Looking for advice - still experiencing large swings in BG

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jakes

jakes

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Hi everyone,

Martin has been on PZI for about a month and a half now - we started out with a high dose (2u) as recommended by our vet and have worked our way down as we realized that 2 units was way too much insulin for him. Right now we're giving him 0.75 units when his pre-shot BG is over 425 and 0.5 units when it's below 425, as that seems to be the most consistent way to get his +6 numbers into the healthy range. I'm concerned though because his numbers are still fluctuating a lot - even though his +6 numbers are pretty good now, his pre-shot numbers are still high and I feel like they might be too high.

I'd love to get some feedback and suggestions on how to stabilize his BG numbers. I understand that pre-shot will always be the high point for his BG, but looking at the spreadsheets of others I feel like Martin's pre-shot numbers are much higher than normal. His spreadsheet is linked in my signature.

Thanks!
 
Re: Looking for advice - still experiencing large swings in

Hi Martin & you are?

Looked at your SS. Yes you do have a rocket ship going on.
I'm not good at dosing advice so I will let the more expiernced memebrs help you with that.

What kind of diet is Martin on?
Are you feeding on a 12/12 schedule? Or 4 small meals a day schedule?
What kind of treats are you feeding?
And last question....are you testing for ketones daily?

Jenn & Baxter cat_pet_icon
 
Re: Looking for advice - still experiencing large swings in

I'm no expert, and am still struggling myself. Here's my two cents . . . My first question is what and when are you feeding Martin? He's got some great mid cycle numbers, which looks like his body really responds to the insulin, but those incredibly high pre-shot numbers might be carbohydrate related.

If you aren't feeding a totally canned food, low carb diet, that's the first thing I would look at. I would discontinue the insulin, or reduce it dramatically if I was switching him to low carb, with the numbers and big swings that he shows, he could drop to normal or hypo very quickly.

I'm sure there will be more advice for you soon, the board is kind of quiet today, but folks will check in eventually.
 
Re: Looking for advice - still experiencing large swings in

Holy space kitty!

Well, I'm gonna assume he's on low carb because I see he's eating cans. No dry food or treats, right?

I don't like the 0.75u even at high numbers, the drop you get with it is huge and I think you're really just rebounding a lot. I think you're gonna be black tonight, think a 370 point drop is going to bounce Martin hard. I think you're shooting at bounces a lot of your ps, I would recommend backing off the dose and holding it the same unless you get a low ps and then you'll reduce. The sliding scale you're using for shots is a little too much increase/decrease. At small doses .25u makes a huge difference. Lets look at 4/19 pm, shot .25u , then the next cycle you shot .75u. That is 3 times as much insulin, think of doses as a percentage. So if you shoot .5 one cycle then .25 the next you have shot 50% less insulin. Do you have u-100 needles so you can get smaller adjustments? I wouldn't adjust more than .1u from .5u.

I would reduce and hold at .5u for a week, nothing but .5 unless you get something really low. No matter how high the ps is. You need to give the hormones a chance to clear out to see what the .5u does, hopefully the numbers you get will have more of a pattern to them and some of those high readings will disappear.

Also, you really need a +6 at the very least for both cycles when possible (nighttime test is especially important M-F since you work and can't test during the day), even if it means setting an alarm at night. Right now there's not enough data to do more than guess what is happening most days. A good dose of insulin should leave you with similar ps's from cycle to cycle, yesterday you had a 300 point difference, so no matter how good a number you get at +6 you need to look at the whole picture and not just one number

Cathy
 
Re: Looking for advice - still experiencing large swings in

Thanks for the help everyone :smile: To answer a few questions:

* Martin only eats canned food - I feed him Friskies Liver and Chicken Dinner which looks pretty low-carb on Janet and Binky's charts. He's fed every 12 hours right before his shot and gets a half can in the morning and a half can at night.
* I give him a freeze-dried chicken treat after testing his BG, so no carbs there.
* The only real source of carbs is that Martin is also on thyroid meds, and I give him his pill in a Pill Pocket (it's basically a treat with a little space in the middle for a pill). The Pill Pockets have wheat and corn in them, but they're about the size of a dry food kibble and he only gets a total of two a day, so it's not a lot.
* I don't have U-100 needles, only U-40 needles, so when I give 0.25 or 0.75 units the dose is really just a guess. I've thought about getting some U-100 needles for more accurate doses but haven't done that yet.

