Schatzie's numbers getting higher

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Michelle and Schatzie

Michelle and Schatzie

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Hi Everyone,

I have to admit, I'm freaking out a little right now. 11 days ago we raised Schatzie's evening dose from .5 units to 1 unit and her numbers started to look really good for a few days. She was finally getting low/mid 200's for both her morning and evening preshots.

Then I went on vacation for 4 days and everything went bad. She started showing mid/high 300s for both preshots (and other than on one occasion when she bounced she's NEVER had pink evening preshots until now). I hoped that maybe she was just a bit stressed that I was gone, even though my fiance was still here taking care of her, and would return to normal once I got back, but unfortunately that hasn't been the case.

Last night she had a 376 for her evening dose and this morning she is at 404! She's NEVER had a red number before--not even when she was still on the steroids and not yet on insulin and being tested at the vet.

I have no idea what to do or what is going on. Does she need a higher dose? I don't think she's bouncing, unless her nadir has suddenly moved later by several hours. I'm going to test at +3 and +5 today to try to get a sense of what's going on.

Other than an increase in her thirst/hunger she's acting normal.

Do you think a visit to the vet is in order? Any suggestions? I'm going a little out of my mind right now with worry...
 
Hey Michelle! First of all, it's going to be OKAY. I see you tested for ketones and it was negative a few days ago and you say she's been acting fine. The increase in thirst and hunger is likely due to the higher numbers...that's normal.

From the mid cycle tests I've seen, I think you might have some bouncing going on. You're hitting blues pretty early in the cycle from pinks...that could definitely cause bouncing to those higher preshot numbers. Which leads me to think Yong might be right and it would have been good to increase to .75, rather than all the way up to 1 unit. Any chance of getting a nadir test today or maybe a curve this weekend?

I don't think you need to go to the vet unless something else is going on..I'd keep testing for ketones every few days but I really think all is well since she is acting okay.

:bighug::bighug::bighug:
 
Thanks everyone for your replies. Sorry if I sound panicky--I'm just also dealing with Schatzie's asthma, which has gotten worse again this past month due to the pollen (and I no longer have the option of giving her the steroid pills in addition to her inhaler since that's what caused the diabetes in the first place!). Toss in the fact that I am wrapping up my PhD and you get a major case of the crazies!

I only teach an evening class today and so I can be here to test up to +9. Should I do a test at +3, +6 and +9? Or do you recommend a different schedule?

I purchased U-100 syringes yesterday and so I should start to be able to fine tune my doses more easily from here on out. Do you recommend dropping her evening dose to .75? Or should I also lower her morning dose to .75 as well?

I forgot to update the spreadsheet, but I tested for ketones again yesterday and she was still fine.
 
Michelle and Schatzie said:
Thanks everyone for your replies. Sorry if I sound panicky--I'm just also dealing with Schatzie's asthma, which has gotten worse again this past month due to the pollen (and I no longer have the option of giving her the steroid pills in addition to her inhaler since that's what caused the diabetes in the first place!). Toss in the fact that I am wrapping up my PhD and you get a major case of the crazies!

I only teach an evening class today and so I can be here to test up to +9. Should I do a test at +3, +6 and +9? Or do you recommend a different schedule?

I purchased U-100 syringes yesterday and so I should start to be able to fine tune my doses more easily from here on out. Do you recommend dropping her evening dose to .75? Or should I also lower her morning dose to .75 as well?

I forgot to update the spreadsheet, but I tested for ketones again yesterday and she was still fine.
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You're doing all the right things. It's difficult to handle more than one health issue at the same time. She'll be OK - you've been frightened by her first bouncing episode, that's all. The U100 syringes are really useful in fine tuning doses.
 
Thanks for the reassurances.

Thoughts on whether I should just change the evening dose to .75 or should I lower the morning dose as well? Or should I wait and see what the numbers today show?
 
Michelle and Schatzie said:
Thanks for the reassurances.

Thoughts on whether I should just change the evening dose to .75 or should I lower the morning dose as well? Or should I wait and see what the numbers today show?
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Your SS is showing 1.0 u for this AM. Has that been given? If you want baseline data, you could stick with 1 u today and tomorrow and aim to do a full curve on this dose (test every two hours between AM and PM shots) tomorrow. That might give helpful data. You've been testing a lot and that's good but we need to see the full action profile of this dose over a 12 hour cycle.
 
If you can get the tests in up to +8, she'll most likely be rising by then, so you could stop until the PS at +12. Is there a reason you're getting +11 tests instead of +12 tests?
 
Djamila said:
If you can get the tests in up to +8, she'll most likely be rising by then, so you could stop until the PS at +12. Is there a reason you're getting +11 tests instead of +12 tests?
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We give Schatzie her shot at 7:30. My fiance gets home from work typically around 6:30-7. Schatzie is used to being fed right as soon as someone gets home--to make her wait 30 minutes to an hour would probably stress her out quite a bit. Since I know that feeding and then testing 30 mins later would give inaccurate results we normally test her a little early for that PMPS.
 
