Finding Alex's Dose

I think a little increase is a good idea. Hopefully you can start to build some longer duration. And like you said, hopefully he'll stay out of the lime green numbers!
 
I really don't know what to do to get these pre-shot numbers to go down. They're always high in the mornings, but this morning was incredibly high, the worst it's ever been at almost 29. I use Freestyle Insulix strips which are usually pretty close but sometimes can be up to 5 points off, so I double checked with an AT2 strip and it was even higher (32.3). I'm going to watch to see when he goes to the bathroom and check for ketones, and I wasn't planning on doing a curve today, but I might do a few more tests between now and +6 to see how fast he drops, but these AMPS/PMPS numbers don't seem to be improving even a little.
 
Another thing I've noticed actually is that the last few days about an hour before he gets his shot in the morning, he's been throwing up stomach acid with bits of fur in it. He's a long haired cat and can get really bad hairballs which sometimes can take him a few days to actually get out and he'll just throw up stomach acid in the meantime until he manages it, but the fact that it's specifically in the mornings about an hour before shot when I know he's absolutely starving is a little concerning.
 
Does he have food out that he can eat overnight? that puking sounds like what cats do when they've been without food for too many hours.

As for the high AMPS, it's really not that much higher than some of your other high reds, however, it's also possible that he's going into the lime green numbers overnight and it's a bounce from there. The nighttime cycle is quite different in some cats than the daytime cycle. As often as you can, try to get at least one number during the PM cycle (before bed, as soon as you get up, or anytime if you get up to use the bathroom during the night). It's hard to get these nighttime tests in, but they really are important.
 
I checked for ketones just now and he was fine.

He does have a middle of the night meal on a timer to feed him at +6, which matches what I give him at +6 in the middle of the day, but he eats it very quickly and I know it's gone in under an hour. I have two cats and so it's hard precisely to know how much each is getting, but I know Alex is eating the bulk of the wet food I put out to the point that I've started sneaking dry food to my other cat Simon when Alex isn't looking because Simon likes to graze and Alex will eat whatever is in front of him for the most part. I'll try to get some middle of the night numbers.
 
He dropped quite well, but actually is climbing up earlier than usual which is frustrating. I think I'm going to change his feeding schedule a little to force him to graze more. Won't give as much food at shot time and then set the automated feeder for +4 and +8 rather than just +6 and hopefully smooth out his feedings so he's not binging as much at meal times and then going completely without for usually 5.5 hours. I worry that he might be without food at his lowest point, but I'll try to wake up at 2-3am to give a check since his nadir is around +5-6
 
Checked in the middle of the night and his numbers came up fine, so I don't think the high numbers are due to bounces. I may just need to eventually switch to a different insulin because if I do increase the dose it seems to increase the strength so he'll drop lower, but not really the duration. Whether he ends up in hypo range or in the blues or even yellows, he's still up around 25 by shot time.

The changing of the feeding schedule seemed to help him from being completely starving this morning and he didn't throw up, so I'm going to keep that going. It actually ends up easier in the long run since I can set up his +4 and +8 meals at shot time and don't actually have to go give him more food during the day or night.
 
Tomorrow I'm going to try for the third time to bump it up to 1.5 proper because this dose seems to be getting less effective. I'm almost worried something happened to the insulin but I'm not sure what? I'm careful with it but I don't know if I need to be even more careful.

I was encouraged for a while about a week ago, but he seems to be sliding backwards and I'm not sure what to do.
 
As far as the insulin - you probably already know all of this, but just in case:
1. make sure it's in the center of the fridge - not the door
2. roll it to mix - never shake it
3. Keep it in the fridge - never leave it out
4. If it ever freezes it has to be tossed
5. Never inject air into the insulin itself. However...(see #6)
6. When drawing the dose: 1) draw air into the syringe to the dose you want. 2) while the vial is sitting on the counter, insert the needle into the rubber stopper, and inject the air from the syringe into the air in the vial (not into the insulin itself). 3) invert the vial and draw out the dose.

If you're doing all of that, and you don't see any floaties in the vial, then the insulin should be fine.

