Jack and Jenell
Member
Hello all. I'm pretty new to the forum/feline diabetes. Please take a look at Jacks SS and help me figure out whats going on. Thanks so much!
Need help with Jack's dose/BG
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nckitties3
Very Active Member
Hi Jenell and Jack. Welcome.
Jack was the kitty in the Health forum right? that has DKA'd a few times? I had read that thread and I'm sorry I don't have any words of wisdom for you. We've only been on PZI for a few months, Lantus and Levemir for the year prior.
Because of Jack's tendency for DKA, you need someone with much more experience than I. I would suggest you read the 'stickies' at the top of the page, there's a lot of info on the insulin.
Looking at his SS, it's hard to see where you might change some things to get a better response from Jack. Others that can advise you on dosing, etc, will really need a few more mid-cycle bg readings to be able to tell exactly what a certain dose is doing for him. I realize that he's having some seriously high preshot numbers, but he also went into the 50's on 1.5U and that certainly needs to be taken into consideration.
Actually, his preshots look like my Lucian's when I try to make him go with 12 hr cycles. For whatever reason, when Lucian first started PZI, it would not last more than 8 hrs. Over the last few months, it is stretching out, with many 10-11 and 12 hr cycles now. Shooting 3 times a day is unorthodox, but so is my cat. The theory I'm working with, is that shooting more often, being able to keep him in good numbers for a longer period of time, will help him heal and be able to hold those numbers and stretch the duration. So far, that's what is happening. Along with keeping my fingers crossed every step of the way.
Every cat is different, some more so than others, like Lucian. But you do whatever it takes to try to make them as healthy and stable as you can.
Hang in there and hopefully some of the others, more experienced with DKA might be able to chime in. And remember, in case of emergency, always go to the Health forum. It can be dead in here but there is almost always someone on Health that can help you.
Hang in there. cat_pet_icon
Jack was the kitty in the Health forum right? that has DKA'd a few times? I had read that thread and I'm sorry I don't have any words of wisdom for you. We've only been on PZI for a few months, Lantus and Levemir for the year prior.
Because of Jack's tendency for DKA, you need someone with much more experience than I. I would suggest you read the 'stickies' at the top of the page, there's a lot of info on the insulin.
Looking at his SS, it's hard to see where you might change some things to get a better response from Jack. Others that can advise you on dosing, etc, will really need a few more mid-cycle bg readings to be able to tell exactly what a certain dose is doing for him. I realize that he's having some seriously high preshot numbers, but he also went into the 50's on 1.5U and that certainly needs to be taken into consideration.
Actually, his preshots look like my Lucian's when I try to make him go with 12 hr cycles. For whatever reason, when Lucian first started PZI, it would not last more than 8 hrs. Over the last few months, it is stretching out, with many 10-11 and 12 hr cycles now. Shooting 3 times a day is unorthodox, but so is my cat. The theory I'm working with, is that shooting more often, being able to keep him in good numbers for a longer period of time, will help him heal and be able to hold those numbers and stretch the duration. So far, that's what is happening. Along with keeping my fingers crossed every step of the way.
Every cat is different, some more so than others, like Lucian. But you do whatever it takes to try to make them as healthy and stable as you can.
Hang in there and hopefully some of the others, more experienced with DKA might be able to chime in. And remember, in case of emergency, always go to the Health forum. It can be dead in here but there is almost always someone on Health that can help you.
Hang in there. cat_pet_icon
Jen&Eddie
Very Active Member
Good morning Jennell and Jack,
I'm going to second what Debbie said. Jack's recent DKA makes me nervous about suggesting a dose reduction. I have zero experience with DKA. If there were no DKA, I would suggest trialing a reduction by half a unit or so to see what happens. That said, if you do decide to try a reduction with the DKA, you'd want to make sure you were testing Jack's urine for ketones (which you should probably be doing anyway), and if there's anything more than a trace -- back to the vet.
