Reduce or skip?

Sidney

Sidney

Member
Sidney's BG seems to be low in the mornings, which makes sense, since he's been fasting 8 hours, but rises to the level that he requires a unit of prozinc in the evening. Is this ok for him to just get the one injection a day? He's not a good bleeder and it's taking us 5-6 sticks before we get blood and at 6 am, I'm barely conscious. His vet said, that for Sidney's case, do not shoot at <151, so other than the one time when he was 123, we haven't been giving him any insulin. How are his numbers looking overall? He's due back at the vet on the 16th for some other blood test that the vet says will give him more info. I wish I understood more about the different methods.
 
The insulin will work best if he has it twice a day. It's hard to tell what to do without seeing his lower BGL during midcycle. That 63 at AMPS is definitely a call for a dose reduction. That and the fact you are only getting one shot a day tells me the dose is too high. Without mid-cycle tests to help us, I would go more conservative than the normal decrease of .25. Next time he is high enough to shoot, I'd do .5 of a unit, and if you still cannot get two doses in a day, I'd reduce to .25 of a unit.

It's very hard on a diabetic to go without eating for 8 hours, and it makes it hard to regulate blood sugar. Can you give him a meal during the night? All you need to do is withhold food for 2 hours before the pre-shot BGL test. It would help protect him from going too low during the night. A cat in danger of hypo will want to eat if there is food available.
 
Hi Lynienu. Took a look at Sidney's SS and I see that you are only dosing once a day, because the morning BG (blood glucose) number is too low to shoot. Agree with not giving insulin if the pre-shot test is <150 mg/dL. At least for now. As you gain experience, that threshold can be lowered.

You want to find a dose that you can give 2 times a day. Prozinc does not last 24 hours in a cat.
I think the 1U dose is too much for your cat.
How about trying a 0.5U dose for this evening? That is, if the PMPS is >150.

That test your vet is planning for later this month is likely a fructosamine test. Not really necessary since you are home testing now. Share the SS link with your vet instead. That way, you don't have to leave your home and can follow the "stay-at-home" recommendations.

Are you warming the ears before you poke? An old sock filled with some type of uncooked grain like rice or barley, heated in the microwave, then applied to the ear can get the blood flowing.

p.s.Missed seeing the tag in my alerts at first. It was too far down. Thanks for tagging me Jacque, so I could help Lynienu.
 
What date in March of 2020 was Sidney diagnosed? Was there something else going on? UTI?

What symptoms was the diagnosis based on?
 
Deb & Wink said:
What date in March of 2020 was Sidney diagnosed? Was there something else going on? UTI?

What symptoms was the diagnosis based on?
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So much was going on. 2019 was his year from hell with being diagnosed with hyperthyroid and then EPI resulting in a 7.5 pound loss. I really think it was the steroid injection he got in January that pushed him into Diabetes. His blood sugar in December was ok. He was diagnosed March 2nd and has gained 2.5 pounds since that date. The reason we had him checked for diabetes was because he started to lose weight again even with the pancreatic enzymes.
 

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Well he just gave us a 91 for his prepm shot. I warmed, rubbed his poor bruised ear for 5 minutes and it still took us 11 tries. My heart is breaking for this dearest piece of my heart. @Deb & Wink
 
That is too low to give any insulin to Sidney.
Is he dehydrated? When cats are dehydrated, their blood does not flow freely.
Are you poking in the "sweet spot"?

Skin tent test, and gum check are the easiest ways to check for dehydration.

p.s. Please add the exact diagnosis date to your signature and to the Spreadsheet, at the top.
 
What was the steroid injection for?

Pill or transdermal meds for the HyperT?
Do you let the enzymes "cook" in each batch of food, so they work better?
 
@Deb & Wink we did the I131 treatment at Blue Pearl in Atlanta. That's also where he underwent endoscopy and ultrasounds. They sucked at giving us any answers other than to put him on a rabbit diet. Our local vet finally diagnosed the EPI, but damage was obviously done by then. Sidney has never had issues with barfing or diarrhea. I have alarms go off 4 times a day to alert me to start Sidney's food. He gets a heaping 1/4 teaspoon pancreapowder plus with each feeding and it sits for 25 minutes prior to feeding. He also gets a B12 vitamin at lunch and a B12 methylcobalomin additive at dinner. FortiFlora is sprinkled in each food as it was the only way he would accept the enzyme. He eats 3 1/2 cans of Fancy Feast classic every day with the last feeding at 9 pm. We've tried really hard to do our best by Sidney. He's seen three different specialist vets in the past year and here we are. But....he IS gaining weight, he IS playing again, and I only get shunned for an hour or so at a time. Thanks again for all your help.
 
Lynienu said:
But....he IS gaining weight, he IS playing again, and I only get shunned for an hour or so at a time. Thanks again for all your help.
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I131 treatment for the HyperT is great! So no meds needed for that. One less thing for you to do each day.

Don't worry, I'm sure he forgives you and lets you pet or brush him after his "shunning hour" is complete.

With steroid induced diabetes, that can often quickly resolve, after the effects of the steroids wear off. That can take a couple of months. But sometimes the resolution of the diabetes happens quicker. That may be what is happening with Sidney.

