Flat readings - suggestions for dosing?

Discussion in 'Prozinc / PZI' started by Ramon's mom, Jan 29, 2019.

  1. Ramon's mom

    Ramon's mom Member

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    Ramon has been having flat readings in the upper 200's (Human meter) for a few weeks. Today's curve was pretty flatish too. I am thinking I should try to bump his dose up a tad (to 1.4 from the 1.2 he's been getting). Am I right in thinking this? I really don't want to trigger a bounce but I'd also rather get his readings down. (check my human meter spreadsheet)
     
  2. Rachel

    Rachel Well-Known Member

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    It's hard to be sure what's going on. Honestly, it could be that you just need to kick it up to 1.4, but without more mid cycle numbers (not even necessarily nadir just whatever you can get) we can't be sure that today's cycle wasn't just a bounce cycle. High and flat all day usually means a bounce...but could also mean a sudden drop is coming. Is there any way you can get more numbers through the day or night? Not always the same, just anything you can. I can't recall your schedule off the top of my head (my memory is terrible I'm sorry!).
     
  3. Ramon's mom

    Ramon's mom Member

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    So you think I need a few more days of checking mid-cycle numbers before making a change? I had stopped for the last week because his readings were disrupted while I boarded him out so I could go on a trip. I'm certainly glad he is steady instead of swinging all over the place like he had been earlier (including on the Alpha Trak spreadsheet). But I'd like to see him lower.
     
  4. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I agree about trying to get a few more BGs in the +4 to +7 range or so. The dose's effectiveness is judged mainly by how low it takes BG. A pattern that's noticed often is that a flat run of yellows often precedes a drop in numbers so keep that in mind. I don't think anyone knows why but it's commented on often.
     
  5. Ramon's mom

    Ramon's mom Member

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    If you think there are enough additional readings now, would you say its safe to try the 1.4u in the morning?
     
  6. Rachel

    Rachel Well-Known Member

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    Looks like part of the day cycle was a fur shot, is that correct?
     
  7. Ramon's mom

    Ramon's mom Member

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    No I'm pretty sure it was not a fur shot. He is shaved and I always rub around the area to see if there is any wetness. He has often gotten flat readings all day with no apparent reaction to the insulin I give him.
     
  8. Kris & Teasel

    Kris & Teasel Well-Known Member

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    He's an up and down and flat kitty. It's trickier to find a good dose but you'll get there. The best way to tell if you've had a total or partial fur shot is to smell the area. Lantus has a really strong Bandaid -like smell.
     
  9. Ramon's mom

    Ramon's mom Member

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    Ramon is on Prozinc.
     
  10. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Oops - sorry! ProZinc has an odour too.
     
  11. Ramon's mom

    Ramon's mom Member

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    Well I am 99% positive he is not getting fur shots. I'm certain I would feel the wetness. And I am using very short needles and can see exactly what I am doing since his hair is shaved off. This has been an ongoing problem with his BG numbers. he tends to have very flat curves most of the time.
     
  12. Rachel

    Rachel Well-Known Member

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    Sorry I think I looked at the wrong SS and saw a note about a fur shot on that! Sure, you can try bumping to 1.4 and see what happens...but I'd be sure to do that on a cycle you can monitor.
     
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  13. Ramon's mom

    Ramon's mom Member

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    Bad news. The 1.4 not only didn't improve the curve much but now he is up past 300 for PMPS and 2+ PM I think I triggered a bounce up. I need to go to sleep and cannot do more testing tonight. I can only hope it doesn't swing way down after this. All I really wanted to do was to get his nadir into the blue. Darn.
     
  14. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I think you haven't yet reached the good dose range and have probably been holding ineffective doses too long. That can lead to glucose toxicity which shows as a general unresponsiveness to insulin. What we often suggest here is to hold a dose for only 3 to 4 cycles if it doesn't give a good BG lowering response - ie., BGs dropping to low blues or high dark greens mid cycle. Why not try a 0.2 u increase after 3 to 4 cycles and continue that until you see progress? For a month now you've been dosing in a very narrow range of 1 to 1.4 u and he likely needs more.
     
  15. Djamila

    Djamila Well-Known Member

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    I agree with Kris - this is more likely insufficient insulin than a bounce. Also, the evening before you had a 295 and the morning of the increase you had a 285, so 310 is right in that same range. Sometimes when it changes colors it makes us feel like the difference is bigger, but in reality those numbers are all essentially the same. So it didn't "go up" so much as just pretty much stay the same.