Good luck with the increase. Hopefully since you've crept towards it slowly, the 1.5u will work well for Alex!
 
It's always been in the fridge but I do worry that the fridge runs cold sometimes and it's such a tiny bottle of liquid it might have frozen or developed ice crystals in it that I wouldn't have seen. There's be no way to know other than decrease in potency, I guess. Since this is still my first bottle of insulin, once it does go bad is the decrease dramatic (like it just stops working entirely?) or is it just a little weaker over time and the numbers will start to climb up and eventually I need to make a judgment call about when to get a new batch?
 
Asiina & Alex said:
It's always been in the fridge but I do worry that the fridge runs cold sometimes and it's such a tiny bottle of liquid it might have frozen or developed ice crystals in it that I wouldn't have seen. There's be no way to know other than decrease in potency, I guess. Since this is still my first bottle of insulin, once it does go bad is the decrease dramatic (like it just stops working entirely?) or is it just a little weaker over time and the numbers will start to climb up and eventually I need to make a judgment call about when to get a new batch?
Click to expand...
My guess is if it's losing its potency for less catastrophic reasons the increase in BG would be gradual. If it was subjected to something like freezing (for example) it would likely seem almost completely ineffective right away.
 
And then I check this morning, prepared to raise it to 1.5u and his AMPS is 20.5, the lowest it's been for weeks!

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Now I'm debating whether to try 1.5u again and I'm not sure based on this latest trend. Yesterday was great and today is pretty good too, but still higher than I'd like. It's hard to know whether to increase when sometimes he's yellow during his typical nadir but it's possible he's dark green.

I changed his feeding right around when the yellows started happening and that is helping a bit with the binging and starving, so it does make me feel a little more confident that he'll be a little less swingy, but I still worry about those days when he's in the dark green already.

What would you guys do?
 
You could try leaving him at 1.4 u for another cycle or so to see if he goes down to dark green. You've seen lime green at 1.5 u twice but he won't necessarily do that again. You could "sneak up on it" by trying a fat 1.4 u. You're using syringe lines to measure out 1.4 u so you should be able to place the flat surface of the plunger in a slightly different position wrt the 1.4 u line so that it's a tiny bit more than 1.4 u. Fat and skinny doses take some getting used to but can be a good thing to try.
 
Attempting 1.5u for a third time. Let's see if he dives again! If he gets too low even this time after spending so much time inching towards it, I'm just going to decide that 1.5u is too much and not try to push it again.
 
So my mid-day test showed it was about the same as the 1.4 which is fine. I'll keep at it for a few days and watch him. I'm wondering how much the feeding change has affected him. So for the record he went from one big meal at shot time and then a little meal at +6, and the same overnight. I changed his feeding schedule right around when these yellows started showing up (I should have written down when I changed it because now I can't remember exactly) to be a medium meal at shot time, then two little meals at +4 and +8. He's getting the same amount of food, it's just spaced out more evenly because he's bad at grazing. It also means that my nadir test at around +5.5 on average is now after he's eaten within the last 2 hours, as opposed to just before I give him his first meal in probably 4-5 hours (depending on how fast he finished his meal from when I gave him the shot).

Is it possible that the drops were just because he was too hungry mid-day and really his dose should be higher overall? Can spacing out feeding time make that much of a difference?
 
We've actually found that a lot of cats do better with their BG when their food is spaced out through the day. I'm not really sure WHY but I've seen it time and time again. Maybe because their BG can be more stable through the day since it has food on board more consistently? Anyway, yes, changing feeding times could definitely affect the BG numbers. Let's hope that this new food schedule and the 1.5 dose can work well together and we can help you get Alex into nicer numbers!

As for not feeding 2 hours before a test, that's only a worry at shot time. That's just so you don't shoot on some artificially inflated number. Throughout the day, even on curve days, you want to feed as you always do and just test whenever you need to. :)
 
It's not that I try to keep him without food. He just eats all his food so fast that he ends up with nothing to eat for most of the day. I have the automatic feeder giving him his +4 and +8 meal, but I can't really be around to give him small meals all day. If he ate slower he'd always have food out (other than the 2 hours pre-shot). He's definitely getting enough food and I worry about overfeeding him as it is. I've had to start giving the other cat meals and dry food on the side when Alex isn't paying attention, to make sure that he's still getting enough.
 
