Home testing and Food

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I still ask for advice on my kitty too! It's just nice to know if I'm in the ballpark of what other people are thinking and I appreciate the peer-review aspect that we check one another's advice.

I want to clarify that my suggestion of lowering the dose wasn't because of the PS number. It was based on the long cycles that you're seeing. One unit seems a little too high for Teddy right now. Figuring out whether to go to 0.75 or 0.5 is because of the overall numbers, not just the 161 that you have right now. Does that make sense?

I would recommend that you lower both doses - AM and PM since your PM numbers are a little too low right now. So as we consider the .5 vs .75 question, do you think you would be comfortable with drawing up a 0.75u dose (in the morning)? It's a little tricky because there isn't a line for it.

I'm not sure what a long cycle means? You mean it takes a long time for teddy to go down and then back up, does it go by 12 hour cycles?

And yes I can make it be .75.
Isn't the goal to be in the green though, so is teddys too low if he isn't always in the green?

(Sorry If I am asking too many questions...I can't believe how much I'm learning, this is really so great)
 
Lol...no such thing as too many questions around here! Remember most of us are/were teachers, so we love sharing information!

Teddy most likely spend a good portion of the day today in green numbers -- but you were with your firsties and didn't see it. And even if he wasn't (though I bet he was), there are two considerations: one is getting into the green numbers, the second is getting two shootable numbers. So first we have to balance it enough for you to get two safe shots, and then we'll hopefully work him down and off the insulin (anti-jinx!).

Long cycle means two different things: either that the nadir is later than the +5-7 range that is typical on prozinc, or that the cycle is over (you're reached +12) but he still hasn't risen enough yet. When you get one long cycle, it's no big deal - sometimes it just happens. But you've had two in a row, which probably means your dose is a smidge too high right now.
 
I believe what Djamila is saying is that your cycle seems to be lasting longer than 12 hours. Looking at yesterday's cycle, you can see Teddy was going down still at PMPS time...so the cycle which usually lasts 12 hours was going longer than that.
 
Lol...no such thing as too many questions around here! Remember most of us are/were teachers, so we love sharing information!

Teddy most likely spend a good portion of the day today in green numbers -- but you were with your firsties and didn't see it. And even if he wasn't (though I bet he was), there are two considerations: one is getting into the green numbers, the second is getting two shootable numbers. So first we have to balance it enough for you to get two safe shots, and then we'll hopefully work him down and off the insulin (anti-jinx!).

Long cycle means two different things: either that the nadir is later than the +5-7 range that is typical on prozinc, or that the cycle is over (you're reached +12) but he still hasn't risen enough yet. When you get one long cycle, it's no big deal - sometimes it just happens. But you've had two in a row, which probably means your dose is a smidge too high right now.

Ahhhh ok I get it now!! You are so good at explaining things!!!!
So I'm going to start doing .75 I think then??
And on the spreadsheet do I write .75?
And if I wake up tomorrow morning and let's say it's over 250, I mm just saying hypothetically, then should I go back to 1 unit??
 
I believe what Djamila is saying is that your cycle seems to be lasting longer than 12 hours. Looking at yesterday's cycle, you can see Teddy was going down still at PMPS time...so the cycle which usually lasts 12 hours was going longer than that.

Ok yes that makes sense now!!! Thank you and djamila!!!
 
I'm glad it's making sense! I always wonder when I'm typing things out if they make sense to anyone else, or just in my own head!

Yes, on your spreadsheet you just type .75 and it should auto-format to 0.75 And my suggestion would be to give that dose on anything over 170. I would like to see if some of the other prozinc folks agree with that idea before you commit to it though. @Yong @Rachel @Kris & Teasel @StephG
 
I'm glad it's making sense! I always wonder when I'm typing things out if they make sense to anyone else, or just in my own head!

Yes, on your spreadsheet you just type .75 and it should auto-format to 0.75 And my suggestion would be to give that dose on anything over 170. I would like to see if some of the other prozinc folks agree with that idea before you commit to it though. @Yong @Rachel @Kris & Teasel @StephG

Yes very excellent way of explaining!!
So does that mean you would say if it's below 170 no insulin at all? Or .5, etc...
 
