calling all brainstormers: kit is a bouncy kitty

[JOJI and Kit]

http://www.felinediabetes.com/FDMB/threads/prozinc-kit-and-low-bgs.225956/#post-2538238

Starting a new thread, we've graduated from Main Forum to the Prozinc Forum. Woohoo! @Deb & Wink and @Juls and Billy have been helping us with Kit's journey. We are very grateful.

 

[Deb & Wink]

Prozinc post again! Welcome Joji and JW.

 

[JOJI and Kit]

kti still dropping at +2 after a no shoot PM.
at 114 and now feeding second dinner
@Deb & Wink or @Juls and Billy dont know if you're around still or if others could chime in. thanks in advance ^jw

 

[Deb & Wink]

Down to 114 with no insulin since that 1.75U in the AM cycle this morning?

That is still a safe number, especially since there is no insulin being used this cycle.

 

[JOJI and Kit]

Down to 114 with no insulin since that 1.75U in the AM cycle this morning?

correct. no insulin since the 1.75U in the AM cycle this morning.

this new territory for us. so we dont know what makes a continuous down trend for the day.
also not sure if we need to test again sooner, or just stay to the plan of next BG at +4 ?
^jw

 

[Deb & Wink]

Since there is no insulin in Kit's body, there is no danger of hypoglycemia.
No reason to test sooner. Stay with the plan of taking the next test at +4 is still good.

 

[JOJI and Kit]

Since there is no insulin in Kit's body, there is no danger of hypoglycemia.

so good to know this. another fabulous gem from you tonight.
^jw

 

[JOJI and Kit]

I know @Deb & Wink is not available. We just got a 77 at +4 and probably need to reduce again tonight. roller coaster Kit.....

 

[Deb & Wink]

I'm here until about 1 PM EST today. Then maybe a bit late afternoon/very early evening.

Yes, that BG of 77 is another reduction.
Down to 1.5U of prozinc for tonight's PM cycle.

 

[JOJI and Kit]

I'm here until about 1 PM EST today. Then maybe a bit late afternoon/very early evening.

Yes, that BG of 77 is another reduction.
Down to 1.5U of prozinc for tonight's PM cycle.

One hour later 222. Is this crazy?

 

[Deb & Wink]

One hour later 222. Is this crazy?

Yes. No food? between last test and now?

 

[JOJI and Kit]

She did have her late morning mini meal after +4, so yes an hour before this 222 BG

 

[Deb & Wink]

Which food? Be specific please. Could have something to do with her wild BG numbers, is why I'm asking.

 

[JOJI and Kit]

Which food? Be specific please. Could have something to do with her wild BG numbers, is why I'm asking.

It was a combo of FF chicken roasted (6% carb), Tiki puka puka (0%carb) and Weruva Paw Lickin' Chicken (3%carb). Working to bring in Weruva and omit the FF.

 

[Deb & Wink]

Darn. I was hoping it was only 1 food, and we could trace it back to that particular 1.
Guessing that Kit loved her smorgasbord of flavors at +4.

145 point spike in BG is more than most foods would cause in 1 hour. But on the other hand, some cats are more carb sensitive than others, and it could be the LOWER carb Tiki cat that causes her to food spike like that.

Sometimes, the lowest carb food out there is not what works for all cats.

You are going to have to try some experimenting with the food. Try only 1 food at a meal. Then test 1 hour later. Could you do that? Will Kit eat only 1 food, of do you have to mix things together to "entice" her to eat?

(Jo or JW, either one of you).

 

[JOJI and Kit]

Darn. I was hoping it was only 1 food, and we could trace it back to that particular 1.
Guessing that Kit loved her smorgasbord of flavors at +4.

145 point spike in BG is more than most foods would cause in 1 hour. But on the other hand, some cats are more carb sensitive than others, and it could be the LOWER carb Tiki cat that causes her to food spike like that.

Sometimes, the lowest carb food out there is not what works for all cats.

You are going to have to try some experimenting with the food. Try only 1 food at a meal. Then test 1 hour later. Could you do that? Will Kit eat only 1 food, of do you have to mix things together to "entice" her to eat?

(Jo or JW, either one of you).

