Mr. Howell AMPS 379, +1 305

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Emily & Mr. Howell

Emily & Mr. Howell

Member Since 2011
Hey all, I'm really new here and started a thread yesterday under the main board, you can read it here: http://felinediabetes.com/FDMB/viewtopi ... 79#p521079
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My kitty Mr. Howell has had diabetes for about two and a half years. He honeymooned after the first year and is now back on insulin.
His normal dose use to be 2u x 2daily with Purina dry DM food. Last night I JUST started him on a mix of his old dry food and some new Fancy Feast (om nom nom).
I'm still getting a hang on the lingo so help me out!
7/25 +1 283, +4.5 223, +9 315, +11.5 388. I gave him 3.5u at 9 p.m. last night and +1 he was at 287, down 100 in an hour, whoo!

7/26 AMPS 379, +1 305. I should also say that in the rush of getting him his new food (which he is so crazy about!! He sits down and purrs after he eats, so much nicer than how he use to sulk before his nasty dry DM dinner), I actually forgot to give him his units until an hour after he ate, which was awful I know. I am just so happy he has stayed out of the 400s for now.
As always, any advice or helpful encouragement is so much appreciated!
 
good morning! your link is broken so i'm reposting it here: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=48392

i saw your post from yesterday and WAHOO - your mr howell looks a lot like my punkin! you can see some pics in my signature if you're interested!

all of your vet info *sigh* sounds just like mine. stick to the 12/12 shots every day, change to canned food only (punkin is 14ish pounds and we give him 1 can of fancy feast (chickenfeast, turkey & giblets or beeffeast) with his shots am& pm, andanother1/2 can (trouble with my spacebar) at +3 right after testing him. so he gets a total of 3 cans of low carb fancy feast each day.

you can add water to mr h's food and that will protect him some against developing ketones from high numbers - nearly 400 is high, and that's an easy insurance thing you can do.

always test before you feed or shoot. you're testing to see what their blood glucose is without being affected by food. if a catgoes low (under 50) we pull them up by using a bit of food. it's very effective, so if you test after mr. h eats, you're not seeing "true" numbers.

our process is basically test blood glucose, feed & shoot as quickly as possible - ideally within 10 minutes. the better you get at all of it, the quicker it will be. i can do it in about 3 minutes now and it used to take me about 1/2 hour.

you're doing a great job making changes that will help him. this site is The Place for feline diabetes - people work with it 24/7 for years on end andthere is a wealth of experience. everybody helps each other through whatever is new.

so welcome - ps,what's your name!? - andwe're glad you're here!
 
oh yeah,and the number we're all gonna getexcited about seeing is mr howell's lowest BG of the day. with lantus, that number determines the dosing. so you get to do a lot of testing in search of that number! :lol: if the sun andmoon aligns, and the politicians all agree on how to solve the debt crisis in the US, andeveryone gets a job in the world, the nadir (lowest number) will be somewhere around +6. BUT, given mr h is a cat andinsulin is a hormone (think tears and slamming doors when you were 13) it might be anywhere. if you test every 2-3 hours a pattern will emerge andwe'llbe ableto see it.

:lol:

good idea to minimize food after +5ish so that mostof the food is givenwhen the insulin is strongest. good idea to also give a bitof boiled chicken or other low-carb treat (small, like 1 tsp only) to keep mr.howell going after each pokey. he needs a reward!
 
Welcome!!

About Fancy Feast; flavours with gravy are NOT low carb. Save these for when you might want to
bring Mr. Howell's (great name :lol: ) UP
 
Oh good, I am so happy you give Fancy Feast too. My boy is about 14-15 lbs as well and I wasn't sure how many cans to give him per day; I think I'm good with 2/day since I am halving it with his dry food for now. He had chickenfeast this morning and was soo happy afterwards :)
And stay away from the gravy flavors, gotcha!
He is pretty good about getting his BG tested - I, however, am the one that has issues!! He will sit patiently for soooo long while I keep trying to get a sample, I just feel awful sticking him so many times in one day. His poor widdle ears :(
I'll report back at +6, thanks so much!
Your Punkin is so charming! Our kitties could be brothers if mine had a tail, shhh ;) he forgets!
Oh P.S. My name is Emily :)
 
hi emily!

