New to this, and really confused! What should I give him today?!

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Hercule's mum, Jul 27, 2020.

  1. Hercule's mum

    Hercule's mum Member

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    Jul 27, 2020
    Hi!

    First of all ,thank you so much for setting up this board, I have learned loads reading it through! I tried to setup a worksheet, which I know you would prefer, but I do not have google drive or a google account. Sorry!

    Hercules was diagnosed with feline diabetes a couple of weeks ago. He wasn't eating, coat was shaggy and he seems lethargic. We came home with instruction to give 1U of prozinc and feed him his prescription diet! Being naive I continue to give him dryed royal canin diabetes food and some purina DM cans. He bounced back a bit.

    One week later we were told to come back to do a blood curve. After returning the kitty with a really bruised leg, I was told his BG was under control and I should keep on 1U and bring him back in a month. I was also told it was unusual to get it stable so fat, so there was a chance of remission and that I should keep an eye for a hypo.

    I noticed last week that he look unwell again, and had very loose and stinky poos. First I tought was the change on food, but by friday he was throwing up and I got really scared. After reading lots of the posts here I plunge the courage and bought an aplhatrak2 as I didn't know if he was unwell due to hypo or hyper, and realized how crazy it is to not have any way to monitor. Buy then, I also realized that food I am giving him is no good and I already bought him Feringa canned food to go forward.

    So, on saturday night and gave my first go. I din't feed him since 18:00. Measured his BG at
    20:26, which gave me 29mM/L. Decided it was not a hypo, and that i needed to do a propercurve on sunday.

    Did a blood curve on Sunday and got totally confused!

    Sun 8:41 - 16.7 mM/L (got overwhelmed forgot to give him insulin!!)
    11:25 - 26.2 (realized what I had done, and gave him 1U)
    13:30 - 24.8
    16:40 - 21.4
    19.43 - 24.2 (got worried the numbers didn't make any sense. checked with calibrated solution, which gave me 8.6)
    22:00 - 22.1 (decided insulin clearly wasn't lowering enough, gave him 1.5U)

    Monday 8:53 - 5.2 (panick that he may have experienced I hypo overnight, but seems better than he has been. Decided it was to loow to give him a dose)
    11:03 - 6.5 (still too low to give him insulin. Decided to skip dose)
    14.20 - 16.7 (so, now worried that it will get too high before next dose is needed)


    What should I do, give him a dose earlier than the the usual 20.45? and how much? seems like 1.5 is too much, but 1 is not enough? I cannot meassure 1.25 with my syringe... Any help really appreciated! I called the vet, but they won't be able to call back until tomorrow :(
     
  2. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    Please set. up a Google account (it's free) and a spreadsheet. We are hugely handicapped if we can't see your numbers not just for a day but the bigger picture. When it comes to dosing, we need to look at trends -- the big picture is important. One of the other helpful aspects of the spreadsheet we use is that it will automatically convert the numbers you're using from mmol/L format to mg/dL format, which is what the majority of people here (and who are in the US) use. If you want help, you will need to multiply all of the numbers you posted above by 18.

    The numbers are likely to be high when you skip a dose. If you do decide to shoot early, remember that your next shot will be due 12 hours from whenever you gave the injection. Chances are that will be a challenge to your schedule.

    There are no syringes with 0.25u markings. You will need to do your best to estimate between 1.0 and 1.5u. You can make up a syringe with the amount as a comparison. You can also purchase a set of digital calipers to help you dose consistently. We have instructions for the use of calipers. It is entirely feasible to eyeball the dose as long as you can be reasonably consistent.

    I'd encourage you to take a look at the information on dosing methods that's on the Prozinc forum. You would keep the current dose unless unless Hercules' numbers drop below 90 (or 5). If they do drop below 5.0, you reduce the dose by 0.25u.
     
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  3. Hercule's mum

    Hercule's mum Member

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    Jul 27, 2020
    Thanks Sienne. I'll try to go for 1.25.

    I am still confused why his number do not go down during the day, but seems to go way down at night?
    I didn't see much of a nadir on first full curve, and probably will not see one again today :(
    Is not possible to have a really long nadir that goes into the night, is it?
    Perhaps that is telling me, that his food is the issue (since he does not eat at night)? But to day I only fed him Encore, which is basicall just pieces of chicken, so why did it jump from 6.5 to 16.7 in 3 hours?

