Tink is HOME!!! More questions though...

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JenM

JenM

Member Since 2013
YAY! He's home!

I was hoping to compare readings on my glucometer vs the vets... but I wasn't able to get enough blood to make mine work. Since she'd gotten a reading, and we'd already been messing with him for awhile as she showed me everything else... I figured I'll figure it out later. Soon as we got home, he sniffed around to make sure everything was as it should be. Of course with Halloween I wasn't able to cuddle with him as much as I wanted to right away... but I found myself checking on him every few minutes. nailbite_smile Finally once things calmed down with the trick-or-treaters, I sat with him on the couch. Poor guy fell asleep fast and was snoring up a storm on my lap, probably the best sleep he's had in 11 days. Cant imagine he slept well in that little metal cage, in a strange space with strange people and animals.

Night feeding and insulin went well. I put a chair by my bed so he could get up there easier. He normally doesn't sleep with me, but he stole my pillow last night. He was restless for a little bit, but then settled down and just purred & snored all night. He's SO happy to be home! This morning he was meowing at me to pick him up and cuddle, even though he basically slept on my head all night. :lol:

This morning didn't go quite as smoothly. I dont have any rice (thought I did), so haven't made a rice sock yet. But I rubbed his ear a little and got enough blood to test. I did get the larger lancets, and I found if I poke with a twisting motion, it seems to work well. It's still hard to see the blood drop through his black fuzz (even on the ear she clipped). I might see if I can shave them better with my electric razor... if he'll let me. Anyway... his bg was 426. I had just fed him via the tube about 5min prior and had not given his insulin yet. I gave him his insulin right away (1.5u Humulin). They wanted me to test 3hrs later, but I work so can't do that except in the evening. But I did test an hour later, just to make sure it was going down. It WASNT! It was then 435. It was still too early to call the vet, and I was supposed to go to work... but I dropped the kids off at school and went home. Figured I didn't want it staying that high till lunch so I'd test again in an hour. I ended up testing after about 45min and it was down to 330... so I came to work. Whew!!! Scared me though.

So... the question is... should I test, then give insulin, THEN feed so the insulin can start working before the food hits? Or ???? I dont like that his bg is over 400 even though his last meal (and last insulin) was 6hrs prior... is that normal? I worry that he needs a bigger dose... but the vet was worried that a larger dose might result in hypo at its peak. I dont work Sat/Sun so I'll be able to monitor the curve better, which might help. But VERY open to your suggestions on timing for food/test/insulin.

Oh... the other thing is, he seems to be struggling a little to poo. He went to the litter box, dug, strained, turned, dug, strained... finally got out a small piece (solid but not hard). Repeated a few minutes later with same result. He's' getting a whole can of a/d each day... seems like more should be coming out than that, and in more normal pieces. Diameter is normal, but it's in little 3/4" chunks. Does that sound normal, given the situation? Lighter in color than normal... but about the same color as the a/d, so that part is probably the diet change. Anything I should give him to make it easier to pass?
 
Our description of his night with you made me cry. :-D He is clearly so happy to be home.

With Humulin, you test(to be sure it is safe to give the amount you planned on), then feed, then shoot. Humulin can cause a fast drop so you want food on board. The number probably went up because food raises bg levels so that is pretty normal.

Are you using Humulin only or Lantus? Humulin is a harsher insulin so I am wondering if you'll change to Lantus at some point (easier insulin to regulate with, longer cycle)

Some people add a little canned pumpkin to diet - not pie filling with sugar, pure pumpkin. Miralax also works but with his multiple issues, you might check with the vet first.
 
Right now he's only on Humulin. He did not respond to Prozinc OR Lantus (though I still have both to try again later). The vet felt that since I needed to remove him from their care, it would be best to keep him on the Humulin until his liver is stabilized and he is eating on his own. His bg did not budge at ALL with either of the longer lasting insulins while he was at the vet, so we're hoping once he's in better condition overall, he'll respond to it better (or at all!).

I will try the pumpkin. I have some in my freezer from my own garden, so I know it's just pumpkin. Thanks!

So... check, feed, inject... got it. Would the food have increased bg in just a few minutes? I just worry that an hour later it was higher than it was when I gave the insulin, especially since it was so high to begin with.

How high is cause for real concern?
 
