Finding Alex's Dose

Discussion in 'Prozinc / PZI' started by Asiina & Alex, Jan 27, 2019.

  1. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    Alex was diagnosed and started on 1U about a week ago, and the dose he's on is not working. He gets extremely high numbers before his shots, and his midday number is still too high. It very clearly needs to be increased, but the vet is insisting that I wait 10 days to do a glucose curve and won't look at the data before that.

    It's frustrating putting him through all this new routine if it's not even helping him.
     
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Actually, he's shown you that this 1 u dose isn't too bad. He had a low of 10.1 on 25 Jan and that's a decent number for so early in the game. I agree with holding a dose a bit longer at the start when kitty's body is new to exogenous insulin and is working to adapt to it. The black number this AM is basically the same as yesterday's red because meters are allowed a variation in reading on the order of 15 to 20%.

    The high numbers you've seen after that blue and possibly after overnight lower numbers you haven't captured are rebound or "bouncing" as we call it here. It's a normal reaction and some kitties are bouncier than others. Here's something I wrote a while ago to explain it:
    1. BG goes low OR lower than usual OR drops too quickly.
    2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
    3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
    4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
    5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
    6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
    One thing we all had to learn about treating FD is to work at the long game. It's often called a marathon and not a sprint. It's rare for regulation to be achieved quickly. It can take many, many months. A ton of patience is required and any attempts to rush the process like raising the dose too much or too quickly are just about guaranteed to backfire.

    Testing his BG and keeping your spreadsheet are two very helpful things you're already doing for Alex. Posting here for help is a good idea and if you can get a before bed test most evenings it'll round out your data. I also suggest you scatter your daytime tests a little more over the 12 hours after the AM dose. That will allow you to see more of the bigger picture.

    You're doing great! :)
     
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  3. Djamila

    Djamila Well-Known Member

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    Hi Asiina! First of all, hugs to you. The first couple of weeks at this dance are tough.

    It does take a cat a couple of weeks to really get used to being on insulin, so while I rarely defend a vets advice (since so often they are wrong), in this case I do agree with your vet. As Kris said, you are actually getting a nice insulin response already. Yes, the numbers are too high right now, but if you just dump in a bunch of insulin you're going to end up sending your poor kitty bouncing all over the place, and that feels awful. Think about how you feel after eating too much junk food, or when your BG goes low because you've waited too long to eat. Those things feel awful, and when a kitty is bouncing up and down, it doesn't feel good to them either.

    So while you're likely going to need to increase the dose, slow and steady is the way to go, and this initial adjustment period is important.

    It looks like you're already seven days in, so it's only a few more days.

    It would be helpful if you can get a test at night before you go to sleep. It also looks like you've moved the shot times rather a lot in the past week. My hunch is that you're trying to walk it back to a time that works better for you, is that right? Once you get there, it will be important to give the shots at the same 12/12 time every day and not keep moving it around. Consistency is important around here.

    Please don't hesitate to ask as many questions as you have, or just post to vent and ask for reassurance. :):bighug::cat:
     
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  4. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    Yes, I was moving it back to 9/9 15 minutes at a time so it should be stable from now on. I'll try to get a later night reading tonight, see if I can get a +3 but probably can't stay up any later!

    Thanks for the help and I'll try to be patient. I have been checking ketones because I'm extremely paranoid, but everything is coming up negative, so that's good. I'll be doing a full curve on Wednesday and then sending the spreadsheet to the vet, and I imagine the dose will go up after that.
     
  5. majandra

    majandra Well-Known Member

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    Oct 11, 2018
    You could also test at +2 tonight. Quite often, the +2 gives an idea how the cycle will go. If it is the same or lower than the preshot, it could be an active cycle and may need steering with food and/or more testing.
    In the beginning, I often did +2 and +3 at night to have a good idea what was happening, and then I would give food and set an alarm to test again if needed. My theory was if I caught it early, I was more likely to get a good night sleep.
     
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  6. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    Instead of waiting 10 days do a full curve on him maybe after 5 or 7 days you could do a partial curve at 4 and 6 hours. I know how frustrating this can be and you'll often read here how bad vets can be but no two cats or vets are the same.
    What Kris said about bouncing. Our second cat bounced and it made me tear my hair out. It is indeed a long process, you're training your cat's body to accept medication because of an organ failure which is anything but natural.
    At least you're doing something about it. I cringe to think of all the people who just couldn't be bothered.
     
  7. Djamila

    Djamila Well-Known Member

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    It's great that you're testing for ketones. That is so important, and often overlooked. As others have said, a +3 is a great time to get a test. The insulin usually starts to kick in around +2, so +3 gives you an idea how much of a response you're heading for. At this point you aren't worried about a hypo so much as just trying to get a sense of the dose - if it's enough for now, or needs to be raised.

    One thing that can help avoid ketones is adding extra water to his food - I usually mix in about 3T of water to a small can of food. We had to build up to that though as Sam was not a fan of soupier food at first. And also making sure other health issues are being monitored or resolved. For example, if he's in need of a dental, you'll want to get it done as soon as you can. Bad teeth have a dramatic impact on BG.
     
  8. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    If you want to think long term and with far less yech factor you can get a ketone meter.
     
  9. Asiina & Alex

    Asiina & Alex Member

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    So I actually have two cats, and Simon is inexplicably fat despite rarely eating. He'll eat at meal times but usually only a tiny bit, because he's easily spooked off of food so if you even look at him while he's eating, he'll walk away from the food, and Alex eats a lot of it. We've had dry food down mostly for Simon so that he's able to snack throughout the day, and when they were young they were both only on dry food and were both pretty thin. Then a vet recommended to put Alex on wet food to prevent urinary tract problems because he didn't drink very much, and after that Simon got really fat.

