Need feedback on cat's glucose curve

Discussion in 'Prozinc / PZI' started by MayL, Feb 24, 2018.

  1. MayL

    MayL Member

    Joined:
    Feb 24, 2018
    Hi everyone, Milo started Prozinc in late December 2017 at 2 units twice a day.

    I bought the Alphatrak meter and started home testing. The first glucose curve on 1/13/18 showed 611, 397, 623, 638, 584, and 530. He was very stressed and we were very lousy at pricking his ears because it was our first time.

    Our vet said to up insulin to 3 units twice a day and we did the curve again on 1/27/18 and we got 614, 458, 468, 385, 580, 582. Vet thought this was a good curve and he's not insulin resistant.

    At his one month recheck at the vet, his fructosamine was 393. Not horrible. Vet suggests we move up to 4 units of insulin twice a day.

    We did a curve on 2/18 and we got 646, 571, 474, 501, 533, 554. Vet is now concerned Milo might be insulin resistant. She suggests we test for Acromegaly and Cushings.

    We have not increase his insulin - he is still at 4 units twice a day. Anyone have any thoughts on what is going on? Why did we not see an improvement when we up the insulin from 3 to 4 units?

    Milo also has irritable bowl disease, stage two kidney disease and on hyperthyroid medicine. So lots going on with my old man. He's about to turn 18 years old! He is on prescription hills k/d wet and my vet recognizes this is not the best option for a diabetic but wants to focus on his CKD. I've read that many folks say forget the prescription diet and I understand, but I am also super nervous to not follow my vet's advice.

    Any tips or thoughts would be wonderful!
     
    Last edited: Feb 25, 2018
    Reason for edit: Added more information.
  2. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Welcome! :) Congrats on testing Milo's BG at home - it's the best way to keep him safe and assess the insulin dosing. Your senior boy has other issues that might make it harder to get him into better BG numbers. It's hard to say right now whether he's truly insulin resistant from acro of Cushings or whether he's been overdosed all long.

    Here's what I suggest so we can help you better:
    • start the basic testing routine we recommend to get a feel for his numbers day by day - details to follow
    • set up the spreadsheet we use here and enter all data you have so far and everything you accumulate from the testing routine
    • leave his insulin dose at 4 u BID for now and start getting baseline data for where he is now.
    Here's the basic testing routine:
    1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
    2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
    3. do extra tests on days off to fill in the response picture
    4. if indicated by consistently high numbers, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
    5. post here for advice whenever you're confused or unsure of what to do.
    Here's the link to the spreadsheet we use here - viewable by all members and key to us being able to help:
    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

    Re being nervous about deviating from vet's advice: we all understand that. Most of us started off following our vet's instructions to the letter - I sure did. However, they can often fall into some common traps:
    • starting kitty at too high a dose of insulin
    • increasing by increments that are too large
    • advising against testing BG at home
    • and more ...
    Here's a description I wrote of what can happen if the insulin dose is too high (we call it "bouncing"):
    1. BG goes low OR lower than usual OR drops too quickly.
    2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
    3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
    4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
    5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
    6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
    Re treating CKD and FD in the same kitty: there are many members who deal with this and can give advice on low phosphorus wet foods that are diabetic friendly and/or other ways to address the CKD/FD together.
     
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  3. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Hi May, and welcome!

    Have you been testing at home other than the curve days? At first glance, your vet may be correct that there is a high dose condition such as Acro or IAA, but it's also possible that given only three curves, you've just had bad luck and caught bounce cycles. The third possibility is that Prozinc isn't the insulin for Milo. Different cats respond better to different insulin types.

    The first thing I would do is change the food. It's great that Milo is on wet food, and it is a challenge to find foods that are safe for both diabetes and CKD. I really like Primal Chicken as it's very low carb and also has a good CA:phosphorus ratio. Here is a list of foods that work for both conditions: https://docs.google.com/spreadsheets/d/112NvvzgxEBOtkb42rA0XR8GeShw9xXs9kccf9-olK7I/pubhtml

    You can also post out on the Feline Health (main forum) and ask for suggestions since I'm not sure how up-to-date that list is at this point. http://www.felinediabetes.com/FDMB/forums/feline-health-the-main-forum.28/

    If you're not comfortable changing food, it might be helpful to have a conversation with the vet about the options you find since it sounds like he recognizes the current food isn't ideal, but maybe just doesn't know what else to do. Vets are so kind, but often just don't know very much about diabetes in cats.

    Second, if you aren't already testing at home on non-curve days, I would suggest getting some tests in to see what else might be happening. If you have already been doing that, it would be great to see some of those numbers as well.

    And finally, if neither the food change nor the testing reveal anything, it would be good to get tested for a high dose condition if for no other reason than to rule that out as a factor.

    There is a wealth of information around here about how to manage all of this, and it can be overwhelming. Please let us know what questions you have and how we can help!
     
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  4. MayL

    MayL Member

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    Feb 24, 2018
    Thank you Kris, Teasel, and Djamila for the warm welcome and great information! I'm going to try to get the spreadsheet filled out to share with the group. I have done just a few random pricks here and there (but I don't have a systematic way in terms of the time I pick to do the tests) and the lowest I got was still in the upper 300s. I am going to process the great information/suggestions/tips and get back to you with all additional follow up (which I am sure I will have). Thanks again!
     
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  5. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Welcome May and Milo! You got great info from Kris and Djamila, so I just wanted to pop by and say hello and we're glad you're here! Please do take the time to think over what you've heard from us so far and ask ANY questions you have. We've all been where you are and it's so much info at first it's completely overwhelming. You'll probably have lots of questions...I did! We're here to answer them.

    I just wanted to pipe in too on the following vet's advice. It's so hard at first to deviate from what they tell you. Don't feel like you have to right away. Most of us followed our vet's advice at first, because they are the professionals and it's hard listening to a bunch of crazy cat ladies on the internet! I did a lot of research before deciding to go my own way and it turned out my vet was super supportive of everything (except the food change...and it sounds like your vet actually gets that!). I told my vet what I was doing and she was great...she basically let me run things because she knew I knew what I was doing. The really good vets have learned that since we are doing research and whatnot and can focus on just one disease in one animal, we will probably end up with good info. They basically have to be general practice doctors on all different species...it's no wonder they don't know that much about one disease in one animal!
     