You are using Humulin N, right? Humulin is a name for a family of insulins make by Lilly. You can also get Humulin R and mixtures of R and N.
I would have expected to see a drop after one hour with N
 
Some general guidelines:

We consider a cat regulated if they are in the 200+ at preshot and below 100 at nadir, but not lower than 40, which is considered hypo territory. We tell new diabetics not to shoot under 200 but to wait 20 minutes without feeding and retest. If the number has risen and is above 200, then shoot but maybe a reduced amount. The renal threshold when the pancreas doesn't heal is above the 250-280 range. It's certainly better if cats don't sit in the 300-400 range.

While he is high, I would definitely test for ketones. You buy strips from the pharmacy just like humans use and stick them in his urine stream. If he won't pee with an audience, we have our ways :mrgreen:
 
YAY!! I'm so happy Tink is home again! It sounds like he's really glad to be there, which will help further his progress along even more. And he loves you and obviously missed you while he was cooped up in that vet's office. :YMHUG:

JenM said:
Anyway... his bg was 426. I had just fed him via the tube about 5min prior and had not given his insulin yet. I gave him his insulin right away (1.5u Humulin). They wanted me to test 3hrs later, but I work so can't do that except in the evening. But I did test an hour later, just to make sure it was going down. It WASNT! It was then 435. It was still too early to call the vet, and I was supposed to go to work... but I dropped the kids off at school and went home. Figured I didn't want it staying that high till lunch so I'd test again in an hour. I ended up testing after about 45min and it was down to 330... so I came to work. Whew!!! Scared me though.

So... the question is... should I test, then give insulin, THEN feed so the insulin can start working before the food hits? Or ???? I dont like that his bg is over 400 even though his last meal (and last insulin) was 6hrs prior... is that normal? I worry that he needs a bigger dose... but the vet was worried that a larger dose might result in hypo at its peak. I dont work Sat/Sun so I'll be able to monitor the curve better, which might help. But VERY open to your suggestions on timing for food/test/insulin.
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Food takes anywhere from a half hour to an hour to affect BGs (perhaps faster in Tink's case because of the tube). It then takes about two to three hours for it to wear off, so those numbers are to be expected.

The general rule of thumb is to test first, then feed and give the shot. Since you're still using humulin for the time-being, it's imperative that he eats at shot time since it hits hard and fast and can drop him like a rock without food on board. Then, because it's so fast-acting, it wears off quick and numbers spike upward. This is why it's not a good insulin to use long-term. The best use for humulin is to get numbers down quickly, like in Tink's case because he's coming out of DKA. If you get a test at about three hours after the shot, that's generally considered the "nadir" (or low point) of the humulin cycle and that's the number you will want to watch for if he drops too low. From the sounds of things, the humulin isn't bringing his numbers down low enough, but maybe get a couple more tests in to see. (At least the 400 was lower than the 426.)

JenM said:
Oh... the other thing is, he seems to be struggling a little to poo. He went to the litter box, dug, strained, turned, dug, strained... finally got out a small piece (solid but not hard). Repeated a few minutes later with same result. He's' getting a whole can of a/d each day... seems like more should be coming out than that, and in more normal pieces. Diameter is normal, but it's in little 3/4" chunks. Does that sound normal, given the situation? Lighter in color than normal... but about the same color as the a/d, so that part is probably the diet change. Anything I should give him to make it easier to pass?
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I know with my kitties that vet visits mess with their poo for a day or two. If he keeps having problems, perhaps someone might be able to offer some suggestions. But, he might still be stressed and it might simply take a couple of litterbox visits before he's regular again.

JenM said:
The plan for longer lasting insulin is to try the Lantus again once Tink is in better shape. Once the feeding tube is out and he's been regulated on the regular insulin for awhile. Probably a couple weeks. I think once he's feeling well and not being stuffed with carbs, it might be easier to get the longer lasting stuff to be effective.
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I would probably suggest starting the Lantus sooner rather than later since it doesn't seem like the humulin is doing enough to bring his numbers down. Remember, Lantus can take up to five days after starting it before you see its full effect on BG nubmers.