    But I noticed Alex snacking on the dry food as well, and wondered if that was making his sugar's spike, so last night we didn't leave any dry food down and didn't put any down today, just gave some extra wet food so he wasn't losing the calories, and now Alex went from two black numbers yesterday, to a 5.3 (93) today at his low point, to the point that I'm going to have to be careful and maybe end up skipping his evening shot if he doesn't go back up enough in the next 6 hours, which I will do if it stays below 12 (especially since it's overnight and there's a chance I'd miss hypo symptoms) but would suck to do during this adjustment/testing period. I really can't tell if this is another, bigger bounce or if a few bits of dry food could really be making that much of a difference.
     
  10. Kris & Teasel

    Kris & Teasel Well-Known Member

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    It's hard to be certain. If a cat is very carb sensitive, as some are, even a few bits of dry food can cause a BG spike.
     
  11. Djamila

    Djamila Well-Known Member

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    It also really depends on which dry food and which wet food. What exactly are you feeding them?
     
  12. Asiina & Alex

    Asiina & Alex Member

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    They're eating friskies wet food (they like the chicken, whitefish, and salmon pate ones but I need to alternate or they get fussy about having too many of the same meal in a row. They were eating the friskies indoor cat dry food, but I guess I'm stopping that.

    Also Alex was having such a good sugar day and I messed it up by giving at least a partial furshot for the evening. I have no idea how much actually got in. Sorry my boy if you have a bad night, I'll do better in the morning.
     
  13. Djamila

    Djamila Well-Known Member

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    My cats are the same way: I have to rotate tons of flavors to keep them happy. Why couldn't I get the kind of cats that will just eat the same thing day in and day out?!?! Mine both eat raw, and a lot of it is homemade, so it keeps me on my toes to give them enough variety.

    Try not to worry too much about the fur shot. We all do them from time to time. It's just one of those things. :bighug:
     
  14. Rachel

    Rachel Well-Known Member

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    Oh these kitties! They do like to have a variety of foods...can't stick with just one!!!

    Yes those furshots happen. We've ALL done them. Don't let it bug you. I always take it as a sign that we both deserved a night off from worry and usually went to bed early on those nights.
     
  15. Kris & Teasel

    Kris & Teasel Well-Known Member

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    In this I am truly blessed! My three get the same food day in and day out and relish every meal. Well, I alternate between chicken and turkey Wellness brand pate for Teasel but that's it. He'd willingly eat only one if I did that. Not bragging, just happy that I have something that counterbalances all of my challenges dosing Teasel.
     
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  16. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    The vet did up his dosage to 1.5 and it seems to be going well. Just 2 days in and he's already responding quite well and I'm getting low numbers throughout the day. I'm a little concerned about tonight's number (14.3/257) and how low it was and I hope he'll be okay with the shot. I'll monitor him and check in a few hours to make sure he doesn't get too low.

    I know this is what regulated is supposed to be like, but having those high pre-shot numbers made me at least able to sleep soundly that he wasn't going to go into hypo.
     
  17. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Another thing that can help you sleep is smaller increases. We generally recommend that if the low numbers (nadir) are under 200/11.2, (which Alex' are), that increases be done just 0.25u at a time so that the shift in numbers is more gradual and less likely to result in a hypo. It looks like the 1.5 is okay right now, but maybe a little smaller for the next increase. Vets usually aren't familiar with making small increases, so they don't know to recommend them. They only see cats every few weeks at best, so aren't as familiar with the fine-tuning we can do with home testing.

    It's great to see Alex spending so much time in the blues mid-cycle, and getting your first yellow PS :)
     
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  18. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    His BG went UP a few hours after his PM shot which I have no idea what that means. I'm sure it got in him. Could have been a bad reading either then or the PM reading, so I'm not going to dwell on it too much. I'm going to wait a few more days and hopefully it all mellows out, but right now he's still spiking really hard by the time the morning dose comes, and I think it's because of a lack of overnight food (which is that they're eating their overnight food too quickly). I might need to adjust their feeding some more, but I don't want to change 2 variables at once, so I'll leave it alone for another 3-4 days and see how it goes. I'm sure I'll come here for advice if it's still a problem.
     
  19. Djamila

    Djamila Well-Known Member

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    What you saw last night isn't uncommon. It's part of why we say not to worry too too much about the PS numbers. Sometimes a dose will last a little longer than usual, and give a nicer PS number, but wears off soon after. Your +2 is pretty much in line with your other +2's, so my hunch is your PS was just showing a little extra duration from the AM shot.

    Eventually, you'll get more duration regularly, and you'll see the PS numbers coming down. It takes some time though.

    Did you really mean 1.4 for last night's shot? Or is that a typo?
     
  20. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    Just had my first brush with hypo, I think. He was at 3.7 (67) @ +6 and I was testing him before giving a midday snack. There were no symptoms and he was jumping around and purring, but with the alphatrak that's right on the cusp. He ate and I tested him about 15 minutes later and he was up to 4.4 (80), so I'm assuming he's fine now.

    We'll see what he's at tonight, but he's jumping around quite a bit with this new dosage. My vet isn't open on Sundays, so I'm not sure if I should give the 1.5 or go back down to 1 or 1.25. He's still getting used to this dosage, but I worry that it may end up being too much and if something happens overnight I won't see it. The numbers are very confusing.
     
