Murphy's numbers high again- dosing advice, please~

Leigh B

Leigh B

Member
Hey there. My Murphy was doing really well for quite some time on 2.5u of Prozinc. I even backed off of testing him b/c his spirits were up, water & food consumption normal, etc., etc.
I did notice that his gums were irritated, and that had me nervous about infection causing problems with his diabetes. So, I had his teeth cleaned in March. I started monitoring again during that time, in case the antibiotics caused any changes in BG.
All seemed ok for a while. Then, I started noticing him at the water bowl again. Not ALL the time (like he was before being diagnosed with diabetes), but more often than I'd seen in a while. (His spirits were good and he had actually started jumping up on our bed. That is a big deal b/c he has neuropathy and could only make it as high as the sofa before.)
SOOO, I started actively testing him again. His numbers have been high and not getting any better. During this time, I was at the end of a vile of Prozinc. I wondered if the new vile would make a difference- "fresh batch"??
As you can see by his chart, his numbers are high. I have increased his dosage and it seems to make a difference here and there, but nothing steady at all.
Is it possible I have started giving him too much?
In the past, I have increased his dosage only to have him "balance back out" to a good level at 2.5 units.
Side note- since I've increased his dose over the last week, he's had some issues with runny poop and seems a little more sleepy. Otherwise, he seems ok, still jumping up on the bed and playing with his furry brother and sister.
Any obvious advice? Thanks so much!!
 
Hi Leigh-

It's great to read that Murphy's clinical signs seem good. Looking at the SS, I don't see any point at which 2.5u really had him doing fine. For a cycle here and there, yes, but not really reaching a point that we would call healthy regulation.

I wonder if getting a human meter might make it easier to test more consistently? Those AT2 strips can be really expensive, and most of us use human meters around here anyway. Just a thought.

I can't really give sound dosing advice without any nighttime numbers. My hunch is that Murphy needs more insulin, but without more data, I can't safely say that. What would you think about testing a little more consistently? Getting a PMPS and a before bed test for a few nights so we can get a little better picture?
 
If it were me, I would try to hold the dose steady for at least four cycles. It looks like you are lowering the dose when he gets into yellow preshots, but that just leads to him bouncing up again, and we can’t really tell if he would do better — getting into healing blues and greens — if you stuck with the dose through the yellow PSs.

I know how hard it can be to hold the dose when the PS is lower than “normal,” but there’s no way to see what happens without trying it. Maybe on a day when you can be home to monitor and help steer if he starts to go too low?
 
Thank you for the fast response and feedback. I'll start monitoring more often, especially PM, and keep the thread updated. I appreciate the advice and support:bighug::cat: stay tuned...
 
Hi Leigh,
Please don't take this the wrong way :bighug:. If you have time to give him his shot every morning and every night, then please take any extra minute to always get a pre-shot test. He's gone down to green sometimes and you happened to catch it and skip those. He's probably done that when you're not testing and blindly giving him his shot :nailbiting:. That can put him in danger and I think it is contributing to his bouncing. He had a nice run on the 2.5U dose in January and from the data you have, I don't think he needs to be on much more than that... but only data can confirm that. Good luck to you and Murphy :cat:.
 
Thank you for all of the feedback. Feeling helpless this morning. I've had him around 3 units for the last several days. This morning he was jumping up and down on the bed, snuggling, seeming full of energy. I woke up happy, thinking he must be in a "good zone." Then, he had a poop accident in the bedroom floor :-( I checked him pre-shot and he is at 567. I went ahead with his 3 units, but I am worried that this dose is not only helping, but maybe making him worse?? I have a few questions: Could I be giving him too much, thus keeping him in high BG numbers? And, he's not pooping in his box. He either poops outside of it, or has accidents in other areas of the house (that has happened twice this week, as well as him vomiting some). Second question is whether his lack of reaction to the higher dose may be a result the actual insulin? I started him on Lantus, and he was not reacting after a while. So, my vet suggested that we try Prozinc. He immediately responded. Is it typical for them to get "used to" an insulin and need to change?
Again, his "clinicals" were good at 2.5. He was eating normally, bathroom was normal, no abnormal water consumption or urinating. It was not until I started bumping his dose up that this has started to change. BUT, the numbers indicate that I need to keep giving him more?? 6 units a day seems like a whole lot to me.
I talked with my vet when I was having his teeth cleaned in March. I told her that I had not been monitoring him as much, because of his demeanor being so good. She said that as long as his appetite was good and water consumption/ urination was normal, that she was not as worried about me constantly checking his BG (maybe just every now and then if needed). I know that is not the consensus here, but, like I said, I feel like since I have been checking and bumping his insulin up, he's acting more sick??
Help! I just want to do what is best for my boy.
 
