Confused by current high numbers

Heather and Gizmo

Heather and Gizmo

Member
Hi Everyone. I am confused by Gizmo's current high numbers especially after a dose increase this evening. As you can see in his spreadsheet, he had some yellow numbers during the AM dose. After a few cycles on 1.5u and not getting great numbers, I decided to increase .25u. Now his numbers have been steadily in the pink numbers.

Is this because I kept him at the 1.5u dose with higher numbers to long and his body just needs to adjust to the new dose? I am just confused because the last 1.75u dose given to him 4 days ago put him in hypo numbers. I don't want this to happen again, but I was expecting lower numbers. The last 1.75u was given at the start of a new vial. The new vial would not have lost its potency this fast would it?

I am just trying to make some sense to these numbers. I am not even sure that there is an explanation, but if anyone would be able to tell me it would be the wonderfully experienced people here. Thanks again for all that you do.
 
Hmmm...well no, I wouldn't think it's at all likely that the vial lost potency in 4 days. I do think the lime green you got was because of the new vial. I think part of the issue is that Gizmo runs lower at night. So I think the increase at night with a new vial along with the fact that Gizmo runs a bit lower at nighttime (most cats do) may have caused that lime green. I generally wouldn't increase when you start a new vial...some drop by 0.25 when they start a new one, but I usually just stuck with the same dose and monitored.

I'm not sure why he's sticking in yellows and pinks right now, but I would just continue with the slow, steady increases. I'd stick with your s1.75 for a few cycles, then increase again if he doesn't seem to improve. I wouldn't let it bother you that he stuck in pinks...even though he runs lower at night usually...for one cycle. It could be anything that caused that for one night, and it is just one cycle. He might have been more stressed for some reason, or eaten more than normal, or found something he shouldn't have to eat, or just been having a weird night. I do think a lot of cats need to sort of settle into a dose change, which can take a cycle or two.
 
Good morning Rachel. Thank you. It is just so frustrating seeing the pinks numbers throughout a full cycle. I have come to accept that he runs high at the AMPS shot, he seems to rarely be out of the pinks at this time of day. The lower numbers during the cycle gives me some relief that he is getting some healing time. When he is in the consistent pinks he looks so miserable. I just want him to feel good all of the time as I know everyone here does. Thanks again for taking the time to talk this out with me. I hope you have a good day.
 
Ugh! I came home at lunch to do his BG reading and it is 53. Second test done to confirm was 55. I am so grateful that my employer is understanding since I just had to tell them I would be late coming back from lunch. This is so frustrating. I gave him the same dose as last night and he was in the 300's all night. I hate leaving him at home alone during the day, because I never know how he is going to respond. I guess he does not like the dose of 1.75u and I will be going back down to 1.5u tonight.
 
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Heather and Gizmo said:
Ugh! I came home at lunch to do his BG reading and it is 54. Second test done to confirm was 55. I am so grateful that my employer is understanding since I just had to tell them I would be late coming back from lunch. This is so frustrating. I gave him the same dose as last night and he was in the 300's all night. I hate leaving him at home alone during the day, because I never know how he is going to respond. I guess he does not like the dose of 1.75u and I will be going back down to 1.5u tonight.
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I've been through all that with Teasel in the past - erratic responses, deep dives, no correlation between the dose's effect one day versus another. It's very stressful. My advice is to leave a slightly larger margin for error in dosing than you would if he was more moderate in his responses. Eventually you might want to try Lantus. There's no guarantee it'll erase all the ups and downs but it can reduce those to a degree. It helped Teasel although he's still unpredictable as you can see on his SS.
 
Thank you Kris. How do you handle the stress of the erratic numbers? I feel so bad for him because I have to leave him home alone during the day. He didn't seem to have the ravenous hunger like he did the previous hypo episodes. That is why I did another check with the AT2 and the human meter and they both gave low numbers. He is showing no signs of hypo except for the low numbers. Do you think 1.5u would be the right dose for tonight?
 
Heather and Gizmo said:
Thank you Kris. How do you handle the stress of the erratic numbers? I feel so bad for him because I have to leave him home alone during the day. He didn't seem to have the ravenous hunger like he did the previous hypo episodes. That is why I did another check with the AT2 and the human meter and they both gave low numbers. He is showing no signs of hypo except for the low numbers. Do you think 1.5u would be the right dose for tonight?
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I'd try 1.5 u (or a skinny 1.5 u) tonight. I totally understand how much more stressful this is when you have to go to work. I'm retired but do spend much of the day out several days a week. Sometimes it's a leap of faith that Teasel will be OK if he dives. I can't leave food out because my three all eat different wet food.

