Chloe 8

I had a feeling something was wrong. She wasn't on the bed when I got home at 1pm. She did come when I called her, but she seemed lethargic. I tested her just now, one hour earlier than normal because she was throwing up, but it wasn't food. When I saw 69, I immediately opened a can of FF, but she was not interested in eating, so I got the honey and put it in her mouth.\

 

According to your SS, you are almost at PMPS time so the insulin should be at the end of it's cycle. Don't sugar her up too much and DO NOT GIVE INSULIN.

 

Still not getting alerts even though it's all checked on my settings page. 30 more minutes to next test.

 

I replied on your other post.
But I'll say it quick here, she probably went pretty low if she's 69@+11 so you will probably see a bounce but I suggest going back down to 2 units tomorrow morning. I agree with NO SHOT tonight.

 

You can remove the 911 from the thread title now, Roberta

 

Where's Roberta at this morning? I think you've proven that 2.5 is too high a dose! I would definitely reduce this morning and would NOT shoot if she is under 200.

 

What a bounce! She's at 580 this morning and yowling for food, even though her dish is full of YA. I went back to fat 2 and will do a curve on Sunday.

 

Roberta, I'm moving over here to your thread so we don't hijack Michelle's thread.

Yes, and that's great! The thing is though that in any given cycle, a cat might be high and flat because of a low from a previous cycle. So while that curve is great, there need to be more mid-cycle tests on other days to really know how a cat is reacting to the insulin. She was flat during the curve you did two weeks ago, but other numbers in your spreadsheet hint that that curve day might not have been a typical cycle for Chloe. That's why mid-cycle tests on other days are so important. Plus, from day to day and week to week, a cat's response can change, so monitoring needs to happen regularly.

 

I was also told that a curve shouldn't be done immediately after a bounce.

 

Again, that's why it's important to get mid-cycle numbers whenever you can. There is no way to know that a cycle is after a bounce or not, unless there are other tests that can show the kitty went low.

 

You can do a mini curve too. Which is every 3 hours if you think it might be the end of a bounce.
Like Djamila said it's difficult to determine how long or when she's bouncing without spot checks. If you want to get her numbers consistently under control and near regulation you'll have to test more. It's impossible to know what dose will work best without more data.

Have you considered Lantus? It's protocol calls for the same dose am/pm and it's better at keeping lower numbers longer. But you MUST do spot checks with lantus. They're more strict about following the protocol on the lantus and levemir group. (Not a bad thing though) but if you're not interested in switching I would get more tests in and see if you can get a better picture of how the insulin is working.

 

Okay, I did a mid-afternoon test and just did her PM. It's making a frown instead of a smile. What does that mean?

 

It's almost impossible to say. You need to get these tests in frequently to build up a more detailed picture of Chloe's responses to insulin. Have a look at Yong's or Djamila's SS to get an idea of the testing routine that I'm referring to.

 

Great job getting a mid-cycle test. That was a +8 which means she had most likely been a bit lower earlier, and was rising by then. Every little bit helps, so keep getting those mid-cycles and soon you'll have enough data to start to make sense of what's going on with Chloe.

 

That+8 test was very close to the 20% variance. I would consider that flat aka r same as her preshot. I agree that she may have gone lower than that so if you can get a +6 tonight it would be great. See what she's up to around the typical nadir.

 

I don't believe she's hypo. She's not acting sick and is eating FF. I will recheck in 20 min. Now she's at 51, but she is eating canned food with gusto. I think I will hold off on the honey and check again in a half hour. She doesn't seem interested in the YA food anymore.

 

Did you retest immediately to verify that 40? That lime green is dangerously low. She might not be showing symptoms of hypo but that BG is too low.

 

Chuck was in the 40s with no symptoms of hypo. He was just really hungry. It can happen. I suggest lowering the dose after skipping her shot tonight.
She will probably bounce but will come back down and it's best to have a smaller dose since we don't know when that will be.

 

Yes, I just retested and she was 51. She's still eating canned food. I'll test again soon.

 

She's not so excited about the YA food anymore. At least, I haven't seen her eating it. But she just ate a lot of canned food.

 

did you get anymore tests in last night?

