New here and Concerned about the numbers.....

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Goose

Goose

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Hi all,

New to this site and feline diabetes. My cats name is Do daa and he is 11.5 years old, 14.5 lbs. and has recently been seen by the Vets and diagnosed with diabetes.

(Yikes this is a long post!)

He is a diehard dry food only cat for his whole life and I know that's a problem in the long run. He has currently been weened off the original dry food Friskes Seafood Sensations and is currently on Dr. Elseys Clean Protein Chicken.
He is supposed to be eating just a little less than a full cup (.90) at (450-470 cals) a day. We have broken it down to 1/3, 1/3 and 1/3. He is also a diehard Grazer and does not eat a lot at any one given time. 10-20% of a 1/3 of a cup. Transitioning him to wet food, if possible, will take time. This is a stressful time for all involved.

He has yet to eat the full 1 cup requirement per 24hrs. but seems to be progressing towards that goal a little each day. Dr. Elseys is 59% protein vs. FSS at 30% and it's taking him longer to digest? His bowel movements are normal so far. There it no unusual walking.

He is on Prozinc with the dosage at 2 units in the morning, and 2 at night, a total of 4 units per day. He has only been on Prozinc since mid day last Friday Sept. 27th. 2019.

I'm using the Relion Prime meter with u40 syringes. Test strips are current.

We are very new to all of this. A couple of times this past week, he has been high "HI" on the meter which means 600+.

The vets are closed on the weekends and on Wednesdays (issues on these days of course) and we've had to wing it logically a couple of times.

I'll give the numbers for the days so far: (TEST/FOOD/INSULIN is the procedure)
9/27: The day he was taken to the Vet
He had his first shot around 1230pm
1048pm 511
Was not told to leave food for him overnight and then... crashed in AM.

9/28: 934am 35 - tested again - 46 no insulin given (very lethargic) Did not know about Karo Syrup at this time or didn't hear from Vet. Information overload.
952am 51 tested again 57 then ate food
1134am 118
133pm 366
535pm 427
931pm 504 insulin given
Food left overnight

9/29: 922am "HI" per meter 600+
937am insulin given
1147am 413
604pm 559
937pm 375
951pm insulin given
1133pm 278
food left overnight

9/30: 849am 112 food but no insulin given
954am 107 (Called Vets because of these numbers - down after food?? Went to Vets, left him there all day, they tested our meter against their "pet" meter, apparently ours is less accurate at the lower end of the numbers 20-30 points - according to them. Picked him up at 530pm, big stress on Do Daa all day, no eating no peeing. Not helpful.)
846pm 460
902pm insulin given
food left overnight

10/1: 850am 373
901am insulin given
851pm 68 no insulin given
10:06pm Checked again 79 - no insulin given
food left overnight

10/2: 854am "HI" per meter 600+
859am insulin given
1050am 592
255pm ( 6hrs after does) 502
842pm 157 no insulin given
food left overnight

10/3: 837am 573
849am Insulin given
846pm 180 no insulin given

*(The food left overnight has been 1/3 of a cup or slightly less)

All the blood work tests were done including a urine tests all of which came back normal except for the high
glucose. Which started us on this journey.

I am confused by these results. Is Something Wrong?
Many of these days he has only received 2 units in the course of the day.
If it's below 200 we do Not give him insulin. A couple of times it's been really high in the AM and really low in the PM.
 
Yikes. I hope you get responses from people familiar with Prozinc and more experienced in general, but that seems like too much insulin. You could also try the Prozinc forum for folks who use that insulin.

You might read in the stickies about the somogyi effect, in case you want to bring that up to your vet. This is when too much insulin can cause high blood glucose.

Good luck, and I’m sure you’ll get a more experienced response soon.
 
Hi Goose! I agree, 2 units is definitely too much for him. You don't want him going lower than 90 on a human meter when he's on ProZinc. The high numbers you're seeing are bounces, it's his body's way of protecting himself from dropping too low. The body dumps excess glucose to protect itself and thus we get those really high 500-600s. He definitely needs a reduction ASAP. I'm not experienced enough to give a suggestion of how much though.
 
Welcome, and well done with the testing!

I do not use ProZinc, so I can't advise on dose, but it does look like the 2U might be too much for him.

