Clarence’s BG continued

Clarence & family

Clarence & family

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@Suzanne & Darcy

Suzanne & Darcy said:
Aaawww. I love Clarence. That’s very interesting about his markings. It is extremely rare (and sought after) for the males to have three colors like a calico (female.) But he came from a Siamese breeder, right?
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Yes, he came from a Siamese breeder, his mom is a red point modern Siamese, his father a seal point traditional/Thai Siamese. His ‘faults’ were thoroughly explained to us and he was the only kitten that had these faults. Clarence is of course neutered, but my understanding is that as he is a Klinefelter he would probably be infertile anyway.

Suzanne & Darcy said:
Now… about his spreadsheet… I love the blue! If je were my cat, I would increase to 2 units. I think we need to lower those blues a bit and hopefully lower the preshot numbers a little. He’s been making good progress! I am happy for him. How os he acting? Does he seem to feel better in the blue?
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He actually went into greens this night, and I’m glad I caught it! He had a lower than normal PMPS, I even stalled half an hour to see if it was going up, which it was. From 218 to 245, so I gave him the whole 1.75 dose and set an alarm. At +4 BG was 67, but he seemed to be feeling fine. Gave him a bit of LC wet food, and by +6 he was at 92. Another test at +9 this morning and 200, so I’m curious where he’ll be at AMPS in about an hour. And if he’ll have another bounce now…
I was thinking I’d ask you if you thought increasing another .25 would be a good idea, but then he does this! I know he technically should have earned a reduction flowing the SLGS protocol, but I think it might be better to keep the dose? He was feeling fine, but I don’t want want to put him in danger.
 
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AMPS was significantly higher, it was at 398, so his BG doubled over 3 hours.
Clarence is a bit stressed at the moment, his big ‘brother’ Bunker isn’t doing too well… Bunker has epilepsy and a bunch of other health problems. Unfortunately Bunker’s seizures are getting worse again which is also giving Clarence a lot of stress.
 
Oh, I am very sorry to hear about what’s going on with Bunker. How do you manage the seizures? Is that Bunker in the photograph with Clarence?

Clarence thought he would be sneaky and go into green at night! I still think we can get him into better numbers, but for now I would wait a few more days on this same dose to see if he does it again. A lot of cats tend to drop a little bit lower at night. Have you ever read through the Modified ProZinc Method on this ProZinc forum (in the sticky note about ProZinc dosing methods?). It looks like he is a cat who would benefit from following MPM instead of SLGS at this point. I am in complete agreement that a dose reduction is not in Clarence’s best interest right now - and 68 on your human meter is a very safe number so he is not in danger. With MPM, reductions are earned when the cat drops below 50. The target nadir range is between 50 and 120. You already know that normal BG range for a cat is about 50-120 (my non-diabetic cats test in the 40s sometimes, but that’s not where we want a cat on insulin to be for safety’s sake.)

You did everything just right last night. You just gave LC and checked him again. Great job handling that 68.
 
Yes that’s bunker in the photograph. He’s ‘only’ 8 months older than Clarence but he really is an old man and it’s a miracle we’ve been able to have such a long time with him. He’s a rescue who survived both toxoplasmosis and feline parvo as a tiny kitten, and he’s suffered from seizures and ataxia his whole life because of it. 14 years ago we were told we could give him a good couple months, maybe years, but he’s 14 now.
He’s on a high dose of phenobarbital, 18.75mg twice per day, nearly 1.5 times the recommended dose and has been on that dose for nearly 10 years.

I’ve quickly read through the MPM, but I’ll give it a good read, it sounds like that might be something he benefits from.
Thank you for the encouraging words! I didn’t want to give him higher carb food and he seemed completely fine (and surprised he got food), but I wanted to make sure he ate something. There is dry food available 24/7, but Clarence doesn’t really eat it unless his BG is really low (for him). It’s low LC dry food, Power of Nature brand, only 4,87% carbs.
The reason we have to leave dry food out is for bunker, he’s had hepatic lipidosis before because of not eating, and he won’t eat enough if he only gets wet food. He prefers dry, even though he has no teeth because of FORL.
 
Yes, when his BG is this high he’s either sleeping or parked at his water fountain. I’ve just tested for ketones and those are at .7 now
 
Oh. I don’t like the sound of that. His ketones should come back down soon hopefully- they can fluctuate quite a bit during the day. He will at least keep himself hydrated.
 
