I can’t make sense of Emmett’s numbers—advice?

KLD

KLD

Active Member
Hello! It’s been a while since I’ve posted about Emmett. Sorry, I’m currently on mobile so not sure how to link my previous threads on my phone.

Anyway, I’m looking for some advice on Emmett and his numbers this past month. About a month ago, I moved with my cats. The stress, quite expectedly, caused Emmett to become completely disregulated. It took me a while to figure out what was going on with his numbers and whether I needed to be decreasing or increasing his dose (and I was too stubborn and sure Emmett would eventually stabilize so I didn’t ask for advice then).

However, a month later, Emmett is feeling comfortable and not so stressed in this new place, but he’s still pretty disregulated. I can’t make any sense of what is happening with his preshot numbers. He seems to be constantly bouncing around. He has extremely high numbers followed by pretty low (for him) numbers. I don’t know if his nadir is changing or if his blood sugar is just bouncing mid cycle.

Currently, his full dose is 3.25 units, but I’ve had to adjust that down with his lower preshot numbers. I’ve also not been able to test him during the day sometimes due to work.

Aside from the move, nothing has changed about his routine or food. He still eats fancy feast pates (and sometimes merrick rabbit pate). He eats at +2, +4, and occasionally +6 (I’ve been skipping this meal more often lately, and he doesn’t seem to be begging for food as much since moving, but that could just be the result of him not feeling as comfortable yet).

I would love some advice about what I should be doing with him/his dose. Thank you!!
 
Wow. Looking at his spreadsheet, he’s all over the place. I think it’s because his doses are constantly changing. He’s also very bouncy. On the days recently when he’s had a blue Amps, there are no tests during the cycle so we have no idea whether the reason he ended up in the black is because it just wasn’t enough insulin or because he dropped and then bounced. I think you need to find a dose that you can stick with pretty much all the time. And gradually increase or decrease On the days where there are no tests, are you gone all day?
 
Once you settle on a dose then you should run a curve testing every 2 hours so we can hopefully see what’s going on.

Could there be anything else wrong like a dental problem or urinary tract infection or anything else you can think of?
 
Suzanne & Darcy said:
Wow. Looking at his spreadsheet, he’s all over the place. I think it’s because his doses are constantly changing. He’s also very bouncy. On the days recently when he’s had a blue Amps, there are no tests during the cycle so we have no idea whether the reason he ended up in the black is because it just wasn’t enough insulin or because he dropped and then bounced. I think you need to find a dose that you can stick with pretty much all the time. And gradually increase or decrease On the days where there are no tests, are you gone all day?
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yeah, I don’t like that how I’ve been changing his dose, but I know the full dose of 3.25 will be way too much with those blue preshot numbers. And I feel like he needs a higher dose with those higher preshot numbers, like how he was doing the month of April. But I can definitely find one dose I can stick with and see what’s going on. I think I’ve at least been consistent with his PM dose.

And yes, unfortunately, and frustratingly, the days he’s had the blue AMPS I’ve had to be in the office for work. That’s why I was so conservative with his dose, to make sure he wasn’t getting too much when I couldn’t monitor him.
 
Suzanne & Darcy said:
Once you settle on a dose then you should run a curve testing every 2 hours so we can hopefully see what’s going on.

Could there be anything else wrong like a dental problem or urinary tract infection or anything else you can think of?
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he still has a sore paw, likely the eosinophilic granuloma, but I have been wondering if I’m wrong about that and there is something else wrong like an infection. It might be time for a vet check.
 
Suzanne & Darcy said:
I would check it with the vet, yes. Because he’s just got so much black and red on there. I know you hate that.
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Thanks. I’m going to email the vet. I’m really hoping we can resolve this. When his blood sugar is relatively good he feels GREAT and will play all day, then it suddenly spikes and I can watch him just crash and have no energy. I feel so bad for him.
 
KLD said:
And yes, unfortunately, and frustratingly, the days he’s had the blue AMPS I’ve had to be in the office for work. That’s why I was so conservative with his dose, to make sure he wasn’t getting too much when I couldn’t monitor him.
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I understand. If only he would do this when you were home we would be able to gather some data to see if it’s too much or too little.
 
You could try a slight reduction to 3 units or 2.75 units and see if it’s something that you can shoot more consistently. Although if he has infection or inflammation it is going to be really hard to get him into more consistent numbers. I am sorry you’re having such a rough time of it. I know it is hard to see him feeling awful. Let’s work on it and see if we can do better for him.
 