I would say no insulin right now just because you aren't home to monitor and don't have enough data on Teddy to be sure he's safe.

It's not that you'll never shoot lower numbers (take a peek at my spreadsheet), it's just a matter of safety until you know how Teddy responds. Right now his numbers are all over the place (normal at the beginning), so I prefer to err on the side of caution.
 
I agree, I think I would go down to 0.75 and see what that does.

ETA: and I would agree no insulin below 170 too. If you're home to monitor and are comfortable with steering, we can revisit that, but I wouldn't give below that until you can monitor so you can keep him safe AND get data for next time.
 
I like 0.75 u for now. Long cycles can happen because that's the duration a particular kitty gets or they can happen when the dose is a little high. Yes, no insulin under 170 until you have a lot more data.
 
*raises hand* with the others :cat:. One extra note, if you get a PS of 170 or less where you do a NS try to get a test a few hours later to see how he's doing without it. Will help figure out what to do if it happens again. Oh Rachel said that too :smuggrin:
 
I think 0.75 might be a little high for that preshot. It's probably fine but I would monitor it. I stick by my original of 0.5. I'll actually tweak that scale just a little more and say

135-150. 0.25
150-185 0.5
185-225 0.75
225+ 1


Of course you hold the needle so you go with your gut and make your best decision.
 
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I think there's some confusion happening. We were recommending NO shot this evening because the PS was under 170. The recommendation to lower the dose to 0.75 u was for tomorrow AM IF the PS is over 170. However, on the SS I see a PMPS of 161 and a dose of 0.75 u. Please let us know if this is correct.
 
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Oops...that's my bad. I thought it would be okay if she gave a small dose tonight since she knew he was rising and would be around to monitor. :oops::oops::oops:
 
No, you're right. That does confuse things to have encouraged her to shoot tonight, but then say not to shoot tomorrow (if he's below 170). Shawna, I'm so sorry for confusing you. I think Teddy will be okay tonight (although do get a test, of course), but I should have been more consistent in my opinion about that!
 
No, you're right. That does confuse things to have encouraged her to shoot tonight, but then say not to shoot tomorrow (if he's below 170). Shawna, I'm so sorry for confusing you. I think Teddy will be okay tonight (although do get a test, of course), but I should have been more consistent in my opinion about that!

No way, no apologies ever!!! You guys have saved my kitty and my sanity!!!
I gave a little less than .75 tonight and I'm here to check him all night.
I appreciate you all SO much and I understand so much more about cycles now hay you've described it!!! Smile! Thank you!
 
Shawna, I apologize if I've created a lot of confusion. We get this sorted out.

No apologies needed ever! There was no confusion! You guys are literally life savers and I am so thankful!!!!! I don't know what I would have done without you all! I'm forever thankful!
 
No way, no apologies ever!!! You guys have saved my kitty and my sanity!!!
I gave a little less than .75 tonight and I'm here to check him all night.
I appreciate you all SO much and I understand so much more about cycles now hay you've described it!!! Smile! Thank you!
Can you imagine if you weren't testing and still blindly shooting 3 units? Yikes.
 
Theodore is purring and snug as a bug in a rug... or snug as a kitty in a blankie LOL.... and he sends all his kitty kisses!!! xoxoxo
IMG_1554.JPG
 
The 4/28 numbers are not accurate because the vet had told me to give Theodore 4 units of insulin....because he got too stressed at the vet and his blood sugar was through the roof... so I can't really take 4/28 and 4/29 into consideration for his "normal" right, since it was due to excessive insulin?

Well, there are three primary blood sugar components that the insulin needs to counteract for control. The first is the background blood sugar level (that is primarily checked at the pre-shot readings; i.e. How much is this reading above 120?). The second is to counter the anticipated rise in blood sugar from the food, and a large part of that is the carbohydrates in the food. These first two are sometimes called the bolus. The third requirement is the constant background demand for insulin that the body needs (basal rate). The difficulty in dosing a cat (or a person) with a single type of intermediate to long acting insulin is that it must cover all of these three requirements in a single shot. That is why some human insulins come premixed with a combination of short and long acting insulin.

So the prime thing that a diabetic (person or cat) that is taking insulin shots requires for the basis of good control is a regular schedule. This would include injection time, level of activity and diet (quantity and time). So yes, the irregularities on 4/28 could probably skew the readings for a cycle.

