Thoughts on readings

I posted to the general forum not long ago, and then Travis had pancreatitis and ketoacidosis for a few days (the panc flare ups seem to be a thing for him - they only last a couple of days though). Since then I created a spreadsheet and recorded all his past and current numbers. I'm determined to try and regulate him, but I'm feeling a bit lost. I'm mainly looking at dates since 3/6, since that's when he was recovering from the pancreatitis/ketoacidosis. He seems to be all over the place! Sometimes the curve is upside down. Sometimes he goes pretty low. A few times he's been way too low during AMPS and PMPS and I have to give him some carbs and wait a while. I feel like some of the high numbers might be him bouncing, but other times it doesn't make sense why he's so high. Thanks for any thoughts anyone has!

 

He's a bouncy guy alright! I think some of the whole unit dose changes have caused some dramatic responses and if I understand it correctly there have been some deviations from a fairly strict 12/12 dosing schedule - can also cause problems. There are also a few instances of a dose given on a pre shot BG that's too low. Dark green is too low to give ProZinc, especially in a volatile kitty.

Here are some things to think about:

• go back to a moderate dose like 1.5 u and keep it AM and PM for several days unless you see lime green
• get a test between +4 and +7 every day if you can and, if not, one before bed
• if several days at this dose and with those tests shows consistently high BGs increase by no more than 0.25 u to 1.75 u
• keep 1.75 u for several days and test, etc.
• stick to as close to a 12/12 schedule as you can
• you can probably give a full dose on a PS over 180 - no dose at lower than that for now.

The goal here is to calm him down, find a moderate dose that might be a little low but evens him out and then increase in tiny fractions of no more than 0.25 u at a time. Dose changing AM to PM is a technique that's better used on a cat who is in a good dose range but tweaking is needed. It's making your kitty very erratic right now.

 

I tr to give him 2 units consistently, but his BG has been recently doing this thing where it's too low on the pre-shot reading. I give him some carbs and wait a while to test again. When he was last sick, he ended up with ketoacidosis because I was skipping shots since he wasn't eating. If he's measuring in below 100 at pre-shot time, should I skip a dose, or continue to give him some carb-y cat treats with his food and give him a shot a few hours later? Actually, I see that you say to skip a dose if he's under 180 at PS time. Really? I'm a bit worried about the keto again, so I'm just confirming.

I will start giving him 1.5 from now through the weekend (since I can do a curve then) and see how he does. Thank you!

 

I agree that this is trickier with a kitty who has had DKA. It's best to avoid skipping shots as much as possible. One reason for a too low to shoot PS is a dose that's too high - and 2 u might be a little too high. That's why I suggested dropping it to 1.5 u. You might prevent lows on a slightly lower dose. You need to try it out for a few days though. If he gives you a PS that's in the 100s post for help with a title that indicates that and mentions the ketosis. Put the blue question mark icon on your thread (to be found at the left end of the thread title bar) to attract more attention.

When was the ketosis diagnosis? Was it full blown diabetic ketoacidosis? Are you testing his urine for ketones at home? Here are some tips using human ketone strips from any pharmacy:

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

 

The vet didn't actually say. He said that he had ketones in his urine back on 3/3. The vet tested again on 3/12 and it was negative. So, I have a curiosity question about testing and ketones. What happens if he's got ketones in his urine? Testing will show them, but what does one do if he does? I asked the vet this, and he said that was a good question. Try and regulate his blood sugar, I believe, was pretty much his answer.

 

Here's what we would say: if a ketone test gives you a "trace" reading call your vet for advice. If it's "small" or higher, take kitty to the vet to be checked. I went through an episode of full blown DKA with my cat 2 months after his diagnosis. The ketones developed very quickly and it took a very expensive 3 day stay is the ER ICU to get him stable again. It's a serious complication of diabetes and testing urine ketones at home is simple. The best preventives are good hydration, enough calories, a proper dose of insulin and immediate attention to any infection or inflammation (dental, pancreatitis, etc.).

