Max - newly diagnosed, still not regulated (part 2)

[NoahFL]

http://www.felinediabetes.com/FDMB/...ew-my-ss-newly-diagnosed.230927/#post-2587481

At least you are starting to recognize those bounces.
Nice blue number for Max, that 154 at +5 on 6/21/20. Way to go Max! (and Rebecca!)
Steroid induced diabetes often resolves quicker, and we can hope that Max is one of those situations.

If you could start a new thread please, and link this one into the top for reference and history, that would be good.
Threads that are longer than 50 posts get to be unwieldy and make the database behind the scenes run slower.

Thanks.

Thanks @Deb & Wink Praying this is steroid induced and this resolves, but if not, we’ll role with the highs and lows. My heart just sank with that high number tonight. I’ve also got an 11 year old dog with arthritis and early heart failure (on meds) and 14 year old dog with CHF grade 3 (on meds).... we got this, just new routines.

 

[Deb & Wink]

Multiple pets that need special attention and care can be very wearing on you and yours.
Remember to take time to take care of yourself, so you can take care of those around you.

 

[NoahFL]

@Deb & Wink I’m thinking about going up to 3U tomorrow morning. What are your thoughts? Thanks!

 

[Deb & Wink]

Dose changes, increases or decreases, should be in 0.25U increments, per our dosing protocols. Better to increase/decrease in small amounts, since cats are such tiny creatures and you could miss the "good dose".

You have to "eyeball" or make your best guess at where the 2.75U dose would fall between the lines.

Do your syringes have 1/2 unit markings on the barrel?
Here is a picture of a U100 syringe (with Prozinc, you are using the U40 syringes), but the concept of the plunger placement is the same.

First picture is of 0.25U

Second picture is of 0.75U and it is definitely a syringe with 1/2U markings, the shorter lines on the barrel.

Basically, you just have to measure a bit below the 3U line, to give him 2.75U. The picture above is 2U LESS than you need to give.

Are you clear on that?

p.s. We don't have pictures of every possible dose, only some of the finer doses, but they help you to visualize the amounts.

 

[NoahFL]

Mine doesn’t have 1/2U lines, but I think I can do 2.75. I’ll try that in the morning.

 

[NoahFL]

@Deb & Wink or @JanetNJ Just when I’m expecting to add .25U, he was at 143 this morning. Currently holding for 30 min. If he goes over 200, do I do 2.5 or 2.75? What if he doesn’t go over 200?

30 min later - 132. He’s never seen a number this low. What do I do?

Decided to hold and do a curve today.

 

[Deb & Wink]

So you stalled this morning, retested Max without feeding him and his number was basically the same.
This early on, a skip was a good choice.
Prozinc ISG can be quiet, so there is always the option for you to post over in Feline Health for more eyes on you.

I'm not seeing the curve numbers on Max's SS.
A curve would be testing every 2 hours, from 1 pre-shot to the next pre-shot.

 

[NoahFL]

Sorry @Deb & Wink , I didn’t realize a curve was every 2 hours. I did the +6 and saw that it had gone high again. Is it bad that I feel so bad poking him so often. . What do you think caused the low number this morning?

 

[Deb & Wink]

What do you think caused the low number this morning?

Good question. One possibility would be if Max's appetite was off and he did not eat as much overnight.
Or he did not get into any contraband food from the other pets.
Cats love dog food. They don't care what it says on the can. Of course, dog food lacks the correct amount of taurine that cats need, but an occasional snack won't hurt them.

You don't have to poke him every 2 hours for every cycle. Only for 1 cycle, and most people choose the AM cycle since they are already awake. Night owls might consider a PM curve. Many cats BG levels go lower at night, since they are more active and burning off more glucose as fuel to provide them that extra bit of energy for running up and down the stairs all night long. Or for teasing the dogs.

 

[NoahFL]

Good question. One possibility would be if Max's appetite was off and he did not eat as much overnight.
Or he did not get into any contraband food from the other pets.
Cats love dog food. They don't care what it says on the can. Of course, dog food lacks the correct amount of taurine that cats need, but an occasional snack won't hurt them.

