BJ's Glucose Numbers?

Status
Not open for further replies.
D

DStreight

Member
An update on the glucose levels since yesterday. I'm a bit puzzled as what they mean and why to do. Any suggestions?
 
Hi Debra, How much insulin did you give this morning? There is no dose listed in your SS. I'm not qualified to give advice (yet, working on it) but Sue and Lori will want to know. :mrgreen:
 
Did you do 4.5 this am? Do you have no ketones again today? And the second day of wet lo carb?

The reason this is so hard, Debra, is that normally you start with 1 unit, hold the dose for several days, while testing. Then you can increase by small amounts - .25 or .5 depending on your numbers. When he is already on such a big dose, it is difficult to know whether he is getting too much insulin or too little. All I can say is very few cats need 4.5 units bid unless they have specific insulin resistant conditions. You might check this document to see if anything sounds like BJ: http://felinediabetes.com/FDMB/viewtopic.php?f=12&t=375

I am still thinking it is too much insulin, producing high flat curves.

It is up to you. You can give it a few more days, making sure he is completely ketone free. Then pick a day you are going to be around to monitor and split his dose in half - 2.0 or 2.5. But let's see what others think....

I hope you can get a number midcycle today and maybe a few numbers after the pmps?
 
I gave 4.5 this morning and was gone most of the day. He doesn't have ketones today and this is his third day of wet low carb food. I was thinking of dropping the dose to 2.5 this evening and then doing a +4 and +7 during the night? Tomorrow I will be home to monitor all day, so there will be more information. I read over the acro stuff and he doesn't seem to have those symptoms.
 
No ketones is really good! This first part with the testing is a lot about data gathering, and, as you see how BJ does on what dose, you can narrow in on what works for him. You're doin' good.
 
Debra, yes we still have such a small amount of data here.
We will learn something when we see how blackjack reponds to this evenings 2.5 dose. I see at first glance it does'nt look as if he liked the first dose reduction he had....but we just don't know for sure.
I suppose the best we can do for blackjack at this time is lower the dose as you did this evening and see how he responds. Mid cycle tests to see if he dips at all especially if he starts giving higher amps and pmps. try at least 3 cycles if you can. of the 2.5, regardless of the high amps or pmps. I think that should be enough to know if he can come down in dose.
after 3 cycles of no breakthru maybe go up in dose .5 units at a time.
of course if blackjack hits the black numbers (over 500) you will likely increase dose faster.
We have to play it much safer with a ketone prone kitty.
Don't worry Debra, we'll break this case!!!!
We've broken tougher kitties before!
Lori
and tomtom too!
 
ya know sue, i don't think yesterday was a high flat day. it was actually a nice curve with a 276 drop. that in itself is good. if he dove down further it would be too much. with more data we will know better but this could actually be a high dose kitty and it's possible he'll need a dose increase if we see curves like that...don'tcha think?
 
The yellows from yesterday were the first day of wet lo carb.... I am wondering why he went back up.

I am not sure what to think. I see the lower dose as a short term experiment since he didn't start with a nice low dose.

Debra, the nice thing about PZI is that you can do this. You can lower the dose and see what happens in a few cycles. You don't have to leave it for a week to find out.

We aren't vets or experts. We are giving you our best guess ideas.

Lori, do you think she should try an increase instead?
 
oh no, i'm not suggesting an increase yet. it's a good idea to see if this high dose is doing more harm than good. but it can't go on for too long if the results don't show cause of the ketone thing.
i think he did'nt hold and went back up cause did'nt she shoot 3u that night?
 
nope my bad, she shot the full dose. well, let's just do some safe data collecting for now yes?
 
Okay, so you are thinking stay with the dose and do the tests and get data before she changes the dose?

Debra, I hope you don't feel like we are talking over you. I think we are brainstorming ideas, Lori. Right? Debra, this forum is all about peer review - getting opinions from more than one person.

In the end, you hold the syringe.
 
No I'm all for listening and hopefully everyone can guide BJ and I through this! I'm going to just continue with the 2.5 dose until I get feedback to what is happening. I set the alarm and got a +7 last night and we'll just see what happens today!
 
