Misho from Bulgaria

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Di&Misho

Di&Misho

Member Since 2014
My name is Diana and I am Bulgarian, it is a country in Europe. My English is very broken but I hope you will understand me. I desperately was searching help using Google and I found your message board. I understand that a lot of people here are very experienced and I strongly believe you will be able to help us. I take care of diabetic male cat. He is 6 years old and was diagnosed in April. Unfortunately vets here don't have any experience with Diabetes Mellitus as people in my country usually PTS pets with diabetes :oops: MIsho ,it is his name, is a rescued ex stray cat whom I used to feed on daily basis. But when I took him to my vet and was diagnosed I realized I have to take him off the streets. Misho was put on Insulin but due to lack of experience his initial dose was 8 units :shock: twice daily which cause very rapid drop of his readings and hypoglycemia . His initial BG number was 33,3 this is in mmol in your readings it is something like 599. I had to administer insulin twice daily total16 units !!! I didn't know by that time that it is totally wrong. Later I contacted a Russian lady that said the cat is overdosed and I had to decrease the dose immediately. From 8 units per shot to 2 units per shot…. She said I have to switch to Levemir as the insulin I was using was not suitable for a cat as it was with peaks that dropped Misho’s numbers from 33 – 2 .Misho had readings below 40 every day and then was again zooming to HI. I use glucometer to monitor his BG every day and it shows HI when the BG is over 599.
Misho is now on Levemir but the problem is that I change the dose for every shot which I read is not right. The reason I do this is because even a dose of 0,5 sometimes causes BG of 30 after 4 hours with starting BG for example 300 . After having such readings ( 30 -35 ) Misho’s BG zooms to over 400 before the next shot . I have to give him at least 1 unit because if I shoot 0,5 the next pre-shot number will be high again.Sometimes I don't see low numbers but even with relatively normal BG like 11-13 he again zooms this usually happens when the pre-shot BG is high and then drops off within 4 hours with 8-10 mmol/L
I am sorry for my explanations I know they sound silly with my English and probably I look like a dummy , that is why I didn’t post in the forum so far.
By the way Misho is on wet Diabetic food product of Integra Protect Animonda- I order it online from Germany as here in Bulgaria we have only dry Diabetic and I think Misho had much higher readings at that time so I switched to wet. He has 255gr each day divided in two meals I feed him when I shoot the insulin . Misho is only 3,200 kgs he lost weight and until now he hasn’t put weight on. He is always hungry and begs for food but this is his daily portion according to the producer. Misho doesn’t drink water at all since we switched to wet food.
I don’t know if I gave you all the info you need. IF you have any questions let me know please. I can give you the numbers for any random day . I cannot measure the BG of Misho very often as he is not at home but for most of the days I have his BG for at least 4 times a day.
PLEASE help me with Misho because I am hopeless that he will be regulated. I am all alone and only reading articles on Internet doesn’t help me though I know much more about feline diabetes now .I know I don’t do things the right way and may be this is the reason why I still have problem regulating him. Very often when I least expect he has hypo and in a few hours after I have found this out and only 1 spoonful of his food he zooms to very high numbers. I read this they call rebound .
Thank you for reading this and I do apologize for my broken English!
 
Welcome to FDMB, Diana and Misho.

It is great that you are home testing. Many find that hard to do.

Levemir is what we call a depot insulin. When it is injected, it locks on to blood proteins and then is gradually released to work. The best way to use it is to keep the same dose every 12 hours.

Do your syringes have 0.5 unit markings? I think you may need to just give 0.5 units no matter how high he is for around 1 full week to get his numbers to stabilize.

The adjustments of Levemir dose are made based on the nadir, the lowest glucose between shots. For Levemir, that low point can be from 7 hours after a shot until right at the next one. You want that lowest number to stay above 50 mg/dL (2.7 mmol/L). If he goes below that, he earns a dose reduction of 0.25 units, which you would eyeball on the syringe as none of them measure that finely.
 
Since Misho is not in immediate danger, it would be OK to go to your first post, click edit, and remove the 911. Perhaps click on the question mark icon instead. (And we use candles and rainbows when a cat has passed.)
 
Thank you so much for answering! And I am sorry I used the wrong icon I know you call 911 when you need help :oops:
Misho is on Levemir twice daily every 12 hours. The syringes we have in Bulgaria are with 2 units marking so I ordered online BD MIcrofine+ syringes with half unit marking and I know how to measure exactly 1 or 0,5 as well as 0,25 . I saw pictures on Internet. I monitor his BG daily with human glucometer. I bought an ACCU CHEK PERFORMA but the tests strips cost fortune so I changed to CodeFree. In my country we use mmol/L which is different from yours. WIth Misho Levemir onset is about 2-3 hours after the shot the peak is usually at 6-8 hours after shot.
Thank you so much for your advice ! As Misho didn't follow the Protocol you all use I took thе same decision to shoot 0,5 no matter what the readings are and I am so happy it was the right one. He is on this dose since yesterday. And I decided to check BG only at pre-shot. Yesterday I only measured 2 times AMPS 05:00 - 25 09:00 - 18,1 13:30 - 10,7 PMPS - 24,8 .This morning BG at pre-shot was 20 .In your readings you multiply by 18 but I guess as exerienced person you know it. The strange thing is that even with readings of 1,8 I have spotted during nights Misho have no symptoms at all his behaviour is absolutely normal and I see no signs of hypo :roll: I want to make for him the spreadsheet you all have in your signatures but I am not sure I will manage. Reading all instructions in your language is not very easy for me but I will try.
Thank you so much for your concern I have read a lot before I decided to write here.And I am happy you understand what I write .I hope I will manage with the spreadsheet too.
 

