Look over my process *help numbers all over

[Emmatacey]

I'm looking for advice and someone to look over what I am doing and what to change, if possible. My cat, Nash was diagnosed in June of this year. Per the vet we started at 3.2u of Prozinc. When we started, he did ok. I took him into the vet for check and his levels were dropping. At one point with checking with them he was 70 which I now know is low. At the time I knew nothing about home testing. We dropped to 3.0 and tested again with vet and determined to do 3u going forward. We were on that until late September when I noticed he increased his drinking water and peeing a lot again. They were scheduled for their annual vet visit early October so I waited for that time to talk about his increase and have him checked again. He was really high. I took him in for a day of testing by them and his levels were in the 500 range and I wondered if the insulin was bad as around the time I noticed the increase we changed to a new bottle of insulin. They ordered a new bottle. I found the facebook group and this page and started reading a lot. I prefer the facebook group vs this message board as it is easier for me to access so this is my first post here. I started home testing last month and will post his spreadsheet. We went back to the vet at the end of November and he wanted me to increase to 4u of Prozinc. I asked if I could slowing increase it as I have learned from here to do .25 and they said that is fine. They want him on 4u for two solid weeks and a recheck. I did 3.2 for 4 days and then increase to 3.5. We are currently 3.5u. I am using Relion Classic meter.

Diet, he was on Science Diet metabolic and I have slowly transitions him to Dr. Elsey's turkey and chicken. I'm going to eliminate turkey and just have chicken this week. He will not eat wet food so Dr. Elsey's is what we are going with at the moment. I tried FF and just bought Friskies to try. I have ground up dry and put on top but he still doesn't eat, I'm going to continue trying though.

All that said, what else can I do? This is really stressing me and I'm feeling overwhelmed.

https://docs.google.com/spreadsheet...vzvJShSNzsM1JRmfrxYxLsl__A/edit#gid=361360320

 

[FrostD]

You're doing a good job!

It doesn't appear that his dose is too high. Since hes on dry food, even though it's low carb, you'll want to reduce the dose any time he goes below 90.

We use a dosing method here called Start Low Go Slow, or SLGS. With this method, you hold the dose for a week, then do a curve. Depending on the the results, you increase by 0.25-0.5U (or hold, or reduce).

It looks like you're dealing with glucose toxicity. So you'll just have to keep increasing the dose until you hit a breakthrough dose, at which point the dose should start to come down. If you hit 6U though, we recommend testing for some underlying conditions.

My advice is to increase every 5 days if needed; two weeks is too long. It just lets the toxicity set in and keep hold.

Do you have a hypo kit? Urine ketone test strips? Did you see the testing tips and tricks?

I can give you links for everything, but you said you've been reading through everything, so just let me know what you need.

What is your feeding schedule?

Does he have any other health issues? History of ketones or DKA?

When you get a chance there's some additional info we like to see in signature, please see mine as example and directions here.

 

[Emmatacey]

You're doing a good job!

It doesn't appear that his dose is too high. Since hes on dry food, even though it's low carb, you'll want to reduce the dose any time he goes below 90.

We use a dosing method here called Start Low Go Slow, or SLGS. With this method, you hold the dose for a week, then do a curve. Depending on the the results, you increase by 0.25-0.5U (or hold, or reduce).

It looks like you're dealing with glucose toxicity. So you'll just have to keep increasing the dose until you hit a breakthrough dose, at which point the dose should start to come down. If you hit 6U though, we recommend testing for some underlying conditions.

My advice is to increase every 5 days if needed; two weeks is too long. It just lets the toxicity set in and keep hold.

Do you have a hypo kit? Urine ketone test strips? Did you see the testing tips and tricks?

I can give you links for everything, but you said you've been reading through everything, so just let me know what you need.

What is your feeding schedule?

Does he have any other health issues? History of ketones or DKA?

When you get a chance there's some additional info we like to see in signature, please see mine as example and directions here.

I would have done SLGS from the start had I known about the process but I started with the dosage my vet told me to to do. From this point I do want to do that. I guess I didn't hold at 3.2 long enough, 4 days. I can hold at 3.5 for 5 days but I'm not sure I will be able to do a curve next weekend. I'm stuck between a hard spot, my partner's father had a stroke and wants me to go visit next weekend. I'm just trying to find someone to give him a shot at current dose to try to get us through. If I can't find anyone then I will stay home. I have contacted my vet to see if they have cat sitter recommendations.

