wait to hyperglycemic?? what?

[sherrib]

I emailed my vet and got a return email from a staff member saying that the vet said to dont shoot skittles if he gets to 100 and wait until he goes back hyperglycemic then shot him. i did not tell them that he was only at 1 unit now but did say that he only gets can food under 10 carbs and that the reading I got this AM was 2 hours after I pulled his food.

AMPS= 169 No insulin

plz look at his SS. one day he doesnt need any, the next he does.

 

[Rachel]

First, I disagree heartily with your vet.

Next, I'm wondering if decreasing the dose would work. I'd like to see some mid cycle tests on a day you do give insulin to see how low he's going. That might tell us what's going on and help figure out the puzzle. I can't review the SS easily on my phone but will check later at home to see if any ideas present themselves.

 

[sherrib]

his +6.5 = 199

I agree with you about his vet

 

[Sue and Oliver (GA)]

Me too. I think I'd try reducing the dose. On 11/30 he came down on his own, without insulin. Says to me the pancreas is helping out. Which is great but tricky. It seems to work in spurts in most cats and then rest for awhile. So you usually don't know when it will jump in to help.

You could try two approaches. Reduce to .5 and see if you get two shootable preshots. And yes, lower than your vet says. I think you were doing 180. You could try 160-170 but it is a little trickier if Mr. pancreas decides to join in which you shoot a lower number. If you are comfortable with 180 stay there.

The other way is to chase the number. It involves more of your time and more tests, but usually the more time he spends in lower ranges, the faster it is to OTJ. (Anti jinx). But with a possible job in the future and time now, maybe an option? You test until he is at your target. Most if 180 is the target, when he reaches 180 today, give him .5. Then test at +12 from this shot. If he is not at your target, test every couple of hours until he is. Then shoot again. It means shooting off 12/12 (mostly often longer than 12 hours apart) and can be tiring because you are literally testing (chasing) until he reaches your target.

I know I've probably given you these ranges before. For a human meter, we consider OTJ, staying between 40-120 for two weeks with no insulin with the majority of the time in double digits.

 

[Carl & Polly & Bob (GA)]

Please ask the vet what number he considers "hyperglycemic". Because litterally speaking he's not wrong.

 

[sherrib]

And yes, lower than your vet says

I dont know if I understand this

I think you were doing 180

Im not sure I understand this

 

[sherrib]

If he under 200 I dont shoot, i did once at 197

 

[sherrib]

Please ask the vet what number he considers "hyperglycemic

I just sent a email asking. Remember she does not know he is at 1 unit. Last time I had him in the office ( 11/20/15 ) she said to give 4 units

 

[Sue and Oliver (GA)]

I thought you had decided to shoot around 180 -190. When we "talked" about it ( on a previous thread) I said 200 was the cut off for a newbie who was struggling with testing and had little data. You aren't a newbie anymore - you can get a test when you need it and you have lots of data. You should always shoot a number you are comfortable with and if you aren't comfortable under 200, then have that be your target. I was thinking you had decided to drop a little lower, but maybe I misunderstood.

 

[Sue and Oliver (GA)]

The part I am not understanding about your vet is when he wants you not to shoot at 100. If he means that anytime he tests under 100 for a preshot, I would certainly agree with that. This website by ProZinc has definitions for hyperglycemic and hypoglycemic. Hyperglycemic is defined by them as over 200-300. We consider 200 a cutoff for a new diabetic, but gradually suggest lowering that number. I think we would always say shoot between 200-300.

https://www.prozinc.us/feline_diabetes.html

 

[sherrib]

. I think we would always say shoot between 200-300.

oh wow, I must have be misunstanding this whole time. I was thinking DONT shoot under 200. So I should have given him insulin this AM? At 7 Pm its time for a test.what number should I shot at?

 

[sherrib]

Its 6;25 PM now

 

[sherrib]

Our vet does not support me testing at all. Told me 2 weeks ago that she will test him from now on

 

[Sue and Oliver (GA)]

Sorry if I am not explaining it well. Yes, for a newbie, we certainly suggest NOT shooting a number under 200. Once they get data, so they have an idea what a given dose does, and once they can get a test anytime that need to, then we suggest lowering that threshold, little by little.

So you can decide you will start shooting anything above 190, for instance. Once you give a dose at 190 and see how low it takes him, you reevaluate and maybe decide it would be safe to shoot at 185, for instance. It's all about what you are comfortable doing.

