RISKY -- NEED SOME HELP!

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MarthaPaige

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Just checked Risky and his BG is too high for the meter to read. At 8:30 this morning before he ate or had his Insulin he was 520. Gave him 3 units at 8:30, he ate a little at that time but nothing since. I checked ketones at 8:30 and they were negative.
Just checked him at 12:30 (been 4 hours since Insulin) and he was too high for meter to read.

Past info..... diagnosed 4-5 months ago. Everytime he went to the vet his BG was getting worse so vet kept increasing insulin until he was at 8 units x2 daily and they wanted me to go up to 8.5 units. Last week is when Kim showed me how to test BG.... he was off insulin completely for 1 1/2 days at which time his BG was 298. With my testing every 2-3 hours, I started back giving him 1.5 units, x2 daily. His numbers were ranging in the high 300s to mid 400s. The only time his BG went near 500 was about 1-2 hours after his insulin/eating. Usually around 6 hours after insulin he tested around 400. Then he developed ketones and was in the hospital for 3 days. While at the hospital his BG was in the high 200s and low 300s. I know the first day or so they only gave him R insulin. When Risky was released this past Wednesday they told me to increase his insulin to 2 units. With 2 units his BG was in the mid to upper 400s. I then increased to 2.5 units and his numbers were better (still high) in and around 350-390. So since Friday I have been giving 3 units and his numbers keep increasing ... Friday ranged from 486 to the lowest of 395.... Saturday started out at 513.... the lowest it was all day was when I checked him last night before giving him Insulin and it was 427. This morning he was 520 and 4 hours later he just tested at TOO HIGH for meter to read. HELP!!!! Martha Paige
 
Well, we know that his numbers did not improve with increased doses (you have tried up to 8 units). Though you were not testing at home on the increased doses, the vet obviously was not getting any lower readings--thus the continued increase. From your data it does appear he does better on less.

It is interesting, that WITH an infection included (infections normally increase bg) your best numbers have been on--- no insulin and 1 unit.

It appears today could be setting up for an inverse curve. It has always been the train of thought that an inverse curve was the sign of too much insulin. It is important to continue to test the cycle today, so we can see if the numbers come back down at the end of the cycle (as the insulin loses potency). Prozinc "normally" has an onset of about 2 hours, so after giving the insulin the first couple of hours it is not unusual for the bgs to read higher and then you should see the values coming down. The nadir (lowest reading) "normally" occurs between +4 and +8, and then duration is what we are concerned with. Prozinc is a 12 hour insulin. Twelve hours after giving prozinc, it "normally" is out of the system, thus we start the cycle over. So, when you skipped a cycle and got your lowest readings---that makes me suspicious that the dose is too high.

Based on the above, if the body is fighting a dose too high, you normally will get your inverse curve's spike anywhere from +4 to +8 when the insulin is at "full strength", then the numbers will come back down. It will be interesting to see if you see this happen today. If the numbers do not come back down, other thoughts might come to mind. The tricky part is --when you get a Hi reading, you don't know if that is 601 or700--so, he could come down at the end of the cycle and still read Hi, but it would be lower. As we increase insulin to counteract these high numbers that are caused by the "body" protecting itself from too much insulin--we create a vicious cycle--more insulin..higher number...more insulin...higher numbers, and so on.

I am not sure this is what is happening---BUT, it very well might be. We all thought you needed to start back at 1 Unit, but due to the illness we had to increase the dose....the question is, have we created the cylce again? I am not brave enough to encourage you to decrease your dose until the infection is totally clear. We don't need ketones again. But, my thinking is, that once the infection is clear--you might need to reduce back down and start over.

I am sure you have told me, but I don't remember and I am certain the group would like to know.....what was Risky's starting dose of Prozinc when originally diagnosed?

Please don't listen to me alone on this........what do the rest of you think?
 
Yikes, it seems that the 3 units isn't enough, I think I remember from another thread there was a few who thought you should go to 3.5u so maybe that should be your dose tonight and see if that is any better.

I hate to see you climb the dose latter so quickly again but as long as he is still eating the dry higher carb food you will have to counteract it with more insulin.

I hate to be a nag but the sooner you can convince him that the wet low carb food is food the sooner we can get a handle on his bg's.

Hang in there.
 
Like I said :lol: .....don't listen to just me! We really don't know what is going on.....but, the more opinions we get, even if differing, the better shot we have at getting Risky in better numbers.

I will add one more thought....we don't know how long the infection was present, so that could have been keeping the increased doses from working--so maybe an increase is warranted. But, today appears to possibly be an inverse curve setting up. Keep testing!
 
