Urgent: Insulin dosing of Monkey

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PH&MonkeyPenPenFaFaTiger

PH&MonkeyPenPenFaFaTiger

Member Since 2020
Monkey's information is in previous post: Monkey

It is my great pleasure to have my second post on FDMB. This is such a lovely community. Monkey and PenPen has receives tremendous help. And there are recovering quickly.

The reason why I say it is urgent is because I am not sure If I have inject any insulin to Monkey. It is 95% sure that I did not due to various reasons. Now, I should not risk the uncertainty to inject again because it can be fatal, right?

Now, if Monkey do not have insulin, how should I help him to gain energy from eating? (His cells take glucose to gain energy). Suppose I find that he is 400+ mg/DL BG after 4 hours of breakfast, should I inject very small dose like 1-2 U, compare to normally 3.25 U.

Another question is I suspect Monkey has neuropathy since he walks on his hind, please see the video to see if I am correct Monkey's walking Youtube video. I see the this page of FDMB recommends taking methyl B-12 supplement, what's your advice?
 
I am not exactly sure what you are asking.
Are you asking if you can give some more insulin to Monkey during the cycle?.......the answer to that is definitely NO!
Never give more insulin to Monkey even if you think that the dose you just gave didn’t all go in properly. It is too risky.

Yes that video looks like diabetic neuropathy.. their feet will slip and slide on surfaces like wood.
I used Zobaline from lifelink.com and it helped greatly with the neuropathy. It takes time though. Monkey doesn’t have it badly.
Getting him into better numbers will help with it too.
 
Hi Peter,
do you think the insulin didnt inject all the way? Did his fur feel wet? If yes to those questions then no do not give another shot. You dont know how much did get into his system. I know his number is very high but I'm not good with dosing advice as I havent had a diabetic kitty in many years. Trouble passed in 2010. Hold on I will try and find someone.
 
jt and trouble (GA) said:
Hi Peter,
do you think the insulin didnt inject all the way? Did his fur feel wet? If yes to those questions then no do not give another shot. You dont know how much did get into his system. I know his number is very high but I'm not good with dosing advice as I havent had a diabetic kitty in many years. Trouble passed in 2010. Hold on I will try and find someone.
Click to expand...

Bron and Sheba (GA) said:
I am not exactly sure what you are asking.
Are you asking if you can give some more insulin to Monkey during the cycle?.......the answer to that is definitely NO!
Never give more insulin to Monkey even if you think that the dose you just gave didn’t all go in properly. It is too risky.

Yes that video looks like diabetic neuropathy.. their feet will slip and slide on surfaces like wood.
I used Zobaline from lifelink.com and it helped greatly with the neuropathy. It takes time though. Monkey doesn’t have it badly.
Getting him into better numbers will help with it too.
Click to expand...

I end up not giving any insulin and next insulin injection will start in 1 hour.

I am asking if during the cycle, let say 6 hours after, which is where nadir often occur, if I find out that his BG is around 400 to 600 ml/DL, then I deduce that I did not inject the insulin (normally 3.25 U), then I should give a bit of insulin to him like 0.5 U to 1 U, in order to for him to gain energy from blood glucose. Then in the next Cycle I reduce the that small amount of insulin. (3.25 to 2.25Ｕ）Is that a feasible and safe practice?
 
Hi Peter!

That is too bad about the suspected "furshot". As others have said, yep, you can't inject a second time, you just have to wait things out.

Looking at your spreadsheet, looks like you've switched meters to a human meter. It's a little weird that the numbers are higher than the pet meter-- usually it's the opposite. In any case, the "take action" number on a human meter is 50.

Not that he's anywhere close to that right now, yikes! Are you able to get any tests other than the pre-shot tests today? It would be good to know what he's up to in between shots.
 
jt and trouble (GA) said:
Hi Peter,
do you think the insulin didnt inject all the way? Did his fur feel wet? If yes to those questions then no do not give another shot. You dont know how much did get into his system. I know his number is very high but I'm not good with dosing advice as I havent had a diabetic kitty in many years. Trouble passed in 2010. Hold on I will try and find someone.
Click to expand...

I did not press the inject button, however, I find that the U40 although it in 3.25 U mark, there is no insulin, Then I deduce I did not suck the insulin to the syringe, thus I did not inject any. However, I thought "What if I was wrong?, double injection can be fatal", therefore I was worried and decide not to inject immediately.
 
