Fuzzy’s BG values

kxk34

kxk34

Member
We’re getting some confusing BG values today that we’re not sure how to interpret. Just now at +3 (10:30 am ET) we tested Fuzzy’s BG and it said it was 596, which seemed strangely high so we immediately tested again and it said 676. Is that possible?? She was a little squirmy the second time, but otherwise the tests were back to back nothing different. We were going to test a third time to see if it was a fluke but she was squirming too much so we let her go.

She last ate just after +2 (9:30 am ET). We just tested her urine for ketones and it came back negative.

This is her third day getting 1.5u of insulin (increased from 1u). The first day her values seemed to be looking better and her nadir was relatively early. Unfortunately, we noticed most of the tests yesterday were pretty high too.

Any thoughts?


(Note: there’s currently a temporary row on our spreadsheet right below the row for today where we’re just calculating the change between each test)
 
Flat blacks is a little odd...

When and where did you give SQ in relation to insulin?
 
Sort of an ECID thing. I always shoot in the scruff, but fluids are in flank. I usually spaced by at least 2 hours if I could. You can always experiment by noting when and seeing if it makes a difference

I suppose the high blacks today could be a bounce, but it seems more like a partial fur shot or something else going on. See how she does tonight.

How are ketones? How is she otherwise?
 
FrostD said:
Sort of an ECID thing. I always shoot in the scruff, but fluids are in flank. I usually spaced by at least 2 hours if I could. You can always experiment by noting when and seeing if it makes a difference

I suppose the high blacks today could be a bounce, but it seems more like a partial fur shot or something else going on. See how she does tonight.

How are ketones? How is she otherwise?
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We were only shown how to do both in the scruff so we’ve been doing both that way… we will definitely wait a few hours before fluids.

Ketone strip came back negative earlier. She’s actually had a noticeably good day today. Good energy and appetite, yesterday she didn’t have much water but today was drinking more normally, walking and balance has been good, poops look formed, etc.

We did start to introduce a new food yesterday (royal canin select protein duck) but her values were high before she got that yesterday too.
 
Ok good!

I actually prefer fluids in flank, I find it easier and less worrisome with that huge freakin needle. Maybe next time you're there you can see if they'll show you. But if she's good with scruff, whatever works!

Just beware changing carb %. It will be difficult for us here to stay on top of all the food changes and experimentation you have to do, so just make sure if you're changing foods to consider the impact it may have on BG. That may be part of this lower number tonight (207), it does take a few cycles to see fuller effects.
 
FrostD said:
Ok good!

I actually prefer fluids in flank, I find it easier and less worrisome with that huge freakin needle. Maybe next time you're there you can see if they'll show you. But if she's good with scruff, whatever works!

Just beware changing carb %. It will be difficult for us here to stay on top of all the food changes and experimentation you have to do, so just make sure if you're changing foods to consider the impact it may have on BG. That may be part of this lower number tonight (207), it does take a few cycles to see fuller effects.
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She's down to 71 tonight... getting pretty nervous
 
She’s alert and excited and eating a bunch rn so hopefully bc it gradually dropped to 71 she’s not feeling bad….

Edit: We just tested again and she’s up to 107 thankfully
 
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Sorry I wasn't around, was in bed.

Please reduce next shot to 1.25U. She's bouncing today, and last night was nearly a perfect cycle. That 71 is lower than we want with her current diet, especially on an AlphaTrak. Looks like possibly the pred dose shaking out a bit.

When you see her that low, go ahead a feed 1-2 tsp of whatever medium or high carb food she'll eat for you, and test again in 30 mins to make sure she at least stays flat (and perhaps feed a little more).
 
FrostD said:
Sorry I wasn't around, was in bed.

Please reduce next shot to 1.25U. She's bouncing today, and last night was nearly a perfect cycle. That 71 is lower than we want with her current diet, especially on an AlphaTrak. Looks like possibly the pred dose shaking out a bit.

When you see her that low, go ahead a feed 1-2 tsp of whatever medium or high carb food she'll eat for you, and test again in 30 mins to make sure she at least stays flat (and perhaps feed a little more).
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Thank you! We can’t measure out exactly 1.25u but we eyeballed halfway between 1 and 1.5u.

She’s been eating a lot less dry food the last two days since we introduced the duck (she LOVES the duck) so that might’ve contributed as well.
 
FrostD said:
Ok good!

I actually prefer fluids in flank, I find it easier and less worrisome with that huge freakin needle. Maybe next time you're there you can see if they'll show you. But if she's good with scruff, whatever works!

Just beware changing carb %. It will be difficult for us here to stay on top of all the food changes and experimentation you have to do, so just make sure if you're changing foods to consider the impact it may have on BG. That may be part of this lower number tonight (207), it does take a few cycles to see fuller effects.
Click to expand...

Hi! I recently added a tab to Fuzzy's spreadsheet where we add the cell notes so that there's more information about when she last ate, etc. relative to each BG test. I also added a tab with her current medications and the time that she gets them and created a Google site (bit.ly/fuzzy-info) so we have a place for all that + additional information (diet, lab results, etc.) to contextualize her case a bit more.