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  6. MayL

    MayL Member

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    Feb 24, 2018
    Hi there, I just added the spreadsheet to my signature and filled out Milo's testing information. I added some bg tests I did today at hours different from when I had done them in the past. I also gave Milo Weruva's Streak Frites and Fowl Bowl and no hills k/d wet to see what impact I would see. He got a new nadir at 307 - don't want to get too excited as I feel I still need to keep testing and gathering more data point. But now that I have everything in the spreadsheet and would love any thoughts on what is in there right now. Thanks!
     
  7. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Great job with the spreadsheet! Yeah, he's staying pretty high...but that super low pink (heck 307 is so close to a yellow that I think we can call it that) was nice! Looks like taking him off the K/D would really impact his numbers. If you do decide to do that, I think you'll see things trend downwards overall.

    It's hard to know for sure what's going on...I agree that just more testing right now is key. He could be staying high all the time, or he could be dipping low sometimes and then bouncing up and you just happen to catch the bounce cycles. Will you be able to follow the testing routine Kris mentioned above? I think that will help fill in the puzzle for us.
     
  8. MayL

    MayL Member

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    Feb 24, 2018
    Thanks Rachel! I hope to be able to follow the basic routine schedule provided by Kris above. Are most folks doing the basic routine every day? I am worried about stressing Milo out. He seems to be tolerating the pricks more and more. But first few times he was squirming so much and getting super agitated that I want to find the right balance of testing.
     
  9. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Most people do follow that testing routine. If you have time, you might check out a few spreadsheets on here to see what kind of testing most people do (mine is really old, so be warned). Over time, they usually realize that the testing isn't bad at all. I found having a consistent spot to do testing (ours was on the floor of the kitchen on a towel) and giving treats after every test, successful or not, helped. It got to the point I could rattle the box of lancets and Gypsy would run to the spot to wait for her test. She didn't like it per se, but she tolerated it just fine. I wouldn't say it ever stressed her once she got used to it and realized I wasn't going to do anything really weird. :)

    You can take it slow...start with the AM/PM and one mid cycle and as he gets used to it, do more testing. That might help.
     
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  10. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    My kitty hated being touched when he was first diagnosed, so he didn't just hate the testing, he hated having me touch him at all. But I knew we had to get past it if I was going to keep him safe and make him better. So with perseverance, and tons of little tricks and training rituals, he's to the point now where he snuggles and purrs through the tests and reminds me if he thinks it's time for another test. Okay, really he's reminding me he wants a treat, but he'll gladly put up with the test for a bite of freeze dried salmon!
     
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  11. MayL

    MayL Member

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    Feb 24, 2018
    Since Milo's last bg curve on Sunday indeed looks more like a curve, can I consider that a sign he is NOT insulin resistant? Or as other members have suggested there could still be the bounce effect going on and I still need more data? I'm just wondering when I should do the tests for Acromegaly and Cushings. Should I do that sooner than later regardless of the curve/testing results? Or no need to go rushing to the vet yet? If he has Acromegaly or Cushings, does it mean insulin injections are harming him instead of helping him? Thank you!
     
  12. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    The usual advice here is if you get over 6 u twice a day it's worth testing for a high dose condition. Acromegaly, Cushing's or auto insulin antibodies can be at the root of it. No, it doesn't mean the insulin injections are harming the kitty but the dose can get quite high and can fluctuate quite a bit. Acro tumours can have a pulsing action. Often, auto insulin antibodies "die off" after a period of time (a year or so in some cases) and the dose has to drop a lot. I'm not sure about Cushing's. Some people can't afford to test for a high dose condition so they just treat with insulin "as if".

    Try hard to get a pre shot test every time. Yes, your curve shoes the insulin is having an effect but the dose is likely too low. At this dose level you can increase by 0.5 u tomorrow AM if you're up for it.
     
    Last edited: Feb 27, 2018
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  13. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    BTW - another cause of insulin resistance is garden variety glucose toxicity. When a kitty is in high numbers a long time their body loses responsiveness to insulin. The way it's dealt with is to carefully increase the dose in a rapid as fashion as is safe. The longer he sits in high numbers the worse the toxicity and the higher the dose has to go to break through it. Once you reach a break through point the dose can come down quickly.
     
  14. MayL

    MayL Member

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    Feb 24, 2018
    Great advice Kris! All his pre-shots are in the 600s so yes, I should be careful when the break through happens and continue to test pre-shot. What are your thoughts on the fact that Milo's fructosamine was 393 on 2/2/18 but no matter what his pre-shots are in the 600? I feel like there is a disconnect. I also heard that maybe fructosamine isn't as helpful as we once believed it to be. My vet also doesn't think Milo is bouncing because his bg isn't low enough. I guess it's possible he could have dipped below 300 in his last bg curve but probably not because right after the nadir (I think a hour had passed) and he was moving upwards again. What are your thoughts on this comment my vet made re: bouncing? Thanks so much!
     
  15. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    A fructosamine test give an idea of average BG in the 2-3 weeks prior. As an average it tells you nothing about how high or how low BG has gone. Once an owner takes on the testing routine we recommend here the BG data you log on your spreadsheet is much more useful so there's really no reason to pay for any more fructosamine tests.

    He's probably thinking of the Somogyi effect as a cause for bouncing - ie., a drop to a very low BG at some point in a cycle whether captured by a test or not. Our definition of bouncing is much broader. Here's something I wrote a while back to explain it:
    1. BG goes low OR lower than usual OR drops too quickly.
    2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
    3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
    4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
    5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
    6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
     
  16. MayL

    MayL Member

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    Feb 24, 2018
    Thanks Kris! Should I try to explain "bouncing" to my vet? I want to express this concern that you shared with me to my vet, but not sure if I will articulate it correctly.
     
  17. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    You can try but there might be eye rolling because it comes from crazy cat people on the internet ... ;) Our definition comes from thousands of observations made by hundreds+ of people. Vets can get hung up on the Somogyi effect idea.
     
