i've been at it a month and need help!

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Hello,
I'm Laura and my 9 yr old male cat is Piedmont, Ive posted a few times to the main board but I really need help figuring out if I'm giving my cat too much or too little PZI or if it just is not the right insulin for him. He was diagnosed a little over a month ago and was started out on 1u then the vet instructed me to immediately increase to 3u since his BG was so high. He was so high the other day I started giving him approx 3.3 u (I use u100 syringes so instead of filling to 7.5 line for 3 u, filled to 8.5) but that has definitely not helped so I backed off last couple cycles. Ive been testing at home all along with a relion confirm meter and he is still is very high much of the cycle even with dose increases.I do feed him the fancy feast classics, i don't have a true feeding schedule I give him probably 5-6 cans per day throughout the day, I tried withholding food after the nadir until next shot once and that actually drove his pre shot BG up.
Ive been thinking maybe lantus would work better for him, any advice, the sooner the better, would be greatly appreciated!
Thank you all in advance!
 
Hi Laura,

I can't get your ss to open. It says a google error. Not sure if it is my computer issue or yours. Did you Publish to the web and allow anyone with the link to share?
 
Oh good - it isn't just me having computer issues!

When using a U-100 syringe with a U-40 insulin, each 0.5 on the U-100 gives you a dose of 0.2 units of the U-40 insulin. This is because the U-40 insulin has only 40% of the concentration as U-100. The number after the dash is how many units are in 1 milliliter.
U-100 mark * 0.4 = U-40 dose
0.5 * 0.4 = 0.2 units of U-40
1.0 * 0.4 = 0.4 units of U-40
1.5 * 0.4 = 0.6 units of U-40
2.0 * 0.4 = 0.8 units of U-40
2.5 * 0.4 = 1.0 units of U-40
3.0 * 0.4 = 1.2 units of U-40
3.5 * 0.4 = 1.4 units of U-40
4.0 * 0.4 = 1.6 units of U-40
4.5 * 0.4 = 1.8 units of U-40
5.0 * 0.4 = 2.0 units of U-40
5.5 * 0.4 = 2.2 units of U-40
6.0 * 0.4 = 2.4 units of U-40
6.5 * 0.4 = 2.6 units of U-40
7.0 * 0.4 = 2.8 units of U-40
7.5 * 0.4 = 3.0 units of U-40
8.0 * 0.4 = 3.2 units of U-40
 
Hi Laura,

Well done for getting the SS set up. :smile:

What I'm wondering is whether Piedmont is having a wee 'bounce' after any numbers that drop into the lower blue numbers or green. Because from the data that is there, it looks to me like there could be an element of insulin resistance in the cycle/s that follow lower blue's and green. But seeing more data would make it easier to spot patterns. Just wondering...do you have any more data that you could add (any test results prior to those already on the SS? Even another weeks' worth would be helpful.)

I would also be interested in seeing more detail about what happens between +2 to +5 (I don't want much, do I?! :lol: ) Just wondering if there are some steep BG drops happening there, which could also cause bounce.

Regarding 'bouncing'; this can happen if the cat's numbers drop too low or too fast, or both. "Too low" doesn't necessarily mean 'hypo low', it can happen when the blood glucose just drops lower than the cat is used to. Cats can get used to having high blood glucose levels, and so even numbers that are nice safe normal numbers (or even a tad higher) can trigger the body to release glucose into the system (and also sometimes counter regulatory hormones that aim to keep the BG high by causing a temporary insulin resistance.)
This may or may not be what is happening with Piedmont. And I think we need more data to get a clearer picture of what's going on.

This is very early days in Piedmont's 'sugardance', Laura. And it can take time to see postive results.

BTW, I think you're doing an absolutely brilliant job with testing Piedmont. He is blessed in having you as a caregiver. :-D

Eliz
 
Now it works! I agree with Elizabeth - although it seems like it has been a long time, it is early in the sugar dance. You have been doing great getting numbers - that is, absolutely, the most important part of this whole thing. Are you around on weekends? Could you do a curve (that is a test every 2-3 hours during a cycle). It will give you a clearer picture of when he starts down, how low he goes, when he is at his lowest etc.

You said the vet started on one unit. How fast did he raise the dose? Were you getting numbers at home then or was he basing the increases on vet numbers? Does Piedmont have any other complications? Did he spend time in the ER? Did he have DKA?

