I finally posted SS today (help)

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Cara and Wynken (GA)

Cara and Wynken (GA)

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I (re) joined the group several days ago but finally got Wynken's 2015 confusing numbers in a SS. I can always add earlier results later - these have always just been written in a little book I have.... THANK YOU to Marje who coddled me through using the SS! As I put his values in, I cringed the WHOLE TIME. ((sigh)) I have learned enough recently to know that I was doing many things wrong. I have left him high BG for awhile... Please be kind, as I lost three civvie kitties from Mid July to Mid October, and have a hyperthyroid girl I have been dealing with multiple issues since early November. Wynk has not been my priority, but I have tried to do spot checks and curves...

The good news: Wynken is doing terrific clinically and feels good, eats well... Bloodwork in Sept was great, with a fructosamine of 397. The bad news, as you will see in the SS is he has been very high BG a LOT in the last 6 months. I have been afraid to go above 2u PZI, because in past years, this has resulted in <100 readings. So it's MY mental block I guess. His vet thinks "clinical presentation" is more indicative of the cat's health than high BG readings. After learning more online, I definitely want his BG to be lower.... but there are some mysteries here, with a few sporadic low readings and a recent thing where the BG doesn't go down at 5-6 hours post morning shot, like it used to. Ideas?
 
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Congrats on the spreadsheet. Doesn't it make the picture much clearer with the colors?

Glad you came over, Cara. We are a small but friendly forum. If you ever have an emergency, post here and on Health for the most eyes. This forum is the best place to get dose advice. You might check out other people's spreadsheets to see how they are doing.

His spreadsheet is interesting, especially the late nadirs in the last few cycles. I think I might try a lower dose for those 200 (yellow) preshots and see if he is lower for amps. My thinking is that the 2 units might be too much for the yellows and cause a bounce for the amps number, or there could still be some insulin on board for pmps, impacting the evening numbers. I think the 2 units is okay for the pinks. It might need tweaking up, but I think I'd make the evening change first and see if it changes anything for the am number. We usually suggest one change at a time to see what is working or not working.

Have you seen the protocol we put together for ProZinc? It's in blue in my signature.

Welcome! Hope we can help.
 
Sue - thank you for looking at Wynk's sheet & commenting! YES, this is "illuminating". :eek: I can see now (especiallly after all Ive read on FDMB) that it's kind of weird for me to just put insulin in him without checking the preshot BG level.:facepalm: I guess I thought if his appetite was constant that the value would be about the same, day to day. I HAVE been looking at other kitties' spreadsheets, and that is illuminating too! MAkes me want to test more, do more pre-shot testing. I DID read the PZI protocol (maybe the first day I returned - last weekend?). But I just re-read it - good job! And I liked that you noticed about the recent shift in Wynk's afternoon nadir coming later... I guess I was focussing on the BG going UP after the morning shot -maybe part of the same phenomenon? Either way, his response to the dose certainly has shifted. So, to clarify: you suggest lowering the evening dose a bit, but leave the morning dose at 2u, at least until we see the effect of lowering the eve dose - but lowering to what? 1.8u or 1.6u? I have 3/10 mL U-100 syringes with half-unit markings (so I convert) and have a LOT of accuracy in dosing available to me, with that syringe type. Let me know what you think the eve dose should be... or should I begin basing it only on a pre-shot value? If that's what's best, I will absolutely do that, since it makes sense, given the data (lower pre-shot BG in the evening). Sudden realization that I am in a mental "box": in the past I've rigidly believed that the am and pm dose need to "match" since he is eating the same amount of food for both meals. Then again, his intake being constant is an assumption on my part, because he lives with his sister (6 lb spitfire civvie girl)... they share a plate & the food is always gone... so it's possible he eats more at one meal, or another. They are practically joined at the hip since birth, so I would never separate them.
 
