Questions with Buster's glucose curve -- ProZinc dosing

Discussion in 'Feline Health - (Welcome & Main Forum)' started by BraveCat, Oct 16, 2019.

  1. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Hi everyone! I'm Cat and my brave kitty is Buster. I posted on the Introduction board and was recommended to repost my questions about Buster's ProZinc dosing here.

    First, thanks SO MUCH for this forum! I've been using the website as a resource all summer, learning a little bit at a time as to what it means to be caretaker to a diabetic cat, but now it's time I come out of my "shy" shell and actually JOIN the forum, because Buster and I really need help with his dosage situation. Our vet is supportive as vets go, but I get the impression he's not sure what to do about this, either. ie I don't want to simply raise the dose again if that's the wrong thing for Buster.

    Buster was an abandoned stray, probably because he had diabetes so severely. A cat rescue received him, and 2 weeks later, I was his foster mom. This was back in February 2019. Buster has come a long way on his healing journey since then, and he is a very grateful sweetheart of a boy!

    On Monday morning, I started the online spreadsheet for him--currently at 5 cycles--and I also wrote a detailed narration about our months-long journey of "dosing" him with Prozinc and feeding him with LC cat food. (See his Bravecat profile.)

    I'm at the point though, where I don't know what to do with the ProZinc anymore. We *thought* he was regulated and approaching remission at the end of August. (He was down to 1.5 units from a high of 6). But then we had a week away where we left him home with other visiting caretakers, followed by another week away at the end of September, and his numbers haven't recovered. They are all over the place! The past several cycles show rainbow colors.

    So here are my questions: Is he "bouncing"? Should I maintain his dose? Lower it a bit? Raise it?

    Buster is now healthy other than his diabetes (he's guess-timated at 8 years old).

    I appreciate any and all suggestions! --Cat
     
  2. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
  3. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    How old is the vial of ProZinc you are using? Has he been checked for other issues? If he has any kind of pain or infection (dental issues, for example), that can raise glucose. How often have dosing increases been made and in what increments?
     
  4. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Hi! We received the vial of Prozinc on August 10. It's half full.

    He had a full slate of lab tests in February when he was brought in from the Cat Rescue, and nothing other than diabetes was identified. The last time the vet visually saw him was on September 6, for an examination re-check, but no labs were drawn (other than a quick BG check). I asked about infection (to explain the high/weird numbers, but the Vet quizzed me about his (normal) urinary behaviors, and visually checked him (teeth), and said he was fine. Buster's behavior is normal (he's playful and fun and also loves to eat), and I don't think he's in pain. (My other cat was very good at hiding pain, and I've been trying to "analyze" Buster on this point, but I'm just not seeing anything.)

    Dosing increments...He started at 1.0 in February. Held for a few weeks, then went to 2. Ditto on these increments until we got to 6.0 (and there were several weird/high ?fructosamine? tests in there, too), and still he wasn't regulated. This went on until ...mid June, I think. Around this point, I'd learned via internet research that dry food is bad--even "diabetic" dry food, so of my own accord, I weaned him off it. (Buster is easy to switch food with...he will eat anything you put in his bowl.) His BG went down. Too much so. Alarmed, I called the vet's office. My vet was on vacation, and another vet in his office told me to "keep doing what you're doing." Um, no. At one point I had a 30 reading! I called several times over several days, and finally realized I was on my own re: the dosage until my vet got back. So I stumbled along in the dark by myself, reducing, reducing, reducing, a half unit at a time every few days/week, until I was down to 2 units. I was doing my own curves, and I thought Buster was doing much better. I was very conscious of not going too low (didn't want that), so I tested him a lot, especially mid cycle, every day. I called in early August to get that new bottle of Prozinc, and the vet said I couldn't have it until I brought him a glucose curve. So I did one the next day, told him what I'd been doing, brought it in...and the vet told me it looked like Buster was heading toward remission and to reduce his dosage even more. We went to 1.5. Then *I* went on vacation, and poor Buster's numbers went all kerflooey. :-(

    When I returned, I waited a few days and then brought the vet his glucose curve, which showed numbers that were much too high (400s). The vet said it was probably because he was upset over us being gone, and to give it another week or two for him to settle in. He (his numbers) didn't settle in. It was like we were starting all over again. The vet raised the dose to 2.0. On Sept 13 he raised it again to 2.5. I went away for another week, and when we got back, it was a little bit worse. I brought in a few more glucose curves to the vet every other week since then, but we're still "waiting to see." I'm really worried about his weird numbers.

    PS I ordered some ketone strips and they should be in tomorrow. I've never done this testing before.
     
  5. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    Now that you have started the spreadsheet, we will be able to help you with the dosing. Do you have any testing data before 10/14 that could be added to the spreadsheet? We are pretty much blind to anything prior to 10/14, so it is very hard to form an opinion and give advice. You said the vet set the dose at 2.5 on Sept 13, so were you giving 2.5 since then until you gave 2 on 10/14? Had Buster gone too low in the cycle previous to the 10/14 AM cycle?
     
  6. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Yes, I will add more numbers to the spreadsheet. I wasn't checking at night at all, though. (My bad--I didn't realize it was important.)

    I'm headed to Google docs, but for now, here are the days preceding...