:-D

nice to have a name! everytime i see Mr Howell's name i think of the Gilligan's Island song. is that where his name is from? or is there a name story?

you want to wean him away from the dry food - some people on here have reported that just 2 pieces of dry kibble will send their cat's BG soaring. but as you do it, you have to make sure and test lots. sometimes if people transition off of dry food for their kitter, their kitter's numbers will plummet. it's the dry food keeping them high. so over the next 2-3 days if you can get rid of the dry, that would be great. no sense in fighting an uphill battle by giving insulin to counteract high carb foods.

if you're worried about leaving out food, people here leave out the canned food without a problem for 12 hours or so. or some people freeze hockey pucks of cat food mixed with water in a cupcake pan and leave out the puck. you can freeze it in ice cube trays, then when you leave pop one out and use it to keep some non-frozen food coldfor a while. punkin is a hoover so there's no "leaving food out" for him. i'd probably have to set out 6 cans to have any left by the time he got through one sitting. :lol:

he has a *ahem* healthy appetite. i love my boy! :lol:
 
Hello and welcome to you and Mr. Howell, who is QUITE the handsome gent!! It is great that you are working low carb wet food into his diet and that he seems to be making the transition well! If cost is an issue, I know many people feed the large cans of Special Kitty from Walmart, which is quite affordable and will be just fine for Mr. Howell.

As for your question about his numbers heading back up, there could be many reasons:
1. It could be a food spike... every time he eats, especially if he is getting dry food, it will give him a little (large?) boost which may exceed the effects of the insulin.
2. It could just be wonkiness... if you have been varying from the 12/12 previously, that likely had an effect on things and it may take a bit to get him on track.
3. It may not be an increase at all. The FDA allows BG meters to have a 20% margin of error in either direction. So a 300 is not necessarily a 300, but rather it is a number somewhere between 240 and 360. At higher numbers, that MOE can be quite large, so the difference between that 305 and that 354 may not be as much as you think (and technically could be the same number. how's that for fun?!?)
4. The most important possible reason.... Mr. Howell is a cat. :-D

Remember as you're doing this to focus on Mr. Howell as not just a set of numbers, but as a whole cat... how is he doing at different numbers, is he showing improvements physically/emotionally, etc. You're doing a great job! Just keep doing what you're doing and post questions as you have them... the folks here are wonderful and will do all they can to help!

For all newbies, I recommend printing off the stickies and putting them in a binder with the contact info for your vet and the emergency vet (and if you're unfamiliar with the emergency vet's location, directions to them as well!) either at the front or on the cover. It is also a good place to keep any test results or other info from the vet. The stickies contain a wealth of important information but it is A LOT to take in all at once. I would remember something from a sticky but then it might take me a bit to find it online. Having them in a binder where I could take notes allowed me easier access to information when I needed it.

Once again, welcome... I look forward to learning about you and Mr. Howell both!!
 
Whew, okay.. I won't sweat it for now but I am going to try and reduce his dry food as much as possible. I've read in multiple places cats can sometimes need up to 14 days to transition to a new food, but if his dry DM isn't good for him, well then it just makes sense to stop ASAP. And keep reading his numbers of course!
I already figured I am literally spending 1/2 as much money per month on his food if I get the wet rather than his prescription, so I am pleased with that revelation as well.
His attitude has been much the same the last few days, although I will note that he was MUCH more excited for breakfast after his first taste of the new wet food last night, which was pleasant to see.
And the backstory on his name... I don't know his real name! He came into the Humane Society as a stray from Howell St.. They gave him the name 'Mr. Howell' at the shelter because they had a precious girl named 'Lovey' and they thought it was cute... and it stuck, because he certainly looks like a Mr! Although I will say he responds to 'kitty' better than anything ;)
Thanks so much, I'm glad to be in good company!
 
