BG numbers all over the place, trying to get them stabilized

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jakes

jakes

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Hi everyone,

We have a 12 year old male, neutered cat who went into DKA a little more than a week ago. We managed to get through that, and since then we've been giving him insulin and trying to get his BG under control to keep him happy and healthy. Our vet started us on PZI, and so far our numbers are all over the place. Some days he'll be extremely high (600+ pre-shot), other days he'll be low (he was hypo earlier today at +6 from his shot with his BG at 33). The vet had us doing 2 units twice a day, but since his BG numbers have sometimes been really low we're going to start scaling back to 1.5 units twice a day to see how that goes. Still, I'm concerned about this since his BG is occasionally very high.

Our spreadsheet so far is in my signature, although since we've only been doing this for about a week there isn't much data yet. If anyone has any suggestions though I'd love to hear them, as we're a bit concerned that his BG is moving around so much and just seems so unstable.

Thanks!
 
Re: BG numbers all over the place, trying to get them stabil

Hi Jakes. Is your cat named Martin? What his diet like? If you are still feeding dry switching to canned could bring this numbers down some...maybe even by 100. I will agree his numbers are high.
I like to stay consistent with a 12 hr schedule. I noticed on your SS it seems to be a little consistent.

As for dosing I am not the right person for that. It does take some time to settle in to a dose. it also takes a little time to see the drinking less & litter box visits less.

Jenn & Baxter
 
Re: BG numbers all over the place, trying to get them stabil

Yep, his name is Martin. We only feed him canned food - 1/2 can in the morning, 1/2 can at night. We're feeding Friskies Liver and Chicken, which we picked after looking at Janet and Binky's charts because it looked like a pretty good lower-carb canned food that's still affordable for us.

We were keeping our doses pretty consistent until 3/10, when his pre-shot BG was at 94 and we decided not to shoot. We waited until his BG went up a bit and then gave him a shot, but of course that messed up our schedule a bit. Since then we've been giving him a shot every 11 hours to try to gradually bring the timing back to our old schedule, since the older schedule is much easier for us.

You mentioned that it takes some time before he's drinking less and using the litter box less - how long do you think this usually takes? We know that this is a process and it's just going to take some time, but we really don't know if we should be expecting changes in a matter of days or if this will probably take months.

Thanks :smile:
 
Re: BG numbers all over the place, trying to get them stabil

My cat had bouncing numbers on high doses also. By the time I figured it out and stopped increasing I was giving 3u. I stopped and dropped to 1u and started back up slowly from there. We are currently at 1.6 and Linus' numbers are much more stable, although not as low as I'm wanting, so we're still stepping up a little at a time. He is feeling and acting good, and I think the more stable numbers are better for him even if they are high.

I know the people with more experience will have lots more advice, but you can check our spreadsheet to see where we started and where we are now.
 
Re: BG numbers all over the place, trying to get them stabil

Welcome - is it Jake? - and Martin! Glad you made it here! As I said on Health, this is a smaller forum than Health but everyone will have good advice/experiences with your insulin.

I see you reduced to 1.5. I hope that gets him in a more normal range and stops the bouncing. Any tests you can get will help you see how the insulin is working for him. Some people get a test as they leave in the am, as they arrive in the pm, before bed and every so often, they set the alarm to get that +6 test at night.

Have you seen the PZI document? Way too big for a one time reading, but full of good info: http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=32799

It's that ECID (every cat is different) thing, but generally in a couple weeks you should notice some improvements in the litter box, maybe more grooming, playing.
 
Re: BG numbers all over the place, trying to get them stabil

Yep, I'm Jake and Martin is our cat :smile: It's challenging to check his BG as often as we want just because of our work schedules, but we're doing the best we can. I did browse through the PZI document earlier and saw that it had a ton of information, so I'll continue to work through it over time. Even though Martin's numbers are still unstable and sometimes very high, he's acting a lot more normal than he was a week ago right after DKA - he's purring, cuddling, playing, etc. He is drinking a lot of water and using the litter box a lot when his BG is high, but other than that he's been pretty normal.

At this point we're planning to stick with 1.5 units and test as frequently as we can. It definitely seems that 2 units was too much, since we had one time where he was at 600 pre-shot and then 2 units brought him down to 33 at +6. If he goes hypo on 1.5 units then we'll look at decreasing the dosage even more, but for now we're hoping to just stick with one consistent dose for awhile to see how he does on it.
 