Suzanne & Darcy said:
I understand. If only he would do this when you were home we would be able to gather some data to see if it’s too much or too little.
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My mom feeds the cats while I’m at work, and she’s getting more comfortable with testing him. Hopefully if this happens again in the future she can get at least one test in during the day
 
Suzanne & Darcy said:
You could try a slight reduction to 3 units or 2.75 units and see if it’s something that you can shoot more consistently. Although if he has infection or inflammation it is going to be really hard to get him into more consistent numbers. I am sorry you’re having such a rough time of it. I know it is hard to see him feeling awful. Let’s work on it and see if we can do better for him.
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Okay, that’s a good idea. I will start doing that. I won’t be able to get him into the vet over the weekend of course. Fingers crossed we can figure out what’s going on with him.
 
It could even just be the inflammation from the eosinophilic granuloma… I mean it doesn’t necessarily have to be an infection, per se, but allergies are an inflammatory response so that could just be it. Have you tried Atopica?
 
Suzanne & Darcy said:
It could even just be the inflammation from the eosinophilic granuloma… I mean it doesn’t necessarily have to be an infection, per se, but allergies are an inflammatory response so that could just be it. Have you tried Atopica?
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Hopefully that’s just it. We haven’t tried that yet but the vet has mentioned it as an option.
 
Emmett is keeping me on my toes today! He had a great cycle, but these drastic differences in preshot numbers are stressful lol. I decided to try sticking with 2.75 and adjust from there. I’m going to monitor him really closely tonight.
 
Hi @Suzanne & Darcy I just wanted to say a big thank you to you for your advice. It was spot on as always. Turns out, Emmett just needed way less insulin. His numbers are way more stable over the past few days, and at least the bouncing numbers the past couple days make sense to me.
 
Those numbers do look better! I am very glad to see this! How’s his paw? What did the vet say?

You reduced to 2.25 last night because of the greens? Just keep tracking his numbers and make sure you have not reduced too much or too quickly. Cats insulin needs can change over time (either up or down). His spreadsheet looks promising. If he can clear up any infection or irritation then he may need even less insulin. I bet he’s been feeling better a lot of the time! :)
 
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Suzanne & Darcy said:
Those numbers do look better! I am very glad to see this! How’s his paw? What did the vet say?

You reduced to 2.25 last night because of the greens? Just keep tracking his numbers and make sure you have not reduced too much or too quickly. Cats insulin needs can change over time (either up or down). His spreadsheet looks promising. If he can clear up any infection or irritation then he may need even less insulin. I bet he’s been feeling better a lot of the time! :)
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The vet thought Atopica might not be the best choice for him (not sure why) but if this goes on any longer I’m not sure there’s a choice.

I reduced because he looked like his blood sugar bounced up really quickly after the 4.8 at +4, when his nadir is typical +6. In the past that has been a sign that he needs an insulin reduction. So I wanted to give him a few days on 2.25 and see how he does. He’s definitely feeling better!
 
Okay. Then try to hold that dose for a while unless he drops low. We may want to keep him at this dose unless he drops below 70. I feel like he’s doing really well right now and it would benefit him to lower the reduction point. I will check back in on his spreadsheet later today.
 
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Suzanne & Darcy said:
Okay. Then try to hold that dose for a while unless he drops low. We may want to keep him at this dose unless he drops below 70. I feel like he’s doing really well right now and it would benefit him to lower the reduction point. I will check back in on his spreadsheet later today.
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Yeah, I agree. I normally wouldn’t have reduced him from the 2.5 units so quickly but I didn’t like the mid cycle bounce.

I just tested him and at +4 he’s at 6.8/122 on the 2.25 units. Which seems to be really good, especially considering how high his AMPS was.
 
Also, I spoke to the vet and she is not concerned with his high preshot numbers. She manages diabetes more based on weight and other symptoms. Which is not necessarily the way I want to manage his diabetes.

In terms of his paw, she wants to try an antibiotic and if that doesn’t work, Atopica. I will try that but I am skeptical of the antibiotic working (if it is just a granuloma and not an infection) as it didn’t really work he was given an antibiotic for his lip not too long ago.
 
Looking good so far. I hope the antibiotics will help. We have another member on this ProZinc forum whose cat was having severe skin problems and she took him to a dermatologist last week and they did a culture— it came back as a staph infection (so he is on antibiotics). If Emmett’s is truly eosinophilic granuloma then it won’t help, as you say — and he’s tried them before. So far I’ve only had it with non- diabetic cats who can get a steroid injection for eosinophilic granuloma.
 