He’s still bouncing like a rollercoaster, I’ve upped his dose twice, he’s on 2.25U now. Two days ago he was at 146 at +10 before his morning shot and at 212 at AMPS, I gave the full 2.25U. An hour after his shot he went into black, did a steep curve down to 110 (and stayed in the blues for a couple hours), before skyrocketing into black again at PMPS :confused:

High PS after that, the lowest being 364 at AMPS this morning, but now he’s at 79 at +6, so I’m watching him and gave him a small snack. He seems to be feeling fine and is very playful.

edit: 68 at +5.25 and 99 at +5.5
 
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And now at +9 he’s back in the red… from 68 to 421 in less than 4 hours :( I only fed him 2 tsp of 7% carb wet food at +5, I know he hasn’t eaten anything since. Could him exerting himself when he’s feeling good cause these very high spikes? As soon as he goes into blues he’s running around and climbing/jumping on everything a LOT. He’s always been like that except for the past months which was/is probably because of his diabetes.
 
Clarence & family said:
He’s still bouncing like a rollercoaster, I’ve upped his dose twice, he’s on 2.25U now. Two days ago he was at 146 at +10 before his morning shot and at 212 at AMPS, I gave the full 2.25U. An hour after his shot he went into black, did a steep curve down to 110 (and stayed in the blues for a couple hours), before skyrocketing into black again at PMPS :confused:

High PS after that, the lowest being 364 at AMPS this morning, but now he’s at 79 at +6, so I’m watching him and gave him a small snack. He seems to be feeling fine and is very playful.

edit: 68 at +5.25 and 99 at +5.5
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I’m confused. I am not seeing any of these green numbers you are mentioning on your spreadsheet. Here’s what I see:
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Ah, I see what’s happening, the US tab doesn’t ‘translate’ certain inputs and puts #VALUE instead. If you look at the world tab they are there, but in the European measurements.
All of the #VALUE cells say ‘HI’ (meaning over 500) in the world tab, except the one from today, that’s a cell with multiple BG measurements in it which it also can’t translate to the US tab.

My meter that reads up to 600 (33.3 euro) broke, the one I use only goes up to 500 (27.7), and then just says HI.
 
Okay. I think it’s just that the numbers didn’t make it onto the US sheet. I understand. When you put multiple entries into one cell (which is the right thing to do in this instance, you have to manually enter them on the US side. But I have looked at the other tab now.

I would caution you against increasing the dose too quickly. With Start Low Go Slow, the dose should be held for 7 days before making a decision to increase. He wasn’t on 2 units long enough (only 5 cycles.). Even with the Modified ProZinc Method (MPM) that would be too soon. We also don’t want to necessarily increase without giving him a chance to clear the bounce so we can catch a nadir for that dose (the 2 units.). So now that he is on 2.25 units do not increase the dose further at this time. In fact, with his nadir of 68 today, he has earned a reduction back down to 2 units under SLGS where reductions are taken when the cat drops below 90.
 
Now, having said that, if he is not eating any dry food and if you would like to, you can switch dosing methods and follow the MPM method where reductions are taken when the cat falls below 50. I would not recommend this to someone who wasn’t doing the high level of testing that you are doing. You test quite a bit and I believe can keep Clarence safe.
 
And my favorite part of everything is to hear how Clarence is much more back to his old self — back to his previous energetic activity level. He must be much happier and feel a lot better. This is a real sign of progress despite any bouncing we see! It’s how we know we are on the right track! It makes me smile.
 
I must say it’s sometimes a bit of a challenge, the vet wanted me to increase to 2.5 when he stayed high for so long. I talked to them about bouncing, but they say they do see effects like that but they shouldn’t last for 6 days (as they did before the increase to 2.25).
Problem is they want me to keep updating them, do consults and stick to their protocol or they say they can’t prescribe the insulin…
 
Suzanne & Darcy said:
Now, having said that, if he is not eating any dry food and if you would like to, you can switch dosing methods and follow the MPM method where reductions are taken when the cat falls below 50. I would not recommend this to someone who wasn’t doing the high level of testing that you are doing. You test quite a bit and I believe can keep Clarence safe.
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He is eating a tiny bit of dry food every now and then. Unfortunately I have to keep dry food out for our other cat Bunker who will otherwise not eat and is prone to hepatic lipidosis. Clarence doesn’t really like dry food and never has, but will nibble on a few bits sometimes. However, I have dry food that is very low in carbs, only 5%. I can’t find a link to the food that’s in english, but there is an English description on the bag:
https://imgur.com/a/VpQheXZ
 