Re: BG numbers all over the place, trying to get them stabil

Hi Jake,
You may have answered these questions already in Health, so I apologize if you have to restate something.

What kind of meter are you using?
Those black numbers you had been seeing are looking like "bounce" numbers to me, and glad you have reduced the dose. Maybe that will stop it from happening.

You said he was DKA, which I know is traumatic. My cat, Bob, was diagnosed DKA three days after he was diagnosed with FD, and he almost didn't make it. He did, we started the "dance", and very lucky for me and him, he was only on insulin (PZI) for ten weeks before he went into remission. You have a big advantage over me though. You found this place quicker than I did. Bob went from 1u twice a day to 4u twice a day pretty fast, and he was coming down in dose about the time I found FDMB. This place helped me save him though. Lots of great people here who are always willing to help and answer questions. PZI is a terrific forum.

Given his history with ketones, are you checking every day to make sure they are not a problem? Kitties who have been DKA are somewhat more prone to ketones again, and checking every day will help you avoid a bad situation before it becomes bad.

Good strategy on holding this dose. Consistency helps, and it's much easier to figure out what is going on with the numbers if things can be kept constant.

How much does Martin weigh? Did he lose weight before he was diagnosed like most of our kitties did? The food you are giving him, the Friskees, is a good choice. Low carbs, not too pricey either. Bob ate (still does) fancy feast and friskees while on insulin, and my non-diabetic (Mullet) eats the same thing. I got rid of all the dry in the house, and both of them adjusted perfectly to canned. One thing that may help is to feed more than twice a day. You don't have to feed more food, just more often. Sometimes that helps smooth the curve by not allowing him to get so low in the middle that he bounces. Just something to consider among all the other things you're trying to absorb right now!

Welcome to our little group,
Carl
 
Re: BG numbers all over the place, trying to get them stabil

We're using a ReliOn Micro for our meter - it seemed like a good choice that wasn't too expensive.

We're not checking for ketones, although I keep reading here that we should be. Getting him through DKA was very expensive though, especially since it happened on a weekend (had to go to an emergency clinic), and I think if he went into DKA again we wouldn't be able to afford the treatment. If we do start testing for ketones and he tests positive, is there anything we can do without racking up hundreds/thousands of dollars in medical bills? Of course we love our cat, but money is limited and unfortunately there's only so much we can afford to do.

Martin weighs about 9 pounds, and prior to being diagnosed he was more like 12 or 13 pounds. So he's definitely lost a lot of weight, although that's been over the last 9 months or so as we switched him off of dry food and onto canned at that time.
 
Re: BG numbers all over the place, trying to get them stabil

The ReliOn is a popular meter here and the cheapest to use.

The hope is that testing for ketones will be a preventative. And test for them is very inexpensive. If you catch a trace ketones, you can increase the fluids. (Grayson and Lu are fighting ketones. If you read her older threads, you can see how she caught them early and gave SubQ fluids. Giving fluids can be done at home and isn't expensive, but the materials are from the vet). A good way to help prevent them is to add water to the wet food to make it soupy. Lots of cats like it that way and it keeps the fluids in their body.

http://petdiabetes.wikia.com/wiki/Ketoacidosis
 
Re: BG numbers all over the place, trying to get them stabil

Hey everyone,

Things are going well with Martin, and his BG is definitely trending downwards. Tonight we went to give him his shot but his pre-shot BG was 168, which is low enough that we don't want to give him any insulin. This has happened before though and we know that if we wait a couple of hours, it will start going up again. What should we do with him tonight? We can't wait more than another hour and a half or so, otherwise we won't be able to wait the full 12 hours before giving him his shot tomorrow morning. I'm also concerned that giving him his full 1.5 units is too much with his BG this low, but at the same time I don't want to start messing with his dose again.

Any advice? Thanks :smile:
 
Re: BG numbers all over the place, trying to get them stabil

Glad you didn't shoot. Has he eaten? The general advice is to wait 20-30 minutes without feeding and retest. If he is over 200, shoot a reduced dose.

If he has eaten but it has been less than 30 minutes, test quickly before the food impacts his numbers. (food raises bg levels)
 
Re: BG numbers all over the place, trying to get them stabil

The BG at 168 was before he ate. We just fed him his usual food right before my last post, so he's eaten now. We were planning to re-test in the next 20-30 minutes to see where he's at and then go from there.

