Need Experienced Eyeballs Please

Hi Everybody! This is my first time posting so bear with me if I don't give enough information or don't get the terminology quite right.

The nutshell... I'm having a terrible time getting my 13yo kitty (Romeo) regulated... we've had a couple of hypo scares, which has me gunshy to shoot when his numbers are low'ish (between 200 and 300) in the morning, especially given I've been crazy busy with work so I've been unable to be home midday to test him and see how low he's going. The good news is that things are slowing down with work so I'm now able to be home to check him at the 6-8h mark and see how low he's going... and of course boost him with sugars if need be. To that end, I would love to have somebody eyeball his numbers over the last month and give me feedback/recommendations (SS attached). I absolutely adore this sweet boy and it's stressful/hard for us both when he goes from 223 at 9am to 525 10h later (today). Thank you SOO very much in advance.

Diet: low carb wet only (<10%), 2x/day

Health: no other known health issues (pancreatitis has been ruled out)

 

Welcome Tami and Romeo! Sorry we weren't here last night. This is a pretty small forum, so we're most active in the mornings and evenings around most people's shot times. If we don't answer right away, be assured we WILL...just might not be til morning. I'm the early shift around here since I have to be up early for work.

Hypos can be scary...but I don't see any recently. I see that 75 from awhile ago, but my guess is that may have been a wonky strip..did you test right away a second time? If you get a weird number, that's what I'd do first. Often, it's just a weird test.

A couple questions. Why did you give nothing the night of 8/1? It looks like he was high enough for insulin. How long has he been on insulin? How long have you had this vial of insulin?

Looking at your SS, I'm thinking 1 unit isn't enough. It's never been in the past and clearly wasn't today. If he was mine, I'd want to go to 1.5 (or 1.25 if you think you can eyeball that) and stick with it for several cycles...preferably 6 (that would be 3 days) and then if the numbers don't get better, move up. That's as long as he is high enough to shoot of course. I think consistency might really help. We've found that giving a consistent dose for a bit can really help kitties settle into numbers and maybe get a bit more regulation. I wouldn't worry about the shooting in 300s...that's not really very low at all and is much higher than you want. The 200s I can understand being more scary, but remember that gives him over 150 points to drop before he's unsafe. And since you said you might be able to pop home that could help. Another thought is the food...you feed twice a day you said. Do you have other animals? Some cats do better with a snack during the day...and if you had a timed feeder and could leave food out to be available to him midday, you might feel better knowing he'd have access to something when he might go low. Most cats will feel themselves getting too low and will seek out food if available.

What questions do you have? Please feel free to ask anything you like! We're here to help. And feel free to question anything Ive said...it doesn't offend me and I know it's tough trusting a bunch of crazy cat ladies on the internet you've never met before!

 

I agree with Rachel's advice.

 

@Rachel Thank you so much for taking the time and your thoughts... and the warm welcome of course. And don't worry, I have plenty of Qs... and I have no problems asking for clarity on anything you share. I trust you have my & Romeo's best interests at heart and I know enough to not get lured too far into the weeds. But let me start by answering your Qs...

re: hypo history - you're absolutely right, the only recorded hypo was back with that 75, but you'll also note that there was a LOT of kitty puke between 7/8-7/15, and I was unable to test midday due to work commitments. There was another incident on 7/22 where I WAS able to test him once midday, and upon consult with my vet -- she suspects what's happening (especially given his high BG the eve of 7/22) is that he's dropping low/hypo midday, and his body is flooding his system with every available sugar and pulling himself out of hypo without my knowledge or intervention. On 8/1, he exhibited the same pattern... I suspect I DIDN'T catch the low, but I had just come home and caught the puke... so I promptly tested him and he was at that 109, presumably on the way back up from hypo. When I strongly suspect that he's gone hypo, I don't shoot the next time, even if his numbers indicate. (intuitive, but also per alignment with my vet) Welcome thoughts on all of this.

He's been on Prozinc since mid-May -- we've been on the same vial since we started (we're somewhere between 1/4 & 1/3 remaining).

