Chloe

I finally got a reading and it's 432 or 439 or thereabouts. What now? I haven't given her insulin since this morning and if I give her shot now, I won't be home tomorrow at 9:40 am. I leave for work at 7:30 am.

 

The shot times need to be consistent. Was there a reason why she didnt get her shot earlier? Generally the rule is that if you miss the shot time, you wait until the next one.

 

I wasn't able to get a reading at 7 pm, but fed her anyway. Have you looked at her SS? She was at 60 this morning. Is that really bad to go up so drastically in such a short time?

 

That steep rise is called a bounce and its totally normal. Make sure you give yourself extra time in the morning to get a test in. You can post in the morning after the test to get dose advice. However, in case no one is around, absolutely do not give her more than 1u, no matter how high her number is in the morning. If it's below 200, skip the shot.

If one of the wise ones is around in the mornng, they can give you more specific dosing advice.

 

Did you get a reading before you gave the 1u this morning? It looks like even 1u might be too much for her. I would recommend you wait to give any dose until you have a test and some advice from someone on here tomorrow. Especially since youll be at work all day.

 

Thank you. Is that Sam in the sink? Does he hang out there often?
I will do a bg test early tomorrow before I leave for work. I just hate having to poke her ear. She cries out. I'm still working on figuring out the lancet pen. I feel I have more control without it, but she cries out.

 

Just remember that you are poking her to keep her safe. Try to get that test as early as possible in the AM so we have a little time to advise you. Also how are you feeding Chloe? Are you leaving food out for her to eat during the day?

 

Yesterday morning, when you gave her 1 unit, do you remember what the BG test was?

 

I agree that 1 u seems to be too much. In a situation like this the diet might have a pronounced influence on BG and insulin needs. Is she on any dry food at all? If so, merely removing it and switching to a canned low carb wet food could give significant control.

The only way to figure this out and keep your kitty safe from hypo (and the risk is high when she appears to need a small dose) is to be very strict in your testing routine and dose timing. You need to gather data at all the important times: AM and PM before feeding and giving insulin as well as in the middle part of a cycle when you expect BG to be lowest. I know it can be hard when you're still uncomfortable with ear pricking, you have to leave for work, etc. However, Chloe's safety depends on it.

 

Could you please clarify? You said she "was at 60 this morning". When I look at your spreadsheet, I see the 60 entered at +8. Assuming you gave insulin in the AM, then +8 would be mid to late afternoon. Knowing the timing of your doses and BG testing is very important when we're trying to give advice.

 

I got it on the 2nd try! The rice sock helps a lot. At 6:20 this morning, she read 396. She is eating now and in a few minutes I will give her her shot. How many units should I give her on a u100 syringe?

 

Please slow down for a minute. I'm getting nervous about the U40/U100 syringe issue.

First off, the BG you've just measured goes into the cell on your SS that says "AMPS" above it. You can record actual times for your own record on paper elsewhere if you wish. You've put BG numbers under +1 and that will confuse viewers of your SS. They'll think those are BG measurements taken 1 hour after the shot was given.

Yesterday 1 unit brought her down to a dangerously low 40. She hasn't had insulin for 24 hours and is now high for (probably) two reasons:

1. missed dose last night
2. a physiologic overreaction to the 40 yesterday that has boosted her BG sky high - we call it "bouncing".

Do you have the conversion chart for dosing ProZinc with U100 syringes right beside you? If you're sticking with those, have you put the U40 syringes away where you won't accidentally grab them? You need to be crystal clear in your mind about how the dosing of a U40 insulin with U100 syringes works.

The 1 unit dose is too high, based on that 40 you saw yesterday. We would normally recommend a 0.25 u dose decrease in this situation. So - if you're using a U40 syringe with half unit marks, you'd eyeball half way between 0.50 units and 1 unit on the syringe barrel. You can't get this fraction on a U100 syringe. If you look at the chart it shows you that these fractions are possible: 0.2, 0.4, 0.6 and 0.8. I suggest you try 0.6 u which will mean going to the 1.5 line on the U100 syringe. In my opinion, 0.8 u is still a bit too high for comfort until you get more data on your SS.

FYI: when you use U100 syringes to dose a U40 insulin like ProZinc, the number you draw the insulin level to in the U100 syringe ISN'T a measure of insulin units. It's just how much space in a U100 syringe a certain number of units of ProZinc takes up. If you refer to the liquid level of ProZinc in a U100 syringe as how many units you're giving you'll scare the living daylights out of us!