Do you have any suggestions on what kind of dose we should give? We were thinking either 0.5 or 1.0 but weren't sure which - we don't want his BG to get really high again, but we also don't want him to go hypo.

Thanks :smile:
 
Re: BG numbers all over the place, trying to get them stabil

The problem is that if he has eaten more than 30 minutes before you test, you won't be able to tell whether the number you get is "real" or food induced.

See what you get. It will be a guess since we aren't sure how much of the rise is food. Better to be cautious when you aren't sure.

The 168 tells you the dose was too high. Not only did you get an unshootable preshot, but he probably was lower mid cycle. I would definitely reduce.
 
Re: BG numbers all over the place, trying to get them stabil

Yeah, we just tested again and he's at 494. Considering he was at 168 just about an hour ago, I'm guessing that that number is mostly because of the food. We're going to give him a reduced dose of 1.0. I'm still concerned about him potentially going hypo, but I feel like 0.5 wouldn't be enough and he'd be back at 600+ in the morning. Figuring out doses is hard and I feel really uncertain about it because too much in either direction could really hurt him :sad:
 
Re: BG numbers all over the place, trying to get them stabil

I think one unit is safe and shouldn't send him too high. That was a fast jump. He must be really sensitive to carbs.

Deciding how much to give is hard at first. The more data you get, the easier it becomes. You can look back to see what you dosed at a similar number in the past and how it worked.

If you recently changed to low carb, things make be a little dicey as he adjusts to the diet. He may trend lower than you expect.
 
Re: BG numbers all over the place, trying to get them stabil

Yeah, since we only have a week and a half of data at this point we don't have much to go on. We've been exclusively feeding him the same canned food for close to a year now, so there hasn't been any change in diet lately.

I'll test his BG again tonight right before I go to bed to get an idea of where it's at, and then we'll see where he's at tomorrow morning as well. Thanks for the advice and your quick responses - I really appreciate it!
 
Re: BG numbers all over the place, trying to get them stabil

Hi Jake! I'm also really new to ProZinc. (Actually I am assuming you use ProZinc, am I right?) My boy just hopped out of remission a couple of weeks ago, so I have just about as much data as you. Sid has been a transient diabetic however since 2003, so we're pretty familiar with dosing on the old PZI. I am finding this to be a bit different so far. The PZI post says Prozinc it can take up to 45 days for kitty can get acclimated to the insulin, and the peak time really jumps around. I am finding that is happening with me. I also have a pretty rough schedule where I can only feed and test at about 5:45 in the morning and when I get home at work at about 6:30pm. And then I will get up in the night to see how things are going. At any rate, Martin seems to have a pretty consistent peak time already, which is great! Of course this is kind of an assumption without more tests in the AM. I am trying to do curves and more frequent testing on my days off in hopes that I spot some trends. It was absolutely right to drop that dosage a bit. I am finding that my cat is very particular with the doses as well. I'm curious to see how today's numbers go. with the PMPS 3/17 I may have kept it at 1.5, and done a +6 test, but I totally understand the fear of hypo, especially with that 33 earlier in the week. [Edit- just to clarify, that 64 from yesterday seems a little scary, but not necessarily a bad thing, especially if we knew he had some blues around it. Under 50 or when kitty starts showing signs of hypo is really cause for concern- every cat is different though!] I totally share the same concerns and fears as you. With our schedule if something happens during the day it's so nerve-wrecking! I also agree about getting those ketone strips at your local pharmacy. They will give you a great peace of mind and aren't expensive at all. Well I definitely want to follow Martin's progress. I don't feel necessarily qualified to give advice about dosing as of yet, but since we seem to be on the same place with treatment, I hope maybe we can learn a few things from our experiences. I wish you and Martin the best of luck!
 
Re: BG numbers all over the place, trying to get them stabil

Hi Jake -

Sorry I missed this post earlier... but did want to share a little of my past 2 months with you. Sue recommended you check out our spreadsheet on Grayson - please do.

When he first started with 1u of Prozinc Jan 13, his numbers were all over as well... and then he had cycles that went forever - like 20-24 instead of 12. So we reduced down to .2u. For a while, the long cycles popped up (I want to say there were 13 of them). We ultimately brought the dose back up - again, slowly, as everyone has advised.

