I need to get P's blood sugar down, need help...

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Melissa and P

Melissa and P

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I'm getting really worried about these numbers in the 400s. He was diagnosed in December, which means his glucose has been high for at least +2 months. I'm really ready to get these numbers down. I need to know what I need to do. I know there isn't much information, so do I need to do more tests at night? I need to know, I'm so worried. I check for ketones everyday since his numbers are high, but they've been negative.

I did a curve last night, to see what's happening at night because his numbers seem to be higher in the morning when I don't do a fur shot. I've done shots at 0.5 for the last few days, and it doesn't seem to be helping.

Any ideas?
 
I think an increase is wise too. Maybe .75 or even one unit for 3 cycles, getting midcycle as often as possible, then raise again if he stays high.
 
Depending on your ability to get tests around the nadir, you might try upping the dose by 0.5 every 2-3 days if the nadirs remain above 300.

I'm borrowing that idea from the Lantus folks, who use an accelerated dose increase when the nadirs are up in the 300s or more. You do need to get those tests around the nadir to be able to see when you're starting to get it down in order to keep him safe.

Its safer to make a bigger dose increase of 0.5 units, rather that 0.25 units when you have lots of room between 50 mg/dL and nadirs in the 300s.

Make sense?
 
Good luck with your trial increase Melissa! We're watching closely :)

I know with Eddie, we reached the conclusion that his nadirs were later if the dose was too high. There were a couple days when his nadir was at like +11 or +12 and he wouldn't start coming back up till +14, so I wonder if the inverse might be true...that if the dose isn't quite high enough, the nadir is earlier, and the shot duration is shorter.
 
The one unit doesn't seem to be doing much so far, but I'd give it a couple cycles before increasing again. Sometimes it takes that long for them to settle into a different dose. (it shouldn't be that ProZinc which is supposed to an in and out insulin, but with some cats, it does seem to work that way.)
 
What might be happening is that the larger dose could push the nadir a bit later, as mentioned above.
Hang in there; its a process, not an event!
 
My kitty always took at least 3 days...usually more like a week to settle into a dose. Every cat is different ya know?

You'll get there! It took a long time for Gypsy to come down but she was eventually consistently in the low 200s pre shot. You just gotta keep trying til you find what works!
 
I'm almost convinced he needs little to no insulin at night. His BG this morning was 525! He got better numbers, hello 200s, when he was getting fur shots at night. I went ahead and increased to 1.5 units this morning since I'll be around today to monitor, and I won't be tomorrow. I know this is a marathon, not a sprint, but I've seen first hand what happens to a diabetic human when their BG is consistently over 400. So that 525 and all these 400s scare me to death. I just don't know what to do at night. I can't purposefully not give him insulin, but when he accidently didn't get any, his numbers were better! Yell at me and tell me I'm stupid if that's what I am, please.
 
The way I look at it, every shot is an experiment. The body is always in flux and continually trying to establish homeostasis (balance). You never know what will change, so you have to be observant and flexible.

Cats are different from humans in that they are obligate carnivores and their pancreas can heal sometimes. We have had a few cats who didn't read the book on how to be a diabetic and sometimes it was protocol be d*mned [ex Xuxu [GA], Lucien [Relaxed Lantus]). You have to do what works for you and your cat, based on the observations you collect (any of them, not just test data -see Secondary Monitoring Tools in my signature)
 
Well, his nadir was at +6 today but it wasn't very low. I know I need to give the dose some time to work. But I am scared to give 1.5 units tonight. I just know he'll be high in the morning if I do.
 
Those amps are very puzzling. If you think he is dropping at night, i guess I'd try to get a +10 some night. But it isn't logical that he'd drop from a pink to 200 or something and then bounce immediately.

Does he eat at night? Maybe it would help to have some food out? A feeder would let you shut that off at +10 so it wouldn't affect the amps number.

I think, if you can monitor, I'd raise the dose again. I don't understand why he is higher than he was earlier this month -sometimes we think that means the dose is too high but we lowered it and the numbers weren't better.

And you might think the insulin has gone bad, but he does drop at nadir, just not enough.

I wish I had the magic answer, Melissa, but I am confused with his numbers. The other possibility is that ProZinc is not the insulin for him. But it was working at first....
 