    Sorry, lots of questions, but I am really confused, and he does not like the testing.....
     
  4. Hercule's mum

    Hercule's mum Member

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    Jul 27, 2020
    I know that I don't have lots of data - I just got the alphatrack 3 days ago..... But did I make the right decisions with the results I got?

    Feedback would be really appreciated as we learning to navigate this.
     
  5. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    There's not one straightforward explanation. Many cats experience lower numbers at night. There is also a process called "dawn phenomenon" whereby numbers start to rise in the mornings. This is due to a normal upswing of corticosteroids in the AM as a means of preparing us (and kitties) for the routine stresses of the day. It may be a matter of Hercules not eating overnight. However, it may also be a matter of how sensitive he is to carbohydrates. A cat's numbers will also jump back into higher numbers if numbers drop low or drop fast. The drop to 5.2 likely triggered what we refer to as a bounce. When this happens, the liver and pancreas release a stored form of glucose along with counterregulatory hormones that cause numbers to spike back upward.

    I went to the Encore food site. Based on ingredients, it looks fine. You may want to do some calculations to make sure the food is low carb. The website did not include information about any supplements, such as taurine, that are included in the food. It would be prudent for you to check to make sure that the brand is nutritionally complete. Supplements, such as taurine, are essential for a cat's health. Without it, Hercules could end up with problems with vision, heart, and digestion. This is the carb calculator I use. It is not exact since most of the information that's available on products or on the web is based on the "guaranteed analysis" versus the "as fed" data. It will, however, give you a reasonable approximation.

    I can't really comment on your curve. I really need to see a spreadsheet. I know that hearing this is annoying but you're also going to hear it from most of the experienced members here. We are very data driven. Frankly, I will not offer dosing recommendations without benefit of a spreadsheet. We want to insure your cat is safe and seeing the numbers in our multi-colored format is what we are used to and it has proven itself essential for keeping our kitties safe.
     
  6. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Dec 28, 2009
    Hello mom of Hercules! Sienne is one of our very best. She knows what she is talking about. It is so neat that you are already testing GOOD FOR YOU! I know Hercules doesnt like testing but have you given him a little treat after each test? Something he REALLY likes? It may make all the difference in Hercules accepting testing (even if just a little)

    Again welcome to the best site on this planet to help you help Hercules. We are dedicated to making sure you learn to, navigate this disease we all share with, our extra sweet kitties.
    jeanne.
     
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  7. Hercule's mum

    Hercule's mum Member

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    Jul 27, 2020
    Thanks Sienne and JT.
    Thanks for the explanation. I am working on the spreadsheet :)
    I have entered the values, but they are in the wrong unit? so highlight is incorrect. I can see there is a formulat to multiply by 18, but when i enter the value is disappearing... I think I managed to link it, can you see it?

    JT - He always loves to eat everything so i never had special treats. I am feeding him straight after so I think he os getting the gist of it....

    Sienne - Encore was just a desperate measure until the order of Feringa comes in. When then I imagine I'll have to figure all out again. I have bought 4 different kinds of food this week :banghead:

    I am finding very stresful making all this decisions.... Hopefully will get easier soon!

    Many thanks again!
     
  8. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    A nuts as it sounds right now IT WILL GET EASIER. ;)
     
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  9. Butters & Lyla

    Butters & Lyla Well-Known Member

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    May 30, 2020
    Welcome! Good for you for taking the initiative to figure out home testing. This is the best way to keep your kitty safe. Once you have the spreadsheet set up and you start tracking there, you will get some good advice on dosing from Sienne and the other more experienced people on here. :)

    I know it all feels overwhelming and stressful. I was exactly in your shoes only two months ago. It will get easier, though, and you have a lot of support here.

    For the spreadsheet, I looked at yours and only see a "world" sheet. There should be tabs at the bottom: One is a "world" page where you would enter all of your data, and a "US" page which pulls your data and automatically converts it to the US numbers. Also a "Labs" page. You shouldn't have to do any conversion of numbers yourself. Have a look at mine. That is how it should look. I don't see the tabs on yours. If you want some help setting one up, contact me directly and I will help you. Click on my name "Butters & Lyla", and then "start a conversation" and send me a note.

