Newbie -- BG numbers all over the place

Status
Not open for further replies.
C

Charlies Mum

Member
Hi everyone. I'm new here, and I only discovered Charlie's diabetes a few weeks ago. I have done a lot of reading since then. He's seen the vet, and I've started the TR method. He eats only raw food I make myself with only meat, eggs, organ meat and bone-- freely available. We started PZI a few days ago. His BG numbers are confusing the hell of out me. I just can't make any correlation between the BG numbers and the insulin, or when he last ate. We've only just begun, but still, these numbers are weird. Is this sort of unpredictablility normal, or what have others with a similar cat/diet found? (Obviously I know these numbers are way too high still, but we're only just starting)

I've been trying to check his BG as close to every 3 hours as I can in order to get familiar with trends (he doesn't mind testing at all). Here's what I have so far

8/9 (not yet on insulin)
360

8/10 (still no insulin)
337
293
340
1 u PZI
165 (3 hours after 1st ever injection)
258 (6 hours after injection)

8/11
415
1.5 u PZI
305 (3 hrs after injection)
305 (6 hrs after inj)
1.5 u PZI
299 (3 hrs after)
291 (6 hrs after)
1.5 u PZI
145 (5 hours after)

8/12
438
1.5 u PZI
379 (6 hrs after)
2 u PZI
284 (6 hrs after)
1.5 u

8/13
387 (6 hrs after inj.)
3 u
320 (3 hrs after)
254 (saw him eat 2.5 hrs earlier)
2.5 u PZI
313 (3 hrs after)
404 (6 hrs after) ate right after inj.
 
Hi Charlies Mum,

Good for you for feeding raw. You must have found the feline nutrition info and recipies.

The mantra here is "Start low, go slow" most of us start at 1 unit every 12 hours. That way we can gather bg data on how that 1 unit effects our cat and than make adjustments according to the data so we don't miss the perfect dose.

I free feed my guys, because Harley needs to have food available all the times (I work full time) incase he goes a little low he can eat and bring up his bg. We usually pick up the food 2 hours prior to shot time so when we test we will get a true number. Food will spike their bg.

PZI usually has a nadir (lowes point in the cycle, every cycle is 12 hours) between 4 & 7 hours after the injection (sometimes earlier, sometimes later, ECID every cat is different).

It looks like you were getting some really good action on the 1 unit. Why did you increase it every day? With every increase it looks like you got a flatter curve. You want your curve to look kind of like a smile, although PZI and some other insulins will raise the first 2 hours and than drop to your nadir (the lowers point of the cycle). We like to hold the dose for anywhere from 3 to 6 cycles (to let the dose settle into their system) to see how it is doing before we make any changes. You don't want to miss the perfect dose.

If you click on Harley's SS in my signature and scroll down to the bottom you can see how we chart the data. AMPS is AM Pre shot since this board is global my 7am may be different than your 7am, so 1 hour after the shot is +1, 2 hours after shot +2, etc. If you go to the tech forum you can set up your own spreadsheet, this is invaluable in an emergency, and to look back on to see the trends.

Yes, the sugar dance in unpredictable and will keep you on your toes.

Welcome to the club.

Ask questions, questions, questions. This forum (PZI) doesn't get alot of traffic so if you need an immediate answer please post on the Health forum, that room gets alot more traffic during the day and night.
 
Welcome! I expect a child to come interrupt me at any moment, so I'm skipping over the pleasantries and jumping right in.

You mention TR. Tight regulation can be a good tool to use, but be careful! In the beginning, especially with a recent diet change, a cat's blood sugar levels and insulin needs can change. I would recommend starting with insulin injections twice a day at 12 hour intervals. Some people have been very successful with TID (three times a day) injections, but they have started with BID (2x day) injections first to see how the cat reacts to insulin. Some cats will have peak insulin action early in the 12 hour cycle and some later in the cycle. Without gathering data on your cat you will not know if you cat's response to insulin has an early or late nadir. FDMBers who have successfully used PZI on a TID schedule tested their cats glucuse levels sometimes as often as every hour day AND night. Also, a cat should never be given more insulin -- before 12 hours from the last shot -- unless it is known that their blood sugar is rising. So for instance (and I am NOT recommending this) if bg was 150 at +5 (5 hours after the insulin was injected) and 145 at +6 and +145 at +7 and +180 at +8, then it would be possible to shoot at +8 (though not necessarily advisable). But without knowing the insulin action had peaked and that blood glucose was rising, then a shot at +8 (or even +10) is dangerous. Insulin is still at work in the cat up to about 12 hours. Injecting more insulin before +12 is tricky because there is still insulin in the cats system. A reduced dose would indicated. How large that reduction should be is based on data that has previously been collected.

