Whisky Update and Dosing Question

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whiskysmom

whiskysmom

Member Since 2019
This is a long update! Warning in advance :)

Whisky had his vet check up yesterday. It was 4 weeks since our last appointment. I really love our vet. He always takes his time with us, is always happy to answer any and all of my questions in person or on the phone between appointments, and he seems to have quite a bit of knowledge/experience treating diabetic cats. I was really happy at the appointment that I could show him that we've started home testing for BG and urine testing for ketones, and while we aren't consistently testing BG yet (because it takes my husband and I working together to get a successful test right now), we are testing some and we are working on being more consistent. The vet was really happy that we are home testing and was thrilled to see my spreadsheet. Yay!

The vet drew blood for a fructosamine test, and then we checked Whisky's BG using the same blood and each of our meters. The vet was using the AlphaTrak (2?) and I was using the FreeStyle Lite. Whisky was DEFINITELY stressed so we both anticipated the BG to be higher than it should be. But at AM+4 the vet's meter read 16.4 and mine read 11.4. Even though there was a noticeable difference in readings, the vet still said it is useful for us to keep home testing because we will be able to see trends and spikes/dips, even if it's all sitting a bit lower than if it was a cat-specific meter. And better for us to read on the low side of things in terms of safety for hypos.

Both the vet and I had a hunch that Whisky was still sitting too high, because he is still having some larger pees, hasn't gained back any more weight since he was initially diagnosed (DKA and Pancreatitis), and still is quite hungry between meals, even with a snack between. The fructosamine test agreed. The vet called today and said that it basically hadn't changed in the month since we re-started insulin (still in the 600's). Darn. But at least he hasn't lost any weight and hasn't had ketones.

Due to Whisky's size (6.6kg or 14.5lbs) and the results over the past 2 months, the vet thinks 1.5U is too low. Since Whisky hasn't shown any signs of hypo or hypo readings, he wants us to increase to 3U, by first going to 2U this evening and switching to 3U tomorrow when we can monitor him throughout the whole day because we won't be working. And since Whisky has been too high on average for a while now and had DKA, I think he wants to get him regulated sooner than later. But I'm worried it might be too much of a jump all at once. I was thinking maybe I could go to 2.5 tomorrow for a couple cycles and test more and then up to 3 if he still is doing ok. And we will definitely test more during the transition.

Any thoughts? And since my meter might be reading low, what might be a reasonable pre-shot number?

Also - I tried polysporin on his ear the past 2 days after testing just to give him some relief from our newbie pokes, and now I see his ear is a bit red and a tiny bit swollen. Wondering if it could be a bit infected or if he is reacting negatively to the polysporin. Debating trying more polysporin to fight any possible infection, or just letting it be in case it's the polysporin causing troubles. Tricky kitty. o_O We won't use that ear for testing in the next few days until it resolves. Luckily the other ear is fine and we haven't put any polysporin on that one ever.

PS: Trying to stay positive that Whisky is stable and hasn't gotten any worse, but it's definitely a bummer that all our hard work the past 2 months hasn't really shown any significant results. Sigh!
 
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First, I want to caution you about shooting insulin without testing first. You never know what the BG might be when you shoot if you don’t test.

On 11/12...just a few days ago, he was at 113, so, no I would not increase the dose to 2u tonight and 3u tomorrow. We don’t increase the dose without knowing how low the current dose is taking him. We already know it’s taking him into low blue.

Without testing, we aren’t able to give you more specific advice but, IMHO, your vet’s advice is dangerous.

I would strongly urge you to hold the 1.5u dose, get a preshot every single cycle, and try to get at least one, preferably, other tests per cycle. With that info, we can offer a lot more help.
 
Hi Stephanie
Thanks for the update.
I have to agree with Marje.
I don’t think the dose should be increased at the moment. Without many tests we have no idea where Whisky is going during the cycle. You have had 2 blue Preshots and a 6.3 at +3, and those are with very few tests done. Whisky could be bouncing a lot after dropping low and that would give you a higher fructosamine test.
Increasing to 2 tonight and 3 tomorrow or the next few days is dangerous in my opinion.
If he is not regaining the weight and is still hungry I would feed him more but I would not increase the dose.
By the time cats are showing signs of a hypo they are dangerously low.

Also wanted to say that there will be a difference between the alphatrak meter readings and your human meter Readings. That is normal.

Please keep asking questions
 
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Thanks @Marje and Gracie and @Bron and Sheba (GA) for sharing your thoughts and experience. Much appreciated!

I will admit, I'm finding it to be a bit of a balancing act to navigate through all the information I am getting and enact a plan that will keep Whisky safe and healthy. There's the info and instructions from my vet, the advice and experience from this group, my own extensive reading and research, my observations of Whisky's behaviour, and my gut. When most of the information aligns, it's easy and clear what to do, but when it doesn't, I'm feeling overwhelmed and unsure. I do really appreciate all of the support and experience here though, and I will keep asking questions for sure.

