skipping a shot?

Hi, I was wondering how low Scout's BG levels would need to be to consider skipping a shot? he is currently getting 3.5 units of ProZinc 2x/day. we just increased from 3 units a few days ago. this is the first time his numbers have been in a normal range throughout an entire day (which I am super excited about!)

Here were his readings throughout today (done on an alphatrak 2 meter):

8:30AM - 157 (before food/insulin)
11:30AM - 93
3:00PM - 82
4:00PM - 75 (freaked out, ran to the store to buy some carb food, gave him half a can)
6:00PM - 115

any advice would be appreciated, thank you!

 

Actually, with ProZinc, you can develop a sliding scale where higher doses are given for higher pre-shot glucose levels and lower doses are given for lower pre-shot glucose levels.

So rather than skipping, you might consider using a lower dose.

As long as he remains above 50 mg/dL on a human glucometer at his lowest, he is safe.
If he is too low to shoot at pre-shot, stall without feeding for 30 minutes and re-test.

 

We generally suggest new diabetics not get a shot under 200. Instead stall. Wait 20 minutes without feeding (which raises bg levels) and retest. You want to be sure the number is rising, not falling and over 200.

After you have enough data to know what he might do, you can shoot at lower levels.

I'm with BJ. If you get an unshootable pre shot, it's time to reduce the dose. The goal is to get 2 shootable pre shots daily.

The protocol we put together for ProZinc is in my signature in blue.

 

oh wow. I'm so glad i have this information now, thank you! I still have a lot to learn.

Scout was diagnosed in the beginning of may (right after his 3rd birthday) and his numbers were always between 300-500. this is the first time I'm seeing anything in the normal range. with getting 2 shootable pre-shots daily, how would i know if he was heading into remission or not? my biggest fear is giving him a shot when i have to leave for part of the day and not being able to test him throughout.

as for tonight, I should test him to make sure his numbers are rising and give maybe a half dose? or would I be better off with less?

 

I think half if you are worried or if you'd can't get some tests in tonight. It's harder to monitor overnight. It may not be enough, but it's always better to be safe. You can always go up in dose tomorrow.

Did you recently changed to wet low carb? That can really reduce the insulin amounts. Or it may be that his body is just learning to adjust to the insulin.

With AlphaTrak, be sure always to mention that when asking for dose advice. It tends to read lower than human meters and we need to take that into consideration. (So our 200 might be more like 230)

 

yes, I switched him over to a low carb wet food diet almost immediately after being diagnosed. he was already eating FF classics 1x/day so all I had to do was eliminate the dry kibble, which wasn't hard for him to give up. is it better to do small meals throughout the day? I've been trying to figure out how much to give him- right now we're at three 3 oz cans of FF and/or Nutro, plus some freezedried treats and I think it's working out, but i'm not sure if I should be spreading the mid-day meal out.

and yes! I made sure to mention the alphatrak in my original post. the strips are expensive though so I might considering switching soon.

 

Lots of people do mini meals, thinking it helps support the pancreas and evens out the cycle. Just take the amount you are feeding and divide into the number of meals you want to feed.

Most people here use the ReliOn meter from Walmart. The meter and strips are the least expensive.

 

Hi, Kristen - Didn't see your post until today - looks like your Scout is doing well!

I use an Alpha Trak 2 meter, too - will you be plugging Scout's BG numbers into a spreadsheet soon? (Really helpful in seeing your kitty's unique BG patterns.) My Bat-cat gets her daily ration split into 4 smaller meals/ daily to help keep her even - but may not be convenient to you if you're not home most all of the time (as I am).

Sue is right-on about using a sliding scale on dosing; although if your kitty's pm meal is at 6 pm (I note that 115 BG @ that time), I would wait to see if Scout's BG rises before the meal - even if you're planning on shooting a reduced dose - as 115 on an Alpha Trak is an awfully low pre-shot #. While I have dosed Bat at a BG as low at the 130's, she is on a VERY tiny dose now (0.15U). Is always better to err on the side of caution where dosing is concerned.

It may be best to to avoid dosing Scout below 150 for now, especially until Scout's BG is regulated at a lower dosage level overall.

Again, would be really helpful if you could plug Scout's #s into a spreadsheet - just be sure you have the Alpha Trak BG range headers at top for your current #s, and then you can switch over to the other (human glucometer BG range headers) if you go with the Relion meter.

What did you end up doing on Sunday night, by the way? Reduced dose ... or what? And can you tell me how much Scout weighs and how much food he gets per day? (Bat eats mostly FF Classic turkey mixed with some Purina DM canned - but we're transitioning out of the DM, as it's sooo expensive & she seems to do just fine with the FF turkey & giblets.)