It does get them in lower ranges when you shoot at ranges under 200. BUT very few people here shoot under 150 and then they are usually giving tiny doses, maybe 0.2 or so. And they know they can monitor and that they can bring up a low number

Does that make sense?

If she doesn't think you are testing, then what is she talking about? How can she give guidelines if she doesn't think you test? Or did she realize you would test anyway?

 

[sherrib]

Does that make sense

yes

If she doesn't think you are testing, then what is she talking about? How can she give guidelines if she doesn't think you test? Or did she realize you would test anyway?

I really dont know, she probably thinks I will test. 2 weeks ago when he dropped to 39 and i rushed him in I think she realized that Im just not going to sit back and just keep shooting every day ( without testing ). I am changing vets,looking for one around here that supports what we do here. I got my last cat into remission following this board but that was close to 10 years ago and Im very rusty

 

[sherrib]

his PMPS is 166 I am not going to give anything.....I think? I only have U40 needles, not half lines on them. when I was giving 4.5 units I was guessing between 4 & 5

 

[Carl & Polly & Bob (GA)]

his PMPS is 166 I am not going to give anything.....I think? I only have U40 needles, not half lines on them. when I was giving 4.5 units I was guessing between 4 & 5

That's a good choice. Whenever you are not sure, play it safe. If you don't feel confident in being able to measure the dose (which I know is hard because I wear bifocals!), then play it safe.

I was typing this as you posted that, concerning earlier conversation in this thread -

You can shoot under 200, Sheri. We suggest that new members who are just starting to test don't do that. Because in order to shoot lower than 200, you need the data to look back on so that you can do so safely. But that doesn't mean you need to shoot under 200. You should only give insulin if you feel it is safe to do so, and if you know what to do if the numbers go lower than you want them to.

I understand that your vet thinks that you are still giving a 4u dose and not 1u. So it would make sense for her to say "wait until hyperglycemic". But what does she consider "hyperglycemic" to be? 200, 300, higher?

The problem is the word "hyperglycemic". Because litterally, it means "above normal blood glucose". It doesn't mean "above the renal threshold", or "above normal but by a lot".

There are only three ranges of BG:
hypoglycemic (below normal)
Normal range
Hyperglycemic (above normal)

So if "normal is "50-130" (some people say 40-120), then "hypoglycemic" is 49 (or 39 depending on what you call normal).
And 131 would be "hyperglycemic", literally. The problem is when people use terms like hypoglycemic and hyperglycemic on the board, the words are usually misused or misunderstood.

"Hypo" means "below", and "Hyper" means "above", and that's all they really mean. Usually though, when people use them here in relation to feline diabetes, they raise big huge red flags that go beyond the real meaning of the words.

 

[Sue and Oliver (GA)]

I think that's wise, Sherri. Not only is he lower than you have shot before (and well below my possible 180-190 suggestion). The other factor is that he has come down since this afternoon, so his pancreas is likely working.

It may be time to pick up some 1/2 unit U100 needles to use with the conversion chart. I think some tiny doses are in your future.

 

[Carl & Polly & Bob (GA)]

I think that's wise, Sherri. Not only is he lower than you have shot before (and well below my possible 180-190 suggestion). The other factor is that he has come down since this afternoon, so his pancreas is likely working.

It may be time to pick up some 1/2 unit U100 needles to use with the conversion chart. I think some tiny doses are in your future.

I agree.

 

[sherrib]

"Hypo" means "below", and "Hyper" means "above

You know until you put that, I didnt even notice they were TWO different words Wow am I so embarrassed!

It may be time to pick up some 1/2 unit U100 needles

YAH!! I actually down to 3 needles ( didnt realize i was that low,BUT if in a emergency I do have all my used ones) I have some coming to me in the mail. Should be here tomorrow. but to be safe, I will get some U100 to. They are "human" needles right? i have to go get all my meds in the morning so i can see if my pharm has some. I got a box of 100 U40's about a month ago. I got the whole lot & the used needle box from my vet ( $30 something for the 100 )

 

[sherrib]

here are the exact words from my email from the vet today "Dr. Temple says if the reading goes to 100 or below not to give insulin until Skittles goes back hyperglycemic."

 

[sherrib]

which I know is hard because I wear bifocals

Me too!

 

[Sue and Oliver (GA)]

here are the exact words from my email from the vet today "Dr. Temple says if the reading goes to 100 or below not to give insulin until Skittles goes back hyperglycemic."

I don't understand what that means. Very unclear directions to follow....

 

[Rachel]

Yeah, I have no idea what your vet means.