My gut tells me that 1.5 is about right, but I'm so worried about him dropping too low given all the pukiness earlier in July. I id'd a 1.25u line that I can use consistently, and promptly furshot him this morning. (SON OF A #))$#*!!) I'm so annoyed by that, especially given his high numbers yesterday. If anybody can understand that, I know you can! The 1/2 mark syringes are new to us and they don't seem to be quite as sharp as the others so it's taking more force to get it in. We'll go with 1.25 for a handful of cycles and see how he does.

I love the idea of giving him a snack mid-day to help him not bottom out. I have 2 other kitties in the house, both of whom would undoubtedly love a snack as well. I've actually been worried that they're all not getting enough food b/cuz they're losing weight and yet still don't always eat their food morning/evening. I've always free-fed dry so this has been quite the adjustment for them. I was told that any other snacking sans am/pm was a no-no, so this is actually a relief. How much is a "snack"? 1/4 of a 5.5oz can? Less?? More??

Just fyi -- I shoot between 9 & 9:30 AZ time (currently same as pst), which is pbly later than most. Given what I'm learning about the AT2, I think I'm going to set his no-shoot at 225 or 250. I have another vial of strips to go through but then I'll be transitioning to one of the human meters. Again, relieved to learn that I CAN do that, and that it's significantly cheaper, and that the strips are more readily available!

 

How much to give for a snack depends on your cat and if they need to gain or lose weight. It's okay to free feed with wet food. I put out my cats' food in the morning, and add a couple of tablespoons of extra water to keep it from drying out, then they can graze until it's gone.

I used to be the queen of fur shots, so I can definitely relate. My kitty has finally settled down, and I've adjusted my technique, so it's better now, but still happens. Hang in there!

 

Honestly, I don't want to go completely to free-feeding -- my other two kitties are NOT on food that is as low-carb as Romeo's, so it would be impossible to keep him out of theirs if I free feed. If I snack mid-day, I guess I'm concerned about giving him TOO much of a sugar bump if I give him too much food...?

I did a little research today about the shooting techniques and I'll employ some new options starting tonight. Fingers crossed!

 

So what you said about hypo made more sense now...I can understand the pukiness making you nervous. Any idea what caused this? Has it been normal for him or was it a change to a new food or something? As for not shooting when you think he's gone hypo...well...I wouldn't do that. Even if you knew for sure that he had gone hypo, you'd want to shoot that night, just a reduced dose usually. And if you knew for sure he'd hit a nice green but not hypo, you'd shoot the same dose that night. If you skip a shot when he's high enough to shoot, his sugar is just going to keep climbing, making it harder for the insulin to work next time. Then it might take a day or two to get his numbers down. That could mean we all think he isn't getting enough, so you raise the dose, and then he crashes again because he really just needed a few days to settle back in after not having insulin for over 24 hours...and the cycle continues. I understand what you're thinking there and that your vet suggested it, but if he was mine, I'd still shoot if he was high enough no matter what. Since you can come home sometimes to check on him that will help you know what's happening. I'd still post here if you feel okay with it and let us know what's going on...and we can help you give a safe dose even if he's gone low during the day.

As for the food, we've actually found that a lot of diabetic kitties do better with several meals throughout the day. It helps keep the sugar more stable rather than causing problems...and being more stable helps them feel better than wild swings up and down.

 

Good morning!! I have NO idea what caused the hypo dips. He was on Halo's low carb recipes to begin with, but I've since switched him over to a couple of pawTree flavors (also <10%)... but the change wasn't correlated to the dips ... nor was anything else that I can identify. Frustrating, right? And he was on pretty low units when that started too.

So if he does go hypo, but by the time we hit shoot time his numbers are high enough-- you mention a reduced dose... how reduced? half the 'normal' dose? (given we're talking between 1 & 2u) It's ok if there's not a hard and fast rule -- or if it depends on how he eats and just HOW high/low his numbers are.

