Finding Alex's Dose

Hi Asiina! I'm so sorry no one responded to your earlier post! Anything between zero and trace is not an emergency, but should be treated carefully at home with as much extra water as you can get Alex to take. Add more water to the wet food, keep fresh water in different types of bowls out for him, and gently encourage him to drink when he's up and about. And of course keep checking. As you know the strips keep getting darker over time, so if you look at the test strip after the time limit it will just look worse and worse. It's important to stick with the 15 seconds when checking.

Now onto the other two posts: I would strongly recommend that you get rid of the kibble altogether. The last thing you want is to end up with TWO diabetic cats. Simon might be okay now, but the dry food puts him at risk of developing diabetes too. Not to mention the impact on Alex when he gets into it (even if it is a rare occurrence). If Simon is very resistant to giving it up, you can find some really helpful information on catinfo.org about how to deal with hard-core kibble addicts. And it may take some time, but it can be done and in the end will help guard against ending up with two cats at this sugar dance.

An influx of carbs can impact them for several days. Bodies are complex, and even if the calories from it burn off quickly the impact of it extends into all of the body's systems and takes a while to clear out. I've read 3-4 days to fully settle back down. It's one of the reasons I encourage folks to steer away from low numbers with low-carb food whenever possible (although of course use HC when it's needed). Most of the time steering with LC food works just fine and it avoids that lingering impact of the carbs.

 

I ended up checking the ketostix under better light right away and they're back to negative, so the colour change may have been the lighting in the room. I did push a little more water into him though throughout the day. He drinks enough on his own, but won't eat food if it's too wet or mushy.

Simon only really has dry food as a supplement because Alex is eating so much. Simon prefers to graze but because Alex is still so unregulated he'll eat everything that's put down. So he'll eat a couple of bites of his wet food and then walk away, and then Alex will eat it. We pick it up off the floor and will try to offer it to Simon uninterrupted at other times, but it can be hard, so giving him a few bites of kibble a few times a day works out. I'm really hoping that as Alex becomes more regulated he'll go back to being able to graze too like he used to, and I'll be able to ween Simon off the kibble as well. He's still getting most of his calories from the wet food, but I need to make sure he's eating enough.

Good to know about the high carb food. Hopefully it won't impact his numbers too badly when he's at the vet on Wednesday, but we'll see. This is the first time he's broken into it, and I'm going to make sure it doesn't happen again. I'm more frustrated because I wanted to increase his dose this morning, and now I can't because I need to make sure his numbers are real.

 

It would have been fine to do the increase this morning. His nadir numbers are consistently high enough and he's been at this dose quite a while. That being said, if you've already injected, it's fine to wait until this evening if you can monitor, or tomorrow.

 

Ack! Alex!!!! We've had cats who've done that before and we joked that the only way to keep them out was to bury the food in a metal container that locks in the backyard. As he gets more regulated, he should be able to graze more, but have you tried offering meals at specific times in different rooms? That might help if Simon knows food is available at this time in his room and won't be available again until the next meal time. I tried that with mine for awhile and it worked fairly well until we got back to grazing. Or is there a place where Simon could get to that Alex can't where you could leave his food?

 

I've tried a bunch of things with Simon to make him eat more in one sitting, but he's just not interested. He'll only ever eat a few bites and then walk away. He's a skittish eater and will look around after every bite. It's also possible he's having teeth problems and so eating hurts which is why he stops. He's also coming to the Vet on Wednesday to have that checked out, so hopefully I'll be able to get some help with both of them.

I wish I'd given Alex a larger dose this morning. I'd only held the 2u so long because I was slowly doing the time change. I didn't realize I had that much leeway. I won't do a dose change overnight, since he can drop low sometimes and I can't really monitor well overnight, but I'll raise it up to 2.25u tomorrow morning.

 

Yeah, okay. 21 @ +5

I knew it was going to be high, but I had really hoped that I'd be able to get sub-15 at least.

It doesn't help that this is happening the day after I had that ketone scare, so I'm still checking basically every time he goes to the bathroom.

