JeanLuc Insulin?

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snorton

snorton

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Will someone please review my spreadsheet and let me know suggestions? I've been giving 1 u / 2x since 5/24. #'s are frustrating me. Thank you,
 
Your ss url is almost right. Go back to your signature and take out the = after JeanLu's Spreadsheet. It should just be the title and then [/url]

Glad you made it over here. This forum is much smaller than Health so you want to come back for responses. It is busiest later afternoon/evening EST. If you ever have an emergency, post on Health where they are likely to be more eyes.
 
It is a confusing spreadsheet. When you were only doing one shot a day, the one unit lasted a long time. I think the 116 and the 96 were an indication that the dose was too high - it lasted longer than 12 hours and gave you a preshot that was too low to shoot. But then the insulin wore out and by the next morning, you had a high preshot number.

The two a day doses are much better. Last night the cycle looks great - down to a blue at nadir and then slowly moving back up. The amps today could have been a bounce from lower numbers he isn't used to. But I don't understand the higher numbers you are getting midcycle today. No chance of a fur shot? No dry food available? Can you think of anything that is different during the day than at night?

I'd say, based on your great cycle last night, stick with the one unit, keep getting numbers and see what a few more cycles look like. I don't think you want to increase based on last night's cycle. I am wondering about reducing the dose based on the low pmps numbers you got when you were dosing once daily and wondering if today is an inverse curve, sometime indicative of too much insulin.

I guess too soon to tell. Get us some more numbers. We will figure it out.

But be encouraged. He has been responding well to a small dose of insulin.
 
Will continue with no change for now. Day #'s will be difficult. Any suggestions on that? For today, no dry food given. He did eat the ff beef today. Yesterday it was chicken and turkey. He is more active and eats more at night. I think I stressed him out at the +12 shot this afternoon. Thanks again.
 
Tests are difficult during the day because you are not around? If so, it's hard because the 4-6 number is the most valuable in terms of figuring out how the insulin is working. You can do an out of the door test as you go to work and an in the door test when you get home. And nadir tests on weekends.

If he is more active and eats more at night, that may help bring down his numbers. So can you feed him small frequent meals during the day? I freeze the wet food and let it thaw and I have an automatic feeder that feeds him a little at a time. Not sure how you can get him active during the day if you aren't around. Adopt a kitten? :mrgreen:

And be sure to test for ketones: http://petdiabetes.wikia.com/wiki/Ketoacidosis
 
When you were only doing one shot a day, the one unit lasted a long time. I think the 116 and the 96 were an indication that the dose was too high - it lasted longer than 12 hours and gave you a preshot that was too low to shoot. But then the insulin wore out and by the next morning, you had a high preshot number.
Click to expand...

I agree with Sue on this. It looks like the 1u dose was too high, and it gave you nighttime numbers that would have been too low to shoot. We usually say don't shoot any number under 200 unless you have collected sufficient data to know that the dose won't be too much for that low number.

If your vet had advised that you shoot twice a day, but had said to drop the dose to .5u am and .5u pm, you would have been giving him the same amount of insulin per day, but it would have been working for him around the clock instead of just during the first 12 hours.

The high numbers that you were seeing in the morning when you were only shooting once per day were due to the fact that the insulin wore off at some point, then there was no insulin in his body to keep the numbers under control. They weren't due to not enough insulin, but were due to the insulin being given all at one time in a 24 hour period.

Last night, the numbers look good in the middle of the cycle. But, kitty may have felt that they were "low" and his body reacted to the low numbers by dumping "sugar" into his bloodstream to preserve itself. We call that "bouncing". What it usually causes is a high number for your next test, and higher numbers for at least one or two more cycles. Today's numbers look like that is what happened.

