High at 4am, give dose early or wait?

Discussion in 'Prozinc / PZI' started by Kathy4Lewie, Sep 1, 2018.

  1. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Lewie’s insulin shedule is 3 units Prozinc at 7 am and 3 units at 7 pm. I’ve just started home testing and he is high in the mornings. I test with a ReliOn Confirm and the reading is “Hi” so I think that means over 600. Two hours after injection, 570. By 6pm he is at 330. My vet isn’t concerned with the “Hi” in the morning since his numbers come down. I tested at 4:30 this morning and he is “Hi”. I went ahead and let him eat his ProPlan DM dry food.

    My question is: since I tested at 4:30am and he is “Hi” and he ate, should I give him his insulin early or wait until his normal 7am injection time?
     
  2. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Can you adjust the time in the evening as well? What have the numbers been mid cycle? It would be easier to advise you if you could set up a spreadsheet of share your testing log.

    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
     
  3. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    I will start a spreadsheet. I just discovered this group yesterday. What do you mean by adjust his schedule in the evening, too? I got up early this morning to see if I could feed him early before his blood sugar went high, but it’s already high. I have not given him in an injection yet since it’s only 5:45 AM now and he’s not due until 7 AM.
     
  4. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    What I mean is if you did shoot 4 am you might do 5pm. Then 6am then 7 pm if you wanted to get back to the 7/7 schedule. ProZinc let's you adjust up to an hour.

    Id say it sounds like you need a dose increase but it's hard to say that without data. :).
     
  5. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    I did NOT shoot at 4am... I just tested.

    I replied from my email but it did not post so I will post my reply here:

    I just entered what information I have on the spreadsheet. The vet didn't want me testing at home so the tests are sporadic because I was just testing to learn. When I took Lewie to the vet on 8/31 his PMPS value was 330 and the vet was happy with this and said not to adjust his dose, even though his AMPS value was 600+.

    Lewie's AMPS value have been 600+ for 3 days now. I called the vet yesterday and he reiterated that he wanted me to stay at the current dosage. I think I need to do something about the AMPS value. He sits above 600 for hours in the mornings.

    I feed ProPlan DM at 7am (wet), 12pm (dry), 7pm (wet), and 10pm (dry).

    I got up this morning and tested at 4:30am just to see what his numbers were... I went ahead and fed him, but did NOT give his injection because I don't know what I'm supposed to do. Just let him sit at 600+ until it's time for his injection?

    What is the best time in the evening to give the insulin since Lewie is going so high pre-dawn?

    Thank you.
     
  6. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Hi Kathy, and welcome! You're doing a great job already getting started with testing and learning about all of this. It's a lot all at once and can be overwhelming. I can tell how much you care about Lewie that you're getting up so early and trying to figure all of this out!

    It's good you waited on the injection. It wouldn't have hurt him to get it early, but as Janet alluded, it would have made your schedule tricky for a few days. It's so hard to wait when we see them in these high numbers, but it was the right decision.

    Unfortunately yes, letting him sit at those numbers for a few hours is the way it goes right now. Remember that he didn't become diabetic overnight. We're going to help you get him into better numbers, but it's a process.

    Can you tell me a little about your schedule? Do you work during the day? Weekends? Stay home? How long after the PM shot do you go to bed?

    One of the best things you can do to get his numbers down is get him off of the dry food. The DM is sold for diabetics, but it's quite high in carbs -- too high for them really. A diabetic cat shouldn't eat food that's higher than 10% carbs. There is a food list in my signature that you can click on and find a zillion different foods and the carbs in each one. Most of us just feed Friskies pate or Fancy Feast classics as they are affordable and low carb. How does Lewie do with wet food? Is he eating that okay?
     
  7. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    In a nutshell:
    • Insulin doses are best given as close to 12 hours apart as possible regardless of the BG number. You have about an hour's flexibility plus or minus if needed with ProZinc.
    • It's quite possible that the very high numbers are the result of an insulin dose that's too high (even though your vet is advising you) and that sets up a rebound phenomenon we call "bouncing" here on FDMB.
    It's great that you know how to test him yourself because it's the best way to keep him safe and learn how he responds to insulin. Please stick around and read those yellow info stickies at the top of the list on the main ProZinc forum page. We all understand the discomfort that learning to do things differently from vet advice causes. :)
     
  8. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Thank you so much for your reply. Yes, I'm terribly stressed so thank you for understanding!

    I work from home so I can do whatever it takes.
    I typically go to bed 3 to 4 hours after the PM shot.
    Lewie is eating very well. Of course her prefers dry, but he likes the Fancy Feast kitten and I have some on hand so I can feed him that.

