Java and Lois, new here, diagnosed Oct., need better MO

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I suggest you post on the ProZinc/PZI forum for insulin-specific advice. You can always post on this main forum for general questions.
 
Looked at your SS just now and I see a BG of 106 at +3 ie., 3 hours after his dose of 0.5 u. That's a big drop from the pre shot BG value. I need to be absolutely sure that the data you entered is as I understand it. If it is, then it's important to do more tests if you're at home. It's about 2:30 PM your time right now. Did you give insulin around 10:45 AM this morning? Will that be your scheduled AM dose time?

If you gave the AM shot around 10:45 AM, you should test again 1 hour after the last test - that blue number. The reason I'm suggesting this is that Java's BG is dropping faster than is desirable and you need to track that. He could be too low for comfort by +6 which is when the nadir usually occurs.
 
Could you please clarify your dose time this AM. Was it at 7 - 7:30 AM or was it later. I know you gave a dose late evening last night. There was discussion of switching to early AM today. I need to know that in order to understand your SS. It's possible that the o.5 u dose overlapped with the remnants of last night's late evening dose and that's the reason for the drop at +3.

I think you can see from the questions I'm asking why we need to know you're following a structured routine. It's almost impossible to understand what's going on or be able to give advice without a routine.
 
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7:30 am BG was 227.
.5 unit at 7:30 am.
3 ish hrs later, at 10:45, 106 BG
Just now, 4 pm, or 8.5 hrs later, 206

He was sluggish at the 106 BG, three hours after. I woke him up before I had to leave, and he ate about a half a can of food, and seem brighter.

I was back by 2 p.m. or 5.5 hrs later, and the two cats and I went outside to enjoy the sun. I thought of testing him, was not thinking of the nadir but more his behavior seemed okay, and typing the phrase 45 jabs in the last 6 days above gave me pause.

I thought to test at 7 pm and go from there.

He's behaving pretty normally. The weakness in his hind legs is noticeable but he's still jumping up on things using both legs as one unit. Wants my food as usual. Has had some FF.

I'd like him to gain some weight back, and get better hind leg use back. It's hard to know what's the disease and what's his age.
The YA food is on its way here, by Sat. He is craving crunchy food. So far, dehydrated chicken breasts chopped up or as close as he's going to get. The Accutrack arrived. I have 2 or 3 strips left from the 50 strip container rec'd on the 23rd.

I think quite possibly no insulin tonight.

Has anyone found a reuse for the test strip containers? They're very cool.
 
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Kris and Teasel, I don't think I've said Thank You adequately. Thank you so very much. And Lisa and Smoky and Larry. Thank you.
 
Lois and Java said:
Kris and Teasel, I don't think I've said Thank You adequately. Thank you so very much. And Lisa and Smoky and Larry. Thank you.
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You're welcome! I think things will fall into place now that you're embarking on a routine. I can't stress the importance of this enough.

Lois and Java said:
I think quite possibly no insulin tonight.
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If his PMPS (evening preshot BG number) is similar to what it was this AM he'll absolutely need a dose of insulin, Lois. Even if his preshot numbers drop a little below 200 over time, he'll still need small doses unless/until he reaches remission. Insulin needs to be given on a strict every 12 hour schedule in cats because they metabolize it quickly. Dosing in a hit or miss way causes spikes and dives and makes regulation almost impossible. You'll have to resign yourself to that. :)

I'll be watching for your PMPS test result. That 106 at +3 tells me he might have gone fairly low around +5 or +6. The yellow afterward suggests he's on his way back to a number like he had this AM or thereabouts. If so, you'd give 0.5 u again at 7 PM your time and do another test before bed or at +3, whichever comes first. You need to build up a data library of Java's responses to regularly dosed insulin.
 
280. 7:30 pm.
1/2? 1/3?
Will be setting alarms tonight, the adrenaline wore off and I'm so tired, am napping when the cats nap.
 