Got a 175 at +6...fingers crossed we've hit a new place...would still love advice on the above questions- if anyone has any insight.
Thanks!
 
Unfortunately many vets don't seem to be on board with BG testing but we think of it as someone wouldn't blindly give a human child insulin before testing so it's no different for our fur babies :cat:. At minimum we suggest testing BG for Preshot tests AM/PM and one between +2 and +4 for one cycle. This tells us how the dose is impacting them. The average dose for non-acro or non-IAA kitties is about 3.0U twice a day. This may sound weird but Murphy's ideal dose may be one of those x.25 or x.75 versus x.00 or x.50 meaning he might have done better with 0.25 dose increases. What kind of syringes are you using? Do they have half unit markings?

Sometimes too much insulin can do the same as too little but it's hard to tell without consistent data :bookworm:.

For his accidents, did you change the litter type? Is it just poop? How are his paws? Could be a sensitivity that he's associating with pain by stepping in the box. Does he have any PICA that may be resulting in him eating things he's not supposed to and then can't properly digest or pass? Any food allergies? Are you testing for ketones? Sorry for bombardment of questions :oops:, just trying to think of things.

As for "typical" and getting used to an insulin, the only consistent thing our sugar babies are is inconsistent and nothing is typical :rolleyes:.

With most recent dose increase from past 2 cycles, there's a little bouncing going on. I also wonder if you should've started prozinc at a lower starting dose like you did with Lantus. Since he seem to respond to Prozinc faster, 2.0U may have been too high a starting dose. The initial 6 cycles on Prozinc is where I'm reading this from. I could be wrong, it's just *my observation* :).

I'm not sure if any of this was helpful... :facepalm:
 
Thank you! Yes, it is helpful.
The syringes I have right now do not have the half unit markings. I have used those in the past, and find them to be much more helpful. Right now I am "estimating" between units as to how much I am doing, on the .5 or .75. Any idea where I can get syringes with the half mark? I usually get them from my vet, and am at the mercy of whatever brand they are carrying at the time. I am on the U40 syringes.

As for his accidents, it is just poop. And, the only "pattern" I have noticed is that he poops outside the box more often when he's been given higher insulin doses. He doesn't always do it* :-/ He is good about urinating in the box, thank goodness.
He does not suffer from PICA or seem to have any other issues that would cause him digestion issues.
One side note, though....I do feed him and his brother in the mornings. I feed them "diabetic approved" wet food. Sometimes they do not finish all of it at once. I have wondered if Murphy going back to the food later in the day is causing his BG to stay elevated more during the day. I have tried feeding them less, so that they both finish all of their food in one sitting (twice a day, when Murphy gets his shot), but they both end up starving and acting out before their next feeding.
Thoughts?

As for the initial cycles on Prozinc, I started him where the vet recommended. As you can see by his chart, he got pretty low and I adjusted here and there. I'm learning that the folks on this site actually seem to know more than the vet sometimes when it comes to monitoring. My guess is that there is so much experience on here??
Anyway-had a 175 reading yesterday with 173 PS. I was nervous to give him a full 3 units with him in that range, so I gave him 2.5 last night. As you can see, he was high PS this morning, so I gave him 3 units again. At +6, he is at 308. I am so discouraged. Feel like I am chasing numbers.
Again, in reference to his feeding info above, I can't be positive he did not have a bite of food today before I tested him, but his food bowl did not look much different. (I also took up the extra food bowl, so he wouldn't be "free feeding" all day. Just left a little down there for the other cat).

I am sorry to bombard YOU with so many questions. I thought I had a good handle on things, but can't seem to get a balance lately.
Thanks so much for you advice and insight.