 

Interesting. I'm just learning about how infections can make diabetes worse. Travis has had chronic eye problems since I got him back in 2013. He has herpes, as lots of kitties do, and he gets the eye problems from it in one eye. I've noticed that since he's been on insulin, his eye has been either perfectly okay, or just slightly irritated. Nothing like it has been before insulin though. He must not have had the full blown DKA a few weeks ago, as I think really it was the pancreatitis that was mainly plaguing him. I will count my lucky stars though, as his panc flare ups don't seem to be near as bad as other accounts I've been reading on pancreatitis support groups.

 

We have a panc expert here on this forum. @Djamila 's kitty, Sam, has flares off and on. She might be able to help.

 

I feel really lucky too - Sam’s flares are bad, but as you said, not to the extent on the panic forums.

I’m a little concerned that your vet doesn’t know what to do if your cat gets ketones though. Are there any other vets in your area that you might consider using?

As Kris said, DKA can happen quickly and be very serious. I would hate to think your vet would have to consult Dr. Google before starting treatment should the need arise

I’m at work right now, but I’ll try to check back in later and take a peek at your spreadsheet.

Welcome to our little group!

 

That was supposed to say “pancreatitis forums” not panic forums!

 

At times it's the same ...

 

Amen to that!

 

Hi Traviscat! Sorry for the quick response earlier! It does look like Travis is a bit all over the place, huh?

Can you give us a little more background about his dosing history? Or if you already explained it in another post, you can just share the link. It looks like he was at 5u in December, then down to 3u, and then a little up and down here and there until the recent dosing. How were dosing decisions being made? Was he on Prozinc the whole time? You have a bunch of mid-cycles around 3/6, but then hardly any more recently - has your work schedule changed, or is there another reason fort the change in testing? Even though the PS was high tonight, it looks like you lowered the dose. Was there a reason for changing the dose tonight?

I'm so sorry for all of the questions - just trying to understand a little better so I don't give you bad advice!

Going back to your earlier question about when do you No Shot - The general rule is no shot under 200-ish when someone is new. When you are confident that you can get tests and monitor/feed if needed (if the kitty goes low), then you can begin to shoot at lower numbers - as your data grows and you can be sure it's safe. Particularly kitties with a ketone history, you are right that you wan to avoid skipping. However, giving carbs isn't your only option. Prozinc lasts 10-14 hours in most cats. So sometimes the PS will be low, but you just wait 30 minutes and re-test, it's worn off sufficiently to give the shot. Giving carbs can cause the numbers to get pretty bouncy for a few cycles, so it's best to avoid doing that if you can. Of course, making the kitty wait up to an hour for dinner is no easy task. They really know how to tug our heart-strings and convince us that they are dying if they have to wait a little bit to eat. But it really is the best strategy - especially with a kitty that really shouldn't skip shots. Personally, I have to leave the house if I'm making Sam wait. I really can't listen to him cry and prowl around while he's waiting without caving in. Probably more than you needed to know in answer to that question.

 

@Djamila I suggested a drop to a dose that might avoid some too low to shoot PSs. There’s been a lot of up and down, no shot, etc. recently and I like to dee things calmed down before any more changes are made. See my post #2 above.

 

That was my initial thought too, but then when I saw that the dose used to be so much higher and had moved around so much, I wanted to make sure I understood what was going on. My hunch is that this is one where the dose needs to go down for a bit, stabilize, and then start climbing systematically - but again, the history gave me a bit of pause to see if there were other factors/issues that might be influencing things. Thanks for clarifying that most recent change! Is there another thread somewhere?

 

Yes, I think there is but I was focusing on recent data and advising a calming routine based on that.

 

Shoot! I missed all these messages! I'll read and respond more when I get to work.