    I think doing some systematic increases as Kris suggested would be a good idea to see if you can't get him moving a little.
     
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  16. Ramon's mom

    Ramon's mom Member

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    Thanks for the input! This morning @ +11 he was 237 and at AMPS, after eating, was @ 258, so I think I'll finish out the 1.4 dose for 2 more cycles (to make 4) and see what this really is going to do for him. If the nadir still doesn't go down I'll try your suggestion of bumping it up another 0.2
     
    Last edited: Feb 2, 2019
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  17. Ramon's mom

    Ramon's mom Member

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    Any thoughts now on his readings? The 1.4 dose has leveled out again so I'm still getting only yellow readings, though I guess there is a nadir dip within that, so I suppose that's an improvement. Anyway, do I keep at the 1.4 longer or make another move to 1.6? Thanks again for any advice!
     
  18. Djamila

    Djamila Well-Known Member

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    Yes, I think you can move to 1.6 now. That's a lot of sunshiny yellow!
     
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  19. Ramon's mom

    Ramon's mom Member

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    Well, 2 doses now on 1.6 u and nothing is any different. Though he is acting kind of hyper and OCD-ish (could that be caused by the increase in insulin?) I'll keep monitoring him but I am back to being confused and frustrated. Any words of encouragement for me? Also, I poked myself with his insulin needle, after I injected him. Should I worry about that?
     
  20. Djamila

    Djamila Well-Known Member

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    Don't worry about the poke. We've all done it and no one has turned into a cat yet ;)

    As for the dose, some cats will push back against a dose change for the first cycle or two and then react to it on the third or fourth cycle. If you don't see anything before cycle 4, go ahead and increase to 1.8u.

    It's a process. It takes some time. And this is Ramon's second round of diabetes which is much more stubborn than the first round. You'll need to be persistent with the increases until he starts to respond. Hang in there, and keep posting. Knowing that you're not alone can really help, especially when improvement is slow to appear.
     
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  21. Rachel

    Rachel Well-Known Member

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    Though sometimes, I wish I WOULD turn into a cat! Sleep in the sun all day, someone else pays the bills and caters to my every need....ahhhhhh!

    I agree with Djamila. Continue the increases every 4 cycles or so (most people prefer to increase on cycle 4 as you probably know...so you can always increase during the day). Give it some time and don't get frustrated. The second round is always harder than the first. :bighug::bighug:
     
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  22. Djamila

    Djamila Well-Known Member

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  23. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I love that image!! So true! :D
     
  24. Ramon's mom

    Ramon's mom Member

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    As I am now contemplating going to 1.8 units I went back and looked over the charts for the past 2 months. December was still on the Alpha Trak meter chart, but it actually looks better at the 1 unit dose than the last month on the Human meter chart on the raised doses. I was raising the dose to try to stop how erratic his numbers and curves were, but now that all I get are higher numbers even as I raise his dose I am wondering if I really need to go back to 1 unit. I still prefer him having steady numbers but his current ones just seem too high. Any thoughts to help me on this?
     
  25. Kris & Teasel

    Kris & Teasel Well-Known Member

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    My opinion is still that his dose needs to go up. Glucose toxicity can build quickly and the kitty loses responsiveness to insulin. Let's see what @Djamila thinks.
     
  26. Rachel

    Rachel Well-Known Member

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    I'd up the dose too. You've done great getting some number throughout the cycle and it shows that he's staying high and flat. You want to see if you can't get some more of a drop during the cycle.
     
  27. Djamila

    Djamila Well-Known Member

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    I absolutely understand the temptation to read the data that way. We've seen lots of people try lowering the dose based on the same reasoning you shared. What usually happens is that the cat will have a nice cycle on the first lowered dose, raising hopes that this was the right decision. But then start to escalate in the subsequent cycles into higher numbers than they've seen before. And on more than a couple occasions, the cat has ended up in DKA as a result. That last part doesn't always happen, but I can think of four off the top of my head in the past couple of years. Too many to risk it, in my opinion.

    I believe Kris and Rachel are right - you're seeing glucose toxicity, and the remedy is to raise the dose in steady and persistent fashion until you break through it. It is super frustrating, but it's a fairly common problem. Sam even went through a round of it recently. I ended up at 4u before we finally broke through.

