High at 4am, give dose early or wait?

Kathy4Lewie

Kathy4Lewie

Member Since 2018
Lewie’s insulin shedule is 3 units Prozinc at 7 am and 3 units at 7 pm. I’ve just started home testing and he is high in the mornings. I test with a ReliOn Confirm and the reading is “Hi” so I think that means over 600. Two hours after injection, 570. By 6pm he is at 330. My vet isn’t concerned with the “Hi” in the morning since his numbers come down. I tested at 4:30 this morning and he is “Hi”. I went ahead and let him eat his ProPlan DM dry food.

My question is: since I tested at 4:30am and he is “Hi” and he ate, should I give him his insulin early or wait until his normal 7am injection time?
 
Kathy4Lewie said:
Lewie’s insulin shedule is 3 units Prozinc at 7 am and 3 units at 7 pm. I’ve just started home testing and he is high in the mornings. I test with a ReliOn Confirm and the reading is “Hi” so I think that means over 600. Two hours after injection, 570. By 6pm he is at 330. My vet isn’t concerned with the “Hi” in the morning since his numbers come down. I tested at 4:30 this morning and he is “Hi”. I went ahead and let him eat his ProPlan DM dry food.

My question is: since I tested at 4:30am and he is “Hi” and he ate, should I give him his insulin early or wait until his normal 7am injection time?
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Can you adjust the time in the evening as well? What have the numbers been mid cycle? It would be easier to advise you if you could set up a spreadsheet of share your testing log.

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
I will start a spreadsheet. I just discovered this group yesterday. What do you mean by adjust his schedule in the evening, too? I got up early this morning to see if I could feed him early before his blood sugar went high, but it’s already high. I have not given him in an injection yet since it’s only 5:45 AM now and he’s not due until 7 AM.
 
Kathy4Lewie said:
I will start a spreadsheet. I just discovered this group yesterday. What do you mean by adjust his schedule in the evening, too? I got up early this morning to see if I could feed him early before his blood sugar went high, but it’s already high. I have not given him in an injection yet since it’s only 5:45 AM now and he’s not due until 7 AM.
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What I mean is if you did shoot 4 am you might do 5pm. Then 6am then 7 pm if you wanted to get back to the 7/7 schedule. ProZinc let's you adjust up to an hour.

Id say it sounds like you need a dose increase but it's hard to say that without data. :).
 
I did NOT shoot at 4am... I just tested.

I replied from my email but it did not post so I will post my reply here:

I just entered what information I have on the spreadsheet. The vet didn't want me testing at home so the tests are sporadic because I was just testing to learn. When I took Lewie to the vet on 8/31 his PMPS value was 330 and the vet was happy with this and said not to adjust his dose, even though his AMPS value was 600+.

Lewie's AMPS value have been 600+ for 3 days now. I called the vet yesterday and he reiterated that he wanted me to stay at the current dosage. I think I need to do something about the AMPS value. He sits above 600 for hours in the mornings.

I feed ProPlan DM at 7am (wet), 12pm (dry), 7pm (wet), and 10pm (dry).

I got up this morning and tested at 4:30am just to see what his numbers were... I went ahead and fed him, but did NOT give his injection because I don't know what I'm supposed to do. Just let him sit at 600+ until it's time for his injection?

What is the best time in the evening to give the insulin since Lewie is going so high pre-dawn?

Thank you.
 
Hi Kathy, and welcome! You're doing a great job already getting started with testing and learning about all of this. It's a lot all at once and can be overwhelming. I can tell how much you care about Lewie that you're getting up so early and trying to figure all of this out!

It's good you waited on the injection. It wouldn't have hurt him to get it early, but as Janet alluded, it would have made your schedule tricky for a few days. It's so hard to wait when we see them in these high numbers, but it was the right decision.

Unfortunately yes, letting him sit at those numbers for a few hours is the way it goes right now. Remember that he didn't become diabetic overnight. We're going to help you get him into better numbers, but it's a process.

