Newbie here, a little worried

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Mindy

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Hi all, I have been lurking here for a several weeks now. Linwood is 12 yrs old and was diagnosed about a year and a half ago. I tried controlling with diet, and it worked for a little bit, but then embarrassingly enough, last Labor Day I came home and he was so bad that I scooped him up and took him to the emergency vet. I felt so bad, especially the way the doctor scolded me. I still feel bad about it. I read someone else's story that sounded so much like mine, that it made me feel a little better.

Anyway, he went on Vetsulin, then the vet changed it to ProZinc 3 unites, 2x/day. He was looking good, playing, and being his typical "don't touch me" self. Then when I went to pick up the 2nd bottle, they told the price was $135 (I paid $35 for the first bottle). I had been reading about Levemir here and the great success. My boyfriend uses it himself. So the doctor said to try it at 1 unit per day. He's been on it since the beginning of the month. Since then he had gone downhill. The past several days he is so so lethargic, and today not eating. I did get him to eat a couple of kitty treats. (I know, not good for him, but I have to get him to eat something). I checked his blood this morning at 7:30 it was 303. then at 10:30 it was 365. I've been keeping a chart. His numbers are everywhere!

I'm scared. I'm supposed to be leaving for today for a couple of days, but I am afraid to leave him. I have not given him more insulin yet today, because I gave him a little over a unit last night at 10:30. Should I give him more now or wait until I get ready to leave in a few hours? I have a neighbor that will be coming in the evening to check on him and feed him, but we have instructed her not to give him more insulin until the morning (b/c that's what the vet said!). My boyfriend said maybe we should up the dose? I'm just worried for him. I finally got the hang of the testing, but his poor ears! He absolutely hates having it done. I think some of the youtube videos are rigged! ;-)

Thank you in advance for any advice anyone can give. You all are a valuable and welcome resource. I'm just worried! :sad:
 
Hi Mindy,

I think the problem is your shooting only once per day. Lev is a long lasting insulin, but not 24 hours.

Great that you're hometesting.

How do you feel about shooting 1U twice a day, about 12 hours apart?
 
I think you're right...I was just afraid to because the vet said to start slow. I can do it twice a day. So you think it will be okay?
I
 
Given the symptoms you are describing, I would be concerned about ketones. Are you testing his urine? If not, you may want to take a quick trip to the vet's since you're leaving town.

Agree that you need to shoot twice a day, 12 hours apart (without being fanatical!).
 
Don't up the dose, just stick with 1U BID(twice a day). Will your neighbor test BGs? You probably should get some ketone strips from the pharmacy if you can't see the vet. It would be a good idea to check on that.
 
Hi Mindy,

Welcome to the Lev board!

Yes, agree with others that Lev needs to be given twice a day, every 12 hours ( give or take 30 mins if you have to).

Cat's metabolize faster than humans, so need insulin more often than is rx for humans. Twice a day ( BID ) is suggested.

The suggested starting dose is .5u to 1u for each dose.

We suggest you hold a dose for at least 6 cycles to allow the dose to "settle", though some of our cats take longer. I hold Paul for 6 days or longer.

Since you've been here for a few weeks checking things out, I assume you have read the stickes that advise in the proper handing and storage of Lev and so on...if not, when you get some time they are very helpful to read.

I am sorry that Linwood doesn't care for the hometesting, but I am UBER proud of you for doing it! GREAT JOB!

Hometesting is really important in managing feline diabetes.

Maybe a thinner lancet would help Linwood? I use 31g Ultra fine.

I also set my lancet cap on 4th to the deepest so we generaly only have to poke once for each test.

It is very helpful to warm the ears first, as you have seen in the "rigged" videos ;-) I am sure....I never did use the rice sock- I rub Pauly's ears or press between my index finger and thumb the place I am going to poke.

While you are adjusting doses and so new to the diabetes thing and in the higher numbers, it is a good idea to test for ketones...you can pick up strips at pharmacy, run strip under urine stream or urine caught in metal spoon or something and count according to bottle directions.

Hope some of that helps. Look forward to your future posts!
 
Please test before you give insulin. In the absence of that data and the nearly flat profile in your spreadsheet, I would recommend that you start with 1/2 unit twice a day rather than 1 unit twice day.
 
Teri, you'd do a 1/2U? I'm no expert but this cat has been on insulin since Labor Day, 3U of PZI BID if I'm reading this correctly.

Realizing there's not much data here, but this is a cat this is used to insulin, " He was looking good, playing, and being his typical "don't touch me" self."
 
I don't think we can know whether the lethargy is from ketones or from insufficient insulin. Unless the neighbor is going to test, not just at shot time but also mid-cycle, I would be worried on either dose to be honest.

I really, really believe you need to have him tested for ketones before you leave town. Ketones are very, very serious.
 
Thank you all for your advice and the warm welcome. I think my neighbor would be more than capable of testing, I'm not worried about that. I actually use a needle to test. The drugstore called a friend who is a tech at a vet's office and she said that's what she uses. I use the rice in the sock, too. I've tried bribing him with treats of dry food and meat, but he's catching on! Before switching insulin, he was even starting to run from us when it was time to shoot him!

After reading the posts, I'm thinking then, maybe about a 1/2- 3/4 of a Unit 2x/day for the next few days. Because, like someone said, he is used to having insulin, so I'm thinking he's just not getting enough. I'm new to the spreadsheet, so I may not be recording it correctly.

