skipping a shot?

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I know it's frustrating and a little scary to have to keep reducing the dose, but it is really good news. He is using less and less insulin - it's a really good thing!
 
Nifty! Like Sue says, a reduction is a good thing. Restarting at 1 feels like going backwards but it isn't. It just means that you may have started at too much insulin, and this is a chance to slowly increase or decrease as needed to find that perfect dose. :)
 
woke up this morning and he is at 99 AMPS! from 1 unit last night! i'm waiting a little bit to re test before i feed him... any suggestions?

he is not happy that breakfast is delayed

oh and he was at 250 last night +2
 
Rachel said:
Nifty! Like Sue says, a reduction is a good thing. Restarting at 1 feels like going backwards but it isn't. It just means that you may have started at too much insulin, and this is a chance to slowly increase or decrease as needed to find that perfect dose. :)
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started at too much insulin at the very beginning when he was diagnosed?! because we started at 1. but yes it does feel backwards.. was worried that I wouldn't be getting him enough!
 
Wow! Go Scout go! I don't see any way he is going to go up to 200. (Be sure to get a second test just to make sure the first one is right.) You could feed him a tablespoon or something if that will placate him, but I would only wait 2 tests (maybe 40 minutes) If he is nowhere close, I'd skip. He may bounce somewhere in the cycle as he could have been very low overnight. Then you could try a chicken *(&% dose and start over again tomorrow.

Looks to me like this kitty might want off the juice (anti jinx) The insulin and food is starting to work well together. We have to find a dose that will let you shoot twice daily, even if it is .5 or under, until he stays in the consistently low range but it's hard because he is a moving target. :D
 
I agree with Sue - if Scout hasn't risen to safe-to-shoot zone in about 40 min. or so from your first test, go ahead and feed him his usual ration & just skip the dose, as it looks like he's hanging onto that insulin more than 12 hrs. Right now it's looking like Scout's pancreas is asking for a dose redux overall. Yep, he sure is a moving target ... try not to get dizzy trying to keep up with him!;)
 
Still too low - you'll just need to skip, I think. Then at your PMPS check, depending on the the # you see (will likely be higher), may want to drop down to 0.5 U and see how he does with the lower dose. (Sue - any additional thoughts here?)
 
Kristin & Scout said:
haha! he starts his riots for food around 6AM! let me sleep, cat!
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I hear that! This morning @ 6:15 a.m. Bat-Bat was already yelling, "Mah-maw, Mah-MAWWW!" before the alarm was set to go off (15 min. later).
Turns out her AMBG was 129 ... so she was essentially saying, "Feed me NOW, you idiot!" She has been teetering on the brink of Honeymoon/OTJ for a while now. Makes me crazy some days ...
 
Robin&BB said:
Still too low - you'll just need to skip, I think. Then at your PMPS check, depending on the the # you see (will likely be higher), may want to drop down to 0.5 U and see how he does with the lower dose. (Sue - any additional thoughts here?)
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Yes, I like reducing the dose and .5 sounds good. We keep trying to lower enough to get 2 shootable numbers and he keeps dropping. It's all encouraging, just a little nerve wracking.
 
alright guys! no insulin this morning.. PMPS is 282 right now. his last snack was a few hours ago and he seems less hungry overall today. i should try .5 tonight?
 
I would. And maybe a +2 and before bed test so you can be sure he isn't dropping too much. Hopefully .5 will give you two shootable numbers.
 
Yes, at least get a +2 tonight. Will keep my fingers crossed for a shootable # in the morning. (Go, Scout!)
 
I give Merlin his shot, too, when he is eating. I just like to make sure that he has something in his stomach so I usually let him eat for a few minutes before I shoot him.

Well, Scout is definitely going to have safe numbers tonight i.e he is not going to go low. :) Just remember ... all data is good data. Have a good night.
 
Kristin & Scout said:
+2 is 353. he ate while i gave him his shot
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Well, he's still rising, which is normal at +2. I don't think you need to worry mch about him dropping super-low tonight; might want to get a +4 or +5, if you can set an alarm, just to have a bit more nighttime data on him. He might actually be heading into a nadir by then ...

Not to worry, he'll even out for you eventually. Some kitties just make it challenging - for a bit - to find that dosing sweet spot.
 