    Adding to the complication, Ramon is on his second diagnosis. It took me a number of months into our second diagnosis before I really started to understand how different it is from the first round. I found that with Sam I had to be much more aggressive with dosing the second time around, and that can be hard to get used to since during a first diagnosis we urge so much caution. Time will tell what Ramon needs, but for now I think we are all in agreement that continuing with the increases every 4 cycles or so is going to be the best thing right now. At some point he's going to start bouncing and when that happens (hopefully sooner than later) you can slow down again.
     
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  28. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I didn't mean to exclude you, Rachel, when I said let's see what Djamila thinks. Just a boo boo. :confused:
     
  29. Ramon's mom

    Ramon's mom Member

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    I am now wondering if he has started bouncing. Last night he was at 225 and this morning he is at 314. I gave him the 1.6 again because I was feeling too ill to stay up and monitor. I can monitor today but now that he has swung back up high again I wonder now if this means I should stop increasing. Don't know if I'll hear back from you or anyone before I have to decide his morning dose but I though it was worth posting the question....
     
  30. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I'd try 1.8 u this AM. You don't stop increasing if you see bouncing but you might have to slow the rate of dose increase. The best guide to know when you're approaching a better dose range is the appearance of blues and then dark greens in the middle part of the cycle.

    This is what @Djamila said:
    At some point he's going to start bouncing and when that happens (hopefully sooner than later) you can slow down again.
     
  31. Ramon's mom

    Ramon's mom Member

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    Thank you for answering so quickly! I'll go ahead and do the increase. I don't know why this one seems scarier to me than earlier increases.
     
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  32. Rachel

    Rachel Well-Known Member

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    Haha don’t worry about it Kris! I knew you weren’t excluding me...you didn’t say let’s NOT see what Rachel thinks. I figured you saw Djamila online or you’d both been helping on this thread and that’s why you tagged her. I just happened to be online and figured I’d jump in too!
     
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  33. Ramon's mom

    Ramon's mom Member

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    Two doses so far on 1.8 and his levels are swinging high and wide. Plus more concerning is that at 1.8 he goes into a deep sleep quickly after. Almost lethargic. Is this good?
     
  34. Djamila

    Djamila Well-Known Member

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    His numbers look consistent with the ranges you've been seeing. It takes awhile to break through the insulin resistance. The lethargy isn't uncommon, unfortunately. Staying in higher-than-ideal numbers leaves them feeling a little wonky, and the influx of insulin can take some getting used to. Especially since his body is going to fight it until you reach a breakthrough dose. This part of the dance can be hard. As I mentioned I just went through it with my cat recently and I'll admit I cried a few times as we went up and up the dosing scale. But once we broke through he started playing like a kitten, his energy returned, and he's been a ton of fun the past few weeks. The waxing and waning of this disease can be hard on us as caregivers too. Please make sure that you're taking care of yourself during all of this. :bighug:
     
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  35. Ramon's mom

    Ramon's mom Member

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    Once you hit the high dose that works will it ever come down again? I guess in the back of my mind I just want him to go back into remission, which seems impossible if I have to keep increasing the dose (I'm also dreading telling his vet, without consulting her, that I went up a whole unit from what she recommended). Thanks, by the way, for all the advice and encouragement.
     
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  36. Kris & Teasel

    Kris & Teasel Well-Known Member

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    If the high-ish flat numbers are from glucose toxicity the BG range can drop once you break through that but not always. Sometimes you get to a dose level that gives a good response and you stay there. Having said that, there are often minor fluctuations in dose needed to maintain a good BG range.
     
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  37. Djamila

    Djamila Well-Known Member

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    In Sam's case, yes. We got to 4u, and now we're down to around 2u (it does go slightly up and down). However, as Kris said, some cats simply need larger doses to stay in good numbers. Only time and data will tell.

    As for the vet, if you show her the data, it's hard to argue too much. The current dose clearly isn't working, and sitting in unhealthy numbers is dangerous as it causes organ damage and greater risk of DKA. I think most of us either win over our vets pretty quickly, or find a new vet. Hopefully your vet will be willing to learn and trust that you're making careful, data-driven decisions, and you'll be able to keep working together to help Ramon.
     
  38. Ramon's mom

    Ramon's mom Member

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    This morning, just as I was planning to go up to 2 units I gave him a fur shot. Do I monitor? Do I stay at 1.8 for the PM shot? I guess I just hope that the evening BG hasn't zoomed too high.
     
