Sparks update

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Care4Sparks

Care4Sparks

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Hello,
Sparks went back On The Juice on 7/28 after a remarked change in behavior. (I hadn't tested him in months...)
At first his readings were very erratic but generally high. Went to the vet on 9/9 and got a new vial of ProZinc.
We hoped it would make things more stable.
He is still high, usually over 350 and often around 400. He's at 4u now, 3x day, and seems much more relaxed and happy but I am concerned about the consistently elevated levels.
Tonight I scribed in the last month of readings to the SS link on my signature.
Am I doing this wrong? Any idea why he is persistently high?

To my knowledge - no food stealing in the last weeks. Consistently getting 2.5 cans FF classic per day. Some exercise. Some dental plaque but had a cleaning in Aug'12.
Feel free to ask anything you might think will help and/or advise accordingly.

Thanks in advance,
Karen

p.s. We don't feed <2hrs before the BG test. Usually he gets ~1/2 can at time of shot and 1/4 can 'snack' after and as needed, but total of 2.5c per day. So the high numbers are not too-soon-after-food-related...
 
I can't see any current numbers. Did you start a new page or just continue on a few spaces down? Sometimes it works just to save it again and publish it again.

I am assuming the vet checked for infections? No change in litter box habits or food choices?

Cats do drop out of remission. The good news is that you know how this works, you are experienced at testing and you can get up to speed quickly.
 
Hi,
Thanks for the encouragement and trying to read Sparks' numbers SS. When modifying the sheet, I must have accidentally changed the permission. Does it work now? Most recent observations are at the top.
Sparks is getting insulin 8am, 4pm, and midnight. Last night's dose got skipped though due to human error. This morning he was over 500 :( but you will see he is usually hanging out in the pinks and reds.
I don't want to be too aggressive with the insulin, but because of his high numbers he's getting fairly large doses. By switching to 3x a day my hope was to get him more yellows and blues, but so far I'm not seeing much improvement (if any).

I'm working at home today so will try to get some observations between am and afternoon. Maybe next weekend I can do a full curve.
 
OK, the SS is just "upside down". Now I get it. ;-)

If you can get a few more +4 tests, you might be able to if Sparks is going lower in the middle.

Can you better describe the "marked changes" you saw when he relapsed?

12u per day is pretty hefty. I'm confused like you are about where the blues or yellows are.
 
We noticed him drinking some water from his water bowl, which he hadn't done in months (I add some water to each wet food at feeding). But it was a very hot day. And his "food obsession" had increased urgency. But he's always been a big eater.

The next day he woke me up at the usual time for breakfast, but seemed distant in his eyes. Then on the way upstairs not only was he walking, but he stopped at the landing instead of running to the food bowl. That's when it all came together for me, I tested and he was high :(
I wrote the following down so I wouldn't forget all the symptoms. Sorry to say I didn't put it all together faster
Change in Behavior
Obsessed with food, begging, stealing
Hanging out in new spots
Extra sleep
Drinking water
Quieter meows, softer voice
Change in gait
Change in Appearance
Dilated pupils
Poor posture (kind of hunched and tail low, instead of perky and tail high)

Luckily, he is still walking/jumping just fine. He poops (gets Miralax daily). He plays. The insulin immediately reversed the change in appearance and the gait.
But yes, I don't understand where are the blues and yellows?? It seems that things aren't improving which has me worried and wondering what else might help.
 
Sigh...
He stole a lentil chip while I was in the bathroom about an hour before the +4, BG = 516.
I'll take another at +6. Today might just be all mucked up between the lack of midnight dose and the stolen carb.
 
Other than the high AMPS today, the skipped shot should not have any lingering effect, just due to how Prozinc works. For the most part, what you see is what you get on a shot by shot basis.
Dosing TID should give you some overlap between doses. But it would still be logical to see a lower number around +5 or +6 after a shot, so yeah, where are they hiding?
I'm assuming your insulin is "fresh"?
 
