Morning feeding question, and a little desperation

[Karen&Rocket]

Hello - I'm REALLY struggling with Rocket's numbers - every time I put a number in his spreadsheet I'm almost in tears. Now, just last night I think I noticed some weakness in his back legs. Waiting for a call back from his vet today. Anyway I have a question about feeding schedules - I usually work til 10:30 p.m., so his shot times are 11 a.m & 11 p.m. But, I get up at 8:30, and of course he wants a meal then, and since it's over 2 hours before shot time, I figured it was ok. But now I'm wondering if it would be better, so his numbers don't shoot up even more before his shot, to wait to feed him until shot time? I'm not sure if this would work; he used to wake me up at 5:30 demanding food. We don't do that anymore, but he really really wants breakfast right when I get up.

Any help is so appreciated - I'm so confused by what's going on with him. We've been slowly increasing his insulin but it doesn't seem to be working. I'm so crushed right now.

 

[SpotsMom]

I feed my cats every 4 hours using an auto feeder. It’s hard to ignore them when they insist on eating NOW lol. If you’re feeding low carb food, as long as it’s not within 2 hours it shouldn’t cause that much of a bump in preshot numbers.

This is the one I use: https://www.amazon.com/dp/B01MXDFB28/?tag=felinediabetesfdmb-20

 

[Karen&Rocket]

I feed my cats every 4 hours using an auto feeder. It’s hard to ignore them when they insist on eating NOW lol. If you’re feeding low carb food, as long as it’s not within 2 hours it shouldn’t cause that much of a bump in preshot numbers.

This is the one I use: https://www.amazon.com/dp/B01MXDFB28/?tag=felinediabetesfdmb-20

Thank you! So is one of your feedings two hours or more pre-morning shot? I've been feeding strictly the FF pates for the last couple days (previously I was switching it up a little with other low carb foods, like Tiki Cat). His numbers are so strange; I'm just trying to figure out some kind of pattern. Sigh.

 

[Sarah&Soph]

I also feed my cat meals throughout the day. Her shot time is at 6:30 am and pm, so she gets fed after I test her blood sugar at 6, then 2 hours after each shot (she’s on Vetsulin so it’s a little different), then she gets lunch at 12:30pm and a final meal at 10:30pm before I go to bed. I also give her a small snack at 4pm and 4am to have something in her stomach, so 2 hours preshot so it won’t affect her blood sugar readings. If his blood sugar is all over the place then it might be good to stick with one food for now, like you said you’re doing, it might make things easier

 

[Olive & Paula]

Olive is fed every 3 hrs. Sometimes more often. Her last snack (1/8 of small can) is 3 hrs before shot. Lately she has been super hungry in the morning so she has been eating every hour until +4 then she settles down in the afternoon.

It looks like you held this dose to long and I see 4.7 given which isn't much of a change. Most people raise doses in 0.25 increments every 3 days if following TR or 7 days if following SLGS methods or dry food is involved.

 

[Karen&Rocket]

I also feed my cat meals throughout the day. Her shot time is at 6:30 am and pm, so she gets fed after I test her blood sugar at 6, then 2 hours after each shot (she’s on Vetsulin so it’s a little different), then she gets lunch at 12:30pm and a final meal at 10:30pm before I go to bed. I also give her a small snack at 4pm and 4am to have something in her stomach, so 2 hours preshot so it won’t affect her blood sugar readings. If his blood sugar is all over the place then it might be good to stick with one food for now, like you said you’re doing, it might make things easier

Thank you!

Olive is fed every 3 hrs. Sometimes more often. Her last snack (1/8 of small can) is 3 hrs before shot. Lately she has been super hungry in the morning so she has been eating every hour until +4 then she settles down in the afternoon.

It looks like you held this dose to long and I see 4.7 given which isn't much of a change. Most people raise doses in 0.25 increments every 3 days if following TR or 7 days if following SLGS methods or dry food is involved.