Hi Debra, welcome to PZI. Great job testing! Just to be clear, the problem is to determine if kitty needs more or less insulin. That sounds nutty, but sometimes the cat's response to too much insulin is to protect itself from a hypo by dumping more glucose into the blood. So high BG could be either too little insulin (i.e. there is already too much sugar in the blood and not enough insulin to help the body metabolize it) or too much insulin (the body protecting itself by dumping glucose into the blood). Normally we start with 1U two times daily and work up by small increments. But possible ketones makes it tricky to lower the insulin dose (we are walking a tightrope of avoiding hypo on the one extreme and ketoacidosis on the other.). So lots of data is most helpful in making the dose decisions.
Forgive me if I am repeating info you already know. I have found that this is often very confusing and I have been helped by people clarifying things for me.
 
I don't see signs to warrant any dose decrease yet. Some cats don't respond as clearly to the LC food, and/or it could be that the dose was still way too low for the HC food, so he may just need a higher dose even on LC. Bix was at something like 4.5 on dry at 13% carbs, and we would see some blue #s here and there but not consistent. When we switched to LC it was almost immediate blues & greens all over the place, and major dose decreases to keep up with that. Here, in contrast, I'm not seeing anything remotely blue or green, and on the lowered dose the #s aren't any better. I think he was on something like 30% carbs, right? So 4.5 was likely way too little insulin. Just guessing of course, but that's the direction I would guess in.

So I'd tend to lean more towards insulin resistance from being at high #s presumably for a while. If you don't see a better PS tonight I would bump the dose back up. Also you can judge the dose to some extent by symptoms - when I did rebound tests with Bix (lowering the dose to see if the #s improve) his levels of drinking & peeing would increase - if you see anything like that I would definitely bump the dose up on the next shot - with a ketone history I just wouldn't risk it.

I can see the merit too in holding a lowered dose for a couple days (even something like 1u) and I would probably lean that way in a non-ketone kitty. So I'm not saying it's totally wrong to hold this lower dose for a day or two and see what happens. I just don't want you get caught up in worrying the dose might be too high when odds are IMO it is too low - and you have a ketone risk, so you don't want to play around for long with a dose that is too low.

Just my 2c. :)
 
Drinking a lot early this morning, but has walked away from the water bowl and went to sleep in the dining room. He rarely ever walks very far away from where I have bowls set up around the house for him to drink out of! I think it's a good sign and he just got up and went to urinate and I got a good sample that was NEGATIVE for ketones!
 
ok, let's look at the big picture here. kitty had his dose almost cut in half without any major upset in the numbers. (the small amount we have so far) That in itself is newsworthy.
just realized we started two changes kind of back to back. low carb food and dose redux (not for the food change but to see if he was in rebound) hmmmm, confuzeled!
well, i
say so far so good on the dose redux. and great with the no-ketones.
blackjack is turning into the cat of interest this week!
lori
and tomtom too!
 
308 at +6! Something I failed to mention and it may not be relevant, but it is a BIG deal at our house. A couple of months ago BJ's poop began to really smell bad. To the point of, if you were on the other side of the house you could smell it and it had to be removed everytime he had a bowel movement. It was a peculiar odor that was unlike the other cat's that were eating most of the same diet as him. This may just have been him, but today his feces does not have the sickening odor that it had! It may be the change in diet, but my husband and daughter are thrilled!
 
well with the glucose so high in the blood, things happen all over the body. the nutrition from the blood cells don't get into the muscle as the glucose cells are so big they prevent that...as well as the water (thus the thirst) so the muscle starts eatting itself thus the ketones...thus i would imagine a different smelling poop. glad it's better :mrgreen:
 
So, looking at your spreadsheet it doesn't look much better than you were getting with 4.5, but it doesn't look any worse either.

Hope other will chime in with opinions.
 
