I would love help with newly diagnosed cat-Nemo. His numbers are so high. I don't know how to do the spreadsheet. I am worried, but at least he physically looks better, but don't know if he is bouncing or needs a higher dose of lantus. Vet doesn't return phone calls. Can anyone help me get ss going?
newbie needs help with numbers
- Thread starter big kitty
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Shelly & Jersey (GA)
Member Since 2014
Hi big kitty,
We would love to help you with Nemo! Here are the instructions for setting up a spreadsheet:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130
Let us know if you have problems with it!
Shelly
We would love to help you with Nemo! Here are the instructions for setting up a spreadsheet:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130
Let us know if you have problems with it!
Shelly
Sue and Oliver (GA)
Member Since 2009
I can get it set up for you, if you get right back to me. I have to leave in an hour. See your private messages for more info. Top of the page "1 new message"
Shelly & Jersey (GA)
Member Since 2014
Thanks, Sue!
Hi, I'm back up with ss numbers yahoo! Very easy from library computer, not from phone. So I feel like I've been going blindly along-he is newly diagnosed. He eats fancy feast in meals, but wants free choice. Vet said try 1u see me in 2 weeks- nothing about testing bs. Last night was scary. Low numbers taken half hour apart, not 1 hr. Latest number today (plus 7) is 375. I am happy about it. Any advise on dosage or too early to tell. I know not to chase the high, but got scared of fruit smell. I am starting new job and won't be around as much, but can do 12 hr schedule. I'm learning the hard way.
Shelly & Jersey (GA)
Member Since 2014
Hi Wendi,
Great job getting your spreadsheet set up and getting those tests in last night.
Can you explain what you mean? Do you mean that Nemo's breath smells like fruit? That can be a sign of DKA, which is extremely serious. Here's a link to more information on it: http://petdiabetes.wikia.com/wiki/Ketones.
If Nemo's breath smells fruity, I would strongly encourage you to contact your vet immediately. If it is DKA, it can be fatal, so it's important to catch it early.
Since you just joined, I'm not sure if you are testing for ketones. You can buy ketone test strips over-the-counter at Wal-Mart or a pharmacy. You hold the strip under the cat's urine stream and then compare the color of the strip to the color chart on the side of the bottle. With Nemo in these high numbers, it will be important to test for ketones regularly since DKA can develop rapidly.
I'm going to try to flag down someone who knows more about DKA than I do. I'll also try to get an experienced user to look at Nemo's ss to help you with dosing.
Shelly
Great job getting your spreadsheet set up and getting those tests in last night.
Can you explain what you mean? Do you mean that Nemo's breath smells like fruit? That can be a sign of DKA, which is extremely serious. Here's a link to more information on it: http://petdiabetes.wikia.com/wiki/Ketones.
If Nemo's breath smells fruity, I would strongly encourage you to contact your vet immediately. If it is DKA, it can be fatal, so it's important to catch it early.
Since you just joined, I'm not sure if you are testing for ketones. You can buy ketone test strips over-the-counter at Wal-Mart or a pharmacy. You hold the strip under the cat's urine stream and then compare the color of the strip to the color chart on the side of the bottle. With Nemo in these high numbers, it will be important to test for ketones regularly since DKA can develop rapidly.
I'm going to try to flag down someone who knows more about DKA than I do. I'll also try to get an experienced user to look at Nemo's ss to help you with dosing.
Shelly
I just finished testing his urine-no reaction. At his diagnosis, she did find some ketones doing urine testing by drawing out of his bladder and she wasn't too concerned, so must not have been too bad. He had been steadily losing weight, but is now definitely gaining. I would just like to get numbers more stabilized, or at least be able to figure why they go up
Shelly & Jersey (GA)
Member Since 2014
It's great to hear that you're testing for ketones, Wendi. I've asked some of the experienced users to help you with your dosing questions. Whatever they tell you/you decide, it's important to try to hold that same dose for several cycles in a row. Since Lantus is a depot insulin, it takes time to build up in the body. That's why we have to wait several cycles at the same dose - so that we can see what it can really do after the depot fills. One exception to the "hold the dose" rule, of course, is to immediately reduce the dose if the kitty falls below 50.
