High at 4am, give dose early or wait?

I started transitioning Lewie to Nulo Limited Ingredient today and that has proven to be the wrong thing to do as high numbers jumped up high. I gave him 1/2 Nulo + 1/2 Fancy Feast Kitten for both breakfast and lunch. I fed him only Fancy Feast for dinner. I was going to try the switch because he is thirsty a lot and was thinking the high phosphorous was being hard on his kidneys. I will just stick with the Fancy Feast until I get his numbers back down. He seems a little nauseated tonight, too.

Does anybody have any thoughts?
 
Wow, that is a big jump. I assume you have double checked to make sure the Nulo is low carb? (please forgive me if that's a stupid question -- I'm not familiar with Nulo). I've heard that when transitioning from one food to the next it's best to do 25% for a few days, then 50%, then 75%, then 100% -- staying a few days at each of those steps. Some cats can move faster than that, but I wonder if Lewie just has a sensitive system?
 
Re: thirst... Do you add water to his food? I add somewhere between 1/8 & 1/4c to Romeo's food and that helps gets more fluids in him. He prefers the "juice" in any case.
 
Goodness. Poor Lewie. That makes sense to transition by only 25%. Hopefully he will recover fast. I add only 2 Tablespoons of water to his food. I give him subq fluids... I will start adding more water to his food. Thank you.
 
Kathy4Lewie said:
Goodness. Poor Lewie. That makes sense to transition by only 25%. Hopefully he will recover fast. I add only 2 Tablespoons of water to his food. I give him subq fluids... I will start adding more water to his food. Thank you.
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Ahhh, that's right, I forgot you were doing subcu too! 2T is 1/8 cup so that's great. I'm sorry he's still thirsty... I hate that.
 
Thank you. I encourage him to eat as much as he wants in the first hours after his shot as I learned earlier in this thread, so tonight, each time I showed him his bowl I added extra water and he enjoyed that.
 
Do you have a water fountain? That might help encourage him to drink too...I have one and my cats seem to like it. Keeps their water nice and fresh from moving...and makes a lovely water feature if they want to zen out some! :)
 
Lewie's AMPS was high this morning at 562. The only thing I did different yesterday was allowing him to eat at his daytime +8 nadir. I guess that messed him up? His evening postshot +9 value was good at 227 so I'm not sure why today's AMPS was so at high at 562.

Will you please take a look at his spreadsheet and see what you think?
 
It might be a bounce from dropping quite a bit through the night (402 to 227). It's possible he was lower mid cycle and that can also contribute to a bounce. I'm not sure about the snack effect but I doubt it was a factor. You could stay at 3.5 u for a bit or try 3.75 u soon if you can monitor and you feel he's tolerating the lows well.
 
He was probably lower mid cycle. His overnight nadir is at post shot +8 but this morning I got up and tested at +9 instead. On 9/6/2018 in the morning is when I gave him Nulo food and that messed up his numbers. I thought he was back to normal since I started feeding the FF Kitten again, but I guess he's not. Thank you.
 
I just gave Lewie his pm shot. His PMPS value was 446 and I probably should have bumped him up to 3.75. It looks like we are setting up for the same scenario as yesterday. Funny things is that he felt so good today! I'll take a reading at post-shot +2. Yesterday his post-shot +2 was higher than the PMPS which is odd don't you think? The +2 reading was mentioned earlier as being an indicator of what the rest of the cycle will be. If tonight's +2 is higher than the PMPS, what should I do? Give him his shot earlier tomorrow morning?
 
I think it may have been me who said we would get a +2 as an indicator, but I meant if we were worried about giving too much insulin on too low a number. I actually expect the +2 to be higher due to a “food spike” since we feed at shot time. Therefore, if the +2 is *lower*, we know to be extra-attentive as the insulin should be kicking in around +3. If it’s higher, it’s probably a normal cycle.
 
If you can tomorrow, try to grab some tests at other times. The nadir does move around, so seeing it at +8 during your curve doesn't mean it's always at +8.

Jenna has already explained the +2, so I would just add that unless you're wanting to change your schedule, there's no need to shoot early tomorrow.
 
Thank you for the clarification... a good teaching moment. :bookworm: Very much appreciated.

I took his +3 value and indeed the insulin had kicked in and the value is MUCH lower than I expected. Looks like he will be in the mid-100s (blue) for his morning nadir.
 
With the low numbers tonight, hopefully he won't be in the black tomorrow morning (like this morning.) I didn't realize the nadir would move around... I'll test at some different times tomorrow. Thanks.
 
Most cats will have a time that is typical for them, but can vary a bit from day to day, or just shift over time. My guy hits nadir super early - usually around +3. But there are plenty of days when he waits until +5-6, so I try to scatter the tests around when I can. Of course work makes that pretty difficult most of the time, but I try to catch a later test on the weekends to make sure.
 
I normally feed Lewie at 6pm... 2 hours before his shot. Tonight I didn't get home until 7:00pm so I wanted to feed him at 8:00pm at which time I was due to give his his shot. His PMPS value was 231 so I went ahead and fed him but did not give him his shot. Now 50 minutes later, his value is only 254... still too low to give him is 3.5 unit.

