Need feedback on cat's glucose curve

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MayL

MayL

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Hi everyone, Milo started Prozinc in late December 2017 at 2 units twice a day.

I bought the Alphatrak meter and started home testing. The first glucose curve on 1/13/18 showed 611, 397, 623, 638, 584, and 530. He was very stressed and we were very lousy at pricking his ears because it was our first time.

Our vet said to up insulin to 3 units twice a day and we did the curve again on 1/27/18 and we got 614, 458, 468, 385, 580, 582. Vet thought this was a good curve and he's not insulin resistant.

At his one month recheck at the vet, his fructosamine was 393. Not horrible. Vet suggests we move up to 4 units of insulin twice a day.

We did a curve on 2/18 and we got 646, 571, 474, 501, 533, 554. Vet is now concerned Milo might be insulin resistant. She suggests we test for Acromegaly and Cushings.

We have not increase his insulin - he is still at 4 units twice a day. Anyone have any thoughts on what is going on? Why did we not see an improvement when we up the insulin from 3 to 4 units?

Milo also has irritable bowl disease, stage two kidney disease and on hyperthyroid medicine. So lots going on with my old man. He's about to turn 18 years old! He is on prescription hills k/d wet and my vet recognizes this is not the best option for a diabetic but wants to focus on his CKD. I've read that many folks say forget the prescription diet and I understand, but I am also super nervous to not follow my vet's advice.

Any tips or thoughts would be wonderful!
 
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Welcome! :) Congrats on testing Milo's BG at home - it's the best way to keep him safe and assess the insulin dosing. Your senior boy has other issues that might make it harder to get him into better BG numbers. It's hard to say right now whether he's truly insulin resistant from acro of Cushings or whether he's been overdosed all long.

Here's what I suggest so we can help you better:
  • start the basic testing routine we recommend to get a feel for his numbers day by day - details to follow
  • set up the spreadsheet we use here and enter all data you have so far and everything you accumulate from the testing routine
  • leave his insulin dose at 4 u BID for now and start getting baseline data for where he is now.
Here's the basic testing routine:
  1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
  2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
  3. do extra tests on days off to fill in the response picture
  4. if indicated by consistently high numbers, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
  5. post here for advice whenever you're confused or unsure of what to do.
Here's the link to the spreadsheet we use here - viewable by all members and key to us being able to help:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Re being nervous about deviating from vet's advice: we all understand that. Most of us started off following our vet's instructions to the letter - I sure did. However, they can often fall into some common traps:
  • starting kitty at too high a dose of insulin
  • increasing by increments that are too large
  • advising against testing BG at home
  • and more ...
Here's a description I wrote of what can happen if the insulin dose is too high (we call it "bouncing"):
  1. BG goes low OR lower than usual OR drops too quickly.
  2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
  3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
  4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
  5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
  6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
Re treating CKD and FD in the same kitty: there are many members who deal with this and can give advice on low phosphorus wet foods that are diabetic friendly and/or other ways to address the CKD/FD together.
 
Hi May, and welcome!

Have you been testing at home other than the curve days? At first glance, your vet may be correct that there is a high dose condition such as Acro or IAA, but it's also possible that given only three curves, you've just had bad luck and caught bounce cycles. The third possibility is that Prozinc isn't the insulin for Milo. Different cats respond better to different insulin types.

The first thing I would do is change the food. It's great that Milo is on wet food, and it is a challenge to find foods that are safe for both diabetes and CKD. I really like Primal Chicken as it's very low carb and also has a good CA:Phosphorus ratio. Here is a list of foods that work for both conditions: https://docs.google.com/spreadsheets/d/112NvvzgxEBOtkb42rA0XR8GeShw9xXs9kccf9-olK7I/pubhtml

You can also post out on the Feline Health (main forum) and ask for suggestions since I'm not sure how up-to-date that list is at this point. http://www.felinediabetes.com/FDMB/forums/feline-health-the-main-forum.28/

If you're not comfortable changing food, it might be helpful to have a conversation with the vet about the options you find since it sounds like he recognizes the current food isn't ideal, but maybe just doesn't know what else to do. Vets are so kind, but often just don't know very much about diabetes in cats.

Second, if you aren't already testing at home on non-curve days, I would suggest getting some tests in to see what else might be happening. If you have already been doing that, it would be great to see some of those numbers as well.