If you have read our post replies to you, if you click on the "Like" that lets us know you have read the reply.

p.s. Who is Sidney's buddy, sleeping in the background with him in your avatar? Your doggo's name is??????
 
@Deb & Wink Please check Sidney's readings for the past day and a half. We had to leave the house and were unable to get mid afternoon readings, but from I can see, in the past 72 hours, he's had 1.5 units of prozinc. I really want to get him, like you suggested, to two equal amounts of insulin twice a day or go into remission (cross fingers) What should we give him in the morning if his reading is >150 and should we again skip totally if his reading is <150. Thanks!
 
I think you want to drop the dose to 0.25U for the AM on 4/11/20.
The 0.5U dose is still a bit too much to give Sidney insulin twice a day.

Plus, he "earned" a reduction with that BG of 80 today.
Reduce immediately if BG <90 mg/dL (5 mmol/L).
Per the Prozinc SLGS dosing protocol.
 
@Deb & Wink One more question for the night and then I promise, I'll leave you alone We are using U40 and are guessing are even .5 dose unit. What syringes would you recommend that would make it easier to see smaller doses. His current syringes are mono jet U-40 1/2 mL 29 G X 1/2”. Thanks again for all your info.
 
You can use a conversion chart and use U100 syringes with a U40 insulin like Prozinc.
Here is the link to the conversion chart. I suggest printing out a copy of the "Printer Friendly version."
http://www.felinediabetes.com/insulin-conversions.htm

The formula is 2.5 times the U40 dose. So 0.25U in a U40 syringe would be 0.625U in a U100 syringe. Still going to be tricky to measure those tiny doses in a U100 syringe.

Lynienu said:
What syringes would you recommend that would make it easier to see smaller doses.
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You want U100, 3/10 cc (volume - holds a maximum of 30 units), 1/2 unit markings on the syringe barrel. Needle length is your choice, but many people like the shorter needle length. 30 or 31 gauge if you can find it, but the volume and the half unit markings on the syringe barrel are more important.

p.s. Bedtime for me is still at least 1 hour away. ;)No need to "leave me alone." If it's too late, I simply won't be signed on and would see your post in the morning.
 
I don't think I linked pictures of what the 0.25U dose and smaller doses would look like. These pictures are for U100 syringes, but the concept is the same for U40 syringes. It's the plunger placement at the end of the syringe you are looking to duplicate.

Pictorial guide using a U-100 syringe marked with half units. Not sure why the photobucket watermark is showing on the photos.

someinsulin-1.jpg


01unit-1.jpg


025unit-1.jpg
 
We practiced with the syringe and water with a paper towel to approximate a .25 unit dose, but lo and behold, Sid's readings were below the noshoot level all day, so now we wait till the morning and see what the day brings.
 
Figures that Sidney would throw you some low numbers. He's a cat after all!
But at least you have practiced now and will be ready for the next shot.
 
Looking at the SS, it looks to me like Sidney is doing fairly well without insulin most of the time.

If possible, if you can test at +3 to +4, when the pre-shot test is in the blue color range (100-199 mg/dL), that will give us some more information if the pancreas is working better. Of course, it figures that the higher blue numbers are the ones you are getting in the PM cycle. :rolleyes: So, you might have to stay up a bit later than normal, to get those tests.

Food raises the blood glucose levels, so if the test +3 to +4 hours after Sidney eats his food, and the BG's go lower than the pre-shot test, it tells us the pancreas is producing some of it's own insulin, to bring the BG levels down after food.

Happy Birthday Sidney! "How olllldddd are you, how old are you, how old are youuuuuuu, How old are you!"
 
@Deb & Wink

Here's an interesting issue. My Sidney gets tested before each injection and sometimes in between. He had a fructosamine test last week with a result of 322. We noticed that his evening readings were generally higher than his morning readings, so I reversed ears. Now his morning readings are higher. When I did back to back readings with each ear, there was over a 40 point difference with the right ear consistently higher than the left ear. I'm soooooo confused! Someone please look at these readings keeping in mind the 322 fructosamine reading and advise me what we are doing wrong. Thank you!
 
I don't think you are doing anything wrong with Sidney, with getting those different BG readings, depending on which ear you use for testing. You have to remember that glucose meters are allowed to be off by 15-20%.

Maybe the blood flow to one ear is better than the other ear.

That fructosamine level of 322 is within the normal range, for a non-diabetic cat, or a diabetic cat getting excellent control.
From our document on the reference ranges. >>>>> Reference Ranges for Fructosamine Test

Cats Fructosamine values (micromol/l)
Normal non-diabetic cat 190 - 365
Newly diagnosed diabetic cat 350 - 730

Treated diabetic cats:
Excellent control 350 - 400
Good control 400 - 450
Fair control 450 - 500
Poor control >500

So Sidney is getting excellent control, based on the fructosamine. I think Sidney is trying to come off the insulin, go into diet controlled remission.