If I am following correct, after a week at 3.5 do curve and increase by .25 or .5 and hold 1 week then curve and increase if need and continue until possible breakthrough?

Hypo kit, I have some of his old dry food that I can give him. I have pancake syrup and honey. I have blank syringe that I can fill with those and put into his mouth if needed. I have urine ketone test strip but what is the best way to use those? I saw him go the bathroom and I went to the litter box and stuck it into the pee, waited the 15 seconds it stated and the strip showed negative, if what I did even worked. I didn't see the testing tips and tricks, I don't think. I will look again.

Schedule is everything is done between 6:30-7 both morning and night. Prior to home testing I would give him food and then hop in the shower and get ready for work. I would then give him his shot. The shot was within 20 minutes from when I gave him food. Now that I am home testing prior to shot, with his levels high I typically test, shot, food. It is just easier to give him the shot right after testing and then give him food.

Health issue from past is UTI. He had UTI when he was probably between 3-5, I can't even remember. Vet recommended prescription food so we did that. He gained weight, 22 lbs so put him on the metabolic to lose weight which he did lose some. He currently is 18lbs, he is large frame and not just large belly. When I took him in June to test for diabeties they put him on Hapato for his liver for 1 month. After a month tested again and said he could come off that.

Thank you for your reply, I think I got all your questions. This really helps me!

 

[FrostD]

Gotcha! We certainly understand life happens.

So yes per SLGS you would hold for 7 days then do a curve. But since his numbers are relatively high, I think we can squeak by every 5 days - if your schedule allows. No harm in 7 days, it'll just take a little longer to get where we're going.

Re: the visit, I've also had luck positing in my city's Facebook group, as well as surrounding cities. Normally I'd say a few skips aren't a huge deal, but with his numbers I worry about ketones if you skip.

Ketone strips - most people use a dedicated soup ladle to slip under them, or put saran wrap over top. It's possible litter can alter the readings, so best not to stick it in there. If getting urine proves too difficult, they do make blood ketone meters. Downside is they're a bit expensive, as are the strips. Due to all the health issues my guy has, I use one (can't always wait around for urine). I use the NovaMax Plus.

Hypo kit - you'll want a range of wet foods. The dry can take too long to kick in, and can hang around a little too long. I know you said he doesn't like wet, but trust me you'll want to have some on hand in a pinch. Medium carb is 11-15%, high carb is 16%-20%. Most of us write the carb % on bags and cans with a permanent marker, because when those low numbers surprise you, last thing you want to be doing is googling carbs. Use this list for carb % https://catinfo.org/chart/index.php

So he is basically free fed throughout the day? That's probably ok. Next time you get a chance, try to note when he seems to eat and how much (for example, 2 tsp @ +3). You can often manipulate the BG curve with food given at certain times.

Once you do a curve post here (and tag me) and we can advise on how much to increase by

 

[Bron and Sheba (GA)]

Hi and welcome!
Also wanted to mention…. Try and get some tests in each day in the pm cycle as it’s just as important as the am cycle. Getting into the habit of a before bed test is a good idea. If that test is lower than the Preshot test I would suggest setting the alarm and getting up later to see Nash is still safe numbers.

 

[Emmatacey]

Gotcha! We certainly understand life happens.

So yes per SLGS you would hold for 7 days then do a curve. But since his numbers are relatively high, I think we can squeak by every 5 days - if your schedule allows. No harm in 7 days, it'll just take a little longer to get where we're going.

Re: the visit, I've also had luck positing in my city's Facebook group, as well as surrounding cities. Normally I'd say a few skips aren't a huge deal, but with his numbers I worry about ketones if you skip.

Ketone strips - most people use a dedicated soup ladle to slip under them, or put saran wrap over top. It's possible litter can alter the readings, so best not to stick it in there. If getting urine proves too difficult, they do make blood ketone meters. Downside is they're a bit expensive, as are the strips. Due to all the health issues my guy has, I use one (can't always wait around for urine). I use the NovaMax Plus.

Hypo kit - you'll want a range of wet foods. The dry can take too long to kick in, and can hang around a little too long. I know you said he doesn't like wet, but trust me you'll want to have some on hand in a pinch. Medium carb is 11-15%, high carb is 16%-20%. Most of us write the carb % on bags and cans with a permanent marker, because when those low numbers surprise you, last thing you want to be doing is googling carbs. Use this list for carb % https://catinfo.org/chart/index.php

So he is basically free fed throughout the day? That's probably ok. Next time you get a chance, try to note when he seems to eat and how much (for example, 2 tsp @ +3). You can often manipulate the BG curve with food given at certain times.