And finally, if neither the food change nor the testing reveal anything, it would be good to get tested for a high dose condition if for no other reason than to rule that out as a factor.

There is a wealth of information around here about how to manage all of this, and it can be overwhelming. Please let us know what questions you have and how we can help!
 
Thank you Kris, Teasel, and Djamila for the warm welcome and great information! I'm going to try to get the spreadsheet filled out to share with the group. I have done just a few random pricks here and there (but I don't have a systematic way in terms of the time I pick to do the tests) and the lowest I got was still in the upper 300s. I am going to process the great information/suggestions/tips and get back to you with all additional follow up (which I am sure I will have). Thanks again!
 
Welcome May and Milo! You got great info from Kris and Djamila, so I just wanted to pop by and say hello and we're glad you're here! Please do take the time to think over what you've heard from us so far and ask ANY questions you have. We've all been where you are and it's so much info at first it's completely overwhelming. You'll probably have lots of questions...I did! We're here to answer them.

I just wanted to pipe in too on the following vet's advice. It's so hard at first to deviate from what they tell you. Don't feel like you have to right away. Most of us followed our vet's advice at first, because they are the professionals and it's hard listening to a bunch of crazy cat ladies on the internet! I did a lot of research before deciding to go my own way and it turned out my vet was super supportive of everything (except the food change...and it sounds like your vet actually gets that!). I told my vet what I was doing and she was great...she basically let me run things because she knew I knew what I was doing. The really good vets have learned that since we are doing research and whatnot and can focus on just one disease in one animal, we will probably end up with good info. They basically have to be general practice doctors on all different species...it's no wonder they don't know that much about one disease in one animal!
 
Hi there, I just added the spreadsheet to my signature and filled out Milo's testing information. I added some bg tests I did today at hours different from when I had done them in the past. I also gave Milo Weruva's Streak Frites and Fowl Bowl and no hills k/d wet to see what impact I would see. He got a new nadir at 307 - don't want to get too excited as I feel I still need to keep testing and gathering more data point. But now that I have everything in the spreadsheet and would love any thoughts on what is in there right now. Thanks!
 
Great job with the spreadsheet! Yeah, he's staying pretty high...but that super low pink (heck 307 is so close to a yellow that I think we can call it that) was nice! Looks like taking him off the K/D would really impact his numbers. If you do decide to do that, I think you'll see things trend downwards overall.

It's hard to know for sure what's going on...I agree that just more testing right now is key. He could be staying high all the time, or he could be dipping low sometimes and then bouncing up and you just happen to catch the bounce cycles. Will you be able to follow the testing routine Kris mentioned above? I think that will help fill in the puzzle for us.
 
Thanks Rachel! I hope to be able to follow the basic routine schedule provided by Kris above. Are most folks doing the basic routine every day? I am worried about stressing Milo out. He seems to be tolerating the pricks more and more. But first few times he was squirming so much and getting super agitated that I want to find the right balance of testing.
 
Most people do follow that testing routine. If you have time, you might check out a few spreadsheets on here to see what kind of testing most people do (mine is really old, so be warned). Over time, they usually realize that the testing isn't bad at all. I found having a consistent spot to do testing (ours was on the floor of the kitchen on a towel) and giving treats after every test, successful or not, helped. It got to the point I could rattle the box of lancets and Gypsy would run to the spot to wait for her test. She didn't like it per se, but she tolerated it just fine. I wouldn't say it ever stressed her once she got used to it and realized I wasn't going to do anything really weird. :)

You can take it slow...start with the AM/PM and one mid cycle and as he gets used to it, do more testing. That might help.
 
My kitty hated being touched when he was first diagnosed, so he didn't just hate the testing, he hated having me touch him at all. But I knew we had to get past it if I was going to keep him safe and make him better. So with perseverance, and tons of little tricks and training rituals, he's to the point now where he snuggles and purrs through the tests and reminds me if he thinks it's time for another test. Okay, really he's reminding me he wants a treat, but he'll gladly put up with the test for a bite of freeze dried salmon!
 
Since Milo's last bg curve on Sunday indeed looks more like a curve, can I consider that a sign he is NOT insulin resistant? Or as other members have suggested there could still be the bounce effect going on and I still need more data? I'm just wondering when I should do the tests for Acromegaly and Cushings. Should I do that sooner than later regardless of the curve/testing results? Or no need to go rushing to the vet yet? If he has Acromegaly or Cushings, does it mean insulin injections are harming him instead of helping him? Thank you!
 
