Nervous - vet upped dose to 3 u 2x a day

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Simon'sMommy

Simon'sMommy

Member Since 2013
Good Morning,
I did not take the sage advice that you gave me last night and took my Simon to the vet this morning for a fasting BG. It was 485 and he upped the dose to 3 units 2 x a day. Is this too big a jump too quickly? The vet tech (not my sweet one but one I am not crazy about as she did not think it was "necessary" for me to home test his BS and said the human meters were not accurate for cats - :roll:

Also, want me to switch from FF to Purina DM canned food (is this cause they make money on this? Simon is not crazy about this food but will eat it. Is it worth the money?

My question is since he is getting his shot so late today, and he has not eaten more than a few bites of food, I am worried he might crash. nailbite_smile nailbite_smile nailbite_smile Should I wait until he eats more before giving him his shot at 3 units? Also, what happens tonight? Do I wait 12 hours? Do I shoot at 6:30 as usual? Very confused! ohmygod_smile
 
This is hard for you. No, I do not agree with your vet. We don't raise doses by one unit at at time - no only can it be dangerous and cause low numbers, but you can skip right over a good dose. You can take your meter with you and test it along side your vet's meter to determine if "human meters are accurate for cats" We know they run 30 points off the pet meters but we adjust for that. 30 points is often within the normal meter variance. We are looking for patterns and trends, not exact numbers. It is quite likely that he was higher at the vet because of stress - some cats test more than 100 points higher.

Simon got some nice nadir numbers a few days ago. If he were mine, I would give him a little longer on 2 units with the diet change. If he stays higher, then increase by .25 or .5 units. You could tell the vet you were nervous about upping the dose and decided to postpone.

If you look at the ingredients on Purina DM, they are no better than the inexpensive OTC foods and not as good as the more expensive ones. There is nothing "prescription" about it except the price.

This morning I would offer him something besides Purina Dm that he likes and if he will eat some, give him the 2 units and monitor.

It's up to you. I am not a vet. I only have experience with my own cat and many others I have tried to help on this forum. I can only tell you what I would do if he were mine.
 
I decided to give him the 3 units this morning and test him every two hours and see what happens. I have to trust my vet and I do. He is a wonderful man. I just trust you guys more to be perfectly honest. You have way more experience with feline diabetes than he does I bet.

So, since I did give him 3 units after he ate a full can of FF, I will see what this brings. I am ready for a day of close monitoring and if anything happens, I have karo, gravy food, kibble and a turkey baster if I absolutely needed to give it to him anally. I am betting that 3 U is too much but I will give the vet the benefit of the doubt and monitor closely. ohmygod_smile I am home today (took a vacation day) and will not let Simon out of my sight.

If the 3 Units is the right dose, it could be very helpful since his numbers have been trending high. My husband is going to get some keto sticks today so we can check that since I did not do that yet.

Simon lost 2 oz this week with the switch over to canned food. He now weighs 14 lbs 11 oz. :razz: He should weigh about 11 pounds the vet said. He was over 16 lbs just a few months ago!

Thanks for being here. I hope I don't need you later but if I do, I will put out the 911!
 
You might find it helpful to review this table of Test Value Ranges

It shows the FDA allowed +/- 20% around a test value which indicates the range in which the test likely falls.

It also shows the estimated lab value that would be obtained if the human glucometer is reading 30% or 40% lower than a lab or pet-specific meter as noted in Dosing protocol for cats on glargine or detemir using daily home monitoring of blood glucose concentrations to adjust insulin dose
It is very important to note that blood glucose concentrations measured using a whole blood
glucose meter calibrated for human blood may measure 30-40% lower in the low end of the range than
glucose concentrations measured using a serum chemistry analyser or a plasma-equivalent meter calibrated
for feline use.
Click to expand...

At higher numbers, a human meter, pet-specific meter, and lab test may vary greatly. It doesn't matter - too high is too high. In the higher numbers, you make the same corrective action of increasing the insulin and determining what else may be contributing (stress, infection, high carb diet, etc)
 
Just checked BS at one hour and he was down to 359 in only an hour and of course this is on the human meter whereas the vet used the feline meter. Are those meter's worth the extra expense? Most people I have seen on here don't use it so I am thinking not.