  21. Djamila

    Djamila Well-Known Member

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    First of all, great job not panicking :). Since it was at +6 a regular low-carb snack was a good idea. I would recommend doing another test in about an hour if you can to make sure he stays up and isn't just rising from the food.

    Is he still getting some kibble? Or is he off it completely now?
     
  22. Asiina & Alex

    Asiina & Alex Member

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    I've taken them both off kibble entirely. I'm not sure if I should give a little overnight as just in case, because part of the problem with any wet food I give is that they completely finish it long, long before it's feeding time again, whereas there was always kibble around before.
     
  23. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    Also, do you mean an hour from now (+8) or an hour after the first test (+7) since that would be roughly now.
     
  24. Djamila

    Djamila Well-Known Member

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    I was thinking an hour after the second test - the 4.4/80 one. Of course if you are concerned test before that!

    I was asking about the kibble because even a few pieces can make their BG bounce around from highs to lows in ways that are hard to predict. If he's off all kibble though, then I would say to reduce the dose a smidge for tonight and try 1.25u. He will likely be rather high overnight since this is his first time down in low numbers and most likely his body has dumped a bunch of stored glucose into the blood stream. It can take a day or two to clean that out again. If that happened, you'll likely see a rather high PS number tonight. Just ignore that and go ahead with the little reduction.
     
  25. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    He seems to be coming back up nicely. I'm going to email the spreadsheet to the vet with an explanation after tonight's dose and see whether he thinks I should lower it immediately. I'm still not sure what's causing the really, really high numbers by pre-shot (especially morning) when he seems to be spending most of the day in a good range.

    Thanks for all the help, by the way. I was just starting to not panic when the numbers are too high, and now I get to panic when they're too low!
     
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  26. Djamila

    Djamila Well-Known Member

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    The high PS numbers are normal. It takes more time in the "healing numbers" before those start to come down. And remember that Alex was just diagnosed. While some cats find regulation quickly, it's not at all uncommon for it to take several months. As is often said...it's a marathon, not a sprint. :bighug:
     
  27. Djamila

    Djamila Well-Known Member

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    Oh, and as for the AMPS numbers being a little extra high, google "dawn effect" for an explanation. You'll find things about the effect in human diabetics, but based on lots of our spreadsheets, there seems to be a similar thing with cats.
     
  28. Asiina & Alex

    Asiina & Alex Member

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    So I went down to 1.25 from 1.5 after the hypo scare the other day, and his mid-day numbers are good (much better than they were on just 1U), but his pre-shot numbers remain very high. I'm running low on strips so haven't been able to do multiple mid-day tests since I want to keep an emergency supply, but new ones should be delivered today or tomorrow, so hopefully will be able to fill out the picture a little more.

    Maybe it was just too much, too fast and 1.5 is actually a better dosage I should have just increased it more slowly. The vet told me to just increase, but I'm getting increasingly distrustful of his advice. I hope I don't need to find a new vet.

    I'm wondering if I should go back up to 1.5 now that he's settled a bit more on 1.25 or stick with this for a while longer. Sunday was supposed to be the curve day at 1.5, but maybe I should stay at 1.25 until then? I'm not sure whether the pre-shot numbers being high is a problem if he's sitting in a good range the rest of the day or if I should be working to bring that number down too.
     
  29. Kris & Teasel

    Kris & Teasel Well-Known Member

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    The best factor for assessing a dose is how low it takes BG, not how high the PSs are. I suggest you stick with 1.25 u for now because the recent mis cycle lows are good. You could keep the dose untli the weekend if you want to try doing a curve. Don't worry about the PSs. The best case is that they come down over time as Alex's BGs are better regulated. Some kitties are very volatile in their response to insulin and that can predispose them to almost always having high PSs. If that continues to be the case for Alex in the longer term a switch to a depot insulin like Lantus *can* help to reduce the highs and lows.
     
  30. Djamila

    Djamila Well-Known Member

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    Those PS numbers are hard to see, but Alex is really doing well in his insulin response right now, especially considering it's so early in his diagnosis. I do think I'd stick with the 1.25 a little longer. It takes time to heal and start to bring the PS numbers down.

    As for the vet, don't be too hard on him/her. There are very few vets that know much of anything about feline diabetes. It's complicated, and they don't get a lot of training about it at vet school. This is all we do here, so we have built up a lot of collective wisdom. I think most, if not all, of us here give our vets updates from time to time, but do all of our own dosing and care decisions. Our vets quickly realize we know more about it than they do and are happy to just sign off on things. I think the only reason you would need to change vets is if your vet was being a hindrance (not renewing your prescription or insisting on lab/in-office testing).
     
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  31. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    So today was curve day at the 1.25u. The curve is much better than the one I did for 1U and he's fairly stable so I feel it's a pretty representative day. Not sure why his +2 was still so high this morning but it dropped like it usually does so I'm not overly concerned.

    I'm going to send this to the vet and get his recommendation (he's probably going to recommend going back up to 1.5) but I'd like some feedback from you folks as well. His mid day numbers are pretty good and the lime green might have just been a fluke. Would you guys experiment with going up to 1.5 to try to get those pre-shot numbers lower without hopefully dropping the nadir ones too low?

    Just behaviourally, his activity level and mood have improved considerably. He's even started running again and isn't quite as wobbly from the neuropathy in his back legs, which is wonderful to see. His pre-shot numbers are high still, but I can tell that his quality of life has improved considerably.
     
  32. Kris & Teasel

    Kris & Teasel Well-Known Member

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    If you can monitor you could try 1.5 u again. He might not dive to lime green this time.
     