Catannc: I agree that the swings are big enough that the 0.75 units might be too much. I did try giving him only 0.5 units for a full week (April 8 - April 14) and based on the data I got at that time I felt like 0.5 might not be enough, because his BG never got that low (even at +6) and his pre-shot numbers were usually pretty high. His numbers are just very inconsistent though - when he was strictly on 0.5 units he was anywhere from 284 pre-shot to 565 pre-shot, even though his dose and diet were consistent the entire time. Do you think maybe the 0.5 is even too much and that's causing rebound for him? That's the only real explanation I can come up with at this point.

And yeah, the data is limited - my work schedule is hectic enough that I'm not able to get as much data as I'd like. If you think a full day curve would help then I could try to get one next weekend.

Thanks!
 
Re: Looking for advice - still experiencing large swings in

It looks like to me you are getting a Great Response to the insulin, just a short duration. Prozinc is said to be a 12 hour insulin, but in a lot of cats, the duration of the insulin is less. This is true for my cat, Kitty. She gets a good response to the insulin and will have blue nadirs, almost always, but when I shoot bid (12 hour cycles) her preshots are almost always mid 400s to Hi. I started shooting tid (8 hour cycles) last July. By doing this it cuts off the extreme numbers on the fringes of the cycle. I do not recommend tid dosing to many, as the cat has to be getting a good response to the insulin and good nadirs, but normally accompanied by high preshots-- for tid to be the most beneficial. BUT, it looks like Martin would be a good candidate for it. By dosing tid, you shoot before the insulin totally "poops out!" It is more more work on the bean, BUT Prozinc is very flexible and easy to work with.

TID might not be a viable option for your schedule and you might have no interest! BUT, if you do let me know! I think it could be beneficial to Martin. If you do think you would like to try it----There are some do's and don'ts for tid, so please ask for some input before attempting it!

Kim
 
Re: Looking for advice - still experiencing large swings in

Yes, it is possible that .5u is still too high, I don't mention it because it's not as common to see a cat that needs that low of a dose, but my Kitten was on a sliding scale of 0.05ish to 0.15ish and would drop from 400's to 100's. You don't see many like that, but anything is possible. You could try to reduce further and see if that evens things out, but who knows. I know you already tried the 0.5, but there are just so few tests at nadir it's hard to tell. Also the risk of Ketones for lower doses of insulin.
 
Re: Looking for advice - still experiencing large swings in

Alrighty, yesterday's cycle looks good....I was surprised, pleasantly, to see that pmps and hope for a good amps. Again, a +6 at night if you can/did get it would be amazingly helpful to see what happened...if the insulin did nothing and he was high or if you got a nice nadir and the duration was too short to hold your amps down is good to know. I would go and get some u-100 needles whenever you can, it will allow you to shoot in 0.2u increments exactly and you can eyeball the 0.1u. It's really hard to see what's going on currently, if you've got bounces or if your high numbers after a reduction in dose the previous cycle are caused by not enough insulin.

Do you happen to know what BG Martin had at the vets at diagnosis?
 
Re: Looking for advice - still experiencing large swings in

Yeah, the last 24 hours have been really good, although I'm guessing it won't stay that way just because of how inconsistent he usually is. He gets his food and shot for tonight in about 45 minutes, so I'll see where he's at then. I can get a +4 tonight but +6 just isn't going to be possible.

Unfortunately I don't know what BG he had when he was diagnosed. This whole experience has been a long, crazy journey that started about 8 months ago with him being diagnosed. At that time he was eating exclusively dry food, so we switched him to canned food and our vet said his BG dropped enough from that that it didn't look like we needed insulin. Then at the beginning of March this year he went into DKA and nearly died. Once we got through that we started testing and giving him insulin, and that's where we are now.
 
Re: Looking for advice - still experiencing large swings in

Okay, so his PMPS tonight is 196, which is really great especially since the last couple of cycles have been a lot more consistent. The problem is that since he's at 196, I'm not sure what to do. On one hand I want to keep him consistent at 0.5 units since he's been doing really well on that for the last couple of days. On the other hand, I'm worried that 0.5 units will make him hypo. Any suggestions?