Wow Kristen & Scout! This read like a good thriller novel for awhile there!
I am learning alot! I'm really happy for you that you seem to be on the brink of discovering his patterns and getting a dosage down pat.
I know THAT'S gonna feel great!!
Gives me hope.
PS Sweet Halloween pic
 
Can somebody please take a look at Scout's spread sheet and tell me what I'm doing wrong? Seems that .5 units isn't enough and 1 is too much. I'm at a loss and I don't know how I'm supposed to get him on the right track.
 
Hmmm. That is certainly a big difference. You could do a fat 0.5. So draw up one unit and let out drops until you have a few drops above 0.5 Or can you eyeball .75? You can decide where it is on your syringe and mark it with permanent marker or tape. Use that one as a sample and draw up to the same spot each time. Or you could try the U100 needles. They would let you dose .6 and .8 But you need to use the conversion chart with them.

http://www.felinediabetes.com/insulin-conversions.htm

It is frustrating as he seems to jump all over. But generally you are seeing some nice low numbers. Some of his issues seem to be bouncing, and late bounces. So the next cycle seems to be a reaction to a low the cycle before.
 
Kristin & Scout said:
Can somebody please take a look at Scout's spread sheet and tell me what I'm doing wrong? Seems that .5 units isn't enough and 1 is too much. I'm at a loss and I don't know how I'm supposed to get him on the right track.
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Any other symptoms - is Scout peeing ok, etc?
 
Sue and Oliver (GA) said:
Hmmm. That is certainly a big difference. You could do a fat 0.5. So draw up one unit and let out drops until you have a few drops above 0.5 Or can you eyeball .75? You can decide where it is on your syringe and mark it with permanent marker or tape. Use that one as a sample and draw up to the same spot each time. Or you could try the U100 needles. They would let you dose .6 and .8 But you need to use the conversion chart with them.

http://www.felinediabetes.com/insulin-conversions.htm

It is frustrating as he seems to jump all over. But generally you are seeing some nice low numbers. Some of his issues seem to be bouncing, and late bounces. So the next cycle seems to be a reaction to a low the cycle before.
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@Sue and Oliver (GA) - Is it possible that Scout is doing that "hanging-onto-the-dose >12 hrs." thing sometimes, too?
 
Yes, that could be also. Which would mean the dose might be too much but it is strange that there is such a big difference between 0.5 and one unit.
 
scout is peeing/eating/acting completely normal. I was thinking the insulin was lasting more than 12 hours but I'm not sure. I tried marking the syringe, the little black bumper inside (idk if I'm describing it right) is thick enough to make it in increments of 3rds- that's why it says I gave him 2/3 of a unit the other night. it's just frustrating seeing his numbers bounce all over the place
 
Kristin & Scout said:
scout is peeing/eating/acting completely normal. it's just frustrating seeing his numbers bounce all over the place
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Yes, I can feel your frustration from here!:bighug: (I'm reading through your earlier posts to see if there are any more clues to what's going on; will try to get back to you shortly.)
 
Maybe he is a cat that just doesn't do sliding scale. I wonder what he would do if you did .75 and just stuck with it a few cycles? I am wondering whether he would flatten out and settle down?
 
A cycle is 12 hours. So you have 2 cycles each day. It couldn't hurt to try sticking with .75 for a few cycles...say 3 or 4. As long as you're getting shootable preshots it might be what he needs.
 
Just finished perusing your earlier posts. So now I have few more questions, Kristin:
1) What is Scout's weight today - 12.8 lbs or what?
2) Is he still getting 3 to 4 cans (3 oz/can) of FF/ Nutro per day on the typical feeding schedule you'd posted earlier?
3) Which formula Nutro canned are you using?
4) When/ if you give any extra snacks beyond what is noted above, what are these and what amt?
5) Is he an "only" cat?
6) Does he spend time outdoors unsupervised?
 
yes scout still weighs 12-13 lbs.
still 3-4 cans FF/Nutro. more so FF right now (the non-seafood Classic), but occasionally salmon/duck/tuna nutro (minced/soft loaf/chunky- a wide variety) but starting to transition to FF only (less expensive).
and yes 2 main meals a day with snack(1/2-1 can) around +6
snacks are freeze dried chicken/beef- the other night he attacked the bag in the middle of the night and ate about 1/4 of bag that was left. but usually 3 pieces broken up
yes only cat. there is a dog in the house but they get along very well
no he isn't allowed outside at all anymore. he used to run out with the dog but I've put a stop to it recently (last 2 months or so) and he's been good at not trying to sneakily escape
 
