Lucy New Questions and Theory

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123joan

123joan

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I talked with our vet last night, and he wants me to be more consistent with feeding, and feed her just twice a day. Thinks that will make it easier to regulate her. Explaining about half life of insulin, it is "used up" in 7 - 9 hours. So If I feed her at that point (mid-day), up goes her BG.

I am consistent with breakfast and dinner timings, but do add in mid morning and mid afternoon cat food if I'm in the kitchen and they are begging. I'm an easy mark.

Following that advice, last night I didn't feed them before bedtime (their late dinner...bedtime snack....last supper?), and this morning here she is
AMPS +169. It's been a half hour. Will wait another half hour to test. The two of them are getting pretty mean out there in the kitchen, can't figure out this delay.
This would certainly be a new approach.
I haven't always entered it into the spreadsheet, but I have been giving them a half a can each (FF) between 8 - 9 at night. I thought that was diminishing Civvie Petey's vomiting episodes in the morning as he wolfed down food on empty stomach. Of course that could be purely coincidence and all in my mind.
 
Good on you for waiting to test again! Those little ankle biters may not appreciate the wait but it's well worth it for Lucy's sake. :-D 20 minutes is long enough to wait if you want to cut the half hour shorter. :smile:

I'm not sure where your vet is getting his information, or maybe there was some misunderstanding (on his part).

ProZinc lasts 10-14 hours in a cat. Nadir, the lowest point, hits somewhere around +5-7. While the lowest point agrees with his numbers, the insulin is still on board for those mid-cycle snacks you've been feeding.

Most, if not all, of the cats here eat more than twice a day. The balance between insulin, food, and all a cat does can be delicate. Many have found feeding more than twice a day helps keep our kitties from going too low during nadir and bouncing to the moon at PS.
 
I don't think Lucy hasn't been going too low at nadir. Next time I'll wait just a half hour to test if she is low PS. I was trying to reduce the times I have to poke her ears. Assuming half hour wouldn't be long enough and I'd have to test again, I put it off. Yay! Off schedule again!

Vet is happy with her weight. Don't know how I can split four or five meals into two. Maybe I'll stretch the morning and dinner ones out and stand here dishing up cat food like a bizarre woman.

Don't know how that late night snack hurts. Especially since it's FF.

Sorry, I'm discouraged today.

But Lucy is in a fine mood now that breakfast was finally served and Petey's puke all taken care of.
 
I understand discouraged. Been there and done that! ohmygod_smile

The delicate balance with food, insulin and everything else is hard to explain for me. Carl seems to understand it and explains it better than I could hope to do. Breaking up Poopy's meals into PS and mid-cycle not only helped keep Poopy on a more even keel, it helped with the balance (as well as my barfer kitty having smaller amounts to prevent some barfing). Poopy wasn't dropping very low at nadir, but it helped keep the PSs down, having that balance during the cycle.

I know I'm not explaining it well. Sorry. @-)

When it comes to vet advice, I've learned to take it with a grain of salt. Unfortunately, we don't have vet specialists when it comes to diabetes (like we do for us beans). Too many vets have only had minimal training regarding diabetes and can only share what little they know or understand. A good example of that is how long your vet thinks ProZinc lasts. We can't really blame them, though. Look at how much they need to know about the health for all the animal types they see. That's a ton of knowledge!
 
I love reading through your and Teresa's conversation with my morning tea. You already have things figured out before I log on!

Teresa is absolutely right. The majority of cats here seem to do best with small, frequent meals -as in figure out what you are going to feed and divide it by 4 or 6. Automatic feeders really help with this. The theory is that the small feedings support the pancreas while not raising the numbers like a large one might. The other thing working here is that food does raise the numbers, but usually only for 2 hours or so, so it doesn't mean a snack at +6 will be making an impact at +12.

But we have had cats that do best with 2 meals a day with a snack when testing. It's the rotten ECID thing. Everything is worth a shot.

Can you copy the scale you are using into your signature? She is playing havoc with it because she is throwing such lovely numbers in the am. Maybe your vet is right and that is because she is eating less overnight and thus the number in the am?

Remember, Joan, it's all just data gathering. We are just trying to figure out a pattern that will help us see how she uses the insulin and how we can best work with that.
 
I don't know what you mean by the scale. And when you let me know what that is, I will need instructions to copy it into my signature.
 
