Mauer

[Deb & Wink]

Dry food takes longer to digest, and see any impact on the BG levels.
You could try giving her some MC (medium carb) wet food. Only a teaspoon or so, and test again in 20 minutes.

 

[SashaV]

Dry food takes longer to digest, and see any impact on the BG levels.
You could try giving her some MC (medium carb) wet food. Only a teaspoon or so, and test again in 20 minutes.

Don't know the carb content of the Sheba wet food I have.. but ill feed her some!

Have you got snow yet?

 

[Deb & Wink]

Don't know the carb content of the Sheba wet food I have.. but ill feed her some!

You could try adding a very small drop of honey (or corn syrup, or some other sweetener that is not artificial) to her food.
Sugars like honey do wear off in a couple of hours though. But it's worth a try, to get the BG levels back up more.

No, we got nearly 2 inches of rain yesterday though. Glad it was warm enough to rain, as that would have been about 2 feet of snow.

 

[SashaV]

You could try adding a very small drop of honey (or corn syrup, or some other sweetener that is not artificial) to her food.
Sugars like honey do wear off in a couple of hours though. But it's worth a try, to get the BG levels back up more.

No, we got nearly 2 inches of rain yesterday though. Glad it was warm enough to rain, as that would have been about 2 feet of snow.

If she's not gone up in 16 minutes, at my 4 am - I remembered!!! - I'll give her some honey then.
Now I went out for a cigarette. So I'm awake enough to make good decisions.

Uh, I know what you mean! But snow lights everything up, and it's so pretty
We haven't got a white Christmas for a decade....

 

[SashaV]

77 +6
Waiting with the honey

I'm sad she didn't go blue last cycle. I even made an unintentional curve, hoping to see blue.

 

[SashaV]

If she can go this low on a 3U dose, but not 24 hours ago on a 133 and 2.25U... was today's dose too high?
I don't get it. One day 3U is too much, next day way to little on the same pre-shot readings.

 

[Deb & Wink]

I don't know Sasha, I really don't know why Mauer goes so low some cycles, but not on others.

 

[SashaV]

I don't know Sasha, I really don't know why Mauer goes so low some cycles, but not on others.

But it isn't just me, right?
This isn't how it's supposed to be?

 

[SashaV]

She's holding steady.
I'm still not seeing the dry food I gave her 1,5 hours ago.

 

[Deb & Wink]

But it isn't just me, right?
This isn't how it's supposed to be?

Not sure what you are asking Sasha.

 

[SashaV]

Not sure what you are asking Sasha.

I don't know either. Or how to explain it..

Same readings, same units given, but totally different outcome. Shouldn't I know within reason what's going to happen?
I know ill never be a 100% sure, but if 3U isn't safe, how the heck did I get away with the blue pmps and 2.25 units yesterday?!

 

[SashaV]

Not moving...
I'm short 20 minutes of 2 hours without food, and a slight rise.
When can I go back to deaming?

 

[Deb & Wink]

Not moving...
I'm short 20 minutes of 2 hours without food, and a slight rise.
When can I go back to deaming?

You want the BG level to be going up, and preferable above 90 mg/dL, without any food for 2 hours. That way, by waiting the 2 hours with no food, you know the BG levels are higher because the effects of the food influence on the BG has worn off. I think that 88 was close enough to say "back to dreaming."

Same readings, same units given, but totally different outcome. Shouldn't I know within reason what's going to happen?
I know ill never be a 100% sure, but if 3U isn't safe, how the heck did I get away with the blue pmps and 2.25 units yesterday?!

Not every thing is under your control Sasha.

1. Because insulin is a hormone, it doesn't work exactly the same every single time.

2. The insulin you give one cycle, can have an effect for several cycles after that. Because you have chosen to use sliding scale dosing, you are going to see more wild swings in the BG levels from cycle to cycle.