 

[sherrib]

I know, thats why i get confused. and why i want a new vet! I copied & pasted their answer. I am going to C & P the entire email
From any checks that skittles has had, has he ever ketones in his urine? Can I get a copy of his last test mailed to me
Sherri & Skittles Brandt
Happy Thanksgiving

Tamara Casper <smallpawsvet@raleigh.twcbc.com>
Nov 27 (5 days ago)

Good morning,

Skittles urinalysis was negative for Ketaones when we tested him in October. Which test did you want, the U/A or bloodwork?


Sherri Brandt <sherrirbrandt@gmail.com>
1:42 AM (18 hours ago)

to Tamara

Both test please.
What reading does Dr Temple not want me to give him his insulin? For example Under 200 under 180, etc . I haven't done a curve ( it's not even close to 2 weeks yet anyway ) but I do check his level before his AM & PM dose. He doesn't eat for 2 hours before I check his level.

Sherri Brandt <sherrirbrandt@gmail.com>
8:26 AM (12 hours ago)

I get up at 5 AM every day just to pick up his can. Then I go back to bed and get up at 7 to check his level and give him insulin. This morning he was 169 so I'm waiting to hear from Dr Temple. He got his last insulin at 7 PM Tuesday night.

Tamara Casper <smallpawsvet@raleigh.twcbc.com>
9:24 AM (11 hours ago)

Yes ma’am we will mail the tests to you. Dr. Temple says if the reading goes to 100 or below not to give insulin until Skittles goes back hyperglycemic.
Sherri Brandt <sherrirbrandt@gmail.com>
4:23 PM (4 hours ago)

what number does Dr.Temple call hyperglycemic?

 

[sherrib]

. Im watching and reading on the prozinc site. I have never drawal back on the syringe to see if I got blood or not, do ya'll?

I have done a mini curve, in the email I said I didnt do any because of the fuss I got at my last visit

 

[Carl & Polly & Bob (GA)]

I know, thats why i get confused. and why i want a new vet! I copied & pasted their answer. I am going to C & P the entire email
From any checks that skittles has had, has he ever ketones in his urine? Can I get a copy of his last test mailed to me
Sherri & Skittles Brandt
Happy Thanksgiving

Tamara Casper <smallpawsvet@raleigh.twcbc.com>
Nov 27 (5 days ago)

Good morning,

Skittles urinalysis was negative for Ketaones when we tested him in October. Which test did you want, the U/A or bloodwork?


Sherri Brandt <sherrirbrandt@gmail.com>
1:42 AM (18 hours ago)

to Tamara

Both test please.
What reading does Dr Temple not want me to give him his insulin? For example Under 200 under 180, etc . I haven't done a curve ( it's not even close to 2 weeks yet anyway ) but I do check his level before his AM & PM dose. He doesn't eat for 2 hours before I check his level.

Sherri Brandt <sherrirbrandt@gmail.com>
8:26 AM (12 hours ago)

I get up at 5 AM every day just to pick up his can. Then I go back to bed and get up at 7 to check his level and give him insulin. This morning he was 169 so I'm waiting to hear from Dr Temple. He got his last insulin at 7 PM Tuesday night.

Tamara Casper <smallpawsvet@raleigh.twcbc.com>
9:24 AM (11 hours ago)

Yes ma’am we will mail the tests to you. Dr. Temple says if the reading goes to 100 or below not to give insulin until Skittles goes back hyperglycemic.
Sherri Brandt <sherrirbrandt@gmail.com>
4:23 PM (4 hours ago)

what number does Dr.Temple call hyperglycemic?

That's confusing to me too. Is Dr. Temple saying that if at anytime Skittles goes below 100, you shouldn't continue insulin until you see a number that is "hyperglycemic"? That wouldn't make much sense, because that would mean any time you see a green number in the middle of the cycle, you wouldn't give him another shot at shot time.

If Dr. Temple is saying "don't give him a shot if you see a number below 100 at AMPS or PMPS, then well "no duh". I wouldn't tell anyone to shoot on a preshot number of 99 either. Especially since they think you are giving Skittles a 4u dose. Any vet that advises a 4u dose of Prozinc on a preshot test that shows below 100 should have his/her license to practice taken away.

What he seems to be saying is "if you see a preshot under 100, don't shoot. And don't give Skittles ANY dose unless his numbers are "hyperglycemic". Which still doesn't clarify what he means as far as a specific number on the meter being "hyperglycemic".

. Im watching and reading on the prozinc site. I have never drawal back ob the syringe to see if I got blood or not, do ya'll?

