Random hypos and where to go from here.

[Sue and Oliver (GA)]

I've heard of people who fashion a box with a hole for a door big enough for the cat but not the dog?

 

[Becky and Toby]

I've heard of people who fashion a box with a hole for a door big enough for the cat but not the dog?

Yeah, something like that - or a similar set-up courtesy of furniture - sounds like it could work.

Toby has had a very strange day today, I'm not sure what to make of it. They're excellent numbers, but what's caused them? And I know it's recommended that 11 is safe to shoot at, but because it's so abnormal it certainly doesn't feel it.

 

[Elizabeth and Bertie]

... I know it's recommended that 11 is safe to shoot at, but because it's so abnormal it certainly doesn't feel it.

Hi Becky,

It's not so much that "11 is safe to shoot at" but rather that we don't recommend that folks new to diabetes give shots at less than 11, until they've gathered some data about how their cat responds to shots at lower numbers.... If that makes sense.... Once people have gathered data on how their cat responds to insulin they may well give their cats shots at numbers lower than 11 (I often give Bert shots as soon as he gets above 8).

Your Toby is a tad tricky in that a unit of insulin can drop his blood glucose from 21.7 to 4.7 in 4 hours. That's not what he typically does but we know that it can happen. And neither do we know why it happens. That may become clearer later on....

Have you given Toby insulin this evening yet? And if so, was his preshot number 17.6? And did you give one unit?
You don't have to stick to the one unit dose. If you are concerned (and if you're not going to be around to monitor his response) you could always give a reduced dose.

Eliz

 

[Becky and Toby]

... I know it's recommended that 11 is safe to shoot at, but because it's so abnormal it certainly doesn't feel it.

Hi Becky,

It's not so much that "11 is safe to shoot at" but rather that we don't recommend that folks new to diabetes give shots at less than 11, until they've gathered some data about how their cat responds to shots at lower numbers.... If that makes sense.... Once people have gathered data on how their cat responds to insulin they may well give their cats shots at numbers lower than 11 (I often give Bert shots as soon as he gets above 8).

Your Toby is a tad tricky in that a unit of insulin can drop his blood glucose from 21.7 to 4.7 in 4 hours. That's not what he typically does but we know that it can happen. And neither do we know why it happens. That may become clearer later on....

Have you given Toby insulin this evening yet? And if so, was his preshot number 17.6? And did you give one unit?
You don't have to stick to the one unit dose. If you are concerned (and if you're not going to be around to monitor his response) you could always give a reduced dose.

Eliz

Yes, sorry, I understand that. I meant it more like "I know that it's generally accepted that even newbies can shoot at 11, but right now I don't feel safe shooting even at 17, because he's been so unpredictable today". Sorry I didn't make that clearer.

And whilst we're on the subject, when I say things like "But why? What's causing it?" it is purely rhetoric... I'm not expecting clairvoyancy from anyone, just thinking out loud :mrgreen: I've just had the realisation that it makes me look a wee bit demanding, so I thought I'd throw it out there.

I've not given him his insulin yet, no, because he couldn't afford to drop 17 again =/ And now I'm having a glucose monitor malfunction! Gahhh...

(Thank you for your input.)

 

[Becky and Toby]

He hasn't been tested - nor received insulin - since yesterday morning due to an issue with his Codefree monitor. We bought an Accu-Chek Aviva today, and just checked him and got 18.6. I chose to shoot him with 0.5 due to his unpredictable nature and not really knowing if the Aviva reads the same. What a strange little gentletom you are, Toby.

 

[Elizabeth and Bertie]

He hasn't been tested - nor received insulin - since yesterday morning due to an issue with his Codefree monitor. We bought an Accu-Chek Aviva today, and just checked him and got 18.6. I chose to shoot him with 0.5 due to his unpredictable nature and not really knowing if the Aviva reads the same. What a strange little gentletom you are, Toby.

Hi Becky,

The Accucheck Aviva is quite popular in the UK (and, just in case you don't already know this, the test strips are usually available on Ebay far more cheaply than in the pharmacies. (Hooray for Ebay!))

Gosh, 18.6 after a day (?) with no insulin? That is quite an improvement, isn't it? Is Toby eating more of the low carb food now..? What sort are you feeding him?

