Finding Alex's Dose

Asiina & Alex(GA)

Asiina & Alex(GA)

Member Since 2019
Alex was diagnosed and started on 1U about a week ago, and the dose he's on is not working. He gets extremely high numbers before his shots, and his midday number is still too high. It very clearly needs to be increased, but the vet is insisting that I wait 10 days to do a glucose curve and won't look at the data before that.

It's frustrating putting him through all this new routine if it's not even helping him.
 
Actually, he's shown you that this 1 u dose isn't too bad. He had a low of 10.1 on 25 Jan and that's a decent number for so early in the game. I agree with holding a dose a bit longer at the start when kitty's body is new to exogenous insulin and is working to adapt to it. The black number this AM is basically the same as yesterday's red because meters are allowed a variation in reading on the order of 15 to 20%.

The high numbers you've seen after that blue and possibly after overnight lower numbers you haven't captured are rebound or "bouncing" as we call it here. It's a normal reaction and some kitties are bouncier than others. Here's something I wrote a while ago 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.
One thing we all had to learn about treating FD is to work at the long game. It's often called a marathon and not a sprint. It's rare for regulation to be achieved quickly. It can take many, many months. A ton of patience is required and any attempts to rush the process like raising the dose too much or too quickly are just about guaranteed to backfire.

Testing his BG and keeping your spreadsheet are two very helpful things you're already doing for Alex. Posting here for help is a good idea and if you can get a before bed test most evenings it'll round out your data. I also suggest you scatter your daytime tests a little more over the 12 hours after the AM dose. That will allow you to see more of the bigger picture.

You're doing great! :)
 
Hi Asiina! First of all, hugs to you. The first couple of weeks at this dance are tough.

It does take a cat a couple of weeks to really get used to being on insulin, so while I rarely defend a vets advice (since so often they are wrong), in this case I do agree with your vet. As Kris said, you are actually getting a nice insulin response already. Yes, the numbers are too high right now, but if you just dump in a bunch of insulin you're going to end up sending your poor kitty bouncing all over the place, and that feels awful. Think about how you feel after eating too much junk food, or when your BG goes low because you've waited too long to eat. Those things feel awful, and when a kitty is bouncing up and down, it doesn't feel good to them either.

So while you're likely going to need to increase the dose, slow and steady is the way to go, and this initial adjustment period is important.

It looks like you're already seven days in, so it's only a few more days.

It would be helpful if you can get a test at night before you go to sleep. It also looks like you've moved the shot times rather a lot in the past week. My hunch is that you're trying to walk it back to a time that works better for you, is that right? Once you get there, it will be important to give the shots at the same 12/12 time every day and not keep moving it around. Consistency is important around here.

Please don't hesitate to ask as many questions as you have, or just post to vent and ask for reassurance. :):bighug::cat:
 
Yes, I was moving it back to 9/9 15 minutes at a time so it should be stable from now on. I'll try to get a later night reading tonight, see if I can get a +3 but probably can't stay up any later!

Thanks for the help and I'll try to be patient. I have been checking ketones because I'm extremely paranoid, but everything is coming up negative, so that's good. I'll be doing a full curve on Wednesday and then sending the spreadsheet to the vet, and I imagine the dose will go up after that.
 
You could also test at +2 tonight. Quite often, the +2 gives an idea how the cycle will go. If it is the same or lower than the preshot, it could be an active cycle and may need steering with food and/or more testing.
In the beginning, I often did +2 and +3 at night to have a good idea what was happening, and then I would give food and set an alarm to test again if needed. My theory was if I caught it early, I was more likely to get a good night sleep.
 
Instead of waiting 10 days do a full curve on him maybe after 5 or 7 days you could do a partial curve at 4 and 6 hours. I know how frustrating this can be and you'll often read here how bad vets can be but no two cats or vets are the same.
What Kris said about bouncing. Our second cat bounced and it made me tear my hair out. It is indeed a long process, you're training your cat's body to accept medication because of an organ failure which is anything but natural.
At least you're doing something about it. I cringe to think of all the people who just couldn't be bothered.
 