I started 'snacks' today... a spoonful of wet food as 6am 'ish & and again 3/4p'ish... and a few freeze-dried chicken livers here and there if he's around and interested (which he usually is). His numbers were steadily in the 300's, even at nadir time -- which I'd prefer over hypo, or way high, but hopefully he settles into a lower number as we get a few days of consistency.

I've been doing he pinch and roll injection technique the last 3 shots -- not sure I love it, but I do seem to be more consistent with it. #knockwood

Thanks again for keeping an eye on us!

Up-to-date SS: https://1drv.ms/x/s!AtvOIOY-2L6EgY9OFyZ_nhtpn6t5MA

 

He's looking good! Those pinks aren't great, but consistent pinks for a day or two aren't as bad as sudden lows and highs. Hopefully he'll settle in and if not, we can look at raising the dose.

Generally if you hit a hypo, you'll reduce the dose by .25 to .50 depending on a lot of factors. That number can be different too depending on how low they went, how late in the cycle it was, and lots of other factors. I know, not that helpful! I'd probably stick with the idea that if he goes hypo, you want to reduce by .25 at next shot time if he's high enough to shoot. We'll be happy to weigh in with our ideas when it happens too if we can.

 

Sounds good... I'll keep all of that in mind and will post if there's uncertainty.

Tangential Q -- I have Romeo on a low-carb (<10%) wet food, but the other two are on the slightly higher Friskies pates... which still seem to be <15% carb. I keep everybody separated while they eat, but HOW sensitive can thediabetic kitties be to a nominal change in food like this? What would be easiest for me and for the other kitties would be to feed them separately for 15m or so, but then let them wander between rooms/bowls for 30-45m... because the kitty grass is always greener in another room. They would eat all of it, within the hour, but Romeo may get 1/4-1/3 can of the Friskies pate. Could this screw him up?? Obviously I'll keep with the current set-up if it's a concern, but I do think my other senior, non-diabetic kitty is eating less cuz she doesn't love being isolated from everybody while she eats so she stops eating sooner (but she'll go try to eat out of somebody else's once I release her). Eventually I'll get them all on the same food -- but, well, ... budgets.

 

Ahhh the eternal question. Well the answer to how carb sensitive can our sugar cats be is...ECID (every cat is different). My Gypsy couldn't handle carbs well..I had her on foods that were less than 5% carbs because more caused her to skyrocket. Other people have their cats up to 10% with no noticeable difference.

I do understand your concern about separating and feeding though. I did that for awhile but one of my cats was upset by it and wouldn't eat enough and I worried about her. My best suggestion here is to test it out some. Maybe spend a few days only letting him eat the low carb stuff and then a few days letting them wander. See if the numbers are really different and you'll have a better idea how carb sensitive he is.

You could also try to play around with like mixing low and the higher carb for the other kitties. That way, when the wandering starts, maybe Romeo won't get as much of the higher carb stuff? Not sure if that's feasible or not, but it was something I thought of.

Getting them all on the same food will be best and easiest, but I understand you gotta use up what you have...the last thing we sugar cat parents have is extra money! There's a lot of money associated with this disease especially right at the beginning.

 

Sensitive little dahlings! Well, I'm pbly not going to dink with anything until I get him stabilized for awhile with his current food. I AM going to look back though and see if he was doing better on the foods that were <5%. I didn't think there was a correlation but I want to be sure... it all starts to blur together. I also think Juliet (of COURSE Romeo has a Juliet!) has gotten a taste for the good stuff -- which isn't helping her eating. SHE'S the kitty that I expected to land with diabetes... she has acute asthma AND EGC, both of which require frequent steroids... but nope, she's plugging along like a champ. Thanks again for all your guidance!!

 

Hmmm.... well, not seeing much downward movement, in fact we got a couple of upticks in the low 400's. Grrrr..... time to move it up to 1.5u? Tonight was shot #7 at 1.25u. I AM grateful that there aren't the big swings I was getting before, but I am starting to see a little neuropathy so I'm anxious to keep this moving in a downward direction (anxious, but patient). I'm also feeling much more confident with the injections -- #knockwood -- I'm using the pinch/roll method and it seems to bother us BOTH less.

