Newly Dx'd and requesting feedback

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Laura & Bundy

Laura & Bundy

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Hi all you experts! Would appreciate any and all taking a look at my Bundy's spreadsheet and letting me know how to proceed. I just increased his dosage to 1.5 U last night so thought I would give this a week, but your analysis/comments would be most welcomed. After he gets his insulin he seems calmer, he sleeps quite a bit, and typically is not as hungry. has been drinking less water, all good signs I think. This is a thin, older cat with other health issues.
 
Hi Laura and Bundy! Welcome to our little forum! Bundy is definitely kind of high up there. We generally recommend increasing after 3-6 cycles, especially when they're high like that. You're doing a fabulous job getting some mid cycle numbers!

Before we can give good advise, I gotta check...can you monitor frequently? Or are you mostly able to monitor just on weekends? I'd keep him on 1.5 for tonight for sure...and try to get a +2 if you can. That PM number can help us see what's going on too. I think you'll probably need to increase soon, but I'd want to give it another cycle or two first.

Also, are you testing for ketones?
 
Do you regularly use both meters to test or do you favour one over the other? I agree with Rachel that he'll need an increase soon. We usually recommend increases after a minimum of 3 cycles. Try keeping the same dose AM and PM for now. Once he's in lower numbers more of the time it's possible to try the technique of varying AM and PM doses.
 
Rachel said:
Hi Laura and Bundy! Welcome to our little forum! Bundy is definitely kind of high up there. We generally recommend increasing after 3-6 cycles, especially when they're high like that. You're doing a fabulous job getting some mid cycle numbers!

Before we can give good advise, I gotta check...can you monitor frequently? Or are you mostly able to monitor just on weekends? I'd keep him on 1.5 for tonight for sure...and try to get a +2 if you can. That PM number can help us see what's going on too. I think you'll probably need to increase soon, but I'd want to give it another cycle or two first.

Also, are you testing for ketones?
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Thanks so much, I can monitor frequently when I'm here, so as much as I can I will. It seems that he reaches his nadir rather early on, I wondered seeing all of these other cats not responding so favorably, does anyone ever dose incrementally? Meaning at different times and lesser amounts? I understand that would be very tricky, but perhaps better for the cat if it could be done safely? It just occurs to me that perhaps the cats need smaller doses more frequently? But that's my thought, however I would not be too keen on experimenting at this stage. I have the ketone strips handy so if I catch him urinating I can get a test, but so far have not but I could set it up as suggested if it's critical. He was negative ketones at the vet.
 
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Kris & Teasel said:
Do you regularly use both meters to test or do you favour one over the other? I agree with Rachel that he'll need an increase soon. We usually recommend increases after a minimum of 3 cycles. Try keeping the same dose AM and PM for now. Once he's in lower numbers more of the time it's possible to try the technique of varying AM and PM doses.
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If you are reading my SS you will see that I'm testing with both each time; yes I was just expressing my thoughts about varying doses and times, I promise I will not on my own (yet). Is a cycle 24 hrs?
 
Depending on the cat, it is possible to dose every 8 hours if you are home enough to monitor each cycle and get enough mid-cycle tests in to be sure that the BG is rising each time before the next shot. This is obviously a big commitment on the part of the bean because you need to be home to do the pre-shot test and injection, catch the nadir, and then another test post-nadir to confirm the rise, and then the next pre-shot and on and on every eight hours. It's not good for the cat to do some cycles like that and others are ten hours and others at 12 hours and so on. Consistency is important since insulin is a hormone. So it kind of keeps you from leaving the house/sleeping for more than about 3-4 hours at a time. But if after a period of BID dosing you want to consider TID dosing, it can be done.
 
Djamila said:
Depending on the cat, it is possible to dose every 8 hours if you are home enough to monitor each cycle and get enough mid-cycle tests in to be sure that the BG is rising each time before the next shot. This is obviously a big commitment on the part of the bean because you need to be home to do the pre-shot test and injection, catch the nadir, and then another test post-nadir to confirm the rise, and then the next pre-shot and on and on every eight hours. It's not good for the cat to do some cycles like that and others are ten hours and others at 12 hours and so on. Consistency is important since insulin is a hormone. So it kind of keeps you from leaving the house/sleeping for more than about 3-4 hours at a time. But if after a period of BID dosing you want to consider TID dosing, it can be done.
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That is what I would like to eventually try, rather than raising the dose, give it more frequently, I do understand the monitoring commitment and necessity to be consistent with the timing. You can see my new numbers from yesterday and this morning. Happy Easter!
 