Can you tell us what circumstances led up to Jack's DKA?
I'm going to second what Debbie said. Jack's recent DKA makes me nervous about suggesting a dose reduction. I have zero experience with DKA. If there were no DKA, I would suggest trialing a reduction by half a unit or so to see what happens. That said, if you do decide to try a reduction with the DKA, you'd want to make sure you were testing Jack's urine for ketones (which you should probably be doing anyway), and if there's anything more than a trace -- back to the vet.
Can you tell us what circumstances led up to Jack's DKA?
Jack and Jenell
Member
This last time I don't know for sure. His UA was negative. But my vet was a little puzzled and the ER vet thought it could have been d/t triaditis - inflammation of the colon, liver and pancreas. Although this time on ultrasound his pancreas looked ok. So I'm not sure exactly. His numbers were high, so perhaps just not enough insulin. The first time, he was on oral meds and I think they just were not working enough for him.
nckitties3
Very Active Member
Oral meds for diabetes? I've read that the diabetes oral meds very rarely work for cats. It's better for him to be on insulin for sure.
He's also on steroids isn't he? That's a battle in itself with the FD. Once he's off that, you might be able to get a little better control of his BG's.
Because of the high preshots, you may consider using a dosing scale for him, rather than trying to keep the same dose at any number. I would be inclined to do that with my Lucian, but I can't get him to stay at 12 hr cycles yet. (not with consistently good numbers)
If you can't get him down the way you are doing it, you might consider dosing more than twice a day. If that's not feasible, then check out the dosing scale in the stickies up top, it's used to determine the dose by the preshot number.
He's also on steroids isn't he? That's a battle in itself with the FD. Once he's off that, you might be able to get a little better control of his BG's.
Because of the high preshots, you may consider using a dosing scale for him, rather than trying to keep the same dose at any number. I would be inclined to do that with my Lucian, but I can't get him to stay at 12 hr cycles yet. (not with consistently good numbers)
If you can't get him down the way you are doing it, you might consider dosing more than twice a day. If that's not feasible, then check out the dosing scale in the stickies up top, it's used to determine the dose by the preshot number.
Jen&Eddie
Very Active Member
Hi Jenell and Jack!
Hope you two are hanging in there.
I've been keeping an eye on Jack's spreadsheet, and you're doing a good job getting some of those mid-cycle tests in. For what it's worth, here's what I'm seeing....
The 3/24 and 3/25 cycles show huge dips on the 5 units and also on the 4 units. I'm not sure how much reading you've had a chance to do yet, but it's extremely common for a cat to "bounce" when they hit numbers that are either too low (i.e. hypo territory), safe lower numbers that their bodies are simply not used to, or if there's a really fast drop. Jack probably did all three of those things on the 3/24 cycle. Dips like that often cause a kitty's pancreas and liver to panic in response - the liver releases stored glucose and the pancreas releases counter regulatory hormones. The "liver panic" results in a huge flood of glucose into the system (and a spike in the BG), and the counter-regulatory hormones can actually create temporary insulin resistance. We call this "bouncing." What this looks like on a spreadsheet is often a fast spike within a couple hours of a low(er) number, a really high pre-shot, or even a high flat cycle. Some cats have a particular pattern to their "bounces" and some do all three. My Eddie mostly does high pre-shot numbers, but he sometimes has entire cycles that are high and flat, which looks like the insulin had no effect.
Bouncing happens to almost all of our cats from time to time, and there's not a whole lot that can be done to stop it. However, it is important to recognize when a "bounce" is occurring because kitty hit numbers that are too low. It can, in some cases, set up a vicious cycle of high-low-high-low, etc. It can also look like the cat is just high and flat and in need of more insulin, when really, the high numbers are due to too much insulin.
