Very Steep curves

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Papa Stark

Member Since 2014
I think Snow might be bouncing from an overly aggressive shootist at the beginning of the week, and the last three days he's given me the sort of numbers I don't like at all. Even more than the high numbers, I'm concerned at the big difference between his last two mid-cycle tests and the preshots.

9/24
PMPS 323 (2.5u)
+9 179 (Gave 1oz plain baked chicken)

9/25
AMPS 535(!) (2.5u)
+6 210

Could 1 oz of regular old chicken really shoot him up over 350 (give or take) in just three hours?
 
Good afternoon!

I don't know if this is the guilty culprit but wanted to let you know - check the chicken package and see if it contains a sugar solution as preservative. If you see nothing noting preservative then it is likely they used 3% sugar solution. Since sugar is considered natural, many don't note it - if they use something else as preservative, they must note it. I finally discovered this when suddenly KT's numbers started going up every time I fed him chicken - the store started sourcing their fresh chicken from another company but kept it in their same 'generic' packaging. Even 'organic' chicken uses it often. This is the same reason that extra sweet kitties shouldn't eat Thanksgiving turkey - almost all of them use sugar solution. One of the freeze dried chicken treats started sourcing human grade chicken which spiked him too. Their packaging just says "carefully sourced chicken"...ruined my buying cheaper fd dog treats for him.

HUGS!
 
PMPS is 104. I'm thinking he was bouncing from the Monday shoot and is bouncing back. I'm thinking to hold the shot to 150 and give him a smaller dose (1.5u).
 
You've only been doing this a few days and I'm seeing lots of bouncing and lots of low numbers. I agree that a dose reduction is in order. I would actually suggest going down to an even lower dose, like 1u, for the next couple of days till the numbers calm down. If you haven't seen it already, here's the Protocol for ProZinc (they actually recommend starting out with .5u BID, but since Snow was in DKA, the 1u might be a better idea). Are you testing for ketones regularly?
 
I agree with Kay - lots of bouncing. Shooting 2 units at 68 is too much insulin on a number too lw to shoot; shooting 2 units at 400 makes more sense. You could either lower the dose to maybe one unit or 1.5 overall and see if the bouncing flattens. Or you could shoot 2 units at those high preshots, lowering the dose to one unit for the 200s and not shooting under 180 but instead stalling (Wait 20 minutes without feeding and retest. If he rises and is close to 200 or above, then dose but a little less than you'd normally shoot )


Tonight, I wouldn't shoot under 180 and then maybe .5 or one unit at most.
 
KPassa said:
You've only been doing this a few days and I'm seeing lots of bouncing and lots of low numbers. I agree that a dose reduction is in order. I would actually suggest going down to an even lower dose, like 1u, for the next couple of days till the numbers calm down. If you haven't seen it already, here's the Protocol for ProZinc (they actually recommend starting out with .5u BID, but since Snow was in DKA, the 1u might be a better idea). Are you testing for ketones regularly?
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Testing for Ketones a few times a week, when we can - it's tricky since the little blighter's decided that he's apparently pee-shy. So far we're okay *knocks on wood*
 
If the budget permits, and especially if he has ever had ketones, the Nova Max meter can test blood ketones.
 
Oliver would never let us watch him pee. We ended up buying aquarium gravel and putting it in a clean box and leaving him in a room with it. He has the christen the clean box so he went, then we could swoop in and get the sample, as it wouldn't be absorbed in the gravel.
 
BJM said:
If the budget permits, and especially if he has ever had ketones, the Nova Max meter can test blood ketones.
Click to expand...

Have you found that the ketone readings using this Nova Max are pretty accurate? Just curious as I've been unsuccessful trying to get a ketone reading using suggested conventional methods.
 
Sue and Oliver (GA) said:
Oliver would never let us watch him pee. We ended up buying aquarium gravel and putting it in a clean box and leaving him in a room with it. He has the christen the clean box so he went, then we could swoop in and get the sample, as it wouldn't be absorbed in the gravel.
Click to expand...

Clever! I'll have to try something like that.
 
Altho' it's not the best solution, you can dip ketone stick in the litter where he peed as long as you can get the end wet. One of my cats became ketonic, I'd been doing this dance long enough that I decided to check that method while I had the chance. He WILL 'pee on my stick' so did fresh test then compared 'litter dipped' stick - they read the same each time I checked. Again, it's NOT the best way but it's better than not being able to do it at all!!

HUGS and good luck! Aquarium gravel or plastic beads are by far a better method...
 