Charlie is going to have diabetes for the rest of his life, which will hopefully be a long and happy one. I know you want him to be healthy and better right away. But it will take time to get him regulated.

Setting up a profile and a spreadsheet is a good way to introduce yourself and to keep track of Charlie's progress.

Spreadsheet set up instructions are here: viewtopic.php?f=6&t=18207
And profile set up instructions are here: viewtopic.php?f=6&t=17766

I would strongly recommend a low starting dose (of perhaps 1u) every 12 hours. Get a pre-shot (AMPS in the morning or PMPS in the evening) bg reading, give the insulin and feed Charlie. Then test bgs every two hours, at least until past nadir (the lowest bg reading of the 12 hour cycle.) PZI usually doesn't start lowering bg until 2 hours after injection and peak action is usually between 5 and 8 hours later. With PZI you might not get the perfect curve the first cycle. As long as lowest part (nadir) of the curve isn't too low (lower than say 100), then you will want to continue with that dose for several more cycles.

I just glanced at your message again, and I'm not sure I answered your questions. Try putting your numbers in a spreadsheet. They might start to make more sense. And it may make it easier for others to see a trend.

I think you are off to a great start. I am not familiar with a raw diet, but to me it shows a real commitment. And many newbies have trouble bg testing and you've mastered that already. Good luck!

Donna
 
Thank you for the welcome, and for the information. I will setup a spreadsheet. (I already plotted the numbers on a graph, but they still didn't make any sense to me.)

I upped Charlie's dose after the first day because I know that first number was on a fast, and it was still high, and going higher.

I free feed because Charlie has always gotten very stressed and grumpy, and acted crazy when he hasn't had food available all the time, and I have another cat that will only eat at night when no one is around. I will try picking up the food 2 hours before his +6 and +12 BG tests (will still test every 3 hours for now though-- for my own peace of mind.)

One thing that has occurred to me is that Charlie eats a lot more than the average cat. Between him and my other cat, they go through 1.5 pounds of meat per day. I read that the average cat only eats about 1/3 of that amount. Since people dose insulin by the amount of food they eat, it would make sense to me if it were also true for cats. Any data available on this?
 
We don't dose insulin based on the amount of food they eat.

We start at 1 unit and plot their bg's in the spreadsheet so we can see how the insulin effects the cat during the day. Then we know where his nadir occurs (nadir is the lowest bg reading of the cycle) and we can see how much duration the cat is getting on that dose.

We keep giving the 1 unit until we have enough data to see if it is the right dose or not. It takes a while for the cat to adjust to the insulin, and also for the dose to settle in.

We never shoot insulin if the cat is not eating, they need to have food in them befor we inject the insulin.

I free feed my guys, 1 diabetic and the others are civies (non diabetic), I pick up the food dishes 2 hours befor Harley's PS tests because the kitty will get a food spike (higher bg's) and we want a true bg# at shot time.

Don't worry, it will all start making more sense every day. Keep asking questions.

You're doing great.
 
Has Charlie always eaten a raw diet? Or is the raw food a diet change after Charlie's diabetes diagnosis? If he has recently eaten a high carb, dry or even wet cat food, it can take a week or two for the effects of that old less healthy diet to wear off.

As his body adjusts to the new diet and insulin, his appetite and blood glucose levels should decrease. Unregulated kitties are often hungry kitties. That's one of the symptoms of diabetes, losing weight while eating more. If the raw food is a diet change, then your cats may just like it a lot better than their old food. Or maybe it's just a novelty which will wear off.

If Charlie has other issues, such as bad teeth or a urinary tract infection or any other infection, those things can make bg hard to regulate.