3. Our cats get such tiny doses, it's very hard to accurately measure the dose consistently from one dose to the next. Your insulin syringes could be marked slightly differently on the barrel, within the same batch of syringes, and/or from batch to batch of syringes that you buy. So what looks like 2.25U could in truth be closer to 1.75U or even as much as 2.5 - 3U. I saw a thread that talked about a manufacturer that said the syringes could be as much as 1/2U different than what the markings on the barrel indicated. (So use calipers to measure the dose instead of only relying on the marked lines on the syringe.)

Take out a dozen syringes. Line them up exactly, with the barrels exactly lined up with each other. See how the markings, the lines on the barrel differ.

4.You don't have control over the activity level of Mauer. She's more active at different times of day, she's less active on some days. She and Miver play more, or sleep less or more during any particular cycle.

5. You don't control exactly how much protein, fat and carbohydrates are in the food you feed. The percentages are a generalization for a batch of food tested by the manufacturer. They make food in such large batches, they can't guarantee there is only a fixed percentage of any ingredient in the food, and it doesn't vary from batch to batch. That is why most foods give a minimum or maximum amount for a particular ingredient. It could be higher or lower than that amount.

The food is listed with "guaranteed analysis" figures. But those can vary a bit. For example, crude protein may be listed as 10% but perhaps it's 11% or 12% for a particular batch of food.That difference means the fat and carbohydrates will be different too for that batch.

Plus, manufacturers only have to provide that guaranteed analysis figures once, unless they make substantial changes to the food. Sometimes that analysis is done in a lab, sometimes the analysis is done with a very small group of cats for a very limited time period.

6. Maybe your cats digestive system is working slower or faster or processing the food better. No way to control what is happening with digestion.

7. Any other health condition, even something as basic as your cat trying to vomit up a hairball can make a difference. Or some slight constipation can slow the digestive system down and impact how much glucose gets into the bloodstream. Perhaps there is an unnoticed infection. Or the teeth and gums are inflamed, or who knows what else could be going on.

8. Prozinc tends to be a bit more volatile, in the swings of the BG levels. It's why so many people switch to a longer lasting insulin like Lantus or Levemir, for less volatility.

9. Bouncing. When Mauer drops low the evening cycle before, she shoots back up the next morning, to compensate. You are then giving her a large dose based on a high pre-shot AND the BOUNCE. Then she drops low again for the evening cycle. You're in a vicious loop, by mainly basing the shot on the pre-shot test and using that sliding scale.

What I'm saying is that there are simply too many variables with how food and insulin work. Most of those variables are not within your control.
In my opinion, the sliding scale dosing is not working well for Mauer.

 

[SashaV]

Why don't you think it's working well?
She's bouncing much less, spends more time in healthy numbers than before.

If she were your cat, what would you do?

 

[SashaV]

Since October 1 she's had 8 red readings.
Her SS is mostly blue in her AM cycle.
She's bouncing much less.
Her behavior shows no clinical signs of diabetes.
In the hours before her AM shot, where she's usually higher she's playful, awake and happy.
Her average BG levels is lower than ever.
I've had far less PJ parties.

Yes, her PM cycle could be more under control. But that's the only negative thing I see.

So what are you really saying?
Should I try a different approach?
Switch to levemir or lantus?
I'm open to suggestions and trying something different. You're the one with the experience, not me. I only want her happy and healthy, so any ideas you have is much appreciated

 

[Deb & Wink]

So what are you really saying?
Should I try a different approach?

I think the high pre-shots are causing you to see the need for more insulin in the morning. But you need to take at least the previous cycle into consideration, the evening before and not choose your dose based on the pre-shot as your main decision factor. Look at how far the dose dropped her in a cycle, what was the nadir or low? That should be your main decision factor, with only some weight given to the pre-shot test. Look at the trends in the BG numbers. Mauer was bouncing this morning, from those lows last night 12/2/20.