Thank you. I need to get some U-100 needles to fine-tune dosages; my "4.7" is just eyeballing a little more than what I was giving at 4.5. But in the same spot each time. I'm a little concerned about continuing to raise the dose because he gets some pretty low overnight numbers sometimes (I'm concerned he might be bouncing - we got some blue numbers 150-ish two hours pre-morning shot last week, isn't that weird?) but I really don't understand the bounce concept yet. And then again maybe I'm just holding out hope that he's not a super-dose kitty. His numbers are very confusing to me.

 

[Sarah&Soph]

but I really don't understand the bounce concept yet.

The way I’ve seen this described is “too much insulin can look like not enough insulin”. Basically when the blood sugar gets too low, or their body THINKS it’s too low (which may be numbers that are good, but lower than they’re used to), the liver freaks out and dumps a whole bunch of stored sugar, which raises your kitty’s blood sugar. So then when you test you see a high reading and go “Oh, they need more insulin!”, when they really need less.

This happened to Sophie, and you can see in her spreadsheet. She kept getting high PMPS readings and not dropping much during the cycle, so naturally I thought the dose was too small. But I wasn’t taking morning preshot readings because I was lazy and wanted to sleep in, so I was like Hmm maybe she’s bouncing. And as soon as I reduced the dose, beautiful numbers! And started testing in the morning of course

It might not be that simple with your kitty and someone more experienced than me should advise you about dose changes, but thats the basic concept of bouncing

 

[Olive & Paula]

When a kitty is diagnosed with diabetes they have usually had it for some time. Their glucoses are high and they got use to it.

So now you give insulin and glucose comes down to where they are not use to and the liver panics. So it releases stored up glycogen putting blood sugar back to what they are use to. It takes a couple of cycles for that to clear and glucose to come back down again only to repeat until the body gets reaccustomed to more normal glucoses.

 

[Karen&Rocket]

The way I’ve seen this described is “too much insulin can look like not enough insulin”. Basically when the blood sugar gets too low, or their body THINKS it’s too low (which may be numbers that are good, but lower than they’re used to), the liver freaks out and dumps a whole bunch of stored sugar, which raises your kitty’s blood sugar. So then when you test you see a high reading and go “Oh, they need more insulin!”, when they really need less.

This happened to Sophie, and you can see in her spreadsheet. She kept getting high PMPS readings and not dropping much during the cycle, so naturally I thought the dose was too small. But I wasn’t taking morning preshot readings because I was lazy and wanted to sleep in, so I was like Hmm maybe she’s bouncing. And as soon as I reduced the dose, beautiful numbers! And started testing in the morning of course

It might not be that simple with your kitty and someone more experienced than me should advise you about dose changes, but thats the basic concept of bouncing

When a kitty is diagnosed with diabetes they have usually had it for some time. Their glucoses are high and they got use to it.

So now you give insulin and glucose comes down to where they are not use to and the liver panics. So it releases stored up glycogen putting blood sugar back to what they are use to. It takes a couple of cycles for that to clear and glucose to come back down again only to repeat until the body gets reaccustomed to more normal glucoses.

Thank you both. So the only way to really know if a kitty's dose is too high is to experiment a bit? That's scary too. I'll take a look at Sophie's chart, and I'm waiting to hear back from his vet too. Lots to think about.

 

[Sarah&Soph]

Thank you both. So the only way to really know if a kitty's dose is too high is to experiment a bit? That's scary too. I'll take a look at Sophie's chart, and I'm waiting to hear back from his vet too. Lots to think about.

Potentially, but the biggest thing is just knowing your kitty and what’s “typical for them”, which comes with home testing.

Your boy might just be a high dose kitty, I don’t have quite enough experience to be able to distinguish one that needs a high dose from one who is bouncing

 

[Panic]

Yikes, those are some high numbers! There's a lot of dosage adjustments going on so it may be harder for our experienced members to figure out what's going on but I'm going to ping @MrWorfMen's Mom , she seems to be our dosage guru around here. Also @Djamila is an experienced ProZinc member. (Hope you two don't mind the pings!)

