Need Injection Advice

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Mewsette2001

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Can anyone tell me what is a good amount to inject? I just tested my kitty and her number was lower than ever on an AMPS: 127. She has never been nearly that low on a pre-shot test.
 
The usual advice is not to shoot below 200. If your schedule permits, wait an hour or so (without feeding) and retest; if over 100, shoot your usual amount or reduce slightly. If you need to stay on schedule, you may be better off skipping the shot. Just be aware if you skip the next ps will be higher than usual--don't overdose in reaction. Give your usual dose. It looks like your kitty's numbers are coming down quickly; you may be due for a reduction.
 
If you find you often have to skip, reduce the dose by 0.25 units.

And check the nadir, around +5 to +7 hours after the shot.
 
Well I'm stumped but I'm sure you guys will know...I tested my kitty this AM and didn't shoot because she was at 127. She has never been that low, even on a nadir. I just did a +9.5 test and she is even lower at 116! I tested myself and I was 125 and also my Aunt at 166 (we had just eaten) just to verify my monitor isn't messed up. Any ideas on what may be happening? Thanks!
 
Three possibilities (At least):
Sputtering pancreas - intermittent function of the pancreas
Remission - wouldn't that be nice!
or
Other illness - not so nice - check appetite to make sure eating.
 
Yes, I fed her after I tested her. Before that she hadn't eaten for 1-2 hours (Aunt not sure what time she fed her). I also just fed her again and she gobbled up the food. So her appetite is great. I guess I will go and google sputtering pancreas. I have to do her PMPS test in 1 hour.
 
Nothing to Google, its just what it says. Sputtering, or intermittent function of the pancreas. Possibly a sign that it is starting to recover.
 
I just PMPS tested Mewsette and she is still low at 126. I don't think I should give her any insulin now either, correct? She hasn't had insulin for 26 hours now due to low AMPS & PMPS tests. She is eating heartily and drinking and seems to be happy and fine. Anyone have any ideas about what's going on? This is a good thing, right? Or are there things I should be watching out for?
 
Hi Susan,

This is lovely, lovely news. If her pancreas and the low carb food can keep her levels in these lower ranges, you may be headed to remission! (We consider a cat in remission if they range between 40-120 OFF INSULIN for 2 weeks)

i'd watch her carefully, testing a couple times daily. If she starts to climb up in the 150 range and food doesn't bring her down, then you might give her a drop of insulin to help her pancreas out. (we have a way to literally give a drop :-D ). You'd want to be sure you or someone could then be around to monitor.

Congrats on being such a good sugar mom - looks like the low carb diet and insulin may have done the trick! You would definitely be one of the lucky ones. And do remember, once a diabetic, always a potential diabetic - no dry or high carb food for her ever.
 
Whenever you're online Sue, or anyone that can advise, can you look at my spreadsheet for Mewsette and tell me if I should be giving her insulin? She has now not had insulin for over 2 days due to low AMPS and PMPS levels. I just now tested her and her level was a bit higher (172, on spreadsheet). So if I'm following you, since she's now well over 150 she should get a dose reduced from the 1.00 that she has always gotten? What is the normal glucose range for a kitty? 40-120? Thank you.
 
Can you be around to monitor her - in the next hour or two and then in six hours? If so, you could try a drop of insulin. Put some food coloring in water and pull up the smallest amount you can easily measure in the syringe (maybe .5 or .4 if you are using U100s) Then let out drops, counting as the drops fall. Record that. Then pull up the insulin to that same spot and let out all the drops, save one. What is left in the syringe should be one drop.

It may not be enough; you might have to start giving a little less than .5 or .5 but it's a good place to start gathering data. If it doesn't bring her down in a good range (yes, the 40-120 is the range we are looking for) then the next time, you'll know to give a little more at 170.

Sound doable?
 
Great, thank you. I changed the 172 to a +4 rather than a +5 while you were viewing it. So, I'm not sure if you saw the change or if that even matters.
 
I'm using U40's but I can figure out .5, mark it so when I do the insulin it's the same. If by 'monitor her' you mean test her rather than just watching her, then yes I can test her in 2 hours and then in 6 hours. But do you mean 6 hours from now, or 6 hours from the 2 hour mark?
 