We often use a chart to help us interpret the numbers - I don't know if you've seen it yet.
Shelly
We often use a chart to help us interpret the numbers - I don't know if you've seen it yet.
Shelly
Welcome to FDMB.
Like the others noted, the issue of a "fruity" breath smell could be worrisome. Please let us know if you have urine ketone test strips and are able to get another test. Follow the directions on the package and let us know immediately if you get a result that's above "trace." Results that are more than trace need a vet visit as ketones can build up quickly and become an emergency. (When my cat was diagnosed, she was suffering from diabetic ketoacidosis and spent 3 days on the kitty ICU. Ketones can become life threatening.) The basic recipe for ketones is an infection + not eating + not enough insulin. If Nemo is eating, that's a good sign. One thing you can do that is good for Nemo regardless of whether there are ketones present is to add water to his food.
As for dose, with Lantus, doses are typically increased by no more than 0.5u. In fact, in most cases, the dose increase is in 0.25u increments. The rationale is that if you increase by too much, the resulting numbers may make it it difficult to discern whether high numbers are due to bouncing or insufficient insulin. You may want to take a look at the starred, sticky notes on the Lantus board. In particular, the Tight Regulation Protocol sticky will give you guidelines for how to approach dosing.
I don't think the 1.0u was enough insulin but, you didn't know to get spot checks. Can you do your best to get some mid-cycle data so we can evaluate the dose? The high numbers you're seeing today are a result of Nemo dropping from the 400s to the 50s. This is what a "bounce" looks like. It can take up to 72 hours for the bounce to clear. The caveat here is what the results from a ketone test tell us. The presence of ketones trumps pretty much everything and we will help you to be aggressive regarding the dose providing that the ketones, if present, can be managed at home.
Like the others noted, the issue of a "fruity" breath smell could be worrisome. Please let us know if you have urine ketone test strips and are able to get another test. Follow the directions on the package and let us know immediately if you get a result that's above "trace." Results that are more than trace need a vet visit as ketones can build up quickly and become an emergency. (When my cat was diagnosed, she was suffering from diabetic ketoacidosis and spent 3 days on the kitty ICU. Ketones can become life threatening.) The basic recipe for ketones is an infection + not eating + not enough insulin. If Nemo is eating, that's a good sign. One thing you can do that is good for Nemo regardless of whether there are ketones present is to add water to his food.
As for dose, with Lantus, doses are typically increased by no more than 0.5u. In fact, in most cases, the dose increase is in 0.25u increments. The rationale is that if you increase by too much, the resulting numbers may make it it difficult to discern whether high numbers are due to bouncing or insufficient insulin. You may want to take a look at the starred, sticky notes on the Lantus board. In particular, the Tight Regulation Protocol sticky will give you guidelines for how to approach dosing.
- Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM in one of the top vet journals.
- New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
- Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
- Lantus depot: This is an important concept for understanding how Lantus works.
- Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
I don't think the 1.0u was enough insulin but, you didn't know to get spot checks. Can you do your best to get some mid-cycle data so we can evaluate the dose? The high numbers you're seeing today are a result of Nemo dropping from the 400s to the 50s. This is what a "bounce" looks like. It can take up to 72 hours for the bounce to clear. The caveat here is what the results from a ketone test tell us. The presence of ketones trumps pretty much everything and we will help you to be aggressive regarding the dose providing that the ketones, if present, can be managed at home.
Yes, I agree and understand with everything you said. Unfortunately it seems like I'm learning backwards. I changed his food raidly after starting insulin, up and down with the doses, not really having aguiding hand. I tested his urine-no ketones. He has and is a good eater, so no prob there, not ravenous, but says he is available should I want to feed him. He does drink more than I would like to see. So I would like to back up to maybe 1.5u, but the syringe is only 1 u increments. Are there ones where it is easier to see?
