Chuck's bouncy journey, part 4.

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StephG

StephG

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OY. So AM looked like they were going in the right direction in a good pace. PM was very strange. PMPS at 2:30pm was 391. Fed 4.5oz. Given 4.5u shot at 2:35pm. At +1 he was "HI". WTH?! No idea how or why he spiked so much from food. The only thing I can think of is 391 was a false reading, he got into his stash (still searching for this invisible stash), or the can of food I fed him from was the "leftovers" from the can all in one.

Don't think I have completely lost it- but do you MIX the liquid (?) in with the chunk of pate that is in the can? I have been mixing the whole can as best I can then feeding him the 4.5oz weighed out on kitchen scale. DH chops off chunks of pate and weighs that way- no including the liquid in the can.

If that liquid is "Gravy" then I can completely understand his spike with dinner because it had gravy from at least 2-3 cans of food.
 
I always mix the can of food up. Whatever the carb count of the can of food you're feeding includes all that is in the can, liquid and solid.
 
Ok. I'll continue mixing it up and make DH do it too. He'll be thrilled. lol Anyway- his numbers were going in the right direction but are on the way back up already. *sigh* I hope tomorrows numbers go lower and rise less after nadir.
Random: He hacked up a hairball Monday or Tuesday afternoon. I haven't seen him do that in at least 6 months. Made me a bit happy only because that means he's grooming more and more! Thinking about adding a hairball remedy. Any suggestions? Do they even have carbs?
I'll check in tomorrow with HOPEFULLY a long streak of yellows! Paws crossed for no more reds and blacks but I'm expecting at least red for AMPS.
 
He is so carb sensitive that I wonder if just a little higher carb food could impact his numbers. His rising so much after preshot is still an unusual pattern to me. I think I'd raise the dose a little - he has room to drop midcycle.
 
I will try a higher dose tomorrow for PM shot. I thought he was doing ok today but he stopped going down between +4 and +6. +4 was his .5oz chicken snack. He's not getting a +8 snack since he ate kitty's food. I gave him another 1 unit shot at +6 to keep him under 600 by AMPS hopefully. AM dose will be adjusted a bit. He usually uses up all the extra insulin I give him mid cycle. Not sure how much he will have to be adjusted to. I won't be home again all day tomorrow. I will be home all night. Next week will be a bit better. Only out of the house all day on Monday and Wednesday. Friday I'll be out for half the day getting SI joint injections in my back. Can't wait! Looking forward to less pain.

On a GOOD note: Chuck is up to 10.1 pounds. I've weighed him a random times throughout the night and he's staying steady at 10.1! The snacks are helping.
 
AMPS 457. 4.5u given
+2 400
+4 170 (spoon of his regular food)
+5.5 182
PMPS (+13) "HI" :banghead::banghead::banghead::banghead::eek::eek::eek::eek:
Fed 4.5oz
Gave 4.8u insulin. Will monitor. To check for ketones. Normal behavior.
I'm guessing bounce. DH thinks it's from the food at +6 but there's NO WAY it jacked him up that much. I am shocked at the HI though. Floors were cleaned last night so there's no way there was contraband crumbs on the floor.
*Sigh* hope he responds to 4.8u better. I was going to do 4.6u but after seeing DH's eyeballed 4.5 it was a fat 4.5...
 
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+5 288
+6 301 :(

Anyone else think he might do better on a different insulin or every 6 hours shot? Or will he eventually get to the point where his +6 is around 100 and his AMPS/PMPS are only around 250? Or is that a pipe dream?!
I think his HI was definitely a bounce. I had the numbers off this morning when talking to DH when he tested him at +5.5... I thought it was +6.5. I wonder how much he dropped- if any... Didn't get a ketones test. He's so offended when I watch him in the box that he will walk out and go later when I'm preoccupied. But it's completely acceptable for him to watch me pee! lol :rolleyes:
 
He's only been on ProZinc a little over 2 months so you could keep keep at it. He's a bouncer and he's carb sensitive, both of which make dosing hard to do. I know there are people who dose 3 times a day but it requires a lot of time/attention from the owner. Can't say I've heard of every 6 hours dosing. For your own sanity you might want to stick to twice a day. You might eventually want to try a depot insulin like Lantus or Levemir but there's no guarantee that bouncing won't still happen.