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Lois and Java said:
280.
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OK. Feed and give 0.5 u again tonight. Don't wait too long after feeding and the meal doesn't have to be large. No need for any more testing tonight. His ears will welcome the break. The same routine has to be repeated tomorrow. I'll be out when you post your AMPS - I'm 3 hours ahead of you (eastern Canada). If his AMPS is similar to this AM/PM, give 0.5 u again. Just building up your data collection ...
 
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Lois and Java said:
280. 7:30 pm.
1/2? 1/3?
Will be setting alarms tonight, the adrenaline wors off and I'm so tired, am napping when the cats nap.
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0.5 u and you don't need to set any alarms tonight. You can do one last BG test before you go to bed and that should do. You'll find that as you continue with a structured routine patterns will emerge on his spreadsheet and you won't have to test as much because there'll be more predictability.
 
.5 done.
Okay! Thanks so much.
I'm so sorry about the Ontario shooting.
There's so much awful political news, it's part of the fatigue probably.
Thanks again, wonderful persons over the Internet. I'm so grateful to have found this site.
 
I suggest you start posting on the ProZinc/PZI forum for insulin specific advice. The users tend to congregate there.
 
Lois and Java said:
165 at 12:15 am, midnight ish
Had a big feed around 9:30, a good snack now.
Will give him a break on the sticks until 7 AM-ish.
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I like that blue number. What type of syringe are you using - U40 with half unit marks? I ask because I want to know how you measure doses. We generally use 0.25 u increments, not 0.33 u.
 
It's a miracle! Thanks for staying on me until I got this!
292 this morning. .5 after some food. He's continuing to come back and eat more, which I like.
I had an alarm set, but both cats woke me up by standing over my face and meowing at me. I'd pulled food up at 4:45 a.m. while up to pee.
I have U-40s, two types from the vet, both of which only have one unit markings. I eyeball it, hold the syringe so the ceiling light from the next room shines through it. I'd asked the pharmacy and the vet for different types of syringes and neither had anything better than this. Where do people get U-40s with half markers?
 
I feel so bad now for putting Java through so much since October. Knock wood, this looks like it can continue being stable. Seriously thank you so much. It's stunning how unhelpful the vet was.
I'll make a point today of doing a test at 6 hours.
 
Lois and Java said:
It's a miracle! Thanks for staying on me until I got this!
292 this morning. .5 after some food. He's continuing to come back and eat more, which I like.
I had an alarm set, but both cats woke me up by standing over my face and meowing at me. I'd pulled food up at 4:45 a.m. while up to pee.
I have U-40s, two types from the vet, both of which only have one unit markings. I eyeball it, hold the syringe so the ceiling light from the next room shines through it. I'd asked the pharmacy and the vet for different types of syringes and neither had anything better than this. Where do people get U-40s with half markers?
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Many folks in the US order from adwdiabetes.com. I'm so glad you're seeing some light at the end of the proverbial tunnel. :)
 
I saw the blue 172 from this afternoon. Give 0.5 u again tonight just to keep things on an even keel. If he has a yellow preshot tomorrow AM, go up to 0.75 u. I'm suggesting the increment of 0.75 u because that's what you'll be eyeballing on a U40 syringe with half unit marks. Have you ordered any?
https://www.adwdiabetes.com/product/carepoint-vet-u-40-syringe-29g-half-unit_16363_112.htm
Let's avoid anything "non-standard" like 0.33 u for now.

Your choice re another test late this evening. I don't think it's needed.
 
Java's hungry now, he'd probably appreciate not being jabbed.
.5, check, no test until tomorrow am.
I have Miralax now, will start with 1/8 tsp sprinkled on food.
Why .75 instead of .5 tomorrow?
I'm not sure where the .33 reference is coming from...?
Have not ordered new needles. I have a lot of u40s now and feel okay about eyeballing .5, etc. but will get the new ones after these.
 