One thing you could do to help people evaluate the data you have is to put it in spreadsheet form. We have a common format we use on this forum (click links in most of our signatures to see examples). Instructions here:

FDMB SPREADSHEET INSTRUCTIONS

Let us know if you have any problems setting it up and putting a link in your signature.


Goose said:
\
I am confused by these results. Is Something Wrong?
Many of these days he has only received 2 units in the course of the day.
If it's below 200 we do Not give him insulin. A couple of times it's been really high in the AM and really low in the PM.
Click to expand...

What you are probably seeing is a phenomenon called "bouncing", which Elizabeth explained very well. The thing that makes it extra-tricky to figure out is that the bounces can last a while-- up to three days! This is one reason we like to see the BG data on a spreadsheet-- sometimes you have to be able to look at patterns over several days before you can see what is going on, and the spreadsheet gives a nice visual shorthand.
 
I agree with @Nan & Amber The dose is too high and Do daa is trying to compensate for that.

Tagging @MrWorfMen's Mom for you. She knows more about prozinc than I do.

In the meantime, please read about what to do in case of a hypo. The information can be found here.
Symptoms of & how to treat HYPOGLYCEMIA - what to do if your kitty experiences hypoglycemia
Jojo's Hypo Tool box - be prepared, what to have on hand in case of an emergency

It is good to print them out and have them on hand.

The only time you need to pick up food is 2 hours before shot time so that the shot test is not food influenced. Until you start shooting a lower dose, I would leave food available at all times.
 
Hi and welcome to you and Do Daa! So glad you are home testing and caught those lows and not given insulin at low pre-shots. The starting dose of 2 units is roughly double what a normal starting dose is. The problem is that our kitties are notorious for being stressed at the vet and that leads to elevated BG. That elevated BG often leads to the vet prescribing a higher dose of insulin than is needed and it only becomes apparent once kitty is back home in their own environment.

The other thing that may have caused some of the low numbers is the change of diet. The difference in the carbs in Friskies dry food vs the Dr. Elsey's is substantial and has likely brought about a lowering of BG. While a kibble diet is not optimal, the Dr. Elseys is an acceptable low carb option. I know only too well how difficult it can be to get some cats to transition to a wet diet. I fought with my girl for quite a while through our journey. Just keep trying.

Does Do Daa have any history of ketones or DKA (Diabetic Ketoacidosis)? If not, I would suggest you reduced the insulin dose to 1u twice daily as long as pre-shot is 200 or higher and mid cycles tests are not dropping below 90. I'd hold the dose for a period of at least 5 days to start and then re-evaluate.

It would help us help you if you would set up a spreadsheet and keep it updated with your test results. We are very data oriented here and the spreadsheet will give you a great way to track progress in a very visual way and keep information readily available so you don't need to type out a list of readings to get help. If you need any assistance getting the spreadsheet set up, just holler. We can set it up for you.
 
Hi Goose and welcome to you and Do Daa. You have come to the right place for information and support to help Do Daa get his BG (blood sugar) regulated and feeling a lot better.

Please create a signature so that we can see Do Daa's information right away when you post.
Setting up your signature (light grey text under a post). Here's how:
click on your name in the upper right corner of this page
click on "signature" in the menu that drops down
type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what he eats/any other meds or health issues he has. You can add your name, and a geographic location (sometimes the country/time zone matters) Be sure to SAVE when you are finished.

Nan gave you the link to the spreadsheet, and here is another link that explains how to understand the spreadsheet:
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

When you set up the signature and then the spreadsheet, it's very helpful to put the spreadsheet link (eg. Do Daa SS) at the very end of Do Daa's info, even make it bold so it stands out.
The instructions tell you how to create a text link (the URL spreadsheet links can be very long and take up a lot of room and signature space is limited).
Much easier to find, just in case you have a bit of an urgent event or question and the spreadsheet data needs to be consulted.

Will Do Daa eat canned food at all? If he is willing, and you decide to transition him to a low carb wet diet, here is a Food Chart from www.catinfo.org by Dr. Lisa Pierson DVM. Dr Pierson recommends " start with protein minimum of 40, fat maximum of 50, carb max of 10, and for cats with kidney issues....phos less than 300."