JenM said:
With feeding... should I just keep doing the Science Diet a/d for a bit as the vet is going to suggest, while we're tube feeding? Even on the can it says "for intermittent feeding only" which tells me it's probably not as nutritious as it could be. It's also labed for "feline/canine" which I found extremely odd since they have completely different needs. I'm guessing any pate could be fed with the tube. Should I switch ASAP to Wellness or Evo or something... or should I just stick with a/d for now? I just dont trust Science Diet AT ALL. I'd rather get him back on a good quality food asap, but managing the bg and getting his body back in order is my primary concern. He needs to gain some weight and build some muscle. My mind is telling me I should seek out a high protein, maybe high fat, low carb, and preferably high potassium food. But I dont want to get things out of whack with his system. The first ingredient in the a/d is water. Corn gluten isn't far down the list. I'd rather he be eating food that's packed with what he needs, not with water and fillers. I mean, he needs water... but we're already adding water to the food for tube feeding... plus he's getting fluids. I'd rather his food be, well, FOOD. Thoughts?
... I thougth I was feeding good food... based on the research I did years ago when I took them off of mainstream brands. But there was no talk of carbs not being good for them back then (at least not that I found)... it was just concerns over corn and byproducts mostly. But the carb thing makes sense. You dont see cats eating grains and things in the wild.
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There's a Royal Canin Prescription Recovery RS that is low enough in carbs for diabetics. Maybe ask your vet if it would be okay to switch to that? I don't want to say to switch the food to OTC just yet because even though I mostly write off prescription foods as completely overpriced snake oil, there are a couple of them that are actually useful for certain things. 15 years ago when Patrick had his hepatic lipidosis, there wasn't nearly as much research out on food and so he got Hills Prescription AD (mixed in a blender with some water and other medicine) while I tube-fed him and then, per the vet, was switched to dry :o Hills Prescription WD for the rest of his life. I had looked up food nutrition for him on what there was of the internet at the time, and there wasn't much out there so I had no idea how bad this stuff was for them. Yeah, I still feel badly about not knowing any better, especially because I tried to research feline nutrition and still ended up thinking I was doing right by them with feeding them expensive "prescription" dry food. But I no longer feel guilty about it because I know exactly who to blame: the pet food companies with their misinformation campaigns and marketing schemes.

JenM said:
Yes, they said it's good to offer it, as at some point his appetite should return. Once he eats on his own, the tube can come out. I'm just not sure WHAT to offer. His favorite food in the world is canned tuna, so that might be good. Not to let him eat a lot of... but to get him eating. He's a dry food addict, so we're going to have to find a canned food he'll eat. I think I'm going to switch my other cats over to at least a grain-free dry. Maybe mixed with canned, to try to reduce their overall carb intake as well, and prevent anyone else from having these issues.
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Since he's being tube-fed wet food, it'll be even easier to switch him over to a wet food diet once the tube is out. In fact, the catinfo.org website tells the tale of a dangerously obese cat (bottom of page 8) that would not eat wet food so they put a tube in her to transition her to wet. I would also use this opportunity where he's not eating on his own to transition all your kitties to a wet food diet. I feed both of mine (only one diabetic) Friskies Special Diet Pates because it's easier than having separate food for both of them and they both love it and do fine on it. If they're not eating any wet food, start the transition slowly, mixing about a 1/4th wet food with 3/4ths of their dry and increase a little by each day until maybe there's just some dry crunchies sprinkled on top of their wet food. Just as a warning, they'll have really stinky poo the first couple of weeks or so as all the dry food crud clears their system. When I got Henry, I didn't even think that he might have been fed dry food before so he was switched overnight from dry food to wet and boy! Did his poop STINK! :lol:

I left food out for Patrick every day to see if he would eat on his own. I didn't force him because I didn't want him to associate food with anything negative; I just allowed him to investigate if interested. I'd also offer him his favorites on occassion: string cheese and tuna. Then, on Thanksgiving day, about two to three months after he'd had the tube in, I offered him some turkey and he ATE IT! :-D I was so excited that he was eating again. I waited another day to make sure he had gotten his full appetite and then I removed the tube (it was Black Friday and the vet walked me through the very simple steps on how to do it). And he was good as new again. :thumbup

JenM said:
I just hope I dont have too much trouble with bg testing at first! I know it'll get easier... it it HAS to be done... NOW. I can't exactly wait till I figure it out. It LOOKS easy enough. But I've thought that about other things and they turned out to be quite difficult! Plus I've always been a bit squeamish about blood... but guess I'll have to get over that real quick!
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Sounds like you're already well on your way with the home-testing. Let us know whatever problems you run into and most all of us have been there, done that and should have some suggestions or advice to help you get past it. ;-)

You are a fantastic Mama Bean and Tink is very lucky to have you (as you are lucky to have him). Remember to take some time for yourself because this has been a very stressful week and, even though he's home from the vet now, it'll still be stressful for you over the next month as you get acclimated to caring for your new sugar kitty. Things do get much easier but it can be quite overwhelming at first. I compare managing Michelangelo's diabetes as easier than prepping their food each morning, so that tells you how easy it gets. drinking24
 
yay he is home!