All food is tightly sealed and locked up now so I know he didn’t get into any. I am feeding 3 times a day. Is that a sufficient frequency?

 

[Deb & Wink]

All food is tightly sealed and locked up now so I know he didn’t get into any. I am feeding 3 times a day. Is that a sufficient frequency?

It depends on if Max is gaining weight, losing weight or maintaining his weight. It also depends on if Max is his correct or ideal weight.

Adding another meal in the PM cycle, before you go to bed could be good for him.
Simply take the amount of food you give him, and divide it into 4 portions, with the bulk of the food to be given with the insulin. His body needs the insulin to process the food correctly, which is why you want to feed mostly earlier in the cycle.

 

[NoahFL]

It depends on if Max is gaining weight, losing weight or maintaining his weight. It also depends on if Max is his correct or ideal weight.

Adding another meal in the PM cycle, before you go to bed could be good for him.
Simply take the amount of food you give him, and divide it into 4 portions, with the bulk of the food to be given with the insulin. His body needs the insulin to process the food correctly, which is why you want to feed mostly earlier in the cycle.

Thank you! I will split his meals some more. He has gained .4# since his diagnosis. He’s about 14.5#.

 

[Deb & Wink]

So the question to ask yourself about Max's weight, is what is his ideal weight. How much more should he gain to be back at his healthy ideal weight?

Here is a chart, that you might see at a vet's office with the BCS or Body Condition Score chart. Where does Max fall on the BCS?

 

[NoahFL]

@Deb & Wink or @JanetNJ Should I be concerned?? +2 and he’s already 209. Should I feed him something?

 

[NoahFL]

So the question to ask yourself about Max's weight, is what is his ideal weight. How much more should he gain to be back at his healthy ideal weight?

Here is a chart, that you might see at a vet's office with the BCS or Body Condition Score chart. Where does Max fall on the BCS?

He is definitely at the ideal weight according to your chart.

 

[JanetNJ]

@Deb & Wink or @JanetNJ Should I be concerned?? +2 and he’s already 209. Should I feed him something?

I'm sorry I just saw this. Looks like you're handling everything like a pro. . When in doubt it doesn't hurt to give some low carb food.

 

[Deb & Wink]

You did an excellent job helping Max with those low numbers last night. You're up much later than I usually am.
The karo syrup gave you that fast bump up to the mid-range yellows. Karo wears off, so you might remember to set an alarm and test again in 2 hours from giving the karo. You gave him some dry food too, per your SS. That dry "sticks with" a cat longer but can take longer to digest and have an effect on the BG levels. Something to keep in mind.

So when you have a lower number, the first thing you reach for is LC (low carb) food. Next step is MC (medium carb) food. Third step is HC (high carb) food. Fourth step would be bringing out the simple sugar like honey, corn (karo) syrup, pancake syrup, ice cream, or whatever you have on hand that is very high in sugar and putting some in the mouth. You don't "break out the candy (dry food) and sweets (simple sugars)" until the cat is in really low numbers, under 68 on an Alphatrak. Or you have to go somewhere or do something important, like get some sleep for the night.

Next time, before you reach for the karo, you want to use your lower carb options first, to see if you can bring the BG levels up. LC, MC, HC.
If you can't be home, have to step out, or something similar like you are working from home and have a meeting, then you could go to step 2, the MC food.

If the BG levels don't respond, you bump up the level of carbs to help bring them up more. Always try the LC food first, a teaspoon or so and see what it does before you reach for the next higher carb level food.

You even remembered to reduce Max's dose this morning, since he give you a BG of <90. Good job! It's hard to remember things, but you did.

I see you think you gave Max a "fur shot" tonight. You could have got more insulin into Max than you believe, so never give more insulin if you think you did a "fur shot". Even with a "fur shot", you should still do that "before bed" BG test, to see where the BG levels are headed. Just in case.