Kim, great points, can you help her set up a ss. My memory from day to day isn't what it used to be, I need a ss to look at to see the patterns.
 
Oh BOy! poor Risky....I was kinda thinin along the same lines as Kim...
Unfortunately Risky got sick so you had to up him kinda fast, but what if the
ketones were from him being on too much insulin for awhile...
Ketones comes from sugars being too high...right...
I would wait and keep checking today and see what his +12 is....
if he comes down , if it were me, I think I might reduce a little to see what happens tonight
How is he acting...is he eating...if maybe you could not feed him that dry food tinght and
try the wet again maybe that would help...
Just trying to come up with different ideas to help
 
Saint Sue ...where are you????

Martha needs SS help!!!!! I will help, but Saint Sue has done both of mine--not sure I know where to start! Where is the link to the set up?
 
I know it doesn't take much dry to spike the numbers, but Martha said she is feeding very little dry. He is mainly eating Tuna. Marcy posted a thread once that talked about "needing some carbs" and the effect of the body producing sugar when it didn't get enough. That has crossed me mind, but I don't think it is what is happening. It was a Think Tank discussion. I am going to see if I can find it.

Marcy, if you come around, will you share it with us again please?

Thanks!
 
I don't know enough to really offer a dosing suggestion and I haven't really studied the history here but I did read something about his numbers before & the first thing I thought was too much insulin. That's the first thing that came to mind when I started reading this today. I did not take the time to carefully read all of Martha or Kim's post and I am probably missing an important part of the puzzle. Don't listen to me by any means, there are others that have a better grip on this dance.
 
Some general thoughts in case any of this helps you clarify things (some of this repeats what others have said):

1) If you reduce the dose, I would not go as low as the dose where he got ketones. Ketones are from a lack of insulin rather than high numbers per se, so (as you have seen I imagine) a higher dose and crappy numbers may still be preferable (from a ketone perspective at least) to a lower dose and moderate numbers.

2) From what I am reading, it sounds like the numbers have improved (PSs and nadirs getting lower, and general U-curve pattern) as you went from 1.5 up to 2.5 units. Then when you went to 3u, the numbers got worse (PSs and nadirs higher, and possible inverse curve setting up). Is that correct? It is hard to say for certain without seeing the numbers in a SS, but that is my take from what you posted.

So I see a couple possibilities:

One is that 2.5 was a good dose and 3u is too high. The problem with that is that the numbers were not good on 2.5, and while you can try something like 2.75, it's hard to imagine that you would get perfect numbers on that. I would lean more toward this approach if he were eating LC canned. With dry food, their insulin needs tend to be higher. High numbers today could just be if he ate a little more dry food today.

Two is that the dose is just too low and you need to keep raising. The problem with that is that you've been as high as 8u before :shock: and weren't getting results, so hmmmm.

So what to do? I don't have any brilliant ideas, but here are my thoughts:

1) Get to LC canned if you can (and test a lot / reduce dose as needed if you are able to change). With Bix that made all the difference (and he was a really hard sell, it took several months of trying before I convinced him).

2) Contact the ER vets, since they got the best results you have seen, and ask them what to do.

3) Consider switching to Lantus or Levemir. You've been on this one for several months, raised the dose, lowered the dose, and no good results. I think with dry in the mix it will be a fight on any insulin, but you may find that a longer-acting one makes things easier.

4) Consider using R as a bolus (? is that the right word) to bring the numbers down. There are several who have done that (not me) and if you want to try that we can try to find some peeps who can advise you. It requires a lot of testing, and awareness of when each of the insulins has it's onset, peak, and wearing-off (duration) so you can use them together safely. With ketone-prone kitties, sometimes people use that when they are building up a dose (especially during an insulin switch) to get the numbers down until the regular insulin gets to a high enough dose that it will work effectively on its own.

5) Consider something like TID with PZI. Daunting and I'm not sure that's the best choice, especially w/o being able to see the specific numbers you have, but it's a possible option. Kim has had a lot of success with it, and a couple others here as well.

If the primary obstacle appears to be food switching, I would post here and on Health for ideas, and read everything you can in the Health links and in Dr. Lisa's stuff about tips for switching if you haven't already. Most cats, even the most difficult, can be switched from what I have read, and my own experience, it's just a matter of finding what trick works for each cat.
 
One more thing that I want to throw out.....when we see a cat that is receiving high doses one of the first things we think of is "other conditions" ...insulin restistant, Acro, etc....But, I do not think that applies here. Risky responded to the R insulin and everywhere that I have read, that is the "quick test" to rule out those conditions. If he will resond to the R, then he should not be a candidate for those conditions.

