Thoughts on JD's numbers and dosing...

I'm fairly new to the board, and I have learned so much since our kitty was diagnosed (on 9/11/17).

Our vet prescribed PZI to be administered in 2u increments, twice daily.

We switched his food immediately (he was eating dry food, and I feel terrible that we fed him that!) to FF classic pate, and we've learned through the board about "no-shoot" numbers, etc. I have stepped back his dosage to 1u and sometimes I'll skip the shot altogether.

We test every morning and evening to get a pre-shot number, and when we're home we try to get a few tests during the day, too. We don't have a TON of data yet, but I was hoping someone who is a bit more knowledgeable and experienced can look at his spreadsheet and tell me what you think.

For the record, his glucose levels haven't been very high. Part of that was him not eating as much as he adjusted to the new diet. His levels the day he was diagnosed were north of 500. His eating habits are getting back to normal, but we no longer free-feed. He eats (close to) a can of FF pate in the morning and another at night.

I greatly appreciate your feedback! Thank you! This board has made this change in our lives so much easier. And our cat, John Denver, is finally back to his old self!

 

Welcome, and great job getting started with home testing, setting up your spreadsheet, and changing the food!

You've also made some great decisions about skipping a few of those doses. Once you are home testing and the food transition is complete, you can shoot under 200, but you've had some really low PS numbers that would have needed to be skipped anyway.

Will you be around one of the days this weekend to get a curve? That's when you test every two hours throughout the cycle to figure out the lowest point (nadir) and how low it is. Also, how would you feel about shooting 0.5u? I'm guessing your vet gave you U40 syringes with only full unit markings? You would kind of have to eyeball the half unit. The reason for that is that you really want to have two shootable numbers each day, and right now at one unit, your PMPS is too low to shoot. If you lower that morning dose to 0.5u, you might be able to do an evening dose as well and keep your cats numbers a bit more even.

Finally, it's okay to free feed with canned food if John is a grazer. My kitties eat either canned or raw, and I just leave it out for them during the day when I go to work. I usually stir in a couple of tablespoons of extra water to keep it from drying out during the day, and extra water is good for cats anyway. It keeps them happier, and helps my diabetic to be keep his levels more stable during the day. You just have to make sure that they aren't getting extra calories - so it's the same amount of food, just available throughout the day. Some people use timed feeders as well if they have kitties who inhale all of their food at once.

Anyway, that's probably more information than you needed all at once. Please feel free to ask as many questions as you have!

 

Thank you for your response! It's nice to know that we're doing things right (mostly!)

I may be able to do a curve this weekend, so if I can I will enter the numbers into the spreadsheet. Any decision I made to not inject him or to lower the dosage was made based on the fantastic information on this message board--my vet said it'd be okay to inject him with those low numbers as long as he was eating, but since I saw nothing on this board or Dr. Pierson's site to agree with my vet, I decided that I wasn't going to risk a hypo episode. Too scary. So my wife and I are really just navigating this process with the help of the fine folks in the Internet. I do call my vet and give her updates on him, though.

I think I can manage to eyeball a .5 u dose. We do have the U40 syringes. I had read that it would be best to have two pre-shot numbers that would allow insulin twice a day, so we will try this and see what it does for his PM test.

One thing John does that is strange is he'll eat a few bites of food and then sort of jump away from the food and run off--it's like something bites him (and I know that is not the case). I don't know if anyone has seen their cat do that, but it's strange! I can usually get him and put him next to his food and he'll continue to eat, but I cannot figure out why he does that.

I wouldn't mind leaving the food out, but lately we've had issues with little black fruit flies in our house and they LOVE the Fancy Feast, so we've been putting his dish away when we leave. FortiFlora also helped him transition from dry food.

THANK YOU for all of the information and advice!

 

Is the food reaction new, or has he been doing that for a long time? Any chance you've tested or given the shot while he's eating? Or done anything else that might startle him while eating? I accidentally dropped an ice cube out of the freezer while one of my cats was eating and it hit him. He runs every time I open the freezer door now. And that was four years ago!

