New to PZ thread 2

ittybitty said:
Previous thread:
https://felinediabetes.com/FDMB/threads/new-to-pz.278084/

@Suzanne & Darcy
Any idea what happened last night? I don’t quite understand last night’s +2 compared to the previous night at +2 with a similar PMPS on both. My only guess is my PS was maybe a bounce if he went lower than normal yesterday?
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I think that last night's cycle was soooo good! With the last few days being blank, we can't know too much about what happened but can only speculate. It doesn't look like a bounce because he went right back into blue last night. But he also went into blue on the previous night, so maybe the two p.m. cycles aren't as different as can be if we consider meter variance of +/- 20 percent. Really, you are doing great under challenging circumstances! Are you off today? For the next few days? :-)
 
Suzanne & Darcy said:
I think that last night's cycle was soooo good! With the last few days being blank, we can't know too much about what happened but can only speculate. It doesn't look like a bounce because he went right back into blue last night. But he also went into blue on the previous night, so maybe the two p.m. cycles aren't as different as can be if we consider meter variance of +/- 20 percent. Really, you are doing great under challenging circumstances! Are you off today? For the next few days? :)
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Thanks for looking. No, at work today too. The weeks I work 4 days doesn’t leave much room for testing so next week will be a little limited. Hopefully I can get some more data Monday/Tuesday.
 
Suzanne & Darcy said:
Tomorrow? you work also? until Monday? Anyway, you've been doing great. I have been checking in to see the numbers each morning.
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Yes, work tomorrow also. Monday/Tuesday/Saturday will be off days this week. Thanks for keeping an eye on my SS. I really really appreciate it! Please let me know if you see anything I can do better!
 
@Suzanne & Darcy

I can’t tell why Tuko’s BG are higher other than it’s time for an increase. Let me know what you think. If we do need to increase, I’m not sure whether to start tomorrow with only 1 day to monitor or wait until Saturday when I’m home for more days.
 
I agree that it looks like he does need an increase, even without a whole lot of daytime data, but I also agree that we probably should not do the increase tomorrow when you only have the one day to monitor how things go on the increased dose.
 
Although I have to wonder where those pink evening preshots came from the last few nights.
Maybe just that it's been 14 hours since shot -- that's possible? Anyway, I will feel better if we can get more information on the new dose. And I do feel like he should be fine on 1 unit... but we need to make sure for a few days before shooting that amount when you're not home.
 
ittybitty said:
Off for 5 days total- will have to decide which days I can monitor to increase him. I meant to check another mid cycle last night but was exhausted.
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I understand. You need to take care of yourself too! Or you won't be able to take care of Tuko. Five days off is good. Let's decide like Friday night/Saturday morning what to do. I'm thinking increase Saturday morning. BUT, now that I've given the threat of increase... all kinds of things may start happening. Tuko... did you hear that? We've threatened to increase your insulin dose. :cat:
 
@Suzanne & Darcy
I don’t know what’s causing these pinks from last night. This AM was 263 at 7:30. Somehow I didn’t have my alarm set so I slept through his normal shot time. Fed and shot at 7:30, hoping that’s okay since his PM shot isn’t until 7:45 so after tonight he should be back on schedule. Today just won’t really help as far as data since none of the hours really line up with what I’ve been shooting. Im not sure how to put this on the SS. Do I just put the AMPS in like normal and indicate shot time of 7:30 or put it in +1.5 box since I won’t have 14hrs until PMPS and I have 14boxes going across. it’s also interesting how he was slightly lower at 7:30 than 2:30AM test… almost like this cycle hasn’t ended. Does insulin last longer in some cycles? It’s very confusing how we are getting such differing numbers when everything (feedings, insulin dose) has stayed the same. I did come home to lots of hairball barf in my bed yesterday that I suspect was within a few hours of PMPS - not sure if that can inflate glucose in anyway.
Thanks for looking and helping!
 
