New Member - PMPS 10.7, Unsure if skipping dose was right

[Diane Tyler's Mom GA]

To make it easier for you
Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods


https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

10% and under is low carb
11% -15 is medium carbs.

16- 24 is high carb.
from The Official Lantus, Levemir & Biosimilars Slang Dictionary MC =11=15% and HC is usually 16-24%

 

[Diane Tyler's Mom GA]

Don't know if you saw this yet it's for our Aussie caregivers A lot of information and also lists the syringe and where you can buy it from
https://www.felinediabetes.com/FDMB...for-aussie-feline-diabetic-caregivers.217781/

I also did a search and found one of our members from Australia use these
Here is the post
These are the syringes you will need:
U100, 3/10ml, 30 or 31 gauge, 6 or 8 mm insulin syringes like these

@Charlie’s Mumma is from Australia and said
yes in Australia and using those exact needles as felt they worked better then a pen
Here is the thread if you want to read it, read post number 4 and 5
The post numbers are to the right of each post
https://felinediabetes.com/FDMB/thr...o-take-charge-after-hypo.281913/#post-3107949

 

[Bron and Sheba (GA)]

Yes, those are the syringes you need to buy. You can get them at a lot of pharmacies...some pharmacies may need to order them in for you. You can also order them online which is what I mostly did. If you do get them from a pharmacy, make sure they are those exact ones, as there are lots of similar ones around. Best to get a box of 100 syringes.

 

[Aimz123]

Good stuff, yes, he’s flat, if he didn’t eat anything at +3 you can give him a few more of his treats. Nice steady blues we like, surfs up!

How’s he doing? Still chilling? A test again at +5 to see he’s still flat or rising would be good.

looks like it’s gone up it’s 8.8 at the 5+ check! Yay! I gave him a bit of cantaloupe as a treat and to add to his sugars too. Thank you and the others for walking me through all that I was literally having a breakdown trying not to lose it completely.

I’ll wait about a few hours and test again.

 

[Bron and Sheba (GA)]

Did Ernie eat well before his dose of insulin this morning?
You might like to offer him a snack at +1 next time to try and slow down the drop. His drop down to 7.9 though was very safe and ultimately you want him coming down into those numbers and lower.

 

[Aimz123]

To make it easier for you
Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods


https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

10% and under is low carb
11% -15 is medium carbs.

16- 24 is high carb.
from The Official Lantus, Levemir & Biosimilars Slang Dictionary MC =11=15% and HC is usually 16-24%

Thank you! I just went out and bought the beef gravy one as he likes licking the gravy off that and this way I know he can get some carbs into him! Also just got a cantaloupe as he loves the juice and pulp squished up and so he’s just had a bit of that too.

 

[Aimz123]

Did Ernie eat well before his dose of insulin this morning?
You might like to offer him a snack at +1 next time to try and slow down the drop. His drop down to 7.9 though was very safe and ultimately you want him coming down into those numbers and lower.

He hadn’t eaten all night and later that day as his pain with whatever is going on made him nauseous so after giving his odansetron this morning then waiting an hour and testing his blood I then gave him Mirtazapine and he began eating before his insulin shot.

Like you said might need to give him a treat at +1 next time because that was a scary drop. I think it was just full on because I’ve never tested during the 12 hour period before so seeing it all plummet was scary!

 

[Aimz123]

I

Yes, those are the syringes you need to buy. You can get them at a lot of pharmacies...some pharmacies may need to order them in for you. You can also order them online which is what I mostly did. If you do get them from a pharmacy, make sure they are those exact ones, as there are lots of similar ones around. Best to get a box of 100 syringes.

I’ll definitely get a few boxes just in case I need to go to a half dose! Thank you!

