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Sammysmom

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Hello everyone,

I want to thank everyone so much for the help with spreadsheets, advice, etc. We are now attempting to monitor Sammy with a .5 unit insulin trial once a day in the morning. In the middle of January, Sammy had a urethral blockage and was hospitalized for three days. While he was there they could not get him to eat so they gave 1 unit instead of the 2 units twice a day that we were giving him before. After he came home and was on a number of medications (prazocine, clavamox, bupeniphrine (sp?) he still was not eating very much so we conintued the 1 unit twice a day until the first day listed on my spreadsheet. We gave him one unit in the morning and noticed he was very lathargic and not acting himself so we attempted home testing and we got some low numbers for a while and were advised not to give him insulin by the vet. As time went on and his numbers started creeping up we noticed he was still testing relatively low four hours after eating. The vet said we still should not give insulin. Recently numbers have been high and the vet recommended we try .5 units of insulin just in the morning and then monitor all day and that is where we are yesterday and today. Any advice about how to proceed will be much appreciated since Sammy seems to be baffling the vet. Thanks again,

Angie
 
Oh good, you are already here. I suggested that in my post on Health. Here is what I said:


I have to admit that I didn't notice you were dosing in the am only. I was thinking you were giving .5 2X day. It would certainly be better to dose twice a day. The problem with ProZinc once daily is that it only lasts about 12 hours, and then he is higher the second 12 hours. So you dose in the am, he does okay during the day, skip at night and he is higher during the night and higher the next am. He didn't go too low today; he stayed in very nice safe numbers.

You have a couple choices. You could split your dose and give .25 twice daily. (You have to eyeball half of the .5 which isn't easy. Lots of PZI members use U100 needles and a conversion chart: Conversion chart

Then you can give smaller doses like .1, .2, .4 units. Ideally, it would give him enough insulin overnight to give you an amps of +200, rather than the 300+ you are getting. You could give the .5 twice daily, but it is a little scarier, especially that first dose overnight. (It's harder to monitor at night, though I still thinking staying up all night is overkill.) He should be fine as he didn't go too low today, but since it's early days with the insulin, I would be reluctant to try that until you have some more data. If you give the .25 twice daily for a few cycles and he is higher than you would like, you can always increase by .25 to .5
 
Hi Angie and welcome to our PZI group.

What nice bg's Sammy has today.

I have to agree with Sue about twice a day dosing, Prozinc only lasts 10 to 14 hours and then it's gone out of their system. There is also another condition called DKA that can be deadly and costly to treat, it is caused by not enough insulin along with an untreated infection and lack of appetite, while I'm not suggesting that is going on with Sammy it is something to take into consideration when only shooting insulin once a day. Are you testing for ketones? Ketones are a warning sign of DKA so it is something to test for on a regular basis even if you shoot twice a day. It's always best to stay on top of this stuff.

I like Sue's idea of splitting the dose to .25 unit AM and PM. If his numbers go up overall you can raise the dose when you will be around to test.

Keep asking questions as they come up.

Robin/
 
I agree that the ideal solution would be to find a dose that will allow you to shoot 2x per day instead of once. It's very hard to eyeball small doses with a U40 syringe though. I did when I shot .25u doses, but it was not very precise.

Today's cycle on .5u looks really good. You would hope he'd get the same sort of cycle on a PM dose, but there's no way to know for sure. Some cats tend to run in lower numbers overnight.

What I find interesting on the SS is what's been happening with his numbers while he wasn't getting any insulin. There are PM cycles there where it looks like there's a boost from eating, but look how quickly the numbers have come back down afterwards? Specifically the PM cycles on the 2nd, the 5th, the 7th and the 11th of February.

It looks like his system was regulating, or attempting to regulate, on its own. Was he on any meds at that point? Is your vet positive that there's no infection present right now? Or some source of pain? I'm thinking like inflamation, infection, dental issue, pancreatitis? Something that would cause the numbers to go higher that isn't necessarily "diabetes"?

Has he been eating well lately, and just low carb food?

Carl
 
You buy these things called "ketostix" from the pharmacy. They are test strips that you use to check urine for ketones. You have to try to catch him while he's peeing, put the stick in the stream, and then wait a set number of seconds to see if the stick changes color and compare it to the color guide on the box. It shows if any ketones are present in the urine.

Carl
 
Sorry, I should have explained, you test their urine.