As far as the ketones, I will go by the drugstore and get some testing strips today. I'm not going far out of town, about an hour away, so I may slide back home for a bit tomorrow to check on him.

Like I said before, thank you for having this forum, it has been a GREAT help. I have been reading everything, and it really has opened my eyes. I wish I would have found it a year ago when he was first diagnosed.
 
Hi, Mindy. I think you will find it easier and less painful for him if you use lancets instead of a needle. Needles just don't have the right point to them and they get "fat" right beyond the tip.

I use BD Ultra Fine II lancets ONLY. I have tried many brands of 30 gauge lancets and none work as smoothly as these do. You definately want 30 gauge and not 28 or 26 gauge. That should help him feel less pain and his ears will not be as irritated. Use a new one for every test.

I also agree that he needs insulin every 12 hours instead of 24. And testing for ketones is a good idea.
 
Hi Mindy, just wanted to say welcome to you and Linwood. I agree with what everyone else has said. I am glad you are going to start shooting the insulin twice a day.

Just one other thing, please get rid of the Wellness dry food as soon as you can. Even a very small amount will raise his bg levels. Try to wean him onto just the wet food that you have been giving him. The dry food will just keep setting you back in trying to get him regulated.

Agree with Sheila, I think if you used lancets (instead of a needle) with a lancet device (although some do do it freehand) it will make things a lot easier when trying to get blood from his ear.

And as a side note, you don't really need to use a rice sock, although you can if you want. Just for future reference, you can just run a wash cloth under warm water, put it into a baggie and microwave it for about ten seconds. Works fine.

Also, like Melissa mentioned, read the Stickies that are on the top of the Lev page when you get a chance. Also, when you get a chance please do a profile on Linwood. You can find the instructions on the Tech forum.
 
Hi Mindy and Linwood - Welcome to the gang!!!

Sorry to hear Linwood is not feeling well - the good news is is that we are all here to help you guys.

The others have given such good advice already i.e., insulin being most effective on a 12 hr schedule, using lancets, removing dry food from his diet. The only other thing i would add is the importance of a treat after testing. It's not easy to find treats that are low carb. Many of us here use freeze dried meats or fish such a Beefeaters Brand freezedried anything or any other kind of freeze dried cat or dog treat. I always test in the same location of the house (the dining room table, shh!) and because of the treat afterwards, Molly often begs to be tested. If someone would have told me Molly would be begging to have her ears poked i would have laughed.

Keep us updated and welcome again!!!! -Michele and Molly
 
Welcome Mindy! Thanks for doing your homework on Levemir! Interested in learning what you/DB ("dear boyfriend", is the meaning - if you see "DH" that's dear husband, Michele uses that alot!) know about it from a human user viewpoint.

I want to echo what Terri says about ketones - you can also get the Precision Xtra meter which tests for both glucose and ketones in the blood. There should be some reviews around somewhere here of that meter, but it's a great idea, especially if you can't catch them at the litter box in time.

1U BID (twice daily) is a good standard to start, especially if you were up to 3U on PZI. Terri, are you thinking that the high flat numbers may be because dose is too high? I think we should consider that she is giving it SID (once a day) and it's just not enough, rather than being too much causing flat numbers. Especially if now Linwood's not eating.

Ketones can be caused by lack of insulin + infection + not eating. It's kind of a snowball effect and the body starts burning fat then throwing ketones.

http://petdiabetes.wikia.com/wiki/Ketones

It's my concern because of the symptoms you describe the possibility of ketones are there, particularly if you're giving only 1U once a day. That's why I agree with Pamela about 1U twice a day. How are his teeth? We sometimes see diabetic cats with tooth infections which go undetected.

Get the ketone urine test or have vet run a quick bloodwork if you have the time and funds for that right now, that way if it's positive he'll be right there. Time is of the essence if there is positive ketones.

We're here for you, so keep asking questions!
 
Thank you all sooo much for your responses. This is the first that i've been able to connect to the internet. We went home today, and he ate for me! yay! He ate about 3 tlbsp of canned chicken. Which is great! My neighbor said she was worried about him Thurs nighte, but Friday morning he greeted her with a big meow and appetite. So I think the 2x/day insulin is going to work. I tested his glucose level and it was little high, but when we get home tomorrow, we're going to raise it to 1-1/2 units 2x/day. Raise it gradually, and see what happens. I will keep you all posted this weekend. Thank you all sooo much again! I feel so much better about his condition.
 
Mindy - very glad he is eating and seems better - but PLEASE don't raise the dose on just a few days and with very little data. You make dose changes based more on the nadir number (lowest BG number) than the PS numbers - so you need to test him between 4 and 7 hours after the shot to see how low he is going. You get spot checks during that time to try and find when he is apt to be lowest then test around that time for a few days (2-5 days).

Since you just went from 1 shot a day to 2 you essentially raised the dose. It's really too soon to raise again - and the raise should probably be .25u, but that is really determined by the PS and nadir numbers as well. When you have a lot of data you will be able to determine if the dose can be changed sooner than "normal", but until then you need to let the dose settle and get spots checks and a curve (testing every 2 hours) in before making a decision to change the dose.

