Crushy and Andrea-Getting desperate with high numbers >600s

Discussion in 'Prozinc / PZI' started by Andrea and Crushy Carran, Aug 14, 2020.

  1. Andrea and Crushy Carran

    Andrea and Crushy Carran Member

    Joined:
    Jan 14, 2020
    I swear we're doing everything right -- I just cannot get my girl's numbers down. We reduced her dose by .25 last weekend after a low blood glucose event and I have held that dose for one week as instructed. I've also stopped giving her Dr. Elsey's dry food as a testing treat even though it's only 5% carbs. I had hoped the change from Hills Science Diet Glycobalance to Sheba pate would bring the numbers down and it did for that one night.

    I had one doctor who told me to shoot half hour before feeding ... he said he very rarely gives that advice but as I recall, her numbers were lower back then -- but we were also using a Freestyle Libre (human meter) to test and now I'm using Alphatrac. Do you think this is something I should try again?

    Her new vet wanted me to jump from 1.5 units to 2.5 units all at once and just "watch for a hypo." I increased by .25 increments instead and things just got worse I think. Do you think I should do a big giant increase like that and maybe jump start her pancreas?

    Any other ideas?
     
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  2. Lisa and little

    Lisa and little Well-Known Member

    Joined:
    Sep 24, 2018
    Hi Andrea,
    I am not one to give dosing advice but what I will say is that It is never advised to do that big of an increase. More/too much insulin will not jump start her pancreas. I wish it was that easy. This whole process takes patience. Always remember this is a marathon not a sprint.
     
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  3. Andrea and Crushy Carran

    Andrea and Crushy Carran Member

    Joined:
    Jan 14, 2020
    I followed my gut and not her advice ... she was a diabetic herself so I thought she might have a good idea there. I just wanted to confirm with you all that I didn't miss an opportunity by slowly increasing instead of the suggested "jump start!"
     
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  4. Andrea and Crushy Carran

    Andrea and Crushy Carran Member

    Joined:
    Jan 14, 2020
    I have been slogging through this marathon since diagnosis in December. I have patience, but the stress is taking a serious toll on me and also on my marriage. Haven't gotten more than 3 hours of sleep at night for 10 days now -- keep waking up and seeing the Alphatrac over 500. Someone posted on Facebook that they were reading their meter upside-down so I got excited and checked all of my past readings only to confirm our horrible numbers. Thing is, Crushy is fine and happier than ever and purring all of the time -- were it not for the testing I'd be oblivious and happy myself, thinking the insulin was working. The more I learn about the chronic high numbers the less sleep I get. :banghead::banghead::banghead:
     
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  5. Panic

    Panic Well-Known Member

    Joined:
    Apr 10, 2019
    Hi Andrea. I'm about to head out but will be back in a few hours to comment. It looks like you need some guidance from @Deb & Wink . She probably won't be online till this evening so hang on, okay?
     
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  6. Andrea and Crushy Carran

    Andrea and Crushy Carran Member

    Joined:
    Jan 14, 2020
    Thank you! She helped me through the pajama party Friday night. I'm off to work anyway and going to beg hubby to get a +4 and +6 reading since he's working from home. More data never hurts!
     
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  7. Panic

    Panic Well-Known Member

    Joined:
    Apr 10, 2019
    Absolutely! And that's something I wanted to talk about too.

    I agree with Lisa, please don't increase the dose. If anything I'm suspecting Crushy is still too high and we're just seeing a lot of bouncing going on, but let's let Deb be the judge of that.

    Your health is just as important as Crushy's, so give yourself some slack (and some sleep!). On July 30th that night you checked him at +3 and saw he was at 510, and then you checked again at +7 where he was at 456. Honestly, if you get a high number like that at +3, do yourself a favor and leave him for the night. It can take up to 6 cycles to clear a bounce (and a black number is usually a good indicator of one) so you're not typically going to see any relevant information 4 hours later. Call it a night and get some sleep. Just using that cycle as an example.

    So the other thing. There's not much data to work with. Now not everyone is retired or working from home and has time to get mid-cycle tests in, but that data is extremely helpful into figuring out what's happening. Crushy could very well be dropping during the day when you're not testing, bouncing, and then when you check him later at PMPS it just looks like he's stayed in the reds and blacks all day. He could be earning a reduction that you don't have the data to see yet. Remember how I said bounces take up to 6 cycles to clear? That's up to 3 days of bad numbers - and then once a bounce clears they can drop again which sets off ANOTHER round of bounces. If you're not catching those numbers, it doesn't look like he's budging from the blacks at all.

    On SLGS method, you have two options. You either do a full curve once a week, or you can do spot checks every day. Not including AM/PMPS, you'd ideally get at least 2-4 mid-cycle tests every cycle. Nighttime usually 1-2 if kitty's BG isn't doing anything "suspicious". A +2 every cycle is very helpful and indicative of what the cycle will be like. I would recommend testing at alternate times each day to fill in the gaps in your spreadsheet. One day you'll test at +2, +4, and +6, and the next day maybe at +3, +5, and +7. That way you're filling in the blanks and we can say "hmm okay he needs more juice" or "oh, he dropped too much in this cycle!".