    Please advise me on switching his food from DM to Fancy Feast... will his glucose numbers shoot even higher?
     
  9. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Goodness. I was originally feeding Nulo. Then the vet switched me to DM and that's when his numbers shot up! I will switch back to Nulo and Fancy Feast kitten. That will probably mean that his dose of 3 units 2x/day will be too much! Since it's the holiday weekend, what should I do? I'll give the 3 units now, but should I only give 2 units tonight?
     
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  10. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    How comfortable are you with testing? If you and Lewie are doing fine with it, I'm not sure I would lower the dose yet. His numbers are quite high. Changing the food should help, but I'd be hesitant to give him less insulin until he shows us numbers that indicate he's ready for that.

    Yes, vets try hard, but they usually go off of information from the food rep, and don't actually research it themselves. Nulo (especially the pate style) is a great food. I would get him back on that and take the DM back to your vet. Most vets will take it back if you just say Lewie wouldn't eat it. ;)

    I wouldn't worry about the holiday weekend. If you get any numbers that concern you, you can post here and out on the Main forum (sometimes it's quiet here in Prozinc since there aren't a lot of us). I would be surprised if you see anything too dramatic though.

    What time zone are you in?
     
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  11. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    I am in Central time zone. Ok, I will stick with 3 units two times per day. I just fed him the Fancy Feast and he scarfed it down.

    I'm very comfortable with testing now.

    How often should I test so we can really see what's going on?
     
  12. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Daily, you want to test before every shot, and then try to grab a test somewhere around +4 to +7 to see how low he goes in the middle of the cycle. So usually 3-5 tests/day if you can.

    Once/week or so, it's helpful to grab some extra tests. There are a few ways that can look: A "curve" is testing every two hours from one shot to the next. That helps you figure out when Lewie hits the lowest points. For example, my cat is lowest around +3 (super early in the cycle). Other cats are lowest at +6 or +8....it just depends on the cat. And of course, that time can change from day to day. Doing a curve helps you figure out what is typical for your cat. If every two hours is too much, you can do every three hours. The day to day tests are the most helpful, but doing those occasional days when you test more can help you figure out where to focus those daily tests.

    Since this is all pretty new for you guys, if you could do a curve one day this weekend it would be helpful for us in guiding your dosing. It does pretty much require that you stay near home for 12 hours though, and this is a holiday weekend, so if this weekend doesn't work, it's okay. Just whenever you can.
     
  13. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    I can do the curve today. Thank you very much for your help and advice... I really appreciate it during this stressful time.
     
  14. Idjit's mom

    Idjit's mom Well-Known Member

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    Apr 3, 2018
    Kathy, would you mind setting up your signature so Lewie's information is available when you post? That way all members who read or respond to posts in your thread know the pertinent information. Here's a link on how to do that:
    SET UP A SIGNATURE
    I will repeat what I was told when I first found this board, it is stressful at first, and there is a whole lot to learn. But this is the very best place to be right now. There are members here who are very knowledgeable and experienced, and have been taking care of their sugar cats for a long time. The rest of us read the posts, add what we can, and are behind you every step of the way. The information, the tools and the support is here. Hugs to Lewie! :cat:
     
  15. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Just a little more info about Lewie. He has only been diabetic just over 1 month. He had surgery to remove a benign mouth tumor on July 12 and his glucose value was high normal at 179. He started drinking more and more water after the surgery and I mistook it for kidneys. He's always been a great eater so the ravenous eating snuck up on me. In hindsight it was ravenous. The vet thinks this may be stress induced diabetes. He has a lot wrong with him so time will tell. He's a good boy and loves people.

    Thank you, I will set up the Signature. Lewie gives purrs back!
     
  16. Becky & Baby Girl Kitty

    Becky & Baby Girl Kitty Well-Known Member

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    Sep 15, 2017
    Welcome. Hang in there Kathy! There’s a lot of info coming your way; but this will become routine in no time! You are doing a fantastic job for your Lewie. We all were overwhelmed in the beginning & so we know how that feels. :bighug::bighug:
     
  17. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Hi Kathy! You've already gotten excellent information, and I don't want to overwhelm you (I'm sure you already are!!!) so I won't add to it. We are so glad you found us. I know diabetes can be stressful and it's so scary thinking your baby isn't well, but we're here to help! I'm in Central Time too and during the week I'm usually on around 4:30/5 AM so if you have early morning questions I can probably help answer them (I'm usually later on the weekends). Since we know your time zone and when you shoot, that will help us. I'm usually at work by 7, but I can check in while at work most days so I'll try to check on on the board during the week to see how you're doing in case no one else is around. We are a fairly small forum, but the good news is we mostly have our settings to where we get emails when someone posts...so we often know when to check in. :)

    Something you might want to read when you have a sec to help with the stress: Dear Mom . It's a lovely letter written by someone long before I got here but still oh so relevant today!