Shelly & Jersey (GA)
Member Since 2014
We all know how hard it is starting out. Believe me - we understand exactly the frustration, worry, and exhaustion you're feeling right now. It really does get easier, though. I promise!
Which syringes are you using right now? They make U-100 3/10 ml/cc syringes that have half-unit markings on them. (If we try to do anything smaller than a half unit - say a 1.25, for example, we just have to eyeball that quarter.) If you don't have syringes with the half-unit marking on them, I might recommend those. Some people here use readings glasses to help them see the syringe better. Others use magnifying glasses or magnifying lamps. Some even use optical visors. And some people use calipers. If you're ever interested in any of the options, just give a shout out. People will be happy to provide you with links to some of the items they have purchased.
You don't always have to get a check 6 hours after the shot. Although most kitties usually hit nadir (the low point) somewhere between 5 to 7 hours after the shot, every cat is different. You can mix up the times to get a better picture of what Nemo likes to do! For example, you might check one night 5 hours after the shot. The next time, you might check 6 hours after the shot, etc.
One recommendation is to check 2 hours after you give Nemo his shot. This +2 check can be a good indicator of what Nemo might be planning to do during the cycle. Let me give you an example that might help:
On April 3rd, Jersey's AMPS reading was 467. An hour and 45 minutes later, her reading was 351. That was a big heads-up to me that Jersey was in an active cycle - that her numbers would continue to fall.
On March 20th, Jersey's AMPS reading was 354. An hour and a half later, her reading was 366. That told me that I was most likely going to have a bounce on my hands, and Jersey's numbers wouldn't fall much during that cycle.
We cannot always rely on the +2 shot to tell us where a kitty is headed, but it's a good test to try to get when we can. I got up early enough in the mornings that I could get the +2 test before I went to work. That way, I could figure out whether I needed to leave the regular food out or leave some high-carb food out.
Since Nemo's new to all of this, we'll have to figure out what he likes to do - what his pattern is. Getting random tests whenever you can will help us figure out his pattern.
I know you're feeling overwhelmed right now. What questions do you have?
Shelly
Which syringes are you using right now? They make U-100 3/10 ml/cc syringes that have half-unit markings on them. (If we try to do anything smaller than a half unit - say a 1.25, for example, we just have to eyeball that quarter.) If you don't have syringes with the half-unit marking on them, I might recommend those. Some people here use readings glasses to help them see the syringe better. Others use magnifying glasses or magnifying lamps. Some even use optical visors. And some people use calipers. If you're ever interested in any of the options, just give a shout out. People will be happy to provide you with links to some of the items they have purchased.
You don't always have to get a check 6 hours after the shot. Although most kitties usually hit nadir (the low point) somewhere between 5 to 7 hours after the shot, every cat is different. You can mix up the times to get a better picture of what Nemo likes to do! For example, you might check one night 5 hours after the shot. The next time, you might check 6 hours after the shot, etc.
One recommendation is to check 2 hours after you give Nemo his shot. This +2 check can be a good indicator of what Nemo might be planning to do during the cycle. Let me give you an example that might help:
On April 3rd, Jersey's AMPS reading was 467. An hour and 45 minutes later, her reading was 351. That was a big heads-up to me that Jersey was in an active cycle - that her numbers would continue to fall.
On March 20th, Jersey's AMPS reading was 354. An hour and a half later, her reading was 366. That told me that I was most likely going to have a bounce on my hands, and Jersey's numbers wouldn't fall much during that cycle.
We cannot always rely on the +2 shot to tell us where a kitty is headed, but it's a good test to try to get when we can. I got up early enough in the mornings that I could get the +2 test before I went to work. That way, I could figure out whether I needed to leave the regular food out or leave some high-carb food out.
Since Nemo's new to all of this, we'll have to figure out what he likes to do - what his pattern is. Getting random tests whenever you can will help us figure out his pattern.
I know you're feeling overwhelmed right now. What questions do you have?
Shelly
Chris & China (GA)
Member Since 2013
The high numbers today are due to bouncing off the low numbers last night.