I mean test her. Not only do you want to be sure she is not headed down too fast in 2 hours or too low at nadir in six hours, but you want the data that will tell you how this tiny dose worked for 172.

It probably doesn't matter when the 172 came. It is most likely that she will go down and it may last longer than a usual cycle so you will be "chasing" the next number like you did this time (that is, waiting until she is high enough to shoot)

You might want to buy some U100 needles so you can shoot .1 and .2 units. You can sometimes get them in small packs so they aren't expensive.To use them, you'll need to use the conversion chart as you will be shooting a U40 insulin with U100 syringes.

Conversion chart

If you decide to do that, start a new thread and ask exactly what kind and where to get them. (I didn't use them so I never can remember. :mrgreen: )
 
I need an Rx for needles and I don't think my vet will give me an Rx for u100's . Very ignorant about all this and she's new and not friendly at all. So I'll have to work with the u40's. Did you mean to give her a drop NOW? Also, do you want me to test her in 2 hours from what? From the +5 test, or 2 hours from when I give her insulin (assuming you want me to give her the 1 drop now?
 
You can give it to her now as long as she is rising (which we assume she is). So take a test and as long as she is over 172, I'd give her a drop. Then test 2 hours from this shot and 6 hours from this shot.
 
If you get a firm ruler with millimeter markings, you can line that up with your U-40 syringe to help you be consistent in measuring. While it won't measure units, it will provide a reference line for dosing.

Some folks use calipers to measure.
 
Can anyone advise? Regarding previous conversation, I was not able to give her 1 drop. I was not able to do a +2 or a +6. I was only able to test her again just now and it is her +10.5 level. She has gone down from 172 to 134 with no insulin. I guess if I had given her a drop we would be assuming incorrectly that it caused her to go down. She does go down from where she is frequently with no insulin but all in all, her numbers are pretty consistent. I know these numbers are a little too high so I'm thinking I should reduce her insulin to .25 from the 1.00 she has always gotten, since she can safely go down significantly. I definitely will not be giving her the usual 1.0 but I think she needs something. At this point, she has not had any insulin at all since Friday night. That's 72 hours. Does that reduction from 1.0 to .25 seem reasonable? Does anyone have any suggestions? Also, do I now need to start a new thread for some reason? Thank you.
 
Interesting...it's great that she came down on her own. I don't think I would give insulin under 150, so I wouldn't give insulin now - especially at night when you can't monitor.

Maybe tomorrow morning if she is over 150, and you can monitor, try the drop again? (no way to know what would have happened with the drop today, but if it brought her down in the greens, she may have surfed along in the lower ranges for a few cycles. The only way to know is to try a small amount and monitor.)
 
You're welcome to start a new thread - maybe put the date and her name in it first.

See what 0.25 units does for her. Giving insulin is always an experiment because things change!

Drop method:
Fill syringe with colored liquid similar in flow to the ProZinc.
Carefully push out drops 1 at a time making them as equal in size as possible.
When you can get the same number of drops each time, you can now reduce the dose by drops until you decide you're ready for an off the juice (OTJ) trial.
 
Sue, I'm very new at this. Why do you say give no insulin if she's under 150? I thought it was don't shoot under 200. Also I see many people here giving their cats insulin under 150 [and I know someone that shoots frequently at 75 (though I don't understand why at this point)]. She's in the blue, not the green, right? Shooting under 150 seems the norm. That being said, I understand not to do it at night at this point.

I understand the drop method but I had only a few minutes before I had to get back to work; not enough time to play with a new method and drops of insulin. I could have injected her but didn't have time for the drop method, it being my first time. I don't even think I have food coloring.

Anyway, I work a lot and I'm frantic with work. I can test her 3 times a day tops but I cannot do more than that. You may notice from the spreadsheet I've had to board her and also got a cat sitter in the past 3 weeks where no testing was done, just injections. I will also have to get a cat sitter this Friday and weekend so there will be no testing for 3 days. I'd like to get back on board with a reduced small amount of insulin while I'm here, so I can test her for the rest of the week and see how she reacts to it before the cat sitter and no testing for 3 days.