Yes, we got a fresh vial from the vet on 9/9 because we wondered the same thing... the insulin is good. I have new test strips arriving soon (ADW) in case they are faulty.

Got stuck in work and missed the +6 but +8 is still 455. I gave 4.5u
 
Maybe this is partly a problem of the feeding cycle? Here is what he gets 90% of the time:
1/2c FF @ 8am with shot
1/4c FF "second breakfasts" ~20 mins later
1 dental chew (CET) for snack before OR after lunch {none today}
1/4c FF "lunch"
1/2c FF @4pm with 2nd shot
1/4CFF 'early dinners' - when he's freaking out while we're cooking
1/4cFF 'dinner' when we eat
1/2cFF at midnight with 3rd shot

I'd heard incremental feeding was good, but what do you think?
 
A bit of brainstorming here:

Were the teeth checked? They're a common cause of relapse.

How much does he weigh? Does his skin seem fragile? I'm wondering if he might have developed a high dose condition.

The dose going up - how big were the increases? (Ie, could the best dose have been unintentionally missed by increasing too much at a time?)

Would you consider trying a different insulin? Sometimes, the cat may become resistant to a specific insulin.
 
Teeth were checked visually in Sept - vet advised there was some plaque accumulating that should be scraped, but not until he's "stable."
In August 2013 he had a full sedation cleaning and had many (9) teeth removed due to dental resorption.

He weighs about 21 pounds. I will weigh him again when Eric gets home. At his lowest, during the first diagnosis when he had some muscle wasting he was 18 pounds. He is a big boy, but from above his profile looks pretty good (narrowing curve between lower ribs and hips).

We started at 3u but it wasn't seeming to help control the numbers so we moved to using a 'tight regulation protocol' chart. But that still seemed off so we questioned the insulin and went to vet for a new vial. The vet recommended 2u but we want to get readings at or under 350 and it seemed to not be enough. After 2 days Eric asked if that was doing him harm and due to the elevated numbers we agreed to raise it back up. Lately we've kept it at 4u because it seems to be an 'ok' response. Maybe that is my misunderstanding.

Maybe a different insulin would help... I am open to it.

Oh the happ-ier news, his PMPS was "only" 320 :) that's below 350!
 
To help prevent tartar buildup, lightly cooked chicken gizzards may help (if he'll eat them) as they're very fibrous.

My smartphone doesn't let me see the spreadsheet; are you using a sliding scale? If yes, the mid-cycle/nadir values will tell you how effective a dose is for a given range of pre-shot glucose level. That may help you tweak the amount you give.
 
I am confused along with everyone else. He is certainly high and flat. You don't have many nadirs, but the ones you have are high. There are some inverse curves but not radical ones, just high and flat. My only suggestion, before trying another insulin, is to try a smaller dose for two cycles to see if the numbers are any better. Starting at 3 units could mean overshooting a good dose.

You are consistenly testing for keyones at these high numbers?
 
Test idea 1:
In the AM, for 12 hours, test 1.0 unit and test about every 3 hours (a mini-curve). Also check for urine ketones, if possible.
Evaluate what you see. Did the glucose levels drop or go higher?
If they went higher, then in the PM, for overnight, test 2.0 units and check until bedtime, unless you're game to set a clock and get up to test on the 3 hour increments.
If the went lower, it supports reducing the dose.

Test idea 2:
Another test idea would be getting some Humulin/Novalin N insulin (inexpensive; no Rx in most states) to see if he responds to it. Test 1.0 unit and see what happens. If he responds to 1 unit of N, but not to 1 unit of ProZinc, you've determined that the specific insulin is the issue. Then you discuss with your vet about using Levemir or Lantus (stings at higher doses)
 
Thanks folks!

Good ideas.
Maybe we did go past his good spot, in our eagerness to get his numbers down.

I put a couple ketone strips on a fresh breeze pad this morning. Hopefully the order of test strips will arrive soon enough to try the reduced dose experiments. I'll look in to whether Humulin is available here without a prescription, too.

Next time I open a chicken, I'll lightly fry the gizzards. Sparks will love that :)
 
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