You might suspect an infection if bg is higher at +6 (or at ~ time of nadir, for PZI anytime from as early as +4 to possibly as late as +10) then at at PS (preshot). Inverse curves can also be a sign that the dose is too high.

I don't know and can't advise on raw food, but many do free feed successfully. The numbers might start to make more sense if you try a full curve. Test before you give insulin for a PS bg, and then every 2 hours until the next shot. BG might stay the same or even rise a bit at +2. At +4, bg should be lower than PS. At +6 bg might be at or near nadir, or lowest number in the cycle. +8 bg might be close to +6 bg or slightly higher. +10 bg is usually rising. +12 should be about the same as the previous PS. If your mid-cycle numbers are higher than the PSs (an inverse curve) then suspect possibly too high a dose or infection.
 
You mean Dr. Hodgkin's protocol? A lot of us here have found we can achieve TR (keeping them in non-diabetic #s as much as possible) without shooting as aggressively as her protocol may call for (it's been a couple years since I've read it, so I can't speak to much about it). I think Hope & Aria & MIchelle & Pru - both now off the juice - may have started with that approach and used a sort of hybrid approach to get results, basically TID, or as-needed shooting when BGs are over 150.

There used to be a site with Dr. H.'s recommended sliding scale that ran from about 0.5u at 150 to 4u with PSs in the 400s, more or less. I think they have scaled back from that, with the higher end being more like 2u now. So, for starters, I'd be careful what scale you are working with. What I've seen here is that many cats on LC food do well in the 1 - 2u BID range. Some cats need more than that, and a few need less. So I get nervous whenever I see doses like 3u, especially if shot more often than every 12 hours - for many cats, that is likely to be too much insulin.

What I have seen recommended here that makes a lot of sense to me is to start shooting on a 12/12 basis, and collect data for a few days. Then even if you don't want to continue with 12/12 shooting and want to go more often, you have a better sense of how the PZI is working in order to tackle a different shooting strategy. Although many cats don't get duration past maybe 8 hours and therefore early shooting works well, a lot of cats do get good duration on PZI. So the problem with starting out with as-needed shooting is that you don't know what duration your cat gets, so you could be inadvertantly overshooting.

Looking at your #s, on 8/11 for instance, you got the same # at +3 and at +6. I wouldn't have shot quite yet then at the +6, since you should only shoot once you know you are past nadir. If it is flat like that, I would wait til you really see a rise to shoot.

When you look at the 8/13 data, that last dose looks too high to me. You got an inverse curve, which is one way they can protect themselves from a hypo if the dose is too high.

With PZI you often CAN get good duration, so when you shoot at +6 it makes it really difficult to interpret the data. The #s after that can be the effect of both the current shot and the one before, making it hard to know what is causing what. I think her protocol makes a lot of sense if you have a cat with short duration and you can hit good #s. So if you get a good nadir that is clearcut and the #s are headed back up, yeah, go ahead and shoot if you want to. When it's not that clearcut though, I find 12/12 a lot easier to decipher, and many cats do just fine on that. If not, and you can see in the #s where they are running out of duration, then you can construct a strategy to shoot early to deal with that. But until you know what kind of duration you are getting, or if you have a cat who will do well on 12/12 shooting, then to me it doesn't make sense to take Dr. H.'s approach.

So my recommendation would be to back off the doses for now, just looking at it, it looks like way too much insulin to me in a 12 or 24 hour period. If you were comfortable shooting less often, maybe pick 10 hour intervals if you don't want to try 12/12, I think that would help you see what his insulin needs actually are. Right now it's hard to tell, except it looks clear to me on that last shot that it's too much insulin.
 
Thanks again for the great information everyone. I've been putting Charlie's info into a spreadsheet, and I have taken your advice and reduced his insulin first to .5 U bid for 48 hours, which didn't appear to have any effect on his BG at all. This AM I increased it to 1 U bid. The first part of the spreadsheet is kind of hard to read since I first kept track without any insulin, then I was giving it to him every 6 hours. I just wrote the 6 hour dose in the column to the right of the +6 reading. I colored those cells the same as the AM & PM injection columns so they're easier to see. I'll get some more numbers entered, then get it linked to my signature as soon as I can. Then maybe you can help me interpret it better.