Meter - i would pop out and get the Relion micro or confirm (and matching strips) - they need half the amount blood. Keep the prime though - you can switch to it when you get better or use it as a backup. Also while you are there buy a pack of urine ketone test strips if you don't have them already - you should test the pee whenever he is over 340 or twice a week. you don't want him getting DKA again - this will allow you to spot it early.

Do you still have the Lantus you bought? I think we can get him to respond to it - there were too many things going on at the vet and he never really gave the insulin a chance. Lantus takes at least a week to settle. Its a better insulin for cats with a good chance of remission..

let us know what kind of humulin it is...

Wendy
 
I'm headed home for our lunchtime dose in a minute, so I'll see what kind of Humulin it is.

I believe the vet only tried the Lantus once or twice. How does the switch over work? The short term stuff is the only thing that brings his bg down, so he needs that UNTIL the Lantus starts working right? Would I be giving both? The problem is that I can't test his bg as often as I'd like during the week. I work 7:30-3:30 (now 7:30-4 while I'm needing to take a longer lunch to run home and dose him)... so I can't really test after his breakfast or lunch dose - or late night dose, unless I opt to never sleep more then 3hrs straight.

My plan was to do insulin at 6am, 12pm, 6pm, 12am... but then to test 3hrs later just isn't feasible for most of those - only the 6pm dose really. I'm just worried if the Lantus DOES start working while he's getting both, he could go hypo easily. But I guess testing before giving the Humulin would help prevent that.

Anyway... I'll let ya'll know what kind of Humulin it is in a bit.
 
Ok... so it's Humulin R. His bg was 438 before I fed or injected him at noon. So I called the vet and he said we should go to 2units rather than 1.5, but to continue checking his bg every 3hrs. So I'll start that with his next dose, since I can be home to monitor him at that point. I didn't want to give the higher dose, then leave for the next 5hrs in case he were to go hypo. I know that the current dose brings him to the low 300's and probably lower, since that was only after 2hrs. Would rather him sit a little high than too low, while I'm not there.

I also asked about injecting into the muscle. They have me doing it in his back muscle, next to his spine... which makes me worry, just being anywhere near the spine! The bottle SAYS "for sub cutaneous use" - can't remember if it says "only" or not. But the other vet was very specific that it goes in the muscle. This vet (the main one) said it CAN be either... but they like to do muscle when they're worried about absorption of the insulin. Since he's been resistant, he prefers it in the muscle for now. He did specify that the longer lasting ones would be subQ.

I plan to take Tink in tomorrow afternoon to get his IV catheter out and I'll talk to him then about the Lantus and when we can start that. I guess with frequent testing, and always testing before I give the Humulin, I would be able to tell when to scale back the Humulin as the Lantus takes effect. Thus far neither of the long-lasting insulins were used for more than a couple days, and it sounds like more time is needed for them to start working - based on comments here. So hopefully we can get over to one of them soon. I'd LOVE the Prozinc to work as it's half the price of Lantus... but as long as SOMETHING works, we'll figure it out.
 
J.D. was hospitalized for DKA and was getting R while in the hospital. After 8 1/2 days and him coming home with a feeding tube, I asked if he could try Lantus and that's what we gave, way back then. It was several years later that my experience with R came in and that was just to give a drop or two to bring his numbers down when he's bouncing. I still use R occasionally. Humulin R's duration is about 4 to 5 hours, and it's onset is pretty quick, but sometimes doesn't seem to drop J.D. very much at +1, probably because he just ate, but by +2 and +3, I can definitely see his numbers dropping.
I would ALWAYS test before you give any insulin and especially R It is a very very potent insulin and if lets just say one time you did not test and he happened to be for whatever reason in the high 100s, he could easily go into hypo with that dose of R.
Hopefully, you can start to give the longer acting insulin soon, and give a much smaller dose of R along with it, depending upon how the longer acting insulin is working on lowering his BGs and what his Pre Shot test number is, and that you can be home to test him up until and through the first 4 hours.
Once you start giving the longer acting insulin, you have to be careful of when you give the R. You never want to give R when the R peak (around +3 to +4) will coincide with the peak of the longer acting insulin (around +5 to +6, depending on the insulin and the cat), and you never want to give R when he is coming down from a bounce as it may make him come down so fast, that it would be a huge struggle to slow his dive or to bring him up. Vets often use R with a DKA kitty, but they also have a glucose drip hooked up to the cat at the same time, so they can monitor the BGs and if the R brings the kitty down to fast or too low, they can increase the glucose drip.
I hope that helps a little. Please be careful and safe while using the R insulin.
 