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Ack! I can't believe I didn't see a tag for this post from two days ago. He ended up having a very nice cycle that day in blue. I have a feeling today he spent a good portion of the day in blue as well, while you were are work. How does he seem to feel?
 
Suzanne & Darcy said:
Ack! I can't believe I didn't see a tag for this post from two days ago. He ended up having a very nice cycle that day in blue. I have a feeling today he spent a good portion of the day in blue as well, while you were are work. How does he seem to feel?
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Yes, as much as I hate I was off schedule it did show me what he might look like if shot on a 12hr schedule.
He’s acting fine. Surprisingly even in these 300s he’s stretching for belly scratches, running after treats, etc. He doesn’t seem to feel bad. I hate seeing pinks, but also realize it could be worse. I think he’s probably in blue more than I’m catching with tests.
 
ittybitty said:
it’s also interesting how he was slightly lower at 7:30 than 2:30AM test… almost like this cycle hasn’t ended.
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I definitely think he was still seeing some action from the insulin at 7:30. I suspect though, that he dipped lower after your 2:30 a.m. test and then was coming back up a little bit at 7:30. The insulin can last between 12-14 hours (which is good with your schedule).
ittybitty said:
I did come home to lots of hairball barf in my bed
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Some people swear that hairballs elevate glucose, but they say they see numbers coming down after they cough up a hairball. It's just anecdotal, of course, but very individual to each cat and some owners have observed this (constipation, too.)
 
ittybitty said:
Yes, as much as I hate I was off schedule it did show me what he might look like if shot on a 12hr schedule.
He’s acting fine. Surprisingly even in these 300s he’s stretching for belly scratches, running after treats, etc. He doesn’t seem to feel bad. I hate seeing pinks, but also realize it could be worse. I think he’s probably in blue more than I’m catching with tests.
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Yes. Sort of reading between the lines (or cells) I agree that he's in more blue than we see.
 
Oh good. I like that. You could collect some data on Saturday hopefully and then we can hopefully see whether it would be beneficial to increase. You can hopefully keep all the variables the same as the days you are off: shot time, food, etc.
 
Suzanne & Darcy said:
Oh good. I like that. You could collect some data on Saturday hopefully and then we can hopefully see whether it would be beneficial to increase. You can hopefully keep all the variables the same as the days you are off: shot time, food, etc.
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Will do! So far that one day is the only one I missed the time on and I still can’t believe that happened. I guess just still getting adjusted to this routine. And I stick with 1.5can/cycle unless it’s a lower than normal glucose… sometimes I leave 2 cans if I won’t be home but it’s always indicated in the remarks on the SS.
 
Well, you must be very tired after long work days. I'm sure this Saturday you will want to get a little extra sleep? But that could be challenging with Tuko's testing schedule. I hope you're good at napping. :)
 
Suzanne & Darcy said:
Well, you must be very tired after long work days. I'm sure this Saturday you will want to get a little extra sleep? But that could be challenging with Tuko's testing schedule. I hope you're good at napping. :)
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Yes, quite tired. This is a challenge to my sleep schedule. But so far I’m just setting alarms to get up and test/feed/shoot and then go back to sleep. That’s also why there aren’t a lot of +1 & +2tests. When he was on insulin in 2021 I was out on medical leave for a while so there were only a few days that I ever left him. So this part is new for us- trying to schedule diabetes related stuff around work. I just take it one day at a time.
 
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@Suzanne & Darcy

Let me know what you think of todays numbers. I feel like it will keep climbing until PMPS. I think I would be safe to increase to 1unit but want your opinion first.

Also, I’m trying to help him lose weight by decreasing calories. He has been on 3 cans/day for a little over a month and he weighed more today than before I decreased his food. Ideas?
 
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Based on today’s numbers, I do feel like you could increase to 1 unit. I agree.

