need dosing advice - blood sugars in 500s last two days

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Carol & Murphy (GA)

Carol & Murphy (GA)

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diagnosed about 5 weeks ago, Murphy has never had great control but in the past two days, out of nowhere, his sugars have been in the 500s - AMPS was 109 yesterday (no insulin given) but 3 hours after he ate, it shot up to over 500 - gave insulin immediately and did curve yesterday -no evidence of dropping low on 2 units
amps 433 this am - glucose 4.5 hours after 2 units this am was 535 - don't know what to do with his insulin
need to work on his dietary issues - vomits canned food - started Evo dry about 10 days ago, but just realized I'm giving him too many calories (he's probably getting 250-275 and he should be getting about 175 or so)
 
Welcome Carol. Glad you made it over here. (I post on both forums). This forum is a small, friendly group. You may have to wait a while to get responses, but everyone here uses or has used your insulin and will help. It may help for you to read some of the threads and look at their spreadsheets. If you ever have an emergency post on Health as well as here so you get more eyes on your problem.

I gave you all the ideas I had on your Health thread. Let's see what others think.
 
Hi Carol! Welcome to our little forum. I'm so sorry you have to be here, though!

I know you've got to be stressed out and frustrated (I know the feeling!). I honestly think today's numbers might be a reaction to yesterday's numbers. That super low you had in the AM that shot up...can I ask if you took a second test yesterday morning? Whenever I got a weird number, I always rechecked. I wanted to make sure it was the right number and not a bad test. Just wondering because it's such an odd number.

I think you're going to see higher numbers due to the food. BUT...he has to eat. It's most important that you give him food he'll eat. I would keep trying to find a canned food that works, but until then, the lowest carb dry food you can find is your best bet. It's imperative that he eats, and you do what you have to do to make that work.

Hugs! :bighug:
 
thank you, Rachel. I did not repeat the 106 test result yesterday morning, but I realize now that I should have. I also learned an important lesson not to ever give a supplement dose of insulin (as I gave 0.5 units on Friday) His 8+ level of 556 I just got is really freaking me out - but to look at him, he is perfectly fine. Does anyone think these 500+ levels are the result of TOO much insulin? What should I do if they remain the same tomorrow?
 
I think you have increased the dose slowly and carefully. Let's what tomorrow looks like. If he is still in the pinks after his shot tonight, I think I might up the dose on the first cycle you can monitor. I think Rachel has a good point. That low amps came out of nowhere and may have been a bad test.
 
Most people don't think to retest until they've run into weird numbers. No worries...you'll know for next time! :)

I agree with Sue. I think upping the dose if those numbers stay high is good...as long as you can monitor.
 
Hey Carol...welcome. The other thing you can do when you get a low number (under 200) at pre-shot time is to stall. That means no food and testing Murphy again in 20-30 minutes. If he goes above 200, then you can shoot (probably a reduced dose). If he still is too low, if your schedule permits, you can stall again. Of course, no food and then test again in about 20-30 minutes. I had to do that two times in the last couple of days (see 9/10 & 9/12). Of course it may throw off your 12 hour schedule for a few days but there are ways you can get back to your regular schedule.
 
Murphy's numbers better today - I'm about to do a PMPS in a little while. This morning I gave him a smidgen over 2 units (just a hair above the line) I'm using the U-40 syringes so eyeballing is difficult. Anyone out there - please take a look at his number and any advice appreciated. I realized I was completely overfeeding him with Evo (about 275 calories a day when he probably needs more like 175 according to my vet), so I'm giving him 1/4 cup 50/50 Evo and Royal Canin glycobalance which has 390 calories/cup (I know the carbs but I have no choice at the present)
 
Merlin said:
Hey Carol...welcome. The other thing you can do when you get a low number (under 200) at pre-shot time is to stall. That means no food and testing Murphy again in 20-30 minutes. If he goes above 200, then you can shoot (probably a reduced dose). If he still is too low, if your schedule permits, you can stall again. Of course, no food and then test again in about 20-30 minutes. I had to do that two times in the last couple of days (see 9/10 & 9/12). Of course it may throw off your 12 hour schedule for a few days but there are ways you can get back to your regular schedule.
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what is the protocol for when the schedule is off? For instance, when I gave his insulin at 10 am instead of 7 am, would I give the pm at 9 pm and the next am at 8 am and so forth?
 