Can you tell me a little about your schedule? Do you work during the day? Weekends? Stay home? How long after the PM shot do you go to bed?

One of the best things you can do to get his numbers down is get him off of the dry food. The DM is sold for diabetics, but it's quite high in carbs -- too high for them really. A diabetic cat shouldn't eat food that's higher than 10% carbs. There is a food list in my signature that you can click on and find a zillion different foods and the carbs in each one. Most of us just feed Friskies pate or Fancy Feast classics as they are affordable and low carb. How does Lewie do with wet food? Is he eating that okay?
 
In a nutshell:
  • Insulin doses are best given as close to 12 hours apart as possible regardless of the BG number. You have about an hour's flexibility plus or minus if needed with ProZinc.
  • It's quite possible that the very high numbers are the result of an insulin dose that's too high (even though your vet is advising you) and that sets up a rebound phenomenon we call "bouncing" here on FDMB.
It's great that you know how to test him yourself because it's the best way to keep him safe and learn how he responds to insulin. Please stick around and read those yellow info stickies at the top of the list on the main ProZinc forum page. We all understand the discomfort that learning to do things differently from vet advice causes. :)
 
Thank you so much for your reply. Yes, I'm terribly stressed so thank you for understanding!

I work from home so I can do whatever it takes.
I typically go to bed 3 to 4 hours after the PM shot.
Lewie is eating very well. Of course her prefers dry, but he likes the Fancy Feast kitten and I have some on hand so I can feed him that.

Please advise me on switching his food from DM to Fancy Feast... will his glucose numbers shoot even higher?
 
Goodness. I was originally feeding Nulo. Then the vet switched me to DM and that's when his numbers shot up! I will switch back to Nulo and Fancy Feast kitten. That will probably mean that his dose of 3 units 2x/day will be too much! Since it's the holiday weekend, what should I do? I'll give the 3 units now, but should I only give 2 units tonight?
 
How comfortable are you with testing? If you and Lewie are doing fine with it, I'm not sure I would lower the dose yet. His numbers are quite high. Changing the food should help, but I'd be hesitant to give him less insulin until he shows us numbers that indicate he's ready for that.

Yes, vets try hard, but they usually go off of information from the food rep, and don't actually research it themselves. Nulo (especially the pate style) is a great food. I would get him back on that and take the DM back to your vet. Most vets will take it back if you just say Lewie wouldn't eat it. ;)

I wouldn't worry about the holiday weekend. If you get any numbers that concern you, you can post here and out on the Main forum (sometimes it's quiet here in Prozinc since there aren't a lot of us). I would be surprised if you see anything too dramatic though.

What time zone are you in?
 
I am in Central time zone. Ok, I will stick with 3 units two times per day. I just fed him the Fancy Feast and he scarfed it down.

I'm very comfortable with testing now.

How often should I test so we can really see what's going on?
 
Daily, you want to test before every shot, and then try to grab a test somewhere around +4 to +7 to see how low he goes in the middle of the cycle. So usually 3-5 tests/day if you can.

Once/week or so, it's helpful to grab some extra tests. There are a few ways that can look: A "curve" is testing every two hours from one shot to the next. That helps you figure out when Lewie hits the lowest points. For example, my cat is lowest around +3 (super early in the cycle). Other cats are lowest at +6 or +8....it just depends on the cat. And of course, that time can change from day to day. Doing a curve helps you figure out what is typical for your cat. If every two hours is too much, you can do every three hours. The day to day tests are the most helpful, but doing those occasional days when you test more can help you figure out where to focus those daily tests.

Since this is all pretty new for you guys, if you could do a curve one day this weekend it would be helpful for us in guiding your dosing. It does pretty much require that you stay near home for 12 hours though, and this is a holiday weekend, so if this weekend doesn't work, it's okay. Just whenever you can.
 
