for him he didn't just tumble down, he rocketed down the dosing ladder. You can peek at his spreadsheet here: https://docs.google.com/spreadsheet...tCcG_k13ZS9g68NHrGt5iqW0zYmbU71TfNxWN/pubhtml

I'm not saying the same thing will happen with Duke - just giving you an idea why it won't hurt to be a little cautious going forward.
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Hi @Shelley & Jess. Not sure how I missed this tag, sorry. Yes, Max was a steroid kitty and towards the beginning of remission, we were doing dose reductions very frequently. We had a lot of hypo pajama parties. I’m happy to report he is still in remission, chubby and happy. He’s still on his wet Fancy Feast classic pate and loving life. In my experience, frequent testing is a must for cats would have become diabetic due to steroids.
 
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