Deb, That's a great idea. I think Kit is really enjoying the recent Weruva addition, and it is smack in the middle of Tiki vs FF as far as carbs go. She's a pretty happy eater. Before adding Weruva (just a few days ago) we were doing a Tiki/FF combo to have a little more than zero carbs, not because she needs enticement. Weruva could be her happy place! That's what I've been hoping and so this could be the perfect time. Thanks! You always ask great clarifying questions to help us zero in. Jo this time

 

[JOJI and Kit]

friends,

we've been working diligently to follow the prozinc protocol. the new dosing method guidelines are so very wonderful. and in particular lots of purr and shout outs to @Deb & Wink and @Juls and Billy who give us tremendous support daily.

we honestly are believers in "consistent and patient," but we feel like we are no closer to regulating kit after 11 weeks.
we are hoping for a bit of a brainstorming in this thread to help us figure out what we might be missing in our practice and how we could improve things for kit.

all ideas are welcome. what do you think?

^Joji and jw

 

[Deb & Wink]

@Olive & Paula Any ideas?

 

[Juls and Billy]

What did Kit eat today? All Weruva? I noticed the pumpkin. I'm sure you checked, but it's pure pumpkin, right? Not pie filling?

First, I'd say one cycle is nothing to make you switch anything, especially with that 77 yesterday. If tomorrow's cycle looks the same, I would consider that Kit might not do as well with the carbs that low. I know you were trying to stick to a single kind of food to see if it was influencing bouncy numbers. Maybe try only the Tiki one day, and only the FF one day. Not all cats do well on super low carb. I'm not saying this is the case with Kit, it was just all I could think to try.

Only other possible random thing I can think of is making sure the insulin is rolled until it's well mixed. But I think you are doing that already.

 

[JOJI and Kit]

What did Kit eat today? All Weruva? I noticed the pumpkin. I'm sure you checked, but it's pure pumpkin, right? Not pie filling?

yes, today we did all weruva. and yes, pumpkin is pure pumkin. not pie filling.

First, I'd say one cycle is nothing to make you switch anything, especially with that 77 yesterday.

right. that 77

we are in a situation where we have had to lower the dose 0.25U twice recently: PM 01mar and PM 07mar
and 04mar we had to skip completely.

If tomorrow's cycle looks the same, I would consider that Kit might not do as well with the carbs that low. I know you were trying to stick to a single kind of food to see if it was influencing bouncy numbers. Maybe try only the Tiki one day, and only the FF one day. Not all cats do well on super low carb. I'm not saying this is the case with Kit, it was just all I could think to try.

yes, good idea. we had been doing a mix of tiki/ff in a meal. a couple of days ago @Deb & Wink had the same suggestion so we started doing just the weruva. isolating with a single food sounds like a reasonable thing to keep trying. so is the idea to do the same single food for a couple of cycles, and then rotate to a different single food?

Only other possible random thing I can think of is making sure the insulin is rolled until it's well mixed. But I think you are doing that already

yeah, we've felt pretty good about our rolling/mixing for awhile. but it's always good to hear the reminder.

thanks for chiming in @Juls and Billy let us know if anything else comes to mind.

^jw

 

[Deb & Wink]

1. Making sure you are getting all the air bubbles out of the syringe. Tap, tap, finger flick against side of barrel.Fingers away fron the plunger as you are doing this. (I got sloppy tonight, had my thumb on the plunger and squirted it all over the room. Luckily, it was only 0.5U dose.)
   
2. Making sure you are measuring the in-between the lines doses consistently.
3. Think about dosing with calipers. Dosing with Calipers
4. Try one food, the Weruva for several cycles, not only 1 cycle.

 

[JOJI and Kit]

• Making sure you are getting all the air bubbles out of the syringe. Tap, tap, finger flick against side of barrel.Fingers away from the plunger as you are doing this. (I got sloppy tonight, had my thumb on the plunger and squirted it all over the room. Luckily, it was only 0.5U dose.)

• Making sure you are measuring the in-between the lines doses consistently.

yes, we keep working to be as consistent as possible with our dosing and we still have room to improve.

Think about dosing with calipers. Dosing with Calipers

i was looking at that guidance. i even have a set of calipers around from when i used to make jewelry. the tolerances for silver solder are tighter than you might think.... well, not like machining parts for nasa or anything like that, but yeah. calipers.