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You are amazing! You have done so well with Misho, using the internet and figuring out things yourself. And your English is fine - I can't imagine that many of us could converse in Bulgarian.

If you want, I can set up the apreadsheet for you and send it to you via email. (you do need to have an account with Goggle to access it. Is that possible in Bulgaria?). We have a spreadsheet that converts from your measurements to US so that would be easy for everyone.

I will send you a private message asking for your email (we don't want to post it here because of possible scammers). You'll see it on the top of the page "1 new message". Click on that and then if you need help, reply and Submit.
 
We have a template for the spreadsheet and instructions here.

As much as possible, you need to test before you shoot every time you give insulin. If you give insulin when he is too low for safety, he could become hypoglycemic. And you won't always see warning signs this is happening until he is in a full blown seizure.

(I fixed my misspelling of his name in my previous posts!)

Google Translated version for some laughs!

Ние имаме шаблон за електронна таблица и инструкции за тук.

Колкото е възможно, трябва да се тества преди да те застрелям всеки път, когато се даде инсулин. Ако дадете на инсулин, когато той е твърде нисък за безопасност, той може да се превърне хипогликемичен. И не винаги ще видите предупредителни знаци Това се случва, докато той е в пълен разцвет пристъп.

(Оправих ми правописна грешка на името му в предишните ми постове!)

Nie imame shablon za elektronna tablitsa i instruktsii za tuk .

Kolkoto e vŭzmozhno , tryabva da se testva predi da te zastrelyam vseki pŭt, kogato se dade insulin. Ako dadete na insulin, kogato toĭ e tvŭrde nisŭk za bezopasnost, toĭ mozhe da se prevŭrne khipoglikemichen . I ne vinagi shte vidite predupreditelni znatsi Tova se sluchva , dokato toĭ e v pŭlen raztsvet pristŭp.

( Opravikh mi pravopisna greshka na imeto mu v predishnite mi postove !)
 
Thank you so much for your support I am trying my best to cope with everything and I do believe it will work with your help. Thank you Sue for the spreadsheet. I have just added the numbers and I guess you will see the mess :oops: MIsho is on Insulin since April but I decided to add only latest numbers as in the meantime I was trying and checking only not knowing if I do exactly what I am supposed to do. I have friends in Austria who support Misho with syringes and food and I am so thankful they do . We will try and re home Misho as he is a rescue and I myself have 3 cats and 2 dogs at home but I know that before I get him regulated this will be mission impossible. Tonight I shot 0,75 :roll: I know you told me 0,5 no matter what the numbers are but it was tooo high -554 ... Please when you have time look at Misho's spreadsheet and tell me what do you think about it. I will be grateful for any advice you can give me. Thank you so much for your time !!!!
Diana and Misho bcatrun_gif

P.S. The Google translation is really fun I guess my English sounds like this :lol:
 
Hi Diana and you too extra sweet Misho

Sue asked me to stop by and give you a hand as both my extra sweet kitties use Levemir.

I took a peek at your spreadsheet and BJM is correct you need to stick to a single dose for a full week regardless of how high he goes. Those super high numbers are coming from him dropping very fast or very low. Its what we call a bounce.

If you look at my Autumn's spreadsheet for the last couple of days you'll see where she dropped down to 30 then sprang up into the 300s. Because she went below 40 I ignored those high numbers and dropped her dose and came right back down again. That's a bounce.

I need to run an errand really quick but I'll be right back to help some more.

Mel and The Fur Gang
 
Please read this post to see one way of using Levemir and Lantus, Tight Regulation. It also contains a link to the Start Low, Go Slow protocol.

He probably is going to be OK if he is a bit high for a while. Please keep the dose at 0.5 no matter how high he is at pre-shot test.

What you may be able to do when he is high is test for urine ketones with test strips. Human diabetics use them. One brand in the US is KetoStix. Maybe a pharmacy near you or an online vendor would have them. If you do not find ketones, he is OK. Too many ketones are a problem needing medical attention.
 
Okay back...sorry about that but my dog was begging to go for his walk :lol:

So back to how Levemir works. First off the shot you give in the morning doesn't become available for Misho to use until after you give his evening shot or even later. Because it has to attach itself to[ a protein in his blood and then unattach itself to bring down his blood sugar. That binding and unbinding process is what we call a shed.

I know it's very hard to see those very high numbers and not want to give more insulin. But insulin is very different than other medication. If you have a little pain, you take a little pain medication but if you have a big pain, you take a bigger dose of the pain medication. Because the pain medication is a drug that does nothing else but fight pain, it is not something a body makes itself. Now insulin is a natural occurring substance in the body that for some reason in a diabetic either isn't being produced or isn't being produced in enough quantity. Since it should be there the body has built in controls. So when Misho starts dropping really fast or very low a signal gets sent to his liver to stop the drop by releasing stored sugars and a different hormone that makes his sugar climb again. It's his body's way of trying to protect itself from going dangerously low.

Now here's where it gets a little hard to understand, see Misho's body has forgotten what normal blood sugar feels like, his body thinks 500s is where it should be so it gets worried when he gets down into even the 400s or 300s and thinks he is going into hypoglycemia so it sends that S.O.S signal to his liver to release those stored sugars and he jets back up again. But if he keeps dropping into gradually lower and lower numbers his body relearns they aren't scary lows and stops fighting back.

Make sense? If I've lost you let me know and I'll try to explain better.

Also since Sue got your spreadsheet up and running and you're a champ at home testing :-D. If you'd like to come over to Relaxed Lantus ISGhere we've have several folks myself included that use Levemir and we'd love to help you get Misho feeling great again.