Right. Keep that same dose of 0.5 u for a third day. My error. When I mentioned 0.33 u it's because you asked me about it as a possibility for last night's dose. We usually stick to fractions of 0.25, 0.5 and 0.75 of a unit. If you can eyeball those on the syringes you have, that works.
 
Hi Lois .. Tanya's Guide to CKD kitties also has really good info on how to treat constpation in a CKD kitty...her suggestions on Miralax dosing make wonderful sense. She says to start out 1/8 t ( full dose once a day or divided dose twice a day) for 3 days before increasing to 1/4 given the same way . Also has other good suggestions on the subject . Hope this helps .
 
I read about Miralax on Tanya's page earlier, there's also a thread about it here. I missed specific instructions to go with 1/8 for 3 days then increase it though. I imagine it depends on whether the 1/8 works or not, and 3 days should be enough to see. Good to know, thanks. That's a good website.
 
I was looking for the PMPS number from last night but you haven't updated your SS yet. A third day at 0.5 u AM/PM will be your baseline data set. The dose will likely need to go up tomorrow, numbers permitting. Systematic ... ;)
 
I didn't test him last night. I thought that's what you suggested. I tested this morning. My mistake obviously. In other words, don't vary from the routine of: AM test, food, shot; PM test, food, shot. What might vary is the # of tests in between AM and PM.
 
Lois and Java said:
I didn't test him last night. I thought that's what you suggested. I tested this morning. My mistake obviously. In other words, don't vary from the routine of: AM test, food, shot; PM test, food, shot. What might vary is the # of tests in between AM and PM.
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Yes, that's correct. Sorry if I wasn't clear about that. It's wise to get at least one other test either mid day or before bed. If it seems that BG is dropping low-ish then more testing is in order.
 
I had an appt and wasn't home until 6:25 to take up food. Tested at 7:45, 368, higher than last two nights; food, then shot at 8. Could the later time be the difference in BG, or 1.5 hrs fasting instead of 2 before testing?
 
Lois and Java said:
I had an appt and wasn't home until 6:25 to take up food. Tested at 7:45, 368, higher than last two nights; food, then shot at 8. Could the later time be the difference in BG, or 1.5 hrs fasting instead of 2 before testing?
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Probably food influenced.
 
I suggest that you go up to 0.75 u this AM. The three days at 0.5 u were to establish a baseline. The numbers say that slow dose increases are needed. Unless something changes, keep the 0.75 u for three days. Once you have a lot more data under this new structure it'll be possible to change doses more often as needed.
 
Okay. I think I should check around +5 to be sure not too low.
Miralax and pumpkin not working super great yet, but he is pooping, just still hard nuggets that sometimes get stuck. One outside litter box this am, but improved over on the dining room table yesterday.
 
>> Probably food influenced
Same food, so different amounts ingested? He ate more, or the fasting wasn't as long.
 
Lois and Java said:
Okay. I think I should check around +5 to be sure not too low.
Miralax and pumpkin not working super great yet, but he is pooping, just still hard nuggets that sometimes get stuck. One outside litter box this am, but improved over on the dining room table yesterday.
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Yes, a test at +5 is a good idea.
 
>>Unless something changes, keep the 0.75 u for three days
Check. Thanks!
Curious -- How did you know his BG would start to go up?
 
I deleted my last post because I reconsidered what I said. The pink preshot numbers you got today could be bounces - an overreaction that raises BG in response to a low number or lower than is typical number. I suggest that you do a 12 hour curve tomorrow at the 0.75 u dose if your schedule permits. Take a BG reading every 2 hours between AM and PM preshots. That might give an indication of where his nadir is as well show how low this dose takes him.
 
I can do that.
His ear isn't bruised any more, it was good to take a break from so many sticks.
I don't quite follow the rationale but I'm game.
Assuming .5 sent him to a low of 117 -- if that's what you're looking at and I don't know that it is -- wouldn't .75 create a lower low?
I believe we can rule out plain pumpkin as a cause of change? And miralax apparently is inert for BG purposes.
 