Thanks for this information! I am not fully understanding what you are saying, but I pretty much get it....I am rereading...are you saying to test him every hour until I find his lowest point?
To find the nadir

Yes and no. To me the three key measurements are the two 12 hour readings and a single nadir value. This is because I'd want to keep a regular insulin schedule at 12 hour intervals with Prozinc (2x/day dosing) . If I were using NPH, I'd probably want to use two 8 hour readings and a nadir value since it would most likely be dosed 3x/day in a cat. Again, regularity is a key.

My objective would be to get reasonable blood glucose numbers at the 12 hour periods without risking an hypoglycemic event at the nadir. The more data that I could correlate among these three values would help determine how much of an initial insulin dose could be given with a level of comfort.

Earlier you seemed to look for a less burdensome way to do a curve. I am certainly not against testing every hour and it does paint a more complete picture, but I feel that it does not add that much more to it. I feel, and this is just my opinion, that each person needs to get a better understanding and feel for dosing their cat and the way to do that is to collect data and use it as a reference for future decisions. Once things have stabilized you could build a sliding scale from your data. So I'm basically saying I would not do testing every hour but I would do testing more frequently where the nadir is likely to occur and bracket test around the anticipated nadir time. Initially, I would try to establish the time to the nadir so that I'd know with some confidence that it would occur 'around' that same time in the future if regularity were maintained and I'd be able to more efficiently test (three point curve). NOW THIS IS IMPORTANT: That is how I would do a curve or a mini-curve. I am very comfortable with this approach and I am used to working with and isolating data and I also have an understanding of diabetes...in humans/me, anyway. On the other hand, the curve generated from hourly testing is foolproof and easy to understand and implement. I guess I'm just trying to say that there is more than one way to get a blood sugar curve and get usable results.

Doesn't the nadir time change based on insulin given and how much/when food is given??

The 'nadir' is the lowest blood glucose value and should correspond with the 'peak' level of activity for the insulin. The time of the 'nadir' should remain fairly consistent providing that a regular injection/feeding/activity schedule is maintained. The 'peak' (height of activity for the insulin) should remain fairly constant for a specific insulin type in the same person/cat. Think of 'nadir' and 'peak' in terms of time after injection and not absolute blood sugar numbers.

I actually try not to be confusing, but sometimes I just don't know when to shut up and I make things worse.
 
Is he getting around any better? Or still struggling?
Still struggling....he actually won't get off his spot on the couch unless I lift him down. I mean he does have a hundred super soft (pink) blankets to cuddle with lol... but really though, it is sad to me but I just keep feeling hopeful that he will start to get better. I left him down to get him to use the bathroom and he is very wobbly on his feet...but he is taking a few slow steps to come back to the couch. This weekend after all that happened he couldn't walk at all, so he can walk now...very shaky and won't do it willingly though.
I'm going to take to his vet tomorrow and I'll update with what she says.
And he'll be starting the b12 soon too.
 
Well, there are three primary blood sugar components that the insulin needs to counteract for control. The first is the background blood sugar level (that is primarily checked at the pre-shot readings; i.e. How much is this reading above 120?). The second is to counter the anticipated rise in blood sugar from the food, and a large part of that is the carbohydrates in the food. These first two are sometimes called the bolus. The third requirement is the constant background demand for insulin that the body needs (basal rate). The difficulty in dosing a cat (or a person) with a single type of intermediate to long acting insulin is that it must cover all of these three requirements in a single shot. That is why some human insulins come premixed with a combination of short and long acting insulin.

So the prime thing that a diabetic (person or cat) that is taking insulin shots requires for the basis of good control is a regular schedule. This would include injection time, level of activity and diet (quantity and time). So yes, the irregularities on 4/28 could probably skew the readings for a cycle.



Yes and no. To me the three key measurements are the two 12 hour readings and a single nadir value. This is because I'd want to keep a regular insulin schedule at 12 hour intervals with Prozinc (2x/day dosing) . If I were using NPH, I'd probably want to use two 8 hour readings and a nadir value since it would most likely be dosed 3x/day in a cat. Again, regularity is a key.