YourDiabeticCat.com is still using the same sliding scale as far as I can tell. It's the same as in Dr. Hodgkins book. It starts with .5 U at 151-170, and goes up to 4 u for a BG of 351-410. The difference between those numbers and the ones I found in some of your spreadsheets is huge. I'm really confused.

While I'm thinking about it, what do you all do if your dose goes right through the skin, or leaks out? It's happened to me twice. Last time I was sure I lost all or most of it, so I gave a small dose in addition. The other AM, I was only giving 1U, and I was careful to check to be sure the needle hadn't gone all the way through, but when I withdrew it and rubbed his side for a second, I felt a wet spot. I didn't give any more because I couldn't tell how much of it I lost. I was so sure the needle was all the way in, and not sticking through the other side, but it seems I was wrong. What do you do if you lose some, or what's the best method to avoid this happening?

Donna, Charlie has been on and off raw for several years, but he was on prescription CD for FLUTD when he developed diabetes. He's always eaten like a pig, no matter what kind of food he gets. His apparent eating disorder has been a problem since he was young, and it's the primary reason I started him on raw the first time, but for several reasons, I couldn't always keep him on it.
 
Welcome back Charlies Mum,

Great news on your spreadsheet, are you using the one that you can get through the Tech Form here? It will sure help when we can see at a glance how he has been doing.

They call it a "fur shot" when it goes all the way through the skin. Since you have no way of knowing how much got into him we advise to NOT give more insulin, just wait until the next PS. If more insulin went in than you think and you give him more you could potentially overdose him.

Are you tenting the skin? they advise shooting at a 45 degree angle into the tent to avoid furshots.
 
hi there, thanks for the update! I have been wondering what you decided and how he's doing. Hopefully you will see some response on the 1u, but if not I would bump it up to 1.5 in a couple days.

My understanding from a few months ago was that the YDC site was more or less defunct, and they started a new site with the modified sliding scale. I could be confused though, I didn't follow the discussion all that closely. I never understood their doses myself. I found that 0.5u is generally way too low a dose at the lower PSs, and 4u at higher PSs is way too high unless they are eating dry food. Plus I wouldn't really want to hit a non-diabetic nadir from a PS like 400 really - it's just so steep a drop it seems like asking for trouble.

Those higher doses at higher PSs are very aggressive shooting, and in some circles there has been a lot of controversy from what I gather, over the level of insulin being given. So I guess the approach on this board is more conservative, that's part of the difference. But a lot of cats here go OTJ, and from what I have seen a flexible approach with PZI is what works best - starting with BID and gradual increases, but getting creative if needed with any combo of sliding scales, TID or as-needed shooting, etc.
 
Sorry I haven't posted in a few days, but I am reading and following your advice.

I have been trying to publish the spreadsheet I created for Charlie, but things have changed a little on Google since the instructions were created, and I'm having a hard time figuring out what's what in the new design. I redid the spreadsheet again in a format similar to Joanna and Bix's, adapting it to the more frequent shooting schedule I was using. it's done now. I just haven't yet figured out how to let you all see it.

The YDC forum is the new one, Joanna. I didn't see the old sliding scale, but the new one I think is the same as what's in her book (I should double check that). I haven't had good luck with that forum. The administrator screens every single post and rejects anything that he doesn't agree with 100%. Because of the extreme censorship, I feel the site isn't trustworthy because they only publish data that fits their hypothesis. I really appreciate the unbiased information I'm getting here, and everyone's helpfulness and patience. There is so much information to grasp all at once!

Thanks for the "fur shot" tip, Rob. I have been "tenting," but I didn't know about the 45 degree angle and had been going in almost horizontally. I appreciate that tip very much. Haven't screwed up an injection since! :-)

If anyone has any more tips on getting the spreadsheet linked, anything would help. Meanwhile I'll keep trying different things.
 
On ss in google I am pretty sure you have to use older version to set it up I know I did and to add photos I had to go back to older version Hope this helps if not check out Tech support and ask someone there or put it in your subject line How to ss sure you will get help.