Also, what is your favorite low carb snack for your Diabetic cat. He is not liking not getting snacks very often and since he is now really eating low carb and low calorie food, I would like to give more than a snack only at test time and insulin time cause during the week, I only test in AMPS and PMPS and sometimes after the PM shot.

Ok, rambling now. He seems alert and doing well at 1.5 hours post shot.
 
2 hours post shot of 3 units he is at 333. Moving down but very slowly which is a good thing. Will test a 4 hours and give him a little break at the 3 hour mark. And then I will test at 6 hours and hopefully this will be nadir or near it.
 
Treats - we use freeze dried chicken. Altho' they have it in the cat section at PetSmart, the 'dog' freeze dried chicken treats are cheaper for the same thing....

I've found this group to know more about treating feline diabetes than ANY vet BUT we LIVE it 24/7 - we have no choice but to learn!

GOOD LUCK!
 
He was sleeping at the 4 hour mark so just tested him at 5 hours and he was still over 300 at 5 hours even at 3 units :sad:
 
Hello Joyce,
if you're nervous about a high dose, take it as your gut telling you not to do it. It's safer and easy to up a dose gradually, but impossible to get it out of a cat once too much insulin is administered. Most cats, unless there is an underlying condition, do not need 3 units. Perhaps, your kitty will need it but you won't know it unless you have a lot more data. You have barely started data gathering. Please, do not go too fast.

Best wishes,
Sophie
 
His BG has barely budged since I gave him his shot. His lowest reading was 301 and now it is going back up and it was just at 328. I am going to give him 2.5 units tonight instead of 3 in case this is some kind of rebound and since everyone who has commented feels 3 is too much.

I will test before giving him the shot and post the result. Will do a plus 3 or 4 tonight in case it is just taking a long time to catch up with him with the 5.5 units today instead of 4. We shall see....
 
Actually, in order to get him back on his regular schedule, I am going to give him his insulin at 7:30 (normally at 6:30) and not a 9:15 which would be 12 hours. I will give him 2 units instead of 2.5 as I said above and certainly will not give him 3.

I am so confused! confused_cat
 
The vet tech (not my sweet one but one I am not crazy about as she did not think it was "necessary" for me to home test his BS and said the human meters were not accurate for cats -
Click to expand...

The vet tech is either misinformed or mistaken (nicer than saying "wrong" :lol: ) Their meter costs a lot more, and the test strips are also more expensive. But it isn't any more accurate or effective in managing feline diabetes than a meter you can buy at walmart for less than $15. The other drawback is that you can only get test strips from the vet. So at 2am some morning, you check Simon's BG, and you see that it's down to 50, then you look and find that you only have two strips left. An hour later, you check and it's down to 40. And you can't get more strips until the vet office opens.... Not a good place to be.

Thousands of cats have been managed by the people here. Almost all of them with human meters. They work well enough for what we're using them for, which is to more safely treat feline diabetes at home. Yes, the vet meter will also allow you to do that. But for a ton of money more than a human meter would.

Also, want me to switch from FF to Purina DM canned food (is this cause they make money on this? Simon is not crazy about this food but will eat it. Is it worth the money?
Click to expand...
YES they make money off of the "prescription diet" food. And NO it isn't worth the money. Assuming the FF you have been feeding are the "Classic" low carb flavors, there is no downside to staying with FF and skipping the Purina DM. The other issue with the DM is that it only comes in one flavor that I know of. And cats seem to enjoy variety. They burn out on the DM, and refuse to eat it? Then you end up needing to feed something else anyway. You can find plenty of off the shelf grocery store low carb options that are much lower in price, and just as good in terms of quality. If money isn't a big issue, you can still buy brand name higher priced food at a pet store like Petco or Petsmart that is much higher quality than the DM is.

