Really frustrated!

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FluffBunny

FluffBunny

Member Since 2014
I am new to the forum and I have been posting in the general forum. This morning, someone suggested that I move here.

Oliver was diagnosed with diabetes in April of this year. We are pretty sure it developed after he started on Prednisolone for IBD in January, so his diabetes is not long standing. The first month I changed to all canned food and lowered his pred. from 5 to 2.5 mg daily. It didn't make a difference. I started him on Lantus on 5/24 and my life has been a nightmare since then.

I have to add that I live in fear of hypoglycemia. I had a cat who had a diabetic seizure in November and it is not something I ever want to see again.

I have gone through 100 test strips since I started this and I have made two emergency trips to the vet when Oliver's BG fell too low. My vet has told me to stop testing and to give him the injection as long as he is eating. I just can't do that.

I started with 2U twice a day and now I am trying 1U. I actually thought things were beginning to stabilize a couple of days ago, then a new pattern developed.

Since I started the injections, I have been injecting in the flank per my vet's instructions. I even had him shaved in the appropriate spots so I could see what I am doing. Injection time has been traumatic for both of us. The only way I can give him the injection in the flank is to wrap him in a towel, put a pillow on top of him, then lean on the pillow to hold him still. Even with all this preparation, he manages to wiggle out of his confinement 4 or 5 times before I am able to give the shot. It has been a twice daily wrestling match. The other night I decided I couldn't so this anymore and I gave him the injection in the scruff of his neck where I have always given cat injections and fluids. It worked like a charm. He didn't even flinch.

Unfortunately, this seems to have changed his curve. He was reaching his nadir 6 - 7 hours after injection. The last two days, his AMPS was so low, I was afraid to give him his morning shot. I just read on this forum that giving the insulin in the scruff slows absorption which is probably why I am seeing this change in his curve.

I just don't know what to do next. My fear of hypoglycemia is almost neurotic. I have been following the general rule of skipping the injection if his pre-injection reading is below 200. But, if giving the shot in the scruff of the neck slows absorption, then his pre-injection reading will probably always be low. I don't know if I will have the courage to inject him with a low AMPS.

Can someone hold my hand?
 
welcome to Lantus Land!

I tried to take a look at Oliver's spreadsheet. Can you make sure that you have the access permissions set so anyone with the link can view it?

We are very good at hand holding and lending a hand if you feel like that's something you want, as well. Having a healthy respect for low numbers is a good thing. Without seeing Oliver's spreadsheet (SS), I'm not sure how low his numbers were. With Lantus, a drop to below 50 indicates a dose reduction is warranted. If you look at other SSs, you'll see that most of us handle low numbers pretty routinely. We can help you with that aspect of managing Oliver's diabetes.
 
I just changed the spreadsheet so anyone with the link can view it. Let me know if you can see it now.
 
i can see it now. there's something wrong with it, though - it's just a pic of a spreadsheet and it's small, rather than full size. Did you use the directions here? If so, let's see if we can figure out what happened and let's get it to look like everyone else's. If you didn't use that link, would you go through and copy the data from your current ss onto one of the ones on the link? It makes it so much easier for us who are trying to help people.

what does the "A113" number on June 3rd mean? I see other A## on the ss too.

we're really good at hand-holding! others have held our hands while we learned, and we just pass it on. we can teach you how to steer Oliver's numbers so you gain confidence and then it's not as scary. When you learn how this all works and how to bring up his low numbers using carbs, you'll feel a ton better. We draw a distinction between having low numbers and having a symptomatic hypo. As long as you're hometesting, it's not likely you'll have a symptomatic hypo. Mostly we see it in people who've just arrived here and having been testing. Otherwise, cats that are monitored might get into low numbers (under 50) but we're able to bring them up using carbs without having problems. We can help you through this.

I'm glad you've made it here. One of the first things i like to tell people is what the purpose of Tight Regulation is. Research has shown that if a newly diagnosed cat is kept in normal non-diabetic cat blood sugar numbers (50-120) their pancreas has the ability to heal and begin producing insulin again. That can allow a cat to go off of insulin and become diet-controlled - something everyone would like. Not every cat gets there, but keeping a cat in normal numbers also protects their body from damage from the diabetes - something every cat needs. It can be intensive, but the pay-off is fantastic!

As you look through this forum main page, you'll see Juno is on an OTJ (off the juice, ie insulin) trial right now. The best chances are for newly diagnosed cats - the sooner they get tightly regulated the better. The PDF about 5 paragraphs down from the top of the page on the Tight Regulation Protocol page that's called "Management of Diabetic Cats Using Long-Lasting Insulins" describes it all. I hope you'll read through it. You don't have to memorize or understand it all, but you'll get the general idea.