 

Have you been monitoring how much is eaten in the day or per cycle? Weighing/measuring it before and after. They do only eat a little bit. 3 tablespoons which I think is 1/4 cup a day. But since she's going at the wet food she might not be eating much so monitoring how much ya she eats is a good idea.
Do you shake the bag before feeding? They have it coated with stuff that can settle.
Like Rachel, I'm curious to know if you got more tests done. I still think you should decrease her dose this morning.

 

Thanks for telling me about shaking the bag. I decreased her dose back to 2 units from a fat 2. She was very hungry and yowling this morning, so I don't think she was eating the YA because it was left out for free-feeding.

 

This is odd. I did a mid-cycle test and it came out as 313. There was a huge drop of blood on the strip, so I decided to pour it on a new strip not 5 minutes later and got 334. Same blood. How do you figure? And either way, it doesn't seem to be going down any. Is it time to get a new bottle of Prozinc?

 

They are within the 20% variance so it's the same number. I think she's bouncing today from the 40 and 51 last night.
Keep getting the mid cycle tests. I would still hold the 2 unit dose. Get a mid cycle tonight and again tomorrow morning.
Based on what you have on your spread sheet she has better preshot numbers on the 3rd cycle after a low/bounce. So maybe plan on a curve tomorrow morning or tomorrow evening. Now I can't be positive about all this because there's not enough data to tell us for sure but I think it's worth a shot to see a curve that isn't a full bounce. The +2 or +3 test should give you a hint on if she is having an active cycle or still staying high and flat from the bounce.

 

Okay, I will test her in about 10 minutes. The plumber was here and said my pipe was misaligned with the main pipe in the middle of the street. This is going to cost close to $10,000 to repair and it's my responsibility. My TV is also going off and on. Sorry, I'm a bit distracted.

 

Uhh I would be calling the city maintenance department of the city you live in and asking them questions.

 

No, several people have told me it's the homeowner's responsibility, including the HOA, of course. So what do you think of Chloe's latest BG number?

 

@srk3cats
Still looks flat and high like a bounce. I'm dealing with similar numbers with Chuck. It's frustrating.
Can you see the possible "trend" I mentioned earlier? With the 3rd cycle after a low she seems to have better preshot. Do a mid cycle tonight and maybe a curve in the morning. If her +2 or +3 if you're doing every 3 hours is high you could try again for the evening tomorrow. But doing mini curve for one cycle and regular for the other would give a lot of useful data...
At least get a +4 +5 or +6 for each. That will show how low she's going in the cycles after a low. Which can show how long her bounce lasts. Valuable info!

 

I'm sorry that really bites!

 

Sorry for sounding so stupid, but could you please define what a 'cycle' is? And I'm not sure what a mini-curve is. I thought I was doing a curve today. Tomorrow, I will get out of the house, so no curve. Maybe one mid-cycle at 1o pm, along with the AM and PM. I'm getting cabin fever because it was 116 degrees here today. I think it would be easier for me if you just tell me what times to do a blood draw. My AM is 7:00. It's almost 7:00 pm now and I'm about to do her PM reading. She was really screaming at me around 5 pm, so I gave her some YA (after gently shaking the bag) just to shut her up, so I'm guessing she will be in the upper 300's. Wrong- 307. I don't think you could get any flatter. Pink all day.

 

A cycle is the 12 hour time frame between shots.

Mini curve is testing every 3 hours, so your preshot test at 7, then 10, 1, 4, then next preshot at 7. Some do +3,+9 because they get +6 for most of the cycles every day.
The 1pm test between her preshots is fine. Maybe tomorrow night you can get 7pm, 10, 2am and 5am? That would be close to a mini curve. Giving you a little more time to sleep between 10 and 2.
If not I think preshot at 7 then 10pm and 4am are a good idea. If she goes low enough for no shot by pm tomorrow the mini curve will probably be the beginning of a bounce.
Hopefully I haven't confused you more! If so tell me where and I'll try to explain better. Sometimes it sounds right in my head but not for anyone else!

 

So today I did a mini-curve, right? am???? I usually go to bed at 10pm. I can do one last test then, but staying up all night is really going to mess with my circadian rhythms. Aha! I see you are half my age. When you get to my age, you'll be falling asleep in front of the TV at 9 pm.