One of the nice things about ProZinc is that you can vary the dose, so you can shoot less for a lower number and more for a higher. And you base the dose on the preshot and the nadir. For example, if his amps is 350 and you give 2 units and he drops to 45 at +6, then you know that dose for that level is a little too high, and the next time you get 350, you drop the dose a little.

So, if you get a yellow preshot tonight, either 1.8 or 1.6. It is a matter of trying a dose and seeing what it does and adjusting. He didn't look like he went all that low overnight last night, so maybe 1.8? Then see how the amps looks - did the lower dose mean it was a little lower or is it a little higher.

ProZinc dosing is all about patterns. So you look at what a dose does on a given level and adjust accordingly. Over time, the patterns (usually) become clearer......At first, this makes the dosing a bit of a guessing game, but over time you figure it out.

Dr. Lisa (of the catinfo.org site) once said to remember that the insulin is only part of the equation. The food is too, but so is the "Oh, look a squirrel!" phenomenon.
 
That makes a lot of sense, Sue. I just need to endeavor to get more flexible in my head about the preshot and the dose. Will do! :) Also - I will try to explore more where his nadir actually IS, this coming weekend. Thanks again!!
 
Ugg. PMPS 177. Not sure of dose now. Certainly not 2 or even 1.6, right? Protocol says NEW diabetics don't get a shot at under 200, but I know he needs some PZI. How much? Oh, and I added in his actual PMPS values from the last 2 evenings, which I had on a post it note here at home. I actually gave a tiny bump up last night, based on higher value before dinner.
 
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Well, dang. I will do that next time... I should have waited for your response but I have gotten pretty regimented in mealtimes being between 6:30 and 7. So, I deliberated and gave him a higher carb meal than I normally would. And gave 1.4 u. So, usually he gets 2/3 of a zero or 2 percent food (like Tiki or NV Instinct (chicken/lamb/venison) plus 1/3 of Wellness GF (chick or turkey). Tonight he got 2/3 Wellness GF Chicken and Herring with 1/3 Wellness chicken. I have reasons for always feeding him 2/3 of one food and 1/3 of another, too complicated right now... My goal for years has been to minimize carbs while offering variety which he enjoys a lot.

Tonight, it is possible that the 1.4 u won't be enough for the 6 percent carbs in the chicken & herring along with the 4 percent carb in the chicken part. He sure ate well!! I gave his insulin at the end of his meal, which I never do... But I was deliberating....

So since I moved too fast for your best suggestion, do you suggest I test at +3 or 4 and maybe give a tiny booster shot if he is high (pink or red)? Or would I not do that because he will be (should be) falling?
 
No, I would not do a booster shot. It is just too hard to know what the insulin will do.

Yes, I'd get a test at +3/4, just to know what is going on with that dose. (All data is good data)

Stalling is a good tool for your FD toolbox. If he rises in that 20 minutes, you can give a dose maybe just a smidge less than usual.
 
Welcome Cara! I know you've gotten great advice from Sue (as always!) so I just wanted to say hi and GREAT job on the testing and SS!
 
Thank you Rachel! It is SO good to be here. I was floundering on my own. I think I have a real chance to get Wynk's BG under better control with these tools and the great advice.
 
@Sue and Oliver (GA) - Well, my gut-guess is that I did not give enough insulin last night to cope with the higher carb meal I fed him (still a relatively LOW carb meal, though). I don't have a lot of data to suggest that the AMPS value of 450 is out of the ordinary, but it sure feels out of the ordinary!! As usual, Wynk feels and eats just fine. If I hadn't tested him, I would have done my blind 2u shoot. I upepd the AM dose to 2.2 because the red value scared me a little. I have the PZ protocol printed out on my kitchen counter, so I read that before I added a little to his am shot. Then later I thought "Wait, Sue said not to change both doses at once!". I think I will go home at lunch (which is hard, but doable) to see what he looks like at +6. Thoughts? (Also - when should I start a new thread? Or do I just keep replying on this one? - Thanks)
 
Hi Cara! If you can get home and get a +6 test, that would be helpful. You don't have to make it a habit..but at this point, with so little data, that will tell us something we don't know! The earlier in the sugar dance you are, the more data we need. Those nadirs can tell us what a dose does so that later in the game, when you get a certain preshot, we can advise based on past experience. :)
 
Your 2.2 looks fine. Not sure - could be a bounce from some lower numbers last night. I actually thought your dose last night was okay and yes, the higher carb could have influenced the amps. It's not a big deal to do more than one change; it's just easier to figure out what might have caused what if you have only one change.