Also sending Angels and healing green light to help you all in a happy healthy recovery ..With the help I got here and Lantus and good diet we only used insulin for 2 months we have 26 days OTJ ..Best place for a DC and all us newbies :mrgreen: ;-) Kath
 
Definitely try and get that SS linked as soon as you can.

Also, and I have to agree 100% with what the others have mentioned about the shots, only shoot 2x a day, every 12 hours. Here's an excerpt from felinediabetes.com:

"Too much insulin causes too much of the blood glucose to be used, and results in very low blood sugar. This condition is very dangerous and can kill your cat in hours - read the hypoglycemia section before you begin your insulin regimen. Additionally, print the hypoglycemia emergency information and place it somewhere easily accessible, such as the refrigerator."

I have my cat on Lantus, after trying 2 other insulins. She started out at 1u BID, and I've been increasing it 0.25 every 6 cycles (3 days). There may be a time when I've increased it 0.5u, but went back to 0.25u increases instead. I feed her Fancy Feast Turkey & Giblets, which is a low carb food (3.9% in carbs).

I would recommend listening to these folks on here. They know what they're talking about, and have helped me in the past. They're still helping me. (*HUGS* guys)
 
I should tell you no can make heads or tails of my SS, LOL. It is a PZI style they used to use, but not many use it anymore I guess. You might want to look at Hope & Aria's or Michelle & Prudence's. I think they both shot TID or at least more often than BID for a stretch, and their format might work better for you. If you are shooting BID now though, I'd probably just go with the normal format, and maybe modify a few lines at the top, since it was only a few days of early shooting.
 
Oh no! You mean I have to redo the SS again? I guess I should have asked first! (Doh!) I thought your SS made perfect sense, Joanna, but then I haven't gotten used to a different format. I will work on it, and will keep trying to publish it, in whatever format I can for now. Thanks for the tips, folks.

Meanwhile, I've gradually raised Charlie's dose from .5u BID to 2u BID, and his blood sugar is responding positively (down to low 300s and high 200s). The nadir is where it's supposed to be-- around 6 hours, and I'm not 100% sure it isn't coincidence, but he's spending more time outside the bedroom, and he's eating a little less. Seems like a good thing.
 
Well if you have a SS already set up I'd go with that for now, and worry about maybe changing formats at some point later - I wouldn't redo what you already have.... Glad his #s are good - what I saw before that looked like doses too high was probably due to the frequency, so the same dose might not be too high on a +12 shot... did you attach the SS you made? I didn't see it, but I'll recheck, may have just missed it....
 
Okay, Charlie's spreadsheet link should be attached to my signature in this post. I'll fix the format later (of the spreadsheet and the link), but this will work for now.

Today his BGs are higher, and I don't have a clue why. I'm so confused.
 
There are a couple things that can account for higher #s after you start seeing better #s:

1) If their liver isn't used to the improved #s it can protest by throwing higher #s.
2) Their body can adjust to the insulin and what looked like a promising dose turns out not to be enough.
3) Something else going on, like that one day he wasn't eating well & was constipated, and threw you some black #s.

Not 100% sure what is going on in his case, but a couple comments:

1) I would make dose increases in no more than .5 increments. Some people say only move in .2s. I like .5s when you are nowhere close to good #s on any kind of consistent basis, and then .2s when you start seeing better #s. The problem with going in bigger increments is their body can kind of resist the insulin and you'll get higher #s, with difficulty then in figuring out if you missed the right dose or not.

2) Are you testing for ketones? That's important when their #s are running higher, especially if they don't always eat well.

3) If it were me, I would probably hold this dose for another day or two and see if the #s settle down a bit on their own. If not, I would go to 2.5u for a few days. You are seeing U-curves, so there's nothing to me to suggest rebound.

4) I'd also start a new thread either today or tomorrow - it makes it easier for people to give you input. If you aren't getting enough responses here, you might also want to post on Health. If you do that, be sure to put PZI somewhere in the title to get the right eyes on his #s. You may get a few people who freak out at the early shooting b/c they aren't used to it - I wouldn't worry about that too much, just be aware that there may be a reaction. Hopefully nothing major. :)
 
Thank you, Joanna. That's very helpful. I really appreciate your insight.