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  18. MayL

    MayL Member

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    Feb 24, 2018
    I hear ya! Where are the crazy cat people on the internet who happens to also be a vet? I would like to be that person's client!
     
  19. MayL

    MayL Member

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    Feb 24, 2018
    I've been reading about ketones - since I am getting readings in the 600s, should I be testing for ketones? My vet has not brought this up at all, but I think I should be concern and I should do what I need to make sure ketones isn't a problem. Thoughts?
     
  20. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    I would at these levels. You can get strips at any pharmacy.
     
  21. MayL

    MayL Member

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    Feb 24, 2018
    I went to Walmart and bought the ReliOn Ketones Urine Strips. Put a little container in his favorite corner of the litter box and collected fresh urine for testing. It was super easy and it came back negative! I am relieved. Should I be surprised that with bg so high that negative ketones is unusual?
     
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  22. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    That's great news
     
  23. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    No, ketones should not be present ever. If it shows as trace, post and get advice on next steps. If it shows as more than trace, go immediately to the emergency vet. Ketones can progress very quickly and are the most dangerous thing that happens to our extra-sweet cats around here. Ketones are usually some combination of these factors - dehydration, not enough calories, an infection/inflammation, and high blood glucose. So things can go along just fine for a long time, but when one of those gets out of balance, ketones can develop. That's why regular testing and appropriate dosing are so urgent. Many folks around here fear hypos, and there is reason for that, but ketones take far far more of our kitties than hypos do, so it's great that you have the test strips.

    I'm curious if you are testing more than we see on the spreadsheet? It looks like it's been awhile since you have any data, and getting your kitty in better numbers will help to lower the ketone risk. We'd be happy to help with that!
     
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  24. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Hurray for negative ketones! However, I completely agree with Djamila's assessment of the risks. Getting BG under good control is so very important and testing is part of that.
     
  25. MayL

    MayL Member

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    Feb 24, 2018
    Hi everyone,

    Thanks for checking in! I haven't mastered the technique of testing by myself so I wasn't able to find an extra pair of hands to hold Milo until today. I've been focusing on changing his diet. I've almost weened him off all hills k/d diet (both wet and dry) and been feeding him low phorspherous, low carb Weruva. My sister held him down this evening so I could test him and we got 430 PMPS (the lowest ever value I got since I started testing)!

    I am determined to test more (and follow the suggested routine) --- any suggestions on how be successful doing it myself? Milo is fairly squirming.

    Also, I am using the AlphaTrak 2 meter and the cheapest I've found the test strips to be are about $1 a strip. Has anyone found anything more cost effective?
     
  26. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Most folks around here use one of the human glucometers from WalMart. Since it sounds like you have one near you (I think you mentioned getting the ketone strips there), that may be your easiest and cheapest option. If you prefer things you can order online, I like this one: https://www.adwdiabetes.com/product/8179/agamatrix-presto-blood-glucose-meter-kit-and-strips

    And here are some videos on how to test at home:
    http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

    The kitties in the videos are much much calmer than my kitty, so fear not if you have a wiggly cat - you can get this to work on your own!
    1. Choose a place that will be your testing place. I like the small section of the kitchen counter that has the upper counter/bar on two sides, and the sink on the other side. It makes it just a little harder for Sam to leap away, but without making him feel confined. Nothing like confining a cat to make him freak out! Some people like to use a small table, or a corner of the kitchen on the floor. Other people sit with the kitty between them and the arm of the sofa. Just some way of limiting the escape without making it too scary for the kitty.

    2. Start with desensitization practice: bring the kitty to the testing place. Rub his ears and hold him gently. Kind of act like you're doing the test without actually doing it. Then give him a low-carb treat and let him go. Do this routine several times every day. He will start to associate having you hold his head/ears with getting a treat and that makes kitties more cooperative (in time).

    3. Try everything. And I meant everything. Some things I've found that help Sam: putting a pot of cat grass in front of him as a distraction. Putting one of his favorite stuffed animals in front of him. Getting him high on catnip first so he's more docile (he relaxes with catnip - this won't work if your kitty gets hyper from it). Singing in a soft low voice. Reciting poetry to him. Seriously try everything. You never know what will help.

    4. Three pokes and you're out. If you've tried three pokes and still haven't gotten a test, give a treat anyway and let the kitty go. Take a minute. Breathe. Relax. Let the kitty have a minute to relax too. Then bring him back and try again. The break in between is important for both of you as kitties sense our anxiety. If we are amped up or nervous about testing, they will be too. They won't be calm if we aren't calm.
     
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  27. MayL

    MayL Member

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    Feb 24, 2018
    Thank you so much for the fast response! I really appreciate it and the helpful information. I know there has been a lot of questions asked about human glucose meter conversion to bg values for cats --- I haven't done the search yet on the forum, but if you know of a link that lays it out clearly handy, please shoot it my way :)
     
  28. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Right now amazon has the strips for $45.95. If the cost is prohibitive some use freestyle lite strips in the Alphatrak. Or you can switch to a human meter.
     
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  29. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015

    You can't convert. In general, the values are the most similar in the lower ranges, and diverge quite a bit in the higher ranges. Human meters run lower, which is why the "take action" number is 50 on a human meter and 68 on an AT2. But beyond that, there is no way to compare as they just don't relate to each other. In the past folks on here have run side by side tests for days and days and there just isn't a consistent conversion. Human meters work though because they give us enough information to know if the kitty is too low (below 50) or too high. Whether the kitty is 240 or 480 doesn't really matter that much - it's all just too high to be safe or healthy. Whether they are 38 or 45 doesn't really matter - they are too low and need to rise a bit. So the human meters can tell us the range and give us enough info to make decisions, even if they aren't precisely accurate. And at $0.22/strips vs. $1.00/strip, the cost difference makes it more than worth it to most of us.
     
