10/26 Newman AMPS 378 , shot 1.5, 209 @ +6, PMPS 320, shot 1.5, 274 @ +3

https://felinediabetes.com/FDMB/threads/10-4-newman-amps-260-shot-1-25-pmps-379-shot-1-25.268961/

Starting new thread and giving Newman's ear a rest, since he only has one good one for testing.

Is it known how activity effects their numbers? Newman usually sleeps all day and wakes for his dinner around 4-5:00 PM. He is active until I go to bed, and may continue for some time. He is ready in the morning for treats, tests and breakfast. I wonder if the lower numbers during the evening cycle and lower AM BG are influenced by increased activity in that cycle?

 

This is funny. I was thinking to myself "I know I just talked about this in another thread recently, which cat was it..." - it was Newman! Lol

But yes, that's part of the theory anyway. We don't see it with every cat, but something I've noticed (pure anecdote) is it does seem to be the more nocturnal cats. Sure by nature they're nocturnal, but some moreso than others.

 

Newman's numbers are creeping up. Do I increase and deal with the lower AM numbers with possible stalls, or is it too soon to increase? There is really nothing that changes in his food or activity to effect his BG. We stay relatively close to schedule.

What do I need to do to make more progress for him? I feel like one step forward, two steps back. Am I not pushing hard enough to get past my fear of overdosing him? Do I need to take more risk?

I know, of course, that every cat is different, but I read about other cats and I look at their SS and it looks to me as though often doses are adjusted based on BG with some frequency.

Here we go again, I'm in the weeds and feeling impatient and inadequate in treating Newman. While my situation is different due to my health issues, is Newman's diabetes far from typical or is there no such thing as typical diabetic cat?

Sorry for the rant aspect of this post. Thanks for reading. Please opine. @Suzanne & Darcy @FrostD @Shelley & Jess

 

Breathe! Step #1

I don't think any of us can fully put ourselves in your shoes, try as we might. It's why so much of what I say ends with "whatever you're comfortable with/can manage". My words for a caregiver who just "doesn't wanna" get up at 3am are much different lol I think you're doing a great job!

I do think he needs an increase, but I also think you're at the point where he's just going to float back and forth between doses.

He's fairly typical of a cat on ProZinc. It does usually help to push nadirs lower, but I'm uncomfortable recommending that in your situation.

I suppose first question is - are you able to get some +9s-ish at night? That would solve the mystery of "is he breaking bounces or going lower than we'd like?"

 

I plan to try for those extra tests. It may take a few days of attempts to establish a routine at that time of night. Hopefully he will surprise me and join me in his test/treat spot and, that I don't fall asleep waiting for him to decide to do that. He is one of those cats who "thinks" about stuff before he acts. lol

 

Because we were thinking of an increase, he came up with that lower AM BG again..

Test got 103, stall for retest 118, fed regular amount and plan to shoot 1.0 based on the data on 10/3 when I did similar and shot .75 which seemed a bit too low.

 

Cutting 30 minutes off of the morning shot time to get closer to usual schedule. PMPS 352, shot 1.0 based on the reduction after the AM 103 and the assumption that he was somewhat lower during the PM cycle. He was 204 @ +3 last night at bedtime so I figure between 204 and 103 this morning surely produced something around 90 or less. I hope this is reasonable, but please comment, especially if I am wrong. Thanks.
@FrostD, @Shelley & Jess, @Suzanne & Darcy

 

Logic is solid!

 

I really don’t understand why, all of a sudden, Newman comes up with these low AMPS. He’s been on the 1.25 and it seriously looks like not enough insulin and then… bam! I guess this is the occasional unpredictability of ProZinc? Unless you have another explanation like he didn’t eat well or something. His PMPS wasn’t even low. Newman!!

 

I agree. No other explanation. His food is measured and monitored. His appetite seems good to me, pretty much eating all that he is allotted in a day. Even when he vomits he eats again almost immediately and catches up in quantity throughout the day.

I will say that it often comes to mind that when he was dx in November '21. the vet started him on Vetsulin, 3 units twice a day. I asked about changing his diet, as he was eating mostly Iams Urinary Formula Dry and a minimal amount of FF Pate. The vet said not to worry about diet, just get him on insulin. I ignored the vet, started him at 1 unit twice a day and immediately changed him to all wet, low carb Fancy Feast Pate, chicken and/or chicken and beef feast. The change was complete and quick. Maybe he progressed, increased doses without factoring in the change in diet. Has he been bouncing from the start?

 

Some cats are just bouncy. Newman is not too bad in that department really. I see way more bouncy cats than Newman- and they stay high for days Hope this morning will be a good one.

 

P.S. glad you ignored the vet and gpt him onto the low carb diet. Smart lady!