    10/10: +3 366, +6 324, +8 426, +10 423 PSPM: 520
    10/11: PSAM: 440
    10/12: +6 130, PSPM: 529
    10/13: +6 416, +10 415. Then, that night at about 3a.m., he vomited, which he hasn't done in about 6 weeks. From experience, I knew his numbers would drop by a lot. I don't know why this happens...there is little to no hairball, just clear liquid.

    On 10/14, out of fear, I lowered the AM dose (on a one-shot deal) to 2.0 because a) I thought the PSAM was low for him (197), and b) he'd vomited. I probably shouldn't have done that, right?

    Anyway, thank you so much for your help.
     
  7. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    I can't answer that since I don't have history to go on, but it's fine. You have to do what you are comfortable with, and it was much lower than you expected to see. Once we have more data, it will be easier to at least make educated guesses on things like this.

    I am leaning toward suggesting that you continue to hold the 2.5 for right now. It usually takes 3 to 4 days (6 to 8 cycles) to really see the impact of the dose (though it can vary by cat). I realize he has been on 2.5 awhile now, but you have started gathering more data, so I would really like to see 3 or 4 days of data with him on this dose. (In addition to doing a test at every pre-shot time, try to grab a test somewhere close to mid-cycle, say in the +5 to +7 range, every cycle that you can.) Then, we will have more to go on in suggesting what to do next. It is possible he went too low during the PM cycle on 10/13, but we have no way of knowing that for sure. So, I would not want to assume it and base a dose decrease on it.

    When a cat goes lower than their body is used to, they can sometimes 'bounce' up into higher numbers. When that happens, it is not uncommon for them to then stay pretty high and flat for a few cycles. He could be experiencing that right now. If so, it may be beginning to clear since a 200 showed up. Once it clears, we will be able to see the impact of this dose. It is not a good idea to 'mess' with dosing while coming out of a bounce. Just let things settle then you can see what is really going on.

    If we see him go lower than desired, then we know the dose is too high. At that point, I would suggest dropping to 2.25. Do you have syringes with 1/2 unit markings to make it easier to visually estimate 1/4 units?

    By the way, he is very cute. I love the photo.
     
    Diane Tyler's Mom likes this.
  8. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Thanks! The photo is from the 2nd night he stayed with us. He was still so skinny and sick from being abandoned, but you can see the spark of life in him. Right now, he's in my home office, leaping and jumping on the floor with a toy mouse as if he's caught it in the wild. He's a happy guy--very grateful--and he's never minded being tested or injected in the least. He knows it's his "medicine."

    The syringes we're given are U-40. But we just got a new (unopened) box, and I'm sure the vet's office will be amenable to us switching. What kind should ask for?

    Thanks for the explanation of what a bounce is. I've been wondering/confused about that. Yes, I will stay at 2.5, and I will record his AMPS, PMPS, plus at least one reading in the +5-+7 range every cycle. I work at home, so I'm lucky to have flexibility in that respect. Except for Jury Duty next Monday. :):sigh::)
     
  9. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    U-40 syringes can have 1/2 unit markings. Do yours just have a mark for each unit or do they also have a mark for 1/2 units?

    A lot of us get our syringes from ADWDiabetes.com. You may want to see if they are cheaper than your vet. Here is an example of one of the options for U-40 syringes w/1/2 unit markings. They have other brands, too. https://www.adwdiabetes.com/product/18553/ulticare-u40-pet-29g-3-10cc-1-2in-half-unit
     
  10. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Hi...never mind...we DO have half markings on this new box.
     
  11. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    Hi. You're doing a great job getting those tests in. Looks like he is staying consistently high. If that continues through today, I would up the dose to 2.75 in the morning. Anyway you can get a +4, +6 and +8 test in during a cycle this weekend? It would be like a mini curve just to see if his nadir is still hitting around +6.
     
  12. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Thank you so much for checking on us! :) Yes, I can do the +4, +6, +8 on Sat or Sun. I'll do it today, too, as a comparison. (I already did a +4.5 today, so that'll work.)

    Question: does it matter on these mini-curves if I test before or after he eats? And what about timing vs the testing? For example, he usually eats around +6. (He ate early today, at +4.5, because he's been very active and also bugging DH to feed him.)

    PS His ketones were negative on his first ketone-strip test yesterday. Yay! I'll do this daily, too. Thankfully, he let me stick the strip under his urine stream. Not much modesty with this guy. :)
     
  13. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    When you do a normal curve, you test before you feed and give the AM shot. Then, you test every two hours after that, feeding as you normally do throughout the day. You want to see what the numbers look like under normal circumstances. So, do the same with a 'mini-curve'. Test before food and AM shot (which you will always do anyway!) then just feed as normal throughout the cycle.

    I'm glad he doesn't have ketones. You sure don't want that!
     
  14. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    OK, thanks. Is it right, then, that we should be stricter about his meal times while we're working to get him regulated? ie Feed him at noon instead of giving in if he bugs us early?
    We have an automatic-feeder with icepack for times when we're away from home mid-day, so we're covered there.
     
  15. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    Well, obviously, the meals that correspond with shot time have to be at the same time each time. I have found that consistency across the board is pretty important, but I think you just have to learn what works best for your cat over time. Maybe +6 is not the best time for the meal if he is always very hungry earlier. Maybe see if you can be consistent with +5 instead? As things go on, you may find that there is a 'sweet spot' during which you need to feed to help with his glucose, too. For example, if a cat tends to dip a bit low at a certain time in the cycle, it can be helpful to plan a meal just prior to that time. (Not seeing that with him right now, just mentioning it as something to keep an eye on/consider.)

