Need advice on falling numbers

NatashaL

NatashaL

Member Since 2019
Continuing on from this thread: http://www.felinediabetes.com/FDMB/threads/need-advice-about-high-numbers.227257/unread

Ron's numbers are coming down, which is a huge relief but we need still need some guidance.

Ron's PMPS number just now was 184 (his lowest pre-meal in a loooong time). His nadir reading this afternoon was 84, which triggers an automatic dose reduction to 2.5 units (we were giving 3 units but do not currently have syringes with half-unit marks so can't go down .25 units).

Do we need to worry about 2.5 units dropping his BG too low if he's at 184? Or will the food he eats at night be likely to keep him in a good range?

Thanks!

@Deb & Wink
 
NatashaL said:
Do we need to worry about 2.5 units dropping his BG too low if he's at 184? Or will the food he eats at night be likely to keep him in a good range?
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There is really no good way to predict that Natasha.

Did you already feed Ron? If not, don't feed, stall and retest in about 20-30 minutes from the Pre-shot test. Let us know what that new test number is. We want to see if the BG levels are rising from that 184 BG PMPS.
 
Deb & Wink said:
There is really no good way to predict that Natasha.

Did you already feed Ron? If not, don't feed, stall and retest in about 20-30 minutes from the Pre-shot test. Let us know what that new test number is. We want to see if the BG levels are rising from that 184 BG PMPS.
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Unfortunately we already fed him. Do we not know since it's rising it's up 100 pts since the nadar?
 
Ron is coming down from the bounce to pinks yesterday. What we call "clearing the bounce."

When a cat is clearing a bounce, they are likely to drop lower during that cycle.

Did you already give him the 2.5U of insulin?

Do you have plenty of test strips?
Are you able to get a +2 test tonight?
Are you able to get tests later than the +2, if Ron drops lower?
Answers to all these question determine what you want to do, in regards to the shot.

P.s. If you already gave Ron food and insulin, please monitor closely tonight.
 
Deb & Wink said:
Ron is coming down from the bounce to pinks yesterday. What we call "clearing the bounce."

When a cat is clearing a bounce, they are likely to drop lower during that cycle.

Did you already give him the 2.5U of insulin?

Do you have plenty of test strips?
Are you able to get a +2 test tonight?
Are you able to get tests later than the +2, if Ron drops lower?
Answers to all these question determine what you want to do, in regards to the shot.

P.s. If you already gave Ron food and insulin, please monitor closely tonight.
Click to expand...

We do have plenty of test strips. But we did feed and shoot him. Okay so we'll keep a close eye on him and test before bed?
 
Yes, please test at +2 and then again before you go to sleep.
If that +2 BG test is lower than the pre-shot test, that gives you a "heads up" that this is likely to be a very active cycle, which means that Ron could drop much lower, lower than the 80's.

If you get a test that is below 68 on the Alphatrak, you need to feed him a bit of food to bring his numbers back up, 1 teaspoon of the canned food at a time. Also, please post on the Feline Health forum, and let people know that you have low BG numbers and need help to walk you through this situation.

I'm really glad you got that pre-shot test this evening, and reduced the dose to 2.5U. Ron has been coming down the insulin dosing scale very quickly. He has earned 3 reductions in dose in the last 4 days. With all those dose reductions you have been doing, it definitely looks like Ron was being overdosed with the insulin.

Many cats will instinctively seek out food, when they feel their BG (blood glucose) levels dropping.

They will be begging, and begging to eat.
Has Ron shown this type of behavior before?
 
Deb & Wink said:
Yes, please test at +2 and then again before you go to sleep.
If that +2 BG test is lower than the pre-shot test, that gives you a "heads up" that this is likely to be a very active cycle, which means that Ron could drop much lower, lower than the 80's.

If you get a test that is below 68 on the Alphatrak, you need to feed him a bit of food to bring his numbers back up, 1 teaspoon of the canned food at a time. Also, please post on the Feline Health forum, and let people know that you have low BG numbers and need help to walk you through this situation.