MayL said:
Since Milo's last bg curve on Sunday indeed looks more like a curve, can I consider that a sign he is NOT insulin resistant? Or as other members have suggested there could still be the bounce effect going on and I still need more data? I'm just wondering when I should do the tests for Acromegaly and Cushings. Should I do that sooner than later regardless of the curve/testing results? Or no need to go rushing to the vet yet? If he has Acromegaly or Cushings, does it mean insulin injections are harming him instead of helping him? Thank you!
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The usual advice here is if you get over 6 u twice a day it's worth testing for a high dose condition. Acromegaly, Cushing's or auto insulin antibodies can be at the root of it. No, it doesn't mean the insulin injections are harming the kitty but the dose can get quite high and can fluctuate quite a bit. Acro tumours can have a pulsing action. Often, auto insulin antibodies "die off" after a period of time (a year or so in some cases) and the dose has to drop a lot. I'm not sure about Cushing's. Some people can't afford to test for a high dose condition so they just treat with insulin "as if".

Try hard to get a pre shot test every time. Yes, your curve shoes the insulin is having an effect but the dose is likely too low. At this dose level you can increase by 0.5 u tomorrow AM if you're up for it.
 
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BTW - another cause of insulin resistance is garden variety glucose toxicity. When a kitty is in high numbers a long time their body loses responsiveness to insulin. The way it's dealt with is to carefully increase the dose in a rapid as fashion as is safe. The longer he sits in high numbers the worse the toxicity and the higher the dose has to go to break through it. Once you reach a break through point the dose can come down quickly.
 
Kris & Teasel said:
BTW - another cause of insulin resistance is garden variety glucose toxicity. When a kitty is in high numbers a long time their body loses responsiveness to insulin. The way it's dealt with is to carefully increase the dose in a rapid as fashion as is safe. The longer he sits in high numbers the worse the toxicity and the higher the dose has to go to break through it. Once you reach a break through point the dose can come down quickly.
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Great advice Kris! All his pre-shots are in the 600s so yes, I should be careful when the break through happens and continue to test pre-shot. What are your thoughts on the fact that Milo's fructosamine was 393 on 2/2/18 but no matter what his pre-shots are in the 600? I feel like there is a disconnect. I also heard that maybe fructosamine isn't as helpful as we once believed it to be. My vet also doesn't think Milo is bouncing because his bg isn't low enough. I guess it's possible he could have dipped below 300 in his last bg curve but probably not because right after the nadir (I think a hour had passed) and he was moving upwards again. What are your thoughts on this comment my vet made re: bouncing? Thanks so much!
 
MayL said:
What are your thoughts on the fact that Milo's fructosamine was 393 on 2/2/18 but no matter what his pre-shots are in the 600?
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A fructosamine test give an idea of average BG in the 2-3 weeks prior. As an average it tells you nothing about how high or how low BG has gone. Once an owner takes on the testing routine we recommend here the BG data you log on your spreadsheet is much more useful so there's really no reason to pay for any more fructosamine tests.

MayL said:
My vet also doesn't think Milo is bouncing because his bg isn't low enough.
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He's probably thinking of the Somogyi effect as a cause for bouncing - ie., a drop to a very low BG at some point in a cycle whether captured by a test or not. Our definition of bouncing is much broader. Here's something I wrote a while back to explain it:
  1. BG goes low OR lower than usual OR drops too quickly.
  2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
  3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
  4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
  5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
  6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
 
Kris & Teasel said:
A fructosamine test give an idea of average BG in the 2-3 weeks prior. As an average it tells you nothing about how high or how low BG has gone. Once an owner takes on the testing routine we recommend here the BG data you log on your spreadsheet is much more useful so there's really no reason to pay for any more fructosamine tests.


He's probably thinking of the Somogyi effect as a cause for bouncing - ie., a drop to a very low BG at some point in a cycle whether captured by a test or not. Our definition of bouncing is much broader. Here's something I wrote a while back to explain it:
  1. BG goes low OR lower than usual OR drops too quickly.
  2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
  3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
  4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
  5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
  6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
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Thanks Kris! Should I try to explain "bouncing" to my vet? I want to express this concern that you shared with me to my vet, but not sure if I will articulate it correctly.
 