Those early cycles looked okay, with blues and greens for nadirs but then a bounce for the preshots. (which is normal) Now he is running higher. That's why a curve would be useful. It is possible that he is getting too much insulin. That once he settled in, the "best" dose was skipped over. Or it's possible he needs more.

Yesterday was strange. Could the morning shot have been a fur shot?

If you will give us some time (get data, post daily so we can keep track of how he is doing) we'd be glad to try to figure this out with you.

Piedmont is a great name. What's the story? :mrgreen:
 
OK, I can see your spreadsheet now.

I definitely think your dose is too high.
Why?
Because I see numerous reds, then a sudden drop to green followed by numerous reds again. Its a checkmark pattern that happens giving too much insulin. The body releases stored glucose until it can't any more and that's when you see the sudden drop. The way to test this is to drop down, maybe to 1.6 units and hold the same dose for about 2 days to see if the pattern of numbers improves. If you decide to do this, you also should check for urine ketones

Also, see the chart I gave above? Write down the actual units of U-40 you gave at each shot based on the conversion table, ie an 8 on the U-100 syringe equals 3.2 units of U-40 ProZINC(the math is 8 * 0.4 = U-40 dose)
 
Hi Laura -

I agree with Sue & Eliz - that's a pretty steep jump in dose, (we usually recommend a half unit at a time). You may very likely have missed Piedmont's ideal dose. It's not uncommon for their numbers to jump around at first, so not to be startled.

What are you feeding him?

Lu-Ann
 
Thank you all! I will put some of my past weeks data in spreadsheet and i will try to get a good curve today, tomorrows tough because i will be away from house in the afternoon, but i all try to get readings as close to every 2 hrs as possible.
Piedmont initially spent 3 days at vet as they wanted to do the curve, i don't believe he had DKA but he had lost a lot of weight and BG and urine glucose was very high.
I saw a different vet when i brought him back a couple weeks later bc his BG was so high and he raised his dose from 1 to 3 units from one shot to the next, I should have done it gradually but was so upset by his BG being close to 500 I did as vet instructed. Piedmont is otherwise very healthy, he had a terrible UTI a day after coming home from vet a month ago now but since no other problems. I do feed him fancy feast classics and add a good amount of water so between that and his hyperglycemia he pees a ridiculous amount.
I really don't think it was a fur shot yesterday, however I should tell you that I live in miami on a quiet street where the weather is beautiful and i have been letting piedmont go outside for an hr or so at a time between shots as he was outdoors almost all the time before his diagnosis, and he has a brother (who is ply outside) he has turf wars with, usually they just puff up and growl at each other and of course now I'm very careful to make sure Piedmont doesn't get scratched or bit. I know stress isn't good for him but since he's spent his whole life with his brother i thought is was more of just dramatics than real conflict but maybe this is raising his BG.
I did drop his dose to 2.0 u (I did this before i saw your post BJM, if I had seen yours first I would have tried 1.6 as you advise) this morning to see how that goes, i will hold it for a couple days to see how that works. Also in my table I am using the actual U-40 units.
And he's named after Piedmont Park in atlanta, where my husband and I found him and his brother in bad shape and apparently abandoned by their mother in a storm drain at 2 wks old and bottle fed them, I have 2 yr old twin daughters now, but the cats were our first set of twins!
 
Hi Laura!

I don't have much to add other than to agree with what's been posted above. You're seeing some green and blue mid-point numbers, which are pretty steep drops from the higher pre-shot numbers. It's possible that those fast steep drops are causing the big swings. I also agree with Eliz that some of the flat cycles you are seeing following those cycles with the drops are probably due to "bouncing." My guy Eddie does this all the time. The fast steep drops can cause a kitty to react by releasing stored glucose, which causes a spike in the BG, and it can also cause the release of counter-regulatory hormones that counteract the effect of the insulin - basically causing temporary insulin resistance. I'm hopeful, you'll see some smoother patterns dropping down the dose a bit. You're doing a wonderful job with Piedmont!
 
Ok - great you've got the conversion down and are posting the actual units.

A few more infobits for you:
- vet stress may raise the glucose from 100 to 180 mg/dL, so readings at the vet may be higher than home levels. Dose adjustments based on office glucose levels can be too big.
- if you've changed from high carb dry &/or canned to low carb canned, that can further reduce the glucose level around 100 mg/dL.
- the nadir, ie lowest glucose between 2 shots, is about +5 to +6 hours after a shot of ProZinc. That is the optimal info for adjustment, as you want your cat to remain above 50 mg/dL on a human meter or above 80 mg/dL on a pet meter.
 