I'm really glad you got that pre-shot test this evening, and reduced the dose to 2.5U. Ron has been coming down the insulin dosing scale very quickly. He has earned 3 reductions in dose in the last 4 days. With all those dose reductions you have been doing, it definitely looks like Ron was being overdosed with the insulin.

Many cats will instinctively seek out food, when they feel their BG (blood glucose) levels dropping.

They will be begging, and begging to eat.
Has Ron shown this type of behavior before?
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Ron begs for food whatever his BG level is, unfortunately! I have often been worried when he begs for food and tested him to find him anywhere from mid 200s-300s. Only one time was he low.
Okay we will test him at 2+ and if he's lower than 184 I will test again in another 2 hours.

Wow, I can't believe he was being overdosed!! This really makes me want to give the vet an education!! Ron and our family are very grateful for all of your help!
 
Well, sometimes a diabetic cats symptoms don't tell the whole story. That was definitely the case with Ron.

So glad YOU found us, and the help we have to offer here.

Next time you get a lower pre-shot, stall. Don't feed, retest in 20 minutes, post for help. You won't always find someone on, when you post, but it's worth a try. You can stall with Prozinc, for up to 1 hour and still keep to your regular schedule for the next dosing cycle.

So you could stall 3 times, before making your dosing decision.
 
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That 184 at Pre-shot to 253 at +2 was a pretty good rise in BG levels.
That was a 37% rise in BG numbers. Part of the rise is the "food spike", but it's not likely all the increase in the BG level can be attributed to the food.

It won't hurt to do one more test before you go to sleep. But I think you are right, and Ron will be ok overnight.
 
Hi again! So this is the data for today:
AMPS-385
6+ 183
PMPS 183

So we're sticking with 2.5U. Does that sound good? Anything else we should be on the look out for? Thank you!!
 
Yes, I'd stay with the 2.5U dose for now. That sounds good.

With that PMPS of 183, you might think about testing at +2 this evening, to see which direction the BG levels are headed. Just like you did last night.

Member Chris&China said this a long time ago and many times. I expanded on it some and modified it to include some specifics for Prozinc.
With Prozinc by Deb & Wink:

More than a number range, think of the percentage of the drop at +2, that may tell you if your cat is going to drop much lower. Think of that +2 as being an indicator of what direction the BG levels may be headed.
With Prozinc, if you see a 40%, 50% or greater drop, between the pre-shot and that +2, that's a serious heads up warning.
If you see a 20-25%, 30% drop, not quite so worrisome. But still be cautious.

Your cat drops 2 color ranges between pre-shot and the +2, pull out your hypo kit and plan on staying up to test.
Your cat drops 2 color ranges between pre-shot and the nadir, that is to be expected. But you don't want the drop to be much more than 50% between pre-shot and nadir with Prozinc.
Cats tend to bounce high if the drop is 50% or more from pre-shot to nadir.
So you steer those mid-cycles with food, to slow down the steep drop and stop the bounces from being too high.

It's a balancing act.

With Lantus/levimir by Chris & China (a lot of this holds true for Prozinc also)
"The +2 is like an "early warning" for most cats!
If the +2 is about the same as the PS, it's usually a pretty normal cycle...dropping down to nadir and then rising back up again. (About the same means taking meter variance, that 15% variance that hand held glucometers are allowed to have into account)
If the +2 is higher than the PS, that usually signals a bounce, and those are the cycles when you can usually take a break from testing.
If the +2 is lower than the PS, that's your "Early warning" that kitty might be going much lower later in the cycle so it's important to plan on getting another test or two (or 6) in.

It doesn’t work every time or with every cat. But it does hold true most of the time, so keep this in mind for next time."
 
Thanks so much again.
I am trying to give him a break so we tested twice:
6+ 183
Pmps: 189

So it seems like we can just go the course? Is the goal remission or is there a number we're looking for?
Thank you! We became monthly members, we're so grateful.
 
What is YOUR goal for Ron?