Once you do a curve post here (and tag me) and we can advise on how much to increase by

He kinda free feeds but I only feed a certain amount each time, morning and night. He eats a good portion when fed and will feed a little after that but come time for feeding the bowl is either empty or for evenings I try to pick up what ever is left 2 hours before testing. The bowl is never filled full, I do portions.

When doing curve through the day, how often do you test? Every 2 hours, every 3? The test that I have done I have tried to be consistent but it has been hard.

I will try the pee tricks.

 

[Emmatacey]

Hi and welcome!
Also wanted to mention…. Try and get some tests in each day in the pm cycle as it’s just as important as the am cycle. Getting into the habit of a before bed test is a good idea. If that test is lower than the Preshot test I would suggest setting the alarm and getting up later to see Nash is still safe numbers.

I will try some more pm test. Thanks!

 

[FrostD]

He kinda free feeds but I only feed a certain amount each time, morning and night. He eats a good portion when fed and will feed a little after that but come time for feeding the bowl is either empty or for evenings I try to pick up what ever is left 2 hours before testing. The bowl is never filled full, I do portions.

When doing curve through the day, how often do you test? Every 2 hours, every 3? The test that I have done I have tried to be consistent but it has been hard.

I will try the pee tricks.

Ah ok thanks

Ideally every hour, but honestly every other is ok.

And actually, you want to get tests at different times on different days to create the whole picture. So some days a +2, +6, +8 or whatever, then the next day try to fill in some gaps - a +1, +4, +11. So over the course of a week you're hitting as many different times as you can. Once we figure out his nadir, you'll want to try to catch that as often as you can as well

 

[Emmatacey]

Ah ok thanks

Ideally every hour, but honestly every other is ok.

And actually, you want to get tests at different times on different days to create the whole picture. So some days a +2, +6, +8 or whatever, then the next day try to fill in some gaps - a +1, +4, +11. So over the course of a week you're hitting as many different times as you can. Once we figure out his nadir, you'll want to try to catch that as often as you can as well

Can you look at my spreadsheet again for night readings. I did open a new bottle of strips last night. This mornings reading was the lowest before shot we have had so I checked him 1 hour after and it was up. I had to go to work but I'm planning to run home on my lunch to check again which will be about +5.5.

Appreciate everything!

 

[FrostD]

Perfect! We do expect the +1/2 to often be higher, since they get a bump from food but also waiting for insulin to kick in.

He will need his dose raised, this is his 6th cycle. I always recommend waiting to increase until a cycle you can monitor more closely. If the lowest he goes is yellow, go up to 4U. If he sees blue above 120, 3.75U. Now if he pulls under 120, which I do not expect at all, we would want to hold.

 

[Emmatacey]

Perfect! We do expect the +1/2 to often be higher, since they get a bump from food but also waiting for insulin to kick in.

He will need his dose raised, this is his 6th cycle. I always recommend waiting to increase until a cycle you can monitor more closely. If the lowest he goes is yellow, go up to 4U. If he sees blue above 120, 3.75U. Now if he pulls under 120, which I do not expect at all, we would want to hold.

Just checked him @5.5 and he is 151. Tested left ear 151, tested again right ear 147 and used OneTouch as back up 146. I am going to stay home and test in another hour. What should I do for this evening? Should I make a new post in Prozic for help as well? This is the first time ever in 100.

 

[FrostD]

Just checked him @5.5 and he is 151. Tested left ear 151, tested again right ear 147 and used OneTouch as back up 146. I am going to stay home and test in another hour. What should I do for this evening? Should I make a new post in Prozic for help as well? This is the first time ever in 100.

Let's see where he's at in an hour, and also shot time. Under 200 you should stall without feeding and ask for help.

Now I'm leaning towards hold the dose, because I'm not quite sure when nadir is. With this 151, if he nadired before you got home, it's possible he hit 120. That would still warrant an increase, but I'd like another day or two of data just to make sure.

For now main forum is good, ProZinc forum gets less traffic.

 

[Emmatacey]

Let's see where he's at in an hour, and also shot time. Under 200 you should stall without feeding and ask for help.

Now I'm leaning towards hold the dose, because I'm not quite sure when nadir is. With this 151, if he nadired before you got home, it's possible he hit 120. That would still warrant an increase, but I'd like another day or two of data just to make sure.