My objective would be to get reasonable blood glucose numbers at the 12 hour periods without risking an hypoglycemic event at the nadir. The more data that I could correlate among these three values would help determine how much of an initial insulin dose could be given with a level of comfort.

Earlier you seemed to look for a less burdensome way to do a curve. I am certainly not against testing every hour and it does paint a more complete picture, but I feel that it does not add that much more to it. I feel, and this is just my opinion, that each person needs to get a better understanding and feel for dosing their cat and the way to do that is to collect data and use it as a reference for future decisions. Once things have stabilized you could build a sliding scale from your data. So I'm basically saying I would not do testing every hour but I would do testing more frequently where the nadir is likely to occur and bracket test around the anticipated nadir time. Initially, I would try to establish the time to the nadir so that I'd know with some confidence that it would occur 'around' that same time in the future if regularity were maintained and I'd be able to more efficiently test (three point curve). NOW THIS IS IMPORTANT: That is how I would do a curve or a mini-curve. I am very comfortable with this approach and I am used to working with and isolating data and I also have an understanding of diabetes...in humans/me, anyway. On the other hand, the curve generated from hourly testing is foolproof and easy to understand and implement. I guess I'm just trying to say that there is more than one way to get a blood sugar curve and get usable results.



The 'nadir' is the lowest blood glucose value and should correspond with the 'peak' level of activity for the insulin. The time of the 'nadir' should remain fairly consistent providing that a regular injection/feeding/activity schedule is maintained. The 'peak' (height of activity for the insulin) should remain fairly constant for a specific insulin type in the same person/cat. Think of 'nadir' and 'peak' in terms of time after injection and not absolute blood sugar numbers.

I actually try not to be confusing, but sometimes I just don't know when to shut up and I make things worse.

Oh no, you are not confusing...you are so intelligent and prior to this I had no knowledge on diabetes, so that's why it took me a bit longer to understand. I appreciate you so much for sharing this information and explaining it to me!!!!!!

This is really great information you just explained! Thank you!! I'm going to save this so I can refer back to it. Oh I didn't mean to imply I wanted a less burdensome way to do a curve...I actaully didn't really know what a curve was lol!! But what you wrote makes sense!

In your opinion - should I give my cat a third meal? I know everyone does it differently - but what do you think? I feed him at 5-6am and 5-6pm. I never want him to be hungry, so do you think if I give him a small third meal as long as I keep it at the same time every day?? Sometimes I can't get him to eat a lot at his meal time.....he was used to eating anytime he wanted before. So I'm interested to see what you think about that since you have so much knowledge.

And thanks again for your help and kindness!!! :)
 
Well, there are three primary blood sugar components that the insulin needs to counteract for control. The first is the background blood sugar level (that is primarily checked at the pre-shot readings; i.e. How much is this reading above 120?). The second is to counter the anticipated rise in blood sugar from the food, and a large part of that is the carbohydrates in the food. These first two are sometimes called the bolus. The third requirement is the constant background demand for insulin that the body needs (basal rate). The difficulty in dosing a cat (or a person) with a single type of intermediate to long acting insulin is that it must cover all of these three requirements in a single shot. That is why some human insulins come premixed with a combination of short and long acting insulin.

So the prime thing that a diabetic (person or cat) that is taking insulin shots requires for the basis of good control is a regular schedule. This would include injection time, level of activity and diet (quantity and time). So yes, the irregularities on 4/28 could probably skew the readings for a cycle.



Yes and no. To me the three key measurements are the two 12 hour readings and a single nadir value. This is because I'd want to keep a regular insulin schedule at 12 hour intervals with Prozinc (2x/day dosing) . If I were using NPH, I'd probably want to use two 8 hour readings and a nadir value since it would most likely be dosed 3x/day in a cat. Again, regularity is a key.

My objective would be to get reasonable blood glucose numbers at the 12 hour periods without risking an hypoglycemic event at the nadir. The more data that I could correlate among these three values would help determine how much of an initial insulin dose could be given with a level of comfort.