I'd go no more than about 30 minutes either way, really, Carol. You can slowly move back to your original shot time like that. You just want to be really sure you aren't shooting into a falling number.

His numbers are certainly staying lower than yesterday. Wondering what his PMPS will look like...hopefully it'll be a little lower too!
 
His PMPS was 504 - at least down from yesterday - I'm going to give him a hairline smidgen more than 2 units tonight - I hope that will be okay
 
Yep Rachel is right - it is best to slowly go back to your regular schedule time. I have gone 15 minutes and I have also gone as much as 60 minutes but never any more than 60 minutes. I would go no more than 30 minutes at least at first and until you know how Murphy handles it. I can never go early at night so when I have to move my schedule, it is always in the morning which makes it tough. Always make sure that the number is rising like Rachel mentioned. It usually is rising at +10 and +11 but I have seen when it wasn't rising and that is never good (to shoot).
 
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Carol - I think that would be ok for tonight. It would be good to give the same dose (if the numbers warrant it) for 3-4 cycles just to see if Murphy can settle into that dose. If you can, get a test in before you go to bed to see if he drops at all.
 
Yes, I'll try to get one right before +4 - I have a question - yesterday, at +8, he was at 556, but at +10, it had dropped to 384 - I gave him the pm insulin, but it was dropping - was that ok? This is much, much harder and far more stressful than I ever imagined. I've tested him 16 times since Saturday - poor guy. I have a terrible time trying to get an amps- he is so starving at 7 am all he wants is food, and he won't be still. Today I let him have a few pieces of the kibble and got the ear stick about 2 minutes later - I take it that is quick enough not to interfere with the reading? Otherwise, I don't know how I could do it. I'm still confused about what to do if I (ever) get a lower pre shot reading - say some blissful day comes when the amps is 250 - would I give him the full dose or use a sliding scale. Is there a sliding scale protocol?
 
I think a tiny bit of food a few minutes before the test is fine. You just don't want to wait too long so it won't affect BG numbers. I'd want to get the test within 5 minutes I think...but I really have no data to support that number. It just seems like a safe number :)

There isn't really a sliding scale protocol. If you get a test under 200, try stalling about 15 minutes WITHOUT FOOD and retest to see if it rose to over 200. If you get a test that is lower than normal, I usually retest immediately to see if that's a bad test or not. Sometimes it can be if it came out of nowhere. Other than that, I might post here for help. I'm generally around weekdays in the early AM...about 5:15 to 6:30ish Central Time (intermittently). There's others around during the day to help out and usually in the evenings.
 
Rachel said:
I think a tiny bit of food a few minutes before the test is fine. You just don't want to wait too long so it won't affect BG numbers. I'd want to get the test within 5 minutes I think...but I really have no data to support that number. It just seems like a safe number :)

There isn't really a sliding scale protocol. If you get a test under 200, try stalling about 15 minutes WITHOUT FOOD and retest to see if it rose to over 200. If you get a test that is lower than normal, I usually retest immediately to see if that's a bad test or not. Sometimes it can be if it came out of nowhere. Other than that, I might post here for help. I'm generally around weekdays in the early AM...about 5:15 to 6:30ish Central Time (intermittently). There's others around during the day to help out and usually in the evenings.
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thanks, I so appreciate the help and support
 
Hey Carol. You were inquiring about a sliding scale. Merlin was a very bouncy kitty for a very, long time so I would give him a consistent dose for about a week and then I would try another consistent dose for another week. It seemed to help the bouncing as he would settle in with that dose. Then slowly, he started to improve and I would start changing my doses, then out of nowhere, he would bounce...again. With the collection of pre-shot and nadir data, I started to see some patterns that some doses worked better for specific numbers. So I would note that and would lock that number into my sliding scale. With the help of some folks here and within a very short time, my sliding scale was built. My sliding scale is changing constantly and I am forever tweaking it. I have not seen any protocol or studies for that matter regarding the sliding scale.
 