 

[Diane Tyler's Mom GA]

Glad to see Ernie is coming up, he must have enjoyed having that cantaloupe.
By the way he's a gorgeous kitty ,
If you up his frequency of ondansetron I hope it helps , poor baby

 

[Bron and Sheba (GA)]

Like you said might need to give him a treat at +1 next time because that was a scary drop. I think it was just full on because I’ve never tested during the 12 hour period before so seeing it all plummet was scary!

Sheba used to drop the most around onset. Ernie had his biggest drop then and then he leveled out and slowed down. It was good data to see and at no time was he in any danger. I know the first few times is scary but remember if you are testing and you have some high carb food and honey in the house, you are in control.

’ll definitely get a few boxes just in case I need to go to a half dose! Thank you!

I think you need to swap over to using syringes all the time. We recommend going up and down in dose in 1/4 unit increments

 

[Bron and Sheba (GA)]

This is how you use the pen to draw up insulin with a syringe

 

[Aimz123]

Sheba used to drop the most around onset. Ernie had his biggest drop then and then he leveled out and slowed down. It was good data to see and at no time was he in any danger. I know the first few times is scary but remember if you are testing and you have some high carb food and honey in the house, you are in control.

I think you need to swap over to using syringes all the time. We recommend going up and down in dose in 1/4 unit increments

Definitely going to get some syringes! thank you so much for all the support it has been very unnerving but also knowing all of you are here and actively responding has been such a big reassurance. Now to see what he reads at PSPM.

So if Ernie is in the yellow or blue category later should I hold my nerve and give his 2.0 units still? It’s a bit against what the vet has told me to do so now I’m confused

 

[Aimz123]

This is how you use the pen to draw up insulin with a syringe
View attachment 67736

Thank you for this! When you put the syringe in do you just draw back? So you don’t go injecting air into the pen first or anything like that? I’m guessing if you take too much out you just squirt that out into the sink rather than back into the pen?

 

[Bron and Sheba (GA)]

Thank you for this! When you put the syringe in do you just draw back? So you don’t go injecting air into the pen first or anything like that? I’m guessing if you take too much out you just squirt that out into the sink rather than back into the pen?

Yes, you just draw back. You don't squirt back any air or insulin into the pen. Squirt excess in to the sink. And keep the pen in the fridge.

So if Ernie is in the yellow or blue category later should I hold my nerve and give his 2.0 units still? It’s a bit against what the vet has told me to do so now I’m confused

Lets see what he is at PMPS. What time is your PMPS due?
Are you going to have some high carb food and honey at home for the PM cycle tonight and are you going to be able to monitor the cycle?

 

[Aimz123]

Yes, you just draw back. You don't squirt back any air or insulin into the pen. Squirt excess in to the sink. And keep the pen in the fridge.

Lets see what he is at PMPS. What time is your PMPS due?
Are you going to have some high carb food and honey at home for the PM cycle tonight and are you going to be able to monitor the cycle?

The PMPS is due at 10pm I won’t be able to monitor for much longer past that maybe a test at the +1. Got the high carb food and the honey ready.

Do you think he’s always been dropping low like that all along and it’s probably that by fluke I’m testing suddenly mid way that I’ve discovered this?

 

[Bron and Sheba (GA)]

I notice you mentioned he had Idiopathic Cystitis and it had resolved. That is something that comes and goes and can be painful. Often brought on by stress.
Very pleased to see you are testing for ketones. Please keep doing that daily at the moment if you can while he is not eating very well and you are skipping doses of insulin. Ketones can develop from not enough insulin and not enough food so we need to keep an eye on that.

 

[Bron and Sheba (GA)]

The PMPS is due at 10pm I won’t be able to monitor for much longer past that maybe a test at the +1. Got the high carb food and the honey ready.

Do you think he’s always been dropping low like that all along and it’s probably that by fluke I’m testing suddenly mid way that I’ve discovered this?

So at the moment it is around 4pm correct?
It is very possible he has been dropping during a lot of the cycles but without data we can only guess.
Do you work outside the home full time?
Did you say your Mum can test him during the day and feed him?
Do you think she would post on here if needed foe help?