I've finished the curve and am not certain what to think. I wish she would drop slower and stay low longer--she does seem to hit her nadir around the 4 hour mark and then just goes up from there...I'm afraid to see what her PMPS is going to be.

Any thoughts on tomorrow's dosing? 1 unit AM/.75 PM?
 
I'm curious what others will say, but I think your curve looks good! You're getting nice drops from the pre-shot to the nadir. Yes, overall the numbers are still higher than you'd like to see, but considering you're just getting started, I think you're on the right track. The increase to 1.0 might have been a little quick, but since you're there, my thought would be to stay with it for a few more cycles, and keep monitoring as the bounce settles. That will likely take a couple of days.

You do have two NS's from the 1.0u dose, which might indicate the dose is a little high. However, one of them was a 191, which you could have shot (you are home testing now, so you can shoot a little lower than 200 as long as you monitor), and the second one was at +11 - some cats make a pretty big jump between +11 and +12, so that one is hard to say. I've seen spreadsheets that show a jump of over 100 points in that last hour. So she may or may not have increased at that point - hard to say.

Are you around this weekend to keep monitoring?
 
I suggest staying at 1.0 u AM and PM for a few more days. Aim to get one or two mid cycle tests while on that dose to evaluate it further.
 
I agree...I think I'd stick with 1 unit for a few days and see what happens...can always lower it if you find that it isn't working out.
 
Not that bad for a first curve :). I think there was a little bouncing today too, so getting some more mid-cycle readings this weekend should give better insight to the 1.0U dose.
 
Another thing to consider is when you're feeding. Some cats will go up faster if they get food after +6. My cat raced to the top if he had any carbs after +6.
Once you get comfortable and have more data you could try moving meals closer to before +6 or make the meals after +6 smaller portions (but still feed the same amount over the 12 hr cycle).
 
Thanks for your replies, everyone! Sorry to just now be responding--I posted right before I left for my evening class and then got home late.

I agree that the curve looks good overall, but what I find confusing and concerning is the fact that Schatzie's numbers are getting higher and higher. If she were totally new to insulin it would be one thing, but as of today she's been on insulin for 6 weeks (we didn't start testing until the middle of the second week). Up until about a week ago her SS was primarily yellows and blues with some pink AMPS and some green nadirs.

What I don't understand is why a week ago we suddenly went up to pink and red AMPS and pink PMPS. If this were bouncing, why did it wait 5-6 days after starting the new dose to start happening? Is this common? And if it is bouncing--she's been on the new PM dose for 12 days now. Shouldn't things have adjusted by now?

I'm just worried that something else is going on--that she's developed some sort of an infection or something that is driving her numbers up. And so I don't know if she has something else going on and needs a higher dose or if she's bouncing and potentially needs a lower dose...ugh. I just hate to think that her numbers might continue to go higher and higher.

Also, what in the world happened last night? Her +8 was almost 100 points higher than her +11! Would feeding her a quarter of a can of Friskies at +6 have made that happen?!

Sorry to have a million questions and concerns--I know that you all suggested sticking with the new dose, but I want to see what you think now that we've got such a high AMPS again.
 
I think the 1 unit looks good for her AM dose. If you can, try to get some mid cycle tests on the pm cycle. +4, +6, +8 range... Some cats need less insulin at night... It could explain the higher AMPS... It could be that she is spending more time in blues and bouncing a bit from that.
I'm sure the others will be along soon to help out too.
I think it's possible the food raised her bg from +6 to +8 and her body or the rest of the insulin helped bring her back down. But it's nice to see that she went back down after the +8 reading.
 
Bouncing can happen at any point...not just dose change. It's possible that Schatzie was stressed by you not being there so was getting higher numbers...but then the dose was bringing her lower (even if it wasn't too low, just going lower than she's used to can cause it) and the bouncing began! Bouncing can take time to settle down, but usually staying at a steady dose for a bit helps that.

As for the possibility that something else is going on..when did you last have her into the vet for a checkup?

The +8 last night could have been food influenced, it could have been a hairball, it could have been what we call "oh look a squirrel!" syndrome. Basically, that number was just one number and I wouldn't worry over it (and you're talking to the queen of worrying over everything!). Remember that Schatzie is more than just a number...how does she SEEM? Is she purring, peeing, pooping, preening, and playing (the 5 p's).

Don't ever apologize for questions or concerns! That's why we're here...we all feel the same way. We had millions of questions when we started and we want to pay it forward for the people who helped us! And as for concerns...well you are NOT alone in that! We all tend to be more concerned as kitty parents...but that's part of what makes us so good at caring for them! :bighug:
 
An infection is always a possibility. The only way to know is a vet visit. Are you seeing anything else that makes you think she might have an infection? When was her last dental cleaning?

