Tiger's crazy numbers

someone help me - I'm about ready to scream! I don't have a spreadsheet (no computer access and I can't do it on my phone). Until recently Tiger was doing great, his numbers were in the low to high 200's. I varied his dose depending on his numbers, and he was pretty stable. Just over 3 weeks ago his numbers went crazy - high 300-high 400s. I've struggled to bring him down, with little success. I even stopped dosing for a couple of days, in case he was continuously bouncing. Without insulin he was in the mid 300s. On Sun he was 393 pre, I gave him 3 units which got him to 229 +8, and 348 +12. I gave him another 3u.
Mon pre was 394; I gave him 4. +6 he was 219, +12 138! I didn't give him any insulin. This morning he was at 474 pre, I gave him 4.5. At +4 he was 461, +9 he was 201, and just now at +12 he is 102! I can't give him any insulin at that low a number. I don't know why he is doing this, some days he only drops 100 or so and rises higher than he was in the morning, and others he drops slowly all day. He only eats pate Friskies, and seems fine in himself. Help?

 

Hi Mandy! I'm so sorry you're getting frustrated. Have you read the Stickies/Protocol for Prozinc recently? They are a great place to start in gaining an understanding of how this insulin works. Assuming you have, I'll try to answer your other questions.

The bouncing numbers are most likely caused by the changes in dose. Prozinc needs to be dosed carefully by considering the pre-shot and the nadir, and finding what dose works best for several cycles in a row. When the dose is changed frequently it causes many cats to bounce - going very high, getting stuck high, or dropping too low.

Another factor could be food if there is any chance he's getting into another cat's food, the dog's food, leftover table scraps, higher carb treats, lost pieces of kibble under the fridge, etc. It sounds like you have him on a good low carb food, so assuming he isn't getting into anything else on the sly, then food probably isn't the problem.

As for the spreadsheet, Google Sheets can be downloaded on your phone. Just ask and someone here can set it all up for you, then you just need to link it in your signature (we can help you figure out how to do that) and you can open on your phone and do it all from there. Or you can even print/make a grid like the one we use, fill it out by hand, and upload pictures of it. The spreadsheet really is an essential tool for identifying the patterns we need to make recommendations of dose. However you need to do it to make it work for you is fine, but data in a paragraph is really hard to decipher, and dosing decisions are made on several cycles of data, not just single cycles now and then.

For now I would recommend choosing one dose and sticking with it for six cycles, collecting data. Don't move the dose around so much. It sounds like 3u wasn't quite enough, and 4 was too much, so maybe try something in between? And let us know when you've downloaded Google Sheets and we can get someone to help with setting up the spreadsheet, or if you prefer paper and pencil, just upload a photo and we can look from there.

 

Thank you for replying! I have actually managed to load the spreadsheet, theoretically copied the blank one (I hit 'copy') and filled in Tigers details. I don't know how to share it here, can someone talk me through, assuming I'm an idiot who knows nothing!
He was 415 this morning (I didn't give any last night because he was 102), I gave 3.5, will hunt him down in a minute and see where he's at.

 

Are you in Google Sheets on your phone or on a computer?

I'll assume phone, but if that's wrong, let me know and I'll send other directions
1. Open your spreadsheet in the app
2. In the top right corner there are three dots like this ...
3. Click on that and then click "share & export"
4. Click "copy link to clipboard" It will look like nothing happened.
5. Come over here and tap in the text box to make a new post. Hold down your finger until a circle appears and then release. It should give you an option for paste or Look Up. Click on paste and the link to your spreadsheet will appear.

 

Thank you! iPhone, no computer here.

 

https://docs.google.com/spreadsheets/d/1NftLYJP6bk3H9QPLfZPkbi9iclDJ0fNvpSbGgxOKlJU

Hope that's it..

 

Yeah! Works from my phone! Good job! And great work getting all your data in there!!!

I’m at work right now, but will try to take a better look when I get home this evening, or if someone else is around they might chime in.

 

I can see it on my iMac. My suggestion would be to choose a moderate dose and give that both AM and PM for at least 3-4 days in a row to see if he'll settle. I'll go out on a limb and say 2 units twice a day. It might be too low but it can be raised carefully later on. The large dose jumps (up and down) might have scrambled him and the goal is to calm everything down.

If you succeed in reducing some of the volatility then I suggest increasing the dose by no more than 0.25 unit at a time. Keep the same dose both AM and PM for now. The technique of dosing based on pre shot number can work once your kitty is more stable and nearer an effective dose. It's more of a fine tuning technique. Too large a dose change and too many close together will contribute to erratic responses.

 

Thank you both!

 

Kris has given you some good advice. I'm not sure what I think about dose just yet though. Your spreadsheet starts with 4u. Can you tell us a little about that dose? Was that Tiger's starting dose from the vet? Did you use a different insulin before that? Your spreadsheet starts in August, you joined here in September...when was he diagnosed? When did he start insulin the first time?

 

He was diagnosed in early March, started at 2u. After about 6 weeks and a curve went up to 3. Another month and went up to 4. Went up to 4.5 in Sep as his numbers were still bad. I have lost a sheet with his numbers on in sep, which is why there's a gap.

He settled down and his numbers dropped, so I went back down to 4. He continued with good numbers so I dropped the dose, and he was good all the way through to the middle of Oct, with varying doses based on his numbers. I was away overnight (my dad came to visit and we went down to Florida), and when I got back his numbers went to hell. They were great during the day, but shot up by evening dose time.
I couldn't give him the same dose twice a day as sometimes he drops low at +12, and I'm afraid he'll hypo. He doesn't seem to always follow a curve - sometimes he just keeps going lower all day. I've told him off but he just laughs..

 

LOL...well if you find a way to get him to listen, let us know.

Given all that, I agree with Kris that shooting 2u for 3 days is your next step. It's likely too low, but he needs to settle down. Then we can start to talk increases. This may take a bit of work to find a good dose for him. Hopefully being really systematic about it will reduce the bouncing so you won't have so much trouble with those long cycles that leave him too low to shoot. Nothing eliminates bouncing completely, but steady doses usually reduce it.

Please keep posting over the next few days though. 2u is a rather random guess, and we'll want to keep an eye on what happens to make sure he's doing okay with it. Lowering usually reduces bouncing, but you don't want to leave him with too little insulin for very long.

When was his last vet exam/blood work/dental cleaning?

 

He hasn't been back for bloodwork since March, I know I need to get him checked again. Money has been an issue - had a cat bitten by a snake, dog that ripped a toenail off (messy!), another cat took the skin off the top of his shoulder blades (no idea how!), another hurt his leg and wouldn't walk on it for days.. the vet has had most of our money this year! He has no teeth - had them all removed 4 years ago - so no dental needed. My vet doesn't know much about diabetes - she didn't tell me about changing food or testing; I found you guys and got that information.

 

You've had a lot going on at your house! Did he have stomatitis? Is that why he doesn't have any teeth?

Most vets don't know a lot about feline diabetes. Vets do their best, but the folks here have collected such a wealth of knowledge and wisdom when it comes to treatment! My vet asks for occasional updates to keep his chart current, but leaves the treatment decisions up to me.

Is Tiger an indoor/outdoor cat?