  33. Djamila

    Djamila Well-Known Member

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    I agree. I think trying 1.5u again makes sense. You're doing a good job monitoring, so you'll catch it if it's too much.
     
  34. Djamila

    Djamila Well-Known Member

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    Also, as important as the numbers are, it's so good to hear that he's feeling better! Those positive signs are super important for keeping up our own spirits in this process, and they are encouraging that you're on the right track.

    For the neuropathy -- are you giving B12? That can make a big difference in helping to heal from the neuropathy. You just have to make sure you get the right one since there are different versions.
     
  35. Asiina & Alex

    Asiina & Alex Member

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    I haven't been giving him anything else since the weakness wasn't too bad. He wasn't walking on his haunches, just had a bit of a limp and the foot would shake sometimes when he'd put weight on it. The new routine is a lot, so I didn't want to add to his stress, and also want to just change one variable at a time in case something goes wrong. Once his dose is settled if he's still struggling, I might try then but he seems to be recovering pretty well. He was even playfighting with his brother which is hasn't done in a couple of months and I know they miss chasing each other.
     
  36. Kris & Teasel

    Kris & Teasel Well-Known Member

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    FWIW - B12 supplement tablets (eg. Zobaline that many people here use) are tasteless and water soluble. You can easily put one in his food dish with a little water to break up the tablet then add wet food and mix it all together. No fuss, no muss, no pilling of a squirming cat.

    https://www.ilifelink.com/zobaline-for_diabetic_cats-3_mg_x_60_tablets.html
     
  37. Asiina & Alex

    Asiina & Alex Member

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    The vet said to keep him at 1.25 for longer and hopefully his numbers decrease, but honestly I don't think he's going to go down on his own. The pre-shot numbers are currently very stable. I might bump it up a little and try that for a week or so and see what happens unless he crashes again.

    Also the vet told me that they're not going to answer my questions/give dosing advice via email anymore without charging me, which makes sense since they are a business and deserve to be paid for their expertise, but makes me nervous that I won't be able to get that reassurance from a professional. Makes me a little more nervous about taking care of this disease and making decisions without that safety net.
     
  38. Djamila

    Djamila Well-Known Member

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    Meh. We know more than your vet does anyway. :);):cat: They know a little bit about everything. We know a whole lot about this one thing (and its comorbid conditions).

    Although honestly that does kind of surprise me that your vet won't provide email/phone support since you're less than a month into this. I don't need much from my vet at this point, but he's always willing to talk if I have a question.

    Regardless, we are here for you, and since we have all received free support, wisdom, and care around here, we all pass it on just as freely.
     
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  39. Rachel

    Rachel Well-Known Member

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    That is a bit surprising to me. My vet will usually talk to me over the phone if I need anything. When I had Gypsy, I could have called them anytime, though I rarely did since I had this board. But we are definitely here for you and we want nothing in return for our advice except for Alex to feel better!
     
  40. Kris & Teasel

    Kris & Teasel Well-Known Member

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    It's a mental shift we all had to go through but I guarantee you have a better safety net here.
     
  41. Asiina & Alex

    Asiina & Alex Member

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    Thanks for the support everyone!

    I tried bumping Alex back up to 1.5 and he dropped again, so 1.5 is definitely too high, but 1.25 isn't carrying him through the day so I'm not entirely sure what to do. I can only really fine tune so much with such small amounts and such tiny needles. Even the difference between 1.25 and 1.5 is just a sliver of a difference in the syringe, and I'm using the smallest syringes I can find.

    If he's in the good range most of the day I don't know if his diabetes is still doing damage to him when he's high during the 2-4 hours around his shot.
     
  42. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You're using U40 syringes for your ProZinc, right? Well, you can switch to U100 syringes with half unit marks and use this conversion chart to allow more dose fractions: http://www.felinediabetes.com/insulin-conversions.htm This would allow you to give a 1.4 u dose (read from the lines) or a 1.3 u dose (eyeballed) if needed.
     
  43. Asiina & Alex

    Asiina & Alex Member

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    Are the u100 syringes thinner so their units are more far apart? I've been using the logo/placement of the numbers to help guide me with the u40 syringes (the bottom of the 1 is right about where I'd guess 1.25 is so that's what I use to line up the top edge of the stopper), but it's more that the circumference of the syringe makes the lines closer together and part doses harder to determine precisely.
     
  44. Kris & Teasel

    Kris & Teasel Well-Known Member

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    They *might* be a little further part but you'll be able to read them with a bit of practice. They really do open up a broad range of fractional doses.
     
  45. Djamila

    Djamila Well-Known Member

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    I've read many people on here saying that they have bought reading glasses at a higher level so that they can see the lines better and be more precise with the doses. I second Kris' suggestion of getting the u100's so you can do finer dose changes. It takes a little getting used to, but it really helps for sensitive kitties.
     
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  46. Asiina & Alex

    Asiina & Alex Member

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    I'm wondering how long it takes to recover from a missed shot. Three nights ago I gave Alex a partial furshot. I guessed around 1U actually got in, but it might have been less, and he's been reading higher ever since. I'm not overly concerned, but just wondering if these numbers I'm seeing are still the result of that missed shot.
     
  47. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    I realized that it's been a month since I started this. Slightly more since diagnosis, but a month ago I gave my first insulin shot at home. It feels like it's been so much longer and I've learned a lot. I tried to teach my roommate how to give the shots in case they ever needed to, but they totally freaked out and found it overwhelming, whereas it's just become my morning and evening routine. I remember the vet telling me it was diabetes over the phone as if it was no big deal and I completely freaked out.

