Red's dose after falling out of remission | Page 2 | Feline Diabetes Message Board - FDMB

Red's dose after falling out of remission

Suzanne & Darcy said:
I don’t even bother to move the furniture to see the skin. I just lift and shoot. The needle goes in under the skin and that’s all that matters.
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This has helped me. I give the injections better, not great yet, but much better.

How do we know we're at the correct dose of insulin? Red's numbers still seem to be high at .5u dose. Even when he doesn't eat for hours, his numbers do not come down. I don't want to rush this, but is there a BG level or reduction we should be trying to achieve when giving insulin?
 
Well, we could try increasing the dose to .75 units, but he dod have a nadir of 87 on the .5 unit dose already— although it seems to just be that particular day 10/5. Do you recall a reason why he was lower on that day? Not eating?
 
Normal feline BG is between about 50-120. So he has room to go lower if you are able to keep getting the BG tests and would be okay following the Modified ProZinc Method (and he is not eating dry food.) I know we were hoping this steroid shot would wear off and he would get back to normal, but he may need for us to be a little more assertive with his dose so we can get his numbers down.
 
Suzanne & Darcy said:
Well, we could try increasing the dose to .75 units, but he dod have a nadir of 87 on the .5 unit dose already— although it seems to just be that particular day 10/5. Do you recall a reason why he was lower on that day? Not eating?
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I went back to my notebook that I keep, and Red was eating fine that day because he had the Mirtazapine the night before. On 10/5 I do have a note my husband said he may have given Red just a hair above .5 unit, but not as much as .75 units. If that was the case, could that have caused the 87 BG? It makes sense now looking back because he has been no where near that BG level since. So maybe Red should be on a slightly higher dose than .5 right now? I think I'd like to try going up to at least a .6. or do you think I should try .75 units? It will be 3 weeks this Friday since he had the steroid shot. Red never eats dry food. He's the only cat I have and he only eats low carb pates ever since being diagnosed.
Thank you for your guidance!
 
I would try the .75 unit dose and see if we can get his numbers down, including the preshot numbers. We have a better chance at getting him back into remission that way. You test enough to keep him safe. When you get a green number just feed him a snack of LC pate and monitor. You do not need to give HC (food/gravy/karo/honey) unless he goes below 50. If he does, give a small amount of HC and test again in 20 minutes to make sure his BG is rising.
 
Could you please change your signature to MPM instead of TR? TR is for Lantus users. MPM is for ProZinc users. Not a big deal since I knew what you meant, but I don’t want others to be confused.
 
Suzanne & Darcy said:
I would try the .75 unit dose and see if we can get his numbers down, including the preshot numbers. We have a better chance at getting him back into remission that way. You test enough to keep him safe. When you get a green number just feed him a snack of LC pate and monitor. You do not need to give HC (food/gravy/karo/honey) unless he goes below 50. If he does, give a small amount of HC and test again in 20 minutes to make sure his BG is rising.
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I gave .75 this morning, and I'll be monitoring him. He ate good so we'll see where he is with the next test.

I laughed when I read you don't bother to move the furniture 😄 but I knew what you meant!
 
Marie & Red said:
@Suzanne & Darcy
Do I keep him at .75 for the PM shot seeing he dropped to 56 BG? It seems he is liking between .5 and .75 right now.
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1) Did he eat at +2? His nadir is awfully early.
2) I see that the small amount of low carb food kept him surfing in green. Did you test again another 30 minutes after that? Don’t stop testing at least hourly until you are sure he’s stable in green or rising.
 
Suzanne & Darcy said:
1) Did he eat at +2? His nadir is awfully early.
2) I see that the small amount of low carb food kept him surfing in green. Did you test again another 30 minutes after that? Don’t stop testing at least hourly until you are sure he’s stable in green or rising.
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He didn't eat much at +2, about 1/3 - 1/2 small pate packets. He did eat a lot at +3.5, after testing at 56 BG.

His tests today:
AMPS 183 BG - ate 2/3 FF can - rec'd .75 units
+2 135 BG - ate 1/3 FF petite packet
+3.5 56 BG - ate 1/5 FF beef/gravy and 2/3 can FF turkey
+4.5 66 BG - no food
+6 88 BG - no food
 
Okay. Thanks for the info. It helps.
He’s really doing ideal on this dose,
but if you feel a little uncomfortable with it at this point, I completely understand. And actually, since I believe we should (hopefully) see a little more waning of the effect of the steroid shot in the fourth week, we can try a dose that is between the .5 and the .75 units and see how it goes. This will give us some wiggle room if the steroid shot wears off completely and he starts staying in lower numbers. We can always increase back up if needed.