I'm glad you found your way here, Emily!!! My daughter is a 19-year-old college student and helps me take care of our Champ. Feline diabetes can be very daunting and you're a very special girl to take this on by yourself. You will have days where you just need to cry and vent so feel free to do it here....we've all been there and done that. We've all got strong shoulders and we're here for you to lean on them!!! You've got one handsome cat, too!!! He's AWESOME!!! My boy is very big, too...bigger than a small dog and weighs 18 pounds (though he should be about 14-15 pounds...he's on a diet!). If you have any questions at all, or you just need some encouragement, you just let us know. btw...if you do decide to change to an all wet food diet (which would be a great idea!!), make sure you'll be home to test every couple of hours. It is VERY likely his numbers will drop substantially when he no longer has dry food to munch on. I'm hoping one of the experienced dosing people we have here on our board will stop in and give you some advice. I know when I found this board, Champ was on 3u twice a day (as directed by the vet). I immediately reduced his dose to 1u twice a day and gradually worked my way up, following the protocol very carefully. We eventually got to a dose of 3.75u, but he's done so well that he's earned reductions all the way down to his present dose of 2.5u.

Welcome aboard, Emily!!! We look forward to seeing Mr. Howell's condo every day and following his progress!!
 
Hey all. Mr. Howell keeps going up and up :( He was +1 305, +3.5 354, now we're at +6.5 and he's up to 469. I get so worried when he goes so high! Should I hold off until his 9 p.m.? Also, should I keep lowering him gradually from 3.5, or does anyone recommend just dropping him to 1u tomorrow and starting over?
I hate to see his numbers get so high, I can imagine he feels absolutely horrible. This is the roller coaster I've been on since April, I am just happy I've finally found a place that understands the extreme anxiety that can come with having a chronically ill animal depend on you so much.
He's gone to the kitchen and is whining for his dinner, but we're about 4 hours early. For now I know I should just wait, consistency is key, it just stinks because he's miserable!!
Also, Patty, so nice to hear your daughter is involved as well, it makes me feel less alone. I've become 'that crazy cat lady' to my friends and I'm barely 22! They just don't get how awesome he is. :)
 
Welcome Emily!!

It seems like you've gotten a lot of the basics from the folks on Health and here. I'm going to do some summarizing just so we're all on the same page
  • You're in the process of transitioning Mr. Howell from DM to Fancy Feast (FF) -- preferably the Classic varieties. These are the pate style food and are low carb (LC). The FF varieties that are with gravy -- roasted, marinated and Gravy Lovers -- are all high carb (HC) and we recommend that you have a stock of those, as well, since they can be used to steer Mr. Howell's numbers. Also, if he's eating FF, you don't have to make the transition overly slow. Many cats are dry food addicts and, when that's the situation, the transition can take some time.
  • Lantus likes consistency. You want to shoot the same dose at AM and PM unless a dose change is indicated. The Tight Regulation sticky gives an outline of our dosing protocol as well as links to the more formal version of the protocol. The protocol is based on research published in a leading veterinary journal. The info that you were using from Pet Wiki is not a dosing protocol and probably not very helpful in the grand scheme of things.
  • Shot time also needs to be consistent. There's a little bit of flex but not 2 hours. Your vet is not fully conversant with depot-types of insulin (i.e., Lantus or Levemir). They do best with 12-hour dosing.
  • We are very numbers driven here. We like data!! If you can put your blood glucose (BG) test info into a spreadsheet it will help you to keep track of Mr. Howell's numbers and to begin to see patterns. It will also help up to help you with dosing decisions.
  • Lantus dosing is based on the nadir, not on pre-shot data. The pre-shot numbers let you know if it's safe to shoot. The nadir tells you if you need to change the dose.

How did you arrive at Mr. Howell's dose? What was his starting dose and in what amount did you increase? We make dose changes usually in the range of 0.25 to 0.5u. You will probably want to get U100 syringes that are marked in half unit increments (unless you have really, really good eyesight and can be much more consistent in your dose amounts than most of us!). Does Mr. Howell have any health problems and, most importantly, does he have any history of ketones or diabetic ketoacidosis?

I'm reticent to suggest any change in dose without more information. I agree with what the others said about the influence of the dry food. As you transition Mr. Howell off of the dry, it's very possible that his insulin needs will decrease.
 