    It's still an adjustment process every day and Alex is far from regulated, but his symptoms have mostly subsided, and I'm confident I can make changes and monitor him safely. It's still difficult, but no longer feels impossible.

    Thanks to everyone here in making this possible.
     
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  48. Kris & Teasel

    Kris & Teasel Well-Known Member

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    We really like reading reports like this! :)
     
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  49. Djamila

    Djamila Well-Known Member

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    That is a great report! And it looks like those mid-cycle numbers are nice and steady. Now if we could get those PS numbers to start coming down...
     
  50. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    I know right?

    I'm experimenting increasing the dose a little and hoping he won't get too low like he does with 1.5, so we'll see how that goes after a few days.
     
  51. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    I think a little increase is a good idea. Hopefully you can start to build some longer duration. And like you said, hopefully he'll stay out of the lime green numbers!
     
  52. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    I really don't know what to do to get these pre-shot numbers to go down. They're always high in the mornings, but this morning was incredibly high, the worst it's ever been at almost 29. I use Freestyle Insulix strips which are usually pretty close but sometimes can be up to 5 points off, so I double checked with an AT2 strip and it was even higher (32.3). I'm going to watch to see when he goes to the bathroom and check for ketones, and I wasn't planning on doing a curve today, but I might do a few more tests between now and +6 to see how fast he drops, but these AMPS/PMPS numbers don't seem to be improving even a little.
     
  53. Asiina & Alex

    Asiina & Alex Member

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    Another thing I've noticed actually is that the last few days about an hour before he gets his shot in the morning, he's been throwing up stomach acid with bits of fur in it. He's a long haired cat and can get really bad hairballs which sometimes can take him a few days to actually get out and he'll just throw up stomach acid in the meantime until he manages it, but the fact that it's specifically in the mornings about an hour before shot when I know he's absolutely starving is a little concerning.
     
  54. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Does he have food out that he can eat overnight? that puking sounds like what cats do when they've been without food for too many hours.

    As for the high AMPS, it's really not that much higher than some of your other high reds, however, it's also possible that he's going into the lime green numbers overnight and it's a bounce from there. The nighttime cycle is quite different in some cats than the daytime cycle. As often as you can, try to get at least one number during the PM cycle (before bed, as soon as you get up, or anytime if you get up to use the bathroom during the night). It's hard to get these nighttime tests in, but they really are important.
     
  55. Asiina & Alex

    Asiina & Alex Member

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    I checked for ketones just now and he was fine.

    He does have a middle of the night meal on a timer to feed him at +6, which matches what I give him at +6 in the middle of the day, but he eats it very quickly and I know it's gone in under an hour. I have two cats and so it's hard precisely to know how much each is getting, but I know Alex is eating the bulk of the wet food I put out to the point that I've started sneaking dry food to my other cat Simon when Alex isn't looking because Simon likes to graze and Alex will eat whatever is in front of him for the most part. I'll try to get some middle of the night numbers.
     
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  56. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    He dropped quite well, but actually is climbing up earlier than usual which is frustrating. I think I'm going to change his feeding schedule a little to force him to graze more. Won't give as much food at shot time and then set the automated feeder for +4 and +8 rather than just +6 and hopefully smooth out his feedings so he's not binging as much at meal times and then going completely without for usually 5.5 hours. I worry that he might be without food at his lowest point, but I'll try to wake up at 2-3am to give a check since his nadir is around +5-6
     
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  57. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    Checked in the middle of the night and his numbers came up fine, so I don't think the high numbers are due to bounces. I may just need to eventually switch to a different insulin because if I do increase the dose it seems to increase the strength so he'll drop lower, but not really the duration. Whether he ends up in hypo range or in the blues or even yellows, he's still up around 25 by shot time.

    The changing of the feeding schedule seemed to help him from being completely starving this morning and he didn't throw up, so I'm going to keep that going. It actually ends up easier in the long run since I can set up his +4 and +8 meals at shot time and don't actually have to go give him more food during the day or night.
     
  58. Asiina & Alex

    Asiina & Alex Member

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    Tomorrow I'm going to try for the third time to bump it up to 1.5 proper because this dose seems to be getting less effective. I'm almost worried something happened to the insulin but I'm not sure what? I'm careful with it but I don't know if I need to be even more careful.

    I was encouraged for a while about a week ago, but he seems to be sliding backwards and I'm not sure what to do.
     
  59. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    As far as the insulin - you probably already know all of this, but just in case:
    1. make sure it's in the center of the fridge - not the door
    2. roll it to mix - never shake it
    3. Keep it in the fridge - never leave it out
    4. If it ever freezes it has to be tossed
    5. Never inject air into the insulin itself. However...(see #6)
    6. When drawing the dose: 1) draw air into the syringe to the dose you want. 2) while the vial is sitting on the counter, insert the needle into the rubber stopper, and inject the air from the syringe into the air in the vial (not into the insulin itself). 3) invert the vial and draw out the dose.

    If you're doing all of that, and you don't see any floaties in the vial, then the insulin should be fine.

    Good luck with the increase. Hopefully since you've crept towards it slowly, the 1.5u will work well for Alex!
     
  60. Asiina & Alex

    Asiina & Alex Member

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    It's always been in the fridge but I do worry that the fridge runs cold sometimes and it's such a tiny bottle of liquid it might have frozen or developed ice crystals in it that I wouldn't have seen. There's be no way to know other than decrease in potency, I guess. Since this is still my first bottle of insulin, once it does go bad is the decrease dramatic (like it just stops working entirely?) or is it just a little weaker over time and the numbers will start to climb up and eventually I need to make a judgment call about when to get a new batch?
     
