Because his BG continues to be high, we just raised Shadow's insulin from 3 units of U40 to 4 units. I am nervous with the increase. If he is going to have a reaction, is that likely to be within a half hour or so after the injection, or should I watch him all night? I don't want to drive him (or me!) nuts but want to be sure I am on hand if he does have a reaction. Any of you with experience, please advise!!! Thanks.
Raise in Insulin - Q re how soon a reaction would be expecte
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JJ & Gwyn [GA]
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Just to confirm: you're on a compounded PZI, yes? Are you giving insulin once a day, or twice a day? And can I ask how you got up to 3 units per day -- what dose did you folks start at, how long did you stay on it before you increased the insulin, and how much did you increase the insulin by? Are you home-testing blood sugar levels and, if so, what was Shadow's evening pre-shot number, and do you have a recent curve?
I'll come back in a minute to explain stuff, but figured I'd post the questions and you could reply while I'm typing some more
I'll come back in a minute to explain stuff, but figured I'd post the questions and you could reply while I'm typing some more
Yes, PZI. We switched a week ago from U100 to U40. Started Saturday on the U40 at 1.5 until Monday AM; went up to 3 units Monday, which he tolerated with no problem but continued high counts= raising it again to 4 for tonight's injection, given about 45 minutes ago. I am doing home testing - this morning he was at 449 and tonight before the injection was at 367. So far HE seems fine but I am a basket case!
JJ & Gwyn [GA]
Active Member
> Are you giving insulin once a day, or twice a day?
I asked this question because cats have very fast metabolisms and they almost always need two shots a day. If your vet had you injecting just once a day, then you need to step back and start over: go to one unit twice a day and see how Shadow reacts to twice-a-day dosing.
> And can I ask how you got up to 3 units per day -- what dose did you folks start at, how long did
> you stay on it before you increased the insulin, and how much did you increase the insulin by?
I asked these questions because another common mistake is for vets to start cats at too high a dose of insulin, or they may increase the dosage too quickly or by too much. Or all three
If Shadow is getting too much insulin for any of the above-mentioned reasons, then he may be experiencing what's called rebound. Basically, he gets too much insulin, his blood sugar drops too low, his body panicks and dumps a bunch of stored sugar into the bloodstream. That prevents Shadow from hypoglycemia, but it also raises his blood sugar artificially high. A not-uncommon mistake is to see that he has high blood sugar and increase the dose again. If this occurs, eventually Shadow runs out of stored sugar in his body and has to go to the emergency vet for hypoglycemia.
Also, if Shadow is experiencing rebound or hypoglycemia, he may be over-sensitive to insulin for a few days, which could make a situation like this worse.
> Are you home-testing blood sugar levels and, if so, what was Shadow's evening pre-shot number,
> and do you have a recent curve?
Assuming that Shadow isn't in rebound, etc, then the nadir for most forms of PZI is somewhere between 5-7 hours after the injection. (Nadir is when the blood sugar is at it's lowest, and the effect of the insulin is at it's peak.) Nadir occurs at a different time for every insulin+cat combination, so it's possible that Shadow's nadir on PZI could be different than the 5-7 hours we most commonly see. If you're home-testing blood sugar levels, you can find out what time nadir occurs by testing his blood sugar every couple hours from pre-shot to pre-shot; this is called a blood sugar curve.
However, you should that if Shadow's pre-shot BG levels weren't high enough, then the blood sugar may drop dangerously low well before the nadir point, which is why I asked whether you had done a pre-shot test.
I asked this question because cats have very fast metabolisms and they almost always need two shots a day. If your vet had you injecting just once a day, then you need to step back and start over: go to one unit twice a day and see how Shadow reacts to twice-a-day dosing.
> And can I ask how you got up to 3 units per day -- what dose did you folks start at, how long did
> you stay on it before you increased the insulin, and how much did you increase the insulin by?
I asked these questions because another common mistake is for vets to start cats at too high a dose of insulin, or they may increase the dosage too quickly or by too much. Or all three
If Shadow is getting too much insulin for any of the above-mentioned reasons, then he may be experiencing what's called rebound. Basically, he gets too much insulin, his blood sugar drops too low, his body panicks and dumps a bunch of stored sugar into the bloodstream. That prevents Shadow from hypoglycemia, but it also raises his blood sugar artificially high. A not-uncommon mistake is to see that he has high blood sugar and increase the dose again. If this occurs, eventually Shadow runs out of stored sugar in his body and has to go to the emergency vet for hypoglycemia.
Also, if Shadow is experiencing rebound or hypoglycemia, he may be over-sensitive to insulin for a few days, which could make a situation like this worse.
> Are you home-testing blood sugar levels and, if so, what was Shadow's evening pre-shot number,
> and do you have a recent curve?
