Chuck's bouncy journey, part 4.

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Happier with his PMPS today. OH BOY OH BOY OH BOY! Shhhh we've hit a BLUE! I'm thrilled! I gave him 4.5oz food with 2oz water and .5oz pumpkin for dinner. I just gave him another snack of .25oz food with .6oz warm water. He seems satisfied with that snack. We will see how much his BG goes up. Hopefully not a lot. He has a .5oz chicken snack scheduled for +7.5 but I think I'm going to reschedule it for +9. I gave him the food and water snack because I was feeding kitty and he was frantic to eat so I decided I'd give him a little of his food and see where it takes his BG. Then I checked his sugar, right when he was done with it so I had a presnack number. I was SHOCKED to see the 174!!
 
Now I have no idea what he will be at in 4 hours but if he's in the 200's should I still give 5u?! I have a feeling this last snack is going to start him on his way up but I hope it isn't much! I have no problem giving him 5u in the 300's but my guy says to decrease a bit for 200s. But I'm kinda expecting a bounce from the blues so I think the big dose might help keep him out of the blacks if he does...
Usually when I think he's going to be pink or yellow for pre-shot he ends up red or black but I'm hoping being in blues this late in the cycle he'll be a nice low pink or yellow.
Please let me know what you think about the dose. If I did decrease I think I'd go down to 4.8u don't want to mess it all up with a big change.
I will update with his AMPS number and see if any of you are online at the time. If not I'll try my best to make the right choice. :cat:
 
+9 259! Big jump but still yellow. All that from chicken this late in his cycle... Guess that gets rid of my dosage question! :banghead:
 
Looking really good! Adding water to his food gives extra hydration plus makes him feel fuller. I'd avoid too much dose tweaking right now. If you can be home to monitor I'd give 5 u again because his blues aren't too low. He hasn't had a green in a very long time and never a lime green. I think this dose is helping to break through insulin resistance so you need to be brave.
 
Much better! He might have a higher, flatter cycle today as his version of a bounce, or he might continue on, liking the new dose. Paws crossed for the latter, but great he is responding to the little higher dose. Now to just stay ahead of him.
 
I agree with Kris and Sue- it is scary to see blues but you need to keep pushing (always putting safety first but you have lots of room) it is a balancing act trying to not let him drop too much so you won't get the bounces. I think you are doing great steering the drops with food
 
I gave him the full 5u this morning and this evening. I didn't get midcycle numbers this morning. But he only got back to his preshot for the morning. He didn't get snacks yet tonight but might not get any. We had company this evening and he's been snoozing most of the night.
 
We have been doing pretty good with the yellows! DH left the dog dish down this morning... ugh. I found it on the floor when I got up at 8:30ish to check him and he was high but coming down a tiny bit from his +3. I gave him .75u eyeballed to counteract the dog food. I told DH to feed April by his side wherever he is so he won't forget to pick it up. It's been working for me. Anyway his +12 from am shot and +6 was 265 so I stalled for an hour and he was going up so I fed and gave him the full 5 units since I am home to monitor. He's doing great so far. +1.5 was 371. 4points lower than pmps! He's playing and raising hell instead of sleeping like his usual so I'm happy with that! I'm checking him in a half hour and probably giving his snack at +4, if not +3. I weighed him last night and he's 9.9 pounds... just from not having his chicken snacks he's lost .2 pounds. I'm going to continue his snacks and if it's necessary we can increase his dose if he doesn't hit yellows anymore. He needs the snacks to keep gaining weight.
 