Mel and The Fur Gang
 
BJM and Mel thank you for your posts! It looks a bit easier when there is someone who knows what you are going through. I promise to shoot only 0,5 and yes it is hard to see these numbers but I understand I have to accept this or I won't be helpful to Misho. Mel your explanation is quite clear and it makes sense to me. I thought that if I don''t not shoot higher dose to lower Misho's high BG I am wrong. I monitor his numbers as much as I can. Misho is a sweetie and doesn't complain at all. I saw many videos on Internet and learned how to take small drop of blood so it is not a problem for me either. I know that as much data you have the easier it is to understand how his body reacts to insulin and I try to measure BG at least 4 times a day. I see that a lot of cats went into remission and I want so much to see Misho with normal BG someday. I believe it is possible but maybe it was me to blame that I didn't find the information I needed in the very beginning. Promise to follow all your advices !
BJM - I have such sticks and I used to regularly test but I have to confess I haven't done it for a month now :oops: It is very strange to me that he has never had any ketones in his urine though in April when Misho was diagnosed he was in very bad condition and with very high BG. I use the sticks shown on the picture I bought them in the beginning from our vet. MIsho also had his full blood count done - it looked perfect, I read that very often diabetic cats have hyper function of the thyroid gland which makes them hard to regulate so he had FT4 and TSH tests done which seemed to be OK. Such tests here are only performed in human laboratories we don't have them available for pets and the reference range is for humans but I contacted online a vet whose name is Dr.Peterson and he said the levels are OK -FT4 24,6 and TSH 0,08 as far as I remember I don't have them at hand now. I also took him to a University clinic in another city as I live in a small town for chest radiography to see his heart and liver condition for possible problems that occur with diabetic patients and because Misho had a strange cough . His lungs and heart are also OK but I just wanted to have all possible tests done to be sure there is nothing to worry about. I will keep adding the numbers to his spreadsheet and if you have any further questions please let me know. Thank you for your help !
 

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You're doing well with learning as much as you can to help your cat.

How long has the container of urine test strips been open? Exposure to air may cause them to be less effective - it may say to discard them a certain period after opening.
 
Hi Diana and welcome from me too. Good plan to hold that .5U dose for a while and see what it does. For a more detailed explanation of bounces, read the second entry of this post. There is a lot of information about Levemir in the Sticky Notes listed at the top of the Lantus TR forum. Even though it's called the Lantus TR forum, it's really for anyone following the Tight Regulation protocol. Several of us over there are on Levemir as well. Both the Lantus TR and Relaxed forum have a lot more activity than the Levemir forum here.

You've done a great job looking after Misha and learning about what to do with his diabetes. I also speak mmol/L as that's what we use in Canada too. :-D One of my best friends is from Bulgaria, one of these days I'd love to visit there.
 
BJM said:
How long has the container of urine test strips been open? Exposure to air may cause them to be less effective - it may say to discard them a certain period after opening.
Click to expand...
Honestly I haven't checked the best before date :oops: I bought them in late April. But thank you for the hint I'll take a close look at the container or maybe I will have to buy a new one just to be on the safe side. It was really strange as in the beginning Misho was drinking so much water and was peeing so often and in a large amount of urine which I could hardly believe is his.... So I checked and checked but no ketones. As a matter of fact the container was already opened , I mean it was not a new one..
About different tests I am worried as he doesn't put on weight and I know there is a reason for this. It is true that he only has his diabetic low carb food but he has 2 tins 100grams each and a half every day and for his weight this is the prescribed dose. I am just trying to figure out where the problem is as I think he has to be at least 4 he looks skinny especially at his flanks :sad:


Hi Wendy ! The world is a small place to live :-D I hope you will enjoy your stay in Bulgaria, our mountains are just gorgeous especially the Rhodpes don't miss it out ask your friend to take you there you will definitely love the nature !
I have read a lot including the tight Regulation Protocol but as I said before Misho is on Insulin 4 months now and we didn't start his treatment as it should be. I don't know if it will work now and frankly speaking the information is too much for me and I sometimes get confused. I wish I had all of it in my native language :roll: My vet is teasing me that I know more about feline diabetes than he does :lol: But I can understand him, when you don't have experience with such patients you don't have the knowledge as well.
You all are so thoughtful and kind and I am happy I found this message board. Thank you for the tips I will keep reading !
 
Wendy&Neko said:
Hi Diana and welcome from me too. Good plan to hold that .5U dose for a while and see what it does. For a more detailed explanation of bounces, read the second entry of this post
Click to expand...

Dear Wendy and BJM I followed the link but what captured my attention was this
The concept of "New Dose Wonkiness" is NOT applied to higher numbers which may be seen after a dose reduction.
There is no "NDW" following a dose reduction nor do we hold a reduced dose 6 cycles (as done with dose increases) to "fill the insulin depot".
"Settling time" does not apply to dose reductions. We don't wait for a reduction to "settle".
When you see numbers trending higher after a dose reduction we immediately return to the last "good" dose as described in the The Tight Regulation Protocol with Lantus or Levemir:
"If the cat will not stay in the normal range after a reduction, immediately increase the dose again to the last good dose."
Click to expand...

I shoot 0,5 but since I do this BG doesn't drop off at all it keeps very high range. Today the BG level at +7 was higher than the AMPS which means that at PMPS it will be somewhere 599 or above. I don't understand how keeping Misho at these high levels for a week can be safe for him :oops: Doesn't the above quote applies to cases like ours as Misho is not new to insulin. I hope there will be someone online now to answer me. It is a bit difficult with our different time zones ...I am sorry for being a nuisance but it really hurts to know I keep Misho at high levels absolutely knowingly
 
Morning Di

Since I don't follow TR I'm hoping this is an accurate explanation of that point in their protocol, if not I'm sure they'll fill in what I miss.