It is normal for the preshot (PS) tests to be higher, especially in the beginning. Have patience. You don't want to rush the process and miss the optimal dose or risk a hypo.

Also, your spread sheet is a bit confusing. In the column next to the date should be a BG number, not a time (because we are all over the country/world time isn't that meaningful), then the dose, then in the next 11 boxes (+1 to +11) you would put in a BG number when you test in relation to the shot - like 4 hours later is +4. Doesn't matter when your PS times are as long as they are close to 12 hrs apart and on a regular schedule that works for you. Mine at about 8am/8pm, but I have seen some that are 1:30am and 1:30 pm because that worked for that person. I feed, test right after he stops eating and then give the shot so shot and food are at the same time most cycles. Take a look at Jeddie's SS (its shorter than Beau's), scrolling down to the current month when he started back on insulin, for how to fill in the BG and dose info. Notes are whatever you think effects him for the day, etc.
 
Hi Mindy,

so glad you are now on the 12/12 schedule and that your boy is eating better!

I agree w/ Sheila, not time to raise dose until you have let it "settle" a little longer ( 3 -5 days) and have more data ( BG spot checks.)

Dose increase and decrease is base on the lowest number ( peak/nadir- usually between +6 and +9 ) in the cycle, not the highest ( pre-shot value)

It would be good if you can get several checks between +4 and +10 to see how the insulin is working in his body uring the cycle and to identify where he is lowest.

Then BEFORE you raise or lower the dose, PLEASE get a curve- test every 2 to 3 hours through a 12 hour cycle- to make sure you've accuratly judged the insulin need.

As Sheila mentioned, dose changes are made in .25u differences.

Basic Tilly Protocol ( find in sticky) suggests doses are left to settle 3-5 days, get spot checks, then curve is done, THEN dose changes are made based on lowest number in the cycle.

Here are few slogans you'll get to know intimately during this sugar dance:

Start Low - Go Slow

It's not a race, it is a marathon

Hang in there! (((Mindy)))
 
Thank you all for your encouragement! I feel so bade when he is not feeling well. Like I'm not doing a good job taking care of him! My internet was down this weekend, so I didn't see the post about not raising the dosage until now. He was still not really eating the wet or dry food, or drinking water. And his numbers were so high. I will have to play more the spreadsheet, I guess I'm not doing it right! So, I gave him about 1-1/2 units last night. It's so hard to tell with the little needle we were given. It's definitely not 2 and may actually be under 1-1/2. So anyway, he woke us up about 6 (his normal time) just SCREAMING for food. ;~) I gave him about 1/4 of a can of wet D/M food, he devoured it. Have been him the wet food off and on all day, he's been hungry, and after not eating for days, I felt he needed it. Checked his blood about 7:00am and it was very high, in the 400's, I think. I would have to look on the meter. So I gave him his shot of about 1-1/2 units. Within the hour we were playing with the shoestrings and he was chasing the flashlight (his two favorite games). He was alert all day, hungry all day, drank water, went to the sun porch, he had a truly great day. And I tested him about every 3-4 hours. His numbers were still high. I just tested him, and it was 366. That's after eating at 5:00 (he can tell time!). I haven't shot him yet. Have been doing about a 7:00-7:30 schedule, so he needs one now. I will cut it back somewhat after reading this. I bought ultrafine lancets today from Walmart, they didn't have ketone strips in stock. I will get those tomorrow. I'm learning every day!! Thank you so much!!

Also, DB just said not to give him any tonight. To check it in the morning to try to get a handle on it. I just hate this!
 
Hi Mindy hopefully the others will be along shortly 'cuz I was just leaving- food and shot time here, too!

I just wanted to say PLEASE don't skip the shot tonight....Insulin needs to be given every 12 hrs to be effective.

Each dose change or skipped shot is like starting over and there is a time period where you will get wacky numbers ( usually higher) until the dose settles.

Settle time takes 3 to 5 days or longer.

Please test BEFORE every shot and get as many spot checks through the day or before bed as you can.

Data is knowledge and knowledge is power!

Do you have the U100 syringe with the half unit marks? That is what you need to use.

Hopefully the other gals will be along to help, I'm sorry, I gotta go shoot my sugarpea...hope to be back in a few.
 
Also, DB just said not to give him any tonight. To check it in the morning to try to get a handle on it. I just hate this!
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Woah, wait a minute, why would you not give insulin tonight? One of the factors in developing ketones is LACK of insulin, skipping shots is unadvisable with numbers as high as you're seeing. Please give insulin. Even 1U is better than none. 12 hours after this AM's dose, even if it's later than that, as long as you can give insulin again in the AM around 12 hours after tonight's shot.

As for the syringes, you can get some with half unit markings which will make dosing between whole units easier. Some pharmacies may not know about them. These are what we have been using for several years now: http://hocks.com/hocks-healthcare/hocks ... 82316.html

Here is the link to the whole page of syringes they have available: http://hocks.com/hocks-healthcare/hocks ... inges.html

It takes a while to get a handle on things. I know the numbers are discouraging, but you'll get there.

Do you need help with the spreadsheet?
 
Mindy said:
So, I gave him about 1-1/2 units last night. It's so hard to tell with the little needle we were given. It's definitely not 2 and may actually be under 1-1/2.
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Can you tell us what kind of syringes you're using? For example, the ones I use are U-100, .3cc (total volume), 5/16" (length of needle), 31 gauge (thickness of the needle). I get them from Walmart and each 1/2 unit is marked as is each full unit. So shooting 1.5 units is quite easy.
 