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  30. MayL

    MayL Member

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    Feb 24, 2018
    Starting Friday Milo we stopped feeling him a high carb food (vet prescribed prescription food k/d hills for his stage 2 CKD). Everything now has been under 10% carb. He surprised us on Sunday 3/4 at 7:45 pm (+10) with a 430 and on 3/5 (PMPS) of 535. Then today at 7:45 pm we get a reading of 574. Can numbers change that much? A little dishearten to see a 430 a few days earlier and then a reading at the exact same time over 100 more. I would hope/expect with the food change that as more time passed with the diet change that we will continue to see lower numbers. Does it take more than a week to see a real sustained difference?
     
  31. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    That is surprising that the food change didn't drop him...it usually does. What food are you feeding now? Some cats really do need time to settle into something new...some have changes right away. It kind of depends on the kitty...

    Any chance you could start to get some more regular testing in? I think that would help make the picture clearer. Preshots every day and whatever mid cycles you can get...even if that's just a before bed test daily and nadirs on weekends. We might be able to figure out how to help get those numbers down...

    Also, I'd be sure to keep up testing for ketones while he's in those higher numbers...
     
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  32. MayL

    MayL Member

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    Feb 24, 2018
    Hi Rachel,

    I do test for ketones every day because it's so easy to catch him urinating mid-stream. Very lucky that he's tested negative every time. The pricks are so much harder because he's squirmy. I was able to get a AMPS in today and he was at 429 AND there was a little fiasco last night. I opened a new bottle of insulin and it was clumpy on the bottom and I didn't know what to do (worried it was spoiled) so I just gave him what's left of his old bottle (barely 3 units when his normal dose is 4 units) so even down one unit we are seeing a 429 which is better than his normal at this time. It's only one data point so probably too soon to reduce his insulin dosage? When is a good time to start modifying (or think of modifying) his insulin dosage? I am going to do a curve this Sunday and will try to do other AMPS, PMPS and mid-day tests today, tomorrow, and Saturday.

    Also, I guess I got excited about the AMPS value that after I pricked Milo's ear and went to pick up the lancet I pierced my finger and drew quite a bit of blood! Argh. I searched the message board and it seems like I'll be okay but would love to hear some reassurance :)
     
  33. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    You'll be fine. I've poked myself with Teasel's lancet after testing him several times. I'm still here! ;)
     
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  34. MayL

    MayL Member

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    Feb 24, 2018
    Hi everyone,

    I've been able to do more testing since we last talked including AMPS and PMPS in a more consecutive fashion. Starting 3/11 Milo dropped into the 200 range for the first time. On 3/12 he had the lowest AMPS I have ever seen at 241 and I panicked and dropped his insulin from 4 units to 3 units and surprising he stayed almost flat the entire day around 200. So I am trying the 3 units for a few cycles. Then I got a 642 AMPS and a whopping 684 PMPS tonight. My heart just sank :(

    A few questions I have:

    1. What might be going on with the flat curve I saw on 3/12? Milo historically has a smile curve.

    2. Is the 642 on 3/13 a bounce because Milo was so low the day prior (3/12)?

    3. Why would Milo's BG go up after his insulin today (3/14)?

    4. The 200s we are seeing happened without a change in dose - I was always giving him 4 units. He has been off k/d prescription food for almost 2 weeks and no dry for over 1 week. I assume the low carb food is helping. But could this be signs of a "sputtering pancreas"?

    Thank you so much for reading!
     
    Last edited: Mar 15, 2018
  35. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Let's see:

    1. Hard to say for sure. That looks a lot like a cycle after a bounce with the flatness...but it's not that high. Since we don't know for sure he didn't go low the night before, it could be that. More likely he just had something going on that day that caused the insulin to not bring him down much. Could be a bit of higher carb food, feeling stressed about something, "oh look a squirrel" syndrome ;). Anything.

    2. It COULD be a bounce...I'm not really sure. He was lower than normal the day before, though he did stay in that same range most of the day. That +6 you got that night might be an indication that he was headed into a bouncy cycle since it was already pretty high.

    3. At +7, he probably had already passed nadir, so his BG was on its way up. He most likely was a bit lower earlier in the cycle.

    4. It could be, but I think it's really just a reaction to being on better food. Lower carb food can (and does!) lower the BG over 100 points...sometimes overnight. Sputtering pancreas is usually indicated by random low numbers that we can't account for and/or going DOWN after eating...even with no insulin on board (because the pancreas makes some of its own then!). Doesn't mean his pancreas won't wake up, though!

    I'd like to see what's he doing a bit earlier in the cycle on this. Any chance of something in the +3 to +5 range today?
     
  36. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Rachel gave you some great ideas in her post, so I'll just add that my hunch is that the flat yellow cycle was just a result of lowering the insulin dose that cycle. The cycle after a dose change can be a little weird sometimes.

    I would suggest that you increase again, but try 3.5, and then after three cycles let's see what the numbers look like. When a kitty is in really high numbers like this we want to be more aggressive with getting the numbers down so that at least a few hours during the day are in healthier numbers. They need to be below 220 for the pancreas to have a chance to heal, and blues and greens are best for that.

    You're doing a great job of increasing testing! The food change and the data you're collecting will really help get Milo into a better place.
     
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  37. MayL

    MayL Member

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    Feb 24, 2018
    Thank you @Djamila and @Rachel! Great advice. And Milo does have stage 2 CKD, hyperthyroidism, and IBD. He was on 10 days of metronidozole for really bad diarrhea (62.5 mg twice a day which really helped but we stopped this past Saturday and his stomach is in bad shape right now). So he has so many other things going on, which I assume causes changes in his BG.

    I will try to get in a number today around +4 and increase his dose back up to 3.5 tonight. I am also switching to ReliOn Confirm to help with cost. I added a second tab to my spreadsheet called "ReliOn" so that's where my data going forward will be.

    @Kris & Teasel has been super helpful too. Do you have any new thoughts on these new numbers?

    Thanks everyone!
     
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  38. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    I agree that a trial at 3.5 u is in order.
     
  39. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Well look at that! You switch meters and now you have some pretty blues! Isn't that fun? I mean, I know the numbers are what they are, but I just think seeing lower numbers helps with our sanity in all of this!
     
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  40. MayL

    MayL Member

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    Feb 24, 2018
    Thanks @Djamila! Then I get a 563 AMPS today and I lose some of that sanity :( I stuck to the 3 units because I was seeing 200 and even some high 100s the last two days and now this... I will keep watching and testing before making the move to 3.5.
     
