Chuck's bouncy Journey part 2

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StephG

StephG

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So +4 is 284. I planned on giving an ounce of food for a snack to increase his calories but I'm sure if I do he's going to stall and be back into the red by PMPS. Should I just say oh well and adjust PM dose to cover extra snack?

If I feed him 3 oz 4 times a day that is 12 oz and 2 cans plus an ounce. Each can has about 160 kcal per can. So with 8oz a day he's getting about 230-235 kcals per already. 10 ounces would give him about 290-300 a day.

If I do feed him 4 small meals 2-2.5 oz a day he will get 8-10 oz a day. How do I adjust the insulin? If I give 3 units with only 2oz of food I'm afraid he'd tank at +3 or sooner. If I don't give the normal dose he will spike after each meal. So how do I account for the later meals or would I change the insulin to every 6 hours to keep him on a more level surf?

I get talking in circles in my own head and it shows when I think out loud here! :oops:
 
I'm looking into lower carb options for him too. I can't afford the good stuff! But thought about getting the EVO for a snack/treat to help gain but I can only find that in dry.
 
+5 235. Going to give an ounce of food for snack. I am hesitant because his bg is going to go up but he needs to get the calories.

I did use the equation on the site for how many calories he should get. I used 11-12 pounds for the weight he should be, instead of 9 for the weight he is... that is how I got the 4 oz per meal that I feed him now.
 
1 oz snack given at +5. His normal food. +6 245, up 10 points from +5. Glad it not a huge spike, yet.
 
Looking good. Steph, I do think you need to work with the possible higher numbers while you get his weight back up - if higher numbers are the result. It doesn't always work that way - sometimes small frequent meals of lower carb keep the numbers flatter. And then in some cats, more food =higher levels. I'd say feed more and work with the numbers like you have been, until his weight stabilizes.
 
PMPS was 585. Gave 3.5 units. +2 is 496. Maybe I should have given 4 since he will be getting an ounce snack at +5...
I want him to gain weight but I don't want to risk DKA with the high numbers. I was tempted to give him another 0.5 units but figured I shouldn't since I won't be up to check him between +6 and AMPS. DH can check him at +7 or +8 but if he's going low he will wake me up to deal with it. I'm already running on just a bit shy of 3 hours of sleep last night.
 
So, looking back at the past few cycles. 1.5 on the 238 gave you some early yellows and a higher pmps, so maybe a little too little. Today for 257, 3 units, the numbers looked worse

What do you think about 2 for the yellow preshots for a few cycles? I think the doses for reds and blues look okay, giving you a nice amps.

He is very volatile, Steph, and I think looking at Teasel's spreadsheet is a good idea. Both kitties seem to bounce a lot, and maybe flattening out the dose will help calm him down?
 
Today's 254 was a false low, I believe. I guess it's possible he spiked to over 600 in 25 minutes that would be about 350 point spike.
I should have given him 4 units tonight on his 585 with snack coming later.
I think I can do the 2 units on yellows. Should I stick with 2 on yellows even when there's no snack planned?
Should I increase the blacks to 4 units and keep it there? Or stick with 3.5 on blacks and 3 on reds?
Keep the blues at what 1 or do the wait 2 hours and shoot thing?
Ok so... ? to try to keep him at a flat dose in certain ranges: correct me where you think it would be better to change it.
1 on blues
2 on yellows
3 on reds
4 on blacks

Side note: I gave him his 1oz snack at 1010. I forgot to pick up the dog food AGAIN. I'm going to move it right by my computer so I'll be logging numbers while she eats between my feet. That way I can't forget. Good news: he didn't eat any dog food! He curled up in his chair by the window and of course watched to see what I was doing as i walked through the dining room. So the snack seems to help him chill out. Hopefully it's not from high numbers. I'm going to my local feed store to see if they carry EVO. They carry a bunch of "specialty" pet foods.

Is EVO cat/kitten dry kibble actuallly carb free?
(I'm following the new USA food list data search thread.)
 
On Teasel's ss it shows a mid day number at 401 today then PMPS was only 257. Does that imply that her pancreas is actually doing some work or that the bounce was triggered and the rest of the insulin was used up with the bounce? Or is that really impossible to tell?
Almost always-- once Chuck starts going back up-- that's it- he's going up. So does that show that his pancreas isn't doing ANY work?
My brain is foggy. I'm off to bed after one more reading. I'll have DH get a reading once he gets home from work around +7.
 