So back to Jack's SS, on the 3/26 cycle, you had a much lower pre-shot number than normal, and elected to shoot a reduced dose. I think this was the right choice. That lower pre-shot number was likely due to the last dose still being at work. ProZinc typically lasts 10-12 hours. However, that varies widely from cat to cat. My guy Eddie for example, often has 14 hour cycles, or even longer. Eventually, you can aim for overlap between doses, but if you get too much overlap between doses, you can end up with too much insulin working at the same time, resulting in a crash. Yesterday morning, with Eddie for example after a marathon of trying to keep him up from numbers that were too low, Eddie was at 44 at shot time. The last dose was still going strong. Had I shot blindly, I would likely have killed him.
For new "beans" (as in human-beans :smile: ), we usually recommend 200 as a "no-shoot" cut off point, until you have the data to show that shooting lower than that is safe. Using Eddie as an example again, I am a testaholic, and have the data to show that usually, I can safely shoot him when he's in the 175+ range. That said, I have also caused him to crash a couple times when I've shot those lower numbers. What we often times do with ProZinc is "stall" when we have a lower number than normal, and re-test, without food, after 20-30 minutes to see if that number is rising, and decide from there whether and what to shoot. You did exactly right to post the other day like you did when you had low pre-shot number.
Unfortunately, the PZI board isn't always real hopping, but I try to keep an eye out as much as I can. One of our "regulars," Sue, is on vacation right now, but she's usually on and available to help most of the time. If I'm having trouble figuring out what to do with Eddie, Sue is my "go-to" person. You can also always post on the "Health" board to get more eyes.
On Jack's PM cycle of 3/27, he did drop rather quickly to a 122 by +3. You got a 105 at +6. Jack may very well have gone lower in between those two readings or after the +6. Now on the morning of 3/28, you indicated a fur-shot. Did you think it was a fur-shot at the time, or did you assume that after getting his numbers? The reason I ask is that if you did get insulin into him, that cycle looks like a "bounce" cycle. It's entirely possible that Jack "bounced" off those nice numbers in the 100's because his body just isn't used to them.
If Jack were mine, I might try reducing his dose to 3.5u for a couple cycles to see what he does. That said, given Jack's history of DKA, you'd also want to be testing his urine for ketones. With his history, I'd strongly suggest testing whether or not you make any changes to his dose. Urine test strips can be purchased at pretty much any pharmacy, and they are simply dipped in the urine stream to test for the presence of ketones. It can give you an early indicator if ketones are present. There's tons of urine testing tips on this site that I can locate for you if you wish. I'm lucky in that Eddie doesn't mind if I just quietly sneak up behind him while he's peeing and stick a strip into the stream. Some kitties are more shy while they're and you need to get a little more creative.
Hope to see you posting again! I'll continue to keep an eye on Jack's spreadsheet.
Hope you two are hanging in there.
I've been keeping an eye on Jack's spreadsheet, and you're doing a good job getting some of those mid-cycle tests in. For what it's worth, here's what I'm seeing....
The 3/24 and 3/25 cycles show huge dips on the 5 units and also on the 4 units. I'm not sure how much reading you've had a chance to do yet, but it's extremely common for a cat to "bounce" when they hit numbers that are either too low (i.e. hypo territory), safe lower numbers that their bodies are simply not used to, or if there's a really fast drop. Jack probably did all three of those things on the 3/24 cycle. Dips like that often cause a kitty's pancreas and liver to panic in response - the liver releases stored glucose and the pancreas releases counter regulatory hormones. The "liver panic" results in a huge flood of glucose into the system (and a spike in the BG), and the counter-regulatory hormones can actually create temporary insulin resistance. We call this "bouncing." What this looks like on a spreadsheet is often a fast spike within a couple hours of a low(er) number, a really high pre-shot, or even a high flat cycle. Some cats have a particular pattern to their "bounces" and some do all three. My Eddie mostly does high pre-shot numbers, but he sometimes has entire cycles that are high and flat, which looks like the insulin had no effect.