Asiina & Alex said:
Yes, I was moving it back to 9/9 15 minutes at a time so it should be stable from now on. I'll try to get a later night reading tonight, see if I can get a +3 but probably can't stay up any later!

Thanks for the help and I'll try to be patient. I have been checking ketones because I'm extremely paranoid, but everything is coming up negative, so that's good. I'll be doing a full curve on Wednesday and then sending the spreadsheet to the vet, and I imagine the dose will go up after that.
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It's great that you're testing for ketones. That is so important, and often overlooked. As others have said, a +3 is a great time to get a test. The insulin usually starts to kick in around +2, so +3 gives you an idea how much of a response you're heading for. At this point you aren't worried about a hypo so much as just trying to get a sense of the dose - if it's enough for now, or needs to be raised.

One thing that can help avoid ketones is adding extra water to his food - I usually mix in about 3T of water to a small can of food. We had to build up to that though as Sam was not a fan of soupier food at first. And also making sure other health issues are being monitored or resolved. For example, if he's in need of a dental, you'll want to get it done as soon as you can. Bad teeth have a dramatic impact on BG.
 
So I actually have two cats, and Simon is inexplicably fat despite rarely eating. He'll eat at meal times but usually only a tiny bit, because he's easily spooked off of food so if you even look at him while he's eating, he'll walk away from the food, and Alex eats a lot of it. We've had dry food down mostly for Simon so that he's able to snack throughout the day, and when they were young they were both only on dry food and were both pretty thin. Then a vet recommended to put Alex on wet food to prevent urinary tract problems because he didn't drink very much, and after that Simon got really fat.

But I noticed Alex snacking on the dry food as well, and wondered if that was making his sugar's spike, so last night we didn't leave any dry food down and didn't put any down today, just gave some extra wet food so he wasn't losing the calories, and now Alex went from two black numbers yesterday, to a 5.3 (93) today at his low point, to the point that I'm going to have to be careful and maybe end up skipping his evening shot if he doesn't go back up enough in the next 6 hours, which I will do if it stays below 12 (especially since it's overnight and there's a chance I'd miss hypo symptoms) but would suck to do during this adjustment/testing period. I really can't tell if this is another, bigger bounce or if a few bits of dry food could really be making that much of a difference.
 
It's hard to be certain. If a cat is very carb sensitive, as some are, even a few bits of dry food can cause a BG spike.
 
It also really depends on which dry food and which wet food. What exactly are you feeding them?
 
They're eating friskies wet food (they like the chicken, whitefish, and salmon pate ones but I need to alternate or they get fussy about having too many of the same meal in a row. They were eating the friskies indoor cat dry food, but I guess I'm stopping that.

Also Alex was having such a good sugar day and I messed it up by giving at least a partial furshot for the evening. I have no idea how much actually got in. Sorry my boy if you have a bad night, I'll do better in the morning.
 
My cats are the same way: I have to rotate tons of flavors to keep them happy. Why couldn't I get the kind of cats that will just eat the same thing day in and day out?!?! Mine both eat raw, and a lot of it is homemade, so it keeps me on my toes to give them enough variety.

Try not to worry too much about the fur shot. We all do them from time to time. It's just one of those things. :bighug:
 
Oh these kitties! They do like to have a variety of foods...can't stick with just one!!!

Yes those furshots happen. We've ALL done them. Don't let it bug you. I always take it as a sign that we both deserved a night off from worry and usually went to bed early on those nights.
 
Djamila said:
Why couldn't I get the kind of cats that will just eat the same thing day in and day out?!?!
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In this I am truly blessed! My three get the same food day in and day out and relish every meal. Well, I alternate between chicken and turkey Wellness brand pate for Teasel but that's it. He'd willingly eat only one if I did that. Not bragging, just happy that I have something that counterbalances all of my challenges dosing Teasel.
 