I am thinking that he is able to make better use of his food now that he’s in a better glucose range. That’s three 5.5 oz. cans of cat food? Or three 3 oz. cans - because you are feeding him Fancy Feast. 9 oz. doesn’t seem like that much food.
 
Suzanne & Darcy said:
I am thinking that he is able to make better use of his food now that he’s in a better glucose range. That’s three 5.5 oz. cans of cat food? Or three 3 oz. cans - because you are feeding him Fancy Feast. 9 oz. doesn’t seem like that much food.
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3 oz cans. I used the calculator based off his ideal weight and I think it was a little under 3 cans but since I don’t like refrigerating extra I just rounded to 3 cans to keep it simple. Using 1.5 cans during AM cycle and 1.5 during PM cycle and having to refrigerate 1/2can at a time. There were a few days where I left 2 cans for a day when I was worried he may drop lower and need the food.
Do you have suggestions for amount to feed? Or weight loss- or should I just worry more about getting him in better numbers and then worry about weight loss. I feel like if he wasn’t as overweight maybe his glucoses would be better, but that maybe incorrect thinking.
 
Hi. I’m just checking in on how you are doing. He has been doing really well on the 1 unit. His numbers are down a bit but still safe for when you are at work. How are you feeling about it?
 
Oh, and I don’t think I really answered about the food. It could be hard to cut back much with all the snacks he needs. I think I would first just try to prioritize the diabetes and then work on weight loss if necessary. You could cut back very gradually.
 
Suzanne & Darcy said:
Hi. I’m just checking in on how you are doing. He has been doing really well on the 1 unit. His numbers are down a bit but still safe for when you are at work. How are you feeling about it?
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I feel much better not seeing the >300s anymore! I feel like each day my AMPS keeps getting a little lower and I’m not sure how low I can safely shoot 1U on days I work. Suggestions? I’m thinking at least down to 160ish since today was in the 170s. But he’s 92 at +4 so I guess it may depend on what today shows me with his numbers. He had one day that he looked like he felt awful- hiding and sleeping, slow to come to me for testing but right now he’s as happy as he can be in the 90s.

His AM feeding is 2/3 can at shot time, then 1/3can at +4 and 1/2can at +8. PM cycle is 1/2 can at shot time then 1/2 can at +3 and +6. If I need to modify any of that let me know. I guess as long as glucoses are doing okay then that schedule is fine and if we see him having steep drops I may need to space some snacks out more? I also am realizing he doesn’t have a “bigger” meal with PMPS, I guess that’s okay?

Not sure how often to test or catch where he maybe going low. If you can see any specific time I need to watch please let me know. I try to get every few hours while I’m home but he does only let me use his left ear so sometimes I can tell when he’s tired of being poked. There was one incident with his right ear in 2021 when he flinched and it scratched/cut it- nothing too deep and bleeding stopped with pressure but I feel like he never forgot. So I’ve probably only stuck it 3 times this year and he pulls back, fidgets and meows that he doesn’t want that ear used.

As to food- maybe just stick with the 3 cans/day since that’s what I’ve been doing and just not cut back anymore even if his weight isn’t going down? Is that reasonable?

Also- I just started a new box of syringes and I’m not sure about these 5/16th needles compared to 1/2in. Any idea what most people use? I got these specifically for the 31g and it was the only U40 I found that had that small size needle.

Thanks for looking in on his SS!!
 
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@Suzanne & Darcy

I’m going back to work a day earlier than planned. If all goes well tonight I plan to shoot 1U for anything 170 and above. I guess anything less, maybe give 0.75U. If you see this before tomorrow morning let me know if you agree. I’m going to be working the next 5 days so limited data to work with.
 
ittybitty said:
@Suzanne & Darcy

I’m going back to work a day earlier than planned. If all goes well tonight I plan to shoot 1U for anything 170 and above. I guess anything less, maybe give 0.75U. If you see this before tomorrow morning let me know if you agree. I’m going to be working the next 5 days so limited data to work with.
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Oh darn. Going back early stinks! I was hoping for one more day of data collection on this dose — but we have enough. We do at least know that down to about a preshot of 170 he should be safe on 1 unit — since we now have data to support that. I agree with your plan.
 