I hope this helps!

 

I thought I was supposed to write the dosages according to the u-40 syringe. So I changed it back to that. This morning I will give her 2 units u40/1 unit u100. I don't have any u40 syringes yet, but will continue to convert.

 

Please DO NOT give her a 2 unit dose!!! It's far too high!

 

Yes, you write the actual dose on your SS, not the level you draw it to in a U100 syringe. You just said above that you'll "give 2 units U40/1 unit U100". I'm sorry but I can't understand this. Here's how it works:

• ProZinc is a U40 insulin so when you say you're giving 2 units U40, that's what you would draw up in a proper U40 syringe.
• If you draw up 1 unit of ProZinc in a U100 syringe, that's the amount of ProZinc that contains 0.4 units of insulin. If you look at the conversion chart, find 1.0 in the U100 column and then look over to the U40 column, you'll see o.40 in that column.
• If your intention is to administer 0.4 u of ProZinc, you fill the U100 syringe to the 1.0 line. If your intention is to give 2 u of ProZinc (and I sure hope it isn't!), you fill the U100 syringe to the 5 line.

There's no need to buy U40 syringes. The U100s work fine BUT it's critical that you have the conversion chart at hand and understand how it works and how to enter your data on the SS. I apologize if I "sound" bossy but I'm very worried about a mistake occurring.

 

I agree with Kris that Chloe has proven that even 1 unit is too much for her. The dose you are giving her goes in the unit box, not the conversion number on the U100 syringes.

Please give her less than 1 unit of insulin to keep her safe. I would only give her 0.6 which is the 1.5 line on the U100 syringes.

 

Whew! Thanks, Bobbie! I was beginning to think I'd just confused the whole issue for Chloe's mom.

 

If you have a chance, could you take a look at someone else's SS? Look at mine if you want (though it's several years old) or anyone else on this forum. That might help clarify where things should go on your SS.

It is SUPER IMPORTANT that you post the data in the SS correctly so that we can help you keep Chloe safe.

• AMPS column - should contain the BG number you got when you tested her before her shot in the morning.
• U column - should contain the amount of insulin you gave in U40 terms, NO MATTER what syringe you used. So if you drew up to 1.5 on the u100 needle, you would write "0.6" in that column.
• +1, +2, +3, etc columns-should contain the BG numbers you get that many hours after the shot. Not all of these will be filled every day, but whenever you test, determine how many hours past the shot it is, and fill in that column.
  
• PMPS column - should contain the BG number you get when you tested her before her shot in the evening.

Does that clear it all up? I know it's confusing and with everything else, it feels like one more thing that maybe doesn't matter much, but it's super helpful since we can spot patterns on it and help you to help Chloe. Let us know if you have any questions about it, and we can help you get it.

I hope you gave Chloe the 0.6 dose. 1 unit/2 units is WAY too much for her. I know we may sound bossy or nitpicky, but we're really just concerned about Chloe. Our goal here is to help kitties and their owners to stay safe and feel better during the diabetes dance. We do it for love of kitties and to pay it forward for others who have helped us...please ask questions as much as possible so we can understand what you need to know and can help you find it and continue being a wonderful mom to Chloe.

 

Aren't the syringes marked with whole numbers? The vet put her on a 2.5 unit for u40, so I've been giving her 5.0 on the u100, which is actually a bit lower I think.

As for the spreadsheet, I've been opening it from my laptop at home and adding stuff in. I'm at work now and can't open it.

 

You can buy both U40 and U100 syringes with half unit marks. It makes it much easier to measure or eyeball fractions of a dose.

5.0 on a U100 syringe is equal to a dose of 2.0 units of ProZinc. Have a look at the conversion chart. It would be wise to print it out and put it with your dosing supplies. Did you give Chloe that dose this AM? It isn't showing on your SS. If you read our posts above you can see that we're very concerned about giving that much insulin. Look at what the 1 unit dose did yesterday - that 40 is dangerously low!

 

The vet prescribed 2.5 units after her glucose curve. That was for a u40. So, actually 5 units on u100 is LESS than what the vet said. Am I reading the conversion chart wrong or was the Vet saying 0.25?

 

Correct, 5.o on the u100s is less than what your vet prescribed. HOWEVER...it's still too much insulin. I wouldn't give more than 1.5 on the u100s which is 0.6 on the u40s because she has ALREADY HAD HYPO NUMBERS on the dose you have been giving.