    I used to feed my girls at 6am/6pm (shot times) and at 12pm/12am. Over time, I shifted those mid-cycle feedings based on 1) what I saw with Mia's numbers, 2) their 'hunger cycles' and 3) trying to impact my sleep a little less since I was getting to the point of exhaustion after so long of having such broken sleep. So, they get their mid-day meal somewhere between 11am and 12pm (usually at 11:30am) and they get their night meal around 10pm. This has worked out good for us.
     
  16. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    Wow, Buster is staying really high. :( I definitely wouldn't linger at this dose any longer. Hopefully, a little more insulin will make a big difference.
     
  17. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    I have to ask... Have you started a new vial of strips in the last few days? Is the meter coded correctly for the vial? Just want to make sure there is nothing funky with the strips.
     
  18. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Thanks for the feeding advice! And, yes, I'll definitely go up to 2.75 tomorrow morning!

    re: the testing strips, this vial is coded at 37 for kitties, and I watch the number come up on the reader each time before I test. The vial is about a week old. Though--I didn't check this one with a control solution first. Hmm. Maybe I should put in an order for a new bottle? (my old bottle of solution is expired)

    Another thought I had was the insulin itself. Do you think it's worth it to get a new vial on Monday? It was opened August 10; it's around half full; there are no "floaties"...BUT...(and here is my paranoia showing, LOL) what if one of his caretakers accidentally left it out all night, or something like that, while we were on vacation? (Yeah, I think I'm talking myself into getting a new one, just to be sure. We're really worried about his high numbers.)

    I'm off to get a ketone test (hopefully soon...he's eating...) and then off to bed. I have to say, though, Buster is acting fine. Playful, cuddly, hungry. He's such a sweet boy.
     
  19. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    407 this morning; 402 at +5 last night. I upped him to 2.75 this morning and ordered more testing strips, just in case I got a bad bottle. I've been wracking my mind for the EXACT DATE I started using this bottle, and my mind is fuzzy. Must be sleep deprivation. So the new bottle will be in tomorrow...just to be sure. (And in future, I'm thinking I need more than one bottle on hand!)
     
  20. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    OK--lightbulb moment. I tested the strips on ME and got 150. They work. (And this also shows me that Alphatrak really is higher than human meters!)
     
  21. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    Yeah, the strips are probably fine. I can't say I've ever had 'bad' strips. I just wanted to have you confirm the coding was correct. I have only used control solution a few times (in over 2 years). I have liked having it on hand just in case though because I too am paranoid. :) I am definitely paranoid about running out of testing strips. I will have two backups, then when I open one of those, I order the next pack, so there is always at least one unopened pack waiting in the wings and several strips left in the pack being used.

    Your insulin is only 2 months old. It should be fine. Even if it was left out overnight (in air conditioning), it would probably still be fine. I always used my vials right at 3 months. I see people say they have used them for 4 or 5 or so, but I always felt like I started to see a decrease in effectiveness at the 3 month mark, so I didn't mess around. It's your call, of course, but I would probably just wait and see if the dose increase(s) have any impact. Maybe the 2.75 will get some movement. If not, after 3 or 4 days, crank it up to 3. If he has some insulin resistance going on, you don't want to linger too long at a dose that is not being effective.

    Mia and I are rooting for Buster and you! :cat::)
     
  22. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Thank you, FurBabiesMama! Thank you, Mia! Buster had a more active morning than usual, pretending that he was hunting mice, using his toys as practice. It was funny--I thought with all this energy he would be lower, but no, he went higher by 40+ points--a 450 number at 10 AM.

    Just to be sure, we called the vet and asked for another vial of ProZinc. We're picking it up this morning.
    Tonight I'll dose him with the new vial at 2.75 and then for the next few days put on a new pair of Patience Pants. :) (Sorry, I saw that phrase somewhere else on the forum, and it cracked me up.)

    I love the back-up strips idea...that's what I'm going to do, too. Always have at least a back-up bottle. Because yes, I once ran out of strips mid-curve, and I had to beg some from my vet's office to finish. They did so without charge--they're nice people.
     
  23. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    Hi. Looks like you are seeing some better numbers. Just a few observations, if I may... I noticed that, of the numbers you got yesterday during the morning cycle, +8 was the lowest. So, his nadir occurred later than in the past (from the data you have, it has been +4 to +6). He also did not rise much from that point to PMPS. Last night, you got 295 at +5 then he was even lower at AMPS. Either he had a REALLY late nadir (as in, at the next shot time...unlikely but definitely possible) or he had gone even lower than 185 last night and was rising by AMPS.

    Just keep this in mind as you pick monitor him/pick your testing times. You gave 2.75 on 374 last night, and he was 185 by AMPS. Tonight, you gave 2.75 on about 100 points lower at 276. So, you may want to add in a later test tonight just to check on things (who needs sleep, right?!). If you go to bed at 10pm, maybe you could do one right before bed (I think your shot time is 6pm like mine, so that would be +4). Then, maybe set an alarm so you can get in something like a +7 or 8???