How do I cope?
  • I "underdose" him a little by the Lantus criteria and that's why there's more yellow on his SS than many would find ideal. I've also seen him look and behave as though he's fine when my human meter shows a lime green reading. If I'm home when it happens I give him his regular LC wet food with a little maple syrup added. Has he hit lime green when I'm out or asleep? Probably - but I also know his "bounce mechanism" is very strong so it's likely propped him up more than once when I haven't been around to test.
  • I'm vigilant but know his patterns really well after more than three years and that allows me to stay more relaxed about it all. I learned a long time ago that I couldn't stay in high alert mode all the time nor could I dose him too close to the edge. What you see on his SS is what I've arrived at: it allows me to go out, sleep through the night, keep him looking and feeling good and avoid hovering in a state of anxiety. Others here are more on top of testing, have remission as a goal with all the monitoring that goes with that, and so on. We each need to find our own balance.
Do you have an automatic feeder for Gizmo? That can give some peace of mind while you're at work. Aside from that it'll be easier on you mentally/emotionally to stick to one meter (and I, personally, love the psychological boost of the lower range you get with a human meter), dose according to the way he reacts rather than aiming for "just this side of too low" in his BG range and try hard to accept that volatility is Gizmo's normal. So many here are stumped by bouncing and stress about finding that perfect dosing method that puts a halt to it. For some kitties that never really happens although Lantus has helped Teasel *somewhat*.
 
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Thanks again Kris. It seems after two months, Gizmo has decided he is going to be a lot like Teasel. I will give Prozinc a little longer. I think the recommended is 6 months. I would be ecstatic if I could get consistent yellow numbers at this time. I have not found that dose yet that will give me these numbers. Am I not being patient enough at a certain dose. I have been trying to hold the doses for at least four to five days. Do you think that with Gizmo's numbers so erratic that I should hold the dose longer? Should I just stick with the 1.5u for a couple of weeks since he has gone down to hypo land the last two times I have tried this?

Well, I am off to work again. I have left him out a couple of plates of food so he can prop himself back up if needed for the next 2.5 to 3 hours.

Thanks again for all the advice. It is good to get the advice from each individual since ECID. I would love to get Gizmo to yellow preshot numbers and blue nadir numbers at this point. I would love remission but I would be happy with well regulated at this time.
 
Heather and Gizmo said:
Thanks again Kris. It seems after two months, Gizmo has decided he is going to be a lot like Teasel. I will give Prozinc a little longer. I think the recommended is 6 months. I would be ecstatic if I could get consistent yellow numbers at this time. I have not found that dose yet that will give me these numbers. Am I not being patient enough at a certain dose. I have been trying to hold the doses for at least four to five days. Do you think that with Gizmo's numbers so erratic that I should hold the dose longer? Should I just stick with the 1.5u for a couple of weeks since he has gone down to hypo land the last two times I have tried this?

Well, I am off to work again. I have left him out a couple of plates of food so he can prop himself back up if needed for the next 2.5 to 3 hours.

Thanks again for all the advice. It is good to get the advice from each individual since ECID. I would love to get Gizmo to yellow preshot numbers and blue nadir numbers at this point. I would love remission but I would be happy with well regulated at this time.
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Certainly with Teasel I find I have to hold doses quite a long time and make changes in tiny skinny/fat increments. You could try leaving Gizmo at a reasonable dose longer to see if he settles. I do know that too many changes too close together and/or in too large an amount can set off more volatility in bouncy cats. Gizmo will do what he's going to do on his own schedule. It can't be forced or rushed. He's still not far from his date of diagnosis in FD terms. It's a marathon ...
 
I have this bad habit of reacting to the flat pink numbers instead of waiting a few more cycles before I increase. I think he is telling me that I need to hold at the 1.5 for at least a week if not a little longer. I hope he only needs to tell me twice. :cat:
 
Kris has given you some great advice, and there are certainly similarities between Gizmo and Teasel in their responses. You test enough, that there is one more option for dealing with the dives, but this one can be stressful. In some cats, that have wonky responses to dose changes: either they seem to push back on the dose change, and then respond later, or they will dive, and then settle into the dose. So one option could be to ignore the dive, and continue with the dose for a few more cycles to see if he settles into it. Of course there is then the stress of knowing that you'll have to deal with a dive, and that nagging anxiety that it could happen again, but I've seen an old spreadsheet (I really wish I had kept track of where i saw these patterns!) where the bean would just press on despite the drop, and it seemed to work.