The vet did up his dosage to 1.5 and it seems to be going well. Just 2 days in and he's already responding quite well and I'm getting low numbers throughout the day. I'm a little concerned about tonight's number (14.3/257) and how low it was and I hope he'll be okay with the shot. I'll monitor him and check in a few hours to make sure he doesn't get too low.

I know this is what regulated is supposed to be like, but having those high pre-shot numbers made me at least able to sleep soundly that he wasn't going to go into hypo.
 
Another thing that can help you sleep is smaller increases. We generally recommend that if the low numbers (nadir) are under 200/11.2, (which Alex' are), that increases be done just 0.25u at a time so that the shift in numbers is more gradual and less likely to result in a hypo. It looks like the 1.5 is okay right now, but maybe a little smaller for the next increase. Vets usually aren't familiar with making small increases, so they don't know to recommend them. They only see cats every few weeks at best, so aren't as familiar with the fine-tuning we can do with home testing.

It's great to see Alex spending so much time in the blues mid-cycle, and getting your first yellow PS :)
 
His BG went UP a few hours after his PM shot which I have no idea what that means. I'm sure it got in him. Could have been a bad reading either then or the PM reading, so I'm not going to dwell on it too much. I'm going to wait a few more days and hopefully it all mellows out, but right now he's still spiking really hard by the time the morning dose comes, and I think it's because of a lack of overnight food (which is that they're eating their overnight food too quickly). I might need to adjust their feeding some more, but I don't want to change 2 variables at once, so I'll leave it alone for another 3-4 days and see how it goes. I'm sure I'll come here for advice if it's still a problem.
 
What you saw last night isn't uncommon. It's part of why we say not to worry too too much about the PS numbers. Sometimes a dose will last a little longer than usual, and give a nicer PS number, but wears off soon after. Your +2 is pretty much in line with your other +2's, so my hunch is your PS was just showing a little extra duration from the AM shot.

Eventually, you'll get more duration regularly, and you'll see the PS numbers coming down. It takes some time though.

Did you really mean 1.4 for last night's shot? Or is that a typo?
 
Just had my first brush with hypo, I think. He was at 3.7 (67) @ +6 and I was testing him before giving a midday snack. There were no symptoms and he was jumping around and purring, but with the alphatrak that's right on the cusp. He ate and I tested him about 15 minutes later and he was up to 4.4 (80), so I'm assuming he's fine now.

We'll see what he's at tonight, but he's jumping around quite a bit with this new dosage. My vet isn't open on Sundays, so I'm not sure if I should give the 1.5 or go back down to 1 or 1.25. He's still getting used to this dosage, but I worry that it may end up being too much and if something happens overnight I won't see it. The numbers are very confusing.
 
First of all, great job not panicking :). Since it was at +6 a regular low-carb snack was a good idea. I would recommend doing another test in about an hour if you can to make sure he stays up and isn't just rising from the food.

Is he still getting some kibble? Or is he off it completely now?
 
I've taken them both off kibble entirely. I'm not sure if I should give a little overnight as just in case, because part of the problem with any wet food I give is that they completely finish it long, long before it's feeding time again, whereas there was always kibble around before.
 
Djamila said:
First of all, great job not panicking :). Since it was at +6 a regular low-carb snack was a good idea. I would recommend doing another test in about an hour if you can to make sure he stays up and isn't just rising from the food.

Is he still getting some kibble? Or is he off it completely now?
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Also, do you mean an hour from now (+8) or an hour after the first test (+7) since that would be roughly now.
 
I was thinking an hour after the second test - the 4.4/80 one. Of course if you are concerned test before that!

I was asking about the kibble because even a few pieces can make their BG bounce around from highs to lows in ways that are hard to predict. If he's off all kibble though, then I would say to reduce the dose a smidge for tonight and try 1.25u. He will likely be rather high overnight since this is his first time down in low numbers and most likely his body has dumped a bunch of stored glucose into the blood stream. It can take a day or two to clean that out again. If that happened, you'll likely see a rather high PS number tonight. Just ignore that and go ahead with the little reduction.
 