Try one food, the Weruva for several cycles, not only 1 cycle.

will do. we've done the last three cycles with weruva only and plan to continue with it for tomorrow AM and PM

thanks for chiming in @Deb & Wink

^jw

 

[Deb & Wink]

Any possibility that Jo or JW could get a regular +2 test in the PM cycle? And maybe one before you go to sleep?

Kit is still bouncing. Still trying to figure out where she is hitting that low that makes her bounce so high.

 

[JOJI and Kit]

Any possibility that Jo or JW could get a regular +2 test in the PM cycle? And maybe one before you go to sleep?

@Deb & Wink
+2 no problem. and i can stay up for a +something else. what do you think a +4?
also, we'll give her second dinner and third dinner mini-meals before bed as well. last night those were at +1 and +2.
any guidance for timing those with respect to taking the PM BGs tonight?
^jw

 

[Deb & Wink]

Thank you on the +2. Yes, a +4 sounds fine. That won't be keeping you up past your normal bedtime will it JW?

Feed as you normally would. By that I mean the same times in the 12 hour cycle. Both AM and PM. Keeping the
feeding times consistent can help to maintain the blood glucose levels on a more even keel.

It's only the pre-shot tests where you want the BG (blood glucose) numbers to be uninfluenced by food. In case you need to stall or the test number is lower than normal. You don't want to be shooting a full dose of insulin into a cat when the pre-shot test number you got was raised by some food within the last 2 hours.

So no food 2 hours before the pre-shot tests is what we want to see.

 

[JOJI and Kit]

Thank you on the +2. Yes, a +4 sounds fine.

+2 and +4 it is.

Feed as you normally would. By that I mean the same times in the 12 hour cycle. Both AM and PM. Keeping the
feeding times consistent can help to maintain the blood glucose levels on a more even keel.

we are reasonably good at this for the "first" AM and PM meals. usually within 3-5 mins barring something exciting like a stall.
where we have had higher variability is in the "second" and "third" meals. so what i understand you to be saying is that we should get similarly consistent with those additional meals?
i can pull the timing details for those on the last few cycles if you would find them useful.

So no food 2 hours before the pre-shot tests is what we want to see.

oh! we've been thinking that the pre-shot guidance was 6 hours. i wonder where we got that idea from .....
and then we've been doing a 2 hour no food before for any other BG during the cycle.

^jw

 

[Deb & Wink]

oh! we've been thinking that the pre-shot guidance was 6 hours. i wonder where we got that idea from .....

No food 2 hours before the pre-shot test. (The BG test you do at AMPS and PMPS)
So no food between +10 and +12.

Feeding AFTER the middle of the cycle, after about +6 can raise the BG levels in many cats, later in the cycle. I think that is where you were getting the "no food for 6 hours before the pre-shot" from.

and then we've been doing a 2 hour no food before for any other BG during the cycle.

Kit can have food before any other BG test during the cycle. She does not need to wait for food for 2 hours AFTER those pre-shot tests and before another BG test. You could feed her at +1, +2, +3, +4, +5, +6 if you wanted to or anywhere in between those times. But, feeding her that many times and that much food could be too much.

where we have had higher variability is in the "second" and "third" meals. so what i understand you to be saying is that we should get similarly consistent with those additional meals?
i can pull the timing details for those on the last few cycles if you would find them useful.

If meals number 2 and 3 are within a half hour or so, that is perfectly reasonable. If meals number 2 and 3 are within 1 hour or so, that is perfectly reasonable. If meals number 2 and 3 are 3 or 4 hours different, that could be throwing off the BG readings for the cycle.

Are you that far off on the feedings? Several hours?