Of course, if Gizmo dropped again right away you would know that this approach doesn't work with him, but it may be something to consider. I wouldn't recommend this to someone who wasn't testing quite often, but you monitor him closely enough that it could be worth considering.

That approach of course does nothing to help your anxiety level - quite the opposite in fact - but I thought I'd throw it out there as something to consider at some point. In some cats you just have to ignore single numbers, and look at the overall trend. In this case, 1.5 doesn't seem like enough, but 1.75 causes a drop. He seems to need more insulin, so you might have to press on through the dive, and see if he can stabilize at the 1.75 if given a little more time and a few extra snacks. (please don't in any way feel like you need to do this - it would require a lot of you both in stress and in monitoring, and there's a reasonable chance it wouldn't work anyway).

The other option, as Kris said, is to leave him at doses longer than typical. The balance there is that sometimes insulin resistance can develop, so it's a bit of an art to figure out how long is long enough, but not too long. You might start by trying 8-10 cycles at a dose, and then teeny tiny baby increases. That would definitely be easier on your heart than the other idea, ;), and it has just as good of a chance at working. It's going to take some trial and error to figure out what works best. Kris can correct me in this, but I believe when Teasel was still on Prozinc she had to hold a dose somewhere around a week or maybe even a little more before she could adjust. He was very sensitive.

And I agree with Kris that Lantus may be worth considering with Gizmo. He's definitely responding to prozinc, which is great, but Lantus or Levemir might give you some steadier cycles. I would start reading over there now so you can have the information you need to decide, and to talk to your vet. There are a ton of really great stickies over there, and as you read through some threads and look at spreadsheets, you can see what you think about the idea. It usually takes a little time to learn about the difference, to talk with the vet, to order the insulin (most folks order from Canada as it's much less expensive than here), so even though it might be a little early to switch, I'd say it's never too early to start figuring out what you think about it.
 
Thank you Djamila and Kris. You have both given me a lot to think about. I agree that he needs more insulin, but the little bugger won't quit diving on me. I would be okay about pushing through if I knew I would be home during the day to monitor him. I think I will hold the 1.5u for the rest of this week. See if his numbers get any better with holding the dose. If not, then increase him to 1.75u on Friday night. This will give me 5 cycles that I will be home to closely monitor him. Do you think the 5 cycles would be enough to give me some idea of whether he will settle into the 1.75u dose? Will the repeat hypo put him at a bigger chance for DKA from bouncing?

Gizmo has a vet appt. on Thursday. I will definitely start talking to the vet about Lantus. That is what was prescribed first but it was $250.00 for a vial vs $140.00 for the Prozinc. I need to get some U-40 syringes with the half mark on them so I can feel a little more confident that the 1.5u is always 1.5u. I know some people use the u-100 syringe with the conversion chart, but I am not sure I am up to that yet.
 
I think Gizmo has some kind of respiratory infection going on right now. He was just laying down and he sounds kind of funny. When he is up and moving around I can't hear this sound though. I will be seeing if I can get him into the vet tomorrow. Could this be causing his erratic numbers?
 
Heather and Gizmo said:
That is what was prescribed first but it was $250.00 for a vial vs $140.00 for the Prozinc. I need to get some U-40 syringes with the half mark on them so I can feel a little more confident that the 1.5u is always 1.5u. I know some people use the u-100 syringe with the conversion chart, but I am not sure I am up to that yet.
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You can definitely order for less than that from Canada. And the u100s are really easy once you figure out the conversion chart.
Here is a link to it: http://www.felinediabetes.com/insulin-conversions.htm

To draw a dose of 1.6 (which might help with Gizmo's reactions between 1.5 and 1.75), you would draw the insulin to the 4 line. There are half-unit lines, so you can easily go to 1.7 by drawing between the 4 and 4.5 line, and then go to 1.8 by drawing to the 4.5 line. So the baby steps become really easy and are helpful for sensitive kitties because you can be more accurate in the tiny adjustments.