 

[Karen&Rocket]

Yikes, those are some high numbers! There's a lot of dosage adjustments going on so it may be harder for our experienced members to figure out what's going on but I'm going to ping @MrWorfMen's Mom , she seems to be our dosage guru around here. Also @Djamila is an experienced ProZinc member. (Hope you two don't mind the pings!)

I don't mind at all, I really appreciate it!!! Thank you so much. I'm going to try to post over on the Prozinc forum too before I have to leave today.

Edit: I'll have to post on the Prozinc forum later tonight. I heard from one vet who recommended just staying on 5U for a few days, and to consider testing for acro if his numbers stay the same. More details later.

 

[Lisa and Witn (GA)]

I don't mind at all, I really appreciate it!!! Thank you so much. I'm going to try to post over on the Prozinc forum too before I have to leave today.

Edit: I'll have to post on the Prozinc forum later tonight. I heard from one vet who recommended just staying on 5U for a few days, and to consider testing for acro if his numbers stay the same. More details later.

The ProZinc users will be able to give you the best advice. I suspect your dose probably is to high unless there are other health issues. If there are any other health issues, please include that in your post to the ProZinc users. You also may want to include yourthem in your signature so anyone that is replying to you will know what else is going on.

 

[MrWorfMen's Mom]

Been scratching my head over your handsome little guy (he is adorable!!!!).

First of all, I don't see anything suggestive of IAA in Rocket's numbers. Typically with IAA a dose increase appears to be working within the first to second day and then the BG just goes back up to where it was....like the dose pooped out.

A number of things lead me to think it's highly likely the insulin dose is too high.

At diagnosis, BG was 450 and Rocket had an infection. An infection would usually elevate BG and it's highly likely that BG was elevated to some degree due to vet stress. I hope a fructosamine was done to confirm diagnosis and not just one in office BG test along with clinical observations.

Rocket recently had a dental cleaning (you mentioned an infection there too) which I would likely increase BG numbers. While tests are scant around the time of the dental, it appears his numbers are going up rather than down following the dental that supposedly dealt with that issue.

On the 20th and 21st of June, Rocket finally dropped into the blues however it was at the end of cycle later than is typical with ProZinc.

On the 22nd, Rocket had an inverted cycle i.e. went from lower to higher numbers mid cycle and dropped down again to some degree at the end of the day cycle.

On the 19th, you indicated you thought you gave a fur shot yet BG did not skyrocket into the black by the end of the cycle. It would have been helpful to have a mid cycle test that night to see if he dropped at all in the typical time frame. We have no way of knowing if all, some or none of the insulin got into his system but if none got in, given the recent numbers, I'd expect his BG would have increased through the cycle leading to an even higher AMPS on the 20th which wasn't the case. If some got in, he may have dropped mid cycle and had a typical cycle. If none got in, then I'd definitely be leaning toward the dose being too high.

Doses have been increased 0.5u at a time and we'd recommend changes in 0.25u increments to ensure not skipping over the best dose. Some cats are very sensitive to dose changes and even changes less than 0.25u can make a difference.

You indicated Rocket was sick when first diagnosed and hospitalized for a couple of days. Was he given antibiotics at that time? Did the vet ever mention ketones or DKA?
Did Rocket get antibiotics following his dental cleaning?
You changed Rocket to wet low carb food around the time of his diagnosis. Was insulin started before the food change?
Assuming you were having curves done at the vet before you started home testing, do you have any of that data?

ETA Are you testing Rocket for ketones at all?

 

[Karen&Rocket]

Been scratching my head over your handsome little guy (he is adorable!!!!).

First of all, I don't see anything suggestive of IAA in Rocket's numbers. Typically with IAA a dose increase appears to be working within the first to second day and then the BG just goes back up to where it was....like the dose pooped out.

First of all, let me say you are a hero on these boards! Thank you so much for taking the time to look at Rocket's info, my posts, etc. - I am so grateful for your help and advice. HUGE hugs to you!!! Ok, I didn't know that IAA could present that way. I know it's just one day, but what do you think of Rocket's numbers on June 5? He went down to 183 after going from 3.0-4.0 units in 24 hours. His vet's advice.

