Evie's numbers

AliceL

AliceL

Member Since 2023
Previous thread https://felinediabetes.com/FDMB/threads/can-i-get-any-help-with-mpm.299452/#post-3258806

Suzanne & Darcy said:
Hello, Alice. Are you doing all right? You have had some good blue numbers for Evie recently. How is she feeling?
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Hi Suzanne. She is doing alright I think? It's taken a few days to clear the inflammation that she developed after eating the bad foods that I gave her recently (to stop the steep drop during PM cycle on 26th March + hypo night 25th March) but the symptoms are abating every day. She has been eating the new good food since then and I've noticed she struggles to finish her dished portions - maybe because it's slightly higher carb it fills her quicker or she is more satisfied?

I did a fur shot three days ago and used the opportunity to reset her to a lower dose. She is doing ok on the reduced dose but is slowly trending upwards at AMPS. I can see current dose is not enough and will increase according to SLGS in a few cycles. The reduced dose stopped the diving night time numbers, now she tends to run higher and flat at night.

I have been extra cautious about double checking for ketone development as she has a reduced insulin dose + inflammation symptoms + not overly hungry as before... thats a perfect storm for ketone development as you know but so far so good. We are still at 0.0 ketones.
 
Yes. I think she could do with the increase. She’s been in blue quite a bit, but mostly higher blues. I had noticed that you decreased her dose. I think it was good to be cautious with the food change — to see the effect on her BG. I hope little Evie is feeling better as her inflammation improves. That’s what it’s all about.
 
We got a surprise blue PM preshot number today! I still shot full dose because her last few cycles haven’t had large drops at nadir and I’m curious to see what happens this evening. If she does well enough I may not increase dose tomorrow just yet.
 
@Suzanne & Darcy I feel like a mad scientist on a mission, don't know whether to laugh or cry o_O

For clarity, here are my current foods:
AC Pure Single Protein / Chicken / 8.8% Carb / Slight inflammatory response (sometimes runny eye) - lots of stock in the cupboard.
AC Pure Single Protein / Turkey / 4.5% Carb / No apparent inflammatory response - virtually no stock (only bought test amounts)
Pingo (supermarket brand) / Chicken / 3.3% Carb / No apparent inflammatory response - Can get stock as needed from the local shop

As discussed on 1.4u the dose looked like it was not enough, even though she was eating supposed low-inflammatory foods AC Pure, mostly chicken, some turkey.
She hardly dropped below 200 nadir on her last curve.

This morning's curve:
- 253 @ AMPS
- Increased dose to 1.6u
- Fed 15g AC Pure Turkey 4.5% + 25g Pingo 3.3% (because I saw a slight inflammatory response on AC Pure chicken 8.8% last night and we don't have much of the AC Pure turkey 4.5% left)

+3
- BG 134 (quite a steep drop for Evie)
- Steered the drop by feeding 30g AC Pure turkey 4.5%

+3.5 (30 mins later)
- BG 198 (popped up so much by apparent low inflammatory food AC Pure Turkey 4.5%?)

+4.75 (45 mins later)
- BG 140
- Fed 30g Pingo 3.3%

+5.5 (45 mins later)
- BG 89 (Pingo did not pop her up as the AC Pure Turkey does)
- Fed a mix of 20g Pingo 3.3% + 10g AC Pure Turkey 4.5% (a little turkey to steer the drop)

+6 (30 mins later)
- BG 89 (I feel this was only level numbers because of the small amount of AC Pure added to last feed, if I fed her only Pingo I'm sure this would be lower)
- Fed 30g Pingo 3.3%

+6.5 (30 mins later)
- BG 96 (slight increase but we have probably passed nadir now so that's a consideration too)

Observations
1. Looking at her numbers today it's evident to me that Pingo has the least inflammatory response as it doesn't raise her BG levels at any point on the curve.
It's also easily available at the local store. On reflection, she was eating this food when she last went into remission in 2023.