    With his numbers 'on the move' a bit right now, I just want to make sure you get the data you need to figure things and out make the next dosing decision.. and, of course, to keep him safe.
     
    BraveCat likes this.
  24. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Thank you! I'm tired, but the tests last night were very helpful.
    My problem is that I have jury duty today and won't be able to test him until maybe 5PM. I'm praying that he's okay!!
    My husband will be home to watch him. He knows what to look for in the signs of hypo and what to do if he suspects there's a problem. Fingers crossed.
    I tested him at 11.75 and got 208. Then his AMPS was 242. He's rising... I hope I did the right thing by giving him his shot. Full dose at 2.75.
    I'll test him at +1, but then we have to leave. There's no parking at this location and it's an hour drive in morning traffic, so...fun times ahead.
     
  25. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    Oh, those greens were so pretty! He had a good cycle last night. (Interesting that the nadir was earlier.)

    Hopefully, you won't get put on a jury and be away for days. Hubby might need to learn to test. :D
     
    Diane Tyler's Mom likes this.
  26. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Wasn't it pretty last night? Now...he's gone back to his prior bad reds!

    Hubby was lucky today...for a time I was seated on a multi-day jury panel, but then they let me go home early. I was able to take 2 mid-day readings.

    I'm not sure what's going on with Buster kitty, unfortunately.
     
  27. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Hello! This morning he was 155 at pre-shot. I stalled for 20 minutes and re-tested: 175. Since his number was rising, I shot the full amount. It ended up being a moot point, because he moved as I was putting in the plunger. It looked like it all got in fine, but after I removed the needle and then released (the flank), I thought I saw a tiny drop of insulin hit the tile floor. I petted him, but felt no damp fur. So I'm not sure he GOT the full 2.75 units. (Then again, I could just be sleep-deprived and imagining things.) I guess we'll see what happens as the day progresses.

    QUESTIONS: How low should the pre-shot number be before I DON'T shoot? I sort of stress out over this question every morning he's in the blue colors. Should I reduce the dose in any circumstance? ie if it's in the green? less than 150? going down after the stall?
     
  28. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    He is being very interesting. I noticed your notes about feeding 10% carbs for AM and lunch and 6% for PM. I am wondering if the difference in carbs helps explain the difference in numbers. Consistency is important. That is a significant difference in cab %. Normally, when I see such wide swings in the PS numbers - one is in 400s and the next in 100s - I see that as a red flag that the dose may be a bit high. But we are never seeing him go TOO low which I would think we eventually would if the dose was too high. Giving 2.75 of ProZinc on a PS in the 100s is risky, yet you gave it on 185 the other day, and he never even dropped. Would he have without the higher carb food?? Maybe, maybe not, we can't know for sure.

    Be sure to monitor today because, under normal circumstances, 154 is a pretty low PS to have given 2.75 on. It's hard to give you a black and white number at which you should reduce or not give a shot because it can vary by cat, and you largely have to base it on data/experience with your cat. If you posted and said it's 154, should I reduce, you might have gotten advice to do so, but I think I am kind of glad you went ahead with the full dose because I think you need to see what it does.

    Talk to me about his food... does he normally get the 6% all the time, and you just pulled out the 10% for the days he had a lower PS? Does he ever get food that is even lower than the 6%? It's confusing how high he stays during the morning cycle, regardless of PS. So, I am wondering if food is doing that and throwing us all off.
     
    Diane Tyler's Mom likes this.
  29. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    We've been giving him the Purina DM Savory Selects (10%) in the morning. He gets half a can at the morning shoot, and the other half at noon (+5-+6, depending how hungry he is). This has been every day.

    In the evening feed, he gets either Purina DM classic (6%), OR Fancy Feast classic (3%). A half can at the PM shoot, and a half can at 10 PM (+4). Hubby says that last night, he got the DM 6%. The night before, he got the Fancy Feast 3%. He says he's been alternating the 6% and the 3% at night.

    How about if we eliminate the DM Savory Selects 10% all together?

    I'm thinking the Fancy Feast 3% in the morning, and the DM classic 6% at night. How does that sound? I'm thinking that we're usually here during the day to monitor if he goes too low... At night, it's harder to monitor.

    Or, we could switch to JUST Fancy Feast 3%, for all 4 meals. Is that better? The vet won't be thrilled, but he doesn't have to know. :)

    And btw...it looks like Buster did get a "caretaker malfunction" shot this morning. I wasn't home for the mid-day tests, but I did test him at a 544 number at +8.5, which is totally "off" for him. My bad. :-( I'll do better with tonight's shot.
     
  30. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    AMPS Buster got 6% food. This is hubby's area, and he got mixed up. We'll do 3% wet tonight and tomorrow morning, for sure, and see what happens.

    Buster definitely got his full 2.75 shot last night and this morning. Last night's numbers, I think, were still due to the effects of the botched shot yesterday AM.

    His energy is extraordinary--he's been extra hungry and this is causing him to jump up on the counters at food time, etc. He scarfed his breakfast and is looking at me for more! I'll see if I can calm him down with a petting session...
     