I do think you actually want to reduce the dose. Try for 0.1U, both AM and PM cycles. Here is a picture of what that looks like in a syringe. The picture shows a U100 syringe, but the concept of the plunger position is the same for a U40 syringe.
01unit-1.jpg
 

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@Deb & Wink it's been a couple of weeks since Sidney's fructosamine test and his numbers still continue to stymie me. His vet wants us to shoot a full unit when Sidney is over 200 AND to take away his evening (9pm) half can of food. With his morning readings being so low, I'm not comfortable with that. It leaves very small range between no shoot and full shoot. Even when we gave him a half unit, his morning readings belay giving him insulin. We want to do a curve, but as you can see, the last 5 mornings, he's been below the shoot level and even without any insulin Yesterday, he was just on that noshoot level in the evening. I was sweating bullets.....both cats had bad reaction to the worm medication we gave them and were stumbling around. Anyway, my question to you is 1. Is it worth it to run a curve if he hasn't had insulin or would it be more beneficial to wait until he requires an AM dose and 2. Am I right to want to continue with a nighttime snack when he's hungry, and 3. Is it ok to continue with a .5 dose or even less when he's not giving outrageous numbers? Thanks
 
Let's see if you can drop the dose to 0.25U, both AM and PM cycles. We really need to find a dose you can give Sidney twice a day.

How about slowly lowering your shoot/no shoot threshold?
Would you be comfortable giving Sidney 0.25U of insulin if his pre-shot test was >= 175 mg/dL?
We can gradually lower the dose also. It's possible to give a cat 0.1U and "some insulin."

Personally, IMHO, I think the 1U would be too much for Sidney right now. BG 200 or higher or not, that looks like too much insulin right now, with the 0.5U he is getting in the PM. He's probably dropping lower in the night time cycle, which is why the AMPS is so low.

1. No, if he has not had any insulin, a curve will not tell you much. But a couple more random tests mid-cycle, especially at night would help. Or even if Sidney is too low to give insulin in the AM, try for a test in the middle of the cycle, to see how high he goes before the PMPS. So a +5, +6 and/or a +7 test. Vary that each cycle.
2. Yes, I'd continue the nighttime snack, since Sidney is still hungry. I'm concerned because of the EPI, that Sidney continues to eat well. Does he need to gain weight? Or lose weight?
3. Yes, it's ok to continue with a very small dose when the numbers are not high.

Really need to see some tests in the night time cycle, after that PMPS pre-test. How about a regular "before you go to sleep" test, every night?
 
Will try for the inbetween numbers and the before bed #. Right now, he's at 12 pounds which is perfect. He was a bit on the heavy side before he got the EQI. Also, we are good with shooting above 150. Thanks again!
 
@Deb & Wink thoughts? I bought a microchip reader dish for my other cat so Sidney is 100% off the dry food. He is not a happy cat about it LOL. I didn't think he snuck much, but maybe I was wrong. What do you think about his numbers? One person in the FB group suggested we skip the insulin next time he is over 150 to see what his little body does. What do you think? TIA
 
Sidney said:
I bought a microchip reader dish for my other cat so Sidney is 100% off the dry food. He is not a happy cat about it LOL.
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Yes, Wink was not a "happy camper" when I took all his dry food away either. But he adjusted.

Is Sidney eating enough wet food now? To make up for the dry food being taken away.
Do you think Sidney has been sneaking dry food and that has caused his BG numbers to spike sometimes?

Do you think the dewormer affected Sidney's BG levels? Has he finished that medication?

Sidney said:
What do you think about his numbers? One person in the FB group suggested we skip the insulin next time he is over 150 to see what his little body does. What do you think?
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You do realize that FB group is not the one affiliated with our FDMB message board. Don't know anything about the level of experience of the person that suggested this to you.

Did you mean next time he is OVER 150? Like that 229 you got on 5/6/20 AMPS?

Ok, I can see what the other person was suggesting, skipping the insulin if Sidney is OVER 150.
IF Sidney is eating well on his EPI enzyme diet.
IF you can ketone test every day. Preferably every cycle.
IF you can test at +3 and preferably +4 also for the 12 hour cycle you do that skip when Sidney is over 150.
Better to get a few more test numbers in during a cycle where you are skipping the insulin dose. Because in this case, you are trying to see if he doesn't need insulin at all anymore.
Day or night cycle, you'd want to have the test data to see what is happening to Sidney.

You need to get some more tests in, after the pre-shot tests. Just because the pre-shot is low, doesn't mean his BG levels are staying low throughout the cycle. Getting those +3 and/or +4 tests will tell you if Sidney's pancreas is working. Since those times are usually after a cat's body has processed the food they got first thing in the morning.

If the +3 and +4 are lower, preferably lower than the pre-shot test (or within meter variance of 20%), it tells you Sidney's body is producing insulin on it's own, if it can keep the numbers low after the food is processed.

We'd recommend that +3/+4 tests be done every cycle for 14 days.

Has Sidney ever had ketones in the past? or DKA? Or pancreatitis?

A cat like Sidney, with Exocrine Pancreatic Insufficiency (EPI), is going to have other problems with their pancreas, such as the insulin not being produced as well or as much as needed sometimes. I'm not sure a cat with EPI will ever be able to go off the insulin entirely. I just don't know. That is something to talk to your vet about.
 
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