What kind of dosing?

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Cindy & Pets

Cindy & Pets

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Yet again I've been completely unsuccessful today with getting Tip's bG. She just isn't tolerating me. Not only that, but I've been unable to even give her insulin as every time I go to give it to her, the syringe has slipped out of my hand and the needle broke. I'm using Relion (30 guage I thing) needles, and this hasn't happened with even this batch until now. Is it alright to attribute this all to bad luck as I've been having a major string of that today, causing a lot of stress for me, so obviously Tip is going to react when I attempt to test her. And then to start her back on insulin tomorrow?

And if so, should I start back at the full 2.5U twice a day immedietly? Or should I go 1U right before I go to school, then 2.5U for when I get home from school so I can monitor har closely to make sure she doesn't go hypo? I'm really not sure what to do in this situation, and I'm really concerned about her going high. I know I officially can't give her insulin tonight unless I'm to skip her morning dose as I leave for school at 7:30 and then I''d be able to start getting her back up to the 7am/7pm shoot time and 6:30am/6:30pm feed time.

I would call the vet, but they're closed. I'm concerned about her bG shooting way up, but I'm also really concerned about making her go hypo as if at all possible, I want to prevent it. Thanks in advance.
 
If you can't be there to monitor her, always go with safety first!

Additional monitoring methods:
Urine Testing
Obtain KetoDiastix or similar product from pharmacy.
You will be looking for glucose and/or ketones in the urine.
Use a long handled spoon to obtain fresh urine sample while the cat urinates, or hold a test strip under the cat.
OR - Pick up some acquarium gravel and put it in a clean litterbox.
Wait for the cat to use it.
Within 30 minutes, push the gravel aside, tip the pan, and dip the strip.
Compare test strip to color chart (this is an imprecise measure)

Note: if cost is a problem, it is possible to remove solid debris from the gravel, and "wash" the gravel, dry it and re-use it. It is, however, very time-consuming and you'll need a large tub and a strainer over the drain to prevent it from going down and clogging the pipes.

Water Consumption
Measure the amount of water you put down each day.
Measure how much is left at the same time the next day.
The difference is water drunk and some evaporation.
This will gradually decrease as you get better control.

Food Consumption
Measure the amount of food you put down each meal.
Measure how much food is left at the next meal.
The difference is food eaten and some evaporation of moisture from the food.
This will gradually decrease as you get better control.

Urine output
Roughly measure the amount of wet litter produce each day and is characteristics
- have you got oceans, lakes, ponds, or cups?
oceans = uncontrolled or possible some other problem such as renal disease or hyperthyroidism
cups = better controlled or lack of water intake

The 5 Ps
Purring - is the cat exhibiting customary signs of contentment or happiness
Playing - will the cat play and interact with others?
Preening - is the cat maintaining its fur and cleanliness?
Peeing - occurrs, and is a normal volume?
Poohing - fecal material is formed and passable? Constipation may happen with a food change; adding a tablespoon or so of water may help, plus ensures the cat is hydrated properly.
 
Right, that's what I was thinking. So far everything seems fine, she isn't peeing too much, or too little. Was a little constipated, but that was from switching from Friskies filet(or it was shreds) to Friskies Pate, that's cleared up though, so fine there. Her drinking has been same as always since switching her to wet food a while back, though to make sure she isn't dehydrated, I've been adding some water to her food. Been eating the same amount, vet has her on a diet though of 4oz per meal to keep her at her current weight, I might weigh her in a little bit as that was a big thing when she was high, is within 24 hours, she'd drop a couple of oz's in weight, which is scary to me and is why I'm so afraid of her being high, but even on diagnosis(and likely being diabetic for a good half year or so), she's never been above the 400's, would she still be at risk for ketones at that point?

Other than that, she's been doing great on the 5 P's, just her sister and her have a few spats over Christmas being a nosy butt. Would these change quick in a cat that's high? Or are these more slow symptoms?


EDIT: Looked at the link in your signature, and that seems to have answered my questions on if these are slow or quick changing symptoms.
 
I'd suspect a cat with hyperglycemia might not feel well and could be cranky at that time.

Of course, each cat is different.

I did observe Spitzer taking no prisoners when he wasn't feeling well.
 
Hyperglycemic means high bG, right? And hypo is low? I just want to doublecheck I'm using those right.