In light of that, would .25 would be okay to give her starting after tomorrow morning if her levels are same as they have been? I'm looking for a safe stable level that can be given without testing more than 3 times during the day. I cannot do +2s +3s +4s. My schedule doesn't allow it. I can usually get a +6, 7 or 8 in.

Thank you.
 
Mewsette2001 said:
...Why do you say give no insulin if she's under 150? I thought it was don't shoot under 200.
Also I see many people here giving their cats insulin under 150 [and I know someone that shoots frequently at 75 (though I don't understand why at this point0
Click to expand...
Hi Susan,

The general advice here for folks new to dealing with feline diabeties is not to give a shot if the BG is below 200. But that is just until the care-giver has got competent with hometesting, has gathered some data, and has some experience of how the insulin is working in their kitty. After that folks can begin to give insulin at lower preshot numbers, and many folks will give insulin if their kitty's preshot is above 150.

Some people - experienced in how their kitty responds to insulin - will give insulin at even lower preshot numbers, especially if their kitty is on one of the long duration 'depot' insulins like Lantus and Levemir.
And some people with kitties going into remission will give teensy amounts of insulin at lower than 150 preshots too.

75 is a mid range normal BG number. It would take a great deal of experience indeed to be able to give a shot at that number, and presumably the care-giver would know from experience that their kitty wasn't going to drop much lower than that 75...?

Eliz
 
I'm with Elizabeth, Susan. The normal advice is for new diabetics not to shoot under 200. But you have some data and are confident testing, so you could safely shoot lower - IF YOU ARE COMFORTABLE DOING SO. Don't do anything that doesn't feel right; your gut is a good guide. Most PZI users whose cats seem to be going OTJ start shooting tiny amounts at 150 and then monitor. If the cat stays in safe numbers at those amounts, they may push it and shoot in the 130s, but only drops of insulin and only if they can test during that cycle. One way to see how others have managed cats whose pancreas is helping out and who seem headed to remission, is to read the Remission thread at the top of this page. Look at the spreadsheets of the cats there and you'll see the different approaches used.

Some people who are doing tight regulation with Lantus shoot at much lower numbers than PZI users do. It's because their insulin tends to last longer, to have a shallower curve, taking longer to get to lower numbers at nadir and sometimes lasting longer than ProZinc. ProZinc tends to have a shallower curve, a faster reaction at the beginning and then dropping to its lowest point at nadir and heading back up. The two insulins work differently. Some lantus users, who have lots of data to predict their cats' patterns and who can test frequently do shoot at much lower numbers than ProZinc users.

The reason I am suggesting a drop rather than .25 is that a smaller amount is safe at the lower ranges, until you see how it affects her. When her pancreas is helping out every so often (and we don't know when and if that'll happen but it clearly did yesterday) I like to advise shooting the smallest amount, when you can monitor. If you can't test at around nadir, I'd be more cautious and probably not shoot at all, just leave out food to graze on (when the pancreas is working, it uses food to help bring down the numbers)

This is the hardest part of the sugar dance, except for those first few harrowing days when you were trying to figure it all out. You want to keep her in low but safe ranges which support that sputtering pancreas, but you want to do it safely, as these days are unpredictable. The good news is that it usually doesn't last long and at the end, you have an OTJ cat. You are asking great questions, and if we don't explain things so you understand them, ask again. You need to feel comfortable with dosing and you need to feel that Mewsette will be safe. Always, always go with your gut. If the advice doesn't feel right, don't take it. :-D
 
Sue, thank you for your explanation! I am just now logging on at 4 PM after being working with clients and I'm frazzled. Couldn't even eat lunch. I will re-read this a little later and may have some questions when I can think straight. As for now, her AMPS was 125 and I'm getting ready to do her nadir in about an hour because I fed her when I got home and want to wait 2 hours which will be an +8.5.
 