I think you're doing great, Kristen - keep up the good work! Cheers - Robin

 

Hi Robin! thanks for replying.

I think my meter has a spot to plug something in, but it didn't come with a cord to connect to my computer (unless I lost it), so if I do make a spreadsheet it would take me a while to input by hand.

I usually feed Scout between 7 & 8 and give him his nightly shot of insulin at 8:30. The other day when Scout had his first low numbers, I gave him 1.5 units- i called the vet on monday and she said that was good and told me i can scale it from now on. on Monday morning his BG # was through the roof though (from not getting enough insulin, I assume?).

Scout weighs in at about 12.8 lbs right now (was 20 lb last november 2014, diagnosed in may 2015 at 11ish lbs). the amount of food he gets varies- but usually 3-4 3oz cans of FF/nutro wet food per day. He is very vocal and tries to convince me he is very hungry every second of the day, but when i'm home i try to spread his meals out throughout the day. on a typical day he'll get a 3 oz can between 7-8 am, shot at 8:30, 3 oz can around 2 for lunch, and a 3 oz can for dinner between 7-8 pm, shot at 8:30. i'll give him some freeze dried chicken/beef as a treat/snack and sometimes if i'm up late at night i'll give him half a 3 oz can before I go to bed. he acts like he is always hungry though so sometimes i'm afraid i'm not feeding him enough, although most of what i've read seems like i'm feeding him enough for the time being (he's gonna rob me dry with all this food!). he is moderately active (sleeps less and plays more than any other cat i've ever had). before he was diagnosed he would scream for more food at night and was eating up to 4 cans of food for dinner! which looking back i realize how insanely crazy i must have been for not realizing something was seriously wrong sooner haha

someone told me that i should avoid dry food even when he's getting low numbers- something about it takes too long to get in and out of the system? any advice on that topic?

today i went out for lunch and when i came home and tested him i had a scare- the meter read at 41. i know that is dangerously low and i feel really bad. i gave him a can of carb FF (with gravy). he wasn't acting weird though, seemed normal. and the other day when his numbers were getting low he didn't seem off either. the vet said he could be in the beginning stages of becoming transient. fingers crossed.

thank you for taking the time to reply and taking the time to read my long response. i hope it all makes sense

 

Kristin, I'd be happy to set up a spreadsheet for you. Just click on my picture and start a private conversation.

 

Setting up a spreadsheet would be really helpful for you and for all of us. It will give you a great picture on how Scout is doing and it will help you find any patterns. You may have already stated it, but are you using a human meter? If you are, it would be helpful for you to put that information in your signature.

I also noticed that you mentioned that you give food 1 to 1 1/2 hours prior to your insulin shot. It is good to not give food two hours prior to your insulin shot so Scout's BG number isn't being influenced by food. Food increases the BG number.

 

Cindi is absolutely right: Please don't wait 30 min to 1.5 hrs. after the meal to give Scout the insulin. Ck. BG, feed, then immediately shoot (provided your pre-shot # is in safe zone, of course). I get the dose loaded into the syringe when Bat is about halfway through her meal, so that I can administer it right when she's finished up. I'd be hesitant to do much scaling of the dose right now, at least not until you have some sort of a good baseline with Scout - only because sometimes it takes a few cycles before a kitty "settles into" an insulin dose, so too many dose adjustments can cause bouncing, adding to the confusion with his BG #s.

Where food is concerned, don't feed him dry kibble, period: Too many carbs! I'm convinced that's how Bat-Bat became overweight (she used to be close to 20 lbs., too. Only Maine Coons should weigh that much!) Bat gets only about 2-1/4 cans of FF Classic turkey/giblets daily, and her weight is holding steady at a healthy 11 to 11.5 lbs. Would she like to eat more? Sure! But overfeeding her would not help me control her diabetes. I simply learned to turn a deaf ear to her "oh, but I'm starving..." routine, because she's actually not being starved at all. (Took her a while to stop pestering me all the time, though!)

What is your schedule like, btw? Are you gone most of the day for work, or do you work from home?

 

right now I'm usually home during the day (for the most part), but I recently graduated from college so I'm currently looking for a career.

Scout is a siamese mix, so theres really no shutting him up when he wants what he wants haha most of the time I think he talks just to hear himself talk.

what do I do if his # is in a safe zone before food? give the normal units of insulin? or only if his #s are high pre-shot?