A number of things lead me to think it's highly likely the insulin dose is too high.

At diagnosis, BG was 450 and Rocket had an infection. An infection would usually elevate BG and it's highly likely that BG was elevated to some degree due to vet stress. I hope a fructosamine was done to confirm diagnosis and not just one in office BG test along with clinical observations.

Rocket recently had a dental cleaning (you mentioned an infection there too) which I would likely increase BG numbers. While tests are scant around the time of the dental, it appears his numbers are going up rather than down following the dental that supposedly dealt with that issue.

I don't remember, but my husband doesn't think a fructosamine was done when he had the infection. I'm going to call the vet later today and see what info I can find. As for his post-dental numbers, our vet said to wait 4-5 days to test him... to give his system a chance to normalize? Adjust? I probably should've snuck in an occasional test. But, what do you think of his numbers on June 19-21? He had a much better curve than before the dental, so I thought it might have helped.

On the 20th and 21st of June, Rocket finally dropped into the blues however it was at the end of cycle later than is typical with ProZinc.

On the 22nd, Rocket had an inverted cycle i.e. went from lower to higher numbers mid cycle and dropped down again to some degree at the end of the day cycle.

These readings are the main reasons I'm so confused/concerned. Though it hasn't happened in the last couple of days.

On the 19th, you indicated you thought you gave a fur shot yet BG did not skyrocket into the black by the end of the cycle. It would have been helpful to have a mid cycle test that night to see if he dropped at all in the typical time frame. We have no way of knowing if all, some or none of the insulin got into his system but if none got in, given the recent numbers, I'd expect his BG would have increased through the cycle leading to an even higher AMPS on the 20th which wasn't the case. If some got in, he may have dropped mid cycle and had a typical cycle. If none got in, then I'd definitely be leaning toward the dose being too high.

Yeah. I really wish I would've gotten a number that night too. Not sure why I didn't, actually.

Doses have been increased 0.5u at a time and we'd recommend changes in 0.25u increments to ensure not skipping over the best dose. Some cats are very sensitive to dose changes and even changes less than 0.25u can make a difference.

Yeah. I know so much more now than I did when this all started, thanks to these boards and people like you. Which is why I'd love to try starting over at a lower dose. But I'm not sure of how to do it safely and avoiding a crisis.

You indicated Rocket was sick when first diagnosed and hospitalized for a couple of days. Was he given antibiotics at that time? Did the vet ever mention ketones or DKA?
Did Rocket get antibiotics following his dental cleaning?
You changed Rocket to wet low carb food around the time of his diagnosis. Was insulin started before the food change?
Assuming you were having curves done at the vet before you started home testing, do you have any of that data?

ETA Are you testing Rocket for ketones at all?

Yes, Rocket was given antibiotics at the time of hospitalization, and at home for either 7-10 days afterwards.
The vet did not mention ketones or DKA. Actually they were quite vague about the "infection," so I'm not sure they even knew what exactly was wrong. Sigh.
Rocket only got antibiotics during the dental cleaning. I asked whether he would be sent home with any, and they said they weren't needed. Which I thought was a little weird for a diabetic, but I don't know.
As for food, I started immediately on low-carb wet food with the insulin. Again, hindsight is 20/20. I wish I could start over with diet change first. Oh! The vet did send him home with Hills Metabolic Dry food at first. Which I very quickly learned was not the way to go. So, there was a bit of time (a week or two?) where he was getting wet and dry.
Sadly, no curves at the vet, since like I said, Rocket HATES going to the vet. Gets extremely agitated. So, office curves would be worthless. He just said to bring him in for spot tests and weight checks every couple weeks, and occasional fructosamine. You know the story. Anyway I started my spreadsheet almost as soon as I started testing, so all my info is there.

I am not testing for ketones but plan to do so. I'm going to try to get supplies today. I'll definitely start if we attempt lowering his dose.

I have a few numbers from overnight and this morning that I haven't put in yet - I need to run some errands right this minute, but I'll put them in as soon as I get back.