Edit: To add more data, we've had him at these pre-shot numbers before (around 150-200) and given him 0.25 units. Whenever we've done this his next pre-shot is quite high - 400+. So that tells me that when he's at 150-200 pre-shot, 0.25u is either too much (and is causing rebound) or too little. The problem is I don't know how to figure out which one it is, and going in either direction (giving less/no insulin or giving more insulin) could be bad.
 
Re: Looking for advice - still experiencing large swings in

I'm impatient so I went ahead and shot :smile: I gave him 0.5u after looking over his spreadsheet a bit more and noticing that when we give him 0.5u, it tends to drop him 50-100 at nadir as compared to pre-shot. So I feel pretty comfortable that this won't make him hypo, but I'll be keeping an eye on him and will get another BG measurement right before I go to bed (which will probably be +4).
 
Re: Looking for advice - still experiencing large swings in

How long ago did you feed him?

Why I ask is you could test him again to see if the food is going to lower the BG. You have to do it before the food kicks in which is about 1-2 hrs.
It will throw off your testing times, but it will be better then a hypo during the night when your sleeping.

Test him again & see where he is & post the result.
 
Re: Looking for advice - still experiencing large swings in

Guess we were typing at the same time.
You went with .5. Get a reading like planned at +4. Can you get one at maybe like a +2. Is there anyway to set your alarm at +7 & get one then? I know it's rough. I have done it lots of times & also have missed the alarm. But maybe try?? It will give you lots of info... ;-)
 
Re: Looking for advice - still experiencing large swings in

For future reference, if you get a number like this that you are not sure on what (or whether) to shoot, one thing you want to do is to hold off and test again. The reason for that is that you want to make sure that the number is actually on the way up when you shoot. See the other night, when you shot .25 on the blue 199? And the next morning you got the black AMPS? To me, that looks like a classic "bounce" number from Martin going too low after that dose on the 199. It's possible that he was falling when you shot that night, and he went so low that his liver reacted, which gave you the really high AMPS in the morning.

Well, the same thing can possibly happen tonight. Like Jenn said, if you can get a +2 and +4, that will tell you where he's heading. Based on those numbers, you'll have a better idea about how low his nadir is likely to be, and whether you need to set the alarm to check him around nadir.

I'll be online for a couple hours anyway if you have any need for help or advice...

Carl
 
Re: Looking for advice - still experiencing large swings in

I'm with Jenn, knowing what this dose does will help you so much in the future, the more data you have the better. I do agree with you that the .25u doesn't really look like it does enough on low ps at this point, but like Carl said it might actually do too much and the only way to know is test. Hope that tonight goes alright and he doesn't get too low, .5u SHOULD be alright. .5 last night looks awesome, left you with the same number for both pmps and amps which is exactly what you want. If he gets a little low tonight then you might get a higher amps from a bounce. If he is lower at any point than 200, do not give the shot or feed and test at least every 30 min-60 min to wait for a rising number at 200ish to shoot. If he is really low, mid blue or lower, try no shot but feed a small meal and test in an hour. If he holds or drops (means his P is working) then keep feeding small meals and testing to see what he does.

Sorry about the DKA, I do wonder what your numbers were like that the vet thought it would be alright to go without insulin. With DKA in the picture you should be checking for ketones regularly.
 
Re: Looking for advice - still experiencing large swings in

Yeah, I'd really like to get more data so I can better understand what's going on with him, it's just that getting a +6 tonight is going to be problematic. I know I can get a +4 though, so that's better than nothing. And I just got a +2 (he's at 313), so that's helpful info as well. Between that and his AMPS tomorrow I'm hoping I'll have some indication of how he's reacting to this dose with that specific pre-shot BG. This cat is just crazy - after looking at a dozen different spreadsheets from other people on this forum I think Martin is by far the most inconsistent confused_cat
 
Re: Looking for advice - still experiencing large swings in

The +2 is most likely still a food spike. +4 should be better & you should start to see a slight decline. As well as a +6. I know you said you can't do a +6. Maybe over the weekend you can't get some more.

