Argyle 10/11 - need some eyes

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jackie

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Hi-

I’ve been trying a higher insulin dose with Argyle and I don’t think it’s going too well. Since I last posted in early September, I switched her to a TID schedule because it didn’t seem like the ProZinc was lasting the full 12 hours, and then I gradually increased the dose. Her numbers are higher than ever. Today I got a “HI” reading, which is over 600, and I’ve gotten a couple of other black numbers in the last few days. I never got any green numbers.

I updated her spreadsheet with data all the way back to May. Before that, she was getting Humulin insulin and transitioning onto ProZinc. Unfortunately, I had to keep it the format of having one line for every insulin shot, rather than using the 12/12 template, because the timing between shots varied so much. I’m sorry that it makes it harder to read. The last BG reading in each row is also (generally) the PS reading for the next row, which starts with the time since the last shot. I was using an AlphaTrak meter until the beginning of July and since that, a TrueResult, so the number aren't the same (AlphaTrak was ~30% higher). Where the notes says “peed oe” that means she peed over the edge of the litter box, which she does when she is feeling especially weak. She is still very weak and peeing more than usual.

I was concentrating on lowering the dose because of her previous history of being over-treated with the Lantus and because her numbers were higher when she was on a higher dose of ProZinc in May and June. She has lost weight, and she is much weaker now than she was earlier in the summer and walking is more difficult for her. That might mean that she should be getting more insulin, but increasing her dose doesn’t seem to have helped with her strength and her numbers are worse. I’m not aiming for remission or anything - my only goal is to make her as comfortable as possible.

I don’t know if this is rebound or liver panic or whatever. Her numbers seemed better when she was on a lower dose. What does it mean that now I’m getting red and black numbers when I go longer than 8 hours between shots when back in July she was staying in the yellow with a lower dose and often longer between shots? Should I keep giving her the higher dose and hope this settles down? I don’t know what to do now.

Help!
 
There aren't too many posters on this late. Most of the PZI crew is East Coast. I would wait to get some other opinions too.

Question - are you giving .1 unit or one unit? I am going to assume you are giving one/ two units, not the tiny amount. I would have raised the dose in September from one unit to 1.25 or 1.5. Sometimes when you raise by a whole unit, you skip a good dose.

I think you may be giving him too much insulin. The only way to know is to experiment with a lower dose. I would go back to 1.5 unit every 12 hours, testing daily for ketones. If you get lower numbers, it was the right move. Keep checking at nadir and post with your numbers. There are several options to deal with early nadirs before trying TID.
 
Hi Sue -

That's the thing - I am giving her only 0.1 or 0.2 unit doses (not 1 or 2 unit). I use the U-100 syringes and the conversion chart to give the tiny doses.

Jackie
 
That does change the picture! So you are mini dosing but alternating between some blue 100s and really high numbers. Makes it more complicated. I can see why you considered TID.

Are you feeding low low carb? Sometimes that will bring those numbers down with mini doses. If you are fixing 7%, try 3-5% for example. Do you let him snack during the day and night? That can help even out the cycle.

Wonder what would happen if you just stopped giving insulin for a few cycles, let him graze all day and night on really low carb? Are you willing to try that and test for ketones?
 
Hi Jackie, and welcome back.
I've looked at Argyle's SS, and I think Sue might have a good idea here. It looks like you are getting "bounces" on doses as tiny as a .1, which is incredible. That' virtually "no" insulin! I really think you might have a shot at getting Argyle diet controlled. What foods/brands/varieties are you feeding? You are giving her such a tiny amount of insulin, that I think if you were to skip a shot, and try to manipulate her BG with food, you may have success with that.

The only thing that caught my eye in your post was the type of meter you are using. I have seen posted a lot of times that any meter with "True" in the name may be a problem. The Accu-Track does usually read higher (that's the one designed specifically for cats and used by vets, isn't it?). I am wondering if the numbers you are getting would be the same with a different "human" meter like a relion. What it comes down to is that you have to trust your meter. Have you checked yourself using the TrueReult? Or tried a control solution?

Let us know what type food she eats, and maybe there is a lower-carb option out there which will get her more consistent numbers.

Carl
 
FWIW, we feed Blue Buffalo Wilderness canned chicken. It is between 1 and 2% carbs. It’s about the lowest I have seen on the market.
 
Hi

Argyle has been eating Friskies Poultry Platter and Mariner's Catch. I have another cat, Zoe, who isn't diabetic, and they both eat the same food. I give them each their own plates, but they don't necessarily respect that. I put out food at breakfast, dinner, and before bed, so there is always available, day and night. All told, Argyle probably eats one can a day. When I'm home, I try to make sure that she snacks every few hours by mixing some water into the food she hasn't eaten yet and bringing it to her where she is resting. Since she has been so much weaker lately, I don't think she gets up to snack as much as she would probably otherwise want to. I will go get some of the Blue Buffalo Wildness to see if I can get her to eat that.