    A refresher on bouncing and how it's caused:

    This phenomenon occurs when the body experiences (or at least thinks it does) hypoglycemia. Luckily the body uses bouncing as a defense mechanism against this where it attempts to compensate the low blood sugar by dumping excess glucose provided by the liver in an attempt to raise blood sugar back to “normal” numbers. Unfortunately, “normal” is a relative term according to the body. For a diabetic whose body has been untreated for so long that it considered very high numbers to be the new normal, lower numbers can often make the body overreact in attempt to save itself, even if it’s not in danger.

    A cat who has been suffering from diabetes for some time may at the point of diagnosis have a new “normal” of 400. When insulin is introduced and brings it down, even to 200 (still diabetic levels), the body thinks it is in danger, dumps excess glucose, and thus the blood sugar skyrockets up to the 400-600s. After enough time has passed, the body will eventually realize that 200 isn’t such a bad number, and bouncing will happen less often. Note some cats are extremely bounce-prone and a switch to Lantus/Levemir are game-changers, as it was for my own bouncy girl.

    There are three main causes of bouncing: when blood sugar drops too low (hypoglycemia), drops lower than the body is used too, or by dropping too much too quickly. Typically if a cat drops more than 50% of their blood sugar a bounce is likely to happen, or if they drop 100 points within an hour.

    While bouncing can be considered as a safety net in the instances of hypoglycemia, it can look very confusing on paper (and even worse, a glucose curve).
     
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  8. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Sometimes, a hypoglycemic event can "jump start" the pancreas, but that's a hard way to get the pancreas working again. Plus, it can lead to bad results for the cat (or the human). Don't think you want to go that route. But please ask your vet, if they would give themselves a "boost" of insulin to bring their own blood glucose down and risk hypoglycemia. I'm betting the answer is no.

    Let's check a few things Andrea.
    1. Do you have control solution to test the Alphatrac meter? To make sure it's reading right? Test your pet meter on yourself if you don't have control solution.
    2. How fresh is the insulin vial you are using? When was it opened?
    3. Storage conditions for the insulin have been what?
    4. Cloudy still, but no floating particles? Never frozen, shoved to the back of the fridge where it's colder perhaps?
    5. Vial always mixed well before each syringe of insulin is withdrawn?

    I agree with Elizabeth, that the numbers could be dropping mid-cycle and you are not catching them. Crush could be going from one bounce to the next.
    Not all cats do well on a particular insulin. You might ask the vet about lantus or levemir.
     
  9. Andrea and Crushy Carran

    Andrea and Crushy Carran Member

    Joined:
    Jan 14, 2020
    Thank you so much for your input! I did NOT increase her dose thanks to your refresher on bouncing. Just going to hold and get some mid-cycle data today (and tomorrow also if possible). Slept well last night until 4 anyway, calming myself and tapping into my patience.
     
  10. Andrea and Crushy Carran

    Andrea and Crushy Carran Member

    Joined:
    Jan 14, 2020
    I purchased and punctured the new vial on 7/30 and saw a drop in levels that day but not again; the vial has been refrigerated at all times in it's own refrigerator in the "cat room", never frozen, temperature is good; the vial is rolled gently to mix before each draw; the insulin is still cloudy, no particles.

    I do not have a control solution but I just tested myself after 4 cups of coffee with sugar and cream and a banana (over 4 hours) and I'm 157 -- which is what I would expect on a pet meter.

    I'm going to hold this dose and try to get more mid-cycle reads this weekend and during the week. Do you think I can just sit tight for the next 3 weeks before seeing the vet and discussing switching to Lantus? Or would you be too concerned about these high numbers?
     
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  11. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    The one thing I would add to Deb's comments is that Crush may be very carb sensitive. One of our member's cats numbers would jump 30 points from a freeze dried chicken treat -- and that was zero carbs. If you are giving any dry food, even Dr. Elsey's, it may be having an effect on your cat's numbers. The difference on the day you gave Crush Sheba's is considerable.

    I'd also see if you can get some PM tests past your +2. It may be that Crush's numbers are dropping in the PM cycle and then causing a bounce the in the AM cycle. Many cats see lower numbers at night.

    @Deb & Wink
    Do you think it would make sense for Andrea to consider using modified Prozinc method? It would allow for larger increases.
     
  12. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    I think waiting for 3 weeks until you discuss with the vet is too long. I'd at least call your vet and ask about a switch to lantus insulin.

    It's the mid-cycle numbers we really need to see, to make sure that Crushy isn't crashing into low numbers, and then bouncing up to really high numbers the next time you get those pre-shot tests. My gut says that is what is happening, but I could be wrong.

    In my opinion, a cat that can drop from the mid-300's to the 50's on a pet meter does not need to have the larger dose increases that can be done using the MPM prozinc dosing method.

    Andrea, I do think that you need to set an alarm and get some PM tests, around +4 or +5. I know it's a lot to ask,to have you get up in the night, but I think the numbers are dropping really low and we need to see that before knowing what the dose should be.

    Do you think you would be able to do that soon? Tonight or Sunday night?
     

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