I'm kind of shooting from the hip here, but can you get a +2 and +3? I'm curious if those high (500+) PS's are a bounce. If the +2 or +3 is quite a bit lower than the PS's, then that would suggest to me there's a bit of a bounce. Or, like Sue said, if you can get a +10, and see if the numbers shoot rapidly upwards, that would also suggest bouncing to me. But from the data you have, it doesn't look all that bouncy to me. From what I can see, it looks pretty consistently high throughout the cycle, so I'm wondering if you might consider keeping pushing P into the lower numbers with higher doses. What I'm trying with Eddie now is ignoring the bounces, and pushing for lower numbers at mid-cycles, rather than trying to establish a gentler curve by trying to stop the bouncing. I know I panic a little bit when I see high 400's for Eddie on the PS, but it doesn't look like P is staying in the 500's for very long each cycle.
 
I can get the +2, +3, and +10... but I really don't think he's bouncing. I think he doesn't need insulin at night. I want to try not giving him any at night, but I'm scared.

I don't leave food out at night. He's been acting hungrier lately, usually around +7 and +10 so I've been giving him small "snack" meals (about 1/4 of a 5.5oz can of Friskies)around +7 (and sometimes +10) in the afternoon. So, lately he's been eating 1 can at 7:45 in the morning, 1/4 can at 2:30pm, 1/4 can at 5:30pm, and 1 can at 7:45 at night. When he was first on insulin, I only fed him once in the morning and once at night. When I was reading about ketones, I saw that not enough food can cause them, so that's another reason I wanted to feed him more. But I won't always be able to give him the little snack meals (like on the weekends, when I'm not home for several hours at a time) so I was kind of wondering if it was better to be consistent and start feeding him twice a day again everyday, or give him the mini meals when I can. He makes me feel bad (and especially DH) when he scratches at the cabinet where I keep the cat food because he is hungry. I know food raises BG a little, but could it cause the numbers to be that high? I didn't think so, that's why I was giving him the mini meals, but this could all be my fault.

If the snow falls tonight, my class tomorrow will be canceled, so I can be increase to 2 units and be home to monitor. I am also really considering not giving him any insulin tonight if we get snow, so I can do another curve.
 
Can you explain your thinking, Melissa, about his not needing insulin at night? What I think I am seeing is that his numbers are in the same range at night as they are during the day. The only difference seems to be the high amps. It's true that when you thought you had given a fur shot, his numbers didn't rise the next am. But fur shots are tricky - often more gets in than you think.

A bounce only happens if the number goes down lower than usual. You really aren't seeing any low numbers. They seem to be pretty flat?

Because of the possible fur shots, and the lower amps, you did lower the dose for a few cycles, but you didn't see any improvement.

As far as the food, since he is unregulated, I'd give him extra food. His body may not be processing food as well as it should. Some cats do better with small frequent meals, some do better with two meals a cycle. But if he is always hungry, feeding him only two meals a day, might mean he pesters you more about food. And yes, food makes the levels rise, but it wouldn't be wise to try to use food to try to bring numbers down by feeding less. He needs more food, not less.
 
What I think I am seeing is that when he was getting fur shots in the pm, and 1 unit in the am, his numbers were lower during the day. The first night that I shot a full 1 unit shot (1/10/14), his AMPS and PMPS the next day were in the 400s, very close to 500. That night (1/11/14), another fur shot, lower AMPS, lower throughout the day, another PM fur shot, lower the next day. Then I started shooting in the scruff, started shooting 0.5 units and shooting full doses, and he goes high. My thinking is that he needs less than 0.5 units at night, and since I don't have u100 syringes yet, that no insulin would be better than 0.5 which takes him too high. I know for sure, sure, sure, one night that I gave a fur shot, I saw the drop of insulin on his fur. The whole drop. He didn't get any, and he was still lower. I know that sounds crazy. I know. I understand how insulin is supposed to work. Insulin is supposed to lower him. But from what I see, at night, more insulin makes him go high.
 
Well, try it one night. I certainly don't have the magic ideas for this sugar dance. Be sure to test for ketones with these higher numbers.
 
I'd make sure to get a test or two in at night if you don't give insulin. That way, you can really see what he's doing with that experiment.
 