Okay, so I'll compare to the notes I took before she was officially diagnosed, but was pretty obviously diabetic? And it seems her weight is fine, if anything might need to adjust it to a little lower after talking to the vet, she's still gaining weight, petite build, and almost 10lbs, so that's obviously not an issue.
 
You've got it.

Hyper in front of a term means more or excessive
- ex hyperactive

Hypo in front of a term means less or insufficient
- ex hypothyroid
 
Alright, thanks. It's always good to get the terminology right. But now I've determined she isn't likely dangerously high, then I'll attempt to test her tomorrow morning, and if I'm successful and she's above 200(it would be a blessing if only after 2 months, she didn't need insulin again, especially since she's on Humulin N), do I go with 1U? Or do I base it off of the results? I want to make sure I have a gameplan tomorrow morning since I usually need to make things work like clockwork due to riding the bus to classes.
 
It looks like 2.5 units gets you down to nearly a no-shoot level each time you do it, thus having to skip 1 or more times. The ideal is a dose you can safely give consistently every 12 hours.

With the limited data you have, I'd be inclined to slightly reduce the 2.5 units, take it down to 2.25 units if you've syringes with half unit markings and can squint, 2.0 units if you only have whole unit markings.

If you cannot get good tests or be able to monitor her due to work, safety is the priority. You can't get insulin out once it has gone in.

Normal, non-diabetic numbers run anywhere from 40 - 150 mg/dl.
I have frequently seen pre-shot numbers in the 200s and 300s which get quite low at the nadir, the lowest point in the cycle. For Humulin N, that is roughly 3-4 hours after the shot. When you can, a curve - glucose measurements taken every 2 hours from pre-shot to pre-shot - will help us advise you better. Plus it will demonstrate how this insulin is working for Tip. If you can't get on a longer acting one, you may have to dose 3 times a day to get decent control.
 
Alright, I do have the half-unit marked ones, so I don't think that'd be a problem.

Right, which is why I was wondering if 1 would be safer, or what. But I can do 2.25, is it okay to go fom 0 for a day and a half to 2.25? I know when she was first diagnosed, the vet tech said that changes in insulin dose are kind of harsh.

EDIT: I was thinking of doing a curve shortly after I get out(about a week and a half from now) so that she has a little more time to let me get better at testing her, since I'm still making mistakes galore, especially with my aiming for the right spot. I've yet to really suggest possibly a longer-lasting insulin, but she's very open to change(even more than happy to research the best human meter that's cheap for her), so I'd imagine she's alright with changing insulins, but it'd be good to see how this one is working for her first. I doubt I have enough data currently to bring to her to prove if Tip needs a different insulin.
 
It would be fine to stick with 1 unit.
Because you don't have any tests from +3 to +6m we don't know how LOW she is going on her doses.
See if you can sneak in some - before you leave for work, before bed, or doing a curve on the weekend (testing every 2 hours for a full curve, testing every 3 hours for a mini curve)

"best" human meter?
Many use the WalMart ReliOn Confirm, a branded version of the Arkray Glucocard 01 (sold online through our shopping Partner, American Diabetes Wholesale - click shopping links at top of page). IT is one of the least expensive, the strips are some of the least expensive, you can get the strips almost around the clock if you're near WalMart, and best of all, they require a very tiny spot of blood to work.
 
Alright, and I might be able to sneak in one test before bed(which can be pretty late for me sometimes, like tonight, mostly when working until the last minute on homework) for a few days before I do a bigger one as soon as I'm out for the summer, which is soon.
EDIT: By best, I think she meant accurate compare to the meter they use in the office. I currently have a Relion Ultima, which I think I remember seeing it mentioned around on the forums a few times, looked in to it, checked with her, mostly and because the bayer contour my mom had given me wasn't well-handled before I got it and broke very quickly. Should I have gone with the Confirm instead? I'm not sure if I saw it at my walmart or not when I went to buy the Ultima.
 
Either is fine.
What is important is understanding that the scale for human glucometer use in pets starts about 30 points lower than an animal specific or lab test, so differences will be expected between the two.

SO 50 - 150 on a human glucometer is roughly equal to 80 - 180 on an AlphaTrak or I-Pet.
The differences get larger as the numbers increase.

Also, the FDA allows glucometers to be as much as 20% different from the 'true' value.
100 -> 80-120
200 -> 160 - 240
300 -> 240 - 360
etc
if a low number + 20% is > high number - 20%, the ranges overlap and the numbers are the same.
 