On your thread on August 25th, we put together a scale that we thought might help you figure out doses. It looked like this:

200 - 250 .6
250 - 300. 1
300 - 350. 1.4
350+ 1.6

If you want to use it, and have us tweak it as her numbers change, it is easiest if it is in your post each day. You can either copy and paste it into your first post of the day or you put put it in your speadsheet - just use a couple lines and columns to add it - and then start the new day's numbers below it. Both ways make it easy for us to figure out whether our scale needs to go up or down in dose.
 
AHA! That scale! The one on my frig next to the U-40 to U-100 syringe conversion chart. OK. I will see if I can add it to the spreadsheeet. I'm leery of messing with the columns, spreadsheets aren't my forte.

I understand, having the numbers all in one place, not having to jump from post to post.
 
You can add it to your signature also; you'd just have to change it if we tweak it.

To do that highlight and copy the scale off my last post, then go to Control Panel and Profile and then edit signature. Paste that scale in and submit. It should show up each time you post.
 
Oops, but your spreadsheet link stopped working. Go back to edit signature. Highlight the whole spreadsheet url. Then go up to the URL button at the top of the post (in the line with the Bold and Quote buttons) Hit it and it should put some computer language in the front and back of your ss url -like [/url] Then choose submit again.

Sorry, didn't mean to complicate things.
 
Well, it works, and it doesn't work. If I click on it, it takes me to googledocs like it's supposed to. But, it tells me that I don't have permission to see it. It's a "sharing" problem.
If you go to it, there should be a button on the top right that says "share". Click on that and it should pop up a window. The top choice should say "Public on the web". If it doesn't, click on "change" and change it to that. That way we can all see it, but only you can make changes to it.

After that, click on the top left on "file". Then click "publish to the web", which will pop up another window. Make sure that there is a checkmark in the box that says "Automatically republish when changes are made". That way when you change it, add numbers to it, or whatever, we'll see them when we click on the link in your signature. At the bottom of that window will be the "url" code that you copy/paste into your signature.

Carl
 
On the food/timing issue -

You have it right. Food raises BGs and insulin pushes them back down in very simple terms. Just knowing that basic science helps, because you can "use" food to influence the effect and the timing of the effect that the insulin has.

The insulin should start to "work" a couple of hours after it is injected. That's called the "onset". It should be at its peak effect (nadir) between 5-7 hours after you shoot it, and then it starts to wear off. by the time the next shot is given, 12 hours after the first one, the insulin should be worn off. Now, notice how many times I used the word "should" in those three sentences. :-D
Insulin isn't a drug, and most everyone thinks in terms of how a drug like a painkiller works. "If I take one, it'll kick in an hour later, it'll start to wear off 4-5 hours later, and by the time 8 hours comes around, I'm needing another one. If I take two instead, it'll work "better" and I'll get twice as much relief (I hope). It might last longer, but it shouldn't because the drug only lasts 8 hours tops".
Insulin is a hormone, and how well or how long it lasts is really dependent on lots of other stuff that is going on inside the cat's body during the day or night. The only factor (besides the size of the dose) that we have any control over is "food". We can affect things by changing the amount of food given, or the timing of the food given. That might not have any effect over how long the insulin works, but it can influence the effect on raising or lowering the BG during a 12 hour cycle.

Unfortunately, I suppose, in this aspect every cat is indeed different. And the only way to see what kind of control you can have over the 12 hour curve is to experiment with different amounts of food and the timing of the feedings.

Using Bob as an example - I fed Bob a can of FF classics when I gave him his AM and PM shots. I also gave him a 1/4 or 1/2 can of Friskees Pates in between shots, usually 5-6 hours after each shot (but that was totally dependent on my schedule, and when I was able to stop by the house during work to feed him). My goal was to give him a little bit of food when the insulin was at or close to "nadir", so that I didn't have to worry about his numbers going too low, especially if I was going to be at work until PM shot time. That seemed to work well for Bob.

The only way to figure out what will work best for Lucy is to try different things as see how they work. It's a good idea to try to keep most of the feedings in the first half of the cycle, but not mandatory that you do that. It doesn't mean you need to increase the daily intake of food, just distribute it differently if you feel she is getting enough food on a daily basis. A lot of it will depend on your schedule, and when it is practical to feed her.

You can use food to slow the rate of drop in BG, or to prohibit the dose from pushing her BG too low at nadir by feeding her a snack an hour or two before her normal "nadir" time. In order to do that, you have to know when that nadir time is by "finding it" with your meter. That can help to keep her numbers safely "up" in the middle of the cycle, and help to avoid the "bounces" that usually occur when the low numbers cause her liver to react by dumping "sugar" into her system.