  31. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    I'm sorry - I didn't see your last two notes until now. The varying carbs could definitely be causing some of the confusion in his numbers, especially if he is very carb sensitive. I would definitely stay away from the 10% carbs. Just keep what you have on hand in case he is ever low enough that you need something to steer him up. Personally, I would try putting the 6% aside, too. It would be good to see if consistent carb intake helped level things out. As far as concern about the overnight cycle, maybe you could try a timed feeder scheduled to give him more low carb food at a 'strategic' time (just prior to when he normally drops).

    I'm glad he is feeling so good. That is VERY important! It is also nice not to see those ugly blacks and reds.
     
    Diane Tyler's Mom likes this.
  32. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Hi FurBabiesMama! I hope you're doing well.

    I also hope I'm doing well by Buster. He seems happy. But whether his blood sugar is in the "pinks, yellows, blues, or greens"--he's always acting the same level of happy. I don't know how his blood sugar is until I test it with the Alphatrak.

    His low "blue" AMPS numbers and the low "green" numbers in the late night cycle frightened me so much that I nudged his dosage down from 2.75 to 2.5. Now he's on his 9th cycle at 2.5. Do you think this is a better dosing number for him? Or did I "jump the gun"?

    I experimented at bit with the wet food. I ended up settling on 3% carbs for day and 6% carbs for night. I kept the 6% at night out of fear...he tends to go "green" at hours when I'm asleep, and I can't monitor him then. I was worried about a hypo scenario. For example, on the night of the 26th I intentionally stayed up to monitor him, but I fell asleep before I could get the 1 AM reading. I know these testing devices have a margin of error, so even though he went up 14 points between 11 AM and midnight, this is within the margin of error on the reader. Maybe he actually went down--to "lime green". (That's what my fear says, anyway!)

    I think you're right about going to an all 3% diet. I actually tried this for 2 cycles in a row on the 26th, and the second cycle is when I got my late-night green numbers. Buster IS very carb sensitive! But yes, you have a good idea--I can set up his wet food feeder to give him a treat of 3% wet food at say, 1 a.m. (+7). He's already fed at +5, before I go to bed. This will make me feel better, too, to know that with his food, he won't get too low, even if I'm not awake to monitor him.

    QUESTION: When I switch to the ALL 3% wet food tonight, should I leave his insulin dosage where it is? (2.5)

    Thank you so much for checking up on us. It means all the world to me. Having a diabetic cat can be a very lonely place. No one else "gets" it.

    I did have a nice conversation with my vet though, and he supports us. I only have to show him my spreadsheet now. Buster is spared all the office visits, unless he really needs it.

    And fingers crossed, we found a Vet Tech to hire to give him his care over Thanksgiving weekend. This is a huge, happy thing for us. We need to work on our own self-care now!
     
  33. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    Oh, don't be scared of dark greens! They are wonderful. I understand why the lower dark greens would be a little concerning to you since you are right about keeping him out of the lime greens, but don't 'run away' from the higher dark greens.

    It worked out okay that you dropped to 2.5. He did go to 71 on that dose, so higher might have put him too low. If you are going to try switching to 3% food all day, I would leave the dose where it is to see how things look with the reduced carbs.

    This is just a thought... You said you feed him at PM +5. It looks like, if he is going to drop, he does it by that point (like that 71). So, maybe feeding him a little earlier, like +4.5, might help counteract the drop. Could you leave food out for him at that time to graze on overnight so you don't have to schedule another meal? Or, is he one of the cats who scarfs down whatever you give him all at once? :)
     
  34. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    He's a scarfer! This poor boy was abandoned in a neighborhood, in the Northeast in winter, for at least 2 weeks before he was reported to a Cat Rescue. The volunteer "trapper" told me that she only had to pop open a can of wet food and he came running. No trapping required. His first night in our home, he was so starved, I caught him eating a beeswax candle. He drank from a cup of coffee before we caught him. Ditto with water in my flower vase.

    Now--eight pounds later--his food and water supplies are regulated and I can trust him home alone. He no longer begs food from us when we eat. Still, WHATEVER we put in his bowl, he WILL EAT IMMEDIATELY.

    We went weeks on end feeding him the same flavor wet food and he never complained. I never knew a cat that didn't get sick of his food at some point, and balk at it. Not Buster. That's what I mean by saying he is grateful for everything we do. He even hops up now on the bathroom counter (just like the vet's counter) to get his blood tested when he sees me going for the testing kit--without me prompting him. He knows it's part of his "medicine." It's part of what I mean when I say he's a very grateful cat. He knows he was rescued, and he wants to stay here with us!
    Lately, he sleeps beside me in bed all night (he doesn't prowl) and gets up when I get up. Aside from the diabetes, he couldn't be easier.

    Which makes me realize...I'd have to train him to watch for the feeder to open at +7, if I do go the route of a night feeder. And then I'd have to be sure to do it every night!

    Bottom line...I'll keep the dosage at 2.5 and adjust his PM feed to 3% carb at post shoot and +4.5. For the first few days I'll do some extra monitoring at night to see when/how low he goes to green.

    Thanks for the help, FurBabiesMama! I feel less afraid. :)
     
    Diane Tyler's Mom likes this.
  35. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Oh Cat he seems like such a sweet boy, thank you for adopting him. He so handsome.
    His story breaks my heart. He's such a good boy. You are doing such a great job with him Good idea just feeding him the 3% carbs for his feedings.
     