Bad last night, but a good morning. I'd gotten so used to red numbers that even pinks feel "low" for me and make me nervous to give a full dose. I've only seen yellow once at pre-shot since starting. Some parts of this feels so routine and some still makes me nervous.
 
Good job sticking with the dose. Hopefully he'll find his way towards some healthier nadir numbers soon!
 
Thanks :)

He did have good nadir numbers, but the change in feeding schedule made those go away. I don't mind so much though, since it means I can probably increase the dose eventually and get all his numbers down eventually, instead of him swinging so hard in both directions. I had been locked out of 1.5 even though I knew it wouldn't be enough because of his nadir numbers. Hopefully I won't have to change insulins now.
 
Alright, so it's clear the feeding change has had a big impact. I'm actually a little relieved, since I have the options to increase the dose that I didn't before. So I'm wondering when I should just accept that he should go higher than 1.5u? His numbers are getting worse, not better, now that he has more steady access to food.

Should I do a curve tomorrow and then increase to 1.75 over the weekend? Do you guys think a curve is necessary? Should I wait a few more days?
 
Any advice? I don't want to rush him, but it really does feel like 1.5 isn't working on this new feeding schedule. He was doing better before. I'm almost worried the insulin is less effective, but it's only been about 6 weeks.
 
His food is low carb wet, right? The schedule does seem to have had a pretty dramatic effect. Although as you said, having him steadier does make the dosing work better. It's just too bad that steadier also means higher in this case.

Normally I don't think doing full every-two-hour curves are necessary, but there really isn't enough data to be sure if he nadirs early, mid, or late, so I think I would recommend doing a curve if you can. You want to be sure that those yellows really are representative of his lowest point in the cycle. It's not impossible that he is going lower before or after that and it's just not being caught.
 
Yes, he's getting the same Friskies pate he's been getting the whole time, and it's all low carb. I alternate between the whitefish and tuna, salmon, and seafood supreme since he can get kinda finicky if he gets the same food several times in a row. I feed two cans a day for both of my cats. He eats slightly more than the other one so is getting about one and a quarter to one and a half cans per day (other cat gets dry food on the side to make up for his not wanting wet food all the time, but always supervised so Alex never gets any).

I'll do a curve tomorrow. I don't think it'll really tell me anything I don't already know, but just to be sure and then likely increase his dose over the weekend.
 
Not actually a bad curve today at all! Sure the numbers are higher than you want, but you had a nice drop into mid yellows, which is a pretty good drop from AMPS. I do think it's time to go ahead and increase the dose...tonight or tomorrow if you'd rather do it during the day. Hopefully that'll help get him into better numbers throughout the cycle!
 
Yeah I'm pleased with how the day went. It's still high, but I'm not really worried about high numbers right now as much as how steep the curve is. It's much gentler now, so I feel safer increasing the dose. I'll do it in the morning so I can monitor him throughout the day.
 
How do you know when an insulin vial is becoming less effective? I'm getting really scared for Alex that he's still so terribly unregulated after all this time. Every day is just red and black numbers and he never seems to be getting better about that. There's no improvement at all there. The feeding change has made a larger impact on his pattern than the insulin has.
 
I checked him for ketones and he's negative still, although he ate the meal that usually takes him about an hour to 90 minutes to eat in 7 minutes. All of his food I just gave him is gone and he threw up stomach acid this morning.

I don't know if the other cat overnight ate too much of his +8 meal so he didn't get much, but he just ate half of a can of friskies in less than 10 minutes and is still here begging me for more.
 
If they drop 50% in a cycle, the insulin is working. So now it's just a matter of continuing to work with the dose. You did a good job of just keeping that last dose for six cycles, and then moving up to the next baby step. And while you're right that the PS numbers are too high, the curve really shows a good response. It's just going to be a process. He really hasn't been on insulin very long at this point. It's so hard to be patient when you're seeing red and black numbers, but there really isn't any way to speed the process.