 

[Diane Tyler's Mom GA]

I just need to understand how to do the curve thing everyone is talking about….

When ever you decide to do a curve , to make it easier for you to understand it, here's an Example Only For You
if you do a 12 hour curve
Say you test at AMPS at 8 AM and give insulin
Next test 10 AM
Next test 12 noon
Next test 2 PM
Next test 4 PM
Next test 6 PM
Then you PMPS test at 8 PM

From the Lantus sticky
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

 

[Aimz123]

I notice you mentioned he had Idiopathic Cystitis and it had resolved. That is something that comes and goes and can be painful. Often brought on by stress.
Very pleased to see you are testing for ketones. Please keep doing that daily at the moment if you can while he is not eating very well and you are skipping doses of insulin. Ketones can develop from not enough insulin and not enough food so we need to keep an eye on that.

Ah ok that explains it the cystitis may not have dissapeared or he’s just still stressed. He’s always been a highly stressed cat the house is filled with feliway plugs atm after that diagnosis was confirmed.

I was told by the vet that with the ketostix I can shove them into a fresh pee ball in the clumping litter. So far it looks like it’s reading as it shows high sugars in his pee but no ketones. He never had ketones at diagnosis.

 

[Aimz123]

So at the moment it is around 4pm correct?
It is very possible he has been dropping during a lot of the cycles but without data we can only guess.
Do you work outside the home full time?
Did you say your Mum can test him during the day and feed him?
Do you think she would post on here if needed foe help?

That’s correct it’s 4.15pm here in Melbourne so same time as Sydney. I work in and out of home as I sometimes need to go into the office and sometimes I can’t work from home. Is a bit unpredictable. Since my own diagnosis I have cut down to four days a week since returning to work so Fridays are my free days. To add to the complex situation, my partner lives in Lilydale which is about an hour and a bit drive away across town. Usually the routine was that I went over there on Fridays and spent the weekend there and return Sunday. We have a puppy labrador named barney over there.

Mum is elderly so trying to get her up to speed was difficult. She can manage the preshot tests and then dose but anymore than that would be a struggle. Her arthritis is quite severe in her hands so dealing with all the needles and test strips is very difficult. That’s why the syringe I’m extremely worried about coz the numbers are tiny as. She’s use to the pen now too so it’s just a lot to deal with. She’s not tech savvy at all so there’s no way she would even know how to type in this forum unfortunately.

I want to get to a point where I can leave the house and feel sure that she’s got it under control. Right now I’d be nervous because Ernie’s isn’t eating solidly yet and needs so much medication with his whole IBS along with this cystitis and insulin regime.

I feel trapped in my home and it’s impossible to go over to the otherside of town atm Sorry I know there are worst things.

 

[Bron and Sheba (GA)]

It is fine to off-load here. We all understand. Can your partner come to you?
Do you think the new low carb food is OK for Ernie's IBS?
If you are there is the mornings maybe you could draw up the dose for your Mum before you leave for work.
If there was an issue, can she contact you at work? Then you could post here and ask for help?.....just trying to think of ways around the problems.
We need to address Ernie's lack of wanting to eat. Could it be from the IBS?

 

[Aimz123]

It is fine to off-load here. We all understand. Can your partner come to you?
Do you think the new low carb food is OK for Ernie's IBS?
If you are there is the mornings maybe you could draw up the dose for your Mum before you leave for work.
If there was an issue, can she contact you at work? Then you could post here and ask for help?.....just trying to think of ways around the problems.
We need to address Ernie's lack of wanting to eat. Could it be from the IBS?

