? PS 144- can't wait any more

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AmyB

AmyB

Member Since 2019
I just took Salem's PS and he's at 144 :nailbiting: why this seems to be a trend is beyond me. The problem is I have to work all day today and can't be here to monitor him. I can stall for another 30 mins probably but then I have to make a decision. He's currently on 2U.
 
Now it's dropped to 141 :arghh: If I give him anything I'll just sit and worry all day so I'm assuming it's safe to skip? I don't know if giving him a lowered dosage would work.
 
The second test is basically the same as the first so he is not rising on his own at least not quickly, If there is no history of ketones or DKA then I'd skip today. You've never shot a pre-shot that low so better to be safe than sorry.
 
I tested him for ketones yesterday and he was fine so I'm assuming it'll be okay? He's driving me nuts with these low pre-shots.
 
Actually as crazy as they make you, low pre-shots aren't a bad thing at all. They could be suggesting a dose reduction is needed. We aim to get the pre-shots down so he's really doing what you want him to do. The problem is that he's done it suddenly and not given you the opportunity to try shooting progressively lower pre-shots. While a lower dose might be OK today, you don't have any data to know what a lower dose would do. You're still early in this dance and things are looking pretty good for that time frame so just take it one day at a time.
 
Yeah he was giving me low pre-shots with the 2.5U so I lowered him back to 2 for the weekend and now he’s doing it with this dose. I want to do a curve but I have to work a lot for the next few days so I can’t do it during the day. The vet was saying just to give him the dose even if he’s low but I don’t feel comfortable doing that.
 
I don't agree with that vet advice at all. We recommend no shot for any pre-shot below 200 for those just starting out with little data. As time goes on, and you learn more about how YOUR cat reacts, you can then try dosing on a little lower pre-shot and keep lowering it as appropriate for your cat. Every cat is unique. They don't all need the same dose of insulin and shooting a full dose at low pre-shots is likewise not going to cause the same result for all cats. Slow methodical pre-shot/dose adjustments will allow you to keep Salem safe, you sane, and get Salem regulated much quicker.
 
Yeah right now I’m worried about how he’s going to react, especially since I’m going to be gone all day, so I’d rather not give him a shot than risk it. I feel bad bc his BG will probably skyrocket but he’s not regulated yet so I don’t know what he even needs to be at just yet.

I’m trying to work with the vet cause for the most part I like him and he’s been helpful, but I really don’t want to dose him when he’s that low. I’ll probably talk to him about it next time I go in.
 
Salem is doing so well for a cat just starting out. You also need to keep your sanity so take it slow. Skipping the dose this morning specially since you were not going to be there to monitor was a good call and I agree whole-heartedly with MrWorfMen;s Mom. Take it slow, even if Salem skyrockets you will get back on track. Try not to stress out about it, you just need to do what will keep Salem safe and you sane. Big hug, you're doing great.
 
When you like the vet but disagree on this particular subject, there are a couple of things you can try. One is to ask the vet if he is going to be available 24/7 to help you if Salem goes too low because you shot on a low pre-shot according to his advice or you can just nod and then do what you comfortable with. You hold the needle and the vet is NOT going to be there to assist 24/7. Vets can be absolutely great with most things but diabetes is a hands on situation so when the vet gives you black and white instructions that don't sit right with you, it's OK to be more conservative than suggested. Vets don't get that much instruction on diabetes, most don't have many feline diabetic patients and many mistakenly recommend dosing meant for dogs rather than cats. Your vet is obviously better than a lot of them because at least he isn't against home testing and that alone makes him a keeper in my books.
 
Staying sane right now is next to impossible for me lol. I caught this super early so I guess I’m not too worried about getting him regulated fast? I’d rather take it slow and be careful. It just drives me nuts that he’ll be high on a dose for a few days then suddenly he’s low on it. I’m still learning what all the numbers mean and it’s still pretty confusing.

And yeah he’s been good with most everything else, he was happy that I was willing to home test and he says I’m asking a ton of questions that most people never do. I just wonder if he doesn’t have a ton of experience dealing with this.
 
if your vet is willing to listen and learn from you and your experiences, what a wonderful thing! may turn out to save another cat's life too --

high and low and it doesn't make sense -- hey, he's a cat ... :cat::cat: ...

been there, done that, used the t shirt to wipe up hairballs, just keep reminding yourself that we are ALL paddling this same boat, and all here to support you
 
AmyB said:
he was happy that I was willing to home test and he says I’m asking a ton of questions that most people never do.
Click to expand...
With that description, your vet is definitely a keeper! Consider yourself very lucky!

Most people think insulin will work like medicine but it doesn't. It's a hormone and it works with other hormones to keep BG regulated. Too much insulin can look just like too little and that is a mistake we see happening all the time around here usually due to vet advice. The vet sees high numbers and thinks throwing more insulin at the problem is the solution but it back fires, sets off other hormones and causes even higher BG and it becomes a vicious circle. Eventually kitty can't keep up to the added insulin and numbers drop.

There is also bouncing which is simply kitty's defences going into action prematurely because BG has been elevated for awhile and kitty overreacts when their BG drops too low, too quickly or simply to levels they are no longer used to.

Diabetes is complex but totally manageable with knowledge of how insulin works and the data you collect of how your cat reacts to it. Be patient with yourself and Salem's seemingly erratic BG. This is all normal in the early days because Salem's body has to adjust to being in more normal BG levels again. In a few short weeks, you will have a far better idea of what to expect from Salem and you will feel far more comfortable looking after him.
 