What are bounces? When a cat isnt regulated, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.
Yes, you've made some mistakes, but you're here now and we can help you learn everything you need to know! It's great that there are no ketones. Now you just need to hold the 1 unit and get some of those mid cycle tests in while he settles down from this bounce and we can truly see where the dose is taking him.
Welcome to the FDMB! The best place you never wanted to be!
What are bounces? When a cat isnt regulated, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.
Yes, you've made some mistakes, but you're here now and we can help you learn everything you need to know! It's great that there are no ketones. Now you just need to hold the 1 unit and get some of those mid cycle tests in while he settles down from this bounce and we can truly see where the dose is taking him.
Welcome to the FDMB! The best place you never wanted to be!
Thanks guys! I will get half u increment syringes. Vet told me only feed at mealtime, no grazing. That has not gone over very well. I end up feeding second and third portions within a few hours after giving shots. From what I have seen this is ok and expected. I will hold at 1u and get some data on that dose
Suzanne & Cobb(GA)
Member Since 2013
Hi Wendi and Nemo! You are in the right place!
You've already gotten great advice. I just wanted to stop in and say, don't beat yourself up about what happened prior to today. When I finally joined FDMB, Cobb was still eating dry (high carb) food. We were shooting a lot of insulin blindly - only checking his BG every few weeks to curve for the vet. And he stayed in high numbers for almost 7 months.
I learned more in the first 6 hours after I joined here than I did in 6 months with my vet (who said she was a FD expert). I now know different! So...you weren't spot checking, now you are! That's great! Don't even worry about what came before. These folks will get you on the right track, quickly, if you're open to learning from their experiences!
~Suzanne
You've already gotten great advice. I just wanted to stop in and say, don't beat yourself up about what happened prior to today. When I finally joined FDMB, Cobb was still eating dry (high carb) food. We were shooting a lot of insulin blindly - only checking his BG every few weeks to curve for the vet. And he stayed in high numbers for almost 7 months.
I learned more in the first 6 hours after I joined here than I did in 6 months with my vet (who said she was a FD expert). I now know different! So...you weren't spot checking, now you are! That's great! Don't even worry about what came before. These folks will get you on the right track, quickly, if you're open to learning from their experiences!
~Suzanne
Shelly & Jersey (GA)
Member Since 2014
My vet told me to only feed twice a day, too. I later found out it's actually better to feed several small meals a day. It's easier on the pancreas that way. Unregulated diabetic cats also often need more food than normal because their bodies can't use the energy properly in the food they are getting. Once the numbers come down, the constant hunger will subside. Jersey was ravenous in the beginning. Towards the end, when I needed her to eat because her numbers were falling, I couldn't get her to eat a darn thing! Dumb ol' cats never do what you want 'em to do! ohmygod_smile :lol:
Ditto on what Shelly said. We use food in a variety of ways to manage numbers. Bottom line -- spreading out your cat's food is just fine. It's best to not feed after nadir since the effective period of the insulin is waning but even that isn't a hard and fast rule. It all depends on what's best for your cat. You do want to make sure food isn't available 2 hours prior to shot time, though. Food too close to your shot time can influence your pre-shot numbers.
Given that you work during the day, you may want to consider getting a timed feeder. That way, you're sure there's food available if Nemo's numbers start to drop.
Given that you work during the day, you may want to consider getting a timed feeder. That way, you're sure there's food available if Nemo's numbers start to drop.
Chris & China (GA)
Member Since 2013
Most cats will go looking for food if their BG gets low, just like human diabetics go looking for a Coke and a candy bar!
As you get tests in, you'll learn how Nemo reacts to both food and insulin...and you try different things until you find what works best for Nemo!
One of the ways I'd know China was running low was that she'd drive me nuts wanting to be fed
As you get tests in, you'll learn how Nemo reacts to both food and insulin...and you try different things until you find what works best for Nemo!
One of the ways I'd know China was running low was that she'd drive me nuts wanting to be fed
Wendy&Tiggy(GA)
Member Since 2011
How's things going now?
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