I don't mean 1 unit/2 etc. I am just thinking if the doses were in a closer range. I am not explaining this well, but not sure how to say it. My thought is if the dose for yellows vs the dose for pinks were less of a jump. So if the dose for 200-300 is 2 units, then the dose for 300- 400 is 2.25 or 2.5, 400-450 2.75 or 3 units etc. He is bouncing a lot. Teasel has this same issue, bouncing when there iseven a little variation in dose.. @ Kris & Teasel has been trying with this with success, slowly varying the dose by small amounts. Kris, can you explain your process?

Sorry forgot about the false low. I do think your dose for the reds/blacks are good.

At this point, I don't think Mr. p is around, but I have hope that he'll be visiting soon.
 
Ok. I see. Should I try to get him into a pink or yellow preshot number before I start the lower and closer in range doses? Today he got a snack so that explains the spike. He got another snack tonight but I won't be home to give him a snack tomorrow so he might get a better PMPS to start the new doses?
If not, do you think it would be a good idea to start with 3 being the mid number like, 2 yellow, 2.5 pink, 3 red, 3.5 black? Or is that still too big of a difference?
2 yellow (2.25 for higher yellow?)
2.25 pink (2.5 for higher pink?)
2.75 red (3 for higher red?)
3 black (3.25 for higher black?)
Or would the higher/lower idea give it too much variance day to day? Hah. I feel like I'm learning all over again! Never too old to learn! I do appreciate your help.
 
Would it be a NS for blues?
Side note: this would be much easier for DH to follow! No more early wake up calls on my days to sleep in! hah. Or so it should be anyways.
 
Steph, let's restart this discussion in the am after a good nights' sleep. I'd like to give you a scale that makes sense, but I am too tired tonight. Also I'd like Kris to help us. She has put a lot of time thinking about Teasel's bouncing. Is that okay?
 
Sue and Oliver (GA) said:
Steph, let's restart this discussion in the am after a good nights' sleep. I'd like to give you a scale that makes sense, but I am too tired tonight. Also I'd like Kris to help us. She has put a lot of time thinking about Teasel's bouncing. Is that okay?
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Oh good! I'm exhausted too! We are off to bed! I welcome all the help I can get!! Thank you!
 
Good morning! +8 was 201!
AMPS 204! DH fed the whole can, *sigh, he thought I meant he gets the whole can at once instead of total throughout the day. Only shot 1.5 units because I won't home to monitor. +0.5 was 325 so that's a good sign! DH will check at +3/3.5 and maybe give snack if he's going too low. So nervous since that 155 and 1.5 unit drastic drop.
I think that snack help him from going too low and he surfed instead of bouncing! So hopefully he will do the same today!
 
Hi Steph,
Maybe feeding him more is a good idea if he still needs to gain weight (I've also been reading your thread on the main board). When Bunny was first diagnosed he was really skinny. I fed him as much as he would eat at AMPS and PMPS and left some in his auto feeder during the day. It seemed to help. He has gradually gained a little weight and now I am reducing the total amount fed. He doesn't notice. I think in the beginning he was ravenous because his body couldn't absorb the nutrients correctly. Now, he needs a little less because he is healthier, overall. I'm sure you've thought of this, but thought it might be helpful to hear from someone who had a similar experience with a skinny cat who had high BG numbers and did some bouncing :).
Angela
 
I want him to get as much as he needs but I want to give him the extra as a few snacks throughout the day. He would eat til he puked I'm sure. I need to look into an auto feeder. Just have to figure out how it's going to effect his bg levels and how much insulin he needs to keep him under 300 at least. This weekend and next week I'll be able to monitor during the morning/day so I'll be able to give consistent doses and see how it changes.
I'll need a hefty/strong one because he has claws and can open just about anything. Caught him the other day trying to and almost opening my roll top desk! Little stinker!
 
When I said "as much as he would eat", that was an exaggeration :). I gave him 2, 3-oz cans or 1, 5.5 oz can in the morning and evening and left another 3 oz serving in his autofeeder during the day and overnight. The "double dose" kept him sated but not so much so that he wasn't hungry at shot time.
 