 

Sometimes, and I wish I knew why, they get extra long duration out of a shot. I've only seen it in about 2-3 ProZinc cats. Glad to see some later tests, one of these nights you're bound to catch one that'll tell us if he's going too low or just getting long duration for whatever reason.

 

Don't know if you caught this comment from an exchange with Suzanne earlier.

I will say that it often comes to mind that when he was dx in November '21. the vet started him on Vetsulin, 3 units twice a day. I asked about changing his diet, as he was eating mostly Iams Urinary Formula Dry and a minimal amount of FF Pate. The vet said not to worry about diet, just get him on insulin. I ignored the vet, started him at 1 unit twice a day and immediately changed him to all wet, low carb Fancy Feast Pate, chicken and/or chicken and beef feast. The change was complete and quick. Maybe he progressed, increased doses without factoring in the change in diet. Has he been bouncing from the start?

I was only testing AM and PM so I don't have a picture of what actually was going on at the start.

 

He probably has been bouncing from the start, but most do...he's in good company there. They just usually settle down after about 3 months or so...and when they don't, and the caregiver wants better regulation, we look to switch to Lantus/it's generics.

What I've noticed - and I hope you know by now this is NO means a criticism - is that the lower you can push nadirs, the more the bounces seem to improve over time. Lee and Spike are in a similar situation - due to circumstances, just isn't safe to push any lower. So you hit the point of "ok this is the best we can do here", and I think that's where you're at with Newman.

Cats that switch to Lantus continue to bounce as well, it's not a completely magical insulin lol it's just it usually does improve quite a bit over time vs ProZinc.

It does look like you can shoot the full dose with these lower AMPS and it may help keep him down a bit - but to be honest I am scared to suggest that in your situation. With my luck, the next time (maybe tomorrow morning by the looks of this PM cycle) you'd try that then he drops low and you can't get to him. It's the same reason I can't suggest that for Spike, or other caregivers who work out of the home/long hours....though some do take the risk.

 

Hi Linda, this is also not a criticism, but how did Newman get down to 1 unit? I feel like I have been "out of it" a lot lately, and am not up to speed. But it seems clear that 1 unit isn't currently cutting it for Newman.

 

@FrostD - been thinking about you every day. Baby yet?

 

Nope (thankfully?). Month left technically, but I'm suspecting only 2-3 weeks left. I should probably be more panicky Just so busy that I keep forgetting there's a baby coming LOL

 

You are amazing! Keep on going (as if there wS any other choice!). I am sure y’all are ready with the nursery and everything as well as getting the other kids excited.

 

I guess the best and easiest way to answer this question would be to refer back to post #6 in this thread and pick up on the numbers and reasoning that got me to 1 unit.

 

I think I thought that was a temporary reduction on October 9, based on a low AMPS number.

 

I was thinking of going back up, and the fat dose I have been shooting for a couple of cycles is very close to 1.25 so I increased with this morning's dose.

I do wonder what are the thoughts, at this point, of me starting to shoot the 1.25 at the AM cycle but reducing to 1 unit for the overnight? @FrostD, @Suzanne & Darcy

I know ideally, test checks overnight would be the best solution, but I fear that is not working out for me, due to restriction of my health issues. I'm not giving up, but realistically I think I need another approach to the situation.

Another answer would be to shoot the same dose AM and PM and trust that he will be okay overnight. I have been treating him for almost a year now with no severe consequences. If he is low in the AM, I can stall for a second test as I have been doing.

Finally, I am going to try to remember to log the times and approx. amount of food he eats at his grazing sessions throughout the day and see how that may or may not be influencing his BG and to what degree.

I appreciate the input.

 

Hi Linda. I recall making the suggestion a while ago that we may want to consider you shooting a slightly lower dose in the evening. It’s not “conventional” but it may work in Newman’s situation. Of course, you may find that you have a situation some nights where you have a preshot number that makes you want to shoot the full dose. You could do a trial of this method of shooting different a.m. and p.m. doses. Nothing is set in stone; you can always change back.

You are doing great! Newman is lucky to have you for his mom (Ozzie and Minnie too.)

 

Agree with Suzanne, I would trial it as well

(And yes we're all ready for baby!)

 

Ok Newman come down buddy!

 

I got a couple of extra numbers overnight to look at. Looks like time to increase but with the "split" dose, how best to increase? Do I bump up both doses, or just quit the trial and balance them again?

@FrostD
@Suzanne & Darcy

 

Normally you'd treat them separately, while trying to factor in potential impact from the other cycle. So for example: say you're getting a nice curve shape overall from the PM cycle, but the PMPS is high so PM numbers stay higher than you want. In that case you'd try an AM increase hoping to bring down the overall AM numbers and give the PM a better place to start. I hope that makes sense?

In this case the dose isn't working in either cycle, so I'd increase both.

 

I hear you and I agree that this is not working. Should those increases be in 0.25 increments? I knew this morning I should have increased the dose to 1.5. but I didn't do it.