Mewsette hadn't had insulin at all since Friday night, 7/11 until just now. I gave her 1 drop and figured out a super simple way to do it, no food coloring required but you really might have to be as nearsighted as me (and that is EXTREMELY nearsighted) to pull it off. I tested the method several times and it was consistent. It's interesting to me that eating nothing for 2 hours before each test is making her numbers go down frequently, at least while she's been in the blue and without insulin for the past 4 days. I thought the pancreas used food to help bring glucose levels down in the absence of insulin. If you look at her chart, it's important to note that she had not had any food for 2 hours prior to each test, ever her nadirs. I don't think she has a sputtering pancreas because her numbers are within a close range of each other for the most part. To my understanding, a sputtering pancreas causes much more variability in scores than in her chart. Anyone have any ideas?
 
Hi,

it's quite possible that Mewsette's pancreas can properly be called slightly under-functioning (healing itself at its own pace since ECID) rather than sputtering at this stage. You're getting beautiful numbers. She appears to be close to remission which, as Sue has pointed out, can be a happy but difficult time of stress. Please re-read what Sue has written just to reassure yourself. And breathe plus treat yourself and your sweetie to extra treats or cuddles. Trust your gut's wisdom. I would not inject even a drop if her BG is as good as it has been over the last few days. Who needs to create more stress in one's life??? Perhaps, her pancreas simply needs a bit more time.

My OTJ Pudge went into his first remission on ProZinc at 1 unit and his 2nd on one drop of Levemir (we switched due to a shortage of ProZinc).

Best wishes
Sophie
 
As Sophie said, every cat is different. We'd suspect the pancreas is helping out any time the numbers drop unexpectedly in a cycle (especially past nadir) that has had little or no insulin. If you look at the spreadsheets of cats in the Remission thread, you see how different their numbers were when moving toward remission.
 
Thank you Sophie and Sue, for your help here! Sue what do mean "past nadir"? Does that mean past the +5,+6 or +7? Is that what you're calling nadir specifically? And starting into remission after only 19 days of insulin? What a short ride. I'll take it though. I just wonder if she has that glycogen storage issue that her breed, Norwegian Forest Cats, sometimes have and if that could have something to do with this. And by the way, she is still quite over weight, which make going into remission even more interesting.
 
The other day when you had a 172 and then several hours later, with no insulin since that number and more than one cycle past an insulin shot, and she went down on her own, we guess the pancreas is helping out. If it weren't, she would have been going up and kept going up.

I consider nadir the lowest point of a cycle. Unfortunately it can vary for each cat and even sometimes with each cycle (part of the reason we call this a sugar dance and suggest only the cat hears the music :mrgreen: ) But usually, it is somewhere between the 5-7 hour point after a shot. So after nadir, we'd assume the numbers would go up. When they go down or continue to flatten out, then we suspect the pancreas is helping. Nadir isn't as applicable with Mewsette if she hasn't had a shot in a few cycles; it's just a reference point.

My guess would be the diet change with a little bit of insulin to push things along. Sometimes, cats who are newly diabetic and on a high carb diet can go OTJ quickly if they are switched to a low carb diet. Not every one; you are very lucky.
 
Well, I suppose I should tell you she was low carb for 3 full months before she ever went on insulin. About a week before she was diagnosed I was doing research on dry feces and constipation, which led me also in the direction of reading about feline diabetes. Through that, I learned that raw had so much more moisture and that it helps diabetic cats because it's low carb. So when she was diagnosed a week later on March 20th, it was a no brainer. I put her on Rad Cat raw a day later on March 21st. Instead of putting her on insulin right away, I attempted to regulate her diabetes with diet, just to give her a chance without insulin. I decided to put her on insulin in late June when she began to show signs of neuropathy in her front legs. Prior to putting her on insulin, I wasn't doing home testing because I didn't know about it unfortunately. :YMSIGH: Perhaps being low carb months before insulin did help the pancreas out though. However her first score on 6/23 was 568, almost exactly what it was at the vet on 3/20. And by the way, the vet said to give her 4 units twice a day. Her first full day, her AMPS was 468 and her nadir went to 167 with one unit. I guess 4 units probably would have killed her. I'm assuming the vet prescribed that 4 units based on the fact that she was thinking I was going to keep her on Science Diet R/D (high carb). But still, it's a bit worrisome.
 