I've have seen the comments about the "True" meters. I don't have a control solution, but I have tried it on myself a few times and always gotten a normal reading. I do wonder about it though. I've only gotten the E-5 (test strip) error maybe 5 or 6 times out of all the hundreds of tests I've done, but a couple of those times, I got the E-5 error on two strips in a row on Argyle and then got a normal reading on myself. It could be coincidental, but it made me wonder if that meter is for some reason more inaccurate on cat blood than on human blood in certain situations. Looks like I need to bite the bullet and go to Walmart - right?

I really like the idea of stretching out her shots - Argyle will be all for it as well! I have the ketostrips, so I can keep an eye on her ketone levels. How do you do this? Just stop giving her insulin and then test every few hours and give her the next shot when she goes above some threshold BG? Seems like the details might be critical.

Thanks for the eyes!
Jackie
 
Wow, I am a little confused by the numbers
I am with Sue and Carl, if you can maybe skip one dose to see what happens..
feed low carb and keep testing....good luck and keep us posted
 
Jackie,
I think what you do is just simply skip either an AM or a PM dose completely. Then you can test her just as if she had insulin if you want, and see what her BG does without it. You would expect it to rise within an hour of eating. Then what you look for is to see if it drops on its own. If it does, that means it's her pancreas is producing insulin the way it is supposed to. It may not bring her as low as the shot does, but if her number goes down within an hour of food, that means it is trying it's best to work as "normal". Then at the next regularly scheduled shot time, you'd check to see what the BG is. If it's a "shootable" number, then give her a teeny tiny dose, and proceed as normal.
The foods you give her are good low-carb choices. The Wilderness just might be the thing that puts her over that edge she's so close to.

What we all need to do is to determine where the shoot/no-shoot line will be I guess. But you want to keep her on her normal shot schedule. You don't just want to shoot the first time you see a number rise above that line. If you do that, then you have to adjust your schedule to fit around her new 12/12 schedule.

Unless somebody else has a different idea....

Carl
 
Lots of people like the ReliOn and it has the advantage of being cheap.

So, you set a number that you would give a dose. Say 180 maybe your .01 Depending on your schedule, you could dose when you get to that threshold, as long as you can test and give a shot (if needed) 12 hours later. That is what makes this so hard. You are dosing on demand. It requires a lot of testing to be sure she is safe. As long as he stays under 120, don't give him any. Also, try an experiment. Test, then feed small meals and test a hour or so after to see if the number went up or down. If it went down (without insulin) his pancreas is working, at least some.

Why has she been weak lately?

Just to be sure, you are using U100 syringes with the conversion chart? Or using U100 syringes with BCP 100 insulin? Here is a thread that talks about the needles, the conversion: http://www.felinediabetes.com/phorum5/r ... 58,1681473
 
Hi -

Thanks for all the input. I'm going to get Argyle back on the 12/12 schedule for a today and give her tomorrow morning's shot and then see what happens tomorrow night if I skip the evening shot. I know there's more to it than that, but I have to spend more time reading your posts to absorb it all. Fingers crossed!

I'm using the U100 syringes with the 1/2U markings and ProZinc (40U/mL).

So far, it's a mystery why Argyle has been so weak lately. She went to the vet in early September. She had some anemia, which she has had for a while because of the diabetes (they called it 'anemia of chronic disease') but the vet didn't think that was the cause. She had her thyroid checked, and a bunch of bloodwork, which were all ok, and she didn't have a UTI or anything. I have read that hyperinsulinemia can cause muscle weakness and fatigue, so it might be related to getting too much insulin for too long, but that's just a guess. She has lost weight over the summer, so maybe that would contribute to the weakness. The weight loss is weird, because she eats well, so that might suggest that she needs more insulin, except when she does get more insulin her BG numbers go wonky. When she was in the hospital in February with the two DKA events, she had x-rays and an ultrasound and they didn't see anything out of the ordinary except a heart murmur they weren't too worried about. I hope that getting her insulin dose straightened out will help with the weakness, although I suppose there is the possibility that there could be else going on.

I'll keep you posted how things go tomorrow!

Jackie
 
Hi Sue,

I have the conversion chart pasted into my "Argyle notebook". To give Argyle a dose of 0.1U, I draw it only halfway up to the first 1/2-unit mark and for a dose of 0.2U, I draw it all the way up to the first 1/2-unit mark. Does that sound right?

Jackie
 
It sounds right to me, but I never used the U100 needles. Hopefully someone who does will double check it for us.

Her symptoms are troubling. On those tiny doses, you would think she would feel better. But maybe it is the swings from high to low.

Your plan sounds good. I would just be sure I was around to test when I stopped the insulin so you can see what happens.
 
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