R insulin is short duration, like its peak effect is 3 to 4 hours. It is not suitable as a twice or even three times a day dosing.
Lantus is a depot insulin and ti can take three days or so to see an effect. Yes you can give R and Lantus together but y have to be careful otherwise BG could go too low. I have used Lantus with R and with N too.
 
Currently we're using the Humulin R every 6 hours. It's hell on my schedule (going home at lunch to dose, 25mi round trip), plus getting up at midnight to dose, in addition to the morning and evening dosages. Definitely not ideal.

The vet is making some calls today to see the best route to take for trying the Lantus again. When we tried it while he was hospitilized, it just didn't do anything. AT ALL. Nor did the Prozinc. He stayed over 400 with no improvement at any time after dosing. But he was also very sick and weak. I'm hearing that I can switch to Lantus and still us R to control his bg as needed... but being at work all day, that's kind of scary. I think if we do have to do it that way, I'll take a few days off work so hopefully we can get him regulated with me there at home.

So far, it's going GREAT with the Humulin (aside from the hassle). He's definitely feeling better and is starting to dread me picking him up, as half the time it means a poke, prod or syringe feeding. :shock: Poor guy. He's starting to nibble at food on his own, but still isn't terribly interested. I think I'm gonna go get some cheap canned today and see if he'll eat it. Kids like candy, cats like cheap nasty cat food. I can work on getting him onto something I actually WANT him eating later. Sounds like a lot of you have good luck with Friskies, Fancy Feast and such, so I'll try those. I'm typically looking at Merrick, Wellness, Evo, etc... but he's not buyin' it.

Anyway... as far as bg goes... he was hanging in the low 400's pre-shot when I was giving him 1.5u 4x/day. So the vet said to try 2u. That is working GREAT, and the last few times I've even gone back down to 1.5. His bg hasn't been over 300 in almost 2 full days. He's testing between 270 & 330 or so pre-shot. 2u is bringing him down to 105, 97, somewhere in there. However, I will definitely keep testing PRE shot... as yesterday at noon, his pre-shot bg was only 205. I had to leave, and obviously didn't want to give him 2u. So I fed him and waited about 20min, then gave him a smidge over 1u. Seemed to do the trick - his bg was 283 6hrs later so we went back up to 2u the next time. I've also upped his food a little bit... we're syringing 1/3 can of a/d 4x/day rather than 1/4 can. I figure that way I know at LEAST 1/4 can is actually making it in. I wear some, he wears some... the cabinets wear some... :lol: but we're getting most of it down.

At least the testing is getting easier... though sometimes the ear bleeds great and on occassion it just wont give me what I need. I hate having to poke him more than once. Usually though, I'm getting the perfect little droplet with no need to "stop the bleeding" after... it's just a drop and done. No scabbing yet, so that's good. I do need to shave his other ear though. Still hard to see, but he's got TUFTS in his ear... so without being shaved it's basically impossible.

Anyway... going good so far. He's getting more and more active and seems to be ALMOST back to his normal self, aside from not eating. Going shopping today to see what everyone is going to be eating. No more high carb foods for us! And my fat little disabled kitty is going on a diet!! At the VERY LEAST I'm going grain-free for my crew, and Tink will get canned. But I'm hoping I can get everyone over to canned... It sounds expensive (4 cats) but it sounds less expensive than the VET BILL I just paid!!! :shock:
 
OH... and I forgot to mention... Tink decided to play doctor on Friday night and remove his feeding tube. So that's why we're syringe feeding. Brat!! It was SO nice having the tube! He had chomped a little hole in it that I noticed at our dinner feeding... but I could just put my finger over it and it worked fine. But then at midnight (cuz it's ALWAYS at midnight ohmygod_smile ), I go to feed him and hear air up by his throat. Then see food oozing out his bandage. GREAT. So I syringed the rest in, and then set him down and the tube just falls on the floor. UGH. Luckily we were going in on Saturday anyway to have his IV catheter removed, so the vet removed the stitches that were SUPPOSED to hold the tube in.
 