Edit: never mind, just added last day or so to the spreadsheet. Also, we have an appt. with his "second opinion" doctor tomorrow morning, so hopefully I can present some of these ideas to her. We're also considering testing for acro, just to rule it out (or not).

Again, thank you, thank you, thank you!!! I hope you're having a great day.

 

[MrWorfMen's Mom]

What struck me about June 5th is that he started the night of the 4th over 500 and unfortunately we don't have any data from that day cycle to know if that could have been a bounce from a lower BG during the day. If it was a bounce, then the drop to 183 on the 5th could have been the bounce clearing. The problem with missing data is that everything is just speculation.

My girl has IAA and I didn't see anything even close to a blue reading for months and not until she got over 5u twice daily and then I'd wait weeks till another would appear. Her cycles were very flat for the most part with very little in the way of any drop most cycles. Rocket's aren't usually flat. Now that said, until you get some more consistent data over a bit longer period, no one say for sure but right now with what you've got so far, I wouldn't suspect IAA.

Chances are the vet gave Rocket an injection of Convenia after the dental which is an antibiotic that works for roughly a couple of weeks. Quite a common practice amongst vets although the drug is actually meant for skin infections and may not necessarily knock out a dental infection. How do Rocket's gums look now? Are they pink or are they still red anywhere?

I'd definitely check with the vet to confirm if fructosamine was done and if ketones/DKA was ever diagnosed. I've seen kitties diagnosed with diabetes based on one high BG in the vet's office and sugar in their urine only to find out the cat either became diet controlled when diet was changed or that perhaps kitty never was diabetic. If you were only having spots checks done at the vet's office, that is not a reliable way to diagnose or make dose adjustments and too often leads to a vicious circle of unnecessary dose increases.

I suggest you test Rocket for ketones and if they are negative, I would try backing up the dose to see if that brings the numbers down a bit. Unfortunately, backing up is a lot harder than moving forward in small increments in the first place. Let us know when you've managed to test the ketones and we'll decide next steps.

 

[Karen&Rocket]

I think his gums look ok, but I'll ask the vet to take a look tomorrow. I'll do my homework, and post again after our appointment tomorrow with an update (if not before then). Thank you again!!!

 

[Karen&Rocket]

What struck me about June 5th is that he started the night of the 4th over 500 and unfortunately we don't have any data from that day cycle to know if that could have been a bounce from a lower BG during the day. If it was a bounce, then the drop to 183 on the 5th could have been the bounce clearing. The problem with missing data is that everything is just speculation.

My girl has IAA and I didn't see anything even close to a blue reading for months and not until she got over 5u twice daily and then I'd wait weeks till another would appear. Her cycles were very flat for the most part with very little in the way of any drop most cycles. Rocket's aren't usually flat. Now that said, until you get some more consistent data over a bit longer period, no one say for sure but right now with what you've got so far, I wouldn't suspect IAA.

Chances are the vet gave Rocket an injection of Convenia after the dental which is an antibiotic that works for roughly a couple of weeks. Quite a common practice amongst vets although the drug is actually meant for skin infections and may not necessarily knock out a dental infection. How do Rocket's gums look now? Are they pink or are they still red anywhere?

I'd definitely check with the vet to confirm if fructosamine was done and if ketones/DKA was ever diagnosed. I've seen kitties diagnosed with diabetes based on one high BG in the vet's office and sugar in their urine only to find out the cat either became diet controlled when diet was changed or that perhaps kitty never was diabetic. If you were only having spots checks done at the vet's office, that is not a reliable way to diagnose or make dose adjustments and too often leads to a vicious circle of unnecessary dose increases.

I suggest you test Rocket for ketones and if they are negative, I would try backing up the dose to see if that brings the numbers down a bit. Unfortunately, backing up is a lot harder than moving forward in small increments in the first place. Let us know when you've managed to test the ketones and we'll decide next steps.