Many members feed Fancy Feast Classics, Friskies pates or 9 Lives varieties, because they are available and affordable. If you worry about him having food when you are at work or during the night, many of us use a timed feeder so that compartments can be set to open at certain times, and food will be available. Many of the feeders have little ice packs that fit under the dishes so that wet food stays cool and can be used in warmer environments.
 
Thank you all for your replies! I've yet to test him, but will be soon.

How do I start a private conversation?
 
Again, thank you all for your assistance. I will be going through this thread in the coming days.

Do Daa's BG tonight was 337 and he was given a 1U dose. We're going to re-test at 1130pm to see what 1U is doing with BG at 337.

Tested at 1130pm - BG at 205. Not sure what it will be in the AM.
 
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We had been giving Do daa 1U at night and 2U during the day (only 2 days tho) after a brief conversation with the vet because of the up/down/bouncing- but that doesn't seem to have helped much. Having the dosage different in AM and PM doesn't seem to be helping. This is indeed frustrating.

I have the last couple of days numbers but today he was high all day.
840am 558
857am 2U insulin given
1140am He ate some wet food for the first time in a long time
3pm 516 - because of the wet food?
843pm "HI" 600+
9PM 2U insulin given ( we felt it necessary to give 2U tonight because of the numbers...)

I haven't looked at the spreadsheet information yet. Someone mentioned that they could assist with that I believe if needed.
 
Goose said:
We had been giving Do daa 1U at night and 2U during the day (only 2 days tho) after a brief conversation with the vet because of the up/down/bouncing- but that doesn't seem to have helped much. Having the dosage different in AM and PM doesn't seem to be helping. This is indeed frustrating.
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It takes time to get anything close to regulation....be patient! It was a good 5-6 months before I started to see anything that resembled a pattern with China.

ProZinc can be dosed based on the Pre-shot test, but we've found it usually works best when you give the same dose both AM and PM …...and it's important to test in between the shots too so you know how low the dose is taking him.

I'd suggest dropping back to 1.5U and holding that dose for several days. Let's see how he's doing then. 2U dropped him too low, so it's best to drop him back a little until you get more tests in.

Goose said:
Someone mentioned that they could assist with that I believe if needed.
Click to expand...

I'd be happy to set you up with our spreadsheet. Just click on my name and choose "start conversation" to send me a private message so I can get some information
 
Hi Chris & China,

Your suggestion is to give him 1.5U during the day and 1.5U at night? Does the constant changing of the dosage help or hurt?

2U was given today because he was high in the morning, and really high at night. I haven't noticed 2U bringing him down too far... like going from 500 back to 300. It's seeming like 100 points is about it. But without the spreadsheet, I'm guessing it's hard to see a bigger picture.

As mentioned above, he was high all day 840am 558 - 2U insulin given - 1140am ate some wet food - 3pm 516 - 843pm 600+ - 2U insulin given. Given this info. how would dropping him to 1.5U twice a day help him?

Does hunger play a role in increasing BG? We gave him 2U at 9pm and tested him again (no food for 2hrs) at 1130pm and the meter still says "HI" 600+.
 
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Goose said:
Given this info. how would dropping him to 1.5U twice a day help him?
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The fact that 2U dropped him to very low numbers on 9/28 is the reason I suggested a lower dose. It's always better to start lower and gradually go up.

Goose said:
Your suggestion is to give him 1.5U during the day and 1.5U at night? Does the constant changing of the dosage help or hurt?
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Yes, 1.5 both AM and PM.....Usually we suggest giving the same dose for both shots at first anyway. With ProZinc, you can give different amounts, but we've seen better results with a consistent dose. If it doesn't end up working well for Goose, we can always try a sliding scale dosing later.

Goose said:
Does hunger play a role in increasing BG? We gave him 2U at 9pm and tested him again (no food for 2hrs) at 1130pm and the meter still says "HI" 600+.
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Until his numbers are lower, he'll want to eat more than normal, but the only time it's really important that he not eat is for the 2 hours immediately before Pre-shot tests so you get a number that's not influenced by food. In between shots, you can feed multiple mini-meals which are easier on the pancreas than 2 big meals per day.
 
Chris,
These numbers were today/tonight 10/8:
850am 560
902am 2u given
309pm 208
850pm 535
858pm 2u given

Your suggestion is nearly the same as @MrWorfMen's Mom.