Hi Steph - Are you saying you gave Chuck an additional 0.75 units at +5, after 5 units at his usual am time? This is usually not recommended, because now you have two doses nadiring at different times. I did it once early on but never after that/
 
Carol & Murphy said:
Hi Steph - Are you saying you gave Chuck an additional 0.75 units at +5, after 5 units at his usual am time? This is usually not recommended, because now you have two doses nadiring at different times. I did it once early on but never after that/
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Yes. My vet said a micro dose like that is ok to keep him from getting so high. He had the 5units at 3:30am. Then had access to dog food until 8:20am. He came down from 516 +3 to 426 +5. He would have been over 600 in no time.
That's why I checked and stalled. He was 265 +11 from AMPS. So I waited another hour and checked. He was 375 +12. So he was already increasing by more than 20%. So I decided it was safe to give him his full 5 units at his PM shot. He's doing great! Looks like he's going to hit the BLUES so I'm happy with that. His +5 shot is or should have nadir at 3:20pm when he got his PM shot. Which it looks like it did since he jumped 100 points a little less than an hour. I planned on moving his shot up to 3pm instead of 330 but based on the 265 I waited til his +12 reading. The extra dose will be full cycle at 8:20pm. He won't get another micro dose today. I only give it if he's staying too high. I always make sure he's increasing before giving the next scheduled dose. I don't like to give the extra but I will in order to keep him from getting too high.
I make sure I chart it so it doesn't look like only 5u got him to his lowest reading that day. So future 5u might only get him to the low yellows and I'll be able to look at his SS to see that these lowest readings for today were after an extra micro dose in the AM.
 
sorry to jump in the middle of this - maybe it's been hashed out already with @Sue and Oliver (GA) and @Rachel - if so - I am sorry. I'm wondering if R insulin would be helpful in these cases - it has a shorter duration of action and maybe could result in a nadir about the same time of the original dose of Prozinc. @Bobbie And Bubba - what do you think of R in this case?
 
HMMM, because I did not use Novalin R with Prozinc but rather with Lantus, I really do not know how to guide with that question. My question is this: Are you testing for ketones? Very important while Chuck is hanging in these higher numbers. I saw on the SS that he might have gotten into the dog kibble. Could this be a frequent happening which would account for the higher numbers? I am grabbing for straws here as I am sure you are too.
 
Carol & Murphy said:
what about onset time and duration of R - that's the question
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While I was using it, I was using tiny amounts of it and checking at + 1 - 5 or 6 depending on the numbers I was getting. It could be a possibility for Chuck but under strict supervision and with since I did not use with ProZinc but rather Lantus, I wouldn't begin to know how to guide. It might be a good question for the vet. I wish I could help. Here's what I would do:

I would make sure that there was NO possibility of contraband from the canines.
I would be checking for ketones while in these higher numbers.


If both of the above are negative, I am at a loss for what could be happening. I will say this 5.25 units was Bubba's breakthrough dose (on Lantus)
 
Contraband is a problem more often than I'd like. We have been doing ok with remembering to pick it up but we do forget now and then. Today was definitely the dog food that increased his numbers so high after his shot. When he gets into any contraband I try to always chart it or mention it on here so I can see that he had a carb overload...
My vet never mentioned a short acting insulin. I could call her and discuss it but I think if we could STOP forgetting and allowing him the opportunity to get into any other food he would be better off in general. I don't think most of his highs are from contraband. I think he just increases fast after his nadir. Especially if he has a snack after it.
I don't think his pancreas is producing any insulin or at least very scant amounts. Without the insulin he is always on the rise no matter what he eats.
He was 184 at +4. I gave him his .5oz chicken snack and that was enough to get him to only go down 38points then surf for the last couple hours.
11/17 and 11/8, I gave him .5oz chicken snack at +8 and he jumped 100 points just from chicken and being in the second half of his cycle.
He's very sensitive to carbs. I'm hoping this 5u will get him into a more consistent trend with his bg readings. Then maybe, just maybe, he will need smaller doses once his body gets use to the "lower" than his diabetic state normal.
 
I can't remember the last time I checked for ketones... He was negative though. He's gotten better at sneaking in the box while I'm preoccupied so I can't catch him peeing. He gets so offended by me bothering him in the box.
 
Well, if contraband is an issue, controlling that will help. Also, try to get all his mini meals/ snacks in before nadir and let's see if that helps his numbers. It very could. Fingers and paws crossed.