Hello Sienne and Gabby :) Thanks so much for your advice and willingness to help a newbie!

1. Right. I did purchase a weeks worth of the Classic Fancy Feast. It's good to know about the gravy ones - I consulted 'The Food Chart' and saw the pattern of gravy = high carb, which makes sense. I was worried if I brought him off his dry food too fast, like many have said his numbers could plummet. Good to know it doesn't have to take forever!
2. Thanks for clarifying about which is THE number to go off of, the nadir. I judged it by his premeal number, now I know that is not right. Since he came off of his honeymoon I have not been able to take him to the vet, probably why I am having such problems now. He ended at 2u/2x daily, so that's what I started him on again. I stuck with it for about two months but he just kept getting higher and higher, so I was increasing his dose by .5-1 whole unit based off of the Pet Wiki chart which says to increase by 1 unit for every 100 over the average, i.e. if he was at 400 before his food I was giving him his prescribed 2u, + 2u for being about 200 over what he should be. Does that make senes? So he had been at about 4u 2x daily when I decided to come here for help, because he still was not going down and I knew 8 units of Lantus a day is not normal.
3. I have gotten the u40/100 needles before, which do have the half mark, but Sunday I went to Walgreens to get some more and they grabbed me the wrong kind. When I went to take it back they said they would absolutely not take them, even unopened with my receipt. They are u100 and have 2unit markings. It is NOT ideal and I wish I had the extra $15 to replace them, but I just can't right now.
4. I am working on putting the data I have for him on a spreadsheet, hopefully that will help to see emerging patterns as you said.

When he was first diagnosed, it was his the ketoacidosis that let me know he was so sick. I had just returned from a spring break trip and a 'friend' had promised to watch him while I was gone. Well the 'friend' never came by and when I got back from my trip he was almost dead. He had to be on an IV at the vet for 4 days before I could bring him home. Since then I've been VERY cautious about it returning, i.e. my paranoia in his prolonged high BG numbers.
 
Welcome to Lantus Land--You have a wonderful support system here so you will be posting everyday, whatever numbers Mr. H gets--I test Moonie at several intervals a day--I Always give her a snack(freeze dried chicken or fish or a little real chicken) right before I test her--She is so distracted by eating it, she doesnt even care that I am testing her--A mini curve would be AMPS, +3(when the insulin starts to work)
+5 or +6 which is her nadir, PMPS, and pre- bedtime number...This is the least I would test her.
Also, Mr. H's numbers will still stay somewhat higher as long as he is getting the dry food--
I would take the dry away gradually, over the next few days, & I believe you will see a difference.
Not to worry we are all here to help you--Have a good night! :mrgreen:
BTW, Mr H is handsome!! :mrgreen:
 
I don't think you screamed loud enough at Walgreens! FWIW, I don't think they stock syringes in half units. Walmart's Relion brand comes in half units or you can get them via mail order at a much more reasonable price. I hope you're not buying your test strips there. I use a Bayer Contour meter and Walgreen's price for strips is 2 - 3 times more than what I pay for double the number of strips. Amazon, Ebay, Hocks or ADW all have strips at a far more affordable price.

You're not using U40 syringes, are you? You need U100 syringes with Lantus.

Extra caution is needed with cats with a history of DKA. I would strongly recommend that you get a package of Ketostix. Most of us test for ketones regularly. It's a simple urine test that is well worth the prevention and peace of mind.

What is Mr. Howell's current dose? I thought it was 3.5u.
 
I have the problem that I look like I might potentially be abusing IV drugs (I'M NOT, just that I'm young and 'different'), so I tend to have problems with the people at Walgreens.
u40 syringes were what my vet gave me!! Why doesn't he know this sh**?! I am an extreme visual learner and maybe I am getting confused by the number markings. Can somebody please send me an image of the box or the type of syringes they use? Every time I look it up there is not enough clarification, and now I am confused. nailbite_smile
I've got the Ketostix but I am also failing at getting a sample. He seems to only urinate in the middle of the night?!
Oooh all of these problems compounding :( my baby!
He is at 3.5u, down from 4.0u since Sunday. I thought it was best to bring them down slowly. Is this not the case? Should I just start over at 1u??
 