  36. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Diane, Tyler's Mom, it's great to meet you! Thanks for the kind words. Your boy is very handsome, too. He looks like he could be Buster's brother, but in a different color. :)
     
    Diane Tyler's Mom likes this.
  37. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Tyler says thank you lol, he can be a real pain in the butt sometimes Lil. I have him and his brother Perry. Perry has kidney disease but is doing very well. Thank god it has been stage 2 for many years. He also takes meds for seizures. He hasn't had one in about 9 months already. They are a handful. But I wouldn't trade them for the world.
     
  38. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    Hi. How was Buster's number this morning? I suspect he may have gone a bit high. I bet that 77 scared you. :) His regular food probably would have been fine, but I understand you wanting to be absolutely sure he would be okay since you needed to go back to bed. From going that low, he may have a bit of a bounce reaction, and having the extra carbs might factor in some, too. It may take a couple/few cycles for that to clear. He seems prone to volatility so keeping things 'calm' and consistent is going to go a long way. You could consider a dose decrease to 2.25 and consistently feed the 3% carb food to see if that levels him out a little more. He's gone a little lower than you like a couple of times now on the current dose.
     
  39. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Thanks, @FurBabiesMama You're right--his number this morning bounced up to 351. And yes, the 77 last night scared me. :)
    I'm going to lower his dose to 2.25 tonight and keep to the 3% food. (This is the Fancy Feast Classic pate, chicken feast.)
     
  40. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    @FurBabiesMama would you mind taking a looking at Buster's chart and giving me your thoughts?

    His numbers are ping-ponging across the color spectrum. I'm wondering if he's getting really low in the wee hours where I don't have much (any) data. Tonight's plan is to stay up late and remedy that.

    Even this morning, I had a (partial?) fur shot--felt the fur afterwards and there was a wet spot--and yet, after the +5 reading, he's still on a downward slope with his numbers anyway. It's very strange to me.

    He's consistently on the Fancy Feast classic pate; he's fed at AM shot, PM shot and also typically at AM+5, AM+7, and PM+5. The two day meals are more like snacks. The rest of the 3 meals are equal-sized.

    I'm gung-ho to lower his dose a bit more if need be!
     
  41. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    He is definitely a complicated one. His spreadsheet looks a little like Skittles which is what I used to say ab@out Mia's. You have held the 2.25 a really long time. You don't want to hold doses too long when they are not resulting in the desired range of glucose. I think he does need doses held longer than most cats, but I still would not hold beyond 5 to 7 days without increasing, if needed. You have enough testing data that I doubt he is going too low. You were just one test short of having done a full curve the evening cycle of 11/9 and 274 was the lowest you got. I think I would up the dose to 2.50 and see how he responds to that dose now. The last time you were on it, he got into the 70s two nights, both times at +5. That is still not too low but getting close. Since you are giving him a meal at that time, that should help counteract any drops like that. Maybe consider dropping the AM +7 snack meal and just give him a regular meal at AM +5. See if not feeding past the mid-point of the cycle helps at all.

    @MrWorfMen's Mom if you have time to read over this thread, maybe you could give your opinion, please. I am curious if you would agree with what I am saying. Buster is a tricky one. :cat:
     
  42. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    What a cutie Buster is! Love the pose! Hard to imagine anyone could give up such a sweetheart but he lucked out finding a loving family and you lucked out getting such a wonderful little companion.

    I agree with @FurBabiesMama.....his spreadsheet does look like a sprinkle of skittles. That said, he'd made some wonderful progress!

    I am wondering if Buster is in a bounce right now. He dropped almost 300 points in the space of 5 hours on the night of the 10th and got into the mid blues from a red start. Looks to me like he might even have dropped a little lower than 143 (same as the night cycle of the 7th). The next cycle this time looks the same as the cycle following the 7th night cycle. I also find it interesting that his BG dropped today despite the furshot. He obviously got something this AM or a bounce is starting to clear.

    I'd be inclined to wait to increase right now in case this is a bounce you are looking at again. I like the idea of keeping his meals/snacks in the first half of the cycles. You could try moving his first snack back an hour or so (around +3.5 or +4) to see if that slows the drop at all which might also help limit some of the bouncing.

    Given you are using an AT2 meter, I'd try not to have Buster dropping to the low 70s in the middle of the night. Just a little to close for comfort. I'd want to be sure he's not bouncing before making a dose increase only because the cycles of the 7thPM/8thAM and 10thPM/11thAM look remarkably similar even if you didn't "see" any green on the 10th night cycle. In situations like this, we all wish we had continuous monitoring so we wouldn't have to guess.

    It looks like he clears bounces fairly quickly but they can take up to 6 cycles sometimes so I'd hold the dose tonight and tomorrow, and if there is no more blue/green showing up, then I'd increase to 2.5u Thursday AM.
     
  43. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Thank you, @FurBabiesMama and @MrWorfMen's Mom. This is extremely helpful to me.

    We'll move his mid-cycle feeds earlier. I'll hold his dosage to 2.25 for now and do increased testing tonight and tomorrow, especially if it looks like he's dropping and might possibly be going too low into the greens. It would be great to find out for sure if this is happening or not.

    If it was possible for a vet to invent a miniature "kitty glucose reader" that attached to a cat's ear and would continuously give us blood glucose readings, that would be such an excellent tool!
     