It isn't likely that you would hit "blood" if you are shooting sub-q. When you give intramuscular shots, there's a possibility that you could hit a vein or an artery, so you would draw back to make sure that they shot is going into muscle and not directly into the bloodstream.
I'm not sure if anyone else here does the "draw back to check for blood" when giving insulin sub-q. I never did.

 

[Merlin]

I never draw back because I am shooting just under the skin and away from the muscle. I do not shoot in the muscle.

 

[Robin&BB]

When you give intramuscular shots, there's a possibility that you could hit a vein or an artery, so you would draw back to make sure that they shot is going into muscle and not directly into the bloodstream.
I'm not sure if anyone else here does the "draw back to check for blood" when giving insulin sub-q. I never did.

Yep! In the very first week that I was shooting Bat-Bat, I was doing the "draw back" thing - & never got any blood in the syringe. Then I went, "Wait a minute: This is sub-q, not an IM injection. Duh..."

So I stopped drawing back. (One less thing to fret about!)

 

[sherrib]

yeah, I always do sub-q too.

I have NO idea what my vet is saying. She said NO testing. ( which means to me no AMPS or PMPS testing)

his -2 was 181

AMPS= 169 No insulin given
+6.5=199
PMPS= 166 No insulin given
-2= 181

 

[Robin&BB]

I have NO idea what my vet is saying. She said NO testing. ( which means to me no AMPS or PMPS testing)

Oh, dear! <sigh> Yet another misguided vet ... someone who would expect you to play roulette with Skittles. (Which we all know that you will not.)

I am changing vets,looking for one around here that supports what we do here.

Good for you, Sherri, on your plan to find a different vet! (You're doing a fine job, btw - it's so obvious how much you love your kitty!)

 

[sherrib]

it's so obvious how much you love your kitty

Thank you so much!! I love animal so much! I wanted to be a vet myself, when I worked at a animal hospital it was a dream on true!!

 

[sherrib]

Look at his AMPS and PMPS.... so close to each other

 

[Robin&BB]

Yep. this is a very exciting trend you've seen rolling out today/tonight ... can hardly wait to see what goes on tomorrow!

 

[BJM]

Vet Interview Topics in my signature link!

Notes to explain to your vet why we test:
Home testing is a safety thing,
- to make sure it is safe to shoot, based on the collected data showing response to dose at various starting levels.
- to check the nadir for dose effectiveness, between +5 to +7 for ProZinc, though typically towards the shorter end of time.
- - the nadir should remain safely above 50 mg/dL on a human glucometer to avoid hypoglycemia.
- to monitor home intervention for slightly low numbers (if the cat is seizing, have someone drive while you give glucose/Karo).
- to monitor high numbers to evaluate likelihood of diabetic ketoacidosis, in combination with urine or blood ketone testing.
- - DKA is a medical emergency.

 

[Carl & Polly & Bob (GA)]

The way the numbers look lately..... What I see is a kitty who is doing a really good job of keeping his numbers reasonably low with little help from outside insulin.

He MAY need a little help to get even better. IF you can get some U100 syringes, I think it would be possible for you to dose tiny doses (with the conversion chart) of .6u or .4u on upper blue preshots that would give him some green numbers mid-cycle without causing bounces. If so, without jinxing anything (anti jinx!), not needing insulin might become a long term thing.

 

[sherrib]

The way the numbers look lately..... What I see is a kitty who is doing a really good job of keeping his numbers reasonably low with little help from outside insulin.

He MAY need a little help to get even better. IF you can get some U100 syringes, I think it would be possible for you to dose tiny doses (with the conversion chart) of .6u or .4u on upper blue preshots that would give him some green numbers mid-cycle without causing bounces. If so, without jinxing anything (anti jinx!), not needing insulin might become a long term thing. [/

 

[sherrib]

I'm wondering about his Numbers tomorrow but if he follows his pattern then he will be in the mid 200's in the morning. He seems to not need any insulin for 24 hrs and stay at good numbers and then he does need his insulin. Like his body it trying to work. Hoping when it does start working it goes longer and longer time periods. I really hope his legs get better!!
I'm going to get some u100 tomorrow. At least I hope so,if not I will just have to use my U40.
Guess it's time to tell the vet that I'm giving 1 unit and not 4?? Wonder what she will do? Probably tell me not to come back. There are only 3 animal hospitals in my city.

 

[sherrib]

DKA .....what does that stand for?

 

[Carl & Polly & Bob (GA)]

Your last message to your vet asked "what number does the dr. say is hyperglycemic?"
And you haven't heard back?