Peter H said:
I am asking if during the cycle, let say 6 hours after, which is where nadir often occur, if I find out that his BG is around 400 to 600 ml/DL, then I deduce that I did not inject the insulin (normally 3.25 U), then I should give a bit of insulin to him like 0.5 U to 1 U, in order to for him to gain energy from blood glucose. Then in the next Cycle I reduce the that small amount of insulin. (3.25 to 2.25Ｕ）Is that a feasible and safe practice?
Click to expand...

It isn't really recommended. I have some thoughts about how exactly you might do this kind of thing with a Caninsulin-type insulin, but I deleted them because I don't want anyone lurking and reading posts to try something like this without guidance :). It would be too easy to veer into dangerous territory, and in the best-case scenario would require very intensive monitoring at stages.
 
Nan & Amber (GA) said:
Hi Peter!

That is too bad about the suspected "furshot". As others have said, yep, you can't inject a second time, you just have to wait things out.

Looking at your spreadsheet, looks like you've switched meters to a human meter. It's a little weird that the numbers are higher than the pet meter-- usually it's the opposite. In any case, the "take action" number on a human meter is 50.

Not that he's anywhere close to that right now, yikes! Are you able to get any tests other than the pre-shot tests today? It would be good to know what he's up to in between shots.
Click to expand...

Sadly, I did not give any test to Monkey today. I was a bit burnout recently due to other life issues. I should have given him the test : (

Please see the image.What I do is I have Pet and Human meter to collect the same blood, for 7 times to calculate the % difference. On average, human meter;s BG value is 5.1% higher,
does my analysis make sense? Do you think seven times is a good enough sample size.
upload_2020-4-12_20-23-52.png
 

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That's an excellent sample. Hmmmm. I wonder what's happening here? At the lower end, things are more or less behaving as I'd expect with the human meter reading lower, but at the higher end things flip, very consistently. All meters have a certain amount of error that is allowed (in the US, +/- 15%), so the amount of difference is not concerning, just that there appears to be a changing systematic bias. Maybe the human meter just isn't as accurate at those super-high numbers? (I don't think that humans get remotely that high BG, and the biggest concern is usually hypoglycemia at the other end anyway).

Anyway, we usually don't do a lot of side-by-side comparisons between the human and pet meters, because even if the relationship has a consistent direction, there doesn't appear to be a predictable numerical conversion between the two measures. Fundamentally, they're just measuring two different things.

What we focus on is the patterns across days or during days with the same meter-- BG going up, going down, etc. As long as that's behaving in a consistent way with whichever meter you use, and as long as it's reasonably accurate at the lower end (so that you know when you are dipping into hypo territory), you will be fine.
 
jt and trouble (GA) said:
Hi Peter,
do you think the insulin didnt inject all the way? Did his fur feel wet? If yes to those questions then no do not give another shot. You dont know how much did get into his system. I know his number is very high but I'm not good with dosing advice as I havent had a diabetic kitty in many years. Trouble passed in 2010. Hold on I will try and find someone.
Click to expand...

Shout-out gratitude to Ji and Trouble. My private message causes his smartphone to ring and woke him up from sleep. My apology, I thought it only alert you if only you are online in the forum. Thanks for your prompt great help. :) Of course, all gratitude to all of you:D
 
Nan & Amber (GA) said:
That's an excellent sample. Hmmmm. I wonder what's happening here? At the lower end, things are more or less behaving as I'd expect with the human meter reading lower, but at the higher end things flip, very consistently. All meters have a certain amount of error that is allowed (in the US, +/- 15%), so the amount of difference is not concerning, just that there appears to be a changing systematic bias. Maybe the human meter just isn't as accurate at those super-high numbers? (I don't think that humans get remotely that high BG, and the biggest concern is usually hypoglycemia at the other end anyway).

Anyway, we usually don't do a lot of side-by-side comparisons between the human and pet meters, because even if the relationship has a consistent direction, there doesn't appear to be a predictable numerical conversion between the two measures. Fundamentally, they're just measuring two different things.

What we focus on is the patterns across days or during days with the same meter-- BG going up, going down, etc. As long as that's behaving in a consistent way with whichever meter you use, and as long as it's reasonably accurate at the lower end (so that you know when you are dipping into hypo territory), you will be fine.
Click to expand...

Excellent interpretation Nan, seems that you have discovered something new. ;)

May I ask how fundamentally it is different? I thought they measure the same thing but calibrate differently.
 