Using calipers for measuring the dose, would be the way to get a more consistent dose from cycle to cycle. Using your eyes doesn't always give you the true picture.
Using the MPM protocol, not a sliding scale dose would be a different approach.

If she were your cat, what would you do?

First thing I'd do, would be to sit down and reevaluate my goals for my cat. Nine months into this journey with diabetes, remission is not likely to happen. It's still possible, but not as likely. So what are my expectations now? Can I continue to support and test and care for my cat, the way I have been doing? Or do I need to make some changes? I'd figure out how I could take care of my cat, and still have time to take care of myself too, and handle all the responsibilities and needs of living a joyful life.

I'd work with my vet to figure out why my cat was gaining weight, even with a reduced amount of food. Canned and raw foods have less calories than dry food, so it doesn't make sense that a cat would keep gaining weight on that type of food. In my opinion, something else has to be going on. Or Mauer is sneaking extra food somehow from other people living with you or visiting, or she is eating more of another cats food, or she is eating when she is wandering outside.

I'd find a way to get the tests for acromegaly and IAA done. BUT I have the financial means to do that. Not everyone does.
I'd take a close look at the food I'm feeding, getting the guaranteed analysis and running those percentages through a simple cat food carb calculator, <<<<< link to one here for you. And think about a different food if needed.

I'd switch to a different insulin for my own cat, most likely Lantus since I have a little bit of past experience with that insulin.
I'd be using the more intensive management guidelines (TR or tight regulation for lantus, MPM or Modified Prozinc Method for Prozinc), not the SLGS guidelines.
I'd be trying to keep my cat in the middle green ranges most of the time, 60-90 mg/dL, as much as possible during the 12 hour cycle.

But that is me. You have to figure out what you can and want to do. There is no one size fits all method or approach. ECID Every Cat is Different, Every Caregiver is Different.

To my mind, getting my cat Wink off insulin was a total fluke. I'm not sure I could do the same thing with another cat.

Sasha, I could not do what you are doing now, staying up at all hours to test Mauer. The days when I could quickly fall back asleep, or take a quick nap are a long time in the past.

 

[SashaV]

So you're not saying that I'm totally awful at this? But that I need to consider if I can withstand this in the long run?
The short answer is I can't.

Prozinc keeps her down there in a least on cycle, and that's an improvement. But with all this testing, witch I find necessary because I can't trust where it's taking her, even on a regular number with the same dose makes me anxious.

With my ADHD I am keeping to my routines at all times, and I need my sleep... and I need to know that she'll be safe even if I decide to spend a day with the twins. Not knowing if she's safe keeps my mind with her, and that's not fair.

I'm still aiming at remission, even though I know it's a slim possibility by now. But the ultimative goal is to keep her healthy and happy.

I know I can't fully trust any insulin to not bottoming her out, but people do this with a full time job. So I know that it's not supposed to be this hard, even when fully understanding that this is a marathon not a sprint. But I need to be able to have an actual life to do this in the long run.

Are you recommending lantus based on your experience or because it's the best thing? I do have levemir in my fridge, but it has been stored in the door. So in theory I could switch her at any time. Lantus is about the only thing left she hasn't done yet.

I've been thinking about the tests for IAA, cushings and agro.. but at some point I don't wanna know. If that's what causing her to not loose weight, then what? There's no cure. Will she just keep gaining weight then?
Then it'll be what kills her. I can't with good conscience have a cat that is so fat she can't stand on her own four legs. So if I get the test and it's positive its a death sentence. And that's why I'm hesitating.

If lantus or levemir is the way to go, I'll do that for sure.
So how do we ship you to the lantus/levemir support groups?
Pack your bags, grandma Deb, you're going on a new adventure

I love her, and I'll do anything for her. But I've also been thinking that I've given prozinc a fair shot, and still haven't got her fully regulated. One cycle a day isn't enough to keep her healthy.

I've been fast in the past with making decisions, so perhaps I've been waiting on you (or someone else) to tell me that we've gone as far as we can on this type of insulin.

