Spacey still not regulated

His BGs are still high right before shots, and running around 150 to 270 at peak times. Plus he is still acting lethargic. I am wondering if I am feeding him too much? He is given friskies special diet at shot times and around the time I think his insulin is peaking, usually 4 to 6 hours after his shots. And more if he acts hungry. Any suggestions? He is on 3.5 u of insulin both shots, but I have lowered it if his BGs were around 150 at peak. But then I'll have to raise it again because the BGs are high before shot times. Very frustrating.

 

Hi,

have just read back your thread from 1st Aug.
Diabetes is a marathon not a sprint.I know it's frustrating but dose hopping will confuse the picture more for you.

I couldn't find an answer from you on if your testing for keytones?
This is so important in an unregulated kitty.

As for purina DM or science stuff-my view is that it's rubbish.

You do need to keep an eye out for the struvite crystals.Not that I know much about them, except not nice!

Have you got time to put a spreadsheet together? Because of changing dose it's hard for people to follow your story and this makes it harder to offer any advice.
In my view, vet has good intentions but actually don't really know what their doing.

3.5u is still a high dose, especially if you changed to much lower carbs.
Do you test before every shot? and then get spot checks in?
If your home today, try and get
+1 and/or 2
+4
+6
+8 (as aone offjust to see what curve your getting, often doesn't give a great deal of info)
+11

Then you can see what effect the dose is having on his bg's. Kitty just needs to not eat about 2 hours before shot time. As for around your checks, just note if he has as this will efect the figure too, but not being regulated he's probably hungry a lot.
Make a note of how much he eats to and when.
Also his behaviour (you've said lethargic-does he perk up at any point?)

Lots of peeps here willing to help you fiure this out so your not on your own :mrgreen:

 

Hi Lori,
I would not worry about feeding Spacey too much. An unregulated diabetic cat is a hungry cat because they can't process the food effectively. You feed as much as he wants at this point, unless he is overweight. The only time you don't feed is within 2 hours of shot time, so you get a true preshot BG, not a food spike.

I strongly urge you to set up a spreadsheet. If you need help, ask and someone will help you. The directions are here: Spreadsheet Directions The SS will help you and members here see patterns, and be better able to advise you. Please click on the link to Tinkles' SS in my signature, we started out on ProZinc with high numbers and it will help you see what I mean about patterns. It really is very difficult for anyone to guide you without some specific info on Spacey's dose and BG numbers.

Just some general comments on ProZinc: The first 45 days can be extremely frustrating with this insulin. It's an excellent insulin, but in the beginning, the numbers can be unpredictable and the nadir often moves around. It will frustrate you and confuse you if you change the dose frequently during this period. This insulin likes to be dosed consistently and you need to make small dose adjustments when you do adjust and allow several cycles for the dose to settle. I always advise to adjust by no more than 0.25u at a time. When we used it, I would adjust by 0.5-0.1u and see a significant response to that. Small adjustments often yield big results with ProZinc. You need to be patient and methodical with ProZinc or you will get extremely frustrated!

 

Thank you for responding Kate and Laurie. I have been unable to set up a spreadsheet on Spacey because I am accessing the internet on my Wii, and it lacks the capabilities of a computer. So until I can set his spreadsheet up on a computer, I will post Spaceys BGs here. For today his fasting BG before a.m. shot was 491 at 9:30 a.m. He received his shot of 3.5 units right after that, and was fed 1/4 can friskies special diet beef and chicken. At 12:35 p.m. his BG was 281, and at 1 p.m. he ate 1/8 can friskies special diet ocean whitefish. At 2:45 p.m. his BG was 146, and he ate about 1/8 can special diet salmon at 3 p.m. and a little more at 5 p.m. At 6 p.m. his BG was 441, and pre-shot at 8:45 his BG was 422. Then I gave him 3.5 units of insulin and he ate about 1/3 can special diet ocean whitefish. I am going to do another BG shortly, and will post it in the morning. I apologize that this is so long, but I wanted to post exactly what his BGs were and when, along with how much he ate and when. Spacey finished his antibiotics a few days ago, and I will take him back to vet for another urinalysis. Now I have a question. Is it OK to give Spacey canned CD or SD if it shows the struvite crystals are still present? Thats another reason I am keeping him on the special diet, because he did have struvite crystals and an infection when he was diagnosed as diabetic. Thanks for helping, and I truly appreciate the advice. Lori

 

Lori,

Since you can't set up a spreadsheet yet, it would be helpful if you would list your bg readings like this:

amps #491 3.5 PZI
+3 281
+5.45 146
+9 441
pmps 442 3.5 units PZI

amps means morning preshot number, pmps means evening preshot number. +3 means 3 hours after the shot etc. This way we can see easily what it happening.

You are getting a nice drop, and then heading right back up.

Hopefully some with crystals experience will be by shortly. I know Dr. Lisa likes wet lo carb for those kitties, with water added .(http://www.catinfo.org/?link=urinarytracthealth) And your Friskies looks okay except that you are feeding quite a bit of fish. The mercury levels can be a problem there; the common practice is to feed fish once a week or so.