 

No, he's actually done it for a while, but it was only when he would eat wet food. I don't recall this reaction to dry food. It's like something freaks him out and he just jets out of the room. He'll start eating again if I put the food in front of him. I don't know--he's got his quirks (as we all do).

As I mentioned, we've had an issue with these little annoying flies, so I suppose it's possible that he does that when a fly gets on his face. We don't test him or inject him while he eats, and he had this weird reaction prior to his diagnosis.

Thanks for your help! I just figured maybe someone else has a weird cat who does this. I am just so grateful he has an appetite again--the two days before his diagnosis and the two days after, he would hardly touch any food. It broke my heart. Now, he meows when he's hungry, just like he used to. For a while there, he'd even lost his meow. It was so sad.

 

That is an odd thing to do! Maybe he's just so excited about the wet food that he has to run around to share with the world that he loves it? Seriously, though, will he come back on his own to eat it after that? Have you tried putting the bowl in a different place to see if he still does it? Is it only with a certain flavor or only a certain time of day? My guess is something scared him somehow and he associates it with food...but still wants to eat!

 

I know. It sounds so kooky. I sat and watched him a few minutes ago--he just stopped eating and kind of ran away from the dish a few steps. Then he started cleaning his paws. It isn't anything new, but he hasn't eaten wet food in a while, and I don't recall seeing him react that way with the dry. It's like it grosses him out. But he will go back and eat again if we leave it out. He does it with all flavors. New can or a can that's been open for a while. It doesn't seem to matter. My cat is a weirdo.

 

Oh don't worry, we all have weird cats! You're in good company!

I wonder if it's because he flicks a little food onto his nose, since after he runs off he grooms. With wet food, they will often flick a little onto their faces, and that doesn't happen with dry food. Or the flies. That seems totally plausible too.

Or just....cats.

And woohoo! on the dose tonight! Glad you were able to get a shot in this evening. Try to grab a test before you go to bed if possible so we can get an idea if that's enough insulin.

I just noticed you live in Kentucky. My friend moved to Owensboro last year. It's such a great little town!

 

I think you are right! I think it is the food flicking off of his tongue.

I tested him about an hour before I normally do this morning and his number was low, so I'll likely skip the AM shot again.

We are Kentucky natives--from Lexington--but we currently reside in Louisville. Owensboro is a nice place; they have a barbecue festival every year, which is worth a visit.

 

One thing you might want to keep in mind is that insulin is very picky about the timing. Many cats will rise as much as 100 points in that last hour. So testing early - even just 15 minutes early, will often give a lower number. Consistency in timing is really helpful in being able to keep consistent dosing. John is in low enough numbers in general, that I wouldn't worry too much about the skip this morning, but if you test before +12, you will usually find a low number.

So all that aside, it's actually really great to see that on a 0.5u dose, he was only at 136 at +11. That's a nice number after a reduced dose!

 

Thanks. The early testing was a result of my schedule this morning; we are fairly regimented on the testing/shot times. But that is good to know!

 

Looks like John is doing well with the reduced dose! If you are skipping those previous blue PM shots, just type NS in the dose column so we know it wasn't forgotten or something . I will say Maury has done what JD does with eating the wet food every so often. Similarly, he will kind of jump up and take a few steps from his food and start cleaning his paws and face lol. So I think it is a piece of food flicking off of his tongue onto his face and he doesn't like it . Hope the curve goes well today

 

Thanks! I am sure that is what it is as far as his food goes. If I don't break up the pate as much when it glops out of the can, it doesn't seem to happen as frequently.

I've not forgotten a shot yet, but I will add that notation to clear things up.

I did not administer his shot this morning because of the low pre-shot test. Is it worth testing for a glucose curve if he's not given insulin? I can try it tomorrow depending on what the meter reads in the morning.

 

Since you are able to this weekend, I would still get maybe a mini curve today +3, +6, and +9 to see how she's doing on her own and then if she gives a shootable number tomorrow morning you can try a curve. If after nadir time (between +5 and +7) his BG is rising you can probably hold off until +10 and give him a break for the +8 . Just my 2 cents .

 

If anyone has a few minutes, could you please take a look at John Denver's latest numbers?

