? Need help please! Fluctuating nadirs and insulin not always working...

[Amanda and a Loudogg]

Morning all!
I would really like some assistance trying to decode my buddy Lou's spreadsheet. We had been having some success (if you can call it that) with slowly increasing his dose. I suspected he needed to be on 2.0 units, and so I was pretty excited when we got to that point. Things started out promising enough, but this last week I feel like things have gone off the rails.

There are times it seems like the dose is working exactly how I want it to and the next preshot numbers reflect that, but then I randomly have these angry hot pinks and reds. They're dismaying because he hasn't gone into the 400s since his diagnosis. I've had a couple of times where the insulin is not working at all (see last night), and then this morning he's in the 400s. I have been extra vigilant and I have not had any fur shots. What's even more depressing is he reached a normal BG yesterday and we were so bloody happy for a normal cycle... but that nadir happened at +8. There was a late nadir (+7) a while ago, but since he's had earlier nadirs that I can see. This late nadir throws me, because then it affects his next preshot BG.

Long story short, I am at a loss as to what's going on, so I figured I'd post to see if anyone else can see something I'm missing. I decided to post in the Main Health forum to get more eyes. It's his 4 month FD anniversary today, and I find myself rather depressed with his progress. Definitely not where I thought we would be at this point.

I appreciate any insight you can give me!

 

[Noah & me (GA)]

I see a few "bummers", a failed vet visit and a new battery in your spreadsheet. It's a very determined and scientific approach to everything which is good. I wish this was a high school lab where everything went licka-dee-split but it never will be despite our best efforts. It's not because "That's what cat's do", it's because (I think) there are so many variables. Injecting into muscle mass makes some insulins absorb quicker and throw everything off. Just a few mm. is all it takes. Then one day he eats a few more or less grams than the previous day or he's stressed about something (failed vet visit?). Poor Kitty's metabolism is never the same day one to the next. My Seventh Circle of Hell is opening a new vial, I have to reduce his shot by a 1/3 and start all over again. Not really an answer, you're not alone in this. I cannot see where you're missing anything.

 

[JeffJ]

From what I can tell, you are doing all the right stuff. You dealt properly with the mini-hypo in June. You put up with getting peed on. And you are testing a lot. Some stuff you could try:

- shorter needles 5/16" to ensure you are only going beneath the skin
- pull skin tent to ensure same, and to avoid muscle shot
- less food if Lou is maintaining weight
- or tighter food regulation
- ensure he isn't sneaking carb crunchies from other kittehs or the droolers

If Lou is not having eating issues and he looks healthy, then the food reduction will help with regulation. I try to keep a layer of fat on Leo for the bad times (and there have been many). And Leo is an expert at sneaking carb food from the other critters, so I'm careful there.

If Lou's weight is pretty consistent, then the insulin is working at allowing him to absorb calories. But it will be good to get him regulated to reduce the glucose toxicity. Really, this is just fine tuning. It can be tough to regulate the little critters.

 

[Wesley and Spicoli]

You're doing everything right Don't be depressed, it's a marathon - Take a look at our SS, it's scary lol. My boy was regulated like yours was and we were having mostly NS days. Then something happened. Turned out he needed dental work. Vet kept saying he doesn't need it, and he did. Had 5 teeth pulled just over a week ago. I'm only saying this because tooth problems can throw off our kitties BG levels. When was the last time Loudogg had one?

Last nights inactivity might be more of a bounce cycle. Lou went below 50% for his nadir yesterday and even that can sometimes set off a bounce. We've had nadirs ranging from +5 to +8 and I'm sure many others have too. Kitty is in control Try not to stress over it too much, and remember that Lou is more than a number - if he seems happy and healthy don't let a few higher numbers bother you. You're doing a great job!!

 

[Amanda and a Loudogg]

Thank you all so much for your replies! Sometimes it's good to hear someone else say I'm not messing up or it could be worse (not that any of you actually say that, but it does remind me that no matter how bad I think it is, it certainly could be worse - it does help in its own way ). Reality checks are good every so often, even for a hard nose like me who likes to think I have things covered (*cough* control freak! *cough*)