Oh, re your previous post - you don't seem at all "demanding"! :lol: Your pondering of why the blood glucose numbers vary so much is entirely natural and understandable! Bertie had a very similar pattern to Toby for quite a while after he was diagnosed (high numbers interspersed with sudden inexplicable drops. I spent a lot of time puzzling over that.... :roll: )

You're doing a great job, Becky. Toby is very lucky to have you looking after him. cat_pet_icon

Eliz

 

[Becky and Toby]

He hasn't been tested - nor received insulin - since yesterday morning due to an issue with his Codefree monitor. We bought an Accu-Chek Aviva today, and just checked him and got 18.6. I chose to shoot him with 0.5 due to his unpredictable nature and not really knowing if the Aviva reads the same. What a strange little gentletom you are, Toby.

Hi Becky,

The Accucheck Aviva is quite popular in the UK (and, just in case you don't already know this, the test strips are usually available on Ebay far more cheaply than in the pharmacies. (Hooray for Ebay!))

Gosh, 18.6 after a day (?) with no insulin? That is quite an improvement, isn't it? Is Toby eating more of the low carb food now..? What sort are you feeding him?

Oh, re your previous post - you don't seem at all "demanding"! :lol: Your pondering of why the blood glucose numbers vary so much is entirely natural and understandable! Bertie had a very similar pattern to Toby for quite a while after he was diagnosed (high numbers interspersed with sudden inexplicable drops. I spent a lot of time puzzling over that.... :roll: )

You're doing a great job, Becky. Toby is very lucky to have you looking after him. cat_pet_icon

Eliz

I plan to transition back to a Codefree (checked it against the Alphatrak at the vets, got 27.5 and 29.2 respectively so it ain't half bad) because it's still way cheaper than the Aviva, but it'll certainly be nice to have the Aviva around the house as a back-up (for one thing, it's so simple to just stroll into a pharmacy and get anything you need for that one).

Yeah, it's confusing, but I guess it can only really be in a good way. He's probably been eating a slighter higher LC:USO, but I wouldn't have said it was that dramatic. Then again, people do say the effects of LC can take a week to really kick in, no? Hm. He's been eating Butcher's Classic and Gourmet. He's also been looking really well, so I plan to trial all LC soon and keep a close eye on that litter box.

Thanks Have you hometested Bertie from the start, by the way? If so, was it at a vet's suggestion or your own research?

Thank you :smile: He's a lucky little man in general.

 

[Becky and Toby]

Just a quick note... managed to check the Tubs with the Codefree and the Aviva, got 15.3 and 14.3 respectively.

 

[Becky and Toby]

Checking for ketones was never suggested to me until this forum, so I only got the strips a few days ago. Until now, I hadn't caught Toby peeing at a time when I didn't forget all about ketones and simply do a happy dance over his constantly improving toilet habits. Anyway, just checked him and got absolutely nothing Also, we're trialing NO USO right now, so it's good for him to get used to everyone following him to the toilet ;-)

 

[Becky and Toby]

Looking at Toby's spreadsheet, is it paranoia making us decrease his dose or does it seem the best course of action? =/ We checked that 14.7 twice because it was hard to believe, but couldn't bring ourselves to give him the full 1U. I know at the end of the day it's up to us, but I was just looking for some opinions regarding if we're short-changing him or not.

Thanks!

 

[Wendy&Tiggy(GA)]

Can you get a test around PMPS +4 or +5? I wouldn't want to do a dose change without checking how low he is going on this one!

 

[Becky and Toby]

Can you get a test around PMPS +4 or +5? I wouldn't want to do a dose change without checking how low he is going on this one!

Oh yes, we'll be getting a +4 as usual because that appears to be his lowest point. It will be in approximately 90 minutes.

 

[Becky and Toby]

Eeesh, way to confuse me, Mr Tobe.

 

[Wendy&Tiggy(GA)]

Maybe cos you just gave 0.5?

 

[Becky and Toby]

Maybe cos you just gave 0.5?

Yeah, but I'd still expect more of "his numbers generally aren't as low" rather than "they're not low for as long". Seems it doesn't work that way. He's just so unpredictable with how much each dose drops him, and I'm definitely still paranoid about hypoglycemia... I guess intracardiac injections will do that to you =[

 

[Elizabeth and Bertie]

...I guess intracardiac injections will do that to you =[

"Intracardiac injections"...??? :shock:

 

[Becky and Toby]

...I guess intracardiac injections will do that to you =[

"Intracardiac injections"...??? :shock:

Yeah, remember I said in my first post that at Toby's last hypo an injection was administered to him at roughly his ribs? I got to read his notes from that a few days ago, and it says that the vet gave him diazepam in an attempt to stop the seizures, and then attempted to insert an IV, failed, and gave him an intracardiac injection. That's how bad a shape he was in. I feel guilty as hell that it ever got that far, and we're NOT going to be having any hypos again.