What dose did you give her today?

 

That's correct. However, you have to alter a dose downward if your kitty shows you it's going to be too much. Chloe showed you yesterday that a small dose of 1 unit was enough to drop her BG dangerously low. In a situation like this, the kitty's BG numbers trump ANY dose the vet recommended, even if you dropped it yourself. Two units is still 2X the dose that dropped Chloe to that very low 40 yesterday.

Could you please clarify: did you actually give only 1 unit in the morning yesterday? I'm going by what's on your SS. If you gave something different please let me know. I'm very worried for Chloe if she was given 2 u this morning.

 

Well, there's nothing I can do about it now. I'm at work and have to make a new schedule for testing, which involves a whole lot of numbers, too. I gave her 2.0 units on the u100, which converts to .8. Hopefully, she'll still be alive when I get home tonight.

 

I apologize if we've stressed you at work. I'm a retired teacher myself and know how much focus, energy and attention the job demands. We were hoping to get this sorted last night.

 

I'm logging out after this reply. She's already almost 2 months into her insulin therapy and I just started my SS. She's still alive. We will get this sorted out by Wednesday evening because the u-40 syringes should be delivered by then.

 

I am so sorry that we've caused you stress. It was CERTAINLY not our intention. Please understand that we just worry (sometimes too much I'm sure) and want to make sure that you get what you need from us. I was NOT trying to suggest that anything terrible is going to happen to Chloe, only trying to be sure I understood what dose you gave her and could effectively advise you.

I hope that this doesn't stop you from posting and you don't feel bad about this. We really want to help in any way we can...we just need to be sure we know what's going on so we can help when it's needed.

 

Roberta, how's Chloe this evening?

 

This morning, Chloe's reading was 163. I struggled with the glucometer a bit. I think I will reduce her insulin just a tad. Off to work.

 

This is a great number. Our advice would be not to give any insulin on a pre shot this low. Later on after you've amassed a lot more data you can be more brave.

 

What a beautiful number! Yes, I wouldn't give any insulin on that number just yet.

Side note, your SS looks great! That's gonna be super helpful to you and us. Thanks!

 

I thought it has to be under 150 for no insulin. I only gave her a tiny bit. I just got home from work and she was up and about. I gave her some food and will test her in 3 hours.

 

The general recommendation we give here is no insulin under 200 until you have a lot of data on your SS to use as a reference.

 

Make sure you put how much the tiny bit was in dose column. Spreadsheet looks much better!

 

Ohhhh I'm jealous of those numbers! Spreadsheet looks great!

 

449. Not so happy about that one. How much do you think I should give her?

 

It could be a bounce. How much did you give her this afternoon?

 

Sorry your spreadsheet wouldn't open on my phone. I see it now. I would try the 0.8 again tonight. It gave you a great preshot on the last cycle. I think 0.6 looks like it could have been too much on the blue number. Hard to tell without a test in there but with the nice blue number I would try 0.8 again.

 

Sorry, I get a bit panicky when I see red numbers. Is it normal for the numbers to go down overnight and creep up during the day?

 

Some cats don't require as much insulin overnight than they do during the day. I've noticed this in my cat too.
The 0.6 units on the 16౩ could have dropped him too low causing his liver to panic and increase his blood glucose. It's hard to tell if that's really what happened without a test mid cycle but seeing how well he did on the 0.8 I think that's more likely than it just not being enough. That's such a high jump in numbers so unless he got into something high carb I think the bounce is more likely the culprit here.
Chuck starts to go back up in numbers around 8 hours after his shot. When he bounces he can go from 300 to over 600 in an hour or two.

 

I agree...I think a bounce is most likely. Any chance of grabbing some mid cycle numbers any time soon? I know with work it's tough...if you can grab even a test a few hours after injection AM or PM, that would be great, and then maybe something +5/+6 this weekend?

 

I will try to do more tests on Saturday, but so far, she's looking good at 108. At 7:00 pm today, I'll probably find her numbers in the 300's since I won't be giving her insulin this morning.

 

Good decision to skip her shot this morning! That's a great number!

 

Wow! Most likely. But it does give you valuable info...now you know that 1 unit on that red number last night was too much (because it gave you a non shootable preshot...not a dangerous one by any means, but too low to shoot). So next time you get one like that, you give less insulin to see if that gives you a shootable number.

