? Dosing advice and general help

[Chloe007]

I'm feeling completely overwhelmed and I feel like I'm driving myself a bit crazy here, guys. I feel like it's just been one worry after another since Oscar has been diagnosed on Oct 24th (I also apologize if I've been driving you all crazy with my questions).

I'm starting to get nervous. For those who don't know, my cat Oscar was diagnosed a couple weeks ago and was originally started on 2u. I was also told to absolutely not home test, and to not go looking online for help (lol). Well considering I highly suspected Oscar went hypo his first shot, I threw that advice out the window very quick and came to you all. It was suggested I start at 1u 2x per day (he only spent 1 day at 2u). I got a meter and was finally able to test him, and I've been trying to take full advantage of that. Which is why I'm a worried wreck now. HIS NUMBERS JUST WON'T GO DOWN!!! And when they do go under 400 he starts acting strange. He gets very lethargic like. When he's acting like himself, his numbers are often above 400. After a few days of nothing but red and black numbers, I increased to 1.25u. Followed by more red and blacks, I started him at 1.5u today. Earlier today his BG was higher at +6 than it was at his AMPS. He's still urinating and drinking water like crazy, and he's never not hungry.

His diet has been fixed, he's eating 3 cans of FF pate a day (sometimes a little more when he's acting real hungry, but never 2 hours before shot time), and we took dry food away about 3 days ago. I give him dried freeze chicken bites for treats. It's really done nothing to help his numbers. I've been researching day and night, trying to do everything right, and I feel like I'm just hurting him. I feel like it'd be harmful to keep titrating so slowly, when he's been in high numbers for this long. Could a larger increase be warranted in this type of situation?

I almost feel like I'm taking in so much information at once that I'm starting to confuse myself. I'm hoping someone could take a look at my SS and help me figure out a plan here. I trust you guys more than I trust my vet at this point, any help would be appreciated.

Btw, I've been testing for ketones and they regularly come back negative.

 

[Jenna Josie]

Deep breaths, Chloe! You’re doing great. It IS very overwhelming at first (and sometimes later, lol), but you are doing a terrific job gathering data and learning what you can do to help Oscar. I know it’s hard, but my advice is to wait another couple of cycles and see what you learn with all of the testing you’re doing: he had a nice response on the 4th cycle after you raised to 1.25 (still high, but a very nice drop by +4). My guess is that the next morning’s high number was a “bounce,” the result of going what was — for him — “low.” (Probably the same thing after Halloween night.). Often it can take a few cycles for them to settle into a dose increase, so hard as it is, we just have to be patient and wait and see.

Remember that he was probably diabetic for awhile before you knew it, and it can take a little to get him regulated.

 

[Chloe007]

Deep breaths, Chloe! You’re doing great. It IS very overwhelming at first (and sometimes later, lol), but you are doing a terrific job gathering data and learning what you can do to help Oscar. I know it’s hard, but my advice is to wait another couple of cycles and see what you learn with all of the testing you’re doing: he had a nice response on the 4th cycle after you raised to 1.25 (still high, but a very nice drop by +4). My guess is that the next morning’s high number was a “bounce,” the result of going what was — for him — “low.” (Probably the same thing after Halloween night.). Often it can take a few cycles for them to settle into a dose increase, so hard as it is, we just have to be patient and wait and see.

Remember that he was probably diabetic for awhile before you knew it, and it can take a little to get him regulated.

Thank you for the advice! I actually am feeling a little positive right now, I just tested him at +2.5 and he was at 310 so I'm feeling really good about that. And for once he's not acting weird like he usually does when he drops below 400. He's running around with his sisters and being a little goofball, I think he's feeling good. Thank you for the reassurance, those numbers from the 2nd-5th were really starting to worry me. I just want him to be feeling better. I'm hoping this last dose increase will do it, but I'm not holding my breath (fingers crossed I don't get some crazy number in the morning). Thank you for the help, Jenna.

 

[Lisa and little]

Thank you for the advice! I actually am feeling a little positive right now, I just tested him at +2.5 and he was at 310 so I'm feeling really good about that. And for once he's not acting weird like he usually does when he drops below 400. He's running around with his sisters and being a little goofball, I think he's feeling good. Thank you for the reassurance, those numbers from the 2nd-5th were really starting to worry me. I just want him to be feeling better. I'm hoping this last dose increase will do it, but I'm not holding my breath (fingers crossed I don't get some crazy number in the morning). Thank you for the help, Jenna.

Jenna has given some good advice and I think I can say we have all been there -feeling overwhelmed, confused and worried we are not doing the right thing. I was a mess when I started and If it were not for this group I don’t think I would have made it this far , at least not without a nervous breakdown!! Some of the best advice I was given here is “this is a marathon not a sprint”. You are not going to fix this overnight. Take some deep breaths, keep testing and once you gather enough information as to how he responds to the doses throughout the cycle, the wonderful people here will be able to advise you about dose changes. You got this! Hugs to you and Oscar!

 

[Sarah&Soph]

Something you’ll see here often is “diabetes is a marathon, not a sprint!” I definitely know the feeling of wanting our kitties to feel better immediately, but it can take some time. You are doing a lovely job so far

And as others have already said, it’s possible Oscar was diabetic for some time before he was diagnosed which might be why he acts “weird” when his BG starts getting lower. It could just be that he’s not used to those numbers anymore, but hopefully he will get used to them soon! He could also have some glucose toxicity depending on how long he was diabetic before being diagnosed so it may take a bit more insulin to get his numbers down, but small gradual dose increases like you’ve been doing is the safest way to get there

 

[Chloe007]

Deep breaths, Chloe! You’re doing great. It IS very overwhelming at first (and sometimes later, lol), but you are doing a terrific job gathering data and learning what you can do to help Oscar. I know it’s hard, but my advice is to wait another couple of cycles and see what you learn with all of the testing you’re doing: he had a nice response on the 4th cycle after you raised to 1.25 (still high, but a very nice drop by +4). My guess is that the next morning’s high number was a “bounce,” the result of going what was — for him — “low.” (Probably the same thing after Halloween night.). Often it can take a few cycles for them to settle into a dose increase, so hard as it is, we just have to be patient and wait and see.