Common consensus is that starting Tomorrow AM/PM I'll start giving ( Do Daa ) 1U of insulin No Matter His High Numbers. Suggestions for how long this should go on before I see any results? What exactly am I looking for? A 100, 200 base point drop constantly? Or?
 
@Goose ….we're very data driven here so we need to get you a spreadsheet for you to put your numbers into.

I'd be happy to help you with it. Just send me a private message so I can get some information from you. Click on my name and choose "Start Conversation"

We also need you to fill out your "Signature" so people can quickly see which insulin you're using and get a little background. You'll see our signatures under each of our comments. Things we like to see are:

Your name/Cat's name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health issues or medications? and a general location.

Goose said:
Suggestions for how long this should go on before I see any results? What exactly am I looking for? A 100, 200 base point drop constantly? Or?
Click to expand...

We want to see a nadir around 90 with Pre-shots around 200 but that will take time to achieve. For now, I'd just stick with the 1U dose (if that's where you've decided to start) and hold it for at least 3 days and then let's see where you're at.
 
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Chris, etc,

I started Do Daa on 1U yesterday morning.

847am 356
904am IU given
3pm 560
843pm "HI" 600+
852pm 1U given

Today:
842am "HI" 600+
852am 1U given
303pm "HI" 600+
900pm "hi" 600+

I'll included tonight's readings later, which will be the end of day two at 1U.

As of right now, and can't see 1U helping him at all. Is this how it's suppose to be? Because it seems he's constantly Really high. I don't want to do damage.
 
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High numbers do take time to do damage...it's the low ones that kill quickly but yes he may need more insulin. I think I originally suggested 1.5

We really need to see his numbers on our spreadsheet though. Without the spreadsheet, you're really tying one hand behind our backs.

Are you testing for ketones? You can get urine ketone test strips at any human pharmacy. Here are some Urine Testing Tips
 
Yes, you did originally say to start at 1.5U. I figured that 1U was as low as I would go as not to overshoot a correct dose for him.

I have been speaking with MrWorfMen's Mom about the Spreadsheet. She has indeed agreed to help me with that. She has been Very helpful.

I have yet to do the SS because I have a clear dislike for Google, however I think we may have found a work around for the phone number exposure - a requirement for a gmail account apparently. I appreciate my privacy and am always online with a VPN.

I have not been testing for ketones. He had a complete blood panel and urine test not 2 weeks ago, everything was fine except the high BG.

I just gave him 1.5U tonight. I'll continue with this dose and hopefully we''ll see some improvement.
 
The Net has been down for a couple of days due to the power being out, so no access to the site. Luckily the generator did just fine.

We've been continuing to test, lately about a week or so 3 times a day, AMPS, +6 , PMPS.

Do daa is still up and down, readings like 120 - 600+. Today marks the 8th day at the 1.5U morning and night, as Chris suggested. Nothing has been steady so far but he has shown little effects aside from noticeably drinking water and peeing a lot. No other outward signs.

I did test Ketone once and it was negative. How fresh does the urine have to be? It was in a clean puddle on some clean plastic sometime overnight.

I'm ready to get some help with the Spread Sheet if anyone can get it up and going for me. I have lots of numbers.

Thanks!
 
Hey, Goose, sorry you have had power outage. That is always difficult.

Please get your signature for Do daa done, and you can click on Chris & China's picture or name, then choose Start a Conversation. She is one of the members that helps others with the spreadsheet set up.

Setting up your signature (light grey text under a post). Here's how:
click on your name in the upper right corner of this page
click on "signature" in the menu that drops down
type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using/glucose meter you're using/what he eats/any other meds or health issues he has. You can add your name, and a geographic location (sometimes the country/time zone matters) Be sure to SAVE when you are finished.
 
I'm wondering if the dose is still too high but the testing being done is not necessarily giving you the full picture of what is going on. It's also possible you are seeing glucose toxicity from sitting in those high numbers for so long.
ProZinc's peak action (nadir) is generally any time between +4 and +7 post shot. Getting a test at +6 every day is great but it may be that the lowest point in the cycle is occurring before +6 and therefore you are never seeing it. Also, you have very little in the way of night time data. If you can grab a test every night at +2 or +3 and again before you go to bed, it will help you see what is happening during the night cycle which is important since our kitties have a tendency to go lower at night than they do during the day.
Do you have syringes with half unit markings? If not I would suggest getting some so that doses can be adjusted in 0.25u increments.
Try to randomly get some tests in during the expected peak period when possible and some night tests and let's revisit the dose again in a couple of days.
 
