New vial
- Thread starter Cassis
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Cassis
Member
Thank you for your reply. We started treatment with this vial our first, at the beginning of February with an initial dose of 0.5 units and have worked up to 3.0 to 3.5 in the AM and 2.5 to 3.0 in the evening. He had been running in the 300s preshot (with a Contour Next meter) with a nadir in the 150-to-200 range. Lately, as we near the end of the vial, his preshot levels have increased to the 400-to-500 range with a nadir in the mid 200s. We are not sure if it's the insulin losing potency or if Cassis is just out of control. This morning he was 398 and we gave him 3.0 units instead of 3.5 from a new vial. Thanks again.
Sue and Oliver (GA)
Very Active Member
Agreed. It is wise to reduce a smidge with a new vial and monitor that first cycle.
If you'd like to post here regularly with him numbers regularly we might have suggestions about how to help reduce his levels.
If you'd like to post here regularly with him numbers regularly we might have suggestions about how to help reduce his levels.
Cassis
Member
Thanks very much for your help. Will post more values soon.
Blamethecats and Hannah
Active Member
Whenever I start a new vial for Hannah, I usually reduce just a tad and monitor closely... just to be on the safe side. However, it's often been my experience that the new vial doesn't seem as potent as the old and takes a few days to yield the numbers we're striving for. Still, from what you've said, I think initially reducing is a good choice. Best wishes.
Cassis
Member
Thanks everyone! Here are some of Cassis's recent numbers starting with his only mclmplete curve on 2.21.2016:
Date/Time Glucose Insulin
2.21/6AM 351 3.0
9 236
12 172
3 210
6PM 446 2.75
2.22/6AM 464 3.5
6PM 454 2.75
2.23/6AM 385 3.25
6PM 470 2.75
2.24/6AM 507 3.5
6PM 342 2.75
12AM 232
6AM 380 3.25
2.28/6AM 489 3.5
12PM 155
6PM 499 3.0
2.29/6AM 331 3.25
6PM 414 3.0
3.01/6AM 425 3.5
6PM 449 3.0
3.02/6AM 392 3.0 (new)
6PM 545 3.5
3.03/6AM 348 3.5
It looks like he needs a higher dose, but we have been going slow as this is his first month, and we don't want him to get hypoglycemic. Although his mommy manages to get him to eat an average of 9.4 ounces of low-carb canned food a day (315 calories, <10% carbs), he is a reluctant eater, especially at night, which is why we have given him less insulin in the evening. He is 17 and also has CKD and has had pancreatitis. We give him subcutaneous Ringer's twice a day plus meds for nausea and gastric acid as well as mirtazapine to stimulate his appetite. We also try too keep his phosphorous intake low but opt for higher protein food since his level has not been too high. He also needs a new vet. Any comments are very much appreciated.
Sue and Oliver (GA)
Very Active Member
I put together a spreadsheet for you. It is so much easier to see patterns with it. It is here:
Cassis' SS
Here is what I think. The changes in doses may not have served him well. I can understand the lower dose at night if he is a reluctant eater but I would work on that. The lower doses at night don't seem to be enough, even on an emptier stomach. I assume you have seen www.catinfo.org with all her ideas. The one that worked best for me was to add warm water and make the food a little soupy.
On the days you were able to give a number 6 hours after the shot (which should be around the lowest point) he had dropped substantially.
