Questioning my dose upgrades...

Would someone please stare at my SS I am driving myself crazy

Between 23rd Aug to 29th Aug Kyra was on 2.25 and was mainly in the pinks and had a couple of between 5 and 8.3 readings, but as they weren't consistent we upped him to 2.5 after 7 days.

Between 30th Aug to 5th Sept Kyra was on 2.5 and started to get more reds and blacks but also had a 10.9 PMPS reading. Again after 7 days we upped the dose to 2.75.

Now, between 6th Aug to 10/11th Aug Kyra is on 2.75 and is still getting reds and blacks but has had a couple of nice (but not quite there) blues. Are we still on course to up him to 3.0 on Sunday?

I really can't figure out if I should have kept him on 2.25 to let that work longer but am going by the rule of upping after 7 days if we have had consistent 5-8.3 readings. If someone else could please take a look and let me know. I feel like the higher the dose the more reds and blacks we're getting. Of course bounces could be a culprit but I think I need some input here....

Also I have some Keto-stix on the way - he hasn't been checked for ketones since a few vet visits a go.

 

Hi Jemma, you are getting some steep drops on the current dose. And that alone may be causing bouncing... It does seem to be the case that you were getting gentler drops on the lower dose...
Raising the dose 'may' just slam the blood glucose down harder and faster. A higher dose 'may' achieve lower nadirs, but there could also be a price to pay in terms of higher bouncing...

What exactly are you feeding Kyra at the moment? And what is your feeding schedule?

Eliz

 

Hi Eliz,

He is eating Feringa wet food only along with low carb treats when he is getting his tests.

We remove the food bowls at 5pm and test at 6:45pm - Feed - Injection at 7pm. I would say the majority of his food he eats is about 10-15 minutes after his injection. We just can't get him to stay at his food bowl at the moment. He seems to know his injection is coming so goes and sits in his box after a few mouthfuls.

We aren't able to remove the food bowls 2 hours prior to AM test and we don't have timer bowls - we have to have the raised bowls and I can't find any on an incline... but then I don't think his AM tests are that different to his PM ones which are without food. Do feel free to correct me on that though!

Cheers
Jem

 

Jemma, aha, so he 'does' have access to food in between shots?
...What I'm wondering is whether it's possible to use food to slow down the rate at which the blood glucose drops. Feeding 20- 30 minutes before a Caninsulin shot can often help. But it can happen that a kitty needs a longer interval between being fed and getting the insulin shot if the insulin starts working very early on after being injected.
Another thing that can help is to feed a snack - or part of the main meal - about an hour or hour and a half after the insulin shot.
Yet another thing that can sometimes help (although not practised so much these days) is to feed a slightly higher carb food at the time of the insulin shots, but feed lower carb food during the rest of the day.
It all depends on the cat...

Is he still nervous about insulin shots, Jemma?

 

Yeah food is left out from the time we put it down until it needs to be taken away 2 hours before the PM test. So he gets to graze at his leisure both during the day and night.

Hmm interesting - I would like to avoid any higher carb food if I can - I like the fact that we are off it now, wouldn't want to confuse things getting that back in the mix. I can try and be a bit better about the 20-30min feed before shot - if I can get him to stick to his bowl.

I wouldn't say he is nervous....The problem with Kyra, god love him, is he is a bit slow on the up take. When we first started his injections he'd jump on a chair for us to do it then he decided, oh hold on I don't wanna do that, so we had a couple of awkward weeks trying to get him to settle to have his injection. I then started to give it whilst he was eating. It seemed perfect, he barely knew what I was doing and carried on eating straight after I was done (or even carried on as I did it). But now it seems he has caught on (in typical Kyra timing) to what we were doing so he has a little to eat then scurries off to his box thinking he has tricked us out of doing his injection. So we are now back to doing it on the chair...after I have gone and fetched him from his box. Once it's all over and he knows the coast is clear he goes back to eating his food.