Earlier you seemed to look for a less burdensome way to do a curve. I am certainly not against testing every hour and it does paint a more complete picture, but I feel that it does not add that much more to it. I feel, and this is just my opinion, that each person needs to get a better understanding and feel for dosing their cat and the way to do that is to collect data and use it as a reference for future decisions. Once things have stabilized you could build a sliding scale from your data. So I'm basically saying I would not do testing every hour but I would do testing more frequently where the nadir is likely to occur and bracket test around the anticipated nadir time. Initially, I would try to establish the time to the nadir so that I'd know with some confidence that it would occur 'around' that same time in the future if regularity were maintained and I'd be able to more efficiently test (three point curve). NOW THIS IS IMPORTANT: That is how I would do a curve or a mini-curve. I am very comfortable with this approach and I am used to working with and isolating data and I also have an understanding of diabetes...in humans/me, anyway. On the other hand, the curve generated from hourly testing is foolproof and easy to understand and implement. I guess I'm just trying to say that there is more than one way to get a blood sugar curve and get usable results.



The 'nadir' is the lowest blood glucose value and should correspond with the 'peak' level of activity for the insulin. The time of the 'nadir' should remain fairly consistent providing that a regular injection/feeding/activity schedule is maintained. The 'peak' (height of activity for the insulin) should remain fairly constant for a specific insulin type in the same person/cat. Think of 'nadir' and 'peak' in terms of time after injection and not absolute blood sugar numbers.

I actually try not to be confusing, but sometimes I just don't know when to shut up and I make things worse.


Sorry to reply AGAIN but I just reread again and saved it in my email - and I just have to say again this is really such valuable information!!! Thank you a million......so appreciated!!!!!!
 
When doing a curve, we generally suggest testing every 2 hours. That way, you can get an overall feel of what the day is like without having to poke every single hour all day.

On a regular day, we suggest testing at both AMPS and PMPS, nadir if you can get it, and then a before bed test at +2 or +3...gives you an idea of where they'll go at night.
 
In your opinion - should I give my cat a third meal? I know everyone does it differently - but what do you think? I feed him at 5-6am and 5-6pm. I never want him to be hungry, so do you think if I give him a small third meal as long as I keep it at the same time every day?? Sometimes I can't get him to eat a lot at his meal time.....he was used to eating anytime he wanted before. So I'm interested to see what you think about that since you have so much knowledge.

First, please don't consider me an expert on feline diabetes. Although I am in somewhat of a unique position in that I myself am I diabetic, I don't have the base of experience treating cats that so many of the regulars here have under their belt. Their experience is a valuable commodity that they are sharing to help me and you.

As far as Teddy's feeding schedule, I would think that you primarily want to be consistent with it whether it's 2 or 4 meals a day or whether it's more of a grazing pattern. If Teddy is eating all of the food that you've been feeding him, then I'd add another meal and/or just leave some food out. Buddy's feeding schedule (and the other two ferals are on the same schedule) is to get about 1/2 of Friskies Pate (remember, that is the larger size can) every 12 hours. I also mix in a little Young Again Zero Mature with it. Then whatever they don't eat initially is just left out for whenever they want it. Typically, a little bit of the food is still in their bowls so I just dump it and start over.

But these guys used to eat one of the highest carbo rich cat foods that I've come across. Their diet now is maxed at 5% carbs, and probably a percentage or two under that. I have noticed that with the new diet they are eating less (maybe much less) in volume and I believe that is a characteristic of switching from a high carb to high protein/fat diet. Remember, it is primarily the carbohydrates in the cat food that screws up their blood sugars. Same thing in humans. When I eat something, I pretty much balance the carb count against an insulin dose. I don't look at proteins at all. In humans, some fats are problematic in raising blood sugars and some aren't at all, but there is a delay as the 'bad' fats are converted to 'something' else that causes the blood sugar rise. From what I understand, the cat's system/metabolism is developed or has adapted to a high fat diet and fat is processed fairly well by them, so I would assume that blood sugar elevation in a cat is minimal...but that's just a supposition on my part based on piecing other bits of information together. So basically, I would just work out a feeding schedule that you can maintain and that makes Teddy happy. Just minimize the carbohydrate content of his food.


I just looked at Buddy's spreadsheet....wow! Did he get better in just less than a month???
And he is so cute! Awww love your picture of him!