I didn't know that. And sorry I couldn't respond last night, I was exhausted and needed sleep. But I tested her this morning and she was at 360 something. So I went ahead and gave her 1.5U. I'll be picking up some chicken from kroger's on the way home from school as a more low-carb treat, since it's her favorite flavor, is there a specific kind I should be looking for? And how should I handle it? I've never dealt with chicken before, but I'm fine with boiling it(read that's something I can do from a different topic I've made), but for long long?

I did not know about that difference. But I'm unsure of the type of meter my vet uses, would that make much of a difference? I've just been recording the numbers I get directly from my meter.

Also, thank you so much. I'm still getting the hang of treating and testing her and everything. I'm still so thankful I've found this board.
 
Sayania said:
And sorry I couldn't respond last night, I was exhausted and needed sleep.
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Well I logged off just about then too, same reason!

Sayania said:
But I tested her this morning and she was at 360 something. So I went ahead and gave her 1.5U. I'll be picking up some chicken from Kroger's on the way home from school as a more low-carb treat, since it's her favorite flavor, is there a specific kind I should be looking for? And how should I handle it? I've never dealt with chicken before, but I'm fine with boiling it(read that's something I can do from a different topic I've made), but for long long?
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Get yourself some inexpensive, disposable, vinyl gloves from a hardware store to cover your hands while you're handling the raw chicken. You can pitch after use rather than having a long term pair you have to wash and disinfect.
Also pick up a spray bottle of disinfectant or bleach mix to clean up any surfaces afterwards.

Start with plain raw chicken, uncooked. Boneless and skinless is a plus, though more expensive. I'd get parts to reduce prep time. Legs and thighs have more fat and more bone in them than breasts and wings, so I'd go for the latter.
To bake them, set oven to 300. Separate and place legs on baking sheet lined with foil (reduces clean up time) or use an oven roasting bag and place the drumsticks in that, spread out, which would contain some of the smell while cooking (which might bother you, since you're vegetarian). Bake about an hour at 300. Let cool.
Not sure about the time for boiling, though I imagine that a low simmer for about an hour ought to do it to.
Let cool, then slice into small bits. Freeze small packages so it doesn't go bad before you get around to using it. Refrigerate one small package - a couple of ounces / quarter cup or so - to use for treats over the next 3 days.

Sayania said:
I did not know about that difference. But I'm unsure of the type of meter my vet uses, would that make much of a difference? I've just been recording the numbers I get directly from my meter.
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I'd ask her what kind she is using. Then I'd research how much blood it needed for testing. If more than the 0.3 mm drop size, I'd use the ReliOn meter. Most human glucometers will read roughly the same number - within the 20% range - except for those with "True" in the name - they aren't true at all!

Sayania said:
Also, thank you so much. I'm still getting the hang of treating and testing her and everything. I'm still so thankful I've found this board.
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You're welcome. We've all been through it with our cats and want to pay it forward.
 
Heh, well that works!

Awww....I was recently at some store and saw some that I could've got but passed. Kickin' myself for that one. But ah well, I'll pick some up. I should already have the bleach mix, so I'm good there. Okay, breasts and wings then? I'll probably only pick up a little bit as a bit of a sampler to make sure she likes them, though I imagine she will. I'll also try for boneless

I'll look more closely at the instructions later, more towards when I go to actually prepare them. Shouldn't bother me. ^.^; I'm not exactly vegetarian, love pepperoni's too much to do that. Just can't have poultry so I'm clueless about how to handle it.

Alright, next time I'm in, I'll ask.

And hopefully I'll be able to do the same one day. :)
 
So I got the chicken, and have used the oven method, rather than boiling, they're done. So I cut off a tiny section to see if she likes it before I go to package it up, and the verdict is: Now she's circling me for more. :lol: So since I'm going to dinner real quick, I had to put it away for when we get home. Now I know to pick up more of this, wasn't terribly expensive either to find skinless, boneless chicken breasts. :)

EDIT: So much so to where I can't really distract her with it while I try testing her. She more of just drags the bowl off to go eat it....and she's much to riled up before eating. What else might I do? Right now she's eating, and I'll test her after again, but I'll also use the chicken as an after-test treat.
 
Created a monster, have we?

She may calm down a bit once some of the novelty wears off.