Ok. It's been a few days since Rocket's vet visit last Friday. The vet said his gums looked good. Urine ketone test was negative, but there was glucose in his urine (vet said "+3"), which I assume is to be expected. Unfortunately I had a couple days where I was unable to test anything other than AM & PM pre-shot. Since then his numbers have been bad. Reds and blacks for the most part EXCEPT - he had one of his late nadir episodes again just this morning - 164 at PM+8. My husband and I are both agreeing with you that his dose may be too high. I backed off to 4.5 last night (from 5) - would that have changed his numbers so quickly? Or is this a possible bounce? Yesterday I read somewhere that approximately 25% of cats have late nadir with ProZinc. But Rocket does this on occasion, not consistently, so that doesn't fit.

It may be a bit early, but we decided to go ahead and send his bloodwork in for the Acro test, for peace of mind really. No results yet, and with the holiday this week I'm sure they'll be delayed. At least then we can either rule out Acro (or not).

They did a fructosamine test at his appt. on June 11. It was 530. Which is terrifying and disheartening. Does that rule out a bounce?

At any rate, if you still suspect that Rocket's dose is indeed too high, is there a "safe" way to bring his dose down over time? It's such a hard thing to do... if we adjust his dose down and then it turns out that he actually does need a high dose... I should add that in just the last few days I've noticed some weakness in his back legs, so that ups the stakes a bit.

 

[MrWorfMen's Mom]

Did you ever find out if a fructosamine was run at diagnosis? Doing it now tells us nothing we couldn't already see on his spreadsheet. I'm curious to know what it was at diagnosis and if it wasn't done, it would make me more suspicious of the dose being too high.

If your vet can add onto the bloodwork that was sent in for Rocket, it wouldn't hurt to run the IAA as well. I believe the acro tests are only run on Wednesdays (unless it's changed) so depending on delivery time for the blood, it may still be possible to add it on. It's relatively inexpensive and often accompanies acromegaly without necessarily showing typical IAA tell tale signs because of the acro. IAA on it's own is relatively rare in comparison.

I've never heard that 25% of cats on ProZinc have a late nadir. Nadir is generally between +4 and +7 but can occur earlier or later in some cats. Some cats are like clockwork with their nadirs while others move around. Most of Rocket's nadirs seem to fall in the "normal" time frame but since they can move, that low last night could still have been his nadir.

I would also caution against taking BG at +9 and dosing based on that number. Rocket has had some of his lowest readings later in the cycle so if he was still dropping after that +9 test, you may have been dosing at a lower pre-shot than we are aware of. I know scheduling can be an issue but getting those pre-shot tests along with mid cycle testing is really vital to getting the big picture.

For starters, you could try holding the dose at 4.5u for a couple of cycles to see if you get any more blue showing up. On second look, I'm wondering if some of what you are seeing could be glucose toxicity. You held the 4.5u dose for quite some time and sometimes kitties just get stuck and need dose increases to get them past it. If that's what is going on, backing up the dose isn't going to help. If he doesn't get any more blues on 4.5u then bump him back up to 5u for a couple of cycles and see if that gets him to blue. If not, I'd raise him up to 5.5u and see if that helps. Hopefully by then you will have the acro test back and we'll at least know if there is a secondary condition causing the lack of response.

 

[Karen&Rocket]

Did you ever find out if a fructosamine was run at diagnosis? Doing it now tells us nothing we couldn't already see on his spreadsheet. I'm curious to know what it was at diagnosis and if it wasn't done, it would make me more suspicious of the dose being too high.

If your vet can add onto the bloodwork that was sent in for Rocket, it wouldn't hurt to run the IAA as well. I believe the acro tests are only run on Wednesdays (unless it's changed) so depending on delivery time for the blood, it may still be possible to add it on. It's relatively inexpensive and often accompanies acromegaly without necessarily showing typical IAA tell tale signs because of the acro. IAA on it's own is relatively rare in comparison.

I've never heard that 25% of cats on ProZinc have a late nadir. Nadir is generally between +4 and +7 but can occur earlier or later in some cats. Some cats are like clockwork with their nadirs while others move around. Most of Rocket's nadirs seem to fall in the "normal" time frame but since they can move, that low last night could still have been his nadir.