 

Hi Lori,
As Sue said, that's not a bad drop. I know it's concerning that his BG goes right back up, but sometimes it takes some time to get those PS numbers down. It looks like he has a bit of a panicky liver, so he is bouncing back up after the 146, which is normal at this stage. If you keep doing what you are doing, he will eventually get used to getting down into those lower numbers and stop bouncing so high. I would stick with the 3.5u dose for a bit and keep posting to let others keep an eye on your progress and help you. As far as the food, I think you are talking about the Hill's C/D and S/D, right? From the diabetes standpoint, If you can avoid feeding either of those foods I would, because they are higher carb than you want. However, I don't have any experience with crystals either, so I can't advise you on what you should feed. Maybe you could start a thread with struvite crystals...diet? in the topic to get more experienced people's opinion.

You don't need to lower his dose if his BG was around 150 at peak, that is still a diabetic number. I know there are some older guidelines out there that advise that, but I would not go by that. If his BG falls below 50 at peak, then you need to lower the dose at the next shot time.

 

Hi Lori,
You're doing great, testing Spacey so often. Make sure to post another topic with the subject line saying "Help with diabetic with crystals" or something like that, so anyone with the experience with crystals could respond to you. ProZinc is a good insulin I hear, and give it a time, and you'll see the numbers go down. Good Luck Lori.

Taline

 

This was Spaceys BGs today--

amps--436 3.5units ProZinc
+4--256
pmps--HI (over 500) 3.5units Prozinc
+3--279
I was out of the house today so did not get as many BGs done, but will do more tomorrow. Diet was the same, 1/4 to 1/3 can special diet at shot times, then about 1/8 to 1/3 can around nadir. I will start giving the special diet non-fish more and limit the fish. I also gave Spacey about 1/2 boiled chicken breast about an hour after pm shot. Post more tomorrow. Thanks to everyone. Lori

 

Hi,

not sure of your time zone.

Can you get a +6?
We need to figure out why he's bouncing so hard and thus need to know how low he is actualy going on the 3.5u dose.

Also as I said in my first post (and you did record in your following one) when he has eaten-it will raise bg's so need to take into account. Be good if you could avoid feeding between say +4 and +6 and test at +6 (If for any reason he was looking suddenly lethargic or wanting food, you would test there and then just in case his bg's have suddenly dipped too low)

It could be that he is a bouncing kitty (can happen in the early days, settles for most cats whilst others it is par of there pattern) or that his dose needs adjusting,that's what we need to figure out.

Keep up the good work :mrgreen:

 

Hi Lori,

Like Kate said, we could use some more tests at other times to get more data. I know you said you weren't home today, but you could get more tomorrow, so I would try to get some tests between +5 and +8 so we can get a better idea of when his nadir is and how low he is actually getting. If the numbers are still going down at +8, keep testing until he starts rising. ProZinc can have a pretty late nadir for some kitties. Tinkle's nadir was usually around +7, but +8 was not unusual for him either. It looks like Spacey bounced today but he's heading back down again, so that's a good sign.

I wouldn't change how you're feeding him, you want to see how the insulin is working with your normal feeding routine. The only time you need to not feed is within two hours of shot time.

The more data you can get, the better picture you will have of how he's doing with the insulin and dose. Keep up the good work!

 

Here are Spaceys Bgs for today-8-24-10

amps-402 3.5u prozinc
+2.5-302
+5.5-140
+8.5-128
pmps-304 3.5u prozinc

I fed him about 1/4 can special diet beef & chicken at shot times and after his nadir BGs. It seemed his BGs were a little better, as I gave him a little less food each time. I'll keep posting.

 

Hi,

A couple of good numbers there.Still think we need more ifyou can get them, either side of that 128. We need to see how low he is going.
It's just to make sure that 304 is a 'natural' bounce and not because his body is going too low and releasing glucagon to raise the bg's.

Your doing great :mrgreen:

 

Just did a BG on Spacey before bed.
+5(after pm shot)-257

 

It looks like his nadir is pretty late, I would like to see more numbers late in the cycle. A late nadir can be normal for your cat, or it can be a sign of too high of a dose. I see his preshot numbers are coming down. That's good, but it can also mean that the dose is too high if the PS numbers get too low to shoot. ProZinc can have a long duration, 10-14 hours or longer if the dose is too high. You can get too much overlap, meaning that the previous dose is still working when the next dose kicks in...that could result in a hypo event....it happened to us. Please get some BG numbers starting around +7, hourly if you can do it, and keep testing until the numbers start to rise again.

Also, do you know about having a no shoot number? If you get a PS number that is below 200, you know you shouldn't give the shot right then, right? If that happens, you should start a new thread and ask for help.