    If you get Hercule to associate test time with a certain treat, as Jeanne mentioned, in my experience it becomes easier to test. My kitty Butters immediately jumps to our "testing spot" on my couch when she hears me open the container of test strips. I just use freeze dried chicken, it's not really special. She also loves to eat everything. But she has made that association with getting a treat (or two! treat for every test whether it is successful or not) and that made home testing much easier for me.
     
  10. Hercule's mum

    Hercule's mum Member

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    Jul 27, 2020
    Hi Butters - I am in the Uk, so my values are in nM/L

    If it is as simple as multiplying by 18, I could do that?
     
  11. Hercule's mum

    Hercule's mum Member

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    Jul 27, 2020
    Sorry just re-read your email. I will try to play with the sheet and see if I can sort it out.
     
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  12. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    I think there's a tab missing on the version of the spreadsheet you're using. This is the link to the spreadsheet information. The World version is almost at the bottom of the post. You should see tabs across the bottom of the shtte.
     
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  13. Hercule's mum

    Hercule's mum Member

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    Jul 27, 2020
    Ok, I started over and could see the right numbers and colours. Hope it is correct now! Please let me know if it is still not right...
     
  14. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    Perfect!

    Just an FYI -- Lantus dosing is based on the lowest number in the cycle. You will want to test at AMPS and PMPS and then get at least one test during both the AM and PM cycles. I'd suggest getting a before bed test every night. If. you think about it, your PMPS last night was 464. Your AMPS this morning was 94. Clearly, numbers dropped over the PM cycle. You just don't know how far they dropped. A test before you go to bed every night can let you sleep knowing that Hercules is in safe numbers.

    Lantus dosing also likes consistency. It's a depot insulin. Any time you change a dose, it affects the depot. If you make back to back changes in dose, you'll likely wind up with wonky numbers. Dose adjustment require that you allow the depot to stabilize for several days. (There are exceptions but this is the general principle.) In other words, I would pick a dose and stick with it. The initial dose of Lantus is based on weight, if that is helpful. The formula is: Initial dose = 0.26 x ideal weight in kilograms.
     
  15. Hercule's mum

    Hercule's mum Member

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    Jul 27, 2020
    Thank yoy for taking the time to look over. Yes, I was worried he went quite low over night, which is why I tried 1.25 this evening. I was very surprised though that he was still so low 12 hours later...

    By the way he is on Prozinc, in case your advice changes.
     
  16. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Dec 28, 2009
    Another thing you want to do is add the insulin and meter type to the spreadsheet. Pretty pleeeeze
     
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  17. Hercule's mum

    Hercule's mum Member

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    Jul 27, 2020
    Just did another test 2 hours after PM shot. It gave me 436 (24.2mM), how fast is supposed to drop? The figures I seem to show a faster drop.
     
  18. Hercule's mum

    Hercule's mum Member

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  19. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Youre gonna think I'm being anal but
    theres a box for insulin type right to the left( in a light brown color. )
     
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  20. Hercule's mum

    Hercule's mum Member

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    Jul 27, 2020
    Hi JT, I don't understand? I can see the insulin type on my sheet?
     
  21. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    I dont understand either. I just looked at your spreadsheet and in the little box directly above your spreadsheet (its a light brown color) its labeled
    Diagnosed: (its empty)
    Current insulin: (also empty ) as well as meter.(empty as well)

    It seems im the only one who cant see it, since no one else has a problem. o_O:confused:
     
  22. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Maybe I'm just too anal? :oops:
     
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  23. Hercule's mum

    Hercule's mum Member

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    Jul 27, 2020
    Hopefully my signature will help?!
     
  24. Hercule's mum

    Hercule's mum Member

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    Jul 27, 2020
    Back to my queries.... I know I'm supposed to increase insuline dose slowly, but if we never hit blue number on the current dose isn't bad to not do anything?
     
  25. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Yes it does I went back to check if it was in there. :D;)
     
  26. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    I see only 3 days worth of testing I'm going to read the dosing for prozinc
    PROZINC DOSING METHODS

    It says to hold a dose for a week.
     