StephG said:
On Teasel's ss it shows a mid day number at 401 today then PMPS was only 257. Does that imply that her pancreas is actually doing some work or that the bounce was triggered and the rest of the insulin was used up with the bounce? Or is that really impossible to tell?
Almost always-- once Chuck starts going back up-- that's it- he's going up. So does that show that his pancreas isn't doing ANY work?
My brain is foggy. I'm off to bed after one more reading. I'll have DH get a reading once he gets home from work around +7.
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Hi Steph,
That red mid day yesterday was probably a dud - look at some other days. I try not to focus on individual numbers for the most part but look at the trends instead. Teasel is very jumpy and you can see that I hold doses constant for several cycles and only change them by miniscule amounts. One difference is that Teasel doesn't spike into blacks.
 
AJHJ said:
When I said "as much as he would eat", that was an exaggeration :). I gave him 2, 3-oz cans or 1, 5.5 oz can in the morning and evening and left another 3 oz serving in his autofeeder during the day and overnight. The "double dose" kept him sated but not so much so that he wasn't hungry at shot time.
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Hah. I'm a little dense sometimes! I thought you were like free feeding.
 
Sue and Oliver (GA) said:
I don't mean 1 unit/2 etc. I am just thinking if the doses were in a closer range. I am not explaining this well, but not sure how to say it. My thought is if the dose for yellows vs the dose for pinks were less of a jump. So if the dose for 200-300 is 2 units, then the dose for 300- 400 is 2.25 or 2.5, 400-450 2.75 or 3 units etc. He is bouncing a lot. Teasel has this same issue, bouncing when there iseven a little variation in dose.. @ Kris & Teasel has been trying with this with success, slowly varying the dose by small amounts. Kris, can you explain your process?

Sorry forgot about the false low. I do think your dose for the reds/blacks are good.

At this point, I don't think Mr. p is around, but I have hope that he'll be visiting soon.
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Steph, the best way to see what I do is to look closely at the dose numbers on my SS. In my head I'm always saying - in regard to dosing Teasel - no sudden moves! I'm tip-toeing around the dosing, if that makes sense.
 
Kris & Teasel said:
Hi Steph,
That red mid day yesterday was probably a dud - look at some other days. I try not to focus on individual numbers for the most part but look at the trends instead. Teasel is very jumpy and you can see that I hold doses constant for several cycles and only change them by miniscule amounts. One difference is that Teasel doesn't spike into blacks.
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Yeah, I always assumed he spikes into blacks because he uses up all the insulin then it's a free for all with a sleeping pancreas.
I am willing to try using your game plan with the doses. I just don't want to be too low or too high with it. I rather keep in pink or below. Terrified of DKA. He's never had it but I don't want to change that history either!
 
Oy! DH just called, +3 was 400. :banghead:
Hopefully he will continue to keep going down. If he spiked his usual 300ish he's still going down. Won't be able to check again until +10 or @pmps.
 
Another stab at explaining my approach:

1. My goal right now is to find a dose that will eventually give me an OK AM/PM preshot - yellow range for now (regardless of number in yellow). If/when I get there, I'll worry about the nadir number, unless he tanks on a given day, of course! So far Teasel's AMPSs are looking better than the PMPSs so I'm focusing on the AMPSs because he probably goes lower at night. I'm ignoring the size of the PMPSs (food, squirrels, etc.).

2. Once I get a dose that gives me a string of yellow AMPSs for several cycles, I stay there and look at the rest of the day over several (2? 3?) days. If BGs stay flat and high-ish (pinks), I boost the AM dose by a TINY amount. Unless something changes, I only make dose changes in the AM so I can monitor during the day. I give the same dose AM and PM regardless of the PMPS because I know he's likely lower through the night than through the day (no food, night time physiology, etc.).

3. If I see a blue AMPS I have to stop and think carefully about what to do. If it's at/near Teasels' "no shot" number - 180 for me - I'll give the same dose as previously but will monitor more frequently. In the past, I've dropped his dose by various amounts when I've had a blue but ended up having to increase eventually. If it's a little too low in the blue for comfort, I'll stall and retest until it's close to 180. The longest I've had to stall so far is 65 minutes.