Peter H said:
Shout-out gratitude to Ji and Trouble. My private message causes his smartphone to ring and woke him up from sleep. My apology, I thought it only alert you if only you are online in the forum. Thanks for your prompt great help. :) Of course, all gratitude to all of you:D
Click to expand...
LOL Peter! I was just as surprised as you were! Its perfectly ok to wake me. I dont mind. I was just very groggy. :p Besides Nan has given you better advice than I ever could.
THANK YOU NAN!!! I am hoping today with more eyes (from more experts) on this subject, you will be steered into better understanding of how all this works. I hope Monkey and you are doing better now.
jeanne
 
It has to do with the different characteristics of feline vs. human blood, and where the glucose is stored (e.g., plasma vs. red blood cells). Cats store most of their blood glucose in plasma, humans it's more mixed. Most home meters are just going to measure one aspect of BG, and extrapolate the rest based on species expectations. So it's maybe a little strong to say that they're measuring fundamentally different things, it's more like they think they're looking at fundamentally different things.

I'm sure other people can fill in more details here, this is just my loose understanding!
 
Bron and Sheba (GA) said:
I am not exactly sure what you are asking.
Are you asking if you can give some more insulin to Monkey during the cycle?.......the answer to that is definitely NO!
Never give more insulin to Monkey even if you think that the dose you just gave didn’t all go in properly. It is too risky.

Yes that video looks like diabetic neuropathy.. their feet will slip and slide on surfaces like wood.
I used Zobaline from lifelink.com and it helped greatly with the neuropathy. It takes time though. Monkey doesn’t have it badly.
Getting him into better numbers will help with it too.
Click to expand...

I have enough Money to buy Zobaline. Should I try some? Is there safety precaution?
 
Peter H said:
Shout-out gratitude to Ji and Trouble. My private message causes his smartphone to ring and woke him up from sleep. My apology, I thought it only alert you if only you are online in the forum. Thanks for your prompt great help. :) Of course, all gratitude to all of you:D
Click to expand...
Depends on how you have your User Id preferences and alerts set up. I stopped all email notifications, since I was getting 50+ a day. Peter sent me a PM also. But I'm not on much past 8PM EDT/EST (east coast of US). Glad other people could answer.
jt and trouble (GA) said:
If I remember correctly the zobaline is water soluble. That is he will just pee it out. Please correct me if i'm wrong guys :rolleyes:
Click to expand...
Yes, the B vitamins are water soluble and any excess will be excreted in the urine. Do NOT know what the recommended dose is.
@Diane Tyler's Mom Will know.
Hi Diane, could you help Peter with the dose of Zobaline. He's in Hong Kong, so may not have access to the Vitacost brand you tell people about.
 
Peter, you simply need to pick one type of meter and use that one going forward. You can drive yourself crazy trying to compare the difference between pet and human meters. Pick the one that has more readily available test strips and more cost effective test strips is what I would do.

Nan & Amber (GA) said:
It isn't really recommended. I have some thoughts about how exactly you might do this kind of thing with a Caninsulin-type insulin, but I deleted them because I don't want anyone lurking and reading posts to try something like this without guidance :). It would be too easy to veer into dangerous territory, and in the best-case scenario would require very intensive monitoring at stages.
Click to expand...
Absolutely. Even someone very experienced, with another diabetic cat for years, and then a second diabetic cat had a very hard time with an alternate protocol. I do not recommend experimenting with the dosing of Caninsulin until you gain a LOT more experience, and get a LOT more test data, to know how your cat responds.

"Know Thy Cat" is imperative as Jill would have said.

As other people have told you, if you think you have given a partial dose, or missed a dose, or are not sure you gave the dose, it's better to skip the insulin shot. There are only a limited number of circumstances, such as ketones or DKA (diabetic ketoacidosis) or HL (hepatic lipidosis) where the risk of not giving insulin would outweigh the risk of giving your cat an additional shot and risking hypoglycemia and possibly seizures and worse.

"Fur shots happen." We've all done it. Chalk it up to experience and learn from it.

If you give insulin later than normal in the cycle, for some reason you were not able to give it on the regular 12/12 hour dosing schedule, you should be adjusting your shot time for the next cycle. 1 hour late, next cycle is 1 hour later. 2 hours late with the shot, next cycle is 2 hours later, 6 hours late, next cycle is 6 hours later. Before you know it, your life and care schedule for your diabetic cats are totally at cross purposes.

There is some flexibility in the shot times with Caninsulin, up to 1 hour occasionally. But you want to stick to the 12/12 hour schedule if you can. Insulins like consistency. So if you keep changing your shot time by 30, 45, 60 minutes every day and every cycle, then the cat is more likely to bounce. Plus, shooting early can act like a dose increase. Shooting late can act like a dose reduction.
 