*he pooped in his box with no accidents this morning- first time that I know of in a few days.
 
Leigh B said:
Any idea where I can get syringes with the half mark? I usually get them from my vet, and am at the mercy of whatever brand they are carrying at the time. I am on the U40 syringes.
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I know every state has their own rules about syringes, but if you can buy them without a prescription, you might consider switching to u100 syringes, and using the conversion chart here: http://www.felinediabetes.com/insulin-conversions.htm

That allows you to be much more precise in dosing and make small changes when needed.

Pooping outside the box can be indicative of high BG, IBD, pancreatitis, food allergies, or just a food that doesn't agree. They will poop/pee outside the litter box when they are trying to tell us they don't feel well. So I'd maybe explore some of those options.

I'm a big fan of free feeding, so I'd go ahead and keep leaving the food out. That isn't likely to be the cause of any of the issues I'm seeing.

As for feeling discouraged, we all go through times like that. So hugs to you.

And you can see from the data, that you didn't need to lower the dose last night. The only sight we have around here is hindsight, so you use that data to help you decide next time. First, you could try stalling for an extra 20-30 minutes and test again - if he's rising, then you know it's safe to stick with the dose. Or you can try reducing, but by less - so try 2.75 next time. And maybe a skinny 3 the time after that. Everytime you collect data, it makes you a little smarter for the next time. :bighug: Kitties don't come with an instruction manual, so that's how we all learn what our cats need.
 
First off :bighug::bighug::bighug::bighug::).

Don't drive yourself crazy chasing numbers. Like Djamila said, we have a lot of hindsight. Try not to let one test or cycle make you discouraged but look at the big picture, which is where the data becomes very helpful. I still have a hunch about something but don't want to mention it until there's a few more days of consistent data :bookworm:. Are you doing any ketone testing? Do you rub/touch the injection site after giving a shot?

Fingers crossed for no more poop accidents but I agree with Djamila, that he's trying to tell you *something* :smuggrin:. Here comes some poop talk; does it look like normal poop?
 
Poop- more runny than solid, but not liquid:arghh: Had a poop episode yesterday with some in the box and looks like he finished on the floor, outside of the box.
Yes, I rub the injection site when I give the shot.
And, his ketone test shows "barely detected" ketones.
Again, his mood is downright giddy. That makes me feel better- I know something is wrong b/c of his poops, but he's acting happy. When he was at his lowest point, he was SUPER lethargic and kept to himself.
Thank you for your continued advice- I will keep monitoring and posting...
Going to try to find better syringes, too.
 
Djamila said:
I'm a big fan of free feeding, so I'd go ahead and keep leaving the food out. That isn't likely to be the cause of any of the issues I'm seeing.
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I have a question about accurate BG if they have access to food all day. For example, I gave them their usual can(s) for breakfast this am. There was some left in the bowl(s) when I left for work.
I just got home, and both bowls are empty.
The first thing I did was get a BG on Murphy, and it was at 356, which is about 6.5 hours after his shot.
How do I know if he's showing a high number b/c his insulin isn't a high enough dose or if it is because he just ate something? If I do not know exactly when he is eating, how do I know if his numbers are/aren't "skewed" higher b/c he has just eaten?
I know I may be overthinking it, but that is why I feel like the ideal situation would be if they ate every bite all at once twice a day.
I know that is not possible, but I struggle with wondering about the accuracy because of eating throughout the day.
Thanks!
 
Yong said:
I still have a hunch about something but don't want to mention it until there's a few more days of consistent data :bookworm:
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I'd love to know your theory. I am not seeing much difference in his numbers. One thing I DID discover- I had a sitter checking on him Fri pm and Sat am. As it turns out, she did not give him his morning dose. That is why the chart is blank for that shot (I was waiting to see what time she'd given it, only to find out that she didn't). SO, he had 0 units, then 3 units...his AMPS was really high that next morning, but I wonder if the missed shot contributed to the 175 and 173 later that day?? Again, wondering if I am overdosing him, although when I decrease the dose by a little not much happens?? I know I am not giving him dangerous amounts to cause him to get to super low levels (that is not what I mean by overdose), just wondering if I am not at the right dosage...again, nearing 6 units a day without much change makes me wonder???
ARG!!!
Again- his mood is up, energy level high (for him :cat:), he's been "chatty"...all signs that he feels ok...just the issue with the soft stool.
About that- he went next to the box again after his shot and dinner. There was a touch of blood in the stool. That has happened before, and my vet said it can happen when there is a change in food. I haven't changed his food, though :confused:
 