Vets do this sort of thing when a cat is in emergency care from a hypo incident or a DKA crisis. But instead of Prozinc and food, they are using fast acting insulin and a dextrose drip. They try to balance the effect of insulin on BG with "sugar" to keep the numbers from falling too much. So the concept is in your vet's head, maybe just not relating it to a non-emergency situation?

Carl
 
I followed all the steps necessary to share the spreadsheet. I will go try a test run on another computer and see if it is truly shared. Works!
The timing of food is overwhelming, it is hard to be here at the right times to test and feed and I know you all know that. Today I wasn't able to test her at all since her last shot, which was an hour late because her BG was so low this morning AMPS. Now it seems so close to PMPS that it isn't worth poking her and then they will just start begging for food ARRGGGHHHH.

Why wouldn't I just feed her if she is low at AMPS? Wouldnt' that raise her BG? Sounds too easy.

I do appreciate that you are pointing out the use of the word SHOULD. I'm trying so hard to "GET IT".
 
Why wouldn't I just feed her if she is low at AMPS? Wouldnt' that raise her BG? Sounds too easy.
Click to expand...

Yes, it would raise her BG. But, the relationship between food and insulin isn't quite that simple.

The number that you get, absent food at AMPS and PMPS is important in determining whether or not a given dose is "safe". Those numbers, combined with the nadir number, show you the effect that the current dose of insulin has over the course of 12 hours.

For instance:
If her BG was 300 without food, and you gave her 1u and fed her, her BG would rise, then drop due to the insulin. And lets just say that her nadir reading was a nice 100 - still well in the safe range, and "normal" for a cat. The food would have raised her number above the 300 you started with, then the insulin would work to control it, and push it down to 100. It would have dropped the BG at least 200 points, but even more than that since it would have climbed higher before starting to drop down.

Now, assume you get a 169 like this morning, instead of that 300. The food is going to raise it, not sure how high, but higher than 169. So you give that 1u dose again. Remember, in the above example it pushed it down at least 200 points. Well, if you shoot a 169, you don't have 200 points to play with, right? So, if the insulin is just as effective this cycle, and the food pushes her BG up about as much as it did in my example, then that 1u dose suddenly becomes "too much", right?

That's why, when we see a number that is below 200 when people are just starting out, we suggest that they wait, without feeding, to see if the number comes up above 200 on it's own before giving a shot.

Lucy started the cycle last night at 350. All you know for sure is that 12 hours later, she was at 169. What you don't know for sure is if that 169 was a number that was rising from a lower number overnight, or if it was actually still falling. Even though you wouldn't expect that it was still coming down, because by that time the insulin should have worn off, you don't know for certain. If it was still falling, then the shot becomes even more risky, because once it's in her body, it's going to do what it is supposed to do and push the BGs lower.

Most vets seem to base Prozinc doses just on the preshot AMPS and PMPS test numbers, and don't pay much attention to "nadir" data. With this insulin, it's the combination of the two - preshot AND nadir - that determine if the dose is right.

Does that help or am I confusing the issue? :smile:
 
I thought that was brilliant Carl - I've been doing this all for a while as you know and I just learned some stuff ... Mostly (and I don't want to hijack Lucy's thread here) that I think Robbie's food situation is a bigger issue than I really have been willing to address...
 
Thank you Ellen, and I am very happy that it helped you out. :smile:

I do try to "help" on stuff like this. Some days the words just come out better than on other days. Some times you have to see something written just a little bit "different" in order for a lightbulb to go off in your head.

And with every day that passes, and with every new kitty who comes on the board, I still learn stuff every day, or at least I get better at trying to get what's in my head to go through my fingers and into living rooms all over the world wide web, lol. I enjoy trying to learn about this stuff. And there's absolutely no better feeling in the world than trying to answer a question, being able to communicate it successfully, and then hearing back that "it helped". I don't even mind hearing "nope, that didn't work" really, because it just makes me keep trying to figure stuff out.

I hope it helps Joan and Lucy, and anyone else who stumbles across it.

Regarding Robbie - sometimes that cat confuses me more than he does you. But if you post a thread about what you mentioned - his food situation in particular, I'll do my best to help you figure something out.

Hugs to all,
Carl
 
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