Remember that he was probably diabetic for awhile before you knew it, and it can take a little to get him regulated.

Hi Jenna! So today we had an unexpected blue (123 at +8) after he was at 491 this morning. I unfortunately didn't get anything earlier than that because I'm running low on supplies and money so I've been trying to be conservative, I should be able to get some more tomorrow for extra testing though. Anyways, becaus he's so used to high numbers and with the 491 this morning, that drop so late in his cycle has me a bit concerned. I know it's a good number, it's just such a big drop, and he had a whole can of FF at +6 so I can imagine he was probably pretty low before that. Do you think I should do anything different at this time or wait until I get more mid cycle data for this dose? It was just so unexpected, and of course on a day where I didn't test much.

I'm going to obviously test him before his PMPS, if it's below 150 still...should I shoot?

 

[MrWorfMen's Mom]

If Oscar is below 150 at shot time, stall without feeding him and retest 30 minutes later to see if his BG is rising on it's own. Chances are good he may bounce to higher numbers by PMPS from that huge drop today but we all know they can and do throw us surprises.

Just how low are you on strips, lancets? Food of different carb levels?

 

[Chloe007]

Just how low are you on strips, lancets? Food of different carb levels?[/QUOTE]
@MrWorfMen's Mom thank you for replying so quickly. I was also thinking he may bounce, that's what happened the last time he went to the 100's but I really don't have enough data to where I feel like that's a sure thing. I have 10 strips left but no lancets, and the strips I was getting are only available online (bad idea). I ended up having a friend offer to go buy more lancets for me and I will now be able to go to the store tomorrow night to get a new meter/new strips. So I have 10 strips until tomorrow night. Lancets I'll have in a couple hours, but if I have to I can reuse a couple that I've only used once and still have around.

I have both low, medium and high carb food around right now too.

 

[MrWorfMen's Mom]

Good to know. So you definitely don't want any surprises tonight. Let's see what Oscar decides to do.

A suggestion.....keep an extra vial of strips for whatever meter you are using in your hypo kit. Every time you buy new strips, just swap out the hypo kit strips for new ones. That way, you always have extra strips at hand should Oscar decide to throw you a low you need to monitor intensely for awhile and the strips never end up expired.

 

[Chloe007]

Good to know. So you definitely don't want any surprises tonight. Let's see what Oscar decides to do.

A suggestion.....keep an extra vial of strips for whatever meter you are using in your hypo kit. Every time you buy new strips, just swap out the hypo kit strips for new ones. That way, you always have extra strips at hand should Oscar decide to throw you a low you need to monitor intensely for awhile and the strips never end up expired.

Thank you for the suggestion, I'll definitely start doing that in the future. I'll know for sure what the deal is in an hour here, if you're still online I'll come back and give you an update!

 

[Chloe007]

@MrWorfMen's Mom 562

 

[MrWorfMen's Mom]

Not surprised but I know how frustrating those bounces are. Regular dose is fine tonight but do get a test in before bed to see what he's up to.

 

[Jenna Josie]

Totally agree with Linda: unsurprising and frustrating! Patience will help here, too, as it can take several cycles to clear a bounce.

 

[Chloe007]

Not surprised but I know how frustrating those bounces are. Regular dose is fine tonight but do get a test in before bed to see what he's up to.

I just tested him at +3 and he's at 448 so I don't think we will have any big changes tonight from that high number. I am a bit nervous because I'll be gone from his +8 after am shot until +4 after pm shot. I have my boyfriend watching him and taught him how to test, but I hate leaving him after something weird like this happens.

I had a question about ketones. I've been regularly testing Oscar and he always comes up negative, which is good. But when we first got blood results from the vet we were told he had some minor electrolyte imbalances, which I've heard is a risk factor for ketones (hence the regular urine testing I've been doing). My main question is, if one day I happen to get a result and he is above trace amount...how serious is that? I hear about people taking their cats to the vet in situations like this and they end up with huge vet bills to treat it. I'm worried I wouldn't be able to afford the costs. Do trace amount of ketones require the same type of treatment that's required with DKA? I'm sure there are variables involved, but idk, I'm just constantly holding my breath everytime I look at his ketone sticks and wonder what I would ever do if one came back positive. The vet did say he thought everything would even out once he's on insulin, but the way things are going and all these high numbers...I'm feeling super discouraged.

 

[MrWorfMen's Mom]

Any reading over trace on the ketostix means a vet consult is needed. Ketones can build up quickly and result in DKA which is expensive to treat and can be fatal. Regular testing is recommended but any time you notice Oscar off his food, particularly lethargic or any other symptoms he's not well, a test for ketones is a good idea. Keeping kitty well hydrated by adding water to their wet food and providing adequate food is key to keeping ketones away along with the insulin shots. Often ketones show up when an infection is brewing which is another reason to get kitty into the vet immediately if ketones are above trace levels.
You've been at this less than a month and while we all wish we could wave a magic wand and fix them, we can't. It takes time to get a kitty regulated and it looks to me like you are making progress in the right direction so be patient. Those higher numbers today are from a bounce and they will pass but it may take a few days for that to happen. The highs are not because the insulin is not working but rather the opposite. As Oscar gets reacquainted with more normal BG those higher readings will lessen.

 

[Jenna Josie]

. The highs are not because the insulin is not working but rather the opposite.

This! This is the hard thing to keep in mind because it seems so counterintuitive, but it is exactly right and why it’s so important to get at least one mid cycle number whenever possible.