My suggestion would be to lower the dose to .75 for tomorrow and the next day to see if it helps bring his numbers down. I know that sounds illogical, but sometimes too much insulin has the same effect as not enough insulin, and it causes high numbers that would make you think he needs more insulin and not less. You went from 1u total per day, to 2u total per day, all at the same time. It could be the "right dose" is someplace in between those two amounts.

See what others think...

Carl
 
Thank you all for your suggestions. His AMPPS was 533 today. I went ahead and gave him 1 unit after he ate. I will try the .75 this afternoon to see if that brings the AM level down. He was very active yesterday afternoon on a quest trying to find any morsel of dry food that was missed or hiding under furniture. It was quite entertaining to say the least. I'm finding it interesting that the vet would suggest 1 unit twice as day rather than .5 U. I've been communicating the BG's on a regular basis. Is it a common occurance for too much insulin to be prescribed? I'm am concerned about the high #'s and impact. He is gaining weight, drinking, eating, and not vomitting (other than beef flavored food, which he seems to hate). He is however still urinating more than normal in am. Am I trying to hard?
 
Vets often prescribe by weight, which works in dogs but not cats. The real mistake your vet made was the once daily dosing. Cats metabolize insulin faster and as you can see, by the end of 24 hours, he was sky high. The great thing is that you were testing and that pattern is easy to see.

My take on vets is that they have to treat snakes to mice and they can't be up on every disease in every species. We only know about diabetic cats but the protocol here has worked for thousands of them.

You aren't trying too hard; you are just anxious to get him better. We have a saying that probably make new members cringe, but it is so true: This is a marathon, not a sprint. Patience. Keep on doing what you are doing. He will improve. Look for small successes. One of the first things I noticed was that Oliver started to groom himself again. He was a Maine Coon and his coat had gotten so dry and dandruffy when he was first diagnosed.
 
Ok, .75U given at approx. 5:15pm. His preshot # was in the 500's again. What time frame should I see some change?
 
They often rise after eating, so you might get a + 3 to see of you have any movement. This is not a science, however. We don't know whether his body has been rebounding. If so, it could take a cycle or more.

While we are changing doses, be sure to get regular ketone tests.
 
Help! His sugar was 516 when i left this am. Gave. 75u, but it may have been a fur shot. His sugar now initially tested 646 at +12. What now?
 
First retest.
Then take a deep breath. It's only one 12 hour cycle, and just a high number. It's okay. Let us know what you get.

Carl
 
That sounds more logical.
I would stick with the .75 and try to get some tests in the next 6 hours to see what it does. The numbers in the middle are the key to figuring this out.

Carl
 
New #'s from last night have been posted. Are we on the right track? Not quite below 200 yet during peak hours. I can't tell if Insulin is lasting the full 12 hours or timing out sooner. Is this normal after 3.5wk of insulin use? He has been grooming himself more and Tuesday evening did get in our bed prior to our normal bed time (he hasn't done that for several weeks). I'm trying to focus on the little things, but frustrated at the same time. I truly appreciate the informative information you all have given me as I continue on this journey.
 
The early mid cycle numbers are better but still high. For reference, a cat who is regulated on insulin is usually in the low 200 range at preshot and the 100 and below range at nadir (around+6) but above 40.

It doesn't look like it is lasting the whole cycle. That can happen with PZI, but let's make sure we have covered all the bases. Wet low carb, under 8%, no dry. No dry treats? Let's see what others think but I am not sure he would be bouncing from the 200s. It is a 300-400 point drop, though. Are you feeding small frequent meals to even out the drops?

It's good to hear that he is grooming again. Not 3 weeks of insulin - the first 8 days were one shot a day so his body never got the benefit of the insulin for the full 24 hours.

And you are testing for ketones, right? Very important at these high numbers.
 
No dry food. Wet food only. He has been eating Fancy Feast Classics with success. We tried 1 can of Wellness Chicken, but after 1/2 can he didn't really seem to car for it. He started slapping the bowl with his paws. He has also had some Hill's M/D, but this has stopped since he eats the FF. He is a free feeder during the day. Most days he will eat between 3 - 6oz of wet during the day. At night, he eats about the same. He does tend to eat most at night at PMPS and then around +8 to +10.

