Need someone to review my cat's spreadsheet

[Ginger Cat]

My cat, Wally, has been diabetic since 2017 and initially we thought he was going to go into remission just from a diet change and insulin (ProZinc), but that didn't happen. We had him on ProZinc and then switched to Lantus and he's again on ProZinc. He was recently tested for acromegaly and is negative. He eats Fancy Feast pate and some Friskies pate and gets a piece of Young Again Mature after testing (and if I need to tempt him to eat). He also is addicted to Forti Flora, nutritional yeast and powdered freeze-dried chicken treats sprinkled on his food.

He just cannot get regulated. My vet thinks his normal cycle is 18 hours vs. 12 hours and he seems to crash every 4-5 days, with a very low reading, followed by a spike. He's had 2 obvious hypo episodes and now alerts me when he's gone low by begging for food. He's never had any ketones in his urine. He has had a couple of pancreatitis episodes but gets over them within a few days, with meds/fluids.

I'd like a fresh set of eyes to look over his spreadsheet and see if you can figure out if his dosage is too high, too low or if he's just an insulin resistent cat. And the spreadsheet is huge.

He's going on 15 and is the sweetest natured cat I've ever had.

Thanks in advance for any guidance, insights, etc. My vet is very supportive and is working with me trying to get his numbers more regulated and she has studied his spreadsheet, trying to see obvious patterns in his numbers.

Gita

 

[Chris & China (GA)]

Yeah, the way you've done your spreadsheet doesn't make sense to those of us that are used to using the format we use here.

If you could start our spreadsheet and enter maybe the last 2 weeks worth of numbers, it would help.

Here's instructions on setting up our spreadsheet http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

 

[Sienne and Gabby (GA)]

We do use a different format for spreadsheets. The other issue is that not everyone here uses or has Excel. We use this template.

From what I can tell, you're not really following a strategy with respect to dosing. For example, a reading of 35 would necessitate a dose reduction. When you see those high numbers after a drop into low numbers or a large drop (e.g., from the 400s to the 200s), it's the result of your kitty's liver and pancreas "panicking" and releasing a stored form of glucose and counterregulatory hormones. which spike numbers back into higher ranges. We refer to this as a "bounce."

You may want to take a look at the guidelines we use for Prozinc. There are 2 threads in the link that you may want to review.

 

[Ginger Cat]

Hello! Sorry to be a pain but, Is there any way to redo your SS so that it’s in the standard format used on here? I can read it but it would take forever to go through it the way it’s set out and find any patterns for you to have a real good look.

I'm using the spreadsheet that was suggested for those of us using the AlphaTrak2 meter. To redo it would take forever. Damn....

 

[Ginger Cat]

Hello! Sorry to be a pain but, Is there any way to redo your SS so that it’s in the standard format used on here? I can read it but it would take forever to go through it the way it’s set out and find any patterns for you to have a real good look.

I'm really sorry that the format isn't what you're used to, but it was one of the ones that was posted for those of us using AlphaTrak2 meters. To redo it would take forever, but maybe I can do it for the past month or so.

 

[Ginger Cat]

We do use a different format for spreadsheets. The other issue is that not everyone here uses or has Excel. We use this template.

From what I can tell, you're not really following a strategy with respect to dosing. For example, a reading of 35 would necessitate a dose reduction. When you see those high numbers after a drop into low numbers or a large drop (e.g., from the 400s to the 200s), it's the result of your kitty's liver and pancreas "panicking" and releasing a stored form of glucose and counterregulatory hormones. which spike numbers back into higher ranges. We refer to this as a "bounce."

You may want to take a look at the guidelines we use for Prozinc. There are 2 threads in the link that you may want to review.

When he goes that low, I do reduce his dosage because I know he's bouncing. But then, even at the reduced dosage for a least a 3-5 day cycle, he starts consistently staying in higher numbers.

 

[Chris & China (GA)]

Not sure where you found that...this is the one we use for US residents using the AlphaTrak

Click on this link for the US Spreadsheet Template for PET METERS CALIBRATED FOR FELINE BLOOD (e.g. Alpha Trak):
US Spreadsheet Template for Pet Meters

And if you can just get the last couple of weeks, that's enough (you can always go back and add more later but generally, the 2 previous weeks is what we're most interested in)

 

[Ginger Cat]

Not sure where you found that...this is the one we use for US residents using the AlphaTrak

Click on this link for the US Spreadsheet Template for PET METERS CALIBRATED FOR FELINE BLOOD (e.g. Alpha Trak):
US Spreadsheet Template for Pet Meters

And if you can just get the last couple of weeks, that's enough (you can always go back and add more later but generally, the 2 previous weeks is what we're most interested in)

I will work on creating the standard spreadsheet you're used to and will enter at least a month's worth of data. Will do it tomorrow. Thanks everyone.

 

[Ginger Cat]

I will work on creating the standard spreadsheet you're used to and will enter at least a month's worth of data. Will do it tomorrow. Thanks everyone.

