Morris4

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I think there may be too many changes. (Some cats can do well with a sliding scale; some can't as they take more than one cycle to really react). He drops well midcycle but does seem to bounce for the next preshot. As soon as you can get a curve, you can see if there is a lower number earlier than +6 or later than +8. My thinking is that he was still dropping at +7 yesterday - maybe he was lower later? The good news is that he doesn't bounce into the 400 range. I think maybe 3.4 was too low for your nice yellow, but it is always better to be safe than sorry.

It is difficult to know whether it is too much or too little insulin, unless you get a huge drop into the 50s. Then we know it's too much. Sometimes if they are high and flat and the dose was rapidly increased, we think about a restart. But you have increased carefully and have seen some lower levels.

If he were mine, I'd stick with 4 units for 3 days, getting a curve in you can and see what things look like. (Unless you get a 200 preshot. Then get advice about reducing). Get a night nadir every so often like you have been.

The good news is that he does drop into nice blues. He may be in good renal ranges a good part of the cycle (under 250ish) his highs are not outrageous. Just keep collecting data, post and we will continue to help you out. He is tricky as he has some medical issues and meds, but I think you are making slow, steady progress.
 
Don't forget that breathing, Patti. That combined with walks are a good idea. Remember, he doesn't know he is diabetic. He is not worried, just liking the food and attention. Your other job besides him is to take good care of yourself.
 
2/01
AMPS 370 4.1u
+6 214
+8 173 1 tsp food
+10 283
PMPS 263 4u
+2 351
+4 334
+6 305
2/02 AMPS 307 4u
+2 368
 
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Great job on the data. Bet you need a nap! Hmmm. So the 4.1 did a nice job with a reasonable nadir a little later in the cycle and a nice pmps. The evening cycle is a mystery to solve - a bounce from the lower number in the am cycle or is something different at night? More food/less activity?

I would stick with 4 (cause it's easier to measure) for a few more cycles and see if he eventually drops. Does his bounce result in two higher flatter cycles and then a drop? Check out Phoebe's spreadsheet. She has that pattern. Eric has been incredibly patient adapting to her cycles.
 
Ok to sticking with 4u.

He eats 6am and 6pm roughly equal amounts same food. At +8 from AM he gets 1 tsp of same food. At +2 from PM he gets a small piece of Glycoflex. We experimented not giving but it seemed to not make a difference.

Day time is more active because dogs and people active. He does some walking around outside with us, appears to eat some fresh grass sometimes, mostly just walks and then naps on a porch. Nighttime is quiet.

It seemed like I had lower numbers on 3.2u through 3.6u earlier (2016 spreadsheet also) thus my question about too much vs too little. I'm baffled why he isn't dropping lower and of course why he doesn't drop at night. Using two people for night injections so pretty sure no fur shots. I was worried I made a mistake back in the 3.2-3.6 range.

Other difference between then and now is he is not getting lysine currently. His herpes is dormant. (Antijinx) Also we ended up not getting his eye med. The vet ophthalmologist said it would not help, that nothing would, and that it does not bother him. She also thought that he probably could see out of that eye.
 
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You will drive yourself crazy looking at numbers too far in the past. I think the problem is that insulin resistance is such a big part of the overall picture. Once their body gets used to a dose and to higher ranges, it often takes some persistent careful raising of the dose to shake them loose. (Not sure about that analogy :eek:)

I would do a few more cycles on 4 units and if his nadir is still in the higher blues, add a little more insulin (4.2?). But today's cycle looks pretty good and I like that he isn't bouncing for pmps the past few cycles. Not sure what to say about night unless his bounce pattern is that he has a flatter higher cycle for the next cycle instead of a faster bounce up for pmps. I would say his pattern makes your life easier than a big bounce....
 
I like the "don't drive yourself crazy?.." That takes some of the pressure off. :)
Ok about 4u.
Thank you Sue.
 
I agree that insulin resistance is a very important and often underestimated/unrecognized factor. Teasel is a prime example of getting stuck because of resistance and I'm in the midst of trying to "shake him loose" right now. At least I've been around this block enough times to recognize what's going on so I don't get too fussed by it. :)
 
So insulin resistance is where a previous dose is no longer effective? And somewhere there is a ceiling? I think that was my question awhile ago about whether me making very subtle changes could actually work against me - changing by .1 rather than by .25 for example.

PMPS 333 4u
+5 336
+7 322
AMPS 318 4u
 
Pati said:
So insulin resistance is where a previous dose is no longer effective? And somewhere there is a ceiling? I think that was my question awhile ago about whether me making very subtle changes could actually work against me - changing by .1 rather than by .25 for example.

PMPS 333 4u
+5 336
+7 322
AMPS 318 4u
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Think of it as a floor rather than a ceiling. Where a dose would initially push BG down in a desirable way, insulin resistance acts as a a floor that blocks the descent of the BG because the cells are less sensitive to the insulin. I suppose it's possible that making subtle rather than more definite changes could aggravate or prolong the issue. It depends on your cat. If I made a large-ish change in Teasel's dose he might well plummet before bouncing back sky high.
 