 

Yes, if he's in the safe-to-shoot zone, feed him & shoot his usual dose of insulin. It's great to know you're mostly at home (until you start your new career), as you can test him to see where he's hitting his nadir. If he drops too low at nadir, then you can steer with a little food. (Bat-Bat actually hit the hypo zone twice this month (6th & 15th) - crazy! But I gave her some FF right away, & her BG was right back up into the green zone within 15 minutes.

I'm really looking forward to the Alpha Trak spreadsheet that Sue has offered to set up for you. (Sue's a jewel!) That will make it so much easier for you (and the rest of us) to see at a glance what Scout's numbers are doing.

We had Siamese cats at home when I was a kid; my mom was a breeder for a while. Ha, they are VERY vocal all the time. I always got a kick out of that!

Congratulations on your graduation, Kristin!!!

 

Yep, the spreadsheet is super helpful! We're all used to looking at it and it helps us help you. The colors on it really help us to see what's going on, as sometimes we can just zoom out and focus on the different colors, which help us to see patterns. Sue's excellent and does a great job helping set up the spreadsheets!

And yes! Congrats on graduating!!

 

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.

 

@BJM BJ, she needs an AlphaTrak spreadsheet like the one you made for Robin. Can you set her up or guide me through the process?

 

okay thank you guys so much! quick question: just tested scout before meal and he's at 102. so what do i do regarding his shot?

 

With ProZinc, stall 30 minutes without feeding and re-test. Then, if rising and/or over 180 mg/dL on the AlphaTrak, you might shoot a reduced dose.
See if you can open the following link and make a copy which will be in your Google account.
AlphaTrak spreadsheet

 

ok i just sent you a request to be able to edit it

 

No, you need to File, Make a Copy, not edit it.
Once you have a copy in your own Google Account, you can double click on the label in the upper left corner to change the name and double-click on the bottom tab if you want to rename that, too.

 

got it!! thank you! and should i input all my numbers as far back as i have them?

 

So, are you at +12? You could stall - wait 20 minutes without feeding and retest. If you get 200+, you could shoot but maybe a little less than the last shot.

 

The most recent couple of weeks is most important as they reflect what is happening currently. Add the rest as time permits.

 

30 min later is at 117. from 102. yes shot was 12 hours ago

 

Just want to summarize and combine Robin's and my thoughts regarding testing, feeding and shooting.

Two hours prior to your "pre-shot", you do not want to feed your kitty. That way, your BG number is not based on food as food typically increases the blood glucose. So no food two hours prior to your AMPS and PMPS. Then you test, feed and shoot all in about 10 minutes. So you test, (confirm you have a shootable number), feed (because you want a little something in their stomach), then shoot either while they are eating or just as they are done.

Hopefully, that makes sense.

 

yes! got it! he hasn't eaten for 6 hours now and i'm waiting to feed him until i know what to do about his shot right now

 

Stall 30 minutes without feeding and re-test.

 

It doesn't look like it is going to come up soon enough. I think you will have to skip.

So tomorrow the amps will probably be high. But I would still reduce your last dose. I think it was 1.5, is that right? If so, .75 would be a conservative dose. One unit might be okay but could give you some lower numbers. It depends on what makes you most comfortable.

This probably seems a little scary. It is hard to decide how much to reduce. But this is really good news! The diet and the insulin are starting to work together and he is needing less insulin.

 

okay. i think i'll skip for tonight just to be safe. better to be high than low, right?

so i should check tomorrow morning and even though his numbers will probably be high i should still shoot with a low dose? i'll be sure to post here to get input before

 

Good morning! Yep, this morning, go ahead and check his BG. If it's above 200, I'd shoot the reduced dose like Sue suggested. More than likely his number will be high since he didn't get a shot last night. That's okay. Even though it doesn't seem right, the higher number will still warrant the lower dose. Since his PMPS was so low, you want to lower the dose to avoid getting such a lower number at preshot again. The goal is to have 2 shootable preshots so that insulin can be given consistently.

 

Hi Kristin.
What an adorable photo of Scout! I love how he is posed. Glad to hear you are getting a spreadsheet up and running, it will help so much.
I am quite new here myself, and just recently switched to ProZinc, so I am reading through all your posts and replies to reinforce my own knowledge! Maybe I won't have to ask so many questions *someday*
I do use the Walmart ReliOn Prime glucometer, works great now that I'm accustomed, and believe me, you will appreciate the cheaper strips!
Sounds like you're doing all the right things and have come to the right place.
All the best!

 

Sounds good, Kristin.

Let us know if you need help with the spreadsheet. Getting it in your signature is the next step so we know what is going on at a glance.

