Sparks 11/25/11 update

[Care4Sparks]

Hello! Long update and more orientation to Sparks' early treatment and open floor questions, below.

Sparks was diagnosed on the 21st, and assigned 2u ProZinc, 2x daily weighing 19.5 pounds at that time.
Nov 4th, he returned for a curve that was "off the charts" - it was stopped mid-cycle and dose upped to 4u, 2x day, weighing 19.8 pounds.
Note - he has extreme social anxiety, doesn't travel well, but he is a big boy.
The vet said that she had only prescribed this much "to a dog." And I am not sure they realize how much stress affects him.

Folks here hinted it might be too much of an increase (2u to 4u). Sparks also shortly thereafter suffered from severe constipation and was admitted all-day again on November 11th for a series of ennemas, IV fluid, and because at that time he couldn't keep down food that morning but had already been given 4u insulin so we asked for another curve/close monitoring.

Our vet's office has been great about squeezing in unexpected visits, but not great about sharing data. I was able to see that he'd lost 1 pound in a week, which we all agreed was too much (down to 18.8 lbs).

Because of his situation we (human companions) adjusted his dose to 3u, fed very small amounts at a time, and did what we could to help him digest (pumpkin, stool softener, h2o in food, etc). It seemed to fit him well. The constipation continued at a moderated pace for about a week, but is better now. His appetite is so great (always has been) that we often did feed him 1/4 can FF Classic many times throughout the day as snacks (he gets 3-3.5 cans per day and I now track this very carefully).
So well and so quickly did the readings drop and normal BMs return that we went to 2.5u and are now floating at 2.75.


Now for a few questions :smile:

1) I've read about this "low and slow" but he is a BIG guy on a fairly large dose. Do you think that adjusting 1/4 unit at a time is too much short term, or 1/2 unit over two weeks?

2) When his reading is low should we postpone or reduce? It seems there are two schools of thought: (a) the insulin is needed every 12hrs and the pancreas ain't doing it, vs (b) wait a few hours until it's a 'normal' pre-shot level and give then.

3) Is allowing him to eat as-requested, even 2 hours pre-shot, ok? Or are there limits to this? I saw 2 hrs on another post and I realize it can influence BG readings, but isn't keeping the BG 'stable' a good thing?

4) His ears bruise. He HATES getting tested. He is strong and fights so I need two humans to do it. We've tried the sock, the warm paper towel in a baggie, the treats, the pressure after reading, watched videos, but are there any other tips to helping with this? Will smaller gauge help (we've got 28 gauge)? Does it really get easier over time? How is that possible with bruising. [sidenote - he was marked feral so one ear is chopped and doesn't bleed well to begin with.]

5) Is there such a thing as too much pumpkin (Vit A)? Why? How much?

6) Open floor for your observations, suggestions, anedotes, questions, or other feedback :smile:

Thanks for your interest!

 

[Sue and Oliver (GA)]

Hi Karen,

Welcome to the PZI family - small but friendly and eager to help.


1) I've read about this "low and slow" but he is a BIG guy on a fairly large dose. Do you think that adjusting 1/4 unit at a time is too much short term, or 1/2 unit over two weeks?

We usually say increase by .25 if the numbers are in the 200-300 range and hold the dose for several cycles.

2) When his reading is low should we postpone or reduce? It seems there are two schools of thought: (a) the insulin is needed every 12hrs and the pancreas ain't doing it, vs (b) wait a few hours until it's a 'normal' pre-shot level and give then.

The general advice for new diabetics (which he is) is to wait 20 minutes and test again. If he is over 200 and definitely rising, you can shoot a reduced dose. You have been shooting pretty big doses at lower than 200. One of the dangers of this is that you need to be sure the number is headed up, not down before you add insulin. I would suggest that you get some midcycle numbers in the next few days. Your preshots are nice - but if he is going really low midcycle and bouncing back up, you could be giving too much insulin. The only way to be sure is to get a cycle of numbers to see how the insulin is really working.

3) Is allowing him to eat as-requested, even 2 hours pre-shot, ok? Or are there limits to this? I saw 2 hrs on another post and I realize it can influence BG readings, but isn't keeping the BG 'stable' a good thing?

