New vial

Status
Not open for further replies.
Cassis,

I recognize the unrest you have about your kitty's response to insulin, because I have it myself. You can drive yourself crazy. Ask me how I know that. :blackeye:

In many cases, I've had to admit my expectations for consistency are too high. The bottom line is we do the best we can with the tools given, and some days it JUST does not feel like enough.

There are SO MANY factors that influence what a cat's blood sugar does. The dose given (even if perfectly and exactly the same amount as given previously - which it never is) will not be absorbed in the same way, nor will the cat's metabolism be the same, day to day. I *really* don't think your insulin is unstable. ;)

I totally understand your concern about being high BG and its effect on the kidneys. I share that concern, for my cat. Hard to not be frustrated, I know!

So, kitty beta cells, liver, pancreas and intestines are all doing a little waltz... And the amount and TYPE of food, pH of stomach acid, cat's activity level... I could go on & on... these will all affect the readings you get. Switching carbs from 4 to 10% is a relatively large move. And it reverberates in the cat for more than just a few hours after the meal.

I fed my kitty the exact same weighed meal twice a day for many weeks, trying to eliminate that variation. It may have helped, but didn't get us where I wanted to be. There was still a lot of variation in his numbers, at the exact same dose.

In addition there are factors like Prozinc being a suspension, so mixing it *perfectly* is impossible. Rolling the vial gently for a minute is the best you can do. Then, the small amounts we try to inject into the cat repeatably is a battle, too, even using the smallest syringes with the most accurate markings. Please realize you might see variation even after a week of exactly 4u twice daily, even on the exact same meal.

And there is the undeniable factor that diabetics really do need to "settle in" to a dose. Some more than others, but for all kitties, there must be patience doing the same thing (as much as possible) day after day, for many cycles at a given dose. Please realize seeing variation in response is normal. Normal.

It's hard for all of us. :banghead:

My struggles went on for months, and Sue and others in this forum were great at helping. But we had trouble increasing dose because a SLIGHT change (from 2.0 to 2.2 or 2.4) was too much. But 2.0 u (or even 2.2u) was usually not enough. He stayed high.

From your sheet, it looks like you will have room to go up on dose... so let others help you do so, slowly, based on data you get for your kitty's BG.

The specialist I just saw with my cat made me realize how complicated this all is. Every cat is different (ECID!) and it will be several more weeks/months of dosing and watching glucose readings before you really understand your baby.

Sue and others in this forum will help you as you begin to see patterns and begin to know what to do... They have many years of experience, and helped ME set my expectations more realistically. You're at the very beginning of this journey. And you are doing the best you can, and it is enough.

Good luck and keep testing! :D
 
Cassis said:
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.
Click to expand...
Also meant to add that shifting the hour all at once will mean you give the shot (effectively) earlier. This may play out like a dose increase for the next cycle(s). YMMV.
 
Up to 398 from 335 at 4 hours. Will check again at 8 hours just to get an idea where this is going. Trying not to stress him too much today. If it's still going up at the next preshot, which seems likely, should we increase his next dose or the morning one?
 
Cassis said:
Up to 398 from 335 at 4 hours. Will check again at 8 hours just to get an idea where this is going. Trying not to stress him too much today. If it's still going up at the next preshot, which seems likely, should we increase his next dose or the morning one?
Click to expand...
I definitely defer to @Sue and Oliver (GA) for dose advice, but please consider what @Mogmom and Goofus said earlier in this thread... She put it well when she said you aren't doing yourself favors by considering frequent changes in dose. Its true. It can make things worse. It's the same concept I was talking about "settling into a dose".
Obviously, if something gets really out of whack (extreme low reading) that goes out the window, but otherwise please know that a few weeks of high BG (as long as ketones don't show up) are not going to cause an issue.

Again, let's see what Sue says...
 
Cara and Wynken said:
I definitely defer to @Sue and Oliver (GA) for dose advice, but please consider what @Mogmom and Goofus said earlier in this thread... She put it well when she said you aren't doing yourself favors by considering frequent changes in dose. Its true. It can make things worse. It's the same concept I was talking about "settling into a dose".
Obviously, if something gets really out of whack (extreme low reading) that goes out the window, but otherwise please know that a few weeks of high BG (as long as ketones don't show up) are not going to cause an issue.

Again, let's see what Sue says...
Click to expand...
Thanks very much for the encouragement and wisdom! We have worried about changing the dose so often and whether it might be making things more complicated. The issue is not without conflict here, as is the idea of switching insulins, and staying the course is difficult, but will continue to try.
 
Cassis said:
Thanks very much for the encouragement and wisdom! We have worried about changing the dose so often and whether it might be making things more complicated. The issue is not without conflict here, as is the idea of switching insulins, and staying the course is difficult, but will continue to try.
Click to expand...
You are doing a great job, and your kitty is already benefitting from what you are doing. :D

It looks like you are going up a little every 3 days and that's ok, if you're sure you've seen how low that dose took him (the nadir). I'm not sure I would continue to increase EVERY 3 days unless it was all blacks and reds with no nadir. Too much insulin can look like too little insulin.