FYI on cat metabolism

Cats metabolize insulin faster than humans, which is why dosing every 12 hours is necessary. A lot of us wish there was a 24 hour insulin for cats, unfortunately there is not.
 
Okay, I guess I screwed up again. I feel so bad about it. DB has been insulin-dependant for 30+ years, so he just wanted to get a "fasting" test. So, it was lower this morning than it had been, so I gave him about a unit this morning. I'm going to order those needles with the 1/2 units. The needles I currently am using I'm not sure of the tecnical name, I'm at work right now, but they are 30 unit needles, with one-unit markings. He is doing so much better, though. He's even letting me test, somewhat. Once I finally got the hang of testing, I have been testing before each shot. I guess I just screwed up when I didn't want to pay the vet for the insulin. I just feel like I haven't gotten a handle on it, going to school fulltime with accelerated classes and working fulltime (teaching also 8 new classes this semester, so basically I'm learning 8 new classes!), I feel like I have not had the time to sit down and really, really study it. It's just completely my fault. I will begin to take the time, I promise. Thank you all for listening to my whining! I just feel embarrassed that I let it happen. :oops:
 
Mindy - all you can do is your best - so stop apologizing and berating yourself! You are learning and getting some conflicting info - sounds like between us and DF.

I, too am curious what syriugnes you have. Are they DF's syringes? You want the "smallest" u100 syringes and those are the 3/10 cc ones. Anything "bigger" (like 1/2 cc or 1 cc) will give you lines too close together to get an accurate dose - and lines will be for 2 or 5 units, I think, but not 1u. Like Vicky said, if you get the half unit markings 1.5u will be easy.

What was his number this am after no shot last night?
 
Mindy! NOTHING to be embarrassed about, friend. Happens to the best of us and learning feline diabetes is a big learning curve.

One thing DB ( or is that DBF?) needs to realize is that feline diabetes is somewhat different than human diabetes in that cats metablolize insulin MUCH faster so they really need to have insulin every 12 hours.

Of course that is "general rule" and there are exceptions, but until we see more data ( bg tests/comments etc) we assume your sugarkitty is a 12/12 insulin user.

Another thing, I don't mean to be picky but it is REALLY important with cats that you are shooting the same dose each time. You mentioned "about 1 unit". Please note the place where the stopper stops when you pull the dose- is it above/below or on the 1u line mark on the syringe?

try to load syringe to the same place each time. Our sugar cats have been known many times to find a good dose at micro values... .1 or .2 or .4 tenths of a unit even!

So if you load 1.2u on one cycle, then 1u on another cycle then .8 on another cycle, those differences will likely effect getting your cat regulated.

Each time a dose changes- even by the tenth of a unit, it is like starting over. Cat will need new settle time of 3-5 days and testing and such to evaluate how the dose is doing.

also- you can get the syringes at just about any pharmacy. I use the WalMart ReliOn brand- BLUE box ( not gray) has purple stripe. The are U100, 31 gauge, 8mm short needle 3/10 ml/cc with HALF UNIT marks.

Hopefully someone will post the link to show you how to draw a certain dose to a certain link.

Hang in there- we understand busy and many folks here are but still manage...we can help, just touch base with us and we'll do our best! :thumbup

(((hugs)))
 
OMG--teaching 8 new classes at one time? I'm overwhelmed and exhausted just thinking about it. One thing about our kitties--they are incredibly forgiving and tough. They seem to know when we are learning or distracted and don't blame us for not always knowing how to give them what they need. You'll get there; we all have.
 
He was 463 at 5:15 am this morning, up from 366 last night. He's still high today. I stopped by WalMart and picked up new syringes. Yes, they have the purple stripe. Yay! And it was very easy to draw, a little hard to stick with the shorter needles, not sure if I'm getting him sometimes. Not using DBs needles, using his own needles. DB (DBF) takes 60 units at once, it would be way too hard to find a unit on that one! We're 51 and 52, he's been doing it since he was 19. He was actually the one that mentioned that Linwood might be diabetic in the first place because of drinking so much water and losing weight. So, I've kind of relied on him about information.

Linwood is acting so much better now. Wanting to eat, especially. And even being a little lovable, when HE wants it! haha Like I said on Thursday and Friday, he did not want to eat anything, and that's what scared me the most. I gave him 1-1/2 units this evening with the new needle; tested at 7, will test again about 9. I will keep it at this dose the rest of the week. Then, at that point it will be 3 weeks since switching and the vet wanted to see him then. I will take him on Friday, and see what the vet says.

Thank you all sooo much for your help and input. I am learning, definitely!! Thanks for the encouragement. I needed it! {{hugs}} :smile:
 
Dear Mindy,

Clearly you don't know Will!! (be quiet everyone else!! :lol: ). Will is my dh (darling husband) and i could not have gotten luckier marrying a man who loves our babies (all felines). He is a man's man (beer drinking, football watching, weight lifting man) who could be brought to his knees in a heartbeat if something were to happen to one of the cats.

Sounds great right??