    We're here for you and Lewie! Please ask any questions you have...the learning curve is steep at first and we want to answer anything you are concerned about!
     
  18. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Thank you so much Rachel. I've been so stressed about all of this especially because of near blindness. My grandmother went blind and I just love eyes anyway. I have spent thousands of dollars on Lewie's eyes because he has Entropion and the eyelashes were scratching his eyes so he had surgery. He has had eye ulcers, too. When I realized Lewie was sick, I had just hurt my shoulder and could barely take care of myself so I didn't realize how bad Lewie was until 2 days later. I thought he was blind, but he has some vision. With his glucose over 600 every morning, I'm afraid of total vision loss. I just have to get it under control. My vet isn't concerned, but I really am. I am so thankful for you and others who spend you personal time helping us. Thank you.
     
  19. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Dogs can go blind from diabetes, but it doesn't effect cats the same way. They can go blind from severe hypoglycemia.... But I believe they don't develop diabetes related blindness by just having it.
     
  20. Idjit's mom

    Idjit's mom Well-Known Member

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    Apr 3, 2018
    Kathy, a friend here on the board posted this and I saved it because it just made so much sense: Start by doing what's necessary; then do what's possible; and suddenly you are doing the impossible. Saint Francis of Assisi
    You are doing just that. You are new to all this, and it sounds to me like you have been taking care of Lewie for a good long time. Granted the eye issues are troublesome, but you have done everything you knew how to do for him. He looks like a real sweetheart, and I think he holds a key to your heart, right? Well, take a break, fix a cuppa and maybe Lewie would like a lap to sit on for a minute, or at least a hug and a kiss. You are getting the best advice, so keep touching base and checking in. Forgive yourself for not being all knowing or being able to see the future regarding Lewie. :bighug:
     
  21. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Hi Everyone. Thank you for the wonderful messages.

    Four more hours till Lewie's evening shot. His appointment on Tuesday is at 8:00am so I pushed this morning dose closer to 8:00 even though I was stressed about his numbers. I don't like feeding him at 8pm because he is used to 7pm... previously 6pm.

    Please take a look at his spreadsheet because I've been testing every 2 hours. He is still in the red, but will probably be in the pink by 8pm.

    I've only been feeding him Fancy Feast Kitten today. Do you recommend that's all I feed him this weekend? I was feeding DM 30th and 31st. I was feeding Nulo and a small amount of DM on the 26th-29th.

    What should be my plan for this evening.tonight?... I really don't want him to be in the black like at 4:30am this morning. Do I feed him at 2am? How do I keep him from going in the black?

    Thank you,
    Kathy
     
  22. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    given that your cat also has kidney disease, you may want to feed foods under 250 phosphorus. A few of the nulo foods are. Tiki Cat is another good choice.
     
  23. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Those are some confounding numbers...high in the morning and then lower in the evening.

    Okay, first I'd keep him on the FF kitten for now. You want to keep the carb amounts low to see if that helps bring him down (it can take a day or two sometimes). Unfortunately, you may not be able to keep him out the black right now. It WILL happen, but it can take some time. He needs to settle in to the new, low carb food and see if that helps. Tonight, grab a test before going to bed if you can (I know...all these tests today!). Let's see what this does for him.
     
  24. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Before switching him to the DM, he ate Nulo and Wellness Complete... but I also fed Solid Gold dry which is not low carb. So I guess he was on DM for about 3 solid days, which are the black mornings. I read somewhere to not make changes for 3 days to let his body settle. I can feed Nulo Chicken and Herring (3gm carb) and Fancy Feast if you think the phosphorous will be too high feeding only FF.

    I can continue to test this evening if that will help.

    I read that some people feed at 2am?

    Do you think he is having the "dawn phenomenon"? If so, what should I do?
     
  25. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    HIGH at 6pm. Two hours until time for his injection.

    Please look at his spreadsheet.

    Thoughts?
     
  26. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Personally id raise to 3.5 tonight. Those numbers are really up there.

    @Kris & Teasel
     
  27. Jenna Josie

    Jenna Josie Member

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    Jun 30, 2018
    Hi Kathy. That curve looks like an actual *curve* today, but Im so sorry that Lewie is having such high numbers. Typically I would think that an increase is in order to help bring those numbers lower overall and at his nadir (typically between +5 and +7), but given that he is so newly diagnosed and with the underlying kidney issues, I would not feel comfortable advising on how much (I am too new for that). We try for .25 increases, but I’m not sure with the new diagnosis and the very high numbers.

    (While I was typing ... Oh, good! There’s JanetNJ!) I like her advice to go to 3.5.
     