Kristin & Scout said:
yes scout still weighs 12-13 lbs.
still 3-4 cans FF/Nutro. and yes 2 main meals a day with snack(1/2-1 can) around +6

there is a dog in the house but they get along very well
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Ok, just a couple more questions:
Is your dog free-fed? (meaning:Is there a bowl of food left down for your dog where Scout could raid it?)
Is Scout a "normal-size" cat? (I know he's Siamese mix - so he's of regular-size bone structure, is that correct?)
Note: my internet service is up & down today, so if I disappear you'll know it's not on purpose ... :banghead:
 
no worries! thank you for taking the time to help.
the dog is fed in the morning and at night, outside. scout has no access to any of his food or treats. he used to love love love eating the dog's food!
yes, scout is normal sized for the most part... although he's always been rather long. before diabetes he was a BIG boy, almost 20 lbs, but i would say he looks "normal" now(before he was straight up fat haha). sometimes i wonder if he weighs enough though because i feel like his ribs stick out, but they might just be wide. he looks healthy
 
I like the suggestion of staying on one dose for a few cycles and hopefully you can monitor. I had to do that several times with Merlin in May 2014 as indicated in my 2014 SS. It helped him settle into a dose and slowed down the bouncing. I tried one dose for one week. Then I would try another dose, another week. I think I did that for a month.

Since Scout has some high numbers, are you able to test for ketones? You may already have some but you can buy testing strips at any pharmacy. The one I have is called Ketostix.
 
no i don't test for ketones, but the vet tests every time we go in. his breath smells like normal kitty breath. last time i went to the pharmacy (CVS) and asked about them, they had no clue what i was talking about. are they human strips or are they specifically for pets? they told me to check the diabetes section of the store and i couldn't find any there
 
Kristin & Scout said:
no worries! thank you for taking the time to help.
the dog is fed in the morning and at night, outside. scout has no access to any of his food or treats. he used to love love love eating the dog's food!
yes, scout is normal sized for the most part... although he's always been rather long. before diabetes he was a BIG boy, almost 20 lbs, but i would say he looks "normal" now(before he was straight up fat haha). sometimes i wonder if he weighs enough though because i feel like his ribs stick out, but they might just be wide. he looks healthy
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(I’ve posted some of this on other threads, but have re-edited for you to better address Scout’s unique situation...Warning: This is a long post!:eek:)

Looking back to the years before Bat-Bat was diagnosed, I now realize that if I had wrapped my head around looking at her food more like it's medicine, I would have paid serious attention to how I was feeding her back then. Because - if I'm brutally honest with myself - I know now that I was feeding her all wrong! (Just kept dumping "...a 'wee' bit more" kibble in her dish when she'd yowl, "Hey! I'm hungry!" because I was on deadline for a client, or late for a meeting, or distracted in any number of other ways.) I didn't pay all that much attention to actually measuring out the amounts of food she was given; I only "kinda" did that. She was fed some canned, but the staple of her diet was dry kibble because, well .. heck! It was organic! it was good for her! And because southwestern Colorado & northern AZ can get hot as blazes, I'd tell myself, "It's sooo hot out - no wonder she wants more water ..."

You’d said Scout weighed a hefty 20 lb last November, and was down to 11 lbs. when diagnosed in May. That sounds so much like Bat-Bat: She was 18+ lbs. back at the end of 2012; was down to about 9.6 lbs. when first diagnosed in August 2013. I had been trying to get her wt. down pre-diagnosis (feeding mainly kibble - ugh!); when she later started dropping the pounds, I simply assumed my (very slight - still too high carb) changes in feeding her had worked. (Wrong!:banghead:)

In my experience, most vets don't even mention feeding habits for our kitties until they're already obese! And look at how cats have historically been pictured in our culture: The plump kitty curled up on a chair, the plump kitty sitting by the hearth. (Anybody remember the cartoonist B. Kliban, whose cat drawings were so wildly popular in the 70's? The cats were all fat cats!) And don't even get me started on cat food commercials (Sorry, "Blue Buffalo" dry-food company ... but if your dry formula is soooo healthy, why did you refuse to give the carb info to Dr. Lisa Pierson?:blackeye:) We've been encouraged to free-feed our cats. But if we take a cold, hard look at that, dry foods were developed for human convenience - not because it was healthier for our pets. So then, not realizing what the consequences might be, we - as a society - bought into all that the marketing hype. I believe that we, as a culture, have come to perceive that it's okay when our cats begin to plump up a little, over time. We barely notice ... not until diabetes strikes.