Also, get a test in for ketones. Let's rule that out. If getting him in the box is an issue ( it was with Bubba ) think about getting a ketone monitor that you can do with blood samples like the About Precision Xtra
 
He's going up fast.
+6 158
+7 207
+8 325
Bounce possibly? No contraband. Guessing AMPS is going to be black. :( Hopefully he proves me wrong. I can't get any readings past +4 til PMPS.
 
I believe the possibility of using R with ProZinc has been brought up in other threads and generally discouraged. No one I know has done it and so we really couldn't guide anyone on it. Not saying it would not work but I don't know how we could help and still keep the kitty safe.
 
I would avoid introducing R insulin at this point. To me that's a very "high level" intervention - no pun intended - and could so easily go badly wrong.
 
Kris & Teasel said:
Actually, not bad. How was his AMPS?
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AMPS was 541 at +11. Fed and shot given an hour early due to being over 500.
I thought maybe DH left Kitty's pate down but his numbers are almost exactly the same as this morning and he didn't get into anything tonight.
Thinking it could be a bounce.
 
It's so easy to feel defeated. Like a game I'll never win and I'm not the one suffering. Tomorrow is another day I guess. But I won't be able to get any readings past +3 til PMPS again tomorrow. Wednesday I will be home all day.
 
So he's looking better today. He was acting a bit odd at dinner today. I fed him his 4.5oz food plus 2oz water plus .5oz pumpkin. He ate maybe half of it and walked away then circled back to it and ate more. He did this a few times and took about 15 minutes to eat vs his usual 5 minutes. Only other time I've seen him do this is that second night when he was going too low and I had no idea.
He ate it all and kept it down. I'm checking in 5 minutes to see his +1. Hopefully he's ok. He DID get into Kitty's pate that had some miralax in it so I'm hoping it's just a bellyache that will go away. He didn't get much since his BG didn't go up that much. He basically licked the plate clean.
I'm currently stalking him to catch him in the litter box to get a ketone test.
 
Yes it does! The pate with miralax was lastnight. He's acting much better now but caught him eating something near where the dogs dish usually is... I think he either found a stray piece of kibble or crumbs. He was on track for blues tonight but I think the crumbs took care of that. He's already almost 400 @ +8. He did ok surfing in the yellows.
I ordered the chip feeder for the dog tonight. It will be in on 12/1. I will have to figure out a way to keep the dog from getting an acne flare up but that is much easier to control and treat than Chuck's diabetes. It will save my sanity and money in the end. I am also looking into one of those cat litter box mats that traps the stray litter. Maybe it will trap any crumbs too! I try to sweep them up when I see them but it's been a hecktic night.
I STILL haven't caught him in the box. I thought about moving it into an area that I can see instead of tucked away for a few hours. I don't think he's got DKA at all but I rather be safe than sorry. Especially because he's going to be getting up higher tonight.
I get so mad at myself or DH for letting him get into contraband. Completely preventable but yet we both keep screwing it up. The rest of this week and next I'll be home more often so I'll be able to lock down the binges on contraband.
 
His numbers were looking good tonight until +9! went from 182 +8 to 348 +9! No snacks. No contraband. Bounce or he just ran out of insulin! I tested twice because I thought it had to be a bad reading.
Happy Thanksgiving to all those who celebrate!
 
StephG said:
His numbers were looking good tonight until +9! went from 182 +8 to 348 +9! No snacks. No contraband. Bounce or he just ran out of insulin! I tested twice because I thought it had to be a bad reading.
Happy Thanksgiving to all those who celebrate!
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Just a number. Maybe a bit of a bounce. Happy Thanksgiving to you Americans!
 
We had a yellow PMPS tonight!! I gave him 4.8 units and an extra snack of .3oz food because we weren't going to be home. He was already 269 at +2. He was 212 at +5 so was shocked to see he was black, 567 at +11.
He was negative for ketones Wednesday night.
Should be able to get more readings this morning but not sure how many or when. He's started to come to our bedroom or the shelf in the bathroom after eating for his nap. One of his old habits!