Welcome to Lantus ISG! my syringes have "U-100 insulin" printed right on the syringe in small type. I have some old U-40 syringes that have "U-40 insulin" printed right on them, so check your syringes and see if they say anything like that.
 
Hi Emily and Mr. Howell and welcome to Lantus Land.

You absolutely must NOT use U40 syringes with Lantus. It is a U100 insulin. (If you use a U40 syringe with U100 insulin you will be overdosing because the unit lines are much further apart in the U40 syringe!) Here is a link to the Monoject syringes I buy at American Diabetes Wholesale. These are U100, 31 gauge (very comfortable for the kitty), 1/2 unit markings. Get the 0.3 cc size for 30 units or less: http://www.americandiabeteswholesal...t-ultra-comfort-insulin-syringes_2552_178.htm
I like these Monoject syringes very much because they have good, accurate markings and don't have many problems with air bubbles. American Diabetes Wholesale ships your order within 24 hours. Very good service.

Good luck with your kitty. I think that you will find that his numbers will settle down when you get on a consistent schedule and find the correct dose. We are all here for support. Again, WELCOME!

Ella & Rusty
 
I know because you're between jobs that money is a major concern for you right now. Maybe since your mom is a physician she can provide the syringes for you. If not, I use the ReliOn syringes (Walmart brand) because they're so cheap ($12-$13 for a box of 100). Walmart also has a meter with the most inexpensive strips around. I use an Accu-Chek Aviva meter (with some of the most expensive strips), but I buy the strips on ebay for cheapcheapcheap!! You might also check the supple closet here on FDMB to see if they have any supplies you might need. Good luck!!
 
Okay. Thanks for the clarification on the needles. The ones I got from Walgreens (on accident) are 1cc (100 units) and only have the mark for every 2 units. Now I know to ask for the .33cc so I can stop eyeballing it. I feel so lousy for being so ignorant.
Now, I got all of his info into the SS but it won't let me 'share' it ohmygod_smile
 
WELCOME TO LANTUS LAND!!

sorry to laugh, but i'm tall and skinny...and you should have seen the folks at walgreens the day i bought syringes AND Wal-phed :shock: :o :lol: :lol:

good to see you here!

celi & binks
 
I haven't used the U40 since before he honeymooned. Since then I've used syringes my mother provided me with, which are 100cc/100U syringes, so at least now I know I am using and have been using the right kinds, at least since April. It's a wonder how he honeymooned before when I was using u40 syringes every day?!
 
This is a photo of U100 syringes:
3992453213_a2fb0c50c0.jpg


The Walgreen's brand meter is not terribly reliable. There are a couple of options. You could write for a newbie kit. It will come with a meter, strips, lancets, etc. It will, however, take some time to get to you. Many people here use the Walmart Relion brand meter. The meter and strips are inexpensive.

Also, since I'm advocating a trip to Walmart, how about stocking a hypo kit. You will need high carb food -- check Janet and Binky's list but this is the stuff with gravy, and make sure you have some Karo syrup or honey, maple syrup, etc. in the house. This is absolutely essential given the food transition. You won't know if Mr. Howell will throw a surprise at you.

For now, I'd hold the dose. Please get a spreadsheet together ASAP. The template we all use is in the Tech Support forum as are the instructions for setting it up and attaching it to your signature. Getting as much data as possible so you know how Mr. Howell is responding to insulin is very important.
 
I agree with Cheryl. I would hold the 3.5u dose for a few cycles and test, test, test to see where that is taking him. Then we'll have a much better idea of whether he needs more insulin or less. And build a hypo toolkit, pronto, to be safe. Don't worry, we'll help you get it all figured out!
 