And testing is no problem with Clarence, he doesn’t mind it at all. He really likes being picked up and held. I put him in my lap/arm on his back like you would cradle a baby and he doesn’t even react to the poke, he’s just happy to be there, lol. We don’t even use food rewards, he likes cuddles better.

and he’s absolutely feeling better, except for peeing and drinking a lot when his BG is really high he’s back to his old self most of the time. His favorite game is playing fetch and I had almost forgotten how annoying that can be, because he’s constantly running after me (and preferably between my legs) with his toys. But I’m happy he’s trying to trip me 20x a day again :D
 
Clarence & family said:
I must say it’s sometimes a bit of a challenge, the vet wanted me to increase to 2.5 when he stayed high for so long. I talked to them about bouncing, but they say they do see effects like that but they shouldn’t last for 6 days (as they did before the increase to 2.25).
Problem is they want me to keep updating them, do consults and stick to their protocol or they say they can’t prescribe the insulin…
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If you had increased to 2.5 he probably would’ve hypoed. He already had a 68 on 2.25. Please don’t increase from here right now. And yes, bounces can last up to 6 cycles. It doesn’t mean every bounce will last 6 cycles, but some can.
 
Clarence & family said:
and stick to their protocol or they say they can’t prescribe the insulin…
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A vial of ProZinc can last a long time! :) I don’t like the sound of a very controlling vet extorting their clients like that. They can be exasperated with you (the client) they can strongly encourage you, etc. but to say that they would actually withhold insulin from a cat who needs it and who has a caregiver who is doing such an amazing job of monitoring her cat on the insulin is just wrong!
 
Clarence & family said:
And testing is no problem with Clarence, he doesn’t mind it at all. He really likes being picked up and held. I put him in my lap/arm on his back like you would cradle a baby and he doesn’t even react to the poke, he’s just happy to be there, lol. We don’t even use food rewards, he likes cuddles better.

and he’s absolutely feeling better, except for peeing and drinking a lot when his BG is really high he’s back to his old self most of the time. His favorite game is playing fetch and I had almost forgotten how annoying that can be, because he’s constantly running after me (and preferably between my legs) with his toys. But I’m happy he’s trying to trip me 20x a day again :D
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That’s so sweet. I have a kitty who plays fetch too. She does it for a long time… bringing her toys back for us to throw again and again. It’s a great sign that he’s doing this.
 
Anyway, you’re doing a great job with Clarence. How about if you would please remove SLGS from your signature and the top of your spreadsheet and put Custom Dosing instead? This way we will not confuse people who won’t understand when reductions are not taken and increases are given not according to the protocols.
 
Suzanne & Darcy said:
If you had increased to 2.5 he probably would’ve hypoed. He already had a 68 on 2.25. Please don’t increase from here right now. And yes, bounces can last up to 6 cycles. It doesn’t mean every bounce will last 6 cycles, but some can.
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By cycle do you mean the 12 hour cycle? Or a full day? I always understood cycle to mean 12 hours/every dose?
His bounce earlier this week lasted 12 cycles or 6 full days, is it still a bounce after that time?
 
Suzanne & Darcy said:
A vial of ProZinc can last a long time! :) I don’t like the sound of a very controlling vet extorting their clients like that. They can be exasperated with you (the client) they can strongly encourage you, etc. but to say that they would actually withhold insulin from a cat who needs it and who has a caregiver who is doing such an amazing job of monitoring her cat on the insulin is just wrong!
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A vial lasts 60 days max they told me?
They seem to think I’m doing everything wrong, according to them I need to switch him to a diabetic prescription diet (royal canin) which is pretty high in carbs (but it’s slow carbs! :confused:) to get him regulated. At the same time they advise me to only test him every 3 days at the 6 hour mark, and only feed him twice a day before his insulin shots.
Because of so much testing I now know his nadir is mostly significantly earlier than +6 and he unfortunately doesn’t seem to get very good duration. They say it should last 10-14 hours and it’s impossible it’s less than 10 hours, but it seems a lot shorter for him.
 
