new: having trouble with dosage

[Michele M]

Hi,

I wonder if someone can look at the spreadsheet I made and give me any thoughts you might have. Im fairly new to this (the board and feline diabetes) and we are having trouble with dosage.

It feels like trying to steer a rudderless ship. If his BG is high and we raise the dose he ends up really low...so we lower the dose and it shoots back super high. Are we adjusting it too much too often? This is mostly what the vet is suggesting: 0.5 unit adjustments depending on what his bg readings are.

He started out on 2 units initially and after a week the vet tested his bg and it was still in the 300s. So he went up to 3 units. The spreadsheet starts after a couple days on 3 units. His BG actually seemed to be higher on 3 units. Its all very confusing.

Any thoughts would be welcome

thanks
Michele

 

[hmjohnston]

Hello there!

A few things- why did you start out with 2 units? Most cats start out with .5 or 1 unit no matter what the number is. Something is apparently effecting Crushy (besides the FIL) and it might be too much insulin is pulling him down then bouncing him back up.

Unless Crushy has a history of ketones (are you already testing?) and since you have relatively just started him out on lanuts (or is it levemir? Both post here) I would suggest dropping back to .5 for at least 3 days if not 5 days while keeping a daily eye on the ketones. This will help you out since Crushy doesn't like to be tested before food and you NEED to get that PS test in to see if he is too low to shoot. I recently had a cat sitter who couldn't test- he kept saying there wasn't enough blood but Sneakers bleeds easily so it was most likely his technique that was wrong. I came home 2 hours after he tested and found her at 35. He shot a full dose and she shouldn't have had any. I spent the next several hours keeping her in gravy and hamburger nibbles rather than sleeping after a 10 hour drive home. So dropping the dose until he settles and you can test easily and before food would be a second good thing.

Both of the L's are dosed based on the NADIR rather than the pre-shot- and you have been catching those at a good frequency.

Just a few other items just in case you missed it in the first posts in Health...
1- Are you giving canned food? Is it low carb (under 8%)? Is there any access to dry? This questions deal with the amount of carbs Cushy gets during the day/night- and carbs bring up the BG levels. If Crushy was on dry are you weaning off it and on to canned?

2- Are you checking for ketones? This is an indicator to DKA- a very serious, very fatal, and VERY expensive condition to treat ($5k give or take a few hundred). Not enough food, not enough insulin, and an infection are the main trifectas to DKA- and two of those we can control, sort of.

3- You mention outside and supervision so I am guessing Crushy loves the outdoors with the smells and haunts he does. Don't worry about lizards and rabbits and mice and voles- they are pretty low in carbs being mostly protein and a cats NATURAL source of food and exercise is well known to bring down BG levels in human diabetics so it should be the same in cats, too. I had to worry about a neighbor who fed the strays in the area with... dry food. Oh that kitty crack was an enticing allure Sneakers could not resist... needless to say she is no an strict indoor kitty unless I am home.

4- The testing... this seems to be a main trouble with the lack of PS #'s and what you mention in the SS. Crushy HAS to be testing prior to his shot no matter how much he protests. You can try the towel/burrito or the clothespin/mohawk but do it and keep doing it until he gets it that he doesn't get fed UNTIL he gets his ear pokey. Have you tried treats? Freeze dried anything usually just has the one ingredient and there are a few others that don't have added carbs or anything. Unfortunately the temptations and other popular brands add flour and sugar to the treats and they jack up the BG's like nothing- so read the ingredients. And make sure your lancets are a smaller gauge one like 26. While the higher ones are nice they leave little holes and until Crushy learns to bleed they aren't much fun as you need to poke several times to get enough blood. Also- do you use a device or do you freehand it?

I hope this helps some- I know it looks like a book but it is something to start out with.

heather

 

[hmjohnston]

Now that the big post is out of the way... a few more thoughts and explanations.

