Nico's a mess | Feline Diabetes Message Board - FDMB

Nico's a mess

I think I messed up calling it DKA & changed it. It's not always DKA just if there's ketones, it's it? I don't think my vet ever said it was DKA. Think that was me.
I still have to catch him with the test, but will get one from him today with the stix.
You said this... "Right now it seems like he is nadiring before +6 because he frequently has bounced back up by that time. Over time that should hopefully change… where his nadir comes a little later."
- How does it change? I thought once he starts taking the meds, within a day or two, what you see is what you get. Does it not work that way? How does his nadir change? Because I was worried that his nadir was so soon in, and then it's just downhill for the remaining 8hrs.

I get the meter debate. When I went to buy mine, the vet said very specifically to buy a pet one, so that's what I did. For one, I never thought about questioning doctors back then. I feel much different now.😅
I was able to get readings twice only with the Relion. I'm pretty sure the errors were just from too little blood. Thing is, I was trying to first grab blood to use on the pet monitor, since it's what I've been using, then trying to use the relion so I can compare them. How do I know if the relion is giving me accurate readings? Which is why I wanted to compare it to mine. But it was at least 80-90 difference.
Not sure how I can compare accuracy when there's quite a difference between the two. I'll try and look on a page for that.
You also said... " Test again at +5 or 6 and see if anything is happening. He could just be bouncing from the pink last night (which could have dipped a little lower into pink). His body is very comfortable in black. Anything as low as something in the 300s could definitely cause a bounce reaction."
-I did test at +6 and of course it was even worse at 585.:( What exactly does that mean 'bouncing'? I know things go up & down. Up right after the shot, and then, as in Nico's experience, down soon after.
And what do mean his body is comfortable in the black? Meaning he's just used to that? Cause lord knows I don't want him to stay there.
You asked how late I stay up past his shot? I've been staying up to 11:30, which is +4hrs, in order to get that reading. Why did he only go in the pink (if only barely) after the evening shot? Why not during the day?
 
Bouncing:

it's a good time to talk about bouncing. High numbers do not always mean more insulin is required (although in Nico’s case I believe he does need more insulin because he is too high all of the time.)

A bounce is where the cat's body reacts to lower numbers that he is not used to being in anymore... since becoming diabetic. It's a protective mechanism where the cat's central nervous system perceives either a steep drop in blood glucose or simply the cat being in lower numbers - and releases adrenaline, cortisol, glucagons and growth hormone, all of which create insulin resistance and can keep numbers high for up to six cycles (the bounce). Bounces don't have to last that long, but in some cats they will. Over time, many cats will start to clear the bounces more quickly. When the bounce does clear, the BG numbers will come back down and give us an accurate picture of what a dose is doing for the cat.

Remember that “lower numbers” for Nico will be anything that his body perceives as low — even the 300s and possibly even the 400s since he is accustomed to being in blacks.
 
Tyleete said:
I thought once he starts taking the meds, within a day or two, what you see is what you get. Does it not work that way?
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Not necessarily. Sometimes it takes several cycles to see the effect of a dose increase. Sometimes you will see it within the first cycle or two. Sometimes you will see higher numbers after a dose increase for the first cycle. Every cat is different.

If a cat is bouncing and is just staying high and flat in numbers then we can’t know what the full effect of the dose is. With Nico being so high it doesn’t matter as much as it would if her were getting into better numbers, but the same principle still holds.
 
Tyleete said:
later."
- How does it change? I thought once he starts taking the meds, within a day or two, what you see is what you get. Does it not work that way? How does his nadir change? Because I was worried that his nadir was so soon in, and then it's just downhill for the remaining 8hrs.
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It won’t necessarily be the same no. Lots of cats learn to use the insulin and over time their nadirs will get later— we will have to see. The feedings at +2 and +4 that you are already doing can help with this too.

Some cats don’t even have their nadir at the same time every day and it moves around.
 
Tyleete said:
Why did he only go in the pink (if only barely) after the evening shot? Why not during the day?
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Well that’s a hard question to be precise about since we don’t have round the clock data on him (nor am I saying we need it) but it’s a common phenomenon that cats will drop into lower numbers at night. We will find out his patterns over time.

There’s also a phenomenon called Dawn Phenomenon where there’s a natural increase in blood sugar levels that occurs in the early morning, typically between 2 a.m. and 8 a.m. Even people have this! The body releases hormones like cortisol and growth hormone to prepare for waking, which can lead to increased glucose production. This is why a lot of cats have higher AMPS than they do PMPS numbers
 
Suzanne & Darcy said:
Well that’s a hard question to be precise about since we don’t have round the clock data on him (nor am I saying we need it) but it’s a common phenomenon that cats will drop into lower numbers at night. We will find out his patterns over time.