 

Sue & BJ - Are you setting Kristin up with 2 pages - 1 each for Alpha Trak 2 & Relion meters? (As sounds like she may be switching over to the Relion human glucometer in the near future. )

 

We can do that. Right now she has the AlphaTrak but we'll just do another one for ReliOn and she can have both in her signature when she switches over. Thanks, Robin.

 

Wow, Kristen - Sure looks like Scout's responding & needs a dose reduction; definitely was too low to shoot last night. (You handled it just right)

Sue's recommendation sounds good to me! Don't worry, it just takes a little time in the beginning to find that "sweet spot" where the dosing is concerned. You'll get there. Hang in! Looking forward to your next update.

 

good morning! still working on scouts spreadsheet, but it's coming along.

without his shot last night, he tested at 403 this morning. I did half a dose (2 units) and will monitor him throughout the day!

 

thank you!! I take a lot of pride in his modeling pictures he is very cooperative and tolerating of me. here is one more I think you guys might enjoy! Halloween 2014

 

Oh...he is such a cool cat!

 

Adorable photo, Kristin! Will be good to see all Scout's #s plugged into the SS. I'm a little confused re: dosages - Scout had been on 3.5U; you reduced to 2U this morning in view of the skipped shot last night ... am I understanding that correctly?

 

yes. but yesterday morning had been a half dose also and he stayed low all day. should i have done lower this morning?

 

Not necessarily, but would need to see his numbers from yesterday. I'm assuming you're monitoring today, too?

 

The spreadsheet works! Looks like the pmps might be low again. Darn! You might try giving him a snack around +7/8 to bring him up when he drops

 

+7/8 is right around now! i just gave him half a can of FF. he did eat a full 3 oz can for lunch right before 2 (+5ish) and his pre-lunch shot was 203

 

So great to have a SS for Scout! Maybe that snack you just have him will help pull his # up by PMPS time. So far, so good! I know it can be frustrating when he drops too-low-to-shoot, but hang in - Scout's responding pretty darned well, all in all.

 

Oops, didn't proof my last post: That was supposed to be "snack you just gave him." My bad. (My bad typing!)

 

Hey, Kristen - Check your Inbox at top right, near where you log in. Sent you a quick note this a.m. - just wanted to make sure you saw. - Robin

 

his pmps is 202 right now... should i still shoot half dose tonight? maybe lower?

 

So, 2 units on the 400 caused more than a 50% drop todayAnd 303 to 41 yesterday. I think it's too much. What would you think about a restart to one unit? You can raise it based on your testing rather than trying to guess how much to reduce. What do you think?

Even with the reduction, I'd get a +2 to see how he's headed.

If your gut says one unit sounds like too much, you could even do a restart of .5. It may not be enough but you can always slowly raise it.

 

I agree with Sue's recommendation of 1.0 unit tonight, with a +2 check (maybe even a +3, as well?) after, since 1 unit is only half as much of the dose that dropped him more than 50%.

 

As you can always steer with a little more food if you think he's heading too low ...

 

ok i gave him 1 unit. will report back!

 

I know it's frustrating and a little scary to have to keep reducing the dose, but it is really good news. He is using less and less insulin - it's a really good thing!

 

Nifty! Like Sue says, a reduction is a good thing. Restarting at 1 feels like going backwards but it isn't. It just means that you may have started at too much insulin, and this is a chance to slowly increase or decrease as needed to find that perfect dose.

 

Just now saw last night's #s on SS - lookin' good there, Scout!

 

woke up this morning and he is at 99 AMPS! from 1 unit last night! i'm waiting a little bit to re test before i feed him... any suggestions?

he is not happy that breakfast is delayed

oh and he was at 250 last night +2

 

started at too much insulin at the very beginning when he was diagnosed?! because we started at 1. but yes it does feel backwards.. was worried that I wouldn't be getting him enough!

 

Wow! Go Scout go! I don't see any way he is going to go up to 200. (Be sure to get a second test just to make sure the first one is right.) You could feed him a tablespoon or something if that will placate him, but I would only wait 2 tests (maybe 40 minutes) If he is nowhere close, I'd skip. He may bounce somewhere in the cycle as he could have been very low overnight. Then you could try a chicken *(&% dose and start over again tomorrow.

Looks to me like this kitty might want off the juice (anti jinx) The insulin and food is starting to work well together. We have to find a dose that will let you shoot twice daily, even if it is .5 or under, until he stays in the consistently low range but it's hard because he is a moving target.

 

I agree with Sue - if Scout hasn't risen to safe-to-shoot zone in about 40 min. or so from your first test, go ahead and feed him his usual ration & just skip the dose, as it looks like he's hanging onto that insulin more than 12 hrs. Right now it's looking like Scout's pancreas is asking for a dose redux overall. Yep, he sure is a moving target ... try not to get dizzy trying to keep up with him!