Also, Cat Info mentions you may supplement with the chicken. "[W]hen fed as a supplement to most commercial canned foods, it is safe to feed ~15% of the daily calories in the form of plain meat. For example, if a cat is eating 6 ounces of canned food per day, you could feed him 5 ounces of canned food plus 1 ounce of chunked muscle meat per day."
 
Congrats you actually got it cooked...lol my bunch will start circling like sharks when I just pull it out of the fridge raw. They love it when I'm trimming chicken and throw them scraps of it raw.

You can also give her raw chicken wings and necks to gnaw on for her teeth, although I highly recommend if you do, putting her and the chicken in the bathtub if she is like my bunch.

Mel, Maxwell, Musette & The Fur Gang
 
Seems so. I hope the novelty wears of soon. Alright, it seems as though she's done after a few bites of chicken, though it also seems like I need to make the chunks a bit smaller, they're a bit hard for her to chew up even after heated up. I think it's mostly because after I cut it up a little more, I went ahead and fed her since she was too much of a wiggle butt to test her. Then I tested her and she ate about half of it and then left. I will keep the ounce thing once I manage to figure out a way to test her before giving her her meal.

:lol: Tipper seems to have absolute 0 interest in raw chicken. So I don't think she'd touch the raw wings to gnaw on.

EDIT: Might be good to mention that after trying to distract her, I did put the chicken up and tried to test then give treat, she wiggled too much and I gave her a little bit of the chicken, then put down her real food, and when she was done, that's when I managed to test her, I can't remember exactly what she came to, but it's recorded. So then I immediately gave her the chicken back.
 
Lucky you! Here I have 13 of them circling my like a bunch of sharks, but then again most of mine started out life as semi-feral so I'm sure they have tasted raw foul before and liked it...lol.

Another low carb treat that is Musette's absolute favorite is fat free cream cheese, and the nice thing about it is it is kind of sticky so they have to work at it to eat it and that alone distracts them long enough to get a test in... :lol:

Mel, Maxwell, Musette & The Fur Gang
 
Heh, I've had 2 of mine(Tip and Christmas) since they were weened from their stray mother, about 11 years ago. Frankie though, I've had about 1 and a half to 2 years now, and it's because he went straight from his old house to mine when his owner died of old age, so we naturally took him in, though outdoor only because Tip is real territorial. Frankie'd probably go crazy over raw chicken.

Oh eww, I'm not sure if I could stand the smell of that. But Christmas might get in to it, as Tip isn't that fond of dairy, but Christmas loves that and strawberries. Tip also likes eating paper. That wouldn't hurt her, like, does it change bG at all? :lol:

Heh, but this has gotten quite of-topic, hasn't it? Back on topic, I'll have to play with the order I do things, won't I? Other than that, I also need to work on my aiming. Because once I do get the right spot, we're golden and, if anything, she bleeds a little too much, but I put pressure on the ear with a folded paper towel to make it padded.
 
Testing Spitzer, I would go into the half bathroom, put the strip halfway in the meter, fold up some tissue, uncap the lancet, and then pick him up (he always followed me in for treats!) on my lap.

I'd push the strip all the way in, brace him against me with my left elbow and hole the folded tissue under his ear, then pick up the lancet and prick. I found that using a rolling motion to move the lancet to the ear seemed smoother to me and let me see where I was aiming (no lancet holder - freehand).

If I missed twice, I'd aim for the vein itself and be ready to blot quickly. Sometimes, I'd get the first droplet on a fingernail while pressing on the nick to prevent droplets from being shaken all over me. I didn't always succeed at that and sometimes had a few things to wipe down, including me!
 
Sorry for not replying until now, but Tip got as low as 59 at +3 on her(3hr late, sadly) shot this morning, and so I was busy trying to make sure she would be fine. Glad I memorized what to do when low, but was it really low enough for me to have worried as much as I did? And she's back up to 290, however, I was thinking of just waiting until tomorrow morning, when her dose is supposed to be. Is this a fair strategy? Or would it be best to at least give her a little bit of insulin, maybe something like .5U?

The one good thing that seems to have come of this though, is that testing her doesn't bother her at all anymore. So I'm likely to do a curve tomorrow.
 
SAFETY first - I'm thinking skipping tonight will help her level out and let you sleep! It will also drain any buildup from higher doses.

Edited: It takes 5 - 7 days for a lantus dose to hit a stable level. Not on Lantus.