Suzanne & Darcy said:
Looking good so far. I hope the antibiotics will help. We have another member on this ProZinc forum whose cat was having severe skin problems and she took him to a dermatologist last week and they did a culture— it came back as a staph infection (so he is on antibiotics). If Emmett’s is truly eosinophilic granuloma then it won’t help, as you say — and he’s tried them before. So far I’ve only had it with non- diabetic cats who can get a steroid injection for eosinophilic granuloma.
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Interesting! I would hate for him to have an infection that I’ve essentially ignored (or at least thought I’ve not been able to do anything about). The last time he had antibiotics, it was only his lip bothering him, not his paw, so who knows.
 
Emmett officially went under 70 on 2.25 units, which I expected to happen sooner rather than later, so I will be decreasing him to 2 units tonight.
 
It’s under 68 on an Alpha Trak, but he still made it! Good catch!

Tell me what he ate and when. That kind of a drop from a pink AMPS to 67 in 4 hours is just too much. He should have eaten by +2 at least, and, if he already is doing that every day, then he is the kind of cat who needs more carbs (8/9) percent for his early cycle snacks and possibly 5/6/7 percent carbs at breakfast. We need to slow him down.
 
Suzanne & Darcy said:
It’s under 68 on an Alpha Trak, but he still made it! Good catch!

Tell me what he ate and when. That kind of a drop from a pink AMPS to 67 in 4 hours is just too much. He should have eaten by +2 at least and if he already is then he is the kind of cat who needs more carbs (8/9) percent for his early cycle snacks and possibly 5/6/7 percent carbs at breakfast.
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He eats fancy feast at +2 and +4. I can’t feed him chicken/poultry so my options are super limited with what I can give him. He likes Merrick rabbit, which I think is around 6% carbs, but rabbit is always hit or miss with stocking issues (we bought out all the pet stores in the area who carry it and it was like six cans total). I’ve tried lamb but he’s ambivalent about it. He loves the Purina DM (slices in gravy which is 10%) but unfortunately that’s chicken.
 
Oh that is a problem because he really needs to stop the diving. So no turkey either? Have you tried any pork options? Finding food is always so time consuming and so frustrating.
 
Suzanne & Darcy said:
Oh that is a problem because he really needs to stop the diving. So no turkey either? Have you tried any pork options? Finding food is always so time consuming and so frustrating.
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I will try to ration the rabbit so he gets it at +2 (I tend to give him it at insulin time so I know he’ll eat as he’s getting tired of his current food). He despises turkey. I think he likes pork but I don’t tend to see many options (mainly only in dry food). I’m in Canada where our cat food options are always so much more limited. I’m going to go to the pet store and look through the options more closely. Or maybe Chewy will have some options now that they ship to southern Ontario.
 
Hi @Suzanne & Darcy ! I’m wondering if you have any thoughts about Emmett’s recent numbers? The last couple days his pre shot numbers have been even higher than usual. Unfortunately today I was in the office so no mid cycle tests. I’ll get some in tomorrow though. Is he likely still bouncing? I’m hoping to see some better numbers tomorrow on 2 units; yesterday was promising.

As an aside, he got an antibiotic shot yesterday to see if it’ll help with his paw. If this doesn’t work (and I suspect it won’t) then the next step is Atopica.
 
I don’t think he is bouncing because He saw blue yesterday. We don’t know what he did today. I think he was doing better on a higher dose. Unless we can control his early drops (with the slightly higher carbs) where he earns a reduction, he may bounce back and forth between doses. When I look at his SS, it really looks like he did better on the higher doses and his preshot numbers were lower. I know you are limited as to what you can feed him ( and you were going to try to save the rabbit for those snacks. I don’t like seeing the black on his spreadsheet (and I know you don’t either.)
 
Suzanne & Darcy said:
I don’t think he is bouncing because He saw blue yesterday. We don’t know what he did today. I think he was doing better on a higher dose. Unless we can control his early drops (with the slightly higher carbs) where he earns a reduction, he may bounce back and forth between doses. When I look at his SS, it really looks like he did better on the higher doses and his preshot numbers were lower. I know you are limited as to what you can feed him ( and you were going to try to save the rabbit for those snacks. I don’t like seeing the black on his spreadsheet (and I know you don’t either.)
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Hmm okay. My mom ran out and found about eight small cans of the rabbit, which I’ll feed him at +2. Let’s see if that helps with the early drops.
 
KLD said:
Hmm okay. My mom ran out and found about eight small cans of the rabbit, which I’ll feed him at +2. Let’s see if that helps with the early drops.
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Sorry. I don’t think you are liking my answer. But if everything else is pretty much the same, I just think his dose is too low. I so hope the antibiotic (Convenia, right?) will help him (although I am not a fan of Convenia). Is the paw really bothering him?