In brighter news, his numbers are getting better and better, however.

 

[Elizabeth and Bertie]

...That's how bad a shape he was in. I feel guilty as hell that it ever got that far....

Oh, (((Becky))), please don't beat yourself up about that. We all have 20/20 vision in hindsight. Your were doing the best that you could for Toby at that time. But now you've found more information and you have the benefit of your own experience of hometesting Toby.

Yes, the blood glucose numbers are looking better and better! Great job! :smile:

Eliz

 

[Becky and Toby]

...That's how bad a shape he was in. I feel guilty as hell that it ever got that far....

Oh, (((Becky))), please don't beat yourself up about that. We all have 20/20 vision in hindsight. Your were doing the best that you could for Toby at that time. But now you've found more information and you have the benefit of your own experience of hometesting Toby.

Yes, the blood glucose numbers are looking better and better! Great job! :smile:

Eliz

Thank you. I can mainly accept that we really were talked into it, but it's still left me a bit paranoid!

We got a 9.9 this evening. 0.5 for the whole day it is. Hmm, Toby.

 

[Elizabeth and Bertie]

Becky,

Just took a peek at Toby's chart and his numbers are just getting better and better! Very exciting stuff indeed! (And those coloured charts are a great way to actually 'see' the progress, aren't they?)

You are doing a fantastic job. You've clocked up quite a bit of hometesting experience now and I get a sense that you're really beginning to develop a 'feel' for what works best for him.

Looking at those numbers, it would seem at the moment that Toby IS doing just fine on Caninsulin too....(so maybe it won't be necessary to switch insulins...?)

How is Toby in himself? Does he seem to be feeling better?

Eliz

 

[Becky and Toby]

Becky,

Just took a peek at Toby's chart and his numbers are just getting better and better! Very exciting stuff indeed! (And those coloured charts are a great way to actually 'see' the progress, aren't they?)

You are doing a fantastic job. You've clocked up quite a bit of hometesting experience now and I get a sense that you're really beginning to develop a 'feel' for what works best for him.

Looking at those numbers, it would seem at the moment that Toby IS doing just fine on Caninsulin too....(so maybe it won't be necessary to switch insulins...?)

How is Toby in himself? Does he seem to be feeling better?

Eliz

I know, I'm so impressed He'll be 16 in April and whooo knows how long he's been diabetic, so I wasn't really expecting such an improvement. The charts are great, I was remarking just yesterday that it's awesome to see whole new blocks of different colours

I am, but I'm also aware that I might be erring on the side of caution just a little too much. He is unpredictable, but I think I need to learn to shoot just a little bit lower. Maybe implement some .25 doses, and maybe even .75 instead of .5 in some cases. Might need some different syringes for that though...

Bit of a surprise too, yeah. He was definitely metabolising it pretty fast at first, but even with it completely out of his system it's pretty smooth sailing now, so maybe that's partly why it's working :razz:

He's very well His coat's looking good, he looks more alert and brighter-eyed, he definitely has a healthy appetite, but he's not constantly after food and acting like he's starving. He runs between rooms now It means he raises more hell now, but hey, fair trade-off :lol:

 

[Elizabeth and Bertie]

Hi Becky,

Are you using the 'vetpen' thingy or the Caninsulin syringes? I've only ever used the .5ml Caninsulin syringes but, from what I've heard/read it can be easier to vary the doses more accurately with the syringes than with the vetpen (and with .25 and .75 dosages it's a matter of 'reading between the lines' ...literally....). But I've not used the 'vetpen' so don't have actual experience to compare....

Another alternative, methinks, could be to further reduce the carb content of Toby's food... What are you feeding Mr Tobes at the moment?

I have to say that it is just SO encouraging to see his blood glucose numbers drop like this. With a cat who's been diabetic for a little while it's tempting to think that this can't happen - but it can! :smile:

I'm guessing (and it is only a guess) that Toby's pancreas is healing and producing more insulin of it's own. And not only does it seem to be producing more insulin but it seems to be producing it more consistently, hence a) the more stable numbers, and b) the fact that the numbers aren't flying up after the Caninsulin has left the system. This is only my theory, based on what I have seen/experienced/'thought to be the case' with my own cat; but whatever the reason for what's happening with Toby, the results are very promising indeed! :smile:

Eliz

 

[Becky and Toby]

Haha, we're currently using the syringes but were actually considering the vetpen doodah because we were told it's easier with that! Well, also because when Toby had issues with very low numbers we were repeatedly asked if we were sure we hadn't given him more insulin than we thought :roll: It sounds like that's another crock, so may as well eyeball those .25 and .75s too.