 

Kinda. The two tests you did are good time wise. Near typical onset of prozinc and 1 hour after nadir.
In the future you could do 10 and 1, then another day 12 and 3... Just to fill out spots you have no tests in recently.
Every test helps. The preshots give us only where she ends up after the insulin is done working or used up in her body. So the mid cycle tests give us a peek at what her numbers are while it's active.
Dose is best when decided with nadir included in the decision. That's why we push so much for mid cycle tests. And those lows you got for pm preshot is definitely why we insist on preshot tests.
I think you're close to her ideal dose so those tests should tell more. They could prove me wrong!

 

Which is the nadir, +6?

 

Yes. That's the typical nadir but some cats have it earlier or later.

 

Boo on the fur shot! I get so bummed when that happens! But we still go on!
This morning would have been a great cycle for a curve! I thought it would be but couldn't be certain especially after the fur shot.
Did you get any tests in between?
I suspect she will bounce in the morning from the blue and NS. So maybe plan a curve for the morning cycle on the 23rd of she does bounce. I think the 2 units is ok for now.
I think if you gave the fat 2 units you most likely would have seen a green or lime green preshot.
Is she still only picking at the YA Zero?

 

After discussing the big drop from your am preshot to your pm preshot with other members...we agreed that 2 units is a bit too much. A decrease might be needed soon.
With that said, if you can get spot checks in the next 2 cycles we might see the decrease needed sooner than the curve on the 3rd cycle after tonight (AM on 6/23).
If the decrease is done for the curve on AM 6/23 it might give you a shootable pm preshot and level her out a bit.

I strongly suggest doing the curve I mentioned (like 5 times in this post sorry) so you can get her closer to regulation numbers!

 

Sorry, Steph, apparently I'm not getting the alerts again. I promise to do a curve tomorrow. This is the 2nd day in a row that she's gone from 400's on the AM to 100's on the PM. Should I give her a reduced dose like 1 unit or wait and do another test in 3 hours and then decide? She's gobbling down the FF.

 

@srk3cats sorry I didn't get the alert either. I'll check out your SS and get back to you in a minute.

 

@srk3cats
I think even a reduced dose tonight would be too risky. If you give her any tonight she can bounce tomorrow morning and the chance for a good curve is gone. I think no shot tonight.
Then in the morning you could give her 1.75 units in the morning, she'll probably be near 400 again. Then do the full curve. You will probably get a shootable number for her pm shot tomorrow and we can go from there.

 

@srk3cats how's the curve going?

 

Oh dear Steph. not happening today. Will get a mid-cycle at 2:00, though.

 

215 @+7(2pm) compare that with the 316 on 6/20 and you can see the difference a bounce makes!
Curious to see what her PMPS will be.
Please plan on doing a curve sometime soon, not a bounce cycle. The mid cycle tests are proving to be very valuable. The more the better!

 

The little bugger squirmed and got away just as I was going to collect the blood on the test strip! I gave her 1.5 u. and will try again later. She's been eating her YA.

 

Oh no. I wouldn't have given her insulin without the test first. She's dropped into mid 100s the last two pm preshots.
Please do get the test and maybe another test at 11pm (+4) to make sure she isn't going hypo.

 

I got the test done this morning (302) and then she was devouring her FF. But as soon as she saw the needle, she ran under the bed and I haven't been able to find her since. She's gotten so small, she could be hiding anywhere. Treats don't tempt her either. I finally got her at 8:40 after chasing her all around the house. So now my injection time is moved up to 8:30.

 

Oh man that stinks. Chuck responds to me flicking his treat packet back and forth. He loves the stuff and won't refuse it.
He also only has 3 hiding spots and I blocked one off. She's probably going to take a nap after eating.
I don't know what tips might work with shot time.
You could just skip the shot or give it late. If you give it late it's going to offset your pm time by that much too.
How much were you giving on the 302?
I think you should try 1.75 or 1.5 units to see if you get a shootable number for her pm shot.

I'm not sure about this but she could be associating the shot with making her feel yucky when she goes low. She could have last night even after the snack after her test.

 

I have a feeling that I shot her with a crooked needle yesterday. It was bent when I threw it away. Or, I've been having some trouble pricking her ears the past couple days. It took me 3 tries this morning. Also, last night, I brought Fuzma in to sleep with us and she sleeps in Chloe's blood test spot by the nightstand. I just spent some time lying down with Chloe and petting her until she purred. I think she forgives me.