 

[JOJI and Kit]

Are you that far off on the feedings? Several hours?

hmmmmaaayyyyyybe?
i'm not sure if you mean "second" meal on day 1 AM has to be consistent with "second" meal on day 2 AM, or if you mean something different.

so maybe i'll show you some recent data and you can help me figure out the answer


07 mar, sat

AM Tiki & Weruva chicken mix 2.8 oz ; FF 0.5 oz chicken

still hungry at +1.5, gave mini meal of Weruva and TIki Weruva,
Tiki and FF after +4BG ​

PM Weruva chicken 3.75oz

after +1BG 1.5 oz Weruva chicken
+2.25 Weruva chicken 1.5oz​

08 mar, sun

AM Weruva Paw lickin chicken 3.75oz w/pumpkin smear

1.5 oz Weruva after +3BG
immediately after +5BG 1.5 oz Weruva​

PM Weruva Paw lickin chicken 3.75oz

+1 1.5 oz Weruva Paw lickin chicken
no third meal this evening​

09 mar, mon

AM Weruva Paw lickin chicken 3.75oz w/pumpkin smear

immediately after +2.25 BG 1.5oz Weruva Paw lickin chicken
immediately after +4.5 BG 1.5oz Weruva Paw lickin chicken​

PM Weruva Paw lickin chicken 3.75oz

+1 1.5oz Weruva Paw lickin chicken
+2 1.5oz Weruva Paw lickin chicken​

10 mar, tue

AM Weruva Paw lickin chicken 3.75oz

+2.25 1.5 oz Weruva
+5.25 1.5 oz Weruva​

PM Weruva Paw lickin chicken 3.75oz

+1 1.5 oz Weruva
+2 1.5 oz Weruva​

11mar,wed (today)

AM Weruva Paw lickin chicken 3.75oz

+1.25 1.5 oz Weruva
immediately after +4BG 1.5oz Weruva​

PM Weruva Paw lickin chicken 3.75oz

two more mini meals to come, each will be 1.5 oz Weruva​

 

[Deb & Wink]

Ok, that's quite a variation in feeding times each day.

And the variations are because.......?

 

[JOJI and Kit]

And the variations are because.......?

based on her behavior, when she "asks"

 

[JOJI and Kit]

so is this more what low variation would look like?

Day 1 AM second meal within 30-60min of Day 2 AM second meal
Day 1 AM third meal within 30-60min of Day 3 AM third meal

Day 1 PM second meal within 30-60min of Day 2 PM second meal
Day 1 PM third meal within 30-60min of Day 2 PM third meal

 

[Deb & Wink]

Yes. A bit less "random" with the meals may help her BG levels stay more level.

She's in an extended bounce cycle right now. Look like she has been bouncing since the evening of 3/7. With no letup in sight.

I think she gets the pink rubber ball award. For being a bouncing champion.

 

[JOJI and Kit]

Yes. A bit less "random" with the meals may help her BG levels stay more level.

ok. so then AM to AM times and PM to PM times better aligned?
as well as distance between "first" and "second" and "third" being closer?
or?
not sure i exactly know which things to adjust to which "less randomness"

I think she gets the pink rubber ball award.

 

[Deb & Wink]

How about this
Feed the biggest portion of food at pre-shot. Then feed at +1, +2, +3
Both AM and PM cycles.

Is that possible?
Do you have a timed feeder?

What you are trying to accomplish, is to flatten the curve.
Instead of having the BG numbers shoot back up so quickly, try to have them stay more even, the shape of a gentle smile shaped curve.
Front loading the food, feeding the food in the first half of the cycle helps to flatten the curve. If we can do that flattening, then we should stop her from diving off the high 10 meter diving platform and then screaming back up at the end of the cycle.

Kit seems to drop the most around +4, so if you can get her food into her before then, that should help to keep her from the steep dives. It's not going to work instantly. It's going to take some time. But getting her fed on a more regular schedule of feeding times should help. It may take a couple of weeks. Don't expect to see a change in a couple of days.

 

[JOJI and Kit]

Feed the biggest portion of food at pre-shot. Then feed at +1, +2, +3
Both AM and PM cycles.

we have been doing the ratios as 1/2 of meal food at pre-shot then 1/4 second meal and final 1/4 third meal. we weigh everything on a food scale. so that part at least is consistent.

now we have to get the timings aligned for second and third meal.

Do you have a timed feeder?

we do, and mostly they open as expected. but last time we used them on 04 mar they did not open

Kit seems to drop the most around +4, so if you can get her food into her before then, that should help to keep her from the steep dives. It's not going to work instantly. It's going to take some time. But getting her fed on a more regular schedule of feeding times should help. It may take a couple of weeks. Don't expect to see a change in a couple of days.

ok, thanks for all the coaching on this. tonight she got second at +2 and third at +3. we can continue on that rhythm tomorrow.

in other wonderings: what should we be doing with dosing right now?