You have way more experience with feline diabetes than he does I bet.
Click to expand...
That's a very safe bet. ;-) And not because any of us "know more" than he does. But collectively? We have "seen" a lot more cases of feline diabetes than one vet would in ten lifetimes. My vet sees 3 or 4 new cases a year on average. "We" sometimes "see" that many in a day. If you stay here for any length of time, you will one day "know more" about feline diabetes than your vet does. (without the cost of vet school :lol: )

Also, what is your favorite low carb snack for your Diabetic cat.
Click to expand...
Bob's favorite is freeze dried shrimp. But he settles for chicken and salmon freeze dried ones also.

Lastly, about today's numbers so far. Don't expect instant results due to one increased dose. Upping from 2u to 3u overnight is not something we usually advise. Cat's can be sensitive to small adjustments in dose, which is why we usually say "adjust in .25u or at most .5u increments". Another reason for that is because the "right dose" could very well be someplace in between 2 and 3, or 1 and 2, or whatever. And if you bump it up in large amounts, you can miss the "right dose" easily. Think of it this way. By going from 2u to 3u, your vet is increasing Simon's dose by 50% all at once. That's a large percentage of increase.

And sometimes, you don't see a great deal of difference after just one dose increase or decrease. There's lots of reasons for that. A few cycles at a "new" dose are more indicative of the effects that dose will have. Insulin is not a "drug". It's a hormone. It isn't like taking a pain med where you think "OK, if I take one, it'll knock out the pain 'this much'. If I take two, I'll get twice the relief or feel better for twice as long". How Simon reacts to a hormone would be different than how he'd react to a "prescription drug".

How his numbers proceed between this morning's shot and tonight's shot won't necessarily be the same as how he'd react to it tonight or tomorrow. We look at trends and patterns in the numbers over the course of days, not just at the numbers themselves over a 12 hour timeframe.

With Prozinc, the insulin usually "kicks in" (we refer to that as "onset") between 2 and 3 hours after eating and getting the shot. Then it usually peaks between 5-7 hours after the shot. After 7 hours, the numbers will usually start to rise as the insulin starts to wear off. If you plotted the numbers on a graph, a 12 hour cycle would have the shape of a "smile".

The numbers that are "key" are the ones before the shots, and a number around the point of nadir, 5 to 7 hours later. Those results will help you evaluate how effective any given dose has been.
 
Actually, in order to get him back on his regular schedule, I am going to give him his insulin at 7:30 (normally at 6:30) and not a 9:15 which would be 12 hours. I will give him 2 units instead of 2.5 as I said above and certainly will not give him 3.
Click to expand...

OK, I'm confused too... :lol:

What time did he get the 3u dose this morning?
 
Just realized that I posted an older reading from the meter! His +7 was 269, not 328. My hubby let it time out and I went back through the numbers and found the wrong one from the other day and posted that one. I fixed it. Now it makes sense. He is going down as it is Nadir time. I am going to wait until hour 11 to shoot his next shot, as 9:15 is too late as we are normally on a 6:30 schedule but the vet visit put us almost 3 hours behind.

His ketones were negative! That was a relief. So, in order to get him back on our schedule, we are going to give his insulin at 8:15 and then tomorrow at 7:15 am and that will be another 11 hour time span and then back to 6:30.

I am not giving him 3 units tonight with the earlier shot. I am giving him 2.
 
OK, that sounds like a good plan. And shooting a reduced dose with the 11 hour schedule is also a good idea.

Prozinc is advertised to have a 10-14 hour duration, so we say "12 hours" on average. And when people want to shoot earlier than 12 hours apart, 11 or even 10 is fine as long as you can see that the number has come up from the nadir low point. When shooting early, if you aren't quite sure that a full dose is a good idea, cutting it back some (like your plan to drop back down to 2u) is a wise move.
 
Sorry I confused you! I gave Simon his 3 units of insulin this morning at around 9:19 am and he normally gets it at 6:30 but we had a vet visit this morning at 8:15. So, because we leave the house at 7:15 every day, I want to give his insulin by 6:30 at the latest. Now that we are off schedule, in order to get him back on track, I am shooting at the 11 hour mark tonight which will be 8:15 and then tomorrow at 7:15 and Sunday he will be back on track at 6:30 we figure.