He seems to be coming back up nicely. I'm going to email the spreadsheet to the vet with an explanation after tonight's dose and see whether he thinks I should lower it immediately. I'm still not sure what's causing the really, really high numbers by pre-shot (especially morning) when he seems to be spending most of the day in a good range.

Thanks for all the help, by the way. I was just starting to not panic when the numbers are too high, and now I get to panic when they're too low!
 
The high PS numbers are normal. It takes more time in the "healing numbers" before those start to come down. And remember that Alex was just diagnosed. While some cats find regulation quickly, it's not at all uncommon for it to take several months. As is often said...it's a marathon, not a sprint. :bighug:
 
Oh, and as for the AMPS numbers being a little extra high, google "dawn effect" for an explanation. You'll find things about the effect in human diabetics, but based on lots of our spreadsheets, there seems to be a similar thing with cats.
 
So I went down to 1.25 from 1.5 after the hypo scare the other day, and his mid-day numbers are good (much better than they were on just 1U), but his pre-shot numbers remain very high. I'm running low on strips so haven't been able to do multiple mid-day tests since I want to keep an emergency supply, but new ones should be delivered today or tomorrow, so hopefully will be able to fill out the picture a little more.

Maybe it was just too much, too fast and 1.5 is actually a better dosage I should have just increased it more slowly. The vet told me to just increase, but I'm getting increasingly distrustful of his advice. I hope I don't need to find a new vet.

I'm wondering if I should go back up to 1.5 now that he's settled a bit more on 1.25 or stick with this for a while longer. Sunday was supposed to be the curve day at 1.5, but maybe I should stay at 1.25 until then? I'm not sure whether the pre-shot numbers being high is a problem if he's sitting in a good range the rest of the day or if I should be working to bring that number down too.
 
Asiina & Alex said:
So I went down to 1.25 from 1.5 after the hypo scare the other day, and his mid-day numbers are good (much better than they were on just 1U), but his pre-shot numbers remain very high. I'm running low on strips so haven't been able to do multiple mid-day tests since I want to keep an emergency supply, but new ones should be delivered today or tomorrow, so hopefully will be able to fill out the picture a little more.

Maybe it was just too much, too fast and 1.5 is actually a better dosage I should have just increased it more slowly. The vet told me to just increase, but I'm getting increasingly distrustful of his advice. I hope I don't need to find a new vet.

I'm wondering if I should go back up to 1.5 now that he's settled a bit more on 1.25 or stick with this for a while longer. Sunday was supposed to be the curve day at 1.5, but maybe I should stay at 1.25 until then? I'm not sure whether the pre-shot numbers being high is a problem if he's sitting in a good range the rest of the day or if I should be working to bring that number down too.
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The best factor for assessing a dose is how low it takes BG, not how high the PSs are. I suggest you stick with 1.25 u for now because the recent mis cycle lows are good. You could keep the dose untli the weekend if you want to try doing a curve. Don't worry about the PSs. The best case is that they come down over time as Alex's BGs are better regulated. Some kitties are very volatile in their response to insulin and that can predispose them to almost always having high PSs. If that continues to be the case for Alex in the longer term a switch to a depot insulin like Lantus *can* help to reduce the highs and lows.
 
Those PS numbers are hard to see, but Alex is really doing well in his insulin response right now, especially considering it's so early in his diagnosis. I do think I'd stick with the 1.25 a little longer. It takes time to heal and start to bring the PS numbers down.

As for the vet, don't be too hard on him/her. There are very few vets that know much of anything about feline diabetes. It's complicated, and they don't get a lot of training about it at vet school. This is all we do here, so we have built up a lot of collective wisdom. I think most, if not all, of us here give our vets updates from time to time, but do all of our own dosing and care decisions. Our vets quickly realize we know more about it than they do and are happy to just sign off on things. I think the only reason you would need to change vets is if your vet was being a hindrance (not renewing your prescription or insisting on lab/in-office testing).
 