Murphy's amps was 551 and I gave him a fur shot (it that what it's called) - he only got max 1 unit I think - actually I as time goes on, it seems the less confident I am with his insulin shots - it takes me forever and today I missed. with a baseline of 551, and probably little insulin in him today, what should I do beside fretting
 
Hi Carol. Just wanted you to know you're not alone. I had been giving insulin shots to Colin for a couple months and only had a couple fur shots. Now, in the last 2weeks, I've had several. Not sure why, but like you it's taking longer and I guess I've lost confidence and I feel pressure because of his high numbers. He's started to wiggle some too, I guess he feels my hesitation. I've gone back and watched videos and try to take a deep breath before shooting. Seems to be helping some. Good luck
 
:(Oh no. What bad timing, Carol. With his high numbers, you might shoot early. You could shoot as early as +10 IF he is rising and in high numbers. Unfortunately it will mess your schedule up going forward, as you would likely want to go back to 12/12 and you'd need to do it 30-45 minutes at a cycle.

The most comforting thing I can say is that everyone does it - even people who have been giving insulin for years. And I am with Sharon. The best thing you can do is to take one or two deep breaths before shooting. If his head is deep in his breakfast, he won't mind waiting
 
Thanks Sue and Sharon If I try to give it to him while he is eating, he stops eating and runs away- so I wait until he is finished - My problem is with the tenting - how much skin to hold up and where to go in - at the bottom of the tent or near the top? I've given SQ fluids without problems to 4 of my previous cats - don't know the problem now. Is there any benefit to doing a 4 hr blood sugar test today? It will be sky high and I think just make me upset.
 
Wow my hats off to you being able to give subQ fluids. I wish I could do that as I know that it would probably help Merlin.

Anyway, regarding tenting. Here is what I do. I pinch the skin and pull it up. I can feel the muscle relax down so all I have is skin. Then I shoot almost between or just a hair below my thumb and finger with the syringe pointing at an angle slightly downward (near 90 degrees). But before I shoot and I am tenting, I will brush back the hair so I can see a little bit of skin. With the angle of the syringe, ensuring that I don't get muscle and the brushing back the hair, I can shoot all over Merlin's body and he doesn't seem to care. Maybe it is a little less painful too. Also, I practice on him throughout the day just pulling up the tent and pretend shooting. That way he gets used to me pulling up, brushing away the hair and touching him with the syringe. If someone comes and visits me today (oh that sounded sad), maybe I can get a picture to upload.

Edit Update: Oh regarding you asking about mid-cycle testing today...naw. If you think you gave a fur shot, then give yourself and Murphy a break.
 
Merlin said:
Wow my hats off to you being able to give subQ fluids. I wish I could do that as I know that it would probably help Merlin.

Anyway, regarding tenting. Here is what I do. I pinch the skin and pull it up. I can feel the muscle relax down so all I have is skin. Then I shoot almost between or just a hair below my thumb and finger with the syringe pointing at an angle slightly downward (near 90 degrees). But before I shoot and I am tenting, I will brush back the hair so I can see a little bit of skin. I think with the angle of the syringe, ensuring that I don't get muscle and the brushing back the hair, I can shoot all over Merlin's body and he doesn't care. Maybe it is a little less painful too. Also, I practice on him throughout the day just pulling up the tent and pretend shooting. That way he gets used to me pulling, brushing away the hair and touching him with the syringe. If someone comes and visits me today (oh that sounded sad), maybe I can get a picture to upload.

Edit Update: Oh regarding you asking about mid-cycle testing today...naw. Give yourself and Murphy a break. But maybe you can practice shooting.
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About how much of a tent do you make? You brush back the hair inside the tent with the same hand you are tenting with? A photo would really help - the videos don't really go into these type of details. My problem is not seeing the skin, and I don't know how to be sure I am avoiding muscle I will try to practice during the day. It's becoming a psychological thing with me now - I'm so nervous about it
 
It isn't much of a tent just enough to lift up some skin. You can feel the muscle drop. Start with the shoulder area. That may have more of a muscle that moves for you. I brush back the hair with the hand that I am holding the syringe. So as I tent with my left hand and while holding up the tent, I brush back the hair with my other hand. I have found helpful for me is to hold the syringe like a dart then with my pointing finger, I brush back the hair. I also found if I go low on the tent, I can go through the skin to the other side and sometimes in the muscle. That is why I go a little higher in the tent. When I shoot between my fingers or just a hair below the fingers, I can feel the needle.

I know exactly what you mean regarding the higher numbers. I was and am so anxious when he gets those higher numbers and sometimes I rush things. Just need to relax and do what you can do. You are doing a great job and one little miss here and there isn't going to be a big deal in the whole scheme of things. When I miss, I do what Sue recommended and that is possibly shoot a little earlier, if the schedule permits.
 