Hi,

The dosage Do Daa is getting is at 9am, check at 3pm, and dosage at 9pm. It's the schedule that works best.

If he's given a test (+2) after 9pm - (11pm) - since he's a grazer - am I suppose to withhold food again, (9pm-11pm) for those 2 hours? Testing him 4 times a day is going to put his paws in tender shape at one point...

We've tried 1u twice a day, 1.5u twice a day, 2u twice a day - none of this, according to the SS is working.

Should we try to switch from (+6) to (+4) to see if there is a lowest point in the cycle? Wouldn't 1/2 way through the cycle (+6) be logical for the lowest point? Or is he just flat out getting too much insulin at 1u, 1.5u, or 2u?

I do not have the syringes with half unit marks yet, I'm about half way through the first box of regulars, but will be ordering those soon.

I've added the last two days to the SS.
 
You need to take the pre-shot test without food influence (fasting). Food doesn't matter when it comes to any other tests that you take.
Half way through the cycle (i.e. at +6) is not necessarily the lowest point and right now you are trying to find the lowest point so see if Do Daa is dropping lower than you are currently aware. If it's possible, to keep testing to a minimum, just do one test on each cycle sometime between +4 and +7. One day do the +4, the next +5 and so on.

If you use a different paw for testing each time, there should be no problem. Have you tried testing Do Daa's ears? Being able to test in both locations would give you more options.

Do Daa's numbers seem a bit better on the 1.5u dose but it's still unclear whether a slight reduction or increase is needed because we really don't know what he's doing on the night cycle at all.
 
Hi,

He's just about as inactive during the day as at night. Testing more at night especially after 11pm is not likely. We need to find the best dosage without numbers past 9pm or, if we decide to, 11pm.

The +6 numbers on the SS have been completely withholding food between 1-3pm for his +6 test. Does this matter? Doesn't the food effect the +6 number just like the AMPS and PMPS? Or at AMPS/PMPS we're just concerned about insulin amount to give him...?

We started doing the testing in his ears, he doesn't like it at all and blood was forming between the layers. We do not want to give him a hematoma, we've dealt with that before in another cat and it was expensive to fix. He is much more compliant testing with his paws.

So tomorrow we should do the +4 test, next day +5, next day +6, next day +7? (just to +7?) Just to see if there are any differences in the numbers from just the +6 test?
 
Goose said:
So tomorrow we should do the +4 test, next day +5, next day +6, next day +7? (just to +7?) Just to see if there are any differences in the numbers from just the +6 test
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Yes that will help us see what is happening.

If you hold mild pressure on the poke spot after testing, there should be no worries about a haematoma. That said, if Do Daa is Ok with paw testing, then use his paws.

It's entirely up to you whether you will do a test on the night cycle or not however, without any night data, figuring out the best dose is going to be difficult if not impossible. The night cycle is half the day and often there are lower readings overnight than during the day cycle. Insulin dosing should be based on how low the dose is dropping BG so missing that data will make it harder to help Do Daa.
 
Ok, for the next 4 days, the testing will change to that. He seems ok with the paw testing, it's just the frequency that might be harder on him eventually.

So people are getting tests in during an entire 24hr period? I can't see many people getting up at 2am, 3am, etc to test. What do you consider the night cycle?
 
There are folks who do test through the night. Some will test if they get up to use the facilities. Others set an alarm. Most will test before the shot, a couple of hours later and then before bed but that depends on your shot and bedtime.

I am not suggesting you get up in the middle of the night to test. Tests done in the early part of the night cycle can be a good predictor of what the cycle looks like which is why we suggest a couple of hours post shot and before bed. Even if the before bed test is the only one on the night cycle, it helps.
Look at the SS like a jigsaw puzzle. The more pieces you have the clearer the picture. Obviously you'll never get all the pieces, but random testing rather than always testing at exactly the same time every day, fills in the missing pieces.
 