I have two ideas. First, take into consideration bouncing. When a diabetic cat's body perceives a level that is lower than what they have experienced before, it panics and releases extra glucose, to protect itself. So the next time a test is taken, the cat may have that extra glucose in his body and the test will be higher than usual. We call this a bounce. It often happens, until the body gets used to lower levels. I think it is likely that a number of his pre shot numbers could be bounces. I definitely think that is a possibility on the two days you got nadirs - 2/28 and 3/21. We have a saying " Cats bounce until they stop" so I have no particular advice other than be patient and trying to keep him on a more level cycle. Dropping from 489 to 155 is a huge drop and is bound to cause a bounce. So, it is possible that a little less insulin that cycle might have flattened out the cycle. His nadirs are not too low but they may be too low for him right now until he stops bouncing. Second, I would look back and see what doses have done for particular numbers and create a sliding scale, so you have a consistent dose for number ranges. I can help with that, but I need more nadir numbers (+5-7) to see how a particular dose works, to do a good job. Meanwhile I think I would stick with 3 units for reds (although he may still bounce), 3.5 for numbers over 500. I think 2.75 has proved to be too low a dose but might work when you get a yellow preshot. I would try giving smaller meals during the day to maybe flatten out the curve..
I would like to know what happened on 3/2. It was either a big bounce, meaning a low midcycle or the dose was a little too low.
Bottom line: data is your friend. The more numbers you get, the better you will be able to see what is really happening between preshots and then be able to adapt to them. Lots of people can't be home to catch the nadir during the day. So they get an out the door test, after the amps shot and before they leave in the am. They get an in the door test, when they get home at night before the pmps shot. They set the alarm at night every so often so they can get a test midcycle at night. And they try to get a curve on the weekends. All that helps.
Couple of questions: Do you test, feed and shoot and limit food 2 hours before the amps and pmps? What percentage carbs are you feeding? (I know you have complicating factors and may not be able to change but we might have some ideas for you) Re the new vet - you could search for your city and state in the search function and find people near you. Send them a private message and ask if they have a good vet.
If you want the spreadsheet to keep track of his numbers from now on, click on my picture and send me a private message. We can get it on your home computer and in your signature easily.
Cassis' SS
Here is what I think. The changes in doses may not have served him well. I can understand the lower dose at night if he is a reluctant eater but I would work on that. The lower doses at night don't seem to be enough, even on an emptier stomach. I assume you have seen www.catinfo.org with all her ideas. The one that worked best for me was to add warm water and make the food a little soupy.
On the days you were able to give a number 6 hours after the shot (which should be around the lowest point) he had dropped substantially.
I have two ideas. First, take into consideration bouncing. When a diabetic cat's body perceives a level that is lower than what they have experienced before, it panics and releases extra glucose, to protect itself. So the next time a test is taken, the cat may have that extra glucose in his body and the test will be higher than usual. We call this a bounce. It often happens, until the body gets used to lower levels. I think it is likely that a number of his pre shot numbers could be bounces. I definitely think that is a possibility on the two days you got nadirs - 2/28 and 3/21. We have a saying " Cats bounce until they stop" so I have no particular advice other than be patient and trying to keep him on a more level cycle. Dropping from 489 to 155 is a huge drop and is bound to cause a bounce. So, it is possible that a little less insulin that cycle might have flattened out the cycle. His nadirs are not too low but they may be too low for him right now until he stops bouncing. Second, I would look back and see what doses have done for particular numbers and create a sliding scale, so you have a consistent dose for number ranges. I can help with that, but I need more nadir numbers (+5-7) to see how a particular dose works, to do a good job. Meanwhile I think I would stick with 3 units for reds (although he may still bounce), 3.5 for numbers over 500. I think 2.75 has proved to be too low a dose but might work when you get a yellow preshot. I would try giving smaller meals during the day to maybe flatten out the curve..
I would like to know what happened on 3/2. It was either a big bounce, meaning a low midcycle or the dose was a little too low.
Bottom line: data is your friend. The more numbers you get, the better you will be able to see what is really happening between preshots and then be able to adapt to them. Lots of people can't be home to catch the nadir during the day. So they get an out the door test, after the amps shot and before they leave in the am. They get an in the door test, when they get home at night before the pmps shot. They set the alarm at night every so often so they can get a test midcycle at night. And they try to get a curve on the weekends. All that helps.
Couple of questions: Do you test, feed and shoot and limit food 2 hours before the amps and pmps? What percentage carbs are you feeding? (I know you have complicating factors and may not be able to change but we might have some ideas for you) Re the new vet - you could search for your city and state in the search function and find people near you. Send them a private message and ask if they have a good vet.