There’s also a phenomenon called Dawn Phenomenon where there’s a natural increase in blood sugar levels that occurs in the early morning, typically between 2 a.m. and 8 a.m. Even people have this! The body releases hormones like cortisol and growth hormone to prepare for waking, which can lead to increased glucose production. This is why a lot of cats have higher AMPS than they do PMPS numbers
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Ok, that is just amazing. That the body works like that. Now if only the body will work right!😅
Just did his PMPS, and they're 537?😒 Shouldn't that have been higher than the previous? Geez. Anyhow, I'd really like to only stab him once more tonight. At what + would you suggest I test him at tonight? Or do I need to test him again? I'm still so unsure about all of this. Tomorrow I'll try to change the numbers like you said.
 
Tyleete said:
Ok, that is just amazing. That the body works like that. Now if only the body will work right!😅
Just did his PMPS, and they're 537?😒 Shouldn't that have been higher than the previous? Geez. Anyhow, I'd really like to only stab him once more tonight. At what + would you suggest I test him at tonight? Or do I need to test him again? I'm still so unsure about all of this. Tomorrow I'll try to change the numbers like you said.
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Would you like to go to bed earlier? You have that luxury right now. If you want to try a +3 tonight it could help is see if the insulin is starting to lower his BG.
 
Suzanne & Darcy said:
You are doing great.
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Thanks. And I would love to go bed earlier tonight. Funny thing, I used to regularly stay up to at least midnight to read in bed. You could find me closing a book at 2am. Not since he was diagnosed, he suddenly didn't want to stay out in the main living area anymore. I keep my bedroom area closed, where 3 girls that need to be back there. He decided he wants to live there now. And he does NOT let me sleep that great. He'll come up periodically and just cry by my face for petting. The one time he wanted to go out and stayed in the living room all night? I had to lift the whole couch as he was hiding. I don't want to have to do that every day. Chase him around the house for shots and testing. So I just let him stay in there. So thanks! Think I might even take an Ambien tonight. Wooh!
 
Tyleete said:
Thanks. And I would love to go bed earlier tonight. Funny thing, I used to regularly stay up to at least midnight to read in bed. You could find me closing a book at 2am. Not since he was diagnosed, he suddenly didn't want to stay out in the main living area anymore. I keep my bedroom area closed, where 3 girls that need to be back there. He decided he wants to live there now. And he does NOT let me sleep that great. He'll come up periodically and just cry by my face for petting. The one time he wanted to go out and stayed in the living room all night? I had to lift the whole couch as he was hiding. I don't want to have to do that every day. Chase him around the house for shots and testing. So I just let him stay in there. So thanks! Think I might even take an Ambien tonight. Wooh!
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I hope he gets along with the three girls! I can totally relate to this.
 
Suzanne & Darcy said:
I hope he gets along with the three girls! I can totally relate to this.
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Just took his numbers at the +3. 374! Can't believe I'm so excited about those numbers.😅
Oh it took a while for them to 'accept' him. My eldest (15yo) has asthma and every time she'd his at him, she'd start an attack.🙄 I live with geniuses.
She finally stopped that. But he never learned social boundaries and loves to shove his little half pint body in their faces. It's so bad, and he annoys everyone except another younger one he got to grow up with from the age of 3 on up. He's 9 now. So, they pretty much tolerate him. My other 2 in here are the diabetic that went into remission that's 13, and an ibd monster that's just an overall brat I got suckered into bringing home after her 2 siblings were adopted and she was left behind at an adoption event I was doing for the shelter she was in. I just felt bad for her, going back to that empty kennel all alone. All 3 were black, but she was a medium hair cat while her siblings took after their mother and were short hair. Long haired cats don't do well at my local shelter. 3 of the 4 I brought home from there were all longer.
 
Tomorrow I want to increase Nico’s dose to 2.5 units (unless something crazy happens today and he drops into yellow or blue!)

I think the slight improvement in the evening numbers could also be attributed to the new ProZinc vial.
 
Oh my gosh, I keep writing this, step away so the phone goes off, then it's erased all I wrote.
I forgot at the +5, but got +5.5. Hope that's ok. It was 411, so didn't last long, ban in the red. But at least it's not black? :/
So 2.5 tomorrow then?😬 Scary. But I'll do it. Question is, do I tell his doc. But at least he's had 2 testing results in the pink. I swear this cat is so stressing me out. At least my other gal went back down to 96. That makes me more comfortable. Was making me nervous for a little there. And you'll be glad to know I now officially have my Hypo bag. Karo, syringe without needle, and fancy feast with gravy recipes.😁