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Leigh B said:
Yes, I rub the injection site when I give the shot.
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You actually don't want to do that. it can degrade the insulin. So inject, and then hands off for a little bit. If kitty likes post-injection snuggles, just stay away from the shot site. Disturbing it can contribute to inconsistent numbers.

Leigh B said:
How do I know if he's showing a high number b/c his insulin isn't a high enough dose or if it is because he just ate something? If I do not know exactly when he is eating, how do I know if his numbers are/aren't "skewed" higher b/c he has just eaten?
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As long as he's on low-carb wet food, you don't need to worry about this. The insulin should be able to support him through snack time if he's on a good food and a good dose. It can take a little while to get there though. You do want to pick up food two hours before the PS time to help with accuracy in dosing. But the mid-cycle we don't worry about it. Just let him eat normally.
Leigh B said:
I feel like the ideal situation would be if they ate every bite all at once twice a day.
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That can actually cause deeper dives and higher spikes. Eating snacks during the cycle can help them be steadier. Think about how you feel if you've gone many hours without food. You might feel sleepy, or hangry, or struggle with concentration -- those are all things we feel when our BG is off. And not eating all day is a big cause of that. Letting them snack actually helps keep them steadier and feeling better.

Leigh B said:
she did not give him his morning dose.
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When that happens (which hopefully it won't ever happen again), you can put NS for no shot into the spreadsheet. That way we know you didn't just forget to enter something in that cell.

Leigh B said:
nearing 6 units a day without much change makes me wonder???
ARG!!!
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Kitties need what they need. There are cats on here who get 40 units/day or even more. We usually send them over to Levemir when they get to around 12 units/day. So you still have a ways to go before we'd be concerned.
Leigh B said:
There was a touch of blood in the stool. That has happened before, and my vet said it can happen when there is a change in food. I haven't changed his food, though :confused:
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It sounds like he might have IBD. Your vet can give him a round of metronidazole since it's been a few days already. That will get it under control. Then you can start using a good probiotic. You'll need to give it every single day, without fail. It takes about a month to build up, but after that it can really make a huge difference in how they feel.

I know that was a lot all at once. Please know that you're doing a good job. This is just a lot to learn! Hugs to you, and hang in there. :bighug:
 
THANK YOU THANK YOU THANK YOU!! That helps put my mind at ease! I'll get his probiotic routine going as soon as I get through a metronidazole round.
He vomited this morning and had a tiny poop accident. I went ahead with a skinny 3 units this am. I can't monitor him during the day today, but will try to get a mid cycle test tonight after his PM shot (and, I'll obviously do a PMPS)
Hopefully, I'll slow down with my help requests...You guys are amazing!!
 
Help! Just tested... about 10.5 hours after his shot. He's at 544!!
Why his numbers not going down as his insulin goes up?:arghh:
 
Djamila said:
I dont' see any of those numbers on your spreadsheet....? Am I just missing them? :bookworm:
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Arg...didnt plug them in...sorry...was at 544 at +10.5, then PMPS he was at 350...at +3 from that dose he is at 410?? I tested him twice, on different ears, just for info's sake...one ear was 410 and the other was 414. I know that is considered the same thing, basically.
His numbers are still not making sense to me. Higher dosing is not making significant changes.
The only difference I am seeing is more upset stomach (bowel movements) and more vomiting.???
 
Deep breaths. His numbers do actually make sense right now - they just aren't nice.

The 410/414 is a food spike. You can see that on most of the PM cycles, the before-bed test is higher than the PS test. That's not uncommon. It just means that the food has brought his number up, but the insulin hasn't kicked in yet. If you tested a little later, you'd most likely see the number come down after that.