So the 9pm PS test and say around 11pm would be ok? Having food would not be a factor at 11pm test? Or any other daytime test?

Yes, this seems like quite the jigsaw puzzle.
 
Okie Dokie :) We'll see how it goes. For the next couple days, you mentioned we should stay at 1.5u. I'm not sure where we'd go from there..
 
hi,

I just tested for ketones in urine stream, it came back negative. I took his BG at +2 from pmps and it went up from 433 to 520 at 1.5u. Why?
SS has been updated.
 
I think you could go up to 2U at your next shot. We usually suggest increases in .25 unit increments, but with him running so high, I think it's your best bet.

Glad you're testing for ketones and that he's negative...keep testing, especially with him running so high

It's really weird that he went so low on 2U before.....Are you 100% sure you were giving 2U?

And are you using U40 syringes? or have you changed syringes?
 
Chris & China (GA) said:
I think you could go up to 2U at your next shot. We usually suggest increases in .25 unit increments, but with him running so high, I think it's your best bet.

Glad you're testing for ketones and that he's negative...keep testing, especially with him running so high

It's really weird that he went so low on 2U before.....Are you 100% sure you were giving 2U?

And are you using U40 syringes? or have you changed syringes?
Click to expand...


How will more insulin be better? I'm having a difficult time understanding this. He seems to be stuck between 400-600+ no matter the dosage which is getting us nervous for his health.

When we were first starting out, the Vet showed us how to measure 2U with the syringe. We were at 2U day/night per the Vet initially, per my notes. 2U seems to be keeping him abnormally high. He has seen a lot of Bouncing. Even 1.5U seems to be keeping him very high as you can see on the SS. This mornings reading was 402 however. It's more difficult to measure/guess where 1/2 is on the normal U40 syringes.

As we look at the syringe, should the back part of the rubber plunger be resting on the 2U mark leaving the space from the front of the plunger to the next mark a .5 unit? Or should the rubber plunger be in the middle with insulin on either side? Does the width of the plunger take up a .5 unit? We may have been giving him to little insulin at the 1.5U giving him 1.25U instead....

How often should we be testing for ketones? He is drinking a lot and peeing a lot. Other than that, he's alert and eating when he's hungry.

We are using the U40 syringes given to us by the Vet and have not changed them. We are in the process of ordering 1/2 unit marked syringes, we'll see.
 
It's more important to be consistent on your dosing than exactly 1.5 or .5 or 2.5, etc.....so when you're doing 1/2 unit increments, decide what .5 is for you, and try to replicate it as closely as possible every time.

If you find a syringe that you feel is pretty accurate (lines all seem to be straight and in the right place) you might want to use that one as a "sample"....draw up some colored fluid like juice, coffee, Kool-Aid, etc. to wherever you want the dose to be and then you'll have something to compare to.
 
Chris & China (GA) said:
It's more important to be consistent on your dosing than exactly 1.5 or .5 or 2.5, etc.....so when you're doing 1/2 unit increments, decide what .5 is for you, and try to replicate it as closely as possible every time.

If you find a syringe that you feel is pretty accurate (lines all seem to be straight and in the right place) you might want to use that one as a "sample"....draw up some colored fluid like juice, coffee, Kool-Aid, etc. to wherever you want the dose to be and then you'll have something to compare to.
Click to expand...

Do Daa was give 2U tonight as he was 573. Updated SS.
 
Goose said:
At +2 pmps he is Up to 585. 12 points higher on 2U.
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Went back to 2U as recommended on 10/23 at night, and 10/24 in the morning - went Straight up as per SS. I'm thinking 4U a day is to much, 3U a day still had him really quite high.

We went back to 1.5U tonight but even then, as you look at the SS, 1.5U twice a day is not helping him out of the high 400's to 600's.

Any ideas guys? Should I go lower that 1.5 twice a day? Insulin overload?

Suggestions welcome from all.

I have the 1/2 mark syringes coming.
 
Goose said:
At +2 pmps he is Up to 585. 12 points higher on 2U.
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12 points is really nothing. It's nothing worth worrying about at all!

Goose said:
Went back to 2U as recommended on 10/23 at night, and 10/24 in the morning - went Straight up as per SS.
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Often, when we first increase, for a reason we don't understand, the numbers go up. We even have a name for it....New Dose Wonkiness (NDW)

I really think you need to hold the 2U dose for at least 6 cycles and we'll go from there.

