NEW MEMBER - Debra & Max - Need Dosing Assistance

[Debra & Max]

Hello All --
My name is Debra and my 12-year-old cat Max was diagnosed in May of this year, so we are navigating through everything and still very much in the learning stage. Max is a very sweet boy and pretty laid back, so thankfully, he has been patient over the past few months as I've learned to test him regularly and give him his insulin shots. He knows the routine now and hops up on the bed each morning and before his dinner, and sits while I run through the testing process and we have our "cuddle time." He's been a real trooper!

I've been using the spreadsheet to log all of his numbers, and have shown it to my vet, who was very impressed with the organization that went into this -- so kudos to Bill and to all of you who have formed this extremely helpful network of experts. I'm amazed at how much knowledge there is and how you are all so willing to share of your time and expertise to help others.

I'm coming today to ask for help because I'm still struggling to get a handle on quantity to dose in order to keep Max's BG numbers down. You'll see on my spreadsheet that I have done a few curves, but have not been able to do one very recently. We are actually going to get the FreeStyle Libre monitor next week so that I can get a better handle (for a few days, anyway) on Max's hourly numbers.

My challenge is in determining how to dose when the numbers change drastically from morning to evening. He has had numerous evenings when he will test too low (I think) for me to dose, but if I don't give him a shot, then of course his numbers jump in the morning or the next day. So then I end up feeling like i'm in a never-ending cycle of having to start all over. I would love some expert advice on what/if I'm doing anything wrong. And specifically, how to react when Max tests in the low 100s. If I don't give him a shot - he mostly will jump up to the 300-400s the next day. But if I give him a lower dose than what I've been doing, then do I need to continue at that low dose again for a full week before starting to move back up again? This is why i feel like I'm never getting anywhere. Right now, I've not made it past 2.5 units (prozinc) without having to stop and start over. And I really want to start getting his numbers down consistently and regulated. My vet had advised me a couple of months ago to bump him up to 4 units (!), but I didn't do that because I knew that jump was too high. So for now, she's not aware that I never increased him to 4 units. :-/ But she'll be fine.

I'll stop rambling here and just allow someone to take a look at Max's spreadsheet and give me your thoughts. I will try to get another curve in the next day or two so I can get some more recent data.

Thank you again for your help and for this wonderful forum!

 

[Bron and Sheba (GA)]

Hi and welcome Debra and Max to the forum.
Well done setting up the spreadsheet, hometesting and adding in all the data to the SS. Also you signature!
One thing I would suggest is to try and get at least one test on each cycle (both am and PM) if you can. That will tell you how low the dose is taking Max. At the moment we have very little information about the pm cycle and that is half the data missing. And also very little information in the am cycle. The preshot BG is needed to see that it is safe to shoot but then tests during the cycles are needed so that we can see how low the dose is taking Max. If you can get mid cycle tests in most cycles that will tell us a lot more about what is going on. Is that doable do you think?

Max could be dropping low during the cycles and then bouncing up high again at the next preshot.

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

If you are finding that you can shoot in the am and then not in the pm, that usually means you will need to reduce the dose by 0.25 units and see if that works. I would definitely NOT increase the dose as you are getting some low numbers in amongst the higher ones.

Do you have a hypo kit set up?

I’m not a Prozinc user so I’ll tag @FrostD about the dose.

 

[Debra & Max]

Thank you - I’m going to try to do another curve today to get a better picture.

 

[Linda and Newman]

Hi Debra & Max.

Just to say hello and say you have done a great job, having prepared the spreadsheet and your signature, to start. Max is a very handsome, appealing guy. I can appreciate his willingness to cooperate as well as my boy, Newman is prone to do. Most days, Newman shows up at test time morning and evening on my desk.

Best wishes, you are in the right place for you and Max.

 

[FrostD]

Welcome!

I don't have much time at the moment, so some quick guidance - I would try 0.75U both day and night, as long as he's above 140 and you can monitor, otherwise give 0.25U. 100-139 I would try 0.25U if you can monitor, otherwise skip.

Ideally you want to give same dose AM and PM, and get a spot check each cycle close to nadir (based on limited data, around +4).

I suspect the whole issue you've had with the wonky numbers is he was pretty overdosed. Hopefully a smaller dose twice a day works better!

If he goes below 90, your new dose is reduced by 0.25U. And you give that for at least a week, unless he earns another reduction. I suspect 0.75U will end up being a little too high once you give it consistently, so expect a reduction down to 0.5U pretty soon.

 

[Debra & Max]

Welcome!

I don't have much time at the moment, so some quick guidance - I would try 0.75U both day and night, as long as he's above 140 and you can monitor, otherwise give 0.25U. 100-139 I would try 0.25U if you can monitor, otherwise skip.

Ideally you want to give same dose AM and PM, and get a spot check each cycle close to nadir (based on limited data, around +4).

I suspect the whole issue you've had with the wonky numbers is he was pretty overdosed. Hopefully a smaller dose twice a day works better!

If he goes below 90, your new dose is reduced by 0.25U. And you give that for at least a week, unless he earns another reduction. I suspect 0.75U will end up being a little too high once you give it consistently, so expect a reduction down to 0.5U pretty soon.

Thank you so much for this! I had already lowered his dose last night and again this morning to 1U before getting your response, and I’ve been so surprised as I’ve been doing the curve today at how much better his numbers have been all day. I never thought that I might be dosing him too high (because of course my vet had told me to go up to 4!). So I kept thinking I just hadn’t gotten to a high enough dose yet. Now, reading your suggestions, it makes perfect sense to me that I was too high. And that’s exactly why his numbers today in the curve looked so much better. I’ll go on down to .75 like you suggested and see where that takes us.

Thank you all so much for the help!

 

[FrostD]

Yes very nice numbers! So glad you didn't go to 4U, that's just bananas, probably would have killed him.