 

[Chloe007]

Any reading over trace on the ketostix means a vet consult is needed. Ketones can build up quickly and result in DKA which is expensive to treat and can be fatal. Regular testing is recommended but any time you notice Oscar off his food, particularly lethargic or any other symptoms he's not well, a test for ketones is a good idea. Keeping kitty well hydrated by adding water to their wet food and providing adequate food is key to keeping ketones away along with the insulin shots. Often ketones show up when an infection is brewing which is another reason to get kitty into the vet immediately if ketones are above trace levels.
You've been at this less than a month and while we all wish we could wave a magic wand and fix them, we can't. It takes time to get a kitty regulated and it looks to me like you are making progress in the right direction so be patient. Those higher numbers today are from a bounce and they will pass but it may take a few days for that to happen. The highs are not because the insulin is not working but rather the opposite. As Oscar gets reacquainted with more normal BG those higher readings will lessen.

Thank you, I know I'm getting way ahead of myself here. I need to chill out a bit. We had quite the day today, when I left to go to work today when we were at +8 after his AM shot, he was at 402. Well I had my boyfriend over testing him and giving him his shot, and when he tested Oscar, it kept reading "low" even though he swore he was getting enough blood. So naturally I was at work freaking out, I had him feed him some HC dry food (although feeding was another problem because Oscar gets depressed when I leave at night we've noticed). I told him to test 30 minutes later and even directed him here in case it still came up low....but then he was at 480. We don't know what happened, but he got his shot. Normally I would have asked you if we should reduce....but I think that low result was very suspect. He was at +11 when he tested him...at +8 he had been at 402. I bought a Relion Prime when I got off work tonight, we did our first test and got a 372. Should I keep using the same spreadsheet or start a new one with the human meter?

@MrWorfMen's Mom

 

[Chloe007]

Thank you, I know I'm getting way ahead of myself here. I need to chill out a bit. We had quite the day today, when I left to go to work today when we were at +8 after his AM shot, he was at 402. Well I had my boyfriend over testing him and giving him his shot, and when he tested Oscar, it kept reading "low" even though he swore he was getting enough blood. So naturally I was at work freaking out, I had him feed him some HC dry food (although feeding was another problem because Oscar gets depressed when I leave at night we've noticed). I told him to test 30 minutes later and even directed him here in case it still came up low....but then he was at 480. We don't know what happened, but he got his shot. Normally I would have asked you if we should reduce....but I think that low result was very suspect. He was at +11 when he tested him...at +8 he had been at 402. I bought a Relion Prime when I got off work tonight, we did our first test and got a 372. Should I keep using the same spreadsheet or start a new one with the human meter?

@MrWorfMen's Mom

@MrWorfMen's Mom I think I got bamboozled again here. I nearly just died a little. I was able to obtain a ketone urine sample tonight and when I first looked at it...it started getting darker than I seen before, and really fast. I had a million thoughts going through my head, but it didn't quite look like any of the shades yet I could just see it was darkening. So in that time I ran downstairs and gave myself a test so I had a negative one to compare to, but the plan went awry. My ketone stick came back obviously positive. I went back up and checked Oscars and his had settled down to a lighter brown color (that doesn't match any on the guide) but it was still darker than his previous negatives. Now I'm a little worried about that, but I also don't know if I should make anything of it since mine came back so wacky...maybe the bottle just went bad? I can't imagine why I would have ketones. But assuming the bottle is okay, what do you think of these results?
http://imgur.com/a/eJtxI4p
The first pic will show his from today 11.11, the second will show his from 11.4 and the third was my comparison that awry

and heres one more pic of the same one from today of his
http://imgur.com/a/HBIaQzN

 

[MrWorfMen's Mom]

When using the ketostix, it's very important to be in a place with a good light source and to ensure you are reading the strips in exactly the time frame indicated on the bottle (usually 15 seconds) following dipping the stick. The colour will continue to darken the longer you look at it. It's hard to reach a firm conclusion based on pictures because all of our screens may display colours a little differently but if I had to guess, I'd say Oscar's tests are neg to trace and yours definitely looks more like small to moderate. Any chance you have been eating a keto diet (no/very low carbs) or ate much less recently? If you happen to be diabetic then yes I would say yours definitely need watching. What's the expiry date on the bottle? It's possible the strips could be bad but the only way to tell would be to try another bottle.

The other option for checking ketones is to get a glucometer that tests ketones as well as glucose. The Precision Neo by Abbott and Nova Max Plus are two options. The blood ketone strips are a bit more expensive but ketones show up in the blood before they show up in the urine so you get an earlier warning if ketones are rising. With cats the level of ketones with a meter needing a vet consult is about 2.3 (I could be off by a point or so there) but it's different than it is for humans.

 

[Chloe007]

When using the ketostix, it's very important to be in a place with a good light source and to ensure you are reading the strips in exactly the time frame indicated on the bottle (usually 15 seconds) following dipping the stick. The colour will continue to darken the longer you look at it. It's hard to reach a firm conclusion based on pictures because all of our screens may display colours a little differently but if I had to guess, I'd say Oscar's tests are neg to trace and yours definitely looks more like small to moderate. Any chance you have been eating a keto diet (no/very low carbs) or ate much less recently? If you happen to be diabetic then yes I would say yours definitely need watching. What's the expiry date on the bottle? It's possible the strips could be bad but the only way to tell would be to try another bottle.

The other option for checking ketones is to get a glucometer that tests ketones as well as glucose. The Precision Neo by Abbott and Nova Max Plus are two options. The blood ketone strips are a bit more expensive but ketones show up in the blood before they show up in the urine so you get an earlier warning if ketones are rising. With cats the level of ketones with a meter needing a vet consult is about 2.3 (I could be off by a point or so there) but it's different than it is for humans.