 

And then 30 again this evening. Those carbs from the dry food really are not joking around. Give how he was still at 20 this afternoon at his usual nadir, I went ahead with 2.25. I don't like him being so high for so long. It is extremely unlikely he'll go into hypo range while he's still recovering from this carb intake. I'll just stay on this dose a little while longer even if it's not enough to make sure the carbs aren't making the dose seem wrong, probably at least until next Friday.

Good news is I checked for ketones and they came up very obviously none, so even though I know he's having a bad time with his blood sugar, he's not in any immediate danger because of it.

 

Still high this morning, but we'll see where the 2.25 brings him in the afternoon.

He wasn't very hungry this morning which is unusual and a tiny bit concerning, but he may just be being picky with the Salmon. I gave him a little bit from another can and he did eat that although reluctantly. Still totally negative on ketones so I'll try not to obsessive over it.

(I'll probably still obsess over it)

 

Sometimes our kitties just aren't super hungry...happens to mine especially when the schedule is wonky from the time change. Don't worry too much...easier said than done I know!

 

Yeah, I'm only worried because he's got 2 (maybe) of the three ingredients of DKA by being so unregulated and having allergies, so that he's eating is important.

Good news is that he was out of the blacks for his pre-shot. Still red, but hopefully he's coming down from his carb load the other day. Hoping to start seeing those lower nadir numbers again.

 

Another high morning though, bleh. He was very hungry this morning and ate well, so that's good. I'm not going to be around at his standard +5 test time which is unfortunate because I really want to see if his nadir is coming down after the kibble and on this 2.25.

Still no ketones, a refrain I'll keep repeating to myself.

I won't change the dose until Friday, I don't want him to get hypo once the carbs clear, but I'm just getting so sick of these high pre-shot numbers. When I talk to the vet on Wednesday I'll see what she says about whether I stick with prozinc or switch to something like Lantus that might even him out.

 

Took a full three days, but it looks like the carbs have finally been cleared and I'm getting blue numbers again. It's a relief.

Today is vet day, and I'm looking forward to getting a second opinion from a different vet. I don't really know them, but they're highly recommended in my area, so we'll see what advice she has and if she thinks either of my kitties need dental work (I'm almost certain they do).

 

How was the vet visit?

 

There was actually a miscommunication in scheduling, and we're supposed to go on Friday, so whoops! Guess we'll see Friday afternoon.

 

So I'm going to ask the vet, but I could really use some help understanding what's happening here. It feels like the more I increase his dose, the worse he gets. He has these good days but when I was at 1.25 I was getting blue nadirs, then I changed the feeding schedule and started getting yellow at 1.5 and 1.75 and now I'm at 2.25 and getting pink? I thought it was the carbs, but he had a 7 yesterday and today at the same time he has a 19. Do I keep going up? Should I get a new bottle of prozinc? Should we give up on prozinc entirely? I really am not sure what to do.

His best numbers were when he was in the 1.25 range but was only eating every 6 hours and was perpetually hungry and just throwing up from hunger every morning. Now that he's able to eat more, he's so much higher.

 

One thing to consider that is kinda difficult, is I'm not sure when I'm testing when he's eaten. The automated feeder opens at +4 and +8, and sometimes he eats right away, but usually there's an amount of grazing and at least some period of time before he finds that it's open, so it's possible that sometimes my +5 or +6 test are when he hasn't eaten in a few hours and also possible that he ate maybe 30 minutes earlier. Still, I'd expect the insulin to be working enough to get him lower than pinks in the middle of the day.

 

Maybe those black PSs are from eating contraband kibble overnight? That food can really mess with the insulin response. Aside from that the extreme difference between PS and nadir is likely how your kitty responds to ProZinc - high PS ---> big drop at nadir ---> rebound to high PS. My guy was like that on ProZinc. A depot insulin like Lantus might even him out a little. I can't recall if this has been discussed on your threads.

 

There's no contraband for him to get into anymore. It was one time where the container wasn't sealed properly, but that's been fixed. There's really nothing he can be getting into but he still ends up high basically no matter what.

I'm planning on talking to the vet about Lantus, but it's more that he was having these low drops but it seems that as I increase the dose, they have been disappearing and his blood sugar is sitting higher at 2.25 than it ever did at 1.25.

