mg/dL is been in the low/mid 100's the past 3 days w/o insul

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C

concrete

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Hi,

I have noticed that my Zoe's sugar has been lower than usual for the past three days. He is not well regulated yet and his dosage is 2 units twice a day of Prozinc.
Normally if I test him in the morning he is somewhere around 350 but the past few days he has been at 112-157. I did see that a few hours after food he was at 240 which is still a bit low to him. His dosage was upped from 1 unit to 2 units about 3 weeks ago. He is eating.

Two things happened recently that may/may not have anything to do with it. He has recently got fleas. I am doing my best to get them off of him but I do not want to use any chemicals as I have an infant in the house.
The other is almost a week ago his injection went into the skin fold instead of the open space when you are pulling up the skin on his neck. It made a bubble in that area, filled with the insulin I am assuming, and was gone the next morning (night shot)

He also threw up overnight the past 2 days

I have been skipping his insulin since his sugar was so low. I only give it to him if it is over 240 or so.

Could he be sick and it is effecting his insulin production? What about the fleas? Could it be stress? He urine has blood in it every so often. He has been to the vet for it but they just give him antibiotics and aren't sure if it is crystals, uti, or whatever. He is has blood in his urine now. Normally I just force him to drink a lot of water/broth and it goes away.
I also want to add that I usually can tell when he is in duress but he looks pretty normal at the moment. The fleas more than anything are annoying him.


Please help me out with some guidance, I don't want my little buddy to die on me.

Thanks,
Dan
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

Hi Dan,
Saw this in Health, but good idea posting it here since the folks here all deal with PZI.
How long has he been on the antibiotics. More than anything else I see, that would most likely be the thing that is upsetting his tummy and making him throw up. The blood in the urine is concerning too. But if it is because of a UTI, then the antibiotics should fix that problem.
The fleas would be making him miserable. Have you thought about advantage or frontline? That restricts the chemicals to just one spot on his fur, so it wouldn't be a danger to anyone else in the house. I put some frontline plus on Bob a couple weeks ago due to a few ticks, and that cured that problem, with no ill effects that I have noticed on Bob.
I remember you posting about the weird shot the other day. That dose may have taken a bit longer to absorb, but I don't think any reaction to that would have lasted more than one day at most. By then the insulin would have been absorbed and used by his system.
His low numbers are really terrific actually. And the rise to the mid 200s would be expected by the BG boost from eating.
It would be great if you could give us "more" numbers, especially if you can create a spreadsheet. Seeing days of data is very helpful when trying to figure out what is going on and determining if a dose adjustment is called for. If you don't have a SS, you can list dates, times and doses in an easy to read format for the time being.
When you see those 120-150 AMPS numbers, are you shooting or no? If so, is it the current normal dose of 2units?
Tell us more....
Carl
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

Oh, wanted to add. I know it's hard but keep in mind that as long as you have his diabetes somewhat under control, kitty isn't going to die from diabetes. Uncontrolled diabetes can be a killer (we're talking 500+ numbers for an extended period). The only danger you face with a cat who is on insulin regularly is using too high a dose and causing a hypoglycemic crisis (BG well below 50). If you are not shooting under 240, that risk is minimal.
The point where you might get soon is to adjust doses based on his numbers. Sometimes called a "sliding scale", where if his BG is say above 250 you shoot x amount, but between 150 and 250 you would shoot y amount, and even 100-150 you might shoot z amount.
Sometimes you need to give a reduced dose based on the AMPS or PMPS rather than skipping altogether, the theory being that some insulin is better than none because it enables you to keep his sugar a low levels more consistently. And like I said, you might get to the point where it makes sense to try that. But not yet, not until you've got more data to go on.
The other really valuable time to test would be the mid-point between doses, called the nadir. That would be the point in the cycle where the BG should be as low as it is going to go. (usually 6 hours after the shot, or +6 in board lingo) That is extremely important, and gives you a much better idea of the insulin dose which is safe to shoot, that keeps him away from a "hypo" situation.

Carl
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

Hi Carl, Thanks for the reply.