For now, Chuck's AM and PM PSs are high from bouncing so I'd give a bit more attention to the mid cycle numbers to evaluate a dose. Those blues today were nice to see but there's still room to drop. That suggests a dose increase is in order. I see you went up to 4.8 u at PM dose time. Maybe leave it there for a couple of cycles?
 
I plan on staying on 4.8 for as long as possible. Thinking once he gets use to the dose maybe he will stop bouncing? I get a bit frustrated thinking I'm doing the wrong thing and making him suffer high blood glucose. He didn't get any snacks tonight. I wanted to see if the chicken was making him go up so much but it looks like he's doing it on his own. I need to learn to be more patient. It's just HARD!
 
StephG said:
I plan on staying on 4.8 for as long as possible. Thinking once he gets use to the dose maybe he will stop bouncing? I get a bit frustrated thinking I'm doing the wrong thing and making him suffer high blood glucose. He didn't get any snacks tonight. I wanted to see if the chicken was making him go up so much but it looks like he's doing it on his own. I need to learn to be more patient. It's just HARD!
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Believe me, Steph, I understand. Bouncy cats are a huge challenge! There are so many variables at play that I think it's good to keep as many of them as constant as possible. You could try just sitting on the dose of 4.8 u for a bit while you focus on meals, snacks, etc. After several cycles, look at the nadir values to see whether an increase is in order. Just a thought ...
 
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I am with Kris. I never would argue with changing insulin if it is not working. But I think giving ProZinc more time is worth it. And yes, bouncy cats tend to bounce - regardless of insulin. And yes, you could try TID - dosing every 8 hours. Does your schedule allow that? You'd need to divide the dose you are giving into thirds, then test around +6 and then 8 to be sure the number is always rising. But like yesterday, he was rising slightly at 6 but 300+ lower than preshot. Adding more insulin would be tricky. And if he'd still bounce from the lows....

I agree - he is very carb sensitive and that is not likely to change. Now that he has gained weight, can you change the amount/times fed in any way?

The insulin works - down from 457 to 182 - it is working. But he bounces.....maybe consider 4.5 for the red preshots and 4.8 for the higher. And stick with it. See how low it takes before he drops a little. Check out Phoebe's spreadsheet. She bounces for several cycles after any lower nadir. Then she has a lower preshot. He has been doing this a long time, but gradually her preshots are a little lower and the bounces last a little shorter time. She used to bounce 6 full cycles, like clockwork, before dropping a little lower.

But, if you want to switch, switch. Maybe we are wrong and a depot insulin is just what he needs.
 
@Carol & Murphy said something to me quite a while ago that has stuck. I'll paraphrase: she said she thought it was less about the insulin and more about the cat. Yes, it's true that ECID when it comes to the right insulin. However, I think very tricky cats like Teasel et al. would be tricky on any insulin. Teasel was on Lantus for 2 months in the beginning, bounced hugely the second week of therapy, then got stuck in high numbers and wouldn't come down. It was the withdrawal of insulin for 48 hours in an attempt to restart him that plunged him into a harrowing DKA episode. It's not my intention to warn you off changing insulin, only to give you an example of how a tricky cat can react.
 