His numbers would be higher on the higher dose if it is too much for him. Crushy is currently a pendulum that is stuck on the wall (of HIGH) rather than swinging back and forth. Think Poe. His body is used to this constant non movement but then you start up the insulin and all of a sudden it is loose from the wall and swings widely the other way to LOW. Well- it can't stay there as it hasn't been tied to the low wall for a while and it isn't used to it so it swings back to HIGH again and the cycle of wild swinging continues until something happens to stall it. You noticed he was better on lower insulin- that is because his starting dose was to HIGH of a dose. How did the vet come to that number anyway? Unless Crushy is very obese for a cat that is an unusual starting number. If the vet did it because he was so high then your vet is not very knowledgeable about FD and you need to be the one to teach your vet.

Eventually we want Crushy to be right in the middle with not to much sway in either direction but that is going to take a lot of time and patience on your part. You've got the testing down- for the most part. now we need Crushy to cooperate.

This is a marathon, not a sprint. Crushy didn't get FD overnight and he won't get better overnight. The common goal of everyone here is regulation. once regulation has been reached then go for OTJ.

With the PS testing- you say Crushy doesn't want to wait for the test as he wants his food- how often do you feed him? How much? I ask because Sneakers was eating 18-20 oz per day- every hour or two hours she would have an ounce- day and night. I got a feeder that would spin around and feed her during the day. And she woke me up just about every hour during the night for food. Once her numbers got better, close to regulation, she stopped eating so much and her meals got further apart. Now she eats 6-8 oz per day and I only get up once during the night to feed her (and she gets a test then, too). You need to remember that an unregulated FD kitty can and will literally starve to death while eating everything it can. It is the insulin that helps get the nutrients Crushy needs from the food he eats. The lack of that insulin means he can't get enough nutrients out of the food so for a while now might be the best time to feed him the lower costing canned food (low carb, of course) and then move up the ladder once Crushy stops eating the house out. The food list has all sorts of canned food that are 8% carb and under. Sneakers got Special Kitty for months as there were 4 types of food she could eat and was .71 cents for a 13 oz can. Cheap, yes, made her poop smell to high heaven, yes, but it was better for me to buy that when she pooped out most of it than her current Merricks BG that she actually gets all the nutrients out of and her poop doesn't smell as bad. Note that- poop smells better or worse with whatever brand you feed Crushy. The cheaper brands do smell worse.

And hold a dose for at least 3 days (6 cycles) if not 5 days (10 cycles) to let it settle. Switching one or two cycles because of the PS doesn't really help in the long run- unless he is too low to shoot but you currently aren't getting those numbers to know.

heather

 

[hmjohnston]

And yet again...

Finished reading his profile-
You feed raw mice and I think someone unearthed a study that reported mice at around 5% carbs for everything. I don't know about the meat/liver/squash mix what count that would be. It depends on the meat you use. As long as they are getting the other nutrients needed that seems to be a great deal healthier than others. But I wonder what brought on the FD as a raw diet is usually healthier and keeps them leaner. There is a link to a raw food diet here using chicken as the meat.

I would split Crushy's meal and feed him more for the time being until his numbers come down and are better. He is starving right now and no wonder he wants his food before he does his PS. He's a hungry kitty at that time and doesn't want anything to stand in his way!

Hope these help.

 

[Michele M]

A few things- why did you start out with 2 units? Most cats start out with .5 or 1 unit no matter what the number is. Something is apparently effecting Crushy (besides the FIL) and it might be too much insulin is pulling him down then bouncing him back up.

That was the Vet's starting dose. (its Lantus btw) This was before I had a chance to do any research. I think he made it so high because Crusher is such a big cat? He's around 18 lbs now. Not really fat....just big. ok he has a little belly, but he's mostly just big.

2- Are you checking for ketones?

yes. Crushy has taken to peeing in the bathroom sink for some reason so Ive been keeping it clean and dipping the ketone stick in it. so far so good

4- The testing... this seems to be a main trouble with the lack of PS #'s and what you mention in the SS. Crushy HAS to be testing prior to his shot no matter how much he protests. You can try the towel/burrito or the clothespin/mohawk but do it and keep doing it until he gets it that he doesn't get fed UNTIL he gets his ear pokey. Have you tried treats?