 

[Ginger Cat]

Am working on the spreadsheet. Will let you know when there's data in it. Just created it.

 

[Ginger Cat]

Spreadsheet is now available to everyone. I put in data for this year so you'll have more to compare. Just a note. I test him at 8:30 am/pm and he then eats between 9 and 9:30 and gets his shot at 9:30 am/pm so the 11 am/pm is his AMPS/PMPS number. If he eats too fast he tends to vomit it all up so I spread it out over the 1/2 hour...

Thanks to everyone for your patience and concern.

 

[Ginger Cat]

fantastic job! So you know that Kate Bush song, rubberband? You got a very bouncy kitty cat! Just curious, but Has he ever had pancreatitis?

I’m more of a hold someone’s hand, shake my Pom poms and give people moral support, and I tend not to give dosing advice.. but it looks to me that you may need to hold a dose for longer than you have been to try to work out a dose that works.

if you shoot the same dose for 3 cycles and get past the bouncing it will give a clearer picture, if this were my cat, I would be asking a knowledgeable person on here if I should shoot 1.5 for at least 6 cycles and see what I was getting when any bounces have cleared and then adjust from there.

see what the others here think.

He has been treated for 2 bouts of pancreatitis, recovering quickly from both of them. He's never had ketones in his urine and his sugar levels fluctuate along with his BG testing levels. Some of the higher numbers correlate to him having recently vomited a hair ball or, but not always. He's sitting here now, in my lap, purring up a storm, thanking you for taking the time to try and figure out why he's such a bouncer.

 

[Chris & China (GA)]

I'm a little confused about your entries.....you have a lot of tests at +11

Are you testing an hour before shooting? Or before feeding/shooting?

The AMPS is the AM Pre-Shot..the test you should get immediately before feeding/shooting in the morning.....then you start the + cells....Each cell corresponds with the number of hours since the shot. The way it looks now, you're giving the ProZinc 11 hours after the morning shot instead of the 12 hours it should be.

 

[Ginger Cat]

I'm a little confused about your entries.....you have a lot of tests at +11

Are you testing an hour before shooting? Or before feeding/shooting?

The AMPS is the AM Pre-Shot..the test you should get immediately before feeding/shooting in the morning.....then you start the + cells....Each cell corresponds with the number of hours since the shot. The way it looks now, you're giving the ProZinc 11 hours after the morning shot instead of the 12 hours it should be.

I test 1 hour before shooting/feeding. He gets his shot every 12 hours so 11 hours is his PMPS. I test him at 8:30 am/pm and he then eats between 9 and 9:30 and gets his shot at 9:30 am/pm so the 11 am/pm is his AMPS/PMPS number. If he eats too fast he tends to vomit it all up so I spread it out over the 1/2 hour...

 

[Deb & Wink]

Just a note. I test him at 8:30 am/pm and he then eats between 9 and 9:30 and gets his shot at 9:30 am/pm so the 11 am/pm is his AMPS/PMPS number.

No, that 11 am/pm is not his AMPS/PMPS. That is +1.5 (since the shot was given at 9:30, 11 is one and one half hours later.
Times are always calculated from the time the insulin dose was given.
Since you give him his shot at 9:30 am/pm, the counting of the hours for subsequent tests are derived from that shot time.

8:30 am/pm is your AMPS/PMPS

I'm a little puzzled, not clear on why you are doing some of the things you are doing. Would you help me out here, to help me understand things better.

If you test at 8:30, why don't you feed him right then? Why are you waiting between the pre-shot test and the food?
I'm sort of puzzled as to why you are doing that. There is no reason you can't give him food right after his pre-shot test.

There are no delays needed when using Prozinc. Sequence is test, feed, shoot, in a short 15 minute window. No need to wait between feeding and shooting the insulin with Prozinc. Vetsulin/Caninsulin does need time between food and shot of insulin, 20 minutes tops. NPH insulins need 1 hour between food and shot of insulin.

Did you mix in some information with the other insulins and thought that applied to using Prozinc?

I'm kind of picturing this sequence for your cat:
Test him at 8:30, give him half his food at 8:35 which he finishes by 8:45, wait a few (5 to 10) minutes and give him his second serving of food at 8:55 which he finishes by 9:05. Give him the insulin while his head is buried in the food dish, for that second serving. Now your test, feed, shoot Routine is greatly shortened.

That would still mean that 8:30 is you AMPS/PMPS. Shot time is only 30 minutes after pre-shot test. Food is eaten within the 1/2 hour you mentioned. Shot is at 9 AM, roughly.

 

[Diane Tyler's Mom GA]

@Deb & Wink I was really confused, I'm glad you asked and went into detail about it, Deb as you know I'm no expert on dosing, especially Prozinc,
I was looking at her SS , why does she keep changing the dosage so often, just trying to learn
I'm sure she knows better than I do

 

[Chris & China (GA)]

I thought that might be what you're doing. As @Deb & Wink said though, you don't need to have any time between your Pre-Shot tests, feeding and shooting.