Woke up to pee, tested, 303, it's 2 am / +6. Am surprised. The 7:45 pm shot went in for sure, this test was a big drop of blood. He ate more than usual I think? We're both going back to sleep.
 
Lois and Java said:
I can do that.
His ear isn't bruised any more, it was good to take a break from so many sticks.
I don't quite follow the rationale but I'm game.
Assuming .5 sent him to a low of 117 -- if that's what you're looking at and I don't know that it is -- wouldn't .75 create a lower low?
I believe we can rule out plain pumpkin as a cause of change? And miralax apparently is inert for BG purposes.
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Logic says that if 0.5 u dropped his BG to 117 then 0.75 u should drop him further. That assumes a simple response to the insulin, ie., more insulin = lower BG. That's true for some cats who don't "bounce" or for bouncy cats some of the time. This phenomenon can make a dose that's too high look like a dose that's too low. I suggest you try searching this term on FDMB by using the search bar at the top right of this page. In a nutshell, bouncing is an overcompensation to a change in BG in which the cat's body converts glycogen stored in the liver to glucose for the bloodstream to counteract the perceived danger of BG dropping too low. The problem is that this response can be triggered by :
  1. a BG that truly does drop too low
  2. a BG that's lower than the cat is accustomed to even if not terribly low
  3. a high or higher than usual rate of descent of Bg after an insulin dose.
The bounce to high numbers can produce a curve that looks like a dose isn't effective and the elevation can last a few days - or can be short lived, ie., a few hours. A short lived bounce can give high AM/PM numbers or just AM or PM. It's complicated and makes it harder to decide on doses and also to judge the effectiveness of a dose.

It's possible that 0.75 u is too high a dose for Java. It's possible that he's doing some short term bouncing. That 303 in the middle of the night when he should have a lower BG suggests bouncing. The way to sort this out is to start with a BG curve done over 12 hours to see the response to a given dose. If his curve today looks high and flat after he's given you some blue numbers on this dose and the 0.5 u dose, there's a strong possibility that he's bouncing.

So - how to proceed? The worst thing for bouncing is to jump around with dose level and timing. Consistency is key to finding out what's happening. The first thing is to do a curve. If it suggests bouncing, you hold the dose for several cycles (up to 6 usually) to see if the bouncing stops and BG drops as it should. Let's leave it at that for now.

Treating FD is often much more complex than finding a dose and that's the dose going forward. The good dose is a moving target and some cats' response is highly variable. The goal of the systematic approach we promote here is to reduce the number of variables to a minimum.
 
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371 at 8:25 AM.
.75 at 9:00

Rereading from start, edit as go along. I could not rouse early again today, between 7:30-8:30 am has to become norm.

Larry asked, could Java be eating different amounts at each meal?
Yes absolutely he is, different amounts, diff times, every day, within parameters. Approx 1/4-1/3 C FF classic am, pm bowls, but he never finishes a helping. Never has, he's always been a grazer. His 'sister' will eat a whole portion, never Java.
During day, I'll urge him to finish by taking food to where he is, or pick him up, take him to bowl. Am careful Lily doesn't get into bowl with miralax. Will make up new bowl during day, FF and dehydrated chicken always down except now the 2 hrs before am and pm testing am. Tests middle of day, night, not fasting tests.
I'm doing it all wrong again, that's why people measure food and use the automatic feeders, isn't it.
 
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OK. If 8 AM suits you better and you're around to do 8 PM testing, etc. by all means move the scheduled times. It has to work for you. You can still do the curve today if you're home.
 
I see that green 97 at +2 this AM. That's a very large drop so soon after the AM dose. PZI is usually slower in onset than this. To clarify:
  • AMPS was 371
  • Was Java fed before injecting?
  • 0.75 u given before or after food? (should be after or at minimum while eating)
  • BG at +2 was 97
  • fed again at +2 or +3
  • BG at +4 was 167
I'm unsure of why you got a 97 so early in the cycle: shot before feeding? incorrect dose drawn up accidentally? It's best if meals are given AM/mid cycle/PM/bedtime especially when doing a curve. Sorry for not emphasizing that.
 