MayL said:
Thanks Kris! Should I try to explain "bouncing" to my vet? I want to express this concern that you shared with me to my vet, but not sure if I will articulate it correctly.
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You can try but there might be eye rolling because it comes from crazy cat people on the internet ... ;) Our definition comes from thousands of observations made by hundreds+ of people. Vets can get hung up on the Somogyi effect idea.
 
Kris & Teasel said:
You can try but there might be eye rolling because it comes from crazy cat people on the internet ... ;) Our definition comes from thousands of observations made by hundreds+ of people. Vets can get hung up on the Somogyi effect idea.
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I hear ya! Where are the crazy cat people on the internet who happens to also be a vet? I would like to be that person's client!
 
I've been reading about ketones - since I am getting readings in the 600s, should I be testing for ketones? My vet has not brought this up at all, but I think I should be concern and I should do what I need to make sure ketones isn't a problem. Thoughts?
 
MayL said:
I've been reading about ketones - since I am getting readings in the 600s, should I be testing for ketones? My vet has not brought this up at all, but I think I should be concern and I should do what I need to make sure ketones isn't a problem. Thoughts?
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I would at these levels. You can get strips at any pharmacy.
 
I went to Walmart and bought the ReliOn Ketones Urine Strips. Put a little container in his favorite corner of the litter box and collected fresh urine for testing. It was super easy and it came back negative! I am relieved. Should I be surprised that with bg so high that negative ketones is unusual?
 
MayL said:
I went to Walmart and bought the ReliOn Ketones Urine Strips. Put a little container in his favorite corner of the litter box and collected fresh urine for testing. It was super easy and it came back negative! I am relieved. Should I be surprised that with bg so high that negative ketones is unusual?
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That's great news
 
No, ketones should not be present ever. If it shows as trace, post and get advice on next steps. If it shows as more than trace, go immediately to the emergency vet. Ketones can progress very quickly and are the most dangerous thing that happens to our extra-sweet cats around here. Ketones are usually some combination of these factors - dehydration, not enough calories, an infection/inflammation, and high blood glucose. So things can go along just fine for a long time, but when one of those gets out of balance, ketones can develop. That's why regular testing and appropriate dosing are so urgent. Many folks around here fear hypos, and there is reason for that, but ketones take far far more of our kitties than hypos do, so it's great that you have the test strips.

I'm curious if you are testing more than we see on the spreadsheet? It looks like it's been awhile since you have any data, and getting your kitty in better numbers will help to lower the ketone risk. We'd be happy to help with that!
 
Hurray for negative ketones! However, I completely agree with Djamila's assessment of the risks. Getting BG under good control is so very important and testing is part of that.
 
Hi everyone,

Thanks for checking in! I haven't mastered the technique of testing by myself so I wasn't able to find an extra pair of hands to hold Milo until today. I've been focusing on changing his diet. I've almost weened him off all hills k/d diet (both wet and dry) and been feeding him low phorspherous, low carb Weruva. My sister held him down this evening so I could test him and we got 430 PMPS (the lowest ever value I got since I started testing)!

I am determined to test more (and follow the suggested routine) --- any suggestions on how be successful doing it myself? Milo is fairly squirming.

Also, I am using the AlphaTrak 2 meter and the cheapest I've found the test strips to be are about $1 a strip. Has anyone found anything more cost effective?
 
Most folks around here use one of the human glucometers from WalMart. Since it sounds like you have one near you (I think you mentioned getting the ketone strips there), that may be your easiest and cheapest option. If you prefer things you can order online, I like this one: https://www.adwdiabetes.com/product/8179/agamatrix-presto-blood-glucose-meter-kit-and-strips

And here are some videos on how to test at home:
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

The kitties in the videos are much much calmer than my kitty, so fear not if you have a wiggly cat - you can get this to work on your own!
1. Choose a place that will be your testing place. I like the small section of the kitchen counter that has the upper counter/bar on two sides, and the sink on the other side. It makes it just a little harder for Sam to leap away, but without making him feel confined. Nothing like confining a cat to make him freak out! Some people like to use a small table, or a corner of the kitchen on the floor. Other people sit with the kitty between them and the arm of the sofa. Just some way of limiting the escape without making it too scary for the kitty.