 

I've only had problems getting blood a few times but it helped when I would run the ear between my fingers for a few seconds. You could try warming it up with a rice sock if being cold is the issue.
I have had a bent before before. No idea why that happens but I'm sure it doesn't feel good.
Glad she forgives you.

 

I was thinking that cold ears are unlikely in the Arizona heat, but air conditioning could certainly cause that! Sam's have to be pretty warm before they'll bleed. I've also found that hydration can impact how easy/difficult it is to get blood. You could add some extra water to the wet food to try to get her a little better hydrated.

 

You bet I have AC in 115-degree heat! I don't keep it especially low, though. I think I can tolerate up to 81 degrees inside with the fan on. I use the warm rice sock. I think you're right about the water. Sometimes I forget to freshen it.

 

I

I think it bent a little when I put it in the bottle.

 

I just noticed my typo. Well not really a typo... More like autocorrect strikes again. I need to proof read more.
I have bent a needle trying to flick the bubbles to the top of the syringe. I think some are a bit more delicate than the others in my batch.

 

I haven't been doing that. I just pull down more than is needed and push it up to the amount I want. Do you think that gets the bubbles out? What happens if there are bubbles? Does it hurt the cat? Maybe that's why she hates the needles. Anyway, I just tried again 3 times in her ears and got not a drop of blood. I have to go out for a few hours but I'll test her as soon as I get back.

 

8:30. I'm losing my touch. Have to poke very hard to get blood, 3 tries again, and poor Chloe couldn't take it any more. Maybe I need a fresh rice sock.

 

Do you reuse the lancets? If so, maybe you need a fresh one?
Have you seen the tips about "milking" the ear to get a drop?
I can tell you that the more you poke the better they bleed. They learn to bleed on a way. I use to poke Chuck on setting 3. We use the lancet device. Now we poke him on a 1. If it's any higher he bleeds like we got the vein. I don't have to push it for on his ear anymore. We use to put some pressure on both the ear and device to make sure it got him enough to bleed. Now I just hold it up to it and poke.
Anyway, I'll try to find the post about milking the ear. That might help.
Have you done the scruff test to see if she's dehydrated? Pull up the scruff and see if it snaps back down or slowly melts back down. It should snap back fairly quick. If it's slow or melts back down she is probably dehydrated. I would give Chuck 1/4 cup water with a tiny bit of chicken baby food or his pate mixed in to get him to drink it. It was also a snack if he just thought he couldn't wait til mealtime... But not 2 hours before preshot.

 

Found it:
Written by Yong:
"When milking the ear, move from base of the ear to poked spot"
I would squeeze/pinch gently with one finger on each side of the ear working my way up.
I hope this helps.

 

I try not to reuse lancets, but sometimes it takes too long to get a new one and a new strip as well. I never heard of that scruff thing before. I'll try it. I don't use the lancet device.

 

It's not a good idea to push the extra insulin back into the vial. It can cause contamination and shorten the usable life of the insulin. Draw up just a tiny bit more, pull the needle out of the vial, flick it to get air bubbles to the top, then use a "screw turning" type of motion to get the plunger to the dose you want.

 

I focused really hard, got a good grip on Chloe and managed the test in one try. 447 is very high and I'm wondering if she had a hypo during the night because she woke me at 3am with vomiting. I need to get her back on the YA because I can't stand her screaming for food in the morning.

 

I'm assuming that after you flick the syringe (with the needle pointing up?), you keep it pointing up when you do the 'screwing' motion?

 

Yes, or on a slight angle so the drop that comes out falls on a tissue.

 

Not sure what's going on here. No curves, just a straight downhill line. I meant to do a curve today, but fell asleep.
I think I'm finally getting the hang of adding comments to show what time the test was given.

 

I think she may have gone very close to or hypo on the AM cycle of 6/24 before you got the 71. Is that your "night" time?

I definitely think you should decrease to 1.75 or 1.5 units.

 

You got a 300s am preshot on 1.5 which could have been a low number bounce since you didn't get a preshot reading it's hard to tell. Either way it's lower than the AMPS after no shot.
Starting tomorrow on AM cycle...
I think you should try 1.5 units for 3 days (6 shots) to see if her preshots level out. It's better for her pancreas to try to heal if she's getting the support from insulin around the clock. So giving the bigger dose on your am shots and then no shot in the PM is taxing her pancreas on the PM cycle.
Try to get as many spot checks as you can to see if this theory is true or if I'm mistaken.
Do you think you could try this?