Visualize a tent |^| .
You are aiming for the center underneath the triangle, closer to the body than to the top - its possible to go all the way through the skin if you're too far away from the body.
 
need dosing advice today - his amps was 223 --definitely strange for him I stalled for 20 minutes and the next one was 500 should I believe the 500 I had to feed him he was becoming uncontrollable but not sure if I should give his 2 unit dose this morning
 
I'm guessing that 223 was a bad test...just because it's so unusual and you did get a 500 not long after. He wouldn't rise THAT fast. Can you be home to monitor (just in case?) I think it'd be fine to give 2 units, and maybe just grab some tests throughout the day to be sure all is well.
 
Eh, it can depend. Sometimes you'll get a bad strip, but it's usually more of a too little/too much blood, strip got contaminated by something, etc. Happens sometimes when your cat is squirmy at test time and moves so you don't get as much blood.

The reason I figure your 223 was wrong is because it is so darn peculiar! Not saying it can't happen, but to get 500 next, which is more normal, makes me think it's likely just a bad test. You KNOW one of them was since both can't be right, and since 500 is more normal...

You did the right thing though! Honestly, if you get a test that is unusually low (or high!) you can retest right away. The stalling thing is so that the number has time to go up naturally when under your no shoot number...but if you suspect a bad test, you can grab another immediately and see. You CAN stall...just saying I know how it feels when you've got a hungry cat glaring at you ;) This way, you can see right away if you get a wildly different second test or not. GREAT job this morning!
 
You and Rachel did great. What do you think about raising the dose, Carol? Pick a day when you can get some numbers and see whether it makes a difference. My thinking is that he has gotten used to these high numbers and it's going to take more insulin for him to react.
 
If you can be around, I think I'd try 2.5. When they are running in high ranges, we increase by more than if we are making small adjustments. That's what I'd do, but he's your kitty. You hold the syringe. Regardless, get an early 2/3 test if possible and then one 5-7?

I think you and Rachel were right on. Sometimes a little too much blood or too little or a bad strip. It was perfect to get another test. I am guessing the 500 was correct, but you'll know for sure the next test you get today.

What is he eating? I know you were struggling to find something that he'd keep down that was lower carb.
 
He's eating - unfortunately a combination of Royal Canin glycobalance and Evo dry - I'm slowly (1/4 tsp a day) trying a single protein canned (venison) to see if I can finally find a canned food he can tolerate. I might also buy a few cans of Tiki cat chicken today. I also need to call Young again (will put that on my list for today)-- thank you so much, Sue - this is such a help
 
I hope he decides the version is good. I think the food is a big part of your higher numbers. We've seen a kitty get into a few pieces of higher carb dry and skyrocket into higher ranges. Once you figure out his diet, I'd think your numbers will come down. For now, I think giving more insulin to compensate is the right choice.
 
Whenever you get an unusual test, test again. And if the 2 are very different, a 3rd test may clarify which range is more likely, particularly if you have some test history to review.
Things can happen - hair balls, diarrhea from a bad food batch, etc, so it can be worth the peace of mind to do 3 tests.
 
thanks all, I learned another lesson today. I think Murphy is incubating a hair ball - I dread the amps as he is focused on wanting food he does not stay still at all, plus his ears are colder from the cooler temperatures. I think I had too little blood on the strip this morning. A question on food - I've been feeding him just twice a day, but he gets so hungry in between shots (he's not used to being without food for so long) can I split up the feedings into 1/4 of the food right before shot, 1/4 4+ hrs for am (at nadir) and the same for pm?
 
That is what I do i.e. divide up the meals throughout the day. For Merlin, little mini meals works well for him otherwise, he vomits up a little stomach acid when he doesn't have something in his stomach.
 
Sometimes mini meals work better. Same number of calories, but cats in nature eat small meals more frequently, so it does reflect what they do more accurately. :)
 
Another option is to load up on the mini-meals prior to nadir and not so much in the afternoon as the insulin wears off. If I got this working right, here is a comment made on another post bye Chris and China. It is better explained below.

Chris & China said:
It's actually easier on a the pancreas to deal with small meals instead of big ones, so I feed China about every 3 hours. It depends on the cat though...some people try to get all their food in before nadir so that as the insulin is naturally wearing off, they're not adding carbs, so they'll feed at PS through about +6 and then nothing after that.
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