He isn't on the antibiotics anymore, it was a 10 day thing a few months ago. Nothing has really changed since this has been happening, except the fleas I guess. I did give him a bath with Palmolive, maybe I didn't rinse all of it away and he is throwing up after licking his coat. the vomit is a darker color and the soap was blue.

I was thinking about advantage or frontline but I am concerned about the chemical part. I would try to keep the baby away from him but She is 9 months now and is all over and he roams freely so I am worrying about him rubbing on a toy or crumbs from the frontline falling off of him and her eating it from the carpet. She likes to pick up lint balls or little stuff up and try to eat it. I was looking for natural solutions but haven't really seen any.


I am happy that he is back in the 1-200's, but just a bit concerned. I will write down the details in the next few days and I'll do a curve and post it here.

When I see 120-150 I just skip the injection altogether. When it was 240 I fed him and gave him the 2 units 15 min later.

The sliding scale makes sense, I would be willing to consider that if I need to.

When I test him I will do it in the Morning, Nadir and Night. Should I test before or after the food or insulin?

Thank you for your help by the way.
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

I understand the concern about your precious daughter. It's been 24 years, but I remember mine at 9 months, and nothing matters to a parent more than the safety of their children. Heck, I still worry about her and she's off in Missouri and married!
The "sliding scale" was something I did with Bob when he started to get better and I was taking him down from 4u BID over the course of 4 or 5 weeks. My vet drew lines in the sand like I described, and then I sort of winged it towards the end. I got him down to .5 BID and was shooting when his numbers were under 100, but a) he had quite the degree of insulin resistance or tollerance, and b) I "knew" how he would react and was here to watch him most of the time. One great advantage I had was to live and work on a small island so I am never more than 10 minutes away from home.

The shampoo may well be what is causing the tummy trouble. That should go away if it hasn't already.

When you test, you should do it before feeding. That insures the number isn't influenced by food, which will raise his BG. I tested, and fed right after, then shot within minutes of eating. Maybe all 3 over a 10 minute time frame. I didn't let Bob have any food for two hours leading up to the AMPS and PMPS tests,so no food was in the equation. During the Mid-cycle testing, it's okay if he's eaten a little before those tests, but just try to note how much he eats and when, so you can account for some "wonky" number by saying "okay, well he ate 2oz just before the test, so that may be why it's a bit high"
To recap, the sequence at AMPS and PMPS is test, then feed, then shoot. And your choice is to stay with the "no shot under 200", or with experience, you'll probably end up with "well, it's 175, I can safely shoot a half dose" or something along those lines. That is the sort of thing that posting regularly here will enable you to determine. Many members who post here have been dancing for a long time, much longer than I've been around.
And you're very welcome for the help, Dan. That's why most of us are here. We've all been helped, so we're just paying it forward...
Carl
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

Just a quick update, today his readings were:

Morning: 111
Nadir: 282
Night: 190

Isn't it supposed to be the inverse of this?
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

Yes,
That is called an "inverse curve". Myself, I call them frowns. Curves are supposed to be smile-shaped.
I am assuming that since you were under 150, you didn't shoot this morning? If that is the case, then the climb today was caused by food, and the fact that the pancreas is not producing enough insulin to combat the BG rise from the food. In a non-diabetic cat, and curve might look like this:
AM 60, then breakfast
+6 85
PM 65 then dinner
Just a rise caused by food, but the natural insulin keeps in under control, and the body uses the glucose and turns it into energy to keep kitty going all day. It drops when kitty needs more food, and the whole cycle repeats.