 

gave him a couple spoonfuls of food and he is now at 121 ( 45 min later)

 

Still too low - you'll just need to skip, I think. Then at your PMPS check, depending on the the # you see (will likely be higher), may want to drop down to 0.5 U and see how he does with the lower dose. (Sue - any additional thoughts here?)

 

So go ahead and feed him before he riots!

 

haha! he starts his riots for food around 6AM! let me sleep, cat!

 

I hear that! This morning @ 6:15 a.m. Bat-Bat was already yelling, "Mah-maw, Mah-MAWWW!" before the alarm was set to go off (15 min. later).
Turns out her AMBG was 129 ... so she was essentially saying, "Feed me NOW, you idiot!" She has been teetering on the brink of Honeymoon/OTJ for a while now. Makes me crazy some days ...

 

Yes, I like reducing the dose and .5 sounds good. We keep trying to lower enough to get 2 shootable numbers and he keeps dropping. It's all encouraging, just a little nerve wracking.

 

alright guys! no insulin this morning.. PMPS is 282 right now. his last snack was a few hours ago and he seems less hungry overall today. i should try .5 tonight?

 

I would. And maybe a +2 and before bed test so you can be sure he isn't dropping too much. Hopefully .5 will give you two shootable numbers.

 

Yes, at least get a +2 tonight. Will keep my fingers crossed for a shootable # in the morning. (Go, Scout!)

 

+2 is 353. he ate while i gave him his shot

 

I give Merlin his shot, too, when he is eating. I just like to make sure that he has something in his stomach so I usually let him eat for a few minutes before I shoot him.

Well, Scout is definitely going to have safe numbers tonight i.e he is not going to go low. Just remember ... all data is good data. Have a good night.

 

Well, he's still rising, which is normal at +2. I don't think you need to worry mch about him dropping super-low tonight; might want to get a +4 or +5, if you can set an alarm, just to have a bit more nighttime data on him. He might actually be heading into a nadir by then ...

Not to worry, he'll even out for you eventually. Some kitties just make it challenging - for a bit - to find that dosing sweet spot.

 

Wow Kristen & Scout! This read like a good thriller novel for awhile there!
I am learning alot! I'm really happy for you that you seem to be on the brink of discovering his patterns and getting a dosage down pat.
I know THAT'S gonna feel great!!
Gives me hope.
PS Sweet Halloween pic

 

Can somebody please take a look at Scout's spread sheet and tell me what I'm doing wrong? Seems that .5 units isn't enough and 1 is too much. I'm at a loss and I don't know how I'm supposed to get him on the right track.

 

Hmmm. That is certainly a big difference. You could do a fat 0.5. So draw up one unit and let out drops until you have a few drops above 0.5 Or can you eyeball .75? You can decide where it is on your syringe and mark it with permanent marker or tape. Use that one as a sample and draw up to the same spot each time. Or you could try the U100 needles. They would let you dose .6 and .8 But you need to use the conversion chart with them.

http://www.felinediabetes.com/insulin-conversions.htm

It is frustrating as he seems to jump all over. But generally you are seeing some nice low numbers. Some of his issues seem to be bouncing, and late bounces. So the next cycle seems to be a reaction to a low the cycle before.

 

Any other symptoms - is Scout peeing ok, etc?

 

@Sue and Oliver (GA) - Is it possible that Scout is doing that "hanging-onto-the-dose >12 hrs." thing sometimes, too?

 

Yes, that could be also. Which would mean the dose might be too much but it is strange that there is such a big difference between 0.5 and one unit.

 

scout is peeing/eating/acting completely normal. I was thinking the insulin was lasting more than 12 hours but I'm not sure. I tried marking the syringe, the little black bumper inside (idk if I'm describing it right) is thick enough to make it in increments of 3rds- that's why it says I gave him 2/3 of a unit the other night. it's just frustrating seeing his numbers bounce all over the place

 

Yes, I can feel your frustration from here! (I'm reading through your earlier posts to see if there are any more clues to what's going on; will try to get back to you shortly.)

 

Maybe he is a cat that just doesn't do sliding scale. I wonder what he would do if you did .75 and just stuck with it a few cycles? I am wondering whether he would flatten out and settle down?

 

that's what I was thinking. maybe I need to keep him on a certain amount to keep him stable? how long is a cycle?

 

A cycle is from amps to pmps, 12 hours.

 

A cycle is 12 hours. So you have 2 cycles each day. It couldn't hurt to try sticking with .75 for a few cycles...say 3 or 4. As long as you're getting shootable preshots it might be what he needs.