Yea, it surprised the hell out of me how quickly Buddy turned around. He was on NPH for a week preceding the Prozinc spreadsheet, but it was full of havoc as the NPH had too short of an activity curve and Buddy's diet was being changed. I was not at all comfortable with things until his 12 hour numbers were getting out of the reds. But I would not say that he is better, because he's probably still classified as a diabetic. One of my preferred adjectives for a diabetic is 'maintained', meaning that their blood sugars are under reasonably good control. Currently I think of Buddy as a well maintained, non-insulin dependent diabetic.

And Buddy is one cool cat. We've got five cats in the house (and a dog). Three of the cats are ferals and the two 'regular' house cats were adopted from rescue shelters. It is very interesting to observe the unique personality of each of the cats and compare and contrast them. The other cool cat that we've got is Ozzie (also a male), but he's more of a 'Dennis The Menace' type and the dog loves playing with him. When the dog won't come to me when I call her, I just start calling for Ozzie and she comes running looking for him.
 
It's very interesting to read about a human diabetic's experience because kitties can't talk. It's true that cats have much lower carb requirements than we do and and their unique biochemistry allows them to convert protein to glucose much more efficiently than we can. Makes sense given that they're obligate carnivores and we're omnivores. I like the information @jbfrank gave about the need for consistency when dealing with diabetes. :)
 
First, please don't consider me an expert on feline diabetes. Although I am in somewhat of a unique position in that I myself am I diabetic, I don't have the base of experience treating cats that so many of the regulars here have under their belt. Their experience is a valuable commodity that they are sharing to help me and you.

As far as Teddy's feeding schedule, I would think that you primarily want to be consistent with it whether it's 2 or 4 meals a day or whether it's more of a grazing pattern. If Teddy is eating all of the food that you've been feeding him, then I'd add another meal and/or just leave some food out. Buddy's feeding schedule (and the other two ferals are on the same schedule) is to get about 1/2 of Friskies Pate (remember, that is the larger size can) every 12 hours. I also mix in a little Young Again Zero Mature with it. Then whatever they don't eat initially is just left out for whenever they want it. Typically, a little bit of the food is still in their bowls so I just dump it and start over.

But these guys used to eat one of the highest carbo rich cat foods that I've come across. Their diet now is maxed at 5% carbs, and probably a percentage or two under that. I have noticed that with the new diet they are eating less (maybe much less) in volume and I believe that is a characteristic of switching from a high carb to high protein/fat diet. Remember, it is primarily the carbohydrates in the cat food that screws up their blood sugars. Same thing in humans. When I eat something, I pretty much balance the carb count against an insulin dose. I don't look at proteins at all. In humans, some fats are problematic in raising blood sugars and some aren't at all, but there is a delay as the 'bad' fats are converted to 'something' else that causes the blood sugar rise. From what I understand, the cat's system/metabolism is developed or has adapted to a high fat diet and fat is processed fairly well by them, so I would assume that blood sugar elevation in a cat is minimal...but that's just a supposition on my part based on piecing other bits of information together. So basically, I would just work out a feeding schedule that you can maintain and that makes Teddy happy. Just minimize the carbohydrate content of his food.




Yea, it surprised the hell out of me how quickly Buddy turned around. He was on NPH for a week preceding the Prozinc spreadsheet, but it was full of havoc as the NPH had too short of an activity curve and Buddy's diet was being changed. I was not at all comfortable with things until his 12 hour numbers were getting out of the reds. But I would not say that he is better, because he's probably still classified as a diabetic. One of my preferred adjectives for a diabetic is 'maintained', meaning that their blood sugars are under reasonably good control. Currently I think of Buddy as a well maintained, non-insulin dependent diabetic.

And Buddy is one cool cat. We've got five cats in the house (and a dog). Three of the cats are ferals and the two 'regular' house cats were adopted from rescue shelters. It is very interesting to observe the unique personality of each of the cats and compare and contrast them. The other cool cat that we've got is Ozzie (also a male), but he's more of a 'Dennis The Menace' type and the dog loves playing with him. When the dog won't come to me when I call her, I just start calling for Ozzie and she comes running looking for him.

Thank you for this excellent information. I really appreciate it and it all makes sense.

Aw I love that you have five cats and a dog....and that's cute about Ozzie!!! Lol
 
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