Look through the yellow-starred stickies at the top of this page. Start with New to the Group? and also look at the Tight Regulation Protocol, and Taking Care of your Insulin pages. You may want to print off the page on "Shooting and Handling Low Numbers" just in case you are faced with that and can't reach anyone here to help you.

I hope you'll post daily/often so we can get to know Oliver and help you learn what you need to help him. I don't want to overwhelm you with information so i'll stop there. Ask questions! there are no dumb ones and we're happy to help you find the information you need.

do you want us to call you FluffBunny?
 
Thanks so much for your reply. I have read through much of the material you suggested. (That's how I discovered that giving him his injection in his sruff probably caused my most recent problem.

I will work on the spreadsheet some more. I am computer challenged.
\
 
I sent a message to BJM to ask about what needs to be done with Oliver's ss. let's see what she says.

Here are some of your previous posts:
5/20
6/1
6/2

by the way, you can shoot in the scruff. i shot punkin for 2.5 years in the scruff while he was eating. Go with what works for you.

I think we might want to drop your dose down to 0.75u or so. The 1.0 looks pretty good, but we want you to be able to consistently shoot every 12 hrs with the same dose. let me talk with a few other experienced people and we'll get back to you on the dose.

We don't have a no-shoot line of 200 here. Experienced users who have learned a bit about their cat will shoot everything over 50. What you will learn is that the entire experience changes when you shoot low. Instead of getting much of a curve, the cat shot low will often end up with a line and perhaps their blood sugar will only vary 10 points in the whole 12 hrs cycle. When you shoot a high number, they might drop 200 points. The same dose shot into a low number might end up flat with little change.

It's highly counter-intuitive, but that is what happens. That said, we don't want you to shoot low yet - let's get Oliver a little more stabilized and gather some data about how he responds to his shots before you do that. If you are faced with a low preshot number, don't feed him & post immediately here. Someone will help you decide what to do next. Often the first time we'll ask you to withhold his food, wait 20 minutes or so and retest. We'll want to see the numbers flat or rising and when that happens, then you can shoot and feed him. But post here and ask for help. We'll have someone stay with you to help you through it.
 
Trying again to post the spreadsheet. Can someone tell me if this one is okay?

The numbers posted with an "A" were taken with the Alpha Trak meter. I bought one to use only when the Micro had really low readings. I have taken those off this new spreadsheet, so all numbers are with the Micro people meter.
 
YAY! yes, that worked! Perfect!

you'll be fine sticking with your relion meter - the strips are far cheaper and everyone here mostly talks in human meter numbers.
 
by the way, what did you do to fix the spreadsheet? i've seen a couple like your first one before and don't know what makes it like that.
 
BTW, Fluff Bunny is what I call Oliver. My name is Linda, but you can call me Fluff if that is easier. I wanted to post a picture of my boy, but I couldn't figure out how to do it.
 
what a cute nickname for Oliver! I'll call you linda!

we need to see a pic of him - you can resize pictures at this site: http://www.shrinkpictures.com/. Choose the "avatar" selection and it will be the right size. Download it to your computer (ya gotta know where it goes! might be under "downloads")

Then go to the User Control Panel (it's at the top left of my FDMB page)
Choose the tab across the top that says "Profile"
Choose the tab on the left vertical side that says "Edit Avatar"
Then choose "Upload from your machine: Choose File"

Find the spot on your computer where you downloaded the avatar picture and click it. It should upload and become the profile picture for you.
 
Linda, find a picture you like, and then go to http://www.shrinkpictures.com/create-avatar/

Avatar pics have to be no bigger than 90x90 pixels

To post it, go to the User Control Panel (upper left of page) and then click on "Profile"

Then go to "Edit Avatar"

Click on Choose File and find your shrunken picture and choose it.

Click on "Submit"

Edited to add...Julie beat me to it! :lol:
 
:lol: Chris! it takes me a while to write posts sometimes, and you always want to ohmygod_smile when you post and someone else has just written the same thing! :-D

Linda, looking at Oliver's spreadsheet, he got to 41 on 6/4 after you'd skipped a shot the night before. Following the protocol, that would mean a 0.25u reduction because he went below 50, so his new dose would be 0.75u.

The thing is, that usually when a shot is skipped it will cause some "draining" of the depot. I saw that someone gave a little explanation of the depot to you on one of your Main Health posts. Think of Lantus and Levemir as being insulins that are somewhat like a "timed release" drug. When you inject, some is immediately available to the body and some builds up and then slow-releases. The "depot" builds in the body with each shot until it is equalized with the shots - so the depot's size is related to the size of the dose. The post on insulin depot is going to explain it better than me, but i want to just give it to you briefly.