CBD- I've used 3 brands with success. I've been told all are not created equal, so here's the ones I've used:
Bought Ellevet from the vets office, though you can go to their site too. Ellevet is costly, but the strongest so you use less. It also tastes really bad as nothing is added to cover the taste. I believe it's $75 for a 1050mg/15ml bottle. But being the strongest and if either your cat won't care about an awful taste going down, or don't mind the mess on putting it into capsules? You pay for what you get there. It worked the best.
Then there's Lazarus Naturals salmon oil flavored. It's a good brand and if your cat likes fish flavor, this is a good alternative. I believe it's $20 for a 600mg/30ml bottle. I like them a lot too.
Guess who had a cat in need of cbd that hates fish?🙄
If you have pain in the bum cats like mine, there is CBDMD's catnip flavored. But it's $30 (unless you use subscription service) for a 300mg/30ml bottle. It's my least favorite for potency results. My cat was allergic to fish so hated the LN's one. And only 1 of my cats ever even knew I was drugging her good with it. I taste tested that one and there's barely a flavor at all to it. Maybe a minty type that's real drowned out? But it does work. My gal that had the ibd turned scl gi, plus the HT, plus at the end the skin cancer was the finicky one. I just squirted it in her mouth twice a day. Everyone else that needs it gets it mixed in their food.:)
Hope that helped.
 
Ok, decided to 'ask' my vet if we could move up to 2.5 & showed her my spreadsheet. She said 2.5 units at the max twice a day. When I asked what if that doesn't work, she said switch to a different insulin.this is all so stressful. Thanks for being there.💕
 
The reason we will go directly to 2.5 units instead of only 2.25 is that Nico’s nadirs are all over 300. If he was having nadirs in the 200s we would be moving more slowly.
 
Oh I trust you. More than my vet, but don't let her hear that.😅
I'm just scared in general over moving about. Staying the same scares me because it's not working very well yet, but moving it up scares me because with each adjustment, comes fears is what is it affects him greatly?
You know. Just the usual 😅
So do you want +3 or +4 tonight? And what kind if testing schedule would you like after giving m the 2. 5 units in the morning?
 
Just get a +3 tonight and if it’s similar to last night you should be fine to go to sleep.

Tomorrow we go ahead with the planned increase as long as he’s black or red. I would start with a +2 if you can get it — just to see if he’s going down much. Based on that number you can test in another couple of hours. If anything dramatic happens you can always test sooner. I do hope to see some movement, but we may not on the first cycle. Nico seems to like to do things incrementally.
 
Aside from what I read about hypo, anything I should look out for?
What could happen with numbers if they move? So I don't freak out in case. Cause I freak out easy. :/ Especially with my babies.
 
Aww, geez. So instead of his usual 7:30 shot, it will be at 6:30? I only wake up at 6, and that's just because of Nico yelling at me.
By the way, just took his +2 and it was 490. Down from his HI.
 
No. The whole point of that message os to show people how to gradually adjust their shot tomes so that they don’t wake up on November 2 and figure out that their shot time is going to be an hour off.
 
Good. At least no black yet. He’s doing a little better today on the new dose. We still have a ways to go, but it’s good to see the small changes.
 
Ok. Looks awful to me, but I'll take your word. Am I still doing +3 tonight? Or did you want +4?
And how about tomorrow? Start at the +2 again? Thanks!
 
Tyleete said:
Looks awful to me
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Well normally he would have been in black by now. And I am sure he will again, but we have to take baby steps unfortunately. If he doesn’t get better numbers soon, we can increase again. Some cats just need a higher dose than others in the beginning, but then they start going back down in dose.

He doesn’t have any inflammatory conditions (bad tooth?) or IBD or anything that might make him insulin resistant does he?
 
Hey @Tyleete I’ve been following along quietly and just wanted to reassure you that it is not at all unusual to see cats start out in higher BG numbers and stick there for awhile. Every cat is different, and it’s a process to figure out what each cat needs insulin wise. Slow, steady, and methodical wins the race, with lots of data collected to drive the dosing decisions. Sometimes we fast-track a bit given circumstances, but the rule of thumb is always to base the decisions on the data the cat is giving us and to be methodical, not impulsive.

You’re in excellent hands with @Suzanne & Darcy

Also, please know that once you reach a good dose, you’ll still want to track and monitor BG. It’s also not uncommon to find a “breakthrough” dose and after awhile at that dose, a cat’s body settles in and decides it needs less insulin. Meaning, you could conceivably work your way back down the dosing scale again at some point. It doesn’t happen with every cat, but it’s an exciting time when that happens. Anyway, like I said, every cat is different and I don’t want to put the cart before the horse, but I find it helps to understand the “big picture” of the possible trajectory of the disease, so I just wanted to toss it out there.

You’re doing a great job, by the way.
 
Suzanne & Darcy said:
Well normally he would have been in black by now. And I am sure he will again, but we have to take baby steps unfortunately. If he doesn’t get better numbers soon, we can increase again. Some cats just need a higher dose than others in the beginning, but then they start going back down in dose.