You can get Ketostix at any pharmacy, they may be behind the counter so you may have to ask for them, they are about $12 tp $15.

Depending on how modest Sammy is in the litter box, if he isn't modest you would wave the stick in his stream of urine and compare the color change to the chart on the bottle. Some people use a ladel to catch a sample and test that, if he's modest and won't go in front of you come back and ask, we have tricks for that too.
 
Hi Carl and bob,

Well Sammy was diagnosed with diabetes about two years ago and we had kept him fairly well regulated up until the urethral blockage. After that i joined fdmb and made the spreadsheet. There was a uti associated with the blockage and we were treating with clavamox for a few days, but he couldn't keep food down. So the vet gave him an injection of convenia a week before i started tracking on the spreadsheet, And ever since he has been urinating normally. The days you noted the only other medicine he was getting was Flovent twice a day ( he also has asthma). I was planning on taking him in tomorrow for a urine sample to make sure the uti has resolved. He has been eating normally only low carb wet food. During the time of the spreadsheet he was on Dm until about 2/6 when we switched to fancy feast turkey and giblets classic. Thank you for trying to help me problem solve. It's been a sort of frustrating getting such random numbers and maybe tomorrow the vet can look at him and make sure nothing else is going on. So I guess maybe tonight based on his pre shot number I should do .25. The vet told me not to shoot if below 250.
 
It almost looks like "something" happened between the PMBG test on the 9th, and the AM test on the 10th. All of a sudden, pink numbers that wouldn't go away. Then you gave .5u, and not much happened the first time. Then today, really nice reaction to the dose. Those several days of pinks and yellows just have me scratching my head...

Carl

edit to add - If he was on insulin on the 9th, I'd just assume the higher numbers on the 10th were "bounce" numbers from going too low. But he didn't get any insulin, so what was making the numbers drop the night of the 9th? Again, just an assumption, but I'd think "his pancreas was working"...
 
Tricky tricky

Carl and Bob,

Thank you for taking the time to look at this so carefully for us. As much as I hate not knowing exactly what's going, I'm relieved that you find it bizarre like I did and my vet. I think that's why she wanted me to try just am insulin because he seems to be so unpredictable. We just did another spot check and it was at 249. +9 seem like a fairly big jump from 119 +7. It sucks not knowing what to do exactly....but I appreciate your thoughts and suggestions so much.
 
Trick tricky

Rob and Harley,

Would you still recommend shooting if between 200-250 given our tricky numbers? I will post numbers pre shot but I'm so anxious all time and I don't want to do the wrong thing. This whole situation is driving me bonkers, but I really appreciate the help thank you so much
 
Take a moment and breeeeathe, you are actually in a really good place. Sammy's numbers are good and he's on a low dose.

Yes I would shoot any number over 200 if I were you. You want to keep him in these good numbers.

I used to call that high anxiety you're feeling as "hyper adrenalin overdrive". A few cleansing breaths will help with that and a piece of chocolate. :-D
 
High anxiety

:) few deep breaths, and I might skip the chocolate and go for a glass of wine. I got some ketone test strips and ready to go! If in the high range, what should I do? I think I read in a post that I should call the emergency vet?
 
You really don't want to see any ketones - even trace. If you did, yes a vet visit is necessary.

The best way to avoid them is to keep him hydrated (add water to the food), make sure he is eating and avoid high numbers. It's the ECID (every cat is different) Some tend to be ketone prone and others don't.
 
I like your choice of treats drinking09 :-D

Yes, any trace ketones is a vet visit. They can flush them out before they become a bigger problem.
 
Pmps

Well pmps was 334 so I shot .25 just to be safe. I'm going to try and stay up for a +6 but that will mean 1:30 am! Good thing tomorrow is a holiday. No luck with ketone testing yet. Fingers and paws crossed!
 
There are some tricks to ketone testing. You can put a piece of Saran wrap where he usually goes in the box.

Oliver would not let us watch him; he wouldn't go if we were in the room. We ended up putting him in a room with a clean box filled with aquarium gravel. He couldn't stand not christening the box. The gravel won't absorb the urine so we could get a sample.
 
What a great idea! He just has not gone yet, at least not that we can see. He and his brother share three different litter boxes that they both use interchangeably. They love sitting with us at night on the couch so we have been watching like hawks! Thank you for the tip. We will definetly try that tomorrow if we haven't been able to test!
 
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