  44. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Did I do the right thing? I was so exhausted this morning, after getting up every hour to take readings, that I couldn't make a decision on what to dose him. So I just kept it the same out of habit.

    I don't understand his numbers AT ALL. Why does he dive so low so late in the cycle? Why do other cycles look like frowns (instead of smiles), or worse, sneers (half a frown, going down a cliff)?

    I'm even more worried that he might be going into greens during the late, wee hours (four, five a.m.) when I'm too tired to get up and test him. It's why I lean more toward a lower dose--to be safe--than a higher dose. (Because it's clear I can't get up to do testing every night. I need uninterrupted sleep--I'm getting sick as it is.)

    And then, there are the cycles where he just flatlines in red. Is that a bounce? And do bounces always happen when he gets too low into the greens, and his body reacts to the danger by flooding the zone?

    If so, then wouldn't that be a signal to lower his dose? Or is it a signal to raise the dose?

    As you can see, I'm very confused on what to do next. :). I'd love your guidance.

    @FurBabiesMama @MrWorfMen's Mom

    PS. To see this cat in action, you'd think he was the picture of health. He leaps in the air when he plays with his mouse toy. He dribbles his ping-pong ball up and down the hallway as if he's the David Beckham of cats.

    When we first got him, he walked on his haunches, couldn't jump, peed all the time, drank all the time, and had ravenous unquenchable hunger. Now, he eats when he's supposed to and doesn't really beg much. He trots on the pads of his feet, leaps onto tall places, pees like a normal cat, and has a glistening coat.

    I just don't get his wildly fluctuating, seemingly uncontrollable blood glucose numbers.
     
  45. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Yes you made the right choice this AM. I wouldn't have increased either given how late he dropped last night and the AMPS this morning.

    Buster is still showing a lot of colour! Liking those blues but he is sometimes attaining them really late in the cycle. While ProZinc can last as long as 14 hours for some cats, it doesn't usually cause the biggest drop at the end of the cycle. You are testing a fair bit and I don't think Buster has gone near any dangerous levels but he is a bit bouncy so even blues seem to push him up.

    How about trying 2u for a couple of cycles to see if that smooths things out at all keeping the cycles a little more even with AMPS and PMPS being more equal. Sometimes a little too much insulin can cause those late drops. Totally unintuitive but Buster is bouncy and it might just help to ease him along a bit.
     
  46. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Thank you! I will try this. Should I reduce tonight or tomorrow--or does that matter?
     
  47. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    You can do either.
     
  48. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    Look at Buster with the blues! He's a silly monkey. :)
     
  49. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Hi @FurBabiesMama Sorry I missed your note...my dad got sick and passed away this month, so I've been in a daze. But it's time to focus on Buster more again, and get some mid-cycle testing done so we can see what's going on.

    He *has* been a silly monkey. I'm not sure whether to raise, lower, or hold 'em. lol
     
  50. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I'd get some mid cycle tests in before deciding to do anything with the dose. He got a nice green on 2u a couple of weeks ago and numbers seem a bit higher on the 2.25u. Mid cycle tests definitely will help determine which way to go with the dose.
     
    BraveCat likes this.
  51. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Hi Cat I'm very sorry to hear about your dad, my sincere condolences
     
    BraveCat likes this.
  52. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    I'm so sorry about your dad. :( With some mid-cycle testing, we can suggest what to do next.
     
  53. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Any ideas? I'm back up to 2.5 units, but he's a steady red/pink throughout the day and night, and has been for over a week now.

    I'm strongly considering getting a new bottle of Prozinc on Monday. It's 2 months old. Last time I switched to a new bottle, his numbers improved significantly.
     
  54. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I think you should raise the dose to 2.75u and hold that for a period of 3 days (6 cycles) and then re-evaluate. Sometimes our kitties go up and down in dose and it appears Buster needs more insulin right now. How is Buster feeling? When is the last time you had the vet check his teeth? Tooth issues are notorious for causing higher BG.
     
  55. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Thanks @MrWorfMen's Mom ! I'm upping his dose right now.

    I feel that he's been emotionally a bit depressed--probably following my lead as I deal with grief over my Dad. Also, we were a couple weeks being out of the house a lot--usually we're home.

    The last two days I'm easing back into my routine, and spending lots of time with him, playing with his toys on the floor (he loves games that mimic hunting) and having him sit on my desk getting cuddles while I work at the computer. He seems happier. He "asked" my husband to walk him on the leash a bit outside this afternoon, which he hasn't done for weeks. I hope this helps his BG numbers!

    Physically, he's eating well--cleaning his bowl as usual, using his litter box as usual, and doesn't seem in any pain. It's funny you ask about the dental issues though...I spent the afternoon internet-searching this. Buster's teeth look okay (I visually check him), but his breath isn't great. It's better than it was a few days ago, maybe because I was sort of "brushing" his teeth a bit with a makeshift toothbrush. It's a tiny bit "mucous-y" but after I "brushed" it was better.

    When he was brought in for rescue, they checked his teeth and said they were fine. Until my research today, I'd never heard of a cat dental cleaning! Buster is due for his comprehensive vet appointment in two months (his yearly check-up)...I was thinking of waiting until then to ask the vet about this. But honestly, I'm really, really leery about the general anesthesia that's required (*I* don't due well under general anesthesia!)