I think a nice longer term goal is to get your cat Ron feeling better, reduce or eliminate the symptoms of diabetes and acting like his old self again.

So your first goal is to try to get Ron's BG levels regulated. Then, hopefully below renal threshold, so his kidneys don't have to work so hard to filter out the excess sugar in his bloodstream. That renal threshold can be anywhere between 180-250 mg/dL, depending on each individual cat. Then getting the BG numbers back into a more normal range is a nice next step to take.

Getting those mid-cycle nadirs down to the lower blues (100-150 mg/dL) and even in the greens (<99 mg/dL) but not so low he has hypo symptoms would be nice to see, and make Ron feel better. It's a gradual process.

A better diet helps with these goals. We tend to focus on the numbers here, because it tells us what the dose is doing and when it needs to be increased or decreased. But there is so much more to Ron than his numbers.

How is he feeling and acting? Is he grooming his coat, playful, no diabetic neuropathy, no repeated UTI's (Urinary tract infections), eating ok, maintaining his ideal weight, purring, pooping normally, peeing amounts like a normal cat would? We call this quick visual assessment the 5 P's (peeing, pooping, purring, preening, playing) plus appetite.

So how is Ron doing on all of those?

Diet controlled status, or as it is also called remission or OTJ (off-the-juice, insulin being the "juice"), is a bonus. Some cats achieve remission, some take months or years to become diet controlled, some never go into remission. Some cats fall out of remission and need to go back on insulin. Whatever happens for Ron, know that you are doing your best for him.
 
Thank you So much again for your detailed reply. He is meeting the five Ps. However he always was aside from in the beginning when he had neuropathy, but that went away pretty quickly. His only symptom once that went away was occasionally peeing large amounts at once. Although the vet did call him obese! He is a little hefty. He is 15 lbs. but when he was first diagnosed and he had the neuropathy he had lost a bunch of weight. So I thought it was a good thing he had gained back.

Today:
5.5+ 87
PMPS 186

So we did the automatic reduction from 2.5 to 2U.

I guess that's it! I just wanted to give you the update.
 
Yes, a cat being overweight can be part of the reason for them to develop diabetes. Male cats and certain breeds are more prone to become diabetic. Too much weight makes the pancreas cells work harder and they can reach a point where they can't work hard enough and some of the insulin producing beta cells will die off. Not good long term to have more and more insulin producing beta cells all die off.

So If Ron needs to take off a little weight, to get to his "ideal weight", a little portion control could help with that.
 
Okay, well hopefully the change in diet with the wet food is helping that.
I'm a little disappointed because i just did his 6+ test and it was 197. That's the highest it's been in a while, but we did just reduce his dose down from 2.5 to 2U yesterday. Could that be why?
 
The dose reduction could be part of the cause for the higher nadir at +6. But he needs time to settle into this dose. Patience is key when you are changing doses and adjusting the diet at the same time.

Also, just to make things a bit more complicated, that nadir can change around from cycle to cycle. It's not set at +6 for ever and ever. Another reason to vary those mid-cycle test times.
 
Deb & Wink said:
The dose reduction could be part of the cause for the higher nadir at +6. But he needs time to settle into this dose. Patience is key when you are changing doses and adjusting the diet at the same time.

Also, just to make things a bit more complicated, that nadir can change around from cycle to cycle. It's not set at +6 for ever and ever. Another reason to vary those mid-cycle test times.
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By vary you mean sometimes do it at 5+ and 7+?
 
Yes, by vary I mean do one cycle at +5, another cycle at +7, vary it a bit from cycle to cycle. A cycle is a 12 hour dosing period.
So one cycle get a +7 test. Another cycle get a +5 test. A different cycle get a +6 test.

Or do 2 tests at mid-cycle if Ron will let you.
 
Hi again. Ron has been coming up at the nadir. If you look at his SS you'll see that he was 253- 2 daysago and today he was 325. We tried to get his nadir yesterday but he wouldn't let us. But his PMPS was 192.

Thoughts? Thank you!!
 
