Urgent...Need dosing help for Denny!

[KimH]

Good morning and Merry Christmas!
Denny is in the process of breaking a bounce and his AMPS reading is 174. Should I continue to give him 1 full dose? I'll be home all day today so I can do a curve if needed.

My spreadsheet has a tab for alpha trak and relion. The reading was taken on the relion this morning.

Thank you!

 

[Chris and Checkers]

I guess no one is around this morning. You gave a reduced dose, good call. If you keep an eye on Denny and test during the cycle he should be fine.

Happy holidays.

 

[KimH]

I guess no one is around this morning. You gave a reduced dose, good call. If you keep an eye on Denny and test during the cycle he should be fine.

Happy holidays.

Thank you. You've made me feel better by letting me know I made the right call this morning.

 

[Sienne and Gabby (GA)]

Kim -

A couple of thoughts.

Especially when you have a question, it's important to make sure your spreadsheet is up to date. You don't have your AMPS or what you eventually shot listed. Many of us are spreadsheet dependent so it's crucial to have the information entered. Having 2 tabs with incomplete data is problematic. You need to pick a meter and put ALL of your data in one place.

Especially during holiday times, it's helpful to remember that there is usually information in the sticky notes on your insulin (Prozinc) board.

What I would have suggested is to wait 20 - 30 min and to re-test. If numbers were rising (appreciably rising -- more than 20%), you could have given the full dose and then monitored. Since you're still pretty new to this process, shooting a reduced dose was fine.

 

[KimH]

Kim -

A couple of thoughts.

Especially when you have a question, it's important to make sure your spreadsheet is up to date. You don't have your AMPS or what you eventually shot listed. Many of us are spreadsheet dependent so it's crucial to have the information entered. Having 2 tabs with incomplete data is problematic. You need to pick a meter and put ALL of your data in one place.

Especially during holiday times, it's helpful to remember that there is usually information in the sticky notes on your insulin (Prozinc) board.

What I would have suggested is to wait 20 - 30 min and to re-test. If numbers were rising (appreciably rising -- more than 20%), you could have given the full dose and then monitored. Since you're still pretty new to this process, shooting a reduced dose was fine.

Well his numbers were in the blue all day and shot back up to 565 tonight . I'm never going to get the hang of this.

 

[FrostD]

Since we don't know what happened yesterday or last night, i would assume hes just bouncing, it will probably continue for some time til he settles down. Those are pretty big drops he's seeing.

 

[Sienne and Gabby (GA)]

I had to chuckle (sorry)! It's not anything you're doing. It's Denny. He bounced. I'll explain...

But first, you need to get a before bed test every single night. The reason being is that I suspect that Denny's numbers were lower than you realize last night. I'm guessing at this based on his PMPS of 219 and his AMPS this morning of 175. There's a high likelihood that he was in at least blue numbers overnight. Those blues -- or even his AMPS -- are lower numbers than what Denny is used to. If you notice, every time you see blues, he's back in higher numbers by the next shot time. When a cat drops into lower numbers than is currently typical, drops into low numbers, or drops a substantial amount in a short period of time, the liver and pancreas release a stored form of glucose along with counterregulatory hormones that cause numbers to spike upward. This is what we refer to as a "bounce." It's annoying but not dangerous. Over time and as Denny gets used to being in a lower number range, the bouncing will flatten out.

 

[KimH]

Since we don't know what happened yesterday or last night, i would assume hes just bouncing, it will probably continue for some time til he settles down. Those are pretty big drops he's seeing.

I'm just not sure what dose he should even be on. He's fully on a low carb wet food only diet.

 

[Sienne and Gabby (GA)]

You can go back to the 1.0u. There's no indication that a dose reduction was needed. If you go back to the Prozinc dosing sticky, you don't reduce unless numbers drop below 90.

 

[KimH]

I had to chuckle (sorry)! It's not anything you're doing. It's Denny. He bounced. I'll explain...

But first, you need to get a before bed test every single night. The reason being is that I suspect that Denny's numbers were lower than you realize last night. I'm guessing at this based on his PMPS of 219 and his AMPS this morning of 175. There's a high likelihood that he was in at least blue numbers overnight. Those blues -- or even his AMPS -- are lower numbers than what Denny is used to. If you notice, every time you see blues, he's back in higher numbers by the next shot time. When a cat drops into lower numbers than is currently typical, drops into low numbers, or drops a substantial amount in a short period of time, the liver and pancreas release a stored form of glucose along with counterregulatory hormones that cause numbers to spike upward. This is what we refer to as a "bounce." It's annoying but not dangerous. Over time and as Denny gets used to being in a lower number range, the bouncing will flatten out.

