Emmett con’t—too many reductions?

KLD

KLD

Active Member
Hello! I wanted to provide an update on Emmett (sorry, I’m on my phone and can’t link his previous thread).

Aside from being his usual bouncy self, Emmett has been doing fairly well recently. However, I’ve been reducing his dose a LOT. It seems like almost every day at this rate. Yesterday (the 12th) I sort of prematurely reduced his dose—even though I didn’t catch him hitting 3.8 (the number we had previously discussed reducing his dose at) on 1.5 units, I had a feeling based on his previous patterns that it was too much. Today, it even seems like 1.25 units is too much. He’s already at 4.3 at +4. I gave him 12% at +4 instead of +2 (I’m finding this to keep him a little more stable compared to giving him 12% at +2) so we’ll see if he dips low by +6 (nadir).

Should I give him 1 unit tonight? I’m happy that he seems to be so much more responsive to insulin lately, but it was only two weeks ago that he was up around 3 units, so I guess I feel weird giving him such low doses lol.

Also, he is still on Atopica—he’s developing bumps on his right paw (his problematic left paw is healed), but the vet said to give the Atopica the full six weeks to take effect and then we can evaluate.
 
Suzanne & Darcy said:
Whoa. I see a lot of reductions. Okay. I have a feeling that you will need to slow down. I would encourage you to not reduce anymore except if he does drop below 68. It’s encouraging to see him doing so well! I am sorry that his other paw is breaking out.
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For sure. I try, but he has a tendency to bounce up early when he has too much insulin, so I don’t always see the 68. That’s why I’ve done some of the reductions (like the reduction to 1.25). I’ve also been experimenting with feeding him 12% because of his early dives, which I think is sometimes keeping his blood sugar higher than it would have been (like September 9 PM where he got it for almost every meal and still hit 68 haha). I didn’t end up reducing tonight but based on the red PMPS I think he’s bouncing tonight.
 
If you can get a +2 today you may get a heads up on whether he will need the MC food or not. (Unless he eats MC for breakfast because that may give him a food bump.)
 
Suzanne & Darcy said:
If you can get a +2 today you may get a heads up on whether he will need the MC food or not. (Unless he eats MC for breakfast because that may give him a food bump.)
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Unfortunately I wasn’t able to because I had to go out. I think he got 12% around +4 (someone else was feeding them today) so his +6 may be a little high because of that, but I also think he’s just bouncing too.
 
KLD said:
Unfortunately I wasn’t able to because I had to go out. I think he got 12% around +4 (someone else was feeding them today) so his +6 may be a little high because of that, but I also think he’s just bouncing too.
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No. He’s gone down in to yellow so he’s not bouncing. I don’t think he needed the 12 percent today. Maybe this evening will be a better cycle. He may be due to break the bounce possibly will be trending downward until PMPS.
 
Suzanne & Darcy said:
No. He’s gone down in to yellow so he’s not bouncing. I don’t think he needed the 12 percent today. Maybe this evening will be a better cycle. He may be due to break the bounce possibly will be trending downward until PMPS.
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I don’t think he needed it, but since I wasn’t going to be around, it was given just in case since he’s had some fairly low +4 numbers lately. At any rate, something is off because he’s really high tonight.
 
KLD said:
I don’t think he needed it, but since I wasn’t going to be around, it was given just in case since he’s had some fairly low +4 numbers lately. At any rate, something is off because he’s really high tonight.
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Sorry. That’s frustrating! Was your mom taking care of him today? That’s nice! But she doesn’t know how to test? You have another cat, right? And wow. A black. :(​
 
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Suzanne & Darcy said:
Sorry. That’s frustrating! Was your mom taking care of him today? That’s nice! But she doesn’t know how to test? You have another cat, right? And wow. A black. :(​
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Yes, she was. And no, she’s not really comfortable testing him. She has done it before, but it’s a two person job for her and even then they don’t always manage to get a successful test.

yes, I’ve got another cat. He’s the one with the history of urinary crystals.

emmett has another fairly high number this morning. I wonder if he’ll eventually level out again.
 
KLD said:
Yes, she was. And no, she’s not really comfortable testing him. She has done it before, but it’s a two person job for her and even then they don’t always manage to get a successful test.

yes, I’ve got another cat. He’s the one with the history of urinary crystals.

emmett has another fairly high number this morning. I wonder if he’ll eventually level out again.
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I am relieved to see he’s back in blue as of the last test! I understand about the testing. Does he behave okay for you (a one person job o a two person job?).
 