My Mario and feeding tube. One Sunday I went to the drugstore to purchase bandages to re bandage the tube insertion site. When I came back the tube was out.
When you post with doses and BG, make sure that your clear state that you are using R insulin (unless you change to another insulin like Lantus) and not just say Humulin.
Also, have you thought about setting up a spread sheet to record BGs and does?
viewtopic.php?f=6&t=50130
 
Holy cow! Those spreadsheets just made my head spin!!! :o

So far I'm just using the chart that came with my glucometer... though I was thinking of doing my own spreadsheet since I'm testing more than 4x/day which is what that's really set up for.

Is there a tutorial somewhere of what everything in those pretty color-coded sheets means??

Also, generally I only access a "real" computer at work. I'm on my phone at home, which has been a real pain lately (gotta love cheap smart phones!).

Basically, I'm just tracking the bg before dosing (and the dose I give) and then the bg at nadir, when possible. Is there more I should be tracking? I was TOTALLY lost looking at those spreadsheets!
 
OH yeah! Tink ATE! Still not much... but he took probably 5 or 6 bites this afternoon, and was actually kinda excited about it! Last few days he's taken maybe one or two bites, hesitantly. It did have a little tiny bit of his old dry kibble in it... baby steps. I think the "crunch" got him excited. Of course then he walked away, so I still syringe fed him. He's feeling a lot less "wimpy" today though. Body feels almost normal. Still bonier than normal... but feels like muscle mass is coming back! I think upping him to 1/3 can each feeding really helped. He was holding steady at 10.x lb at the vet, and was just over 10.5 on Saturday. He used to be 14lb, though I think that was a little bigger than he probably should be. I think 12 would probably be good. Soon!
 
Sue and Oliver (GA) said:
I can set it up for you, Jen. I'll send you a private message with details. (Look at the top of the page and click on "1 new message")
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Awww! Thanks! That's so sweet of you! I can print it off and take it home. Then I can just enter the numbers here from time to time and ya'll can see it. Will probably be VERY helpful when we start working on switching to Lantus!
 
Yay! You are having such amazing progress with Tink! I'm so happy for both of you. You guys are in great hands here with people who can help you with everything you've been going through, including switching him over to the longer-lasting insulins so you won't have to keep up this 6-hour shot schedule.

Here's a cheat sheet for help on filling out the spreadsheet. You might have to add a couple of extra columns at the 6-hour mark to show he's got 4 Humulin R cycles in a day vs. the 2 cycles both Lantus and ProZinc have.

KPassa said:
Questions on understanding how to use the spreadsheet get asked a lot, so I thought I'd share a quick run-down of spreadsheet-specific terminology:
  • Fur shot: when the syringe needle pokes through almost like a sewing needle through fabric and it is unknown how much, if any, insulin actually made it inside the cat. Usually detected by wet fur or the smell of insulin (it smells like band-aids or scotch or antiseptic). IT IS ALWAYS ASSUMED THAT THE CAT GOT THE INSULIN AND YOU NEVER GIVE ANOTHER SHOT. It is always better to miss a shot than to give too much insulin.
  • AMS/PMS: morning (AM)/evening (PM) shot
  • AMPS/PMPS: morning pre-shot test/evening pre-shot test (it's assumed the shot is given within 15 minutes or less of this test).
  • +1, +2, +3...: How many hours after a shot, i.e. +1 would be one hour after their last PS (pre-shot) test
  • BG/BS: Blood Glucose or Blood Sugar (numbers). Usually used in relation to testing and dosing and what "level" or "point" the cat is at. Used in a sentence: "Michelangelo's BGs have been high so I've been increasing his dose."
  • AMBG/PMBG: morning/evening Blood Glucose. Used when no shot has been given at the regular shot time.
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Ok... I just filled in Tink's spreadsheet so far. It's a little confusing with being on Humulin R, since it's a 6hr cycle instead of 12. If there is a better way for me to depict this, I'm open to suggestions. We will try Lantus again soon... but not sure when yet. The vet really wants him eating on his own before we change anything.
 
That's what I was thinking... I didn't want to add or remove columns since I'll be using longer lasting stuff in the near future.

His numbers are looking better! :) It's hard because I'd love to be testing after his shots too... but can only do that in the evening or on the weekends. For instance today... he vomited for the first time since coming home. I cleaned it up into the same cup I'd used to mix his gruel for syringe feeding... so I could get an idea of how much he kept down. Of course it's a little frothier coming up... but I think he kept about half down. With his bg being almost 300, I wanted to give 1.5u... but since I wouldn't be there to watch him for hypo... I figured better safe than sorry and just gave 1u. Wish I could check him this afternoon, but I wont be able to be home until 5 at the earliest, just an hour before his next shot is due.
 
