Moving shot time 2 hours back in 8 days. Advice?

[max&emmasmommie]

***The body of this post is exactly the same as "Newbie asks: Time to raise the dose? +200 pt swings," but with a different Subject Line to make sure people who would respond to a time change question (but not a dose change question) will read it.

The intersection of these issues is troublesome. I read the post at http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=65070, but I hope I can move the time of the shot more than 4 times in a week byt 15 minute increments and/or more than 2 times in a week by 1/2 hour increments. In fact, that post seems to indicate that I could, in theory, move the dose back an entire hour at once when we consider my cat's current high BG values. Nonetheless, I'm worried about bouncing/Somogyi effect due to a sudden jump like that being the equivalent of a dose increase. Adding in the .25 dose increase he seems to need just makes it that much more problematic. God forbid he needs another .25 increase about a week after the first one. Messy, huh?***

Hello everyone, and good morning. I'm not getting good test results.

Max acts very normal. He goes outside, he is not waking us up early in the morning for food. He cleaned his bowl while we slept last night and was hungry this morning at 9:00. He looks good -- clean, fluffy, not oily or with spiky fur. He's using his litter box or going to the bathroom outside. He's not drinking as much water as he used to.

Last night his BG values went from 474 at PMPS time to 260 at +3 to 474 at +11. I don't know what it was at +6 or at +9. This can't be good for him, his liver or his kidneys, let alone his other organs.

1. Dose incorrect? Max's BG readings are not leveling out. I haven't had time to do a full curve yet, and I didn't get far with the mini curve I tried to do last night. However, I do believe that this dose (2u) is not working out. Please take a look at the spreadsheet. As to food, today he is having 1/4 can Hills m/d mixed with 3/4 can Wellness Beef and Chicken. Tomorrow it will be 1/8 Hills, and Sunday, he will be eating only Wellness. If I do increase the dose I intend to increase it by only .25u. Before I do, do I need more BG level information? If so, do I need a full curve or could I use a mini curve?

2. A complication: I need to change his shot time by 2 hours. He was getting it at 10:00, and I just gave him one at 9:45. We are leaving on vacation in 9 days, and the cat sitter needs to give him his shot at 8:15 or 8:30. So, I'm planning to move his shot time back 1/2 hour for a day, then another 1/2 hour for a day, and so on. I'll run full curve once we are firmly established at 8:15. Questions: 1. Should I move it by only 15 minute increments? 2. Can I move it EVERY shot time, or only once a day?

3. How many days of a new dose should pass before I leave? In order to know if the new 2.25u is working, I need his shot time to be stable, right? If so, it will take me until the day before we leave to get an answer if I move the shot time only once a day by only 15 minutes. If I move it twice a day, we'll be done in 3 1/2 days. Likewise, if I move it by 1/2 hour increments only once a day, we'll be there in 3 1/2 days. However, I could get there in 2 days if I move it twice a day by 1/2 an hour each time. Then, I would have over 5 days at 2.25u without any movement of the time going on, and I could run a full curve. Then, I could raise it again if I had to.

4. Leaving him at above 200 at PS time for a couple of weeks? I hate to raise the dose right before we leave. I'm worried that the pet sitter will not be able to test him, and he'll be on a new dose without monitoring. If his AMPS and PMPS levels are above 200 for the 10 days we are gone, and I can get them down shortly after we get back, that's better than risking a Hypo. Any comments?

Thank you.

 

[Blue]

***The body of this post is exactly the same as "Newbie asks: Time to raise the dose? +200 pt swings," but with a different Subject Line to make sure people who would respond to a time change question (but not a dose change question) will read it.

The intersection of these issues is troublesome. I read the post at http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=65070, but I hope I can move the time of the shot more than 4 times in a week byt 15 minute increments and/or more than 2 times in a week by 1/2 hour increments. In fact, that post seems to indicate that I could, in theory, move the dose back an entire hour at once when we consider my cat's current high BG values. Nonetheless, I'm worried about bouncing/Somogyi effect due to a sudden jump like that being the equivalent of a dose increase. Adding in the .25 dose increase he seems to need just makes it that much more problematic. God forbid he needs another .25 increase about a week after the first one. Messy, huh?***

Hello everyone, and good morning. I'm not getting good test results.

Max acts very normal. He goes outside, he is not waking us up early in the morning for food. He cleaned his bowl while we slept last night and was hungry this morning at 9:00. He looks good -- clean, fluffy, not oily or with spiky fur. He's using his litter box or going to the bathroom outside. He's not drinking as much water as he used to.

Last night his BG values went from 474 at PMPS time to 260 at +3 to 474 at +11. I don't know what it was at +6 or at +9. This can't be good for him, his liver or his kidneys, let alone his other organs.

1. Dose incorrect? Max's BG readings are not leveling out. I haven't had time to do a full curve yet, and I didn't get far with the mini curve I tried to do last night. However, I do believe that this dose (2u) is not working out. Please take a look at the spreadsheet. As to food, today he is having 1/4 can Hills m/d mixed with 3/4 can Wellness Beef and Chicken. Tomorrow it will be 1/8 Hills, and Sunday, he will be eating only Wellness. If I do increase the dose I intend to increase it by only .25u. Before I do, do I need more BG level information? If so, do I need a full curve or could I use a mini curve?