Usually skipping a shot will reduce that depot in the body and we might see higher numbers afterwards. Sometimes we do it on purpose if a cat keeps running in low numbers in order to raise the overall level of its blood glucose. So the fact that Oliver got to 41 on the first shot after a skipped shot might indicate that he needs even less than 0.75.

I'm saying all of this to lay out some of the reasoning behind your choices. If you were following the protocol, you would reduce to 0.75u. But he's had the response after the skipped shot, and then you've also had to skip some shots because of low preshot numbers, so it might be reasonable to come in now with a 0.5u dose.

What questions do you have? what would you like to do?
 
What I did wrong the first time with the spreadsheet.

Instead of downloading the spreadsheet directly to my Google drive, I copied and pasted it to Excell, then filled it in and downloaded the Excell version to the Google drive. I guess that's why it looked like it did.

The first time I tried to download the spreadsheet to the Google drive, I couldn't do it. That's why I did a copy and paste. This time it worked fine.
 
Hello Linda and Oliver! I just wanted to welcome you to LL. You've been busy today! I was once paranoid about hypos myself. In the beginning, I wasn't hometesting and I almost lost Buster. I wouldn't leave the house for longer than 4 hours after his hypo episode. Thanks to the wonderful people here, I am now confident and can shoot lower numbers with only a slight tug on the nerves nailbite_smile Hang in there, it will get easier and you have an amazing support group here to guide you through it.
 
What a sweet kitty Oliver is! I love those yellow kitties! My very first kitten was a yellow tabby, so I have a special place in my heart for them

I agree with Julie on dosage too. I think I'd go down to .5 and see how Oliver does. If the dose is "right", you should be able to give it every 12 hours without having to skip or stall a lot. I'd try it for at least the next few cycles and see how he does (unless he drops below 50 again!) It's always hard to see those higher numbers at Pre-shot and not feel like you should give more, but we always base the dose on how low it takes them, not how high

He's doing REALLY well for being so new to the sugardance, as well as continuing to take the Prednisone!
 
Are you saying that tonight I should perhaps give him .75 U instead of 1, even though I skipped his shot this morning? I can do that, but I have to eyeball it. My syringes mark individual units. I can get .5 pretty accurately, but .75 is a stretch. I am beginning to understand the insulin a little better. But the lows still really scare me. I gave him Karo syrup when he dropped to 41. It scared me that he continued dropping so quickly. (That was one of my trips to the Pet ER.)

Have you ever seen a diabetic seizure? It is really, really awful. I lost my cat that night. Not to diabetes. He had large cell lymphoma and the tumor just ate up all of his blood glucose. He went blind and his sight didn't come back even after they brought his BG back up to a normal range. I really think that is why I am so afraid of this whole process. If I give Oliver insulin and he has a seizure, I'll probably never get over it.

I sure would like to continue giving Oliver his shot in the scruff of his neck. It is so much easier. But if it is absorbed more slowly and his BG is low in the morning, I am not at the point where I could inject him with a low reading. (Not without having a nervous breakdown.)
 
Diabetic seizures are, indeed, pretty awful. You need to find a dose that you can give every 12hrs instead of skipping shots which is why Julie and Chris are saying to reduce the dose. If you post your numbers here, and Oliver starts to go low, there will be someone here to help you get him into a safe range. Just ask for help. They will stay with you literally by the minute to make sure he's safe. Go easy until you're ready. Hopefully, Oliver will ditch the juice all together.
 
I've always given China her shots in the scruff, so if that's more comfortable for you, I'd do it!

They do make syringes with half unit markings, which are really important for those .25 and .75 doses. I know WalMart has their "Relion" brand syringes in half unit markings because that's where I get them. They're about $13 for a box of 100. Sometimes they don't know they have half unit markings, but they do

With as much skipping as you've had to do with Oliver, I think I'd go with just .5 for now. We can always go up later if that's not enough
 
What brand of syringes are you using? there are syringes with half unit markings that make the dosing a little easier. .75 would be between the .5 line and 1 unit line.

I think you can give the shot in the scruff, especially if it makes the shot process less stressful you and your pet. I am not sure that I have heard there is a big difference in response. Absorption might be a little slower but I didn't find it to be a significant difference in my pet and you will be reducing the insulin amount as well.

Let's let other members respond about shooting in the scruff. One of my former vets said that I should shoot in the flank or back to get faster absorption, but my new vet disagreed.
 
Welcome Linda and handsome Oliver!

I've always shoot in the scruff, but never on the same spot. In the morning I'd shoot on the left side and in the evening on the right side or vice-versa, so that I could alternate between spots. Juno is now on his OTJ trial day 10, so apparently it doesn't make a difference to shoot in the scruff or in the flank. But I've also read that it makes the absorption quicker if it's given in the flank, but that must hurt, and for that it was enough the poking in the ears that my Juno is not very fond of :lol:.

