Screechy-newbie needing guidance, advice, and encouragement

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mtdenise

Member Since 2013
Hello! Need advice and guidance on what I can do to get Screechy’s numbers in a better range. This is all new to me.

I agreed to take Screechy in as a foster as he had nowhere else to go. I’ve had him for just over a week now. I noted on the SS when I got him and you can see the previous numbers from his other foster, who had tried adjusting his insulin . This is my first time dealing with a diabetic cat. He’s okay for ear sticks, although seems to be getting a little fussier the longer I have him. His numbers just seem to be all over the place. Unfortunately, it’s hard for me to do more than the three tests a day right now, and some days I can’t do the mid-day one.

I’m currently feeding him 1-1/2 cans of FF classic in the a.m. around 8:45, 1 can FF classic around 2:45 p.m., and 1-1/2 cans of FF classic in the p.m. He always seems starving and eats every morsel of food in the bowl. I just bought some Friskies Pate as it is a larger can and gave him that yesterday afternoon. His PMPS was very high so I don’t know if that was due to the food or just Screechy’s erratic numbers. He gets 1 unit of Lantus a.m. and 1 unit p.m. He had a low B12 level and gets B12 shots monthly now. The vet also believes he has IBS and he is on probiotics and fish oil.

Since arriving to his first foster home, he gained 3 lbs. and his coat looks healthy and shiny now and you can no longer feel his ribs and vertebrae, so even though his numbers are crazy there has been improvement in the way he feels and looks. I know the high BG levels are not good for his other body systems, so I want to see what I can do to help him out more.

Thank you for your time, information, and guidance for this newbie 
 
Re: Screechy-newbie needing guidance, advice, and encouragem

You might try putting neosporin ointment (not cream) with pain relief on the ear a few minutes before testing. Wipe off, then test. It will reduce some of the annoyance of testing, plus help the blood bead up.

Using positive reinforcement, such as a low carb treat, after testing (even if unsuccessful!), helps reduce the resistance to being tested. ("Gee, if I put up with this pokey thing, I gets treats!!!") A piece of cooked, raw, or freeze dried meat, poultry, or fish, or dried fish or shrimp can be used for this.

Some desensitization, ie getting him used to it, by petting him around and on the ears at non-test times, may help too.

Slightly shifting the mid-day meal earlier may help; when you feed at nadir, you may be speeding up the increase at the end of the glucose curve. Alternatively, many of us allow our cats to free feed the 10 hours after the shot, if the cat isn't a scarfer. In the scarfing cat, freezing part of the food to be nibbled as it thaws may help. If the budget permits, an automated pet feeder may be used. This allows food to go in more gradually and have more gradual effects on the gluocse level.

One of our recommendations when starting out is to not shoot below 200 mg/dL. As you get more data, you may gradually lower that number. Looking over the spreadsheet, you might consider 150 as your no shot number.

If testing around the nadir during the day isn't possible, try to get a before bed test or occasionally set the alarm for the middle of the cycle at night. (Yeah, I know. Very inconvenient!) Cats may go lower at night than during the day.

Take a look at my signature link on Secondary Monitoring Tools. There are few other assessments you may want to make, such as urine ketone testing. Ketones are a by-product of fat breakdown. Too many ketones may indicate diabetic ketoacidosis (DKA), a potentially fatal, expensive to treat, complication of diabetes.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

Thank you for the tips for ear testing him.

I like the idea of freezing the food (I'm assuming freezing it in an ice cube tray would work. Would it be a good idea to put a few frozen cubes out before his mid-day meal and maybe a couple after. I know he has tipped over the automatic feeder at his first foster home. He's so persistent when it comes to food, so I don't think that's going to be a viable option for me.

So if I get a number below 150, I hold that dose of insulin, correct?

Should I start adjusting the insulin dose at all? His numbers are all over the place. If I should, I'm assuming it would be by 0.5 increments as that is how the syringe is marked.

Thanks!

Denise and Screechy :smile:
 
Re: Screechy-newbie needing guidance, advice, and encouragem

Screechy does have a bit of a wacky SS doesn't he?

Did he start out at 1u originally? Have you thought about dropping to .5u BID just to see if those where too high of a dose and he's just hanging up in the air?

And give Screechy food right now- as a FD he is literally starving while eating everything until the insulin starts working. My cat ate 15-18 oz per day and is now down to 6-8oz per day. I freeze mine in blue ice cube trays (drinking ice is in white ones) and add water. Then I also add a real water ice cube when I put it out to keep the food moist and to add water content.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

Welcome Denise and Screechy!