Kathy, would you mind setting up your signature so Lewie's information is available when you post? That way all members who read or respond to posts in your thread know the pertinent information. Here's a link on how to do that:
SET UP A SIGNATURE
I will repeat what I was told when I first found this board, it is stressful at first, and there is a whole lot to learn. But this is the very best place to be right now. There are members here who are very knowledgeable and experienced, and have been taking care of their sugar cats for a long time. The rest of us read the posts, add what we can, and are behind you every step of the way. The information, the tools and the support is here. Hugs to Lewie! :cat:
 
Just a little more info about Lewie. He has only been diabetic just over 1 month. He had surgery to remove a benign mouth tumor on July 12 and his glucose value was high normal at 179. He started drinking more and more water after the surgery and I mistook it for kidneys. He's always been a great eater so the ravenous eating snuck up on me. In hindsight it was ravenous. The vet thinks this may be stress induced diabetes. He has a lot wrong with him so time will tell. He's a good boy and loves people.

Thank you, I will set up the Signature. Lewie gives purrs back!
 
Welcome. Hang in there Kathy! There’s a lot of info coming your way; but this will become routine in no time! You are doing a fantastic job for your Lewie. We all were overwhelmed in the beginning & so we know how that feels. :bighug::bighug:
 
Hi Kathy! You've already gotten excellent information, and I don't want to overwhelm you (I'm sure you already are!!!) so I won't add to it. We are so glad you found us. I know diabetes can be stressful and it's so scary thinking your baby isn't well, but we're here to help! I'm in Central Time too and during the week I'm usually on around 4:30/5 AM so if you have early morning questions I can probably help answer them (I'm usually later on the weekends). Since we know your time zone and when you shoot, that will help us. I'm usually at work by 7, but I can check in while at work most days so I'll try to check on on the board during the week to see how you're doing in case no one else is around. We are a fairly small forum, but the good news is we mostly have our settings to where we get emails when someone posts...so we often know when to check in. :)

Something you might want to read when you have a sec to help with the stress: Dear Mom . It's a lovely letter written by someone long before I got here but still oh so relevant today!

We're here for you and Lewie! Please ask any questions you have...the learning curve is steep at first and we want to answer anything you are concerned about!
 
Thank you so much Rachel. I've been so stressed about all of this especially because of near blindness. My grandmother went blind and I just love eyes anyway. I have spent thousands of dollars on Lewie's eyes because he has Entropion and the eyelashes were scratching his eyes so he had surgery. He has had eye ulcers, too. When I realized Lewie was sick, I had just hurt my shoulder and could barely take care of myself so I didn't realize how bad Lewie was until 2 days later. I thought he was blind, but he has some vision. With his glucose over 600 every morning, I'm afraid of total vision loss. I just have to get it under control. My vet isn't concerned, but I really am. I am so thankful for you and others who spend you personal time helping us. Thank you.
 
Kathy4Lewie said:
Thank you so much Rachel. I've been so stressed about all of this especially because of near blindness. My grandmother went blind and I just love eyes anyway. I have spent thousands of dollars on Lewie's eyes because he has Entropion and the eyelashes were scratching his eyes so he had surgery. He has had eye ulcers, too. When I realized Lewie was sick, I had just hurt my shoulder and could barely take care of myself so I didn't realize how bad Lewie was until 2 days later. I thought he was blind, but he has some vision. With his glucose over 600 every morning, I'm afraid of total vision loss. I just have to get it under control. My vet isn't concerned, but I really am. I am so thankful for you and others who spend you personal time helping us. Thank you.
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Dogs can go blind from diabetes, but it doesn't effect cats the same way. They can go blind from severe hypoglycemia.... But I believe they don't develop diabetes related blindness by just having it.
 
Kathy, a friend here on the board posted this and I saved it because it just made so much sense: Start by doing what's necessary; then do what's possible; and suddenly you are doing the impossible. Saint Francis of Assisi
You are doing just that. You are new to all this, and it sounds to me like you have been taking care of Lewie for a good long time. Granted the eye issues are troublesome, but you have done everything you knew how to do for him. He looks like a real sweetheart, and I think he holds a key to your heart, right? Well, take a break, fix a cuppa and maybe Lewie would like a lap to sit on for a minute, or at least a hug and a kiss. You are getting the best advice, so keep touching base and checking in. Forgive yourself for not being all knowing or being able to see the future regarding Lewie. :bighug:
 
Hi Everyone. Thank you for the wonderful messages.