 

[Deb & Wink]

in other wonderings: what should we be doing with dosing right now?

Holding the dose for now. Ask me again in another day and a half, so there has been some time on the adjusted feeding schedule before you make another change. Changing too many variables at once can make it more difficult to figure out what is going on.

 

[JOJI and Kit]

Holding the dose for now. Ask me again in another day and a half, so there has been some time on the adjusted feeding schedule before you make another change. Changing too many variables at once can make it more difficult to figure out what is going on.

will do. thanks again. and happy zzzz!

 

[JOJI and Kit]

@Deb & Wink , FYI This morning Kit was having soft yellowish brown stool, and too many trips to the litter box. We measured ketones from a tiny bit of urine at a low end of the box, and it measured "trace" (we're not sure how valid it was since it was so small) She's at the vet now for tests. With everything going on in the world added to our kitty issues we are pretty wobbly!! (PS the vet office is not up to speed at ALL on taking COVID precautions!)

 

[Deb & Wink]

Keeping all paws crossed here for Kit's good health and the vet being able to find out the cause for the stool color.

You are going to think this is weird, but if you have a picture of the poop to share, there are a lot of things that can be told by the color and consistency.

Ketone test could have been thrown off by the litter itself. After you get back from the vet, you may want to test your litter with the urine ketone test strip. To see if the litter by itself causes the test strip to register ketones. It has been known to happen.

 

[JOJI and Kit]

Thanks Deb. Kit's home! Negative ketone. Negative glucose even in her urine! They are sending out her stool as well as her urine for testing. We've done the ketone test before with high certainty that we got it right, so we're chalking this up to a poor setup. We are thinking that her stool is a reaction to switching quickly to Paw Lickin Chicken. Normally we do a gradual switch, but this time it was more of a rapid change. She's so happy to be home. The house feels so empty without her, even for a few hours! PS we didn't get a poophoto. Next time.

 

[Deb & Wink]

At least the negative ketones is reassuring. As is the fact there was no glucose in her urine, which tells you her urine glucose level is below renal threshold (ranges from 180-250 most of the time).

Renal threshold is when the excess glucose is filtered out of the blood by the kidneys and is subsequently dumped in the urine. That urine glucose usually lags several hours behind the blood glucose levels.

PS we didn't get a poophoto. Next time.

Oh darn!!

Glad to hear that Kit is back home and doing better. Probably getting plenty of pampering back home.

 

[JOJI and Kit]

if you have a picture of the poop to share, there are a lot of things that can be told by the color and consistency.

well, kit is giving us more photo opportunities today. looking forward to yesterdays' stool sample results due back from the vet today. on vet advice we started adding fortiflora with yesterday's PM food.

itmw here's her latest effort. the second one of the day is shown here and is firmer than the first one of this morning.
the part at the top is pulled apart to disambiguate a bit from the corn litter which is similar in color.


^jw

 

[Deb & Wink]

So thanks for the comment on that being corn litter on the outside. At first glance, it looked like Kit was not digesting her food at all.

Looks a bit soft, where you pulled the poop apart.
That looks very tan or tannish in color. Would you agree on that color assessment JW?

 

[JOJI and Kit]

Looks a bit soft, where you pulled the poop apart.

yes, and this sample is firmer than the one from a few hours prior.

That looks very tan or tannish in color. Would you agree on that color assessment JW?

that's fair.
i think it tracks reasonably with color of the weruva chicken, with the main difference being the poop sample is darker than the food.


^jw

 

[Deb & Wink]

Usually when food passes through the body, it turns darker as it gets processed by the stomach, then all the different enzymes and good bacteria in the gut (small and large intestine). Then it comes out a darker brown color.

Lighter colored poop could be a food intolerance, bacterial or parasitic infection.
Is the poop darker with feeding a different food?

What did the vet think?

 

[JOJI and Kit]

What did the vet think?

not much comment on color. but labs back neg for parasites, so there's that to be thankful for.
^jw

 

[Deb & Wink]

Just about time for a new thread. Moderators are reminding me via PM to keep'm short.