I do agree that the dose increase from the vet was substantial, and it made me nervous to go up that much that quickly. So we will be taking a more gradual approach. And we will be testing much more frequently and consistently to ensure we keep Whisky safe. We will proceed with caution for sure. I work from home in the mornings so I'm home until about +5 or +6 and check on Whisky often. We always give him a good snack between meals including overnight, and when I'm not home or asleep there is always some food left out for him. But we will definitely test more to keep him safe.

But I do agree with the vet that 1.5 units isn't quite enough right now, given Whisky's response and his size. We've had him on 1.5 units for a month and he is stable, but not improving. He is a REALLY good, consistent eater and we're giving him snacks between meals, but he just isn't putting on any weight and he is bugging me for more food sometimes an hour after having eaten some. His water intake has increased in the past couple weeks, and he's had some larger pees during this timeframe as well. My observations plus the vet's testing make me agree that 1.5 isn't quite enough right now.

I understand that human readers usually do read a bit lower than pet meters and that this forum has set up the spreadsheets to work best for human meters. But mine read 11.4 and the vet's read 16.4, which seems substantial to me. I understand it's a ratio of difference, so at lower numbers the difference would be smaller. But I also was reading on Dr.Lisa's site that she doesn't recommend using the FreeStyle Lite meter as it reads far too low. I'm not sure if that comment is up to date or not, but it puts out the question of if my meter is reading noticeably lower than other meters, which could explain why our spreadsheet numbers look ok but the fructosamine didn't improve. Or Whisky could be really bouncing. I think the only way to test this theory would be to get another meter to compare readings numerous times. I'll look into this.

There are lots of questions right now, and I know the only thing that will give us more clarity and answers and keep Whisky safe is getting more BG tests. So we will make that a priority and proceed with caution.

Thanks for sharing your advice, experience, and support!
 
That notation by Dr. Lisa is a few years old and there was a time quite a while back that there was a problem with the FS meter. At this point in time, the Freestyle Lite and Freestyle Freedom Lite (identical to AT2 meter in different colour) are two of the top recommended meters by Consumer Reports. I have seen the FS Freedom Lite on occasion read low in comparison to the AT2 in very low BG range but for the most part it wasn't reading excessively low.

You need a meter you trust so if you are not happy with the FS meter, get another. The important thing is to find a meter you like and stick with it for consistency. Personally I'd rather have a meter that reads a little low than one reading high for low BG situations.

I agree with Marje and Bron. I'd stick with the 1.5u dose until you get more tests to see how low that dose is taking BG. The size of your cat doesn't provide any clue as to how much insulin Whisky needs. There are small cats on higher doses and big cats on teensy doses. Each cat is different and only by determining how low a dose is dropping BG can dosing be handled properly and safely.
 
Thanks @MrWorfMen's Mom - good to know about the issue with FS being from a few years back and that it is highly rated now. I will look into comparing ours with another meter and decide which one we're most comfortable with and then stick to it.

Will get more BG tests done. Got AMPS this morning and will get AM+4 soon along with other tests today and moving forward.

Thanks for your help!
 
whiskysmom said:
But I do agree with the vet that 1.5 units isn't quite enough right now, given Whisky's response and his size.
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I’m sorry but this is just not correct for a couple reasons. As Linda says, it doesn’t matter his size. And the other point we’ve made and I do believe you are listening is that you don’t have enough data to know that the 1.5u is not enough. There are three experienced members here telling you that we’d hold the dose until you get enough data.

If he’s dropping into lower numbers and then bouncing back up and you take him into the vet when he’s bouncing, then he’s going to look like he needs more insulin. The bouncing also will throw off the fructosamine as well as any urine glucose tests. Keep in mind, as well, that we aren’t saying he absolutely does not need more insulin. If as low as he’s getting is 113, then he does. But you just don’t have the data to show that he’s not going lower than that and this dose might or might not need to be tweaked. It’s also important to note that cats can still bounce even when the dose is a good one for them. Their liver just hasn’t adjusted yet.

We appreciate you trying to do more tests. It will help in the long run in finding the best dose for him and keeping him safe.
 
Hi Stephanie and Whisky,
I'm glad that you are going to be getting tests more regularly, and I see that Whisky got into some lowish blues last night with the new 2.5u dose, I would recommend given the big jump in BG that you aim to get at least one other test in each cycle (am cycle and pm cycle) to give you a clearer picture of what the dose is doing especially with the large change in dosing. Bear in mind that as a hormone, absorption rates can vary from one shot to another and as such the same dose can impact BG more one day than another.