For now main forum is good, ProZinc forum gets less traffic.

Thank you for such quick responses. I just tested @+6.5 and got 133. I will test again in another hour and keep testing until it starts to go up. I'm so nervous on all of this.

I will also pull food, if there is any left, at 4:30 so no food for 2 hours prior to night shot.

 

[FrostD]

Thank you for such quick responses. I just tested @+6.5 and got 133. I will test again in another hour and keep testing until it starts to go up. I'm so nervous on all of this.

I will also pull food, if there is any left, at 4:30 so no food for 2 hours prior to night shot.

He is still completely safe. He's probably at nadir about now, it's usually around the 6 hr mark with ProZinc but can vary.

Let's hold the dose and see what he does next few days. If.yoi had gone up to 4U like vet wanted you'd be having quite a fun day right now

 

[Emmatacey]

He is still completely safe. He's probably at nadir about now, it's usually around the 6 hr mark with ProZinc but can vary.

Let's hold the dose and see what he does next few days. If.yoi had gone up to 4U like vet wanted you'd be having quite a fun day right now

He started to increase and PMPS was 332. I gave full dose and will monitor.

I couldn't imagine being at 4u right now.

 

[FrostD]

Depending on your schedule, we always recommend a +2 or +3 "before bed" test. It can help you catch any big dives (same as your recent daytime tests). If you catch him diving, it's usually a good idea to feed 1-2 tsp LC wet (it works faster than dry). It can help slow the drop and prevent/minimize bounces. If its a really big dive, sometimes MC is a good idea. Whole idea is to "ride the brakes" down the hill

He seems to hit the lower numbers during the day, bounce and then stay a bit high at night and sometimes through the next day

 

[Emmatacey]

I did +3 and +5 checks last night and he was high this morning. I plan to check at noon today. I only have today, Wednesday and Thursday the chance to go home from work to check. My week next week is limited with work. I also have to go out of town this weekend to visit my future father in law who is still in the hospital but should be released soon. Should I stay at 3.5 and then look to up to 3.75 Sunday evening if things stay the same? I will be able to check and monitor up to Friday morning, leave Friday morning and be back Sunday evening.

He is just all over the place and I'm stressed all around. I have been working on wet food and I got my other cat transitioned so there is a win, but wrong cat. But still a win for her to transition to wet. She has seizures so she gets phenobarbital twice a day. I have quite the pair of kids.

 

[FrostD]

Just take a deep breath, his numbers are still fairly good (I see a lot of 400,500+). Yes I would hold 3.5U unless he earns a reduction by dipping below 90, and consider an increase on the next day you can be around to monitor.

I hear you on the health stuff, every time I turn around I've got something new to deal with

 

[Emmatacey]

Can I get help as to why his numbers are all over the place.

Should I take him to the vet to get test run? I am holding at 3.5u of Prozinc. I have to leave town this Friday and have my aunt coming to give him shots until I return Sunday evening. Staying home isn't really an option, my partner's father had a series of small strokes and I'm going to visit. Thankfully the father is fine and has been released from the hospital but it is kind of important that I go visit. So I won't be here this weekend to monitor my cat.

I can come home today at lunch to check him but today and tomorrow are the only days I can monitor during the day and also the only days this week to take him to the vet.

What should I do? I'm stressed and tired.

 

[FrostD]

He's just bouncing, it's very normal and may happen for some time until bus body gets used to everything and settles down.

Hold the 3.5U dose while you're gone, it's a safe dose to give him so you shouldn't have to worry about going too low.

When you get back and can monitor I'd take him up to 3.75U unless at some point you see green.

 

[Emmatacey]

He's just bouncing, it's very normal and may happen for some time until bus body gets used to everything and settles down.

Hold the 3.5U dose while you're gone, it's a safe dose to give him so you shouldn't have to worry about going too low.

When you get back and can monitor I'd take him up to 3.75U unless at some point you see green.

Help, please. I posted a new thread but replying here too. My out of town plans changed so I am home. I up the dose to 3.75 last night, on spreadsheet. Tonight his PMPS was 144. I'm holding for 20 minutes. No shoot or reduce?

 

[FrostD]

Help, please. I posted a new thread but replying here too. My out of town plans changed so I am home. I up the dose to 3.75 last night, on spreadsheet. Tonight his PMPS was 144. I'm holding for 20 minutes. No shoot or reduce?

I am here will look at SS and other.post for now no shot