  39. Ramon's mom

    Ramon's mom Member

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    Is it possible that his high flat readings are due to his insulin not working anymore? He is on Prozinc since late November, the same vial. Could it have gone bad in that time? Its been refrigerated since then except for one 8 hour stretch.
     
  40. Djamila

    Djamila Well-Known Member

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    Ramon’s numbers are high enough that I’d go ahead and increase tonight. The odds of going too low are very slim give his usual range right now.

    It’s not impossible that you have a bad vial, or that it’s lost effectiveness, although unlikely. We regularly use prozinc 3-4 or even up to 6 months with no problem as long as it’s stored properly (not in the door of the fridge, not shaken, proper temp). Unless the eight hours was during a heat wave, it’s probably fine.

    You can always go ahead and get your next vial and give it a comparison.
     
  41. Rachel

    Rachel Well-Known Member

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    I agree, I think it's time to go ahead and increase. He might be high tonight but that's okay. It happens...fur shots happen to everyone and we just deal with them.

    As for the vial, you could try a new one if you wanted. How much of the old vial have you used up?
     
  42. Ramon's mom

    Ramon's mom Member

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    Its about half used up. It cost $100 so I would love it to last longer. This cat has cost me a ton of money for all his tests and now his ongoing meds and supplies. :-(
     
  43. Djamila

    Djamila Well-Known Member

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    I used my first vial for six months and it didn't seem to lose effectiveness. After six months I just felt better replacing it.
     
  44. Rachel

    Rachel Well-Known Member

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    I think you'd be fine to hang on to your current vial then. You could give it some time and then see if things get better before worrying about replacing.
     
  45. Ramon's mom

    Ramon's mom Member

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    Since I started raising the dose every few days things have not only not improved but now we are regularly getting numbers in the 300's. I really feel nervous about this.
     
  46. Djamila

    Djamila Well-Known Member

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    Ultimately, you hold the syringe. We will always give you our best thoughts, but in the end, since you are the one who has to live with the consequences, the choices are yours to make. I still think the increases are the right thing to do right now, but if you decide to try a lower dose instead, we will still be here to help. No one gets their feelings hurt around here. :bighug:
     
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  47. Ramon's mom

    Ramon's mom Member

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    Tonight his PMPS was 351, the highest he has ever been at home. I gave the 2 units again but it just seems to get worse and worse.
     
  48. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You could try an experiment and drop the dose to a level you feel might work better. Leave it there for a few days to see if there's an improvement. If there isn't you can increase again. At least you'd have evidence one way or the other.
     
  49. Ramon's mom

    Ramon's mom Member

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    Well the last dose that he got any blues on was 1.2 though they didn't stay there long. Is that too big a drop, to go from 2 units to 1.2?
     
  50. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I can't say for sure but I don't see why it should be. Too large an increase in dose is potentially more dangerous. ProZinc isn't a depot insulin although sometimes it can have slightly longer than 12 hour duration. You should see the effect of the dose decrease in a couple of days. We always worry about ketone development when BG runs higher so you might want to do urine ketone testing while you do this experiment.
     
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  51. Ramon's mom

    Ramon's mom Member

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    Since his BG dropped to 283 this morning I decided to do one more cycle of the 2. I will try to do a ketone urine test today and then try dropping his dose this evening. Thanks.
     
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  52. Ramon's mom

    Ramon's mom Member

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    Well I stuck with the 2 Units because his PMPS was 250 and now @ +2 he is at 205! I will have to set my alarm to check him at @ +6ish at this rate.
     
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  53. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aside from finding the good dose range, Ramon's two inflammatory health conditions as well as the meds he needs to control them are probably affecting his insulin response. As we often say to others, it's a matter of dosing around them.
     
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  54. Ramon's mom

    Ramon's mom Member

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    Today I am going to try to drop the dose back to 1.2 and see if his numbers come down. At least when I was staying steady at 1.2 his numbers stayed in the mid 200's instead of the high 200s/low 300s. Plus he seemed to feel better at 1.2 than he does right now. He is definitely not feeling well currently.
     
  55. Ramon's mom

    Ramon's mom Member

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    Well the numbers are just as bad but he was acting so much happier all day at this lower dose. I guess I'm committed now to the lowered dose.
     
