NEW MEMBER- help needed- PS 500s, weeks in

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JENNof2

Member Since 2022
@FrostD

please and thank you for your suggestions....
Hunter is acting and looking very good since the day he switched to all wet food. His preshot numbers have been trending UP though!! as in they were better before he started on insulin. Help. we are discouraged. what is going wrong, and (if anything), is anything right?

we are trying not to switch too many things at a time so we can isolate the variables...

He eats almost exclusively just twice a day, preshot- Wellness chicken pate, and sometimes his sister's Friskies pates- all of the lower carb types. although we were trying to give him 1 or 2 small snacks, for the past few weeks, he has NOT had small snacks on a consistent basis.

Question 1- Is this a factor?

Question 2- because his PS were in the 400's for more than a week, this past week, we INCREASED his dosage to 1.5 from 1.25. should we have DECREASED it to 1.0?? he had two readings in the 500s after increasing, so we are reluctant to continue with 1.5

just took a reading now- 180, with 2 hours to go until evening shot

HELP. Please, and thank you

here is link to previous post

https://www.felinediabetes.com/FDMB...r-182-pmps-and-low-mid-s.270288/#post-3013148
 
I have a couple of thoughts...

First, the way you're feeding Hunter is not a factor. Most folks here will give their cats several small meals a day.

I don't know if you've had a chance to look over the information on Prozinc dosing. You held Hunter's dose at 1.25u from 10/27 until 12/13. That's considerably longer at a dose than what we would suggest. Basically, you want to review your data once a week and if your cat's numbers aren't in the range you want, you increase the dose. If you stick with a dose that isn't getting numbers into a better range, you risk glucose toxicity developing. The name sounds worse than it is! What it means is that your cat's body gets used to being in higher numbers and treats that high range as the new "normal." So to answer your question, yes -- you were wise to increase the dose. Lowering the dose would likely not help.

In addition, there's a lot that can go on between your pre-shot tests. We also encourage you to get at least one test per cycle in addition to your pre-shot tests. As you can see on the days that you were getting an additional test, Hunter's numbers are usually lower. He dropped from 482 to 180 at +9. That large of a drop (and he may have been even lower at nadir) can cause a bounce -- the liver and pancreas react to the drop in numbers by secreting a stored form of glucose along with counterregulatory hormones that cause numbers to spike back upward. While it's a protective mechanism, it's really annoying to us. It would be very helpful if you can get at minimum, 4 test per day -- your AMPS and PMPS and at least one test during both the AM and PM cycles. It will go a long way to help you sort out what's going on and have more confidence in making dosing decisions.
 
Sienne and Gabby (GA) said:
I have a couple of thoughts...

First, the way you're feeding Hunter is not a factor. Most folks here will give their cats several small meals a day.

I don't know if you've had a chance to look over the information on Prozinc dosing. You held Hunter's dose at 1.25u from 10/27 until 12/13. That's considerably longer at a dose than what we would suggest. Basically, you want to review your data once a week and if your cat's numbers aren't in the range you want, you increase the dose. If you stick with a dose that isn't getting numbers into a better range, you risk glucose toxicity developing. The name sounds worse than it is! What it means is that your cat's body gets used to being in higher numbers and treats that high range as the new "normal." So to answer your question, yes -- you were wise to increase the dose. Lowering the dose would likely not help.

In addition, there's a lot that can go on between your pre-shot tests. We also encourage you to get at least one test per cycle in addition to your pre-shot tests. As you can see on the days that you were getting an additional test, Hunter's numbers are usually lower. He dropped from 482 to 180 at +9. That large of a drop (and he may have been even lower at nadir) can cause a bounce -- the liver and pancreas react to the drop in numbers by secreting a stored form of glucose along with counterregulatory hormones that cause numbers to spike back upward. While it's a protective mechanism, it's really annoying to us. It would be very helpful if you can get at minimum, 4 test per day -- your AMPS and PMPS and at least one test during both the AM and PM cycles. It will go a long way to help you sort out what's going on and have more confidence in making dosing decisions.
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thank you for you reply. to be sure I understand, is it recommended that we stick with the 1.5 at this point?
, even though the numbers went up even higher after increasing from 1.25 to 1.5? I was tempted to DECREASE it to 1.25 as there were two readings over 500. yes, we will attempt to get more readings midcycle. if we stay at 1.5, shouldn't the numbers start to go down? they all seem to be higher after beginning insulin period.
 
Hi and welcome Jenn and Hunter to the forum. I echo Sienna’s comments. Getting those tests in during the cycles will tell us how well the insulin dose is working. Every cycle is different. Some days the dose works better than others and sometimes if the BG drops lower than normal Hunter might be bouncing. (More about this below.) so it is really important that we see those tests during the cycles. Have a look at other peoples SS and you will see how much the BGs move around during the cycles.
Don’t be discouraged…you are doing a good job…it’s a big learning curve in the beginning…and you have come to the right place to get help and support and lots of information. Keep asking lots of questions, we are very happy to help
From the yellow stickies, Bouncing:
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
 
In theory, when you raise the dose the numbers "should" go down. However, there can be a number of factors that influence the immediate response to a dose change. Bouncing is one of those factors. Another factor is what we lovingly refer to as "new dose wonkiness." There are times when we raise the dose and numbers go up for a cycle or two.

It helps to remember that insulin is a hormone. It doesn't work like an antibiotic or other drug where you take a dose or two and things change immediately. Because it's a hormone, other bodily systems (like our own naturally produced hormones) influence how it works. For example, you give a shot. During the course of the day, your cat is stressed. As a result, numbers go up. This happens all the time when you need to take your cat to the vet -- the blood glucose numbers at the vet's office are typically influenced by the stress of a car ride, being in a strange place with strange people, etc. If your cat is not feeling well, the presence of an infection or inflammation can cause a rise in numbers. It also helps to remember that a dose that was good 2 weeks ago may no longer be a good dose now - you may need more or less insulin.

Basically, if you have good data from testing, you will start to see the pattern of your cat's numbers and feel more confident in making decisions about raising the dose.
 
The only way to figure out where nadir falls is to do curves. You've don't them on some occasions. It looks like you've done a curve roughly once a month. You may want to get a weekly curve for a month or so in order to have a clearer sense of what Hunter's cycles look like. Nadirs can and do move around so if you're only getting them infrequently, you may not know if what you're seeing is truly accurate.
 
Just echoing what Bron and Sienne have said. Once you get about a week of data let us know and we can take a look. If he goes below 90 at any point you would reduce by 0.25U; if you think he might have gone below 90 let us know as well so we can take a look.
 
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