New... and confused (Aloysius)

[MFMeow]

Hi everyone. My name is Kirsten, my cat Aloysius was diagnosed 2 weeks ago. This board has been so helpful helping me figuring out how to manage this.

Brief history - Aloysius is about 12, he had been eating Purina Cat Chow and had gotten up to 20 lbs. (Hanging head in shame.) He lost 6 pounds (without being on a diet) and I also noticed increased urination so I took him to the vet where he had a full geriatric profile (blood work & urinalysis) and was diagnosed with diabetes with blood glucose in high 300's.

Since then:

I switched him to a canned food diet. The first week he got a tablespoon of dry Purina DM here and there, but the more I read, the less of a good idea that seemed, so we've cut that out. He's getting FF classics turkey & giblets or savory salmon now. Eating well, urine output had gone way down, and he is active, alert, and happy.

We are using ProZinc, intial dose was 1 unit twice a day.

By day 2, I was uncomfortable injecting him without home monitoring, so I got a ReliOn Confirm meter and started testing. Just PMPS at first, now I am testing before every shot.

Did a 12 hour curve on day 6.

After one week we went back to vet for BG check at +5 hours. Correlated my meter with theirs, I got 254 and they got 273 (and they gave me an A+ for all my homework and home care).

We kept the dose the same, but since then, his numbers are all over the place. Often it is too low to shoot at +12. We seem to be in a cycle where I felt like I needed to skip around every 3rd shot. I spoke with my vet a few days ago and discussed whether it was OK to give a reduced dose sometimes (I want to keep my vet on board with everything I am doing) and she agreed I could cut the dose back in some cases. Basically we decided (for now), if lower than 175, do not shoot, if 175-250, reduced dose (she suggested half), if 250+, full dose. As I collect more data that can be adjusted.

Unfortunately due to my work schedule it is hard for me to get a midcycle test number but what I have gotten is in his spreadsheet.

We did another 12 hour curve yesterday, he was actually too low to get his AM injection at the regular time, I delayed an hour and a half until his numbers rose somewhat and gave 0.6 instead of 1.0. His numbers were really flat for a long time and at +12 he was still only at 132. I did not shoot and this morning he was at 436 at 22 hours after his last shot.

If anyone has a moment to look at his numbers and weigh in that would be awesome. confused_cat

My gut is saying he maybe needs a lower dose more regularly… but my gut doesn’t know very much about this yet. The 436 scared me so I gave him 1 unit this morning.

I also know I need to find some Patience Pants. I am sure there are some around here somewhere. :mrgreen:

 

[stacia]

I have no idea about the dosing - I'll let someone else address that - but I wanted to say that for two weeks in, it seems you're doing an amazing job with testing and monitoring! And how awesome to have a vet who is working with you. Not all of us are so fortunate. Mine's come around a bit but we still butt heads here and there.

Also, if you find those Patience Pants? Please let me know where I can place my order.

 

[Sue and Oliver (GA)]

Welcome! And I agree, great job getting on top of this sugar dance with diet,a good insulin and hometesting.

I agree he is getting too much insulin. The goal is to have 2 shootable preshot numbers every cycle. Last night, when you skipped, he went up high this morning, after 24 hours since the last shot. Skipping is the least desirable strategy because of that.

I think I'd try .5 units and see how that works. Today is a crapshoot as he may be too low to shoot again tonight, but he might be okay. I think your vet's ranges are generally okay, except for the lowest range. I am a little uncomfortable with new diabetics shooting under 200 without having enough data to know how the cat will react. We suggest stalling instead: If you get a number under 200, wait 20 minutes without feeding (which raises bg levels) and retest. If the number has risen (you don't want to shoot a falling number) and nearer 200, shoot but maybe a smidge less than the dose before.

Last night, the stalling might not have worked as he was much lower than 200, but it is sometimes surising how much and fast they rise after that +12 number.

We put together a protocol for ProZinc that might be helpful

http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=109077

 

[MFMeow]

Thank you both for the feedback. It seemed kind of incomprehensible to me to inject insulin into a cat without knowing what his blood glucose was preshot. :shock: My former husband died at 53 from uncontrolled diabetes and it is not something I am inclined to take lightly.

I get the feeling the vet didn't suggest it (home monitoring) because they are afraid of overwhelming their clients... but they seem fully on board with what I am doing.

ANYWAY, I was going to do another curve today but decided to give his ears a break... I will at least test at +4 and +6 since I am home today, to see what's going on... then try to get him stabilized on a lower dose. We do have another vet appointment tomorrow so I can have another go at correlating my meter with the vet's, and discuss with them to see if they agree that a lower dose more regularly might do the trick. Not sure how experienced they are with feline diabetes, but I have been going there for years with many cats and feel like they are competent and reasonable.

I am also blessed with the world's most cooperative cat. He will let me do anything as long as he is sitting in my lap. This would be way harder if the cat wasn't such a good sport about it!