2. If we are following SLGS (while figuring out inflammation issues) she has officially earned a reduction on her insulin dose back to 1.4u (in just one cycle on the increased dose mind you!)

3. I am planning to only feed Pingo for a few days and see how her curves react to this food going forward on 1.4u.

I might have finally found the way forward in this inflammation journey... but really curious to hear your thoughts on all this?
 
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Oh, wow. That is all pretty confusing— the foods and various responses to them. I applaud your efforts to track everything by each food and the corresponding BG results depending upon which food is being fed. So for now it’s only Pingo while you see how everything goes? She had quite a good cycle today during the a.m. cycle. I guess you decided later on to try 100% Pingo, since I see she had AC Pure and Pingo both today. You are wonderful to be analyzing all of this. I am sure you will figure it all out. I definitely think it is a good idea to try one food at a time for several days in order to see the full effect of different foods on her BG. If she gets a mix, I think we really can’t tell much about what’s happening. Naturally you won’t want to feed food that gives her the runny eye though (regardless of its effect on BG.)
 
Suzanne & Darcy said:
I definitely think it is a good idea to try one food at a time for several days in order to see the full effect of different foods on her BG. If she gets a mix, I think we really can’t tell much about what’s happening.
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I am planning on doing this now, using Pingo exclusively. Yesterday I had to steer the drop using a little AC Pure Turkey because her BG doesn't react to Pingo at higher insulin doses. I may rather do a drop of honey in future as you suggested.

Suzanne & Darcy said:
Naturally you won’t want to feed food that gives her the runny eye though (regardless of its effect on BG.)
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Well exactly. We've had so many twists and turns and unexpected things happen while trying MPM that I would just like to have more of a handle on what is happening with her inflammation so shooting insulin is safer. I am really still traumatised by how I couldn't keep her blood sugar up on that hypo night. In hindsight I had given her Pingo to stop the initial drop - which I've since learned doesn't spike her blood sugar at all. I feel I still have lots to learn about all this though because today she had a slight runny eye - WHY THOUGH as she has been eating Pingo - it's hard to understand what exactly is wrong...ie, is it residual inflammation from a previous food or a reaction to new food? So I agree with you there, I have no more foods to try and feel like Pingo is going to be our best shot right now so I'm going to keep her it exclusively for a long while and see what happens.

By the way, seeing her cycle this morning which is pretty flat so far on reduced dose of 1.4u I think I should modify my SLGS reduction point to 70. We did that last time with Evie because she tended to dive on dose increases...I think that's what happened yesterday but it may have leveled out on a few more cycles with some patience.
 
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So she has just had a big dip now at +5.5 suggesting a delayed insulin response. I know it could be anything - site of injection etc, but it is good to note that the slight runny eye she had this morning has just cleared in the last hour. It appears that the flatter start of the cycle is related to some sort of inflammation response. And my husband just told me he saw her eating grass this morning... Evie only does that when her tummy is sore.

So much to think about and take note of.
But forging ahead, one food PINGO, raise steep drops using honey and modified reduction point of 70 on SLGS. Do you agree with these guidelines?
 
AliceL said:
So much to think about and take note of.
But forging ahead, one food PINGO, raise steep drops using honey and modified reduction point of 70 on SLGS. Do you agree with these guidelines?
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Yes. And I see you have already modified your signature to reflect these changes.
 
And I am glad you only gave Pingo at +5.5 and following.

Looks like her eye clears up when her BG is in the more normal range/lower. Since sugar is inherently inflammatory, this may be why it cleared up today (or a contributing factor.)
 
Suzanne & Darcy said:
Since sugar is inherently inflammatory, this may be why it cleared up today (or a contributing factor.)
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Definitely something else to keep in mind!

Suzanne & Darcy said:
Do you give her a Lysine supplement for her eye? I find it very helpful for my cats with herpesvirus.
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It is helpful to Evie too. But I haven't been able to find a brand since I moved to Europe that doesn't contain flavour ingredients that might also upset her stomach or risking spiking blood sugar due to added glucose etc. I've even emailed a few manufacturers asking for ingredients but found no appropriate products. I am currently doing more research on adding a probiotic at this time to help the inflammation overall.