  61. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    My guess is if it's losing its potency for less catastrophic reasons the increase in BG would be gradual. If it was subjected to something like freezing (for example) it would likely seem almost completely ineffective right away.
     
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  62. Asiina & Alex

    Asiina & Alex Member

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    Okay, good to know. Thanks :)
     
  63. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    And then I check this morning, prepared to raise it to 1.5u and his AMPS is 20.5, the lowest it's been for weeks!

    [​IMG]
     
  64. Djamila

    Djamila Well-Known Member

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    Lol....love the gif!
     
  65. Asiina & Alex

    Asiina & Alex Member

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    Now I'm debating whether to try 1.5u again and I'm not sure based on this latest trend. Yesterday was great and today is pretty good too, but still higher than I'd like. It's hard to know whether to increase when sometimes he's yellow during his typical nadir but it's possible he's dark green.

    I changed his feeding right around when the yellows started happening and that is helping a bit with the binging and starving, so it does make me feel a little more confident that he'll be a little less swingy, but I still worry about those days when he's in the dark green already.

    What would you guys do?
     
  66. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    You could try leaving him at 1.4 u for another cycle or so to see if he goes down to dark green. You've seen lime green at 1.5 u twice but he won't necessarily do that again. You could "sneak up on it" by trying a fat 1.4 u. You're using syringe lines to measure out 1.4 u so you should be able to place the flat surface of the plunger in a slightly different position wrt the 1.4 u line so that it's a tiny bit more than 1.4 u. Fat and skinny doses take some getting used to but can be a good thing to try.
     
  67. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    Attempting 1.5u for a third time. Let's see if he dives again! If he gets too low even this time after spending so much time inching towards it, I'm just going to decide that 1.5u is too much and not try to push it again.
     
  68. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    So my mid-day test showed it was about the same as the 1.4 which is fine. I'll keep at it for a few days and watch him. I'm wondering how much the feeding change has affected him. So for the record he went from one big meal at shot time and then a little meal at +6, and the same overnight. I changed his feeding schedule right around when these yellows started showing up (I should have written down when I changed it because now I can't remember exactly) to be a medium meal at shot time, then two little meals at +4 and +8. He's getting the same amount of food, it's just spaced out more evenly because he's bad at grazing. It also means that my nadir test at around +5.5 on average is now after he's eaten within the last 2 hours, as opposed to just before I give him his first meal in probably 4-5 hours (depending on how fast he finished his meal from when I gave him the shot).

    Is it possible that the drops were just because he was too hungry mid-day and really his dose should be higher overall? Can spacing out feeding time make that much of a difference?
     
  69. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    We've actually found that a lot of cats do better with their BG when their food is spaced out through the day. I'm not really sure WHY but I've seen it time and time again. Maybe because their BG can be more stable through the day since it has food on board more consistently? Anyway, yes, changing feeding times could definitely affect the BG numbers. Let's hope that this new food schedule and the 1.5 dose can work well together and we can help you get Alex into nicer numbers!

    As for not feeding 2 hours before a test, that's only a worry at shot time. That's just so you don't shoot on some artificially inflated number. Throughout the day, even on curve days, you want to feed as you always do and just test whenever you need to. :)
     
  70. Asiina & Alex

    Asiina & Alex Member

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    It's not that I try to keep him without food. He just eats all his food so fast that he ends up with nothing to eat for most of the day. I have the automatic feeder giving him his +4 and +8 meal, but I can't really be around to give him small meals all day. If he ate slower he'd always have food out (other than the 2 hours pre-shot). He's definitely getting enough food and I worry about overfeeding him as it is. I've had to start giving the other cat meals and dry food on the side when Alex isn't paying attention, to make sure that he's still getting enough.
     
  71. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    Bad last night, but a good morning. I'd gotten so used to red numbers that even pinks feel "low" for me and make me nervous to give a full dose. I've only seen yellow once at pre-shot since starting. Some parts of this feels so routine and some still makes me nervous.
     
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  72. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Good job sticking with the dose. Hopefully he'll find his way towards some healthier nadir numbers soon!
     
  73. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    Thanks :)

    He did have good nadir numbers, but the change in feeding schedule made those go away. I don't mind so much though, since it means I can probably increase the dose eventually and get all his numbers down eventually, instead of him swinging so hard in both directions. I had been locked out of 1.5 even though I knew it wouldn't be enough because of his nadir numbers. Hopefully I won't have to change insulins now.
     
  74. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    Alright, so it's clear the feeding change has had a big impact. I'm actually a little relieved, since I have the options to increase the dose that I didn't before. So I'm wondering when I should just accept that he should go higher than 1.5u? His numbers are getting worse, not better, now that he has more steady access to food.

    Should I do a curve tomorrow and then increase to 1.75 over the weekend? Do you guys think a curve is necessary? Should I wait a few more days?
     
  75. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    Any advice? I don't want to rush him, but it really does feel like 1.5 isn't working on this new feeding schedule. He was doing better before. I'm almost worried the insulin is less effective, but it's only been about 6 weeks.
     
  76. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    His food is low carb wet, right? The schedule does seem to have had a pretty dramatic effect. Although as you said, having him steadier does make the dosing work better. It's just too bad that steadier also means higher in this case.