I can't remember what you've said about Alex' weight? If he's under weight, it's okay to feed him more - high numbers do legitimately make them hungrier. If he's over weight, he might just have to tough it out until snack time. Regardless I'd make him wait a little bit so he doesn't throw up. A full meal that fast has a tendency to make a reappearance. :confused::eek:;)
 
He's a little underweight, although he's gotten better. He's about 10.5 lbs but is a large frame, so I can feel his spine and rib and hip bones quite easily. Hard to visually see his weight because he's so fluffy and the long fur makes him look bigger than he is.

I know it was just one day, I was just really hoping the 1.75 was going to make a bigger difference. I'd agonized about going from 1.25 to 1.5, but with the feeding change his numbers just haven't come back down. I'd gotten really hopeful consistently seeing those single digits a few weeks ago, and they haven't been back since.
 
I only need to wait 6 cycles before increasing, right?

Much better mid day numbers today, but these black numbers at pre-shot are getting more frequent and I'm getting scared. He was having some trouble with his legs earlier today and he was so hungry that I fed him more than I usually do. He eats so fast that he burps a lot after eating and I worry he's going to throw up.

I know I'm doing everything that I can but he was doing well for a while and now seems to be getting worse. Some days this feels manageable and some days it's like I'm just taking notes as I watch him waste away.
 
Yes, you can increase after 6 cycles if you're not seeing lower mid cycle numbers. I know this is scary, but give it time...he's getting some good responses to the insulin and it really DOES take time. Remember that he didn't become diabetic overnight, and he won't get better overnight either. :bighug::bighug:

You could try giving him smaller, more frequent meals so he doesn't eat as much at once, but is still getting more food. I can't recall your feeding schedule, so if you already do this, ignore me. :)
 
I updated my signature to put in his meal schedule, since I did change it and that's what had him end up higher, although less starving over the day. If he was staying the same it wouldn't be so bad, but I'm seeing black every day now at at least one pre-shot test, whereas before it was pretty rare. It feels like he's getting worse.
 
Is there anything going on that might be causing him inflammation? Is he having any litter box issues? Dental issues?
 
No. He uses the litter fine, and eats great. He could probably get a cleaning, but his teeth aren't bad for his age. His gums look fine.

When he was diagnosed in January we didn't know what was wrong with him so they did a full lab workup and found nothing but the diabetes.
 
I took a really good look at Alex's gums (which he hated) and they are a bit red, and then I tried brushing them gently and they bled, so I'm going to see if the vet can give me an estimate of dental work, since if he does need dental work his diabetes will never be controlled until I do it. I'm likely going to have to go into debt for this, as I hear it can cost thousands of dollars, but there's no point in continuing diabetes treatment if it's just being counteracted by gum disease so right now I'm just throwing money away.

I don't really know what else to do at this point because the dose seems to have no relation on how the insulin works The insulin is working, he has a nice curve, but I'm getting the same curve regardless of whether I give 1.25u or 2u. He's in the red or blacks at pre-shot and drops to yellows or maybe high blues at nadir.

Those two weeks mid-February of blues seem to be a result of him being hungry at the same time as his nadir, because as soon as I changed the feeding schedule so he could eat smaller meals more often, they went away and haven't returned.
 
Goodness, I hope not thousands of dollars! They are expensive, but with all the blood work and meds and procedure it shouldn't be more than one thousand - unless there are perhaps a number of extractions involved. They are certainly expensive, but hopefully less than you're imagining.

I would strongly encourage you to switch to a human meter. For one thing, they are much less expensive, and much more convenient. And for another, the numbers read so much better while still giving you the data you need to adjust doses. I really do think it would make you feel better, and how you are feeling about all of this matters a lot. :bighug: Plus, the study on which we based our guidelines for dosing was done using human meters, so it just fits a lot better. Of course you can keep using the AT2 if you prefer, but I'm a big fan of using human meters.
 
In the high ranges, a human meter and a pet meter can give quite different numbers. So a 400 on a pet meter might be a 300 on a human meter. There's no way to convert between the two, so those are just random numbers.