He hasn't had USO since 27/10. He's eating Butcher's Classic most of the time, with the occasional pate at about 2.7% when he seems to fancy a change. He really isn't a picky eater, it's just nice to distract him with something when he feels he's missing out on something the girls have got :lol: Again, that isn't often because they mainly eat with him, the kitten just really wants a few biscuits sometimes, and the other moggy is a bit of a Dreamies addict. I'm still reading up on food and am definitely open to feeding him something else, I'm just slightly overwhelmed by the options. I mean, Toby definitely likes the pates, for example, but I can't really find any information on them.

I agree. I definitely think a part of it is that we're putting less sugar into the cat, but his little body certainly seems to be having a good go at it too! It really is wonderful to see :smile: As is that 11 we got tonight

 

[Elizabeth and Bertie]

Hi Becky,

Re the "vetpen doodah", I heard/read that it's considered an accurate way to give a specific dose (the dose is set on the dial so there's less opportunity for 'user error') but that the doses on the cat vetpen are in .5 unit increments and so it's not so easy to do less than .5 of a unit, or to do 'between' doses, such as .75. (But I could be wrong about this......)

There is some general info on the Caninsulin vetpen here.
http://www.caninsulin.co.uk/vetpen/about-vetpen.asp

I don't use the same insulin or syringes as you but I regularly shoot doses that aren't a full unit or a half unit. Our typical dose is currently .75 of a unit. But, depending on Bert's numbers (and the 'pattern' of how his body seems to be dealing with insulin at any given time) it could be anything from a 'skinny half unit' up to a 'fat whole unit'. And it is a matter of 'eyeballing' it. A light behind the syringe and/or a magnifying lens can help!

Some folks using very small doses of Caninsulin actually find it easier to use different syringes (made for different insulin) with a conversion chart. Using different syringes (made for different insulin) is not generally recommended because of the errors that can occur if people haven't fully understood the conversion method, but some folks do find it very helpful.

Quick explanation: Caninsulin is a 'U40' insulin. That means it contains 40 units of insulin per ml. Most insulins are 'U100' insulins. They contain 100 units of insulin per ml. So, a U100 insulin is 2.5 times as 'strong' as a U40 insulin. That means, for example, that a unit of U40 Caninsulin would measure to the 2.5 unit mark on a U100 syringe, and .4 of a unit of Caninsulin would measure as 1 unit on a U100 syringe, and .2 of a unit of Caninsulin would measure to the .5 mark on a U100 syringe.
The conversion chart is here if you want to see how that works:
http://www.felinediabetes.com/insulin-conversions.htm

This may be more info than you either want or need. Sorry. I've had a lot of coffee this morning, he-he! @-)

Will try to post some cat food info later.

Eliz

 

[Elizabeth and Bertie]

...He's eating Butcher's Classic most of the time, with the occasional pate at about 2.7%
I'm still reading up on food and am definitely open to feeding him something else, I'm just slightly overwhelmed by the options. I mean, Toby definitely likes the pates, for example, but I can't really find any information on them.

Becky, if Toby likes smooth (rather than chunky) style foods there are quite a few low carb foods that might be worth a try, especially if you're willing to buy online. Prices vary quite a bit.

The following have a finely minced consistency.

From Zooplus: Bozita canned food is popular and very economical. I think it's about 4% calories from carbs. (Bozita also do a chunks in jelly type food, slightly higher carb, in tetrapacks). The link is here:
http://www.zooplus.co.uk/shop/pet_food/ ... ita_canned
Bozita is also available from some independent pet stores and garden centres.

Also from Zooplus are Catz Finefoods and Grau 'grain-free'. Some of the Catz Finefoods are very low carb indeed. And Zooplus have mixed trial packs of it available at the moment, so it's a good chance to try out the different flavours.
The Grau 'grain-free' has about the same carb content as Butchers Classic, I think (about 8%), but it is a premium food with high meat content. It's pricey though, but can be quite economical in the huge 800g tins. There is a trial pack of Grau grain-free available at the moment too (but the yellow tin in the pack works out too high in carb for diabetics...)
http://www.zooplus.co.uk/shop/cats/cann ... z_finefood
http://www.zooplus.co.uk/shop/cats/cann ... uches/grau

Zooplus offer free delivery on orders of over £25. The parcel will need signing for. (Or I think there is the option of getting the parcel delivered to a post office to be collected from there).