 

Just finished perusing your earlier posts. So now I have few more questions, Kristin:
1) What is Scout's weight today - 12.8 lbs or what?
2) Is he still getting 3 to 4 cans (3 oz/can) of FF/ Nutro per day on the typical feeding schedule you'd posted earlier?
3) Which formula Nutro canned are you using?
4) When/ if you give any extra snacks beyond what is noted above, what are these and what amt?
5) Is he an "only" cat?
6) Does he spend time outdoors unsupervised?

 

yes scout still weighs 12-13 lbs.
still 3-4 cans FF/Nutro. more so FF right now (the non-seafood Classic), but occasionally salmon/duck/tuna nutro (minced/soft loaf/chunky- a wide variety) but starting to transition to FF only (less expensive).
and yes 2 main meals a day with snack(1/2-1 can) around +6
snacks are freeze dried chicken/beef- the other night he attacked the bag in the middle of the night and ate about 1/4 of bag that was left. but usually 3 pieces broken up
yes only cat. there is a dog in the house but they get along very well
no he isn't allowed outside at all anymore. he used to run out with the dog but I've put a stop to it recently (last 2 months or so) and he's been good at not trying to sneakily escape

 

Ok, just a couple more questions:
Is your dog free-fed? (meaning:Is there a bowl of food left down for your dog where Scout could raid it?)
Is Scout a "normal-size" cat? (I know he's Siamese mix - so he's of regular-size bone structure, is that correct?)
Note: my internet service is up & down today, so if I disappear you'll know it's not on purpose ...

 

no worries! thank you for taking the time to help.
the dog is fed in the morning and at night, outside. scout has no access to any of his food or treats. he used to love love love eating the dog's food!
yes, scout is normal sized for the most part... although he's always been rather long. before diabetes he was a BIG boy, almost 20 lbs, but i would say he looks "normal" now(before he was straight up fat haha). sometimes i wonder if he weighs enough though because i feel like his ribs stick out, but they might just be wide. he looks healthy

 

I like the suggestion of staying on one dose for a few cycles and hopefully you can monitor. I had to do that several times with Merlin in May 2014 as indicated in my 2014 SS. It helped him settle into a dose and slowed down the bouncing. I tried one dose for one week. Then I would try another dose, another week. I think I did that for a month.

Since Scout has some high numbers, are you able to test for ketones? You may already have some but you can buy testing strips at any pharmacy. The one I have is called Ketostix.

 

no i don't test for ketones, but the vet tests every time we go in. his breath smells like normal kitty breath. last time i went to the pharmacy (CVS) and asked about them, they had no clue what i was talking about. are they human strips or are they specifically for pets? they told me to check the diabetes section of the store and i couldn't find any there

 

(I’ve posted some of this on other threads, but have re-edited for you to better address Scout’s unique situation...Warning: This is a long post!)

Looking back to the years before Bat-Bat was diagnosed, I now realize that if I had wrapped my head around looking at her food more like it's medicine, I would have paid serious attention to how I was feeding her back then. Because - if I'm brutally honest with myself - I know now that I was feeding her all wrong! (Just kept dumping "...a 'wee' bit more" kibble in her dish when she'd yowl, "Hey! I'm hungry!" because I was on deadline for a client, or late for a meeting, or distracted in any number of other ways.) I didn't pay all that much attention to actually measuring out the amounts of food she was given; I only "kinda" did that. She was fed some canned, but the staple of her diet was dry kibble because, well .. heck! It was organic! it was good for her! And because southwestern Colorado & northern AZ can get hot as blazes, I'd tell myself, "It's sooo hot out - no wonder she wants more water ..."

You’d said Scout weighed a hefty 20 lb last November, and was down to 11 lbs. when diagnosed in May. That sounds so much like Bat-Bat: She was 18+ lbs. back at the end of 2012; was down to about 9.6 lbs. when first diagnosed in August 2013. I had been trying to get her wt. down pre-diagnosis (feeding mainly kibble - ugh!); when she later started dropping the pounds, I simply assumed my (very slight - still too high carb) changes in feeding her had worked. (Wrong!)

In my experience, most vets don't even mention feeding habits for our kitties until they're already obese! And look at how cats have historically been pictured in our culture: The plump kitty curled up on a chair, the plump kitty sitting by the hearth. (Anybody remember the cartoonist B. Kliban, whose cat drawings were so wildly popular in the 70's? The cats were all fat cats!) And don't even get me started on cat food commercials (Sorry, "Blue Buffalo" dry-food company ... but if your dry formula is soooo healthy, why did you refuse to give the carb info to Dr. Lisa Pierson?) We've been encouraged to free-feed our cats. But if we take a cold, hard look at that, dry foods were developed for human convenience - not because it was healthier for our pets. So then, not realizing what the consequences might be, we - as a society - bought into all that the marketing hype. I believe that we, as a culture, have come to perceive that it's okay when our cats begin to plump up a little, over time. We barely notice ... not until diabetes strikes.