 

Hi Jemma,

It's worth paying attention to Kyra's reluctance to receive injections now. I'm not saying that this is the case for Kyra, but sometimes the action of a particular insulin may disagree with a particular cat. an I've seen similar behaviour exhibited by Saoirse and some other cats on the board in the past when being treated with Caninsulin, and I've seen reports here of other cats not getting on with other insulins. For example, after a while on Caninsulin Saoirse started trying to hide in the most inaccessible place she could find every time her injection was due (happened when using both U40 syringes with 12.5mm needles and U100 syringes with 8mm needles, so not due to the actual injection itself). I think it may have been due to the wide swings in BG that Caninsulin can produce. The behaviour stopped immediately and never returned after I switched her to Lantus.

I suggest keeping a log of such behaviours in the spreadsheet so that it might help you spot any emerging pattern behaviour. Also look out for whether Kyra gets any way lethargic while the Caninsulin is most active in his system.

WRT the spreadsheet, Kyra seems to have a typical response to this type of insulin - big drops between PS and nadir, and petering out of the dose several hours before the next dose is due. As Eliz observes above, big drops can also contribute to big bounces.

If things don't improve soon, I'd suggest talking to your vet about trying a gentler, longer-acting insulin. Under current UK veterinary drug licensing rules, I think your vet may have to opt for Prozinc next before any other insulins may be considered.


Mogs
.

 

Thanks Mogs! that's really useful to know.

I wouldn't say he hides, more just wanders off. His box is really accessible to get to him and he knows we fetch him out of there when ever we need to. There are much better, and more difficult, hiding places he could go to if he really wanted to avoid us. Nevertheless I will note it down how we go each time and how he seems.

Also WRT to being lethargic he always seems pretty bright an alert during these times of nadir. During these times he may either be asleep or just chilling around the house, but if I pick him up to do a test he is alert and purring and looking for his treat. So I'd like to think he is OK...

Do we think I should still up him to 3 units on Sunday, as per the 7 day rule? I wonder then if that doesn't show much improvement and if I get get his urine tested for ketones at home I can send the spreadsheet to the vet and strongly insist we switch to Prozinc.

Is there a reason vets always (in my limited experience) seem reluctant to come off of Caninsulin? Are they paid more for prescribing this than another insulin type?!

 

That all sounds good, Jemma.

Prozinc hasn't been licensed as long as Caninsulin. Maybe they're like many people and prefer to stick with the familiar?


Mogs
.

 

ah maybe!! I have just been doing some reading on the Prozinc forum, all seems so daunting after getting settled in to how Caninsulin works. I'm sure if the vet did switch us though it would all start to make sense soon enough.

I will up Kyra to 3units as of Sunday AM and hopefully get some keto tests done as soon as my sticks arrive. Then if after 7days we still aren't seeing any good improvements I'll send the SS to the vet and ask to be considered for a change of insulin.

Thank you all for your insights x

 

Hi Jemma, it wouldn't exactly be 'higher carb food' as such, it would likely still be below 10% cals from carbs, just a bit higher than is currently the case. It can sometimes be a useful strategy in cats that are very prone to bouncing due to steep drops in numbers. But it can take a bit of experimentation to find out which foods work best for this....

'If' you can just feed 20 - 30 mins before the shot that could certainly help. If Kyra is OK with this...
Bouncing can be really frustrating if it becomes an entrenched pattern. So, anything that can just slow down the drop in blood glucose may help to break that cycle... Do be aware that just increasing the dose may also increase the bouncing problem...

Is this from the Caninsulin user guide? If so then these are just very broad guidelines, and cannot cover every situation. 'Every Cat Is Different'...

I do agree with Mogs that Kyra would most likely do better on a gentler, longer lasting insulin. That may also help with levelling out the numbers.
The current prescribing guidelines recommend longer lasting insulins for cats; Prozinc, lantus, and levemir. Of these three only Prozinc is actually licensed for use in cats. But more vets are willing to prescribe the human insulins, lantus and levemir nowadays too.