  27. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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  28. Hercule's mum

    Hercule's mum Member

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    well, of course, i just took another reading and it was a blue one! I can see why we need to have nerves of steel!
     
  29. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    lol yep! I'm confused by your recording. Today is the 28th of July...Did you enter todays reading?
     
  30. Hercule's mum

    Hercule's mum Member

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    Jul 27, 2020
    I did entered today's results.... but I can't find a way to save it? perhaps that is why you canoot see it?
     
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  31. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Dec 28, 2009
    There is def something wrong here (with the spreadsheet that is) I cant remember which mods do the spreadsheet...
    @Chris & China (GA)
    @Marje and Gracie

    I hope I've tagged the right people. :rolleyes:
     
  32. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Ive never had a spreadsheet. Trouble was long gone before they came into play.
     
  33. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    It may be easier to start over with the correct version, especially since you only have a few day's worth of tests in.

    I'd be happy to set up a new World spreadsheet for you...just click on my name and then "start a conversation" so you can send me a private message
     
  34. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Please take Chris on her offer it really will serve you in the future.
     
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  35. Deb & Wink

    Deb & Wink Well-Known Member

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    Tagging @Elizabeth and Bertie who is also from the UK and has recently been checking posts again on the message board.

    Here are 2 links for you, with UK (and some European) specific food suggestions and other supplies. Elizabeth was one of the members that helped put together these 2 documents.
     
  36. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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  37. Hercule's mum

    Hercule's mum Member

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    Morning everyone. Thanks to Chris for sorting out the spreadsheet. Of course after all this testing, I ran out of strips. Have just bought loads of them, so can keep up from next week hopefully!
     
  38. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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  39. Hercule's mum

    Hercule's mum Member

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    Thanks for noticing. Hopefully it is sorted now?
     
  40. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Yep its sorted. :D
     
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  41. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Good job!
     
  42. Hercule's mum

    Hercule's mum Member

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    So, i'm running out of strips and there is no Prozinc to be purchased :nailbiting:... In a way is lucky that this is happening during a pandemic when i am working from home, but it is sucking so much energy taking care of him and procuring the supplies (plus the ridiculous cost!). Please someone tell me it is going to feel easier at some point....

    Talked to the vet in the phone, and she is worried that if I give him the foods suggested here, that his (suspected) pancreatitis might flare up.... Any thoughts about this?
     
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  43. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    It will get easier. You are battling two conditions so it will be a little tricky but this can be done. Many here have been through the same thing. I cannot give dosing advice but hold on as you know, help will come. this is for you:bighug:
    j
     
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  44. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    A lot of vets still think that a cat with pancreatitis should eat a low fat diet. That's "old school' thinking. It's true in dogs, but cat's process fat very efficiently. We've got a lot of members here that feed the low carb foods we recommend to their cats with pancreatitis without problems.
     
  45. Deb & Wink

    Deb & Wink Well-Known Member

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  46. Critter Mom

    Critter Mom Well-Known Member

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    @Deb & Wink - really helpful pancreatitis article, Deb. Bookmarked.


    Mogs
    .
     
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  47. Hercule's mum

    Hercule's mum Member

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    Jul 27, 2020
    Thanks! We are not really sure he has it, but might as well be careful. I got my Feringa food today, and a bunch of new strips, so we can start food changing, and then adjusting the dose if necessary.
     
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  48. Hercule's mum

    Hercule's mum Member

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    Ha! Just read the article, and I guess there is a good reason for not knowing for sure that he has it....;)
     
  49. Deb & Wink

    Deb & Wink Well-Known Member

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    It's from the Health Links/FAQS forum. You never know how much is there until you poke around. The Index Sticky at the top of that forum has the links to so much stuff, you will be overwhelmed if you try to read it all. But I remembered there was a separate link to a UK Pancreatitis article. There is a Pancreatitis thread for the US also, written by Marje and Gracie.

    There are a couple of blood tests that can be run (fPLI is the more specific one). But if I remember, the pancreatitis needs to be actively happening when the bloodwork is done, to be accurate. The Snap FPL is a quick test that only gives a normal or abnormal result. For more specifics, you want to have the fPLI test done.
     

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