  28. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    His shot is due at 8pm... what would you think if I were to give it to him at 7pm instead?
     
  29. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    I agree with Janet. I think an increase to 3.5 u tonight is in order. Once he's in pinks, yellows and blues the usual 0.25 u increase would be in order. I'd give him his insulin at the usual time.
     
  30. Jenna Josie

    Jenna Josie Member

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    Jun 30, 2018
    I'm sorry. I'm trying to read through the thread to find the info, but I can't find it . . .

    How many hours are you post-AM shot? (I happen to be on CDT as well, but we're from all over, so it helps to talk in terms of plus-[number of hours past the shot]. So, for example, if you shot 11 hours ago, you're at +11. (Technically i think you're at +11.5 :) )

    Are you simply trying to stretch your cycle one hour longer so that you can be at the vet's on Tuesday am at shot time? If so, there's certainly no need to do it all at once: you could move the shots in 15 minute intervals and still be at shot-time at the time of your vet appt on Tuesday morning if that is your goal.

    In which case -- and assuming that you are indeed at +11.5 from this morning's shot -- I don't see why you shouldn't give him his PM shot at his regular time (in about 30 minutes, I think?) vs. waiting an entire hour. Again, you can "add" that hour in over the next couple of days to get him on the vet's schedule if that's the goal.
     
  31. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    I apologize... I forgot to talk in the + terms.
    I gave him his shot at 8am and it's 6:45pm now so I'm coming up on +11.
    8pm will be +12.
    So if I wait an hour I will still maintain the appointment time schedule.
    I'm just stressing because here he is sitting in the black again waiting for his shot.

    Thoughts?
     
  32. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    I'd wait to the normal time. I know it's stressful, but the increase might help with the numbers and the new food should help too. If you give him his shot early, then tomorrow he sits in the blacks for even longer waiting for his shot...and that's no good. I know, I KNOW how stressful and scary it is to see those numbers, but they WILL come down. I've been here since...2013 I think...and I've seen a ton of cats come through here hanging in high numbers all the time. With time, patience, and careful increases and monitoring, we get them down. Remember you JUST switched to new food today. That can often take a few days to really get their system in gear. He WILL get into lower numbers and we will help you. Just gotta have patience. :bighug::bighug:
     
  33. Jenna Josie

    Jenna Josie Member

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    Jun 30, 2018
    And in the meantime, do something nice for yourself to take your mind off it.\ while you're waiting: a walk around the block, a bar of chocolate, a little glass of wine . . .
     
  34. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Yes, omg... I feel like I'm in here staring at the computer while he's out in the other room suffering. Dreadful feeling.

    So here's the plan:
    1. Wait till normal time to give injection.
    2. Increase ProZinc from 3 units to 3.5 units.
    3. Continue feeding Fancy Feast Kitten.

    Please correct me if I need to know anything else.
    Thank you very much
     
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  35. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    4. Drink wine. :D
     
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  36. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    LOL I'll say YES to that!
     
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  37. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    If anybody is awake... I fed Lewie at 8am, noon, and 8pm.

    Will it help his blood sugar from going so high at dawn if I feed him at midnight?
     
  38. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    It's 10:30pm here... +2.5 Post-PM shot... and he is hungry now even though he ate great at his PM shot. If he's hungry, should I feed him now?
     
  39. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Yes, give him a snack. Until they get better regulated they're hungry all the time. The usual advice is to give most of the cycle's food ration in a couple of small meals/snacks in the first half of the cycle when insulin is rising to its peak activity.
     
  40. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Excellent. Thank you so much for replying! Great information and Lewie will be happy!
     
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  41. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    I'm Very Encouraged!

    This morning's AMPS was low enough to actually have a reading on the meter! 506 I'm happy with that since we're down 100 points from yesterday's reading. (The meter doesn't read over 599... just says High.) And his +2 after shot was 343! Happy with that! The food and the little extra insulin is working! I actually only gave 3.3 units because I was nervous about giving too much since we were changing 2 variables: food type and insulin.

    I also started giving him a phosphorus binder called ConSeal with each meal since JanetNC pointed out that the Fancy Feast Kitten is so high in phosphorous. (I have a 19 year old that uses ConSeal so I have it on hand.) He's drinking lots of water this morning so I hope all is well there.

    I also started offering him additional meals at +1, +2 and +3 after his shot as Kris & Teasel mentioned to do... feeding most of the food in the first half of the cycle. Last night he ate 3 meals in the first half, this morning 2 1/2 meals.

    He is feeling better, purring and grooming. Big change from the last couple of days.

    I'm going to test his blood again at +8 since that seems to be his low spot. I really love using the spreadsheet!