He doesn’t have any inflammatory conditions (bad tooth?) or IBD or anything that might make him insulin resistant does he?
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Nope, none of that known. He was just seen too & she tells me when their teeth need work.
But last night when I texted with the vet, side said 2.5 units twice a day is max to try with him. When I what were supposed to do after that, she said try a different insulin.😬
 
JL and Chip said:
Hey @Tyleete I’ve been following along quietly and just wanted to reassure you that it is not at all unusual to see cats start out in higher BG numbers and stick there for awhile. Every cat is different, and it’s a process to figure out what each cat needs insulin wise. Slow, steady, and methodical wins the race, with lots of data collected to drive the dosing decisions. Sometimes we fast-track a bit given circumstances, but the rule of thumb is always to base the decisions on the data the cat is giving us and to be methodical, not impulsive.

You’re in excellent hands with @Suzanne & Darcy

Also, please know that once you reach a good dose, you’ll still want to track and monitor BG. It’s also not uncommon to find a “breakthrough” dose and after awhile at that dose, a cat’s body settles in and decides it needs less insulin. Meaning, you could conceivably work your way back down the dosing scale again at some point. It doesn’t happen with every cat, but it’s an exciting time when that happens. Anyway, like I said, every cat is different and I don’t want to put the cart before the horse, but I find it helps to understand the “big picture” of the possible trajectory of the disease, so I just wanted to toss it out there.

You’re doing a great job, by the way.
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Thanks! I still feel like a monster sticking his ear so many times a day, but I've looked at other's charts and realize that 3x a day checks are still pretty much mandatory. Sucks.
My bigger worry is if he turns out insulin resistant, or if (&when with our luck) the 2.5 doesn't work either, Suzanne's & my vets advice are going to swing widely apart. If this doesn't work, my vet wants to call it quits with Prozinc. I actually trust the advice given here more, as my vet isn't as up to date on treatment for diabetes as well the knowledge here. But how to explain that to my vet.😅
She's an amazing vet, but doesn't like it when I seek answers from online groups instead of what she tells me.😒I had a cat dying and at the end of kidney failure, and went to this board called Tanya's. They ended saying all sorts if treats to give him, Yada yada. Have me the one thing worse than no hope, and that was false hope. :(
I was emailing her questions about what they were saying and all the tests. She finally just called me (this was at 11:30pm) and told me, "Sure we can run all these expensive tests costing over $1,000. But in the end the results will take us right back to where we are now. They don't know his particular case. Haven't gone through this step by step with him, and haven't watched his decline to see where we are now".
And I get it. But ever since, she's hated when I say I 'liked online' about a case or situation.😅
How do you know when to get off the Prozinc train and how much should a cat be given up to that's safe? I forgot to ask that above.
Right now I'm driving my family crazy. They want to go out and do stuff, and I'm just sitting here trying to track and treat Nico as best I can. We were supposed to go away on holiday the 13-15th, just a small trip to the beach. Due to $ and say health/conditions, we rarely get to go away. This would only have been our second holiday in the last about 12yrs! But then Nico got diagnosed and with all the testing, I knew that was out the windows. I am the only one hell even allow to pick him up. 😔
 
JL and Chip said:
Hey @Tyleete I’ve been following along quietly and just wanted to reassure you that it is not at all unusual to see cats start out in higher BG numbers and stick there for awhile. Every cat is different, and it’s a process to figure out what each cat needs insulin wise. Slow, steady, and methodical wins the race, with lots of data collected to drive the dosing decisions. Sometimes we fast-track a bit given circumstances, but the rule of thumb is always to base the decisions on the data the cat is giving us and to be methodical, not impulsive.

You’re in excellent hands with @Suzanne & Darcy

Also, please know that once you reach a good dose, you’ll still want to track and monitor BG. It’s also not uncommon to find a “breakthrough” dose and after awhile at that dose, a cat’s body settles in and decides it needs less insulin. Meaning, you could conceivably work your way back down the dosing scale again at some point. It doesn’t happen with every cat, but it’s an exciting time when that happens. Anyway, like I said, every cat is different and I don’t want to put the cart before the horse, but I find it helps to understand the “big picture” of the possible trajectory of the disease, so I just wanted to toss it out there.

You’re doing a great job, by the way.
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Question!
Nico eats at 9:30 which is +2, his smaller meals. But I'm supposed to do the BG test at +3. I know food shoots up their glucose. Should I still keep feeding at the +2, even when doing the BG test at +3?
 
Tyleete said:
Question!
Nico eats at 9:30 which is +2, his smaller meals. But I'm supposed to do the BG test at +3. I know food shoots up their glucose. Should I still keep feeding at the +2, even when doing the BG test at +3?
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I would proceed as normal, regardless of when you’re grabbing a test.
 
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