One thing...every cat is different so when looking at other SS keep that in mind. Don't compare it will only confuse you & maybe frustrate you. Its just like people....I'm sure I'm different then you. You are different then the next person. Cats are just like people different then next one. ;-)
It's good to look at other SS because you can learn from them. Take a look at Baxters....make sure you wear sunglasses because all the yellows lately are blinding. :cool:
 
Re: Looking for advice - still experiencing large swings in

I am sorry I dont have time to read everyones input, I did look at Martins SS
and here is my thoughts...
The lst 3 cycles you gave .50 unit and you are starting to get good numbers
I would stay away from the .75 and hold at the .50...
or decrease if you get a very low preshot,
but the .50 holding steady you might be able to stop the bouncing
 
Re: Looking for advice - still experiencing large swings in

Agree that right now the .5u still looks really good, looks like you might have gotten a little bounce, maybe from what I'm going to assume was a long string of blue numbers yesterday morning. Your amps may be kind of high, even if they are hold the .5 and wait for the numbers to come down, shooting a larger dose at a bounce can make the cat even bouncier. The last 3 cycles were the most consistent and low he's had yet, hope it continues!
 
Re: Looking for advice - still experiencing large swings in

Well, what a little bounce it must have been, that amps is so nice i feel like doing a little dance!

dancing_cat

Lets hope this continues, a high number at pmps would be a sign that 0.5u into 200 is too much and you can't tell that from last night because of the bounce. Also be on the lookout for Mr. P, he really likes to pop in unannounced when you get a run of really regulated looking numbers.
 
Re: Looking for advice - still experiencing large swings in

jakes said:
This cat is just crazy - after looking at a dozen different spreadsheets from other people on this forum I think Martin is by far the most inconsistent
Click to expand...

I don't know...I'm reading your thread because my Pumbaa is all over the place, too! Here's hoping that both of our cats settle down! :)
 
Re: Looking for advice - still experiencing large swings in

Also don't get too discouraged on his previous inconsistency, most of the active users who you're looking at have a lot of data and have been at this for a while. The most important thing is to find the right dosing range, a dose that was too high can mess you up for a few cycles and I think you've been seeing a lot of rebounding in the past. Right now your ss is looking pretty damn good, you will probably see some more mini bounces like last night once he starts going green (if he hasn't already) but hopefully no more black and maybe no more red. Black numbers to me always indicate way too much or way too little insulin, and with the periodic blues you'd been getting obviously it wasn't too little.

It is also time to go and get some u-100 needles, if this current trend keeps up you will need smaller doses and it sucks trying to do it on the u40s. Conversion factor for Prozinc to be used with these needles is x2.5, so if you need to shoot .4u it will line up exactly with the 1u line on the u100 syringes, .2u will be exactly 0.5u on them. Makes it so much easier. Here is the conversion chart, print it out and keep it on the fridge and always check and double check your doses.

http://www.felinediabetes.com/insulin-conversions.htm

For the needles, open the box and check that there are 1/2unit markings on them to the left of the whole units. The pharmacy doesn't seem to know the difference between the 1/2 u and 1u needles: Relion U100s; 3/10 mL; 31 g.; 8mm needles from WalMart. Model #81131-0311-79 . They are just under $13 for 100 syringes, cheaper then the vet and so much easier. For small doses to make it easier to get the right amount without all the back and forth with the plunger, draw slightly more insulin than you need then rotate the plunger clockwise, this will press out the insulin one drop at a time until you hit your mark.
 
Re: Looking for advice - still experiencing large swings in

Yeah, these last couple of days have been the best he's had since we started him on insulin. Hopefully it stays this good :smile:

Thanks for the tips on the U100 needles also. I use a Relion meter so I get test strips from Walmart - I'll pick up some U100 needles next time I get more strips (which should be in a week or so).
 
Re: Looking for advice - still experiencing large swings in

Alright, maybe not the amps you were hoping for. Can you try to get a +4 every night? If you had one last night you could try to figure out why this morning is so much higher. My guess is Martin went lower then he has before during one of the cycles yesterday, may have been in the morning after the 208 and the 275 was the point you caught at pmps while he was on his rocket ship again. Either way, hold the 0.5 since a pink bounce isn't that bad I would assume that he over reacted to a safe green rather than reaching a dangerously low number. Hope PMPS tonight is more reasonable!
 
Re: Looking for advice - still experiencing large swings in

Well, that didn't last long - Martin's BG is all over the place again. I've been thinking about why his BG is so inconsistent when everything else is consistent - his dose, his food, etc. and I have a theory about what might be going on. I'm using U-40 needles that don't have half-unit markers, so when I say I'm giving him a half unit, really I'm just guessing and I think he might be getting anywhere from 0.4 to 0.6. As I'm learning, even a tiny change in dose like 0.1u can make a pretty significant difference in his BG - after all, 0.4u is 20% less insulin than 0.5u.