Suzanne & Darcy said:
I am relieved to see he’s back in blue as of the last test! I understand about the testing. Does he behave okay for you (a one person job o a two person job?).
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And a green at nadir! Clearly he’s responding well to this dose.

yes, I can test him on my own no problem. We figured out a good routine pretty quickly in the beginning. If he’s awake, I wrap him in a blanket, which he loves. If he’s sleeping I can just test him as is. My parents just aren’t as confident in the routine.
 
Suzanne & Darcy said:
Why the reduction to 1 unit?
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He kept going really high at preshot and it was making me suspicious that his nadir is at a different time than I think and he’s dipping lower than I’m catching. When he’s done this in the past it’s been because he was getting too much insulin. If the numbers don’t go down I’ll put him back up.
 
He tends to nadir around +4 to +6. It’s also a common pattern for Emmett to have a red or pink preshot test. He’s not getting great duration from the ProZinc yet. Is he eating after nadir because if he eats much apart from a low carb testing treat after nadir that can shorten the duration and cause numbers to rosé prematurely. Of course, this also seems to be a pattern with some cats until they start getting into the better numbers on a more consistent basis. When we start seeing the preshot numbers coming down it will be real progress.
 
Suzanne & Darcy said:
When did you see this? I am trying to find it on the spreadsheet.
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I’m mostly thinking of most of May. His blood sugar was all messed up and it more or less resolved after massively reducing his insulin.

I find that Emmett’s blood sugar will spike up before his typically nadir if he is getting too much (or too little) insulin. The way it typically goes is if he’s getting too much insulin, he will get down to single digits (mmol/L obviously) and spike up before +6 (like around Sept 10). If it’s not enough, he’ll typically stay in double digits and spike up before +6 (like in mid August). Sometimes I just go off feelings haha.

I could be entirely off base, but the September 13 AM cycle made me suspicious of the above trend.
 
Suzanne & Darcy said:
He tends to nadir around +4 to +6. It’s also a common pattern for Emmett to have a red or pink preshot test. He’s not getting great duration from the ProZinc yet. Is he eating after nadir because if he eats much apart from a low carb testing treat after nadir that can shorten the duration and cause numbers to rosé prematurely. Of course, this also seems to be a pattern with some cats until they start getting into the better numbers on a more consistent basis. When we start seeing the preshot numbers coming down it will be real progress.
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I try not to feed him after nadir. The vast majority of the time he doesn’t. Today he didn’t and he hasn’t the last few days, and he never does at night. But if he’s awake and active, he begs for food all day because six hours is just a really long time for him to go between meals so sometime he gets a low carb snack. I don’t like to do that because I know his insulin doesn’t last the full twelve hours.
 
Hello! I wanted to post an update about Emmett.

Turns out I was wrong about going down to 1 unit, and what was actually happening is his fun new pattern of becoming suddenly unresponsive to his dose. We’re back up to 2.5 units and hopefully will be seeing some normal numbers again soon.

This is such a frustrating pattern he’s been showing since June. He’ll suddenly become responsive/unresponsive to insulin and I have to dramatically increase and decrease his dose. And he doesn’t seem to be able to maintain one dose long term, which is really messing with his ability to regulate, obviously.

is there something more going on that I’m not noticing or considering? I don’t think it’s an infection or his eosinophilia granuloma. His food is consistent.

Are there any thoughts about what is going on? I’m almost afraid to ask, but would a different insulin help, or would he just show the same pattern?

His vet was asking for an update so I’ve also explained what’s going on to her.
 
Dropping him back to a much lower dose and working back up was not a good move for Emmett. I think you should pick a dosing protocol- either SLGS or MPM and stick to it as much as possible. If MPM, then only reduce if he drops below 68 on your AT. If SLGS, then only reduce of he drops below 90. Also, hold the doses for 3 full days with MPM and seven full days if SLGS. He was doing better on a little higher dose (although none of the doses are really high - he would not be considered a high dose kitty.)

His doses have been a little wonky and I don’t think it helps him. Now he is a challenging kitty, but I really think following a protocol would help (MPM would be my preference especially for Emmett because he is a cat who seems to have changing insulin needs.) I am not happy to see so many high numbers on his SS. Glucose toxicity has probably set in again and will make it harder to break through. Now he may do better on a different insulin, but it would be more important than ever, if he were to switch to Lantus, to be consistent in dosing and you also would need to shoot low numbers. I hope Emmett is feeling okay?
 