Up-to-date SS: https://1drv.ms/x/s!AtvOIOY-2L6EgY9OFyZ_nhtpn6t5MA

 

Yes, I'd increase to 1.5 u. If you don't see yellow, increase to 1.75 u after 3-4 cycles.

 

We got a yellow (251)!! And now I'm terrified that he's going to drop too low (as has been his m.o.). So here's my Q -- what's my no shoot # in the morning?? 225? (I'm using an AlphaTrak meter). I'm going to set an alarm and try to test his nadir in a few hours... cuz I'm a paranoid mama.

Up-to-date SS: https://1drv.ms/x/s!AtvOIOY-2L6EgY9OFyZ_nhtpn6t5MA

 

Are you sure the Friskies' pates that you're feeding are too high? If you click on the food chart in my signature, all of the Friskies' pates on there are lower than 10%. Maybe they can all eat the same food and save you having to deal with one more thing?

 

Honestly, I'm not 100%. I did the calculator on my own a couple of months ago, but haven't looked at the food chart to confirm. I got values between 11 & 15%, still not terrible -- but not as low as I want. I'll look again, but I'm loathe to change anything right now given how spradic he is. I definitely will!!

 

Sooooo..... I've been shooting at 9a/9p (give or take 15m), but tonight I had a client emergency so I wasn't able to get back home to him until 10p. When I did, he tested at 521!! This was up from 237 at 4pm. What would cause such a major shift? Could the hour delay cause such a spike? I really don't think he went hypo -- a) no puke anywhere, and b) I was home between 7 & 8p and he was out and about and acting a-ok. Any ideas would be greatly appreciated.

Also, given everything -- am I ok to shoot him at 9:30a tomorrow or would you wait a little longer?

Up-to-date SS: https://1drv.ms/x/s!AtvOIOY-2L6EgY9OFyZ_nhtpn6t5MA

 

That high number is possibly a rebound/bounce from going significantly lower earlier in the day. Keep the 1.5 u today and try hard to get a test or two between +4 and +7 to capture his low.

 

It's also possible that he just ran out of insulin. Ideally, you want a little bit of overlap from one dose to the next, and that's what starts to bring down the PS numbers. Since the test was late, he may have just not had anything holding down that number. And a third possibility is a bad test. Those happen sometimes if there is too much or too little insulin. How picky the meter is can depend on the specific meter.

Given the numbers on your spreadsheet, a lower-than-normal number seems unlikely, although nothing is impossible with cats.

 

Thanks guys. EVERY other time he's dipped hypo, I get kitty puke. Doesn't mean he didn't, but I'm skeptical this time. He just tested at 240 (+8). I'm going to wait an hour and test him again before I head to my client to be sure he's headed up. I'll also cancel my much needed day trip so I can test multiple times today to make sure he's not dipping. (insert super big pout here!)

 

The calculators are super inaccurate. They are based on minimums and maximums instead of actual values. The food chart was created by contacting the companies and getting the real values. Recipes do change, so you could contact Friskies to confirm, but I'd go with the chart over a calculator -- and that means that the Friskies should be fine for all of your kitties, which will make your life a lot easier. Everyone can eat everyone else's food and be just fine!

 

He was at 260 +8 (not 240), and just tested at 336 45m later. On the way up, but i don't like that he's climbing that fast. @Djamila, we're using the AlphaTrak2 with the matching strips.

 

So he's around +9 now?

I'm only seeing your spreadsheet updated until 8/10. Is that correct? (no judgement -- mine is a few days behind too). If you could put in the numbers from today, that would help.

What is your schedule like? Are you home most of the time, or do you work all day during the week?

 

Well THAT'S a problem.. . No, I've updated it through last night but it obvs didn't upload the changes. I'll be back home in about 90m and will fix it then. Thanks for highlighting that!