You'll probably see a high number tonight, but I'd definitely reduce the amount you give her no matter what it is. GREAT job with the testing!

 

Thanks. It took me 2 tries this morning. Have you found that one ear is better than the other for testing? I'd rather she have a higher number than a lower number, right? I'm not giving her any insulin this morning because I won't be home until 7 pm.

 

One higher number for a moment is better than a too low number for any second, especially when you are not going to be home .

 

Yes, low numbers can be very dangerous. And as Rachel said, the high numbers you are getting is an indicator that your dose is too high. I know that seems backwards right now, but when Chloe's BG goes too low, her body panics and responds by dumping stored glucose into the blood stream and making the number higher. So when you lower the dose, the body doesn't go through that panic response and you'll start to move toward better numbers. It does take a little while though for her numbers to start to stabilize. Since you're setting consistent shot times, and getting the tests done, you're taking great steps to keeping her safe, and getting her to healthier numbers.

So tonight, even if you see a high number, it will be important to give her less insulin so her BG can start to level out instead of bouncing high and then low and then high and then low.

As far as the ears, yes - Sam's left ear bleeds better than his right ear (although it's harder for me to get the test in his left ear). And the "sweet spot" on his ear gives the most blood.

 

I test on Chuck's right ear 90% of the time. It bleeds better and is less sensitive due to cauliflower ear.

 

Gypsy didn't have cauliflower ear...but one ear seemed easier to use than the other. I can't remember which anymore, but I almost always used that ear as it caused less stress for both of us.

 

I've been having better luck with Chloe's right ear. I just got her reading on the first poke. She's eating dinner right now. Her number is 398. So what dose do you think I should give her? Hurray! u-40's just delivered.

 

0.8 units got you a yellow preshot on the past so I would try the 0.8 units.

 

Yeah!!! Great job! And so glad to hear that it was a little easier tonight!

 

I'm looking forward to seeing what number that gives you today!

 

520. Her highest score ever. Tested 1st try on right ear. Possibly ate some dry food left out. Cries when she uses the litter box. UTI? Is that common? Giving her 1.5 units this morning.

 

Wow, that is surprising! Is she in and out of the box fairly constantly? Is she actually getting some pee out or just little drops? Any blood?

 

Actually, I'm not quite sure what's making her cry out. Maybe she doesn't like being locked in the bedroom by herself. Should I leave her some dry glycobalance food out to nibble on?

 

It's hard to know but that black might be a bounce number after dipping low overnight. The only way to know is to get some extra tests in. If she's showing signs of a UTI that can also cause higher BGs. You've essentially doubled her insulin dose by giving 1.5 u so I'd make a point of testing as soon as you're home from work. Look at what 1 u gave you on March 26.

Just to clarify: your SS shows a dose of 1 u given after getting a lime green preshot on the morning of March 26. Is that correct? If so, that's a very low number and giving insulin would not have been recommended.

 

Looking at your SS it seems like the dose that worked the best is the 0.8 BUT that gave you a preshot number too low to shoot.
I suggest trying .06 or .75units and see where she gets that way. You might see preshot numbers that are similar.
I see you gave 2 units tonight. I don't think that was a good dose. I think the increase to 1.5 probably made her bounce and gave you the black again... Did you leave food out for her tonight?
I would have stuck with .8 or 1 unit at the most because of the good number you get after the .8 unit dose.
When they bounce their liver senses they are going too low and increases their glucose levels (more scientific than that but I can't remember the fancy words) and when they do this so often their liver reserves run out and they can go hypo with no natural defense mechanism. This is what I worry about seeing the two black numbers and the large doses on your spreadsheet.

 

I agree with Kris and Steph, I think the doses that you're giving are dangerously high. Please, please try to get a +3 or +4 test before you go to bed tonight. And please listen to Steph about lowering the dose to .6, or .8 at the absolute highest. Until you have more mid-cycle tests, it's not safe to keep giving Chloe such high doses.

 

I am not understanding this. Never mind. I see now that the lower the numbers, the higher the dose and the higher the numbers, the lower the dose. Now, how does eating affect her and should I leave out some dry food for her to snack on?