Four more hours till Lewie's evening shot. His appointment on Tuesday is at 8:00am so I pushed this morning dose closer to 8:00 even though I was stressed about his numbers. I don't like feeding him at 8pm because he is used to 7pm... previously 6pm.

Please take a look at his spreadsheet because I've been testing every 2 hours. He is still in the red, but will probably be in the pink by 8pm.

I've only been feeding him Fancy Feast Kitten today. Do you recommend that's all I feed him this weekend? I was feeding DM 30th and 31st. I was feeding Nulo and a small amount of DM on the 26th-29th.

What should be my plan for this evening.tonight?... I really don't want him to be in the black like at 4:30am this morning. Do I feed him at 2am? How do I keep him from going in the black?

Thank you,
Kathy
 
Kathy4Lewie said:
Hi Everyone. Thank you for the wonderful messages.

Four more hours till Lewie's evening shot. His appointment on Tuesday is at 8:00am so I pushed this morning dose closer to 8:00 even though I was stressed about his numbers. I don't like feeding him at 8pm because he is used to 7pm... previously 6pm.

Please take a look at his spreadsheet because I've been testing every 2 hours. He is still in the red, but will probably be in the pink by 8pm.

I've only been feeding him Fancy Feast Kitten today. Do you recommend that's all I feed him this weekend? I was feeding DM 30th and 31st. I was feeding Nulo and a small amount of DM on the 26th-29th.

What should be my plan for this evening.tonight?... I really don't want him to be in the black like at 4:30am this morning. Do I feed him at 2am? How do I keep him from going in the black?

Thank you,
Kathy
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given that your cat also has kidney disease, you may want to feed foods under 250 phosphorus. A few of the nulo foods are. Tiki Cat is another good choice.
 
Those are some confounding numbers...high in the morning and then lower in the evening.

Okay, first I'd keep him on the FF kitten for now. You want to keep the carb amounts low to see if that helps bring him down (it can take a day or two sometimes). Unfortunately, you may not be able to keep him out the black right now. It WILL happen, but it can take some time. He needs to settle in to the new, low carb food and see if that helps. Tonight, grab a test before going to bed if you can (I know...all these tests today!). Let's see what this does for him.
 
Before switching him to the DM, he ate Nulo and Wellness Complete... but I also fed Solid Gold dry which is not low carb. So I guess he was on DM for about 3 solid days, which are the black mornings. I read somewhere to not make changes for 3 days to let his body settle. I can feed Nulo Chicken and Herring (3gm carb) and Fancy Feast if you think the phosphorous will be too high feeding only FF.

I can continue to test this evening if that will help.

I read that some people feed at 2am?

Do you think he is having the "dawn phenomenon"? If so, what should I do?
 
Hi Kathy. That curve looks like an actual *curve* today, but Im so sorry that Lewie is having such high numbers. Typically I would think that an increase is in order to help bring those numbers lower overall and at his nadir (typically between +5 and +7), but given that he is so newly diagnosed and with the underlying kidney issues, I would not feel comfortable advising on how much (I am too new for that). We try for .25 increases, but I’m not sure with the new diagnosis and the very high numbers.

(While I was typing ... Oh, good! There’s JanetNJ!) I like her advice to go to 3.5.
 
I agree with Janet. I think an increase to 3.5 u tonight is in order. Once he's in pinks, yellows and blues the usual 0.25 u increase would be in order. I'd give him his insulin at the usual time.
 
I'm sorry. I'm trying to read through the thread to find the info, but I can't find it . . .