 

And yes @Djamila, he's at +9.

 

We use OneDrive at work and do run into that fairly often. If you house the spreadsheet in Google, it might help eliminate that little quirk. Google is less robust, but it works fine for the spreadsheets since they are already formatted.

If Romeo is burning through his insulin this fast (often indicated by those steep rises at the end of the cycle), it means he needs more insulin. If your schedule allows it for the next shot, you could shoot at +11 now, and then adjust your next shot time to accommodate the change. If you've been at 1.5u since 8/10, he's probably due for an increase to 1.75u as well (although since i'm a few days behind on the data, I could be wrong about that).

 

I'll tag you when I've updated it so you can take a look and confirm...pretty sure he started 1.5 Friday morning... Rachel had recommended 6 shots before changing? I'll be home now today so we can see how low he's going. Every other time we've neared/shot 2u he starts going hypo so I start to get uneasy as we near that mark. Not that I disagree that he needs that much, just that it seems to be a catch 22 for him and I'm not sure how to get him balanced. And yes, I'll switch over to Google today too.

 

I’d say go with what a Rachel said, since I’ve been gone for most of the past week and haven’t read everything. We often say increase after three cycles, so I’m betting she had a reason for saying six.

 

Hi! Sorry I've been out and about this morning. If I remember correctly, you're not able to do to the 0.25 increases right? I think that combined with the jumping around is why I suggested 6 cycles (which would be 3 days). I felt like the jumping around made the numbers kind of wonky and maybe just settling in to a nice regular dose would help the numbers settle down so we could see what was REALLY going on. From what I've seen, it probably is about time to head up the dosing scale. I'd like to take a look at your updated SS beforehand though...just to get an idea of what's going on.

 

Hi guys... lots of Qs to answer now that I'm back at my laptop -- and 20m to +11. Assuming he's high, I'm going to shoot him and get him back to regular, and I'll be around this afternoon from +4 on so I'll curve him and see what we see.

I'm using U-40 needles with 1/2 marks, so while I don't have a line for .25, I do have a plunger line that I can consistently use so while it may or may not be exactly .25, I'm comfortable that it's consistently the same amount each time, and it's pretty darn close to .25.

Re: food -- I would like to switch him to the Friskies -- for ease of everybody (plus, he loves it). I looked at the chart and in ANY case, it's lower than the food I have him on now. I envision switching everybody to 1/2 and 1/2 until it's gone (it'll be awhile) -- and would like to do it sooner, but if you think I should get him stabilized on his current food before making that change, I can wait.

@Djamila I'm self-employed, and have had a crazy summer schedule -- it's lightening up now so I've been able to keep the +6 & +7 hours open to get home and do at least one check on him. That's not ALWAYS the case, but I'm trying to make it so so I can get him freaking stabilized... and not going hypo.

The SS has updated: https://1drv.ms/x/s!AtvOIOY-2L6EgY9OFyZ_nhtpn6t5MA

I'm at +11 now -- assuming he's high, as I expect him to be based on the +8 & +9 #s... I'm going to shoot early and get him back to 9a/9p.

 

392 at +11

 

Howdy Furriends--

I did a mini-curve today and his numbers are so weird... stayed red most of the day, after starting the day at 260 at 6am. I have to imagine that it's a bit of a hangover from the 521 last night... if that's a thing? Updated: https://1drv.ms/x/s!AtvOIOY-2L6EgY9OFyZ_nhtpn6t5MA

I'm transitioning his food, and I plan to shoot 1.75u in the morning. Any thoughts or guidance -- are always welcome! I can't figure this stinker out! Thanks so much!!

Fingers crossed.

 

Definitely time for an increase. It almost looks like a bounce cycle to me (they often run high and flat after a bounce) but he didn't really go low yesterday...could be like a small bounce due to yellows. That can happen when they have lower numbers than THEY are used to. That's my best guess on that, but I can't really be sure. With that in mind, I'd just say it's time to increase. What food are you transitioning from and to?