    Thank you to everyone for helping me so much yesterday! I know it's a holiday weekend and it means the world to me that you jumped on the board so quickly to answer my questions.
     
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  42. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    I am so glad he seems to be feeling better. Those super high numbers can def make them feel yucky. You’re doing a great job. I am glad you are finding the spreadsheet helpful.
     
  43. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    How do you measure a 3.3?

    We wanna start seeing some yellows... I would do 3.5 with the next shot.
     
  44. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    3.3 = 3.25 + smidge :)

    I just checked Lewie's suspected nadir low point time at AM shot +8 and his glucose reading is 261. His first yellow reading.

    He isn't due for his next shot until 4 more hours.

    How much can I feed him now? He is asking.
     
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  45. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    It's OK to give a snack now. Just no food at least 2 hours prior to the preshot test!

    Hooray for the first yellow!!!!! Still id do 3.5
     
    Last edited: Sep 2, 2018
  46. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    What quantity is considered a snack? At his regular mealtime, he will eat about 5 tablespoons of Fancy Feast Kitten... at +1 he will eat another 5 tablespoons... at +2 he will eat about 3 tablespoons.

    Would you say a snack would be about 3 tablespoons?
     
  47. JanetNJ

    JanetNJ Well-Known Member

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    Sure
     
  48. Kathy4Lewie

    Kathy4Lewie Member

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    I gave him 2 tablespoons and he seems satisfied with that. :cat:
     
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  49. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Oops... our messages crossed. Thank you.

    Question: Lewie's AM numbers are always higher than his PM numbers. I checked his numbers every 2 hours last night. At today's +8, he is 156 points lower than yesterday. If I apply this logic to his evening numbers, his evening nadir might end up being 182. Is that too low? I hope to be asleep at that time tonight so I won't be checking.
     
  50. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    182 is not low. Normal on a human meter is 50-120.

    Your goal is to aim for about 80-100.
     
  51. Kathy4Lewie

    Kathy4Lewie Member

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    Perfect. Thank you
     
  52. RRaptor

    RRaptor Member

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    Jul 24, 2018
    Hi Kathy, I'm CDT too! I'm glad you're here right away for Lewie. I just did what my vet instructed when Olivia was diagnosed in February and she nearly died in July. Since then I've received some excellent guidance here and while we're still trying to figure out what works, I feel much more confident we'll get it right. I'm glad to see that Lewie is already responding to diet and dose changes!
     
  53. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    I'm sad Olivia almost died in July... and so happy that she is doing better now!

    This group is amazing. My vet wanted me to rely only on readings from the vet's office because of discrepancies in meters, but he never saw the 600+ numbers... that's when I reached out to this group. I told the vet that with this long holiday weekend, I felt like a fish out of water. He said Lewie would be fine, but I just couldn't wait and hope. There is a possibility that Lewie's diabetes is stress induced from a surgery about a month ago so I want to be super careful to watch for a spontaneous remission... that's when I knew I had to learn how to test. I'm testing the pad of his back feet and he is tolerating it much better than his ear.

    With this group's help, I too am feeling much more confident that I'll get it right. :)

    Thanks for writing.
     
  54. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    One little correction - you're actually aiming for anything in the normal range, not just 80-100. :) That is in the protocol as a caution when reaching regulation. But remission is usually between 50-80.

    Love seeing that great cycle today! And hooray for a yellow!!!
     
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  55. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    So the normal range, since I'm using a human meter, is the 50-120 as mentioned above? Being watchful for repeated values of 50-80 which may indicate remission?
     
  56. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Remission is anything under 120 without insulin (we usually say to test for 14 days to make sure it's really remission and not just a good day or two), with most numbers in the 50-80 range for a typical cat.

    With insulin the protocol says to aim for 80-100 at nadir to offset any moments when a kitty has an unusual response. However, if you're monitoring and being careful with dosing, it's fine to let them hit nadir anywhere in the 50-120 range, and many cats feel their best in the lower 50-80 range. There are things to consider in that such as the bean's work schedule, but if you're keeping an eye on things, there's no need to try to keep them at the top of the range.

    To anyone else reading this, those ranges are talking about a human meter, not a pet-specific meter. If using at AlphaTrak the ranges are slightly different.
     
  57. Jenna Josie

    Jenna Josie Member

    Joined:
    Jun 30, 2018
    I think the goal is to get them to spend as much time in the normal range, with insulin support, as possible. It’s not remission until they can stay there on their own for 14 consecutive days.

    Cross-posted with Djamila. Hi there!
     
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  58. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    So excited to see that yellow!
     
  59. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Thank you for the further explanations of the ranges and goals! Hopefully more yellow to come!
     