Just wanted to put that out there. Maybe I am wrong, but that is my understanding.
 
Oh did I misunderstand and he's not eating dry? Just straight tuna? :shock: Can you feed a tuna-based food? Trader Joe's makes one (it's disgusting looking let me warn you) that is lower carb and their prices are good too, if you have one in your area. There are a lot of health problems they can develop from eating just tuna, so I would go for something more balanced asap.

Not sure how to approach the dose in that case. Was the 8u on dry and now the food has changed? Can you explain the food/dose/ketone crisis timeline for clarity, i.e. has there been a food switch and when along the timeline?
 
Re: RISKY -- 2:30 update

Risky is mostly eating straight tuna/water combined (I'm assuming Tuna has 0 carbs). He probably eats 2 tbsps. of Fancy Feast dry (daily) to give him a little carbs. Vet told me it was VERY IMPORTANT for him to eat while getting through this infection. Risky will not even smell of the FF canned and won't even eat the Science Diet which is what he was accustomed to eating. He is not free feeding any longer. I feed him when giving Insulin and will mix a little of the FF dry in with the remaining Tuna so he will eat. He was given insulin at 8:30 this morning.....4 hours after he was HI..... now, 6 hours after he is 592. He has eaten some Tuna/water (no dry). I will keep checking every 2 hours. My instinct is to cut back but I'll keep checking/posting his BG. When he was initially diagnosed they started him on 2.5 units and have kept increasing .... his last check about 10 days ago at the regular vet showed his numbers still high so they told me to increase him to 8.5 and that is when Kim came into the picture :razz:
 
The 8 units was on dry (Science Diet). Risky was free feeding and eating a little Tuna while on the 8 units.... No, there isn't a Trader Joe's any where near...... Yes, started switching diet when I lowered dose about 10 days ago. Risky loves baby food (will even eat it out of a baby spoon :lol: )..... is there a meat flavored baby food that is real low in carbs.
 
The problem with both baby food and tuna is they are so imbalanced. Ok for treats and stuff (I think the baby foods are low carb? maybe someone else will know - be sure no onion is added, Gerber is safe but check the label on anything before you buy, I think onions are toxic for both cats & dogs? some baby foods add that, I have no idea why babies would like onions but whatevs).

It's 2 tablespoons of the dry? That's probably enough to send the #s skyhigh, even 2 teaspoons I think is enough. Definitely though eating is the MOST important of any of it, so if that's all he will eat you have to go with it til you can improve on it.

ideas:

- Wellness chicken or turkey is closer to baby food than some of the other foods - my cats loved it, and also loved baby food (ok, they all love baby food!!!)

- Some have found if they put the canned food with some water in a blender the kitties like the consistency

- any tuna flavored cans, maybe stay away from FF if he doesn't like that, but I think there are several other brands that make tuna, some in pouches, so in small cans, and some may have more the consistency of tuna so maybe he would like that - even if you get him on a higher carb canned food, that may be an improvement over the dry, and may be a stepping stone to lower carb canned

- I don't know the carb level of the FF dry (I didn't even know they made dry! ohmygod_smile ), but maybe try going with the lowest carb dry that you can if he is eating well on dry food? So maybe EVO, or DM or m/d are the lower carb ones I know of. I have seen some newer brands at Petco that say "grain free" on the bags, so in theory they might be lower carb also and worth trying.

- if you like a challenge, some make their own food - you can add things to baby food or tuna to make them more balanced. I don't know much about it, but I'm sure there is info around.

- tuna is addictive, so I would probably lean towards baby food over tuna - my fear is the more he gets used to those things, the harder it will be to get him to eat something else - I don't recall the details of "tuna addiction" but I recall reading about it years ago...

Did you already check out the Tech forum for the SS? There are instructions there that might help too...
 
My feeling is that the dose is too high as well. Ketones aren't simply not enough insulin-coukd have been caused by the uti as well.
 
dang, late to the party....
Just so you all know, for the next week, I'll be working the "night shift", from 2pm till 10pm. So any emergencies or crisis need to happen AFTER then, okay? ;-)

I'm thinking the dose is too high, and maybe going back to 2.5 for at least 3 or 4 cycles will prove that?
I also had no idea that FF make a dry food, but the sooner he kicks the crack habit, the better. The problem with dry, beyond the carbs, is that it tends to stick with a kitty longer than the wet does, so it'll cause wonky numbers for longer, and just confuses things.