For me, feline diabetes was an unfortunate wake-up call: Hey, Robin - treat the food as medicine, too! Measure her low-carb diet carefully, and monitor its consumption. Don't give in to her adorable kitty face:cat: when she begs for more food than is correct for her optimal weight and her unique metabolism. (Bat-Bat doesn't get a treat in exchange for an ear-poke; she gets soft words before, during & after, then a nice scritch under the chin. She's being treated for a disease; she's not being rewarded for cleaning up her room.:p)

And on that note, Kristin --- after looking over Scout’s SS & considering the additional info you provided me today, my gut is telling me that two things as relates to feeding are likely happening here:

1) Scout’s probably getting a little too much food. That may sound crazyo_O right now because he’s always hungry, but the real reason he’s so ravenous is because his diabetes is not yet under control. Trust me, this will change as his blood glucose becomes better regulated. Based on his numbers not coming down for you regardless of dose adjustments, I would wonder about his current daily ration load inhibiting the effective action of the insulin. Has he been bouncing around? Yep! But I don’t think that’s the only thing happening here.
2) Forget the snacks, at least until his numbers have come down. You reported earlier today that he gets two main meals + some snacks at later points in the cycle; also, in a previous post you wrote, “...but when I’m home I try to spread his meals out throughout the day.”

From what I can see on his spreadsheet, your current approach to feeding - coupled with too many ounces of food per day (9-12 oz+) - may be working against you in your efforts to get his numbers down.

Notice how his numbers are all over the place, regardless of insulin dose? Start thinking of food as “medicine!” The “total daily dose” of food, and how you divide that “dose” up in a 12-hour insulin cycle can have a huge impact on how Scout metabolizes that insulin!

Remember: Every time you feed your cat something, his blood sugar rises. (This is why we so quickly feed whenever a cat drops down into the hypo-zone: To get that BG # back within safe limits.)

Although there are others who find that mini-meals/ snacks throughout the cycle work fine from the start for their cats (the concept is that it helps the pancreas heal), I can’t say I recommend this as the optimal approach with either Lantus or Prozinc in the early stages of treatment for a cat without other health complications. (I’ve used both insulins, as you can see in my signature: First, the Queensland Tight-Regulation (TR) Protocols on Lantus in 2013. Since her diabetes recurred last Feb. & she went on ProZinc, I’ve also used the TR approach, but with some modifications given that “long-acting” ProZinc behaves somewhat differently than the “ultra long-acting” Lantus.)

I’m lucky to work from home (I’m a writer), so when Bat-Bat was dx’d I could monitor closely from the start. Some people simply cannot do it due to their schedules (they often use time-release feeders to guard against hypo-events when they can’t be home to monitor); others have sugar-kitties with additional health problems that make it very important that they have mini-meals throughout the day. In those cases, I can see the point of the mini-meal approach. I can also see a real value for it later in treatment, when your cat’s BG is very well-regulated (down to near-remission) and you’ve got that cat on a micro-dose twice a day, or even a micro-dose “as needed” (where Bat-Bat is at present), because at that point your cat is so well-regulated that it’s preferable to keep blood sugar on a more even keel throughout the day/night cycles.

But until that great regulation happens, if you keep dumping food into your kitty every few hours during the 12-hour cycle, how do you ever find your cat’s nadir? (Answer: Good luck with that!:rolleyes:) The great news for you, Kristin, is that you’re fresh out of university:joyful: & looking for a job at present - so you actually have the opportunity at present to closely monitor & get Scout’s BG better regulated before you’ve found a full-time job in your chosen career! :cool:

Here’s what I’d suggest you consider trying with Scout:

1) He could probably stand to lose about a pound: Aim to get him down to about 11.8 to 12 lbs. (That means he’ll be a lean, mean kitty machine!:cat:) Lest you think he’ll be getting too small a ration, here’s some perspective: Bat-Bat maintains her 11-lb. weight eating between 6.75 oz/daily to 6.85 oz/daily! (That’s about slightly more than 2.25 cans of Fancy Feast.) In portioning it out, I actually cut the food in the can like a pie: In quarters and even in eighths sometimes.