    Normally I don't think doing full every-two-hour curves are necessary, but there really isn't enough data to be sure if he nadirs early, mid, or late, so I think I would recommend doing a curve if you can. You want to be sure that those yellows really are representative of his lowest point in the cycle. It's not impossible that he is going lower before or after that and it's just not being caught.
     
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  77. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    Yes, he's getting the same Friskies pate he's been getting the whole time, and it's all low carb. I alternate between the whitefish and tuna, salmon, and seafood supreme since he can get kinda finicky if he gets the same food several times in a row. I feed two cans a day for both of my cats. He eats slightly more than the other one so is getting about one and a quarter to one and a half cans per day (other cat gets dry food on the side to make up for his not wanting wet food all the time, but always supervised so Alex never gets any).

    I'll do a curve tomorrow. I don't think it'll really tell me anything I don't already know, but just to be sure and then likely increase his dose over the weekend.
     
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  78. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Not actually a bad curve today at all! Sure the numbers are higher than you want, but you had a nice drop into mid yellows, which is a pretty good drop from AMPS. I do think it's time to go ahead and increase the dose...tonight or tomorrow if you'd rather do it during the day. Hopefully that'll help get him into better numbers throughout the cycle!
     
  79. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    Yeah I'm pleased with how the day went. It's still high, but I'm not really worried about high numbers right now as much as how steep the curve is. It's much gentler now, so I feel safer increasing the dose. I'll do it in the morning so I can monitor him throughout the day.
     
  80. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    How do you know when an insulin vial is becoming less effective? I'm getting really scared for Alex that he's still so terribly unregulated after all this time. Every day is just red and black numbers and he never seems to be getting better about that. There's no improvement at all there. The feeding change has made a larger impact on his pattern than the insulin has.
     
  81. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    I checked him for ketones and he's negative still, although he ate the meal that usually takes him about an hour to 90 minutes to eat in 7 minutes. All of his food I just gave him is gone and he threw up stomach acid this morning.

    I don't know if the other cat overnight ate too much of his +8 meal so he didn't get much, but he just ate half of a can of friskies in less than 10 minutes and is still here begging me for more.
     
  82. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    If they drop 50% in a cycle, the insulin is working. So now it's just a matter of continuing to work with the dose. You did a good job of just keeping that last dose for six cycles, and then moving up to the next baby step. And while you're right that the PS numbers are too high, the curve really shows a good response. It's just going to be a process. He really hasn't been on insulin very long at this point. It's so hard to be patient when you're seeing red and black numbers, but there really isn't any way to speed the process.

    I can't remember what you've said about Alex' weight? If he's under weight, it's okay to feed him more - high numbers do legitimately make them hungrier. If he's over weight, he might just have to tough it out until snack time. Regardless I'd make him wait a little bit so he doesn't throw up. A full meal that fast has a tendency to make a reappearance. :confused::eek:;)
     
  83. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    He's a little underweight, although he's gotten better. He's about 10.5 lbs but is a large frame, so I can feel his spine and rib and hip bones quite easily. Hard to visually see his weight because he's so fluffy and the long fur makes him look bigger than he is.

    I know it was just one day, I was just really hoping the 1.75 was going to make a bigger difference. I'd agonized about going from 1.25 to 1.5, but with the feeding change his numbers just haven't come back down. I'd gotten really hopeful consistently seeing those single digits a few weeks ago, and they haven't been back since.
     
  84. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    I only need to wait 6 cycles before increasing, right?

    Much better mid day numbers today, but these black numbers at pre-shot are getting more frequent and I'm getting scared. He was having some trouble with his legs earlier today and he was so hungry that I fed him more than I usually do. He eats so fast that he burps a lot after eating and I worry he's going to throw up.

    I know I'm doing everything that I can but he was doing well for a while and now seems to be getting worse. Some days this feels manageable and some days it's like I'm just taking notes as I watch him waste away.
     
  85. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Yes, you can increase after 6 cycles if you're not seeing lower mid cycle numbers. I know this is scary, but give it time...he's getting some good responses to the insulin and it really DOES take time. Remember that he didn't become diabetic overnight, and he won't get better overnight either. :bighug::bighug:

    You could try giving him smaller, more frequent meals so he doesn't eat as much at once, but is still getting more food. I can't recall your feeding schedule, so if you already do this, ignore me. :)
     
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  86. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    I updated my signature to put in his meal schedule, since I did change it and that's what had him end up higher, although less starving over the day. If he was staying the same it wouldn't be so bad, but I'm seeing black every day now at at least one pre-shot test, whereas before it was pretty rare. It feels like he's getting worse.
     
  87. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Is there anything going on that might be causing him inflammation? Is he having any litter box issues? Dental issues?
     
  88. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    No. He uses the litter fine, and eats great. He could probably get a cleaning, but his teeth aren't bad for his age. His gums look fine.

    When he was diagnosed in January we didn't know what was wrong with him so they did a full lab workup and found nothing but the diabetes.
     
  89. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    Alright, time to give 2u a try. Unless he needs to go back down, gonna stay on this through the time change just because I don't want to mess up dosing.
     
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  90. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    I took a really good look at Alex's gums (which he hated) and they are a bit red, and then I tried brushing them gently and they bled, so I'm going to see if the vet can give me an estimate of dental work, since if he does need dental work his diabetes will never be controlled until I do it. I'm likely going to have to go into debt for this, as I hear it can cost thousands of dollars, but there's no point in continuing diabetes treatment if it's just being counteracted by gum disease so right now I'm just throwing money away.

    I don't really know what else to do at this point because the dose seems to have no relation on how the insulin works The insulin is working, he has a nice curve, but I'm getting the same curve regardless of whether I give 1.25u or 2u. He's in the red or blacks at pre-shot and drops to yellows or maybe high blues at nadir.