I must mention, I've noticed a difference in FHV runny eye vs inflammation runny eye.
The inflammation eye produces a red or brown-coloured liquid whereas the FHV eye produces a clear or greenish liquid and her eye is more swollen.
I've been dealing with her FHV clear runny eye for years and it's quite well controlled in general, but this period in life is the first time I have ever seen brown gloop leaking from the eye. I've come to associate that with inflammatory response now instead of the FHV. But you never know.
 
@Suzanne & Darcy
Evie is doing well. Her new reduced dose is holding her quite well - nadir within SLGS guidelines.

Now that she seems more stabilized on the food and responding reliably to her insulin dose I have been looking at food timing to help shape the curve.
Evie's usual feeding schedule is a normal meal at insulin time, then smaller snacks every 2-3 hours along the curve, and even smaller snacks after the nadir.

I've been pondering why she has such a big food spike at +2/+3, and sometimes when she is low at PMPS she even has an inverted or higher curve.
She is also consistently higher during the night cycle than during the day cycle.
So last night I tried a small +1.5 snack to see if it would somewhat blunt that +2/3 food spike by introducing food when insulin is just starting to work and that seemed to help both soften the spike and still bring her nadir lower than ever last night. She had a great cycle with no sharps drops or distress (meowing for food). I will continue to feed a +1.5 snack in the evening to see if that trend continues.

I tried the same +1.5 snack this morning and it seems to blunt the insulin effect rather as she has not gone as low on this cycle as she usually does.
I think she is perhaps more insulin-resistant early in the morning and does better with less food earlier in the AM cycle as per usual.
Tomorrow I will continue with the usual first snack at +2.5/+3 as per other AM cycles, which seems to bring her to a lower nadir.

Hopefully, by balancing these nuances in her AM and PM cycles, we can start achieving lower preshot numbers along with consistent green numbers on both cycles.
 
Suzanne & Darcy said:
It looks like the Pingo has not been keeping her runny eye at bay?
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Oh, I read this too fast. you said it's NOT been keeping her runny eye at bay.

If you are referring to 2 April I'm not that worried about it because we had a little incident on the evening of 1 April where Evie got hold of a raw chicken foot and presumably ate a toe before I got it away from her. She retched afterward but I didn't see the toe so it's possible she digested it. The runny eye the next day could have been from this but maybe not. I'm never sure how to interpret it.

But I haven't seen much of the runny eye in the last few days so I think it's ok maybe. It's really hard to pin down exactly what is happening here with that eye.

I'm still waiting on the probiotics and I might go back to the vet to get some eyedrops for itchy eyes to see if that helps.
 
AliceL said:
Yes, there's definitely an improvement. She gets a touch of it here and there but hardly ever enough to even note and it clears up quickly.
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Okay. That’s good. I saw it in your remarks and was concerned it was back to being a regular occurrence — even though you didn’t mention it daily. So it’s improved a lot. Very good.
 
@Suzanne & Darcy We did a routine ketone test this evening, she has 0.3 ketones. I suspect it's come about due to feeding Pingo which is very low-carb. I have started adding water to each meal but maybe I can also feed her more volume of food to help the ketone issue. She is currently eating around 300g a day which is ok for her weight bracket. The ketones are not overly concerning yet but I don't really want to change foods when things are going quite well. However, if ketones increase I will have to feed higher-carb foods, and that means starting all over again trying to find something that doesn't upset her system. Clinically all is well, she is not drinking water, not dropping weight like before, very active, no lethargy. I will watch her like a hawk as always of course.

She had a great preshot number this evening. I'm going to use my strategy of feeding a +1.5 snack during the evening cycle to see if I can prevent an inverted curve or high food spike resulting in a higher than preshot curve... that is usually what happens with a low PM preshot number.
 