2. A complication: I need to change his shot time by 2 hours. He was getting it at 10:00, and I just gave him one at 9:45. We are leaving on vacation in 9 days, and the cat sitter needs to give him his shot at 8:15 or 8:30. So, I'm planning to move his shot time back 1/2 hour for a day, then another 1/2 hour for a day, and so on. I'll run full curve once we are firmly established at 8:15. Questions: 1. Should I move it by only 15 minute increments? 2. Can I move it EVERY shot time, or only once a day?

3. How many days of a new dose should pass before I leave? In order to know if the new 2.25u is working, I need his shot time to be stable, right? If so, it will take me until the day before we leave to get an answer if I move the shot time only once a day by only 15 minutes. If I move it twice a day, we'll be done in 3 1/2 days. Likewise, if I move it by 1/2 hour increments only once a day, we'll be there in 3 1/2 days. However, I could get there in 2 days if I move it twice a day by 1/2 an hour each time. Then, I would have over 5 days at 2.25u without any movement of the time going on, and I could run a full curve. Then, I could raise it again if I had to.

4. Leaving him at above 200 at PS time for a couple of weeks? I hate to raise the dose right before we leave. I'm worried that the pet sitter will not be able to test him, and he'll be on a new dose without monitoring. If his AMPS and PMPS levels are above 200 for the 10 days we are gone, and I can get them down shortly after we get back, that's better than risking a Hypo. Any comments?

Thank you.

OK first thing is that I don't think I'd worry too much about upping a dose if you are going to be away in a week and someone else is going to be watching/shooting. Lots of people leave instruction to shoot a purposely LOWER dose so they can err on the side of caution... for me, I would leave the increase until you return because you know your own cat, can read the signs in Max if too much or too little .

For the time changing of the shots, people change their shot times twice a year by an hour over a weekend.... time change pretty much dictates it. If you are OK to be giving shots now at the sitters preferred time, why not move the shot times over the next 2 days? You still have to be careful of shooting early .... if you test at +11 and you don't think the BG is high enough, you can forget about shooting early on that shot. You have the luxury of a week to move the shot time, you can pick which ever days you want but I would get it changed earlier rather than later.

Also, looking at the ss, you had a massive nice string of blue numbers on the 2u dose, but then you got that big bounce to the moon. It's expected because you gave insulin that put Max where he should be, but when it wore off, the body went soaring back to numbers it was used to having and feeling.... those wrong numbers feel right still, and it may take a few more visits down to the better numbers before all of Max gets used to it.

With that big string of blues, I don't think I'd want to raise the dose, especially with a sitter who may not be testing.

Stick with moving the shot time back and the early shots are the equivalent to dose increases.
Who knows? You may find that the numbers level off a bit this week with the combo of early shots and settling dose in Max.

For all you know, you will move the shot time to 830/830 and Max will be giving you some nice yellow numbers!
Then you may think about asking the sitter to go with a dose of 1.5u BID until you return!
Always err on the side of caution and don't worry if the numbers are a wee bit higher as it's better than numbers on the bit too low side!

 

[max&emmasmommie]

Ahhh, thanks Gayle. Just the answer I was hoping for - he's still adjusting even after 14 of the 2 unit doses. That makes me feel better.

 

[Blue]

Be sure to ask if you have any other questions before your holiday.
The better your plans are put into place, the better your holiday will be.

 

[max&emmasmommie]

SIgh . . . . it's 4:00 a.m.. Now Max is having readings over 600 at +11; gave 2u at PM shot time; 566 at +7. This is an emotional rollercoaster for both of us. He came to the bed and lay down in between my head and my husband's head - something he never does. He didn't paw at us or scratch us, but I knew he needed food. I gave him food, and tested his BG before the food had a chance to hit his blood stream, and then I fed him more. This is just crazy. Is there any way to stop this, or do I just have to wait at this 2u dose until he levels out? I know he could have fast acting insulin, but then the Lantus schedule will be all messed up, and I don't even have the energy to contemplate how that would all work. Besides, when I tell the vet I haven't been giving him the 3u he prescribed, what do you think he's going to feel? Does anyone know a vet in the San Diego or LA area who is knowledgable about diabetes?

 

[max&emmasmommie]

Diabetes Vet in San Diego or LA?

Does anyone know a vet in the San Diego or LA area who is knowledgable about diabetes?

 

[Blue]

Re: Diabetes Vet in San Diego or LA?

Does anyone know a vet in the San Diego or LA area who is knowledgable about diabetes?

If you can't find a vet who is knowledgeable, then one who will work with you and learn is good.
You need a vet for testing and Xrays and ultrasounds and meds, and mending broken bones and things like that. when it comes to diabetes, I don't think many vets know much.

You are using Lantus? Why not switch to lev? There have been a few others who have had issues with Lantus and switched to Levemir with very good results.

I know one of my cats is much better on Levemir than Lantus... it's something to consider.