That would apply if you had been holding a dose for a certain period of time. I believe they hold 3 days at minimum. Because it takes at least that long for the shed to establish.

There are two different protocols when working with Levemir. Tight Regulation and Start Low Go Slow. TR raises doses very quickly because they test a lot everyday and SLGS doesn't raise as quickly mostly because we as care givers don't have as much time to test as much or have cats that need more time to settle on a particular dose. Some cats just don't read the manual on how to be a good sugarcat. Lol

But neither protocol adjusts the dose every shot. You are testing enough to follow TR if you so choose or you're more than welcome to join us in Relaxed Lantus (start low go slow). Or start in one place and move to the other later. Relaxed is a smaller group while TR is a very large group.

Mel and The Fur Gang
 
Good morning Mel ! It seems I have to keep to 0,5 as BJM advised . I am just feeling guilty as Misho's numbers the last days just zoomed . Not to speak that he has his meal at the same time with the insulin shot and after having it his BG will raise . It is his second day on 0,5 and I have no idea how will I bear to see the glucometer showing numbers in the range of 22-30 mmol/L nailbite_smile nailbite_smile
 
Just give us 3 full days at 0.5 units, so we can see how he is when stable. He may need 0.75, but doing it as if you were starting from scratch will show that clearly, rather than jumping around in dose. Especially since you are using Levemir, not Lantus. Levemir can have a very late nadir (when the glucose goes lowest between shots) sometimes right up at the next shot time.

When you "shoot what you see" and dose based on pre-shots, you're always playing catch up to try to control your numbers and you always end up reducing again after going down to below 50 mg/dL.

Also, any time you get a very high or very low number, test twice. Remember, the test is somewhere between 20% lower to 20% higher - it isn't an exact number. By testing twice, you can overlap the ranges and be more confident where his real value is.


Google Translate versions (If the following are any more clear, try putting sentences from the TR protocol into Google and see if that helps you understand it better.)

Просто ни даде 3 пълни дни при 0,5 единици, така че ние можем да видим как е той, когато се стабилизира. Той може да се наложи 0.75, но го прави така, сякаш започва от нулата ще покаже, че ясно, а не да скача наоколо в доза. Особено, тъй като вие използвате Levemir не, Lantus. Levemir може да има много късно надир (когато глюкозата отива най-ниската между изстрела) понякога чак при следващия път изстрел.

Когато "стреля това, което виждате" и дозата въз основа на предварителни удари, вие сте винаги играе улов до опитайте да контролирате своите номера и винаги в крайна сметка намаляване отново след захождането до под 50 мг / дл.

Също така, по всяко време можете да получите много висока или много малък брой, тест два пъти. Не забравяйте, че тестът е някъде между 20% по-ниски до 20% по-висока - тя не е точна цифра. Чрез тестване на два пъти, можете да се припокриват диапазоните и да бъде по-уверен, когато истинската му стойност е.
Prosto ni dade 3 pŭlni dni pri 0,5 edinitsi , taka che nie mozhem da vidim kak e toĭ , kogato se stabilizira . Toĭ mozhe da se nalozhi 0.75 , no go pravi taka, syakash zapochva ot nulata shte pokazhe, che yasno , a ne da skacha naokolo v doza. Osobeno, tŭĭ kato vie izpolzvate Levemir ne , Lantus . Levemir mozhe da ima mnogo kŭsno nadir (kogato glyukozata otiva naĭ-niskata mezhdu izstrela) ponyakoga chak pri sledvashtiya pŭt izstrel.

Kogato " strelya tova, koeto vizhdate " i dozata vŭz osnova na predvaritelni udari , vie ste vinagi igrae ulov do opitaĭte da kontrolirate svoite nomera i vinagi v kraĭna smetka namalyavane otnovo sled zakhozhdaneto do pod 50 mg / dl .

Sŭshto taka , po vsyako vreme mozhete da poluchite mnogo visoka ili mnogo malŭk broĭ , test dva pŭti. Ne zabravyaĭte, che testŭt e nyakŭde mezhdu 20 % po-niski do 20 % po-visoka - tya ne e tochna tsifra. Chrez testvane na dva pŭti , mozhete da se pripokrivat diapazonite i da bŭde po-uveren , kogato istinskata mu stoĭnost e .
 
Thank you BJM ,I do understand and JYI Google provides very strange translation in Bulgarian. If you use it to translate from English to German it is nearly perfect but to Bulgarian or vice versa is awful.
I keep adding numbers to the spreadsheet and I hope you can view it. I had a problem accessing it a minute ago, I don't know if that was a software problem or my internet connection. Today’s PMPS was again very high :cry:
I checked the container of the Urine test strips it says best before February 2nd 2015. I keep the container closed so I believe it is OK. And I will test for ketones these days. You mentioned Lantus - do you think that Lantus is a better choice than Levemir ? And do I need to switch to it? I thought both are nearly the same and there is no big difference but if Lantus works better I will switch to it .
P.S. I forgot- I always double check BG when I see high numbers just to be sure it is correct, I don't do that for low numbers though :oops:
 
Both Levemir and Lantus are depot insulin. Levemir has a later onset, a later nadir and usually a flatter curve. Lantus also has an acidic base that some cats react badly to, while Levemir has a neutral base. The best insulin is the one your cat responseto. Some cats do great on Lantus, others do better on Levemir and some do great on Prozinc which works entirely different from either Lantus or Levemir.