If you have a WalMart near you, you can get a box of u100's for around $13, so the price savings is nice too.

And as for the funny breathing sound, yes, any infection can impact numbers. Although if spring is starting where you are, it's also possible that he's just having a little hay fever. Sam gets a funny nose whistle when he's sleeping at this time of the year. It always resolves once this initial bloom is over. Hope Gizmo feels better soon!
 
Thank you Djamila. I may go ahead and the u-100 syringes. I need to do something to get his numbers down. I hate that he is going backwards and not forwards. He wasn't this sensitive to the last vial of insulin.
 
Gizmo is at it again. BG reading 50 at +3. He really does not like this new vial of Prozinc. I wish I was off tomorrow so I could try and stick with the 1.5u. Since I am not, I will take him to 1.25u and hold that until Friday night. Does this sound like the right thing to do?
 
Yes, I think reducing is the right thing to do here, especially given that you won't be around. He's really keeping you on his toes these days, isn't he?
 
Thanks Djamila. He certainly is. I took him to the vet today. No respiratory infections. Hooray!!! He coughed up a really good hairball last night so maybe it had something to do with the weird noises I heard the other night. I ordered some U100 syringes last night. The vet is very much against me using them due to fear of me accidentally overdosing Gizmo. I was going to order the U40 syringes with the half mark, but then I saw the U100 comes with a shorter needle and I could not find this with the U40 syringe. I did talk to her about switching to Lantus in the future and she thought this was a great idea. She wants me to hold Gizmo at 1.25 units for the next two weeks and then take him in for a glucose curve and fructosamine so they can see what kind of variance there is between the glucometer that they use vs the one I am using???? I am not sure I understand this logic since we both use the Alphatrak 2 and there is always going to be a variance with each test strip and glucometer so there will be a difference. Maybe she thinks it isn't working properly anymore. I should have mentioned that I have a second glucometer that I will use to double check the low numbers for this very reason, but I didn't think of it at the time.

She thinks that I do to many BG readings, which I would agree with her. I told her that I would love to not have to test him so much but he is all over the place and his nadir is never consistent to take one test between the AMPS and PMPS. She mentioned a new study that they are doing at Ohio State university where they implant something in the dog/cat that you can take the BG reading through an app on your smartphone. She said that she would refer me if I was interested so that way I would not have to poke his ear so much. This may be something I may consider in the future but I am not at this point yet. The one vet did mention that maybe Gizmo's pancreas is starting to produce some of his own insulin now and that may be a reason for the low numbers lately. From his mouth to God's ears!! I would love Gizmo to go into remission, but I would be happy with regulation at this point.
 
I don't tell my vet I use the u100's :smuggrin:. He's pretty great about letting me manage things, but he was also not a fan of the conversion idea. I just round the dose to u40 numbers when I'm talking to him.

It's up to you about the vet curve and fructosamine. The curve likely won't be as accurate as your home data (unless Gizmo likes being at the vet?) since stress impacts numbers. And the fructosamine won't give you any info you don't already have. I would tell the vet you'll do it if you don't have to pay for it. ;) And you're right about the variance. Odds are (assuming both meters are coded correctly) that the numbers will be pretty close to the same. And if they are far apart, one of them probably has the wrong code for the test strips.

Of course if having the vet data would make you feel better, it certainly won't hurt anything.

It sounds like she's just trying to take back control of the management since you've gone rogue. :rolleyes:

As for testing too much, if it's stressing out Gizmo, you could get away with less testing, but if he tolerates it well, and if you're taking care of yourself, then don't worry about it. I can't test Sam that much because he doesn't tolerate it that well, but there are people over in Lantus-land that test as much as you do (or even more) and their cats are just fine. I'd be curious about the thing over at Ohio State. There is a meter you can have attached to the cats scruff, but it's kind of big, and not very accurate. It's also been around for awhile though, so I'm guessing OSU might have something new they are working on? Let us know if you learn anything more about it. It would make leaving our cats with sitters a million times easier!

I do agree with the vet that you are seeing some pancreas activity. Unfortunately, that doesn't necessarily equate to remission. Most cats still produce natural insulin, just not enough to keep themselves healthy. And that activity can be more or less on different days/cycles. That being said though, you haven't been at this dance for very long yet, there is still a reasonable chance of healing, and that is always the hope for the new kitties!
 