I'll probably look into a ketone meter so I'm not constantly second guessing myself and driving myself crazy. It drives me nuts that the negative/trace colors don't look anything like the ones on the bottle..they look brown. But when I looked at them in real life, there was an obvious difference between mine that was bright pink and his that was a neutral brown, so I think all is probably well and I was just overthinking it. I think I looked too quickly, because it started turning dark but then within the 45 second time frame it settled down to that brown color, where as mine didn't. Funny that the one time I need a negative one to compare to, I test positive haha, but I think it was equally as helpful. I checked my blood sugar to be sure after that result and it was fine btw lol, but I'm not on any kind of keto diet so I should probably keep an eye on that haha. Thanks for the second set of eyes, as always it just helps to have any kind of second opinion even if accuracy isn't all there.

 

[FurBabiesMama]

The Precision Neo by Abbott and Nova Max Plus are two options.

Another option is the Keto-Mojo. That is the one I have.

 

[Chloe007]

When using the ketostix, it's very important to be in a place with a good light source and to ensure you are reading the strips in exactly the time frame indicated on the bottle (usually 15 seconds) following dipping the stick. The colour will continue to darken the longer you look at it. It's hard to reach a firm conclusion based on pictures because all of our screens may display colours a little differently but if I had to guess, I'd say Oscar's tests are neg to trace and yours definitely looks more like small to moderate. Any chance you have been eating a keto diet (no/very low carbs) or ate much less recently? If you happen to be diabetic then yes I would say yours definitely need watching. What's the expiry date on the bottle? It's possible the strips could be bad but the only way to tell would be to try another bottle.

The other option for checking ketones is to get a glucometer that tests ketones as well as glucose. The Precision Neo by Abbott and Nova Max Plus are two options. The blood ketone strips are a bit more expensive but ketones show up in the blood before they show up in the urine so you get an earlier warning if ketones are rising. With cats the level of ketones with a meter needing a vet consult is about 2.3 (I could be off by a point or so there) but it's different than it is for humans.

@MrWorfMen's Mom

Hey there, so for the past day Oscar's ears are looking pretty rough. His right ear (that has been used much more often) is looking red, has little white bumps near the poke spots, and is feeling a little warmer than the other, so I want to try to give him a small break from testing. I'm still doing 2 today just to make sure he's safe, but I think that's all I'm going to do both today and tomorrow, they really need to heal, and I don't want them getting infected. This doesn't feel like it's just typical, minimum poke trauma, but a little bit more. We're also making the switch tomorrow from his 20% carb dry food to Dr. Elsey's (he has IBD and the only thing that keeps it at bay for whatever reason, is having some type of grain free dry incorporated in his diet). So despite feeling like he likely needs another increase very soon, do you think it would be fine to wait a couple days to give his ear's a chance to heal and to check for any effects the new dry food has on his BG?

 

[MrWorfMen's Mom]

I understand you wanting to deal with both issues at once but quite honestly, it could be dangerous to switch out 20% dry for the Dr.Elsey's and NOT be testing. The change of food could have a dramatic lowering effect on Oscar's BG so if I were you, and you need to keep testing to a minimum for a couple of days, I'd hold off any dietary change until his ears are better and you can get some mid cycle tests. If his left ear is OK, I'd still suggest grabbing at least one mid cycle during the day and at minimum a before bed test to keep Oscar safe. And definitely don't increase his dose until you can adequately test either.

Was it meter failure this AM or did you not get a pre-shot test? Pre-shot tests are the only way to see if it is safe to give insulin and mid cycle tests ensure that BG is not dropping too low. While I doubt he's dropping too low, our kitties are known for surprising us on occasion so better to err on the side of caution. You could try putting some Neosporin with pain relief on his ears to help them heal.

 

[Chloe007]

I understand you wanting to deal with both issues at once but quite honestly, it could be dangerous to switch out 20% dry for the Dr.Elsey's and NOT be testing. The change of food could have a dramatic lowering effect on Oscar's BG so if I were you, and you need to keep testing to a minimum for a couple of days, I'd hold off any dietary change until his ears are better and you can get some mid cycle tests. If his left ear is OK, I'd still suggest grabbing at least one mid cycle during the day and at minimum a before bed test to keep Oscar safe. And definitely don't increase his dose until you can adequately test either.

Was it meter failure this AM or did you not get a pre-shot test? Pre-shot tests are the only way to see if it is safe to give insulin and mid cycle tests ensure that BG is not dropping too low. While I doubt he's dropping too low, our kitties are known for surprising us on occasion so better to err on the side of caution. You could try putting some Neosporin with pain relief on his ears to help them heal.

It was a mix of both. We switched to the Relion this morning and I tried three times not realizing what I was doing wrong, two times were because I tried to take the sample on the wrong screen (I think I didn't have it fully set up or something) and the third time was because I didn't get a big enough blood sample. I think I just had to get used to practicing with that meter a couple times, and we switched to a thinner lancet because I think that was what was contributing to the painful looking ears (the lancets that the pet meter I was using before came with were 21g, we switched to 26). I couldn't stand to poke him again, and knew I'd be home today and could watch over him. It wasn't my intention to not get a preshot test, I would have rather had that but settled for the mid cycle test when we couldn't get it done. The mid cycle test went really well, and I don't think we will have problems with the new meter or lancet from here on out.

I can definitely do the switch slowly, I think things may look better once we're on a set feeding schedule for him. Things were a bit rocky up until now, we tried to do all wet for a couple days but the diarrhea started up and so we incorporated the dry back in. So he's currently eating a can of FF before each shot, and he gets a handful of dry food in between each shot (meal/shots are at 8am/8pm and his dry snack is at 12am/12pm currently). I was thinking about mixing the two and slowly put more Elsey's than Crave in each day until he's fully eating just Elsey's. Would this be a good idea or should I just make the switch quick while monitoring?