  41. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    It's possible the 563 is a response to a low overnight number, although looking at the previous night it could also just be one of those things. Are you still feeding Weruva only? Any chance higher carb treats or kibble have snuck back in? Or stealing kibble from the dog or other cats? Big fluctuations in numbers are sometimes the result of carbs. Other times it's just how the cat is at this point.
     
  42. MayL

    MayL Member

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    Feb 24, 2018
    Yup, just weruva and no kibble in the house. Today's nadir is the lowest I've seen - 149 and it's possible it could have gone even lower but it was feeding time and I suspect that's why the bump to 239 when I tested the hour after the 149. It's a little scary to see how his AMPS can drop way more than 50%. I've read that is something I should monitor closely (when the nadir is more than a 50% drop). Should I be worried that he's dropping so much? :(
     
  43. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    I don't see those numbers on the SS, and I'm not sure I'm following what you were saying. What time was the 149 in relation to the AMPS shot? And then the 239 was an hour after the 149?
     
  44. MayL

    MayL Member

    Joined:
    Feb 24, 2018
    Hi, are you able to see it now in the spreadsheet? Maybe it didn't save properly. The 149 was +8 and the 239 was +9. His AMPS was high today at 415. I will test mid-day again to see how low he goes today.
     
  45. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    I see your SS but there's data missing, including those two numbers.
     
  46. MayL

    MayL Member

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    Feb 24, 2018
    Very weird. I tried on a different computer and I can see the numbers I referenced above in the SS. In the ReliOn tab right? Not the Alpha Trak tab because I recently made the switch and just added a ReliOn tab to the spreadsheet so people can flip between my Alpha Trak numbers and ReliOn numbers.
     
  47. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Oops! My mistake ... I didn't notice the two tabs. Djamila might have made the same mistake.

    A mid cycle test or two will be good data.
     
  48. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    ACK! Yes, I did the same thing. Maybe put a note at the end of the AT2 spreadsheet to prompt us to look for the other tab? You know, since sometimes we forget things...:oops:;)
     
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  49. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    It looks like Milo hits nadir rather late. Would it be possible to get a +8ish test early in the morning to get a feel for the night cycles? It's not uncommon to have very different AM and PM cycles, I just want to check if he's going lower during the night.
     
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  50. MayL

    MayL Member

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    Feb 24, 2018
    Hi there, Milo just got his first green on his spreadsheet today! He had a high AMPS at 407 (using ReliOn) because I had to leave for work earlier so he had ate about 1 hour earlier and not 2 hours earlier. We just checked at +7 and he's at 62 for ReliOn and then we did a check with AlphaTrak and he was at 97. I'm not sure what I will see at his PMPS, but what are people thinking? What range should I still give him 3 units and maybe what range I should cut the dose to 2.5 or 2.75? I'm not sure what his body will do in the middle night so I want to go conservative to be safe and will probably wake up once at least to get a BG test in around +6 or +7 which is sort of his typical peak time. Thank you!
     
  51. MayL

    MayL Member

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    Feb 24, 2018
    Good idea @Djamila! I just posted an update on Milo's green nadir today (please check the thread) and think I should definitely check him after his PM shot.
     
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  52. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Wow! What a GREAT number! I think you'll have to base it off what the PMPS is. Maybe 2.5 for a yellow and 3 for a pink or higher? Or if you're feeling comfortable with it, you could hit 2.75 for a yellow. That's not as conservative though, and you may want to go to the lower dose if you need to get some sleep, as we often do at nighttime. ;)

    If it was me, I'd try to get a +2 if you CAN (to tell you if you're going to see an active cycle) and then you can decide what other test you want through the night if he isn't dropping too fast.
     
  53. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Well, heck! Here you are - and I just suggested you post over here. :smuggrin:
     
  54. MayL

    MayL Member

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    Feb 24, 2018
    Maybe we got too hopeful too quickly :( I went down to 2.75 units from 3 units because his PMPS was 221 and was afraid I was going to see too big of a drop at night and won't be awake to catch it BUT instead the complete opposite happened. He was high all evening. I don't normally test after PMPS (so we don't have much prior data to work with) but at +2 he was at 418 and then +6 he was at 571 and now right before his AMPS he is at 573. It's like he didn't even get a shot, but I know he did :eek::nailbiting:

    Was last night a bounce from him being so low yesterday? What are some of the reasons why his night numbers be so different from his morning numbers?

    Any words of encouragement would be appreciated!
     
  55. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Yes, a huge bounce from that green. This is a very common phenomenon and it can take a couple of cycles to settle. As you accumulate more data you'll be able to "stand back" and see trends more easily. Reacting to individual numbers is very stressful so try hard to look at the big picture. :)
     
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  56. MayL

    MayL Member

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    Feb 24, 2018
    Milo continues to surprise us! Yesterday his PMPS was 167 so I cut down his insulin to 2.5 units and I just tested him for his AMPS and it's 112! I am going to stall and retest in a hour, but at this number I have no clue what insulin amount to give him? 2 units? no units? Help please! @Djamila @Kris & Teasel @Rachel

    Thank you!!!
     
  57. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Will you be able to do a couple of mid-cycle tests? It looks like on a 169 last night the 2.5 worked well, so fingers crossed you get that much of a rise and can just do it again!
     
  58. MayL

    MayL Member

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    Feb 24, 2018
    Yup, someone is home with him and can watch him and do mid-cycle tests. I guess if we see he's dipping too low we can try to get some food in him and consider reducing the units even further? I am really nervous he's going to get to hypo levels :(
     
  59. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Try the stall and if he doesn't get above 150 maybe drop to 2.25 u. It's great to see nice numbers but scary too. Yes to a snack if at +2 he's dropped 50+ points.
     
  60. MayL

    MayL Member

    Joined:
    Feb 24, 2018
    After stalling for an hour plus he got up to 144 and we decided to shoot a 2.25 and will monitor/test the little guy closely throughout the day. Keep you all posted!!!
     