Ill work on this. I do give him a treat after the ear poke but if I have it in my hand or anywhere near me during the whole process he just spends the entire time wiggling around trying to get the treat.

Wait, what is the clothespin/mohawk? I missed that one

And make sure your lancets are a smaller gauge one like 26. While the higher ones are nice they leave little holes and until Crushy learns to bleed they aren't much fun as you need to poke several times to get enough blood. Also- do you use a device or do you freehand it?

The lancelets I have are 30 gauge. I started out with 33 gauge but couldnt make those work. Ill try the 26 gauge (for some reason I thought the larger gauge numbers meant smaller needles...duh) yes, I am having to poke him a lot to get blood which is frustrating..for both of us. I tried the device and freehand and so far free hand is working better. I cant really aim well with the device.

His numbers would be higher on the higher dose if it is too much for him. Crushy is currently a pendulum that is stuck on the wall (of HIGH) rather than swinging back and forth. Think Poe. His body is used to this constant non movement but then you start up the insulin and all of a sudden it is loose from the wall and swings widely the other way to LOW. Well- it can't stay there as it hasn't been tied to the low wall for a while and it isn't used to it so it swings back to HIGH again and the cycle of wild swinging continues until something happens to stall it. You noticed he was better on lower insulin- that is because his starting dose was to HIGH of a dose

this is really helpful thank you!

With the PS testing- you say Crushy doesn't want to wait for the test as he wants his food- how often do you feed him? How much?

twice a day. 1/3 cup of ground chicken, chicken liver, and 7% squash at night (maybe I should move that to 5%?) and 10 baby mice in the am (about 1.7 oz) I WAS feeding 2 adult mice (same weight) but I started getting paranoid about the mouse chow in their stomachs which has lots of grains. and you never know if they ate before they were euthanized or not. So I switched to the not yet weaned mice just in case.

(also,Im just now wondering how much his dinner weighs and whether or not Im really splitting his meals evenly)

he also gets an ounce or so of bacon treats through the day. (Its just cooked uncured pork, nothing added)

I do worry about the mice he catches outside. They are about the size of your fist and he can down the whole thing in an instant. seems like that has to have an effect considering his blood sugar is high with what Im already feeding him.

we have a cat fence that keeps him in the backyard so he is not getting random cat food from the neighbors or anything.

got a feeder that would spin around and feed her during the day.

where can I get my hands on one of these?? can you put raw food in it?? Ive tried to free feed Crushy in the past but he always eats the entire bowl in one sitting.

But I wonder what brought on the FD as a raw diet is usually healthier and keeps them leaner.

THAT is what I would like to know! We had a cat 10 years ago that died of diabetes and part of the reason I switched to a raw diet in the first place was because I didnt want to go through that again. And here we are. at least the insulin is better now (all we had was humulin U back then) and there is MUCH more info and support on the web now.

thanks for all your help
Michele

 

[hmjohnston]

Lantus is a great insulin and most vets are used to dogs and dogs get dosed by weight at the beginning so that makes sense. But everyone knows a cat is so much different than a dog so why should dosing be the same? I would suggest, since there have been no ketones and given the swings, reduce to 1u and hold it for 3-5 days.

If he is a big cat (but not obese) and he was eating raw- did he have any steroid shots in the past? That sometimes brings on FD.

Currently I wouldn't worry much about what the mice are eating that he gets outside. True, the grain might effect him but you currently can't do anything for it. Increasing what he gets at home *might* slow down the outside eating- depending on how much he caught before :shock: :lol: .