Thanks for updating your spreadsheet. Those numbers are looking pretty good. I hope you can start on some longer acting insulin soon. I hope you are still getting ketone tests whenever you can (hopefully, at least once a day). The throwing up worries me. But, you're doing a good job in a difficult situation. Keep up the good work.
 
Just wanted to pop in an congratulate you on the super job you are doing. You are being an awesome fur-mom to Tink. :-D

I don't know much about the insulin you are using, but it is obvious that you are in good hands (paws) here.

I am so happy that Tink is doing better and that you are feeling more confident about treating him. :-D
 
Can ya'll please check out Tink's SS this morning? I have some questions/concerns.

So... yesterday at lunch he vomited after our syringe feeding session. This was pretty immediate, and there was a wad of plastic in there (he thinks plastic bags are a food group). I have NO idea where he got it as he's been locked in my room. I searched high and low and didn't find anything he had been munching on, or would be interested in munching on with his plastic fetish. In any case... I THINK the vomiting was due to the plastic being in his lower esophagus and all the liquidy food landing on top of it. I'm definitely concerned about his plastic-eating... he's always done it and always passed it fine (and we've always tried to keep any plastic out of his reach). But with him having more trouble defacating currently... I can see how it could be an issue.

Anyway... no more vomiting since (or prior), so I think that's all it was. However... his numbers have been way lower over the last 24hrs despite me giving a lower dose of insulin. I skipped this morning's shot completely. Last night at 9pm his bg was just 65 - that's down from 260 3hrs earlier with 1.5u of Humulin R given at that time. I syringed 1/4 the regular amount of food and he seemed fine. Since it wasn't dangerously low, and since I added the extra food, we just went to bed. He's been sleeping with me, so I figured I'd notice any problems.

At midnight his bg was 239, so we did the usual feeding (1/3 can a/d via syringe) and I only gave him 1u, since his bg was reasonable and he'd been so low a few hours prior. At 6am this morning, his bg was just 176. Wasn't sure what to do. He's been showing SOME interest in food on his own, a few bites here and there. So I syringed half of what we normally do, and left food out. I did NOT give him any insulin this morning. I was afraid to give even 1u, given his recent lows. So I'm HOPING that by syringing less than normal, maybe he'll actually eat some of his food on his own. I hope this was the right decision. I figure I'd rather his bg go a little high than fall too low, since I have to be at work.

I think I'll head over to our "pet health food store" later today and see if the owner is there. He's a nutritionist and really seems to know his stuff. I used to buy my pet food there, but then I found similar brands much cheaper at the feed store. Then I realized that Costco had basically the same ingredient label as the pricey foods, so I've fed that for years now. But I'll see if they have any low carb dry food (preferably samples). He REALLY seems more interested in anything that crunches (including plastic bags :roll: ), so I've been putting a few pieces of his old food (which is now mixed with a grain free dry, since I'm switching everyone over) mixed in with his canned.

Last night in particular he was really ACTING hungry. Pacing around by the food, sniffing the food - ran over there at feeding time, etc. But then he just sniffs it, maybe takes a couple bites, and walks away.
 
Oh.. also... re: Lantus. So... at the vet when he was still in DKA and had some liver stuff going on (which at point I'm assuming was hepatic lipidosis, since it seems to have resolved itself), he was completely non-responsive to Lantus and Prozinc. However, both were only tried a couple times. The vet, nor the internist he consults with, seemed to "believe" that it takes several days to see results with these. :roll: They also seem highly reluctant to use the R in conjunction with Lantus... but if it doesn't work for a couple days, I dont see any other option. Of course since they dont think it's accurate that it doesn't work immediately, I can see why they wouldn't want to mix them. I REALLY wish they knew more about FD!!!

Anyway... I dont know if this is an accurate assumption or not... but I'm thinking that there's a good chance he will respond to these now. His bg was consistently over 400 at the vet, dipping into the 300's and occasional 200's. We're doing much better than that at home, even on lower doses than he was getting at the vet. So I'm thinking there's a good chance that he might respond to the longer lasting stuff now/soon. Does anything about this assumption strike anyone as totally off base?
 
