Need help with dosing

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Katie and Fuzzy

Member Since 2010
Hi. I haven't had to post here for a long time since Fuzzy was in remission. Sadly, as of about 2 and a half weeks ago, Fuzzy is once again back on the juice. :( He actually had become insulin dependant again in February, but I was able to manage it easier, and his blood sugar always stayed the same numbers, (around 120 to 140 on a tiny amount of insulin). Finally he went back into remission, but unlike his remission periods before, this one lasted only a few weeks. Before they would last for a year or more. This is the 4th time he's come out of remission, I was really hoping he would stay there this time. :( Anyway, the reason he came out of remission this time was because of a incident that made him ill. He had been a little backed up, so I gave him some Lactulose which I had done many times before when he had constipation problems. It's always been a little hard on his stomach, and sometimes he throws up because of it. However, this time I was trying to give him a new kind of food, and apparently it didn't react well with the Lactulose. Another thing was the Lactulose was old, over a year, but I had called the vet who said it was ok to give to him since Lactulose doesn't really expire. I'm not sure if that had anything to do with it, but as soon as he ate the new kind of food, he started to violently throw up. He vomited so hard that he fell over. I was able to catch him, but he couldn't stand up and flopped onto his side. His eyes glazed over and it was like he couldn't move. I rushed him to the vet who told me that he had choked on some of the vomit which had made him fall and have that glazed look in his eyes. Luckily he made a quick recovery and seemed fine by then. He didn't eat for a while that evening, but after a good rest, his appetite returned and it seemed that everything was normal again. Except that his blood glucose was creeping into abnormal numbers. The next time I tested him he was 205 which was a week later, (after he went into remission I was testing him every week). I got him on Lantus again, just giving him a small amount. I thought that the higher number was from stress of being so sick, and that he just needed a nudge to get back into remission. I was wrong. Since then he's been having very strange numbers and I just don't know how to dose him properly. I tried giving him half a unit, but it led to him getting below 70, which I know isn't that low, but it's too low for him. He's always been a higher blood sugar kitty with glucose levels usually between 80 and 145 when he was in remission. Anything below that makes him nauseated and either lethargic, or overly restless. What was weird was that some days his BG would drop to 60 at +2, then be at 180 at +9. I thought it was rebound at first so I started giving him a smaller dose. Unfortunately that didn't help and he was at 180 this morning again. I just don't know what to do. I don't want to keep switching his doses like this, but it seems no amount works for him. He either gets too low on a dose of half a unit (or even a little less). Or he gets too high on anything smaller than that.

I was thinking of getting a blood panel done, but I need to save up for it first. I know his teeth are not in the greatest shape, but the vet has told me they weren't bad enough to have a dental done and take such a risk. Fuzzy is 20 years old, has diabetes and a hyperactive thyroid with a heart murmur. The only way the vet would consider using anesthetic on him now is if it was something life threatening, like removing a tumor or something where there's no choice left. Other than his BG being abnormal, he's in good shape. He still runs upstairs to sit by the patio, he can still jump pretty high, he's affectionate and eats well. He sleeps a lot, which is expected from an older cat, but he sleeps even more when he's getting insulin. He doesn't get constipated a lot, just once in a blue moon which is also expected of an older cat. I really don't think he has any other health issues that could cause these weird higher numbers, the vet couldn't even believe what great shape he's in for such an old cat. He seems physically and mentally well, so why are his BG numbers so out of control? There's nothing that's stressing him, nothing has changed about him. How should I dose him to prevent these higher numbers? I gave him half a unit this morning and plan to test him around +3. I can't do a curve on him until Tuesday because I will be in and out of the house all the time until then. When I have more time I'll try to update my spreadsheet.

Sorry for the long post. I just wanted to make sure everything was explained about what's been happening. I'm at the end of my rope with these abnormal numbers he's been getting and could really use some help and advice. Thanks.
 
Katie --

We really need to see a spreadsheet or more information with dose and BG test data in order to lend a hand.

One thing you really should considers. Lactulose is a disaccaride (sugar) and the product also contain lactose and other sugars. This product is really not the best choice for treating constipation in a cat with diabetes. You might want to discuss the use of other products, such as Miralax, with your vet.
 
I'm actually trying to make a spreadsheet right now. I lost my old one, and it's been a really long time since I made one so it's taking a while to figure out.

As for Lactulose and diabetes, the sugar is non-digestible so it really shouldn't affect BG numbers. He had it quite often when he was in remission and it never affected his BG. I usually give him unflavored Metamucil every second day to prevent constipation, and it usually does the job. Only once in a while do I have to give him Lactulose because he's a little backed up.
 
I made the spreadsheet but was not able to figure out how to properly put it in my signature so I just pasted the link. I have to go so maybe I can do something about it later.
 
Katie...what brand of cat food are you feeding Fuzzy....what flavors and what is your feeding schedule.