My partner unfortunately can’t leave the dog as he’s the only one at the house also bringing the puppy here is out as Ernie gets so stressed and the puppy wouldn’t be allowed inside which wouldn’t work either

I’ll draw up 0.5 syringe doses in case he reads low in the mornings I’m gone or doesn’t matter if we have to bin it as long as she has that option.
I’m hoping the low carb food is ok it’s scary as his IBS was pretty bad for years and Pred stabalised it along with the hills I/D. Now changing it entirely is high risk but if I don’t it’ll defeat the purpose of the insulin. It’s just a **** show unfortunately.

I need the vet to figure out the issue relating to his lack of appetite off Buprenorphine and cerenia. It must be the cystitis or the liver. Unsure which one. Sigh it’s just extra complicated with the IBD and the FLUTD and the enlarged liver.

 

[Aimz123]

@Christie & Maverick @Diane Tyler's Mom @Bron and Sheba (GA)

Tested Ernie again at +8 and he’s still 8.8

 

[Bron and Sheba (GA)]

Do you know what Ernie can’t eat.? I’m just wondering if he would do well on a home made diet where you can control the ingredients. Sometimes cats need to stay on their IBS food and we have to work around it by giving a larger dose. These are some options to think about.

 

[Aimz123]

Do you know what Ernie can’t eat.? I’m just wondering if he would do well on a home made diet where you can control the ingredients. Sometimes cats need to stay on their IBS food and we have to work around it by giving a larger dose. These are some options to think about.

I only know that Hills I/D with fortiflora has been the only thing that agreed with him. He got the runs with Royal Canin sensitive and Hills Z/D. I’ve got a mix of Ziwi Peak beef fry kibble atm and Hills I/D as I was going to change him right over after reading everything in the forum. His prednisolone is slowly being lowered but we need to be careful not to go too low or we’ll set off his IBD on-top of everything else.

Just need him to stabalise with the insulin and the appetite to go back to normal. Sigh.

I don’t have those syringes yet either I ordered some today after our convo so they’re waiting to be delivered. What I’m thinking is that is mum needs to do the shots and she needs to go to 1.5 for example, I’ll get a JuniorStar pen so she can use the pen still. If he needs a 0.5 dose I’m just going to have to draw some up so it’s there for when I’m away. This is for now until we can rectify everything and she’s more comfortable. It’s either this or I won’t have a life with my partner anymore the thought is already stressing me out.

I’ll touch base at the PSPM at 9.30pm if anyone is around. Because atm he seems quite low still based on the last reading.

 

[Bron and Sheba (GA)]

I’ll make sure I am around at 9.30 pm.
If he needs to stay on the prednisolone we will just work around it with the dose. We do have other kitties here with IBD and diabetes.

What I’m thinking is that is mum needs to do the shots and she needs to go to 1.5 for example, I’ll get a JuniorStar pen so she can use the pen still. If he needs a 0.5 dose I’m just going to have to draw some up so it’s there for when I’m away. This is for now until we can rectify everything and she’s more comfortable. It’s either this or I won’t have a life with my partner anymore the thought is already stressing me out.

I think that is a good idea. Try not to stress. It will all work out in the end.

 

[Aimz123]

I’ll make sure I am around at 9.30 pm.
If he needs to stay on the prednisolone we will just work around it with the dose. We do have other kitties here with IBD and diabetes.

I think that is a good idea. Try not to stress. It will all work out in the end.

Thank you so much it means a lot that you and the others have basically been holding my hand the whole day.

Very nerve racking stuff. Wish it was just one thing but nope universe throws me the bus and then some.

 

[Aimz123]

I’ll make sure I am around at 9.30 pm.
If he needs to stay on the prednisolone we will just work around it with the dose. We do have other kitties here with IBD and diabetes.

I think that is a good idea. Try not to stress. It will all work out in the end.

@Bron and Sheba (GA)

just letting you know his PSPM number was 12.3. Should I give him the full dose of 2.0? Or halve it?

I’ve been halving it when at this number but as others have mentioned this is not maintaining a stable dose.

 

[Bron and Sheba (GA)]

@Bron and Sheba (GA)

just letting you know his PSPM number was 12.3. Should I give him the full dose of 2.0? Or halve it?