If you want the spreadsheet to keep track of his numbers from now on, click on my picture and send me a private message. We can get it on your home computer and in your signature easily.
Cassis
Member
Thanks very much Sue and Oliver. We were also concerned about bouncing but not sure how to level things off. Getting more post-insulin levels makes sense, and we will do that this weekend. Too difficult during the week, even in and out the door. The spread sheet looks great. I have been graphing the data manually, but that takes a while. I cannot find where to send a personal message - not familiar enough with the system - but I would like to down load the spread sheet if you can post how to do it.
BJM
Very Active Member
You don't actually download it. You create a Google Drive acount and do a File, Save a copy to save it in your own account. This keeps the spreadsheet online, so you can access it anywhere, plus you can create a view-only link to let others see it and give you feedback here.
There are instructions for the entire process here.
There are instructions for the entire process here.
Mogmom and Goofus
Very Active Member
I've noticed that you seem to changing the dosage with every am and pm test. I don't think this is doing you any favors. Typically, the dosage with ProZinc is only changed after 3 -24 hour cycles as it takes time for the cats body to learn to work with the dose. The exeption to this would be if the test number is either oddly low or high.
Sue and Oliver (GA)
Very Active Member
Cassis' parents (what are your names?). Look up in the upper right hand corner of this page. There will be a small number under inbox. Click on that. I need an email address to send it to you and we don't want to put that out on the Internet so we do it by private conversation. Then I'll send the one I created to you and explain the further steps.
Sue and Oliver (GA)
Very Active Member
Peter and Janet,
Check our private conversation again. It is in the upper right hand corner of this page under Inbox. I sent the spreadsheet to your email address.
Check our private conversation again. It is in the upper right hand corner of this page under Inbox. I sent the spreadsheet to your email address.
Cassis
Member
Got it and filled in the blanks. This morning he was 498 and got 3.5 units. Just took a 6 hour and it's only down to 398. If that's his nadir, it looks like it's going to be very high tonight. Janet thinks the insulin is not working. Someone (not on this site) suggested giving a small interval dose at 6 hours to level things off, but that seems like it might complicate the curve and throw off the schedule. Any further thoughts?
Sue and Oliver (GA)
Very Active Member
Glad you got the spreadsheet. Now we need to put it in your signature. Check your Inbox and we'll get that done.
My first concern is that you really increased rapidly. We suggest increasing by 0.25 every three cycles if the numbers are high. How were the increases done? Sometimes too much insulin can look like too little.
But I also see that he has gotten some good numbers on 3 units so I wonder what makes the difference day to day.
Can you get a curve this weekend - getting a number every 2 hours from the morning test to the evening one? That will tell you if the insulin takes him down early in the cycle or later than +6 or if he is flat and high the entire time.
My first concern is that you really increased rapidly. We suggest increasing by 0.25 every three cycles if the numbers are high. How were the increases done? Sometimes too much insulin can look like too little.
But I also see that he has gotten some good numbers on 3 units so I wonder what makes the difference day to day.
Can you get a curve this weekend - getting a number every 2 hours from the morning test to the evening one? That will tell you if the insulin takes him down early in the cycle or later than +6 or if he is flat and high the entire time.
Cassis
Member
Will try to get a curve tomorrow.
Sue and Oliver (GA)
Very Active Member
Peter and Janet,
I have copied the info from our private conversation here. The norms for the forum require all discussions about doses to be done in public, as none of us are vets and advice should be peer reviewed.
Stressful morning. Blood sugar 582 on first try, then 449 on repeat, but over 600 on 2 subsequent tries using different ears. Should have checked a nadir last night , but we had a prolonged bleeding episode during the evening preshot and decided to let him rest. Gave him 3.5 units from the old vial this morning in case there is any inconsistency in the one we just started last week. Urine is negative for ketones, and Cassis is acting OK but not happy about all the jabs this morning. It will be a struggle, but we will try to get a curve and fill in the numbers.