 

No, that's not correct. Dosing is more complicated than that. For now, follow this:

1. If the pre-shot is lower than 200 = no shot
2. If the pre-shot is between 201 and 600 = .6 or .8

Do NOT give anything higher than .8u, no matter how high the number is. I'll do my best to explain why. Let's imagine that it's morning. I think you said you were doing your tests and shots at 7:30, is that right? I'll use that time for now:

1. 7:30a.m. The first thing you do is test and get a pre-shot number. We usually call this AMPS (a.m. pre-shot)
2. Then you feed Chloe.
3. If her blood glucose number is higher than 200, you give her a shot of insulin.
4. The food she just ate will usually make her blood glucose (BG) go up for a couple of hours. This is normal in a diabetic cat.
5. After about 2 hours, the insulin will start to lower her BG.
6. After about 5-7 hours, Chloe's blood glucose will reach it's lowest point in the cycle. This is called the nadir. This number should never be below 50. If it's below 50, she's hypoglycemic, and it's very dangerous.
7. After the nadir, the BG will start to rise again, and will continue to rise until the PMPS (p.m. pre-shot).
8. At the pm pre-shot time (7:30pm for you), you test again, feed Chloe her dinner, and if her PMPS is higher than 200, give her some insulin.

Okay, so that's how the cycle goes. But now what about the dose? Here is what happens:

1. If you get the AMPS number, and give a dose that is too low, then a diabetic cat would have BG numbers that rise after eating, and then slowly over the day, the BG would stay more or less the same, or slowly go down until the PMPS. The numbers would be too high all day. If that goes on for weeks and months, it will make the cat sick.

2. If you get the AMPS number, and give a dose that is too high, then the BG will drop too much. Here's where it gets tricky though: the BG number will drop, and then the cat's body panics and dumps stored glucose into the blood stream. If you are testing during the day, you will see the number go down, and then you will see it rise quickly as the stored glucose floods the cat's body. If you are NOT testing during the day because you are at work, then you will see the AMPS, and you will see the high number at the end (the PMPS), but you won't see that low number in the middle because you couldn't test at that time. So you'll see the high number at the end, and think that her BG is really high and she needs more insulin. But that is WRONG. She actually needs less insulin because that whole thing happened because she had too much insulin at the beginning of the cycle.

So here is an example with actual numbers from one of our cats. The +1, +2, etc. is how many hours after the AMPS. The numbers are the blood glucose numbers:

AMPS: 432
+1: 478 (it went up a little because the cat ate breakfast)
+2: 332
+4: 147
+5: 48 (at this point, the cat is hypoglycemic - the blood glucose is too low and it's dangerous - when this happens, it's important to give the cat high carb food and try to get the numbers to rise)
+6: 52 (this is still very low)
+7: 389 (see how high this number is now? that's a normal response when the BG has gone too low - we call it a 'bounce')
+10: 402
PMPS: 455

So if the owner had only tested at AMPS and PMPS, it would look like a test of 432, and a tests of 455. The owner would think that the insulin wasn't helping, but really, it had been too much insulin, not too little.

I know you're teaching all day, and can't do those mid-day tests. That's okay right now. But as we look at your spreadsheet, our best guess is that this is what's happening to Chloe: She's dropping low while you're gone. So giving her more insulin will keep making her drop too low, and if she runs out of stored glucose, she won't be able to bring her levels back up. That could be dangerous. So until you have a day off on the weekend and can get some mid-cycle tests, please give her less insulin, not more insulin.

Please ask as many questions as you have. This whole process is complicated, and we really want to help you and Chloe. And again, if there's any way you can get a test tonight before bed, it would help to get some idea of what's happening for Chloe.

And in answer to your last question: yes, please leave food out for Chloe tonight, and when you leave for work. It's best for diabetic cats to have access to food, especially when they aren't regulated yet.

 

Thank you. You explained it very well. I'm going to test her now. At 10pm she's at 255. I hope that's not a bounce. Goodnight.

 

Great job getting the test done! I would recommend that you leave some food out for her since that is a more than a 50% drop already and she's still early in the cycle. Take care and have a good night!

 

Nice explanation!!
Glad you got a before bedtime test. Dosing can be such a pain but it's great that she is responding so well to such a small dose!

 

Djamila, that was a FABULOUS explanation! I'm totally going to steal it when we have other new folks in this forum...I'll give credit!

Chloe is doing great...that before bed test tells us that you almost surely are seeing bouncing...those low drops and then sudden highs. This morning, no matter what number you get, I wouldn't give more than 0.8. I might even be more likely to give 0.6.

I know this is complicated and confusing, but things will get more clear as you get more data. I remember we talked about getting some mid cycle testing this weekend...are you still able to do that? That will really help.

 

Djamila, your explanation was fantastic! !!!