Mel and The Fur Gang
 
Thank you Mel.When we switched to Levemir I was told that Misho needs prolonged insulin and as Levemir is the most used one by Humans I made this choice. We don't have any insulin for pets here by the way.
Wendy actually the first forum I found was the German, thank you :smile:
Misho keeps his numbers high and I already hate red and black colours :sad: I hope this won't do him any harm.
 
Patience is the worst part of working with a depot insulin. :YMHUG: but if it helps he got a nice drop early for Levemir. :-D. Because Levemir has a late onset ( when the insulin starts lowering blood sugar ), most cats are still rising until about +4-+5.
It's not uncommon for a Levemir cat to have a bell shaped curve early on instead the smiley face curve like Lantus.

It'll just take him a few days to settle down, and the worst that's going to happen is you're going to have to take him up again.

It is always better to be too high for a few days than too low for a moment.

My Autumn I adopted as a diabetic, her original owner couldn't treat her when she was diagnosed, so she went 10+ months before I adopted her running in the 500s. When I got her she didn't even weigh 5lbs, she was extremely dehydrated, with moderate ketones. She's been with me 2 1/2 years now and she's a healthy happy girl. That's her as my avatar.

Mel and The Fur Gang
 
MommaOfMuse said:
It is always better to be too high for a few days than too low for a moment.
Click to expand...
This is the part I have to accept and believe that nothing wrong will happen if he stays rather high for a few days. I know you all have seen a lot , you are more experienced than I am and I do trust you. So I work on patience . He is doing fine but is more hungry these days and he eats as if there is no tomorrow .I know I worry too much but this is because I don't have your knowledge. I read a letter by a sugar cat to mom this morning and it was fun :lol: I enjoyed reading it as I am sure all of us have gone through this . Today I measured BG at +5 because I want to have an idea of what is the level in diffrent hours after the shot.Todays number is relatively low to what I have seen the last days.
I am so happy I found people to give us a hand. Thank you to all of you for being there for us :thumbup
 
Tight Regulation Note:
Once you have 3 full days at 0.5, on the 4th day, if the nadirs have been high, you may increase as follows:
- If nadirs were > 300 mg/fL, increase by 0.5 units
- If nadirs were between 200-300 mg/dL, increase by 0.25 units (you'll need to estimate on the syringe)

Tight regulation will get you to better numbers sooner. As you start getting lower mid-cycle numbers, you may decide you want to slow down a bit and go to the Relaxed Lantus Forum.

Also, starting off, we suggest not shooting below 200 mg/dL. As you get data showing it would be safe, you may slowly reduce that limit down to 150 mg/dL. If you want to shoot any lower than that, you may find that the TR forum is the best place to post. They will "shoot low to stay low" and they carefully monitor mid-cycle to keep the cat safe.
 
BJM said:
Tight Regulation Note:
Once you have 3 full days at 0.5, on the 4th day, if the nadirs have been high, you may increase as follows:
- If nadirs were > 300 mg/fL, increase by 0.5 units
- If nadirs were between 200-300 mg/dL, increase by 0.25 units (you'll need to estimate on the syringe)
Click to expand...
Shall I increase dose for tomorrow morning shot( it's 8 p.m. now with me) or I have to wait one more day because of the 0,75 evening shot on 21st ?
And my second question is- if I follow the protocol I have to increase with 0,5 i.e. shoot 1IU but I am afraid that 1 unit will drop off quickly or much lower than the BG Misho had the last days and he will bounce again. Will it be wrong if I initially increase only by 0,25 and shoot 0,75 ? If that is not too much of a trouble please take a look at his spreadsheet and tell me if shooting 0,75 instead of 1 unit is better.Thank you !
 
You always hold the syringe, if you're more comfortable only going to
75, then go up to that and do the same thing hold for a minimum of 3 days.

Mel and The Fur Gang
 
What Mel said.
Also, because Levemir lasts so long, going up 0.25 is fine - the 0.5 level may not have completely hit a steady level yet. You'll have time to check nadirs to see if you're getting too high by going slowly.
 
Good luck with the increase. One additional thing the TR protocol suggests is at least one additional test in the night time. With Levemir, it's better to get one in the last half of the cycle if you can, but even a test before going to bed will help. It is possible for Misho to be going lower at night then bouncing and showing you higher numbers during the day. Many cats go lower during the night than the day.
 
Good mornig everyone ! Thank you for your answers and support it really means a lot when I read your point of view.Today I increased to 0,75. I did that not because I prefer one Protocol to another but because with 1 unit I have really seen very low numbers - with preshot of 435 the BG at +7 was 95 and next preshot high number again. I will keep adding the BG levels and I hope things will be under control for the next days as with Misho you never know- his body reacts in absolutely different way and most of the time even the data I have don't help me to predict what will happen. :roll:
 
The unpredictability was partly due to changing the dose so frequently. By sticking to a dose for 3 full days, it gets a chance to stabilize and show how well it is working. It is tempting to go faster, but then you can pass over the optimal dose.
 
BJM said:
The unpredictability was partly due to changing the dose so frequently.
Click to expand...
It is really strange to me that I don't see any low numbers . Now with 0,75 it drops off to 19 again and that's it, then it begins to rise somewhere at +7 and the preshot is again high. May be the next days it will be better ...I just wonder what will happen when we increase the dose to 1U and the BG begins to drop off . Do you think that his numbers now are normal to what we shoot ?
And I have a question regarding his low carb food. Misho is now fed with Integra Protect Diabetic But I read that many cats are not on special diabetic food so I wonder if just a normal wet formula will be OK with Misho. It is a product of the same company but is much cheaper though high premium quality too. If it is OK I'd rather switch to it or combine with Diabetic as the last one is quite expensive- almost double and a half the price :oops: Here is the link to both,product of German company Animonda.
This is his food now :
http://www.animonda.de/int/products...tegra-protect-diabetes-wet-food.html&mtid=109

and this is the one I am asking for. I didn't see in the analysis if any sugar s addded :?:
http://www.animonda.de/int/products/cats/wet-food/tin/carny-fleisch-menue-adult.html&mtid=109

I will appreciate your advice. Thank you ! :thumbup
 
The second food looks like it would be fine. I don't see any carbs like rice or gravy or meal of any kind. It doesn't look the ingredients in the first food are any better - just more expensive?
 