Thanks again!

 

[MFMeow]

Also - I agree that 175 is too low to inject for us right now. I don't feel like I have enough data on how much he reacts to a specific dose to be safe doing that. Especially when most days, I have to sail off to work after his AM shot and can't monitor him at all.

 

[Sue and Oliver (GA)]

Just a comment about coordinating meters. Every meter has a 20% variance from one test to the next, so if you and your vet are within 20% of each other, it's not an issue. If he is using a pet only meter, we know those run higher than human meters. As we are generally looking at patterns and ranges, we just adjust.

Yes, often vets don't want to overwhelm their patients and don't mention home testing. It does sound like your vet is easy to work with as is your kitty. Good news all round!

 

[Critter Mom]

Hi Kirsten,

I believe you were looking for a pair of these ...

 

[MFMeow]

CritterMom, those are perfectly *lovely* patience pants!

So today he was 436 at AMPS, 233 at +4, 180 at +6.... and 86 at +12. :shock: I was with him all day and he didn't display any signs of hypoglycemia... I am wishing I would have tested a couple times between +6 and +12 to see what went on in there though. At this point I plan to test him frequently the rest of the night until I see him going up, just to be safe.

I am now regretting my panicked administration of the vet-recommended "full dose" this morning when I saw the 436,.. but I guess you don't know what will happen until you see what happens.

Can I just say... I can only *imagine* the mess I might be in if I was just blindly injecting 1 unit twice a day without monitoring. Which is basically what the vet sent me off to do.

Really glad we have a vet appointment tomorrow!

Sue - I get what you are saying about meter correlation. Being a quality control geek in real life, I will just feel a little better to have another point of correlation and know my meter and my vets were "roughly close" on 2 occasions instead of just one lone data point. And the numbers I am getting are so *crazy* that it will make me feel a little better to double check my meter again. I also think that will give them more confidence in my numbers going forward. They have already agreed that going forward I can fax my curves and numbers to them and not drag him in so often so that is a big win. I do know the real thing to observe and care about is the patterns and ranges with my own meter. Thanks so much for your input.

 

[Sue and Oliver (GA)]

One unit definitely looks like too much, even in that 400+ range. ( a long cycle usually means too much insulin) Looks like no shot tonight. I'd be prepared for a high amps (24 hours since the last shot) but I would still lower the dose tomorrow.

I would definitely mention to your vet that Aloysius could have hypoed several times if you weren't home testing. Hope he gets how important it is!

 

[MFMeow]

One unit definitely looks like too much, even in that 400+ range. ( a long cycle usually means too much insulin) Looks like no shot tonight. I'd be prepared for a high amps (24 hours since the last shot) but I would still lower the dose tomorrow.

That is my plan. Thanks again!

 

[Critter Mom]

So today he was 436 at AMPS, 233 at +4, 180 at +6.... and 86 at +12. :shock:

Maybe instead of the patience pants I should have sent you some brown trousers (I've got spares ... )

... I can only *imagine* the mess I might be in if I was just blindly injecting 1 unit twice a day without monitoring. Which is basically what the vet sent me off to do.

That's the situation I found myself in when Saoirse was first diagnosed because I got no support for my strong desire to home test at our previous veterinary practice. We moved to a different practice shortly afterwards. Our new vets recommend home testing although not all of their clients choose to do so. Home testing saved Saoirse's life when we had a hiccup during her wet food transition (unexpected inappetence). Even now, in spite of being able to home test I am nervous every time I give insulin to Saoirse. Blind dosing would be completely beyond me. nailbite_smile

They have already agreed that going forward I can fax my curves and numbers to them and not drag him in so often so that is a big win.

If you like, you could email the link to your spreadsheet to your vets and set the sheet sharing permissions to allow anyone with the link to view it online (but not edit it). That would save you the palaver of faxing, and your vets would have access to Aloysius' up-to-date info any time they need it. Our vets have online view-only access to Saoirse's spreadsheet. Our main vet is able to do the majority of her consults over the phone. He thinks it's much better for his diabetic patients to avoid vet visit stress wherever possible. It's a great arrangement for my little love. (Works for her agoraphobic mammy bean, too!)

 

[MFMeow]

Update: today he was 335 at AMPS (+23 hours from previous shot), gave him .5 units. Vet checked BG at +5, got 208 on their meter and 187 on mine. (We all feel better having that second data point that shows my meter reading around 20 points below theirs... and at least it was consistent with last week's reference check.)

Vet looked at my wild and crazy numbers from the past week and the latest curves and we agreed to lower the regular dose from 1.0 units to .5 units to see if he evens out.

I'll report back in a week or two just to let y'all know how it went. Hopefully we won't have any crises between now & then. He seems happy and contented, alert and playful, good appetite, and I am thankful for all that.

(Patience pants. Patience pants.)

 

[Sue and Oliver (GA)]

Sounds like a great plan!