If you were using U-100 syringes you could actually draw a .6 dose, but you will have to just eyeball a “skinny .75” where the plunger is just slightly less than the (already eyeballed”) .75 units. We could call it a “fat .5” which might be easier to imagine— where the plunger is a little past the half unit mark but not as far as you would draw it to eyeball the .75. This is where using U-100 syringes allows for finer dosing.

Let me know how you feel about it. If he doesn’t do well on the dose, we can make alterations. Between 50 and 120 is where we want him to be if we want to get him into remission again, but there’s no rush — especially since we still potentially have the steroid at play.
 
Suzanne & Darcy said:
Okay. Thanks for the info. It helps.
He’s really doing ideal on this dose,
but if you feel a little uncomfortable with it at this point, I completely understand. And actually, since I believe we should (hopefully) see a little more waning of the effect of the steroid shot in the fourth week, we can try a dose that is between the .5 and the .75 units and see how it goes. This will give us some wiggle room if the steroid shot wears off completely and he starts staying in lower numbers. We can always increase back up if needed.

If you were using U-100 syringes you could actually draw a .6 dose, but you will have to just eyeball a “skinny .75” where the plunger is just slightly less than the (already eyeballed”) .75 units. We could call it a “fat .5” which might be easier to imagine— where the plunger is a little past the half unit mark but not as far as you would draw it to eyeball the .75. This is where using U-100 syringes allows for finer dosing.

Let me know how you feel about it. If he doesn’t do well on the dose, we can make alterations. Between 50 and 120 is where we want him to be if we want to get him into remission again, but there’s no rush — especially since we still potentially have the steroid at play.
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He startled me at 56. He's never tested that low before, even 3 years ago when he went into remission. I'm comfortable with him in the 60's, but 50's worry me a tad right now - especially it he gets to that level or lower during the night. He got there so quickly.

I'm using U-40 syringes, holds up to 12 units, with 1/2 unit marks. I believe I can get .6, going just above the .5, which I guess would be called the "fat .5". I call it a .5+ ☺️

I didn't know we were able to use U-100 syringes and I just ordered a box of U-40. I was searching for ones that had a small total volume and half units. If I can get .1 and drop dose, I know I can get .6! I will do that tonight.

Thank you!
 
U-100 syringes can only be used with a U-40 insulin like ProZinc if you use the special conversion chart that tells you how much to draw on a U-100 syringe to get the correct amount— otherwise the insulin would be underdosed or overdosed (without the conversion chart I mean.)

I look forward to seeing how he does on the .5F
 
What do you want your reduction point to be. With MPM it’s below 50. With Start Low Go Slow it’s below 90 (which I don’t think is going to help Red.). You indicated yesterday that you were okay with 60s. I see he dropped to 61.
 
If you want to do custom dosing and use a reduction point of 60, then please change your signature to say Custom Dosing, Reductions at 60. Or reductions at 59 (so below 60 would trigger a reduction.)
 
Also, he’s dropping too fast and hitting nadir too quickly. He either needs to eat more at +2 or needs to eat higher carbs (not higher carbs but something closer to 10 percent) to slow him down. If he’s not hungry at +2 then cut back on his breakfast so he will eat more at +2.

I hope I am communicating okay this morning. I am in a rush to get out the door. Have a vet appointment and still have to feed the cats before we leave.
 
Have you rechecked his AMPS? Do you have any food with a few more carbs than the FF pate?

If he’s still at 130, I would just give .5 for this cycle because he has such a propensity to drop early in the cycle (which is why I was suggesting feeding something in the 7-9 percent carb range to try.)
 
Suzanne & Darcy said:
Have you rechecked his AMPS? Do you have any food with a few more carbs than the FF pate?

If he’s still at 130, I would just give .5 for this cycle because he has such a propensity to drop early in the cycle (which is why I was suggesting feeding something in the 7-9 percent carb range to try.)
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He doesn't eat much at any meal. He's a light eater.
I will give him .5 this morning.

Thank you!
 
Marie & Red said:
He doesn't eat much at any meal. He's a light eater.
I will give him .5 this morning.