 

@Rachel Just switching him from pawTree (9%) to the Friskies pate... Mostly so everybody can be on the same food. They'll be half/half for awhile until I can get rid of the old stuff.

 

@Djamila @Rachel I was going to up his dose to 1.75u this morning but his amps was 232. He's eating now and I'm going to retest before making any decisions . Thoughts?

UPDATE: HE went up to 250ish 20m later so I stayed with 1.5u.

 

My hunch is that you could have gone for the increase anyway, but I understand the hesitation. Increases are hard enough, but even more so when you get an unusual PS like that. Fingers crossed he has a good cycle today!

 

Yeah -- I'm a bit of a scaredy. I did find some bile puke this morning (after I shot him), which has me a little worried that he went hypo overnight... but in the past when he's dropped and bounced, the vomit has lots of partially digested food and usually a little hairball for good measure. Is there a general rule around hypo puke? lol (of course not, cuz there's no rule about ANYTHING with these beloved sugarcats!!! lol) oh,
and it may not even have been his puke! One of the other two could be to blame. Not usually, but maybe.

I just tested him and he's at 335 at +3'ish -- which of course has me worried that he's not high ENOUGH ... argh. I'm crazy, he's making me crazy!!

 

I've honestly never heard of a cat puking when hypo, and the only low numbers I see on your spreadsheet are from back in June. Am I missing something?

Can you say more about what you mean by "not high enough"? 335 is high enough to be causing damage, so it's quite high. I think I'm not understanding....?

I do understand being a bit of a scaredy. I think we're all that way a bit around here which is why we come to rely on the data so much -- it keeps our imaginations in check.

 

Yes, there is supposition behind
the numbers... I explained it in one of my first posts after I made a similar comment that Rachel questioned. I wasn't great at tracking when I first started, both out of a lack of understanding and schedule. I'll repost it when I get home if you can't find it.

 

Ah, I think I remember now.

Don't worry about the 335 today. Romeo is high enough that he shouldn't drop steeply at this point.

 

Hi Furriends! It's been a few days so I thought I'd check in and get any thoughts on Sir Romeo's #s. I expect you'll recommend I bump up to 2u... but given his number swings over the day, I want to make sure that's what you guys would do too! He was on the cusp of a no-shoot today at 221, but I went for it because a) he's still running high during the day, and b) I can be home at his bottom this afternoon to make sure he doesn't swing low. PLEASE let me know if you guys wouldn't have, so I learn. Happy Thursday!!

Updated SS: https://1drv.ms/x/s!AtvOIOY-2L6EgY9OFyZ_nhtpn6t5MA

 

Is it possible to get one before bed test to see what his overnight cycles look like? The 221 was shootable but his recent AMPSs have been a lot lower than the PMPSs. One cause is going significantly lower overnight.

 

Hi! I'm afraid it's a moot point for tonight... He ran low (for him) all day today... mostly yellows, and had a pmps of 149. Maybe because I shot after a relatively low AMPS? So no shot tonight -- I'll check him once before I go to bed (pbly +2 at most)... but I obviously expect him to run higher now. If, for some reason, he's still low-- I'll set an alarm for +6'ish and check him. Ugh.

What kind of crazy diabetes voodoo would cause him to run so much lower at night than during the day? (today excepted)

SS is FINALLY in my signature. (gremlins were thwarting that effort previously.)

 

Honestly? A lot of cats just run lower at night. Not sure why. It could be they don't eat as much at night, they aren't running around as much as during the day (except that 1AM run around the place like crazy thing ), etc. It's fairly normal, but no one really knows why for sure.

 

Next time you get a strange number like that, wait 20 minutes and test again (no food while waiting - sorry, Romeo). Sometimes it's just a strange test, and sometimes they just need a few more minutes to start rising. With the numbers you're seeing, you want to avoid skipping shots if you can, although obviously you couldn't shoot on a 149 just yet. The stalling technique can be painful when we are listening to a kitty pull our heartstrings to try to get food, but it's an important tool in keeping them steady.