Holy cow can this man screw up dose amounts, shot schedules, feeding schedules -you name it!!! (again, zip it everyone else!!). Are his intentions good? Absolutely!! Does he muck things constantly? Absolutely!! Did u see that long winded thread in this section titled "i have a kitten - Molly"? I'll give you the shortened version...Will gave too much insulin and i spent my entire vacation day watching Molly's numbers nose dive!

See, here's the thing. Your dbf knows more about human diabetes than all of us put together. You are so fortunate to have someone who knows the disease so well and is willing to help (can you believe a lot of boyfriends and husbands won't even help!). You keep reading stuff here and gathering information from all of us and then the dbf offers differing advice because he is relying on what he knows in regard to human diabetes. They are so similiar (i have a friend with diabetes and i feel she's the only one of my friends who can relate. I never stop asking her questions) in so many ways but also different in other ways. Like for instance cats ability to metabolize insulin at half the speed humans can. The 12/12 is crucial. Consistency is also key - as the others have already said.


Guess i just wanted to write and say i know how hard it is wehn you have a loved one who is willing to help (something you don't want to discourage) but does not have the same info. you have. I hope this helped and you don't perceive it as putting your man down - i would never do that.


Let me give you Will's cell phone number so you can pass it along to your dbf, hee hee.

Hang in there friend - we are here to help!!!
 
Like for instance cats ability to metabolize insulin at half the speed humans can. T
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Michele, you meant twice the speed, right?

And thank you for explaining Will to Mindy! LOL

Mindy, please don't feel bad or embarrassed! You didn't do any major harm by not giving insulin and I see where your DB was coming from with the fasting BG. Cats need to eat, which is why we don't do fasting BGs on them like is done in humans. Cats cannot go very long without food or their liver gets damaged. Hepatic Lipidosis it's called, or fatty liver.

The 400+ number was caused by the period without insulin. Despite having a faster metabolism dose and time changes with their insulin has a delayed reaction for some cats, so instead of Linwood's BG being high after no insulin, it was lower ( if you withheld food that's why it was lower) and in the following cycle you saw a much higher preshot even though he had been given insulin and it carried through the entire cycle (not that same number, but high numbers. That's to be expected after a skipped cycle. The higher numbers may stick around for another couple cycles, generally we expect changes in dose or timing to interrupt things for 3 to 4 cycles.

I don't know that raising the dose is necessary yet. We have not gotten reliable (not affected by things like time changes or no shot) nadir numbers on 1U yet. I know the 463 seems high, but cats can tolerate higher BGs better than humans.

Glad you got the 1/2 unit marked syringes, they will make it easier for you! With such a hectic schedule, you need things as easy as possible! Anything else you think you need help with, please ask. Most of us have jobs and busy lives and have made it work, even if we have to rely on DH's like Will sometimes! If we can share some of that experience to help you with daily management, please reach out.

It gets less complicated the more information you gather. Hang in there! :smile:
 
My computer was down at work, so this is the first I've been able to reply. Linwood was at 210 at 5am this morning, then after eating and resting, at 7am he was 154!!! No, I didn't shoot him then. DBF tried to get a reading while I was at work, but he's not very good at it. Then when I walk in at 5:00 that's Linwood's signal to EAT. So I tried, but he kept squirming, so I let it go. I will try again at 7:00. So, if at 7:00 it's the normal 3-400 he's been having, do I give him 1-1/2 units or 3/4, or 1? And I'm assuming if it's low again, nothing. This is just crazy! How can it be so high one day, and so low the next?
 
I just tested him, all the meter says is "HI". So I'm assuming, that's pretty high! haha

Okay, back to one unit, 1.1/2 units? not sure....He seems okay, just very, very hungry!
 
ETA- test again to make sure it wasn't a fluke

Well, highs and lows could indicate settling or rebound or any number of things.

Can you update your Spreadsheet for us so we can see whatever checks you've been able to get?

If it were me, without data to show me what to do ( spot checks ) and with the lower BG's you are getting and no other health issues, I would be tempted to go with the .5u

I think .5u might give you steadier results that you may be able to continue to shoot without skipping shots.

Once you start the .5u, even if numbers are higher initially, you need to HOLD the .5u dose and let it settle for a minimum of 3 to 5 days, then take a day when you are around and get checks every 2- 3 hours or so - a curve- which will show you how the dose has been working through the day.

It is important to ientify what point in the daily cycle kitty is lowest

Doses arew adjusted according to the lowest number, not the highest.

See what others say, but I would pick a more conservative dose of .5u ( half a unit) and let the dose settle without changing dose for a few days.
 
thanks, I will test now. just strange. I haven't been updating the chart, because I wasn't doing it right. I can give you the numbers from the meter...starting with the 21st, because he was just way out there the weekend. And the numbers are high, but he has been fine, beginning on Sunday, the 21st.

2/21
6:46 am 530
9:00 am HI
1:00 pm 390
7:12 pm 366

2/22
5:15 am 463
7:16 am 519 (after eating)
6:45 pm 478 (after eating)

2/23
7:16 am 458
7:30 pm 540

2/24
4:30 AM 201
7:15 am 395
4:30 pm HI

2/25
4:45 am 220
7:00 am 156
6:20 pm HI
7:00 558
 
What doses did you give on those days you just posted? Please add the dose.