Vet formulas are very expensive here Sue no matter dry or wet food. They are especially made for diffеrent health conditions like Renal failure, Digestive problems, Diabetes etc. I wouldn't be able to afford diabetic formula if my friends didn't help. Animonda is premium quality food and is known to be grain and soya free.
 
Depot insulins build up their effects over time. You don't want to overshoot and wind up having to test and feed 1-2 teaspoons of high carb food every 20 minutes until Misho is back in safe numbers. Too much insulin can kill quickly.

After you give it a full 3 days, if the nadirs have been too high, you may increase by another 0.25. The Tight Regulation protocol was developed to be a safe, effective method to adjust the insulin dose by home monitoring.
 
Re: Misho from Bulgaria/Additional Query

Hi All,

I'm still unfamiliar with how best to use this forum so I hope it is OK to enter another thread and ask a question of my own?

I've just read the entire thread, including links to bounce info etc. and it seems that Misho is experiencing the same problems are my own Mr. Mojo.

Those of you who followed my persistent rebound post will be aware of where we were at the time of posting, i.e. using super low dose Lente to stabilize before considering a switch back to Lantus because of it's depot action release mechanism and less inclination to spike.

Where we are now, 1/2 unit Lente 3 x daily did start to slowly reduce numbers however as soon as I upped to 0.75, the rebounds were occurring again by +6 so I abandoned and resumed Lantus.

Two cycles of high and flat out of rebound as expected on 1 unit BID, and today we have a +5 currently of 12.3 from a Pre-shot of 22. Now, if things pan out as they usually do, either by +12 this evening or maybe tomorrow morning, he is likely to bounce because he's in the area where his liver panics. As above, two high cycle will follow, he'll drop again, then the whole process will repeat itself over and over. On this basis, my question is, what do you do when the liver keeps kicking in? Should I too be sticking with a 1/2 unit BID Lantus for a period of time in these circumstances with the aim of getting his body used to lower numbers?

I have my appointment with the RVC tomorrow, but it would still be nice to have some thoughts from experienced long acting insulin members prior to this to help me decide if I should leave him there or merely consult, bring him home again, and keep trying - i.e. is there anything they might be able to establish in terms of why he continues to rebound that I can't do at home????? Has this problem been reported long term (2 months) by other members in the past?

Also interested to know what this acidic thing with Lantus is and how it is recognized, as well as wondering if Levemir is available in the UK as an alternative?

Thank you in advance.

Angela.
 
Hello Angela - if you have a question about your own situation, it's best to start your own thread. Go to the forum and select the NewTopic button and re-enter this information. As for liver panics, each cat is different (ECID), but once they've spend enough time in normal numbers, the liver will panic less. And yes - it can definitely happen for more than two months. We've seen some cats bounce all the way to remission. If you decide to follow a protocol, the Tight Regulation Protocol has been mentioned here, they have guidelines for how long to hold a dose.
 
Re: Misho from Bulgaria/Wendy

Hi Wendy and thank you, but I already posted my own thread (referred to) and didn't receive the more detailed bounce responses I was looking for obtained here, so was working on the theory perhaps it would be better to post within an active thread. Sorry if that was the wrong thing to do, just the two cases are identical to some extent.

I am following the TR BTW, I read that from the very start and it was this that had me worrying (as it turned out correctly) that my vet in her eagerness to have him in remission (pancreatitis case cat) was starting on too higher dose, looking for quick increases when I wasn't keen, and generally causing utter confusion until she decided to forget it and start with PZI instead.

I do understand the bouncing mechanism however, when you have a cat that bounces from say 12 to HI on the meter within an hour consistently, the problem is they never have the chance to get used to being in the lower numbers, so it was this problem I was looking at advise on how to get over, i.e. using shorter acting insulin to stabilize then resuming, but as this failed also, the question I was ultimately asking is, as per the advise within Misho's thread, should I too be thinking 1/2 unit BID Lantus for a period of stability before creeping up to the actual effective doses, ( and by that I mean the ones which currently have him bouncing) ????

Thanks again. Angela.
 
Re: Misho from Bulgaria/Additional Query

DMUKCAT said:
...wondering if Levemir is available in the UK as an alternative?
Click to expand...
Yes, Angela, Levemir is available in the UK. It's not used a lot, but some vets favour it. (And it's often used for cats with acromegaly and other high dose conditions.)
 
Hi Angela.You are right to some extent it sounds like Misho. I have never had an answer of the question why his BG rises so quickly to high numbers sometimes with no particular reason and I thought it is his liver doing this mess
Misho still keeps his high pre shot numbers and I am so unhappy to see this red color in his spreadsheet. I know I have to be patient but on some unknown reason I begin to worry that I will never see more blue and yellow color on his ss.
I continue reading and today I was surprised that cat Tasha they feed at midnight providing shot is at 5 p.m. Misho has his meals twice daily immediately after insulin. If I don't give him his meal his BG will drop off quickly and very low. It will happen even if he only eats 1/2 of his meal. So i just wanted to ask I am doing something wrong by using this feeding schedule? And do I test at the proper time or I have to check earlier or later? I guess that tomorrow I will have to increase Misho's dose by 0,25 and shoot 1 U twice daily. Am I right or I have to wait ?
It s 6 a.m. here and I don’t know what's the time with you so I wish you all a happy day ahead. Thank you for helping us
cat_pet_icon
 
Many of us free feed. This requires cats which do not scarf 'n' barf, ie eat so fast they immediately vomit.