Deb & Wink said:
Depends on how you have your User Id preferences and alerts set up. I stopped all email notifications, since I was getting 50+ a day. Peter sent me a PM also. But I'm not on much past 8PM EDT/EST (east coast of US). Glad other people could answer.
Click to expand...
hahaha i didnt even know I had fdmb on my phone! I rather like it though..although like you I'm not much good after 8PM I figured I could at least hold a hand or hope to get someone to respond. THANK GOD Nan did!
Poor Peter. He cant know what all goes into this fdmb family. BUT I think he gets it now! :bighug:;):coffee:
 
Watched Monkey's walking video, and that is definitely neuropathy. It's not too bad yet, he isn't walking entirely on his hocks. Getting the blood glucose under control is the best way to help the nerve damage. The neuropathy will take months to get better.

Wink had it really bad, when I fostered him from the cat shelter. Walking entirely on his hocks, difficulty with stairs, couldn't walk more than 3-4 steps without pausing, could not climb on anything at all. When he started walking a bit better, when he was able to jump up 1 foot to get on the cat bed in my home office, when he started to jump onto the kitchen counters from the step stool, when he started to eye jumping to the top of my 6 foot bookcases, I knew he was getting better. :)

Baby steps, Baby steps, but the neuropathy completely resolved and he was able to walk on his toes again. :cat:

Neuropathy and any type of nerve pain is very painful too. Just ask any human diabetic or someone with sciatica. Trust me on that level of personal knowledge. You might want to talk to your vet about pain management.
(2015) AAHA/AAFP Pain Management Guidelines for Dogs and Cats
 
My another question, I find that AMPS and PMPS of Monkey is often >500, what should do to prepare if the dose need to increase from 3.25 to 3.5? As mentioned in my previous post, the vet prescript a increase of dose of Monkey from 3 U to 4 U. But, as you people have said, his BG fell to 70mg/DL on 04/09/2020, was very dangerous. Also, the transition of increase 1 unit is bad for cat.
 
Peter H said:
I have enough Money to buy Zobaline. Should I try some? Is there safety precaution?
Click to expand...
Hi Peter you can order the Zobaline from ilifelink.com
One pill per day, just crush it up and mix it in the wet food, it has no taste

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Deb & Wink said:
Watched Monkey's walking video, and that is definitely neuropathy. It's not too bad yet, he isn't walking entirely on his hocks. Getting the blood glucose under control is the best way to help the nerve damage. The neuropathy will take months to get better.

Wink had it really bad, when I fostered him from the cat shelter. Walking entirely on his hocks, difficulty with stairs, couldn't walk more than 3-4 steps without pausing, could not climb on anything at all. When he started walking a bit better, when he was able to jump up 1 foot to get on the cat bed in my home office, when he started to jump onto the kitchen counters from the step stool, when he started to eye jumping to the top of my 6 foot bookcases, I knew he was getting better. :)

Baby steps, Baby steps, but the neuropathy completely resolved and he was able to walk on his toes again. :cat:

Neuropathy and any type of nerve pain is very painful too. Just ask any human diabetic or someone with sciatica. Trust me on that level of personal knowledge. You might want to talk to your vet about pain management.
(2015) AAHA/AAFP Pain Management Guidelines for Dogs and Cats
Click to expand...

WOW thanks I did not even know this can cause pain.
I did not observed Monkey has any pain, maybe it is because I have no skill of identifying pain in cats. I will read the AAHA guide. Do you think this give me more reasons to buy the methyl supplement? I am will to spend the Money, what I worry is I use it wrongly and pose danger to Monkey. (Also, I want to ask, it is safe to give methyl B12 supplement to cats without neuropathy, or it is not completely sure if they have,)
 
Peter H said:
WOW thanks I did not even know this can cause pain.
I did not observed Monkey has any pain, maybe it is because I have no skill of identifying pain in cats. I will read the AAHA guide. Do you think this give me more reasons to buy the methyl supplement? I am will to spend the Money, what I worry is I use it wrongly and pose danger to Monkey. (Also, I want to ask, it is safe to give methyl B12 supplement to cats without neuropathy, or it is not completely sure if they have,)
Click to expand...
I posted above where to buy the Zobaline, you will not use it wrongly, you just crush up one pill and put it in the wet food, that's all
Once you get Monkey's BG levels under control, looking better and using the Zobaline the legs should get better. It might take about 2 months to see a difference
Don't know if it's ok to give to cats without neuropathy
 
The AMPS and PMPS are high, because the duration of the Caninsulin/Vetsulin is too short. Monkey is not getting coverage for the full 12 hours.