I am inclined to agree with Melissa to go to a half unit. He does seem to be rebounding - and there isn't a lot of data to see a pattern yet. If he is low again (I doubt) in the mid 100s try a .25u, or a half unit or wait and test in another hour. With lev it is safe to shoot at least some insulin at 154.

Please test for ketones daily until he is regulated or at least out of the 300-400 and "HI"s.

FYI - Beau was ravenous until he was regulated and he spent a good many months in rebound from high, once a day doses before I started testing him at home. It really was a matter of getting rid of all dry food and lowering his dose.
 
Linwood started getting 1.5 doses on Sat night. Of course, nothing this morning. Dry food is tough. He wants to eat, literally, all day long! I will need to post a pic, he is the typical Garfield, loves anything with spaghetti sauce!!

I have not had a chance to test for ketones, yet. Not home when he does his business, of course!

Thanks, that's good to know about Beau.
 
Well, I just deleted everything I wrote because if he did not have a shot this morning, THAT is why he is HI, not rebound.

The gist of this is that he is showing promise on the 1.5U, but skipping shots is setting him 2 steps back every time.

If you're uncomfortable giving the full 1.5U dose on a 220 BG, at least give 1U. It's better than nothing.

Also, please write daily preshot and progress numbers as follows:
2/25
AM preshot (AMPS) 220 no shot
+2.25 156
PMPS +13.5 HI 1.5U
+.75 558

It's universally how we wrote numbers here before we had spreadsheets. :smile:
 
Also, want to be sure you understand that unlike Vetsulin and PZI, Levemir can be given at blood glucose preshot levels close to or within the normal range. 220 is a perfectly acceptable BG to give a shot on, even with limited data because you haven't seen really low numbers on 1.5U. The 156 is very promising even after no shot, it's what Levemir does - it maintains BGs at near normal or normal levels over a period of time. Works the same in cats as it does in humans in that respect.
 
Okay, I get what you're saying. And yes, I just accidentally erased everything I had written, too!!
I did give him 1.5 units 2x a day until this morning. I was afraid to do it at 156, so I didn't.

what does the plus sign mean on your numbers? is that the dose?
just a little confused on the spreadsheet and numbers thing. I need help, desperately on this! I teach computers all day long and just can't get this! doh!

So I still have not shot him yet tonight. I'm going to test him again now. If I shoot him, what about .75 or 1 unit?
 
Mindy said:
Okay, I get what you're saying. And yes, I just accidentally erased everything I had written, too!!
I did give him 1.5 units 2x a day until this morning. I was afraid to do it at 156, so I didn't.
Click to expand...
OK, I understand. So the 7AM time would have been the time he got a shot? I thought it was 2 hours after when he would have gotten his shot.

Mindy said:
what does the plus sign mean on your numbers? is that the dose?
Click to expand...

Ah! The +2.25 means that 7AM was 2 hours and 15 minutes past when I thought he should have had his shot.

Maybe this will help:

7:30 AM +12.5 375 1U
+2 352
+4 292
+5 310
+6 265 Ate regular meal
+7 209
+8 234
+9 220
+11 259
+12 263 1U

Mindy said:
just a little confused on the spreadsheet and numbers thing. I need help, desperately on this! I teach computers all day long and just can't get this! doh!

So I still have not shot him yet tonight. I'm going to test him again now. If I shoot him, what about .75 or 1 unit?
Click to expand...

Despite everyone else saying he needs the dose lowered, I don't see that. Yes, we need a few more test results more often throughout a cycle to be sure, but 1.5U was looking promising. Perhaps do less than that, but 1U is a full 1/3rd less than he was getting and had higher numbers on. The progress you saw with the 156 is pretty typical and suggests the 1.5U dose is in the ballpark. It takes 3 to 5 days to sometimes see results on a dose - you were beginning to see that. And the skipped shot will cause him to run higher for another 3 cycles probably.

Your spreadsheet looks fine. each +column indicates how many hours after the shot the test was done - +1, 1 hour after shot, +7, 7 hours after shot, etc. Then in the blue column you put the dose amount or "no shot."

Have you looked at others' spreadsheets? That helps a lot.
 
okay- now that I can see BG numbers and have a dose connected, I would like to see you drop the dose and shoot 1u and hold it for 3 to 5 days.

I don't think the 1u was ever given enough of a chance and the fact that there are higher numbers ( 400 or HI) at the end of a cycle and lower at the start ( 150's) IMO you are getting a bounce or rebound.

Rebound is higher numbers after much lower ones. ( liver throws out stores of insulin to raise BG uncontrollably)

hoping if you cut back to the 1u you will gradually get lower numbers after 5 days probably. In any even you may likely get numbers you are more comfortable shooting at and once you are more comfortable and have more testing data, you might raise dose- but that is for a later date IMO.

Is there any way you can you post more often so we can be more helpful to you? Maybe each day or every other day at least?

To answer: +1 is one hour after shot, so +3 would be 3 hours after shot

PMPS is night ( PM ) pre shot ( PS) so AMPS is morning preshot....preshot is the BG value you get BEFORE shooting a dose.

so, to re-do your 2/25:

you wrote:
2/24
4:30 AM 201
7:15 am 395
4:30 pm HI

assuming shots are 7am and 7pm- Should read
2/24/10
+9.5 201 <--- 9.5 hrs from the night before's PS
AMPS 395 gave 1.5u
+9.5 HI
PMPS --- gave 1.5u

you wrote:
2/25/10
4:45 am 220
7:00 am 156
6:20 pm HI
7:00 558

assuming shot is 7/7 should read:
+9.75 220
AMPS 156 no shot
+22.25 HI <--- since you didn't shoot at +12, it was 22 hrs and 15 mins, so +22.25
+24 558 gave 1u
 
Normally I'd suggest a compromise at 1.25U, but am not sure Mindy can manage an in- between dose on the syringe yet!