Unfortunately, Denny is not super agreeable at the end of the day with multiple tests per day. I can try to get some night time numbers but I don't think I'll be able to every night. I do always give him food before bed. His meals are the same for each 12 hour cycle - amps test, 3oz FF, insulin. Then 3-4 hours later he gets half a can of low carb wet food, sometimes FF, sometimes Weruva pate...repeat the same for dinner and bedtime.

I read a lot on here about keeping the same dose for a week before adjusting, but I never know if he needs to go up or down in dosing since some of PS numbers are questionable.

Thanks for explaining the bouncing. I didn't know it would happen even for numbers in the blue. Probably will be high tomorrow night as well. Should he get one unit tonight or .75 since that's what he got this morning?

 

[FrostD]

You've been at 1U for 5 days now once you shoot tonight. I do think you have room for an increase BUT I also think that will exacerbate the bouncing problem.

His nadirs right now are pretty good. As long as ketones are negative, I would hold the 1U for a bit to see if the bouncing settles down.

 

[KimH]

You can go back to the 1.0u. There's no indication that a dose reduction was needed. If you go back to the Prozinc dosing sticky, you don't reduce unless numbers drop below 90.

I guess my issue is that I never know if it drops below 90. The lowest number I have seen is 94 but I can't test him around the clock unfortunately. I can give him the full 1 unit tonight. I'm trying to do the best I can but feel stretched pretty thin with 3 other senior pets. I've been trying to get my other senior hyperthyroid kitty on the same feeding schedule but any time she doesn't have access to food for a few hours, she throws up whatever she eats. Somehow, the only thing she keeps down is the dry food which I monitor all day long (or put away when I leave the room so Denny doesn't get into it).

Sorry for the venting! It's been hard and a lot more of a struggle than I imagined. The thought of re-homing him has come to mind but I love him dearly and can't give him up.

 

[FrostD]

Unfortunately, Denny is not super agreeable at the end of the day with multiple tests per day. I can try to get some night time numbers but I don't think I'll be able to every night. I do always give him food before bed. His meals are the same for each 12 hour cycle - amps test, 3oz FF, insulin. Then 3-4 hours later he gets half a can of low carb wet food, sometimes FF, sometimes Weruva pate...repeat the same for dinner and bedtime.

I read a lot on here about keeping the same dose for a week before adjusting, but I never know if he needs to go up or down in dosing since some of PS numbers are questionable.

Thanks for explaining the bouncing. I didn't know it would happen even for numbers in the blue. Probably will be high tomorrow night as well. Should he get one unit tonight or .75 since that's what he got this morning?

Keep the 1U as long as he's above 180. Below that stall and ask for help and hopefully someone is around (probably post on the main board).

Remember dose is based on nadir. On ProZinc we usually look for nadirs around 90, lower than that we decrease by 0.25. Close to it, we hold. Well above, we increase by 0.25. Right now I'd say his numbers are close enough and to hold for a few more days

 

[FrostD]

I guess my issue is that I never know if it drops below 90. The lowest number I have seen is 94 but I can't test him around the clock unfortunately. I can give him the full 1 unit tonight.

That's where we have to "read between the lines" so to speak. What I see recently on your spreadsheet doesn't stand out as needing a decrease yet, or going below 90 (though it certainly is possible, hopefully he becomes better with testing over time).

 

[KimH]

Keep the 1U as long as he's above 180. Below that stall and ask for help and hopefully someone is around (probably post on the main board).

Remember dose is based on nadir. On ProZinc we usually look for nadirs around 90, lower than that we decrease by 0.25. Close to it, we hold. Well above, we increase by 0.25. Right now I'd say his numbers are close enough and to hold for a few more days

While I was typing here, my husband gave .75 units tonight so we'll go back to 1 unit in the morning. Whoops

 

[Sienne and Gabby (GA)]

Kim --

You're doing your best. The front end of this learning curve is very steep. Give yourself more than 2 weeks to get comfortable.

One thought -- there's no reason you need to feed Denny only twice a day. You can divide up his food and keep him on the same schedule as your hyperT kitty. The only time you want to hold off on feeding Denny is during the 2 hours prior to his shot time.

 

[KimH]

That's where we have to "read between the lines" so to speak. What I see recently on your spreadsheet doesn't stand out as needing a decrease yet, or going below 90 (though it certainly is possible, hopefully he becomes better with testing over time).

We took a bit of a break for his sake and ours over Christmas. Today we spot checked him at +6 and he had dropped down to 67! We will decrease his dose now to .75 and keep an eye on him. Behaviorally I wouldn't have known the difference. He ate lunch a little later than usual and happily ate a slightly higher carb wet food for lunch.