 

Normally we suggest waiting closer to six months before switching from one insulin to another, but given your anxiety right now, I wonder if it might not be better to switch sooner? You might find it helpful to sort of start over, and many cats do well on Lantus. It has much stricter rules for dosing which might also help you feel safer and more secure in the process.

I am still wondering what's happening during the PM cycle, and if those daytime pinks might be the result of some good nighttime responses that we're just not seeing. Given the high PS numbers at this point, anytime Alex goes lower there is going to be a higher cycle that follows (and maybe even a few higher cycles). Of course it's also possible that he's just getting high numbers in general right now, but without that data from the second cycle, we can't really know.

I'm not seeing anything that concerns me about his dose, but again, we are missing half of the picture, so I could be wrong. And believe me, I understand how hard it is to test at night! I am definitely one that needs my sleep, and sleeps quite soundly! A before bed test is the best I can do most nights. But something is better than nothing when we're trying to figure out what Alex needs.

 

I don't usually test in the overnight cycle partially because the times I have, I don't really get anything unexpected, but also because shot is 9pm and I usually go to bed before midnight, I never really bother because I know the onset isn't going to be before +3. It's hard because I don't want to waste expensive strips since I'm on a budget, when I know they're not going to be at the best time to tell me anything important. I can try waking up more in the middle of the night to test.

I just have no idea how to bring these PS numbers down because nothing affects them in the slightest, either feeding schedule or dose. I'd be happy to stay on prozinc if he just starts cooperating!

I am wondering if the bottle of prozinc has become less effective over time. I've followed the rules for the most part, but since it was my first bottle I did a few things early on that I wonder now if they are decreasing the lifespan, like overfilling the syringe and then pushing back some insulin into the bottle because it was easier to push to get to the right dose number than pull. I don't do that anymore since someone said not to, but I didn't realize right away and did that for the first few weeks. Also possibly rolling it too harshly to mix up the insulin. I'm not sure if I would have seen the effects right away if I did something wrong with it, or it just means I won't get the full 6 months of use out of this bottle, and will be closer to the manufacturer's 2 months.

 

Vet trip went very well, she was patient and receptive, and sat with me for a long time while I talked about my spreadsheet. As an aside, I'm very thankful to this forum that I was able to address all of her concerns in making sure I was doing everything right. She was impressed I was checking for ketones and that I knew what the Somogyi effect was. Because of that we were able to rule out the simpler things.

Simon (civvie) is going to be having some dental work and probably some extractions done in the next few weeks, but she wants to take a few shots at controlling Alex's diabetes before we do the dental work on him. He has some gingivitis, but it's not nearly as bad as Simon, and likely will just need cleaning. She recommended dropping his dose down to 1.5u for 4 days and doing a curve on the 4th day, to see if he's bouncing, but she's also open to changing to Lantus if it doesn't work, so I'm feeling good that I finally have some support from a vet who doesn't act as if I'm inconveniencing them by asking questions.

I'm a little nervous about dropping his dose when he's so high and I'm checking for ketones all the time, especially if this isn't the reason, but I know that I'm monitoring him carefully and will be able to react quickly if something happens.

 

Okay, I have to admit, you guys (and likely the vet) are right and the night cycle is very different. I've checked before and it's been more or less the same, but I happened to be awake at 1am and checked and it was fairly low, so checked an hour later and it was lower. Now it's 3am and it's finally starting to go back up and I can go to sleep, so I can wake up in 6 hours and give him his shot. We'll see what the AMPS is, but if it's high like it usually is, I'm pretty comfortable calling this a bounce. Going from 25 (450) to 6 (100) in 5 hours is a lot.

 

On a sticky somewhere it talks about bounces lasting 3-6 cycles. So maybe a good rule, given how quick to drop Little is these days, would be to make yourself wait at least three cycles before you try an increase. She seems to clear them pretty quickly, so if you haven't seen another green by three (or four so that increases can be during the day), then you can consider trying a little increase after that if it looks like she needs one. For now though, 1u is looking like it's enough.

 

I think you mean 2.25 u, @Djamila ? Or am I missing something?

 

I think that was meant for someone else's thread

 

Oh geez! How did that happen?!?! That post was for Lisa and Little, but somehow ended up here....? That's what I get for posting before I start drinking my coffee! Asiina, I'm so sorry for the confusion there!