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Hi Steph - I'm so sorry Chuck is still bouncing around. But those blues are very nice, aren't they. It shows Prozinc is working.
Regarding changing insulins - Murphy was on Prozinc for close to 11 months - if definitely worked for him, but his responses were erratic -his curves showed a big grin most days - big drops which would cause bouncing and not having a consistent nadir. And I used a sliding scale (sort of) so I tailored the dose to his #s. Reluctantly I switched to Levemir in June - he is still unregulated but he definitely has flatter curves - still bounces with unclear, changing nadirs. But in the end, I am glad I switched - I like always knowing what dose I will give ahead of time, and the fact that there is an insulin depot.
I agree with the others that Prozinc is working, and hopefully he will stop the bouncing. Are you around enough to see if he is dropping quickly or into a blue - to feed him a bit to slow down the drop and hopefully stop the bouncing? Maybe if you could aim for a low yellow nadir for a bit, then slowly try to lower the nadir - steering with food - you can stop the bouncing? Or feed more often in smaller amounts? Prozinc works great and is the right insulin for a lot of cats. Maybe it is for Chuck if you can stop the bouncing . So I stand by what I told Kris - it may be less about the insulin and more about the cat.
I feel for you :bighug::bighug::bighug:
 
Carol & Murphy said:
Maybe if you could aim for a low yellow nadir for a bit, then slowly try to lower the nadir - steering with food - you can stop the bouncing? Or feed more often in smaller amounts? Prozinc works great and is the right insulin for a lot of cats. Maybe it is for Chuck if you can stop the bouncing . So I stand by what I told Kris - it may be less about the insulin and more about the cat.
I feel for you :bighug::bighug::bighug:
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I think that might work... Seems to me that he seems to be kinda like "regulating" in his response to the nadir-- Every time I increase, his preshot would get high then seems to balance out a tiny bit. Unless I'm fooling myself with wishful thinking-
I think it looks like with every increase he responds well then the nadir makes him bounce a bit- until he gets use to that nadir.

His PMPS was 317 tonight- I gave him a Skinny 4.8 so more like 4.7. He's looking good- 303 at +2.15

He would have had a snack at +3 but I'm holding off til +4.
 
He's already in the blues... Doing better already by sticking to the same dose and focusing on the nadir. He had a few days there where he didn't get under 300... those days frustrated me beyond belief.
 
He had a nice 4 hour surf tonight... if you consider the 20% variance all the numbers between +4 and +8 are within that. Feeling optimistic! Nervous about seeing a preshot in the yellows... I don't think it will be this time but when it does happen... maybe a 4.5? My stomach flips when I think about giving that much but it flipped while giving the skinny 4.8 today too and that turned out to be a nice dose. He does have room to go down a bit at nadir but at this point I'd like to try to get his body comfortable with the higher blues...
 
Ok boy was I wrong! He's 213 +10!
I have NO IDEA how much to give him.
I think if he's under 250 we are going to give 4.5 and if above he will get the 4.8 since that is in the 20% variance. We will monitor.
 
StephG said:
Ok boy was I wrong! He's 213 +10!
I have NO IDEA how much to give him.
I think if he's under 250 we are going to give 4.5 and if above he will get the 4.8 since that is in the 20% variance. We will monitor.
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Yes!! You're getting somewhere. Now the challenge is to stay the course and not get frightened by the nice numbers - if you can monitor of course. For ease of measuring with the U100 syringe, you could give 4.6 u under 250 and 4.8 u if he's over. At this level of dose the difference between 4.5 and 4.6 u is insignificant and the 4.6 u is easier to draw up.

I think what happens when you keep going at it like this is that their insulin resistance drops and they become more responsive. This is the "breakthrough" point. It requires vigilance and they can suddenly need a smaller dose. Exciting times! :)
 
Not sure if this afternoon is a bounce or if it's from his snacks. I didn't think the chicken made him spike that much so I'm thinking a bit of a bounce. So I think he would be safe with the 4.8 normal on 275+ with his chicken snacks. I thought about trying the chicken in with his feedings but he really likes the snacks and I like that he's not always so "starving". I use the u100 syringes but DH is still wary of using them. I thought about drawing up the doses and leaving them in the fridge but IDK if that will effect the insulin or not. DH doesn't like the short needle on the u100 that I'm using now but we have some with longer needles like the u40 ones. I'll have to show him the conversion chart and get him comfortable with it.
I am very excited that he's doing so well! My wallet wishes he'd do better on a smaller dose haha but we will survive better now that our new vet has the insulin about $40 cheaper!
 