Assuming that Shadow isn't in rebound, etc, then the nadir for most forms of PZI is somewhere between 5-7 hours after the injection. (Nadir is when the blood sugar is at it's lowest, and the effect of the insulin is at it's peak.) Nadir occurs at a different time for every insulin+cat combination, so it's possible that Shadow's nadir on PZI could be different than the 5-7 hours we most commonly see. If you're home-testing blood sugar levels, you can find out what time nadir occurs by testing his blood sugar every couple hours from pre-shot to pre-shot; this is called a blood sugar curve.
However, you should that if Shadow's pre-shot BG levels weren't high enough, then the blood sugar may drop dangerously low well before the nadir point, which is why I asked whether you had done a pre-shot test.
JJ & Gwyn [GA]
Active Member
Okay, we cross-posted
> he is getting injections 2X a day, [....]
> I am doing home testing - this morning he was at 449 and tonight before the injection was at 367.
> So far HE seems fine but I am a basket case!
Injections twice a day is good, and the fact that you're already home-testing is wonderful.
> We switched a week ago from U100 to U40. Started Saturday on the U40 at 1.5 until Monday
> AM; went up to 3 units Monday, which he tolerated with no problem but continued high
> counts= raising it again to 4 for tonight's injection, given about 45 minutes ago.
Okay, you're raising the dose too quickly. You need to give each dose 5-7 days to 'settle in' before you raise it, otherwise you'll quickly pass Shadow's optimum dose. You should also raise the dose by just one unit at a time, otherwise you again risk missing his optimum dose. The high numbers you're seeing may be rebound.
Has Shadow ever had either ketones or diabetic ketoacidosis (DKA)?
(Will be back in a moment to talk about ketones and food .... )
> he is getting injections 2X a day, [....]
> I am doing home testing - this morning he was at 449 and tonight before the injection was at 367.
> So far HE seems fine but I am a basket case!
Injections twice a day is good, and the fact that you're already home-testing is wonderful.
> We switched a week ago from U100 to U40. Started Saturday on the U40 at 1.5 until Monday
> AM; went up to 3 units Monday, which he tolerated with no problem but continued high
> counts= raising it again to 4 for tonight's injection, given about 45 minutes ago.
Okay, you're raising the dose too quickly. You need to give each dose 5-7 days to 'settle in' before you raise it, otherwise you'll quickly pass Shadow's optimum dose. You should also raise the dose by just one unit at a time, otherwise you again risk missing his optimum dose. The high numbers you're seeing may be rebound.
Has Shadow ever had either ketones or diabetic ketoacidosis (DKA)?
(Will be back in a moment to talk about ketones and food .... )
Nope, neither ketones nor DKA so far. He actually seems to be feeling good: has started playing again and eats well. His vet wanted to raise the dosage again because she is very concerned about his consistently high counts; in effect he has has only been below 315 once in the 3 weeks since his diagnosis. We are doing another curve on Friday.
JJ & Gwyn [GA]
Active Member
Dose raising: BTW, in the PZI forum, there's a sticky with some information about some of the forms of PZI. You can get to the forum by using the 'Jump To' box in the lower right-hand corner of the page. A direct link to the sticky is here. At a very minimum, you'll want to review the linked notes on Start Low, Go Slow.
Handling hypos: You'll also want to read Melissa and Popcorn's on signs and symptoms of hypoglycemia and how to treat it, and Jojo and Bunny's post on making sure you have everything available to do as much as you can to treat hypoglycemia at home. (Note that sometimes you *have* to take a hypoglycemic cat to the vet's, but sometimes you can treat at home.) Read the posts, and print Melissa's post out and tape it to the side of your fridge. When you suspect a hypo is not the time to find that your internet connection has gone down.
Ketones are a not-common possible side effect of uncontrolled or under-controlled diabetes. Low levels of ketones may be treatable at home; high levels of ketones may require hospitalisation at a 24-hour care facility. For this reason, we recommend that anyone who's cat has unregulated / under-regulated diabetes test their cat for ketones.
You can pick up ketostix in the diabetic section of most pharmacies (some folks have reported that they're kept behind the counter in their area; I've always found them in the aisle). You stick the ketostix in fresh urine and, if it changes color, ketones are present. The more the color changes, the more ketones are present.
If a cat has ketones, or has a history of ketones/DKA, then that's a reason to consider raising his/her insulin dose faster or in higher increments than we would normally consider, which is why I asked whether Shadow had any history of ketones.
Back in a moment with more comments / questions ...
Handling hypos: You'll also want to read Melissa and Popcorn's on signs and symptoms of hypoglycemia and how to treat it, and Jojo and Bunny's post on making sure you have everything available to do as much as you can to treat hypoglycemia at home. (Note that sometimes you *have* to take a hypoglycemic cat to the vet's, but sometimes you can treat at home.) Read the posts, and print Melissa's post out and tape it to the side of your fridge. When you suspect a hypo is not the time to find that your internet connection has gone down.