The Happy Kitty Company also have some good foods that may be worth a try.
Some of the Mac's grain-free varieties are very low carb. It's a good quality economical food too. Ropocat is also available from the Happy Kitty Company, as is (going up in price range and quality) Granatapet. Granapet is popular with many cats, and most varieties are very low carb.
Delivery costs for orders over 5kg (equivalent of around 13 x 400g tins) is £3.95. But The Happy Kitty have some special trial offers going on too (including postage costs) which may be worth considering.
http://www.happykittycompany.co.uk/pages/special-offers

There are lots of other good foods out there too. For specific varieties and carb values do have a look at Juliet's (AKA 'Dr Schrodinger' here at FDMB) 'Useful Food Chart For Brits'.
https://docs.google.com/spreadsheet/ccc ... mWmc#gid=1

Eliz

 

[Becky and Toby]

Ah, we must have only been discussing it with the vet in terms of those .5 doses then. That makes sense. Also, the whole 'there's no possible way he's had a hypo because he's on EIGHT UNITS a day. Must be something else'.

Our vet has actually told us that he has some 'skinnier' syringes so that, to the eye, the space between units is larger. I am familiar with the U40/U100 conversions too (but thanks for taking the time all the same!) and have considered that as an option, but my partner - who does a lot of the actual putting the needle in the cat - is uncomfortable with the idea. Paranoid about messing it up. That happens to be the main problem with .25 and .75, too, he's worried about misjudging it. It looks like our best option is simply to practice and get him comfortable with the regular syringes, however, or have me draw the insulin even if he's going to do the sticking. Now I just need to evaluate what calls for a .25 or a .75 nailbite_smile


As for Toby liking smooth food, he just likes food :lol: I'm definitely willing to buy online though.

The Bozita is one I've been seriously considering, I'm just slightly put off by the one flavour, just in case Toby does happen to throw a diva-fit :lol: I guess I could go for a couple of smaller packs instead, or even two huge ones... but that's a whole lot of cat food if no one wants to eat it! I'm not very familiar with the others you've linked, I'll take a look at those now, and I'll pore over that list, too.

Thank you very much for all the help! :RAHCAT

 

[Elizabeth and Bertie]

...Our vet has actually told us that he has some 'skinnier' syringes so that, to the eye, the space between units is larger.

Ahaa.... Have you been using the 1ml syringes that hold up to 40 units? There are .5ml ones available too, so these would certainly look skinnier by comparison. There's a pic of the (3) available sizes here:
http://www.vetmedsdirect.co.uk/caninsul ... 0-x-0-5ml/

And have you been buying syringes from your vet? They can be a lot cheaper to buy online, and worth shopping around for... (ie vetuk.co.uk, medicanimal, viovet, vetmeds direct... Some sites offer free postage too.)

...Now I just need to evaluate what calls for a .25 or a .75 nailbite_smile

Becky, it might be worth your starting a new thread asking for 'sliding scale' help, and getting some more eyes and expertise on Toby's chart.
And in fact you are already beginning to work out a 'sliding scale' for Toby (for example you've worked out when it might not be appropriate to give a full unit and have tried .5 instead).

You are certainly seeing more consistency lately in Toby's response to insulin (no sudden steep drops (touch-wood, anti-jinx!)), so maybe this is the time to start experimenting with slightly different dosages if you and your partner are comfortable with this (it sounds like you're a great team, BTW! Toby is very lucky).

One thing I'm wondering is - if you could get the hang of measuring a .25 unit dose then that could give you an alternative option for some of the evenings where you're skipping a dose (because the evening preshot number is too low for you to feel comfortable to give .5 unit...?)

Oh, re the cat foods I linked to, yes some of them will seem very unfamiliar. Quite a few really good foods have only recently become available in the UK. Most of these are from Germany, where they make exceptionally good cat food for some reason! (And some of us are thrilled that these are available here now because it's a lot easier than importing from German websites... ;-) )

Lowering the carb content of Toby's food could make quite a difference to him. It certainly looks like his body is really trying to heal itself...

Eliz

 

[Sue and Oliver (GA)]

I'm with Elizabetn - new thread as this one is two pages. Toby is doing very well!

You might ask in the new thread if Canninsulin U40 could be given with U100 syringes if the conversion chart is used. PZI users (U40 insulin) often get 1/2 unit U100 syringes so they can dose under .5 units. But they have to convert the dose. See this chart:

http://www.felinediabetes.com/insulin-conversions.htm

It seems like it should work for Canninsulin, but I don't know if anyone has done it.....