I have been reading about insulin resistance. There are a number of references to Omega 3's, particularly EPA and DHA from marine sources, and increased insulin sensitivity. A lot of the studies were on overweight rats or humans. In those situations there is usually a past history of an inverse ratio of Omega 3's to 6's (more 6's in the diet than 3's). Morris is already on grass-fed only meat and receives daily wild salmon oil so he already has a higher 3:6 ratio. I wonder if it is worth trying to increase his 3's even more? Increasing the wild salmon oil would give him too much vitamin D but I also have Nordic Naturals (white) fish oil that is high dose Omega 3's that I can use. Seems like an experiment Morris would enjoy. Thoughts? I know adding the NN and increasing insulin at the same time isn't a good idea.
 
Pati said:
I have been reading about insulin resistance. There are a number of references to Omega 3's, particularly EPA and DHA from marine sources, and increased insulin sensitivity. A lot of the studies were on overweight rats or humans. In those situations there is usually a past history of an inverse ratio of Omega 3's to 6's (more 6's in the diet than 3's). Morris is already on grass-fed only meat and receives daily wild salmon oil so he already has a higher 3:6 ratio. I wonder if it is worth trying to increase his 3's even more? Increasing the wild salmon oil would give him too much vitamin D but I also have Nordic Naturals (white) fish oil that is high dose Omega 3's that I can use. Seems like an experiment Morris would enjoy. Thoughts? I know adding the NN and increasing insulin at the same time isn't a good idea.
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I don't know, Pati. You're far more knowledgeable about supplementing a kitty's food than I am. I agree about addressing one factor at a time though.
 
I'll read more and think about it. I'm familiar with using it for inflammation in dogs.
 
It really stinks to set the alarm for +6 pm and get a 390. :)
AMPS 393 4u
I talked with the person who formulated Morris' diet. We are going to delete the raw kale we were using for fiber. I had already ruled out raw pumpkin previously because of causing higher BG. We're going to use psyllium starting tomorrow pm.
 
Pati said:
It really stinks to set the alarm for +6 pm and get a 390. :)
AMPS 393 4u
I talked with the person who formulated Morris' diet. We are going to delete the raw kale we were using for fiber. I had already ruled out raw pumpkin previously because of causing higher BG. We're going to use psyllium starting tomorrow pm.
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You might try going up by 0.2 u soon, Pati. He's giving you blues quite consistently in the day time. The pink PSs might just be that nature of the beast for Morris's ProZinc "smile curve" or maybe he does little short term bounces off the mid cycle numbers. His overnight highs are a conundrum for sure. He's proof that ECID.
 
PM will be 6th cycle on 4.2u. Seems pretty similar numbers to 4u. I'm getting more blues and yellows for PMPS at 4 and 4.2 so that is progress. Day mid cycle seem about the same. Haven't checked night cycle last two nights. If I'm going to set the alarm I need to be rewarded. :) Any brain storming on why he stays high at night? He's less active for sure. He is sleeping. He gets less food but only because of the snack at +8 day cycle. AM and PM food same. Give more insulin at night as an experiment? Or just accept he might always be high at night? Increase to 4.4u tomorrow am?
 
I think I'd up the dose by 0.2 on a cycle you can monitor, Pati. He is in the blues during the day but still has room to drop. Maybe an increase will bring down the numbers overall. You could look at 11/13 (shooting at +11 in the am and +13 at night) to even things out a little, but I'd try the increase first. Only one change at a time.
 
Increased to 4.4u yesterday morning. My observation is that I'm getting roughly the same numbers day mid cycle as I was from 3.4u to now but he is staying lower longer through PMPS. Yes no? I'm thinking as much as I would love high double digits mid cycle it might be healthier for him to stay in yellows/blues longer.
 
Staying in yellows and blues longer is good. We think that's when his pancreas are able to heal, increasing chances of remission one day. Those greens are lovely, but when you get them from high preshots, bouncing is almost sure to happen. Having a gradual decrease and then gradual increase is better...and probably feels better for them too. The hope is that the increases in dose will slowly lower those preshots so that you're getting greens mid cycle with yellows at preshot. :)
 
Midcycle numbers are so nice. I'd stick with 4.4 a few more cycles. As Rachel says, he is in nice numbers the majority of the time, which is wonderful.
 
PM today is 6th cycle at 4.4u. I leave Thurs through Sun pm. If I am going to make a change it would need to be tomorrow or Wed the latest. I'm good with waiting until I come back unless that will let him sit too long at this dose. He is also having nasal discharge this afternoon. I started him back on lysine. I don't know if a flare up affects his BG.
 
Side effect or coincidence? Morris is still sleeping. It actually started at the previous dose change. He always goes back to bed until +4. At 4.2u he would sleep until +5. He is still sleeping at +7. I have tested him four times today and had to go to where he is sleeping to do it. Usually he hears the cabinet and microwave and comes to the kitchen. Eating and eliminating fine. Not sneezing today. Not cold - high 70'sF. I do think he has been walking slower. Maybe the Glycoflex we were giving as a treat was doing him some good. Remember we don't have a clue as to age other than "senior". Vet thought maybe 10 years.

Just did a AT strip and FS strip same drop of blood - 141/140
 
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