I do think there is some improvement, I’m seeing blue numbers 5 days in a row now which is the longest we’ve had! His BG does really spike though at the end of the cycle, even up to the mid 500’s. But this morning we suddenly had an AMPS of 245 which is really low for him. Still gave the whole dose and I’m curious about what he does and if he’ll bounce again.
 
Wow. Look at all that blue. Just watch him today with that lower preshot. He just seems to be losing duration of the insulin. Hopefully that will get better with time. He’s not eating after nadir is he?
 
Don’t forget to always get a “before bed” test in the p.m. cycle as well. Many cats tend to drop lower at night. I am sure he’s not going too low, but possibly lower than in the daytime so it’s important to know so that we can make good dosing decisions.
 
I see that some nights you have gotten some even later tests in the evening cycle and that is very helpful data. It’s just that this week he’s really started to see better numbers. :cool:
 
Suzanne & Darcy said:
Wow. Look at all that blue. Just watch him today with that lower preshot. He just seems to be losing duration of the insulin. Hopefully that will get better with time. He’s not eating after nadir is he?
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He’s already going up today, just over 200 at +5. And no, I don’t feed him after his nadir, but…. I can’t guarantee he doesn’t sneak a bite of bunker’s dry food. He does not like it and I’ve never actually seen him eat it except for a single stray bit of kibble before deciding it’s still yucky.
I’ve tried to put Bunker’s (low carb) dry food in a separate room (mudroom) where there’s a microchip activated cat door, but Bunker has a lot of trouble getting through the door with his ataxia so that isn’t really fair to him. I kind of have to pick the lesser of two evils there…

Clarence’s nadir seems to be pretty early, usually around +4 - +5.

If I wake up at night I usually try to get a BG measurement in, takes only a couple seconds with Clarence and he doesn’t mind.
 
It’s great that you shot the full dose today and got tests. Now we know that mid yellow preshot number is still a safe number for him. Well done.

Since most of your nadirs are higher blues and you have held this dose for more than seven days now, you can increase to 2.5 units. I would just be sure to get a +2 reading in the evening to see if the +2 is about the same or much lower than the preshot number. If the +2 is significantly lower (as I have seen on occasion recently) then set an alarm to wake up and test him at +4 to make sure he’s okay. He is making progress. We should start to see his preshot numbers come down hopefully and for his nadirs to either just come a little later or just for his BG not to rise up quite so quickly.

How is he feeling?
 
So Clarence is doing something weird this morning… he had a very good night, I didn’t, lol. I gave him the 2.5U last night with a PMPS of 373. At +2 he dropped to 266, which isn’t unusual for him. I decided to set alarms every two hours until I saw his BG rise again, and he had a late nadir (of course….) for him of 97 at +6. At +8 he was at 185 and I didn’t check again until his AMPS. Which is 115!!

Unfortunately I really have to work today in two hours and be out of the house, so I’ve skipped his shot for now and I’m stalling. I will be able to drive back and forth every couple hours, so I think I’m just going to do that and check on him if his BG doesn’t rise in the next few hours.
 
His BG is rising, after an hour of stalling it was 146 and now after another half hour (1.5 hours past usual shot time, without feeding) at 209, so I’ve given him a 50% dose. I don’t feel confident giving him more now, as he’s dropped very low (36) before at a low PS. I can make it work to check on him at least every two hours today.

I’ve also manually filled in the gaps that didn’t translate from the world to the US tab in his sheet.
 
Did you feed him a snack at +2 and +4 (since you were up at +4 and beyond :facepalm:). ?

Of course he would do this. I was going to say yesterday to watch out since I made the “threat of the increase— it usually works and they get up to some shenanigans.
 
I did! Not much, but a couple tsp of wet food as he was going down already at +2. I usually check him at +2 before bed and give him a snack, this time he also got a +4 snack. Thought about giving him something to eat at +6 since his BG was low for him but didn’t as he was looking completely fine. I would have probably been up without alarms, as he was trying to break his PR doing laps around the house at 4 AM, after dropping (wet!!) toys on my face didn’t work to get me up.
 
I’m glad I did a 50% dose! He took a dive from that +2 347, +4 was 95 and I gave him a snack to prevent him dropping further, now at +6 he’s at 128.

I’m home again and staying home tonight, so I’ll keep an eye on what his BG does for the rest of the cycle.
He’s been sleeping every time I came home to check on him, but he’s not lethargic, as soon as I wake him he’s active.
 
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