It looks like he is still bouncing again this am. IMHO, I would stop shooting under 180. The 1.5 on 151 looks like a bounce producing dose, so the goal is to shoot lower than that. The concept of bouncing is that his body is used to the higher range he has seen lately, so when he gets a green, the liver panics and releases extra glucose, causing the number to bounce up. It is this phenomena that causes the high amps, not too little insulin.

What would you think about going back to one unit, shoot it consistently for 3 cycles (unless you get under 180) and then, if the numbers are too high, increase by .25. It is so much easier to increase slowly, based on your data, then to try to figure how much to reduce.

As frustrating as it can be, this is a slow process. He didn't become diabetic in a week; you can't get him in remission in a week. I think it is best to go slow and steady, avoiding bounces, keeping him in safe ranges until his body learns how to best utilize the insulin and new diet.
 
Sue and Oliver (GA) said:
It looks like he is still bouncing again this am. IMHO, I would stop shooting under 180. The 1.5 on 151 looks like a bounce producing dose, so the goal is to shoot lower than that. The concept of bouncing is that his body is used to the higher range he has seen lately, so when he gets a green, the liver panics and releases extra glucose, causing the number to bounce up. It is this phenomena that causes the high amps, not too little insulin.

What would you think about going back to one unit, shoot it consistently for 3 cycles (unless you get under 180) and then, if the numbers are too high, increase by .25. It is so much easier to increase slowly, based on your data, then to try to figure how much to reduce.

As frustrating as it can be, this is a slow process. He didn't become diabetic in a week; you can't get him in remission in a week. I think it is best to go slow and steady, avoiding bounces, keeping him in safe ranges until his body learns how to best utilize the insulin and new diet.
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I had a similar thought, but yeah, I think I was making just that mistake... trying to work my way down rather than going down and working my way back up. I can't believe we've only been at this for two weeks. It feels so much longer. :P

By a cycle, do you mean a 12-hour shot-nadir-pre-shot cycle (so 3 shots worth) or a day cycle?
 
Hi there,

I was a Lantus user, so I can't help you with Prozinc dosing. I did see your last question, though, and thought at least I could help answer it! :-D (Great question, by the way!)

By a cycle, do you mean a 12-hour shot-nadir-pre-shot cycle (so 3 shots worth) or a day cycle?
Click to expand...

A cycle is 12 hours. So you have two cycles each day - an AM cycle and a PM cycle. I think Sue was telling you to give this dose three times (three cycles) if over 180 and then re-evaluate it.

Hope that helps!
Shelly
 
Three 12 hour cycles is what we suggest before changing a dose (so amps, pmps, amps all on the same dose) - unless you see a low that is too low.
 
Shelly & Jersey said:
Hi there,

I was a Lantus user, so I can't help you with Prozinc dosing. I did see your last question, though, and thought at least I could help answer it! :-D (Great question, by the way!)

By a cycle, do you mean a 12-hour shot-nadir-pre-shot cycle (so 3 shots worth) or a day cycle?
Click to expand...

A cycle is 12 hours. So you have two cycles each day - an AM cycle and a PM cycle. I think Sue was telling you to give this dose three times (three cycles) if over 180 and then re-evaluate it.

Hope that helps!
Shelly
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Thanks, Shelly, it does help. :) I kept meaning to ask it but more pressing questions kept coming up and shoving it out of my head.

Every time someone mentioned it, all I could think was "Cycle not Drazi Week. Cycle Drazi year" and thinking that I *really* wished there were a clearer term. :-D
 
Papa Stark said:
I had a similar thought, but yeah, I think I was making just that mistake... trying to work my way down rather than going down and working my way back up. I can't believe we've only been at this for two weeks. It feels so much longer. :P
Click to expand...

In the beginning, it is such a steep learning curve: the food, the insulin and dosing, the hometesting. You have all that working! Every time you test and every time you shoot, you learn a little more about the way his body is working with the insulin and become a little more confident about how to make this all work.

The good news is that the insulin is working well. Anytime he drops from red to green, the insulin is doing its job! Ideally, you are looking for about a 50% drop from preshot to nadir - a nice smile curve.
 
Sue and Oliver (GA) said:
Ideally, you are looking for about a 50% drop from preshot to nadir - a nice smile curve.
Click to expand...

That's definitely good to know. Having a target like that makes it easier for my mathy brain to understand what's happening vs. what should be. So determining whether or not it's working right is based on the preshot-to-nadir ratio... I think I can work with that.
 
Two more ranges for your math brain. Generally we consider a cat regulated if they are in the mid to lower 200s at preshot and double digits at nadir, but not below 40 which is approaching hypo territory. A cat in remission, off insulin, ranges from 40 to 120 with the majority of the time in double digits
 
Have a look at my signature link Glucometer Notes for your mathy brain :smile:
 
BJM said:
Have a look at my signature link Glucometer Notes for your mathy brain :smile:
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I've read it a lot. :) Actually used it as the base for my algorithm up there, adjusted for what I've read here, since the little troublemaker's still all over the place.
 