While on Lantus, step back and go through a checklist of everything.
1. Food.
what are you feeding, how much, how often. What about snacks.
Foods very important so you want to make sure you are feeding only low carb wet foods. Anything else can make the BG all over the place.

2. Health.
Be sure there are no dental issues or ongoing infections. If your vet's given a clear for health, blood work shows no problems and also urine is fine with no infections, what about any regular meds that may be affecting numbers.

3. Tracking.
On your ss, make a note when you feed a meal or a snack. if that info is on the sheet, you will be able to see how much the food is affecting the BG numbers.

Something's going on, so first eliminate the above .... then look further for the reason to be getting such wild numbers.

 

[max&emmasmommie]

Thank you, Gayle. Maybe the jumping around is partially because he hasn't been completely weaned off of the Hills m/d? He got 1/8 of a small can of that yesterday with the Wellness. We will be completely off the Hills m/d wet today, and he'll get only Wellness. I don't think that could explain the 600 reading I got at +11 or the 566 at +7. This morning it was 561 at AMPS.

Could slight dehydration be causing his scores to go all over the place, or would they be consistently high or low? Perhaps they have been high the past 12 hours because of dehydration? He hates having subcutaneous fluids, of course. So, I don't do it if there is only slight dehydration. I just encourage him to drink more, and I mix water into this food.

He is "free feeding," but he doesn't eat much unless I'm there to move the food around in the bowl. Sometimes he will finally go to eat if I never get around to "helping" him. He gets only protein snacks: a little bit of lard after his blood test, and a small piece or two of chicken or whatever meat we are eating. I never give him commercial cat treats or any carbs.

I guess I'll take him back in for another round of tests. It seems to be 150 to 300 each time. I hate to spend that when I could be spending it on his food, test strips, etc.

I could take him off his herbal kidney medicines. He gets Standard Process' Renal Support chewable pill twice a day, and he gets a solidago pill crushed into his food once a day. I was giving him Rehmannia Eight tincture once a day, but I eliminated that temporarily in case it has sugar that is not listed on the bottle.

I wanted to give him a full curve today, but it is the one year anniversary of my husband's father's death. So, we are going to be away at +2 and +4.

 

[Blue]

Thank you, Gayle. Maybe the jumping around is partially because he hasn't been completely weaned off of the Hills m/d? He got 1/8 of a small can of that yesterday with the Wellness. We will be completely off the Hills m/d wet today, and he'll get only Wellness. I don't think that could explain the 600 reading I got at +11 or the 566 at +7. This morning it was 561 at AMPS.

Could slight dehydration be causing his scores to go all over the place, or would they be consistently high or low? Perhaps they have been high the past 12 hours because of dehydration? He hates having subcutaneous fluids, of course. So, I don't do it if there is only slight dehydration. I just encourage him to drink more, and I mix water into this food.

He is "free feeding," but he doesn't eat much unless I'm there to move the food around in the bowl. Sometimes he will finally go to eat if I never get around to "helping" him. He gets only protein snacks: a little bit of lard after his blood test, and a small piece or two of chicken or whatever meat we are eating. I never give him commercial cat treats or any carbs.

I guess I'll take him back in for another round of tests. It seems to be 150 to 300 each time. I hate to spend that when I could be spending it on his food, test strips, etc.

I could take him off his herbal kidney medicines. He gets Standard Process' Renal Support chewable pill twice a day, and he gets a solidago pill crushed into his food once a day. I was giving him Rehmannia Eight tincture once a day, but I eliminated that temporarily in case it has sugar that is not listed on the bottle.

I wanted to give him a full curve today, but it is the one year anniversary of my husband's father's death. So, we are going to be away at +2 and +4.

Hi Dale,
If you already had tests done, why not just get copies of the results? You can have others help you look them over and make some suggestions. No need to spend all that money again if you had testing done recently. Also, get copies of any test results the last time urine was checked.

I know you mentioned free feeding the wet food; do you pick up the food at the +10 mark? If not, you may try that so your BG numbers by ps time will not be food influenced?

For fluids, when someone mentions cat does not like them, I immediately think of the needle size! All the vets I have seen are usually including needles sized 18ga and they are BIG thick needles that MUST feel uncomfortable. I always ask for size 22ga UTW (ultra thin wall) and while the fluids take a bit longer, you may find that it does not bother max so much. Even a little bit dehydrated may need some fluids and you can split the daily total; give half the amount your vet says to give some in am and some in pm, but take care to give them when numbers are higher, not dropping. Maybe you can call your vet to pick up some finer needles and to ask about how much fluids you should be giving. The needle size is going to make a big difference.

Don't worry about a curve being a full day of many tests; over time, you can gather a great deal of numbers that will fill in the picture for you. As you will be away for the front half of the cycle, no problem to test later on and in the evening or even tomorrow. Whatever time is convenient for you is good.

For the supplements, if they are recommended by you vet, be sure to ask of the effects if you stop them, and for the ingredients, you can always try to email the company to ask about the ingredient list as you want to check for any that may be affecting your cat as he is diabetic. I think they should be good enough to give you the list, then you can search around online for info on any that have you wondering.