For me, feline diabetes was an unfortunate wake-up call: Hey, Robin - treat the food as medicine, too! Measure her low-carb diet carefully, and monitor its consumption. Don't give in to her adorable kitty face when she begs for more food than is correct for her optimal weight and her unique metabolism. (Bat-Bat doesn't get a treat in exchange for an ear-poke; she gets soft words before, during & after, then a nice scritch under the chin. She's being treated for a disease; she's not being rewarded for cleaning up her room.)

And on that note, Kristin --- after looking over Scout’s SS & considering the additional info you provided me today, my gut is telling me that two things as relates to feeding are likely happening here:

1) Scout’s probably getting a little too much food. That may sound crazy right now because he’s always hungry, but the real reason he’s so ravenous is because his diabetes is not yet under control. Trust me, this will change as his blood glucose becomes better regulated. Based on his numbers not coming down for you regardless of dose adjustments, I would wonder about his current daily ration load inhibiting the effective action of the insulin. Has he been bouncing around? Yep! But I don’t think that’s the only thing happening here.
2) Forget the snacks, at least until his numbers have come down. You reported earlier today that he gets two main meals + some snacks at later points in the cycle; also, in a previous post you wrote, “...but when I’m home I try to spread his meals out throughout the day.”

From what I can see on his spreadsheet, your current approach to feeding - coupled with too many ounces of food per day (9-12 oz+) - may be working against you in your efforts to get his numbers down.

Notice how his numbers are all over the place, regardless of insulin dose? Start thinking of food as “medicine!” The “total daily dose” of food, and how you divide that “dose” up in a 12-hour insulin cycle can have a huge impact on how Scout metabolizes that insulin!

Remember: Every time you feed your cat something, his blood sugar rises. (This is why we so quickly feed whenever a cat drops down into the hypo-zone: To get that BG # back within safe limits.)

Although there are others who find that mini-meals/ snacks throughout the cycle work fine from the start for their cats (the concept is that it helps the pancreas heal), I can’t say I recommend this as the optimal approach with either Lantus or Prozinc in the early stages of treatment for a cat without other health complications. (I’ve used both insulins, as you can see in my signature: First, the Queensland Tight-Regulation (TR) Protocols on Lantus in 2013. Since her diabetes recurred last Feb. & she went on ProZinc, I’ve also used the TR approach, but with some modifications given that “long-acting” ProZinc behaves somewhat differently than the “ultra long-acting” Lantus.)

I’m lucky to work from home (I’m a writer), so when Bat-Bat was dx’d I could monitor closely from the start. Some people simply cannot do it due to their schedules (they often use time-release feeders to guard against hypo-events when they can’t be home to monitor); others have sugar-kitties with additional health problems that make it very important that they have mini-meals throughout the day. In those cases, I can see the point of the mini-meal approach. I can also see a real value for it later in treatment, when your cat’s BG is very well-regulated (down to near-remission) and you’ve got that cat on a micro-dose twice a day, or even a micro-dose “as needed” (where Bat-Bat is at present), because at that point your cat is so well-regulated that it’s preferable to keep blood sugar on a more even keel throughout the day/night cycles.

But until that great regulation happens, if you keep dumping food into your kitty every few hours during the 12-hour cycle, how do you ever find your cat’s nadir? (Answer: Good luck with that!) The great news for you, Kristin, is that you’re fresh out of university & looking for a job at present - so you actually have the opportunity at present to closely monitor & get Scout’s BG better regulated before you’ve found a full-time job in your chosen career!

Here’s what I’d suggest you consider trying with Scout:

1) He could probably stand to lose about a pound: Aim to get him down to about 11.8 to 12 lbs. (That means he’ll be a lean, mean kitty machine!) Lest you think he’ll be getting too small a ration, here’s some perspective: Bat-Bat maintains her 11-lb. weight eating between 6.75 oz/daily to 6.85 oz/daily! (That’s about slightly more than 2.25 cans of Fancy Feast.) In portioning it out, I actually cut the food in the can like a pie: In quarters and even in eighths sometimes.

2) Maybe reduce his daily total ration of canned Fancy Feast to just 3 cans/day. (9 oz. total); you may want to start the reduction out at 3.5 cans/ day the first few days, then 3.25 cans, then 3 cans. (Since he’s lately accustomed to 3-4 cans + snacks, right?) Divide his total daily ration into 2 meals per day: AMPS & PMPS. (I can hear him yowling from here: Get some earplugs.)