His ear's are looking a bit better today, it's just the warmth of his right ear is what has me most concerned, but it seems a bit better right now. In the meantime I'm just going to use his left ear and take it a bit easy for just maybe one more day. I've already been using Neosporin with pain relief, I also use Vaseline before I poke and hold the spot tightly afterwards to prevent bruising, I'm not sure why they're looking so rough. I was a bit worried about it becoming infected, but fingers crossed it get's better and not worse. I do have a Triple Antibiotic Cream I got from my mom when she took her dog in for a cut on her face. I was wondering if it would be safe to do that, just in case it is infected.

 

[MrWorfMen's Mom]

Glad to hear you got the human meter sorted out. I'm sure the 21g lancets are contributing to the ear issue. Those are huge and likely meant for paw testing rather than ears. In any event, you have 26g now so that should help keep Oscar's ears in better shape.

Changing the food gradually is definitely the best way to go especially if you have found the switch is causing diarrhea. It also makes it easier to monitor BG changes and avoiding a sudden drastic drop in BG.

 

[Chloe007]

Glad to hear you got the human meter sorted out. I'm sure the 21g lancets are contributing to the ear issue. Those are huge and likely meant for paw testing rather than ears. In any event, you have 26g now so that should help keep Oscar's ears in better shape.

Changing the food gradually is definitely the best way to go especially if you have found the switch is causing diarrhea. It also makes it easier to monitor BG changes and avoiding a sudden drastic drop in BG.

We seem to have taken a huge step backwards it feels. I haven't updated his SS yet as I'm on mobile but his amps was HI and his +7 was 442. His symptoms that were getting better, seem to be coming back with a vengeance. Just constant drinking water and peeing today. Not sure what to do here, but staying at this dose feels wrong.

 

[MrWorfMen's Mom]

I agree it looks like a dose increase is needed but I think some of what you are seeing in high numbers is bouncing from the drops in BG like the drop from 453 to 280 in 2 hours last night. No telling how low Oscar actually went a few hours later.
Our kitties have a habit of going lower at night than they do during the day. Any chance you could set an alarm tonight to test around +5/6 to see I Oscar has indeed dropped into better range?
If you can test tonight and he doesn't drop, then yes I think you could increase to 1.75u but I would do so on a cycle you can monitor.
How is the food switch going now? Are Oscar's ears improving at all?

 

[Chloe007]

I agree it looks like a dose increase is needed but I think some of what you are seeing in high numbers is bouncing from the drops in BG like the drop from 453 to 280 in 2 hours last night. No telling how low Oscar actually went a few hours later.
Our kitties have a habit of going lower at night than they do during the day. Any chance you could set an alarm tonight to test around +5/6 to see I Oscar has indeed dropped into better range?
If you can test tonight and he doesn't drop, then yes I think you could increase to 1.75u but I would do so on a cycle you can monitor.
How is the food switch going now? Are Oscar's ears improving at all?

I do have Saturday off, so I'll see how tonight and Friday go with the food change and if things don't get better I'll move up to 1.75u on Saturday morning. He did give me a 390 for his pmps we just did, so maybe that means the food switch is helping? It's been going well, in my experience with him, as long as he has some type of grain free dry food incorporated in his diet, he does fine. Still not sure why, but it works. His ears are worrying me less now too, I think easing off these past two days has helped them heal, I feel comfortable poking him a bunch again haha. He acted quite odd after the shot I just gave him, it's just been a weird day for us. Normally he barely notices and keeps eating his food, but this time he completely stopped, walked around a bit and wouldn't go back to it. He went to his water bowl and sat a little funny to drink his water, although maybe I was simply paying too close attention, idk. His tail was flicking around like he was a bit irritated, and he's now gone to his "spot" without ever going back to his food. He's reacted this way before, I'm not sure why it sometimes happens.

It's also weird how all of a sudden after that really high number this morning, it's like he instantly started getting his symptoms back. He's been drinking so much water and urinating so much today. And yes, I'll set an alarm tonight to get a +5/6 in.

 

[MrWorfMen's Mom]

Until you get these fur kids regulated, they will have ups and downs. Probably drinking more because of the higher BG. While they usually don't notice the shot when they have their faces planted in their food, sometimes they do. I think sometimes they maybe move just a smidge and feel the needle while most times they either don't feel it or they just don't care 'cause they are more interested in the food. As long as he is eating and doing normal cat stuff, no worries.

 

[Chloe007]

Until you get these fur kids regulated, they will have ups and downs. Probably drinking more because of the higher BG. While they usually don't notice the shot when they have their faces planted in their food, sometimes they do. I think sometimes they maybe move just a smidge and feel the needle while most times they either don't feel it or they just don't care 'cause they are more interested in the food. As long as he is eating and doing normal cat stuff, no worries.

Thank you, I've definitely been over analyzing his behavior lately haha I'm sure he thinks I'm nuts . His +2 was 258, and I'm going to try and stay up for a +5 and see how that goes. I'm interested to see if this food switch is going to help him from spiking back up by morning. I do suppose I should wait to see how the diet change will affect him, and wait for that to settle before I raise his dose. Either way, I should probably have a good idea by Saturday I think. I highly doubt the switch will be enough to keep him from needing the increase, but it will help me get an idea of what his low's will look like once we do.

 

[MrWorfMen's Mom]

I'm interested to see if this food switch is going to help him from spiking back up by morning.

While the food switch will lower BG overall and therefore likely diminish the higher AMPS, it won't stop the higher AMPS completely, at least not immediately. The lower the BG gets, the more used to those lower numbers Oscar will get and then the BG should smooth out more across the entire cycles.

 

[Chloe007]

While the food switch will lower BG overall and therefore likely diminish the higher AMPS, it won't stop the higher AMPS completely, at least not immediately. The lower the BG gets, the more used to those lower numbers Oscar will get and then the BG should smooth out more across the entire cycles.