Mindy, there's nothing wrong with trying a 1U dose for several days, BUT you need that ketone test. Are you aware there's a meter which tests both BG and ketone blood levels? It's called the Precision Xtra. The strips are expensive, not sure if meter comes with strips or not, but it may make things easier for you on the ketone testing.

Sorry we're giving conflicting advice. If the 1U will make the numbers more comfortable for you to shoot consistently for the time being, then do 1U. But I'd hate to see him continue riding in the 400s, which I'm afraid he's going to do at 1U when 1.5U gave goal numbers, like the 156. Cycles under 200 are desirable. You're still early in the dance yet and the sooner you can give him steady numbers below renal threshold (no more than 250) the better his chances of remission.
 
Vicky has very valid points. Many folks that soot Levemir or Lantus will be more aggresive in the dosing to get the peak numbers lower and, as Vicky said, give a better chance at remission. It works well for many cats.

I should explain that I am a fan of a shallow curve.

I'd prefer to have numbers a little higher throughout the entire curve in favor of the steep drops and rises.

It is my experience with Paul-Kyle and observation of some others that the shallow curve gives the body a chance to "relax" and become predictable so the liver doesn't always have to be on guard ready to release insulin to bring up a steep drop.

I'd prefer to have kitty less than 100 points different from one end of the curve to the other, for example:

AMPS 267
+3 248
+5 221
+7 198
+9 176
+11 201
PMPS 233

Instead of:

AMPS 326
+3 288
+5 121
+7 92
+9 60
+11 169
PMPS 249

The goal of my shallow curve is to allow the body gentle healing so that over time- hopefully a few weeks to a month of shallow curves and healing pancreas, the BG's drop with the healing and a curve may look more like:

AMPS 201
+3 188
+5 169
+7 154
+9 142
+11 149
PMPS 155


A shallow curve may not offer the greatest or most preferable numbers, but one needs to look at behavior as well..Some kitties don't tolerate the ups and downs so well and it may feel a bit yucky for them.

I'd be curious about what DBF says about how it feels to have steep drops and rises...

Some kitties, though the numbers may be a bit higher than ideal, feel so much better with the shallow curves.

We used to use Vetsulin, then Lantus and now using Levemir. Of all the time with all the insulins and doses, Paul has done the best when there is the least amount of peaks and valleys in his curve. He went off insulin for 6 months at one point from a shallow curve, actually.

And I did try doing things more aggresivley for some time...PK seemed miserable and sleepy and w/3rd eyelids up most of the time. Now with our higher numbers but shallower curve, Paul is more active, alert and bright eyed.

In any case, testig for the ketones is a very important part of finding a proper dose for a kitty while the numbers are a bit higher.

Let us know what you decide and how we can help you further. ;-)
 
Melissa has some very good advice. So the strategy becomes what dose will give him those steady numbers.

Unfortunately only time and a little trial and error are going to tell you that. Right now it's still up in the air because we don't have much testing data to work with. Picking a dose you can give reliably and staying with that dose, as well as the schedule, which means not skipping doses, is the key to getting good data you can make future dosing decisions on.
 
Rebound is higher numbers after much lower ones. ( liver throws out stores of insulin to raise BG uncontrollably)
Click to expand...

Melissa meant to say "the liver throws out stores of glucose to raise BG".

I'm not sure I would call "uncontrollably", but the liver *thinks* it is saving the being from a hypo, so it just dumps the stored sugar - which can lead to uncontrollable high BGs. And the drop does not have to be to a dangerously low number for this to happen. It can happen because the drop was too fast for comfort (100 pts in an hr) or fairly far (500 down to 100).

The reason I think there could be rebound is that the BG was dropping still at 7 am this morning, which should have been 12 hrs after his shot, right? And the "holes" in the data could be missing drops to lower numbers at other times. We just don't know. The dry food could be sending him into the 500s and higher, but in my experience 400s and above are often from rebound.

And as far as dry food goes, he should not have it. It's like feeding potato chips to children "just because they want them". I leave wet food down during the day and overnight. Since Linwood is not yet regulated he may be very, very hungry, but feeding more low carb wet food will give him the food he needs without making regulation very difficult. Feeding dry food to a ravenous unregulated diabetic cat is spinning your wheels. Incidentally, both my diabetics ate a lot when they were either unregulated or catching up for losing significant amounts of weight - up to twice the normal amount of food. Normal would be about 6 ozs of low carb canned per day. Beau ate about 10 ozs until after he was regulated and Jeddie ate about 8-9 ozs to gain the weight he had lost.
 
