Roller Coaster Readings

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I agree with Kris. It looks like the 2u dose might still be too much for him right now. Dropping to one unit might not be enough, but right now we just need his numbers to stabilize instead of swinging from 67 to 600! Once he's a little steadier we can start to figure out what he really needs.
 
And as I've been thinking about this, I have a zillion more questions...:bookworm::smuggrin:

Is he indoor only, or does he go outside? Are there any other pets in the house that eat different food?

Also, have you been home testing ever since his diagnosis? I just re-read your intro and was wondering about his journey up to 4u and if he's ever had stable numbers? Did he swing up and down dramatically like this even in the earlier days of his diagnosis when he was on a lower dose?

How did your vet decide on the increases? fructosamine test? in-office curve? at home curve?
 
Whew, I'll try to answer your questions. He is indoor only. The only time he goes outside is with me, on a leash. I have two other fur babies, a brother/sister duo named Rosie and Buddy. They eat with him in the mornings, and get their own snacks separately through the day.
I took him to the vet for routine exam in August. He was very heavy (21 pounds!) and we put him on a diet to help him lose weight. Suddenly in October he started dropping weight way too fast, as well as peeing all the time, even missing the box a couple of times. I took him in and he was diagnosed with diabetes, and put on 1 unit of Prozinc twice a day. The vet told me to bring him back in two weeks to check it again. When I brought him back, at the nadir for testing, he was almost 600. (It must be noted that even the small dose did benefit him greatly...feeling better, weight loss stopped, more energy, etc.) I suggested home monitoring, the vet disagreed, saying it can be "inaccurate". Upped his dose to 2.5, said come back in two weeks. I did...it was still in the 500's. So he upped it to 3 units. At this point I decided to take him to a cat specialist in Omaha. She encouraged home testing and worked with me on getting some curves, staying in touch via e-mail. We discovered the swings with my home testing. It got upped to 3.5, then 4 units. She thought "perhaps" his pancreas was kicking in and out of working, but no real solutions. That's when I turned to this page. Any more questions? :cat:
 
I think he’s spent the last 2 days bouncing from that green. I’d keep the 1.5 u dose for another day. Try to get a before bed test tonight.
 
Yes, it looks like he might be settling down higher than I was hoping, but at least he's settling down. How many hours between his PM dose and your bedtime? I'm wondering if you can get a +3 or +4 before bed without being exhausted for class the next day? If so, it would be great to get a peek at where he's heading with the 1.5u dose so we can have a game plan for the weekend. If that's too late for you though, no worries. Teaching is hard enough without adding sleep deprivation!
 
Djamila said:
Yes, it looks like he might be settling down higher than I was hoping, but at least he's settling down. How many hours between his PM dose and your bedtime? I'm wondering if you can get a +3 or +4 before bed without being exhausted for class the next day? If so, it would be great to get a peek at where he's heading with the 1.5u dose so we can have a game plan for the weekend. If that's too late for you though, no worries. Teaching is hard enough without adding sleep deprivation!
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+ 3 hours, and it is 354. Woo hoo!
 
Okay, so now my next question. We appear to have thankfully reached a point of stasis; red for the last three days. But obviously these numbers are still to high. What can I do to try and get the numbers down, and what would be a good goal to aim towards number-wise? Thanks!:bookworm::cat:
 
Lots of guesswork involved because dosing is based on the pre shot BG as well as how low he’s going. I suggest you do a full curve tomorrow and we can take it from there. If you can’t get mid cycle data on work days you need to try hard to get at least a before bed test.
 
The next step is to start slowly increasing, but as Kris mentioned, we need a peek at a couple of mid-cycle numbers to know how much. Will you be home tomorrow? Could you grab a couple of tests in the +4 to +7 range? (or do a full curve if you'll be home through the cycle).

There are two ways of thinking about that - one of is to do the curve first, and then check in before the PMPS tomorrow evening. The advantage of this is that if the mid-cycle numbers are over 200, you can change the dose more, and if they are under 200, you change the dose less. So knowing first can help make a better dosing choice. The other option is to make the dose change in the morning and then monitor through the whole cycle (so you'd need to be home through the day) in order to make sure he stays safe. Given how high and consistent your PS numbers are, I think either option is okay. The first option has some advantages, but delays the increase until Saturday night, and many people don't like increasing at night because you have to set an alarm to check on the impact. Or wait until Sunday morning and then you only get to see two cycles at the new dose before you go back to work. The second option lets you make the change sooner, but there is a little risk and the change wont' be as targeted.
 
Did his curve today; still consistent in the 400's. We even went outside for a walk and had some exercise. I had hoped that might help bring the numbers down a bit...nah.
 
Seeing a little bit of a "swing" today with the change in dosage...a nice 293 this afternoon, and an obnoxious 569 at 9pm.
 
Oh, that is not pretty. I'd hold the dose tomorrow morning, and then if you can get a before bed test (+3 or +4), increase to 2u tomorrow night.
 