He really is running high. I'm glad you are getting a curve today. Be sure to be very liberal with treats.mmlet's see if there is any downward movement today. If not, I would increase the dose. Once they sit in high numbers for awhile, their bodies become used to them.
What was the bleeding issue last night? Did you hit the vein when poking?
I have copied the info from our private conversation here. The norms for the forum require all discussions about doses to be done in public, as none of us are vets and advice should be peer reviewed.
Stressful morning. Blood sugar 582 on first try, then 449 on repeat, but over 600 on 2 subsequent tries using different ears. Should have checked a nadir last night , but we had a prolonged bleeding episode during the evening preshot and decided to let him rest. Gave him 3.5 units from the old vial this morning in case there is any inconsistency in the one we just started last week. Urine is negative for ketones, and Cassis is acting OK but not happy about all the jabs this morning. It will be a struggle, but we will try to get a curve and fill in the numbers.
He really is running high. I'm glad you are getting a curve today. Be sure to be very liberal with treats.mmlet's see if there is any downward movement today. If not, I would increase the dose. Once they sit in high numbers for awhile, their bodies become used to them.
What was the bleeding issue last night? Did you hit the vein when poking?
Cassis
Member
Down to 528 at 2 hours, still acting fine and eating. Will check every two hours until next dose. If still high, maybe 3.5 instead of 3.0 like he has been getting at night? Probably nicked the vein last night; he's jumpy when we do the ear pricks. Forget about the paws. The hemorrhaging will be our own.
Sue and Oliver (GA)
Very Active Member
Let's see what his day looks like. I was thinking 3.5 at night and maybe 4 during the day.
A couple things that might help. Have you put a flashlight behind his ear so you can see the vein and the little capillaries running off it. The capillaries are what you are aiming for. Sometimes a tiny smear of Neosporin where you plan to poke will help the blood bead up, and the pain relief kind may help with any bruising. It also helps to have something behind the ear to poke against - we used a small make up sponge. What lancet size do you use? 25-27 gauge can work best until they start to bleed well.
A couple things that might help. Have you put a flashlight behind his ear so you can see the vein and the little capillaries running off it. The capillaries are what you are aiming for. Sometimes a tiny smear of Neosporin where you plan to poke will help the blood bead up, and the pain relief kind may help with any bruising. It also helps to have something behind the ear to poke against - we used a small make up sponge. What lancet size do you use? 25-27 gauge can work best until they start to bleed well.
Cassis
Member
Down to 376 at four hours. Starting to breath a little now. Hopefully, it will continue to drift down over the next two hours and not get too high after that. Wonder if he was high because he bounced last night? Won't know he since we didn't get the nadir. Bleeding has been a problem, either too much or too little. Trying to be consistent with the placement of the jabs, but his squirming doesn't help. He's not like the cats in the videos. We are working on it though.
Cassis
Member
Came down as low as 346 at 8 hours, but now headed up with 440 at 10 hours. Wondering if we should give him his next dose early or wait it out for a higher dose at 12 hours, probably 3.5? I hate to throw him off the schedule but don't want to get too far out of control. Thanks.
Sue and Oliver (GA)
Very Active Member
You certainly could shoot at +11 and yes, I'd increase to 3.5 tonight and see if that lowers your amps. If The amps is still in the 400s maybe try 4 during the day and 3.5 at night.
What may have happened is insulin resistance. If their body gets used to sitting in the higher numbers, it can take moving up on a regular basis to a higher dose to "break through."
What may have happened is insulin resistance. If their body gets used to sitting in the higher numbers, it can take moving up on a regular basis to a higher dose to "break through."
Cassis
Member
OK, will test and shoot at 5 instead of 6PM with the 3.5. Maybe get a nadir tonight, although he is not going to be happy about it. Thank you.