Thank you!
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Well then I would go with the slightly higher carbs to help him.

Having said all that, his AMPS this morning is almost within the normal range for cats. That is definitely progress. It’s probably the fattened dose that helped him to get there, but it’s still really good news. We hopefully will see his AMPS and PMPS come down below 120 (and hopefully even lower) as the steroid shot wears off (I am still hoping).
 
I'll check the carb content of the meals I have. I usually buy by the case. I do have a couple med carbs on hand.
He actually went down to 56 yesterday after the AM shot. It's 3 weeks since his steroid shot, so hopefully that's going to help.

Good luck at the vet appt!
 
Our goal should be to keep him in that 50-120 range as much as we can so his pancreatic beta cells can continue to heal from the steroid. Then hopefully his pancreas will take over!
 
Marie & Red said:
I'll check the carb content of the meals I have. I usually buy by the case. I do have a couple med carbs on hand.
He actually went down to 56 yesterday after the AM shot. It's 3 weeks since his steroid shot, so hopefully that's going to help.

Good luck at the vet appt!
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Oh yes. I know about the a.m. 56, we talked about that yesterday and that’s why you reduced from.75 to the .5 F for the p.m. cycle. So that is why I was talking about the p.m. cycle where he had 61.
 
Suzanne & Darcy said:
Oh yes. I know about the a.m. 56, we talked about that yesterday and that’s why you reduced from.75 to the .5 F for the p.m. cycle. So that is why I was talking about the p.m. cycle where he had 61.
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Almost all of the food I have at home is low carb, in the range of 2-4% Guess I'll go shopping for some a little bit higher.

Are there any toppers I can put on his food to increase carbs a little? I have sprinkled parmesan cheese on his food when he wouldn't eat, but that's low carb too but it got him to eat. Would Churu's help, either on top of his food or separate? I used to give him 1/2 tube of Churu when my other cat needed it for her meds. I haven't given any to Red since he fell out of remission.
 
Here’s a food list of foods appropriate for diabetic cats— but these are lower phosphorus foods so also appropriate for cats with kidney disease (which Red does not have, but lower phosphorus foods are good for senior kitties anyway because they are easier on the kidneys.) I am not sure about the carb percentage of Churus
https://www.bizave.com/foodlists/CKD Diabetes Food List.pdf

Some of the Weruva foods are also available at local pet stores like PetsMart, Petco, and others… so that you can just buy a few cans and not a whole case.
 
Suzanne & Darcy said:
Here’s a food list of foods appropriate for diabetic cats— but these are lower phosphorus foods so also appropriate for cats with kidney disease (which Red does not have, but lower phosphorus foods are good for senior kitties anyway because they are easier on the kidneys.) I am not sure about the carb percentage of Churus
https://www.bizave.com/foodlists/CKD Diabetes Food List.pdf

Some of the Weruva foods are also available at local pet stores like PetsMart, Petco, and others… so that you can just buy a few cans and not a whole case.
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Thank you! I haven't seen this list yet. I do have some Weruva cans at home. Of course the ones I purchased are like 0-2% carbs!
 
Marie & Red said:
Yes! :) I gave him a little Mirtazapine in the afternoon because he wasn't eating much again, sometimes just a few licks.
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I hope his iffy appetite is just a result of the Convenia injection and will also wear off. Otherwise, I don’t know why he wouldn’t be eating at least normally (you said he has never been a big eater.)
 
Suzanne & Darcy said:
I hope his iffy appetite is just a result of the Convenia injection and will also wear off. Otherwise, I don’t know why he wouldn’t be eating at least normally (you said he has never been a big eater.)
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Before Scuffy was very sick, he would eat his food and then some of hers. Ever since she passed, he has been eating less. The prior dose of Mirtazapine lasted 4 days, so he seems to be getting better.

Am I able to give either a .5 or .5F depending on his pre-shoot number? Or should I be sticking with the same dose? This morning he was 179. I still gave the .5 unit.
 
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I meant to write you earlier this morning and say that if his AMPS was over 140 to do the fat dose. I hurt my back and so then forgot to write!

Try to stick with the .5F dose as much as possible. I am kind of disappointed in the 179 AMPS, but I also expected it because, really early in the morning I had checked his spreadsheet and saw that he only had blues last night. I don’t think that the .5 is keeping him where we want him to be. The lower dose yesterday morning was meant to only be a one time thing because his AMPS was 130 (although I don’t think the fat dose would have hurt him yesterday either, but I wanted to confirm this because he hadn’t had an AMPS that low since falling out of remission.
 