The other night (3/2) she oddly dropped a bit quickly relative to what we've come to expect, but this time she had eaten a good amount pre-shot and there was nothing that stood out as abnormal when we fed her and administered the shot so we're not quite sure what happened there. We did add a little bit of karo syrup to some food once she hit low 90s just because we were scared of what would happen if she continued to drop and stopped eating for us since it was late at night and we don't have a reliable emergency vet nearby.

If you have a minute at some point could you please see if you have any thoughts based on the notes from that day now that additional information is available? I'm interested in what you think about her recent values since we have been mostly holding at 1.25u since we last discussed her dose (other than a few days she received less than that as a precaution) and her meds have been updated since then (lowered pred, discontinued metro). Her liver values have unfortunately worsened, but other than that she's seemed to be doing well lately as far as we can tell.
 
Hmm, not liking these blacks. But that 92 doesn't give you much room to increase

I'd say t's time to bite the bullet and switch to a depot insulin. I personally am leaning Levemir because it tends to be flatter, but also see what @Wendy&Neko thinks. Wendy, also, is there a case to be made for R here? Obviously not at the same time as an insulin switch
 
This is not an appropriate time for R. This cat is on high carb foods, a relatively low insulin dose, and not experiencing ketones.

This cat hasn’t been on ProZinc long enough to throw in the towel on it yet. Normally we suggest giving an insulin more than two months to see how it does,

I did fluids in the scruff, and insulin in the flank when I gave fluids.
 
We asked our vet about a week ago whether she thought trying something else would be worthwhile because Fuzzy's current insulin will expire on March 12, but we specifically asked about Lantus since that was the only kind of insulin presented to us initially other than ProZinc. She said that she would worry about a 24 hour insulin with Fuzzy seeing how much she bounces around so we put in an order for more ProZinc. But we can always still broach the topic with her again if it seems there's not much more tweaking we can do to improve her values while on the ProZinc.

Her appetite has been great since adding the Royal Canin Select PD to her diet, so maybe we could try restricting dry food after all and hopefully that would help? We were previously dissuaded from doing so because of her very low weight, but she's been maintaining her weight at 4.0-4.2 lbs for a few weeks now and has already started to eat less dry food since we began feeding her the duck.
 
Wendy&Neko said:
This is not an appropriate time for R. This cat is on high carb foods, a relatively low insulin dose, and not experiencing ketones.

This cat hasn’t been on ProZinc long enough to throw in the towel on it yet. Normally we suggest giving an insulin more than two months to see how it does,

I did fluids in the scruff, and insulin in the flank when I gave fluids.
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Thanks.

It has been 2 months? Started 1/6/22.

My concern is the swings and lack of duration, plus no room for increase yet. And not a reliable eater to slow the drops. Granted, could still happen with Lantus...and from what I've seen usually cats like this on ProZinc are a bit similar on Lantus
 
kxk34 said:
We asked our vet about a week ago whether she thought trying something else would be worthwhile because Fuzzy's current insulin will expire on March 12, but we specifically asked about Lantus since that was the only kind of insulin presented to us initially other than ProZinc. She said that she would worry about a 24 hour insulin with Fuzzy seeing how much she bounces around so we put in an order for more ProZinc. But we can always still broach the topic with her again if it seems there's not much more tweaking we can do to improve her values while on the ProZinc.

Her appetite has been great since adding the Royal Canin Select PD to her diet, so maybe we could try restricting dry food after all and hopefully that would help? We were previously dissuaded from doing so because of her very low weight, but she's been maintaining her weight at 4.0-4.2 lbs for a few weeks now and has already started to eat less dry food since we began feeding her the duck.
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I would not restrict food in that sense since she is still small; still needs overall calories but you can try to play with timing to slow those drops. I know we've asked before, but what is ideal weight?
 
FrostD said:
I would not restrict food in that sense since she is still small; still needs overall calories but you can try to play with timing to slow those drops. I know we've asked before, but what is ideal weight?
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Realistically, we'll be happy if we can get her back to around 5 lbs although that is still a good bit less than what she weighed previously.

The last time she weighed around 5 lbs was 10/28/2021 but even then she was down from 5.9 lbs in May 2021. (Dating further back she typically weighed between 6 and 7.5 lbs).
 
FrostD said:
Thanks.

It has been 2 months? Started 1/6/22.

My concern is the swings and lack of duration, plus no room for increase yet. And not a reliable eater to slow the drops. Granted, could still happen with Lantus...and from what I've seen usually cats like this on ProZinc are a bit similar on Lantus
Click to expand...

Regarding the lack of duration, we have noticed that it often seems like she reaches nadir relatively early in many cycles, but she's so inconsistent we have a hard time assessing what's normal for her.
 
Another thing I'm not totally clear on is how her BG values relate to her liver (and vice versa)... she's had elevated ALT on every set of lab results we've gotten since she was diagnosed with diabetes, but recently AST and ALP increased as well. Our vet submitted a referral for us to see an internal medicine specialist, but we are still waiting to hear back about scheduling that appointment. Is there anything we should be trying to do or avoid in the meantime to prevent damage to her liver or increased risk of damage down the road? Her recent lab results can be seen here (or via the tab for lab results on her spreadsheet); her liver was also mentioned in the write-up of findings from the ultrasound that she got in early Nov 2021.

Her BG at AMPS this morning is lower than it has been recently (382) and her appetite isn't great so we were thinking that we will probably stall a bit and give a lower dose than the 1.25u she's been getting just to be on the safe side.
 
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