Are you home monitoring for ketones?

whiskysmom said:
because he is still having some larger pees, hasn't gained back any more weight since he was initially diagnosed (DKA and Pancreatitis), and still is quite hungry between meals, even with a snack between.
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I just wanted to share my experience with the above.

One thing I noted with George, he was ravenous when his bg was high, but even more hungry when his BG dropped sharply or got into numbers that he wasn't used to.

When he first started dropping into green he would hunt me out and demand food, and when he first started going below 60 on a human meter, he would not move away from his food dish, howling for more food. So hunger can be a sign of lower than normal BG as well as high BG, and some cat's sense their BG is dropping and actively seek food out from their CG.

I also found that Georges pee out put did not settle down until he was well regulated, and by that I mean until his BG was in the 50-100 range with my human meter. I also used the FS freedom lite and though it measured a little lower than my other human metre, I wouldn't say it was significant and it was adequate for monitoring BG.

As for George's weight, in the initial stages of insulin therapy his weight stabilised, but it wasn't until he became well regulated that he started to gain weight.

Glucose stopped showing up in his pee once he got below 200 regularly.

So all though weight loss/ excess pee out put/glucose in urine/ hunger can be indicators of high BG experience has taught me that is not always the case. Monitoring those signs in the absence of measuring BG can sometimes give the wrong impression of how well a cat is doing on a dose, the only fail safe way is to monitor regularly. George's BG once dropped below 30, he was showing no symptoms of hypo, he was alert, active, seemed fine, but he was crazily hungry.
 
Hi Stephanie, I just saw your guy had a lower than usual amps.

What are your thoughts?
I'm worried about you shooting the full 2.5u, given the jump from his previous dose, if you decide to shoot , and with DKA in the picture, skipping is not a good idea. I think it would be wise to monitor those BG's closely this morning.
 
Thanks @Gill & George for sharing your advice and experience with George!

Very good to know about his weight gain and pees not really changing much until he was well regulated. And I totally feel George on being hungry when your BG is low. I experience mild hypoglycaemia from time to time (just like my mother) and boy oh boy I feel seriously hangry when my BG is dropping or too low. I get irritable, panicky, and I get serious tunnel vision on getting food into me. I know that Whisky can't tell us when he's feeling low vs high, so tests are crucial.

My husband and I discussed the dosing change at great length. We took the advice and experience in this thread very seriously and the danger if Whisky drops too low. We love Whisky and want to keep him safe and healthy. We weren't comfortable going straight to the 3U the vet wanted, so we decided to increase part of the way, but ONLY on the agreement that we would test him often and continue testing regularly. We are also testing ketones regularly - daily if we can catch him in action.

Today I got my first solo test done on Whisky. Up until this point we were only successful with 2 of us holding him. It was hard and it took 2 pokes for me to get enough blood because he kept escaping my grip, but I got it done, so I can keep up the testing during the day when my husband is gone to work. I think he bounced in the PM cycle and his hunger reduced. But 100% we will keep testing.

Thank you!
 
Bouncing is an elevation of BG not a drop. Bounces happens when kitty's BG goes lower than they are use to which is relative ( if they are use to being in the 400 range a drop to 300 could trigger a bounce) or if they drop quickly or a lot even if not into very low BG range. Whisky's BG yesterday during the day appeared to be a fairly normal cycle but it appears he was still dropping at PM +7 and no telling how low he might have gone with that lower AMPS this AM. If numbers go up today instead of down, that would indicate a bounce. The lower AMPS today suggests the dose might be too high or Whisky got better duration out of the shot last night but that can only be determined with testing.
 
Gill & George said:
Hi Stephanie, I just saw your guy had a lower than usual amps.

What are your thoughts?
I'm worried about you shooting the full 2.5u, given the jump from his previous dose, if you decide to shoot , and with DKA in the picture, skipping is not a good idea. I think it would be wise to monitor those BG's closely this morning.
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Hi @Gill & George and @MrWorfMen's Mom, so glad you asked! I was just debating skipping or shooting a reduced dose. Whisky didn't wake me up in the night last night for food for the first time in almost 2 months. He was still active as normal (used the litter box, changed beds, snuggled me) but he wasn't hungry. His AMPS this morning has my senses on alert. He normally eats his entire breakfast but he only ate about half this morning so I'm nervous to shoot.

What do you recommend? Should I test him again now that he's had a bit of breakfast, knowing it's probably a bit higher from the bit of food and then decide? Or should I go back to the 1.5U we were at before? Skipping isn't ideal since he did have DKA before.
 
The one thing I would not recommend is skipping due to the DKA.
Sounds like other than not wanting all of his breakfast he's feeling OK, though inappetance in a post DKA cat is not something to be ignored, but he has eaten.

I would be inclined to shoot a reduced dose, given that he was only on 1.5u recently, it seems a reasonable choice, given that you jumped up from 1.5 just 3 cycles ago, and he wasn't throwing ketones at that.
Do check him again, see what his BG is in light of his snack and that might sway you one way or other.