So today was curve day at the 1.25u. The curve is much better than the one I did for 1U and he's fairly stable so I feel it's a pretty representative day. Not sure why his +2 was still so high this morning but it dropped like it usually does so I'm not overly concerned.

I'm going to send this to the vet and get his recommendation (he's probably going to recommend going back up to 1.5) but I'd like some feedback from you folks as well. His mid day numbers are pretty good and the lime green might have just been a fluke. Would you guys experiment with going up to 1.5 to try to get those pre-shot numbers lower without hopefully dropping the nadir ones too low?

Just behaviourally, his activity level and mood have improved considerably. He's even started running again and isn't quite as wobbly from the neuropathy in his back legs, which is wonderful to see. His pre-shot numbers are high still, but I can tell that his quality of life has improved considerably.
 
Asiina & Alex said:
His mid day numbers are pretty good and the lime green might have just been a fluke. Would you guys experiment with going up to 1.5 to try to get those pre-shot numbers lower without hopefully dropping the nadir ones too low?
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If you can monitor you could try 1.5 u again. He might not dive to lime green this time.
 
I agree. I think trying 1.5u again makes sense. You're doing a good job monitoring, so you'll catch it if it's too much.
 
Also, as important as the numbers are, it's so good to hear that he's feeling better! Those positive signs are super important for keeping up our own spirits in this process, and they are encouraging that you're on the right track.

For the neuropathy -- are you giving B12? That can make a big difference in helping to heal from the neuropathy. You just have to make sure you get the right one since there are different versions.
 
I haven't been giving him anything else since the weakness wasn't too bad. He wasn't walking on his haunches, just had a bit of a limp and the foot would shake sometimes when he'd put weight on it. The new routine is a lot, so I didn't want to add to his stress, and also want to just change one variable at a time in case something goes wrong. Once his dose is settled if he's still struggling, I might try then but he seems to be recovering pretty well. He was even playfighting with his brother which is hasn't done in a couple of months and I know they miss chasing each other.
 
Asiina & Alex said:
I haven't been giving him anything else since the weakness wasn't too bad. He wasn't walking on his haunches, just had a bit of a limp and the foot would shake sometimes when he'd put weight on it. The new routine is a lot, so I didn't want to add to his stress, and also want to just change one variable at a time in case something goes wrong. Once his dose is settled if he's still struggling, I might try then but he seems to be recovering pretty well. He was even playfighting with his brother which is hasn't done in a couple of months and I know they miss chasing each other.
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FWIW - B12 supplement tablets (eg. Zobaline that many people here use) are tasteless and water soluble. You can easily put one in his food dish with a little water to break up the tablet then add wet food and mix it all together. No fuss, no muss, no pilling of a squirming cat.

https://www.ilifelink.com/zobaline-for_diabetic_cats-3_mg_x_60_tablets.html
 
The vet said to keep him at 1.25 for longer and hopefully his numbers decrease, but honestly I don't think he's going to go down on his own. The pre-shot numbers are currently very stable. I might bump it up a little and try that for a week or so and see what happens unless he crashes again.

Also the vet told me that they're not going to answer my questions/give dosing advice via email anymore without charging me, which makes sense since they are a business and deserve to be paid for their expertise, but makes me nervous that I won't be able to get that reassurance from a professional. Makes me a little more nervous about taking care of this disease and making decisions without that safety net.
 
Meh. We know more than your vet does anyway. :);):cat: They know a little bit about everything. We know a whole lot about this one thing (and its comorbid conditions).

Although honestly that does kind of surprise me that your vet won't provide email/phone support since you're less than a month into this. I don't need much from my vet at this point, but he's always willing to talk if I have a question.

Regardless, we are here for you, and since we have all received free support, wisdom, and care around here, we all pass it on just as freely.
 