Quick check here:

How much does your cat weigh?
How much should your cat weigh? Ie is he over or underweight?

Feeding 5-6 cans of 3 oz Fancy Feast per day works out to15-18 ounces of food daily. That seems a bit high ... and may reflect the use of too much insulin if he's also ravenous. OR it could suggest an additional problem such as hyperthyroidism.

Maybe try this: 1 to 1.5 cans, fed in mini-meals over each 12 hours and drop the insulin back to 1 unit. One trick is to freeze half a meal then put both out at feeding. The frozen one may be nibbled as it thaws.
 
Okay Piedmont currently weighs about 12.5 lbs, at his prime outside, well fed, on dry food, before DM he weighted about 15 lbs (prior to that indoors only he weighed up to 18 lbs, but really did carry it well), maybe with a little saggy belly but he has a large frame and head and was muscular, i believe the vet would say 13 -14 lbs would be ideal for him. A month ago when the finally agreed to check for DM he was down to 10lbs and looked emaciated and he upon coming home quickly gained 2 lbs. Because he's regained quickly on low carb food and before tended to be heavy I don't think hyperthyroidism is a problem of his. When he and his brother were indoors their first 5 yrs they seemed to want to eat constantly out of boredom, since Piedmont's been feeling better he's starting to harass me at 5 am for food even when he has some left in his bowl! But I will try the freezing trick, hopefully that works and should make it more interesting for him too!
I will try to get more nadir readings, also Ive got figure out how to fill out my profile, but I am so bad at techy stuff. I use the relion confirm meter.
Thanks again!
 
A number of folks here use a timed feeder such as the Pet Safe 5 to mange the mini-meals. Something set to give him a bit at O'dark hundred might keep him from waking you up ;-)
If so inclined, see our shopping link above, and search on Amazon for it. We get a tiny bit of money if you do purchases via the links here.
 
I agree with BJ that the extra food may be influencing the bg levels. One way you can keep him feeling satisfied on less food is to add some water water to the pate and make a gravy. Some cats like that texture better, it makes them feel more full and it is getting needed water into their diet.
 
My Grayson has the PetSafe 5 as well. It's set to give him 1/4 can FF at +2, +4, +6 and +8 (both am & pm). That keeps him from having food spikes, AND from waking me up in the middle of the night hungry! Might be worth the investment if you're able.

I got mine at our local Petsmart - but they price-matched the online Petco price ($49) - saved $15 - you just have to ask (and bring a print out of the on-line ad). I was THRILLED!

Lu-Ann
 
Okay thank you all again, I will order an auto feeder, but how do you do it with wet food? put it in frozen and its okay all day and no bug problems?
Hi Lu-Ann, that's only 2 cans of FF, are you also giving a whole or 1/2 can at injection time? I thought Piedmont would need at least 4 cans per day to get enough calories, Ive been going based on how hungry he seems (which comes out to more than 4 cans per day) and trying to avoid feeding at end of cycle since i knew my vet's instructions of only feeding him twice per day at injection time was not ideal.
Im discouraged that reducing his dose this morning did not lower his end of cycle bg, but I kept him at 2u and will do so for a couple of days and follow, right or should I incr a little starting tomorrow AM?
 
I just looked on amazon from the shopping link on this site to order pet safe 5 feeder, but saw a few reviewers said their cats quickly figured out how to break in to feeder, have any of your cats figured it out? I know with anything on amazon there will be people not satisfied and this feeder does have the most positive reviews but just thought Id check with you all before I buy!
 
Hi again Laura! Don't be discouraged. Often, it takes several cycles before a new insulin dose takes effect. Give it a few cycles to see what happens. Remember, the sugar dance is marathon, not a race!

I don't have an auto feeder but I do leave wet food out all day. No bug problems honestly.

You're doing excellent! Some more numbers will help and posting here daily if you can will also help. Let us know what else you need!
 
I just looked on amazon from the shopping link on this site to order pet safe 5 feeder, but saw a few reviewers said their cats quickly figured out how to break in to feeder, have any of your cats figured it out? I know with anything on amazon there will be people not satisfied and this feeder does have the most positive reviews but just thought Id check with you all before I buy!
 
