should I be giving insulin? I really don't know.

Status
Not open for further replies.
D

DiabeticMom

Member
Hi all,
Chong's numbers have been under 200 for the last 3 times I tested and I haven't given her insulin. They are climbing from a low last night but still under 200. Should I be giving insulin or not? I just don't know.

I've been giving Chong SubQ fluids & B...pain med. I was supposed to give pain med at 8 pm tonight and she just got it at 10:34 pm, and hopefully 1/2 got in. Things aren't working well today. I had to stick her 3 times to get the SubQ fluids going inside & not everywhere else.

I'm also giving Pepcid AC and Ptitis homeopathic. Tomorrow I give her B12 shot. She got one last Sat.

Thanks for all opinions and advice.

Barb & Chong
 
Barb -

It looks like you gave .5u into (187) on 3/13 and 1u into (188) on 4/27. What is your do not shoot number? In other words, what is the lowest number you'll shoot into? I'm going through my own dosing confusion right now, but I'd say if you shot into those numbers and were pleased with the results, then continue with whatever BG is your line in the sand. Blue PS's are great, but it looks like Chong's pancreas still needs a little help.

Just my $.02. Hope you have a great night!

Libby (and Hershey, too!)
 
I might reduce a little, .5 even to be safe. Is Chong eating normally, earlier he wasn't. I would be concerned because of that and the fact that your numbers have been staying regulated (which Caryn cause the need for insulin to drop). At the least shoot light when you won't be home to check, if you're still shooting 1u you need to be available to check at 4 hours and 6 hours
 
You have 2 choices - watch carefully to see if he goes down for a few cycles, or mini dose as Libby suggests. We consider a kitty in remission if they run from 40 - 150, off insulin, with the majority of the time in double digits. Can you get some more numbers today? If he is in low double digits at nadir, that makes your preshot numbers look better and may suggest watching. If he is flat and running in triple digits during the whole cycle, that suggest mini dosing.

The weekend is a good time to start mini dosing so you can monitor carefully. Maybe get some numbers today and consider mini dosing tomorrow?

The medicines may be influencing his numbers, either higher or lower, so I would get data and then decide.
 
I screwed up my SS

Hi,
Sorry. I screwed up my SS. I didn't give insulin until 194, then .5, or less than 1. I use U40 so it is hard to tell. At 188 I didn't give it to her.

Do fluids, pain meds & Vit B12 effect BG levels this much? Is her BG high because she is in pain or is it just sugar level?

Under 200 I start to watch what I'm giving her. This is an arbitrary number and that is what I am starting to question. I think a vet told me this a few months ago. I need to test during the cycle again at these numbers. I just hate to poke her any more. With insulin she is poked 4X/day (testing & insulin) and doesn't like it, now getting fluids daily (another 'poke'), pain meds am & pm, B12 shot 1X/week on Sat--today (another poke), homeopathics into mouth 1X/day, Pepcid AC 2X/day. Maybe I'm just overwhelmed but quality of life? Or am I just trying to get to the other side of a flare up? I just feel like everytime I come near her I'm doing something to her.

On the other side of things, she's eating well now but I have to leave it out. She doesn't eat much in one sitting. Her blood work per last Sat was pretty good according to the vet. She was hiding a bit last night---not sure if hiding or found a new spot she likes. She wasn't in there very long.

Is mini dosing a smaller number or more dosing than am & pm?

Barb & Chong
 
If you mini dose, you really need the U100 needles. It is generally an on demand system - frustrating and time consuming but doesn't last long. You set a number and shoot at that number, being sure it is rising. It is generally off the 12/12 schedule, often longer between shots. Catannc's spreadsheet is a good one to check out. She recently did it and her kitty is off the juice.

It is hard to feel like you are constantly poking and prodding. Think of it as temporary and the path to good health? And maybe make time for lots of loving when no pokes are needed? And of course, treats always.
 
Hey Barb -

Grayson's fluids usually impact the next preshot. Nothing too noticable when I give them - usually at +4 ot +6... but when I was doing them 2x/day the preshots were consistently lower. Probably as much as 30-50 points, but I've never really looked at his SS from that angle.

The fluids could be part of the recipe for Chong's numbers. Of course other factors can influence as well. I'll see if I can find the thread w/ Dr. Lisa's comments about the multiple facets that affect numbers and get back to you with it.

Lu
 
Grayson & Lu said:
Hey Barb -

Grayson's fluids usually impact the next preshot. Nothing too noticable when I give them - usually at +4 ot +6... but when I was doing them 2x/day the preshots were consistently lower. Probably as much as 30-50 points, but I've never really looked at his SS from that angle.

The fluids could be part of the recipe for Chong's numbers. Of course other factors can influence as well. I'll see if I can find the thread w/ Dr. Lisa's comments about the multiple facets that affect numbers and get back to you with it.

Lu
Click to expand...