    Okay, I'm late...got to give him his insulin now! :-O
     
  56. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Our kitties do indeed pick up on our moods and with the usual routine disrupted, that may have been playing a role in the numbers. So sorry to hear about your Dad. Sounds like Buster might be feeling better if he is asking for attention With things starting to get back to normal, hopefully he'll continue to perk up and his numbers will improve.

    Bad breath can be a sign of dental issues and some dental issues just don't show up on visual inspection...an xray is needed. Lots of kitties have dentals and with the drugs they use in vet medicine these days, it's pretty safe. Not that I don't understand the apprehension. We all go through that but as long as they are monitoring kitty during the procedure, there is little risk of a problem. Better to nip those dental issues early. He could just have gingivitis or he could have something more sinister brewing like an abscess so it would be worth getting him looked at.
     
    BraveCat likes this.
  57. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    Cat dental care is so important. You would be surprised how much dental issues can impact their overall health. I hate it every time I have to leave one of my girls for a dental procedure/anesthesia, but I do it because I know the value. Some cats are prone to tooth resorption which can cause a lot of pain (that they are so good at hiding) and can lead to infections, so x-rays are very important.
     
    BraveCat likes this.
  58. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    :D
     
  59. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    I'm really grateful for the help, @FurBabiesMama and @MrWorfMen's Mom ! I checked my vet's website...he does feline dental. Tomorrow morning I'm making an appointment to get X-rays for Buster.

    "Some cats are prone to tooth resorption which can cause a lot of pain (that they are so good at hiding) and can lead to infections, so x-rays are very important."

    Wow--I just looked up "tooth resorption." That is scary! I had no idea. :eek:
     
  60. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    I should videotape him. He really is a character. :cat:
     
    MrWorfMen's Mom likes this.
  61. FurBabiesMama

    FurBabiesMama Well-Known Member

    Joined:
    Jul 6, 2017
    I suggest asking your vet about the dental cleaning. Hopefully, the vet will say that they always do bloodwork a few days in advance and that they do x-rays as part of the procedure. If they do not do those things, I would go elsewhere for the dental cleaning.

    You said your cat is due for his annual exam in two months. It's a good idea to do that before the dental since that should include bloodwork as well as a full lookover. Just a thought... maybe consider/speak with your vet about bumping up the annual exam up, maybe schedule it in January, then you can schedule the dental shortly thereafter. (February is pet dental month and some vet's offer discounts on dental procedures that month. So, if that is something that would help you, maybe ask about that, and if your vet does this, schedule for very beginning of Feb.)
     
    BraveCat and MrWorfMen's Mom like this.
  62. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Thank you so much for the advice!!

    I called the vet's office this morning and got an appointment for the first day Buster's vet is in next--Tuesday the 17th. I told her Buster's symptoms and that I was concerned about a dental issue. I asked about dental X-rays as part of the appointment.

    The receptionist told me that while they do "dental work," they "don't do dental X-rays." This exam on Tuesday "will be visual." [Note: I know they have an X-ray machine there--they did a stomach X-ray on him once. Maybe a dental X-ray machine is different?]

    I'm bringing my BG spreadsheet with me on Tuesday, and I'll use the opportunity to get a fresh vial of ProZinc. I'll also make sure we get his annual exam and bloodwork moved up and scheduled for January. If my vet really doesn't do dental X-rays as part of their dental services, then I'll see if I can get a referral to a dental specialist.

    Question: When you say "schedule the dental," does that specifically mean just an oral exam and X-rays under anesthesia? And then, depending upon what shows up on the X-rays, a further treatment plan for a later date would be made from there? Or does "schedule the dental" mean scheduling an oral exam, X-rays under anesthesia, AND cleaning under anesthesia, all in one appointment?

    I'm trying to figure out exactly what I need to ask for on Tuesday. :) I find that the more prepared I am, the better for Buster!
     
  63. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Generally, the vet will do a visual to determine if a cleaning is needed, if there is any gingivitis or any other visually apparent issues that need treatment. Bloodwork is usually done with a week or 2 of a scheduled dental procedure (annual exam bloodwork would cover it all). At the time of the dental procedure, xrays are taken under anaesthetic to determine if there is anything else going on that wasn't noted on the visual exam. When you get a visual exam, they will give you an idea of what needs to be done along with an estimate of cost with the caveat that costs could change if other issues are found. Xrays are done under anaesthesia so they won't be done at the time of your appt. on the 17th. You just need to know if they do xrays as part of the dental procedure.
     
    BraveCat likes this.
  64. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Okay, thank you, that answers my question. I think I understand the process now.

    In the meantime, I have Buster 3 cycles in at his new, increased insulin dose. This last PMPS was 346...not great, but the lowest pre-shot test in 8 days...
     
  65. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    It's been 6 cycles now. He's still high. :-( Should I raise him to 3 units tonight or wait until after his dental evaluation visit tomorrow afternoon?
     
  66. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Yes I'd increase the dose to 3u tonight and hold again for 6 cycles. No need to wait for the dental evaluation. BG needs to come down no matter what and I doubt the dental procedure if deemed necessary, will be booked immediately. :)
     
    BraveCat likes this.
  67. BraveCat

    BraveCat Member

    Joined:
    Oct 14, 2019
    Thank you! :)
     
    MrWorfMen's Mom likes this.

Share This Page