Will try and test for ketones this afternoon. Need to pick up the strips. This may be a challenge. He doesn't like to be disrupted in the bathroom? Any particular Walmart brand the best?

:YMSIGH:
 
Any brand works - the same urine testing strips humans use.

We could never get Oliver to pee if we were in the vicinity. So we cleaned out the box (or you can get one just for ketones testing) filled it with aquarium gravel and left him in a room with it. He couldn't stand that there was a clean box. Since the urine won't stick to the gravel we swooped in and got our sample.
 
I think you got a good amount of drop on the .75 dose. What caught my eye was the meal between +8 & +10. That feeding might be why the insulin appears to be not lasting for twelve hours. It would be pushing the BG up when the insulin is wearing off, making it appear that it was completely gone. If you can push that feeding back towards +6, you might see lower PS numbers. I'd stick with the .75 and try that for the next cycle or two.
Carl
 
I usually leave out food out for him while we are sleeping. The shot is given around 5pm and he eats. Should I remove food or leave smaller quantity out before I go to bed? He was a free fed dry food eater before the diagnosis. Feeding suggestions are welcome. What amounts are you feeding your cat and when? Jean Luc is currently ~11.5lb.
 
Ketones test was negative. Yea.... Still having trouble with the BG though. Morning # better but increased sharply. I did remove food around +6 last night.
Is this still bouncing? Suggestions.
 
Your numbers look more encouraging in the last cycle. Your amps looks better as did your +4. Any idea what happened after that? When did he eat? It is unusual for them to bounce that fast and that much. Most often the bounce happens at the end of the cycle or even the following one.

He is a puzzle. Have you considered an automatic feeder? It would give him an amount of food, when you wanted him to eat. If the food makes him go up that much, maybe smaller feedings more often?

I'd try the aquarium gravel. It was the only way we got a urine sample from Oliver.

Let's see what others think. I think I might increase the dose.

What I can't figure out is your first few days. On one unit, you got a long cycle. On .75 you should get a shorter one but the numbers should be good. He isn't doing what we would expect. I think I would go back up to one unit this weekend when you can monitor and get some numbers mid cycle. Maybe more data will help us figure him out.....
 
Other than giving two shots a day, are you doing anything different now than you did when shooting once per day? I agree with Sue this doesn't seem to make sense. You are using U40 syringes, right? And drawing up just shy of the first line on the scale?
Nothing has changed in terms of eating times or amounts fed?
Carl
 
The 1st few days he was on an antibodic for any potential infections related to the kidneys spilling glucose. He didn't have a fever. The vet thought it a wise precaution. He was being fed purely Hills MD. I was starting to incorporate the ff classics. No dry food. I did have to leave for a few days and during that time he continued to receive 1u / day. He was finished with the antibodies, and my DH did give him some dry Hill's w/d food with the Wet MD to get him to eat. Jean Luc was active during my absence. He chased the wrinkles in bed sheet and played with his toys. I cannot determine when the 1u / day stopped resulting in below 100 after 12 hours during these few days. No testing was done during my absence. He is now back on purely wet food of ff classics. No antibodies. No dry food. He eats approx. 2-3oz cans daily.

I did increase his dose back to 1u/day this weekend. He does not have the wild swings, the ps #'s are lower, but nadirs are still not in the 100s or 200s regularly. Any thoughts? He is eating more during the +0 and +5, so perhaps that is causing the difference.
 
I've noticed the BG levels seem more consistent during the first hours after food. The numbers looked good last night until sometime between +7 and +12. If he eats smaller but more regular throughout a 24 hour window will he bounce as much?(liver not freak with the glycogen).

How often do you space out the feedings? Every 2 hour, Every 4 hour etc. I ordered the 5 part auto feeder several of you are using. How did many you set-it up?