Sue and Oliver (GA) said:
Well, try it one night. I certainly don't have the magic ideas for this sugar dance. Be sure to test for ketones with these higher numbers.
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Rachel said:
I'd make sure to get a test or two in at night if you don't give insulin. That way, you can really see what he's doing with that experiment.
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I have been reading your posts every day and could not come up with any suggestions. :YMSIGH: But it seems like you really know how P 'works' and wanting to try no insulin at night is a good idea. BUT...As Sue said check for ketones and like Rachel said get those tests in over night to actually see how the experiment works.

Hope it goes well...looking forward to tomorrow's AM post. cat_pet_icon
 
I gave the teensiest tiny drop of insulin, barely over the very bottom line on the syringe. I wanted to try no insulin, but the damn 498 PMPS scared me too much. I'm going to do a curve tonight to see what's up. So far, the +2 tonight is already lower than last night's +3, but he wasn't as high at PMPS last night as he is tonight. But an 80 point drop in 2 hours looks pretty good.
 
Aaaand, I've been meaning to ask where do you guys buy your syringes? I'll be able to get u100s tomorrow, so I just wanted to know where I can go to get them.
 
Melissa and P said:
Aaaand, I've been meaning to ask where do you guys buy your syringes? I'll be able to get u100s tomorrow, so I just wanted to know where I can go to get them.
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Melissa, I ordered mine from American Diabetes Wholesale, and they arrived within a few days.
 
Well, it certainly isn't conclusive that less insulin at night equals better numbers in the morning, but he was 384 at AMPS. I gave up on doing the rest of the curve last night because I was beginning to think I was going to have to do a 2 unit dose this morning, so I needed to sleep so I could be up to monitor today. I gave him 1.5 units this morning, to see if that's a good dose for the day time. If not, I'll have to wait until Friday to change to 2 units so I can be home to monitor. If things go well today, I'll do another tiny drop dose tonight and at least get a +2, +3, and +10.

Jen, that seems like a pretty good deal, eh? I think the u40s I got from the vet were almost $30.
 
You know, I didn't really price compare. I just wanted u100's and I wanted them NOW! :lol:

Here's a link specifically to the ones I ordered: http://www.americandiabeteswholesale.co ... s_5739.htm
It's only 60 of them, and I think the ones I got from the vet anyway, was like 100 of the u40s but I don't remember how much they cost. Money was just flying out the window at that point in time, so I didn't really notice. :YMSIGH:

I went with these because they have the 1/2 unit markings. I will note that the needle is shorter on these than the u40's My hubby, who faithfully does the shooting, isn't quite sure whether he likes the shorter needle yet or not. If he decides he doesn't like them, I may see if I can find ones with a longer needle. A shorter needle might help with the fur-shot problems you were struggling with earlier, although you seem to have that under control now. :smile:

Your experiment results are indeed interesting. I know it's gotta be incredibly frustrating seeing not-so-good numbers and worrying constantly. {{hugs}} P's got a lot of followers pulling for him :)
 
:lol: :lol: :lol: I completely understand. I was the same way. The only reason I found out how much they were is because I stumbled upon a post where people were talking about the costs of different syringes and insulins, so I went and checked my vet receipt to see if I got ripped off or not. :o

I think I've got the fur shots under control. Shooting in the scruff is easier, he doesn't move at all (he used to wiggle a little when I shot in his flank), and I think the majority of the problem was I was pulling the needle out too quickly without making sure I pushed the plunger all the way down. I have 1/2 inch needles, so I think I'll stick with those since I've gotten used to them. I want the syringes where I can dose like 0.2 and 0.8, so which ones should I get?

Thank you, thank you, thank you. I am so thankful for you guys. :-D
 
Melissa and P said:
I want the syringes where I can dose like 0.2 and 0.8, so which ones should I get?
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You want u100's with 1/2 unit markings to measure in increments of 0.2. Some u100 syringes do not have the half unit marks. Each half unit on the u100 syringes is the equivalent of 0.2 of u40 insulin. Here's a link to the conversion chart: http://www.felinediabetes.com/insulin-conversions.htm

And here's a picture of what the markings on the syringes look like: http://steverapaport.com/jock/SyringeFineGradations/
 
You did get a lower amps, but the whole cycle is still in the pinks which isn't great. I'd continue to try it for a few more cycles and see.

The only thing I can think of, if his numbers continue to drop, is that we didn't lower the dose enough when you tried lowering. Maybe you should have gone down to less than .5?
 