What a call craptastic night! Gave him .4 extra at +5. Got down to 299 before I went to bed. He was HI this morning. DH fed and gave 4.8 insulin... Still HI +2. +3 was 460/480(can't remember exactly) so I decided he needed more insulin based on last night's numbers all other +3 readings. Tried giving a skinny 1 u and failed! Total fur shot! Almost got my own finger. Chuck freaked because April barked right when I tried poking him. Ugh I could scream! So I gave him .2 because DH won't be up for 2 hours. If he's still higher than he should be (enough to end up high again) he will give another half unit.
I don't like giving the extra mid cycle but i don't want him hi either!
What a mess this day has started with!!
 
I SHOULD kinda expect it. Few good stress free days then BAM! We will get through it! No other choice. I'm just a worry-wort and get anxiety over being high. Soooo scared of DKA. He managed not to go that far in the 4 months after his depomedrol shot til the time of Dx. Plus the 2ish weeks past that when we tried diet controlled approach. The dog food was on the floor the whole time then too.
But I'm sure the minute I think it won't happen, it will! So I try keep him at least under 600!
 
StephG said:
I SHOULD kinda expect it. Few good stress free days then BAM! We will get through it! No other choice. I'm just a worry-wort and get anxiety over being high. Soooo scared of DKA. He managed not to go that far in the 4 months after his depomedrol shot til the time of Dx. Plus the 2ish weeks past that when we tried diet controlled approach. The dog food was on the floor the whole time then too.
But I'm sure the minute I think it won't happen, it will! So I try keep him at least under 600!
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Yes, DKA is always a concern but if Chuck is eating well, well hydrated and getting insulin you don't have to be in a panic about it. Do you add extra water (warm) to all his canned food meals?
 
I do not add water to his meals. I do sometimes for my other cat, Kitty, because he's a UTI prone kitty with crystals in his urine and gets constipated easily. I could start adding it. He gets water with his chicken snacks because I put the half ounce of chopped chicken in the icecube tray with some water to make a chicken icecube that will melt/stay cool until his snack time.
I will try to add some water to his food. I'm sure he will eat it. I have held off the pumpkin for a few days trying to see if that was pushing him over but plan on restarting it for his potty issues.
Tonight he got a whole can of food instead of the 4.5oz. He hasn't gotten his 1 ounce chicken snacks each cycle the last few cycles. Except for yesterday morning when he ended up "HI" for PMPS. He didn't have the chicken snacks this morning and his BG was 290 for PMPS. He had the 4.8 plus the .2 at +3 since he was "HI" after +2.

I feel like we are back on the road to better numbers.
Looking at his SS. I see him hitting good numbers AM 11/11. Bouncing (better controlled bounce) PM 11/11 and AM 11/12. Then Good numbers PM 11/12 and AM 11/13. Then Bounce (less controlled) PM 11/13 and AM 11/14. Now getting better numbers PM 11/14.
So looks like he's getting nice numbers two cycles in a row then bouncing two cycles... on the 4.8u dose.
 
Well he didn't go down much tonight. He's already 424 at +9.
Do you think maybe we should increase to 5 units? I'm debating on feeding and giving him his shot at +9.5. He's increasing pretty quick and I figured if we give his shot (4.8 units) and breakfast early we might be able to keep him out of the black and get back on track. But He had plenty of room to decrease with 4.8 units on a 290 BG this evening.
If we shoot 2.5 hours early I can monitor until +6 then not again until +10. Then his PM shot would be at +13 instead of +12.
Thoughts?
 