UPDATE:
PMPS 300 today
Could the rise be because we've been adding the probiotic fortiflora to their food occasionally? Should we increase to 2.25? Thank you!
 
Fortiflora should have no effect on the BG levels.

I don't see any pre-shot tests, to put those mid-cycle nadirs into context. Need to see both BG levels, a pre-shot test AND the mid-cycle nadirs to tell what is going on with Ron.

So I have no idea if Ron needs more insulin or not.
He could be bouncing. That could explain the higher nadirs. But again, no way to put those mid-cycle numbers into perspective, without seeing pre-shot tests along with the lows in the middle of the 12 hour cycle.
 
NatashaL said:
Do you mean am? We haven't been doing the am one.
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You need to do both. Please.

Otherwise, there is no way to tell if you are shooting into a dangerously low number, < 50 mg/dL or even a number below 90, since you are using SLGS dosing method. We want to help you keep Ron safe. Best way to do that, is to test at every pre-shot, both AM and PM cycles.

Our Prozinc dosing protocols are based on knowing what the pre-shots are in combination with the nadirs. Without both, there is no way to adjust the insulin dose using our protocols.
Sticky PROZINC DOSING METHODS
 
Okay, we will be more diligent about them from here on.

Is there any guidance you can give us with what is in the SS now? Should we just hold at 2 until we can get more data?
 
NatashaL said:
Is there any guidance you can give us with what is in the SS now? Should we just hold at 2 until we can get more data?
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Until you can gather more data, yes it's probably wise to hold at the current 2U.
We know that 2U drops Ron into the blues, but we don't know if he drops lower, or is currently bouncing from low numbers.

Do I think that Ron is bouncing, seeing the test numbers you do have? Yes, yes I do.
Bounces take 3-6 cycles to clear usually. So please try and get those test BG readings I mentioned, so we can see when Ron clears the bounce.
Increasing a dose, when a cat is clearing a bounce, can cause the cycle to be very active and require a bit more monitoring.

So yes, hold the dose for now please.

A curve, testing every 2 hours could tell you if Ron needs a dose increase, hold the dose, or reduce the dose.

It's like trying to "read between the lines" with the limited data you have. Easy to assess things incorrectly.
 
Hi again,
So today's numbers are:
AMPS: 358
6+ 175
PMPS: 201
I'm wondering if the morning numbers are always higher because we give a snack of the diabetic dry food at night before bed? Do you think that we should stick with 2.0 or go higher?
Thanks! Also, should we do this kind of testing again tomorrow?
 
The diabetic dry foods are high in carbs. So that could definitely explain why Ron is higher in the AM.
Plus the bouncing, from the lows.
Just because his BG level was >200 at PM pre-shot, does not mean he stayed high all night.
NatashaL said:
Also, should we do this kind of testing again tomorrow?
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Absolutely. Both cycles. At least a "before you head to bed" test in the PM cycle.
Try for a +5 tomorrow AM cycle.

If you set an alarm and did a +5 or +6 test in the PM cycle, I bet you would find that Ron is dropping low overnight. It's not fun to get up in the middle of the night to test, but if you are already up for another reason, then it's the perfect chance to get a BG test in for Ron.

So as Chris would say, "drink a big glass of water before you head to sleep."
 
The only time you want to wait between feeding and testing, is at the pre-shot tests.
Or if you are using the stalling technique at pre-shot, to see if the BG number is rising high enough for you to shoot insulin.

The "no food 2 hours before" the pre-shot tests, is so you are not giving insulin to a cat, where the BG levels would be "inflated" by the food eaten within 2 hours before the insulin shot.

ALL other times, it's perfectly fine to get another BG test. We expect some food influence in those mid-cycle tests.
NatashaL said:
+5 is usually only 2.5 hours after his snack. How long do we need to wait until after he's eaten to test?
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So no time at all is needed to test at that +5 time. Or any other + time during the cycle.
 
Okay great to know, thanks. I just think it may be high bc that snack is the dry diabetes food which sounds like we're going to have to get rid of. It's their favorite!
 