Laura & Bundy said:
Thanks so much, I can monitor frequently when I'm here, so as much as I can I will. It seems that he reaches his nadir rather early on, I wondered seeing all of these other cats not responding so favorably, does anyone ever dose incrementally? Meaning at different times and lesser amounts? I understand that would be very tricky, but perhaps better for the cat if it could be done safely? It just occurs to me that perhaps the cats need smaller doses more frequently? Let's just not comment on this in public! But that's my thought, however I would not be too keen on experimenting at this stage. I have the ketone strips handy so if I catch him urinating I can get a test, but so far have not but I could set it up as suggested if it's critical. He was negative ketones at the vet.
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I have some numbers for you from last night I got a +2 and a +5, would have liked to continue but got pretty tired.
 
Another possibility down the road is a depot insulin. It might get him into lower flatter numbers on a 12/12 schedule and that would be easier on you. I like those yellows. :)
 
I have just posted his +4 from this morning, unless I somehow didn't get the insulin in his body, these are very high unusual numbers. He's not eating either, lethargic, doesn't seem to feel well. I should test for ketones I suppose. I had to force feed him soup to give his morning dose, he didn't want to eat. So not good.
 
Laura & Bundy said:
I have just posted his +4 from this morning, unless I somehow didn't get the insulin in his body, these are very high unusual numbers. He's not eating either, lethargic, doesn't seem to feel well. I should test for ketones I suppose. I had to force feed him soup to give his morning dose, he didn't want to eat. So not good.
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some cats eat better if a bit of Parmesan cheese is grated and sprinkled on top of their food.
Some like a bit of dried oregano or tuna juice in water (not veg broth).
I agree that getting ketone test is arch important. Fingers crossed that soup will make him go!
 
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Negative ketones is good! You want to keep up with that testing as much as you can while he's in these higher numbers.

Has he eaten yet? Will he try something like tuna water or some of his favorite treats?
 
Yes, he seems to have snapped out of the earlier lethargy, I gave him some Cerenia, thought he might be a little nauseous and he seems better now, responding more normally. My AT tester isn't working properly, I don't know what happened, but it's giving me readings all over the board, I keep repeating the tests but they aren't accurate and it doesn't seem to be responding properly when I touch the strip to the blood sample. This just started happening this afternoon. I feel bad for him having such high levels, it must be taking a huge toll on him at his age. @Rachel you did say to continue at the current dose, that's fine, let's see what happens.
 
You can continue with your ReliOn meter. We all understand how to interpret those numbers. Less work for you if you don’t test with two meters and log two sets of results - cheaper in test strips too. :)
 
My AlphaTrak went down, am using the Relion, would like some feedback on his numbers now that we have a few cycles. It seems he spikes after 10 hrs. but is going into blues mid-cycle some of the time, yesterday his lowest 108, I'm wondering if I can give him his PZ injection earlier before he is so high, like at 10 hrs. instead of 12. I can increase the dose, but don't want him going too low mid-cycle. This morning his reading was just "Hi" meaning didn't register on the meter--not good! and he had not eaten most of the night, so food didn't push it up. Would appreciate some feedback on how to proceed. This doesn't seem ideal having him all over the chart like this.
 
Laura & Bundy said:
My AlphaTrak went down, am using the Relion, would like some feedback on his numbers now that we have a few cycles. It seems he spikes after 10 hrs. but is going into blues mid-cycle some of the time, yesterday his lowest 108, I'm wondering if I can give him his PZ injection earlier before he is so high, like at 10 hrs. instead of 12. I can increase the dose, but don't want him going too low mid-cycle. This morning his reading was just "Hi" meaning didn't register on the meter--not good! and he had not eaten most of the night, so food didn't push it up. Would appreciate some feedback on how to proceed. This doesn't seem ideal having him all over the chart like this.
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I'd stick to the 12/12 dosing for now. If his AMPS and PMPSs were very different you can try 11/13 dosing to try to even them out but that isn't happening. The blues are nice but he has a very deep curve on ProZinc. We usually recommend working on getting the lows into a nice range and waiting to see if the PSs settle in lower numbers. I suggest staying at 1.5 u for now. If this continues to be a big issue you could try a depot insulin like Lantus. They can give flatter numbers but it's not guaranteed.
 