Does tuna water from the can have carbs? I tried googling but didn't get a clear answer. I figured it probably doesn't since it's water and tuna meat juice(?) it use to be one of his favorites!
 
StephG said:
We had a yellow PMPS tonight!! I gave him 4.8 units and an extra snack of .3oz food because we weren't going to be home. He was already 269 at +2. He was 212 at +5 so was shocked to see he was black, 567 at +11.
He was negative for ketones Wednesday night.
Should be able to get more readings this morning but not sure how many or when. He's started to come to our bedroom or the shelf in the bathroom after eating for his nap. One of his old habits!

Does tuna water from the can have carbs? I tried googling but didn't get a clear answer. I figured it probably doesn't since it's water and tuna meat juice(?) it use to be one of his favorites!
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Just a bounce black. You're getting somewhere, Steph!
 
It seems strange to me that he's always so much higher in the morning. He was "HI" again this morning! I hate seeing black and definitely hate seeing "HI"! Hopefully still a bounce from yesterday. He ate pretty slow this morning again. I thought twice about giving him his whole 5u shot then decided it's ok because he's over 600 to start! I'm hoping for better numbers today. Trying not to test quite as much. His poor ear is sore and he's scratched it til it bled for some reason. I have been putting neosporin with pain relief on it to help heal the scratches. No snacks scheduled for today. I really want him to get back on the snacks but without a dose increase he will be black for each preshot reading I'm sure.
Do you think we should hold out a bit longer with the 5 units or try increasing to 5.2 to see if that gives him a little more room for snacks? I don't really understand why he's needing more insulin like this. He was getting less insulin and 1 oz of chicken each cycle and did better but with no snack on 5 units he's still only going as low and if snacks are included he's too high.
Could he be working toward insulin resistance?
I googled it and it said insulin resistance is when they don't respond to 2 units per pound of body weight per day. So for him that would be 20 units! That seems a bit crazy to me. I remember someone on here saying it starts looking like insulin resistance around 6 units per cycle so that's weighing on my mind now too.
 
StephG said:
It seems strange to me that he's always so much higher in the morning. He was "HI" again this morning! I hate seeing black and definitely hate seeing "HI"! Hopefully still a bounce from yesterday. He ate pretty slow this morning again. I thought twice about giving him his whole 5u shot then decided it's ok because he's over 600 to start! I'm hoping for better numbers today. Trying not to test quite as much. His poor ear is sore and he's scratched it til it bled for some reason. I have been putting neosporin with pain relief on it to help heal the scratches. No snacks scheduled for today. I really want him to get back on the snacks but without a dose increase he will be black for each preshot reading I'm sure.
Do you think we should hold out a bit longer with the 5 units or try increasing to 5.2 to see if that gives him a little more room for snacks? I don't really understand why he's needing more insulin like this. He was getting less insulin and 1 oz of chicken each cycle and did better but with no snack on 5 units he's still only going as low and if snacks are included he's too high.
Could he be working toward insulin resistance?
I googled it and it said insulin resistance is when they don't respond to 2 units per pound of body weight per day. So for him that would be 20 units! That seems a bit crazy to me. I remember someone on here saying it starts looking like insulin resistance around 6 units per cycle so that's weighing on my mind now too.
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Hi Steph,
I don't have any specific advice to offer but will say that insulin resistance can set in at much lower doses whenever kitty is in high numbers too long. I think some say to look for high dose conditions like acromegaly when the insulin dose goes beyond 6 or so units BID.
 
Yes, our limit is around 6 units. Then we start looking at other issues. But he can be resistant to insulin without having a specific condition. I think we goofed you up going so low in the beginning and working our way back up so slowly. I keep thinking he will have a breakthrough.

If he is consistently higher in the am, it could be a blue overnight and a bounce. (You did see the blues a couple nights ago). Sometimes cats drop lower overnight than in the day cycles - different food - maybe no change of any contraband(?), less activity etc.).
 