"And not because any of us "know more" than he does. But collectively? We have "seen" a lot more cases of feline diabetes than one vet would in ten lifetimes. My vet sees 3 or 4 new cases a year on average. "We" sometimes "see" that many in a day. If you stay here for any length of time, you will one day "know more" about feline diabetes than your vet does. (without the cost of vet school :lol: )"

As for the dose, I am giving him 2 units, not 3. I made the decision after reading all of the comments from this wise community. I trust your knowledge more than my vets as the quote above makes a lot of sense to me!

Thanks for the support and the advice. I am very appreciative of all of it. This is a scary and nerve wracking time for my kitty and for my hubby and I because we want to do everything right.

Sue, want to thank you most especially for all of your support and help and for doing Simon's spreadsheet. You are a great source of comfort for me at this time of need.

Hope my explanation above is clearer now. I know that I am feeling more confident about everything since I made my decision not to give him 3 units. I will go up a quarter shot if he keeps spiking high and then a half but not a whole unit! Also, I am feeding my kitty the FF. He likes it. To heck with the DM money maker the vet wants to put him on. I bought two cans and Simon ate it but not with relish like he does the FF classics. Simon does not like liver very much and he does not like any fish except shrimp and tuna
 
Your high number at the vet makes more sense now - not only could it be vet stress, but it was taken at +14? By then the insulin is gone and yes, he would be higher.

I'm glad you are being more cautious. You can always raise it if you need to, after he adjusts to the diet and the dose.

When you shoot tonight, be sure the number is rising, not falling. With the higher dose this morning, it could be a long cycle (usually a sign of too much insulin)
 
Just did his pre shot and it was 320 so definitely rising. Going to give him 2.25 units and hope it is not too little. He has only had one good day since starting on the insulin and it was only good, not great.

FWIW,I think he does need a dose increase, but not all the way to 3 units so quickly as that makes me nervous. I will follow, start low, go slow instead. But, he has had 14 doses at 2 units and never had a green reading, not once. So, I think the small increase is needed at this point. Giving him the insulin in 15 mins as he ate well and is very hyper and alert. No ketones as I finally tested him for those but man was that a trip! Getting his urine was a J.O.B! ohmygod_smile :lol: :lol: .
 
Simon's BS was 244 this morning which is the best so far. 2.25 is working well. I shudder to think what 3 would bring if I kept giving it to him after the initial shot yesterday morning after the vet told me to give him 3 units. Even though his BS remained high all morning after the shot, I am unsure if it was Somogyi or some other reason. 2.25 did bring down his levels so going to stick with that dose for at least a week.

Thanks for all comments. I did take all of your concerns about the higher dose of 3 units into consideration and decided that he should indeed have an increase but SLOWLY so we don't shoot way past ideal.

Keep questioning my vet. I am listening!
 
That is a lovely number. Can you get a midcycle number today?

It seems silly, but increasing by more than .25 (or .5 when in high ranges) can get you over a good dose. Too much insulin can cause sudden low numbers or a high flat cycle, like you got yesterday.
 
I will do a 3 hour (10:30 ish) and a mid cycle (1:30 ish) to see where he is.

He got a high flat cycle yesterday for sure. His lowest reading of the day was the last one before his PM pre shot test but this morning was a lovely surpise! 2.25 worked much better than 3 it seems!
 
10:30 BG (+3) was 273 which is great. He ate an entire can of Fancy Feast beef so this is after food where the other reading (the 244) was pre food. I am thrilled with this! He has not had nice readings like this (for him they are nice) in several days since he had readings in the 100's. I am hoping to see that soon!
 
291 @ +6...not great but still under 300 which is the best it has been for several days. Will do a +9 to see if he keeps climbing. Not seeing a true Nadir yet? He climbed from his morning pre shot at each test. Still liking the yellow instead of pinks though!

Could it be because I am free-feeding him? I am giving him the option of going back to his food all day due to that being the only way I can get enough calories in him with the wet food. I am perplexed why no drops in BG after insulin administered. Any ideas?
 
I'd suggest getting nadirs for a couple days at this dose and we'll see. Some cats have to settle into a dose. And it may be that the dose is too high. Your blue nadirs were 4 days ago on 2 units.