I am still confused about the spreadsheet. I started to enter numbers, but I'm not sure if I'm doing it right. Started giving him 1.5 units on Thursday night, 25th, so that we could watch him the weekend. I think he's doing great on the 1.5 units; shots are given around 7-7:30 morning and night. Appetite is incredible!
These are my numbers from the meter:
2/26, 5:08 am, 283 (before eating)
2/26, 7:00am, 477 (after eating)
2/26, 1:30PM, 252
2/26, 4:30pm 221 (before eating)
2/26, 6:50pm, 232(after eating)
2/27, 7:20am, 363 (after eating)
2/27, 11:17 am, 315
2/27, 3:58 pm, 352
2/27, 7:41 pm, 429 (after eating)
2/28, 6:10am, 310 (before eating)
2/28, 7:26 am, 342 (after eating)
2/28, 12:20 pm, 296
2/28, 6:30pm, 431 (after eating)
3/1, 5:21 am, 233 (before eating)
3/1, 7:11am, 479 (after eating)
3/1, 6:50pm, 156 (after eating)
3/1, 8:00pm, 205
3/2, 4:50am, 228 (before eating)
3/2, 7:00am, 401 (after eating)
3/2, 4:40 pm, 145 (before eating)
Will do another in a few minutes before shooting.

I'm not sure if I'm doing any of this right or not, but he's doing so much better. Thank you all again so much for your help. I really, really appreciate it! Reading cat food labels like crazy. He is no longer on dry food, canned only. It seems the light food has the better numbers, I've been experimenting with different types. I like the idea of the grain free stuff, it seems to have fewer carbs and more protein?
 
Hi Mindy -

Looks like the testing is really coming along! Fantastic you!!

And wow, no longer on dry food?!? No easy task - prod of you. Just please keep in mind that his insulin needs will be different now that he's eating wet food only.

I see he's still showing some high numbers. I'm trying to understand the data you presented but am having a hard time since it is not written in the format we use here (remember that since we are all in different time zones, i don't know if your 5:08 am is the same as my 5:08 am. I know you stated that you shoot (sloppy slang for gave insulin) at 7am and 7pm but it would be easier if you can add, next to the data, what amount you shot.

Looking at your data on this post is this correct?

2/26 +10 283 (i am assuming you gave insulin at 7pm the night before so 5:08 am is 10 hours after that shot - thus +10)
amps (am meaning morning, ps meaning pre shot number) 477. Since we know you shoot every 12 hours, i don't need to need to see +12. I will always know the amps and pmps mean 12 hours since the last shot. Please also record how much you shot.
+6.5 252 (6 and a half hours after his 7 am shot he was 252).
+9.5 221 (9 and a half hours after his 7 am shot he was 221).
pmps (pm meaning night, ps meaning pre shot number) 232. (again, i know you shot 12 hrs earlier by seeing your amps number and dose).

Does that make sense?

For some reason, i can only type so much before i can't see the screen anylonger. No iddea why that happens. Let me post this and add more on after i can see what i wrote.
 
me again -

I hope that helped a little and didn't cause more confusion.

Again, great job on the testing. I swear it gets easier :-D

Michele and Molly
 
It looks like he is getting a few decent nadirs in the mid 100s in the past few days, so maybe hold the dose where you are for another few days and do another curve on the weekend. Getting the dry food out of the way is great - and may be why he is starting to come down lower.

When you test in the 400s and it is "after food" how long after the food and how long is that after the shot? That seems to be his high point so I am wondering if you can help that by not feeding from about +8 to shot time, then feed, test, shoot all in about 10-15 mins (or test, feed, and shoot just as he finishes eating or while eating). Aligning the food and shot might prevent the climb to the 400 mark, but again, that might come down now that the dry food is gone.

Part of what Michele posted about listing numbers, the use of PS for preshot and the +numbers will tell us automatically when you shot. So if he see amPS we know that is when insulin was given, etc... make sense?

You are getting the hang of this!
 
I don't know, I need to have the chart maybe in front of me and your instructions at the same time! ;~) So, I'm going to print what you said and try to get it right!

I shoot every 12 hours around 7-7:30, 1.5 units. He is starving at 5am, so I give him about 1/4 of a can of food and again around 6-6:30; so he gets about 1/2 can in the morning. When I get home at night, around 4:30-5:00, he is screaming for food again. Phil feeds him 1/4 of can sometime around lunchtime. sometimes later, like today around 3pm. So it is tough to try to hold out 8 hours before shot time.

So, I get home tonight at 5:00, I test him before feeding. 48.....48!!!
So, I'm like, wow, maybe a bad reading. I do it again....54.
I fed him about 1/2 can, he ate most of it, but not all of it.

Just tested again, it's up to 121. So it is rising, I'm going to wait until about 7:30 to test again. Should I possibly lower his doses to 1.25 or 1 again? I know someone said to hold the dose at what I was doing, which is 1.5 units. He is not eating any dry at all. (which bites because I just bought the big bag of Wellness dry food at $20+!! But I'm going to donate it to a local cat sanctuary, Fran's Felines.)

So, I've always done the shot right a feeding time. Then with Levimir and testing, I've waited a couple of hours later. Should I not do this? I test before feeding and before shooting just to get an idea of where he is. Of course, usually down before eating and rises after eating. So interesting. Phil says that testing has created a monster in me! haha When it's time to test, I "sing" to Linwood, "time to get the blood!" Then I pick him up, and he literally goes slack. He's so funny, just like a child!

I'm getting there, I guess. I'm getting better at sticking his ear. His left one, though, has gotten kind of tough. So I'm trying to avoid it. Poor thing!
 
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