NO snacks. Not unless his BG #s indicate he’s close to hypo.

Get a baby scale and weigh him every day or two for a while. (Maybe right before bedtime?) That’s a big help in determining whether he needs reduction/ increase in rations. Give it a little time before you make any portion adjustments, though - safe weight loss isn’t instantaneous.

Make sure he cannot get into any extra food - from any source - that’ll just make it that much harder for you to get his diabetes under control.(So glad to hear your dog eats outside, where Scout can't get to it!)

With a shift away from snacks, Scout might wolf down his two meals too fast. (Bat did this!) To help prevent scarf & barf: Add some water to his meal (slows him down), elevate his dish on a shoebox (so that he’s not eating with his nose @ floor level) - & pick up the plate/bowl when he’s halfway through for a 5-minute “food rest” before letting him finish. (Then shoot the insulin.)

Will you run into an occasional snag? Sure! Bat-Bat recently barfed her ENTIRE meal, right after one of her “as needed” insulin shots. nailbitinganic time!) So first, I reminded myself to breathe. I waited 15 minutes & fed her 1/3 of the usual ration. (TG, it stayed there.) Then 10 minutes later, fed the 2nd 1/3; and in 10 more min. fed the final 1/3. It all stayed down. Checked her BG - it was going up. Checked again at nadir-time to reassure myself. All was ok; crisis averted.

Keep on getting those BG tests in: around say, +3.5 or +4, and maybe in the +5 to +6 range, - both am & pm cycles, if at all possible - so that you have a clearer picture of where his nadir occurs. You may even need to do a mini-curve. (This will make things easier for you down the road, too - because you’ll start seeing his patterns come more into focus on the SS. (You already know the importance of avoiding hypos, so his BG drops are especially important to learn when you’re not doing the snack/ mini-meal thing.)

I hope I did not overwhelm you here, Kristin. But I know you can do this; even if you have to wear those aforementioned earplugs for a while! After you’ve successfully run this gauntlet that is feline diabetes, you will find that Scout will still love you in spite of the diet controls, the ear pokes and the insulin shots. And you will have him around to love for years to come!

Here’s the little line I have framed over my desk (it has helped me keep my resolve in weak moments): “The greatest pleasure in life is doing what others say can’t be done.” Make that your mantra as you and Scout kick diabetes into submission (and hopefully, remission)!

 

Great information here...thanks Robin. I have learned some things and will definitely try some of your feeding suggestions.

Kristin - I get my strips from Walmart. I also have found them at Walgreens too.

 

wow thank you so much! i really appreciate everything! i will definitely cut out snacks for now.

i just did his PMPS and it's at 182. i'm so confused. is it possible for the insulin to be taking too long to get into his system? all day in the 400's and now its less than 200. how would you guys suggest i shoot tonight?

 

Can you stall? Don't feed him and wait 20 minutes to see if he comes up closer to 200 (and if he is sure rising)

 

As far as the dose, I am conflicted. The .5 took him down over 50%. That was a big drop. If you'd give .5 can you monitor? If not, then I guess .25. It may be a little too little, but it should be safe. I like that he is has a good pmps and would like to keep his momentum going, but I'd want him to be safe.

I have to say, though I love the pmps, I am completely confused why he is there. Maybe he needs less insulin, not more. Maybe the .75 was too high a suggestion.

 

stalling right now. i'm pretty confused too! he's getting impatient... just tried to take a bite out of my arm while waiting for his food!

 

alright. assuming that last test was wrong. it just came in at 437. makes me wonder how many other numbers have been wrong

 

Hmmmm. It could have been a bad test or I guess a really fast bounce. Maybe we will figure it out with more data in the next few days. So, what are you thinking? .5 or .75?

 

i'm thinking .75 since .5 hasn't been making much of a difference? what causes a bad test?

 

Too little blood, too much blood, a bad strip - no way to really know.

 

Hi Kristin,
I've read most of the way thru this thread (will try to finish later) and just wanted to throw this out there. You might consider getting some U-100 syringes with half-unit marks and use the conversion chart. This will allow you to accurately measure doses less than 1 unit and lets you adjust the dose in 0.2 unit increments. Here's a post with more info on this and it contains a link to the conversion chart. I did this a few months ago with Mitz and have found it very helpful. I printed the chart and have it stuck on the fridge for easy access.
http://www.felinediabetes.com/FDMB/...bies-and-oldies-links-info.32799/#post-340819
best,
Joan