How many hours are you post-AM shot? (I happen to be on CDT as well, but we're from all over, so it helps to talk in terms of plus-[number of hours past the shot]. So, for example, if you shot 11 hours ago, you're at +11. (Technically i think you're at +11.5 :) )

Are you simply trying to stretch your cycle one hour longer so that you can be at the vet's on Tuesday am at shot time? If so, there's certainly no need to do it all at once: you could move the shots in 15 minute intervals and still be at shot-time at the time of your vet appt on Tuesday morning if that is your goal.

In which case -- and assuming that you are indeed at +11.5 from this morning's shot -- I don't see why you shouldn't give him his PM shot at his regular time (in about 30 minutes, I think?) vs. waiting an entire hour. Again, you can "add" that hour in over the next couple of days to get him on the vet's schedule if that's the goal.
 
I apologize... I forgot to talk in the + terms.
I gave him his shot at 8am and it's 6:45pm now so I'm coming up on +11.
8pm will be +12.
So if I wait an hour I will still maintain the appointment time schedule.
I'm just stressing because here he is sitting in the black again waiting for his shot.

Thoughts?
 
I'd wait to the normal time. I know it's stressful, but the increase might help with the numbers and the new food should help too. If you give him his shot early, then tomorrow he sits in the blacks for even longer waiting for his shot...and that's no good. I know, I KNOW how stressful and scary it is to see those numbers, but they WILL come down. I've been here since...2013 I think...and I've seen a ton of cats come through here hanging in high numbers all the time. With time, patience, and careful increases and monitoring, we get them down. Remember you JUST switched to new food today. That can often take a few days to really get their system in gear. He WILL get into lower numbers and we will help you. Just gotta have patience. :bighug::bighug:
 
Rachel said:
I'd wait to the normal time. I know it's stressful, but the increase might help with the numbers and the new food should help too. If you give him his shot early, then tomorrow he sits in the blacks for even longer waiting for his shot...and that's no good. I know, I KNOW how stressful and scary it is to see those numbers, but they WILL come down. I've been here since...2013 I think...and I've seen a ton of cats come through here hanging in high numbers all the time. With time, patience, and careful increases and monitoring, we get them down. Remember you JUST switched to new food today. That can often take a few days to really get their system in gear. He WILL get into lower numbers and we will help you. Just gotta have patience. :bighug::bighug:
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And in the meantime, do something nice for yourself to take your mind off it.\ while you're waiting: a walk around the block, a bar of chocolate, a little glass of wine . . .
 
Yes, omg... I feel like I'm in here staring at the computer while he's out in the other room suffering. Dreadful feeling.

So here's the plan:
1. Wait till normal time to give injection.
2. Increase ProZinc from 3 units to 3.5 units.
3. Continue feeding Fancy Feast Kitten.

Please correct me if I need to know anything else.
Thank you very much
 
If anybody is awake... I fed Lewie at 8am, noon, and 8pm.

Will it help his blood sugar from going so high at dawn if I feed him at midnight?
 
It's 10:30pm here... +2.5 Post-PM shot... and he is hungry now even though he ate great at his PM shot. If he's hungry, should I feed him now?
 
Kathy4Lewie said:
It's 10:30pm here... +2.5 Post-PM shot... and he is hungry now even though he ate great at his PM shot. If he's hungry, should I feed him now?
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Yes, give him a snack. Until they get better regulated they're hungry all the time. The usual advice is to give most of the cycle's food ration in a couple of small meals/snacks in the first half of the cycle when insulin is rising to its peak activity.
 
I'm Very Encouraged!

This morning's AMPS was low enough to actually have a reading on the meter! 506 I'm happy with that since we're down 100 points from yesterday's reading. (The meter doesn't read over 599... just says High.) And his +2 after shot was 343! Happy with that! The food and the little extra insulin is working! I actually only gave 3.3 units because I was nervous about giving too much since we were changing 2 variables: food type and insulin.

I also started giving him a phosphorus binder called ConSeal with each meal since JanetNC pointed out that the Fancy Feast Kitten is so high in phosphorous. (I have a 19 year old that uses ConSeal so I have it on hand.) He's drinking lots of water this morning so I hope all is well there.