So tonight, if your pmps is under 200, I'd stall and be sure it is rising. And yes, starting a new thread then would be helpful. Whenever you need dose advice, it's good to put that in your subject line.

You are doing great, Cara. Think of this time as data gathering. You're getting info about doses and levels that you can use. He is in safe numbers and you can test anytime you are worried about what is going on. That is a big plus!
 
Thank you Rachel and Sue!! I am taking this all in. :) I realize I am VERY fortunate. I have a kitty who feels good and who (Incredibly!) is pretty good about his ears and the testing. For last night's check at +4, he was snoozing on his covered bench, and when I woke him with a gentle pet (he is deaf) he saw the meter and just looked up at me like "OK..." and didn't even get up when I poked him. He's been very active otherwise, but sometimes he is just SO CHILL - I love him so much!! (He isn't always that good, tho, cuz he's always dancing around like "where's the food?" on a preshot value....) LOL!! I will start a new post next time.
 
Cara and Wynken said:
So, usually he gets 2/3 of a zero or 2 percent food (like Tiki or NV Instinct (chicken/lamb/venison) plus 1/3 of Wellness GF (chick or turkey). Tonight he got 2/3 Wellness GF Chicken and Herring with 1/3 Wellness chicken. I have reasons for always feeding him 2/3 of one food and 1/3 of another, too complicated right now... My goal for years has been to minimize carbs while offering variety which he enjoys a lot.
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Cara and Wynken said:
Then again, his intake being constant is an assumption on my part, because he lives with his sister (6 lb spitfire civvie girl)... they share a plate & the food is always gone... so it's possible he eats more at one meal, or another. They are practically joined at the hip since birth, so I would never separate them.
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Hi there, Cara - Welcome back to FDMB, and great job on getting that SS up & running! I have questions as relates to Wynken's food/weight:

- Am I correct in assuming that he's eating roughly 11 oz. food every 24 hours? (About two 5.5 oz cans/day?)
- Is Wynken still at 15 lbs, and is this his "ideal" weight for his skeletal frame? (Is he an unusually large/long cat or more a "normal-size" cat?)

Slender (not skinny or emaciated, but slim) is better for a diabetic kitty in general - unless, of course, there are other medical conditions that would require special dietary/weight considerations.

It's just fine that you feed two meals a day and it's wonderful that your diabetic kitty and your civvie have such a close bond.

However, is not a good idea to feed them from the same plate. Why not simply put two plates side-by-side, and monitor your two kitties at mealtimes - to be certain that Wynken is eating only his own ration?

For diabetic cats, food is (in its own way) as much "medicine" as is the insulin doses we give. (One of the reasons low-carb canned is so important, too.) And the amount of low-carb you feed can either work with the insulin - or against it. So portion control - whether a diabetic is fed 2 meals per day or mini-meals throughout the day - is an essential part of getting that kitty's blood glucose levels well-regulated.
 
Hi Robin - I appreciate your interest and your suggestions very much. Please continue to help me in this regard - I have assumed I knew what I was doing (given some constraints I have) but am willing to learn/change to help Wynken! By the way, I had a lovely 17 year old calico girl that I lost in July (quickly to cancer:() that was named "Bat Girl". I called her "Batty Bat Bat." Miss her BUNCHES.