Lori I think the dose reduction was only due to the food change, not a rebound check (at least that's how I saw it! :-D ). The dilemma I see now is on LC and #s still high, did he drop down to unseen lows on the LC and that has triggered rebound now? So now there's the Q of do you try a lower dose b/c maybe we've got rebound on the LC, or stick with the higher dose until you see anything in the #s to suggest a dose decrease is warranted.

I lean towards keeping the dose higher in the absense of any good #s, or something to suggest the dose is too high, like an inverse curve. Thus far, I don't see any sign of rebound, just looks to me like the dose is too low. Especially if tonight's PS is higher and we have a clear U-curve. If tonight's PS is blue or something, then that changes things.
 
I'm going to set my alarm this evening and then hope that I have some good numbers for everyone to look at. I am still optimistic that I have some good data to warrant what ever change comes. BJ was at a low of 160 at 3.0 PZI and every two weeks the vet would just keep increasing the dose by 1.0! She never had the morning glucose level to look at. By the time I always brought him in he was at least two hours post insulin shot, so I feel optimistic that we are looking at realistic numbers!
 
I think one more cycle is a reasonable test, Debra, if you feel safe doing that. Be sure to monitor behavior and ketones. We have not seen a big drop in numbers like we would like. But the numbers aren't scary either.

As you notice, most posters are thinking more insulin, not less. And I am firmly in favor of majority rules. This forum is based on peer review. I need people to question my ideas. If you are feeling safe about one more cycle, go ahead. But don't do it just on my say so.

Just to check - all wet lo carb now and lo carb snacks?
 
Hmmm, 160 on 3u? Uh oh, now I iz confuzed!

:dizcat

New day tomorrow, new data, will put the thinking cap back on then. :-D Can't get my mind around it for the moment. If that was valid data, then yeah the dose might be too high. If that was something where the feeding pattern was different than normal (like he would normally eat mid-cycle but didn't at the vets) then I'd disregard it. But if it's a valid #, then.... hmmm.
 
joanna i think sue was concerned by the initial posts that had bj at 4.5 units with no prior testing and numbers on the rise...sooooooooooooo, as usual, we always like to make sure once testing begins that dosing was accurately prescribed by vet as so often vet's *cough* don't dose well...*cough* i did not just say that!
 
I set my alarm for 1:30 a.m., but didn't hear it go off until 2:30 a.m. and his +8 was 433. The only thing different during the night is that he sleeps most of the night like the rest of us. After I woke him up to do the stick, he wanted to eat and I fed him. I also noticed his full bowl of chicken broth hadn't been touched, but then three hours later when I got up, the broth bowl was empty and his pre-injection level was slightly down from last night. I injected him with the same small dose. Thoughts this morning on if I go up, how much?
 
Well, that yellow in the middle of the night was nice. Will you be able to get mid cycle tests today?

Is there anything else that would complicate things? Infection? Teeth issues? Any high carb food or treats?

Wait until you get enough responses today to get everyone's thinking. I am going to wait to see any possible numbers today.

Although the dose question is, I am sure, frustrating, I hope you are feeling more in control now that you have numbers. :-D
 
BJ has had only FF wet food and fresh boiled chicken thighs since Day 2 of my log. I was encouraged by the low number during the night and I think I slept through what was probably even a lower number before it started up(: I did have some cans of FF that were chicken and turkey varieties that had 5 carbs instead of the lower fish varieties. I am going to the store and am going to only get the lower fish varieties, since he's eating a lot of chicken thigh meat anyways. He loves the broth and I think that is accounting for most of his fluid intake during the day. He has chronic allergies that never go away completely, but other than that I don't know of any infection or bad teeth that could be causing anything. I will be home all day to do some mid-range levels. I figure there is no need to do any sticks earlier than +4, is that okay? Yesterday I tried to follow through that critical low in the day to see just how low he goes.
 
Great, Debra. All numbers help us see the whole picture. You want to get a number around the time his earlier lows have been, and then a hour or so later. We want to catch that nadir.

Does he take anything for the allergies?

We do suggest fish only twice a week or so with the high mercury and phosphorous levels. You might study the food chart to see what other brands have the lowest carb non fish varieties too.
 
Status
Not open for further replies.
Back
Top