I'd say that at this time, you don't need to tell them anything about what dose you have been giving. I wouldn't say anything unless asked.

 

[Carl & Polly & Bob (GA)]

DKA is "diabetic Ketoacidosis". It what ketones can lead to if things go badly. That's why checking for ketones is a good thing to do. Once a cat is " DKA", it is life threatening and almost always requires a stay at an emergency clinic, and can cost huge bucks to treat. It happened to Bob, and he almost died before I even started treating his diabetes at home.

 

[Rachel]

I wouldn't tell the vet anything. My vet was (thankfully) fully supportive of home testing. They didn't push it...they just said that if I wanted, I could test at home and if I did, I should grab a human glucometer since those worked just fine and animal ones were more expensive. The only thing we butted heads on was canned food vs prescription food. I just pretended we were feeding it at first and eventually said my cats refused to eat it. It was just easier.

If I was you, I'd shop for a new vet. In the meantime, I wouldn't tell this vet anything. If she is saying no tests at home and then berating you for doing it...nope. You don't have to put up with that for doing what it takes to keep Skittles safe!

 

[sherrib]

You don't have to put up with that for doing what it takes to keep Skittles safe!

I agree 100%!

 

[sherrib]

I was right last night, this AM mid 200's. He was so hungery this morning that I went ahead and gave him his insulin earlier ... I got up at 5 AM to pick up his food and he wouldnt leave me, begging for food. I guess he didnt get his snack in before I got up and I had planned on just going back to bed and not getting up at 7:00 and taking my daughter to school because she doesnt need me to take her today ( BUT NO! Im wide awake now, if I had to take her I wouldve been very sleepy! LOL)

AMPS= 216 @ 5:39 AM and 221 @ 5:40 AM gave 1 unit then instead of at 7:00 AM

he pigged out on his food LOL,ate it all!

 

[Robin&BB]

AMPS= 216 @ 5:39 AM and 221 @ 5:40 AM gave 1 unit then instead of at 7:00 AM

That's ok, Sherri! Just adjust your mid-cycle testing accordingly - you might want to try testing him around +3 to + 4 from his shot time this morning, just to see how he's processing the dose with this little schedule shift. The important thing is that Skittles is making really good progress! His # this morning isn't bad at all, not by any means.

I had planned on just going back to bed and not getting up at 7:00 and taking my daughter to school because she doesnt need me to take her today ( BUT NO! Im wide awake now, if I had to take her I wouldve been very sleepy! LOL)

Ha, isn't that always the way things like that go!

 

[Merlin]

Guess it's time to tell the vet that I'm giving 1 unit and not 4?? Wonder what she will do? Probably tell me not to come back.

I have another thought regarding on "telling your vet." Actually, I would tell your vet about the dose change, the spreadsheet, home testing, etc. and here is the reason why. This vet is going to continue to give bad advice to other clients and maybe, just maybe, if she heard all of this and how well Skittles is doing, she may rethink her own approach to diabetes. I would be afraid that if I didn't share this information with her, that other pets would be in peril due to her current advice. To me, it would be more of an obligation. It may not go anywhere and the vet may not listen, but at least you would have tried to share what you have learned with the vet. What do you have to lose? You are going to change vets anyway. Just my two cents worth.

 

[sherrib]

. Just my two cents worth

Very true on all you said, I am also going to tell her about the 3 mistakes her staff did in less then 2 weeks with me. She really needs to know about them, if I had listen and not followed my gut Skittles might not even be here

you might want to try testing him around +3 to + 4 from his shot time this morning

I did get to fall back asleep after all and slept through that test time

Here is my return email from the vet this morning
Tamara Casper <smallpawsvet@raleigh.twcbc.com>
10:31 AM (1 hour ago)

Good morning! Here is the information that you requested.
100 and 200-220

Thats all the email said...

 

[Sue and Oliver (GA)]

A woman of few words and none of them particularly helpful.....

 

[sherrib]

thats one of her staff members. They didnt even tell me which number went to which word

Here are his numbers for today
AMPS=216 , 1 min later 221 gave 1 unit
PMPS=129 No insulin

I ended up giving him his insulin at 5 AM instead of 7 Am ( its all explained above, figured it was safe to do because he didn't get any insulin yesterday) BUT now I have get him back to 7AM ( he did NOT get any at 5 tonight)

 

[sherrib]

I have to bring his insulin to my phar for them to see before they will sell me any needles, so I didnt get any yet