Java was tested. Then fed. Then got a shot.
He consistently had big fast drops with insulin before, then gradual gains, under the erratic protocal I was trying before with the non-help from the vet.
Maybe it's from the increase from .5 to .75?
I don't know. It's possible he had a big drop and then a gain under .5 but I wasn't testing him that close to the AM dose.
 
Lois and Java said:
Java was tested. Then fed. Then got a shot.
He consistently had big fast drops with insulin before, then gradual gains, under the erratic protocal I was trying before with the non-help from the vet.
Maybe it's from the increase from .5 to .75?
I don't know. It's possible he had a big drop and then a gain under .5 but I wasn't testing him that close to the AM dose.
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Has he always been on PZI insulin? I know that Vetsulin/Novolin/NPH can drop them fast but as we say, ECID - "every cat is different". I suggest you finish up today's curve and go from there. It's possible that he reacted to the 50% increase from 0.5 u to 0.75 u. That's a big increase in proportion to the magnitude of the dose. You might have a lot of U40s in whole units left but I suggest you buy others with half unit marks. You could dose just over the 0.5 u line. At tiny doses like this there's a large margin of error when eyeballing between whole unit marks.
 
Yes, always PZI. I didn't know there were other types until coming here.
Okay, will order some U-40s with .5 markers. It's possible by eyeballing it, that it's closer to 2/3 than 3/4. You're right, small area.
edit to add, stick with .75 for 3 days?
 
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Lois and Java said:
Yes, always PZI. I didn't know there were other types until coming here.
Okay, will order some U-40s with .5 markers.
edit to add, stick with .75 for 3 days?
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Give 0.75 u tonight and do a +2 test because of what happened this AM. If this is his pattern you need to know that. Give him a snack around +2 or +2.5 is he seems to be diving. I'll be in bed when this late testing happens because I'm 3 hours ahead of you. If he's low-ish tomorrow AM I might suggest backing off on the dose. He's a low dose kitty and appears to be quite insulin sensitive. Caution is needed.
 
He laps up such small amounts at every feeding, I take his bowl to him several times over the morning. All day really.
I knew he had big drops from insulin from the handwritten graphs at the very top, 3 from historical info, and 1 from regular testing when I first got here.
If it's possible that a big low is created by a higher dose of insulin, then my hunch is that the 368 BG PM on 2/1 could have been ignored as a lone outlier, and .5 stuck to for a while longer. What do you think?
 
Lois and Java said:
He laps up such small amounts at every feeding, I take his bowl to him several times over the morning. All day really.
I knew he had big drops from insulin from the handwritten graphs at the very top, 3 from historical info, and 1 from regular testing when I first got here.
If it's possible that a big low is created by a higher dose of insulin, then my hunch is that the 368 BG PM on 2/1 could have been ignored as a lone outlier, and .5 stuck to for a while longer. What do you think?
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Yes, it's possible. If you'd feel more comfortable going back to 0.5 u this evening, that's fine. It's very difficult to explain individual BG numbers. What tells the story is the trend in numbers at various doses over time. The scattering of pinks, yellows , blues, etc. on the SS are revealing. That's why we keep stressing systematic data gathering.
 
Oh crikey, I'm an hour late. Okay, 332 at 4 PM, let's see. Thats +7.
Edit to add: just saw your message above. I will do .5 tonight.*
I hope it isn't just grasping at straws to hope to find a dose that more or less is the same thing every AM and PM!
* re times. His AM test + food took long enough that he didn't get a shot until 9 AM today.
I'd like to try to stick as close to 8 AM / 8 PM as possible. Tonight, go for 8 PM instead of 9 PM?
How feasible is it to go for 8 AM, 7 PM, which would be my ideal?
 
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