I know the highs are discouraging, Steph, but there are some nice yellows in there and even a couple blues. I really think the blacks are bounces and worry that increasing makes that worse. But it's worth a try if you want to increase to 5 on those blacks and see what that does. I do agree letting him hang out there in the blacks doesn't seem wise.
 
I agree with Sue, Steph. These bouncy cats are so hard to read. They can trick us into thinking they need a higher dose because of the high bounce numbers. What can help is to stand back and look at the scattering of blues/yellows on your SS and note what dose range produced them. Combine that with paying more attention to nadir numbers than AM/PM PSs to judge a dose's effect and decide how to proceed. My opinion is that reacting to individual numbers and rates of increase within a cycle by dosing early/giving fractions within a cycle can create a very complex set of variables in operation at the same time. I think that with bouncy, unpredictable cats the more we can reduce the number of variables the better - because they're so reactive.

I truly understand your frustration and worry about Chuck's numbers. He's sure not making this easy for you. I stick with my gut instinct, though, that says we shouldn't overreact to the events of their cycles. Choose a good dose and stick with it AM and PM. Feed set amounts on a good schedule for kitty's needs. Adjust carefully as needed.

My thoughts for what they're worth ...
 
He's not getting his snacks like he was before at +4 and +7/8. He was getting .5oz chicken each snack. I stopped them thinking it was the issue but it isn't the only issue.
I just gave him .25oz chicken snack tonight at +5 because he seems so hungry. I'd like to get back to giving him the snacks and staying out of the blacks!
 
StephG said:
He's not getting his snacks like he was before at +4 and +7/8. He was getting .5oz chicken each snack. I stopped them thinking it was the issue but it isn't the only issue.
I just gave him .25oz chicken snack tonight at +5 because he seems so hungry. I'd like to get back to giving him the snacks and staying out of the blacks!
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Did you find that the chicken snacks messed up his numbers? If not, keep giving them so he's less stressed from feeling hungry.
 
Kris & Teasel said:
Did you find that the chicken snacks messed up his numbers? If not, keep giving them so he's less stressed from feeling hungry.
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His .25oz chicken was at +5 which was 279. His +7 is 392 (around there can't remember exact number). So he's almost to 400 already :arghh::banghead:

I am finding it very hard to focus on Nadir numbers or his lower numbers when they're only for two or three hours out of twelve, or not even under 250.
Idk what else I can give him for a snack. I thought chicken didn't have carbs? If that's the case, would that young again zero carbs still increase his numbers? I was debating on trying that for snacks and if it didn't increase maybe replace an ounce of wet food with that for feedings?
It's expensive compared to 9Lives but if it's just snack and supplement I might be able to swing it. Not right away because my Jeep broke down today! Needs a starter and that's costing $150 to repair. Never fails, I get an extra dollar and either the cars or fur kids go nutty!! *Knock on wood*
Enough whining!
He hit yellow today and may have gone lower if I didn't forget Kitty's dish!:mad: I'm starting to think I should hold it on my hands for him so I can't forget! I have been taking April's dish into the living room and feeding her between my feet! Can't forget to pick it up that way!
I'm so scattered brained it's scary!:oops:
 
I'm sorry you're in one of those !!@&%*!! spots, Steph. Sometimes life conspires against us. :(

So - if snacks are creating a problem, try stopping them for a few days. Remind me: is Chuck getting 3+ set scheduled meals a day aside from snacks? I can't see that YA Zero carb food would be lower than plain chicken. I suspect it's Chuck's complex physiology and not what the snack is so long as it's low carb.

Your SS shows that Chuck DOES come down, even after a high PS. Dosing every 12 hours and keeping the same dose AM and PM hasn't really made anything worse and it's easier for you. The middle third of a cycle tells the story more clearly than the bouncy ends I think. The last two days have pink and yellow in the middle third. That suggests to me that you might try 5 u.
 