4. My dose changes right now are very small, smaller than they were in the past because my SS shows how volatile Teasel is.

5. Since I began here on FDMB, the sugar dance with Teasel has run us through a variety of ups and downs in dosing (SS). I think we're getting closer to better numbers now so dose tweaking has been refined.

Having said all that, this morning I had a green AMPS so I didn't shoot. He'll be high tonight and, depending on what I see, I'll go back to his usual dose. If I'm successful in varying his shot site, I'll need to get data about how that affects his BG numbers and will let that guide the dosing. My basic method won't change though.

I hope this helps! I've already described how I feed Teasel. :)
 
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I will read and try to comprehend that once the little one watching lays down for a nap. Til then I have a 3 year old maniac demanding all of my attention.
 
StephG said:
Yeah, I always assumed he spikes into blacks because he uses up all the insulin then it's a free for all with a sleeping pancreas.
I am willing to try using your game plan with the doses. I just don't want to be too low or too high with it. I rather keep in pink or below. Terrified of DKA. He's never had it but I don't want to change that history either!
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My understanding of the spikes is that the cat's body reacts to a lower than accustomed (not necessarily too low) BG level by mobilizing the biochemical processes that convert glycogen stored in the liver to glucose that circulates in the blood. Others on here refer to it as "liver panic" as a layperson's way of describing a complex process. So it's not strictly a matter of Chuck's unregulated BG numbers coming to the fore. In fact he's overcompensating for lower BG numbers than his body is used to caused by the insulin therapy. It takes time for their physiology to learn to cope with the lower BG levels and they'll bounce until it does. Some cats bounce for a long time: Teasel has been at it for over 8 months now.

I understand your fear of DKA. I've lived it - Teasel spent 3 days in hospital with it at the end of March this year. The reasons it happened are complicated: not doing well on Lantus that he was put on at diagnosis (plateaued in high numbers), stopping Lantus for 48 hours to try a restart to shift him ..... I could go on but won't. It was very expensive, he took weeks at home to recover and I learned a lot. He went on ProZinc right after he was stable post-DKA.

The best ways to keep DKA at bay are enough food, keeping BG down as well as possible (but don't worry about every single number!), adding warm water to wet food for extra hydration, and urine testing for ketones. Anything above trace needs vet attention stat!

I've outlined my methods for Teasel. They might give you a general guide but Chuck is his own cat and might have much to reveal to you. :)
 
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Good morning, Steph. Thanks, Kris. I was trying to think about your method, but couldn't explain it. It is the smaller increases I think are wise - so if the 1.5 or 2 works for the yellows, then let's settle on one and keep it there if possible. Let's see how the 1.5 does.

The complicating factors for Chuck are the high pmps numbers and the fast rise he gets in the am. Re the AM - I can't decide if that fast rise in am is food (because it doesn't happen in the pm - he just starts down then) or it is a later bounce from the night before. But the last three mornings have been encouraging and I think we enjoy them. If we just accept that usually he rises right after the am shot and then drops, then we can concentrate on night.

The pmps numbers are a puzzle. I don't know if they are a bounce because they are such an anomaly. He would be bouncing from the cycle a full night before (when he drops such a big drop, from 500 to the blues sometimes) and the bounce wasn't reflected in that day cycle. How about if we settle on a little lower dose for the pm and see what he does? My thinking is that those blacks don't seem to fit with the rest of his numbers. He clearly needs more than 2 units for those (I think anyway) but I wonder if we even things out more (by even out I am thinking the big difference between 1.5/ 2 units am and 3.5 pm.). What about 3 at night for a few cycles for those highs? See what that does.

So either 1.5/2 for yellow am (whatever you think and depending on how today looks) and 3 for pm. And see if things settle down?

As far as the food. You could feed him small frequent meals (divide the amount you want to feed in the meals you want) or feed him 3 times a day or twice daily with a snack in between. I'd just try to see if you can get a higher calorie food that is still low carb (buy a few high calorie more expensive brands and mix 1/4 can with the regular each meal?) or mix some protein in his regular food. (for example, you could bake chicken and shred some into his regular food every meal to increase the calories and give him some extra protein). And maybe up the amount overall - if you haven't- so if he was getting 2 (3oz) cans daily, maybe make it 3. Yes, extra food may mess with the numbers (raising them after eating) but once you have a plan for food and it is consistent, we just see the changes it makes in levels, if any, and know they are part of the picture.