Eliz

 

Oh I see - sorry for my misunderstanding there. So currently the food Kyra is on is 3.47% carbs but I have found another that is 9.48%. Maybe worth buying this and adding a little of it to his normal breakfast and dinner? Or have I over shot it with that %?!

I do feel as though we are in a constant bounce. Looking back on when he was on 2.25 he seemed a lot more stable but as he wasn't hitting the 5 - 8.3 nadirs I put him up by .25 after 7 days (as per the Caninsulin use guide) and have carried on doing so every 7 days. I just don't think his scores have been as good as when he was on 2.25. But it seems crazy to drop him back down to 2.25 with his scores being as high as they are.

Talking myself in circles here!! lol

 

I'm absolutely NO expert but after reading through this thread, I have to say, I agree with Mogs. Some cats get on fine with caninsulin. Ive seen it here. But the fact Kyra isnt so willing just may be him telling you "I feel better with out that, but ok...whatever" hes not running away because he trusts you. That is SO sweet!
j

 

Well I am completely second guessing myself now. Just went to do his injection and nearly only gave 2.25. Have I been doing this the whole time or am I over thinking it too much and it was nearly just a balls up tonight. Oh my head!!!

 

LOL BEEN THERE DONE THAT Its enough to make you second guess your own name!
(((Jemma)))

 

Hahaha tell me about it!!!

 

Hi Jemma
We started on caninsulin on 15th Aug at 1iu the vet increased this to 1.5 iu after the 8 day BG curve was reviewed. He asked that we then do a full BG curve once 7-10 days had passed on the new dose. That was last Saturday. The am shot reading was very high then dropped rapidly after the shot, had an early nadir then went back up so overall did not stay in the ideal zone for long.
He would have increased the dose again but when I asked he was very happy to swap us to prozinc instead. He said that was his usual first choice as it tends to give a gentler curve but he had gone with caninsulin as it was the time of the UK shortage. He was not going to suggest a swap just yet if we liked the caninsulin and we had just bought some more but was more than happy to swap us when we asked. He is quite a young vet so maybe hasn't had years for caninsulin to be his go to insulin. But maybe yours will be willing to listen once he sees your results and will have a proper open chat with you about it.
Sending best wishes to you both
Gill

 

Thanks Gill!!

Yeah I think a conversation with the vet is required. Though we have had some good days on caninsulin it's not been consistent enough. We'll see how we get on these next 7days and go from there.

 

If you do end up swapping don't faint when you see the cost (whether via your vet or online) prozinc is 4 times the cost of caninsulin - but the vial is 4 times bigger ! So its really very similar in price - just a slight shock when you see that first bill until you realise that !

 

sticker shock

 

Hi all - little update...Matt and I had a miscommunication I upped Kyra to 3units, Matt thought we were still only giving 2.75. We are now on 3.00.

I know this mistake won't make this week the best to look at due to that inconsistency but we still aren't budging out of the reds and blacks in the AM and PM. Back when we were on 2.25 we were getting pinks in the morning (though admittedly red and blacks in the evening).

We have changed out routine so that Kyra is tested and given his food at 6.30 then his insulin is not until 7.00. I feel like this had made a difference and we aren't getting the significant drops in the first 2 hours like before, but he doesn't seem to be reaching super low numbers to encourage a bounce, not that I can see anyway?!

We also did a ketone test and that appears to be negative https://www.felinediabetes.com/FDMB/threads/ketone-help.235421/

One thing we have noticed over the past 2 nights is that he is a hungry hippo at around 9pm (we have to wait for him to finish before doing his 'bedtime' test) but then that test isn't showing that he has dropped any lower than he is used to and setting in a hypo, so I'm hoping his hunger is a good thing and he is just filling his boots

I do want to point out some positives though - Kyra is the purriest he has been in the longest time. He managed to jump up on both the table and the counter the other day to get chicken (seemed as though he had lost his confidence to do that) and just his general manner is showing I have my old Kyra back. I just want him to have the best numbers.