Some more ear testing tips and tricks can be found in this document: https://docs.google.com/document/d/13c_CPZVKz27fD_6aVbsguadJKvjSrSAkD7flgPPhEag/pub

Insulin dose increases can be done in 0.25U increments. It's a little harder if you only have syringes with the 1 unit markings. But, it sounds like you have syringes with the 1/2 unit markings. Here is a picture with the plunger set at 0.25U.

025unit-1.jpg
 
Re: Screechy-newbie needing guidance, advice, and encouragem

hmjohnston said:
Screechy does have a bit of a wacky SS doesn't he?

Did he start out at 1u originally? Have you thought about dropping to .5u BID just to see if those where too high of a dose and he's just hanging up in the air?

And give Screechy food right now- as a FD he is literally starving while eating everything until the insulin starts working. My cat ate 15-18 oz per day and is now down to 6-8oz per day. I freeze mine in blue ice cube trays (drinking ice is in white ones) and add water. Then I also add a real water ice cube when I put it out to keep the food moist and to add water content.
Click to expand...


I believe he did start at 1 unit. It looks like his previous foster home did drop him to 0.5 units for a day. I'm not sure what you mean by hanging up in the air.

I will start feeding him more throughout the day and leaving the ice cubes as you suggested for the times I can't be here. I'm a pet sitter so my schedule is crazy and changes from day to day.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

mtdenise said:
...So if I get a number below 150, I hold that dose of insulin, correct?...
Click to expand...

Actually, when you first get a pre-shot under 150, without feeding, wait about 20 minutes, retest, and see if it is a rising glucose level. If it is rising, you may be able to shoot anyway. When you first try doing that, though, it is recommended that you be home to monitor. For safety, if you can't be home to monitor, you don't shoot or only shoot a token dose. Also, if you find that you start skipping shots because a pre-shot is too low and not rising, it can be a clue to reduce the dose. If you're ever in doubt, post in Health or in Lantus TR for suggestions.

If you pop into the Lantus Tight Regulation forum, you can review the sticky posts there, part way down the page, to see how that protocol for regulation with Lantus (or Levemir) goes, including handling low pre-shot numbers.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

mtdenise said:
I believe he did start at 1 unit. It looks like his previous foster home did drop him to 0.5 units for a day. I'm not sure what you mean by hanging up in the air.
Click to expand...

Hanging up in the air- his numbers are high. Too high maybe, they don't dip down or raise.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

I've started feeding him more throughout the day, either giving him food in his bowl or leaving food ice cubes out. I didn't realize it's okay for him to eat or graze for 10 hours in between insulin doses. I'll monitor him this way for a few days and see what happens to his numbers. Lots of info for me to read. Thank you all. I'm sure I'll be back with more questions.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

Hello there

I am not sure I would reduce the dose - if anything he might need an increase but I am not an experienced doser. Before we can tell what is really going on though we need a few over night tests (sorry) to see if he is dropping low at night. Say around + 6? That low number is what we base dose changes on. Once we have that data we can get some more experienced dosing eyes to take a look and see what they think.

It will also give him a chance to settle in a bit more to his new house - could be a little bit of stress too spiking his blood.

Wendy
 
Re: Screechy-newbie needing guidance, advice, and encouragem

Couple of things.

1. If the drop of blood is too large, does the glucometer not work correctly? Tonight it seemed there was a large drop and the glucometer would not give me a reading. That has happened once before. I had to prick the poor guy again but did get a reading the second time.

2. Yesterday I started feeding Screechy throughout the day as he will not graze, he's a wolfer, and someone mentioned cats on Lantus should graze. Both days I've gotten numbers in the 200s (which is great for Screechy) but the PMPS was high. You can check out his SS, but here are the last couple of days:

5/24 (this day I fed him his last snack before PMPS at +10
AMPS 254
+4 262 (I was not around for +6)
PMPS 372

5/25 (this day I fed him his last snack before PMPS at +8)
AMPS 272
+6 225
PMPS 372

Not sure if these numbers can tell anything. I'm assuming the PMPS is high because the insulin is wearing off at that time, but I could be wrong as I'm certainly not well-versed in diabetes.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

Sometimes too large a drop can cause issues, so I put a little on my nail and use that.

Feeding through the day can help maintain a constant blood glucose level so there aren't so many peaks and troughs. Really I don't see much difference in the last few days though. Still yellows and pinks, and yes lantus lasts 12hours so Preshot is high because its wearing off.

What you also find a lot is that cats blood sugar drops more at night since they don't tend to eat as much etc. I see that frequently with both my boys although it doesn't happen every night.. Which is why I Am asking for some night tests.


Wendy
 
Re: Screechy-newbie needing guidance, advice, and encouragem

I may be able to get an overnight value next week. I also foster dachshunds and if I get up in the middle of the night one of them will bark. He's getting adopted the end of the month so I'll be able to sneak out of my room without waking the entire house.