 

Hi all,

Thanks so much for the help. Here's a little history. I got Travis in 2013, and at that time, we had a dog with a dog door too. He quickly learned to use the door and would come and go. We don't live near a big road and my neighbors loved him, so I let it happen. Now that I know what a panc attack looks like, I can remember a few times where he threw up more than usual and didn't feel well. At that time, he also had chronic eye problems with one eye and would get colds due to herpes, so I thought perhaps it was all related. I've had him on so many eye drops and was getting ready to take him to a specialist. Anyway, back in early 2017 he was feeling particularly bad, so I took him to the vet and they did some testing and told me he had diabetes. Nothing about the pancreas, even though those symptoms were what made me take him to the vet. Since being diagnosed, he's had three panc attacks. They never last more than 2-3 days, and he seems to recover easily. During most of those attack days, he actually looks pretty good. He will cry for food, eat half of it, and cry for more (even though he has access to more). The attack will peak around the end of day two, where he won't look so good. Given what I've read in other panc message boards, this seems like nothing. KNOCK ON WOOD! I'm worried things will get worse as time goes on.

As for readings history - there are two vets in the practice I go to. I originally saw the lady vet. I did what what she advised me to do, which was give him shots and bring him in for a reading every few weeks. She also put him on Purina DM prescription food. She started him out on 1 unit and would raise him a unit if she felt testing was too high. She would literally only go off that one reading every few weeks. He has always been a big cat (17 pounds at the heaviest), but when he lost the ability to eat when he wanted, he started losing a little weight (1/2 pound to a pound a month). This also concerned the vet, though I mentioned that he probably needed to lose some weight anyhow. Through this journey, I definitely feel like when his weight goes down, his need for insulin goes down. When the weight went back up, his need for insulin went back up. I started researching other foods, because 60 for a 10 pound bag seemed excessive. As you can imagine, I started to learn all sorts of things as I started to research! The first thing I did was ask the vet if she minded I did some readings myself. I'm sorry to admit that I can be frugal, and my initial reason for doing it was to save money from her doing it. She said she didn't have any cat owners who did their own checks, but that she would allow it if I 1. never changed his dosage on my own, and 2. didn't become too hyper vigilant and go overboard. I bought a tester, and taking her advice, I tested him about 8 hours after the morning shot on the weekends. I also researched food, and started feeding him Evo cat food at about that same time. I was reading some other users on here who liked it for a dry food, so I ordered some online. That is why his numbers went up and he ended up at 5 units. I didn't THINK I was feeding him too much, but after he started gaining weight and his insulin use went up, I realized I fed him too much. When that happened, I got fed up and decided to research and figure things out better on my own. I had long been trying to balance the vet's advice of not being too vigilant, yet wanting to do what I felt was right (particularly after reading things here). It's been a long road, but I'm getting there. I started testing him more frequently and trying to get curves. I also cut back on how much Evo I gave him and he started to lose a healthy amount of weight. As his weight went down, I noticed his numbers go down. I wasn't writing on the message board, so my changes in doses were still to large and erratic. The last time I talked to her about his numbers she warned me about not going overboard again. LOL

During this last panc attack (at the beginning of March), I saw the other vet and he thinks what I'm doing is fabulous. He's far more receptive to my checking him more often. The problem is that I don't have enough history with him, and I'm not sure how he wants me to report numbers. I have not officially switched to him, and I'm not sure how to go about that. So, here I am, looking for advice and trying to do the right thing by my guy. I posted here that his numbers were super inconsistent, and 'Kris & Teasel' has been wonderful at looking at my stuff. I like the logic of getting him to be consistent on the curve, and then slowly increase dosage if he needs more. However, this morning the number was 158, so I wrote to the message board asking what to do. Still a bouncy guy!

 

My vet also told me initially not to go overboard with the testing. I wonder what they think will happen LOL. IMO there is no such thing as too much data!

 

I feel like her reasoning was that she didn't want Travis to be put through too much stress. However, I'd rather him alive and thriving with some pokes in his ear than sick or worse! Travis doesn't seem to mind so much really. I think the thing that bothers him the most is if you tickle the hair in his ear, or your finger brushes the hair in the opposite direction it grows on the ear. As I wrote out his history above, I realized how ludicrous it was to try and monitor his dosage off one tiny number every few weeks (sometimes longer!). Sadly, my Mother had a diabetic cat at one point in her life. Her vet had the same strategy of only monitoring her occasionally. I'm not sure how long the cat lived, but I don't think it was much more than a year. She died after having a major seizure. When my mom took her to the emergency vet, she had them test the blood to make sure it wasn't insulin that caused it, but that vet told her the numbers were good, so?? I wonder now if they didn't rise from the stress of having a seizure, but I will save my Mom the grief of bringing it up. She was mortified to think it was something she did.