I fell asleep literally right before +5 last night, so I'm going to get those later PM cycle numbers tonight instead. Today's numbers are looking a little better, but Oscar is still acting weird. AMPS was 371, +2 was 250, +6.5 was 326....I was at work from +2 until +6.5, ideally I'd like to see what those numbers are so I'll get that done on Saturday. He's still drinking and urinating a ton, acting lazier than usual/walking a little slow, but seems to be eating okay. His food consumption has gotten better so the slight decrease in his eating isn't concerning me too much. Maybe he dropped lower than he's used to when I was at work, and he's just not used to those numbers right now? Or the jumping in numbers is making him not feel very well? We got a negative ketone test today, it was lighter than the one I showed you a picture of the other day. His ears are still warm, and I'm still not sure what that is about.

 

[MrWorfMen's Mom]

Yeah for negative ketones. Oscar is dropping a lot very early in the cycle. Can you feed him a bit more canned food before his shot? Or perhaps offer him a snack of canned food around +1.5 hours post shot to see if that slows down the drop a bit and extends it out further into the cycle. Some of the bouncing may be happening because of those steeper early drops. It will be interesting to see what his readings are in that +3 to +5 timeframe when you can manage it.

 

[Chloe007]

Yeah for negative ketones. Oscar is dropping a lot very early in the cycle. Can you feed him a bit more canned food before his shot? Or perhaps offer him a snack of canned food around +1.5 hours post shot to see if that slows down the drop a bit and extends it out further into the cycle. Some of the bouncing may be happening because of those steeper early drops. It will be interesting to see what his readings are in that +3 to +5 timeframe when you can manage it.

Lately his hunger has been much more manageable, so he gets more to eat than he actually consumes as is. I leave it out for him to keep going back to if he wants and sometimes he will, and sometimes he waits until his timed feeder opens up with dry at +4. He definitely was eating more wet food when we took the dry food out of the equation (obviously) but we just can't do that due to the IBD. He basically always has food available except for the two hours before shots. So I'm not really sure how I can get him to eat at +1.5. I could try restricting food/ less free feeding so he's hungrier at shot time and eats more wet food then? He's usually always willing to eat chicken Pure Bites, maybe I should get more of those and give them to him at +1.5. Hmmmm.

He definitely perked up a couple hours ago, and has been acting like himself since about +9...I do think that big drop is causing him to not feel well, and then when he comes back up near the end of his cycle he starts feeling better.

 

[MrWorfMen's Mom]

They get so use to those higher numbers that the lower numbers even if still not normal don't feel "right". It takes time. I remember when my girl was starting to make progress, she seemed to feel off when in good numbers and better sitting in yellow range. That went on for awhile. Maybe you could try giving Oscar a bit less wet at shot time and put the remainder in the feeder for +1.5. He might be more willing to eat then if he eats less pre-shot. Just throwing that out for consideration. You know Oscar best and sometimes it takes some experimenting to see what works.

 

[Chloe007]

They get so use to those higher numbers that the lower numbers even if still not normal don't feel "right". It takes time. I remember when my girl was starting to make progress, she seemed to feel off when in good numbers and better sitting in yellow range. That went on for awhile. Maybe you could try giving Oscar a bit less wet at shot time and put the remainder in the feeder for +1.5. He might be more willing to eat then if he eats less pre-shot. Just throwing that out for consideration. You know Oscar best and sometimes it takes some experimenting to see what works.

I actually hadn't considered that, that may work. Part of the appeal for Oscar is hearing the sound the timed feeder makes when it moves over and he knows there's food there lol. So if I put wet food in there....it may just trick him! Now that his appetite has been less ravenous versus when he was first diagnosed, it's definitely setting up a challenge for us because he's going back to his old ways of holding out for dry food and I can't just simply take it out without him getting sick. I know I could get him to eat dry at +1.5 easily...but I also know I need to keep him eating wet food one way or another. I was thinking about looking for other users around here who have IBD kitties that also need dry in their diet to try and come up with some ideas here.

As always, thank you Linda!

 

[MrWorfMen's Mom]

You can post over in Health mentioning the IBD and see if anyone can help. Some IBD kitties do fine with wet food once you find the right one and dry food is more of a rarity around here but some folks still feed low carb dry for a variety of reasons. Some, like me just have a kibble addict who refuses to acknowledge that wet food is actually edible! Thankfully my girl finally realized that wet food was Ok but she'd still kill for a feed of kibble if allowed.

If the snack of wet at +1.5 doesn't work, give Oscar his beloved kibble. Any food is going to help slow that drop.

 

[Chloe007]

You can post over in Health mentioning the IBD and see if anyone can help. Some IBD kitties do fine with wet food once you find the right one and dry food is more of a rarity around here but some folks still feed low carb dry for a variety of reasons. Some, like me just have a kibble addict who refuses to acknowledge that wet food is actually edible! Thankfully my girl finally realized that wet food was Ok but she'd still kill for a feed of kibble if allowed.

If the snack of wet at +1.5 doesn't work, give Oscar his beloved kibble. Any food is going to help slow that drop.

I ended up getting him to eat a small amount last night when I saw he dropped to 283 at +1.5, he was willing to eat a couple bites when he heard that can open, but had no luck this morning. I'm going to do an hour by hour curve after his PM shot tonight, I don't work in the morning so I can stay up. I'm trying to decide if I should raise his dose in the morning. I feel like maybe that will let me know for sure that it's safe to do the next day? I was thinking maybe not even do a .25 increase but less, try and do very small increases until we have this food thing figured out. What are your thoughts, bad or good idea? (assuming he doesn't drop much lower than at that +2 mark during his evening tests tonight). I'll have to re think things if he is. Maybe I'm getting ahead of myself, but I feel like I've been at 1.5u a bit too long.