With Zoe, he is somewhat self-regulating, but not quite normally. So he shows you a non-shoot number in the morning, eats, but there isn't quite enough insulin being produced, so while he can use some of that glucose to make energy, but not all of it. The excess is peed out mostly but his BG climbs out of "normal" range during the day. As he approaches dinnertime, his number falls because he's used up all that food or peed what he can't use out, and then he gives you a possible shoot number at PMPS. Did you give him a dose at dinnertime?
If yes, then you are helping his pancreas by adding insulin to combat the excess glucose. If no, then this would start having a cumulative effect. Without insulin, his BG at AMPS and PMPS would start to creep up until you get "shoot" numbers you feel safe shooting into. Then you'll see his PS's go back down under that line, and so on and so on. Obviously, if his body can't yet produce sufficient insulin, and you never gave him any, it would spiral "out of control" resulting in uncontrolled diabetes (which is where most of us started this dance).
Good news for you is that it seems Zoe is not bad off. He is somewhat regulated, but the pancreas still needs time to heal, so h'e'll need help from you.
At least that is how I understand this whole thing to work!
Carl
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

Dan,
Eventually, you will get comfortable with shooting into numbers lower than 240 (I think that's where you draw the line?).
Is his current normal dose still 2u?
When you get a number, whether it's 240 or whatever, that you shoot into, and you test him at least once around +6, you will see what that does to his BG during the 12 hours between shots. With that data, you will be able to make adjustments accordingly. I'm just tossing out numbers here, but for instance.
If he was a 240 at AMPS, and 75 at nadir, then went back to 240 at PMPS on say 2u per shot. At that time, you might continue that dose if you saw no improvement at AMPS or PMPS. But what will most likely happen is that you see his PS #s drop some. You wouldn't want to continue 2u if that happens, because if everything stayed constant, the drop would put him below 75 at nadir. So you might choose to reduce his dose. Let's say his AMPS and PMPS started being around 200. You could drop his dose (rather than choosing to not shoot) to maybe 1.5 per shot. That dose might keep his nadir in a safe 65-85 range, but still help him heal so that his pre-shots fell lower to like 150. Then his dose could be further reduced, etc. The trick is to keep a nice shaped curve - not too drastic, not too flat, while at the same time not making his BG to drop too low which often sets off what we call liver panic. That is where the liver dumps glucose into the system because the liver thinks the BG is too low. One of the primary protocals on the board is that when you make adjustments to the dosage of insulin, you do so in small increments. ECID. Some cats respond to an adjustment as small as .1 units. Some act the same way when the adjustment is .5 units. A safe adjustment for most kitties is .25 units (that's per shot, so the daily reduction or increase would be 2 times that amount). So when the time comes to adjust Zoe's dosages, do it in baby steps. That helps avoid issues such as liver panic or hypos.
Keep us posted on how Zoe is doing, and ask all the quesions you can think of!
Carl
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

Carl,

Thanks again for the reply.
In the morning I skipped his dose and at night he received 1 unit instead of 2U.
I am cautiously optimistic with the lower numbers but I do wonder why the inverse curve. It just started happening out of nowhere and I have seen him way higher, he was 500+ a few times a couple of months ago.
I do have to say that he is visibly gaining his weight back, he had dropped a few pounds and was boney from the diabetes and now he is looking a lot better. Coat is nicer as well. His demeanor is generally better as well. I'm sure the switch to exclusively eating wet food had something to do with it too.
By the way he did not throw up again this morning, though I am a bit concerned because he is due for a bath because of the fleas.

I'll keep posting the numbers for a few days. I really appreciate the advice.
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

Dan,
Good call on giving him 1u tonight. In general, and as long as you feel comfortable shooting, a reduced dose is better than a skipped dose. Some insulin is better than none. It all comes down to your level of comfort, and to having the data to back up your decision. If you have a good feel for what a 2u or 1u (or any) dose is going to do - based on what you've seen - then you can feel safe with reduced doses.
An inverse curve when no insulin is involved (which is what you saw today) is evidence that his body is doing at least a part of what it is supposed to be doing with glucose and insulin. It means he's getting better, but he's just not well enough to do it all on his own. Inverse curves when you have given shots usually indicate that the dose is too high, and they have caused his BG to actually rise instead of drop. You're seeing "frowns" that are not "shot" induced. Those are much nicer to deal with, so that's a good thing!
Carl
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

Today his readings were as follows:

Morning 201
Nadir 50
Night 144

I fed him after the Nadir. That's the lowest I've ever seen him.
I gave him 2u in the morning, probably should have given him less. I gave him .5u at night. I want to see if I need to meet somewhere in the middle for now.
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