As far as Tuna foods. I've got a lot of experience with the various store brand tuna varities. The ones I've used are FF, Friskees, and 9-Lives. Already mentioned is the danger of feeding just tuna and seafood. Just like people, cats can't handle that much tuna. Mercury levels and all that stuff. I've been pushing them on Bob somewhat, because the seafoods tend to contain more postassium, and that's an issue with Bob. But it's a fine line between enough and too much. If Risky is only eating "human" tuna, that's too much.

I'd suggest trying to mix the tuna in with other meats, like turkey or beef. Maybe as long as it smells like tuna he'll go for it. Maybe even just pour the juice/water from the can over other wet canned food? Or, try buying Beefeater freeze-dried treats from Petsmart, and crushing it to powder over canned food. I've tried the shrimp, salmon and chicken ones, and they all really stink (but apparently the smell works for cats, because my two will knock me over to get to their bowls once I sprinkle on the treats powder). The salmon, naturally, smells closest to Tuna.
Of the three brands I listed, I think the FF tuna is okay, and that's what I try to use mostly. But it doesn't look like, or have the texture of the other brands. The 9-lives tends to be really watery and loose. It's also hard to find just tuna. usually I would have to buy the tuna and egg, or tuna and cheese. The Friskees pates tuna flavors tend to resemble human canned tuna the closest in terms of texture. They all stink like hell! All are really low in carbs (1-2%) I think.

Carl
 
Martha,
the real problem with a kitty that throws off ketones and wants to march to DKA, is balancing the insulin with the BG#'s and ketones. It does seem as if he DOES better on a lower dose but the fear is, is it too low to offset everything else.

Personally I would use R to bring his #'s down. In CA you can buy without a RX, not sure about NC? R is a quick acting insulin (what they used in ER) that fights the high #'s AND ketones. You need U100 syringes with it, but I believe both can be purchased at WalMart.

So if he is receiving 3u pf prozinc x2 .... I would give him 2u of pzi and 1u of R x2 .....

I know you travel some but I would also consider trying t.i.d. for awhile, at least until his #'s come down.

No ketones is a huge advantage in all of this. Where as the purpose of ProZinc is to last 12 hours, the purpose of R is to attack the #'s and ketones quickly, so it's duration is usually 2-4 hours.
 
Re: RISKY -- 4:30 update

Risky today:
amps -- 520
gave 3 units and Risky ate a little dry food
+4 -- HI (too high for meter to read)
ate some tuna/water (no dry)
+6 -- 592
+8 -- 496

I'll keep posting the numbers every 2 hours......

THANKS!!!! I'm reading all the posts and just trying to comprehend it all :shock:
 
I'm by no means an expert, I'm still trying to figure out my own kitty. But I have to agree with the dose being too high crowd.

Lucky was having those BG jumps between +8 and +10 and then his PS would be lower. It's not always hugely drastic either but it left me scratching my head. I'm doing a lowered dose test right now. The risk of DKA is scary when dropping dose so I'm not going to suggest doing that. I'll let others here suggest what to do! Hope you get it figured out soon and get Risky to accept that wet food will make him feel better ;-)
 
You don't have to be Catholic to be a Saint in my book....just good helpful people! So you have earned the name Saint Sue! :mrgreen:

It has a good ring to it!
 
Dang. I was hoping Risky was seeing numbers in the other direction.
I like Nancy's suggestion of adding R to bring Risky into better numbers. The FF dry is still pretty high in carbs - 28%. Better than than the Science Diet....but still pretty high. With the recent ketones I'm very hesitant to reduce Risky's dose.
You're doing a great job, Martha!!!
 
bookw0rm said:
My feeling is that the dose is too high as well. Ketones aren't simply not enough insulin-coukd have been caused by the uti as well.
Click to expand...

I should have been clearer - ketones (as I understand it) are caused by too little insulin combined with another factor, either infection or not eating enough (or both), so not simply too little insulin in and of itself. But the distinction I meant to point out is that it isn't high #s per se, it's too little insulin, so we have seen cats before that get higher #s on a higher dose, however, no ketones, and then lower the dose and get improved numbers, but also get ketones.
 
Just thinking, what if it is not enough insulin for the food that he is eating?

could be inverse, but it could be the food...

sorry but I havent been able to stop thinking about Risky...
keeping everything crossed he is able to get off the dry and his numbers start looking better
 
Just got a text form Martha.....+10 is 410

If there is a such thing as an inverse curve, this has to be it.......

We have always said here that an inverse curve means too much insulin.....The +4 was Hi (abover +600--that would be at peak insulin) now at +10 as the insulin is wearing off he is at 410.

I am scared,I admit it.....but, if I have ever seen an inverse curve since posting here, this is it.