I think the best thing for me to do is to pick up some U-100 needles soon so I can make sure my dosing is as accurate as possible. I usually order my test strips from Walmart's website but it looks like they don't sell needles online, only in stores. Going to an actual Walmart store is a hassle because I'm not that close to one, so I'm wondering if I can get these somewhere else. I know my vet's office carries Ulticare needles, but looking on Ulticare's site it's not clear to me if any of their needles have half-unit markers. Does anyone know if they do?

For reference, these are the needles I'm using right now: UltiCare Vet Rx U-40 Veterinary Insulin Syringes - 29 Gauge 1/2 cc 1/2 inch
 
Re: Looking for advice - still experiencing large swings in

I know walgreens dose but they are like 3 bucks for 10.
 
Re: Looking for advice - still experiencing large swings in

Do you have SAMs club close? I purchased my box there for about $10 for 100. What about Walgreens or CVS? It might cost a little more, but be worth it until you can get to Walmart or some place cheaper.
Warning some of the Pharmacys need a script to purchase needles. So maybe take your insulin box with you. So they know you are a drug addict searching for some clean needles.
 
Re: Looking for advice - still experiencing large swings in

I don't have a Sam's Club membership but I do have a CostCo membership, so I can check and see if they carry them. I'll also check with CVS and Walgreens. Thanks for the tip about bringing my insulin box along - it's sad that I might need to do that, but I understand why.
 
Re: Looking for advice - still experiencing large swings in

They do take the information at the least.....be prepared for some strange looks, "And what relation are you to Martin Jones?" "Uh, he's my cat..." ::cricket noise:: ::cricket noise:: ! :lol:
 
Re: Looking for advice - still experiencing large swings in

Alright, at least he's doing a bit better again. Weekend is here, so get some tests and continue to try to get whatever tests you can in at night, +2, +4...whatever you can fit in your schedule and try to do a curve this weekend so we know what's up.
 
Re: Looking for advice - still experiencing large swings in

Yep, I'm planning to get as much information this weekend as possible. I also just got some U-100 syringes, so I'm going to start with those tonight and should hopefully be able to get more accurate doses.
 
Re: Looking for advice - still experiencing large swings in

Catannc said:
They do take the information at the least.....be prepared for some strange looks, "And what relation are you to Martin Jones?" "Uh, he's my cat..." ::cricket noise:: ::cricket noise:: ! :lol:
Click to expand...

*LMAO* I went through this at Costco for Pumbaa's Lantus! Pumbaa is registered with the pharmacy there and I am not! haha_smiley
 
Re: Looking for advice - still experiencing large swings in

jakes said:
Yep, I'm planning to get as much information this weekend as possible. I also just got some U-100 syringes, so I'm going to start with those tonight and should hopefully be able to get more accurate doses.
Click to expand...

Great, I'm interested to see what is going on. that pmps could be a bounce, no way of knowing but Martin may be seeing good numbers during the day. Hopefully a couple curves can tell us quick way to go.
 
Re: Looking for advice - still experiencing large swings in

Wow, Martin's BG is just moving around like crazy. 432 AMPS so I gave 0.6u, then 322 at +4, and then dropped all the way to 73 at +6. Just to be sure I tested twice at +6 and the second test was 93, so he's right around there. Looks like I need to give him a lower dosage even when his pre-shot is that high.
 
Re: Looking for advice - still experiencing large swings in

You are definitely getting huge drops and big rebounds. I like staying with .5, getting some midcycle tests and maybe feeding the curve. If he gets food around that +6, it may raise it up enough to slow the rebound at preshot time. A flatter curve may lower your preshots and shot his roller coaster, which can't feel good.

This thread is getting really long. Can you start a new one?
 
Re: Looking for advice - still experiencing large swings in

Looks like you were in a bounce cycle, and the bounce cleared middle of the cycle. This is why its normally not good to increase dose into a bounce, numbers can drop quickly. Stay with the .5 and hope he calms down- 70s are a good number the drop was steep and he might bounce again. At least we know why he's been all over the place, I was betting you were getting some good numbers causing all this!
 
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