Do try to get a couple of tests on the PM cycle if you can. Not always just a +2
 
Chris & China (GA) said:
12 points is really nothing. It's nothing worth worrying about at all!



Often, when we first increase, for a reason we don't understand, the numbers go up. We even have a name for it....New Dose Wonkiness (NDW)

I really think you need to hold the 2U dose for at least 6 cycles and we'll go from there.

Do try to get a couple of tests on the PM cycle if you can. Not always just a +2
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2U for 6 cycles = 3 days? oops.

NDW happened for the first 7 days and he was on 2U. We stayed on 2U after that for 3 more days, then per recommendations, we went to 1.5U for the last 14 days.

On the SS, the first time he was on 2U per the vet he bounced and crashed. He seems to have gone up in BG the entire time he has been on 2U day/night. This also seems to be happening on 1.5U, although no bouncing to low numbers, he's in the 400-600 range consistently. We've noticed that when he was on 2U he was drinking a lot, lately it seems to have lessened on 1.5U. He is not ravenously hungry either, he eats his allotted 1 cup (470-500 cals) per day.

I am failing to see how more insulin is going to help him, even 1.5U seems like it's too much, according to his Spread Sheet information. Are you seeing something that I am not?

+2 for us is 11pm, so no testing after this point, sleeping. I'm afraid for his organs and his health looking back over the information and seeing such high numbers consistently. Kentones were tested tonight, they are Negative.
 
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Goose said:
2U for 6 cycles = 6 days?

NDW happened for the first 7 days and he was on 2U. We stayed on 2U after that for 3 more days, then per recommendations, we went to 1.5U for the last 14 days.

On the SS, the first time he was on 2U per the vet he bounced and crashed. He seems to have gone up in BG the entire time he has been on 2U day/night. This also seems to be happening on 1.5U, although no bouncing to low numbers, he's in the 400-600 range consistently. We've noticed that when he was on 2U he was drinking a lot, lately it seems to have lessened on 1.5U. He is not ravenously hungry either, he eats his allotted 1 cup (470-500 cals) per day.

I am failing to see how more insulin is going to help him, even 1.5U seems like it's too much, according to his Spread Sheet information. Are you seeing something that I am not?

+2 for us is 11pm, so no testing after this point, sleeping. I'm afraid for his organs and his health looking back over the information and seeing such high numbers consistently. Kentones were tested tonight, they are Negative.
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Chris asked me to respond as she isn’t feeling well tonight.

2U for six cycles is three days.

I will be quite honest; I’m not a PZ user and haven’t dealt with it. But, with any insulin, you have to know how low the dose is taking the kitty and cats often will be low at night. I’ve seen cats go from 400 to 40 to 400 in one cycle and without the midcycle tests, one would think they are just high.

I know it’s difficult to get up at night but with no midcycle night tests, I’m not comfortable making a comment whether this dose is too high or too low.

There is indication that he’s definitely come down on the 1.5u dose but you are going to have to decide if finding out where he’s going at night is worth losing a little sleep for a few nights.

edited to add: NDW never lasts for 7 days. It’s usually 24 hours or less altho it doesn’t apply to PZ. Only cats on depot insulins like Lantus and Levemir experience NDW.
 
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Hi,

As I look at the SS, 10/6, 10/7 and 10/8 he had 2U night and day. Other than the numbers that are all over the place at the beginning with 2U, those are 2U numbers for 3 days in a row.

How many nights do you suggest? + what after his 9pm Shot?
 
Goose said:
Hi,

As I look at the SS, 10/6, 10/7 and 10/8 he had 2U night and day. Other than the numbers that are all over the place at the beginning with 2U, those are 2U numbers for 3 days in a row.

How many nights do you suggest? + what after his 9pm Shot?
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Sorry....because you didn’t tag me, I didn’t see your question. I kept coming back but figured after Sunday morning that you weren’t around.

I see you’ve been getting another test in at night and that helps. I would suggest a +2 and +6 test; you can mix it up, too. Another night, get a +3 and +7. A couple tests a night will help. It’s not possible to say for how many nights because it depends on how he does.

However, it certainly looks to me with the last few nights’ tests, that he needs an increase to 2u if you can and will test.