I was just looking at the evening cycles going back a week or so. I do not see an inverted curve. What I see is very typical of a lot of cats on ProZinc. There is a +2/+3 where numbers have risen a bit before they start to decline for a while and then go back up. The rise in numbers after the shot can be due to the fact that the previous shot has worn/is wearing off and the new shot hasn’t onset yet. So during that time, it’s not uncommon for numbers to rise a bit before descending down toward nadir. Some cats will get a food bump during this time but, unless a cat is extremely carb sensitive, it’s generally not a very big food bump. Combine those two things together and a ProZinc cycle looks a lot like the ones Evie has been having in the evenings recently. You said the Pingo is very low carb so it’s probably not bumping her up too much or for too long. Your snack timing is a good idea — to see what works for Evie.
 
Maybe inverted curve was the wrong description, when she has a low preshot number she will often have a curve where the nadir is higher than the preshot number. But your explanation makes sense. Let’s see if the snack helps her to stay with the lower nadirs we’ve been seeing on her night curve lately…
 
AliceL said:
when she has a low preshot number she will often have a curve where the nadir is higher than the preshot number
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Which dates? I am trying to find it to see. I do see a couple of nights where this may have been the case, but the nadir may have occurred after the last test for the night. (30 March and 31 March - p.m.)
 
She’s on track to have a lovely cycle. I would not have given honey yet. The normal guidance at this point would be to give a small LC snack to encourage her to surf in green and to monitor.
 
And you should be able to use only honey? That is IF honey became necessary.
I think you are still really feeling frightened of green after the 20-ish numbers that evening. I do understand.
 
Yes, it was very scary last time. I really do still feel very traumatized by it.

I just know yesterday she dropped about 90 points between +3 and +5, despite eating a meal, because Pingo doesn't stop the drop at all.
I expect it to not stop the drop tonight either. Anyway, I just gave her a tiny drop if honey which seems to have blunted the drop a little in the last half hour.
I will monitor again at +4.5 and decide to feed her more food then.
 
AliceL said:
Yes, it was very scary last time. I really do still feel very traumatized by it.

I just know yesterday she dropped about 90 points between +3 and +5, despite eating a meal, because Pingo doesn't stop the drop at all.
I expect it to not stop the drop tonight either. Anyway, I just gave her a tiny drop if honey which seems to have blunted the drop a little in the last half hour.
I will monitor again at +4.5 and decide to feed her more food then.
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Yes. It is rather limiting to only be able to feed the Pingo, isn’t it. Sorry.
 
Suzanne & Darcy said:
Will she eat food if you just mix a drop of honey into the food?
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I think so, never tried it but Evie loves her food so she probably would. Honey is the only thing I can really use to stop a sharp drop without resorting to our other foods which all seem to be more inflammatory.

The next food up to try would be the AC Turkey at 4.5%. Not outwardly inflammatory (ie no runny eye after) but it shoots her up about 60 points after eating it so I think it must be more inflammatory than the Pingo. She has done really well on the Pingo and it would be a shame to go backwards now.

Suzanne & Darcy said:
94 is good
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I'm going to test again in 15mins just to check that wasn't a temp reduction of rate of drop due to honey. I would prefer she drift down, not fall like a stone!
 
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77 @+4.5. I'm going to feed her some Pingo but a drop of honey or not? She is usually lower between +5 and +6

Edit: I added a drop of honey. Because I know the rate of drop has resumed after that honey bump and Pingo doesn't pop her up. Honey is essentially my mid-high carb food now.
 
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I know I said we should modify the reduction point to 70 but perhaps I don't have the constitution for that right now.
I might feel more comfortable with it later on if she is constantly earning reductions or her dose is smaller so the rate of drop isn't as steep.
It would also help my nerves if I did have other foods to feed that helped to stop the rate of drop but I just don't right now.
Perhaps better to err on the side of caution?
What do you think @Suzanne & Darcy?
 
