Not sure what to do

[Sarah and Baby]

OK, thank you to everyone who helped me with the low BS problem yesterday. My mom tested her when she got there at 8pm and she was 325 so she did not go up too badly.

D/T the overabundance of BS readings in the 300's, after conferencing with my mom and my aunt who are both nurses with extensive experience with diabetic patients, I decided to up my dose to 1.5 daily. Unfortunately, I am not around to do a curve right now and I won't be able to do one until next wednesday. I am a little concerned with the low numbers I have been getting, but because of her history of ketones in her urine, I am not willing to go another week with her numbers reading so high.

Her first dose of 1.5 was this morning at +12 from last night. check out her spreadsheet and let me know what you think.

In summary, Baby was diagnosed 3 months ago, started her on Humulin insulin 2 units, moved her up to 3, and then dropped her back to 1 when I found FMDB, on Lori and Tom's advice. Switched to lantus last month, started at 1u on 7/31, moved up to 1.25 on 8/8, and now up to 1.5 on 8/17. When Baby was originally diagnosed, she had ketones in her urine, I bought ketone testing strips but have not been able to test yet.

I think that's basically it. Thank you so much everyone for the help!!!

Update: Baby's PMPS was 145, so advised no shot. I really don't know what to do here, if you have some ideas, please let me know. My mom who is caring for my cat while i'm on vacation, said that Baby didn't eat all day. I'm just completely lost here.

This is cross-posted to the Health board.

 

[Anonymous]

Sarah, have baby tested again. if she is on her way up give her a smaller dose. let us know what the number is...i'll wait.

 

[pamela and tigger]

OK, thank you to everyone who helped me with the low BS problem yesterday. My mom tested her when she got there at 8pm and she was 325 so she did not go up too badly.

D/T the overabundance of BS readings in the 300's, after conferencing with my mom and my aunt who are both nurses with extensive experience with diabetic patients, I decided to up my dose to 1.5 daily. Unfortunately, I am not around to do a curve right now and I won't be able to do one until next wednesday. I am a little concerned with the low numbers I have been getting, but because of her history of ketones in her urine, I am not willing to go another week with her numbers reading so high.

I understand the thought to up the dose because of the ketone history. But ketones usually develop not just from lack of insulin and consequently high numbers, but also from a possible hidden infection. Was there ever a culture run on her urine? Is your vet sure there isn't an infection lurking somewhere?

Her first dose of 1.5 was this morning at +12 from last night. check out her spreadsheet and let me know what you think.

It looks like her dose increase was yesterday morning on the 16th, but I understand you have an update below. Maybe need to update your spreadsheet to make it more clear?

Edit to add - I see you have the 15th date on your spreadsheet twice! So no wonder my confusion.

In summary, Baby was diagnosed 3 months ago, started her on Humulin insulin 2 units, moved her up to 3, and then dropped her back to 1 when I found FMDB, on Lori and Tom's advice. Switched to lantus last month, started at 1u on 7/31, moved up to 1.25 on 8/8, and now up to 1.5 on 8/17. When Baby was originally diagnosed, she had ketones in her urine, I bought ketone testing strips but have not been able to test yet.

I think that's basically it. Thank you so much everyone for the help!!!

Update: Baby's PMPS was 145, so advised no shot. I really don't know what to do here, if you have some ideas, please let me know. My mom who is caring for my cat while i'm on vacation, said that Baby didn't eat all day. I'm just completely lost here.

This is cross-posted to the Health board.

As far as not eating, that is not good news. I am not sure what you are feeding Baby, but tell your Mom to sprinkle some Parmesan cheese (from the green shaker can) over the top. There are lots of tricks that people have here to get a cat to eat. Post on the Health forum and ask for tips. You will get lots of advice.

Meanwhile here is one forum that gives lots of help even if it is for CRF kitties called "Persuading Your Cat to Eat":

http://www.felinecrf.org/persuading_cat_to_eat.htm

As far as the dose, it is hard to say what is going on. If someone could get some spot checks in during each cycle then it would help. I am sorry this is so hard. Everyone here is concerned and just trying to help in any which way we can.

 

[Vicky & Gandalf (GA) & Murrlin]

Thank you, Lori. I agree with that assessment. It's not good for a ketone prone kitty to go without any insulin over a cycle. She should probably have half a dose, unless she is going to be left alone at your place. Can someone test her later on?

I wonder if she didn't eat because you were gone? Cats are sensitive to disruption to their routine.

I'm a little concerned that the dose was raised with so little mid-cycle testing. I'm not very knowledgeable about how humans dose their insulin, but for cats and especially on Lantus or Levemir, dose increases or decreases should be based on the lowest point of a 12 hour cycle. The fact that she had a 97 preshot after the previous dose was given at +10 says to me that her 1.25U dose was fairly close to a good dose. It is probably a good idea not to increase above the 1.5U until you can get that curve in next week. That will actually be a good amount of time on one dose, so it should yield some good information by then as to how well it's working.