2) Maybe reduce his daily total ration of canned Fancy Feast to just 3 cans/day. (9 oz. total); you may want to start the reduction out at 3.5 cans/ day the first few days, then 3.25 cans, then 3 cans. (Since he’s lately accustomed to 3-4 cans + snacks, right?) Divide his total daily ration into 2 meals per day: AMPS & PMPS. (I can hear him yowling from here: Get some earplugs.:eek:)

NO snacks.:stop: Not unless his BG #s indicate he’s close to hypo.

Get a baby scale and weigh him every day or two for a while. (Maybe right before bedtime?) That’s a big help in determining whether he needs reduction/ increase in rations. Give it a little time before you make any portion adjustments, though - safe weight loss isn’t instantaneous.

Make sure he cannot get into any extra food:stop: - from any source - that’ll just make it that much harder for you to get his diabetes under control.(So glad to hear your dog eats outside, where Scout can't get to it!)

With a shift away from snacks, Scout might wolf down his two meals too fast.:banghead: (Bat did this!) To help prevent scarf & barf: Add some water to his meal (slows him down), elevate his dish on a shoebox (so that he’s not eating with his nose @ floor level) - & pick up the plate/bowl when he’s halfway through for a 5-minute “food rest” before letting him finish. (Then shoot the insulin.)

Will you run into an occasional snag? Sure! Bat-Bat recently barfed her ENTIRE meal:arghh:, right after one of her “as needed” insulin shots. (:nailbiting:Panic time!) So first, I reminded myself to breathe. I waited 15 minutes & fed her 1/3 of the usual ration. (TG, it stayed there.) Then 10 minutes later, fed the 2nd 1/3; and in 10 more min. fed the final 1/3. It all stayed down. Checked her BG - it was going up. Checked again at nadir-time to reassure myself. All was ok; crisis averted.:)

Keep on getting those BG tests in: around say, +3.5 or +4, and maybe in the +5 to +6 range, - both am & pm cycles, if at all possible - so that you have a clearer picture of where his nadir occurs. You may even need to do a mini-curve. (This will make things easier for you down the road, too - because you’ll start seeing his patterns come more into focus on the SS. (You already know the importance of avoiding hypos, so his BG drops are especially important to learn when you’re not doing the snack/ mini-meal thing.)

I hope I did not overwhelm you here, Kristin. But I know you can do this; even if you have to wear those aforementioned earplugs for a while! After you’ve successfully run this gauntlet that is feline diabetes, you will find that Scout will still love you:kiss: in spite of the diet controls, the ear pokes and the insulin shots. And you will have him around to love for years to come!

Here’s the little line I have framed over my desk (it has helped me keep my resolve in weak moments): “The greatest pleasure in life is doing what others say can’t be done.”:joyful: Make that your mantra as you and Scout kick diabetes into submission (and hopefully, remission)!:bighug::bighug::bighug:
 
Great information here...thanks Robin. I have learned some things and will definitely try some of your feeding suggestions.

Kristin - I get my strips from Walmart. I also have found them at Walgreens too.
 
wow thank you so much! i really appreciate everything! i will definitely cut out snacks for now.

i just did his PMPS and it's at 182. i'm so confused. is it possible for the insulin to be taking too long to get into his system? all day in the 400's and now its less than 200. how would you guys suggest i shoot tonight?
 
As far as the dose, I am conflicted. The .5 took him down over 50%. That was a big drop. If you'd give .5 can you monitor? If not, then I guess .25. It may be a little too little, but it should be safe. I like that he is has a good pmps and would like to keep his momentum going, but I'd want him to be safe.

I have to say, though I love the pmps, I am completely confused why he is there. Maybe he needs less insulin, not more. Maybe the .75 was too high a suggestion.
 
stalling right now. i'm pretty confused too! he's getting impatient... just tried to take a bite out of my arm while waiting for his food!
 
Hmmmm. It could have been a bad test or I guess a really fast bounce. Maybe we will figure it out with more data in the next few days. So, what are you thinking? .5 or .75?
 
Hi Kristin,
I've read most of the way thru this thread (will try to finish later) and just wanted to throw this out there. You might consider getting some U-100 syringes with half-unit marks and use the conversion chart. This will allow you to accurately measure doses less than 1 unit and lets you adjust the dose in 0.2 unit increments. Here's a post with more info on this and it contains a link to the conversion chart. I did this a few months ago with Mitz and have found it very helpful. I printed the chart and have it stuck on the fridge for easy access.
http://www.felinediabetes.com/FDMB/...bies-and-oldies-links-info.32799/#post-340819
best,
Joan
 
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