Suzanne & Darcy said:
Dropping him back to a much lower dose and working back up was not a good move for Emmett. I think you should pick a dosing protocol- either SLGS or MPM and stick to it as much as possible. If MPM, then only reduce if he drops below 68 on your AT. If SLGS, then only reduce of he drops below 90. Also, hold the doses for 3 full days with MPM and seven full days if SLGS. He was doing better on a little higher dose (although none of the doses are really high - he would not be considered a high dose kitty.)

His doses have been a little wonky and I don’t think it helps him. Now he is a challenging kitty, but I really think following a protocol would help (MPM would be my preference especially for Emmett because he is a cat who seems to have changing insulin needs.) I am not happy to see so many high numbers on his SS. Glucose toxicity has probably set in again and will make it harder to break through. Now he may do better on a different insulin, but it would be more important than ever, if he were to switch to Lantus, to be consistent in dosing and you also would need to shoot low numbers. I hope Emmett is feeling okay?
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Sorry, I’m confused. Aside from when I tried 1 unit, I only reduce his dose when he hits 3.8. I’m looking at his spreadsheet and there were one or two times he didn’t technically hit that number but only because I had been continuously feeding him medium carb all morning according to the notes. There were also a couple times I dropped the dose a bit because he had a lower than usual preshot number and I wasn’t able to monitor him and knew he was going to go low on the full dose. I’m really trying to stick to that 3.8 number. The problem is, from late August to mid September, he just kept hitting that number on lower and lower doses until suddenly he stopped responding. It’s the same thing he did in June and July.

Im also not happy to see the high numbers and that’s what I’m trying to resolve. His vet just tells me it’s normal. That’s why I’m trying to figure out my options and what is best for Emmett. Shooting low numbers is not a problem, except when I know the dose will bring him low and I’m not around to monitor him.

Emmett is feeling fine. His plays lots and ketones are negative.
 
Hey, sorry for the delay. You are doing great, and Emmett is such a challenging boy (and not just his diabetes). Let me look at his SS again on my widescreen (not my phone, which I hate) and tell you what I was seeing. I think there were just a few moments where I had questions. I'm sorry if the reply came off as negative. I was definitely not criticism. You must get so frustrated, but I admire you keeping at it!
 
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Okay, just working backwards from today, the 1.75 unit dose wasn't held for 6 cycles (September 22 and 23.) I understand how it is to see your cat in high numbers, believe me (remember, my cat was at well over 40 units, plus supplemental short acting insulin, in addition to Lantus at one point in time). The protocols have been tested for safety and so it's best to hold for at least six cycles. Anyway, he's fine so all good.

Then the 1.25 units was only held for 4 cycles (September 17-18), so not according to the MPM protocol. I also didn't understand the 1 unit in there for 3 cycles (p.m. on 9/15 and both cycles on 9/16,) because a reduction had not been earned by dropping below 50 on your human glucometer. Were you just testing a theory? I recall we talked about it.

Those are just some of the more recent (September) things that I was wondering about. Definitely not criticism. You are dedicated to taking care of Emmett. I know you love him. Anyone who looked at his spreadsheet could see how much you love him. He's a special boy, too, from everything you have told me about him.

I just have found over the years that the cats really do a lot better when you stick with the protocols. I didn't believe it at first with my own cat either when I was new to all this. I was also getting some really bad advice that eventually led my cat to go into DKA. But I won't go there.

I have also seen cats who do go up and down in dose a lot. It's frustrating, but actually it makes it simpler in a way when you know what to do (I mean when to increase and when to decrease) by following the protocol. I don't think it's been totally wacky or anything, just a few things that I noticed when looking last night (because we hadn't really talked since about the 15th or 16th of September.) More in a moment. I'm going to send this message before a kitten comes along and wipes out everything I've written.
 
So after having said all that... and studying his SS even more, I am so troubled by the blacks (and you said he's feeling well, playing, ketones neg. ... thank you so much for checking that too!!) ... on his next increase, if his nadirs stay above 200 like they are now, the increase in insulin can actually be a .5 unit increase. From the MPM protocol:

"If nadirs are more than 200, increase the dose by 0.5u. Dose increases should be made every 3-6 cycles and should continue to increase until nadir numbers begin to come down."
 
Suzanne & Darcy said:
Hey, sorry for the delay. You are doing great, and Emmett is such a challenging boy (and not just his diabetes). Let me look at his SS again on my widescreen (not my phone, which I hate) and tell you what I was seeing. I think there were just a few moments where I had questions. I'm sorry if the reply came off as negative. I was definitely not criticism. You must get so frustrated, but I admire you keeping at it!
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Sorry, no, you’re good. I’m just frustrated with him haha.