Petsmart/petco sell different feeders but you can also find them on Amazon for cheaper. If you use the shop link at the top of each page FDMB gets a commission for sending shoppers their way and the money goes to help pay for the website costs. You can do the raw in a feeder- I froze my raw in ice cube trays and would put down two frozen cubes and one frozen ice water cube. It would take about two hours to melt and be ready to eat by the time it turned around.

Testing- at the beginning give him a treat for getting to the poke place and another for the poke. And once he knows more food is available during the day he might not be so desperate. You are right that the higher number lancet is thinner- but at the beginning you need a lower number so the ear 'learns' to bleed. Keep those higher lancets as you should be able to use them once you finish the box of smaller numbers. The kitty mohawk is using clothespins to hold the nape of the neck- like a momma cat would carry the kittens when they were little- and it immobilizes them. I never had to use it or the burrito but I've seen a u-tube post and it seemed effective- I think they had 5 or 6 pins. When finished you just unpin and the cat gets up.

I don't know if squash is a high carb plant or not. I know people who use mashed up green beans to keep their kitty well, um, moving. Just increase Crushy's food until he lets you know his body is adjusting to the insulin. For Sneakers it was around the time she got below 300 consistently. Yes, she would have red PS but those eventually went away and the more she was in the pinks the less she ate. When she started in the yellows she ate even less and in the blues she is down to her 'normal' 6-8 oz per day.

One last thing- your profile states you have a True meter from Walgreens. Just letting you know that many cats, mine included, have given false readings with the True meters (they are generic ones of branded meters). They don't like to read too high for many cats. While yours seems fine above the 300 mark there were many that haven't been and many owners were led into believing their cats were so much better when they weren't. If you are close to a Walmart the Relion Prime is a good meter with the cheapest strips around (50 count is $9), the Micro comes in next and I do believe the Target brand Up and Up (?) also has comparable pricing on the strips- for the 25 ($9) and 100 ($36) count. the 50 count is more expensive at $20. And you will learn that getting a good meter with cheap strips that is readily available is a must if you have to go and buy some at 3 in the morning. Also, using the shop icon above going onto ADW (american diabetes warehouse) to purchase FD supplies is also a good idea. I was able to get the Arkray Vital plus 200 strips for $45. The strips are also $45 for 250 (comes to .19 cents each, like the Prime) when I auto ship from them. But things to purchase from them also includes a needle sniper (takes off the needle from the syringe) so you can throw it in the trash rather than having to collect them and find a way to dispose of a bio-hazard material- about $5, lancets galore, syringes if you can't find them cheaper- Walmart has theirs 100 for $13.

Well, I think that wraps up this chapter in Crusty's notebook :roll:

Hope you have a good evening!

heather

 

[Deb & Wink]

Without those pre-shot tests, there is no way to put the mid-cycle tests into perspective. Once you start getting those pre-shot tests, we'll know how far a dose of insulin is taking Crushy.

 

[Michele M]

If he is a big cat (but not obese) and he was eating raw- did he have any steroid shots in the past? That sometimes brings on FD.

nope, he never had a steroid shot

thanks for the tips on the feeders and insulin supplies. Good to know!

Im having a hard time imagining him eventually stopping eating if I give him all he wants though. I tried to free feed him in the past and he got huge. My other cats lost weight, but he gained. He's just always been very food oriented.

with the automatic feeder, how many times a day do you feed? the more the better?

Ill work on those pre shot tests! its got to be done. His ear IS bleeding easier now than say a week ago, so thats progress :smile:

thanks!
Michele

 

[hmjohnston]

It takes a while for those pesky ears to learn. Sneakers avoided me (and the egg timer) for about a week while hers were learning.

It depends on how many slots you get. A lot of us like the petsafe5- which has 5 slots that rotate around. it eats batteries but you can set it to go at any time. divide the morning food by 4 (or 5 if you think he will eat it immediately) remembering that you want to have 2 hours of 'fasting' before his PS shot- both AM and PM.

right now he is so hungry he probably can't stop. 1.5 - 2 oz small meals- 2 hours apart might be a good start for him. He will eat it all at first. Afterwards he should slow down but it might take a bit. Or you might consider he has food issues :roll: :?