 

Seriously Djamila! Great explanation! Very clear to help new members !

 

233 is a better preshot! What dose are you going to try? I would try the 0.6 units. To see if you get a shootable number tonight.

 

Her PM reading was 436 and I gave her .8 u. She is looking so skinny! Will she ever put on some weight?

 

Chuck was down to 9 pounds when we started insulin. He was seriously skin and bones. It took us 6 months to put 2 pounds back on but he has been nowhere near regulation in those 6 months. When their blood glucose is high they can't use the nutrients they eat. I suspect you might have an easier time getting her to gain weight than I did with Chuck. How much FF do you feed her a day? Chuck gets 2 cans of 9Lives and 2 tsp of Young Again Mature Zero. There is an equation for determining about how many calories a kitty needs. I will try to find it and post it for you. That's what I used to decide how much Chuck needed.

 

This was from Bobbie and Bubba a while ago:
Use the cats ideal weight in the formula
cat's weight X 13.5 + 70
Using a ten pound cat as the example 10 pounds X 13.5 = 135 +70=205
Take 205 and divide up the calories in to several meals. If your cat needs to gain weight, use that weight in the formula or if weight loss is needed, use what the ideal weight should be. This formula is a guideline to start with and depending how active your cat is, you might need to increase a little.
I didn't divide the meals into several little ones because I didn't have a feeder at the time. I still give almost all of his food at once (4.5oz at each feeding/shot)
I also think maybe the 436 could be the bounce lingering.

 

Last time Chloe was weighed was at the vet. She was about 9 pounds. In the photo, which I think was taken in October, Chloe was still a big girl and Chico was still a kitten. Now he weighs 14 pounds and still pounces on her, but she runs away. Chuck eats two 5.5 oz cans of 9Lives? I've been giving Chloe only two 3.5 cans of food each day and a few treats. I have a bag of Royal Canin Glycobalance, so I'm leaving her some dry food out at night. I hear her eating it and drinking a lot of water.

 

Drinking a lot of water is pretty typical for a diabetic cat. Since you want her to gain weight, you could probably just feed her as much as she'll eat for now. Then once she's gained a bit, look at the calories and figure out her proper amount. My cats are both around 11 pounds which is a healthy weight for them. They each eat: 1 can FF classics, one lump of frozen raw, and about a 1/4 cup of primal rehydrated raw. Plus lots of treats. There is usually some food left over that gets tossed from each of them. But different cats needs different amounts of food depending on health, exercise, age, build, etc. The formula Steph gave is probably a good place to start.

Great job getting tests today, and sticking with the dose!

Are you going to be home tomorrow or Sunday? It would be great if one of those days you could get some mid-cycle test at regular intervals one of those days so we can start to see what's happening for Chloe. Ideally, if you could test at AMPS, +2, +4, +6, +8, +10, and PMPS. It's called doing a curve. It's a lot of tests in one day, but it can really help to figure out if her nadir is really around +4 to +6, and how low she's going at the lowest point.

 

Yep. He's been getting two cans a day for a while now. If you look in my thread "Chuck's bouncy journey part 16" I posted comparison pictures of when he started and a somewhat recent pic of him at 10.4 pounds. You could probably increase it to 3 cans a day... Maybe leave half a can out with the dry each cycle. Whatever works best for your schedule. I think Chuck's biggest was 14-15 pounds but he wasn't really "fat". Even at 11 pounds he's skinny but much better than 9 pounds! If you increase the food it's possible the insulin will have to increase too but don't do that until the numbers prove it's necessary. His pancreas might make up for it on it's own.

 

Hi Steph and Djamila. I tested Chloe before I even got out of bed this morning, because all the stuff is on the nightstand and she was right there. I'm not happy with her number this morning. It's the highest it's ever been for an AM read. Maybe she ate during the night. I'll do the curve on her today.

What's with the "trophy points"? Everyone has 0.

 

Good morning! I'm sorry Chloe had a high number this morning. Is your test time at 7:30? Was her test at that time, or early or late? For some cats, if the timing is off, that can impact the number. Or maybe it's just one of those days...

I'm glad youre going to do a curve today. I think seeing what's happening during a cycle will really help!

 

I think it was 7:10. Isn't there any leeway? I'm going to do her +3 now.
She's at 501. Isn't it supposed to go down after her shot?