I also started offering him additional meals at +1, +2 and +3 after his shot as Kris & Teasel mentioned to do... feeding most of the food in the first half of the cycle. Last night he ate 3 meals in the first half, this morning 2 1/2 meals.

He is feeling better, purring and grooming. Big change from the last couple of days.

I'm going to test his blood again at +8 since that seems to be his low spot. I really love using the spreadsheet!

Thank you to everyone for helping me so much yesterday! I know it's a holiday weekend and it means the world to me that you jumped on the board so quickly to answer my questions.
 
Kathy4Lewie said:
I'm Very Encouraged!

This morning's AMPS was low enough to actually have a reading on the meter! 506 I'm happy with that since we're down 100 points from yesterday's reading. (The meter doesn't read over 599... just says High.) And his +2 after shot was 343! Happy with that! The food and the little extra insulin is working! I actually only gave 3.3 units because I was nervous about giving too much since we were changing 2 variables: food type and insulin.

I also started giving him a phosphorus binder called ConSeal with each meal since JanetNC pointed out that the Fancy Feast Kitten is so high in phosphorous. (I have a 19 year old that uses ConSeal so I have it on hand.) He's drinking lots of water this morning so I hope all is well there.

I also started offering him additional meals at +1, +2 and +3 after his shot as Kris & Teasel mentioned to do... feeding most of the food in the first half of the cycle. Last night he ate 3 meals in the first half, this morning 2 1/2 meals.

He is feeling better, purring and grooming. Big change from the last couple of days.

I'm going to test his blood again at +8 since that seems to be his low spot. I really love using the spreadsheet!

Thank you to everyone for helping me so much yesterday! I know it's a holiday weekend and it means the world to me that you jumped on the board so quickly to answer my questions.
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I am so glad he seems to be feeling better. Those super high numbers can def make them feel yucky. You’re doing a great job. I am glad you are finding the spreadsheet helpful.
 
How do you measure a 3.3?

We wanna start seeing some yellows... I would do 3.5 with the next shot.
 
3.3 = 3.25 + smidge :)

I just checked Lewie's suspected nadir low point time at AM shot +8 and his glucose reading is 261. His first yellow reading.

He isn't due for his next shot until 4 more hours.

How much can I feed him now? He is asking.
 
Kathy4Lewie said:
3.3 = 3.25 + smidge :)

I just checked Lewie's suspected nadir low point time at AM shot +8 and his glucose reading is 261. His first yellow reading.

He isn't due for his next shot until 4 more hours.

How much can I feed him now? He is asking.
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It's OK to give a snack now. Just no food at least 2 hours prior to the preshot test!

Hooray for the first yellow!!!!! Still id do 3.5
 
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What quantity is considered a snack? At his regular mealtime, he will eat about 5 tablespoons of Fancy Feast Kitten... at +1 he will eat another 5 tablespoons... at +2 he will eat about 3 tablespoons.

Would you say a snack would be about 3 tablespoons?
 
Kathy4Lewie said:
What quantity is considered a snack? At his regular mealtime, he will eat about 5 tablespoons of Fancy Feast Kitten... at +1 he will eat another 5 tablespoons... at +2 he will eat about 3 tablespoons.

Would you say a snack would be about 3 tablespoons?
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Sure
 
Oops... our messages crossed. Thank you.

Question: Lewie's AM numbers are always higher than his PM numbers. I checked his numbers every 2 hours last night. At today's +8, he is 156 points lower than yesterday. If I apply this logic to his evening numbers, his evening nadir might end up being 182. Is that too low? I hope to be asleep at that time tonight so I won't be checking.
 
Kathy4Lewie said:
Oops... our messages crossed. Thank you.

Question: Lewie's AM numbers are always higher than his PM numbers. I checked his numbers every 2 hours last night. At today's +8, he is 156 points lower than yesterday. If I apply this logic to his evening numbers, his evening nadir might end up being 182. Is that too low? I hope to be asleep at that time tonight so I won't be checking.
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182 is not low. Normal on a human meter is 50-120.

Your goal is to aim for about 80-100.
 
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