My plan of action is to keep him on 3.00 for a few days longer to make up for mine and Matt's mistake and then maybe it is time for a call to the vet...I'm worried they will just keep telling me to up the dose tough as we still aren't reaching desirable numbers during the day....will see I suppose...

 

That is such good news - it is so lovely when our sugar kitties start showing those improvements - as lots of posts say on here: celebrate those small victories.
My vet is really rates such clinical signs as being important indicators as to how things are going not only the numbers.
Hoping Kyra keeps purring away
Gill

 

Thanks Gill!! Yeah I feel like I have really tied myself up in the numbers lately and I just need to appreciate my little baby isn't spending all his time under kitchen table anymore. He is happy and interactive again, that's the most important thing.

 

Hi Jemma! I just read though the thread hoping I had something useful to say, but I might settle for . You are doing great! it is fiddly work!

The one thing I noticed, is that Kyra, like Hercs seem to respond strongly when you first change the dose, but then "settles in". As you have seen my day today, I don't reccomend pushing too hard... but it might be that it does need a bit of pushing to get through whatever fight the pancreas is putting up with....(remember I am an absoliute newbie!)

I have changed Hercs food to more concentrated on the first 4 hours of the cycle, for the reason that Eliz said, and it seems like made things a bit steadier...

 

Aww thank you!!!

I was a little frustrated this morning, with the situation not with baby of course but we are all just trying to make our way through the fog!

Yes you're right he has a great day on a new dose then returns himself to the yellows and pinks...

What are you doing with your food then? I measure out his feringa and that is left out throughout the day for him to go back to as he pleases (taken away 2hours before pretest of course) then treats are the feringa sticks and tesco sticks (https://www.zooplus.co.uk/shop/cats/cat_treats_catnip/feringa/816510 and https://www.tesco.com/groceries/en-GB/products/286543599)

 

Well, I am very lucky that I am still mostly working from home. I am getting very stressed on how I am going to manage once I have to be back, but that is a different subject all together.... Anyhoo... for now, I feed him and give him the shot at the same time. he is about 10 lbs, but he could gain a bit, so I am giving him 300g of Feringa cans. 50g at PS, 50g +2, 50g +4. and no food after that (except when he have cheeky days like today...).

The logic was that his food has huge impact on Bg (maybe because he easts so much?) so I tought it will slow his downward by giving him food in regular intervals, and slow the upward by having no food. Not sure it makes a noticeable difference, but it helps me isolate which variable to work on, if that makes sense (what is food effect vs what is insulin effects....)

 

That makes sense. I was giving all 3 of ours 150g fergina each in the am and then a fresh 150g at pm however they were leaving soo much and I was having to throw it away I have reduced the portion sizes, though I think I will have to up them sooner rather than later as Kyra seems to be getting a bit of an appetite back.

I was also giving Kyra his injection as he ate, and that worked brilliantly for a while, but then he caught on which is why I think he went about sheepish about eating. Now he has his test and food then 20-30 minutes later we give the injection. That seems to be making a big difference as we don't seem to be having as many 200 drops between shot and +2 reading.

I'm also working from home and it has been a godsend. I really don't know how well we would have coped getting the diagnoses and me still being at the office. Are your work a bit more flexible now to allow more working from home if you needed to or do you think the return will be back to strict hours on location?

 

Work is flexible, unless when it isn't... There isn't many times when I must be somewhere, but when I do there is no way around if you see what I mean... Besides what time is a good time to walk away until they get into a predictable schedule? Can't be before insulin shot, can't be around nadir time.... I really do hope both Kyra and hercules settle down into some schedule sooner rather than later!