I’ve been halving it when at this number but as others have mentioned this is not maintaining a stable dose.

I think you should give 1 unit. Until you get the syringes you can’t give any other dose except full unit doses and I think 2 units twice a day would be too much.
If possible if you could get a test sometime during this pm cycle I think it would tell us a lot.
Were you able to get a ketone test done with the urine he peed at 9.30pm…I noticed you had write it in the SS?

 

[Aimz123]

I think you should give 1 unit. Until you get the syringes you can’t give any other dose except full unit doses and I think 2 units twice a day would be too much.
If possible if you could get a test sometime during this pm cycle I think it would tell us a lot.
Were you able to get a ketone test done with the urine he peed at 9.30pm…I noticed you had write it in the SS?

1 unit sounds like a plan. I’m comfortable with that. If I did have the syringes would you have suggested 1.5?
Just trying to learn how it works when dosing down.

No ketones in the urine yay!

Will try to get a +1 test before bedtime

 

[Bron and Sheba (GA)]

If you had had the syringes I would most likely have suggested 1.5 units as we want to find a dose that you can safely give both cycles.
However we need to take into consideration other things as well…how much he is eating…is he eating well or not, how much you can test during the cycle. The main priority is to keep him safe.
Excellent no ketones. That is important and can effect our decisions as well.

 

[Aimz123]

If you had had the syringes I would most likely have suggested 1.5 units as we want to find a dose that you can safely give both cycles.
However we need to take into consideration other things as well…how much he is eating…is he eating well or not, how much you can test during the cycle. The main priority is to keep him safe.
Excellent no ketones. That is important and can effect our decisions as well.

Perfect thank you so much for all your help today and for getting us through this. I would have had a nervous breakdown if it wasn’t for this forum.

 

[Bron and Sheba (GA)]

Happy to help.
Tomorrow are you going to be home or do you go to work?
If you go to work, can your mother monitor the BGs during the cycle do you thinks? And feed him during the cycle?
Can you add ‘no ketones’ or the result into the SS each time you test please? as we always look.

 

[Aimz123]

Happy to help.
Tomorrow are you going to be home or do you go to work?
If you go to work, can your mother monitor the BGs during the cycle do you thinks? And feed him during the cycle?
Can you add ‘no ketones’ or the result into the SS each time you test please? as we always look.

I will be working from home tomorrow but it might be a bit hectic. I should be able to manage a couple of tests but not as much as today. Will give it a go.

Is the purpose to see if the trend is similar to todays?

He free grazes so usually that happens in the morning after his test and then at random times during the day. That’s if he decided he wants to eat tomorrow. Today he was on the pain relief and mirataz so ate. I need to try to get more pain relief tomorrow as I only have one syringe left. I’ve emailed the vet and told them what happened along with his pee issues that are still going even tonight.

 

[Bron and Sheba (GA)]

He needs to continue with anti nausea meds (Ondansetron), pain meds and the appetite stimulant every day for the time being. The appetite stimulant should be giving after the Ondansetron has had a chance to work.
The purpose of testing is 1. To keep him safe and 2. To try and find a dose that will let you give it both cycles without having to skip doses and doesn’t drop him too low.
It is important he eat well.
There is an injection called cartrophen which can be given for cats which is really good for FLUTD and for arthritis in cats. I gave the course to Sheba who suffered from FLUTD and arthritis. It is usually a weekly injection for 4 weeks and then monthly after that as needed….if my memory serves me correctly.

 

[Aimz123]

He needs to continue with anti nausea meds (Ondansetron), pain meds and the appetite stimulant every day for the time being. The appetite stimulant should be giving after the Ondansetron has had a chance to work.
The purpose of testing is 1. To keep him safe and 2. To try and find a dose that will let you give it both cycles without having to skip doses and doesn’t drop him too low.
It is important he eat well.
There is an injection called cartrophen which can be given for cats which is really good for FLUTD and for arthritis in cats. I gave the course to Sheba who suffered from FLUTD and arthritis. It is usually a weekly injection for 4 weeks and then monthly after that as needed….if my memory serves me correctly.