Bouncing happens to almost all of our cats from time to time, and there's not a whole lot that can be done to stop it. However, it is important to recognize when a "bounce" is occurring because kitty hit numbers that are too low. It can, in some cases, set up a vicious cycle of high-low-high-low, etc. It can also look like the cat is just high and flat and in need of more insulin, when really, the high numbers are due to too much insulin.
So back to Jack's SS, on the 3/26 cycle, you had a much lower pre-shot number than normal, and elected to shoot a reduced dose. I think this was the right choice. That lower pre-shot number was likely due to the last dose still being at work. ProZinc typically lasts 10-12 hours. However, that varies widely from cat to cat. My guy Eddie for example, often has 14 hour cycles, or even longer. Eventually, you can aim for overlap between doses, but if you get too much overlap between doses, you can end up with too much insulin working at the same time, resulting in a crash. Yesterday morning, with Eddie for example after a marathon of trying to keep him up from numbers that were too low, Eddie was at 44 at shot time. The last dose was still going strong. Had I shot blindly, I would likely have killed him.
For new "beans" (as in human-beans :smile: ), we usually recommend 200 as a "no-shoot" cut off point, until you have the data to show that shooting lower than that is safe. Using Eddie as an example again, I am a testaholic, and have the data to show that usually, I can safely shoot him when he's in the 175+ range. That said, I have also caused him to crash a couple times when I've shot those lower numbers. What we often times do with ProZinc is "stall" when we have a lower number than normal, and re-test, without food, after 20-30 minutes to see if that number is rising, and decide from there whether and what to shoot. You did exactly right to post the other day like you did when you had low pre-shot number.
Unfortunately, the PZI board isn't always real hopping, but I try to keep an eye out as much as I can. One of our "regulars," Sue, is on vacation right now, but she's usually on and available to help most of the time. If I'm having trouble figuring out what to do with Eddie, Sue is my "go-to" person. You can also always post on the "Health" board to get more eyes.
On Jack's PM cycle of 3/27, he did drop rather quickly to a 122 by +3. You got a 105 at +6. Jack may very well have gone lower in between those two readings or after the +6. Now on the morning of 3/28, you indicated a fur-shot. Did you think it was a fur-shot at the time, or did you assume that after getting his numbers? The reason I ask is that if you did get insulin into him, that cycle looks like a "bounce" cycle. It's entirely possible that Jack "bounced" off those nice numbers in the 100's because his body just isn't used to them.
If Jack were mine, I might try reducing his dose to 3.5u for a couple cycles to see what he does. That said, given Jack's history of DKA, you'd also want to be testing his urine for ketones. With his history, I'd strongly suggest testing whether or not you make any changes to his dose. Urine test strips can be purchased at pretty much any pharmacy, and they are simply dipped in the urine stream to test for the presence of ketones. It can give you an early indicator if ketones are present. There's tons of urine testing tips on this site that I can locate for you if you wish. I'm lucky in that Eddie doesn't mind if I just quietly sneak up behind him while he's peeing and stick a strip into the stream. Some kitties are more shy while they're and you need to get a little more creative.
Hope to see you posting again! I'll continue to keep an eye on Jack's spreadsheet.
Jack and Jenell
Member
Thank you so much for the thoughtful reply. I've been so frustrated with his numbers! Sometimes I think "yeah, we're finally getting it" followed by a terrible cycle. I too was wondering if maybe he was bouncing (from the info I've read on this site), but was unsure if I had enough data.
So I think I will reduce his dose to 3.5 and see how he does. I feel like Jack would not tolerate a break in his regimen to "reset" so to speak, so I think I'm just going to have to play with his dose until I find the right number. I'm kinda thinking he may eventually need a sliding scale...
Unfortunately today he was 110, so no shot, which means he will be high tonight. Poor guy. Wish we could find some consistency.
I have bought all my ketone supplies and have eagerly been trying to catch him but can't seem to. I'll keep stalking him and encouraging him.