As far as the dose, you need to look at the data on the pre-shot and the nadir to know what a dose is doing. So far, many of your mid-cycle tests indicate that the drop is at least 50%, and anytime the BG is dropping that far, it can cause bouncing. Which means that you aren't looking at one bounce in your data, but possibly several bounces over the past 12 days.

Lows: 4/17AM, 4/21PM, most likely 4/22PM, 4/23PM, 4/26AM, 4/27AM, 4/28AM There may be more than that, but those are cycles with mid-cycle data to know for sure.

Any of those cycles listed could cause a bounce to higher flatter numbers for awhile. And if all of them caused bounces, then that is why you're seeing this run of high PS numbers right now.

What we often see is an active cycle (more than 50% drop), followed by high flat cycles. Then the bounce clears and there is another active cycle, and then a few more high flat cycles. The high flat cycles can make you think the dose isn't working, when really it's just the body trying to adjust. That can typically take anywhere from 3-6 cycles to clear and get another active cycle. The active cycles are the ones that inform the dosing. The high flat cycles you have to just try to ignore.

The thing that makes it hard is the work and feeding schedule. When we work during the day, we have to kind of guess at the mid-cycle numbers, and the +11 tests are an extra complication. I totally understand about that, so please know that isn't said with any judgement - it's just noting a reason why it can be a little hard to tell for sure what's happening.

Assuming there isn't an infection, my thought is to ride this dose for awhile. Eventually either the pre-shots will start to come down, or the cycles will flatten out and you'll need an increase at that time. Right now though, adding extra insulin to already active cycles will probably just cause more bouncing.

You're doing a great job with testing by the way, and with thinking about the data you're getting. And I echo what Rachel said....as much as we are all hyper-data driven around here, considering how your kitty is feeling and acting is important too!
 
Yes, I was VERY surprised when my fiance sent me that PMPS number. And glad I could enjoy my Friday night a bit more because of it!

I agree with you about 1 unit for the AM dose--she seems to have been doing well with it. I'll try to grab more PM cycle tests (ugh).
 
Djamila said:
An infection is always a possibility. The only way to know is a vet visit. Are you seeing anything else that makes you think she might have an infection? When was her last dental cleaning?
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This is where things get a bit tricky (or should I say trickier, haha). Schatzie definitely has dental disease. In fact, this is what caused all of this asthma complications/steroid-induced diabetes in the first place. Back in September I took Schatzie in for her annual check-up and wanted to schedule a dental cleaning because I knew she needed it. Unfortunately, I found out that my vet requires all vaccinations to be up to date for dental cleanings since the cats have to stay at the vet for several hours. I had been choosing to NOT update Schatzie's vaccinations since she was diagnosed with asthma a couple years ago, but I listened to the vet when she said it would be fine and let her do it. A week later Schatzie started to have asthma attacks :-( She went from 3-4 attacks a year to 2-3 attacks a week! I can't guarantee it was because of the vaccines, but...that would be a huge coincidence if not.

So that started the cycle of adding prednisolone steroid pills to her daily inhaler to try to (unsuccessfully) control the asthma, which then led to diabetes...*sigh*

Then there's the complicating factor that Schatzie has been on a low dose of doxycycline, an antibiotic with anti-inflammatory properties that can help asthmatics, since February. This is probably the only thing keeping her from having more asthma issues now that she's off the prednisolone...but I'm wondering if it could lead to resistence to antibiotics?

She hasn't been displaying any symptoms of infection or sickness...she's doing the 5 P's as usual (a little less running, but that's typically when her asthma is flaring).

She was last seen by the vet in early April, her last round of bloodwork, etc was in mid-February.
 
I forgot to mention--we haven't even done the stupid dental cleaning yet because I'm not willing to risk putting Schatzie under anesthesia when she is having breathing problems. So who knows if that is suddenly causing issues.
 
Wow, she's had a rough year! So now that she's up to date on the vaccines, is she going in for cleaning/extractions? Or is that on hold trying to get the asthma under control?
 
Michelle and Schatzie said:
I forgot to mention--we haven't even done the stupid dental cleaning yet because I'm not willing to risk putting Schatzie under anesthesia when she is having breathing problems. So who knows if that is suddenly causing issues.
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Ah, that makes sense. Dental disease can cause higher BG, so it may be a factor. There isn't really any way to know without getting the dental taken care of, but I completely understand your hesitance right now!
 
I may schedule a vet visit for next weekend if things don't improve this week.

So is everyone basically agreed that I should stick with 1 unit in the evening rather than dropping down to .75?
 