ProZinc is a gentle insulin that usually doesn't start to "kick in" for about 2 hours after given, so as long as Wally is willing to eat, you can Test/Feed/Shoot all in 5-15 minutes. I usually tested China, fed her to see if she was going to eat my offering that day and while her head was in the bowl, shoot. Never took more than about 5 minutes.

Wally can take his time eating if he likes....you can still Test/Feed/Shoot. A lot of cats eat too fast and then vomit (we call it a scarf and barf) but there's ways around that too. Spreading the food out on a flat plate instead of in a bowl makes them work a little harder to get it and slows them down. You can also do something like put a golf ball in the bowl that forces him to slow down and "work his way around it". There are also special slow-feeder bowls you can buy.

In this case, you could T/F/S at 8:30 or 9 (whichever works best for you)….If you choose to shoot at 9am (for example), if you tested again at noon, that would be 3 hours since the shot, so the test result would go in the +3 cell....if you tested again at 3pm, that's 6 hours since the shot, so the number would go in your +6 cell....all the way up to +11.....then it's 9pm for the PMPS and the cells start all over again.

 

[Ginger Cat]

No, that 11 am/pm is not his AMPS/PMPS. That is +1.5 (since the shot was given at 9:30, 11 is one and one half hours later.
Times are always calculated from the time the insulin dose was given.
Since you give him his shot at 9:30 am/pm, the counting of the hours for subsequent tests are derived from that shot time.

8:30 am/pm is your AMPS/PMPS

I'm a little puzzled, not clear on why you are doing some of the things you are doing. Would you help me out here, to help me understand things better.

If you test at 8:30, why don't you feed him right then? Why are you waiting between the pre-shot test and the food?
I'm sort of puzzled as to why you are doing that. There is no reason you can't give him food right after his pre-shot test.

There are no delays needed when using Prozinc. Sequence is test, feed, shoot, in a short 15 minute window. No need to wait between feeding and shooting the insulin with Prozinc. Vetsulin/Caninsulin does need time between food and shot of insulin, 20 minutes tops. NPH insulins need 1 hour between food and shot of insulin.

Did you mix in some information with the other insulins and thought that applied to using Prozinc?

I'm kind of picturing this sequence for your cat:
Test him at 8:30, give him half his food at 8:35 which he finishes by 8:45, wait a few (5 to 10) minutes and give him his second serving of food at 8:55 which he finishes by 9:05. Give him the insulin while his head is buried in the food dish, for that second serving. Now your test, feed, shoot Routine is greatly shortened.

That would still mean that 8:30 is you AMPS/PMPS. Shot time is only 30 minutes after pre-shot test. Food is eaten within the 1/2 hour you mentioned. Shot is at 9 AM, roughly.

The way the spreadsheet is formulated, I can't indicate that the tests are in 1/2 hour ranges. And I am testing him every 12 hours (8:30 am/pm). If I've given him his insulin at 9:30 am/pm, then his next test is 11 hours later (8:30) so putting the number in the +11 column seemed right. I know that I can feed him immediately, but I have come up with this schedule as it's worked out best for me and my other 3 cats (who eat separately from him) and my work schedule. It allows me to get their food prepared, etc. Sorry is this is confusing..

 

[Deb & Wink]

The way the spreadsheet is formulated, I can't indicate that the tests are in 1/2 hour ranges.

Sure you can. Put the test in the cell for +1, but indicate it is a +1.5 test and then manually color code the cell.

Or add a column for the +1.5 if that is more typical for your testing.

Got you on the scheduling you are doing. Don't know if you are able to get some things prepared the night before, to save you some time in the morning before you head off to work.

 

[Ginger Cat]

Sure you can. Put the test in the cell for +1, but indicate it is a +1.5 test and then manually color code the cell.

Or add a column for the +1.5 if that is more typical for your testing.

Got you on the scheduling you are doing. Don't know if you are able to get some things prepared the night before, to save you some time in the morning before you head off to work.

I do try and do his testing in hourly increments so that's not an issue, really. If I shoot at 9:30 and then test at nadir (3:30), that's +6 hours. And - to confuse you even more - I work from home and I do prepare his food in advance as even though it's the FF pate, he prefers it like soup so I run it through a mini food processor with water. Then I can just reheat it in the morning. I got onto this schedule because I run a bed & breakfast and had to work around my guest's breakfast schedule (and my time prepping their breakfast in the morning). Now, with the pandemic, that schedule is out the window since the B&B is closed until further notice. I had thought about changing the times, but then, if I do re-open, would again have to go back to what I'm doing now.

And - don't forget that I have been using a different spreadsheet for over a year and that indicates that actual times of shots. I only just started to use the FDMB spreadsheet so you all could review and provide insights.

And to Dyan Tyler's Mom, who asked why I'm changing his dosages, it's based on knowing when he's most likely to crash due to his past history and on how much he might have eaten at that meal. If his numbers are low and have been trending downward AND he doesn't eat much, I lower the dose.