To tag any of us so we see you have responded, just go to the post where we responded and I’m the far right corner, click on “reply”. We will get an alert that you replied just as you should get an alert on this response.

Also, you can tag members by just putting the ampersand in front of their user ID in your text. As an example, to tag me, you’d type @Marje and Gracie. Once you start with a User ID, it will give you a drop down box of members to select from.
 
Marje and Gracie said:
Sorry....because you didn’t tag me, I didn’t see your question. I kept coming back but figured after Sunday morning that you weren’t around.

I see you’ve been getting another test in at night and that helps. I would suggest a +2 and +6 test; you can mix it up, too. Another night, get a +3 and +7. A couple tests a night will help. It’s not possible to say for how many nights because it depends on how he does.

However, it certainly looks to me with the last few nights’ tests, that he needs an increase to 2u if you can and will test.

To tag any of us so we see you have responded, just go to the post where we responded and I’m the far right corner, click on “reply”. We will get an alert that you replied just as you should get an alert on this response.

Also, you can tag members by just putting the ampersand in front of their user ID in your text. As an example, to tag me, you’d type @Marje and Gracie. Once you start with a User ID, it will give you a drop down box of members to select from.
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Hi,

Sorry about that.

Given that 3 day stint at 2U and the bouncing in the beginning with 2U, and 1.5U giving him consistently high numbers - how will giving him more help? Isn't he already getting too much insulin and his body is fighting this? - isn't that what another poster had suggested? Glucose toxicity?

A quote from MrWorfmens Mom in one of the posts above: " I'm wondering if the dose is still too high but the testing being done is not necessarily giving you the full picture of what is going on. It's also possible you are seeing glucose toxicity from sitting in those high numbers for so long."
-- The dosage he was and still is on as of this quote above is 1.5U day/night ... to much?

+3 after 9pm is all that's reasonably attainable for extra numbers at night.
 
Goose said:
Hi,

Sorry about that.

Given that 3 day stint at 2U and the bouncing in the beginning with 2U, and 1.5U giving him consistently high numbers - how will giving him more help? Isn't he already getting too much insulin and his body is fighting this? - isn't that what another poster had suggested? Glucose toxicity?

A quote from MrWorfmens Mom in one of the posts above: " I'm wondering if the dose is still too high but the testing being done is not necessarily giving you the full picture of what is going on. It's also possible you are seeing glucose toxicity from sitting in those high numbers for so long."
-- The dosage he was and still is on as of this quote above is 1.5U day/night ... to much?

+3 after 9pm is all that's reasonably attainable for extra numbers at night.
Click to expand...
You had zero nighttime tests for the dates you gave so missing half your data means you can’t interpret anything from those dates.

Glucose toxicity is when they are hyperglycemic too long. The consistently high numbers start to impact the body in negative ways and cause increased insulin resistance making it harder to get to a dose that works.

While it might look to you that the BG was seeing a lot of variation, it wasn’t on those dates.

What Linda (@MrWorfMen's Mom) was saying is she couldn’t tell whether the dose was too high or too low and glucose toxicity has set in.

It looks to me like 1.5u is not enough insulin. I know he has dropped low on it before and there are reasons why he likely did:

  • insulin syringes are notoriously inaccurate even some being up to 0.5u off; many use calipers to dose accurately especially if more than one person is shooting
  • absorption can vary up to 50% from shot to shot
  • If you don’t test enough to know onset, nadir, and duration then you probably aren’t feeding the curve appropriately and if food is not given at the right times, numbers can tank even if the dose might actually be ok
  • things change; diabetics can be affected by things such as barometric pressure
I have seen cats on this board die from prolonged hyperglycemia and definitely hypoglycemia when vets instructed the caregiver to shoot a dose (too much as it turned out) without testing. Both are terrible deaths.

The only way we can really help you and find out what is going on so we can get the dose to the right place is for you to test enough, even just for seven cycles, at one dose so we can see the full picture. It’s your decision whether you want to do that or not.
 
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I agree that it looks like an dose increase is needed. I think 2u would be safe given how high BG is but if you are still concerned about going up to 2u, then getting syringes with 0.5u markings would be an alternative as that would allow you to more accurately increase in 0.25u increments.
 
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