Is an hour stall too long?
 
No it's fine if it won't mess up your schedule. But why not shoot? You gave this dose on a similar numbers few nights ago and it seems like it was fine.
 
Yes, 9/5 is the night I stalled for 40 minutes.

I just tested 9:15pm so that would be +13. He was 360 so I gave him his shot of 3.5 units.
 
Thanks for being here to reply. I made a note to myself that the next time this happens just stall an hour.

So technically I should wait 12 hours until his next shot.

He always seems to be high in the morning so I will test at his regular A.M. time and if he is high, is it ok to give the shot at +11?
 
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You have about an hour wiggle room with Prozinc, so I think it would be ok to give him his shot at +11 if you're comfortable with his glucose numbers.

It makes me nervous to shoot at those mid/low 200s too, but you probably could have shot at your usual time tonight. I'm working on being more brave with those numbers, too, to keep Olivia feeling well more often.
 
Thank you for sharing your thoughts. Lewie has been feeling great lately and is laying on his boxes again. I've heard it several times about ProZinc having "wiggle room" but I'm not exactly sure what that means. Is there an article you can point me to? Or is it simple to explain?
 
Prozinc does have some wiggle room. The reason is there is no depot, so you don't have to give quite as exactly as the Ls. You want to give as close to +12 as you can often, but if you need to stall or shoot a little late for some reason, you can.

In the morning, you can give early, but only if he's high enough and you're sure he's rising. You could do your test at +11 and then try again in like 15 or 20 minutes to be sure he's rising.
 
Rachel: Thank you for the early morning post. I did read it when you posted, I just didn't have time to reply as I was getting ready for an early more vet appt for another cat. I decided to wait on giving his shot... and then I was an hour late in giving his shot because the vet appt ran late. So it was actually awesome that I stalled his shot last night! His AMPS number was good for him at 437.

Question: What does "depot" mean? Does that mean ProZinc doesn't build up in his system? Is "Ls" label says? I looked in the dictionary but don't see these terms. Thanks!
 
L's refer to the insulins that start with L: Lantus and Levemir. And you're correct about the depot, except that in general we don't say that Prozinc has a depot because the overlap doesn't last quite as long as it does on the L insulins. So they have a depot, we just have overlap :)
 
Thank you for the explanations. That's really interesting about the depot forming with the other insulins... but not with ProZinc... so much to learn! :bookworm:
 
What to do? Yesterday's early morning vet visit with my other cat caused me to be late in giving Lewie his shot... but that day turned out good.

However, this morning I need to leave early so I was hoping I could give his shot early. I just checked and his reading is 92... the lowest it's ever been. I was needing to leave my house in 30 minutes but he won't be within shooting range in 30 minutes.

What do I do?
 
When will you be back home? Or are you leaving for the day? I would do one more test to just make sure it wasn't a bad test (since that number is a little surprising considering his usual ranges). If you're leaving and he's not in a shootable range, you may just need to skip today. I hate to suggest that, but you can't shoot on an unusually low number without being able to stick around and monitor.
 
Usually Kris and I are cross-posting in the mornings! I don't' see her around this morning though. Always nice when two posts agree!
 
Alrighty then. Probably best to just skip. You really can't shoot on an 88 at this point. It would be too dangerous for Lewie. At least you won't have to worry about him going too low while you're gone! :)
 
Kathy4Lewie said:
Will he get too high during the day?
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Likely yes. But it's just one cycle. The alternative is that you give him insulin on a number that is too low, the insulin starts pulling down from an 88 and he ends up hypo. It's not worth the risk. Give him a kiss and tell his pancreas to do it's best. Some days this is just how it goes. It's important for you to be able to live your life too. You'll get him back on track.
 
Ok. I just feed him. If he's still too low in 30 minutes, should I have someone come in and shoot say... in a couple of hours? I know a gal that might be able to help out.
 
I agree with Jenna. If someone comes and shoots in a couple of hours, you are going to face the same issue tonight with the number being off from what you need. Plus, if they aren't also testing, you will have no idea what number they are shooting on. I know it's hard to skip, but if you don't have a good safe number after feeding, I really do think skipping is your safest option.
 
I'm heading to work soon, so may miss your next post. If no one else is around and you aren't sure the number is high enough, please err on the side of caution.
 
His number is 130 after feeding 30 minutes ago... he's still eating actually, he grazes a long time on his Fancy Feast Kitten.

I will skip his shot this morning.

Thank you everyone so much for your help... I don't know what I'd do without you.
 
Lewie survived the SKIP yesterday, but it was hard on him. When I arrived home, he was really worried. He normally greets me with outstretched paws and happy eyes. I tested him and he was off the meter so that 600+. I gave his 3.5 units. At +1 he was still worried and was still 600+. At +2 he was alert and slamming down the water with a reading of 458. He calmed down after than.

I still haven't given his AM shot because of these low numbers:
+12=128
+12:50=216
+13:45=281

Why is he so low this morning? I normally shoot around 350.

Thank you!
 
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