 

Yes, there is some flexibility with Prozinc. It's just that since the BG rises throughout the cycle, a late test can sometimes show a slightly higher than usual number. It sounds like your test was a few minutes early, so that isn't what caused the high number this morning.

Pre-shot numbers can be a bit unpredictable, especially at the beginning before you have a lot of data. Try not to worry too much about it for now...as you collect more data, patterns will emerge and all of this will get easier.

 

On Sam's SS, in the PM, you wrote 'fat' a couple times. What does that mean?

 

Usually "fat" means the plunger is just on the other side of the mark on the syringe for that unit. Skinny usually means just on the lower or inside of the mark. Some people will use skinny when they let one drop of insulin out before giving the dose. I have tried that am not ever able to get just one drop out. I always push too much. Some practice with colored water.

 

That 501 is food influenced. If you look at my spreadsheet (don't let it scare you, Chuck is a complicated kitty) you'll see he almost always goes up after his meal.

 

Especially when cats are on lower doses, like Sam, a single drop of insulin can make a difference. So sometimes going up or down a whole mark on the syringe is too much of a change, so we'll just go fat or skinny on the dose. And sometimes it's just nerves, too - like if I know I won't be able to monitor him, I might go a little bit skinny so I know he's in safe numbers while I'm gone.

 

Also, 456 and 501 are essentially the same number due to the 20% meter variance. You'll probably see a lower number by +4 and +5.

 

I see you feed him baby food. Any particular flavor?

 

This diagram was very useful for me, thanks. I'm much better at this now.

 

I agree with Steph - the 501 could be food. I also agree with Steph about not letting Chuck's spreadsheet scare you .

Okay, and here is your next lesson in cycles and dosing (remember how we said this is a little complicated):

So we've already talked about bouncing as it relates to the BG numbers dropping and rising sharply. But there is a second part of bouncing that you need to understand.

BOUNCING - PART II

After a kitty has had a sharp drop, the next cycles may be high and flat. This is how the kitty's body tries to recover from the drama of the bounce.

On Sam's spreadsheet you can see that during the PM cycle on 3/5/17, he went from a PMPS of 386, to a nadir of 84. Now 84 is still a safe number, but it's more than a 50% drop, and it's lower than his body was used to at that point. Those two factors (more than 50% drop and lower than the cat is used to) cause him to bounce. Now during that cycle, I went to sleep, so I didn't get the test that would have shown his number go high, so just imagine that part.

In the morning, of 3/6/17 (the next day) his AMPS was 255, and then all day, his numbers stayed pretty close to that (204, 209, 225, 247). We call that a flat cycle because it looks like the insulin isn't doing anything. However, that's a very normal response to the bounce from the night before.

When that happens, you have to just ignore the lack of response, and stick with the same dose. It can take up to six cycles for the bounce to clear. During those cycles, it will look like the insulin isn't working. But you stick with the same dose anyway because the cat needs time to recover from the bounce. You'll know the bounce has cleared, when the BG starts to respond to the insulin again.

This is why we generally don't recommend changing dose in reaction to the number you see during the PS - because the numbers aren't just individual numbers, they are part of a larger pattern, and being able to see the big picture is important in deciding what dose to give.

It takes awhile to get enough data to know how your cat will respond, so being very cautious about dose changes in the early weeks is super important.

Sam only takes about two or three cycles to clear a bounce. Lots of kitties take the full six cycles. We won't know how Chloe responds until we have a lot more data to look at.

Steph is probably right that you'll see a bigger drop as you get closer to +5 today, but even if you don't, it's important to be patient and not move the dose around until there is more data to use in making those decisions.

If you look at Sam's spreadsheet, you'll see that the dose changes are slow and methodical between 2/10 and 3/15. After that, things get a little wacky because he's had a couple of hypos. The rules change when that happens. We'll get to all of that later though...

 

Baby food doesn't have all the nutrition for kitties but works in a pinch if they won't eat. Look for chicken, beef, or ham ones with just broth. No seasonings, onions, etc.

 

I get BeechNut chicken and broth or beef and broth. It's only used for a snack. He prefers the chicken and so do I. It's less gelatin like once in the fridge. If you get baby food make sure it doesn't have any spices or cornstarch. The label should tell you the ingredients. It's a good way to get more water in them if you need them to drink more. Chuck likes a dab of chicken baby food in 1/8th cup of warm water. I use it as a snack if he's acting like he's starving before mealtime. But I never feed anything 2 hours before his meal. Of course he still has access to fresh water.
Chuck looks like he's bouncing today from his blues last night.