I decided to try a different approach today. I tested him at +10 and he was 579. So I fed him early and gave insulin.
He got 5 units of insulin.
3.5oz food
0.5oz pumpkin
1oz warm water

The other ounce of food I split into two snacks with half ounce of water in each. Scheduled for +3 and +6.
I'm hoping this will help his insulin last longer but it could go the other way. It's not any more calories than he usually gets but if this helps I could add some chicken in each snack or in the second half of his cycle...
I think starting low was a good idea. I have a feeling he was diabetic longer than we thought before diagnosis. He was fine in May 2016 and got the depo shot. We didn't take him back until mid August. We should have taken him sooner.
I'll have to Google that condition to see if he fits the symptoms. I'm thinking he might go back for some follow up bloodwork to check for infection or anything else that might be effecting his numbers. I'm going to call the vet to get a quote. Might have to wait until the end of December.
 
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Different feeding schedule did not help his insulin last longer or lower his numbers. I gave him .4u of insulin at +8. Will probably give him 4.8u when he is due that way he's not getting more than 5.2u total. I fed him 2 hours early today so if he's continuing to go down I'll delay his next meal and get back to the 2am/2pm for now then work towards 4am/4pm.

I might try chicken baby food for a snack. I'd like to find something packed with calories to help him start gaining again.
 
Look at the calorie count on the food chart. Wellness is one that is fairly high calorie, as is Merrick Duck.
 
The extra .4u at 8:30pm let him surf in the 400s. Fed and shot at +12. DH will monitor over night and I'll take over in the morning. The .4u will be +12 at 8:30am.
 
Gave him an extra .2u at +6 this evening. I think it might be time for a dose increase. I don't think the .2 unit made much difference in his BG. I think it kept him from increasing as quickly as he would have. Seems to be surfing in the high 200s/low 300s. I am holding off his AMPS/dinner until 2AM if possible. That will be +14 from his AM shot. We need to get him back to a "normal schedule".
 
He was "HI" PMPS last night. That extra .2 units didn't last or didn't do much. I gave him a fat 5 units. I don't have the readings right now.
Just checked him at +10.5 and he was "HI" AGAIN! So I fed him 4.5oz plus .5oz pumpkin. Gave him 5.4 units. Shot was given in his right flank. Hopefully the site change and increase will help him go down and stay down. I'm beyond frustrated right now. :banghead::(:blackeye::arghh:
 
I certainly understand your frustration, Steph. I would be banging my head too. I see two options. One, continue to raise the dose until you reach some better numbers. I think one of the possibilities is that restarting at the low dose allowed him to build up a resistance, and it will take more insulin to break through. Personally I would raise by 0.5 every six cycles. The other option is to try another insulin like one of the depot types. It may be that he needs the longer cycle that a depot insulin can give.

I'm so sorry you are having such a tough time. I wish I had a brilliant fast fix......
 
I agree with Sue, Steph. I think the issue of development of insulin resistance is bigger than we think or that many vets recognize. They label it as such once you're up into very high doses but I think it happens at whatever is an ineffective dose if it's held too long.

Depot insulins work well for many people but ECID ...
 
He's still "hi" after +2. Guess the flank shot was an awful idea. Now I don't know what to do!?!?
 
I just read about the depot insulin. My head is spinning. He needs longer control but he also needs the food spike covered too.
I have debated on keeping him locked in the bathroom with his litter box and water to see if he's getting into something that I haven't found yet. As far as I know there is NO contraband available.
Idk what to do about his hi reading. I didn't think the flank shot would make that big of a difference.
If he's still HI I'm going to give him more insulin. See if he responds to .2 units in his scruff. I can deal with the hypo later if that's the case.
 
Hard to know if scruff versus flank makes a difference. There are many claims out there that absorption is better along the sides of the cat. I've changed over from Teasel's scruff area to along his side and indicated that on his SS. Not sure that there's a drastic difference ...
 
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