I will plan to shoot the evening dose at 1.25 unless directed otherwise, and increase tomorrow morning to 1.5

 

Yes, still 0.25U increases....he's not quite in "fat" territory

 

After 208 @ +3 last night, the 198 this AM was no surprise. I did a 10 minute stall just to be sure he was going up naturally. He was having a paste like stool last evening with frequent trips to the litter box. I fed about a tbsp of food this AM to go easy on his digestion and avoid vomiting. His stool is still unformed this AM and now he is under the bed, out of reach so I have no choice but to wait for him, there's no one here to help.

With food bump, an hour after eating, he was 301 so I shot 1.5

 

Thanks for checking on us and thanks for the support.

 

The poop is a little unusual, just keep an eye on that... hopefully shortlived. S. Boulardii works great for loose stool.

 

Yes, the poop, but I failed to post that it is both cats, so perhaps something about the food or treats for testing. I will keep watch and look into the S. Boulardii. Never heard of it. Thanks.

I was hoping to get a +4, but he was unavailable. Now he is out but in an accessible spot where if I push in to reach him, it sets up the 'just out of reach moves" staying just out of range.

He is grooming and relaxed as he would normally be.

 

Well, his poop is back to normal.

I thought that this morning his fasting bg was't too bad at 334, and the 209 at +4.75 was encouraging, but the 340 at 8.75 not so much.

I fed him his regular dinner and we are now in the 2 hour hold before the PMPS.

Is this bouncing from the change in doses and do I just stay with the current dose for a day or two more?

The 2 hours is up at 7:10. I shot his morning dose at 8:15. Can I shoot closer to 7:30 since he is so high, assuming it will still be high after the 2hr fast?

@FrostD, @Shelley & Jess

Update: I went ahead and tested at +11, got 422 and used that as his PMPS, shooting 1.25.
He was loafed up and I just felt I needed to go ahead and get some insulin into him.

 

Yes you can shoot early. I'm not quite sure what to make of doses yet so I'd hold another day or two.

 

Our posts crossed. I updated to inform that I went ahead with the early dose. I appreciate your support and comment so my mind is at ease in my decision. By the way I am still trying to get some test overnight, but he realizes it is not the normal and I end up giving up after a brief chase. I don't want to jeopardize the daytime routine. lol There's no dumb cats!

Feeling okay? My birthday is the 25th - just saying. LOL

 

Today's AMPS is better!

So far so good! Curious if I'll make it to November.

 

My schedule just abruptly and unexpectedly changed, not sure just yet when I can be around anymore

 

Thank you for giving me notice, that's very thoughtful.

While I won't be looking for you, I will be thinking of you. I hope all is well. Say hi when and if you can.

 

I would increase PM to 1.5U now. The AM probably needs an increase as well, but I'd like maybe 2-3 days to see how the PM change affects the AM numbers.

 

Sounds good. I agree and prefer to make one change at a time, keeping it simple.

 

Weekends are hectic around here so Newman did not do his usual grazing during the early AM cycle. He ate around 2PM after the 173 a spot check when I introduced a new treat, Dr Elseys Duck. He then ate the remainder of his AM food and vomitted. He is ready for another 1/2 can FF and then we do the 2 hour hold for PMPS.

I wonder if the change in eating pattern this morning contributed to the lower BG. Good to see a blue number.

 

You know me well enough to not be surprised that I am a little nervous about the 98 @ +7.
@FrostD @Shelley & Jess

ETA: I will try to check him again in an hour.

ETA: Okay, as the title shows and the SS is updated, he was 135 at +8. Now I am anticipating a number at his PMPS that I won't be sure what to shoot. Is there a "probably safe" number?

It looks like the PM increase was good for the AM number, but the bedtime test last night wasn't really too different than other nights at bedtime, so it is really not much of a prediction. I just can't count on any tests during the night cycle. I wish I could.

PMPS: Getting 314 made it easier to decide to go ahead and shoot the newly increased 1.5 units. I hope the night is uneventful.

 

He would do that!

Bouncing now so tonight probably won't tell us much either. It's very likely he was lower before that 98, but doubt below 75/80...not quite sure what to do with that information. I don't think a reduction just yet because I'd like to see how the change evens out, but ultimately it's up to you.

 

Hi Shelley, good to see you!

 

Stayed up for as long as I could last night to get some extra tests.
This morning fasting BG 218, shot 1.5.

His ear is pretty beat up, I probably do more than what is helpful some days.

What tests would be most insightful today?

@Shelley & Jess
@Suzanne & Darcy
@FrostD

 

Very interesting he stayed so flat!

I would try for a +5 or +6 just to see if he's going lower before the later tests

 

I have the +5 and +6 on the SS. I got 260 and 270. I expected lower, so I was surprised.