That is right. Chuck didn't go down much on his AM cycle today and I believe that is from his bounce. It looks like the 8 units wasn't enough on his 231 preshot but if you look at AM cycle on 3/31 he reached the same numbers with an 8 unit dose on a preshot that was 200 points higher. So if he wasn't bouncing he would have had some blue numbers with that dose this morning. The bouncing can and will make your head spin!
After a low number like you've been seeing they can be more sensitive to insulin. So once you get her leveled out you might see that she needs a tiny increase on her usual dose (like a "fat" of her usual dose) but only after you get your curves and more data on your spreadsheet will you be able to determine it.
You're doing great so far and learning much quicker than I did! I'm still learning as we go... almost 7 months into this.

 

Djamila, we're going to get you to do FD 101!

Also, I know you asked about trophy points above...I have no idea what they are. I think they are just something that comes with the software we use and we don't use them for anything.

I do think you'll see lower numbers as the day goes on. Have you gotten more tests in?

 

I'm looking at her curve the vet did on 2/24. They told me they were concerned about the numbers and that I should raise her dose from 2 to 2.5 units. The numbers in order were: 409, 501, 304, 279, 326. That's like an S-curve.

Now 427

 

I think I've been messing with her dosages too much. From now on, no matter the numbers, I'm going to give her .8 units. Now, my syringes don't have markings between the units, so I'll have to eyeball it.

 

No no, should always be numbers permitting!

 

Try not to drive yourself crazy. (Some advice that I need to take as well.) It looks like we both have tricky kitties. For the food, since we're almost in the same boat as far as kitty weight, etc...Frank started about 2 pounds under weight 2 weeks ago. I bumped his food up to almost 4 5.5 Oz cans a day. (Half a can for breakfast, 1.5 can frozen and left out during the day, .5 for dinner and a can left out over night.) He gained just over a pound in a week. His eating has slowed down now, and he's at like 2.5-3 cans a day and still needs to gain about a pound. So I'd definitely bump up your kitty's food!
Good job testing! It's frustrating not getting the numbers that you want, though.

 

Which brands of cat food do you buy? Do you put the cans in your freezer?

 

I'm feeding friskies pate. The freezer meal....I mix some water (maybe 3 Tbsp?) with the 1.5 can and put it in one of his bowls then put it in a plastic bag and freeze it. And it goes out in the morning after his shot.

 

It is interesting that she stayed high all day (which was not what I expected to see). It is possible today is a bounce though.

I do agree though that the dose has been changed too frequently. We do have sliding scales on occasion, but that's not until we know slow, steady increases
haven't worked. I'd suggest sticking with one dose for 6 cycles (3 days) and then increase if warranted. But ONLY shoot if over 200.

And if you can continue getting some data when you can, that would really help. I know you can't get mid cycles during the week, but if you can grab ANY extra tests at all, that would help. I don't know when you leave in the morning, but if you can get a test on your way out the door, and then get one in the evening before bed, that's a great way to get extra data without having to alter your schedule.

GREAT job today!

 

Thank you. I never even bothered to get out of my jammies today. I will probably go out for a bit tomorrow, but will at least try to get a mid-day reading in there. During the week, I take readings at 7 am and 7 pm, but will try to get an extra at 10pm, which is my bedtime.

 

I think you're right to keep her dose at .8u for a few days (as long as her pre-shot numbers are above 200, of course). That stability in dose will help us to see if today was a high flat cycle after a bounce, or if it's too low of a dose. Keeping this dose and getting some tests is the only way to know for certain which one is true.

You're doing a great job of getting tests done, and learning to make the best decisions for Chloe - it's a lot to figure out: food, testing, dosing, schedule...so hang in there!

One note about freezing the food - this probably goes without saying, but do take it out of the can before you freeze it. When I freeze food, I do it the same way as Sarah (Franks' Mom) in freezing it right in their bowls. Someone recently commented that their ceramic dish had broken in the freezer, so be careful about that. My cats have two metal dishes and two plastic dishes. Those have all been fine in the freezer. Then at meal times I give them non-frozen food to eat right away, and put out the frozen dishes down for them to eat later.

And really great job getting some mid-cycle numbers today. I know they aren't the numbers we were all hoping to see, but she'll get there!

 

I think that's a great idea - especially since today's numbers didn't really reveal when Chloe is going to hit nadir. Hopefully some more data will start to make that clear.