2. Start with desensitization practice: bring the kitty to the testing place. Rub his ears and hold him gently. Kind of act like you're doing the test without actually doing it. Then give him a low-carb treat and let him go. Do this routine several times every day. He will start to associate having you hold his head/ears with getting a treat and that makes kitties more cooperative (in time).

3. Try everything. And I meant everything. Some things I've found that help Sam: putting a pot of cat grass in front of him as a distraction. Putting one of his favorite stuffed animals in front of him. Getting him high on catnip first so he's more docile (he relaxes with catnip - this won't work if your kitty gets hyper from it). Singing in a soft low voice. Reciting poetry to him. Seriously try everything. You never know what will help.

4. Three pokes and you're out. If you've tried three pokes and still haven't gotten a test, give a treat anyway and let the kitty go. Take a minute. Breathe. Relax. Let the kitty have a minute to relax too. Then bring him back and try again. The break in between is important for both of you as kitties sense our anxiety. If we are amped up or nervous about testing, they will be too. They won't be calm if we aren't calm.
 
Djamila said:
Most folks around here use one of the human glucometers from WalMart. Since it sounds like you have one near you (I think you mentioned getting the ketone strips there), that may be your easiest and cheapest option. If you prefer things you can order online, I like this one: https://www.adwdiabetes.com/product/8179/agamatrix-presto-blood-glucose-meter-kit-and-strips

And here are some videos on how to test at home:
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

The kitties in the videos are much much calmer than my kitty, so fear not if you have a wiggly cat - you can get this to work on your own!
1. Choose a place that will be your testing place. I like the small section of the kitchen counter that has the upper counter/bar on two sides, and the sink on the other side. It makes it just a little harder for Sam to leap away, but without making him feel confined. Nothing like confining a cat to make him freak out! Some people like to use a small table, or a corner of the kitchen on the floor. Other people sit with the kitty between them and the arm of the sofa. Just some way of limiting the escape without making it too scary for the kitty.

2. Start with desensitization practice: bring the kitty to the testing place. Rub his ears and hold him gently. Kind of act like you're doing the test without actually doing it. Then give him a low-carb treat and let him go. Do this routine several times every day. He will start to associate having you hold his head/ears with getting a treat and that makes kitties more cooperative (in time).

3. Try everything. And I meant everything. Some things I've found that help Sam: putting a pot of cat grass in front of him as a distraction. Putting one of his favorite stuffed animals in front of him. Getting him high on catnip first so he's more docile (he relaxes with catnip - this won't work if your kitty gets hyper from it). Singing in a soft low voice. Reciting poetry to him. Seriously try everything. You never know what will help.

4. Three pokes and you're out. If you've tried three pokes and still haven't gotten a test, give a treat anyway and let the kitty go. Take a minute. Breathe. Relax. Let the kitty have a minute to relax too. Then bring him back and try again. The break in between is important for both of you as kitties sense our anxiety. If we are amped up or nervous about testing, they will be too. They won't be calm if we aren't calm.
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Thank you so much for the fast response! I really appreciate it and the helpful information. I know there has been a lot of questions asked about human glucose meter conversion to bg values for cats --- I haven't done the search yet on the forum, but if you know of a link that lays it out clearly handy, please shoot it my way :)
 
MayL said:
Hi everyone,

Thanks for checking in! I haven't mastered the technique of testing by myself so I wasn't able to find an extra pair of hands to hold Milo until today. I've been focusing on changing his diet. I've almost weened him off all hills k/d diet (both wet and dry) and been feeding him low phorspherous, low carb Weruva. My sister held him down this evening so I could test him and we got 430 PMPS (the lowest ever value I got since I started testing)!

I am determined to test more (and follow the suggested routine) --- any suggestions on how be successful doing it myself? Milo is fairly squirming.

Also, I am using the AlphaTrak 2 meter and the cheapest I've found the test strips to be are about $1 a strip. Has anyone found anything more cost effective?
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Right now amazon has the strips for $45.95. If the cost is prohibitive some use freestyle lite strips in the Alphatrak. Or you can switch to a human meter.
 