I’m also realizing I think a few tests didn’t make it to his spreadsheet. The battery on the meter was dying and would shut off immediately after displaying the number, and when that happened the test wasn’t recorded in the memory. So when I went back through the memory to put them in the spreadsheet, some were missing.
 
Suzanne & Darcy said:
Okay, just working backwards from today, the 1.75 unit dose wasn't held for 6 cycles (September 22 and 23.) I understand how it is to see your cat in high numbers, believe me (remember, my cat was at well over 40 units, plus supplemental short acting insulin, in addition to Lantus at one point in time). The protocols have been tested for safety and so it's best to hold for at least six cycles. Anyway, he's fine so all good.

Then the 1.25 units was only held for 4 cycles (September 17-18), so not according to the MPM protocol. I also didn't understand the 1 unit in there for 3 cycles (p.m. on 9/15 and both cycles on 9/16,) because a reduction had not been earned by dropping below 50 on your human glucometer. Were you just testing a theory? I recall we talked about it.

Those are just some of the more recent (September) things that I was wondering about. Definitely not criticism. You are dedicated to taking care of Emmett. I know you love him. Anyone who looked at his spreadsheet could see how much you love him. He's a special boy, too, from everything you have told me about him.

I just have found over the years that the cats really do a lot better when you stick with the protocols. I didn't believe it at first with my own cat either when I was new to all this. I was also getting some really bad advice that eventually led my cat to go into DKA. But I won't go there.

I have also seen cats who do go up and down in dose a lot. It's frustrating, but actually it makes it simpler in a way when you know what to do (I mean when to increase and when to decrease) by following the protocol. I don't think it's been totally wacky or anything, just a few things that I noticed when looking last night (because we hadn't really talked since about the 15th or 16th of September.) More in a moment. I'm going to send this message before a kitten comes along and wipes out everything I've written.
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With MPM can I increase doses by half a unit if he’s not dropping below 200? I know I didn’t hold him at 1.75 for six cycles. I was just kinda being frustrated and dismissive because I figured he would need a lot more insulin anyway.

with the 1 unit, yeah, I wanted to see if it would help the weirdly high PM numbers he kept having. Back in April, when he was consistent, by the end he kept going really high, and the issue only resolved when I reduced his dose, despite him not hitting the reduction number. And then I realized actually he was doing that thing when he suddenly becomes unresponsive to insulin.

i know what he needs is consistency, I’m just finding that so hard to do when he keeps dropping low and then becoming insulin resistant.
 
Suzanne & Darcy said:
So after having said all that... and studying his SS even more, I am so troubled by the blacks (and you said he's feeling well, playing, ketones neg. ... thank you so much for checking that too!!) ... on his next increase, if his nadirs stay above 200 like they are now, the increase in insulin can actually be a .5 unit increase. From the MPM protocol:

"If nadirs are more than 200, increase the dose by 0.5u. Dose increases should be made every 3-6 cycles and should continue to increase until nadir numbers begin to come down."
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Ha, I asked below about a half unit increase before I read this. I think this will help. The problem is that I can’t seem to keep up with his increasing insulin resistance, if that makes sense. Like, in the beginning, he seemed like he would only need a small increase. But by the time I got there, he would need an even bigger increase. And then even bigger. I wanted to head that off but knew I was only supposed to increase so quickly.
 
I should also mention that his vet suggested maybe he has asymptomatic pancreatitis, but this would require a blood test, and maybe that is influencing his changes in doses. Otherwise, she doesn’t ever work with Prozinc (she only ever prescribes Lantus, and it was a different vet at the same clinic that gave Emmett Prozinc) so she isn’t really able to speak on anything Prozinc specific.

Edit: and also, she said that we could start weaning him off Atopica once the lesions on his paw are gone. I no longer see anything, but he is occasionally holding up his paw still. So once he stops doing that, I’ll let her know and we can start weaning him.
 
KLD said:
Ha, I asked below about a half unit increase before I read this. I think this will help. The problem is that I can’t seem to keep up with his increasing insulin resistance, if that makes sense. Like, in the beginning, he seemed like he would only need a small increase. But by the time I got there, he would need an even bigger increase. And then even bigger. I wanted to head that off but knew I was only supposed to increase so quickly.
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We just need to make sure that the doses are held for a minimum of 6 cycles.
 
Emmett dropped below 200 today so think I will increase his dose by only .25 units tomorrow?
 
Any reason Emmett’s numbers are so wild tonight?! His preshot number was 27.2 and three hours later he’s at 37.1. I don’t understand.
 