 

[MrWorfMen's Mom]

I agree it looks like Oscar needs a little more juice but I think you'd be fine with a 0.25u increase. No need to skinny it up. Get the curve tonight. Oscar may e dropping a little lower than you are aware of and the curve now will hopefully answer that burning question. Just give the 1.5u tonight and then change the dose tomorrow AM if warranted which I'm pretty sure it will be.

 

[Chloe007]

I agree it looks like Oscar needs a little more juice but I think you'd be fine with a 0.25u increase. No need to skinny it up. Get the curve tonight. Oscar may e dropping a little lower than you are aware of and the curve now will hopefully answer that burning question. Just give the 1.5u tonight and then change the dose tomorrow AM if warranted which I'm pretty sure it will be.

Do you think there's a good reason to do a curve tonight before raising his dose? Should I just go ahead and increase tonight and do a full curve on that instead? I feel like the curve won't turn up much more than we already know and now I'm wondering if I'm being too cautious, since I plan on poking all night anyways...maybe I should make it worth the testing...ya know? I have plenty of testing supplies and different levels of carb food just in case.

 

[MrWorfMen's Mom]

Don't raise the dose because there is a strange phenomenon called New Dose Wonkiness (NDW) which sometimes causes higher BGs when doses are increased. I'd do the curve on the current dose knowing Oscar is not bouncing at the moment and it should be a good representation of what the current dose is doing for his BG. All good info.

 

[Chloe007]

Don't raise the dose because there is a strange phenomenon called New Dose Wonkiness (NDW) which sometimes causes higher BGs when doses are increased. I'd do the curve on the current dose knowing Oscar is not bouncing at the moment and it should be a good representation of what the current dose is doing for his BG. All good info.

Linda, I need to fully update the SS for last night when I get the chance but nothing surprising happened. I ended up missing his +2 but got pretty consistent testing in through the rest of the night. PMPS was 365, +1 330, +3 294, +4 289, +5 322, +6 297, +7 301....then I went to sleep and woke up to AMPS 355 and went ahead and raised the dose to 1.75u. I gave him a snack at +1.5 as suggested (I'm missing that +2 data so I wouldn't be surprised if that's when he went his lowest) but I think it definitely seemed to help slow down any dramatic drops. He had his dry food at +4 so I think that could account for the small spike at +5. I was pretty happy with his cycle last night, while still too high, it actually made some sense haha. Fingers crossed for the increase today

 

[Chloe007]

I was hoping you could possibly help me come up with a consistent feeding schedule for Oscar, as up until now it hasn't been as consistent as it probably should be and I'd like to have it worked out by the time we do his next dose increase...as it looks like that's where we're headed.

Currently, he's eating 1/3 can of Friskies Pate twice a day (before each shot at 8am/8pm). Sometimes he finishes it all, other times he doesn't. Usually eats at least half of what I give him. I switched back to Friskies instead of FF because my other two girls didn't like it, and if they are each eating something different, it's like a game of musical chairs. So instead they each share one can split up before each shot. Then a 2/3 cup of Dr. Elsey's is split up into four equal sections in the timed feeder. 9:30am/9:30 pm and 12:00am/12:00pm. The three cats share this, but Oscar does eat a little more than the girls. For the record, he does need to gain some weight back.

Does this sound reasonable? At least until we can slowly start replacing the dry food with wet? Most nights I try to entice Oscar with some wet food for that 9:30 snack, but it often doesn't work, and the dry food he eats at that time seems to help with slowing those big drops we were seeing.

And also, he had a 533 this morning. I can't be too sure what happened last night, when I went to sleep he was at 303. I'm not sure if he dropped lower than I anticipated, but according to my roommate he started scouring around the downstairs before she went to sleep (a place where the cats never ever go) and the beta fish she saw him eyeing, was gone in the morning...with water all over the ground. So he ate the beta fish. So I'm not sure if that high number is from a bounce because he went low, or because he ate a beta fish...or some combination of the two. This also makes me think he's not getting enough food....but I don't want to be feeding him too many calories.

Any suggestions?

@MrWorfMen's Mom

 

[MrWorfMen's Mom]

I think I might move the food times just a smidge. How about trying 10am/10pm and then 1:00pm/1:00am. This is something we are just going to have to play with a little so it may need adjusting but that's just part of the process.

While the Dr. Elsey's is low carb, I'd be careful with the portions because it is really calories dense. As long as you are sure the other kitties are getting a reasonable share of the kibble, that's fine, but if you know Oscar eats more, an extra helping meant for the others could also elevate his BG.

I'm so sorry to hear about your Beta. I take it Oscar wasn't in the habit of wanting to eat the fish previously? I suppose he could have been hungry and gone after the prey but could it have been an accident of knocking over the fish bowl and opportunity knocked?

He may have dropped lower last night and is bouncing now but the only way to catch those drops is to use night time bathroom trips or set an alarm to test later into the night cycle.

 

[Chloe007]

I think I might move the food times just a smidge. How about trying 10am/10pm and then 1:00pm/1:00am. This is something we are just going to have to play with a little so it may need adjusting but that's just part of the process.

While the Dr. Elsey's is low carb, I'd be careful with the portions because it is really calories dense. As long as you are sure the other kitties are getting a reasonable share of the kibble, that's fine, but if you know Oscar eats more, an extra helping meant for the others could also elevate his BG.

I'm so sorry to hear about your Beta. I take it Oscar wasn't in the habit of wanting to eat the fish previously? I suppose he could have been hungry and gone after the prey but could it have been an accident of knocking over the fish bowl and opportunity knocked?

He may have dropped lower last night and is bouncing now but the only way to catch those drops is to use night time bathroom trips or set an alarm to test later into the night cycle.