Not sure if this helps for tonight or not. If someone can monitor her or will at least be there, I recommend giving half a dose, which would be .75U. Maybe .5U if no one will be there with her, but she should not go without any insulin again. Skipping another shot when a cat has previously had ketones and just the other day a shot was skipped as well is not a good idea.

 

[Anonymous]

Vicky just so you know I did not suggest the dose increase. I was surprised by the decision.
No behind the scenes dosing advice going on here...just the beginning, the starter so to speak.

 

[Vicky & Gandalf (GA) & Murrlin]

I understand where the dose advice came from. Actually it's probably not wrong, as everyone else seems to be telling her. They are not reading details of spreadsheet very well - the 97 is about where she should be and in general a 2 hour sooner shot needs a 15% decrease, so 15% MORE than 1.25U is about 1.5U! Meaning that if the +10 1.25U shot resulted in a 97 preshot by +12 then a better dose is probably about 1.5U.

I do this kind of math on doses for Gandalf all the time because I have to change shot times. The devil's in the details, so to speak.

Sarah, it's often confusing for the original poster when they post in numerous places 'cause they'll get many different responses. And since not everyone has read the details, such as ketones and the customized schedule, inadequate advice or misassumptions can result.

You did the right thing by posting on Health about the lower preshot and what you should have your mom do. That would have been fine. It's not necessary to post in the ISG's too. Lori's doing good looking out for you in different spots on the board, thanks Lori.

 

[Sheila & Beau GA & Jeddie GA]

I would have to second the concern over raising the dose without mid-cycle testing and a curve. Given that she has had low PS that caused yuo to skip shots, the 300s are more likely from TOO MUCH insulin that too little. Really, the whole cycle should be looked at, not just the PS numbers. My cat, Beau, was raised to 7u of insulin because of testing his BG at the vet at the wrong time. It was closer to 11 hrs after his shot, but they were analyzing it as if it was a nadir number. The receptionist actually took me aside and told me it should be 6-8 hrs after the shot. Not to mention it was a once a week test at the vet! Anyway, point being to look at the lows as well as the highs.

Too much insulin will cause a low number that is either too low, or is lower than what the cat has been used to and that causes rebound bounces to higher numbers. Lower the dose and after a few days that rebound response fades and the lows are not as low and the bounces not as high - or no bounces at all.

Diabetes in cats is very different than in humans. Feline metabolism is much faster so these "slow" insulins act faster in a cat than a person. And cats can generally tolerate higher numbers for longer than a person can, but knowing she had ketones means being a little more cautious.

It would be a good idea for you to push yourself to use the ketone test strips. They are really easy to use, once you figure out a away to "capture" the urine - either by sticking the strip in her urine stream as she pees, or in the puddle just after she finishes (shoo her out so she doesn't bury it). Knowing that she doesn't have ketones will give you peace of mind.

 

[Sarah and Baby]

Baby did actually have a UTI when I took her to the vet. She was on antibiotics for a very short time, as she HATED them and stopped eating completely and wouldn't come out from under the bed while i was giving them to her. When I took her back to the vet, they said her UTI had been cleared up.

I am dropping back to the 1.25u and now I am not going to raise the dosage until I can get back and test like every other hour like everyone says. Ok, yes I'm being sarcastic, but I will attempt to get many more tests mid-cycle. Cannot do it today though. I am not in town. Sorry about all the cross-posting. I was feeling a bit frustrated last night.

 

[Anonymous]

Hey Sarah, in some rooms here that is not sarcasm...but reality. You only need to get a curve, (every 2 hour test) every so often, monthly until you feel confident. Or pay the vet $100 to do it and get stress cat results.
Pretty much a getting a different + hour every day will start to paint a picture.
It would be great to get a curve in soon so you know the basic idea of what he's doing.
That is diabetes for animal, hooman, anyone...a curve.

 

[Sarah and Baby]

I'm sorry everyone. I didn't mean to come across as ungrateful, I'm really not. I do understand the need for curve testing and for mid-cycle testing. As soon as I get the chance, I will do both of those things.

I am frustrated because right now I am away from home, my mom is coming in twice a day to do her testing and feed her. I am on a short, but much-needed vacation, and everyone here is telling me i need to be home taking care of my cat, and my mom is telling me the same thing. I am just not going to be able to do that right now.

I really really appreciate all of the help I am getting here, I know what i need to do right now, which is keep her at the same dose and do some curve testing. I will start with the curve testing as soon as I get home tomorrow.

 

[Sheila & Beau GA & Jeddie GA]

I don't think anyone thinks you are ungrateful. It is had, especially in the beginning, to fight that impulse to raise the dose in order to get lower numbers. You just need s "bigger picture" of data before making that move. That's all.

Enjoy what is left of your vacation! We all know what it is like to leave our sugarcats home with someone else, but I bet your mom is doing a great job.