Your SS is attached just fine...and there are plenty of numbers there now for people to see. good job!
I do see greens after your AMBG time which is a good sign. I am wondering if you give Fuzzy a snack
during the night and in the day time at around +8 in the cycle....

Hopefully an experienced person will be back to check and help you out...
(for constipation, I have used tuna oil and given Miralax 1/4 tsp mixed with it or water in food with good results)

Fuzzy is 20 years old!!!! Wow! That is amazing!!! Congratulations to you both! :YMHUG:
 
I feed him Fancy Feast, just the low carb flavors. He gets 3 of the 3 oz cans a day and I free feed him. I don't give him any snacks, just a tiny treat after his needle that's way too small to affect his BG. It's one of those Temptations ones.

He gets those lower numbers when I give him half a unit. If I give him any less, then his numbers don't drop that much. The problem is that half a unit brings him down too low too fast, and by his PMPS, he's at around 135 or 140 which is too low for half a unit, especially that I can't watch him during the night. So I have no choice to give him a smaller dose which results in a higher AMPS. :( I don't know what to do anymore. The numbers are just crazy and uncontrollable and it's got me worried all the time. Could it be just because he's old, or is something else causing his BG to rise like this?
 
What may help is if you spread out his meals in the beginning of a cycle.
breakfast/dinner, +1, +2 and +3 plus a snack around +8 to +9

The temptations are a bit higher in carbs...you may want to consider some low carb treats like Pure Bites or Halo's freeze dried treats
Low Carb Kitty Treats

Keeping the dose consistent helps too.

As for nite time, we encourage evening spot checks up until your bedtime.
And leaving food out for him to graze thru the nite.
 
I just got him now at +5 and he's at 2.9, so even lower than he was an hour ago. This is far too low for him so I've been feeding him treats to raise his BG a bit. If they are higher in carbs, then they should help. He's really irritable and drowsy right now so I want his BG to get higher, and obviously half a unit is too much for him no matter what. I'll just have to keep giving him around 0.2 even if his BG stays a little higher. Better a little high than low.

I free feed him, but he only eats every 2 hours, sometimes even 4 hours because he's pretty lazy. I often have to bring the food to where he sleeps or he won't eat much of it because he loves sleeping so much.

As for spot checks, I don't know how many I can do considering how expensive the strips are. Usually I only do AMPS and PMPS, and sometimes mid-cycle, but anymore than that will result in me running out of strips before I can afford more. :(
 
Couple of things...

You said you're shooting a half of a unit (i.e., 0.5u). However, your SS says you're shooting 0.05u. I'm assuming the notation on the SS is an error but could you clarify?

What meter are you using? And where do you get your strips? The Walmart brand meter and strips are pretty inexpensive compared to the other brands that are out there. If you're using some other meter, I hope you're not buying strips at a pharmacy-- they are hugely overpriced. Amazon, Ebay, or even Hocks will be at least half the cost. For example, the pharmacy where I get Gabby's Lantus was charging $63 for a box of 50 Contour strips. I just bought the same amount of strips from Hocks for $26.

I am curious too, whether an elderly cat metabolizes insulin differently. Older adult humans certainly metabolize drugs differently and lower doses are needed.
 
I had to put 0.05 for half a unit on the SS because if I just put .5 or 0.5, the SS automatically converts it to 0.50 which basically could be the same thing but I prefer 0.5.

I'm from Canada and I'm not sure if Hocks ships out here. I have a Freestyle Freedom and a Freestyle Lite meters. I like them because they need such little amounts of blood. But the pharmacy is the only place I can get strips since no other place except ebay ships them here, and with ebay, other people bid against me, them shipping charges and Canadian conversion yet, it would either be the same amount as the pharmacy or more expensive! And at least at the pharmacy I can get them right away instead of waiting for them to be shipped here. But it is really expensive, $80 for 100 strips. I'm thinking of switching to a meter that has cheaper strips, even if it takes more blood to read.

It's strange with Fuzzy. He's really sensitive to insulin and usually goes into remission easily. But I guess now that he's older it's a lot harder to keep his BG down. As you can see on my SS, he's high again this evening. It doesn't make sense since he dropped so low today. I just don't get why he's getting these stupid high numbers at his PS times. It's never been this bad before. :(
 
I just dropped a note to Ronnie/Luna. She's in Toronto and may know of some other resources for strips that are less expensive.

If you're shooting 1/2 unit, writing it on your SS the way you are is going to confuse people. If you go to the menu bar that has the symbols, there's one marked "123." You can change the format for decimal places. You may need to block a section and make the change but it is important that the information on dose that you're putting in reflects what you're actually shooting.

I do think that a before bed spot check at night will help. You have no clue where Fuzzy's numbers are at night and they could be dropping lower. I'm curious why you wouldn't want to shoot 0.25u? Did you think this amount wasn't enough?
 
