Elmsley Curve - Interpretation & Advice?

[Scott & Buster]

Elmsley's insulin dose was increased twice over the past 2 weeks. We're currently at 2.5 units Prozinc, which started last Thursday. I was expecting to see much lower numbers with the dose (though there has been a bit of a drop, to me it looks like his numbers are somewhat all over the place), so I was able to run a curve yesterday.

Notes about the curve: Breakfast 1.5 cans FF Chicken, lunch at +5.5 thru +6.5 1 can FF Oceanfish & Tuna (first time he's had fish in over a month). Normally he would have had a snack at some point during the day (1.5 oz Tiki Cat shreds or homemade baked chicken tenderloin and chicken stock), however I got busy at work and didn't remember it until he was already into he PMPS fasting period so he didn't get it.

It seems like the insulin is struggling to cover the lunch food since his BG jumped 240 points within 90 minutes. We are still waiting 30 minutes between 1/2 cans (otherwise he'll eat an entire can in under 5 minutes) - is this causing some kind of double glucose peak that the insulin can't handle? Does there happen to be a bounce occurring here on top of being fed that is spiking BGs? Is a single can not enough and we're getting a bounce afterward? A bounce would explain AMPS as well, since there is no lunch at +6 at night - at most he's getting a 1/2 can of tiki cat at +4 or +5... and we're moving ~+200 over a 6 hour fast.

It also looks like his insulin drops off at about 10 hours. I see the same rate of BG decline from +8 to +10 that I saw in 0 to +2, but after that on a fast it was only able to maintain until +12. So basically if he's not just outside of a normal range by +8 he's not going to get there.

This does shine some light on why is PS BGs are consistently near 400 though.

I welcome any comments/thoughts/advice before going back to the vet. Graph is in the attachment.

449 0, 345 +2, 243 +4, 211 +6, 451 +8, 359 +10, 372 +12

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[FrostD]

Looks like you're doing everything mostly right. I would try to move that lunch back though to maybe +4/+4.5 - you're right, the carbs are hitting him too late (at/after the usual nadir) when insulin is wearing off so it's like an extra boost up. If you don't think he can go that long without food, you can offer a small (1 tbsp) snack around +8. It's ok if he eats the entire can quickly, my cat usually does. Only concern is the ol' scarf and barf.

The duration issue is also very common and will get better as you get closer to a good dose and he stops bouncing. It does look like those blues are causing a bit of a bounce, but the next time it happens it's worth testing about 2 hours later to see if he continues to drop (because if/how far he drops after that will affect whether you increase dose.or hold).

Other than that, it's just a waiting game unfortunately.

 

[Scott & Buster]

Thanks @FrostD , I'll start moving back his lunch tomorrow. It makes total sense being able to see it in the data. I'll also start condensing meal time to not be so spread out, and follow up on blues.

Hopefully moving away from eating more often and not being full to less often and feeling full helps him with his counter surfing and more importantly gets him closer to being regulated.

 

[Scott & Buster]

The sustained "tantrum" he threw yesterday with the change to his feeding schedule...

But based on yesterday's readings I thought it might be worth dealing with a few days of behavioral issues since it was the first time all of his readings for the day were under 400! Except this morning he bounced back to 439 AMPS. Last night PMPS 390, +4 194, +6 299; after the +4 reading I gave him ~1.5oz of Tiki cat After Dark with a quarter human sized egg because he was absolutely on the hunt already.

Am I wrong that Tiki Cat After Dark have no carbs, and that he got basically 0 carbs from a 1/4 egg? I think I am right, so that means he started his bounce around +5 and just kept going all night. Generally how long does it take for his body to get used to being below 300? I know its a waiting game.

He is getting 1.5 cats of Fancy Feast with each of his shots, plus a single FF can for lunch. He's still really underweight and hasn't got his muscle back because his BG is out of control still. Does anyone think I should increase his shot cans to 2 each? Maybe give a 1/2 can +3 at night of FF instead of Tiki (to put the brakes on the BG drop)?

 

[FrostD]

Nice day for him, more even cycles! They really are just furry toddlers I swear.

It is so widely different for each cat. He's seeing fairly decent cycles for how early he is, so my hope is that within the next 2 months a lot of the bouncing should be settled and short lived. They often last up to 6 cycles, but over time they generally become less drastic and clear more quickly.

Correct on the carbs. Yes I would save the Tiki for later in the cycle for his snacks since it's very low/no carbs depending on which one you have.