MayL said:
Thank you so much for the fast response! I really appreciate it and the helpful information. I know there has been a lot of questions asked about human glucose meter conversion to bg values for cats --- I haven't done the search yet on the forum, but if you know of a link that lays it out clearly handy, please shoot it my way :)
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You can't convert. In general, the values are the most similar in the lower ranges, and diverge quite a bit in the higher ranges. Human meters run lower, which is why the "take action" number is 50 on a human meter and 68 on an AT2. But beyond that, there is no way to compare as they just don't relate to each other. In the past folks on here have run side by side tests for days and days and there just isn't a consistent conversion. Human meters work though because they give us enough information to know if the kitty is too low (below 50) or too high. Whether the kitty is 240 or 480 doesn't really matter that much - it's all just too high to be safe or healthy. Whether they are 38 or 45 doesn't really matter - they are too low and need to rise a bit. So the human meters can tell us the range and give us enough info to make decisions, even if they aren't precisely accurate. And at $0.22/strips vs. $1.00/strip, the cost difference makes it more than worth it to most of us.
 
Starting Friday Milo we stopped feeling him a high carb food (vet prescribed prescription food k/d hills for his stage 2 CKD). Everything now has been under 10% carb. He surprised us on Sunday 3/4 at 7:45 pm (+10) with a 430 and on 3/5 (PMPS) of 535. Then today at 7:45 pm we get a reading of 574. Can numbers change that much? A little dishearten to see a 430 a few days earlier and then a reading at the exact same time over 100 more. I would hope/expect with the food change that as more time passed with the diet change that we will continue to see lower numbers. Does it take more than a week to see a real sustained difference?
 
That is surprising that the food change didn't drop him...it usually does. What food are you feeding now? Some cats really do need time to settle into something new...some have changes right away. It kind of depends on the kitty...

Any chance you could start to get some more regular testing in? I think that would help make the picture clearer. Preshots every day and whatever mid cycles you can get...even if that's just a before bed test daily and nadirs on weekends. We might be able to figure out how to help get those numbers down...

Also, I'd be sure to keep up testing for ketones while he's in those higher numbers...
 
Rachel said:
That is surprising that the food change didn't drop him...it usually does. What food are you feeding now? Some cats really do need time to settle into something new...some have changes right away. It kind of depends on the kitty...

Any chance you could start to get some more regular testing in? I think that would help make the picture clearer. Preshots every day and whatever mid cycles you can get...even if that's just a before bed test daily and nadirs on weekends. We might be able to figure out how to help get those numbers down...

Also, I'd be sure to keep up testing for ketones while he's in those higher numbers...
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Hi Rachel,

I do test for ketones every day because it's so easy to catch him urinating mid-stream. Very lucky that he's tested negative every time. The pricks are so much harder because he's squirmy. I was able to get a AMPS in today and he was at 429 AND there was a little fiasco last night. I opened a new bottle of insulin and it was clumpy on the bottom and I didn't know what to do (worried it was spoiled) so I just gave him what's left of his old bottle (barely 3 units when his normal dose is 4 units) so even down one unit we are seeing a 429 which is better than his normal at this time. It's only one data point so probably too soon to reduce his insulin dosage? When is a good time to start modifying (or think of modifying) his insulin dosage? I am going to do a curve this Sunday and will try to do other AMPS, PMPS and mid-day tests today, tomorrow, and Saturday.

Also, I guess I got excited about the AMPS value that after I pricked Milo's ear and went to pick up the lancet I pierced my finger and drew quite a bit of blood! Argh. I searched the message board and it seems like I'll be okay but would love to hear some reassurance :)
 
MayL said:
Hi Rachel,

I do test for ketones every day because it's so easy to catch him urinating mid-stream. Very lucky that he's tested negative every time. The pricks are so much harder because he's squirmy. I was able to get a AMPS in today and he was at 429 AND there was a little fiasco last night. I opened a new bottle of insulin and it was clumpy on the bottom and I didn't know what to do (worried it was spoiled) so I just gave him what's left of his old bottle (barely 3 units when his normal dose is 4 units) so even down one unit we are seeing a 429 which is better than his normal at this time. It's only one data point so probably too soon to reduce his insulin dosage? When is a good time to start modifying (or think of modifying) his insulin dosage? I am going to do a curve this Sunday and will try to do other AMPS, PMPS and mid-day tests today, tomorrow, and Saturday.