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  61. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    Exciting! These experiments where you push the envelope a bit are great learning experiences and excellent reference for later on. :smuggrin:
     
  62. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Ohhh this is exciting! Can't wait to see what happens!
     
  63. MayL

    MayL Member

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    Feb 24, 2018
    Did I push the envelop too far?! :eek::confused::banghead: I noticed Milo did not do well with the 2.25 or 2.5 units so I have been monitoring him on 2.75 and today at +8 I got a 52 on the ReliOn. I didn't see any clinical signs but I did panic :( I gave him some feed, treats, and when he wasn't eating much (he doesn't like me to force anything on him), I rubbed a little karo syrup on his gums. I tested 15 mins later on ReliOn and got a 60 and Alphatrak a 93. I tested him again at +9 and he's at 110 on ReliOn. I'll keep testing him before the PMPS and then after his PMPS, but wow I am still shaking from the experience.
     
  64. MayL

    MayL Member

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    Feb 24, 2018
    And a huge bounce at PMPS 533 :confused: we also gave him insulin late (about 1.5 hours because he went hiding after today's ordeal). Poor guy.
     
  65. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I think you did the right thing in right thing in going back to 2.5 u for now. He's a bouncy kitty and it often works better for them to keep a dose a bit longer. If changes are too frequent it can send them off into space. Speaking from experience here ... o_O
     
    Last edited: Mar 27, 2018
  66. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Poor thing! And poor you! You both deserve a break and a treat today!
     
  67. MayL

    MayL Member

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    Feb 24, 2018
    Thanks everyone! Milo is getting some greens but then bouncing back up. It's a wild ride - doesn't seem like much I can do but be mindful and keep collecting data :)
     
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  68. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    As long as you're still getting those greens, I agree you just keep doin' what you're doin' and collecting data.
     
  69. MayL

    MayL Member

    Joined:
    Feb 24, 2018
    Hi @Djamila, @Kris & Teasel, and @Rachel,

    Today I didn't give Milo his morning insulin. Last night he was hanging around the 100s and when he got up to 156 I gave him 2.25 units which is down from his 2.5 that he's been on for awhile. He's had quite a few nice greens and then some bounces along the way.

    This morning his BG was not moving up. His first AMPS at 8:33 am was 100; second AMPS at 9:25 am was 87; third AMPS at 10:09 am was 117; fourth AMPS at 11:22 am was 107; fifth AMPS at 11:55 am was 111. Unfortunately, I had to leave and would not be home to monitor him and did not feel comfortable giving him any insulin when he's sitting this low for over three hours in the am.

    I just got home a little bit ago and at 2:50 pm he's at 195. Today was a first for me so I am not sure if I did the best thing for Milo :(

    Is the dosage too high and that's why the duration lasted passed 12 hours? What are thoughts if this happens tomorrow again?

    And I guess for tonight if he's doing 200 and up, I'll just shot the 2.25 units (and go on as usual)? This am was really strange and I am a little baffled!

    Thank you!!!
     
  70. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    Wow! Well first you did absolutely the right thing this AM. With those numbers, I would never advise giving insulin.

    The dose COULD be too high...that might be why. It could be the pancreas too. Did he eat after his first test this AM? Numbers going down or staying low after eating is a sign the pancreas is kicking in, and I think that's most likely what is going on. Which is exciting but nerve-wracking!

    Yes, tonight, if he's over 200, I'd give the lowered dose you mentioned and just make sure to grab a +2 if you can...and go from there. If he is low again, you could try the stall without food and retest strategy and see what happens. He might raise enough to give insulin, and if he doesn't, then at least you know. :)
     
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  71. MayL

    MayL Member

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    Feb 24, 2018
    Thanks @Rachel! He had breakfast a little before 7 am and then we tested around 8:30 am because he was hungry again and wanted to eat and we got the 100. He then had some food and then we got the 87 so maybe the pancreas was working then. At 9:30 it would have been close to 12 hours since his PM shot. Then we stalled for about two hours hoping the food from 9:30 would pass and got the 107. We gave him some food around 11:30 or so and right before we left at noon we got the 111.

    It's hard to predict what's going to happen next for Milo!
     
  72. MayL

    MayL Member

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    Feb 24, 2018
    Also, I was also wondering if no shot is the right decision because I wasn't sure if I should have given him at least something like a token shot. Like 1 unit? I wasn't sure if it made sense for me to go from 2.25 to 0 units. I know we want to make small changes to dosage and going to zero was a big change, but I guess his numbers were so low, did I really have any other option besides zero?
     
  73. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    I don't think so. The other option we sometimes suggest is feeding, waiting 45 minutes, then giving a reduced dose. BUT that's only if the number is rising. Since you know for sure the number was still so low after eating, we wouldn't have suggested any insulin at that point.

    Honestly, he stayed in normal, non-diabetic numbers all day, even with food on board. That really signals pancreas to me. And if that's the case, giving insulin could have been really dangerous since his pancreas was putting some out too. Even if you had been home to monitor, I wouldn't have felt comfortable with you giving ANY at all. And since you WEREN'T...nah, you had no real choice. You made the absolute safest decision for Milo and I think every single person here woul dhave done the same.

    We do want to do small dose changes, but that's because we want to be sure we don't skip over the ideal dose. When it comes to lowering doses, or skipping them, that's a different story since we have to be sure they stay safe.
     
  74. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I don't see today's numbers on your SS yet. :)
     
  75. MayL

    MayL Member

    Joined:
    Feb 24, 2018
    Hi @Kris & Teasel, I just have the numbers in the notes. I am going to move it into the cells now. It felt weird to put a number into say +7 for an imaginary shot of zero haha.
     
  76. MayL

    MayL Member

    Joined:
    Feb 24, 2018
    I tested him at 6:11 pm and he jumped all the way to 525. Gave him his 2.25 units after I tested him again and got 515. I will see what direction he is heading in a couple of hours when I retest.
     
  77. MayL

    MayL Member

    Joined:
    Feb 24, 2018
    Hi ladies @Kris & Teasel @Djamila @Rachel,

    I continue to scratch my head!! Milo ran high all day 4/3 so I gave him 2.25 units after his PMPS of 405. I didn't get a chance to test throughout the night, but this morning AMPS he was low (105). We stalled for a hour but he was hungry and had a little bit of fancy feast broth and Isla Bonita Werura (not much) but he's at 89 now. I will try to test again in a hour to see where he's at.