    Those two weeks mid-February of blues seem to be a result of him being hungry at the same time as his nadir, because as soon as I changed the feeding schedule so he could eat smaller meals more often, they went away and haven't returned.
     
  91. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Goodness, I hope not thousands of dollars! They are expensive, but with all the blood work and meds and procedure it shouldn't be more than one thousand - unless there are perhaps a number of extractions involved. They are certainly expensive, but hopefully less than you're imagining.

    I would strongly encourage you to switch to a human meter. For one thing, they are much less expensive, and much more convenient. And for another, the numbers read so much better while still giving you the data you need to adjust doses. I really do think it would make you feel better, and how you are feeling about all of this matters a lot. :bighug: Plus, the study on which we based our guidelines for dosing was done using human meters, so it just fits a lot better. Of course you can keep using the AT2 if you prefer, but I'm a big fan of using human meters.
     
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  92. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    How do you mean the numbers read better?
     
  93. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    In the high ranges, a human meter and a pet meter can give quite different numbers. So a 400 on a pet meter might be a 300 on a human meter. There's no way to convert between the two, so those are just random numbers.

    In the lower ranges, the two can be quite similar, and sometimes the pet meter will actually read lower than the human meter, although they're usually fairly close in the green numbers.

    So while the human meter isn't precisely accurate, it still gives you the info you need: too high, too low, just right. If you decided to switch it would take you a little while to mentally adjust, but once you do, I think it will help you feel better.
     
  94. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    I ordered one of those free human meters that are available in Canada, so I'll give it a try. In the meantime I'll try not to freak out too much about the exact numbers of too high, and just accept that it's too high.

    I am still frustrated that nothing seems to bring these pre-shot numbers down, but I did get a 6 yesterday, which was nice. It's been a while since I've gotten a nice nadir number like that.

    I'm going to see about getting that dental work done, but he needs some vaccines first (he's completely indoor so vets haven't ever really insisted on it). I'm working with the vet because I'm a little worried about the vaccines when his diabetes isn't controlled super well. I know they can sometimes cause mild illness and I don't want the illness plus the lack of control to trigger DKA.
     
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  95. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Hopefully getting the dental work done will help. and while vaccines can make them a little blah for a day or two, they bounce back pretty quickly.
     
  96. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    Talked to the vet. They might wave him on the vaccines because of the risk of DKA and he can get them once his diabetes is more controlled, but they want to do an exam first to see if he can even handle the dental work and whether he really needs it. I look at his gums and they're a little swollen on the gum line and there's some discolouration on the teeth, but I'm really just guessing on how serious it is.

    Another bad sugar day, which sucks. I try not to get so worked up about particular days and look at the whole, but it's hard. This is pretty personal, but I went to the doctor myself today and get some anti-anxiety medication because I haven't been sleeping well because I'm so stressed about this. I'm starting to dread pre-shot time because I know it'll be bad and there's nothing I can do about it.
     
  97. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Yes, I saw that mid-cycle and almost said something. Days like that are hard. :bighug::bighug::bighug:

    All of this can be quite stressful, so I'm glad to hear that you are taking care of yourself and getting the help you need for now. We spend so much time giving our kitties what they need that it can be hard to step back and make sure we're taking care of ourselves too. You are taking steps to do that, which is so good! It's kind of like they say on airplanes - we have to make sure we have our own "oxygen mask" in place first, right?
     
  98. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    I posted this in the main forum this morning but haven't gotten a reply and I'm not sure what to do.

    Alex has allergies, I think. He's been coughing a bit and his nose is runny. He's still eating and drinking, but obviously his BG isn't where I want it to be. Today especially he was pretty high at nadir. I've been testing him for ketones every day, but the last few days he's been closer to trace than none, it's kind of in between. I realized that the light in the bathroom wasn't the best, so next time he goes I'm going to make sure to get a reading with good light. By the time I did get good light last time it definitely was at trace, but it had been longer than 15 seconds so I'm not sure.

    I have no idea when this becomes an emergency. He's going to see the new vet on Wednesday so if I'm just being paranoid, I don't want to potentially waste hundreds of dollars I don't have for them to say that he's fine.

    I've put out extra food which he's eaten and even made him drink a little more water just to make sure he has every opportunity to flush these out (also so that hopefully I can get another test in again today). I'm trying not to freak out but failing pretty bad.

    There's lots of information about how ketones are serious and DKA can happen fast, but how fast is fast? 6 hours? 12? 24? 48?

    If he really was at trace a few hours ago but let's say worst case I'm not able to check again for ketones until tomorrow morning, is that fast enough for it to turn into DKA without me noticing?
     
  99. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    Ughhh

    Alex broke into contraband dry food this morning. We keep dry food around for Simon, and when I woke up this morning and realized that neither of them were bothering me for food I knew something was wrong. Sure enough I find them and the container is open on the floor with the lid popped off. I need to start using a lid that locks, they're getting smarter.

    Well, Alex was still unregulated anyway, so I don't think this will make a huge difference, but I imagine today is going to be a pretty high sugar day since he'd be snacking on junk food for some amount of the night.
     
  100. Asiina & Alex

    Asiina & Alex Member

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    Jan 16, 2019
    Yuuuup. Over 30 for AMPS. I know he ate dry food in the last 30 minutes, so it's artificially high.

    Hopefully because it's carbs it'll burn off quickly and won't affect anything beyond this cycle? I'm actually not sure.
     

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