Dan,
those numbers are great!
this is just my opinion regarding doses....
I think I'd stay away from 2u. The 50 is actually an ideal number for nadir. You don't want him going too much lower than that, unless you are right there to monitor his condition. I think the lowest I ever caught on the meter was a 44. That said, I think your instinct is right, you are going to find a happy medium between the 2 and the .5 that will keep him in a great place. It will be interesting to see what his AMPS is tomorrow given the reduced dose, but I'm guessing it'll be a nice number.
You may be close to a point where 1 or .5 works day and night. It would be best if you can find a dose that can be equal for the 2 daily shots, because that will keep his BG more level around the clock. Along with that, in order to make sense of it all, it's a good idea to keep with the same dose for 3 or 4 days running so that you can see definite patterns and so that his body can fully adjust to the dose level. But, if he's getting this much better this quickly, you may not be able to do that. If his numbers keep falling every day, and his doses are dropped accordingly, it's hard to remain consistent for days at a time.

I've got a hunch this isn't going to be a very long "dance" for you and Zoe, and that's awesome.

Carl in SC
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

Carl,

That makes me feel great. I am really happy about these numbers.

Here are the numbers from the last couple of days:

Morning 99 no juice
Nadir (actually 8 1/2 hours after) 82
Night 172 - .5u

Morning 100 - no juice
Nadir (actually 8 1/2 hours after) 89
Night 103 - no juice

I was late with the Nadir reading but I figured it wouldn't be far from it. I am trying to be consistent with the shot but I am a bit afraid to go too low. I would hate to come this far in his recovery and then kill him from a mistake. When he is at 100 or so what do you think I should do?

Dan
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

Dan
I would not shoot at 100. I might shoot .25 between 101 and 150.
Above 150 I think that the. .5 is wise.
Carl
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

Thanks for the advice Carl.
That sounds pretty do-able. Though the .25 seems like it will be difficult to measure. Sometimes when I do .5 it feels like I didn't do anything.
I wonder if they have syringes that work better for smaller scale use.

I must say, it is really starting to be nice to not have to give him juice every day. :)
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

Dan
many people use u100 syringes when trying to microdose. You can find a conversion chart if you search for "u100 conversion" on the board. Hopefully one of the other pzi folks can tell you more. I think some of them use those.
Carl
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

That sounds like a good idea. I'll check out the 100u ones.

I haven't given him insulin in the past few days, his readings were all under 100 each time. I'm crossing my fingers that stays that way. It would be really convenient, he has maybe a 1/4th of insulin left in the vial, and that stuff is expensive. I think I paid like 125-130 to the vet. It would be awesome if I didn't have to buy any more.
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

Dan,
It sounds like you and Zoe are doing GREAT! We all wish we could be so lucky.
Keep up the good work.
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

Ginny & Alex said:
Dan,
It sounds like you and Zoe are doing GREAT! We all wish we could be so lucky.
Keep up the good work.
Click to expand...


Thank you!
I don't know if we caught it early or if the switch to wet food made the difference or what, I just hope it stays that way. He's been between 60-90 for the most part with no insulin in the past 8 days.
He's also gained most of his weight back, which is a good thing, he was over weight and now he is where he should be. Coat even looks better.

These Message Boards are awesome. They helped me with everything. the vet was clueless, he was asking some other doctor on what to do.

Oh, and thanks again Carl!
 
Re: mg/dL is been in the low/mid 100's the past 3 days w/o i

Dan
Thank you for the update, and keep us posted. What you should do eventually is share exactly what you've done and how with the vet. Show him how it worked for Zoe so that he understands how important the low-carb diet change is, and how important testing is. I would hope that he would pass this information on to the next diabetic patient's "people", or at least give him your email address and tell him you would be fine if he shared it with other diabetic owners. It's okay if he was "clueless", not all vets know up-to-date info on any one specific disease, and I'd think he'd be happy for the free education. If he chooses to remain clueless with "proof" supplied by Zoe, then that's his loss.

Carl
 
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