I’ll definitely be continuing all of that. I’m worried the appetite stimulant given everyday is a bit dangerous though as the vet was concerned it’s filtered via the liver and his liver is enlarged atm. It’s a bit of a catch 22.

One of the reasons why I find it hard testing regularly like today is not only work but Ernie is a very stressed type of cat. Once he’s stressed it causes a big array of issues usually. It’s been ongoing since I adopted him when he was three. I’ll try the testing again as I know it helps all of us determine a more accurate dose that’s suitable. Just trying to balance not stressing him out and getting the answers too.

The vet did mention catrophen but they wanted his appetite and pee issues under control first. So they’re holding that one as he was limping when he was diagnosed but the limping seems to have gone away now so not sure what happened there. I might mention it again to them because it might knock out the pee and poo issue as it very likely could be due to pain elsewhere too. I’m suspecting it was the withdrawal of the pain med that set him back. The vet wanted to withdraw the meds sooner rather than later but I should have just kept him on the pain meds till they ran right out. Clearly the issue is still there and it’s masking the cause.

 

[Aimz123]

He needs to continue with anti nausea meds (Ondansetron), pain meds and the appetite stimulant every day for the time being. The appetite stimulant should be giving after the Ondansetron has had a chance to work.
The purpose of testing is 1. To keep him safe and 2. To try and find a dose that will let you give it both cycles without having to skip doses and doesn’t drop him too low.
It is important he eat well.
There is an injection called cartrophen which can be given for cats which is really good for FLUTD and for arthritis in cats. I gave the course to Sheba who suffered from FLUTD and arthritis. It is usually a weekly injection for 4 weeks and then monthly after that as needed….if my memory serves me correctly.

Final reading for today at +1 after his PM shot of 1 unit it sits at 14.5. Not sure if that’s normal but at least he’s not dramatically dropping like this morning! Phew ‍ thanks again

 

[Bron and Sheba (GA)]

+1 Looks like a food bump after the main meal…normal.
It is a mistake to remove the pain and anti nausea meds too soon.

 

[Sienne and Gabby (GA)]

If I may make a request...

Can you start a new threat? We try to keep the individual threads to approximately 50 posts. Otherwise, they get long and if you need help, there's a lot to read through.

 

[Aimz123]

If I may make a request...

Can you start a new threat? We try to keep the individual threads to approximately 50 posts. Otherwise, they get long and if you need help, there's a lot to read through.

No worries will do.

Should I keep the title of my post as New Member and in the main forum? Or switch to the Lantus forum and post there? Sorry just trying to figure out the etiquette of posting.

 

[Bron and Sheba (GA)]

Hi Aimee,
How are things today?
Have you taken any more tests since the +1 in the pm cycle?
Re starting a new thread...you can either stay on this page for a bit longer until you get the syringes and get sorted or you can start posting over on the lantus page. Either way start a new thread and link this current thread to the new one for continuity.
If you stay on this page I would put in the subject line .".New Member, waiting for syringes and finding best dose for IBD kitty."
If you decide to go over to the lantus page they have a specific way of posting the subject line and you start a new thread each day.
Subject line...date, Ernie AMPS (or PMPS) and any subsequent BGs, and any question you might have. You can use the ? sign that is in the subject line options if you have a question to gain attention.

 

[Sienne and Gabby (GA)]

It's entirely up to you where you post. Once you have your signature and spreadsheet set up, you're more than welcome to switch over to the Lantus board. The rules for your subject line are a little different than on Health and you create a new thread every day that you post. I'd encourage you to look over the sticky notes regarding posting guidelines and being new to the group so you have a feel for how the forum works.