I am looking for something that will help with the wild swings from yellows to blacks, because they are hard to deal with and not good in general. I wish I could say "just do this and it'll work" but as Kris says, this insulin is so dependent on each individual cat's reaction to it, that the same plan for each cat doesn't work. Chuck's patterns are not like ones I have seen - those high levels at night are not logical to me.
 
"So either 1.5/2 for yellow am (whatever you think and depending on how today looks) and 3 for pm. And see if things settle down?"

I can do that. I can also put some chicken in his food for extra calories and protein... how much should I add per feeding?
I always thought the higher pm number was from not enough insulin in the morning... he just never gets much lower after his meal spike... I figured if I gave him more in the morning to get him into the yellows or blues that he would be yellow or pink for PMPS. But either way the 1.5 or 2 is more than I've been giving him in the mornings so it should help. I'm going to look for u40 syringes with half unit marks. That way I won't give more by just guessing where half is.
Thank you both for all the info and going out of your way to explain it. I think this technique makes sense and I can't wait to try it. I'm scared to try the morning doses until I can monitor but I think the 3 units in pm might give a higher AMPS so I might feel more comfortable anyways.
 
StephG said:
"So either 1.5/2 for yellow am (whatever you think and depending on how today looks) and 3 for pm. And see if things settle down?"

I can do that. I can also put some chicken in his food for extra calories and protein... how much should I add per feeding?
I always thought the higher pm number was from not enough insulin in the morning... he just never gets much lower after his meal spike... I figured if I gave him more in the morning to get him into the yellows or blues that he would be yellow or pink for PMPS. But either way the 1.5 or 2 is more than I've been giving him in the mornings so it should help. I'm going to look for u40 syringes with half unit marks. That way I won't give more by just guessing where half is.
Thank you both for all the info and going out of your way to explain it. I think this technique makes sense and I can't wait to try it. I'm scared to try the morning doses until I can monitor but I think the 3 units in pm might give a higher AMPS so I might feel more comfortable anyways.
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Hi Steph,
U40 syringes with half unit marks will help but if you find later on that you need even smaller dose fractions, U100 syringes can be used along with a conversion table. It's actually quite simple once you get used to always referring to the table. This method allows you to give 0.2, 0.4, 0.6 and 0.8 of a unit fractions. http://www.felinediabetes.com/insulin-conversions-printer.htm
 
@Sue and Oliver (GA)
Hi Steph,
Would there be any merit in trying an 11/13 dosing schedule so you hit Chuck with insulin 1 hour earlier in the PM (at+11) and maybe forestall the extreme high at a +12 PMPS? Then you'd be doing the AMPS at your normal time (making it +13) and you'd see what that does to his AM number. It might result in him needing an AM dose tweak. I don't recall if this was suggested previously.
 
I wonder if Chuck is doing the same as Cappuccino - she doesn't curve, she slides and the view of the specialist is she has a long duration of action with nadir very late and sometimes at 12 hours or longer, to complicate things she does head up with a food spike as well. Some days I can't shoot in the evening (even with the scary dose instructions) I experimented a couple of days by extending the PMPS out to 13 hours and did get a number I could shoot, albeit after the +1 was known. A week ago I had to give her PM dose early and I think got significant overlap as her numbers headed down and despite steering with food we had a night of testing - we both were fed up by 2 am but I figured she was safe by then, which she was. Not doing that again!
 
I will try the steady dose first. We do give insulin early or late more often than I'd like because of schedule conflicts. It's gotten better since we switched back to around 5:30-6.
 
Ok +11.5 and he's 516. First reading said "HI" So I tested again and got the 516. I fed him the whole can- which was only 5.3 oz plus .5 oz of pumpkin and possibly a snack around +6. Shredded chicken, 0.5-1 oz.
Question is: Should I give him the 3 tonight or the 3.5?
 