I think this is the thread Lu is talking about...one of my all time faves!
http://felinediabetes.com/FDMB/viewtopic.php?f=24&t=61241&p=663242
Believe me, I completely 'get' the frustration involved with managing any diabetic cat - especially one like Copper - but I just hate to see people ripping their hair out over the dosage of insulin....down to impossible-to-accurately-measure increments of 0.1 or 0.2 units when there are SO many other factors involved in the glucose curve making that level of dosage change pretty darn moot. Yes, it would be great if we really had *that* much control over the disease process but we don't.

(Lori - I am hoping that the last statement will take pressure off of you - not add to it. Copper's body is in charge and we are just along for the ride...doing the best that we can with the ability to affect only a few pieces of the puzzle....ie....diet, insulin, constipation, body weight - in the case of an overweight cat.)

Serum glucose, at any single time point during the glucose curve, represents the sum effects in the *rate* and *amount* and *timing* of:

*Exogenous insulin absorption

*Endogenous insulin production

*Intracellular uptake of exogenous and endogenous insulin

*Insulin degradation and elimination - different for exogenous vs endogenous

*Intestinal glucose absorption

*Endogenous glucose production

*Tissue glucose uptake and utilization

and then throw in the amount of exogenous insulin....excess body fat....inflammation....subclinical infection....etc...etc....

....and then add in Copper's recent bouts with constipation (stress => increased BG) which prompted an email to Lori to get Miralax (or generic PEG 3350) into him asap before he ended up needing an enema at her vet's office...which is not easy for her to get to and I hated the thought of Copper having to go through all of this. (Dosage Rx was to start with 1/8-1/4 tsp AM and PM - mixed into food - and dose upwards to effect.)

When you consider all of the above, to me, at least, I can't get caught up in agonizing over minute dosage changes...so dear Lori....please stop driving yourself nuts over such small dosage increments.
Click to expand...

Carl
 
Great post, thank you!

Right now the pain meds, subQ fluids, B12, etc. seem to be keeping Chong's numbers right below 200. I have not been giving insulin although I still check on schedule. The only time it broke 200 is when I gave insulin in the last cycle. In a way, I think we both need a break. I hope this is not a mistake. Anyone have any experience with doing something like this?

Does anyone know why fluids, B12, pain meds bring BG numbers down. They obviously reduce the physical stress so I guess I'm still asking the question, diabetes or pain?

Thanks again.

Barb & Chong
 
No way to know (wouldn't it be nice if they could just talk?) but pain = stress and stress can raise bg levels.

Some people here think there is a limited "window" for getting cats OTJ and they work for remission by really hitting the numbers. I don't like to see vets say 200 is remission, and then cats going completely off insulin and hometesting curbed for months. That often seems to mean a return to insulin at some point. I don't think relaxing for a week or so and seeing how his numbers do is a bad idea.

But at this point, he should be below the renal threshold if he stays at 200 or below, so the theory is that you aren't damaging his body. I would test at least once a day. If he gets back up above 200 regularly, I would advocate insulin.
 
Do you know what the window is? And what numbers am I shooting for? I hope I haven't missed it or done the wrong thing!

I haven't talked to the vet about what I'm doing. I did say once that I didn't shoot below 200 & she seemed happy (one of them anyway) but there has not been any real conversation. She did discuss experiments where some vet school implanted a monitor into a cat and saw that a cat could hit a low number for less than 5 minutes & have a rebound effect. Apparently no one expected that.

If I can find the U40 to U100 chart, and if Chong's numbers are below 200 still, I will try the mini doses. I hope i didn't blow it but when i gave Chong a 1/2 dose her numbers went higher.

I don't have pain meds after tomorrow am. Should I be asking for more? She doesn't seem like she is feeling well often and just when I think she is really sick, she rallies.


Barb & Chong
 
Here's the conversion chart: http://www.felinediabetes.com/insulin-conversions.htm I'd also check out Catannc's spreadsheet to see how she did it.

The remission window is a &%$# EECID thing, if it exists. I think the idea came from the fact that some cats go off insulin in a few months and some stay on insulin forever. I don't like to see cats sitting in numbers above 200 for weeks or months, with no insulin.

We consider a cat off insulin when they run from 40-120, without insulin, with the majority of the time in double digits. Many cats here seem to run in the 70 -80 range off insulin.

You want choose a number just under 200 when you mini dose - usually in the 150-180 range. And start very low, like .1unit. And monitor carefully.

If you think she is still in pain, I would ask for more pain meds.
 
A cat that is acting like it feels bad i would worry is still in pain and get more bupe. I'm gonna start a thread on micro doses.
 
Maybe it is pure coincidence but I am so sorry I gave her any insulin. Look at my SS. 170's without insulin, about 250 with insulin. Disappointed. As I said, maybe it is pure coincidence and our break is just over . . .

At 248 (This AMBG) I gave 1 unit U40 syringe. Last night at 170 I gave what was '1' on a U100 syringe. She also had a small amount of Alta Dena Raw Milk Goat Cheese--never had it before, loved it, but I wouldn't give more than small amount. An hour later her BG was 254. I wouldn't think that small an amount would do much. The goat cheese? No reason?