 

[BJM]

using the formula for estimating a starting dose:

18 lbs / 2.2 * 0.25 = 2.045 units

So a 2 unit start may have been appropriate for him.

 

[Wendy&Tiggy(GA)]

I second what everyone said - those preshot tests are critical. He could be low then and by shooting him you are setting up bounces.

If you can get some more tests as below over the next few days we can work out whats going on here - we need 3 days of data to get a good picture.

- ALWAYS getting a preshot test
- if you can a mid cycle (5-7hours after morning shot if your schedule allows)
- a before bed test 2-3 hours after his nighttime shot.

Also Lantus works best on consistent dosing. I would move to 1.5 units and hold that for 3-5 days unless he drops under 50... or you see a preshot number under 200 in which case you would skip (for now until we get more data)


Wendy

 

[Michele M]

I switched to 1 unit for the last 3 days and his numbers still look kind of all over the place. Should I give it longer to settle out? Raise the dosage?

I got a new Glucose meter! I went with Wal Mart's ReliOn. I tested my walgreens tru track glucose meter on myself and got three different readings. two of them were 20 and 30 pts higher than the ReliOn readings! (I took 2 ReliOn readings and they were both the same.) So hopefully things will be more accurate now.

Ive managed to get the pmps for the last couple days but still working on getting the amps. Getting him to calm down before breakfast is a bit challenging. Going to start burrito-ing him in the morning tomorrow I think.

oh and the new meter only needs 0.3 Microliters of blood compared to 1.0 that the True Track one needed. This makes a HUUUUUGE difference! Cant believe how much easier it is when you only need such a teeny spot of blood

Thanks!
I really appreciate everyone's help here
Michele

 

[doombuggy]

Michele - great that you got a Relion meter. I have a micor that I bought in 2011 and let me tell you with all the test strips I go thru, especially lately, my pocketbook thanks me for it (Cedric;s emergency vet and regular vet bill for the past month got to about $5k).

I am in a rush to start work, but I have a C20 Cat Mate autofeeder that I bought from petmountain.com (cheapest place I found it). It comes with an ice pack and 2 trays. The lids pop up (versus turn) which I like. This summer Cedric started to try to chew on the lids, but I have put peper on them to get him to stop. I put a cold portion around an ice cube in the left side to open around 4 hours after injection and then a frozen portion on the right side to open aroun 8 hours after amps. of course over the past 3 days i have cut him back to 1 snack during the day, but that's another story. Gotta run..good luck!

 

[Wendy&Tiggy(GA)]

The tru meters can be inaccurate at higher numbers so its good you now have the relion. Keep the tru as an emergency back up but bear in mind anything over 200 may be underestimated.

Try feeding him first, then testing and shooting? As long as you get the test within 30 minutes of the eating ( hoping he isnt a slow eater) the numbers shouldnt have had time to rise much. Also if you take the pressure off by offering meals through the day and night (timed feeder) he shouldnt be so desparate and it will help put less pressure on his pancreas.

Wendy

 

[Michele M]

I have a C20 Cat Mate autofeeder that I bought from petmountain.com (cheapest place I found it). It comes with an ice pack and 2 trays. The lids pop up (versus turn) which I like.

My c20 Cat Mate autofeeder arrived today. I put some treats in it and he's currently trying to break into it. ohmygod_smile hopefully he cant and gives up soon.

Also if you take the pressure off by offering meals through the day and night (timed feeder) he shouldnt be so desparate and it will help put less pressure on his pancreas.

fingers crossed!

 

[hmjohnston]

doesn't look like anyone covered this- but you should hold a dose for 3-5 DAYS unless the cat is throwing ketones for being too low.

It is good that you have gotten a new meter- and it is a really reliable one so you won't need to worry about that.

I hope Crushy likes the new feeder. He's had a weekend to get used to it.