He’s doing pretty well overall and you are doing a good job. He is a bit bouncy, but he doesn’t stay high too long. I am glad you did the temporary reduction to 2.5 with the lower preshot this morning. I guess he has earned a reduction down to 2.75. What do you think?
 
Oh, I forgot to say I am sorry for the delay in replying. I have not been feeling well for the last three or four days and have not been on the FDMB much recently.
 
Suzanne & Darcy said:
He’s doing pretty well overall and you are doing a good job. He is a bit bouncy, but he doesn’t stay high too long. I am glad you did the temporary reduction to 2.5 with the lower preshot this morning. I guess he has earned a reduction down to 2.75. What do you think?
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Yeah, he’s definitely doing pretty well lately. The more stable dose helps lol. And yeah, I reduced him to 2.75 tonight. Hopefully he does well with this.

Edit: also, I worried about the 37 number the other night, but I’m fairly sure it was a bad test. I should have retested right away instead of an hour later to confirm.
 
Well, Emmett is back on his roller coaster and quickly trending downward with his dose again. Hopefully we will be able to be more consistent this time.
 
Wow I really feel for you. He is a wild man! Here he was going along fairly well on three units and then he decides to go into lime green over and over. It looks like you’ve done everything correctly with the reductions. Let’s try to hold the dose a little longer than normal (a week maybe) to see how he does. I know that sounds crazy, but with all those limes recently it makes me think he needs to stay at a dose for a week and then we decide what to do. I am not saying that we need to do this every week, but just in light of the recent limes and reductions.
 
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Okay wait…. I am really confused now. Were these readings taken with a human meter? You had used the AT and then a human meter and now? That changes everything. If those were Freestyle Lite readings they were not lime greens at all and are perfectly fine for a cat following MPM — in fact they would be good as long as he stays above 50. If you went back to the Alpha Trak then they are lime greens and warrant a reduction. …. Edit…. Sadly, I see you went back to the AT meter and he really did drop too low so…. my first recommendation stands.
 
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Suzanne & Darcy said:
Wow I really feel for you. He is a wild man! Here he was going along fairly well on three units and then he decides to go into lime green over and over. It looks like you’ve done everything correctly with the reductions. Let’s try to hold the dose a little longer than normal (a week maybe) to see how he does. I know that sounds crazy, but with all those limes recently it makes me think he needs to stay at a dose for a week and then we decide what to do. I am not saying that we need to do this every week, but just in light of the recent limes and reductions.
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So to clarify, do you mean keep him at 2.25 for a week, even if he goes into limes? (Also, yes, I’ve been using the alpha trak 3).
 
Sitter unfortunately can’t get a test tonight and since he’s been all over the place I told them to skip the shot for tonight.
 
KLD said:
So to clarify, do you mean keep him at 2.25 for a week, even if he goes into limes? (Also, yes, I’ve been using the alpha trak 3).
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Sorry. The Board went down earlier tonight and my messages would not go through.
I do not mean we will hold the dose if he goes lime. We will still reduce if he goes lime.
 
Do you still have your human meter? I am trying to remember why you went back to the AT. You must be spending an awful lot on test strips.
 
And I wanted to ask you which foods you found that have a few more carbs in them but are still ten percent and under? I need a few food recommendations for another member - things that are higher than the really low carb FF foods - and I remembered that we had talked about it a while ago and you had found a few foods.
 
Suzanne & Darcy said:
Hi there. How’s Emmett doing? I see he’s back at 2.5.
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Yeah, he didn’t seem to be doing too well on 2.25. I don’t know if he just didn’t “recover” very well from the missed dose or what, but I thought it would be better to bring him up again. Hopefully I can keep him on 2.5 for a while and see if he evens out again.
 
Suzanne & Darcy said:
Do you still have your human meter? I am trying to remember why you went back to the AT. You must be spending an awful lot on test strips.
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I still have the human meter as back up, but I’ve been using the AT because his insurance covers the strips, so it ends up being cheaper for me. After insurance pays their share, I end up paying $20 for 50 AT strips vs. $70 for 100 of the cheapest human ones (I don’t think there are any cheaper options in Canada).
 
KLD said:
Yeah, he didn’t seem to be doing too well on 2.25. I don’t know if he just didn’t “recover” very well from the missed dose or what, but I thought it would be better to bring him up again. Hopefully I can keep him on 2.5 for a while and see if he evens out again.
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I’m not seeing a whole lot of difference between his nadirs (or most of the red a.m. preshots) on the 2.5 dose.
 
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