Thoughts? She needs to shoot in 2 hours. I have money on his PMPS being in the 300s.
 
Nancy,
if you were going to throw R into the mix, what would the 24 hour shooting schedule look like? What type and when?
 
Re: RISKY -- 6:30 update

BG is 410.... the lowest it has been all day. Risky has not had any dry food since a.m. He ate about 2 tbsps of tuna (leftover) during the afternoon.... at 6:30 after testing, he ate some more tuna. I will test again at 8:30 and post numbers at that time. He is due for insulin between 8:30 and 9:00.... I'll wait to see what everyone says before I give next dose. I'll work on the food issue this week :sad:
 
Re: RISKY

I am scared to give R insulin tonight because all of you will be asleep and the vet's office closed..... I would rather wait until daytime when I can get hold of someone if there is a problem.....
 
Okay, so assume the +4 spike is the carbs. But, doesn't the dry hand around longer than that?

:dizcat
 
I didn't really understand this...but after some afternoon conversations...if I understand it correctly, the only difference in R and long lasting insulins is the R has not had molecules added to make absorption slower. It acts immediately, whereas Prozinc has gone through a process that allows it to be absorbed slower and longer.

But, I don't blame you for waiting until tomorrow.
 
Okay. Logically...
His bg continues to drop. Can be explained by food not boosting it. But there shouldn't be any insulin still on board, right? He is eating tuma, which has like no carbs, but would still give him some rise. If his bg is lower at +12, why would that be?
Carl
 
Sue, trying to figure out how to get to the PM..... I hate being so new at all this !!!!

Okay, just thinking/simplifying....... We're trying to decide if Risky needs more or less insulin. It seems to me that past experience with the local vet going up, up, up on the dosage and his BG numbers not getting any better indicates he was either getting too much insulin OR he needs another type of insulin. Since I have been testing (the past 10 days), his best numbers were when he went without insulin for 36 hours..... I realize that food is a problem but I'm going to have to work on that as he is awfully stubborn (imagine that!) So my gut tells me to go down to a fat 2.0 tonight and lets see what his numbers are during the night. I am heading back to the NC mtns. on Thursday as Risky has a vet appt. on Friday morning. The vet wants to see his numbers from a week. The vet did say that his numbers would be higher due to the infection/antibiotics ... I need a nerve pill.
 
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Carl, my understanding of why the bg continues to drop is the body (liver) dumped big time to the dose this morning for protection and now there is no insulin, so no need to dump again....until she gives the dose (too much) and then the cycle starts over.....

Martha, I wish the infection was gone and we knew it was clear before reducing a lot...You don't have a lot of choices--either increase (that hasn't helped), stay the same (terrible curve today) or decrease (you had better numbers, but ketones due to infection and lower insulin)----if you do decrease....test, test, test the bg and for ketones. If the ketones show up, you have the R and Nancy knows how to incorporate it into the equation to help with the ketones. You might want to get a blood ketone meter.

Hopefully you will get some additional input before shooting!
 
Oh get him off any of that FFeast dry stuff as quickly as possible even if you have to mix it with some other dry for a few days. It's 'smell' coating molds if you leave it undiscovered under the food bowl for 2 days. I'm not sure of the formula to figure carbs but Ocean Whitefish and Salmon FFeast dry is 32% Protein, 16% Fat, 4.5% Fiber and 10% Moisture. I got a small bag when I used to use it as a treat for this crew - most of my cats loved it but, in my opinion, it's not a good food. I won't even use it for treats any more.

You're doing wonderfully - keep it up! BIG hugs from all of us,
 
Have we told you about FortiFlora? It is magic for some cats. It smells good and has the "additive" stuff from dry food. Some cats aren't interested - some love it sprinkled on food.

Sometimes you can get it from your vet, sometimes you can buy it from the vets at PetSmart. If neither of those work, yup can order it online.

Have you found a source for Evo?
 
Re: RISKY -- 8:00 p.m. update

I admit I am impatient. I went ahead and tested Risky at 8 p.m. BG was 425 (slightly up from 410 at 6:30) could this be due to his eating tuna around 6:30????? He has had no dry food. So what is your final opinion on what dosage to give tonight????
 
To me those two test are not different....there is a 20 percent variance in test...so, they are not that far apart. Test again in an hour before dosing and let's see what it is.
 
Martha, if you want to try the FortiFlorta to see if he likes it or not before you buy a whole box I can send you a couple of packets to try, let me know.
 
Not sure about the Baytril, but he was getting it in the ER and it didn't spike his numbers. You could post on Health and ask, someone in that forum probably could tell you.
 
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