Bottom line, you need a better insulin.

Cats hide pain really well. It can be difficult to identify.

Imagine that your leg feels like it is on fire. Imagine that it feels like a very large tiger is raking their claws down the back of your leg, over and over again. Imagine that the pain is in both legs, that it sometimes goes as far down as your toes, and your toes feel tingly and numb. Imagine that walking or bending down (to squat in the litter box for example) hurts. Imagine that you are limited in your movement and even sleeping can be painful. Imagine that you can't get your four feet steady under you, and you are slipping and sliding around on the floors and are leary of moving too much.

Yes, since the methyl B12 is water soluble, you can give it to a cat that is not showing signs of neuropathy, but why would you? You wouldn't give a non-diabetic cat insulin.
 
Zsofi & Zokni said:
Hi Deb!
Your comment makes me wonder, do you think the methylc. is an overkill then? I've been giving it to Zokni and he's better but he also started insulin at about the same time.
Click to expand...
No, I do not think the methyl B12 is overkill. When Wink had the bad neuropathy, I said "Don't care if it's proven to work or not. We need to get him any little bit that will help."

I bookmarked this thread discussion from a couple of months ago. It talks about Zobaline and methyl B12 and has some other good information about feline diabetic neuropathy.
http://www.felinediabetes.com/FDMB/threads/zobaline-and-leg-neuropathy-question.224153/#post-2508214
 
Peter H said:
WOW thanks I did not even know this can cause pain.
I did not observed Monkey has any pain, maybe it is because I have no skill of identifying pain in cats. I will read the AAHA guide. Do you think this give me more reasons to buy the methyl supplement? I am will to spend the Money, what I worry is I use it wrongly and pose danger to Monkey. (Also, I want to ask, it is safe to give methyl B12 supplement to cats without neuropathy, or it is not completely sure if they have,)
Click to expand...

Hi Peter,
Zokni walked just like Monkey in January. I could only tell he was in pain because he would not let me touch his hind legs for even a second. Now he's much better than a few months ago and he is not bothered if I touch them. He had lost a lot of muscle though, because he only took a few steps at a time before sitting or lying down. So one thing was to manage his pain, but then he needed time to rebuild the muscles to walk properly. He literally doubled his muscle mass in a few weeks. So I'll keep my fingers crossed hoping Monkey does well too!
I also ordered Zobaline recently and I'm still waiting on it here in Spain, it shipped a month ago. I hope you have better luck in HK.

By the way, I was smiling when I read about your finding on cats and the fact that they like moving water. I never knew why mine prefers rain water when his bowl is right there...
 
Zsofi & Zokni said:
Hi Peter,
Zokni walked just like Monkey in January. I could only tell he was in pain because he would not let me touch his hind legs for even a second. Now he's much better than a few months ago and he is not bothered if I touch them. He had lost a lot of muscle though, because he only took a few steps at a time before sitting or lying down. So one thing was to manage his pain, but then he needed time to rebuild the muscles to walk properly. He literally doubled his muscle mass in a few weeks. So I'll keep my fingers crossed hoping Monkey does well too!
I also ordered Zobaline recently and I'm still waiting on it here in Spain, it shipped a month ago. I hope you have better luck in HK.

By the way, I was smiling when I read about your finding on cats and the fact that they like moving water. I never knew why mine prefers rain water when his bowl is right there...
Click to expand...

The discovery is super important to cats. When I manually feed moving water to Monkey, he loves it and have increase water consumption in a large extent. I think one of the reason for his rapid recovery, is because of water.
 
Peter H said:
My another question, I find that AMPS and PMPS of Monkey is often >500, what should do to prepare if the dose need to increase from 3.25 to 3.5? As mentioned in my previous post, the vet prescript a increase of dose of Monkey from 3 U to 4 U. But, as you people have said, his BG fell to 70mg/DL on 04/09/2020, was very dangerous. Also, the transition of increase 1 unit is bad for cat.
Click to expand...

Should I increase Monkey's dose from 3.25 to 3.5?
 
Diane Tyler's Mom said:
Just thought I'd post this for you Peter

  • Be sure to poke in the "sweet spot" and not the major vein thatruns along the length of the ear. Poking the vein will not only hurt, but will result in a lot of blood. The sweet spot is on the edge of the ear.
4395c545-36bf-4aba-bec7-4392fcdb191c-jpeg.48119
Click to expand...

Great illustration!!! It really help me to understand, my success rate is greatly improved. :D
 
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