If you can get him completely off dry, his numbers may drop any more. It could be that he doesn't like the texture of the wet, as it is pate. Some cats like it if you mix in a little warm water and smoosh it up make a sort of gravy.

I'm going to post on the Lantus forum with a link to this thread. I know we have had some people who have used both insulins together and maybe they'll have suggestions for you.
 
I've been using Lantus and then Levemir for 8 years, I think it is. They are both depot insulins, and it takes about 5 to 7 days for the depot of insulin to build up in the system.
 
I wonder... have a lot of you had good results with ProZinc? I have both (because neither worked initially, but I was charged for the full bottle), but the ProZinc is half the cost. Though I can probably get the Lantus cheaper at Costco or something in the future... but still pricey. Just a thought. Since both didn't work before (probably because he only tried it for one or two doses), either one might do the trick now. Would rather go the cheaper route (as if $115 is cheap... but the Lantus was over $200) if it works.
 
Yep, I definitely think it's time to discontinue the Humulin (or at least start switching over to a longer lasting insulin). He's stabilized now on lower numbers and is doing much better food-wise and health-wise. ProZinc is an "in-and-out" insulin, meaning you should be able to see the results immediately. Lantus is a "depot" insulin, meaning it takes up to 5-7 days when first starting Lantus to "build the depot" before you see the full impact of the dose (although you do start seeing some impact immediately). Both of these are given at 12-hour intervals and they both end up costing relatively the same if you buy Lantus in pen form instead of vial. If you're able to use a coupon with the Lantus, then the Lantus is even cheaper. It is up to you which insulin you prefer to go with. Me, personally, I'm biased toward the Lantus since that's what I use. ;-) :lol:

For comparison:
  • Humulin = trying to navigate a speedboat (hard to make changes in direction when you're going too fast)
  • ProZinc = trying to navigate a sailboat (easier to make changes, especially on a dose-by-dose basis)
  • Lantus/Levemir = trying to navigate a cruise ship (you make a change and you have to wait a while to see it change, but it's steady and predictable)
As for the dry food, if Tink loves crunchies, you can find some freeze-dried meat treats (make sure the only ingredient is meat). My Henry is a dry food addict even though he hasn't had access to dry food since I got him at 4 months old. He'll chew through bags of sunflower seeds, chips, croutons, anything with crunch to it. He is obsessed with the freeze-dried chicken and I use those sometimes to get him to eat his wet food when he's trying to boycott it for whatever reason. :roll:
 
Hello,
I've had good results with ProZinc & Levemir, but have never used Lantus. I have two OTJ kitties, both were originally on ProZinc. One went OTJ on ProZinc during his first remission (lasted @1 year), after @6 months on ProZinc. His 2nd remission (may 2013) is off Levemir which I had on hand & used immediately, within a matter of a few days he was in his 2nd remission & still is. The 2nd kitty was on ProZinc & Levemir before going OTJ. There was a shortage of ProZinc & that's why I purchased Levemir pens. I prefer ProZinc because the possibility of prolonged hypos on Levemir scares me, but I'll use any insulin that's in my fridge if either cat goes off remission.

I'm glad you have insulin in the fridge basically available when needed -- I'm convinced that my Pudge went into his 2nd remission because he got insulin immediately, even before a vet visit & delays for purchasing it, waiting for a vet visit, etc. Plan to keep insulin on hand.

You're doing a great job!

Best wishes, Sophie
 
KPassa....I am biased towards ProZinc....that is what I use. Heee Heee :lol:

I use ProZinc because of my goofy work schedule...I need the flexibility of ProZinc....a 'depot' insulin would not work for my schedule. After accumulating a ton of info on Rumpelteazer's ss, I can judge by her past PS numbers how much to give. NOTE: You need a lot of good data on your ss to dose like I do.....if you look at her ss.....please don't follow the dosing until you have enough data.

I like KPassa's comparison scenarios. Good info in a cute way. :lol:

IMHO....I would go with the insulin type that works with your schedule to keep Tink safe. :smile:
 
Hmmm... a cruiseship sounds good... as long as I dont have to try to back it into the garage! :?

I didn't realize there was so much difference between ProZinc and Lantus... thought they were basically the same (every 12hr) deal. I'll have to put some thought into it. Every 12 hours works fairly well for me. I have dairy goats, so I milk them on this schedule... more or less. THEY are pretty forgiving if 12 turns into 13 or 14hrs... a little flexibility would be strongly preferred... but we'll make it work however we need to. I have no social life anyway. :lol:
 
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