Anyway, about the dose— I would wait and see if he gets any better numbers tonight before going back to 2.25. Will you be at home tomorrow?
 
Suzanne & Darcy said:
Sorry. I don’t think you are liking my answer. But if everything else is pretty much the same, I just think his dose is too low. I so hope the antibiotic (Convenia, right?) will help him (although I am not a fan of Convenia). Is the paw really bothering him?

Anyway, about the dose— I would wait and see if he gets any better numbers tonight before going back to 2.25. Will you be at home tomorrow?
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No your answer is fine! I’m just really hoping to see Emmett level out again and thinking about what I need to be doing.

yes, that’s what he got. He just holds his paw up a lot. It’s pretty swollen too. But he’ll sure ignore it and run around playing when he wants.
 
Yes. We will see if the 6 percent rabbit will help. It may not be enough. You may have to experiment with adding a tiny drop of corn syrup to his food or something…. I am just trying to think of something since he’s so limited on what he can eat. Sorry.
 
Suzanne & Darcy said:
Sorry. I don’t think you are liking my answer. But if everything else is pretty much the same, I just think his dose is too low. I so hope the antibiotic (Convenia, right?) will help him (although I am not a fan of Convenia). Is the paw really bothering him?

Anyway, about the dose— I would wait and see if he gets any better numbers tonight before going back to 2.25. Will you be at home tomorrow?
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And yes, I will be home tomorrow. I’ll see how it does on 2 units tomorrow and then go back to 2.25 if he’s not improving.
 
KLD said:
No your answer is fine! I’m just really hoping to see Emmett level out again and thinking about what I need to be doing.

yes, that’s what he got. He just holds his paw up a lot. It’s pretty swollen too. But he’ll sure ignore it and run around playing when he wants.
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Wow. He’s a tough guy. How old is he? Any chance it could be arthritic? Has it ever been x-rayed? Does the skin on the paw look broken or red or blistered? He’s had these skin problems for years?
 
Suzanne & Darcy said:
Yes. We will see if the 6 percent rabbit will help. It may not be enough. You may have to experiment with adding a tiny drop of corn syrup to his food or something…. I am just trying to think of something since he’s so limited on what he can eat. Sorry.
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No problem. I super appreciate all your help. I’ve been at a total loss for him. Especially since his vet doesn’t care about his preshot numbers. But I don’t see how him always in the red/black could possibly be good for him. I’ve got human diabetics in the family and can’t imagine NOT being concerned about constantly going into the 20s and 30s
 
Suzanne & Darcy said:
Wow. He’s a tough guy. How old is he? Any chance it could be arthritic? Has it ever been x-rayed? Does the skin on the paw look broken or red or blistered? He’s had these skin problems for years?
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He’ll be 4 on July 1st! It was x-rayed when the issue first appeared two years ago and there was nothing out of the ordinary. He hasn’t had any tests done on it since. Sometimes the paw pads look red and raw and crusty, but this time I’m not noticing anything unusual except it’s swollen.

The issue first appeared two years ago, but we were going on a year without any major issue, until he got diabetes and started eating more chicken based food. Now it seems like it’s always his paw or his lip having problems.
 
I’m just thinking now, there are some brands of food like Nulo that have non poultry flavours he’ll eat, but I don’t see listed on the food spreadsheet. I’m not sure how many carbs are in those pates. I’ll have to look into options more on the weekend when I have more time.
 
How is Emmett? His numbers don’t look good, but the last few days are blank so we can’t know if he stayed high or went down. But I am a little worried.
 
Suzanne & Darcy said:
How is Emmett? His numbers don’t look good, but the last few days are blank so we can’t know if he stayed high or went down. But I am a little worried.
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Yeah, unfortunately I have to be in the office twice a week, hence the blank days.

I feel like I’m starting from scratch with him. But if that’s what he needs to get regulated again, so be it. Today and tomorrow I’ll be able to get lots of tests in to see how he’s doing back up to 2.25 units. I think it’s absolutely bizarre that 2 units had brought him down to around 8, and before that 2.25 units seemed really good for him, and now we’re stuck in the 20s.

According to my mom who watched him while I was at work, he also spent all day yesterday attacking my other cat. Aggressively licking and sniffing him, then holding him down by the scruff until my other cat yelped. I have never seen Emmett do anything like that before. I have a blanket I only really use to burrito wrap Emmett when I’m taking his blood sugar, so I used that blanket to wrap my other cat and run Emmett’s scent all over him. That seemed to do the trick and he’s no longer attacking him at least.

Just another recent bizarre Emmett thing to add to the list I guess.
 