 

This is a sign of the dose being too big. Dropping from 400s to 94 is enough to make her bounce.
I definitely think you should decrease to 1.75 or 1.5 units.
You got a 300s am preshot on 1.5 units which could have been a low number bounce since you didn't get a preshot reading it's hard to tell. Either way it's lower than the AMPS after no shot.
Starting tomorrow on AM cycle...
I think you should try 1.5 units for 3 days (6 shots) to see if her preshots level out. It's better for her pancreas to try to heal if she's getting the support from insulin around the clock. So giving the bigger dose on your am shots and then no shot in the PM is taxing her pancreas on the PM cycle.
Try to get as many spot checks as you can to see if this theory is true or if I'm mistaken.
Just to be clear:
I think you should try the 1.5 units for both shots for 3 days (if they are above 200) and do a curve on the 3rd cycle after tonight's. So am cycle on 6/27/2017.
Do you think you could do this?

Sorry for the multiple replies. I added them all to one to try to make it less scattered around.

 

I have to sign off soon. Early and long day tomorrow so I'm heading to bed.
But I'll be on early tomorrow, 7ish am eastern time. So I'll check in before your shot time to see if you have any questions or if there's any replies. I'm not getting alerts for your thread again. Darn technology.

 

I think Steph has given you some good advice!

 

She's been eating voraciously, almost 2 cans of FF. I added some water and she licked the bowl clean just a moment ago. I'm going to test her again in about an hour and give her 1.5 units if she's over 200. See you in the morning.

 

If you give her a shot this late, you'll be off your schedule. Plus an hour after eating, her test will be food-inflated, so you could end up giving her too much insulin. If she was 94 at shot time, I think you should just skip the shot tonight. It can be dangerous to give a dose based on a food-inflated number. If you already did give the dose, please try to get another test in before you go to sleep and/or during the night so you know she's okay. And then make sure that the morning shot is 12 hours after the shot you give tonight. Keeping the shots 12 hours apart is really important.

Let me know if you have any questions about all of that.

 

I agree with Djamila's post.
It is safer to skip. Others with more data to show how food effects the no shot cycle have given a reduced dose 2 hours after they feed. Usually they are the cats who have a big spike from food and don't go down or get control on their own. I don't think you have enough data yet to attempt this.
Chuck is one of those. He eats and without insulin will spike 300+ points in 2 hrs just from eating and stay there. His body doesn't control his blood glucose on it's own. I have months of data showing this even with a small dose of insulin before eating.
Again, I don't suggest doing this with Chloe due to not enough data and I suspect her body is helping a little at least.

Please update us on if you gave insulin. I see the 295 @+3.
Please give the next shot 12 hours after her last. It's best for her and you can change the shot time on the next cycle after you have a no shot again.

 

What time did you give insulin last night?
I see the 206 for AMPS on your SS.
I would not shoot early.

 

I gave her a fat 1 unit at 9 pm after testing her. I just finished testing her now, at +3 and she's eating FF. I plan to give her 1 unit in 5 minutes, 9o am. I'm probably messing up my chart. Should I have put her am (206) test at +9 PM yesterday and make the AMPS her current shot?
Also, I don't like skipping shots. I think it really messes with her BG level. I would rather give a reduced shot than nothing at all.

 

Yes, if 206 was at +9 then put it there.
Did you feed and shoot at +9? If so you should keep it in the AMPS spot but add +9 with it.
If you fed at +9 but shooting at +12 make a note of it on your spreadsheet. Put the 206 at +9. Then put the number you get before the shot in the AMPS box but add "3 hours after meal" so when we look at the data from today we will see that it wasn't a "normal" schedule.

The schedule of no food for 2 hours before shot time and TEST, FEED, SHOOT are to keep her safe and keep the data you get as accurate as possible.
Giving the reduced dose every 12 hours will give you a shootable number so you don't have to skip. That's what I've been trying to make happen by suggesting the 1.5 units every 12 hours.
I think 1 unit on the 200s is a good idea.
But to prove all of this we need you to get some mid cycle tests.
Once you get more data to show how the insulin is working on each preshot you will eventually need to shoot under 200. BUT that is NOT NOW.
PLEASE test again BEFORE you give her insulin.