 

[FrostD]

We took a bit of a break for his sake and ours over Christmas. Today we spot checked him at +6 and he had dropped down to 67! We will decrease his dose now to .75 and keep an eye on him. Behaviorally I wouldn't have known the difference. He ate lunch a little later than usual and happily ate a slightly higher carb wet food for lunch.

Good catch! What time is it now? Have you checked him again to make sure he didn't go lower? Did you give him any food when you got the 67?

And I know this is beating a dead horse but I have to do my own due diligence - I understand the need for a break but if you absolutely cannot get a preshot test, it's best to temporarily reduce the dose, especially if you're seeing blue (and ketones are negative).

 

[KimH]

Good catch! What time is it now? Have you checked him again to make sure he didn't go lower? Did you give him any food when you got the 67?

And I know this is beating a dead horse but I have to do my own due diligence - I understand the need for a break but if you absolutely cannot get a preshot test, it's best to temporarily reduce the dose, especially if you're seeing blue (and ketones are negative).

I haven't rechecked him yet. He ate 1/2 can of Fancy Feast immediately after the test along with 5 or so pieces of Dr. Elsey's clean protein kibble. That was all about 20 minutes ago. Now he's running around the house with his mouse toy in his mouth so he seems to be feeling okay

 

[Sienne and Gabby (GA)]

Please don't gauge whether Denny is OK just because he's playing. The numbers don't lie. Cats are masters of hiding if they don't feel well and numbers can drop with your cat acting fine until he isn't acting fine. Catching numbers before they plummet is a lot easier on your cat and on your nerves than on catching a number in the 30s and panicking. I also can't emphasize enough that you need to start getting before bed tests every, single night. Without those tests you have no idea if Denny is in safe numbers over night. In addition, you're missing half of your data.

 

[KimH]

Please don't gauge whether Denny is OK just because he's playing. The numbers don't lie. Cats are masters of hiding if they don't feel well and numbers can drop with your cat acting fine until he isn't acting fine. Catching numbers before they plummet is a lot easier on your cat and on your nerves than on catching a number in the 30s and panicking. I also can't emphasize enough that you need to start getting before bed tests every, single night. Without those tests you have no idea if Denny is in safe numbers over night. In addition, you're missing half of your data.

I know, I suck, I get it. I'm doing the best I can. I have 4 senior pets with special needs and have spent nearly $10,000 on vet bills this year. All of these schedule and diet changes have now led to my other sick (hyperthyroid) cat to go on a full out hunger strike. I have to force feed her all day long on top of my full time job. I know cats are good at hiding how they are feeling, but Denny is one to be very obvious about how he feels. If he felt like garbage, he would not be out and about. I don't have the time or resources to test Denny all day long and feel like I just get chewed out here because I don't test him every hour of my life. I can stop posting here since I'm not good enough. Sorry to be a bother.

 

[Sienne and Gabby (GA)]

We (I) really do understand. There are many members who juggle other special needs pets and/or family, jobs, their own medical issues, etc. If you didn't care about Denny, you wouldn't have joined this community. Part of the difficulty is that it's hard to offer you guidance that's safe and meaningful without information to inform our decisions. We're not there with Denny and we don't know him (or you) very well yet. No one would ask you to test every hour or any amount of testing close to that unless he'd dropped into low numbers and needed more intense monitoring to get him out of what could be a dangerous situation. You are getting a good number of tests during the day. If you could include a "before bed" test during the PM cycle, that would be very helpful and reassuring. The minimum number of tests we suggest is 4 -- your AM and PM pre-shot tests and one additional test each cycle. Like you, I worked a full time job. There were times when I couldn't get a test other than at AMPS. You do your best.

If you catch a number like the 67 and can't be home to test, leave a note in the comments section. If you can't be home, then leave higher carb food as a safety measure and include that information.

Part of why we coach the way we do is to get new members in the habit of managing their cat's diabetes. Once those habits are in place, it makes management much easier. It becomes a no brainer.

And most importantly, you're not a bother. If there are ways we can help or answer questions, please let us know.

 

[watsonanna]

A friend of mine has a cat who also has this disease. Thanks to good help from the vet, she has quite long remission now. Her cat developed it after she broke bone as a kitten. From what I understand AMPS symptoms can come on suddenly or take weeks to develop. But as I said, now fortunately her condition has improved. Also for a long time she had problems with intolerance to some foods, I even found some info, can look at this site. Nutrition is very important, cause a cat can easily catch an infection by socializing with other animals or by eating food contaminated with parasites. This can cause additional complications with this diagnosis.