At some point I was too paranoid about a potential hypo episode. The first weeks I couldn't sleep at all just thinking he could have seizures from an hypo event. Or I would be at work thinking how low Juno would be, and sometimes I'd left work too early just to check on him. This lasted for quite some time until I started feeling comfortable with the insulin shots and realizing he would be okay. I would always leave food for him just in case he would drop too low. But just like you I also skipped mostly in the beginning some shots because I wasn't feeling comfortable to shoot at very low numbers (you can see on Juno's ss). When I couldn't monitor him during working time, I wouldn't shoot if he was too low.

I still can't believe Juno's vet recommended 2u of insulin twice a day and testing one hour AFTER giving the shot :shock: :shock: :shock:. I'm very fortunate that someone recommended me FDMB and I followed the advices of many experienced and good people in this board. They helped me a lot. If you follow the tight regulation protocol, I'd say you have very good chances to get your baby's diabetes into remission.

I wish you all the best,
Cristina
 
Hello, I would go with the lower dose (.5) suggested by Julie and Chris as well with the skipped shots, low numbers, and your past experience. It is better to be more conservative definitely. I was just using the .75 or .25 dose as an example.
 
I don't think that his low morning numbers are the result of where you shoot. Yes, absorption rates can vary from site to site, but i think your lower morning numbers are a consequence of the dose being a bit too large for him.

On his ss I see you dropped his dose to 0.5u tonight. I think that was a good choice. It's easier to go up in dose than to be fighting low numbers. Let's give him 6 shots at this 0.5u dose - it doesn't matter exactly what you shot and called 0.5u as long as you can replicate it in your future shots. Know what I mean by that? it's important with Lantus to give the same quantity as much as possible - and we all know how hard that is with these tiny dose increments. Some people will take a used syringe and put the dose in colored water or tea in it and use it for a comparison tool so they can replicate the dose again.

If he goes below 50, then he gets a dose reduction of 0.25u.

We encourage everyone to get a before bed test every night. Many cats get their lowest numbers at night, and since we base dose decisions on the lowest numbers a cat gets to, the night cycle is really important. It's also very helpful to get a +2 in each cycle if you can.

The +2 is a good indicator of which way the cycle might go. If it's higher than the preshot number, it might say that the cat is starting to bounce and is on its way high.

If it's significantly lower, that's a red flag that the cat might be diving and it says you need to pay extra attention in the next few hours.

If the +2 is about the same as the preshot test, that signals a "typical active" lantus cycle. There is a description of that in the "New to the Group" sticky. Basically it suggests the cat's blood sugar will decrease over the next few hours, flatten out in a nadir and rise to the next preshot test.

The +2 is the "crystal ball" for the cycle for many cats. of course, not all cats read and follow the guidelines, but for many cats, the +2 is very helpful.

I really liked the Terumo thinpro syringes - the barrel of the syringes is a little narrower than some syringes, which spreads out the dose markings and makes them a little easier to read. I signed up at http://www.mrrebates.com first, then went to American Diabetes Wholesale through the mrrebates site. Then you get a rebate back on everything you spend at ADW. Here is the link to the Terumo Thinpros with 0.5u markings.

When we first started I woke up every morning wondering if punkin was still alive. He slept downstairs with our other cat, and first thing i did was open the door and see that he was ok. He always was. The lowest I got with him was a 32 - he had no symptoms at all. I posted here, people told me to give him a teaspoon of gravy from high carb canned cat food and then to retest in 20 or so minutes. I did, they waited to check on me, and led me through the process.

Once you've done it a few times it becomes routine. I have heard of other cats having hypo episodes with symptoms. As I said, though, that's typically someone who is new here. Sometimes it's their first post. It can be bad, and a hypo with Lantus or Lev can last a while, so we try to avoid it. Safety is always on our minds - it's a big responsibility to give advice to someone on how to take care of their diabetic cat and no one here takes it lightly. For the most part, people who are newer or don't feel able to give dosing advice won't do it.

Anytime you get a number that seems odd, a LO (meaning less than 20) or HI (over 600) or something that just seems weird, like a 450 after you just got a 150, it's a good idea to immediately recheck with another test. Sometimes strips are wonky.

A couple of things - we do start a new thread (condo) every day so that the volume of posts is manageable, and we ask people to only have one per day on the TR page. That keeps everyone on the front page so we don't miss people. If you have a question or topic, go ahead and edit the subject line OF YOUR FIRST POST in the thread. It has to be the subject line of the first post, that way it shows up on the main page.

It also helps if you use the ? post icon above the posting window, then take it down after your question is satisfied. People will look for the ? to make sure people's questions don't get missed.

Feel free to read and post on other cat's condos. It's a great way to learn!
 
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