  56. Rachel

    Rachel Well-Known Member

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    Please do make sure to keep up the ketone tests! Let's see how this dose goes and then we can go from there.
     
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  57. Ramon's mom

    Ramon's mom Member

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    This morning BG is 332. So this is not going well. Weirdly enough his ketone tests have been normal including when he was tested @ 415 while at the vet's (his highest BG). I am assuming that I should give it the 4 cycles before heading back up in dose?
     
  58. Djamila

    Djamila Well-Known Member

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    You don't need to wait to start increasing the dose. You can move him up now. I wouldn't go all the way back to 2u in one jump though - maybe increase by around 0.4u now and tonight, and then the rest of the way tomorrow.
     
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  59. Kris & Teasel

    Kris & Teasel Well-Known Member

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    If you can monitor you can increase right away. Are you planning on trying 1.4 u then 1.6 u etc. or just bumping him back up to 2 u?

    As I said before I think his less than ideal response is due to his two inflammatory conditions and the meds he needs for them. It doesn't mean you won't find a better dose range for him but it likely will mean erratic responses and a rockier road getting him to good BG levels. It will probably be harder to hold him there too. It is what it is and we aim for the best BG level we can sustain in the circumstances. My cat has some level of IBD and a long history of being erratic and hard to predict. My SS is still quite colourful after three years, three insulins and two bouts of DKA. To some my SS would look horrible but to me it looks like Teasel's version of good enough.
     
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  60. Ramon's mom

    Ramon's mom Member

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    I gave him 1.2, not knowing I would get advice this quickly. That was 40 minutes ago. Could I give .2 or.4 more at this point? I can monitor except late afternoon (2:30 - 7 pm, which would be +6 to +10ish). Ramon has been erratic since July except for the time on 1.2 where he was flat in the 200's. I had switched from Lantus because of the erraticism. Should I be looking at switching him back? Or is Prozinc just as good?
     
  61. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I suggest you wait until this evening for the increase in dose.

    Give the ProZinc some time. What was the date of the switch to ProZinc? Maybe include it in your signature. If it turns out that you can't get him to a good BG range you can try Lantus again in the future.
     
    Last edited: Feb 13, 2019
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  62. Ramon's mom

    Ramon's mom Member

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    I feel kind of bad because trying this experiment seems to be making my kitty swing up and down in how he feels. He felt better from having the insulin dropped but his higher BG numbers are now making him very grouchy and he's gotten aggressive with my other cats again from it. I bumped him up to 1.6 tonight (his BG at PMPS was 372 which is yet a new high). I guess I'll follow the advice I'm getting here and just keep going up and up on the dose and pray we get a stable place that he will feel better at. For a moment there I almost thought maybe the insulin is actually doing bad things to him and that I should take him off it completely. But all the aggression tells me otherwise.
     
    Last edited: Feb 14, 2019
  63. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You'll get there. It's very possible that you might want to try Lantus again at some point. It's less likely to cause big ups and downs and you might have success if you follow the Lantus dosing guidelines more closely. For now let's see what ProZinc can do. :)

    Another member posted this link to a FB video of a research vet at Britain's Royal Veterinary College. He's discussing a research trial they conducted comparing remission rates in cats treated with Lantus versus ProZinc. He also makes a lot of good points about other issues:
    https://www.facebook.com/watch/?v=10154849470681010
     
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  64. Ramon's mom

    Ramon's mom Member

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    Thanks for the link. I will try to view it this weekend. At this point he has received the 2 units 3 times (we're just starting the 3rd cycle after going down to 1.2 and then back to 1.6 and now 2 units). Tonight I caught him eating @ +11.5 so I quickly took his blood sugar on his second mouthful and it was the lowest its been in almost 3 weeks (211). @ PMPS I retook the BG (after he had eaten) and it read 286. I gave him the 2 units again and plan to monitor. Assuming he doesn't bounce too low over night but continues to read @ 200 (or even lower) in the AMPS, should I still give the 2 units? I just don't know what to do next. Thanks!
     
  65. Kris & Teasel

    Kris & Teasel Well-Known Member

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    The general approach is to keep a dose for 3 to 4 cycles. If the nadir numbers don't drop to at least blues, increase by 0.2 u (because you use U100 syringes) and repeat. Ignore the pinks, etc. and focus on the middle range numbers. If he bounces, so be it. Your goal is to lower the middle numbers in the +4 to +7 range. That's where you'll see the progress if you're getting to the good dose range. If you have a much lower than usual PS you can stall without feeding for a half hour, retest and if he's rising give the usual dose.
     