The PetSafe5 is the only one my cats couldn't break in. The base moves instead of a lid popping up. Oliver broke into 2 other feeders, but couldn't get into the PetSafe.

I freeze it sometimes, sometimes I use an ice pack, sometimes I just put it in.
 
Okay, thanks Sue! I'm going to order it now, I tried the frozen trick last night, I put it out at 11 then checked on him at midnight and all the food was gone! He was banging on my bedroom door at 5 am, so I really hope this feeder helps! Piedmont's been acting starving all morning, he was at 454 pre shot and now 2 hrs later is at 344, i feel bad that he's so high and feeling the effects, of course on 3 u he was having these highs too, please advise when I should adjust dose again or just keep holding for another few days. Im going to try to get as many readings as possible this cycle especially around nadir to provide a better picture of whats going on.
 
I like these new numbers! It is a smile shaped curve which is what ProZinc does - going from pre shot down to a low in the +5-7 range and then back up to preshot. And that he is getting the same range of numbers at a lower dose indicates the lower dose may be the way to go!

Since he was at 168 last night at +4 and 198 at +6 the cycle before, he might have dropped lower by +6 last night and then bounced a little for the preshot this morning. He has already dropped 100 points at +2 so hope this cycle looks good too.

Have we given you the Prozinc protocol? It may help or may raise more questions. :-D Be sure to ask if you have questions.
http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=109077

I'd stick with the 2 units for a few cycles and gather numbers so you can get a real picture of his numbers. It's clear the insulin is working - he is going down mid cycle and in pretty decent numbers then.

With the feeder, you can feed a little less overall, divide it into several small snacks and add water to make it seem like more to him. I have always been amazed how quickly they learn how the feeder works. My cat goes to the feeder about 10 minutes before it goes off and sits and watches and waits…….
 
Thanks Sue for encouragement and advice! I did order the auto feeder so that should be a huge help. I have looked at the province protocol and thought things were getting better on the 2u dose, however Im alarmed that its +9.5 hrs and he's at 425! I guess I will have to wait until scheduled time to give him insulin, but Im scared to find out how high he'll be in 2 hrs! I've been giving him mini meals today, and he's been begging for food all day, is it possible I have decreased his food so much he's releasing more sugar or is this just how it goes?
 
That number is discouraging, but the numbers midcycle look good. Maybe if this same pattern continues, raise the dose to 2.25? (usually we say 3 cycles before rasing the dose.)
 
Okay thanks Sue, Ill hold the dose and try to keep getting as many readings as possible. Ive read the prozinc protocol a few times over the past few weeks, but i am not sure how to apply it to Piedmont as he does drop more than 50% from pre shot to nadir, but nadir has never been too low and pre shot is so high. Do you think he bouncing from his nadir values or just burns through the insulin quickly? He has really had much less food today and spread out as much as possible and no food during the 2-3 hrs pre shot, I'm disappointed because based on yesterday's better readings I was thinking that the reduction in food made a big difference.
Oh well, I hope tomorrow is better! Thank you again!
 
any protocol is a general guideline which may be adapted to you particular cat. As you collect data on how he responds to insulin and various food and feeding options, you'll get a feel for what works best for him.

Also, the smaller the frozen piece, the faster it thaws. Have you got a heavy ceramic dish that can be chilled to slow that down?
 
Haven't been on for a while, but wanted to just interject one thought. If Piedmont goes outside, does he eat a lot of grass and isn't that a "high carb" item? Since vegetables contain carbs, doesn't grass also? I am not sure if I am right, but if he is eating grass outside, it might affect his numbers if he eats enough of it or other plants. Otherwise, you are doing a great job!
 
Simon'sMommy said:
If Piedmont goes outside, does he eat a lot of grass and isn't that a "high carb" item? Since vegetables contain carbs, doesn't grass also? I am not sure if I am right, but if he is eating grass outside, it might affect his numbers if he eats enough of it or other plants.

Hi, that's an interesting thought but I think grass consists mainly of cellulose that is hard to digest. It's not the same as carbs from grains/cereals/sugars. My cats are indoor/outdoor cats and they eat grass mainly 'therapeutically' - to make them puke when they have upset tummies or furballs! The grass comes up intact (and only affects Bertie's BG's beneficially (as furballs tend to increase his BG)) . But even if they could digest it I think there'd be very low carb/calorie value in grass, rather like us nibbling on lettuce maybe...?
 
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