  60. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Lewie had a good day yesterday with yellows in his chart so I was going to sleep through the night and not check his nadir +8 (4am Central). Well I just happened to wake up at 3:50am. Drats.

    So I check on him and I find him laying in the litter box. His glucose value was 271 which is good for him, so I let him eat 3 tablespoons of food.

    When I checked his blood glucose at his morning shot time it's 421 so I gave him 3.5 units.

    Do you think feeding him at PM shot +8 shot his reading up? Yesterday at his nadir PM shot +8 (4am Central), I only fed him 2 tablespoons of food.

    He does have hip problems and heartworms so I don't know if the laying in the litter box is related to that or diabetes.

    Thanks for your thoughts.
     
  61. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Assuming it's low carb food, then most likely the rising number is simply that the insulin ran out. It's not uncommon for a cat to rise a hundred points in the last hour, that's why when you get a low PS number, stalling for 20 minutes or so often gets it into more typical range. When a cat is at a good dose, the insulin lasts longer, when they aren't getting quite enough yet, it runs out early. It's all a balancing act.

    I don't know anything about heart worms, but hip problems if they involve inflammation (like arthritis) can increase numbers. Hopefully he'll feel better as the day goes on.
     
  62. Kathy4Lewie

    Kathy4Lewie Member

    Joined:
    Sep 1, 2018
    I'm feeding him Fancy Feast Kitten Turkey. We are have terrible rains so maybe the damp and cooler weather is bothering his joints. Thank you.
     
  63. Kathy4Lewie

    Kathy4Lewie Member

    Joined:
    Sep 1, 2018
    I just checked Lewie's afternoon nadir at +8 and his blood glucose reading is 109. Looking at his spreadsheet from this morning I didn't expect such a drop, although I did bump his insulin up to 3.5 this morning. I went ahead and fed him now to prevent him from going too low.

    Note: I already ran through my 1st box of test strips and bought a new box yesterday and they are reading 20 points higher so his comparable value to the previous strips is 89. :-0

    Any thoughts? Should I go back down to 3.3 units of insulin tonight?
     
  64. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Wow! Well that's a really good number for nadir! It's actually not unsafe at all, and I would probably feel fine sticking with the same dose tonight if he was mine. You want them in those good greens at nadir time, so it's really okay if he was hanging out in that...and he still had room to drop. :)
     
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  65. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Great! Thank you Rachel. So it sounds like I shouldn't have fed him... just let his body enjoy the low number for awhile?
     
  66. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Nothing wrong with a little snack, but it certainly wasn't necessary as far as safety goes. A cat is quite safe down to 50. That's the "take action" number, so they can even go below that and still be fine, we just don't really want them below that because at some point they can start to have a symptomatic hypo and that's to be avoided. So 50 is like the safety railing to keep them from going over the edge. :)
     
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  67. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Thank you Djamila. My vet said if Lewie goes hypo he will most likely die with all the things going on with him... that's why I've been so nervous. Now that I know his nadirs, I'm getting a little more comfortable with this. My vet is out of town for the week so I'm so glad this group is here. Next time I take a nadir reading, I'll skip the snack and let his body enjoy the low reading. Thank you.
     
  68. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Since she's that medically fragile then yes, using greater caution is important. Given that, you might want to set your "take action" number a little higher so you have a bigger safety margin.
     
  69. Kathy4Lewie

    Kathy4Lewie Member

    Joined:
    Sep 1, 2018
    May I ask for recommendations on what a "take action" number might be for Lewie?
     
  70. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    First of all, I'm so sorry for calling Lewie "she". My fingers got ahead of my brain :). I'd be hesitant to suggest one since he has conditions I'm just not that familiar with, and because the vet's prediction was so dire. It might be worth talking over with your vet and deciding what level he thinks Lewie can handle. Or maybe someone else might have some thoughts on it?
     
  71. Kathy4Lewie

    Kathy4Lewie Member

    Joined:
    Sep 1, 2018
    No worries about she/he. :)

    My vet said nothing lower than 200. That seems high. My vet also was ok with reaching a height of 600. That seems high. I trust my vet and my vet is very smart and knows what he's doing... I just have to live with myself when this is all said and done. When I first started charting Lewie's numbers, there were just too many 600s for my comfort. Lewie seems happier at the lower numbers.
     