So why do I withold the dose in the morning, as his sugar is high? And why would I increase to 2u tomorrow evening? Just wanting to know the whys.
 
Sorry hold the dose, not withhold the dose. I'm so glad you asked for clarification! I meant that I think you should keep the dose the same in the morning.

The reason to keep it the same is that you aren't home during the day to test and it's best to only change doses when you can monitor to make sure if the kitty has a strong initial reaction you can keep him from going hypo.

The reason for increasing tomorrow night is that the mid-cycle number today is too high still, and the big increase at +2 tonight both indicate that the dose is too low.

We had you lower the dose just to stabilize the bouncing, but now we need to start increasing again to get into some better numbers. The hope is that the small steady increases will get you into better ranges without setting off those wild swings you were seeing before. If Ringtail starts swinging from blacks to greens to pinks to blues again, then we'll need to slow down the increases, but I'm hoping that every three to four cycles will be okay.

And always always ask when we say something that doesn't make sense! You never need to feel badly about asking for more information!
 
THAT does make more sense...it's late, so, yeah...so I will keep it at 1.75 tomorrow morning, then increase to 2.0 tomorrow night, and monitor closely.
 
First day with 2.0...not too bad, I guess. No spikes, and a reading in the 300's this evening. I'll take another reading around 10pm.
 
Not amused at an AM reading of 600+ this morning...I thought things were mellowing out into the 300's. This is so frustrating!
 
That is really surprising. Thank goodness the weekend is almost here and you can get some mid-cycles to see what's going on with this dose. It seems unlikely that he went too low overnight, but anything is possible with these kitties!
 
One thing when you get a number that's really surprising like that is to do a second test. I got a HI the other day and nearly had a heart attack. When I retested it was 121. Sometimes there's a bad test strip, or having too much or too little blood on it can make a false reading as well.
 
I know it sucks, but his SS actually is way better than before when you had lows and then soared back up. It's steady and you'll DEFINITELY get him there with those increases. We know he CAN go down with the insulin, we just have to help him figure out what's a good dose.
 
Okay, I have Ringtail's latest numbers. It actually looks like his numbers looked better at 2.5 than they do with a higher dose...what's up with that?
 
AmFon said:
Okay, I have Ringtail's latest numbers. It actually looks like his numbers looked better at 2.5 than they do with a higher dose...what's up with that?
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You're still trying to get to a good dose range. I'd stick with the 3 cycles then increase by 0.25 u for now. You have a bouncy cat and that makes all this harder. Have you been testing his urine for ketones?
 
Kris & Teasel said:
You're still trying to get to a good dose range. I'd stick with the 3 cycles then increase by 0.25 u for now. You have a bouncy cat and that makes all this harder. Have you been testing his urine for ketones?
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No, I have not. How do I test for ketones? This morning's reading was 540; he was in the 500's all day yesterday.
 
Ketone testing is super important...and it really isn't as hard as it sounds. There's lots of tips and tricks to help. :)
 
Forgot to mention-on the day you see the recent 600+ reading in the evening, he had a rabies shot about 4pm. Could that have elevated his readings?
 
I dont' know about the rabies shot itself, but going to the vet can definitely raise their BG!
 
AmFon said:
High readings all day today...not a happy camper.
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Go to 3.25 u and keep it no longer than 3-4 cycles. If no improvement go to 3.5 u for 3-4 cycles. Don’t hold an ineffective dose any longer than that because glucose toxicity can take hold. When yellows and blues appear regularly you can slow the rate of dose increase.
 
Here are Ringtail's latest numbers. Had to drop back to 3.25 for a bit because I could see a "swing" developing ( 60 at night, over 600 the next day). Had to see the vet to get insulin. She wanted me to jump him back up to 4.0 right away...um, that's how he got such bad swings to begin with!? She doesn't seem to understand the incremental increases. Neither did the last vet...should I look for yet another? I have to have a vet to get the insulin.
 
AmFon said:
Here are Ringtail's latest numbers. Had to drop back to 3.25 for a bit because I could see a "swing" developing ( 60 at night, over 600 the next day). Had to see the vet to get insulin. She wanted me to jump him back up to 4.0 right away...um, that's how he got such bad swings to begin with!? She doesn't seem to understand the incremental increases. Neither did the last vet...should I look for yet another? I have to have a vet to get the insulin.
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You did the right thing in dropping back to 3.25 u regardless of what your vet said. You have a very bouncy cat who might do better on a depot insulin like Lantus. You might want to ask your vet about that. If you like this vet for other pet care no reason to switch. Most don’t know about or recommend what we do here - tiny increases, etc.
 
Wait, so you gave him his shot two hours late? On your spreadsheet it looks like it was on time. If it was late, can you shift the numbers over so someone looking can know you shot late? (if I understood that correctly).
 
Djamila said:
Wait, so you gave him his shot two hours late? On your spreadsheet it looks like it was on time. If it was late, can you shift the numbers over so someone looking can know you shot late? (if I understood that correctly).
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Yeah, I gave the shot two hours late, since I could not give it with that low number.
 
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