Seriously Deb, you couldn't have told me this last week?
I just bought a new vial!
I'll stick to the prozinc until the final decision has been made.

And thank you
Nice to know your thoughts on this, even though they weren't what I'd hoped to hear.
So really thank you, Deb

 

[Deb & Wink]

So you're not saying that I'm totally awful at this?

Sasha, you're pretty darn good at this. Making your own decisions for Mauer when you can, and asking for help when you are unsure. It's tough when you live so far away, and can't get timely answers on your choices.

But that I need to consider if I can withstand this in the long run?
The short answer is I can't.

Yes, that is what I wanted you to think about. I didn't expect any answer but the one you came up with on your own. The choices of what to do always have to ultimately rest with the caregiver. We care so much for our beloved cats, sometimes we sacrifice too much and end up not taking care of ourselves the way we should or need to.

So have a good long think about what you will do going forward. Take your time. You don't have to make all those decisions in one day or even one week. Those thoughts and plans don't have to be set in stone, never changing. But try to get an idea of how you would like to proceed with Mauer's care, AND caring for yourself at the same time.

the ultimative goal is to keep her healthy and happy.

Good goals! Seeing our cats return to some of their previous behavior, improvement in symptoms, good appetite are all worthwhile goals. Remission is ok, but your cat can live a long and healthy life on insulin for the rest of their life.

But I've also been thinking that I've given prozinc a fair shot, and still haven't got her fully regulated. One cycle a day isn't enough to keep her healthy.

No, 1 cycle a day isn't enough to keep her feeling good and healthy. So it's definitely time to try one of the depot type insulins. You HAVE gone about as far as you could, using Prozinc. Time to switch.

If lantus or levemir is the way to go, I'll do that for sure.

Either of the L insulins (lantus or levemir) would be a fine choice for Mauer, for a different insulin to try. Since you already have some levemir on hand, try that one first. But this time, you will know to give it a longer chance to work and see changes. You've learned a lot in the last few months. How old is the vial? Does the insulin still look clear? No floating particles?

ISo how do we ship you to the lantus/levemir support groups?

About the only way I'd be found in the Lantus/Levemir support group on a regular basis, is if there were a lot more people to help with Prozinc. But there aren't. So here I am in this ISG, with the help of only one other person to manage all the new people using Prozinc. There are literally dozens of people in the L/L forum that can help. So I don't visit there much at all, only to say hi occasionally to other former Prozinc caregivers to see how they are doing since they switched insulins.

The only other way I can think of that I would be in the L/L ISG forum, is if I fostered or adopted another diabetic cat and was not getting good control of the BG levels, and needed some help with that. But with my very skittish former feral colony cat, bringing another cat into my life is not something I would consider right now. She's been with me nearly 10 years now, and she still runs away from me at times and hides under the sofa, like this morning. No idea why this morning was any different, but she gets scared at times. I had to coax her back to her food dish to eat, and she is very food driven. Dancer walk away from food? She must be sick is my first thought, but she's fine. I simply moved too fast for her, and scared her. It happens.

Big storm coming tomorrow 12/5/20. Heavy rain changing to wet heavy snow and high winds. Hopefully, the power stays on and my plow guy gets me dug out on Sunday morning after the storm stops. Then, it's up to me to shovel out the rest.

 

[SashaV]

Thanks Deb!
The positive thing about being so far away, is that Mauer drops lower at night when you're online

Going forward I'd like to sleep
At least some nights, without having to get up and test. I'd like not testing as much as I do now, without feeling it's unsafe.
I can live with having to give insulin every 12 hours, but I'd like not having to live in 5 hour intervals. The safest time as I see it, is the first 5 hours after her shot. So I can go see the twins for 4 hours, then home and test. If I wait leaving after the +5, there's a slight possibility that Mauer is too low and I can't leave. That's the thing bugging me the most.