  72. SpotsMom

    SpotsMom Member

    Joined:
    Feb 10, 2018
    The closer to normal you can keep him the better he will feel. 600 is way too high and puts him at higher risk of ketoacidosis. Low 200s is where glucose starts appearing in the urine (renal threshold), which means the kidneys are struggling to keep up. The longer you can keep him below that threshold, the better off he’ll be. If he were my kitty I would aim for low to mid 100s for a nadir (120-150), which gives you a bit of a safety cushion. I am only speaking of my own personal comfort level (if I had a kitty with multiple medical issues), so you may feel comfortable keeping him higher, but aim to give him as much time as you can under the renal threshold.
    600?? Yeah.... that’s a no....... :banghead:
     
  73. Kathy4Lewie

    Kathy4Lewie Member

    Joined:
    Sep 1, 2018
    Thank you so much for telling me about the renal threshold! Information is power. :) I am going to get up at his am nadir (yawn) and check, but not feed. He felt much better today and was all purrs tonight. He’s still a sick kitty, but it’s good to hear the purrs. Thank you for sharing your thoughts on his goal nadir. (And I love the emoji hitting the wall!)
     
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  74. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    I think your numbers will depend on where you are at in the cycle too. Like if you're at 100 at nadir, you might grab another test an hour later to be sure he's still rising or something...but if that is at an earlier time in the cycle, you keep a closer eye? It's hard to be sure of a number with his other medical issues.

    In the end, you do have to be sure you can live with whatever you choose. As Djamila said, 50 is the take action number for a human meter, so you want something maybe between that and 100 as your take action number? And you could say you're going to set something for a take action number now and then lower that number as you get more comfortable and get a better idea of what Lewie is doing...whatever makes you most comfortable and keeps Lewie feeling good. :)
     
  75. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Good advice about your own take action number for Lewie. I'd say something around 100 at nadir is a good goal for now. You can see how she does if her BG gets to that level. You don't want 600s though. That is definitely putting her at risk of a DKA episode and that would severely tax her fragile body.
     
  76. Kathy4Lewie

    Kathy4Lewie Member

    Joined:
    Sep 1, 2018
    I give Lewie 150ml subq fluids everyday. Yesterday, I gave him his fluids in the afternoon because he was a little dehydrated... I usually give fluids in the evening. Can giving subq fluids lower the glucose value?
     
  77. SpotsMom

    SpotsMom Member

    Joined:
    Feb 10, 2018
    My experience says yes it does lower BG values modestly. But I think it probably depends on how dehydrated they start out, and when you give the fluids in relation to the shot time. You may want to be a little more careful until you see how he'll react.

    *Edit: sorry I answered this in a hurry and just realized you meant you just gave it to him a little earlier than usual yesterday. Are you wondering if that's what caused the lower than usual number? It is certainly possible.. though that would be a bigger drop than I would expect.
     
    Last edited: Sep 5, 2018
  78. Kathy4Lewie

    Kathy4Lewie Member

    Joined:
    Sep 1, 2018
    Yes, I was wondering if it caused the lower AM+8 nadir value of 109. I'm waiting today to give his fluids after his PM shot as an experiment.

    Thank you for your reply!
     
  79. Kathy4Lewie

    Kathy4Lewie Member

    Joined:
    Sep 1, 2018
    Ok, so his AM+8 nadir value just now is 101. So for him, the fluids didn't appear to have influenced his value today.

    Yesterday, his AM+8 nadir value was 109 and I let him eat because I was a little unsure about that new low value.

    Do you recommend for today NOT to feed him now, but let his body enjoy the 109 value? Maybe check his value again in an hour?
     
  80. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Please take a look at Lewie's Spreadsheet and let me know your thoughts?
     
  81. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Post AM Shot +8 value is 101. No food given.
    Post AM shot +9 value is 105. No food given.

    He's going to want to eat at +10.
     
  82. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I'm sorry you didn't get a response earlier. Lewie's numbers look good today. The lowest blue was almost green. I'd keep the 3.5 u dose for a few more cycles.
     
  83. Kathy4Lewie

    Kathy4Lewie Member

    Joined:
    Sep 1, 2018
    Thanks... we are fine... just was looking for a little hand holding but it worked out great. :)

    I tested him at AM shot +10 and he is 134. I gave him his evening pills and a small snack. Since he is starting to climb, I'll go ahead and give him his fluids.
     
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  84. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Those last two AM cycles look really good. It's nice to see him get time in those healing numbers!
     
  85. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    I just took Lewie's PMPS and his value is 266. That's about 170 point below the previous 3 days. :confused:

    I'm a little concerned about giving the 3.5 units now.

    How much should I give?
     
  86. Jenna Josie

    Jenna Josie Member

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    Jun 30, 2018
    I’m so sorry that I don’t feel qualified to advise! First, that’s a very nice PS for him! It looks like he’s been dropping about 70% or so during the day on 3.5 but about 30% or so at night...? If that’s accurate (I see math coming at me, and I duck!) and it holds, then 3.5 on 266 would still keep Lewie in the safe range, but I also see the concern in holding that dose on such a markedly lower (but still very nice!) PS. When I am nervous about a shot, I usually reduce by 0.25. I am then usually sorry ... but as they say, “better too high for a day than too low for an hour.” Esp given his other health issues.