Yes, your cat has only been on insulin for two weeks. It usually takes a couple of months to start to regulate. If you start messing around at this point it can take even longer. His body needs some time to adjust and “learn” how to use the insulin. Please be patient. You can see he’s bouncing around a little which is totally normal at this point. It makes it important that you are systematic and consistent so his body can settle in.
 
OK thanks for the advice, @Kris & Teasel, why did you end up using Levemir? One more question, if he's not wanting to eat when it's time for his injection, is it OK to give some cat treats? Otherwise I have to force feed pureed meat soup. Last night he ate a few cat treats before his shot and had such a high reading this morning, so I wondered, but it wasn't very many.
 
Laura & Bundy said:
OK thanks for the advice, @Kris & Teasel, why did you end up using Levemir? One more question, if he's not wanting to eat when it's time for his injection, is it OK to give some cat treats? Otherwise I have to force feed pureed meat soup. Last night he ate a few cat treats before his shot and had such a high reading this morning, so I wondered, but it wasn't very many.
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ProZinc is slower in onset so if you can get him to eat even a couple of teaspoons of food you can give his shot. Then he has 2-3 hours before insulin onset to graze a bit more.

I endded up on Levemir to see if it would level out my bouncy car somewhat. He bounced a lot on ProZinc, was still bouncy but better on Lantus. Lantus mad him lethargic and grumpy off and on so I decided to try Lev. He's still bouncy similar to Lantus but feels much better on it.
 
Checking in to this forum, I've raised Bundy's PZ to 1.75 this week, just wondering if anyone had a comment or has seen my SS lately. He seems to reach his nadir around 8 hrs. and then goes sharply up after 10 hrs approx 200 points in 2 hours. My Relion seems to be defective, giving very high readings, over the AT. Thanks!
 
Laura & Bundy said:
Checking in to this forum, I've raised Bundy's PZ to 1.75 this week, just wondering if anyone had a comment or has seen my SS lately. He seems to reach his nadir around 8 hrs. and then goes sharply up after 10 hrs approx 200 points in 2 hours. My Relion seems to be defective, giving very high readings, over the AT. Thanks!
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He definitely responds to the insulin - a bit too vigorously. I think he's nadired at earlier times based on numbers on your SS. I suggest you do a full curve at this dose to get a better picture on onset, nadir and duration.
 
Doing that today. What is it about his numbers that makes you say he responds too vigorously? Also what do you think about the discrepancy in my two devices that I mentioned. Just now they were in normal range of each other but hasn't been that way for two days.
 
Laura & Bundy said:
Doing that today. What is it about his numbers that makes you say he responds too vigorously? Also what do you think about the discrepancy in my two devices that I mentioned. Just now they were in normal range of each other but hasn't been that way for two days.
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I’m referring to the large difference between his high PSs and lower mid cycle numbers. I’m not sure what to say about the differences on your two meters. There are a lot of things to consider from the allowed variance of 20% to the fact that you can get 2 different numbers from the same blood drop using one meter. There’s inherently a lot of variability in BG measurements.
 
Yes certainly, I'm aware of that but in this case Relion was so much higher than AT, I thought it was malfunctioning. Do you take extra care to clean your hands before touching the strips? and keeping the meters clean? I wondered if this could be causing the meters to give inaccurate readings. One thing about Bundy, you know he doesn't eat very much, so the insulin has a big effect and then wears off.
 
Laura & Bundy said:
Yes certainly, I'm aware of that but in this case Relion was so much higher than AT, I thought it was malfunctioning. Do you take extra care to clean your hands before touching the strips? and keeping the meters clean? I wondered if this could be causing the meters to give inaccurate readings. One thing about Bundy, you know he doesn't eat very much, so the insulin has a big effect and then wears off.
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I handle the test strips carefully - clean hands, try not to touch the part that sips the blood, etc.
 
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