He's been all over the place, today in the 300s. Tomorrow we're going to do a 12 hour curve and then maybe you can give us some advice about raising his dose?
 
I haven't added it yet, but today he is so far
AMPS 359
+2 386
+4 379
It seems like so far we need to up his dose, would you agree? Or do you want to wait until I've done the whole curve?
 
NatashaL said:
It seems like so far we need to up his dose, would you agree? Or do you want to wait until I've done the whole curve?
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He's bouncing still.
He's been bouncing since he dropped into those lower blue range BG's on 5/3/20.

Please finish the curve this AM before you decide to up the dose.
In fact, let's see when he clears this bounce before we decide to increase the dose.
It may take him another cycle or 2 to clear the bounce.
Let's see what the PMPS is for tonight.

I won't be back on until later this evening.
What time do you give Ron his PMPS test?

p.s. Would you please add your general location in your User Id Profile? Gives me an idea of what time zone you are in.
 
So Ron's BG number is at 163 I see.
Did you stall and retest without feeding?

If we could see some data for the PM cycle, that would tell us if Ron is dropping low overnight.

No, I don't think that Ron needs a dose increase right now. Not based on that 163 BG reading you got today 5/6/20.
Looks like he cleared the bounce, and is back to better numbers.
 
Thank you! Okay should we do one test +4 tonight?
I feel like he's done this before though. He was testing in the blues for a week and this last bounce just happened for seemingly no reason. We haven't changed the dose in 10 days. And he just went into this last bounce a couple days ago out of nowhere.
 
Yes, please get a +4 tonight.
Even better, would be a +2, to tell you in which direction the BG's are headed.

Did you give Ron the full 2U dose?
 
163 and 173 are basically the same number, within meter variance. So "flat cat".

Probably will not be a lot of movement in his numbers tonight, but do get that +4 to be sure he isn't dropping low.

I can't stay up that late, so please post over in the Feline Health forum if you need help with low numbers.
 
Hi, Ron has been plateauing it seems at around 100 for both the 6+ and PMPS. We stopped giving wet food all together two days ago. Ideally we would like him to go into remission, but do we just stay here at 2U until we see another change?
 
NatashaL said:
We stopped giving wet food all together two days ago.
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Do you mean you stopped giving Ron DRY food altogether 2 days ago?
That is what the note on the SS in the Remarks column says.
Please confirm.

Eliminating the last of the dry food, may cause Ron's BG levels to drop even lower. So it's super important to always get a pre-shot test in, before you give him insulin. After all, you wouldn't want him to have a hypoglycemic episode, because you give him insulin on a really low pre-shot.

NatashaL said:
Hi, Ron has been plateauing it seems at around 100 for both the 6+ and PMPS. Ideally we would like him to go into remission, but do we just stay here at 2U until we see another change?
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I actually think you need to reduce the dose for Ron right now. Those 91's at pre-shot and at mid-cycle +6 indicate he is ready for less insulin. I know the SLGS Prozinc protocol says < 90 mg/dL, but those 91 BG tests are low enough and close enough to the reduction point.

So down by 0.25U, to a dose of 1.75U for Ron.
 
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NatashaL said:
Okay great! And yes, I did mean dry food!
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Thought you typed it wrong, but wanted confirmation. Thanks for confirming that you meant to say you stopped all the dry food, and are now only feeding wet/ canned food.

You really need to do a +2 or a +3 test tonight, to make sure Ron doesn't drop too low, under 50 mg/dL.
If he does, get out your hypo toolkit, post on the Feline Health forum and put a 911 prefix on the post, so someone can help guide you in bringing those low BG numbers up safely.

I'm not on late at night. So probably will not be here to help you.
 
So Ron's BG went up from pre-shot to +5. That looks safe. I was concerned that the number would drop lower, and lower for Ron.
 
Ron's +5 was 70 today so we fed him. We gave him 1.75 last night. So I guess that's an automatic reduction and we should give him 1.5? I think that's the lowest he's been.
 
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