 

Yes, definitely don't mention all this to mom! Certainly not her fault if she was following the vets advice. It is perfectly reasonable to think we should be able to trust them to guide us. Unfortunately, vets know so very little about FD. It breaks my heart to hear what happened to her poor kitty!

Thank you so much for taking the time to share all of that background! That really helps to make sense of the numbers on your spreadsheet too.

It looks like you went with 0.5u today which may not have been enough based on the PMPS number. Anytime you can get a test or two in during the cycle, especially around +4 to +7, that's really helpful in figuring out if a dose is too high or too low. The 1.5u dose gave you a low AMPS, so maybe try 1.0u for a couple of cycles? Or if you think you could eyeball it, I'm thinking 1.25u might be good.

 

I also forgot to mention that after the last panc attack, I switched him off dry food and onto Fancy Feast Classics. He absolutely loves wet food, so it's like a treat each day. I'm very curious to see what happens with him the next time he gets an attack. I can't imagine him not wolfing down all of his food! About chronic pancreatitis - since he has these periodic attacks, does that mean he always has pancreatitis? Will he always get these attacks? I read in the pancreatitis Facebook group about people who have cats who deals with it for two years+, and from the sounds of it, it ebbs and flows, but never actually goes away in all that time!

His reading this morning wasn't too horrendous, but I think I might try 1.25 this weekend. I can get some more readings on him and see what that makes him do during the day. I wish my work was closer!

 

How many hours between the PM shot and your bedtime?

This morning's AMPS is making me change my mind about that dose change though. Are you going to be around tonight to get an extra test in? If you could even get a +4, it would help to gauge if the dose needs to go up or down for Saturday morning's dose.

 

I can definitely get a reading at 4+ tonight.

Thank you so much for looking at his spreadsheet and offering thoughts!

 

Question about what good spreadsheet numbers should look like... is the goal of a regulated sugar cat to have the between-shot tests under 100? Or is it okay for them to be in the 100s? What should the ideal pre-shots look like? In the lower 200s? At one point, I asked my vet this. She said the pre-shots should be in the lower 300s and mid-shot be in the 100s.

 

Here's the general guide based on (probably) human meter numbers:

• PSs in the low to mid 200s
• nadirs in the high double digits to low 100s.

 

He was 385 PMPS, and 196 4h 40m after. G'night!

 

That's a pretty good insulin response, but definitely not enough to indicate reducing the dose. If you are home tomorrow and can get a couple more mid-cycle numbers, you might try 1.75 (assuming that the pre-shot number is in the normal high-yellow/pink range)

 

Ugh, I'm sorry to report that he barely budged today! I was careful not to have any cups of milk or food out (challenge with kids), and I'm certain I didn't have a fur shot. I'll try again tonight with 1.75 and see what 4+ says... So weird.

 

Okay, I posted this and then went and did a 9+ reading. He went down! 196. So weird.

 

When you factor in the allowed meter variance of up to 20% these three daytime numbers are almost the same. Pretty good so far.

 

Maybe this is what's happening when he's low on a preshot. I've always given it to him in the scruff, because that's what I was taught. Perhaps I should investigate shooting him somewhere else? I've been reading about it acting faster when you shoot somewhere else. Though I don't know what that is at the moment.

 

It might or might not make a difference. You can try to see if it does.

 

People have tried different methods like that. I'm not sure we've ever seen it definitively make a difference, but hey! ECID! If you do give it a try, I'd mark on your SS where you shot on which days to help you determine if that is a factor.

 

PMPS 116!!! I'm going to feed him because I have to go to a flashlight egg hunt with my kiddos. Test again when I get home. Ugh.

 

Well, I fed him before I left, and the reading was 116. I'm back - it's been about 1.5 hours since he ate, and he's now 190.

 

You could try 1.5 u again I think. Test two hours after the dose to see whether he’s dropping quickly.