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  66. Ramon's mom

    Ramon's mom Member

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    I've followed your advice. And now in his 2nd cycle at 2.2 units he dropped 135 points from a PMPS of 322 to a +4 reading of 187! I plan to set my alarm and test again @ +6 to see if he drops another 135 ! I hope not. I hope this is just getting to his good dose range. Any thoughts to encourage me? @Djamila ? @Rachel ? @Kris & Teasel ?
     
  67. Rachel

    Rachel Well-Known Member

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    Sorry! I was fast asleep last night when you posted this. :) It looks like he stayed nice and safe last night though. I'm hoping this will help lead to a nice AMPS!
     
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  68. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I'm so happy to see those blues! :cool: The 135 is a very nice but safe number. Keep the 2.2 u today and we'll see how he does with it in the daytime. They often run lower at night.
     
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  69. Kris & Teasel

    Kris & Teasel Well-Known Member

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    You can try 2.4 u tomorrow AM, evening numbers permitting.
     
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  70. Ramon's mom

    Ramon's mom Member

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    Dec 6, 2018
    AMPS 234! But PMPS 373. No blues today. This brings me to another dilemma. I'm also going to be boarding him for 5 days while I go out of town. The cat sitter will give him his meds, test BG and give insulin but I was planning on prefilling syringes for her and instructing her to only inject if the BG is above say 225? Given this, should I continue increasing the next 2 days or stop and resume when I get back?
     
  71. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    I'd stick with increases until it's time to go out of town. When are you leaving? Are you boarding him at the vet or having someone come over to your house?
     
  72. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    How long is it before you leave on your trip? We can suggest a safe dosing routine according to the BG data you accumulate between now and then.

    I suggest you increase to 2.4 u this AM.
     
  73. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    I agree with Kris and Rachel about continuing the increases for now. Leaving town is always hard, but we can help figure that out when the time comes.
     
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  74. Ramon's mom

    Ramon's mom Member

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    Dec 6, 2018
    I leave in two days (7:30 am CST). I am boarding him with a pet sitter who tells me she has experience with a diabetic cat. I can't leave him at home because he'd hide from a pet sitter there (plus he bullies 2 of my other cats). And the vet charges $80 a day. Anyway, please do suggest a safe dosing routine for him! I'll go ahead with 2.4 today. 2.2 has worsened things again. 352 this morning.
     
  75. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Actually, until you get his BG down more you're very likely to see these ups and downs. You might see a glimpse of better numbers then he'll go back to higher values. It's quite normal. After you're back home you can resume the dose increases. Easier said than done but try not to focus on individual ups and downs. Scan your SS from a distance and see the overall pattern. That's a better way to assess the dosing regimen.
     
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  76. Ramon's mom

    Ramon's mom Member

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    Dec 6, 2018
    @Kris & Teasel Since there is often a delay in getting responses here, can you suggest the dosage to me sometime on Wednesday (in the next 30 hours) so I can get his meds prepped for the cat sitter? I will be leaving early on Thursday before I typically get responses here. Thanks tons for all this help! I assume I will be giving her instructions to skip doses at certain levels (or if he resists her too much she may end up having to skip!).
     
  77. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I would give at least 2 u. His AMPS will be useful in making a final decision. He can probably handle a full dose if he's at 200 or higher and a slightly reduced dose (1.6 u or 1.8 u?) if he's 150 to 200. I'm guessing on this though. @Djamila ?
     
  78. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Assuming he stays in his typical yellows/high blues after this dose today and tonight, I might be inclined to have the sitter go with 2.2 if she can test and knows he's 200 or higher, and maybe 2u if she can't test. He isn't showing any indication that he needs a lower dose, even when being cautious. And I would not have her skip. If he's low, I would instruct her to stall if she's able to, and give the dose late. If she can't stall, and is low, I agree with Kris about the 1.6-1.8. Skipping when he's in these numbers and with the added stress of not having mama there, could be risky for him.
     
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  79. Ramon's mom

    Ramon's mom Member

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    Dec 6, 2018
    Well AMPS and PMPS are both in the 300's. No blues for 2 days.
     