I wonder if it would be helpful to post about the vaccine/dental/asthma/antibiotic issues out on the main forum and see what folks out there say about that. I just don't know a lot about those factors. There might be someone with some experience around that who could give some advice.
 
Ha, yes, Schatzie and I have had a very rough year. Between the asthma, the diabetes and trying to finish writing and defending my dissertation I sometimes feel like my head might explode!
 
It's an art history PhD. I specialize in interwar German art and am writing about the politicization of motherhood imagery during this period. Basically how motherhood and female reproduction (birth control, abortion, etc) became political hot topics in Germany in the 1920s and how this carried over into the painting of the period.

Luckily I recently successfully defended so as of June I will officially have my PhD! :):):) Then I'll just have to worry about the impossibilities of finding a full-time job with an art history PhD, lol, in addition to my high-maintenance cat.
 
Michelle and Schatzie said:
It's an art history PhD. I specialize in interwar German art and am writing about the politicization of motherhood imagery during this period. Basically how motherhood and female reproduction (birth control, abortion, etc) became political hot topics in Germany in the 1920s and how this carried over into the painting of the period.

Luckily I recently successfully defended so as of June I will officially have my PhD! :):):) Then I'll just have to worry about the impossibilities of finding a full-time job with an art history PhD, lol, in addition to my high-maintenance cat.
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Great accomplishment! :D And female reproduction continues to be a hot topic ... :confused:
 
Thanks for the congratulations, everyone! Sorry to be so late responding--I normally receive email alerts when there's a new response, but somehow managed to miss these! And I've been so swamped with grading midterms and papers that I've been bad at checking in.

So Schatzie's pre-shot numbers are still not great and are typically higher than when we first started testing about 6 weeks ago. Any dosing advice? I'm torn between lowering her evening dose from 1 unit to .75 since she seemed to be doing better initially on a lower dose, but then the numbers really do seem like she needs a dose increase (maybe her increased asthma issues are causing higher numbers? She hasn't had any asthma attacks, but her meow is quiet and scratchy lately, which means she's having trouble with all of the pollen).

Thanks, Yong, for the thread on managing diabetes and asthma.
 
My vote would be for a dose increase to 1.25, but not until you can monitor, so maybe over the weekend? I'd wait to see what everyone else thinks too...
 
Djamila said:
My vote would be for a dose increase to 1.25, but not until you can monitor, so maybe over the weekend? I'd wait to see what everyone else thinks too...
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For just the evening dose or for both doses? The insulin definitely seems to drop her to lower numbers during the day than it does at night.
 
Hmm...that's a good question. It's hard to know without those nadir numbers during the AM cycle (Wouldn't it be nice if we didn't have to work? ;)) Her nadir looks like it's on the early side though, so likely not too much lower than the +3 numbers.

Option A: raise both, making sure you can monitor the AM cycle on Saturday and Sunday -- lower it back to one unit if she gets too green.
Option B: raise just the evening cycle for this week and then raise the AM cycle next weekend if the numbers indicate it.

Now that I'm talking this out, I would bet that she's hitting some high greens at +4 during the day, in which case you wouldn't want to raise that dose...so maybe go with Option B instead. Glad we've had this little talk....;):rolleyes::p
 
I am actually home during the day a couple times a week (when I teach evening rather than day classes) and so I can test her at any point. I've just been choosing to test her at +3.5 because that's when it seems like she normally reaches her nadir (at least judging from the days that I've done a curve or a mini-curve). So I'm not certain if she's really going lower than those low blues...

Depending on what others have to say, I'm leaning towards Option B right now. :)
 
I think option B may be best...but I would do it on a cycle I could monitor.

As for testing, if I may make a suggestion...I'd try to concentrate on getting numbers at different times during the day. Think of it like doing a curve over a number of days. So say one day you get a +2 and a +6...another day you get a +3 and a +7..etc. Doesn't have to be exactly those hours, but that will help you pin d0wn when the nadir is better without having to curve every chance you get and will also help you get a more complete picture of what the cycle is likely to do. Make sense at all or am I just blabbering? I do that sometimes :p
 
Rachel said:
I think option B may be best...but I would do it on a cycle I could monitor.

As for testing, if I may make a suggestion...I'd try to concentrate on getting numbers at different times during the day. Think of it like doing a curve over a number of days. So say one day you get a +2 and a +6...another day you get a +3 and a +7..etc. Doesn't have to be exactly those hours, but that will help you pin d0wn when the nadir is better without having to curve every chance you get and will also help you get a more complete picture of what the cycle is likely to do. Make sense at all or am I just blabbering? I do that sometimes :p
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Makes perfect sense!
 
I'm liking Djamila's option B and Rachel's plan. +3.5 is really an early nadir for Prozinc, so she may be going lower at more expected nadir time between +5 and +7 :)
 
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