Another data point, Steph. He's as much a mystery in his own way as Teasel is in his. All we can do is try different things and gather data. Others have said you should focus first on weight gain and accept higher BGs that will probably be part of that. He'll be less vulnerable overall if he has more weight on him. Cats can generally tolerate hyperglycemia better than humans and dogs. Yes, DKA is a nasty complication but I wouldn't focus on that alone in making dosing decisions. You're testing for ketones and that's your best tool for now. :cat:
 
Quick question on carbs. With the "as fed" percentage and the "dry matter" percentage... Is the dry matter percentage the one I want to follow? As long as it's based off the "as fed" numbers?
 
Here's a reply that Mogs made to someone else's question:

You need to go by the % of calories from carbs being under 10%, not the dry matter carbs. It might make a difference when determining which foods are suitable.

For anyone reading who hasn't already got one, here's a carb & calorie calculator:

http://fnae.org/carbcalorie.html

Mogs
 
StephG said:
:confused: So why are they trying to get "as fed" values on this thread? http://www.felinediabetes.com/FDMB/threads/usa-food-list-anyone-willing-to-help-update-it.164222/
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The manufacturers would not do the dry matter formulation so getting the "as fed" by values gives the starting point

As was stated on:

http://www.felinediabetes.com/FDMB/threads/usa-food-list-anyone-willing-to-help-update-it.164222/


"So, an initial task would be to contact food manufacturers and ask for the current as fed values. (Some manufacturers are more helpful than others...) It could take time to get the answers needed. So patience will be required. ;)
Then, carb calculations would need to be done. (That's not so bad. A spreadsheet can do the calculations, so it only requires that the data is entered.)
Then the info needs to be added to a list."
 
Ok so I should use the AS FED values in the calculator that Kris & Teasel reposted on this thread?
Ok so i used the as fed values and the document shared for 9Lives has the carb % already listed So the food he's getting is 31 calories per ounce of food and 1.52% carbs.
 
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StephG said:
Ok so I should use the AS FED values in the calculator that Kris & Teasel reposted on this thread?
Ok so i used the as fed values and the document shared for 9Lives has the carb % already listed So the food he's getting is 31 calories per ounce of food and 1.52% carbs.
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Which 9Lives are you feeding? We have that portion of the chart finished if you want to know the % calories from carbs, I can look it up. We're having trouble getting info from some of the other companies, so I don't know when we will post the chart.
 
Super Supper 4.5% calories from carbs
Chicken & Tuna 3.9% calories from carbs
Ocean Whitefish 2.9% calories from carbs
 
Those are good right? And thank you!
I think I had a moment of clarity... or maybe just less foggy haha
Chuck's increase in sugar after his insulin Nadir is a bounce because he should surf if his body wasn't trying to compensate?
So if his body wasn't doing it's liver panic he should stay in a range around his +6 of 273?
Like last night his +8 was 201 and his AMPS was 204 so he may have gone a bit lower between the two or he surfed.
Am I way off or am I FINALLY actually understanding the bounce?
 
StephG said:
Those are good right? And thank you!
I think I had a moment of clarity... or maybe just less foggy haha
Chuck's increase in sugar after his insulin Nadir is a bounce because he should surf if his body wasn't trying to compensate?
So if his body wasn't doing it's liver panic he should stay in a range around his +6 of 273?
Like last night his +8 was 201 and his AMPS was 204 so he may have gone a bit lower between the two or he surfed.
Am I way off or am I FINALLY actually understanding the bounce?
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Ideally with ProZinc, the BG numbers should start off at AMPS at some decent value in the low to mid 200s, gradually fall to a nadir mid-cycle in the low 100s or high double digits, then gradually rise again to a PMPS that's close to what AMPS was. On a graph this would look like a smile-shaped curve. If there's bouncing you might see a nice descent to nadir and then the BGs go shooting up high to PMPS or you might see high, flat numbers the next cycle, next day, etc. There are lots of different bouncing patterns. My understanding of "surfing" as it's used here on FDMB is the BGs continue in a small range of values (eg. mid blues) for a longish period during a cycle. This has the effect of flattening the BG curve.

To come back to your question about Chuck's BG of 273 at +6: if that truly was a nadir, BG should gradually rise higher than that to end at some value at PS that's not extreme, eg., 400. It wouldn't be an ideal curve because that's too high a nadir value but it would be typical curve shape.

As for last night and this AM: if his +8 overnight was 201 and his AMPS 4 hours later was 204, he might well have gone lower between the two or he might have been surfing as you have said. You're clear on that bit.
 
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