Hi Katie

Unfortunately, the Relion isn't available up here.

The only meter as cheap as U.S's Walmart Relion strips is the TrueTrak, available up here in Canada, but it's not a very reliable meter.
As you can see from this review from a few years ago, it is rated pretty low.
Consumer Reports Meter Reviews

Maybe you know someone in the U.S that you arrange for a Relion meter and strips to be sent to you?
Ebay works too, I did that once via my brother who is an avid e-bayer

I used the One Touch, the Freestyle and had began our insulin journey with the True Track.

Sucked it up and forked out funds for the One Touch strips which are about the same price as the Freestyle.

There is another meter kicking around up here. It's called the iTest.
I got one free with 10 strips from their website. http://www.itestglucose.com/.
Just don't tell them it's for your cat :lol:
Nifty little meter, looks like an ipod
I checked out their prices and they are up there with the One Touch and Freestyle in price.
Oh well.

If you have a Walmart near you, strips for Freestyle are a little bit cheaper than pharmacies.
If you have a Shoppers Drug Mart near you, you can use your points from the Optimum card to redeem for strips, knocks off about $20!
You can alsoa collect points too when you buy strips. :thumbup
At a Costco, you can also get a little reduction too on strips, but not by much. You could always use someone for the senior's discount :idea:
Why, I just used my mom last weekend for senior's discount at a store! :lol:

Thanks for getting those numbers today - very good info to have!
Any chance for a couple of numbers tonight?
 
Sorry to hear Fuzzy is back on insulin. I checked and the Hocks site says they do not ship internationally. However, i Googled freestyle strips + canada and found this site w/ Freestyle Lite strips for $25.95 , a little cheaper if you buy more than one. http://www.canadadrugs.com/otc/product/+FreeStyle+Lite+Test+Strips+/9532

The Temptations treats are higher carb and even a few can effect BG. However, they take longer to go to work and longer to clear the bloodstream. It's better to give a little HC gravy. It will boost him up faster and not stay in his system so long.
 
My mom has an optimum card. I never thought of using it to buy strips, but it's a good idea. :mrgreen: We actually have a pharmacist who always gives us discounts for pretty much everything we buy. But usually the most he can give is $10, so saving $20 would be awesome and would help a lot!

I'll probably stick with the Freestyle because I've found it to be really accurate with my vet's glucometer. I probably couldn't find a more accurate meter, and I feel comfortable with it. I just wish the price for the strips would go down.

I'm not able to get spot checks in before bed because I go to bed pretty much right after Fuzzy's PMPS. I'm always early to bed, early to rise. In any case, I'm really running low on strips and can't afford more just yet so I've got to be careful for a while. :( I want to do a curve on Tuesday, so until then I can only test at his PS times.

Ann & Tess, thanks for the site, but I couldn't find the strips for 25.95. All I found were ones for $107.
 
Hi Katie

can you begin a new thread/condo for Fuzzy?
Your subject line should read like this: 09/19/10 Fuzzy AMPS #
And we ask that you link the previous day to the new day so we can glance back quickly if needed.

What is your shot times? 7am/7pm? 8am/8pm? 9am/9pm?

I do have to tell you, you will need some spot checks at nite, there is really no way around that - as well some kitties do tend to go lower in the evening cycle...
you would be basically be missing half your data and without the evening checks - it makes very difficult to offer dosing feedback.

Having to conserve strips is fine, but save one at least for a before bedtime check until things get better for you., even if your bedtime is one hour after you shoot... Always very important.


You could always set an alarm for later in the evening to check on him.

Not to mention, if Fuzzy is low for a PMPS, you may have to stay up a bit to monitor numbers to keep him safe.
Without knowing where he went in the evening, it really makes suggestions difficult to do.

Keep that in mind ok?
 
]That's odd. I clicked the link and got back to the page w/ the price I found. Here's a screen shot of it.

I wonder if it is because I'm connecting from the US. There is a phone number in the screen shot, you could call.
 
It says country of origin is the United Kingdom so I'm guessing that price is for the UK only maybe?

My shot times actually vary since I have a really busy schedule so I've go to go around that. But it's usually around the same times. In the evenings it's around 8:00 and I go to bed at 9:00 because of early classes. I could try to get a spot check before bed, but I really can't guarantee it. But I do know for sure Fuzzy will not get too low over night on such a small dose, and also that he eats the most at night. I do need an adequate amount of sleep to preserve my own health so I can take care of him, and go to school and my job the next day.
 
I also use the iTest meter. I get the strips from Costco. They gave me the meter for free and it came with 100 lancets.
They charge $63 for 100 test strips in Alberta.
I like the meter and it uses very little blood.
I've cross tested with my Accu-Chek and Freestyle meters and the readings are within 0.1 of a difference.
 
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