I agree that food is part of the medicine, and I have thought of it this way since I did my original research after his DM diagnosis. This is why I am pretty careful choosing low carb foods for him, and never allowing any contraband. The only other thig he EVER gets is Orijen freeze dried treats, and that's pretty occasional... You are absolutely right that it would be better if I controlled (or at least watched!) how much he eats... but it's a time issue with me. Could I devote the time to watching him eat? Yes, and I will if it comes to that. I have lots of other civvie cats, though, and 3 of them are in somewhat bad shape right now - thyroid, heart condition and one 19 year old HOT MESS...:rolleyes: Perhaps some folks may say I'm over-committed, but I genuinely want to do right by ALL of them, so I really try. I rescued a lot of kitties around 1998-2003 and found homes for a lot of them, but ended up with a group (ended up being MY cats) that was NOT adoptable - misfits. These have now become a large geriatric population which require a lot from me, so I give each day where the need is greatest. I work 45-50 hours a week, too.

I DO always (of course) make sure he's eating and I watch well enough to know that he hasn't wandered away from the plate and let his tiny (6-7 lb) sister eat it all. Her weight is pretty constant - she is extremely tiny (even a tiny head and tiny paws) - really small framed and slender. Wynken is a big-boned boy, and a little longer than most cats, big paws, large head, etc... That being said. 15 lb is probably a bit on the heavy side for him. I was not happy when he was 13 and a half pounds earlier this year... too low, so I suppose he needs to be about 14 lb, ideally.

I'm glad you're making me think this through again... I had calculated at one time that Wynk needs about 120 calories per meal (240 per day) to maintain his weight. Of course his sister (being half the size) needs about half that. I am splitting foods several different ways of out of several cans (for other kitties too), and trying to offer a constant amount to Wynken and Blynken for EVERY meal. I figured that would help with BG and the insulin dose. So, I am putting down 2.8-3.0 ounces for each of them, each meal (5.6 to 6 ounces on the plate). SO if he eats exactly half...he would get about 5.6 to 6 ounces every 24 hours. I've always thought he probably eats a bit more than half (I mean he's twice her size!) but she hasn't starved, and maintains her weight! So perhaps he is getting more like 8 ounces total per day. If he ate ALL of it it would be no more than 12 ounces (on a higher calorie day). Does this help? I'm going to guess he gets ~7-8 ounces per day. Quick estimate from a couple of his food labels says there is about 38 kcals per ounce, so idelaly (eating half) he would get 110 kcals per meal/220 kcals per day. Theoretically (if I calculated his colorie need correctly, he would lose weight slowly at that intake. But since he may well eat more, he might be getting 267 kcals(7 ounces per day) or 300+ kcals (8 ounces per day... or more). He has been gaining since earlier in the year, so probably at the higher intake, recently. I don't think TOO much about his weight... maybe I should & need to cut him back... I do weigh him occasionally on a baby scale.

Further thoughts? Thanks again!
 
Wow, Cara - you are one loving, big-hearted gal - especially evident in that you are caring for a big geriatric population (are we talking a dozen or more?), many of those not adoptable. Takes a very special person to take on all that you have on your plate!:bighug:

It sounds as though you have all of your kitties on the 2-meals-daily plan, is that correct? So does this mean that none of the kitties in your household are free-fed (allowed to graze throughout the day)? I only ask about this as relates to how your household is set up; i.e., would be helpful if you can make sure that Wynken absolutely cannot get to anyone else's food dish (say, for example, if you have a picky-eater in the mix who needs to be allowed to graze in order to get him/her to actually eat the day's ration). Just trying to run through every scenario in my head here ...

You're doing a great job with the low-carb food choices and by giving only occasional, freeze-dried treats!

I know you have some time constraints, but is there any way that you can feed Wynken & his favorite tiny sister in a separate room from the others at mealtime, where you can closely monitor until the two of them are finished eating? As my gut instinct here is that Wynken is most likely eating some of tiny girl's ration, too. Here's why I say this: If she is only 6 to 7 lbs, if she were eating half the food you put down for the two of them every day, that would total 6 oz. --- and she'd be gaining weight if a cat as small as she were eating 6 oz./day.