I would also caution against taking BG at +9 and dosing based on that number. Rocket has had some of his lowest readings later in the cycle so if he was still dropping after that +9 test, you may have been dosing at a lower pre-shot than we are aware of. I know scheduling can be an issue but getting those pre-shot tests along with mid cycle testing is really vital to getting the big picture.

For starters, you could try holding the dose at 4.5u for a couple of cycles to see if you get any more blue showing up. On second look, I'm wondering if some of what you are seeing could be glucose toxicity. You held the 4.5u dose for quite some time and sometimes kitties just get stuck and need dose increases to get them past it. If that's what is going on, backing up the dose isn't going to help. If he doesn't get any more blues on 4.5u then bump him back up to 5u for a couple of cycles and see if that gets him to blue. If not, I'd raise him up to 5.5u and see if that helps. Hopefully by then you will have the acro test back and we'll at least know if there is a secondary condition causing the lack of response.

Thank you! I'm on my way out for a bit so this will have to be short, but I'll update more later. Apparently no fructosamine was done at diagnosis. I called yesterday, and asked to have the IAA test added as well (I had just found out the 2 tests are done at the same lab). That's it for now, stay tuned for the continuing saga of Rocket!

 

[Karen&Rocket]

Did you ever find out if a fructosamine was run at diagnosis? Doing it now tells us nothing we couldn't already see on his spreadsheet. I'm curious to know what it was at diagnosis and if it wasn't done, it would make me more suspicious of the dose being too high.

If your vet can add onto the bloodwork that was sent in for Rocket, it wouldn't hurt to run the IAA as well. I believe the acro tests are only run on Wednesdays (unless it's changed) so depending on delivery time for the blood, it may still be possible to add it on. It's relatively inexpensive and often accompanies acromegaly without necessarily showing typical IAA tell tale signs because of the acro. IAA on it's own is relatively rare in comparison.

I've never heard that 25% of cats on ProZinc have a late nadir. Nadir is generally between +4 and +7 but can occur earlier or later in some cats. Some cats are like clockwork with their nadirs while others move around. Most of Rocket's nadirs seem to fall in the "normal" time frame but since they can move, that low last night could still have been his nadir.

I would also caution against taking BG at +9 and dosing based on that number. Rocket has had some of his lowest readings later in the cycle so if he was still dropping after that +9 test, you may have been dosing at a lower pre-shot than we are aware of. I know scheduling can be an issue but getting those pre-shot tests along with mid cycle testing is really vital to getting the big picture.

For starters, you could try holding the dose at 4.5u for a couple of cycles to see if you get any more blue showing up. On second look, I'm wondering if some of what you are seeing could be glucose toxicity. You held the 4.5u dose for quite some time and sometimes kitties just get stuck and need dose increases to get them past it. If that's what is going on, backing up the dose isn't going to help. If he doesn't get any more blues on 4.5u then bump him back up to 5u for a couple of cycles and see if that gets him to blue. If not, I'd raise him up to 5.5u and see if that helps. Hopefully by then you will have the acro test back and we'll at least know if there is a secondary condition causing the lack of response.

Ok -- I finally have some time to sit and write. I called my vet last week and was told that no fructosamine was done at time of diagnosis (which is odd, because I thought one had, but I could be wrong). I called to try to have the IAA test added to the IGF-1, but haven't heard back, but the vet tech said she thought it would be possible. Hopefully I can find out tomorrow or Monday. As for the 25% late nadir Prozinc thing, I'll have to try to find that again. I thought I had saved the link on my phone but I can't find it.

And now for my current concern - Rocket had a high last night of 650, after 2 cycles of backing off from 5U to 4.5. BUT -- I just tested him right now and got an AM+7 of 166. Does this look like a bounce? Think I should lower his dose again tonight? I got a couple of long emails from his vet yesterday (after he took a good look at my spreadsheet and your ideas too), and he is finally saying that Rocket could possibly be bouncing, among other things. I was going to wait until we got the Acro test back to do anything with dosage, but I'm wondering if I should back off a little more. Is there a "safe" way to lower his dose? This has really been a roller coaster ride. (And, since Rocket did hit blue today, does this rule out glucose toxicity? I don't fully understand the concept yet.) His vet is on vacation right now, but I have plans to follow up on Monday.