I gave 200 fluids yesterday. She usually gets 100 but we were at the end of the bag and vet said 200 was OK. She seemed great last night and this morning and her coat was nice & smooth. I gave her the last of the pain med and she doesn't seem as good as before the pain med, but I thought I needed to finish that cycle. Could extra fluids jump her BG level?

Thanks for joining me on this ride.

Barb & Chong
 
Not sure about your doses. We are thinking .1 unit based on the conversion chart for U100 needles - not one unit. Hard to know what is happening. The yellow right after your shot last night could be a food spike - a midcycle number could have been much lower. If you are going to try mini doses, you will need to get some midcycle numbers. Otherwise you are just guessing about what happened - was it a higher flat cycle? Did she dip low and is this number a bounce? The monitoring is a huge part of the mini dosing. Hard but usually it is a short period. Some people set the alarm for +6 at night, wake up and take a test and go back to sleep. Can you get any numbers midcycle today?

In some cats, anything can raise bg levels - cheese is one of the big culprits. While you are working so hard to get her OTJ, I would stick to only wet low carb food and snacks. Tough love :-D

Check out Grayson's spreadsheet. Though every cat is different, with fluids his numbers were different.
 
I don't know what .1 is on U100 syringe. I have a syringe that says it is U100 and the large lines are marked 5, 10, 15, etc. Between these are smaller lines marking the in-between. The box says .5 ml to use with &-100 insulin for 50 units or less. On the needle it says 1/2 mL U-100 Insulin One use only. The syringe has an orange cap on it. Are we all talking about the same thing?

I gave her the first line of the in-between lines, the first after the basic line. Is that 1, .1?

Because I am unsure about the U100 syringes and because her numbers are now in the mid-200 range, I went back to U 40 and gave 1 unit, her normal dose.

I will test at +3 and maybe more. Her ears are crusted from being pricked and she now slaps at me rather than bites me. I figured that is because she has the pain killer in her. I tried neosporin cream a couple of times. I got weird numbers (90 when she was normally running 300) and it didn't really seem to make it easier for her. Maybe I'm doing it wrong. Can anyone tell me about neosporin?

Any dry food, no matter what carb %, seem to shoot her numbers. Even a small amount. So I don't give her any dry at all unless I think the need outweighs the harm. Dry food is her favorite. Her 'treat' is a chicken flavor pill pocket with Pepcid AC in it, otherwise she doesn't get treats. In the middle of the day I give her a little FF Chicken Classic, which is what I feed her day & night. I tried some Wellness but she didn't like it, or some of the other FF flavors. Sometimes I put out FF can and leave it out all day for her. I might boil up some real chicken for her today but that is unusual. I never wanted her used to people food.

I might have already said this, but I gave 200 fluids yesterday afternoon and she seemed great today until I gave her the pain med which seemed to bog her down.

Thanks for staying with me on this.

Barb & Chong
 
I never used the U100 needles. But until someone else checks in, here is a thread with info and pictures: http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=64269&p=697204&hilit=U100+needles#p697204

Her ears should "get used to it" Do you hold the spot for a few seconds after poking? That should help with the bruising. With the neosporin, you only want to put on a tiny thin smear. A bigger amount can mess with the numbers.

Have to tried FortiFlora? It doesn't work for every cat, but for some it is magic. Here is some info from a vet about it: Try a product called FortiFlora. Most cats LOVE FortiFlora and this has recently become my favorite trick. This is a probiotic made by Purina but you are not going to use it for its probiotic properties. You are just going to use it as a flavor enhancer. The base ingredient in FortiFlora is animal digest - the very substance that makes dry food so very enticing to cats. The directions say to use 1 package/day - and you can use this much if you want to - but this amount is not usually necessary. You may only need ~1/4 of a package - or less - with part mixed into the food and part sprinkled on top of the food just as you would use salt and pepper on your own food.

You can find it on the internet or sometimes from your vet.

You are doing great, Barb. This is hard with just the diabetes, but you have the extra complications. Remember to breathe and take time for yourself every evening with your favorite beverage and snack. (Wine and chocolate work for me. :-D )
 
I posted a pic in Cathy's Micro-Dosing thread of what the whole vs. half-unit syringes look like.

Barb, if I understand right, if you shot 1u on the U40 syringe then of course that is "1 unit". If you shot 1u of the U100 syringe, then that equals .4 units of prozinc, so a little less than half the dose.

The basic math is just the U40 dose times 2.5 equals the dose in the U100 syringes. So a .4 dose, you'd go to the 1u line. A .6, you'd draw up 1.5 in the U100. A normal 1U dose in your old U40 syringes would be 2.5 units in the new U100 syringe.

Carl
 
I haven't talked to the vet about what I'm doing. I did say once that I didn't shoot below 200 & she seemed happy (one of them anyway) but there has not been any real conversation. She did discuss experiments where some vet school implanted a monitor into a cat and saw that a cat could hit a low number for less than 5 minutes & have a rebound effect. Apparently no one expected that.
Click to expand...

Barb,
Is there any way you could prod the vet for more information about these experiments? Like when/where they were done? I'd love to know more about it!
Carl
 
Status
Not open for further replies.
Back
Top