Don't worry and angonize over the numbers. Think of it as collecting data. Then we'll analyze when you get several days worth. :mrgreen:
 
244, 273, 291 and 299 are the 4 BG readings so far today. :-D AMPS was the lowest and then a steady climb. I suspect the PMPS will be in the 300's. Then I will do at least one more this evening. His insulin will be at about 8:15-8:30. His PMPS will be at 7:30 to give him time to eat prior to his shot. Then I will test again about 10:30 or 11:30 if I can last that late. If I can stay up even later (I will know how I am feeling by around 10:30 to know if I will be able to stay up late enough) I would rather do the last test around 12:30. I have a hard time staying up late these days cause I just finished radiation treatment for breast cancer and I get tired easily. Maybe if I nap I can do a later one.

Someone on the board here said that cats tend to go lower at night than in the daytime so I want to see what happens after giving him 2.25 for the evening round. I did not stick him last night as I felt he was agitated by all of the testing yesterday. :sad: Today, he is really behaving and almost coming willingly for the testing! It is not the treat either. It seems to be all of the praise he is getting. :cool: He has always loved being told how he is a "good boy" and lately he hears it a whole lot and seems to be responding to that and allowing me to test him much more easily. Also, the Neosporin seems to help him more than the Vaseline I was using.

This is going to be much better than I thought initially when I got the news he was diabetic. I was so worried and upset and scared for him. Now, with the support of this board, I am so much more confident that Simon will live his normal life span barring any complications once we get this under control. Of course, I am hoping he goes OTJ eventually, but one step at a time :YMSIGH:

I am thinking it might be time for me to join the PZI group now that I am feeling more comfortable with everything. I so appreciate the collective wisdom of this message board. Without you, I would be so lost! :oops: Thank you!
 
It's great both you and Simon are feeling better about this whole sugar dance.

Why do you wait an hour after his pmps number to give him the shot? He could be quite a bit higher in that hour (with PZI generally it lasts 12 hours and when it's gone, it's gone) If you can keep his shots closer to the preshot, it will give you a clearer picture of what is happening. Feeding him 2 hours before getting the preshot number is fine; I just wonder about why you wait for the shot and which is 12/12 preshot to preshot or shot to shot.

I will watch for you on PZI. (I post on both Health and PZI) It is a much smaller forum than Health but everyone there has experience with your insulin. It is busiest in the am and pm. If you have an Emergency, post on Health.
 
I generally do the pre shot test about 45 minutes before the shot to allow him time to eat. I am worried that if he is not hungry and does not eat enough, he could crash? Because he was always a grazer, eating very tiny amounts many times a day, I was concerned about him having insulin without making sure he had food. I literally sit there and hand feed him wet cat food to get him to eat enough! Should I just do the test and shot and then worry about the food?
 
The glucose drop from insulin may make him hungry and prompt him to eat. Try it on a day when you can watch his behavior to see if that happens.
 
Is he just eating fancy feast now only?

You asked about free feeding. different people on the board have different strategies. Personally I prefer free feeding because I think it keeps the blood glucose more stable than 2-3 meals a day but some people feed a number of mini meals through the day.

Do you leave the food out all night too?
 
Yes, he is eating 3 cans of FF a day and made the transition from dry (Hills Science Diet DD duck and peas) to wet quite easily. He loves it actually. Also, despite the warnings from my vet, he has had no skin issues AND no GI issues. Poop is solid and normal. I am so pleased. All this time I was paying 23 bucks for 3 lbs of the prescription food which he wasn't even crazy about, I was giving him garbage since most dry food is mostly cereal. Kind of ticks me off actually.

I don't leave food out at night. I free feed him between the morning shot until he finishes one can of FF. Then around mid day, I give him another can and make sure to take that away when he finishes that and so he has had two cans by 1 or 2 pm. Then he gets another can before his PM shot (6:30 when I am back on schedule) to make sure he has food in his tummy for his insulin.

I suppose since he has already had two cans, it doesn't matter if I shoot him right after the PMPS test but I wanted to make sure. My dad was a brittle diabetic and small things sent him soaring or crashing so we always worried about food and how much and when with him. I guess with a cat, it could be different. My dad had to eat within 20-30 mins of his shot or he could crash but that was when he was on a faster acting insulin.
 
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