Right now he eats 2.25oz FF 15-25 minutes before shot, then .25oz about 20 minutes later. I then leave 1.5oz of frozen FF for him to graze of later. This is repeated for the AM and PM Shot.
 
I think you might add a small snack around that +8 mark and see if that evens out the rise up. And after several days on one unit, you had a couple better midcycle numbers but he has room to move. What would you think about increasing the dose by .25? I would do it when you will be around to monitor.
 
No problem doing that in a couple of days when I can keep an eye on him. If I raise the dose, will he still have a chance to go in remission?
 
There are no guarantees for remission. The idea is to get him into the best numbers possible and hope his pancreas starts to heal. Some cats do; some don't. Most cats on a wet low carb diet with the right insulin at the right dose become regulated - staying in good numbers cycle after cycle. We figure regulation is the goal; remission is a gift.
 
Still trying to get regulated here. After review of my spreadsheet, my vet suggested on Friday 1.5u 2 per day. I have gone that route, but not sure if it is working. I think he had a bounce tonight after a # in the 200s earlier today. Does that make sense? How long to contine on this dose? His ketones were negative on Friday. Trying to catch him in the act tonight to retest. He eats approx. 3 cans ff classics daily. He is 12lbs. 3oz at shot, .25oz +2, .25 more roughly +4-+6.

On another note, has anyone had issues with the alphatrak 2? I tested him tonight and the 1st # was 701, the 2nd number 1 min later was 529, the 3rd 3# about 20 min later was 652?

I really do feel like I am on a roller coaster....up, down, up, up...! Waiting on the level coast.

Thanks again for everyones help and support. It is nice to have a calming voice that has been through this.
 
I have no knowledge on the AT meter at all...

I agree with the increase advice from the vet. The thing that strikes me the most on the SS is how he seems to do much better overnight in terms of numbers than he does during the day. Is the feeding routine the same day and night? Same amounts at generally the same number of hours from the shot?

It is possible that the yellow caused a little bit of reaction from his liver, but that wasn't a big drop, so I don't think it is likely. The 500+ number is confusing, unless he just isn't getting 12 hours out of a dose.
I would stick with 1.5 for another day or two and see if the overall numbers come down. Is there anything else "going on" with him? Has he been tested for any kind of infection (which would elevate his numbers) recently? We definitely would love to see the "reds" at AMPS and PMPS come down into the pink range soon, and it may require more insulin than 1.5, but you should definitely ask the vet if there is anything else that might be causing the numbers to stay high besides "just" diabetes.

Carl
 
My little guy to visit with vet tomorrow. I am asking about the insulin's effectiveness (ie is it still good), urinary tract infection, cushings, pancreatitis, functioning of my glucometer, kidneys. Is there something I am missing? My brain is thinking of all kinds of crazy things and needs to be reigned in. As always, the help I have received here is truly, truly appreciated. My logical side and emotional side are having a duel over the #'s today.
 
If everything else checks out (no infection or anything else contributing to the high numbers) my guess is that the vet is going to advise upping the dose to get those black and red numbers to go away. And I think I'm in agreement with that, because even the mid-cycle numbers are getting to be too high.
Ask the vet if you can have a copy of his lab work from when he was diagnosed. There will be all sorts of things they checked out, and it should be clear which ones are "above or below" normal ranges. If you get that info, and post questions like "what does it mean when the potassium is way too low or the sodium is way high?", there will be people here who can help you to understand what all those values mean.

Keep us posted after your visit!
Carl
 
Is there anything i can do to help him stop faster? I imagine these fluctations don't feel well.
 
There seem to be cats who bounce and cats who don't. You are right, it probably doesn't feel good, so anytime you can slow the fall a little with food, it may soften the bounce. (So if you see him headed down pretty fast around +4, give him some food and see if it slows him down a little.)
 
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