    I have a new question. When should I give him his next insulin when I skip a dose? Since I am at home today, I can keep testing him until I get a reasonable number and then give him a shot. Or should I just wait it out until we get to the 12 hour mark?

    The issue is I can't always be changing up his shot times on a daily basis, i.e., if I notice his numbers are high and I give him the shot at 3 pm, there is no way I can give him his next shot at 3 am (when his typical shot is around 9 am / 9 pm). It's probably not practical to keep changing the 12 hour marks of when to give him his shot, but I also don't want him to go too many hours at a high number. Thoughts? Strategies? Thank you so much!
     
  78. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    When you skip a dose give the next one at the usual time. ProZinc allows up to an hour's dose timing flexibility so you could give it an hour early. It's best not to scramble your dosing schedule.
     
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  79. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Wow! That’s quite a number...and looks like he is staying low so far. I’m very interested to see where he is tonight!

    Warning: he may be high since no insulin onboard. That’s okay and expected...you don’t want to increase even if he is. :)
     
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  80. MayL

    MayL Member

    Joined:
    Feb 24, 2018
    Nailed it @Rachel! He came in at 458. I stayed with our 2.25 units and let's see what happens tomorrow!
     
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  81. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    My hunch is that you need to reduce the dose a little. For each of the last five days, one cycle has been a zero or reduced. You really want to be able to shoot both cycles, so I wonder if you drop back to 2.0u if you'd be able to be more consistent.
     
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  82. MayL

    MayL Member

    Joined:
    Feb 24, 2018
    I will try this for a few cycles and see what happens!
     
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  83. MayL

    MayL Member

    Joined:
    Feb 24, 2018
    Hope everyone had a good weekend!

    I tried to do a curve for Milo's internal specialist this weekend so I switched back to Alphatrak (which is what the vet office uses) and Milo's BG has been running super high :(

    I had him on 1.75 units for a few cycles and then 2 units for a few cycles and he hasn't dropped down to some of the lows I saw earlier in the week. Not sure if he needs more time to settle down or we need to go back to 2.25 units. But as you remembered at 2.25 units I was getting nadirs at the 12 hour mark or getting PS at 100 (see ReliOn tab 4/2/18 and 4/4/18). Those days I gave no insulin.

    Because I am doing the curve with Alphatrak sometimes I checked with ReliOn to see what I am getting. The numbers are much higher on Alphatrak. Now I am wondering for 4/2/18 and 4/4/18 would the Alphatrak have given me a BG of 200 plus (instead of low 100s per ReliOn) and I should have given him a shot? What are yours thoughts on this? @Djamila @Rachel @Kris & Teasel

    Thank you!
     
  84. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Yes, at high numbers the human vs pet glucometer difference can be quite dramatic. Try not to stress about it too much. It does look like he can handle an increase, so if you're home to do some spot checks, I'd say to go ahead and move up to 2.25.

    When you get a number that seems too low to shoot, you could do a second test and see how it looks on the AT2. The other option is to stall without feeding until the number starts to rise, although listening to a hungry cat crying for dinner can be tough. :confused::cat::bighug:
     
  85. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    I agree...it's time for an increase I think. I know that before you were getting a cycle that was too long on the 2.25 but insulin needs can and do change. It's very possible that the dose was too high at one point in time, but now it will be perfect. That's part of what makes this sugar dance so tough...things can change so quickly!
     
  86. MayL

    MayL Member

    Joined:
    Feb 24, 2018
    Things continue to change rapidly! I gave Milo 2.25 units yesterday because the 2 units on many cycles was keeping him pretty high. Well, the 2.25 units was a long cycle again. 12 hours would have been roughly around 9/10 pm and at 11:30 pm he was 104 on ReliOn and 178 on Alpha Trak. I decided to go very conservative because it was a PM shot and I won't be up watching him. I only gave him 1.5 units.

    At 2 am, he was restless wandering around the house. I decided to test him and he got a 121 on Alpha Trak so he was going down. I decided to be safe and wake up at 5 am and tested him and got a 67 on Alpha Trak!!! I didn't really see any symptoms but he seemed agitated and restless so I rubbed some karo syrup on his gums and syringed him some fancy feast broth. He didn't want to eat anything. I got 72 on Alpha Trak 30 mins later. So not much changed. I brought out a high carb gravy fancy feast and he ate about 2 ounces and at 7 am he was up to 111 on Alpha Trak. We have been feeding him all morning and he's sitting at 242 Alpha Trak at 9 am.

    Wow! I am just shocked. He was running high on 2 units and one cycle of 2.25 and this happened? And a reduction to 1.5 units and I get the lowest nadir I have seen with Milo. Help!
     
  87. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Unfortunately you've been shooting partially blind because you missed two AMPSs and have no evening data for those four recent days at 2 u. He might have dropped low enough overnight on 08/09 April to justify staying at the dose.

    An overly long cycle can be a sign of a dose that's too high. Looking only at the 104 from the ReliOn, that's too low a dose to give insulin. At most a very small token dose would be given. Even with a 178 on the AT that's a sign to skip or greatly reduce. A token dose might have been 0.5 u at the most.