Ketones are a not-common possible side effect of uncontrolled or under-controlled diabetes. Low levels of ketones may be treatable at home; high levels of ketones may require hospitalisation at a 24-hour care facility. For this reason, we recommend that anyone who's cat has unregulated / under-regulated diabetes test their cat for ketones.
You can pick up ketostix in the diabetic section of most pharmacies (some folks have reported that they're kept behind the counter in their area; I've always found them in the aisle). You stick the ketostix in fresh urine and, if it changes color, ketones are present. The more the color changes, the more ketones are present.
If a cat has ketones, or has a history of ketones/DKA, then that's a reason to consider raising his/her insulin dose faster or in higher increments than we would normally consider, which is why I asked whether Shadow had any history of ketones.
Back in a moment with more comments / questions ...
JJ & Gwyn [GA]
Active Member
> Nope, neither ketones nor DKA so far. He actually seems to be feeling good: has started playing
> again and eats well. His vet wanted to raise the dosage again because she is very concerned
> about his consistently high counts; in effect he has has only been below 315 once in the 3 weeks
> since his diagnosis. We are doing another curve on Friday.
Are you doing the blood curves at the vet's or at home? I'm asking because many cats are stressed when they're at the vet's, so their blood sugar levels can be artificially high at the vet's. If you're raising the dose based solely on curves done at the vet's, you may once again have missed Shadow's optimal dose.
Does Shadow have any other health issues at present, or is he on any other medications? Any medical condition that causes pain, infection or inflammation -- even something minor like tartar build-up on the teeth -- can increse BG levels. So can some medications. If Shadow has a health problem or is on medications, it's possible that that's contributing to keeping his BG levels high.
> again and eats well. His vet wanted to raise the dosage again because she is very concerned
> about his consistently high counts; in effect he has has only been below 315 once in the 3 weeks
> since his diagnosis. We are doing another curve on Friday.
Are you doing the blood curves at the vet's or at home? I'm asking because many cats are stressed when they're at the vet's, so their blood sugar levels can be artificially high at the vet's. If you're raising the dose based solely on curves done at the vet's, you may once again have missed Shadow's optimal dose.
Does Shadow have any other health issues at present, or is he on any other medications? Any medical condition that causes pain, infection or inflammation -- even something minor like tartar build-up on the teeth -- can increse BG levels. So can some medications. If Shadow has a health problem or is on medications, it's possible that that's contributing to keeping his BG levels high.
The 1st curve was done at the vets; i am staying home on Friday so I can do it at home (I do worry about the stress even though my vet is truly wonderful it's a long trip and a long day for him).
His teeth were cleaned in December and have been checked so he does seem fine on that count. He was diagnosed with a heart condition two years ago but has been asymptomatic since. He has only recently become my cat: he is actually my brother's but because my brother is having some health problems of his own Shadow has moved to live with me for diabetes management- so there has been a lot of stress for him since the diagnosis: leaving home, plane flight, meeting the cats already in residence -
I will ask about rebound; and get the ketostix; thanks for those thoughts. It really helps to be able to explore this with otehrs who are more experienced than I am!
His teeth were cleaned in December and have been checked so he does seem fine on that count. He was diagnosed with a heart condition two years ago but has been asymptomatic since. He has only recently become my cat: he is actually my brother's but because my brother is having some health problems of his own Shadow has moved to live with me for diabetes management- so there has been a lot of stress for him since the diagnosis: leaving home, plane flight, meeting the cats already in residence -
I will ask about rebound; and get the ketostix; thanks for those thoughts. It really helps to be able to explore this with otehrs who are more experienced than I am!
JJ & Gwyn [GA]
Active Member
[and we're crossing-posting again ... ]
The last thing to cover is diet. What are you feeding Shadow? Most diabetic cats (unless they have other health issues), do best on a diet that's less than 10% carbohydrates. Feeding them a higher-carb diet is like feeding a human diabetic pizza and ice cream and wondering why they have problems with their blood sugar.
You can check out the carbohydrates in many foods sold in the US and else in Janet and Binky's food charts. Assuming you're feeding a high-carb food (and that includes almost all dry foods), print the charts out, take them to your local store and pick up a selection of low-carb foods for Shadow to taste-test. You're looking for one or more low-carb foods that Shadow likes to eat, that fit in your budget, and that are easy to find in your area.
However, the switch from high-carb to low-carb food *will* have an effect on BG levels. If you are currently giving a high-carb food, please do NOT switch to a low-carb food without also reducing the amount of insulin being given *and* home-testing BG levels.