Quite a few feed mini-meals. This ensures the food is coming in to match the insulin as it starts to work. It also helps prevent huge food-related glucose spikes.

A few of us may meal feed.
 
BJM said:
Many of us free feed. This requires cats which do not scarf 'n' barf, ie eat so fast they immediately vomit.

Quite a few feed mini-meals. This ensures the food is coming in to match the insulin as it starts to work. It also helps prevent huge food-related glucose spikes.

A few of us may meal feed.
Click to expand...

It is absolutely impossible to free feed Misho. He is always hungry and if I just put his daily dose in his food bowl he will eat all of it immediately. I have sometimes tried to only give him 1/2 portion after his shot but if I do this BG drops very quickly and at +3 when I come back to measure and give him the rest of his food sometimes I have seen very low numbers . I don't know if that was a result of the split food but definitely the BG is always lower when I give him less food at his shot. I can try to do the same now when I follow your instructions for the doses but honestly I don't know how to proceed. MIsho has 3 tins per day that is 300grams would you suggest a better feeding schedule than twice daily ? I will try to follow it though I am not all day at home. Sorry if I ask silly questions but sometimes I am just afraid to make the wrong decision as I don't have your knowledge :oops:
 
The only silly question is the one you don't ask. :mrgreen: One thing you could try is to add warm water to the food to make a kind of gravy. That might slow him down and spread the food out a little more.

If he goes down when there is less food on his stomach, you might be able to use that to your advantage. It could mean his numbers are very influenced by food and so spreading out his food intake might lower the numbers overall. If he likes the food with the "gravy" you make with water, you could try adding water to a tin of food, mix it up and freeze it. Then give it to him, frozen, during the day. Some cats will just munch on the frozen food as it thaws. (have to say, this technique did not work with Oliver. He would drag the frozen food around the house, all over the rugs, till it fell apart. But it does work with many cats. :-D )
 
Sue and Oliver (GA) said:
(have to say, this technique did not work with Oliver. He would drag the frozen food around the house, all over the rugs, till it fell apart. But it does work with many cats. :-D )
Click to expand...

It won't work with Misho either :lol: Frozen, cold, warm whatever it is he will eat it, ALL of it. His hunger is persistent though not that severe as it was in the beginning. Misho's BG is definitely influenced by the food I have read about these post meal spikes if I am not wrong. This was the reason why I tried to give him less food at insulin shot but when his BG began to drop too quickly I stopped. Today at his PMS I fed him only 1 tin and the rest 1/2 I will give him in 2 hours and will take the chance to measure BG at +2 and again in the usual +5 to see what numbers we will see :roll:
 
Hi Diana,

the replies you have received here in terms of getting Misho's numbers more stable after prolonged periods of insulin overdose and subsequent rebounds are very valuable as in this setting, regulation becomes more difficult, and while it is hard to leave your cat hanging with high BG, with insulin, sometimes LESS is MORE, and it does require a great deal of patience. The other problem is lack of consistency, so again, if you try to make those increases more quickly, you are just prolonging the agony and regulation does not occur overnight even when you do everything perfectly so don't panic too much.

Yes there can be other reasons which complicate regulation, for example my cat has a concurrent pancreatitis, slight liver abnormalities, he is on low dose steroids to control upper respiratory inflammation AND he threw a nasty urinary tract infection right in the middle of our trying to regulate so all these things are obstacles to regulation, steroids being antagonists to insulin therapy and any type of infection or inflammation will cause BG to be erratic and often stubbornly high, so I mention these things to you only because sometimes concurrent disease is not diagnosed correctly or overlooked, and this too can cause great confusion.

From everything you've written I think you are doing an excellent job in the circumstances and in your case it mostly likely IS that you were overdosing at the start, a degree of glucose toxicity caused by prolonged elevated cycles can also contribute to an increased insulin resistance until you break the bad habits, and I'm sure if there are no concurrent disease factors complicating the diabetes, that consistent dosing with tiny increases after 6 -10 12hr cycles will get you on the right track as from what I read, you are still trying to increase too quickly!

In terms of feeding, long acting insulin in cats is well suited to cats who eat little and often and while Misho may be experiencing excessive hunger at the moment, that is more about the spikes up and down in his BG, as often cats will eat ravenously as they detect a too low, and then feel starving when their BG shoots up really high with rebound so you have a vicious cycle, but his appetite should settle as the numbers start to become flatter and lower for longer periods within the 12hr insulin cycle.

Another thing you could try to make sure he is eating throughout the cycle when his numbers start to drop, is buy several timed feeders and place a smaller portion of food in each, that way you know he is eating consistently without over eating within any 12hr period and this should also eliminate the problem of food spikes, as though low carb high protein food doesn't generally cause food spikes, having no food available as the insulin reaches nadir is not helpful in a cat suffering rebound.

I hope this helps, and I am following your progress with interest.

Take care,

Angela.
 
Tomorrow/next shot, you will be able to increase to 1 unit, if you choose.

You may start seeing some pre-shots below 200 mg/dL as the dose increases. Because you have been collecting data mid-cycle, you may lower your no shot level to 150 mg/dL. If it is below 150 mg/dL at pre-shot, stall/wait for 30 minutes without feeding and see if he is rising. If he is rising, it may be safe to shoot below 150 mg/dL so long as your data show it is likely to be safe.