 

Ah would appear it was holding off a bounce

 

Just when I think there is progress, a high number shows up. I presume these are bounces, one after another?
@Suzanne & Darcy
@FrostD

 

Yes it would appear so :/

I don't think there's much you can do besides hold the doses the way they are. He's seeing some decent yellows and blues when he isn't bouncing.

 

From your experience, would you expect or believe it is possible for him to get past the bouncing at some point?

 

My best guess is not really; usually that happens within the first 6-12 months. And that's because in order to really get him to spend time in those numbers we'd have to be a little more aggressive with dosing - but as you know he can take some surprise dives, and from where I sit at least it's not worth the risk.

His BGs really aren't too terrible with all things considered. As long as we can keep him seeing mid to low blues when bounces clear, I'm pretty happy with that.

I do think Lantus is worth considering at some point. Cost wise, most people are able to get it for the same or cheaper than ProZinc now.

 

This is interesting. Several of my cats have had diarrhea (well, it's been really bad diarrhea) and haven't had a good appetite and have been lethargic. Fortunately, Ginger is getting over it. Now Amber is sick. A few others are having diarrhea but are still eating. When I was at the vet yesterday with some kittens getting their shots, I was telling my vet about this and I asked if it was possible that this was just an intestinal virus (like people get sometimes) -- she said yes (but of course cautioned that if it continues I need to bring them in.) Oh, I also forgot to mention that I tried a course of Metronidazole on Ginger for the diearrhea. I'm not sure it really helped since normally my cats will respond to Metronidazole within a day or so -- and her diarrhea continued. I also gave probiotics of several different kinds. I'm glad she's getting over it since she refused to use the litter box for several days when pooping. Anyway, this is a long story to say that I hope Newman and Ozzie are already both back to normal.

 

So, I'm trying to catch up a bit with what's been happening with Newman. Did you try the split doses and then decide it was not working or too complicated?

 

Still trying the split dosing, but my advice was to increase the PM dose first and see what happens to the AM numbers as a result. Right now...not much lol

 

Did the split dose for 6 cycles, the 16th thru the 21st. I had been sitting on 1.25 for too long, so the split involved raising the daytime dose to 1.5 and keeping the 1.25 at PM. It just wasn't working, so I increased the PM dose and he seems to be bouncing ever since! Oh, Newman!

 

I'll have to read about Lantus, but how do you think it may act in our case? Is that a simple answer?

 

I do like Lantus. I like Levemir even better for giving flat cycles, but every cat is different. Lantus can give you some very nice gentle cycles. You would have to get used to shooting low preshots though because it works completely differently than ProZinc. The mantra is "shoot low to stay low" - you shoot lower numbers and it keeps them low but it doesn't drive them down like ProZinc can do. Anyway, you're right that the best thing to do is to read up on it. There's lots of good information on the LLB forum about how the depot insulins work. You don't need to be in a hurry to make any changes.

 

Suzanne makes a good point with Levemir - it tends to nadir later which may be better for you. Not sure ...

Lantus he'll probably continue to bounce for a bit (likely another few months) but should be more muted.

Really the question is what is your desired range for him?

 

How’s it going, Linda?

 

Hey Suzanne, quiet day here, so far. Newman slept most of the day and I am resting my back, apparently having strained it. I am feeling a bit bummed out if I can't do better in helping Newman get better regulated. I took a quick glance at the Lantus forum information pages but not yet in the frame of mind to study. In the meantime I will stay with the current dosing, hoping he gets past the bouncing. I would like him to at least get to yellow preshot numbers and mid to high blues in between most of the time.
Thanks for asking and please continue to share your thoughts and advice. I would not have gotten this far without you and Melissa.

 

Well, we are not super human, and we have to live within our limitations. I have quite a few myself (that I don’t like to talk about, of course! Lol.) Now what I mean is that I frequently find myself, without fully realizing it, being very hard on myself and expecting that I should be able to know everything and do everything correctly. It’s ridiculous of me. I just can’t. Nobody can, although we all have different areas of expertise and competence. You are an amazing person. You do such a great job with so many things, and are very strong and independent. I admire that.

Just keep on trying and tweaking Newman’s dose if needed. Then when you are ready, you can do some research. No rush.

And remember, you said Newman, in his behavior, seems very happy and well. You are responsible for that positive change in him since the time before he was diagnosed. Without your care he would not be doing well. You have made such a beneficial change to his life.

I’m sorry about your back. I’ve had quite a lot of back problems in the last month or so. Very painful. I hope yours will be better very soon.

 

Thanks, Suzanne.

It seems like most adults have some back issues from time to time. Thankfully so far, my backaches and pinches respond well to a day or two with the heating pad. I'm feeling much better.

 

Echoing what Suzanne said ...we can only do as much as we can do! Any decent control over the diabetes is much better than no control at all. As long as he's feeling good and happy, that's a good thing.