Sue and Oliver (GA)
Very Active Member
We had to wrap Oliver in a kitty burrito at first. We'd wrap him up in a towel with only his head showing. One of us would poke while the other gave treats. When he finally figured out treats were part of the process, he was much better.
Cassis
Member
Discouraging. Back where we started 11+ hours ago at 572. The big question here is whether we need to consider Lantus or another insulin or keep on trying to adjust this one. It has been a month, but I don't think we have handled methodically. Would switching be reasonable or set us back?
Sue and Oliver (GA)
Very Active Member
I don't know. It may be that he needs more insulin and when you hit that point, you'll see improvement. It may be that another insulin would work better.
Another possibility is a high dose condition. It's a little early to consider that - we start thinking about those possibilities when they are getting 5+ units. Here is a thread describing those. There are some broken links, but you can look at the symptoms and see if anything seems familiar.
http://www.felinediabetes.com/FDMB/...-other-high-dose-conditions-what-we-know.375/
Another possibility is a high dose condition. It's a little early to consider that - we start thinking about those possibilities when they are getting 5+ units. Here is a thread describing those. There are some broken links, but you can look at the symptoms and see if anything seems familiar.
http://www.felinediabetes.com/FDMB/...-other-high-dose-conditions-what-we-know.375/
Cassis
Member
Thanks for the encouragement. We are hanging in. Level down somewhat this morning. Decided to stick with 3.5 for now. Hopefully it won't shoot up into the 500s again, but we don't want it sinking too low either. Appreciate your support.
Sue and Oliver (GA)
Very Active Member
I think I would move up to 4 units. He is not dropping.
Cassis
Member
Back up to 546 from 399 this morning on 3.5 u. Urine 0 - +/- at 2:25PM, probably reflecting an earlier drop in his blood level. Insulin seems to wear off between 8 and 10 hours. Think we'll try 4.0 u tomorrow in AM. Was hoping we could stay below 4 u.
Sue and Oliver (GA)
Very Active Member
I think four units is a good choice. I assume there is no way you could shoot every 8 hours? It is possible with ProZinc. Some people try it for a while and then are able to go back to twice daily.
Cassis
Member
Looks like we posted at the same time. Thanks for keeping watch. Every 8 would be difficult to work around. Something to think about though. Hopefully, the 4 u will last a little longer.
Cassis
Member
Not sure what happened. Thought we were making progress on 4u morning and 3.5 at night. At least it seemed to be coming down into the 300s preshot, but this morning he's back up to 538 after getting 3.5u last night. We had gone back to the old vial, which is getting pretty low. I don't know if that had anything to do with it, but we opened up a brand new vial this morning just in case and gave him 4u. We will have to see what the level is tonight, but we are not expecting to get back where we were in one day. Don't know if it's the insulin that's too inconsistent or just Cassis.
Sue and Oliver (GA)
Very Active Member
It could be he dropped a little lower than he was used to last night and bounced. It doesn't have to be a low number - just lower than he is used to. Glad to see his preshots are coming down a little. If you want to be more agressive about dosing, give each dose three cycles and if he is still high, increase by 0.25. That might be something to try this weekend when you can get some midcycle numbers?
Cassis
Member
We wondered about a bounce, but he was drinking more last night like his level was up, which makes us suspicious of the insulin, but as you say, we need to see what happens with the numbers. Is a cycle a 24-hour period or 12-hour period or something else?
Sue and Oliver (GA)
Very Active Member
A cycle is 12 hours from am to pm or vice versa. The 3 cycle increase is a suggestion, not a hard and fast rule. You can do what works for you - you may want to extend the time between increases, but I wouldn't increase more often than every 3 cycles. Just be sure you can monitor the first cycle you increase.
Sue and Oliver (GA)
Very Active Member
It is so hard to know what is really happening without some numbers in the middle of the cycle. The curve on 3/6 looks like he is high and flat. It will be good to know if the increase has changed that.
If not, I would definitely change insulin and research high dose conditions.
If not, I would definitely change insulin and research high dose conditions.