 

Hi Laurie
I will do the BGs every hour after 7 hours, good idea. I have had a death in the family and will be gone this afternoon and tomorrow afternoon, so I may only get 4 to 5 BGs today and tomorrow, but I will start on that Saturday. Below is his BGs from yesterday and this morning-

8-25-10
No amps BG-(I know thats a no-no) 3.5u prozinc
+2 334
+4.5 76
+7.5 345
pmps 467 3.5u prozinc
+2.5 295

8-26-10
amps 457 3.5u prozinc

 

Lori, I'm so sorry for your loss. :sad:

Ok, that data helps. It also changes my thinking about what is going on, about the nadir being late. Now I'm thinking that the 128 late in the cycle was him coming down from a bounce, not a nadir.

It looks like he got a big drop early in the cycle, then he zoomed up. That 76 is a nice number, but it's a big fast drop, and his liver is dumping sugar to protect him from a hypo event. It may seem paradoxical, but if you are giving too much insulin, you can see higher BG #s. We want to get a nice even curve, not a fast drop and then a zoom to high numbers. Less insulin should help even it out.

I would try lowering his dose to at least 3.0u, (and personally I would like to see an even bigger reduction, maybe 2.5u, for safety's sake...but I am conservative) and keep getting as many numbers as you can and post them. You're doing great! I know it is hard to test all of the time and have a life, just do as much as you can. :smile:

There is a PZI insulin support group, you might want to post a thread over there too, to get more eyes on you numbers. I'm going to post a link over there now, so others will take a look at your data. There are people over there currently using your insulin, and can also give you more input. More opinions are better! You should also look at the threads over there, it will help you learn. I know you can't make a SS with the Wii, but are you able to view other people's SS at all?

 

Wow, that +4.5 really is good data, amazing how one spot check can really clarify things. I was on the fence til I saw that - with that in the picture, I agree it looks like this dose is a little too high and is giving him some big swings. I would probably try 3u like Laurie said, and see how the data looks on that.

I'd also suggest you put PZI in the title of the 1st post in the thread, otherwise some PZIers will likely skip over the thread.

 

I haven't posted Spaceys BGs for a couple of days, so thought I would post them now--

8/28/10-
AMPS-HI (over 500) 3.5u prozinc +4 367
+7 349
+9 335
PMPS 402 3.5u prozinc
+5 327

8/29/10
AMPS 494 4u prozinc
+2 442
+4 379
+6 259
+7 186
+8 111
PMPS 416 3.5u prozinc
I got worried when he went down to 111 and gave him some Hills KD which could be why his BG was back to 416 by PMPS. But all day I made sure he was fed only small amounts of friskies special diet, as I wanted to get a good curve. His BGs on 8/27/10 were
AMPS HI 3.5u prozinc
+4 HI
+8.5 325
PMPS 299 3.5u prozinc
+6 192
His BGs were high all day on 8/28, which is why I raised his insulin to 4u today am shot 8/29. I know some of you have suggested I lower the insulin. Should I do that if his BGs are so high? I can't tell if he is reaching nadir or if his liver is releasing sugar like some have suggested. Help!

 

It can be tough to know if the dose is too high or too low when you see high or mixed #s. Because I have tended to only see #s like HI on this kind of dose with cats who either have some reason they are throwing high BGs (high carb or dry food, or some medical reason), my suggestion is to lower the dose a little and see if the #s settle down.

If you KNOW the dose is too low and you are seeing high #s, then you can be confident in raising the dose. When you're not sure, then you are sort of playing with fire to raise the dose when you don't really know if that is the right answer. Since there's at least one cycle where you have some evidence of a lower # early in the cycle, to me that is your cue to test out a lower dose and see what happens. If the #s just get higher, then you can raise the dose back up, with the confidence that you are doing the right thing.

I wouldn't stay at lower doses for a long time if you aren't getting results, but sometimes when people lower the dose a bit they will actually get better #s, though it's counterintuitive. There isn't really one right answer or a magic solution, it's just trying things and collecting data until you figure out what works.

Although some recent cycles look like a good U-curve, a number don't. A HI mixed in with decent #s tends to look reboundy to me. The late nadirs tend to look to me like a dose that might be slightly high. That's why something like 3u, or possibly 2.5u, looks worth trying to me. My guess would be at 1u you will get all high #s (though of course you never know).

I know it's scary! How is Spacey doing overall? Is he feeling ok-ish or is he acting really symptomatic? Are you checking for ketones daily?

 

Update on Spacey
I took him to the vet for urinalysis, and he had no infection or crystals. They gave him the 4u of Prozinc. When he came home his Bgs were 150 to 60s. Yesterday they were in the 200 to 300 range. This amps Bg was 120! That is the first time before an amps or pmps that his Bg has been that low. I debated about his insulin, and decided to give him 1u amps, due to lower Bg. But by pmps his Bg was back up to 500. So I gave 3.5u. I have not been testing for ketones but will get some ketostix. I will have to isolate him and his litterbox to get his urine, as I have a multi-cat household. I'll post more on his Bgs tomorrow night. Lori