If I get too big a drop of blood, I will try the fingernail trick. I'm still learning. Screechy is usually cooperative with me but at times I can tell he's had enough. Thank you for your responses. I really do appreciate it.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

What time is your nighttime shot? Maybe you can get a before bed test a few hours later? That would help too.

Its great that you also foster doggies, you must be a very caring and busy person!
 
Re: Screechy-newbie needing guidance, advice, and encouragem

I give his PM shot around 9 p.m. If I can't get a middle of the night reading, how long after his PM shot should I test. I can't do that to him tonight as this last ear stick he was not happy about. I'm off to the natural food pet store tomorrow to find him some nice low-carb treats.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

As late as you can before you head to bed, 11pm earliest will tell you at least if he is dropping.

I like the freeze dried chicken treats.. Very low carb and my boys love those.. And the liver ones too.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

I can try that maybe tomorrow night. Thanks for the info.

I'll look for freeze-dried chicken treats. He'll love those...he loves everything!
 
Re: Screechy-newbie needing guidance, advice, and encouragem

I get mine in a big bag from Walmart. The dog ones are cheaper and bigger bags and its exactly the same stuff. 100%freeze dried chicken.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

I'd like to see a few more random test numbers, especially in the evening.

If you could get a last test before you go to bed that would be very good. Give us a better idea of what is going on. Screechy has been at that 1U dose for a long time and it isn't working for him. Like to see some more numbers before any dose advice from the folks here.

Also, a few tests at the +9, +10 timeframe would be useful.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

I got a couple of other tests in today, but I'm exhausted now and heading to bed. If for some reason I can't sleep, I'll try to get another reading in a couple of hours. Thanks.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

i would LOVE to see a middle of the night test Whats your phone number so i can call you middle of the night and wake u up? lol

I agree with Deb as regards the dose but my concern is that he could be dropping low at night..... and if we increase the dose he could drop too low at night.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

i would LOVE to see a middle of the night test Whats your phone number so i can call you middle of the night and wake u up? lol
Click to expand...

Wendy, you crack me up! :lol: :lol: :lol: :lol: :lol:
 
Re: Screechy-newbie needing guidance, advice, and encouragem

LOL! I'm going to try to get a middle of the night test next week. My one foster dog is getting adopted then. If I wake up in the middle of the night and leave the room, he'll start barking and wake up the whole household. I'm still on thin ice for bringing in yet another needy animal (Screechy). Once that foster dog is in his new home, I can get up without any issues (well, except for me probably not getting back to sleep). My other dogs don't care if I leave the room or the house when they are sleeping. I'll let you know when I get the testing done. Thanks.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

ok cool - quick question though - she isnt eating the dogs kibble right?
 
Re: Screechy-newbie needing guidance, advice, and encouragem

No, Screechy is currently staying in my finished basement, so no access to dog food or my other cat's food.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

My glucometer is working again. I got a couple of other readings today. I wasn't going to do the +6 one when I feed him as I did one at +5. Boy are his numbers high.

Are there any others you think I should get before his 9 p.m. insulin shot? I'll try to get one +2 PMPS tonight. Hopefully over the weekend I can try to get some middle of the night readings.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

Screechy's numbers just seem to be all over the place and don't make sense to me. I'm starting to wonder if I should get a new vial of Lantus. I believe the one he has is the original from when he was first diagnosed in March.

I recorded today's AMPS and am going to try to get +3, +6, and +9 reading on him today. I can't do overnight testing tonight as I need to be up early tomorrow but can try to do that Saturday or Sunday night.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

If the vial was opened this March I would not suspect it to be bad but it could be. I would purchase the five pack of dispose pens next time.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

May I ask why the dispose pens would be better. I'm fostering Screechy for a rescue and all his supplies came from them. I'd like to give a reason as to why the pens would be better than the vial.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

Each pen contains 3 ml of insulin and typically you will use up the whole pen before the insulin loses effectiveness. The vial contains 10 ml and typically you hony us half the insulin or less before it loses effectiveness. On a per ml basis the pens cost more but you can get a coupon to pay less for the initial pens
http://www.lantus.com/sign-up/offers.as ... 4-58228089
 
Re: Screechy-newbie needing guidance, advice, and encouragem

What time zone are you in? Just want to know so when you do those middle of the night wake up calls, I can shut the ringer off...... ;-)
 
Re: Screechy-newbie needing guidance, advice, and encouragem

Eastern Standard...I'm in Maryland. I'm not looking forward to those middle of the night tests at all. I'm not a very happy person when awoken from sleep and I probably won't be able to get back to sleep. Oh well, my foster's health is worth it. :-D
 
Re: Screechy-newbie needing guidance, advice, and encouragem

The lantus is probably fine - if anything he is bouncing ( but you will find that out this weekend) or needs a dose increase

lets see what those night tests bring!
 