So I actually have a question about the dose being too high- is there a way to tell from the numbers if the dosage is too high? I'm worried my vet has just been increasing based on one number and I don't want him to go too high if he would be better off on a lower dose. I don't have too much data so far, but what i have noticed is he tends to drop and then sit in the 100s and not go back up. I also suspect he's been bouncing a little bit. He's still peeing a bit more than normal but is also getting more water than he's used to? I haven't caught him at the water bowl at all since I started feeding them wet. And his energy levels have improved a bit. Obviously I still want to go in and talk to the vet about this, but I'm just curious what I should be looking for in his numbers. I really want to try testing more but my work schedule is erratic for the next few days.
 
Sometimes it's only by trial and error that we can figure out whether the dose is too high or not. If kitty seems stuck and was getting better numbers on a lower dose, that's sometimes the only clue. If doses have been increased by 1u at a time or even 0.5u at a time sometimes, and numbers remain high, it suggests the dose may be too high and the ideal dose has been skipped over. And of course when you are getting a considerably lower pre-shot at the end of a cycle than at the beginning causing skipped doses, it can also suggest the dose may be too high but it can also suggest kitty is just getting some carry over of the dose. All of these scenarios have to be viewed along with the data collected to really get perspective which is why it's really important to get mid cycle tests when you can. When your schedule is erratic it's hard to do, so just grab a test when you can. All data is good data and helps to fill in the pieces of the puzzle.

Given the lows Salem attained the other day on 2u, I'd reduce the dose to 1.75u (or 1.8u if you are using U100 syringes) and see if that doesn't even out the cycles a bit more. The goal right now should be to find a dose you can safely shoot twice daily without having to skip doses.
 
So I know the lows he got the other day was due to him getting 2.5U and then having a low pre-shot number, which I went ahead and shot 2U and stayed up and monitored him all night. I went ahead and just gave him 2U after his PMPS was 342 so I'll see how that does tonight. Maybe I'll set an alarm and try and grab at least one mid-cycle number. I'm just concerned bc the vet keeps wanting to push him up going off of one mid-cycle number and then I end up like the other night with really low pre-shots. Also I'm using U40 syringes so is it safe to just eyeball the 1.75 if I go for that? I assume it's just trying to get in between the 1.5 and 2 markers.
 
Yes unfortunately, you just have to eyeball the 1.75u as best you can as you said...halfway between the 1.5 and 2u marks.

Amy, take a copy of your spreadsheet with you and show the vet that you've been getting low pre-shots and if he suggests you could have given insulin, tell him you were not comfortable giving it at that low a BG. If he suggests a higher dose based on one BG test especially if that BG is being taken at the vet's office and elevated from vet stress, tell him Salem's BG is not that high at home. If he insists, nod your head and then do what you are comfortable doing dose wise. What you do at home is entirely up to you.
Don't let the vet intimidate you but you don't need to confront him either. You are in control of this situation far more than the vet is and you have to deal with this 24/7....the vet doesn't. Ultimately when Salem is well regulated the vet won't be able to argue with the results.
 
Yeah I think dealing with the vet has been something that is stressing me out. I want to get a more accurate curve on him before I go in again, hopefully I can do that this week. It's just hard because I always think of the vet as a person of authority who should know what they're doing, but now I'm coming to learn that they don't necessarily know what's best. I also worry about changing his dosage all over the place so I'm going to try and keep it the same for a few days unless his numbers are just that low. I really don't want to go above 2 though. I'm feeling way over my head trying to figure all of this out and not being able to rely on the vet is a huge stressor. This site and everyone here have been super helpful, it's just also a lot to take in at once.
 
You are in the very early learning stage and this all seems so overwhelming. Of course you want to be able to rely on your vet but vets are only human and IMHO have one of the hardest jobs on the planet. Your vet learned about all sorts of different diseases for numerous species in vet school. How could they possibly be experts in everything? Vets do their best but they can't be expected to know it all. They have patients who can't tell them if it hurts or when or where it hurts and often times hide their illness very well. When you get right down to it, vets have a very tough job and do a excellent job most of the time despite their inability to clearly communicate directly with their patients. Human doctors are only dealing with one species but we still have specialists for everything.

Everyone helping here has dealt with feline diabetes themselves and has learned from their own experience and the experience of other members here. You will soon be far more of an expert with your cat's diabetes than your vet can ever hope to be based on their training alone. Hands on experience is the greatest teacher and unless your vet has a diabetic cat of their own, they are never going to get that hands on experience.

You are the vet's client as much as Salem is, and as Salem's caregiver, you have to be comfortable with the treatment plan. If your vet isn't willing to listen, seriously consider your concerns, and hopefully learn, there's nothing you can do to change that. That said, you are in control of what you do for Salem at home. This has nothing to do with authority. Your vet should work with you as your partner not as a dictator.
 
Yeah, I get all that and I guess I shouldn't jump to conclusions before actually sitting down and talking with the vet some more. I know that there's only so much they do since they rely on what we tell them and what little testing they can do. I'm hoping once i get some more data I'll be more comfortable with his dosing and coming up with a plan. The vet has listened to all of my concerns so far so maybe if I go talk to him in person we can figure something out that I'm comfortable with. And thank you for all of your advice, I'll be on here a lot I'm sure in the next few weeks trying to get him sorted. It's so nice to get advice from people who have been through all of this.
 
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