Also, I guess I got excited about the AMPS value that after I pricked Milo's ear and went to pick up the lancet I pierced my finger and drew quite a bit of blood! Argh. I searched the message board and it seems like I'll be okay but would love to hear some reassurance :)
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You'll be fine. I've poked myself with Teasel's lancet after testing him several times. I'm still here! ;)
 
Hi everyone,

I've been able to do more testing since we last talked including AMPS and PMPS in a more consecutive fashion. Starting 3/11 Milo dropped into the 200 range for the first time. On 3/12 he had the lowest AMPS I have ever seen at 241 and I panicked and dropped his insulin from 4 units to 3 units and surprising he stayed almost flat the entire day around 200. So I am trying the 3 units for a few cycles. Then I got a 642 AMPS and a whopping 684 PMPS tonight. My heart just sank :(

A few questions I have:

1. What might be going on with the flat curve I saw on 3/12? Milo historically has a smile curve.

2. Is the 642 on 3/13 a bounce because Milo was so low the day prior (3/12)?

3. Why would Milo's BG go up after his insulin today (3/14)?

4. The 200s we are seeing happened without a change in dose - I was always giving him 4 units. He has been off k/d prescription food for almost 2 weeks and no dry for over 1 week. I assume the low carb food is helping. But could this be signs of a "sputtering pancreas"?

Thank you so much for reading!
 
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Let's see:

1. Hard to say for sure. That looks a lot like a cycle after a bounce with the flatness...but it's not that high. Since we don't know for sure he didn't go low the night before, it could be that. More likely he just had something going on that day that caused the insulin to not bring him down much. Could be a bit of higher carb food, feeling stressed about something, "oh look a squirrel" syndrome ;). Anything.

2. It COULD be a bounce...I'm not really sure. He was lower than normal the day before, though he did stay in that same range most of the day. That +6 you got that night might be an indication that he was headed into a bouncy cycle since it was already pretty high.

3. At +7, he probably had already passed nadir, so his BG was on its way up. He most likely was a bit lower earlier in the cycle.

4. It could be, but I think it's really just a reaction to being on better food. Lower carb food can (and does!) lower the BG over 100 points...sometimes overnight. Sputtering pancreas is usually indicated by random low numbers that we can't account for and/or going DOWN after eating...even with no insulin on board (because the pancreas makes some of its own then!). Doesn't mean his pancreas won't wake up, though!

I'd like to see what's he doing a bit earlier in the cycle on this. Any chance of something in the +3 to +5 range today?
 
Rachel gave you some great ideas in her post, so I'll just add that my hunch is that the flat yellow cycle was just a result of lowering the insulin dose that cycle. The cycle after a dose change can be a little weird sometimes.

I would suggest that you increase again, but try 3.5, and then after three cycles let's see what the numbers look like. When a kitty is in really high numbers like this we want to be more aggressive with getting the numbers down so that at least a few hours during the day are in healthier numbers. They need to be below 220 for the pancreas to have a chance to heal, and blues and greens are best for that.

You're doing a great job of increasing testing! The food change and the data you're collecting will really help get Milo into a better place.
 
Thank you @Djamila and @Rachel! Great advice. And Milo does have stage 2 CKD, hyperthyroidism, and IBD. He was on 10 days of metronidozole for really bad diarrhea (62.5 mg twice a day which really helped but we stopped this past Saturday and his stomach is in bad shape right now). So he has so many other things going on, which I assume causes changes in his BG.

I will try to get in a number today around +4 and increase his dose back up to 3.5 tonight. I am also switching to ReliOn Confirm to help with cost. I added a second tab to my spreadsheet called "ReliOn" so that's where my data going forward will be.

@Kris & Teasel has been super helpful too. Do you have any new thoughts on these new numbers?

Thanks everyone!
 
MayL said:
Thank you @Djamila and @Rachel! Great advice. And Milo does have stage 2 CKD, hyperthyroidism, and IBD. He was on 10 days of metronidozole for really bad diarrhea (62.5 mg twice a day which really helped but we stopped this past Saturday and his stomach is in bad shape right now). So he has so many other things going on, which I assume causes changes in his BG.

I will try to get in a number today around +4 and increase his dose back up to 3.5 tonight. I am also switching to ReliOn Confirm to help with cost. I added a second tab to my spreadsheet called "ReliOn" so that's where my data going forward will be.

@Kris & Teasel has been super helpful too. Do you have any new thoughts on these new numbers?

Thanks everyone!
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I agree that a trial at 3.5 u is in order.
 