Unfortunately, I hadn't checked in before I upped his dose again this morning to 3U. At +6 he's down from 484 to 284, which is great, but I'm only cautiously optimistic. I'm thinking since I already started the 3U, I should keep him there rather than reducing to 2.5 again right away, but that's just my guess.

I will take your advice and start a new thread in the general forum for any more questions.
 
As long as the pattern is a U-curve (not too sharp though), in theory it means the dose is right, or too low. With PZI, you want a drop from PS to nadir somewhere in the 60% range, + or -. So, so far today looks fine. I'd just be careful if you see a change from a U-pattern - if the mid-cycles start being higher than the PSs, for instance.

I'd be careful too on raising the dose from this point - 3u BID is a good-sized dose for being on LC food. If it were me I would raise in only 0.2u increments from here. I'd also give it a full 3-5 days at a dose before raising (assuming you aren't seeing ketones). Although sometimes I am in favor of raising the dose faster, with him I feel like you need to let things settle out a little bit, especially with the bigger dose changes. You will get more chance for overlap, so keep an eye out for dramatically improved #s on cycle 2, 3, or 4 of this dose. When Bix had a breakthrough, he dropped down from yellows to greens on the 4th cycle of a dose increase. Which was perfect, but can be a bit unnerving when you've gotten accustomed to seeing only higher #s.
 
Super. Thank you again, Joanna. I'll pick up some 100U syringes today so I can make the smaller doses.

Beginning tomorrow, I'm going to be traveling with only sporadic Internet access, so I'll do my best to check back in and update his spreadsheet, but I'll probably mostly be on my own. Thanks for clarifying things for me before for that happens. Hopefully I'll have access often enough to be able to get my signature working right too, and hopefully we won't have any emergencies!

Thanks again! I really appreciate it.
 
Hope your trip goes great! I'd lower your dose to 2.5, I'm seeing some red flags the dose might be too high:

8/23 - 8/25:

PMPS 492 3u
+6.5 372
+12.5 331 3u --> When the following PS is lower than the mid-cycle # like this is, it can be a sign the dose is too high.
+6 390 --> Ditto when the mid-cycle is higher than the PS. Could be part of an inverse curve, though you can't tell for certain without the next +12 data - if that were lower it would confirm that pattern. (Although the +14 doesn't confirm an inverse curve, he could have dropped back down for a +12, then zoomed back up as the PZI wore off, so it's an unknown.)
+14 405 3U
+11 516 3U --> Significantly higher # could be a sign of rebound, suggesting dose may be too high.

Although the 1st cycle on 3u looked like a nice U-curve, the #s look increasingly suspicious to me starting with shot 2 on that dose. Since for many cats the insulin reaches full strength after 2 or 3 back-to-back shots on a dose, the #s look to me like there is a high probability that 3u is too much as an on-going dose.

If it were me, I would pull back to 2.5 for a few days and see if you can get back to a U-curve shape. If you are seeing a U-curve but the #s are too high overall, then I would try 2.75 for a few days (reducing again if you start seeing non-U-curve patterns). If the dose is too high, it is a hypo risk, and also can cause rebound issues that can be hard to overcome. I know it's frustrating to see high #s and feel like you can't get anywhere - sometimes it takes some patience and finessing to get things working well, and sometimes if you give their body a little time to adjust to things on a slightly lower dose (not way too low of course), the #s will start improving on their own.

Hope that helps, and best wishes on your travels! :-D
 
You are really good at explaining this stuff, Joanna. I think it's finally beginning to make sense. I see the inverse curve, and the last couple of shots confirmed it. Yesterday I got really weird numbers-- low, which seemed good, but it was a straight drop over 12 hours, not a curve. I will cut back to 2.5 for a while and see how that goes. Thank you, as always! :)
 
Thanks :) happy to help. I agree with what you said that the next couple shots confirm it. The nice thing is now you have a bracket to work with on the dose - 3u looks too high, and 2u looks too low. That is a big help, hopefully, in your being able to figure out what dose works well for him. It can still be tricky, but at least you have some good data and some reference points to work with. The picture can always change and tell you something different, but that's how the data looks to me for the moment.
 
Status
Not open for further replies.
Back
Top