Ummm...its close.

Stalling = waiting 30 min without feeding - you want to know the glucose is rising on its own

As you get mid-cycle data, you may be able to gradually reduce your no shoot number to 150 mg/dL so long as the nadirs remain safe. Some folks have shot lower when there was mid-cycle data to show it was safe.
 
BJM said:
Ummm...its close.

Stalling = waiting 30 min without feeding - you want to know the glucose is rising on its own

As you get mid-cycle data, you may be able to gradually reduce your no shoot number to 150 mg/dL so long as the nadirs remain safe. Some folks have shot lower when there was mid-cycle data to show it was safe.
Click to expand...

Thanks for clearing that up for me. I'll go ahead and made the change to the stalling action. I'll adjust the file itself when we have any data to support it (reducing the no-shoot, e.g.). Right now, he's all over the map, so I want to get something nailed down to stabilize him.

Now, a bit of further clarification: When stalling, if the glucose is tested and is rising on its own, do you hold both food and shot until the no-shoot cutoff, or can I feed him when I see he's on his way up, and then shoot him when he hits 180?
 
Typically, if the glucose is too low to shoot, one of the following common explanations may be true:
- the dose was too high and the cat is still dropping
- the cat didn't eat for some reason
- the cat was ill in the night - vomiting may cause unexpectedly low glucose levels
- there was a sudden change in food batches and the carb level is lower than usual (watch the batch numbers on cans - there have been batches from different companies making cats sick, including Wellness and Friskies, so brand reputation/quality doesn't make a company immune to having problems)

An advantage with ProZinc is that you can adjust the dose based on pre-shot glucose tests.
- If the cat is rising, over 150 mg/dL, the nadir hasn't been below 100 mg/dL, and you'll be home to monitor, you can go for it.
- If the cat is rising, over 150 mg/dL, and the nadir has come near 50 mg/dL, you may want to reduce the dose a bit.

Get data when you can; it helps you learn the patterns for your cat.
 
BJM said:
Typically, if the glucose is too low to shoot, one of the following common explanations may be true:
- the dose was too high and the cat is still dropping
- the cat didn't eat for some reason
- the cat was ill in the night - vomiting may cause unexpectedly low glucose levels
- there was a sudden change in food batches and the carb level is lower than usual (watch the batch numbers on cans - there have been batches from different companies making cats sick, including Wellness and Friskies, so brand reputation/quality doesn't make a company immune to having problems)

An advantage with ProZinc is that you can adjust the dose based on pre-shot glucose tests.
- If the cat is rising, over 150 mg/dL, the nadir hasn't been below 100 mg/dL, and you'll be home to monitor, you can go for it.
- If the cat is rising, over 150 mg/dL, and the nadir has come near 50 mg/dL, you may want to reduce the dose a bit.

Get data when you can; it helps you learn the patterns for your cat.
Click to expand...

That's what this whole project is aiming to do - get some rules down so we don't overreact and screw things up again.

So at what point during the "stall" do we feed him? Wait for the shot?
 
Food raises bg levels and you want a number not food influenced, to be sure it is rising and high enough to shoot. So no food until you've decided that he's high enough to shoot or that you'll have to skip. A few treats would be okay, but not a meal.
 
Sue and Oliver (GA) said:
Food raises bg levels and you want a number not food influenced, to be sure it is rising and high enough to shoot. So no food until you've decided that he's high enough to shoot or that you'll have to skip. A few treats would be okay, but not a meal.
Click to expand...

That makes sense. Thanks.

Because the ProZinc is 12-hour cyclic (and because he'd be hungry), obviously we can't wait forever for him to get high enough to shoot. Do you think an hour is a reasonable cutoff?

"Hold food and shot, re-test +30min.
If BG not increasing, feed and skip shot.
If BG increasing but <180, repeat test at +60min. If >=180, feed and shoot. Else, feed and skip shot."
 
I think you might think in gradients of 20/40 minutes. If the insulin is gone he'll probably rise soon after +12, if he's going to rise. Yes, I'd skip if it's over an hour.
 
All that effort into fine-tuning the rules, and I go and blow it with a fur shot. cat(2)_steam

Gonna be one of those days...
 
Rules were meant to be broken.

... and your cat likely won't read nor follow them.

They are general guidance only; you have to be prepared to adapt as things change :smile:

My Spitzer didn't read the rules and I got pretty creative trying to control his glucose.
 
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