I don't have as much experience as Sue or Rachel at dosing advice. I would trust them completely until you start to get a feel for this in your own... Keep learning & asking!
 
Starting in the evening on 3/11, I see some encouraging signs: the yellow preshot and the lower amps numbers. They are still high but the trend is headed in the right direction. If he were mine, I think I'd leave the dose tonight and tomorrow and see if he continues to trend down. If not, then yes, a 0.25 increase on a cycle you can monitor.

Is he eating well enough at night that you could raise that dose a little to be more in line with the daytime dose- if you continue to see red preshots at night?
 
That sounds reasonable, and hopefully the preshot won't be too high tonight. Despite some very high preshot values, however, he seems to be languishing in the lavender numbers during the last few days anyway. We would hope to see those numbers come down eventually, but testing is difficult during the week. We might try to grab one at night now and then, and that might be important. So far, we haven't seen a big drop at night, but he does eat a lot less and acts like a slug in the early part of the evening after getting the shot, which makes us nervous.
 
Straight purples today. Seems to be his favorite color. Don't know what that means, but hope it's not red or black tomorrow.
 
He sure did surf along yesterday. You said you can't test during the week right? I'm thinking let's see where he goes tonight, but it may be time to raise the dose if he stays high like Sue suggested. However, I'd feel better if you could monitor.

When you say he is eating less, do you mean he isn't eating enough? Or does he just not eat as much? Because as numbers get regulated they tend to get less hungry since they can use the food better.
 
Rachel said:
He sure did surf along yesterday. You said you can't test during the week right? I'm thinking let's see where he goes tonight, but it may be time to raise the dose if he stays high like Sue suggested. However, I'd feel better if you could monitor.

When you say he is eating less, do you mean he isn't eating enough? Or does he just not eat as much? Because as numbers get regulated they tend to get less hungry since they can use the food better.
Click to expand...
He has been a very fussy eater ever since he had pancreatitis be two years ago. Often, many different cans must be opened before he will take a bite. It's been a constant struggle between him and his mommy. At night he's worse. He has, however, averaged about 9 ounces of canned food a day, most of it low carb.
 
Didn't get interval blood levels, but urine glucose was 2+ at 4 hours and negative at 8 hours, so he must have been running lower today. Ate pretty well also. Hope he will continue. Same evening dose tonight.
 
375 this morning. Wasn't sure if we should increase the dose to 4.5u. He seemed to have a pretty good day yesterday. Hoping he might repeat.
 
I like your 4.25. Think maybe save the higher dose for the blacks, if and when you get them. You are getting the process beautifully - look back over the past cycle or two to help you decide on the dose. Since your dose on a similar amps yesterday gave you a nice pmps, stick with that. Good job!
 
Bad day. Stubborn and growling today. Not eating. Many cans opened and refused. Urine negative at 2:30 (+8.5). BS 460 at 4:30 (+10.5). Going to try giving him a little Pepsid and Zofran to see if that will stimulate his appetite and retest BS before PM dose.
 
PMPS 575. Too high too ignore. Increased his PM to 4u even though he is not eating well. Will have to check him later tonight.
 
Rachel said:
Sorry it was tough day! How is he feeling today?
Click to expand...
Thanks for asking. Still very fussy with his food today, which is a chronic problem but gets worse on certain days and gets his mommy very upset. It seems to be a matter of which food he wants to eat at any given time. He doesn't seem sick otherwise, but it's been 7 or 8 weeks since he's had his blood work to check his renal function, related chemistries and blood count. We are still looking for a new vet.
 
It is so difficult when they won't eat right - not only do you just worry in general, but dosing can become more problematic.

You might post your city on the health forum and ask if anyone knows a FD vet near you. Or search your city in the Search function at the top of the page. The thread of anyone who has posted and typed in their city should come up.
 
We just made an appointment with a new vet for next Tuesday (3/22). Hopefully, mommy can stand the stress until then, although I doubt that it will help with his eating. He will eat when she puts food in his mouth but goes sporadically to the dish on his own. I hlave been looking into syringe feeding but doubt that he will take to it well.
 
Glad you are looking at a new vet. Something you might consider is either to ask some questions before the appointment over the phone, or go without Cassis the first time and ask. There is a list somewhere, but the basics are:

What kinds of insulin do you prescribe? It would be nice to find someone who has success with ProZinc and at least one of the two depot insulins - Levemir or Lantus. For me, I would stay away from a vet who only prescribes Vetsulin
(canninsulin) or Humulin.

What kind of diet do you advocate? If they are insistent on only prescription or only dry food, I would be unhappy. If they like wet low carb, I'd be ecstatic.

Do your patients test at home and are you okay with that? If not, they are likely to insist on curves at their office, which as you know, are usually higher and less reliable than those done at home.

What kind of success have you had with diabetic cats? Do you have patients regulated and in remission?

I don't want to discourage you, but it is good to have some information about their methods and success rate upfront.
 
Status
Not open for further replies.
Back
Top