Sue and Oliver (GA)
Very Active Member
It is a big drop but it is not a low number. (We consider 50 a number to start intervening to stop a possible hypo and the double digits in the 60-99 range to be a nice nadir - on a human meter.) It would be interesting to see if there is a lower number before or after that one as nadirs are not always at exactly +6) Maybe a full curve this weekend will give you that information.
What do you think about high dose possibilities?
What do you think about high dose possibilities?
Cassis
Member
Down to 272 at 12 hours. Guess he didn't bounce. Ate less this afternoon, which may have contributed to the lower number. Stuck with the 3.75u for his PM dose. Hope he will eat enough to cover it. May have to check him again at midnight.
I don't know about a high-dose condition. He has put on weight over the past two years, but his former vet attributed that to over-feeding and blamed us for causing his diabetes (his mommy has tried to compensate for his poor appetite). Other than that, he has no physical manifestations of acromegaly or Cushing's syndrome that I can see, unreliable though that may be. I guess the only way to be sure is to get the hormone levels, but without a vet at this time, that would be difficult. We might be able to get a urine spot checked for cortisol:creatinine, which would help exclude Cushing's if it's normal.
I don't know about a high-dose condition. He has put on weight over the past two years, but his former vet attributed that to over-feeding and blamed us for causing his diabetes (his mommy has tried to compensate for his poor appetite). Other than that, he has no physical manifestations of acromegaly or Cushing's syndrome that I can see, unreliable though that may be. I guess the only way to be sure is to get the hormone levels, but without a vet at this time, that would be difficult. We might be able to get a urine spot checked for cortisol:creatinine, which would help exclude Cushing's if it's normal.
Sue and Oliver (GA)
Very Active Member
That's encouraging. He probably will bounce for amps but I'd still try the 4.25. It's beginning to look like he just needs more insulin.
If he doesn't have any of the symptoms for a high dose condition, that sounds great.
If he doesn't have any of the symptoms for a high dose condition, that sounds great.
BJM
Very Active Member
He may have a duration issue. On 3/6, you got tests at +10 and +11 and he'd already gone up to red by +10.
You might still have bouncing with Lantus or Levemir (Lantus may sting at higher doses for some cats).
If you decide to switch, you may find ordering from Canada's Marks Marine a great cost savings as they charge about 1/3 of the US price right now.
You might still have bouncing with Lantus or Levemir (Lantus may sting at higher doses for some cats).
If you decide to switch, you may find ordering from Canada's Marks Marine a great cost savings as they charge about 1/3 of the US price right now.
Sue and Oliver (GA)
Very Active Member
Yes, but last cycle, with the increase, the lowest number was at +12. I still think it is the dose. And it is looking good! Nice amps this morning, no bounce into the blacks. Let's see how he does today.
Cassis
Member
Was hoping for a somewhat bigger drop, but maybe it will drop a little more like yesterday. He was eating lower carbs yesterday morning (4%). Today a little higher (10 or 11%).
Cassis
Member
Wonder how much the injection site matters. We have been using the side rib cage area recently. In the beginning we used the shoulder and scruff area, and the drops seemed more dramatic on lower doses
Cassis
Member
Not much of a change in level today compared to yesterday on the same dose. Can the insulin be that variable in its effect? Is it too soon to think about insulin antibodies after only six weeks of treatment?
Sue and Oliver (GA)
Very Active Member
Yesterday was better and the same dose on a little lower numbers didn't do as much today - as far as we know. A complete curve with tests every 2-3 hours will tell you more. Possible?
Cassis
Member
After last week's ordeal, we would rather not run another curve just yet. Hopefully, we can get some information from the mid and end points, but it seems like the insulin is not acting consistently from one injection to another. As far as I can tell, I am mixing it and injecting it properly. Does anyone else have problems with stability of the insulin?
Cassis
Member
Bigger drop at 4 hours tonight on a smaller dose than this morning's. Tonight's cycle will be an hour shorter because of the time change in order to keep on schedule.
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