When I tested for ketones on Thursday night (Feb 23rd), about 8 pm (vet is now closed), his color-coded strip registered as MODERATE. The word was GO TO THE ER VET!!! So I called the local ER vet and she didn't seem too startled by the reading (everyone here, especially those that had DKA experience, said to go!). I called the NC State Vet School ER and spoke w/ them. They asked the perverbial questions... is he eating? Has he shown any signs of infection? etc. etc. The told me that most of the DKA cases they see, the cat hasn't eaten for days, therefore the people couldn't shoot insulin and the numbers were crazy... Grayson was still snarfing down food faster than I could get it out of the can, which to me was a good sign. I stayed up w/ him all night, spoke to the ERs 4 times through the night, and we were in at my vet first thing the next morning where he was thoroughly checked, given fluids and an antibiotic, and came home.

Since that time, he's registered NEGATIVE or TRACE most recently, but he flashed another MODERATE a couple of times. I was initially giving him 2 doses of 100 mL SubQ Fluids (lactated ringers); now I'm down to once a day. Not sure how long I'll continue, but it's not very expensive, so I see it as insurance. We've since upped his dose significantly, and he's doing well. Never went DKA, but the ketone scare was enough to me. Poor guy can barely go near the litter box w/o me running after him with a test strip! :lol: But that little $6 bottle at Walmart ($10 at Walgreens), kept me from a much more sizeable expense! The bags of fluid have 10 - 100 mL doses (which is what I give 13# Grayson - smaller cat you may want to do 50-75 mL. I think they're $8 at the vet; with the needles and the IV line, I just picked up 2 bags yesterday for $20. So not too much - especially compared to the ER run.

I can't say it enough - TEST, TEST, TEST for ketones - for your own sanity, the health of your cat and your bank acct. If I can answer any other questions for you, please don't hesitate!

Lu-Ann
 
Re: BG numbers all over the place, trying to get them stabil

Thanks for the information and replies everyone :smile: We decreased Martin's dose of PZI to 1 unit because his BG was getting too low on 1.5 units, so now we're going to get some data on 1 unit for awhile to see how he does on that. We're still just trying to get his dose figured out and get his BG under control, but it's still moving around quite a bit from one day to the next. Hopefully it will stabilize at some point and then we'll have a good idea of what works for him.
 
Re: BG numbers all over the place, trying to get them stabil

Hey everyone, we have a new, interesting situation with Martin's BG and I'm looking for advice. Since we switched him to 1 unit PZI his pre-shot numbers have been improving and he seems to be doing really well. Last night his pre-shot number was 309, and then at +5 he was at 334 which surprised me since I expected it to be lower. I figured that would mean his number this morning would be high, but it was actually 160. We waited one hour and retested and it had only gone up to 194. He really wanted food so we went ahead and fed him, waited another hour, and now he's only up to 282.

I'm confused as to why his pre-shot number this morning is so much lower than his +5 number was last night and also why his BG doesn't seem to be going up very much. The last time he was low pre-shot and we fed him, within an hour he had gone from 168 to 494, which is very different from what happened this time.

Any advice? We haven't given him his insulin yet but don't want to wait too long because it'll throw off our whole schedule :smile:
 
Re: BG numbers all over the place, trying to get them stabil

Any time I get a number that seems maybe a little high or a little low, I'll tend to grab another test strip. I had a 154 that kept me on the edge of my seat at dinner one night, and when I finally returned home, he was more where he usually was - the number may have just been bad.

The 309 PS to +5 334 could still be the food spike hanging on. Likewise, the 194 - 282. Until you have more numbers, it's hard to say. I've started recording the type of food I'm giving, and stick with it for a couple of cycles to have something more uniform to compare. Removing excess variables helps see the numbers more clearly.

Another thing to keep in mind, especially now that you've reduced the dose, and are still getting some high numbers... be sure to test for ketones. I'm not sure how susceptible a cat is following DKA, but I expect it could recur without a lot of effort. So keep testing him for ketones!!!
 
Re: BG numbers all over the place, trying to get them stabil

Your ss has alot of extreme swings in it.

I'm wondering if your dose is still too high. Once you get back up to 200 I would try .5u and see if that stablizes him a little more. Wouldn't it be nice if you could keep him in the 200.
 
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