    Not really if you're looking at those recent days at 2 u. I recommend you stay at 2 u both AM and PM for a few more days. Post here for advice if you're unsure of what dose to give.
    ______________________________________________________________________________________________

    http://www.felinediabetes.com/FDMB/...prozinc-pzi-insulin-for-diabetic-cats.164995/

    This is an excerpt from this guide:
    • The proper sequence for dosing insulin is: Test/Feed/Shoot. In the beginning, if your cat’s BG is not up to at least 200 mg/dL {11 mmol/L}, if your schedule allows, you can stall (without feeding) for 20+minutes, then retest the BG. You are looking for a number that is rising, not falling and up to 200 mg/dL {11 mmol/L}. If you stall once, but can’t do another round of stalling and your cat hasn’t reached a BG of 200 mg/dL {11 mmol/L}, you’ll need to skip the dose and wait until the next cycle. NOTE: Because pet-specific meters (such as the AlphaTrak2) often read higher than human meters, you may want to adjust the NO-SHOOT number to 225 mg/dL {12.5 mmol/L} or even 250 mg/dL {14 mmol/L} This gives you an added margin of safety when using an AlphaTrak2 or other pet-specific meter.
    • IMPORTANT NOTE: Do not feed your cat within the two-hour window right before the scheduled dose time; doing this can raise your cat’s blood significantly, giving you a higher BG number based on food. This could result in your giving insulin when you should not, or giving more insulin than you should.
    • FDMB has general BG references for use with human meters: A cat is considered regulated if BG is in the mid-200s mg/dL {mid-11s mmol/L} for pre-shot and in low 100s mg/dL {low 5.6s mmol/L} or double digits (U.S. mg/dL) for nadir. (BUT not below 50 mg/dL {2.8 mmol/L} which is approaching hypoglycemia range, which is too-low blood glucose - we commonly call this “hypo.”) If you are using an Alpha Trak2 (pet meter) your hypo range starts at 69 mg/dL {3.8 mmol/L} and below. Again: You may want to consider raising your No-Shoot number to as much as 250 mg/dL {14 mmol/L} in the beginning of this sugar dance when using a pet-specific meter. That’s your and your vet’s decision.
     
  88. MayL

    MayL Member

    Joined:
    Feb 24, 2018
    Thanks Kris - I'm sorry if I weren't cleared. I switched between AlphaTrak and ReliOn so between the two tabs I should always have a AMPS and a PMPS. I never shoot now without testing 2 hours after no eating.
     
  89. MayL

    MayL Member

    Joined:
    Feb 24, 2018
    I must got the wrong impression that a reduction to 1.5 from 2.25 unit was enough. I considered prior 100s on the ReliOn and saw that a zero shot ended up too high at the end of the cycle and that I should really try to shoot 2 shots every day so that's why I made the decision to give him insulin. How does one decide between a token 0.5 units vs 0 units? Or maybe 1 unit would have been okay?
     
    Last edited: Apr 12, 2018
    Reason for edit: Added question
  90. MayL

    MayL Member

    Joined:
    Feb 24, 2018
    On Alphatrak he was in the high 200s to mid 300s on April 7 and 8 - I thought 200-300 was considered high? And that I needed a dose that kept him in the 100 range?
     
  91. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I should have checked both SSs. If I could put in yet another plug for using only one meter ... ;) Using both and going back and forth can confuse us or cause us to miss info (puts hand up ...) and it has to be burdensome for you. You test with one or the other, try to evaluate numbers on each and can feel OK or not OK depending on which meter reading you're looking at. If you can afford the AT strips by all means stick to that. If you're concerned about BGs that are close to vet measurements use the AT. I guarantee that we all know how to interpret human meter numbers here if you're game to try that. You'd get very comfortable with it yourself in time.

    Here's another thing to consider: one of the best ways to get a feel for how your kitty is doing overall is to sit back from your computer screen and get a "forest" view - colour concentrations, increase in blues/greens over time, etc. This is impossible when you have some data on one SS and other data on the second. All you're looking at are the individual "trees" and really can't see trends over time.

    When I suggested staying at 2 u for now I was looking at your ReliOn sheet because you have more data there over a longer period of time.
     
  92. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I'll talk in human meter terms for now to make it clearer. BGs in the 200-300 range aren't high. High is high 300s and up. You won't likely find a ProZinc dose that will keep him steady in the 100 range because of the action the insulin has. An ideal ProZinc curve is a smile shape. The high ends of the smile are the AM/PMPSs. After the AM dose the insulin gradually lowers BG until it's at its lowest at nadir, the lowest part of the smile shape, and from there the BG will gradually rise again to about the level it started at as the dose finally wears off at the end of the 12 hour cycle. A good ProZinc dose will be one that gives PSs (on a human meter) in the low to mid 200s and a nadir in the high double digits to low 100s. If you're using a pet meter you might expect PSs nearer 300 and nadir around low to mid 100s. These are all approximations.
     
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  93. MayL

    MayL Member

    Joined:
    Feb 24, 2018


    Yes, tonight, if he's over 200, I'd give the lowered dose you mentioned and just make sure to grab a +2 if you can...and go from there. If he is low again, you could try the stall without food and retest strategy and see what happens. He might raise enough to give insulin, and if he doesn't, then at least you know. :)[/QUOTE]
    Thanks Kris! I was only using the AlphaTak to do the curve for the vet so I have numbers consistent with the vet. Otherwise I am sticking to ReliOn. But I thought why not get some ReliOn numbers for comparison and then realized that if I used the AlphaTrak number instead of the ReliOn I would have given an insulin on some days instead of zero. I plan to stick to ReliOn :)

    As for approximates, sounds like the protocol you copied earlier is that for human meters don't shoot if BG is around 200 and pet meter is probably 225 or 25o. But it sounds like some folks would still shot a token shot with these numbers. How do you decide maybe just give .5 or 1 unit instead of the zero? Is it better to have a little vs. zero or does it all depend on the PS number and each cat?
     
    Last edited: Apr 15, 2018
    Reason for edit: typo
  94. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    OK. I understand it better now. Vet wants AT curve numbers. :)

    Yes, that protocol is for human meters because the majority of people use them. It does give reference values for pet meters as you've seen. Those "no shot" guideline numbers are meant for people who are new or haven't collected a lot of data yet. As you get further down the road you can experiment with giving a full dose on a lower number - eg. a 180 PS on a human meter or a 200 on an AT. Over time you push the envelope to see how low a PS you can give a full dose on and then you try slightly reduced doses on an even lower PS. It's this collection of experimental results (the BGs on your SS) that you can refer to because they'll be specific to your cat. Learning whether you can give 0.5 u when a PS is quite low (eg. low 100s) is yet another experiment. There's a lot of judgment required on the part of the owner and a SS data base is what you need for those judgments. Early on, you might have to post here for help quite often but over time you'll get more confident in looking at your SS and making good dosing decisions most of the time.
     
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