Re: Screechy-newbie needing guidance, advice, and encouragem

When you need to wake up during your sleep cycle, you may find it helpful to do on a multiple of 45 minutes. That is the average amount of time in one cycle of sleep, which means your level is lightest at the 45 minute marks. (as hours:minutes combinations, set your clock for these kinds of intervals -> 0:45, 1:30, 2:15,3:00, 3:45, 4:30, 5:15, 6:00)
 
Re: Screechy-newbie needing guidance, advice, and encouragem

Would you please provide us with some more information and put this in your user control panel? It helps us to help you better.

Go to the upper left corner of your screen and click on the words, User Control Panel
On the next screen, a row of tabs is presented. Select the Profile tab
On the next screen, there are a number of choices along the left hand side. Select Edit Profile.
Go down to the location field and enter your country, state/province, and city if you are willing to share that info.
Click on submit to save this change.

Still in the User Control Panel, Profile tab, this time select Edit Signature from the left hand list of options.
A free form text box appears.
We like to see information like your name, your cats name age and sex, the diagnosis date for the diabetes (DX 4/30/13), what meter you are using for testing, what insulin you are using , what you are feeding (wet or dry, what brands/style of food), any complicating health issues your cat may have, any additional medications your cat is receiving.

Click on submit to save this information. Now, this will appear at the end of every post you make. You can update the info when you need to.

Think of this as having some very useful information at our finger tips for those that are replying to your posts.

Would you please do those updates when you get a chance? Thanks.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

Ok, I'm back. I just updated my signature line and hope I provided all the necessary info.
I got some overnight readings last night. Not fun but I know it was best for Screechy. I guess now is the time I'll start needing advice on where to go with his dose and what to do next. I've done a lot of reading but am still confused by it all. Is this the correct board for posting about dose guidance or is there another forum to use? Heading to bed shortly for a full night of sleep and will check back in the morning. Thanks all!
 
Re: Screechy-newbie needing guidance, advice, and encouragem

Thanks for the signature info updates it really helps.
 
Re: Screechy-newbie needing guidance, advice, and encouragem

Once you've got home glucose testing down, have made whatever diet changes you are willing and able to make, have a spreadsheet, some info in your signature, and have your hypo kit stocked, you have the basics down. If you feel ready to move into your insulin group, go for it.

2 Options:

LANTUS (GLARGINE) - Tight Regulation
- very active; mainly follow the Tight regulation protocol described in the sticky posts

"RELAXED" LANTUS
- less active; an option for those who aren't able to follow the TR protocol for whatever reasons, often scheduling difficulties
 
Re: Screechy-newbie needing guidance, advice, and encouragem

:? I don't like all those yellows and pinks and you have been doing this since march...

I would like more eyes on you and would recommend you pop over and start posting in the tight regulation forum... But they will ask for a bit more testing at first ie am preshot, mid cycle, PM preshot and before bed.. Depending on your schedule of course...

http://felinediabetes.com/FDMB/viewforum.php?f=9

You are welcome to continue to post here, I just think that they might be able to help you more over there. I post there myself every couple of days but most people post daily to ensure the experinced dosing members are keeping a close eye on their cats. Plus it's a great sense of community and they will be able to advise when and how much to change dose.. Read all the stickies on that page and post there as often as you can.

Heres how to post
Every day ( or as often as you can) you open a new thread/post. We call them "condos"
- The subject has the date/cats name and BG readings ie 06/02 Screechy AMPS 342 +6 211 PMPS 351. You add a ? icon if you have a question. You can update your subject as you get a reading, or whenever.

- The contents of your post have a quick update on how screechy is feeling as regards the 5Ps ( peeing. pooing, preening, playing and purring) and any questions and a link to your previous post ie : Today screechy was in a good mood, playing and eating well. But still peeing a lot and BG is really high. Should I increase the dose?

For your first post put "newbie" also in your subject so everyone can welcome you!
Wendy
 
Re: Screechy-newbie needing guidance, advice, and encouragem

Thanks. I'll pop over to the Tight Regulation board and ask for advice on where to go from here. Just to reinstate, I have only had Screechy since 5/15/13. I don't think his previous foster homes really followed any type of protocol. I wanted to make sure I was comfortable with testing before really getting started on dose adjustments.

I probably fall somewhere in between tight and relaxed protocol, but I'll post to tight regulation board and see what happens. I'm a pet sitter so my schedule is wacky from day to day. Sometimes I'm home, sometimes my day is filled with visits. I just need someone to guide me through all this as I really have no idea about dose adjustments at all. Thanks.
 
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