 

I always test before giving her insulin. I'll have to fix my SS. btw, I saw on another kitty's blog, you said,
Also, was just reminded of this, you don't rub the injection site after dosing do you? I always rub because it seems to hurt her. Why is that bad?

 

That was Yong. I've read it can effect how the insulin is absorbed.
I don't rub but I do run my fingers through his fur where I shoot to feel for wetness. I give a quick ear rub after injection to take his mind off the poke I just gave him. I don't think it hurts him but I don't want him to think I only want to poke him all the time.

 

Yes, I also want to see if it is wet. I do more of a massage thing. How does it affect the absorbtion? I would guess it would help it absorb faster.

 

@Yong can you give more info on this? I really haven't looked into it so I have limited info on it.

 

It looks like Chloe is doing well on only 1 unit. Her nadir is 140. I hope she's heading towards remission.

 

She is looking good! Are you doing a complete curve today? It will help see how long the 1 unit keeps her down.

Seeing these numbers makes me think 1 unit might be a good dose to stick with for 3 days to see how she levels out. You should see shootable numbers for both am and pm shots with 1 unit. But we can look over it again once we see your PMPS number.

 

She does look really good on 1 unit! I think it would be great to see how it works as a steady dose for the next several days (as long as she's over 200 at preshot that is!).

 

Very nice curve today!

 

N

Not much else to do here in Tucson when the temperature is this high. The only time I left the house was to get my mail.

 

You shouldn't do more than a feather touch on fur to see if it's wet. Any more pressure on injection sight causes insulin to be absorbed more quickly and it is not helpful. It is counterproductive. Please try to break the habit.

 

I would be parked in front of the AC! I try not to leave the house when it's in the 80s here! The humid heat too long and I look like I ran a marathon. But as long as I have a I'm ok! Lol
I'm off to bed. I'm sure one of the pros will be around to help with your PMPS if you have questions.
If you can, get a +3 or +4 tonight to see how the continued 1 unit is dosing is working it. If you have a preshot over 200.
If no one answers you can try on main health forum and if they need more info direct them to this forum thread.
I'm excited to see how this turns out for Chloe.

 

Bummer on the ns last night. Did you test again at +12 to see if she went up at all? She was close to 200.
If your schedule permits it you could stall for a half hour to see if she goes up without food. If she goes up over 200 after stalling you would feed then give insulin like usual but make a note on your chart. But be prepared to get another test in to be safe.
I think you'll see a shootable number tonight. Getting a few mid cycle tests on the pm cycle (when you do give insulin) will help figure out how she does at night with insulin.
But a +2 even on the cycles without insulin will show us how high the food takes her with no shot.

 

She looks mean, but she is always very sweet, and never hurts anybody.

 

Chloe is beautiful!

 

So elegant!

 

Your Chloe and my Beenie could be cousins !!

 

Beenie is beautiful too!

 

Both are lovely kitties!!!

 

So pretty!
I see that shootable pmps! Yay!
If you can, get a +3 or later mid cycle tonight. See if she goes lower at night like some cats like to do!

 

Beenie is a cutie! I really like her white markings and her white paw.

 

Two yellow preshots in a row! Looking good!
If you could get some mid cycle tests in for the yellow preshot cycles it will help see where she's going and if the dose needs adjusted.
How's she feeling and acting?

 

She's acting normally even though she sleeps most of the days. I heard cats sleep about 70% of the day, anyway. She doesn't have a spring in her step, but that's normal for her age. We are growing old together. We take naps together after General Hospital. She's the only on who sleeps with me anymore, since Pogo and Genghis are gone. They used to chase her off the bed, so I think she's happy with the attention now. Tomorrow, I'll be home until evening, so I'll get a mid-cycle reading around noon.

 

Aww all 3 of mine plus the dog would sleep in bed with us. Bubba has been gone since 2013. Chuck won't go far away from his dish/feeder for long. So I get sandwiched between my civvie, Kitty, and my dog April.
I'll check in to see her numbers tomorrow!

 

Mine don't sleep with us...we used to leave the door open and they wouldn't get in bed with us then. Now we don't let them in the room as they took to attacking feet in the middle of the night!