I just have to go out to walk my dogs, it's getting dark.

See you later.
 
I agree with Gill. I'd stick to the 1.5u dose for today and going forward until you can get some tests to see how low that dose is dropping BG. It's quite possible that Whisky just isn't as hungry because his BG is lower. While regulating my girl, I found she was very hungry when running high, ravenous when running low and in between, where Whisky was this AMPS, she wasn't fussing for food but would eat.
 
whiskysmom said:
Thanks @Gill & George for sharing your advice and experience with George!

Very good to know about his weight gain and pees not really changing much until he was well regulated. And I totally feel George on being hungry when your BG is low. I experience mild hypoglycaemia from time to time (just like my mother) and boy oh boy I feel seriously hangry when my BG is dropping or too low. I get irritable, panicky, and I get serious tunnel vision on getting food into me. I know that Whisky can't tell us when he's feeling low vs high, so tests are crucial.

My husband and I discussed the dosing change at great length. We took the advice and experience in this thread very seriously and the danger if Whisky drops too low. We love Whisky and want to keep him safe and healthy. We weren't comfortable going straight to the 3U the vet wanted, so we decided to increase part of the way, but ONLY on the agreement that we would test him often and continue testing regularly. We are also testing ketones regularly - daily if we can catch him in action.

Today I got my first solo test done on Whisky. Up until this point we were only successful with 2 of us holding him. It was hard and it took 2 pokes for me to get enough blood because he kept escaping my grip, but I got it done, so I can keep up the testing during the day when my husband is gone to work. I think he bounced in the PM cycle and his hunger reduced. But 100% we will keep testing.

Thank you!
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Not to overwhelm you more with information, but my big guy tolerates Paw paw sticks better than ears. If getting more samples is what you are trying to accomplish - you could always try using his toes/ rear paw pads and giving his ears a break or maybe just checking a ear sample against a food poke- if that makes sense. There were some videos online that show how to get samples from paw pads, but typically my guy just lays there and tries to reach a snack that is placed too far from him to get- or on his tummy ( if I know I am not close to giving insulin and I am just grabbing a midday BG).
You are doing great by just seeking more information and trying to get all the angles of the equation ! It's hard!
 
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Thanks @Si am cat mom for that info and for your support. It definitely is hard, but I'm trying to do the best we can for our kitty.

I think a paw pad test is a great idea for us to try. He typically hates both his paws and ears being touched haha, but I've been trying to touch both his ears and paws more often since I knew we'd be home testing. Even if it gives his ears a bit of a break for a bit, I think it could be a good idea for us to try it and see how he does.

Thank you!
 
@MrWorfMen's Mom and @Gill & George - Quick update: Got a +3.5 test today after the delayed/reduced AM shot. 13.1 (236). He wasn't happy and it took me a couple pokes to get him but I got it and now fed him the remainder of his breakfast.

I have to leave for work now but my husband will test him PMPS when he gets home from work.

I'm feeling shaken/stressed from doing the shots solo and having to poke him a couple times to get it, and I can tell he's upset. But trying to remember that in the big picture it's important that he is safe.
 
whiskysmom said:
@MrWorfMen's Mom and @Gill & George - Quick update: Got a +3.5 test today after the delayed/reduced AM shot. 13.1 (236). He wasn't happy and it took me a couple pokes to get him but I got it and now fed him the remainder of his breakfast.

I have to leave for work now but my husband will test him PMPS when he gets home from work.

I'm feeling shaken/stressed from doing the shots solo and having to poke him a couple times to get it, and I can tell he's upset. But trying to remember that in the big picture it's important that he is safe.
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Look at you ! flying solo.

The first two days... I wasted at minimum 8 strips and cried every single time I had to do anything...my poor guy was weirded out. By the end of the second day, he was hiding and running away from me. Now, he just lays there for test and tried to snag pieces of turkey out of my hand before I can even set them down :) Sometimes- he sits in the place where we do his PMPS test and just waits- you guys will get there. And I tend to think they know we are trying to help
 
Gill & George said:
No problem, how are you guys getting on?
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Much better than yesterday, thanks! Yesterday he didn't want to eat much and was acting super weird, probably from the increase. Went back to the original dose last night and he's acting like himself today. Phewf! Had a couple of failed test attempts last night and this morning, and he was so stressed and grumpy and I was so stressed and grumpy that I took a break. But will try try try again!
 
Our kitties are great picking up our emotions. They are like little sponges. If you can approach testing with a "can do" attitude, chances are that Whisky will have confidence in you too and things will go smoother. As silly as it might sound, some folks find that singing to themselves or their cat, helps to calm their stress. It does take a little practice but be patient with yourself and Whisky and it will all be routine in no time at all. :D
 
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