Oops -- almost last thing. You seem to be ahead of a lot of folks when they arrive here, but we all know how overwhelming this can be. We're here to help, so ask whatever you need to and we'll do our best to answer
The last thing to cover is diet. What are you feeding Shadow? Most diabetic cats (unless they have other health issues), do best on a diet that's less than 10% carbohydrates. Feeding them a higher-carb diet is like feeding a human diabetic pizza and ice cream and wondering why they have problems with their blood sugar.
You can check out the carbohydrates in many foods sold in the US and else in Janet and Binky's food charts. Assuming you're feeding a high-carb food (and that includes almost all dry foods), print the charts out, take them to your local store and pick up a selection of low-carb foods for Shadow to taste-test. You're looking for one or more low-carb foods that Shadow likes to eat, that fit in your budget, and that are easy to find in your area.
However, the switch from high-carb to low-carb food *will* have an effect on BG levels. If you are currently giving a high-carb food, please do NOT switch to a low-carb food without also reducing the amount of insulin being given *and* home-testing BG levels.
Oops -- almost last thing. You seem to be ahead of a lot of folks when they arrive here, but we all know how overwhelming this can be. We're here to help, so ask whatever you need to and we'll do our best to answer
I have him on the DM dry and am starting to think I need to revisit that. I will review at the food chart you sent ASAP; thanks!
I am trying to learn as much as I can as fast as I can, but I hate the fact that Shadow pays the price for any error or slowness in my learning curve!!! I am really grateful for the support; it helps enormously.
I am trying to learn as much as I can as fast as I can, but I hate the fact that Shadow pays the price for any error or slowness in my learning curve!!! I am really grateful for the support; it helps enormously.
JJ & Gwyn [GA]
Active Member
In the absence of other health issues / medications that complicate things, the things that will make the biggest difference in his life are:
1. home-test BG levels -- before every shot to know that it's safe to give insulin; do intermittent spot-checks between shots to gather data on how he re-acts to insulin and to check whether he's going too low; do curves to know how he's reacting to the insulin over the course of a normal day; and test anytime he appears to be acting / feeling 'off'.
2. switch to a low-carb diet;
3. know the ins and outs of your insulin (see the PZI sticky I mentioned earlier). And start with a low dose and raise that dose slowly. Any BG data you have, you can post to the boards and ask for dosing advice.
At the moment, my suggestions to you would be:
1. Bookmark this board, then print out the hypo post and stock your hypo toolkit;
2. continue testing BG levels. Keep a log of BG numbers and how much insulin you gave;
3. go back to 1 unit of PZI twice a day, give that several days to 'settle in', then ask for dosing advice before increasing the insulin;
4. switch to low-carb food;
5. test for ketones;
6. read the sticky in the PZI forum;
7. when you have some time, there's a sticky in the Tech Support forum on creating an online spreadsheet so you can easily share your BG testing data with others. (See this link.) But until you have time to address the spreadsheet issue, it's perfectly fine to just type the info into your forum posts.
8. any questions you have, just ask. We've all asked questions that we were *sure* were stupid, and it turned out that we were wrong;
9.breathe
> It really helps to be able to explore this with otehrs who are more experienced than I am! [...]
> I am really grateful for the support; it helps enormously.
You're more than welcome. We've all been exactly where you are right now; we're just paying forward a little of the help and support we received ourselves
1. home-test BG levels -- before every shot to know that it's safe to give insulin; do intermittent spot-checks between shots to gather data on how he re-acts to insulin and to check whether he's going too low; do curves to know how he's reacting to the insulin over the course of a normal day; and test anytime he appears to be acting / feeling 'off'.
2. switch to a low-carb diet;
3. know the ins and outs of your insulin (see the PZI sticky I mentioned earlier). And start with a low dose and raise that dose slowly. Any BG data you have, you can post to the boards and ask for dosing advice.
At the moment, my suggestions to you would be:
1. Bookmark this board, then print out the hypo post and stock your hypo toolkit;
2. continue testing BG levels. Keep a log of BG numbers and how much insulin you gave;
3. go back to 1 unit of PZI twice a day, give that several days to 'settle in', then ask for dosing advice before increasing the insulin;
4. switch to low-carb food;
5. test for ketones;
6. read the sticky in the PZI forum;
7. when you have some time, there's a sticky in the Tech Support forum on creating an online spreadsheet so you can easily share your BG testing data with others. (See this link.) But until you have time to address the spreadsheet issue, it's perfectly fine to just type the info into your forum posts.
8. any questions you have, just ask. We've all asked questions that we were *sure* were stupid, and it turned out that we were wrong;
9.breathe
> It really helps to be able to explore this with otehrs who are more experienced than I am! [...]
> I am really grateful for the support; it helps enormously.
You're more than welcome. We've all been exactly where you are right now; we're just paying forward a little of the help and support we received ourselves
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