Based on the info on this board, we don't inject him with insulin if his glucose number isn't above 150. As you'll notice, we've skipped a lot of doses. His glucose levels seem to fluctuate anywhere from just under 100 to over 200.

What should we do? I know that we would ideally give him a PZI injection twice per day, but it's tough given the low preshot numbers. He seemed to have responded well to the reduction in dose from 2u to .5u, and switching his food (immediately) after his diagnosis seemed to help bring his overall glucose numbers down. But we are just wondering how to proceed from here.

I'll try to get a glucose curve done over the weekend.

Thanks in advance for all of your help and advice!

 

The pre-shot numbers are looking good. Many of us do shoot below 150, but you can only do that if you have an idea when the cat hits nadir, and can get some mid-cycle tests around then to ensure safety. Without being able to get mid-cycles, it's not safe. The thing with insulin is that the most important number to know isn't the pre-shot, it's the nadir (although pre-shots are important too!). That point somewhere in the middle when the cat reaches his lowest number. Since prozinc makes a smile-shaped curve, that low number lets you know if John is getting enough insulin, or too much insulin. And the nadir can happen pretty much any time during the cycle. My cat usually hits it early - between +2 and +3. Most cats it's somewhere around +5-+7. There are a number of late nadir cats who hit it around +10.

Hopefully after you get a curve this weekend, we'll have a better idea of next steps. Overall though, he's really getting some great numbers! Hopefully those will keep trending lower!

 

I also think it's worth trying a small dose when you can monitor him on those PS numbers. They are looking very nice though ! Most kitties don't go from 0.5U to remission, as it's still a decent jump. Kind of following what Djamila stated, when you will be able to stay with him and get mid cycle tests, you could try a 0.25U on a PS of 100-150. In the meantime, it would still be worthwhile to get extra mid cycle tests, especially on those NS cycles when you can too . We have no idea when J.D.'s nadir is occurring .

 

Thanks, @Yong and @Djamila !!

I should be home at least one day this weekend and I will test him every couple of hours. I appreciate your advice.

 

Any mid cycle tests you can get will help too. If you can get a +1 or +2 on the way out the door during the day or before bed at night, that will help us too. We can take a scatter of info over many days to get a better idea of what's going on overall in a kitty.

 

Thanks! We will try to give more mid-cycle tests.

 

Hi, @Yong , @Djamila , @Rachel :

While I haven't been able to get a full curve of tests, I was able to get two days in a row of a +2 test after his evening injection. Went from about 190 to about 80 both days, two hours after his shot.

I know every cat is different, as they say, but this seemed like a precipitous drop in a short timeframe.

Thoughts?


Thank you all so much for all of your advice!

 

Very nice! That is a bit of a drop in 2 hours but he doesn't seem to be bouncing in the mornings from it. What are you thoughts on trying a 0.25U dose? Do you think you could draw that? I forget if your syringes had half unit markings . Definitely looks like JD is on a good path to the R word so by lowering the dose, he could still get 2 shots a day, which can help lock in a Remission .

 

I can try giving a .25u dose. I do use the U-40 syringes, so it'd be no better than an estimate, but I think I could manage!

Thank you for the encouraging reply.

 

0.25 is Definitely worth a shot (pun intended)! Seriously I think it could help get those numbers down a smudge to hopefully set you up for that R word!! It's fine that it'll be just an estimate...0.25 is just what we say since it's easier to measure. Basically it just needs to be more than none and less than half...as long as you're being as consistent as possible the exact amount doesn't matter much.

 

Thanks!

 

Lots more mid-cycle tests the past few weeks, and JD seems to be doing really well.

He hasn't needed insulin in almost 5 days, and the last shot I gave him I probably shouldn't have. His readings to this point over those 5 days have been like clockwork. He is usually around 100 in the mornings, dips a little lower in the middle of the day, and is back to about where he started in the evenings. We are very encouraged by this, but aren't counting our chickens yet.

Let me know if there is anything else you all would advise. Thank you!

 

Wow! He's looking great!

 

Looking really good!!

 

Wow! looking good!!! That's such great news! Keep it up, John D!