1. I have noticed I have been having issues finding good skin to tent when I'm giving some shots. I don't know if this means he's gotten fatter or if I'm doing too many shots in one area (one side used to be better for tenting than the other). I have wondered if I've injected where I shouldn't be, but those times seem more when the insulin isn't working. I'll try to vary more (where I can) on injection sites. Last night I spent 30 seconds to a minute just trying to find a good place to poke, so it definitely could be a problem.
2. Food. Food and Lou have felt like the bane of my existence so far. I just weighed Lou and he is a very respectable 16.8 lbs (He was 16.2 Aug 15). He's always been a big boy (18-20 lbs) prior to diagnosis. I have struggled the most here because Lou is a grazer, and my civvie (Bella) is a pig. I have thought I wasn't feeding him enough, so I have tried to increase his food intake based on that caloric need formula. I had fed Friskies for a short time, but his BGs seemed to spike greatly on it, so we stopped feeding that. It has seemed to help. He used to just nibble on his YAZ, but right before he failed his OTJ trial, he started eating it much more. I like the idea of it because Bella doesn't eat it, but I've quit that as of yesterday to see if that helps as well. It's almost impossible to keep food out for him to graze as needed because my Hoover Bella will swing by and eat it all up if I don't put it up away from her and only put it down when he wants it. Obviously I can't be on food duty all day. I would love to get an auto-feeder that would keep her out of his food, but I can't get a collar on him to save his life. I wouldn't mind if Lou gained more weight at this point, but I have wondered (probably far too often) if I am not helping his BGs when I'm feeding him more often/when it seems he needs it. Lately with these higher numbers, he has seemed so hungry, so I worry keeping food from him (because I need to test soon, etc) is doing more harm than good.
3. I have wondered almost nonstop about what caused his failed OTJ trial. I was leary of bringing him into the vet right away, but now that his insulin needs have changed, I definitely want to bring him in (peeing on me be damned!). I have really wondered if he has a dental issue. One weird thing I've noticed is he'll sit with his mouth ever so slightly open. Not wide open like he's smelling something, but perhaps open like he can't shut it or something's uncomfortable?? I don't know, and it's about time I figure out if there's something medical going on that we could fix. I have had him for 7 years now, and he's never had a dental... I've heard about it so much on here, but I don't know what exactly it entails. I think the vet had said something about his teeth in June when he was diagnosed, but as you can imagine, I had other things on my mind that day. After the failed vet attempt on Wednesday, I have ordered a new carrier, pee pads, and Feliway spray, so I hope this one will go better and I can get some answers. I keep holding out hope that it may be something "easy" that can be taken care of so we can get him back on track.

Obviously it's not great for me to worry about these things, but I'm that type of person (super annoying, I know - control thing I reckon). I promise I'm working on it (I'll be just fine and then something seems to happen). Other than an increased appetite on occasion and some increased peeing again (not just on me, in general), he seems perfectly happy and healthy... it's just those stupid numbers making a liar out of that statement. I haven't had any other kidney or pancreas issues with him, so I worry about that aspect of the higher numbers the most.

 

[Alfred's Human]

I would love to get an auto-feeder that would keep her out of his food, but I can't get a collar on him to save his life.

Just throwing this out there. I had a wonderful kitty Tom who had lymphoma. He was not a big eater, but Alfred is, so I needed a way to keep Alfred out of Tom's food. I got the Microchip Pet Feeder by Sure Petcare. It's not a cheap solution but it worked really well for Tom. If Lou has a microchip you can program the feeder to open for only him and then you don't have to put a collar on him.

https://www.surepetcare.com/en-us/pet-feeder/microchip-pet-feeder

Just an idea. It takes time to teach the cat to use it and if Lou is very skittish the flap opening might scare him, but just something to consider.

 

[Wesley and Spicoli]

I've noticed is he'll sit with his mouth ever so slightly open.

We had the exact same thing. It might be worth having a dental even if your vet recommends against it like mine did. It usually requires pre op blood work, but if he's had some done recently they may not need to. Usually they use anesthesia to knock them out, clean the teeth, and pull anything that requires it. It really isn't a big deal

 

[Amanda and a Loudogg]

Just throwing this out there. I had a wonderful kitty Tom who had lymphoma. He was not a big eater, but Alfred is, so I needed a way to keep Alfred out of Tom's food. I got the Microchip Pet Feeder by Sure Petcare. It's not a cheap solution but it worked really well for Tom. If Lou has a microchip you can program the feeder to open for only him and then you don't have to put a collar on him.

https://www.surepetcare.com/en-us/pet-feeder/microchip-pet-feeder

Just an idea. It takes time to teach the cat to use it and if Lou is very skittish the flap opening might scare him, but just something to consider.

I think that's a great idea. He doesn't have a microchip, but I have been tempted to get him one just to utilize this. I will definitely keep that option in mind!

We had the exact same thing. It might be worth having a dental even if your vet recommends against it like mine did. It usually requires pre op blood work, but if he's had some done recently they may not need to. Usually they use anesthesia to knock them out, clean the teeth, and pull anything that requires it. It really isn't a big deal

Awesome! I think I'll definitely look into that! I think I'll call my vet tomorrow and see if they even do dentals there. We have an animal hospital pretty close by that does do them, so I'm tempted to cancel with the current vet and check with them.

Thanks to you all!