Suzanne & Darcy said:
I meant to write you earlier this morning and say that if his AMPS was over 140 to do the fat dose. I hurt my back and so then forgot to write!

Try to stick with the .5F dose as much as possible. I am kind of disappointed in the 179 AMPS, but I also expected it because, really early in the morning I had checked his spreadsheet and saw that he only had blues last night. I don’t think that the .5 is keeping him where we want him to be. The lower dose yesterday morning was meant to only be a one time thing because his AMPS was 130 (although I don’t think the fat dose would have hurt him yesterday either, but I wanted to confirm this because he hadn’t had an AMPS that low since falling out of remission.
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Sorry to hear about your back. I know that can be tough, not to mention painful! It's put me down a few times. Hope your back heals quickly.

Red's morning levels in the past always seem to run high too. I agree with you on sticking with the .5F. I just worry about him after the PM dose if I go to sleep and he drops low. What happens if I don't catch it? What would be the lowest pre-shot number for me to decrease his .5F injection dose?
 
What can I put on Red's ear? I feel bad that I keep testing him so often on the right ear. His left ear has been snipped where you normally test so there's not a lot of room there and it doesn't bleed well. I'm going to try it again though.
 
Does his ear (the one you have been testing) look red or what? Some people will put coconut oil on the ears. Do you have anything like a colloidal silver gel? Arnica is very healing for these things but I would have to make sure it’s a pet product safe for cats. They do make it. I bought a product called Silverquine gel for my cats and, although I haven’t used it on ears I would not hesitate to.

Cats don’t have a lot of pain receptors in the outer edge portion of their ears. Do his seem to be bothering him?
 
Suzanne & Darcy said:
Does his ear (the one you have been testing) look red or what? Some people will put coconut oil on the ears. Do you have anything like a colloidal silver gel? Arnica is very healing for these things but I would have to make sure it’s a pet product safe for cats. They do make it. I bought a product called Silverquine gel for my cats and, although I haven’t used it on ears I would not hesitate to.

Cats don’t have a lot of pain receptors in the outer edge portion of their ears. Do his seem to be bothering him?
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The ear I test looks red just a bit from the pokes, not infected at all. He doesn't seem in pain at all either, even when I poke him. I do have coconut oil and colloidal silver spray that I can use on him. I never thought of that. I also have arnica gel but I wouldn't use it on him.
Thank you!
 
Suzanne & Darcy said:
Does his ear (the one you have been testing) look red or what? Some people will put coconut oil on the ears. Do you have anything like a colloidal silver gel? Arnica is very healing for these things but I would have to make sure it’s a pet product safe for cats. They do make it. I bought a product called Silverquine gel for my cats and, although I haven’t used it on ears I would not hesitate to.

Cats don’t have a lot of pain receptors in the outer edge portion of their ears. Do his seem to be bothering him?
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What's the lowest pre-shot BG for me not to give Red the .5F dose?

Once I see levels going up, is he okay for the rest of the cycle?
 
This could change, but right now it looks like if he’s 130 or over he can have the fat dose. These numbers can change as his response to the insulin changes and his insulin needs change.
 
Marie & Red said:
Once I see levels going up, is he okay for the rest of the cycle?
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Do you mean at night? I would say if you get a couple of tests and he’s stable or rising he should be okay. Also take into consideration where he is in the cycle and when he typically nadirs. Use the daytime numbers to help you see what he normally does then and it should be similar at night— except he may drop a little lower (some cats do go lower at night but not all.)
 
Suzanne & Darcy said:
I hope he will eat well now and at +2. I would get a +2 test to see how things are going.
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Good Morning, Red did well yesterday.

I have a family emergency and have to drive up 2 hours to my daughter tonight. I need to help her and her baby while she recuperates. I'm taking Red with me so I can watch him and track his levels. I'm just wondering if this change in environment will affect his BG levels and cause a spike due to stress? They have a dog, super friendly & sweet, but nonetheless still a dog that Red is not used to.
 
Oh no. I am very sorry to hear about your daughter. I know she will appreciate your help. Good idea to take Red with you. Stress can elevate BG, but we will just have to wait and see. It may not affect him too much. A baby could be something different too! Drive safely.
 
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