 

Bah, another high day. I'm giving the vet's plan time to work, I imagine it will take a little bit to settle, but I hate seeing him so high.

They did wake me up this morning by having a playfight, which they haven't in a while and was nice to see Alex so feisty, so disappointing that his numbers were so high later.

 

To be honest, this dose reduction makes me really nervous. I'm glad you're so good about checking for ketones.

 

Does it make you nervous because of the speed or because it's too low?

Something needed to change, since his pre-shot numbers were only getting worse the higher the dose went, and that night cycle showed he was bouncing quite a bit, going fairly low and then back up.

I'm still not entirely sure how fast ketones can develop. All the resources I see just say "fast" and if I see above trace to get him to a vet asap, but I'm not sure if fast is 6 hours, 12 hours, 24 hours or longer. I check at least once a day and don't mind checking more, but I'm not sure what timescale is likely.

 

It just seems like Alex is now sitting in those high numbers a LOT. That's never good for kitties since they usually don't feel well in such high numbers and ketones do develop fast. I can't give you a definite time scale since I'm not really sure...I think once a day checking is fine, but I would make sure you don't skip any days.

It's just SUCH a large drop and you were going up systematically...I doubt that a lower dose is going to help. Yes, he was bouncing some, but he definitely wasn't going into unsafe numbers. He was actually getting some beautiful blues with plenty of room to drop lower safely...and the more time spent in blues and greens the more the pancreas can heal.

 

I think that's part of my concern now too that the pre-shot numbers seemed to only be getting worse and his nadir numbers were really unstable too, sometimes blues and sometimes pinks.

I'm basically willing to try anything at this point. This is step one. I have another bottle of prozinc in case it's that this one is becoming less effective. The vet is also open to switching insulins. She'll also do the dental cleaning if she needs to at the state he's at, but she wants to try other solutions first just because he's so unregulated.

 

It's unlikely he'll get regulated without the dental if there is an issue there. My concern is ketones, but it's also the organ damage that occurs at the high numbers, and as Rachel said, the fact that it just feels lousy to be that high. At the higher dose, you were seeing a blue nadir followed by pink nadirs because that's what cats do on their way to healing. A good cycle followed by anywhere from two to six bad cycles. And as you found, some of his good cycles were happening during the PM cycles and hiding because there wasn't data to show them.

I know it's hard when a vet, who is supposed to be an expert, tells us something. However when it comes to diabetes treatment, they just don't have the experience with daily data to fully understand what they are seeing on the spreadsheets.

I do understand how frustrating it can be when a cat isn't making progress as quickly as we'd like. Hopefully this experiment will at least reassure you that too much insulin wasn't the issue.

 

I feel like I'm not seeing the same thing you guys are seeing, because yes I can get good nadir numbers if I keep upping the dose, but they come at the cost of high nadir numbers on other days and even higher pre-shot numbers. I don't know how it can be good and healing if he's getting into high reds and black numbers every single day on these high doses. That can't feel good either and upping the dose just makes him bounce even more.

Like I'm being told that my vet is wrong and I should trust you guys, but doesn't she have a point that the high dose wasn't working? One good cycle of blues can't be worth several cycles of terrible. He was getting worse the more I increased, not better.

I appreciate everyone's time and I've learned so much here that I feel informed going to the vet and advocating for Alex. But honestly no advice I've gotten here so far has been able to help me bring those pre-shot numbers down even a little, so I'm frustrated that it feels like I'm being shamed for following my vet's advice to try different things and see what works. We're trying this for a few days, I'm doing a curve today to send her. We'll likely try a different strategy next.

 

Asiina, I'm sorry if my post made you feel shamed. That was certainly not my intent. At issue is that too many times over my years here, I've seen vet advice to lower the dose lead to DKA, hospitalization, and even worse. I don't feel like it serves anyone if I soften that. In an effort to be polite, I have failed to speak up in a couple of those situations and the consequences were tragic. I simply won't do it again in consideration of what is at stake.

That being said, we always always always respect yours (and any caregivers) decisions. You are the one who is there and can see and know your cat, so you have to be the one to make the decisions. We will give you our best thoughts in a situation, but you get to decide, and we will be here for you no matter what. You are always free to take or leave any suggestion.