That is a bit surprising to me. My vet will usually talk to me over the phone if I need anything. When I had Gypsy, I could have called them anytime, though I rarely did since I had this board. But we are definitely here for you and we want nothing in return for our advice except for Alex to feel better!
 
Thanks for the support everyone!

I tried bumping Alex back up to 1.5 and he dropped again, so 1.5 is definitely too high, but 1.25 isn't carrying him through the day so I'm not entirely sure what to do. I can only really fine tune so much with such small amounts and such tiny needles. Even the difference between 1.25 and 1.5 is just a sliver of a difference in the syringe, and I'm using the smallest syringes I can find.

If he's in the good range most of the day I don't know if his diabetes is still doing damage to him when he's high during the 2-4 hours around his shot.
 
Asiina & Alex said:
Thanks for the support everyone!

I tried bumping Alex back up to 1.5 and he dropped again, so 1.5 is definitely too high, but 1.25 isn't carrying him through the day so I'm not entirely sure what to do. I can only really fine tune so much with such small amounts and such tiny needles. Even the difference between 1.25 and 1.5 is just a sliver of a difference in the syringe, and I'm using the smallest syringes I can find.

If he's in the good range most of the day I don't know if his diabetes is still doing damage to him when he's high during the 2-4 hours around his shot.
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You're using U40 syringes for your ProZinc, right? Well, you can switch to U100 syringes with half unit marks and use this conversion chart to allow more dose fractions: http://www.felinediabetes.com/insulin-conversions.htm This would allow you to give a 1.4 u dose (read from the lines) or a 1.3 u dose (eyeballed) if needed.
 
Are the u100 syringes thinner so their units are more far apart? I've been using the logo/placement of the numbers to help guide me with the u40 syringes (the bottom of the 1 is right about where I'd guess 1.25 is so that's what I use to line up the top edge of the stopper), but it's more that the circumference of the syringe makes the lines closer together and part doses harder to determine precisely.
 
Asiina & Alex said:
Are the u100 syringes thinner so their units are more far apart? I've been using the logo/placement of the numbers to help guide me with the u40 syringes (the bottom of the 1 is right about where I'd guess 1.25 is so that's what I use to line up the top edge of the stopper), but it's more that the circumference of the syringe makes the lines closer together and part doses harder to determine precisely.
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They *might* be a little further part but you'll be able to read them with a bit of practice. They really do open up a broad range of fractional doses.
 
I've read many people on here saying that they have bought reading glasses at a higher level so that they can see the lines better and be more precise with the doses. I second Kris' suggestion of getting the u100's so you can do finer dose changes. It takes a little getting used to, but it really helps for sensitive kitties.
 
I'm wondering how long it takes to recover from a missed shot. Three nights ago I gave Alex a partial furshot. I guessed around 1U actually got in, but it might have been less, and he's been reading higher ever since. I'm not overly concerned, but just wondering if these numbers I'm seeing are still the result of that missed shot.
 
I realized that it's been a month since I started this. Slightly more since diagnosis, but a month ago I gave my first insulin shot at home. It feels like it's been so much longer and I've learned a lot. I tried to teach my roommate how to give the shots in case they ever needed to, but they totally freaked out and found it overwhelming, whereas it's just become my morning and evening routine. I remember the vet telling me it was diabetes over the phone as if it was no big deal and I completely freaked out.

It's still an adjustment process every day and Alex is far from regulated, but his symptoms have mostly subsided, and I'm confident I can make changes and monitor him safely. It's still difficult, but no longer feels impossible.

Thanks to everyone here in making this possible.
 
That is a great report! And it looks like those mid-cycle numbers are nice and steady. Now if we could get those PS numbers to start coming down...
 
Djamila said:
That is a great report! And it looks like those mid-cycle numbers are nice and steady. Now if we could get those PS numbers to start coming down...
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I know right?

I'm experimenting increasing the dose a little and hoping he won't get too low like he does with 1.5, so we'll see how that goes after a few days.
 
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