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66 @ +5. I've given more honey because I need it to pop right up now. Her lowest point may still come in 30mins-1hour if yesterday's cycle is anything to go by.
The single drop of honey only blunts the drop to 10mg/DL per half hour.

If the rate of drop hasn't stalled or reversed by +5.5 I'm going to have to give AC Turkey. Because I can't risk coasting so low without high-carb foods.
 
That honey during the evening cycle made her cough during the night. Poor girl.

By the way, I'm not scared of green numbers, I want the greens! I want her to spend as much time as possible in the green numbers because they are optimum numbers for pancreas rest and recovery. What I’m more nervous about is how to slow a steep drop without feeding her inflammatory foods.

To reiterate:
LC 3.3% Pingo / 30g - doesn't stop / blunt / surf drops at any point on the cycle between +0 and +6 according to my previous tests. Likely non-inflammatory
LC 4.5% AC Single Protein Turkey / 30g - shoots her up as much as 60mg/dL between +0 and +3, and around 40mg/dL between +3 and +6 (as insulin gains traction after +3 and rate of drop doubles). No outward inflammation effects (no runny eye) but BG runs higher on this food alone so I expect it's slightly inflammatory.
MC 8% AC Single Protein Chicken - known inflammatory
Hypo foods >15% - likely inflammatory
Honey - temporarily reduces the rate of drop, and also could be mildly inflammatory

Last night's rate of drop and why I decided to use honey at various points
+0 (197) to +3 (127) = approx 23.3 mg/dL per hour / fed Pingo twice during this time at +0 and +1.5.
+3 (127) to +3.5 (101) = approx 26 mg/dL per half hour, double the speed as insulin gains traction / fed Pingo once during this time at +3 / drop of honey +3.5 to slow steep drop because if I don't slow the current rate of drop she could be 75 @+4 / 49 @+4.5 / 23 @+5.5 (nadir likely between +5 and +6)
+3.5 (101) to +4 (94) = approx 7mg/dL per half hour, rate of drop slowed by honey I suspect as I've previously noticed Pingo does not stop drops at any time during the cycle
+4 (94) to +4.5 (77) = approx 17mg/dL per half hour, rate of drop picked up again as honey glucose is short-acting / fed Pingo with another drop of honey because if I don't slow the current rate of drop she could be 60 @+5 / 53 @+5.5 / 37 @+6 (nadir likely between +5 and +6)
+4.5 (77) to + +5 (66) = approx 11 mg/DL per half hour, rate of drop slowed by honey but not as much as before, likely insulin action is peaking / gave 2x drops of honey because if I don't slow the current rate of drop she could be 55 @+5.5 / 44 @+6 (nadir likely between +5 and +6)
+5 (66) +5.5 (88) = out of the woods as nadir likely past

I just have quite a unique issue here where I’m trying to simultaneously manage Evie’s food sensitivity along with the diabetes.
My food testing and subsequent careful monitoring have taught me so much about how she reacts to different food.
I know this is an unusual way to manage this but I don't know what else to do.
Maybe you have some suggestions on how to proceed going forward?
 
Evie’s curves are running higher than usual the last few cycles, it looks like we’ve lost efficacy on the current dose. The only thing I changed is my dose time from 5 to 6. I did this because I saw a +9 snack in the night cycle improves her AMPS.

Anyway, do we think a dose increase is warranted or hold for a few more cycles?
 
She had some unusually low PM preshot numbers lately that needed temporary reduction for that cycle. Since then we are running flat curves at the resumed dose so I’m really not sure if I need to increase or reduce dose. I think increase but I’m wary of overdosing. Seems odd that her dose would just suddenly lose efficacy like that based on a few temp reductions.
 
I was just thinking about you the last few days!