General rule - no eating 2 hours before the test. Food does raise bg levels and you want to be sure you are shooting a "true number", not one influenced by food. If he would have been 150 without food but tests at 200 with food, it is a whole different approach to the dose.

4) His ears bruise. He HATES getting tested. He is strong and fights so I need two humans to do it. We've tried the sock, the warm paper towel in a baggie, the treats, the pressure after reading, watched videos, but are there any other tips to helping with this? Will smaller gauge help (we've got 28 gauge)? Does it really get easier over time? How is that possible with bruising. [sidenote - he was marked feral so one ear is chopped and doesn't bleed well to begin with.]

You could try the paws if he will let you mess with his feet. We had to wrap Oliver in a kitty burrito at first. Towel down on couch, cat on towel, wrapped up until only head is showing. Lots of treats before and after poke. You can use neosporin with pain relief to help with the bruising.

 

[Carl & Polly & Bob (GA)]

Hi and thanks for the updates and all of the questions. I especially like it when I don't know the answer and have to look it up!

5) Is there such a thing as too much pumpkin (Vit A)? Why? How much?

I would think the answer is "yes" generically, because too much of anything is going to cause some kind of problem someplace. All I can find is relating to "too much Vit A in humans". Vitamin A from pumpkin would be considered a beta-carotene. The danger of too much is

risks with beta carotene include a yellow discoloration of the skin and depletion of other fat soluble vitamins. Vitamin E should be taken in addition to beta carotene.

That's for humans.... But the primary reason you are using pumpkin is to eliminate or control constipation, correct? Not for the vitamin A per se.

4) His ears bruise. He HATES getting tested. He is strong and fights so I need two humans to do it. We've tried the sock, the warm paper towel in a baggie, the treats, the pressure after reading, watched videos, but are there any other tips to helping with this? Will smaller gauge help (we've got 28 gauge)? Does it really get easier over time? How is that possible with bruising. [sidenote - he was marked feral so one ear is chopped and doesn't bleed well to begin with.]

Easy one first. Yes, it does get easier. From what I've seen, that's pretty universal. Here's a pic of the "sweet spot". But you don't have to hit that spot. Anyplace around the edge of either ears works. Try to hit between the vein and the edge. One ear is okay too. I only tested Bob's left ear most of the time, because it bled better. Bruising was never a problem, but I didn't have any secrets that I used. Smaller lancets would make it harder to do for you. 28 g is the size I learned with. I was able to do the 33g weeks later, but by that time his ears were "trained" to bleed better. There isn't too much difference to kitty as far as the gauge goes. He probably hates having his ears touched more than he feels the poke. You can also poke the inner surface rather than the outer, if he's agreeable. It's probably easier to see things from the inside? All I used was a cotton ball held on the inside with my left hand, and my thumb and finger outside on the edge. Then I used the lancet freehand rather than with the device, like I was sewing. After enough practice, and holding the lancet at a 45 degree angle to his ear (rather than poking straight through), I was able to get blood without poking all the way through. Their ears are thin for sure, but you can do that with enough practice.

3) Is allowing him to eat as-requested, even 2 hours pre-shot, ok? Or are there limits to this? I saw 2 hrs on another post and I realize it can influence BG readings, but isn't keeping the BG 'stable' a good thing?

The reason we don't feed for 2 hours prior to preshot testing - you don't want the BG boost from eating to influence the preshot reading. It makes you think his numbers are higher than they are, which leads to higher dose thinking. The numbers that matter most are what the BG is on an empty tummy at shot time, and what the number is roughly 5-6 hours later when he would be at the "nadir", the low point BG wise of the day. The combination of those determines dosage. How much effect the dose has on his BG from zero to max efficiency. It isn't a problem feeding him small meals the rest of the day, as long as you don't feed for the two hours leading up to shots.
Stability of BG - if he were a non-diabetic cat, that job would be done by his pancreas. It would produce insulin as needed throughout his day of eating, sleeping and activity. The problem is that his pancreas can't do that right now, except maybe in spurts as he improves. So you are playing the part of his pancreas. But unlike nature, you can't tell when during the day he needs it. All you can do is determine to figure out how much he needs every 12 hours. That's the constant in the equation, while food, and his activity levels are the variables.
I'll be back to address 1 and 2 above! I wanna see what anyone else has said so far...

Carl

 

[Carl & Polly & Bob (GA)]

OK, next questions....