He gets 4.5oz 2 times a day then he was getting half an ounce chicken snack at +4 and +7. So total of 9oz food and 2oz Chicken in 24 hours.

I stopped the half ounce pumpkin at night too. I stopped his chicken snacks about a week ago... 11/13 am he got both. He got .25oz last night.

I noticed the more he sleeps the better his numbers are... It's really strange. If we aren't home his numbers seem to do better... That's probably because I'm not there to forget any contraband is out!

I thought about trying the 5u tonight. Still holding out hope he's not black this afternoon. He was this morning. 565 out around there. 4.8 given then by +4.5 he was only 407. I keep thinking if we can keep him from getting above 400 and he drops 250 from a 4.8 shot then maybe we can keep him surfing in the blues but ANY time I think that will happen he gets stuck higher or goes lower than expected.

I feel like I'm failing him. I get mad when he gets into contraband and I tell him he's going to eat himself to death! But it's my fault for letting it happen so I don't punish or yell. Well I'll yell to get him off Kitty's feeding stand!
 
You are NOT FAILING him, Steph. He is a bouncy cat who also is really impacted by food - even lower carb food. The chicken snacks should not spike him - giving him one around nadir seems like a good idea if it makes him happy. Failing him would have been saying dealing with a diabetic cat is too much and having him PTS. Instead, you are working hard to get him stablized, watching his levels carefully and keeping him safe.

I think I would try 5 units. He will probably bounce, but I think he will do that until he stops. In the meantime, maybe it will bring the levels down a little overall.
 
For what it's worth I think that expecting that dose X will cause a drop of Y rarely works for bouncy unpredictable cats. I can't do that with Teasel because he'd trip me up most of the time. I look at the previous few days of middle third of cycle numbers and ask myself whether his dose is OK (for now!) or should I raise it. Previous history can give me very, very general impressions but I don't rely much on it because every day is a new day with Teasel.
 
DH gave him 5u this evening. So far he's doing ok. Numbers are very close to preshot at +2. Testing again in 15 minutes.
 
+6 282
He had a FF tuna flake treat. Only .05 or .1 ounce. Will check at +8 then I'm off to bed. I wonder if his nadir will be later than +6 due to the slight increase in insulin. Who knows.
 
+8 292.
AMPS 345! 5u given.
+3 305
+4 272 (came down and DH had left dog dish on the floor! Ugh! Hopefully Chuck didn't notice!)
+5 278 Chuck may have had a dog food snack. Ugh. Figured there'd be a way bigger drop here but I'm still happy with the yellow.
 
StephG said:
+8 292.
AMPS 345! 5u given.
+3 305
+4 272 (came down and DH had left dog dish on the floor! Ugh! Hopefully Chuck didn't notice!)
+5 278 Chuck may have had a dog food snack. Ugh. Figured there'd be a way bigger drop here but I'm still happy with the yellow.
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Keep at it, Steph! :)
 
Yes I agree Sue&Oliver. April has pretty bad reaction to plastic dishes so I haven't gotten the chip feeder for her but am thinking I need to at least try it and maybe put some foil (?) over the plastic rim. She gets severe cystic acne on her chin and lips from plastic dishes. I can always use it for kitty's food if she can't use it.
I reluctantly gave him a snack of .5oz pumpkin at +8 because he started with loose stool again and started stinking pretty bad. I didn't think it would jack him up that bad but it does have natural sugars in it so I'm sure it could. I will give it tomorrow with his dinner. His +1 looks promising. Usually he's up by 100 by now.
I added 2oz of warm water in with his 4.5oz food. I left Aprils dish down and he walked by it a few times with NO interest! But now an hour later and he's sniffing around looking for goodies. Piggy. I think I'll try to puree the chicken. Maybe I can get away with .25oz chicken per snack to help keep his numbers in check and fill his belly up more with water and chicken.
 
His numbers are looking better tonight. I'm giving him a .5oz chicken snack at +8. Hopefully it doesn't send him over the edge.
 
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