When you start getting pre-shots below 150 mg/dL, you may want to move into one of the protocol specific forums - either Tight Regulation, or Relaxed Lantus. In Tight Regulation, you learn to "shoot low to stay low". In Relaxed Lantus, it is a bit less aggressive in dosing. Its up to you which is more comfortable for you to follow. What we've asked you to do so far is following the initial phase of Tight Regulation.

Brief explanation:
Fatten a dose - to slightly increase a dose, but not a full quarter unit
Skinny a dose - to slightly decrease a dose, but not a full quarter unit

Looking at the beginning where you started your spreadsheet, I have a feeling that either a fat 0.75 or a skinny 1.0 units may be about right for him because after 5 shots of 1 unit, he gave you a beautiful nadir of 52 mg/dL (2.9 mmol/L).
 
Hello Diana,

Di&Misho said:
Misho is now fed with Integra Protect Diabetic But I read that many cats are not on special diabetic food so I wonder if just a normal wet formula will be OK with Misho. It is a product of the same company but is much cheaper though high premium quality too. If it is OK I'd rather switch to it or combine with Diabetic as the last one is quite expensive- almost double and a half the price :oops: Here is the link to both,product of German company Animonda.
This is his food now :
http://www.animonda.de/int/products...tegra-protect-diabetes-wet-food.html&mtid=109
and this is the one I am asking for. I didn't see in the analysis if any sugar s addded :?:
http://www.animonda.de/int/products/cats/wet-food/tin/carny-fleisch-menue-adult.html&mtid=109
Click to expand...
Do you have a Zooplus online store in Bulgaria? (Is this the link? http://www.zooplus.bg/shop/kotki/konser ... rana_kotki )
If so then there are lots of suitable foods you can try for Misho, for example; Bozita (cans and tetrapacks), Granatapet, Grau (grain-free version), Catz Finefoods....
You will find many Zooplus foods listed on a spreadsheet that a UK member here, Juliet, has put together. The column on the far right of the list shows the carbohydrate content of the food. The list is numbered, and the foods numbered 41 - 131 are usually all available from Zooplus.
https://docs.google.com/spreadsheet/ccc ... mWmc#gid=1

Eliz

PS. Well done for getting Misho's spreadsheet set up! :smile:
 
Today at his PMS I fed him only 1 tin and the rest 1/2 I will give him in 2 hours and will take the chance to measure BG at +2 and again in the usual +5 to see what numbers we will see
Click to expand...
:roll:
I had some problem with my I-net provider and had no chance to write here. So yesterday evening everything was as every other day no matter I split the food. I mean no significant drop of BG. It seems that all situations before were due to improper insulin doses. In the morning I increased insulin by 0,25 and now Misho has 1U twice daily. As you will see he has two yellow readings and then rise again. I don't know if it is normal or not but I like to see a different color on his ss.
Thank you so much for all the thoughts you share with me. I have to admit that when you brief :razz: it is much easier as it is a total mess in my head with so much reading here :roll:
Angela special thanks for your detailed post. I am trying to be patient and not to panic , I do try very hard but it seems with no much success :oops: My idea is not to see beautiful blue and green colors but to not keep MIsho's BG over 360. It is because I am under the impression that his liver will get used to high numbers and then even at normal BG levels it will panic. Lately I haven't seen a pre shot in other color than red and this is what bothers me most. As for the health conditions that usually complicate the regulation as you say I did all tests that are available here for pets( they are not much though) as I read about these concurrent diseases that most diabetic cats have. With Misho all turned to be well or at least I can only trust what vets told me. But you are right it didn't start as it should and now it is hard to see any significant progress but I still hope that real soon Misho will be much better. I will be happy if he puts some weight on as well and if his coat doesn't fall out so much :sad:
I am not sure I know what timed feeders are and if they are available on our market .I have a slight idea of what you are talking about but isn't it only for dry food? Misho is on wet only.
BJM thank you for the directions. Today Misho already had 1 unit twice. I hope to see nice pre shot numbers soon though today they are still red :sad: But I promise to follow your advice when that happens. All you have written is really helpful to me !
Do you have a Zooplus online store in Bulgaria? (Is this the link? http://www.zooplus.bg/shop/kotki/konser ... rana_kotki )
Click to expand...
Elizabeth, what a coincidence - I was browsing this webs site today :lol: and I actually added as second choice to Animonda ( which I know is premium quality ) Bozita and Grau. The last is quite expensive like the diabetic brand I am buying now. For our standard these foods are really costly :oops: I will try either with Animonda and Bozita because both are grain free and because they are a bit cheaper than Grau . I also saw on Animonda's list sugar free snacks and I am about to order some for in between meals because I cannot free feed Misho and he has measl only at shots but always cries for food :YMSIGH: Misho's SS was set up by Sue it is not my merit.
THANK YOU so much to all of you for your time, for your concern and for being so thoughtful. We do appreciate it very much
:YMHUG:
 
Remember that the number you want to see get lower is in the mid-cycle, around the nadir.

The pre-shot number only tells you if you need to :
- Reduce - too low to give insulin - right now, 150 mg/dL - or can't give twice a day due low numbers at 1 of the 2 times
or
- stall before injecting - wait 30 minutes without feeding and retest to confirm the glucose is rising and it is safe to shoot.
 
BJM said:
The pre-shot number only tells you if you need to :
- Reduce - too low to give insulin - right now, 150 mg/dL - or can't give twice a day due low numbers at 1 of the 2 times
Click to expand...
I didn't quite get that. I should not shoot if the pre shot is 150, right? But the second part I can't understand, I am sorry :oops:
 
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