In the lower ranges, the two can be quite similar, and sometimes the pet meter will actually read lower than the human meter, although they're usually fairly close in the green numbers.

So while the human meter isn't precisely accurate, it still gives you the info you need: too high, too low, just right. If you decided to switch it would take you a little while to mentally adjust, but once you do, I think it will help you feel better.
 
I ordered one of those free human meters that are available in Canada, so I'll give it a try. In the meantime I'll try not to freak out too much about the exact numbers of too high, and just accept that it's too high.

I am still frustrated that nothing seems to bring these pre-shot numbers down, but I did get a 6 yesterday, which was nice. It's been a while since I've gotten a nice nadir number like that.

I'm going to see about getting that dental work done, but he needs some vaccines first (he's completely indoor so vets haven't ever really insisted on it). I'm working with the vet because I'm a little worried about the vaccines when his diabetes isn't controlled super well. I know they can sometimes cause mild illness and I don't want the illness plus the lack of control to trigger DKA.
 
Hopefully getting the dental work done will help. and while vaccines can make them a little blah for a day or two, they bounce back pretty quickly.
 
Talked to the vet. They might wave him on the vaccines because of the risk of DKA and he can get them once his diabetes is more controlled, but they want to do an exam first to see if he can even handle the dental work and whether he really needs it. I look at his gums and they're a little swollen on the gum line and there's some discolouration on the teeth, but I'm really just guessing on how serious it is.

Another bad sugar day, which sucks. I try not to get so worked up about particular days and look at the whole, but it's hard. This is pretty personal, but I went to the doctor myself today and get some anti-anxiety medication because I haven't been sleeping well because I'm so stressed about this. I'm starting to dread pre-shot time because I know it'll be bad and there's nothing I can do about it.
 
Yes, I saw that mid-cycle and almost said something. Days like that are hard. :bighug::bighug::bighug:

All of this can be quite stressful, so I'm glad to hear that you are taking care of yourself and getting the help you need for now. We spend so much time giving our kitties what they need that it can be hard to step back and make sure we're taking care of ourselves too. You are taking steps to do that, which is so good! It's kind of like they say on airplanes - we have to make sure we have our own "oxygen mask" in place first, right?
 
I posted this in the main forum this morning but haven't gotten a reply and I'm not sure what to do.

Alex has allergies, I think. He's been coughing a bit and his nose is runny. He's still eating and drinking, but obviously his BG isn't where I want it to be. Today especially he was pretty high at nadir. I've been testing him for ketones every day, but the last few days he's been closer to trace than none, it's kind of in between. I realized that the light in the bathroom wasn't the best, so next time he goes I'm going to make sure to get a reading with good light. By the time I did get good light last time it definitely was at trace, but it had been longer than 15 seconds so I'm not sure.

I have no idea when this becomes an emergency. He's going to see the new vet on Wednesday so if I'm just being paranoid, I don't want to potentially waste hundreds of dollars I don't have for them to say that he's fine.

I've put out extra food which he's eaten and even made him drink a little more water just to make sure he has every opportunity to flush these out (also so that hopefully I can get another test in again today). I'm trying not to freak out but failing pretty bad.

There's lots of information about how ketones are serious and DKA can happen fast, but how fast is fast? 6 hours? 12? 24? 48?

If he really was at trace a few hours ago but let's say worst case I'm not able to check again for ketones until tomorrow morning, is that fast enough for it to turn into DKA without me noticing?
 
Ughhh

Alex broke into contraband dry food this morning. We keep dry food around for Simon, and when I woke up this morning and realized that neither of them were bothering me for food I knew something was wrong. Sure enough I find them and the container is open on the floor with the lid popped off. I need to start using a lid that locks, they're getting smarter.

Well, Alex was still unregulated anyway, so I don't think this will make a huge difference, but I imagine today is going to be a pretty high sugar day since he'd be snacking on junk food for some amount of the night.
 
Yuuuup. Over 30 for AMPS. I know he ate dry food in the last 30 minutes, so it's artificially high.

Hopefully because it's carbs it'll burn off quickly and won't affect anything beyond this cycle? I'm actually not sure.
 
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