Another question. If I reduce his dose tonight with his PM dose to 3.5, do you think I could do a curve on Tuesday? Would that be enough time for me to get some good info on him, or should I wait a little longer?
Thanks so much everyone!
So I think I will reduce his dose to 3.5 and see how he does. I feel like Jack would not tolerate a break in his regimen to "reset" so to speak, so I think I'm just going to have to play with his dose until I find the right number. I'm kinda thinking he may eventually need a sliding scale...
Unfortunately today he was 110, so no shot, which means he will be high tonight. Poor guy. Wish we could find some consistency.
I have bought all my ketone supplies and have eagerly been trying to catch him but can't seem to. I'll keep stalking him and encouraging him.
Another question. If I reduce his dose tonight with his PM dose to 3.5, do you think I could do a curve on Tuesday? Would that be enough time for me to get some good info on him, or should I wait a little longer?
Thanks so much everyone!
Jen&Eddie
Very Active Member
Here's a link to some tips for urine testing. A lot of people use the aquarium gravel trick: https://docs.google.com/document/pub?id ... fQqL3zX_88
If you want more tips on urine testing, I'm sure we can get some others to chime in. :smile:
You don't have really have to wait till Tuesday to get a formal curve. If you can get several tests in throughout a cycle, that will give you lots of data about what a dose is doing. For instance, depending on what your shot time is tonight, if you can get a couple tests in before bedtime, that will give you a good idea if Jack is dipping low during the cycle. If you are home tomorrow, a few tests around the middle of the cycle can also give you some good data.
Since our guy Eddie is often a little too low to shoot in the AM, we ultimately ended up moving his shot time earlier to allow some time to "stall" and see if he would go high enough to shoot. When he is high enough to shoot as his normal AM shot-time, the earlier time also lets me get a test in around 2 hours or so after his shot. ProZinc typically "onsets" or kicks in between 2-3 hours after the shot, so if there's a big dip by +2 or so, that can indicate that it's going to be an "active" cycle. Might moving shot time around a bit work for your schedule?
Edited to add: I also invite you to post Jack's "condo" in the ProZinc forum with his test results. That way you can get some eyes on his numbers to help interpret what's going on. If you take a look at the PZI board, you can see how these "condos" are formatted.
If you want more tips on urine testing, I'm sure we can get some others to chime in. :smile:
You don't have really have to wait till Tuesday to get a formal curve. If you can get several tests in throughout a cycle, that will give you lots of data about what a dose is doing. For instance, depending on what your shot time is tonight, if you can get a couple tests in before bedtime, that will give you a good idea if Jack is dipping low during the cycle. If you are home tomorrow, a few tests around the middle of the cycle can also give you some good data.
Since our guy Eddie is often a little too low to shoot in the AM, we ultimately ended up moving his shot time earlier to allow some time to "stall" and see if he would go high enough to shoot. When he is high enough to shoot as his normal AM shot-time, the earlier time also lets me get a test in around 2 hours or so after his shot. ProZinc typically "onsets" or kicks in between 2-3 hours after the shot, so if there's a big dip by +2 or so, that can indicate that it's going to be an "active" cycle. Might moving shot time around a bit work for your schedule?
Edited to add: I also invite you to post Jack's "condo" in the ProZinc forum with his test results. That way you can get some eyes on his numbers to help interpret what's going on. If you take a look at the PZI board, you can see how these "condos" are formatted.
nckitties3
Very Active Member
Throwing in my 2cents. When I try to test Lucian's urine, I have found that once he's in mid-stream, he can't just turn it off and run away. :lol: I wait until I 'hear' him going, then stick the stream under his butt and wave it around until I can tell I hit the stream. We're good to go. If he hasn't started, he'll jump out of the litter box. We got this down a year ago. :thumbup
Of course, it always helps, that he puts his back to the LB door to pee. ;-) He can't see me coming.
Of course, it always helps, that he puts his back to the LB door to pee. ;-) He can't see me coming.
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