Evie looks like she is doing very well! I don’t see any reason to reduce the dose (it looks like she should have had the full 1.4 today although that is just hindsight.) The last two cycles she’s had excellent duration. The lower preshots are actually what we are want to see. It looks like she could do with an increase, but I know that you will only do that when you’ve satisfied any questions in your mind or things you are concerned about. What I see is a cat who is quite stable on this dose and who is not doing any diving. I am actually really pleased to see this…. lots of blue and even her yellows are not very high. :)

How are you feeling about her inflammation and the symptoms of it? Does she seem to be feeling well?
 
Suzanne & Darcy said:
How are you feeling about her inflammation and the symptoms of it? Does she seem to be feeling well?
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I think she is doing amazingly well. No signs of inflammation, and the runny eye is a distant memory, we haven't seen it for 3 weeks. She had a few short coughing fits when her sugar was>250 but I think that's a mild marker directly related to the high glucose. It goes away once she stays in blue numbers. I also feel her BG reacts much better to her food now as well - I've noticed the Pingo does help her to surf or pop her up a little when insulin is working hardest whereas previously it wasn't doing anything, I'm thinking it's all about better digestion possibly?
Overall I'm really happy about all of it. I feel like I've finally fixed what broke her - now to work on the diabetes.

Suzanne & Darcy said:
The lower preshots are actually what we are want to see.
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Yes, she was getting low PMPS but I finally figured out the key to lowering AMPS. I noticed the few times she ate her 3am/+9 snack from the automatic feeder she had much better AMPS numbers. However, she was not eating it consistently by herself, so for the last two days I've been setting an alarm and prompting her myself.

Suzanne & Darcy said:
it looks like she should have had the full 1.4 today although that is just hindsight
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I agree with you there, but it was our lowest ever AMPS so I had no data about what a full dose would do. She has reacted differently on the day vs night cycles previously. Going forward I will shoot a full dose on anything >140.

Suzanne & Darcy said:
What I see is a cat who is quite stable on this dose and who is not doing any diving
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Suzanne & Darcy said:
It looks like she could do with an increase, but I know that you will only do that when you’ve satisfied any questions in your mind or things you are concerned about.
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I want those greens so I agree with an increase. I would just prefer a couple more cycles of lower AMPS (my 3am feedings) to see if she will continue to trend lower by herself if I can get her to hold those blues throughout a full day. Today is the first day she will have a whole day of blues. I want to see if I can get it to hold tomorrow and possibly increase to 1.6u on Monday morning.
 
With regard to the lower AMPS:

For some cats, food brings down the numbers (pancreas produces insulin in response to food). So we suggest feeding a snack at +9 in both cycles to see if that gets rid of the blue preshots (or in Evie’s case the yellow preshots.) This is not something we usually recommend until a cat is on a very small dose and is nearing remission. It is a strategy to help them into remission and can really bring down the preshot numbers in a cat whose pancreas is working/sputtering back to life. I am happy that it’s helping Evie even now though. I think that is a good sign!
 
I’ve been wondering about that myself, it does feel like the late cycle snack is prompting endogenous insulin doesn’t it. Another alternative I’ve considered is that she is experiencing hunger stress on top of dawn phenomenon and the late cycle feed is helping to control those early morning cortisol levels. The poor girl gets really stressed out by feeling hungry. Whatever it is I’m just happy to help lower her sugar levels in any way.

PS. Last night we had an unusual steeper drop into green at +6. Nothing had changed, we fed her usual routine until then but husband panicked a little because I was asleep and fed her a slightly larger meal at +6 which popped her up into blues again by +7. She still gave us a nice AMPS this morning. Her mid cycle reading was close to my modified reduction number of 70 but I know Prozinc has the odd sharp drop so I’ll continue holding dose for a few cycles as discussed and see if we continue to trend towards lower numbers…
 
Yes. A nice nadir last night. :D Good things are happening. I agree about the fact that some cats get really stressed about being hungry. I’ve seen a few who had rough backgrounds where they we hungry as youngsters and they got very stressed when they were hungry…. And the BG went up.
 
I see Evie is dropping into a little green at about +6 at night and she has continued to have the blue AMPS. I think you have figured out the best way of feeding her. :)
 
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