1) I've read about this "low and slow" but he is a BIG guy on a fairly large dose. Do you think that adjusting 1/4 unit at a time is too much short term, or 1/2 unit over two weeks?

Insulin dosing for kitties is a bit different than say for dogs. I think with dogs, it's based on weight, but with cats, it doesn't seem to matter size-wise. Bob weighed, at one time, 22ish pounds. Last november, pre-diagnosis, he was 18. The day he was dx'd, he was 13 pounds. But his dose was 1u BID, which seems to be the standard "cat dose" no matter the size, the BG numbers, or anything else. Unless there are other conditions present when they are diagnosed that would lead to a higher dose to start. I think the theory is "you have to start someplace, so let's make it 1u twice a day". See what happens, and adjust accordingly. The reason we "go slow" is because it is possible that by increasing in large increments, you can miss the "right dose". For instance, his "right dose" might be 1.5 but if you go from 1 right to 2, you miss that. What happens then is that you don't get good results, and the reaction always seems to be to increase it even more. It sets off a cycle of numbers and rebounds that are difficult to correct. Many cats come here, on higher than a 1u dose, with wonky numbers, and the only way to "fix" it is to suggest going back to 1u BID and starting over. That happens a good bit of the time, and usually the "do over" gets good results.

2) When his reading is low should we postpone or reduce? It seems there are two schools of thought: (a) the insulin is needed every 12hrs and the pancreas ain't doing it, vs (b) wait a few hours until it's a 'normal' pre-shot level and give then.

Sue explained it well. All I would add is that at some point in the future, once your data shows how much he drops on a certain dose, you will be able to shoot numbers under 200. Most likely, these will be tiny (less than 1u) doses. The absolute best thing to do is make sure that we know his "normal" shot times. Then we know to pay attention near that time. If you EVER have a question about whether to shoot or not that you don't feel comfortable with without advice, post it here, and put some sort of "Need Help with Dose!" note in the subject line. We pay attention to that!

One other thing I wanted to say about the basic insulin cycle. Sort of ties in with several of your questions:
The numbers you get can mean totally opposite things, which can be very confusing and frustrating. A given dose can give you numbers in between shots that are "flat". Most people would assume that this means that the dose is too small, and needs to be increased. Sometimes that is correct. Sometimes the opposite is true. Flat numbers can also mean the dose is too high. Confusing, but if this were easy and simple, sites like FDMB would have little reason to exist!
When insulin pushes BG levels down far enough, you kitties body has a built in defense - his liver will dump glucose into the bloodstream as a "life preserver" in order to raise the BG to what it feels is "safe". And it doesn't have to be a really low "hypo" type number. If your cat has had high BG for a while, like most new diabetics, that number can be in the 100-200 or higher range. Sometimes the liver doesn't do that, or can't dump enough in. Kitty has a 2nd line of defense.... think about what a human diabetic does when he or she feels that his BG is too low. They grab for a sweet drink, or a Hershey's bar, or some other food or drink that will boost their sugar quickly. Well, kitty can't tell you when he's low, but he sure can try. Some cats, even though they just ate an hour or two earlier, will vocalize that "FEED ME NOW!!!" meow I am sure you know well. They are telling you "Hey, Mom..... my sugar's kinda low.....I need a boost NOW!". So they eat to get their sugar up, instinctively. Insulin's "job" is to lower BG. That's what it does naturally or artificially (via syringe). Food makes it go up. So does stress, and pain or infections in some cases. And so does a lack of insulin when you skip a shot for instance.

I am with Sue's advice regarding testing. If you can, on a weekend day when not much else is going on, get a few mid-cycle tests and post the numbers in your SS, I think that things will start to make more sense to you. You'll see what happens all day as the food and the insulin work together or opposing each other. My gut feeling is that your current dose is too high, and you have some flatness going on that might reveal that. But I'm not certain, and I'm interested to see the numbers to figure out the puzzle.

Only question I can think to ask right now - you said he's a big cat, but I might have missed if you told us his current fighting weight? And is that more or less than you believe it needs to be (ie, his "ideal" weight)? I think the amount you are feeding is good, but can't tell unless we know his weight and calorie needs.
Carl

 

[Rob & Harley (GA)]

It looks like your questions were covered.

So just wanted to say Hi and Welcome to our little group.