Sounds like a plan, I'll move the food times up and keep things the way they are for now otherwise, I'll also try to figure out exactly how much of the dry food he is eating versus the other cats. I think maybe the later food time (1am) will help him not get so hungry during the night, he usually eats throughout the night once his timer opens...but I think last night he ate it all too early and was hungry again by later in the middle of the night. Idk, last night was a weird night for him. And no, he never tried to eat the beta before lol. It wasn't an accident, the bowl wasn't tipped over...just a missing fish and water splatter on the ground (I presume from him scooping the fish out). Unfortunately it wasn't even my beta...it was my roommates . Luckily she is very sympathetic to Oscar's "changes" lol. Totally out of the norm for him though.

I'm thinking give this new dose a couple more days and revisit a dose increase then?

 

[MrWorfMen's Mom]

Oh dear! No more live fish in the house I guess. While Oscar may seem the logical suspect any chance one of the others might be the culprit? Just saying. I'm glad your roommate is understanding.

It's looking like Oscar is going to need more juice but I would increase to 2u only when you can monitor closely for a cycle or two.

 

[Chloe007]

Oh dear! No more live fish in the house I guess. While Oscar may seem the logical suspect any chance one of the others might be the culprit? Just saying. I'm glad your roommate is understanding.

It's looking like Oscar is going to need more juice but I would increase to 2u only when you can monitor closely for a cycle or two.

I could start banging my head against a wall today. It looked like things were settling after that high AMPS yesterday, and his AMPS today was looking much more like our current "normal"....I get home from work at +8 and he's at 511. What the hell could have happened? He's been all over the place with these numbers lately.

I have the weekend off, so I'll increase then so I can test as much as needed. For some reason this doesn't feel like a bounce...I've never caught him under 200 so I have a hard time believing this is a bounce, instead it feels like his insulin starts to wear off too early.

 

[MrWorfMen's Mom]

You may be right about the duration. Looking at those cycles where you've been able to get more tests, it quite often appears Oscar is hitting nadir around +4 or so. It's possible he is dropping lower than you are aware of earlier in the cycle when you are not able to test and then bouncing up.
He doesn't have to drop below 200 to bounce. He just has to drop quickly, more than his body thinks is safe or just to a level his body now considers unsafe because he has become so used to higher BG.

Are you absolutely sure there is nothing in the way of contraband he might have found? There was a member here who had an extra bag of kibble (I think for her other kitties) that her extra sweet kitty found in a closet and chewed a hole in to get what he wanted. Another had one stealing dinner buns amongst other things. My girl once tried to eat a peanut butter sandwich. The possibilities are endless with a determined kitty.

 

[Chloe007]

You may be right about the duration. Looking at those cycles where you've been able to get more tests, it quite often appears Oscar is hitting nadir around +4 or so. It's possible he is dropping lower than you are aware of earlier in the cycle when you are not able to test and then bouncing up.
He doesn't have to drop below 200 to bounce. He just has to drop quickly, more than his body thinks is safe or just to a level his body now considers unsafe because he has become so used to higher BG.

Are you absolutely sure there is nothing in the way of contraband he might have found? There was a member here who had an extra bag of kibble (I think for her other kitties) that her extra sweet kitty found in a closet and chewed a hole in to get what he wanted. Another had one stealing dinner buns amongst other things. My girl once tried to eat a peanut butter sandwich. The possibilities are endless with a determined kitty.

Yeah I get that, I just felt like his cycles were starting to look more "stabilized" the past few days where I was able to test, with his AMPS usually being around 350-380 lately, the 200 somethings I was able to catch didn't feel like it should be such a dramatic drop that it would cause a bounce, but then again, I haven't been able to test during those peak hours the past few days so it's totally possible something has changed in that time.

I think I may have figured out today's issue. After much thinking, and searching around the house to try and find some contraband he might have gotten into (he is known to chew through bags of treats and dry food, but those were all put away, didn't appear to be broken into) I realized I made a big mistake earlier. This morning at AMPS my other cat who is a very picky eater, turned her nose up at two different pate's I put in front of her...so in my frustration I opened up a can of the Friskies Saucy Seafood Bake that I had from pre-diabetes diagnosis, and put it on the landing for her to eat by herself while Oscar was upstairs eating his pate. I was supposed to pick it up after she was done eating and before I left for work, but was in a rush, and didn't notice it was still there until I was searching through the house for contraband. I looked up the carb count and found it confusing....the website I found said it was 7.5% in the "guaranteed analysis" while it said 34% for the dry matter analysis 'normalized for moisture content'. Those are obviously two very different numbers, and I don't know enough about reading labels to know which one I should be looking at, but either way, it's more carbs than he's been getting from his wet food. So I think that may solve today's mystery at least.

I decided I'm going to take him back to the vet next week to do another full blood work up, it's been about a month since his last work up when we found out about the dx. His eyes are looking a little runny, which isn't unusual for him, but that along with his ears that are at times oddly warm I just want to be 100% there's not an infection going on. I'm finding myself so constantly worried about DKA that I think it would just make me feel better to know there's no infection or anything brewing. I'd also like to get his records/test results from the last time we were there...and I'm guessing I'll need to go in for that.

Anyways thank you for the idea to check around for contraband, I really didn't think there was any way he had gotten into anything and probably wouldn't have remembered my mistake if I hadn't done that walk through!

 

[MrWorfMen's Mom]

Having 3 kitties myself, two of whom are grazers I know all too well how difficult it can be to avoid those occasional pilfering escapades. My extra sweet girl dives in and finishes her meals but then will push her brothers out of the way to scarf down their meal too. Luckily they are on diabetic safe food BUT she has food allergies so I still have to play lunch room monitor at every meal. When I have to go out for lengthy periods, it's no doubt a free for all on many occasions. Now you know Oscar will go and pilfer so just be on the lookout. None of us can monitor them 24/7 but take necessary precautions when you can.

Chances are good the carb count for the Saucy Seafood is high. Guaranteed analysis can give some pretty misleading numbers on occasion. Go by the dry matter analysis numbers.