Even giving insulin the rest of her life wouldn't bug me. But even now I see my old cat returning to her old self, but it would be nice having her old self back at all hours, not just her AM cycle.

The levemir is from end of March. I'll check it before I use it. And then I want my vet on board but I don't think that'll be an issue.
I think I have a lot better understanding of how insulin is working, and the difference between prozinc and levemir so hopefully i can avoid Mauer getting sick like the last time. Last time I didn't realize that any changes I made in her dosage wouldn't be showing right away, I used it like an in and out insulin witch I now know is wrong.

Nice to hear you're stopping by to say hi!
Speaking of only you and Janet to help around here, what about Panic? It's been long since I've seen her!

Then you and Dancer should enjoy your time together! Miver gets spooked too sometimes, it just happens. Mauer is more like a dog in that way. I don't know witch is better
Do you know about Dancers upbringing?

Holy! That sounds like a big storm!
Please let me know that you're alright! At least you have Dancer as company, and I'm sure you're well prepared with lots of food
Do you have someone keeping an eye on you? In case you'll need help?
You be safe Deb!

 

[Deb & Wink]

When you first switch to levemir, you have to test more at the beginning, to see how that insulin affects Mauer. Nadir on Levemir is usually much later, like at +7 to +10, so it involves a different mindset to use. Plus, you need to let the depot fill, for several days, to see the full impact. You'll likely need to reduce the dose too, not sure to what amount right now. When you get closer to deciding to switch, you should post a thread in the L&L ISG forum and ask for help with that.

Panic is taking some time for herself right now.

Dancer was rescued from a feral cat colony, and she had most of her teeth removed due to suspected stomatitis, while she was at the cat shelter. So she is my "toothless wonder". She was only 18 months old when I first fostered her, and then adopted her. In the beginning, I was told she had renal lymphoma, and was not expected to survive more than 6 months. I took her in as a hospice foster cat. Ended up, she was misdiagnosed. So I adopted her.

She was so skittish then, constantly hiding under a chair in my master bedroom. I had to learn to "not look" at her, and lay down on the floor to get her used to me. The shelter wanted me to weigh her twice a week, so I learned to quietly approach, and then quickly scoop her up for her weigh in. She has come to love laying on my legs when I'm laying down on the sofa reading. Dancer still hates being picked up and barely tolerates her nail trims and twice weekly weight checks, but she gets them done anyway by her "mean mommabean".

I mentioned the storm, because with the heavy wet snow, and the winds, there could be power outages and I might not have the ability to sign on to the message board until the power returns. Hoping for no loss of power, but it could happen. Current predictions are for between 6 -15 inches (15 -38 cm) of snow where I live. Right now, it's still rain and hasn't changed over to snow - yet.

I have someone that plows my driveway, but I shovel the steps myself. I have 2 friends that I can call to check the power outage map and expected restoration times for me, and I'm all set for food. I have a gas stove, so I can cook if the power is out. I do have to use a match to light the stove, since there would be no electricity to make a spark. I've got water in jugs, and some extra water in buckets and jugs for flushing the toilet. I prepared a bit ahead of time, knowing this storm could be bad. Turned the heat up too, to keep the house a bit warmer for now. Charged my cell phone too.

I'll let you know how it goes.

 

[SashaV]

Of course a switch requires more testing at first, I'm ready to do so. A few more won't hurt
I'm close to doing a curve on her blue days anyway

It's understandable
I was just worried about her

Aaaaaw your toothless wonder! She sounds amazing, and what a story you have together. Nothing mean about you I wish we could tell animals that we aren't doing things to hurt them.

Is it Dancer or Wink on your profile picture?

Gosh you're prepared indeed! I wouldn't have thought of any of that
I'm so glad to hear someone is checking up on you!
Fingers crossed for no or just a tiiiiiny bit of snow!
I didn't know power outages was so common. Is your heat running on power too?
Be safe!!!