I'm definitely going to do a PMPS test tonight, and possibly one before then (though with all the firecrackers going off in our neighborhood right now I'm sure his stress is a little high).

Sorry for all the questions. Hugs, and happy 4th!!!

 

[MrWorfMen's Mom]

That does look like a bounce. Looks like Rocket hit blue and bounced up and is now coming out of the bounce with the blue again today. And with his BG still dropping that late in the cycle (+10) I'd be inclined to drop him back to 4u for a few cycles and see what he does.
I am surprised your vet didn't do a fructosamine to diagnose the diabetes but he's not the first and won't be the last. Getting both the IAA and Acro tests done will at least give some clarity of what you are dealing with.
Let's see what Rocket does on 4u before we make any judgement calls here. Right now I'm back to leaning toward dose being too high but he's still a bit of a puzzle with those really high pre-shots.
Do you have a hard time testing Rocket or is it scheduling that has you testing at +10 and not retesting at pre-shot? It would have been good to know what his BG was right before you shot today especially with him dropping at the end of the previous night cycle.

Happy 4th to you. I dealt with the fireworks on the 1st.....I'm Canadian! Fireworks are no fun when our kitties get so bent out of shape.

 

[Karen&Rocket]

That does look like a bounce. Looks like Rocket hit blue and bounced up and is now coming out of the bounce with the blue again today. And with his BG still dropping that late in the cycle (+10) I'd be inclined to drop him back to 4u for a few cycles and see what he does.
I am surprised your vet didn't do a fructosamine to diagnose the diabetes but he's not the first and won't be the last. Getting both the IAA and Acro tests done will at least give some clarity of what you are dealing with.
Let's see what Rocket does on 4u before we make any judgement calls here. Right now I'm back to leaning toward dose being too high but he's still a bit of a puzzle with those really high pre-shots.
Do you have a hard time testing Rocket or is it scheduling that has you testing at +10 and not retesting at pre-shot? It would have been good to know what his BG was right before you shot today especially with him dropping at the end of the previous night cycle.

Happy 4th to you. I dealt with the fireworks on the 1st.....I'm Canadian! Fireworks are no fun when our kitties get so bent out of shape.

Ha! Happy Belated 1st then I did notice you were Canadian when I saw your profile a few days back. It's been a stressful week.

And, I just got an AM +9 of 234. At least our 166 today was AM +7, not 9 or 10.

As for the +10 readings, this week anyway, I was trying to save a strip here and there - I'm getting a little low, and with the holiday, the new ones I ordered won't be here 'til Saturday. So I'll cautiously try 4U for the next bit and see what happens (and I will take a PMPS tonight for sure). Thank you! I'll keep you posted.

 

[Karen&Rocket]

I just wanted to say thank you to all of you who have helped me here, and give you an update... Rocket has been diagnosed with Acromegaly. Which explains why it has been so very hard to treat him. My heart is broken... shattered. But my husband and I are going to do what we can. I've posted a new thread in the acromegaly forum, and I'll share the link here just in case you want to follow along. The biggest of hugs to all of you. I'm the saddest I've been in years, but so grateful to have found this community.

http://www.felinediabetes.com/FDMB/threads/well-its-official.216489/

 

[CandyH & Catcat]

and Catcat adds -- remember, knowledge is power, now you have the tools to understand what's going on

 

[Karen&Rocket]

and Catcat adds -- remember, knowledge is power, now you have the tools to understand what's going on

Thank you! Give beautiful Catcat a huge huggle from me!

 

[CandyH & Catcat]

oh I will, he comes up when I'm reading in bed, and snuggles with his paws proprietarily draped over my outstretched arm ..

MINE, he says ...

and big meows to you too