My 11-year-old Bat-Bat stays at between 10.7 to 11 lbs. (I weigh her weekly.) She's a big cat (long & large-boned, for a female). When she weighed about 18 lbs, all my vet said (after she'd torn an ACL in her back leg) was, "She could stand to lose a few pounds." I tried, but I was feeding the wrong stuff - mostly dry kibble.:facepalm: And she seemed healthy when she first started losing the weight; only she wasn't: Suddenly she was down to less than 9.5 lbs; it was the diabetes starving her, not healthy weight loss! That was in 2013 - I was devastated, of course. I cried & cried, and felt like a monster for having fed my cat all the wrong stuff all that time.:(

Today she eats between 6.875 oz & 7.125 oz. of Fancy Feast Classic pates (turkey w/giblets, and once a week the Salmon Feast), depending on whether her weight is up or down on any given week. Sounds pretty "anal," I realize:eek:, but it's not as hard as it sounds: I divide the cans into 8ths, like a pie, which makes it easy for me to be exacting about her quantities. What helped me to put portion control/ weight control in perspective: Reminding myself that one extra pound on a 10-lb. cat is like an extra 10 pounds on a 100-lb. person. (Wow!)

One note about the can-label guidelines: They're merely guidelines, and not written for the diabetic cat. I'd recommend you weigh your Wynken at least weekly for the time being (for a time, my current vet had me weighing her daily). If you're going to reduce his rations, do it slowly, though - it's a safer approach.

Cara, I realize that you have some special hurdles that I don't have (Bat is an "only" cat & I don't work outside the home, either) so some of my suggestions may not work for you. And I know you're doing your best, too.:bighug:
 
Robin, you are so sweet. I just love all the things you are thinking of, to help me try and get Wynken where he needs to be...:D:bighug: I should explain a little better. I have 11 cats, down from 14, twelve months ago... When I take in a kitty, it's a til death do us part thing, if they can't get a better situation (and be someone's ONLY CAT!:cat:) I have lost 5 in the last two years, all to geriatric issues. Prior to those losses, I think I was in denial that they would all live to be 30. Until 2005, I fed mostly kibble. Because it was convenient. :facepalm: Then I had several kitties with urinary issues, including Wynken who ultimately needed a urothrostomy. :eek: But he recovered just fine. It was at that time that I started to feed wet food to quite a few of them, exclusively and to EVERYONE, about half the time. I also researched what the better foods were, ingredients, etc and had a pretty good idea of what to look for…. Then there was Wynk's DKA in the Spring of 2012, and insulin. So he has kibble only once since then, and that was a misunderstanding with his pet sitter.

There is no way for him to get to anybody else or their food. Wynk & Blynk have been together since birth, both congenitally deaf and have always been segregated from the others (tried to integrate them in 2004 when they were kittens -no dice!). So they have their own generous quarters, a large sunroom with access to a Catio of sorts (absolutely unable to get out of that because they are deaf, and that would just be dangerous!). Now very occasionally, they actually get a bird or a mouse. And they eat it. That happened a couple months ago, and I even tested him afterwards (not knowing who ate the mouse, or maybe they shared it?). His BG seemed unaffected.

So, you have made GREAT points and I appreciate your input. I am going to try and watch them eat, and see if I can't discern how much he's getting. And he's easy to weigh, so I can do that more often & start putting that in the spreadsheet too. Tonight, (the last week or so, really, I think) his nadir is later (started a new thread to discuss this).... Still learning about that, too.

Thanks again for reminding me about weight awareness, weight management and portion size. This will ALL help him. I will come up with something!
 
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My babies. I still call them this, because at 12, they ARE younger than many of my kitties. They "mostly" love each other. :joyful:
 
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