The 544 to 350 is curious to me and makes me wonder if the 544 might have been a bum test. Sometimes just a little too much or too little blood can throw off a test. And the AT2s seem particularly sensitive to things like that. Or it could just be that he's got that much variation. When cats arent' regulated, their numbers can be all over the place sometimes.

And the high numbers and apparent lack of insulin response are most likely because (a)you're at work most of the day and can't see the lowest part of the cycle, and (b) he's sick right now. The inflammation in his GI tract is going to raise his numbers and make him push back against the insulin. Hopefully your vet will give you some metro and that should start to improve things in a few days.

Oh, and the as for a probiotic, I've had good luck with this one: https://www.chewy.com/animal-essentials-plant-enzyme/dp/49372

Again, you have to be patient while it builds up (so the sooner you can start, the better), and be super consistent and make sure to give it every single day without fail. You can also post out on main and ask for recommendation for probiotics. There are several others that are used commonly around here, but I'm not as familiar with the other brands as this is the one I've used for years now.
 
Good morning!! Had a 219 AMPS!! AND...no vomit...AND poop IN the box!:D
I realized that I have been rubbing his ear before testing to get the blood flowing/warm up his ear. Wondering if that affects anything?
I am going to stop doing that, just to see. Thoughts?
Should be able to start the antibiotic today, and will research probiotics! Thank you for the recommendation.
You have no idea how reassuring your advice is!! Thank you!!!:bighug:
 
I don't think rubbing his ear should make any difference. Rubbing the injection site is a no-no, but the ear shouldn't matter. I've been rubbing Sam's ears through every winter and it doesnt' seem to make any difference. Certainly doesn't hurt to try though and see if it matters for Murphy. ECID and all!
 
What's the antibiotic for? I'm sorry, I can't recall. More than likely, it will make him feel better pretty fast so it might really be that it kicked in that fast! I know when I take ABs I usually start to feel better in 1 or 2 days at most and that is probably true for cats too.
 
Already seems to be responding to antibiotic. Still had a few accidents outside the box, but less runny and no blood. (yuck, I know! But, good signs!)
His BG seems to be better, too!
Really hoping that this IBS issue is why he wasn't responding to the higher doses.
Thanks again for the advice!!
 
I will probably start a new thread, but wanted to reach out here, since you guys have been with me for a while :)
Murphy's numbers are not getting better. He responded well to the antibiotic, and I have him on probiotics. His poop is back to normal. He is still going outside the box from time to time, but I think that may have something to do with habit &/or his brother's poop habits (We have 2 boxes that they share).
ANYWAY- he has started drinking more water and I'm noticing more urine in the litter box. It is not as extreme as it has been when he was really bad in the past (before diagnosis), but I want to get ahead of it.
He seems in great spirits, which is good, but I do not want him getting sickly again.
Any thoughts on what may be the issue? Wondering if I need to switch insulin brands? I still have some of his old Lantus in the refrigerator. It doesn't expire until next year. If I did that, I would obviously start with a much lower dose, etc. It makes me nervous to "toy" with meds, so I am hoping to avoid that.
Another thing is my monitoring. I question the accuracy of some of my mid-day tests (I get them when I can), because I do not know if he's just eaten some food or not.
As you can see, I had a 190 within the last few days. That makes me nervous about continuing to bump up his doses. PLUS- as you can see, bumping up his doses has not resulted in much change. We are starting to move in the other direction it seems?
Advice? :banghead:
Thanks!
 
We don't worry about the mid-day tests being food influenced. Cats do better with snacks, so giving them access to food is more important than worrying about how long since he last took a bite.

I do think that a longer acting insulin might be a better fit. I'm afraid I don't know/remember why you left Lantus. Was he not doing well on it? If so, you might try Levemir. It seems to work really well for a lot of cats. If he was fine on Lantus, and you just weren't getting the results you wanted, then it might be worth another try, especially if you feel like you've learned a little more since then.

If you do decide to switch, post in the L/L forum and ask for help with determining a starting dose. In general, we recommend starting at or near the current dose. And considering that it looks like Murphy needs more insulin than he's getting, I would really not suggest lowering the dose much when you switch, but check with the folks over there for more specific guidance on that.
 
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