Well look at that! You switch meters and now you have some pretty blues! Isn't that fun? I mean, I know the numbers are what they are, but I just think seeing lower numbers helps with our sanity in all of this!
 
Djamila said:
Well look at that! You switch meters and now you have some pretty blues! Isn't that fun? I mean, I know the numbers are what they are, but I just think seeing lower numbers helps with our sanity in all of this!
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Thanks @Djamila! Then I get a 563 AMPS today and I lose some of that sanity :( I stuck to the 3 units because I was seeing 200 and even some high 100s the last two days and now this... I will keep watching and testing before making the move to 3.5.
 
It's possible the 563 is a response to a low overnight number, although looking at the previous night it could also just be one of those things. Are you still feeding Weruva only? Any chance higher carb treats or kibble have snuck back in? Or stealing kibble from the dog or other cats? Big fluctuations in numbers are sometimes the result of carbs. Other times it's just how the cat is at this point.
 
Djamila said:
It's possible the 563 is a response to a low overnight number, although looking at the previous night it could also just be one of those things. Are you still feeding Weruva only? Any chance higher carb treats or kibble have snuck back in? Or stealing kibble from the dog or other cats? Big fluctuations in numbers are sometimes the result of carbs. Other times it's just how the cat is at this point.
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Yup, just weruva and no kibble in the house. Today's nadir is the lowest I've seen - 149 and it's possible it could have gone even lower but it was feeding time and I suspect that's why the bump to 239 when I tested the hour after the 149. It's a little scary to see how his AMPS can drop way more than 50%. I've read that is something I should monitor closely (when the nadir is more than a 50% drop). Should I be worried that he's dropping so much? :(
 
I don't see those numbers on the SS, and I'm not sure I'm following what you were saying. What time was the 149 in relation to the AMPS shot? And then the 239 was an hour after the 149?
 
Djamila said:
I don't see those numbers on the SS, and I'm not sure I'm following what you were saying. What time was the 149 in relation to the AMPS shot? And then the 239 was an hour after the 149?
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Hi, are you able to see it now in the spreadsheet? Maybe it didn't save properly. The 149 was +8 and the 239 was +9. His AMPS was high today at 415. I will test mid-day again to see how low he goes today.
 
MayL said:
Hi, are you able to see it now in the spreadsheet? Maybe it didn't save properly. The 149 was +8 and the 239 was +9. His AMPS was high today at 415. I will test mid-day again to see how low he goes today.
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I see your SS but there's data missing, including those two numbers.
 
Kris & Teasel said:
I see your SS but there's data missing, including those two numbers.
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Very weird. I tried on a different computer and I can see the numbers I referenced above in the SS. In the ReliOn tab right? Not the Alpha Trak tab because I recently made the switch and just added a ReliOn tab to the spreadsheet so people can flip between my Alpha Trak numbers and ReliOn numbers.
 
MayL said:
Very weird. I tried on a different computer and I can see the numbers I referenced above in the SS. In the ReliOn tab right? Not the Alpha Trak tab because I recently made the switch and just added a ReliOn tab to the spreadsheet so people can flip between my Alpha Trak numbers and ReliOn numbers.
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Oops! My mistake ... I didn't notice the two tabs. Djamila might have made the same mistake.

A mid cycle test or two will be good data.
 
ACK! Yes, I did the same thing. Maybe put a note at the end of the AT2 spreadsheet to prompt us to look for the other tab? You know, since sometimes we forget things...:oops:;)
 
It looks like Milo hits nadir rather late. Would it be possible to get a +8ish test early in the morning to get a feel for the night cycles? It's not uncommon to have very different AM and PM cycles, I just want to check if he's going lower during the night.
 
Hi there, Milo just got his first green on his spreadsheet today! He had a high AMPS at 407 (using ReliOn) because I had to leave for work earlier so he had ate about 1 hour earlier and not 2 hours earlier. We just checked at +7 and he's at 62 for ReliOn and then we did a check with AlphaTrak and he was at 97. I'm not sure what I will see at his PMPS, but what are people thinking? What range should I still give him 3 units and maybe what range I should cut the dose to 2.5 or 2.75? I'm not sure what his body will do in the middle night so I want to go conservative to be safe and will probably wake up once at least to get a BG test in around +6 or +7 which is sort of his typical peak time. Thank you!
 
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