    I hope someone with more experience pops in to help. In the meantime, I would stall and test in 20 minutes from the 266 test to see if his numbers are climbing. I’ve read that there can be up to 100 point difference in the last hour of a cycle. Maybe his is still ending ?
     
  87. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Cool that you noticed the 70% during the day, and only 30% at night. I've been wondering about that.

    It's been 35 minutes so I'll check now...
     
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  88. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Now he's at 351... 35 minutes from +12.
     
  89. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Give 3.5?
     
  90. Jenna Josie

    Jenna Josie Member

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    Jun 30, 2018
    Aha! So that looks a lot closer to what's typical for him. If the 30% drop is accurate and holds true, that would bring him to the low yellows/high blues <--- check my math!!! -- and that seems good for him given his other issues.
     
  91. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Yes I think that would work. Can you get a +2 this evening to see how she's doing?
     
  92. Kathy4Lewie

    Kathy4Lewie Member

    Joined:
    Sep 1, 2018
    Awesome. Thanks for teaching me that math. I've been wondering if he needs more insulin overnight and less during the day.
     
  93. Jenna Josie

    Jenna Josie Member

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    Jun 30, 2018
    Totally up to you. As they also say, the care-giver holds the syringe! I would probably do it, but there's not a whole lot of data, so I would definitely want to get at +3 if I did. He's just responding and moving down so much overall, it's hard to know, esp since I am new, still very much learning, and do not feel confident to advise someone on their kitty.
     
  94. Jenna Josie

    Jenna Josie Member

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    Jun 30, 2018
    Oh, yay! There's Kris & Teasel! That's confirmation! :)
     
  95. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Kris & Teasel: Yes, I can take the +2 reading. If I gave too much, what will I see at +2?
     
  96. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    A +2 that’s significantly lower than PS can mean a more active cycle requiring more testing so you know if kitty is going too low. If +2 is similar to or higher than PS it usually means the cycle won’t be dramatic.
     
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  97. Kathy4Lewie

    Kathy4Lewie Member

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    Sep 1, 2018
    Kris & Teasel: That's interesting! How often do people test? I could see 6 times a day: AMPS, +2, nadir, PMPS, +2, nadir

    I was trying to back off on stabbing him, but I'm not having much success. I'll buy the big box of strips this time!
     
  98. Jenna Josie

    Jenna Josie Member

    Joined:
    Jun 30, 2018
    I’ll chime in!

    We try for four: AMPS, +6 (when work allows), PMPS, and then “before bed,” usually around +3 or +4, which gives a good indication of where the cycle is going once you have enough data. If that number is any cause for concern, then we’ll try to get a follow up before bed. I will get a +2 (or get what if I originally planned for +4) if I am a little nervous about the shot and want an early warning, as Kris describes above.

    And them sometimes, since we have less data for nighttime, I one of us happens to be up later, we’ll grab an additional one just for data’s sake.
     
  99. HuskerGyrl

    HuskerGyrl Member

    Joined:
    May 31, 2018
    I've had to get over my guilt about testing him so frequently... the data is just too valuable and there's NO other way to know what's going on. Are you using the pain-relieving neosporin? I try to put that on Romeo's ear at least once a day and it does help him heal up faster. The other thing that makes it more tolerable for him is a low-carb treat after EVERY stick. I use freeze-dried chicken liver or beef liver... but there's a list somewhere in here of low-carb treats. It's gone a long way towards making Romeo a happier camper at testing time. :)

    For another reference point... I test at LEAST 3x/day amps, nadir (anywhere between +5 & +8), and then obviously pmps. Additional sticks simply depend on my schedule and how his numbers are trending.... and if I get a gut twinge that I need to. ;)

    Your nadir #s are great, btw... I'm so impressed with how you've managed to get him down so quickly... I bet he's feeling so much better!! Yayy!
     
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  100. Kathy4Lewie

    Kathy4Lewie Member

    Joined:
    Sep 1, 2018
    When I first started testing, I tried the ear but Lewie took it really personally! He's never been one to complain so I respected him on not stabbing the ear and took to the back paws, which he really doesn't mind at all. He's a real trooper. He seems to be really taking to the insulin. Today is the first day in a while that I can tell he is really feeling better, except he is getting dehydrated faster than before so I probably need to wean him off of the Fancy Feast Kitten and start feeding more Nulo, except my cans aren't labeled medal series... hum.. need to call the company.

    This group has been so helpful and I really appreciate all the help! Yes, today he felt good!
     
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