  80. Ramon's mom

    Ramon's mom Member

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    Dec 6, 2018
    @Kris & Teasel @Djamila @Rachel Today's numbers kind of look like a bounce. 250 AMPS then 219 @ +2ish and 151 @ +5ish and 294 @ +7 (though he did eat after the +5). But now the question is - what do I do tonight and with my pet sitter starting tomorrow? I believe that she will test at AMPS and PMPS but probably not inbetween. Thanks for your advice!
     
    Last edited: Feb 20, 2019
  81. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    I think Djamila's advice in post #78 above still applies. You could drop back to 2.2 u tonight if you're more comfortable with that.
     
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  82. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Yep, I agree!
     
  83. Ramon's mom

    Ramon's mom Member

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    Dec 6, 2018
    Hi all. I am back home with Ramon and I just filled in his readings from when I was gone (the pet sitter was great about testing and following the dosing instructions per Djamila's advice. Wonderfully enough he settled into yellows and blues! I am thinking I should check the nadirs for a few days and stop increasing for a while? Does this sounds right? @Kris & Teasel @Djamila @Rachel
     
  84. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Welcome back! I think I would hold the 2.2u tomorrow, and see how he does. Cats often respond differently when mama is out of town because they might not eat as much, or might have some anxiety. So let's see where he goes now that you're back and then decide if you need to adjust again. Hopefully he'll keep on like he is because it's nice to see him staying out of the pinks for a few days!
     
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  85. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    I agree. Let's hold the dose for now and see what happens. I know my cats for example don't eat as much when I'm not home. That can make the numbers a little lower so waiting to see if Ramon's behavior changes now that you're home and seeing how that affects BG is a good plan.
     
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  86. Ramon's mom

    Ramon's mom Member

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    Dec 6, 2018
    His numbers have risen last night and today. Why would they go up after coming home?
     
  87. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    As mentioned above, cats will often eat less while mama is away which can make their numbers a little lower. They are also stressed (even if they like the pet sitter), so while most cats go higher when they are stressed, there are some cats (mine included) who will run a little lower than normal.
     
  88. Ramon's mom

    Ramon's mom Member

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    Dec 6, 2018
    So do I stay a 2.2 or continue increasing as before?
     
  89. Rachel

    Rachel Well-Known Member

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    I might give it one more day at 2.2 to make sure he's settled back in to you being home and then increase if he doesn't go down.
     
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  90. Ramon's mom

    Ramon's mom Member

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    Dec 6, 2018
    Since he did not go down, I went up to 2.4 this morning and now he has gone further up. I will give the 2.4 tonight and tomorrow morning as per previous suggestions from you folks but once again I kind of regret changing his dose. I do want him to go down into the blues but I can't seem to make that happen (at least not at home. His pet sitter did however...) He also has been off his food today and had a case of diarrhea too. Can't tell if it is the insulin increase or something to do with his IBD? I have been holding off contacting his vet because I have been changing his insulin dose against her orders, and assume she will just blame any problems on that.
     
  91. Ramon's mom

    Ramon's mom Member

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    Dec 6, 2018
    Please advise me - I stayed on the new higher dose of 2.4 for an extra day because the numbers seemed to be going down. Now they are zooming way up again. Based on your earlier advice I should be raising it again? I'm sorry I am so needy for advice and/or encouragement/assurance. I really hate this roller coaster. @Djamila @Kris & Teasel @Rachel
     
  92. Jenna Josie

    Jenna Josie Member

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    Jun 30, 2018
    Hi -- Do you think that today's pinks may be a long bounce from having gone into the blues (which his little body thinks are low) overnight? That's the only thing that makes sense to me if you are sure that you did not have a partial fur shot this AM. In either case, I might hold it one more day, either to see if he clears the long bounce or to be sure you got all the insulin into him.
     
  93. Ramon's mom

    Ramon's mom Member

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    Dec 6, 2018
    I am sure it was not a fur shot. (I always rub around the area afterwards to feel for moisture. And I could see the needle going in plus it s very short 6mm needle). But it could be a big bounce. Since July I have not been able to get him to stay stable on any particular dose, so to me it just looks like the same old out-of-control situation. Djamila and Kris have been advising me that he probably has glucose toxicity and/or insulin resistance, and have been advising regular increases in an attempt to find a stable dose for him. I guess I'll take your advice and try another day at the 2.4. I'm really losing hope of ever getting this under control. But thanks for your response.
     