"Fur shots happen." We've all done them. You pick up again at the next cycle, and make a note like you did on the SS about the fur shot.

 

[NoahFL]

You did an excellent job helping Max with those low numbers last night. You're up much later than I usually am.
The karo syrup gave you that fast bump up to the mid-range yellows. Karo wears off, so you might remember to set an alarm and test again in 2 hours from giving the karo. You gave him some dry food too, per your SS. That dry "sticks with" a cat longer but can take longer to digest and have an effect on the BG levels. Something to keep in mind.

So when you have a lower number, the first thing you reach for is LC (low carb) food. Next step is MC (medium carb) food. Third step is HC (high carb) food. Fourth step would be bringing out the simple sugar like honey, corn (karo) syrup, pancake syrup, ice cream, or whatever you have on hand that is very high in sugar and putting some in the mouth. You don't "break out the candy (dry food) and sweets (simple sugars)" until the cat is in really low numbers, under 68 on an Alphatrak. Or you have to go somewhere or do something important, like get some sleep for the night.

Next time, before you reach for the karo, you want to use your lower carb options first, to see if you can bring the BG levels up. LC, MC, HC.
If you can't be home, have to step out, or something similar like you are working from home and have a meeting, then you could go to step 2, the MC food.

If the BG levels don't respond, you bump up the level of carbs to help bring them up more. Always try the LC food first, a teaspoon or so and see what it does before you reach for the next higher carb level food.

You even remembered to reduce Max's dose this morning, since he give you a BG of <90. Good job! It's hard to remember things, but you did.

I see you think you gave Max a "fur shot" tonight. You could have got more insulin into Max than you believe, so never give more insulin if you think you did a "fur shot". Even with a "fur shot", you should still do that "before bed" BG test, to see where the BG levels are headed. Just in case.

"Fur shots happen." We've all done them. You pick up again at the next cycle, and make a note like you did on the SS about the fur shot.

Thank you for this! He did eat dry last night (I was freaking out). I guess that would explain why it doesn’t seem like the insulin has done much today. I will check him before I go to bed. I wish I knew what his little body was doing and why he went down so quick last night. He is urinating a lot today. Hopefully tomorrow is a better day for him. He’s starting to get anxious around me now, maybe anticipating I’m going to poke him again.

 

[Deb & Wink]

Sooth him whenever you get the chance, and let him know that attention will not ALWAYS mean a poke. Small treats, a tiny piece of anything pure protein along with the attention will help to calm him also, and help him learn that he does not need to be so anxious around you.

The poking last night was to keep him safe from a hypo, and you needed to do that. So today he bounces. He'll get back on track.

Cats can learn to associate a treat or attention with something good. "Conditional behavior modification" is what you are doing, for the fancy scientific term.

 

[JL and Chip]

Just a quick fly-by but I noticed a reference to steroids. Is Max still on steroids? If not, when was the last steroid given?

Steroids are notorious for spiking BG in diabetic cats and they can come down the dosing scale pretty quickly once steroids are removed. Charlie was a steroid-induced diabetic and I remember well the ride.

 

[NoahFL]

Just a quick fly-by but I noticed a reference to steroids. Is Max still on steroids? If not, when was the last steroid given?

Steroids are notorious for spiking BG in diabetic cats and they can come down the dosing scale pretty quickly once steroids are removed. Charlie was a steroid-induced diabetic and I remember well the ride.

Max got a steroid shot about 2 months ago and we’re suspecting that’s the cause. After about 3 weeks after the shot is when I noticed the symptoms of diabetes.

 

[NoahFL]

We expect other BG numbers during the cycle to be food influenced.
It's usually best not to feed after +6, as they will raise the BG levels in the later half of the 12 hour cycle.

Deb, I saw this on Heather’s post and wanted to ask if I’m doing incorrect feedings. Now that we are off dry (well, until my pajama party last night) and I’m still teleworking, I’ve been feeding a mix of DM and FF before morning shot, at +6 after midday check then before evening shot. Is that ok?