Honestly, I sometimes feel that NO insulin does provide lower numbers for some cats if they eat enough. At least for Simon, that happened sometimes. You might be on to something regarding the fur shots producing better numbers for you. I don't know why, but when Simon did not get insulin and ate enough, his numbers were so much better than when I was dosing him. It might be that Simon's pancreas was in a much better place than P's is, or it is just the way some cats are. His evening number was almost always better than his AMPS was .

Maybe you can give a larger dose during the day and a smaller evening dose and see what happens? Not sure what else to advise. P might need a bit MORE insulin than you are giving or he might need less. It is a process for sure. Hugs to you both!
 
Hi Mellisa! We're neighbors. :-D

Have no advice to give, know nothing about ProZinc or PZI, but my boy will start PZI on Friday, after a lousy year of Lantus and Levemir. Hoping the PZI works for Lucian. Yes, THAT Lucian! The one BJM says doesn't know how to behave as an FD kitty. :lol: He bucks the rules in a big way and never does what he's supposed to. :o

Best of luck to you and your baby. :YMHUG:
 
Thanks for the clarification Jen! :-D

Sue, this is blowing my mind, and not in the good way. I'm so glad to be out of the reds, but we're still not there yet. Going to keep holding the PM dose and play around with the AM dose to see how it goes.

Joyce, boy am I glad to hear that. Of course I wanted P's sugardance to be more like a line dance than a tango, but we've gotta do, what we've gotta do. And it's good to hear that he's not the only sugarbaby that does this. It's hard to wrap my brain around it, especially my DH. His brother was diabetic so he knows all about diabetes and it just makes no sense to him. I don't care who's wrong or right, or that it doesn't make sense, less insulin at night seems to be working, and that's all I care about! What I'm going for is what you said, a larger dose in the AM, smaller in the PM. And then I went a gave a fur shot this morning. ohmygod_smile ohmygod_smile ohmygod_smile ohmygod_smile I was going to switch to 2 units tomorrow morning, but since I missed the dose this morning, I think I'll wait until Saturday to try 2 units. Hugs to you and Simon!

LUCIAN! Debbie! Hello neighbors! Nice to meet you two! Yes, I've heard how much Lucian loves to dance the tango. Hopefully he'll learn to be a better sugar dance partner on PZI! P and I are wishing you two the best of best of luck! Hugs and paw fives to both of you!
 
Saw you had a fur shot this am? That might give you some good data. If he is lower, maybe less insulin all around will be the ticket. You are getting a higher nadir than preshot which sometimes can mean too much insulin - if it is consistent. For now, PJ seems to be dancing to his own drummer and isn't too consistent about much. (his sugar dance music must be jazz)

His numbers seem a little lower with the lower dose but still too high, so this weekend would be a good time to try something - whether lower than .5 or 2. I'm just not sure yet. Hopefully he will start declaring himself. :mrgreen:
 
He is pretty jazzy :smile:

Yep, fur shot this morning, but I wasn't able to get enough numbers around his nadir today so I don't have much data. *siiiiigh* The numbers I did get today are lower than yesterday's though, so I am thinking less in the AM may possibly be the ticket. I think I may try .5 tomorrow morning. I'm basing that on when he was in the 200s and getting fur shots at night, he was only getting one unit in the AM. I'll let you know how it goes. Paws crossed, good things will come!

Thanks for all your help! :mrgreen:
 
Well, I dropped the ball yesterday. My meter died on me yesterday morning so I didn't get an AMPS. I went out and got a new battery and then I still didn't get enough tests in. BUT! We got a yellow! A high yellow, but yellow nonetheless! I'm going to do better today with testing. Stuck with same PM shot, and 0.5 AM shot.
 
Very nice to see a yellow. It'll be interesting to see what his numbers are today.

Interesting that our earlier experiment with .5 didn't do much. Glad this one is working out better.
 
Thanks guys!

We skipped last night's shot because DH fed a snack too close to dinner time, and P didn't want to eat much of the dinner. Just in case he didn't eat much of the snack (I wasn't home to see, I'm normally the one that feeds, so I know how much he normally eats, DH doesn't) I thought it would be better to skip the shot altogether. Doesn't look like it made a lot of difference. I am thinking I need to slightly increase his morning shot though. I tried giving him the same amount I give at night, but he stayed in the 300s. So I gave.5 shot this morning and he's in the 200s again. I'm waiting for my u100s to come, then I'll increase to 0.6 first to see how that goes.
 
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