Thanks again. He tolerates the testing. He sits there most of the time with no trouble, other times he likes to roam a little across the desk a couple of times before he settles down in the spot we do the testing. He is such a good boy. He tolerates quite a bit. I felt so bad for him this morning. When I picked him up to do his testing, his body was limp for a few minutes. I panicked at first, but then he started to move around normally. I think his poor body was worn out from all the highs and lows from the night before.

I will use the U100 to get a more accurate and consistent dose. Right now I just can't say they are consistent. The vet is afraid since it is such a low dose that I am going to have a hard time filling the syringe, etc. She says it is easier to use for larger doses but not with the a dose of 1.25U.

I don't know if I will have the vet do the curve because Gizmo is definitely stressed out when he has to go to the vet. I would do it if I knew that their way would be more accurate, but I can't see that being the case since they use the same glucometer that I do. She said that the fructosamine gives a precise reading opposed to the average we get from the testing we do at home. I am okay with the fructosamine.

I will let you know if I find out more about the new study/program that OSU is doing. The vet did say that it has not been done on to many cats at this point it has been more dogs. She heard about it at a conference she attended recently.
 
Heather and Gizmo said:
She said that the fructosamine gives a precise reading opposed to the average we get from the testing we do at home.
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I'm hoping you just typed that wrong, because it's actually the opposite of that - fructosamine gives an average of BG over two to three weeks, while glucometers give precise readings in the moment. I really hope your vet knows the difference there! yikes.

That's great that Gizmo is unbothered by the tests! Most kitties don't mind them at all. My civvie will literally sleep through it. He doesn't feel a thing. (I just test him once in a blue moon when I'm hoping the meter is broken - it never is. sigh). As long as Gizmo doesn't mind, there's no reason to change your testing as long as you're comfortable with it. And you've been able to catch some interesting data which has been helpful!
 
Hmmm...the things your vet said are odd to me. A fructosamine is definitely not as accurate as readings in the moment. It won't give you any info you don't already have from testing since that gives you the actual readings in the moment and a fructo will give you the average of BG. You can get it if you want, but I never did one...it didn't seem necessary and my vet agreed when she saw I did my own home testing. As for the u100s they will actually be EASIER to fill at lower doses than the u40s since they have markings that you use with the conversion chart.
 
Thank you Rachel and Djamila. Maybe I have the wrong test. Is there another one they would do to get a precise reading of his blood sugar from his blood vs the variances we get from the glucometer. She said (and we all know) that the glucometer strips will vary from test to test, this blood test will give a precise reading at that time. Does this make more sense? We covered a lot of information at the appt. and I may be getting things confused. I swear that the older I get the less I can remember. :confused:

I am going to use the U100 syringes when they come. I need to know I am giving consistent doses.
 
In humans, the A1C test gives an average over months, the fructosamine gives the average over weeks, and the daily glucometer gives the number in the moment. As far as I know, cats don't have an equivalent to the A1C. I suppose a lab tested BG reading might be the most accurate in-the-moment reading, although in reality even labs have variation in their testing results.

I honestly think your vet is just trying to re-establish her authority here. Yes test strips have variation, but that doesn't render them useless. They have an allowed variance, but it's within reason and the number is still sufficient to determine dosing. I think we've talked about this before regarding pet vs human meters, but it also applies between two different test strips or two different AT2's: it doesn't really matter if they are 250 or 350, they are still too high. That's all we need to know.

Sometimes giving our vets a little less information can help keep the relationship amicable. The trick is to not spend hundreds of dollars on unnecessary lab tests in the process. You could always claim lack of funds and/or concerns over Gizmo's anxiety. As long as she'll keep prescribing the insulin, you're good.
 
Thanks again. Currently I am looking into dental work on Gizmo. The estimate given was $594.00 for the low estimate (urinalysis, fructosamine, marsh glucose, glucose curve, sedation, etc). The high end is $1160.50 and that would be if they had to extract all his teeth. Does this sound reasonable?
 
The cost really varies by area. That's a little lower than it is here. the cleaning estimate is about the same (I think mine is around $675 and includes x-ray, pain meds, and IV as well - although not including all those tests you listed). Extractions, especially full mouth, would be way more than the 1160 you were quoted. I think one extraction and the cleaning cost me about that much a couple years ago....or maybe it was two extractions....??? Oh, my memory...:rolleyes:

Other people have shared their quotes as lower than that. So again, I think it just depends on where you live.
 
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