Thanks for the clarifying photos.
I got the most recent information up on his SS. I didn't know whether I should add older info, which I'm beginning to think isn't reliable (I'd swing his dosage time by up to 2 hours, not check his BG frequently). Also, I did a poor job of documenting when, exactly, I increased his dose, whether the reading on my meter is before the dose or after, etc.
Got the high-carb food; I did grab some of the FF Classics w/gravy, in addition to having LOADS of honey around the house (my boyfriend is a mead home-brewer!).
I'm beginning to think I should just ditch Walgreens and go WalMart; do you know what kind of meter comes with the Newbie kit? I have a OneTouch Ultra but can't afford the strips for it, so that's when I got the Walgreens brand.
Gotcha, holding the dose at 3.5. He's an hour away! The last few days have seemed so long. :(
 
I don't think there's one particular brand of meter that comes in the newbie kits. You could contact Lori/Tom and ask. I think they depend on who sends in coupons for free meters and you get whatever Lori can chase down.

I'd strongly encourage you to ditch Walgreens for Walmart. There's a Walgreens literally across the street from where I live and I buy the majority of my supplies on-line.

All of us have been at the front end of this learning curve. It's overwhelming! On the other hand, you don't have to do this alone. There's a ton of experience here and people are extremely generous with their time and information.

Do you have any idea what caused Mr. Howell to fall out of remission? Has he ever had his teeth cleaned? Dental issues are notorious for throwing cats out of remission.
 
PMPS 266, I gave him 3u just because I decided to give him an entire can of Turkey&Giblets to see how he does with just wet food. I am prepared to watch him all night! He has been crying at me this whole entire hour (the way he does when he is hungry), and right before I checked his BG he vomited a tiny bit on the floor :( But he seemed more than thrilled for dinner.
 
And the fact that he was scheduled for a teeth cleaning could have brought him out of remission. He was suppose to have it in January. I started having to give him insulin again in April. So it could very well have something to do with it.
 
Hi again, Emily,
The WalMart ReLion "Micro" and "Confirm" blood glucose meters cost only about $9.00 and are good meters. The strips for them are very economical: $20. for a box of 50 the last time I bought them. They are the ones to get if you are on a budget and want ease of purchase. They require a very small blood sample and are easy to use.

Good luck with getting your spreadsheet up and running.

Ella & Rusty
 
PMPS 266, +1 341.
Any idea why it jumped up so much? Pretty positive I didn't miss when I gave him his 3u's!
I'll be up the rest of the night checking him and updating.
 
hi Emily,
welcome to Lantus Land,
good job on the spreadsheet (ss)!

wanted to pass along this link from here, New to The Group (with the star icon up top) viewtopic.php?f=9&t=18139


the +1 can be higher than your preshot number due to food on board, so don't panic, however there may be times, the +1 may drop, and you may be asked for follow-ups early in the cycle.
overtime you will see patterns on your SS, the chart below from the sticky I linked, is a guideline on what to expect during a cycle.
It's also useful to see how a curve might look like, we do suggest curves here, when you are home and have plenty of strips.
A mini curve is about every 3 hours, or a regular curve about every 2 hours.
Nadir checks are also important, nadir can change and not always at the same + hour on SS, but like I said, overtime you will begin to see the patterns that will help you learn how your kitty is responding.


Learn how YOUR kitty is responding to insulin:
Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
Peak/Nadir - the lowest point in the cycle
Duration - the length of time insulin continues to lower blood glucose
How to do a Curve

Example of a typical curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
 
Hi again, Emily! Just wanted to throw in another cost-saving tip as I know your budget is tight...

The Walmart Relion meter is a branded version of the Arkray GlucoCard 01. American Diabetes Wholesale(ADW) sells the generic strips for this meter in various bundles (some with a meter) at very affordable rates that are generally better than walmart's, epecially if you can get to the $100 needed for free shipping (though, shipping is pretty reasonable otherwise!). If you get on their mailing list, they will occasionally send out 5% off coupons, and if you link through Mr. Rebates, you'll get 8% cashback on each purchase... and you'd be surprised how much that cashback can add up!

The nice thing about using the Walmart meter is that strips are easily accessible, AND they do sell a 20 pack of strips for $9, which can be handy if you're short on funds and need a few to tide you over until payday.

I use the Walmart syringes and find them to work just fine. They are around $14 for a box of 100. Just write down what you need as the pharmacist assistants can get testy.... as you've learned!

Let us know if there's anything else we can do to help!
 
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