If you recall, my kitty Mewsette had been getting 1 unit of insulin for a few weeks and then didn't get any insulin at all for more than 3 days because her numbers decreased significantly. Then I started giving her 1 drop for a couple days and it didn't seem to really affect her numbers and she was still in the blue, so yesterday morning I gave her .25 and her nadir went down to 108. Did the same this morning and her +7.5 nadir was just now at 61. She has never been in the green. I'm happy that she is, but 61 is pretty close to that too-low 40 so I wanted to know if anyone had any advice or thoughts for me. I believe in the AM tomorrow I'll get back to giving 1 drop perhaps, based on her number, because the .25 getting her down to 61 is a little too close for comfort for me at this point. Need to experiment a little and then maybe get back to it if her numbers warrant. Anyone have any ideas, insights, apprehensions, advice? Thank you.
 
The 61 is a nice nadir, assuming she didn't go lower before or after it. She is definitely in regulated numbers. Two choices, I guess. Lower the dose to maybe 2 drops, on days you can't monitor. On days you can monitor, continue with the .25 and see if she will drop low enough overall that you can stop the insulin. She is very close. :-D
 
2 drops sounds like a good strategy Sue. About the .25 dose option, what is the minimum AMPS number that would make a .25 dose safe? And, what should I do if her glucose is lower than 40 on a nadir? Put honey or Karo Corn Syrup on her gums? When is a trip to the emergency vet necessary? Really want to avoid those last 2 scenarios, but just in case, I should know what to do in advance.
 
Managing low numbers:
1) Be sure you have the necessary supplies - ample test strips, high carb gravied food, Karo or other sugar syrup.
2) on discovering low numbers, do the following
- feed 1-2 teaspoons of high carb food
- wait 20 minutes
- re-test
- if still low, repeat

You want to get past nadir, with 3 rising numbers 20 minutes apart, and up in safe numbers, ex over 100 mg/dL.
 
She is beautiful and looks as French as her name. I'm with BJ - if she drops to 40, then high carb. Some people just feed a tablespoon of the gravy off the higher carb.

You have given .25 at 130 and she was okay, but I'd be nervous giving it at anything lower than that.
 
Thank you BJ & Sue! Can you give me an example of high carb canned cat food? And I will pick up the Karo. Also thank you for the compliment Sue. Fortunately she doesn't shed at all. Her fur just occasionally makes fuzz on the carpet and I peel it off and that is so much easier than all the shedding I've experienced in the past with every other kitty and doggie I've ever had. She doesn't get any fur on my clothes either. I think I'll keep her. When is a trip to the emergency vet warranted? Thanks.
 
Any of the gravy Fancy Feast ones will work.

It's hard to say when it's an emergency. Many cats don't seem to have symptoms until things go south fast. Any strange behaviour is a bad sign - yowling, hiding, not walking up easily, acting blind - and by that time, late to go to the vet. I'd say if she gets to 40 and you can't bring her up with gravy or Karo and she is going down, not up, I'd get to the vet. It's one of those safe not sorry things. Once they are truly hypoglycemic, it can be deadly. If she goes up from 40 and you can keep her up with food first or Karo if necessary, you should be able to manage it at home.
 
And what does the vet do at this point? And when you say 'keep her up', do you mean keep her awake? Or does that refer to her glucose levels?
 
Yes, you want to keep her levels up. The vet can inject a glucose solution to bring her levels up - just like a human diabetic will eat something sugary when they feel a hypo episode coming on.
 
My trip to the grocery store yielded 2 kinds of Karo. LIght Corn Syrup (with real vanilla) and Dark Corn Syrup. Does it matter? Both have the same sugar and carbs - dark has 1 more gram of each. I PMPS tested kitty cat 1.75 hrs late and she was at 103 so I did not shoot.
 
Thank you Sue. I think I'll return the dark one, as I think if I cook something that calls for it, I'd probably use the light one. Though I don't know, never using corn syrup. Odds that I'll ever use it are very slim as I don't eat much sugar. I didn't give kitty insulin last night and this morning her AMPS was 96. She has never been this low on an AMPS. So, no insulin this morning either. Happy! :razz:
 
She is really looking good! So her pattern could just be in double digits from now on (and in 2 weeks declared in remission ANTI JINX) or you could have to chase her numbers for awhile. Set your target number (150? 180?) and give her a little insulin when she reaches it.
 
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