Wow. That is strange. I would keep the two cats separated if he starts up again. I’m glad you will be home and can get some tests. How are his lip and paw?
 
Suzanne & Darcy said:
Wow. That is strange. I would keep the two cats separated if he starts up again. I’m glad you will be home and can get some tests. How are his lip and paw?
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For sure. Thankfully they were fine last night—not as many places for my other cat to hide in my apartment as at my parents’ house.

His paw is no better. He’s still holding it up. His lip actually looks like it’s starting to get swollen again. So frustrating. But I have officially cut out all chicken (before I had just cut back because I couldn’t find enough flavours he would eat, but not cut it out entirely) but it will take a few weeks to tell if it makes any difference. If it doesn’t, maybe it’s not the chicken but some fish flavour he’s been getting. Hopefully we figure it out.
 
KLD said:
For sure. Thankfully they were fine last night—not as many places for my other cat to hide in my apartment as at my parents’ house.

His paw is no better. He’s still holding it up. His lip actually looks like it’s starting to get swollen again. So frustrating. But I have officially cut out all chicken (before I had just cut back because I couldn’t find enough flavours he would eat, but not cut it out entirely) but it will take a few weeks to tell if it makes any difference. If it doesn’t, maybe it’s not the chicken but some fish flavour he’s been getting. Hopefully we figure it out.
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I feel sorry for him. If it is bad enough that he’s holding it up it must be really bothering him. And that may be the cause of him attacking your other cat.
 
Suzanne & Darcy said:
I feel sorry for him. If it is bad enough that he’s holding it up it must be really bothering him. And that may be the cause of him attacking your other cat.
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Yeah. I think it’s the act of putting pressure on it that bothers him. At least, he lets me play with his paw no problem.

thankfully he hasn’t been attacking my other cat today. Rubbing his blanket on him seemed to do the trick.

Emmett’s blood sugar spiked up super early today. I was really worried his PMPS would be in the 30s or something. But it ended up being lower than I expected. Still super high. Fingers crossed he can stabilize soon.
 
I am back to a complete and total loss about what is going on with Emmett’s blood sugar. He’s higher at “nadir” than he was this morning. I don’t know what’s causing the extreme mid cycle bounces. Wrong choice to up his dose today? I just don’t understand how, after a solid week of good numbers, he’s unregulated again. It’s so hard for me to tell if he’s getting too little or too much insulin.
 
Hello there. Did I miss this last post? If so, I am so sorry. Something told me to check in on you today, and then I see this post from the end of June and I feel awful that I missed it!

I had been caring for my dear Ginger kitty with heart disease. We struggled a lot during June and it was really hard. I lost her on July 12, and I am just starting to reemerge after that — so I wasn’t on line very much for a good month or so.

So anyway, I see that Emmett has earned a reduction today down to 3.25 units. Are you okay with that? He is kind of all over the place sometimes. You have been doing a good job of keeping up with it!
 
Suzanne & Darcy said:
Hello there. Did I miss this last post? If so, I am so sorry. Something told me to check in on you today, and then I see this post from the end of June and I feel awful that I missed it!

I had been caring for my dear Ginger kitty with heart disease. We struggled a lot during June and it was really hard. I lost her on July 12, and I am just starting to reemerge after that — so I wasn’t on line very much for a good month or so.

So anyway, I see that Emmett has earned a reduction today down to 3.25 units. Are you okay with that? He is kind of all over the place sometimes. You have been doing a good job of keeping up with it!
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Hey, no worries! I managed to figure it out, all good :)

I’m so sorry to hear that. That is so difficult. I know you do a lot for this community but I hope you took the time you needed for yourself.

You actually have great timing because I was about to make a post today asking for some advice after the weird day we had today. I had no idea what dose I should be giving him tonight—he had been on 3.5 and I know he needed a reduction, but given that he got 3 units today and still went down to 3.7, I didn’t know what his reduced dose was supposed to be. He was actually at 5.2 at his usual insulin time, and I delayed two hours until he was at 10.7. I’ll give him 3.25 tonight, unless he has another unusually low number (and will keep in mind his new insulin time).

Also, I know the last time we talked, we discussed how Emmett had gotten a Convenia shot. Do you know if there is any correlation between convenia and insulin resistance? Looking back, Emmett suddenly needed a large increase in insulin starting the evening after he got the shot (June 18). I just thought it was so weird how he had been doing relatively well on 2.25/2 units and suddenly I’m increasing his dose all the way up 3.75 before I started seeing normal numbers again. My mom is convinced the convenia did it, but I couldn’t find anything in my (limited) research. I just didn’t know if this was something that had been observed before, or if it was just a coincidence.
 
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