  94. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Good morning! Sorry I didn't get your tag...I was asleep early. I've been sick all weekend.

    It definitely could be a bounce. Remember bounces don't mean the cat got too low...just lower than they are USED to. It's not a bad once if it is a bounce though, which is good.

    If he doesn't get into lower numbers this morning, I'd go ahead and increase again. If he does have a bit of glucose toxicity, which is likely, you want to got on top of it if he finally starts to dip a bit lower. And it does look like he was going down last night when you got that test in, showing that he wasn't staying high and flat like a bounce cycle...so hopefully if it was a bounce, he'll have cleared it!
     
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  95. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    I'm so sorry this has been such a struggle. You do want to keep increasing - I know it's hard, but some cats need quite large doses for a while, and especially when you're dosing around budesonide. While for some cats it raises BG less than other steroids, it looks like Ramon is in the group of cats that are impacted by it, so your dosing isn't going to be "normal". I know I would struggle too if it felt like the insulin wasn't doing anything. It's going to be a matter of adjusting your expectations for what Ramon's spreadsheet might look like. As long as he needs to be on the steroid, you're going to see that impact in his numbers and his dose.

    I want to assume your vet walked you through all of your options before starting the steroid, but given the variations in vet quality we run into around here, it may be worth double checking....

    If I remember correctly, Ramon already takes a probiotic daily, correct? Have you already tried removing any foods with carrageenan (this causes IBD and skin allergies in many cats)? Have you tried a diet completely free of fish (checking the ingredient list very carefully since it often hides)? Have you tried a novel protein diet for at least a month (rabbit, kangaroo, or venison are usually the easiest to find - making sure there are no added chicken, turkey, or fish sneaking into the ingredient lists)? Have you tried a raw food diet?

    If you've already walked through all of those for several weeks (typically 4-6 week trials) and he's still showing the IBD symptoms, then the steroid is likely simply necessary and you'll just need to dose around it. If your vet didn't tell you about one of those steps, or you're not sure you tried it long enough and want to give it another go, for many cats their IBD can be managed without an ongoing steroid through consistent probiotic use and careful diet choices. And if that's an option, it will likely help with the BG numbers. Again though, if the steroid is needed, then it's needed. And knowing that may help your heart as you can adjust your expectations of his numbers and find some peace in knowing his numbers are just going to look different.

    Please ask if you have any questions about any of that, and again, if you've already tried them, no need to type out the whole history of the trials and fails along the way. I just wanted to make sure you knew about them in case your vet hadn't been thorough. My assumption is that he/she was though, so we'll just keep dosing about the budesonide and get to the best numbers we can for Ramon. :bighug::bighug::bighug:
     
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  96. Ramon's mom

    Ramon's mom Member

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    Dec 6, 2018
    Hi Djamila - He was diagnosed with IBD with some symptoms but also with an ultrasound that showed thinkening intestine walls. They (both my regular vet and the internal medecine specialist) told me that its either IBD or Lymphoma. They can't know which without an endoscopy but I was holding off from doing that. All that was offered to me was the budesonide. However I have done elimination diets on him previously for the pemphigus. At this point he is on a limited diet of raw and homemade with organic supplements. He's only been on the budesonide since mid January. I went ahead and increased his dose this morning to 2.6
     
  97. Ramon's mom

    Ramon's mom Member

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    Dec 6, 2018
    Can I have some feedback on the current situation with Ramon's readings? I'm up to 2.8 and the first day he had great readings but today it has gone back high (maybe because I gave a low dose last night because of a low BG reading). Do I stay at 2.8 a little longer? Or do I go on up to 3 units? @Djamila @Kris & Teasel @Rachel Thanks for your thoughts!
     
  98. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Yes, I think the reduced dose is the cause. I would stay at 2.8 today, and then increase again tomorrow (unless he gives you a low PS like that again).
     
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  99. Daddy Jack's Mommy

    Daddy Jack's Mommy Member

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    Feb 18, 2019
  100. Ramon's mom

    Ramon's mom Member

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    Dec 6, 2018
    I'd been up to doses of 3 units since Saturday and thought I'd reached his good dose range becasue of getting blue numbers, but since he repeatedly has now been getting pinks (300's) I upped his dose again today. Can anyone give me more specifics about how to tell if it is time to stop raising his dose? @Djamila ? @Kris & Teasel ? @Rachel ?
     

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