Tomorrow, IF over 200, only 0.5 to 0.75 units. No higher than that, no matter how high she tests. Some carryover from the 2.5 units could still be working its way out.

And in the evening, IF over 200, only 0.5 to 0.75 units.

You need to get a dose you can do consistently. You start on the low side and do any increases S L O W L Y
 
Alright, yes, skipping tonight will help me sleep, so I'll do that just in case.

Would it be the same for Humulin N?

Okay, I'll follow that, should I still do the curve? The vet was having the dose increases slowly at first, went from 1U twice a day(I guess that was probably a bit of a high start though), then increased .5 each time. But Tip recently recovered from a UTI, I've heard that messes with the bG, but will it still continue to do that after she's gotten better from it?
 
Sorry - forgot you were using Humulin N. Um .. you might add that to your signature, so folks can see that quickly, rather than look it up!.

There is no carry over with the Humulin N, so a curve should be OK to do tomorrow. It looks like her nadir is right around +4 hours after the shot and a curve will demonstrate that to the vet.

It is possibly safe to give her 0.5 units tonight, to knock off the edge a bit.

I'm concerned that 1 unit could be too much for her in one shot, given how she did today; maybe go with 0.75 (it means eyeballing between the lines if you have half unit syringes) in the morning.

A UTI definitely can mess with the glucose, so getting that treated could really change how she's testing. Patience, testing, and stable dosing is what will determine how best to manage her.

If you continue to use Humulin N, you may discover that going to TID dosing - every 8 hours - will keep the glucose levels more stable.
 
Oops, sorry, I'll do that now.

Just checked when she had stopped the antibiotic for that, it was the 9th this month.

EDIT: I can do the .75, and I'll still do the curve. How would I go about adjusting her time back to 7am? Could I skip tonight and start again at 7am? Or go ahead and give the .5 and slowly move it back up? I will need to get it back up to 7am-7:30am by monday morning. Though I might be able to skip riding the bus, which would buy me a bit of time, until around 8am. I can probably figure out something for that on my own though.
 
Don't need to worry much about time change with Humulin - when its gone, its gone. And its gone at about 8 hours after the shot.

You're good to shoot tonight.
 
Did not know that. Thanks, I'll keep that in mind, since 7:30am's in ~10 hours, I guess I'm free to start her back then, then? I'm likely to test her once more in about 3 hours, which'll probably be close to when I get to bed. .5U seems like so little, but I agree, especially with how she was today, that 1 is too much, and I'm likely to call the vet on Monday(closed tomorrow) to discuss a possible dose change.

And, little question, what does TID dosing mean?
 
TID = three times per day, ie every 8 hours. It is a much tougher schedule to maintain, and requires more insulin and testing supplies.

This is why we recommend a longer acting insulin - Lantus, Levemir, ProZinc, or PZI.

Lantus and Levemir are depot insulins - there is some carryover of insulin from shot to shot. Dose changes must be made carefully because of this cummulative effect.

ProZinc and PZI work more like Humulin N - once its done, there is no carry over. They last longer than Humlin N, roughly 12 hours (plus or minus 2 hours), instead of 8.
 
If you can persuade your vet to go with Lantus or Levemir, get the 5 pack of pens without the additional needles. Each pen contains 3 mL. Each mL contains 100 units. and thus each pen has 300 units in it. You use a regular 3/10 cc U-100 insulin syringe with half unit markings and a 30-31 gauge needle of 5/16" length to draw out the insulin.

At 2 units a day, 1 pen lasts 150 days (5 months). At 4 units per day, 1 pen lasts 75 days (2 1/2 months). Don't let sticker shock at the initial outlay surprise you - a 5 pack (check the expiration date when you get it) could last as much as 750 days (5 * 150), or over 2 years.

You may be able to locate single pens on Craigslist or at a hospital pharmacy. If so, it should have been kept refrigerated on a shelf, not on the door due to movement, unopened (unless you KNOW the person!), and with an expiration date out far enough that you can use the entire pen.
 
Once I get the numbers to persuade the vet, I'll definitely try, since it seems like the current strategy isn't working well for Tip. I guess I'll know tomorrow though.

So seems like I wouldn't need to buy different syringes with Lantus or Levemir. That's the exact kind I'm using now, which will be nice. I probably wouldn't mind buying the 5-pack because it lasts so long.
 
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