Suzanne & Darcy said:
Oh darn. Going back early stinks! I was hoping for one more day of data collection on this dose — but we have enough. We do at least know that down to about a preshot of 170 he should be safe on 1 unit — since we now have data to support that. I agree with your plan.
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Hitting greens tonight has me a little worried for tonight.
Am I missing something I should be able to see from the SS - why is tonight so much lower than last night with a higher PMPS today?
 
Suzanne & Darcy said:
It looked like he just dipped into green a bit last night. And you didn’t give him anything when he hit 89 according to his spreadsheet. Right?
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That’s correct- he just had his regular LC meals. I stayed up to make sure he wasn’t lower but had to get some sleep.

I think I try to compare cycles too much. In my mind, if he has a similar preshot glucose and the same dose of insulin I feel like my +2,+3, etc should be similar… and they aren’t always like that. That’s where I’m getting confused.
 
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206 and I gave the 1U. He’s a little grumpy- fussy with ear prick and then tried to pull away with his shot. Maybe he just didn’t want to be bothered… he was very happy when we woke up.
 
Suzanne & Darcy said:
I see you shot a skinny 1. I don’t think I would have had the courage to shoot that when being gone all day. But I see Tuko is okay.
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The repeat in the 160s is what made me feel more comfortable to go with that dose. Since I had data for 1 full U in the 170s. And I gave somewhere between 0.75 and 1U… I’ve got good vision but it’s difficult to be precise with in between the lines dosing. I debated on the dose until I was almost late for work. Someone was in the house with him. I felt like we had made such progress with his numbers, I was nervous for shooting too little and him being high.. although I know too high is better than too low.
 
Suzanne & Darcy said:
I’m just checking in on Tuko. It looks like you are off today. How many days will you be off? Did Tuko get a snack at +2 today?
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Yes, was thankfully able to be off work day. I’m off work Monday, Tuesday and then Saturday this week.

He got his normal routine of 2/3 can at shot time and then 1/3 can at +4 and then 1/2 can at +8. I wish I had a +2 test but I was exhausted and didn’t wake up until +4.
 
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@Suzanne & Darcy

Please let me know if you have dosing suggestions or if you think what I’ve done is okay. Yesterdays AMPS was lower than normal so I did 0.75U and then last night was a tad lower than normal but probably within meter variance and he had been 180s before but I knew I couldn’t stay awake to test so I shot 0.75U again and I’m pretty sure he probably went into the greens but I felt okay about the rate of the drop. This AM I did a skinny 1U. I know I’ve shot 170s at least once in the past but it made me a little nervous with how his numbers were lower yesterday.

I feel like I shouldn’t be bouncing around with doses. I’m not sure if he earned a reduction from yesterday or not since I had already shot a reduced dose. I never officially decided but was considering a custom reduction point of 80. I guess if that’s my decision, I should continue 1U unless he drops below 80. Is it common to use a custom reduction point or follow the SLGS protocol of reductions below 90? And continue to give reduced/token dose if PS is lower than his baseline?
 
About a reduction: I don’t think you will want to reduce him permanently back to .75 with those 80s numbers— since we weren’t completely happy with his numbers on the .75 units dose anyway. People who have gathered data on their cat are able to customize their reduction points while still following the SLGS protocol in general regarding length of time to hold doses (7 days unless the cat drops below the reduction point.)
 
Right now it looks like your reduced doses have worked for him. You seem to have a good feel for what is going on with him. I’m pleasantly surprised by how well he does with the 14 hour intervals and am not surprised that those morning numbers are a little low sometimes since it’s only been about 10 hours. I think you’re doing all right.
 
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